Immunization Theory and

Practice
A Training Program and Workshop for
Pharmacists and Student Pharmacists

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Principles of Vaccination
Nereah Kisera, Bpharm, MSc
Teruna Siahaan, Ph.D.

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 Learning Objectives
Module 1:
• To understand the fundamentals of the immune system,
vaccines, and generation of host immunity as well as
active and passive immunity
• To learn about humoral and cell-mediated immunity.
Module 2:
• To differentiate between live attenuated and inactivated
vaccines
• To understand polysaccharide, DNA and RNA vaccines.

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 What is Immunity?
• Body defense mechanism to fight against foreign
invaders (e.g., Virus, Bacteria)
• The immune system can tolerate “self” but fight
“nonself” (foreign) material
• As a result, the immune system protects the body
from infectious disease.
• Recognize and eliminate infectious organisms and
eliminate and prevent infection in future
• Accomplished with help of antibodies specific to
single organism or group of closely related organisms

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 How do we acquire immunity?

• Active immunity is generated by the host own immune

system
• The activated immune system can protect the person
• Two ways to acquire immunity
• Infection with disease-causing organism
• Vaccination
• Weakened or inactivated antigen is administered
• Response: Production of in immune response such as
antibodies, memory B- and T-cells.

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 What are Antigens?
• Infectious substances capable of stimulating an immune
response
• Viruses
• Bacteria
• Toxins
• Antigens stimulate immune system to mount a defense by
generating antibody and cellular response
• Think of antigens as “immune system stimulator” to generate
antibodies
• After vaccination, the body recognizes the weakened antigen
and generates a defense mechanism such antibodies and
cellular response.

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 Immune System Cells
Innate Immunity Adaptive Immunity
Fast Response Slow Response

B-cell Antibody
Macrophage Dendritic Cell T-cell

T-cell

Natural Killer Neutrophil

Cells Natural Killer
T-cell

CD4+ CD8+
Eosinophil Basophil
T-cell T-cell

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 Communication and Activity of T cells
Helper T cells [Th] serve as regulatory cells for the immune system

CD4 T-cell

CD8+ Th1, Th2, Dendritic Cells B cells Macrophage Stem Cells

T cells (CTL) Th17, Treg

Inflammatory T and B cell Antibody Phagocytosis Hematopoiesis

Cytotoxic or Activation Production
Activity Regulatory
Activity

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 Infections and Humoral Response
TCR

Virus

Naive
Macrophage or Dendritic MHC-Ag T-cell
Cells are Antigen
Presenting Antigen-
Cell (APC) Specific
T-cell

B cell
B-cell (APC) Receptor

B-cell (APC) Antigen

Plasma Cells Antibodies Removal

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 B Cell Cycle and Function
Bone Blood Peripheral lymphoid organ
(spleen/node) Blood Bone marrow
marrow

IgM

Ag Plasma cells Low levels,

Low affinity Ab:
IgG, IgE, IgA
Mature
naïve B
cell Activated
B cell
High levels,
Immature High affinity
B cell (Ag-specific) Ab:
IgG, IgE, IgA
B cell
FDC Plasma cells
Tfh cell

Germinal center Plasma cells

in survival
niches

Memory B cells
Ag

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 Cellular Response: T Cell Activation
109 different sub-
population of T cells

Activate Killer
Cells to Kill Infected Cells in
Antigen-Specific Manner
Generate
Memory T cells

Signal-2
TCR (B7/CD28)
CD28 Signal-1
(MHC/TCR)
MHC-Ag Immunol.
Synapse
B7 Formation

Antigen Presenting Clonal expansion of

Cells (APC) T cells recognize the T cells that recognize
antigen on APC the antigen

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 The Memory Response
• Vaccines act by inducing the primary response.
• The second time the individual is infected by the antigen, the
individual will produce a stronger and faster immune response.

• The secondary (Memory)

response has larger
magnitude and last longer
than the primary response
due to an increased number
of memory immune cells.

1) Kindt, T. J.; Goldsby, R. A.; Osborne, B. A.; Kuby, J., Kuby Immunology. 6th ed.; W.H. Freeman and Company: New York, 2007.
2) http://www.uic.edu/classes/bios/bios100/lectures/immune.htm

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Antibody-mediated protection for vaccines
• Depends on…
• Peak of antibody titers induced by vaccines
• Avidity of antibody response
• Persistence of vaccine antibodies
• Generation of memory cells

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 Passive Immunity
• Transfer of antibodies from one human or animal to another
human
• Temporary protection
• “Wanes” with time typically several weeks or months
• Sources
• Transplacental during last one to two months before birth - extremely
important to infants
• Mother’s milk also contains antibodies for passive immunity
• Many blood or blood products
• Homologous “pooled” human antibody (IgG)
• Homologous human hyperimmune globulin
• Hepatitis B immune globulin (HBIG).
• Human rabies immune globulin (HRIG)
• Heterologous hyperimmune serum (antitoxin)
• Monoclonal Antibodies

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 Herd Immunity
• Herd immunity is generated when large population or
community (the herd) have been vaccinated against a particular
antigen.
• The population will be immune against the antigen.
• The spreading of the disease from person-to-person becomes
difficult. Thus, the whole community is protected.
• The contagiousness of the antigen influences the Herd
immunity.
• The more contagious the disease, the higher the number of
immune individuals that are needed to reach herd immunity
(e.g., measles).
• Herd immunity can protect vulnerable individuals that cannot be
vaccinated.

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 Antibodies (Immunoglobulins)
• Proteins produced by plasma cells
• Over 2000 antibody molecules per second
• Nearly infinite diversity = 1012 different molecules
• Antibodies bind to antigens like a lock and key to recognize
Proteins; Lipids; Nucleic acids; Small organic compounds
• Antibody neutralizes the antigen so it cannot multiply
• Aids in elimination of pathogen
• Complement activation
• Opsonization
• Antibodies and other immune cells (T-cells, macrophages and
others) can destroy and eliminate antigens.

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 The Immune Response (simplified)
Vaccines (contain antigens)

Antigens are recognized by immune system

and evoke an immune response

B cells activated T cells Activated

Results in production of antibodies

Antibodies attack and destroy the antigen

Antigen is eliminated
Memory B and T cells are formed

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