IMMUNOPROPHYLAXIS OFIMMUNOPROPHYLAXIS OFINFECTIOUS DISESEASINFECTIOUS DISESEAS

DefinitionDefinitionImmunoprophylaxis is anImmunoprophylaxis is anantiepidemic measure ( of publicantiepidemic measure ( of publichealth) taken in order to preventhealth) taken in order to preventthe spreading of infectiousthe spreading of infectiousdiseases via immunization of thediseases via immunization of thesusceptible groups of thesusceptible groups of thepopulation.population.

DefinitionDefinitionImmunoprophylaxis is anImmunoprophylaxis is anantiepidemic measure ( of publicantiepidemic measure ( of publichealth) taken in order to preventhealth) taken in order to preventthe spreading of infectiousthe spreading of infectiousdiseases via immunization of thediseases via immunization of thesusceptible groups of thesusceptible groups of thepopulation.population.

Main targetsMain targets Reducing the incidence (VHB,Reducing the incidence (VHB, pertussispertussis,,

mumps, rubella)mumps, rubella) Liquidation of the morbidity (eliminatingLiquidation of the morbidity (eliminating

the disease from certain territoriesthe disease from certain territories ––diphtheria, polio, measles)diphtheria, polio, measles)

Eradication of the disease (smallpoxEradication of the disease (smallpox))

Main targetsMain targets Reducing the incidence (VHB,Reducing the incidence (VHB, pertussispertussis,,

mumps, rubella)mumps, rubella) Liquidation of the morbidity (eliminatingLiquidation of the morbidity (eliminating

the disease from certain territoriesthe disease from certain territories ––diphtheria, polio, measles)diphtheria, polio, measles)

Eradication of the disease (smallpoxEradication of the disease (smallpox))

Eradication of smallpox

1966 - was adopted the Global program of eradication by the WHO( 1966-1976)

1967 – smallpox was registered in 44 countries including in 31countries with endemic character (Brasil, the majority of countriesfrom Africa and 5 Asian countries: Afganistan, India, Indonesia,Nepal, Pakistan).

Registered cases ≈15 mil. among 1,2 billion population. 1970 – elimination of smallpox in the 20 countries from Central and

Western Africa. 1971 – Brasil 1972 – Indonesia 1975 – Asian countries 1976 – Ethiopia 1977, October 26 – Somalia 1980, May 8 – WHO announced officially about the global eradication

of smallpox.

Eradication of smallpox

1966 - was adopted the Global program of eradication by the WHO( 1966-1976)

1967 – smallpox was registered in 44 countries including in 31countries with endemic character (Brasil, the majority of countriesfrom Africa and 5 Asian countries: Afganistan, India, Indonesia,Nepal, Pakistan).

Registered cases ≈15 mil. among 1,2 billion population. 1970 – elimination of smallpox in the 20 countries from Central and

Western Africa. 1971 – Brasil 1972 – Indonesia 1975 – Asian countries 1976 – Ethiopia 1977, October 26 – Somalia 1980, May 8 – WHO announced officially about the global eradication

of smallpox.

Cost-efficiency of the immunoprophylaxis

the estimative cost of the Global smallpoxeradication program – 300 million US dollars

efficiency of over 1 billion $ saving annually(stopping the immunization, quarantine measuresetc.)

global eradication of polio starting with 2015 willmake savings of ≈ 3 milliard US dollars

1 $ spent for the production of MMR vaccine saves21 $

1$ spent for the production of DTP vaccine saves29 $

Cost-efficiency of the immunoprophylaxis

the estimative cost of the Global smallpoxeradication program – 300 million US dollars

efficiency of over 1 billion $ saving annually(stopping the immunization, quarantine measuresetc.)

global eradication of polio starting with 2015 willmake savings of ≈ 3 milliard US dollars

1 $ spent for the production of MMR vaccine saves21 $

1$ spent for the production of DTP vaccine saves29 $

Conclusion: public health measuresConclusion: public health measuresused for the prevention andused for the prevention and

control of infectious diseases viacontrol of infectious diseases viaimmunization are very costimmunization are very cost--

efficient.efficient.

Conclusion: public health measuresConclusion: public health measuresused for the prevention andused for the prevention and

control of infectious diseases viacontrol of infectious diseases viaimmunization are very costimmunization are very cost--

efficient.efficient.

The role ofimmunoprophylaxis

Immunoprophylaxis of over 30 infectious diseases:smallpox, diphtheria, tetanus, pertussis, polio, measles,mumps, chikenpox, Haemophilus influenzae type binfection, VHA, VHB, TB, meningococcic infection,pneumococcic infection, influenza, typhoid fever, cholera,rabies, tick encephalitis, anthrax, yellow fever, rotaviralinfection, tularemia etc.

Infectious diseases in the prevention of whichimmunoprophylaxis holds the main role are called vaccinepreventable diseases.

Immunoprophylaxis as an individual protection: rabies,yellow fever etc.

Immunoprophylaxis of over 30 infectious diseases:smallpox, diphtheria, tetanus, pertussis, polio, measles,mumps, chikenpox, Haemophilus influenzae type binfection, VHA, VHB, TB, meningococcic infection,pneumococcic infection, influenza, typhoid fever, cholera,rabies, tick encephalitis, anthrax, yellow fever, rotaviralinfection, tularemia etc.

Infectious diseases in the prevention of whichimmunoprophylaxis holds the main role are called vaccinepreventable diseases.

Immunoprophylaxis as an individual protection: rabies,yellow fever etc.

Types of immunity

Hereditary(For certain

biologicaltypes)

Acquired

ArtificialNatural

(from motherto child, post-infectious)

PassiveActive

ArtificialNatural

(from motherto child, post-infectious)

Depending on the participation of immunocompetent cells, the immunity can be –

The indications ofimmunoprophylaxis

Schedule (routine) immunization(obligatory, mass)

Epidemiological ( spreading danger –flu, sickening danger – rabies, yellowfever).

The indications ofimmunoprophylaxis

Schedule (routine) immunization(obligatory, mass)

Epidemiological ( spreading danger –flu, sickening danger – rabies, yellowfever).

Classification of vaccines

Live attenuated Inactivated (killed)Live attenuated Inactivated (killed)

Live attenuated vaccines

ViralOPV, MMR

Bacterial:BCG, STI

ViralOPV, MMR

Bacterial:BCG, STI

Inactivated vaccines

Corpuscular FractionatedCorpuscular Fractionated

Inactivated corpuscular vaccines

Viral:IPV, Antirabic, VHA

Bacterial:Pertusis, typhoid fever,

holera

Viral:IPV, Antirabic, VHA

Bacterial:Pertusis, typhoid fever,

holera

Fractionated inactivated vaccines

Proteic Polysaccharide

Pure: meningoccicinfection, pneumo-coccic infection, Hib

Out of the subunitsof pathogenic agent:

VHB, aP

Toxoids:diphtheria, tetanus,

botulism

Pure: meningoccicinfection, pneumo-coccic infection, Hib

Conjugated:

VACCINES

Live attenuated Inactivated

Viral Bacterial Corpuscular Fractioned

Viral

Bacterial

Proteic Polysaccharide

Subunits

Toxoids

Pure

Conjugated

Principles and methods of obtainingvaccines

Live vaccines – E. Jenner, L. Pasteur (avirulent andimmunogenic stems of pathogenic agents)

Inactivated vaccines - t˚, chemical substances(alcohol, acetone, formaline)(Pathogenic microorganisms and their inactivatedand - immunogenic products)

Obtaining of necessary amounts of microorganisms- cultivating in mediums-biotechnological methods

Principles and methods of obtainingvaccines

Live vaccines – E. Jenner, L. Pasteur (avirulent andimmunogenic stems of pathogenic agents)

Inactivated vaccines - t˚, chemical substances(alcohol, acetone, formaline)(Pathogenic microorganisms and their inactivatedand - immunogenic products)

Obtaining of necessary amounts of microorganisms- cultivating in mediums-biotechnological methods

National Program of immunization (NPI) for the years2011-2015

Approved by the Decision of the Government of theRepublic of Moldova nr. 1192 from 23.12.2010

Main objectives: reducing,elimination or eradication of

transmissible diseasespreventable via immunization

Main objectives: reducing,elimination or eradication of

transmissible diseasespreventable via immunization

Main targets: Assuring access to the population from the republic; Assuring the quality (efficiency and safety) of the

vaccines used within the framework of the Program byimplementing the control procedures of the qualityand maintenance of the “Cold chain” at all levels ofstorage, transportation and use;

Assuring the vaccine coverage of over 95% at thenational scale, in the target age groups of thepopulation;

Improving the epidemiological surveillance of thepreventable diseases via vaccination.

Main targets: Assuring access to the population from the republic; Assuring the quality (efficiency and safety) of the

vaccines used within the framework of the Program byimplementing the control procedures of the qualityand maintenance of the “Cold chain” at all levels ofstorage, transportation and use;

Assuring the vaccine coverage of over 95% at thenational scale, in the target age groups of thepopulation;

Improving the epidemiological surveillance of thepreventable diseases via vaccination.

NPI is elaborated in accordance with the Law ofthe Republic of Moldova nr. 1513-XII on June 161993 “Concerning the sanitary-epidemiological-sanitary assurance of the population” and theLaw of Health Care nr. 411-XIII on March 281995 and in accordance with the ExtendedGlobal Immunization Program. The Program wasapproved by WHO, supported by the UNICEFand the General Assembly of UN

NPI is elaborated in accordance with the Law ofthe Republic of Moldova nr. 1513-XII on June 161993 “Concerning the sanitary-epidemiological-sanitary assurance of the population” and theLaw of Health Care nr. 411-XIII on March 281995 and in accordance with the ExtendedGlobal Immunization Program. The Program wasapproved by WHO, supported by the UNICEFand the General Assembly of UN

The Cold Chain – the system of personsand equipment

PersonnelEquipment

Personnel training

Attesting and licensingthe institutions and personnel

of the immunizationservice

For the production of lowtemperatures-refringe-

rations, freezers,

For keeping the lowtemperatures –

containers

Attesting and licensingthe institutions and personnel

of the immunizationservice

For keeping the lowtemperatures –

containers

For the monitoring of thetemperature–thermographs,

thermometers,indicators

For the transportation ofvaccines

Indicator for the cold chainIndicator for the cold chain

Freeze indicatorFreeze indicator

Freeze controlFreeze control (0(0°°C)C)

Indicator on the botlle

Immunization schedule

Document including methods and instructions, which establishesthe target groups for the immunization, consecutivity, indications

and the scheme of the vaccines use for a certain period of time.

Preventable diseases included in NPI (epidemiological situation.Morbidity objective. Operativ tasks)

• Viral hepatitis B Polio• Tuberculosis Measles• Pertussis Rubella• Diphtheria Mumps• Tetanus Hib• Rotaviral infection Infection with pneumococi

Immunization schedule

Document including methods and instructions, which establishesthe target groups for the immunization, consecutivity, indications

and the scheme of the vaccines use for a certain period of time.

Preventable diseases included in NPI (epidemiological situation.Morbidity objective. Operativ tasks)

• Viral hepatitis B Polio• Tuberculosis Measles• Pertussis Rubella• Diphtheria Mumps• Tetanus Hib• Rotaviral infection Infection with pneumococi

Immunization schedulefor 2011-2015 years

General characteristic of the vaccines used for theimmunoprophylaxis of infectious diseases

included in the scheduleViral hepatitis B – inactivated vaccine, proteic fractioned (HBsAg)– plasmatic, biotechnologic

Tuberculosis – live attenuated vaccine, BCGDiphteriaTetanus – associated vaccine DTP, DTPa, DT, TdPertusisPolio – live attenuated vaccine (OPV)

Corpuscular inactivated vaccine (IPV)MeaslesRubella – live attenuated vaccine (MMR)Mumps

Haemophilus influenza type b (Hib) – inactivated vaccine, fractionedpolysaccharide

General characteristic of the vaccines used for theimmunoprophylaxis of infectious diseases

included in the scheduleViral hepatitis B – inactivated vaccine, proteic fractioned (HBsAg)– plasmatic, biotechnologic

Tuberculosis – live attenuated vaccine, BCGDiphteriaTetanus – associated vaccine DTP, DTPa, DT, TdPertusisPolio – live attenuated vaccine (OPV)

Corpuscular inactivated vaccine (IPV)MeaslesRubella – live attenuated vaccine (MMR)Mumps

Haemophilus influenza type b (Hib) – inactivated vaccine, fractionedpolysaccharide

Measures taken by the Ministry of Health and SocialProtection, medical

departments and institutions for the implementationof the National Program of Immunization

Control of the vaccines quality Surveillance of the postvaccinal reactions Assurance of the safety of vaccination Monitoring the “Cold Chain” Personnel training Attesting and licensing the institutions and the personnel of

the immunization service Social mobilization Selective control of the immunity level via serological

methods Scientific studies International cooperation

Measures taken by the Ministry of Health and SocialProtection, medical

departments and institutions for the implementationof the National Program of Immunization

Control of the vaccines quality Surveillance of the postvaccinal reactions Assurance of the safety of vaccination Monitoring the “Cold Chain” Personnel training Attesting and licensing the institutions and the personnel of

the immunization service Social mobilization Selective control of the immunity level via serological

methods Scientific studies International cooperation

External donor assitanceUNIICEF, WHO, WB etc MH Acquisistions

National Scientific-Practical Center for Preventive Medicine

Primaryhealth care

sectorMaternities

Departmentalmedical

institutions

District and municipal Centers of Preventive Medicine

Efficiency and the quality assessmentEfficiency and the quality assessmentof immunoprophylaxisof immunoprophylaxis

Vaccination coverage indexVaccination coverage index Epidemiological methodEpidemiological method Immunological methodImmunological method

Efficiency and the quality assessmentEfficiency and the quality assessmentof immunoprophylaxisof immunoprophylaxis

Vaccination coverage indexVaccination coverage index Epidemiological methodEpidemiological method Immunological methodImmunological method

Side effects and postvaccinal complications

Local- pains- oedema- hyperemia- infiltration-adenopathy- nodules- abscess- ulcerations- necroses

Systemic- fever- headaches- indisposition- myalgia- luck of appetite- arthralgia- sleepiness- thrombocytopenia- paralysis

AllergicLocal- pains- oedema- hyperemia- infiltration-adenopathy- nodules- abscess- ulcerations- necroses

Systemic- fever- headaches- indisposition- myalgia- luck of appetite- arthralgia- sleepiness- thrombocytopenia- paralysis

- generalized urticaria- face andlarynges edema

- shortness breath- encephalopathy- collapse- shock

Measure of reducing the frequency ofside effects and postvaccinal complications

selection of the persons for the vaccination observance of the immunization rules precocius registration and medical assistance evidence, epidemiological investigation and

case analysis population information

Measure of reducing the frequency ofside effects and postvaccinal complications

selection of the persons for the vaccination observance of the immunization rules precocius registration and medical assistance evidence, epidemiological investigation and

case analysis population information

Means used for the formation of passive immunity

Immune serums ImmunoglobulinesImmune serums Immunoglobulines

Homologous Heterologous Homologous Heterologous

Obtaining methods:

Homologous medicines – out ofdonors’ blood

Heterologous medicines – out ofhyperimmunized animals’ blood

Obtaining methods:

Homologous medicines – out ofdonors’ blood

Heterologous medicines – out ofhyperimmunized animals’ blood

Use indications:

- Epidemiological (urgent) – for therapid immunization (immuneprotection)

- individual protection of the personswith the high risk of sickening(rabies, tetanus, measles, VHA etc.)

Use indications:

- Epidemiological (urgent) – for therapid immunization (immuneprotection)

- individual protection of the personswith the high risk of sickening(rabies, tetanus, measles, VHA etc.)