The Immune System - PDF

**THE IMMUNE SYSTEM** The immune system is the body's tool for preventing or limiting infection. Its complex network of cells, organs, proteins, and tissues enable the immune system to defend the body from pathogens. A fully functional immune system can distinguish healthy tissue from unwanted sub...

**THE IMMUNE SYSTEM** The immune system is the body's tool for preventing or limiting infection. Its complex network of cells, organs, proteins, and tissues enable the immune system to defend the body from pathogens. A fully functional immune system can distinguish healthy tissue from unwanted substances. If it detects an unwanted substance, it will mount an immune response --- a complex attack to protect the body from invaders like bacteria, viruses, and parasites. It also recognizes and removes dead and faulty cells. The immune system does not always get it right, however. Sometimes, for instance, it is unable to fight effectively because a person has a health condition or needs certain medications that affect how the system works. In autoimmune diseases and allergies, the immune system mistakenly perceives healthy tissue as unhealthy and launches an unnecessary attack, leading to uncomfortable and sometimes dangerous symptoms. The immune system [[consists of]](https://www.imgt.org/IMGTeducation/Tutorials/ImmuneSystem/UK/the_immune_system.pdf) a range of components, including: - [[white blood cells]](https://www.medicalnewstoday.com/articles/327446) (leukocytes) - [[the spleen]](https://www.medicalnewstoday.com/articles/320698) - [[the bone marrow]](https://www.medicalnewstoday.com/articles/285666) - [[the lymphatic system]](https://www.medicalnewstoday.com/articles/303087) - [[the thymus]](https://www.medicalnewstoday.com/articles/thymus) - the tonsils, adenoids, and appendix White blood cells circulate in the blood and lymphatic vessels. The lymphatic system forms a network similar to the blood vessels. It carries a substance called lymph instead of blood. Lymph is a fluid [[that carries]Trusted Source](https://training.seer.cancer.gov/anatomy/lymphatic/components/) immune-related cells to areas that need them. White blood cells are constantly looking for pathogens. When they find one, they begin to multiply and send signals to other cell types to do the same. The body stores white blood cells in different places, known as lymphoid organs. These include: - **The thymus:** A gland behind the breastbone, where white blood cells known as lymphocytes mature. - **The spleen:** An organ at the upper left of the abdomen where immune cells gather and work. - **Bone marrow:** Soft tissue in the center of the bones that produces red and white blood cells. - **Lymph nodes:** These are small, bean-shaped glands throughout the body, especially in the neck, underarms, groin, and abdomen. They link via lymphatic vessels. Immune cells gather in lymph nodes and react when antigens are present. This can lead to swelling. - **The tonsils, adenoids, and appendix:** These are gateways for pathogens to enter the body, so lymphoid tissue is also there. **Immune Response** The immune system needs to be able to distinguish healthy from unhealthy cells and tissue to work effectively. It does this by recognizing signals called DAMPS --- danger-associated molecular patterns. Cell damage may be present for many reasons, including: - infectious agents, such as [[bacteria]](https://www.medicalnewstoday.com/articles/157973) or [[viruses]](https://www.medicalnewstoday.com/articles/158179) - toxins, such as a [[bite]](https://www.medicalnewstoday.com/articles/174229) or sting - noninfectious physical damage, for instance, a [[burn]](https://www.medicalnewstoday.com/articles/burns) - a genetic problem within cells, as happens with [[cancer]](https://www.medicalnewstoday.com/articles/323648) An antigen is any substance that can spark an immune response. In many cases, an antigen is a bacterium, fungus, virus, toxin, or foreign body. But it can also be a cell that is faulty or dead. The immune system detects pathogen-associated molecular patterns --- PAMPs --- in the antigen. In this way, various parts of the system recognize the antigen as an invader and launch an attack. **Types of white blood cells** There are two main types of leukocytes, or white blood cells: **1. Phagocytes** These cells surround and absorb pathogens and break them down, effectively eating them. There are several types, [[including]](https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book%3A_Anatomy_and_Physiology_(Boundless)/20%3A_Immune_System/20.1%3A_Innate_Immunity/20.1B%3A_Phagocytes#:~:text=The%20main%20types%20of%20phagocytes,dendritic%20cells%2C%20and%20mast%20cells.): - **Neutrophils:** These are also known as granulocytes and provide an early response to inflammation. They kill pathogens but also die as a result. - **Macrophages:** These clean up after a response. They remove pathogens, dead neutrophils, and other debris. - **Dendritic cells:** These activate the immune response and help engulf microbes and other invaders. - **Monocytes: **These [can differentiate](https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book%3A_Anatomy_and_Physiology_(Boundless)/20%3A_Immune_System/20.1%3A_Innate_Immunity/20.1B%3A_Phagocytes#:~:text=The%20main%20types%20of%20phagocytes,dendritic%20cells%2C%20and%20mast%20cells.) into dendritic cells and macrophages, as needed. - **Mast cells:** These trigger an immune response when they detect an antigen. **2. Lymphocytes** [[Lymphocytes]](https://www.medicalnewstoday.com/articles/320987) help the body remember previous invaders and recognize them if they return to attack again. Lymphocytes begin their life in [[bone marrow]](https://www.medicalnewstoday.com/articles/285666.php). Some stay in the marrow and develop into B lymphocytes (B cells); others travel to the thymus and become T lymphocytes (T cells). These two cell types have different roles. B lymphocytes produce antibodies and help alert the T lymphocytes. T lymphocytes destroy compromised cells in the body and help to alert other leukocytes. Natural killer (NK) cells are also lymphocytes. NK cells recognize and destroy cells that contain a virus. **The role of B lymphocytes** Once B lymphocytes spot the antigen (antibody generators), they [[begin secreting]](https://www.imgt.org/IMGTeducation/Tutorials/ImmuneSystem/UK/the_immune_system.pdf) antibodies. Antibodies are special proteins that lock on to specific antigens. Each B cell makes one specific [[antibody]](https://www.medicalnewstoday.com/articles/what-is-an-antibody). For instance, one might make an antibody against the bacteria that cause [[pneumonia]](https://www.medicalnewstoday.com/articles/151632.php), and another might recognize the common cold virus. Antibodies are part of a large family of chemicals called immunoglobulins, which play many roles in the immune response: - Immunoglobulin G (IgG) marks microbes so other cells can recognize and deal with them - IgM specializes in killing bacteria - IgA congregates in fluids, such as tears and saliva, where it protects gateways into the body - IgE protects against parasites and plays a role in allergies - IgD stays bound to B lymphocytes, helping them start the immune response Antibodies lock on to the antigen but do not kill it --- they only mark it for death. The killing is the job of other cells, such as phagocytes. **The role of T lymphocytes** There are [[distinct types]](https://www.imgt.org/IMGTeducation/Tutorials/ImmuneSystem/UK/the_immune_system.pdf) of T lymphocytes, or T cells. Helper T cells (Th cells) coordinate the immune response. Some communicate with other cells, and some stimulate B cells to produce more antibodies. Others attract more T cells or cell-eating phagocytes. Killer T cells (cytotoxic T lymphocytes) attack other cells. They are particularly useful for fighting viruses. They work by recognizing small parts of the virus on the outside of infected cells and destroying the infected cells. **The role of natural killer cells** Also a type of lymphocyte, these [[contain]](https://www.imgt.org/IMGTeducation/Tutorials/ImmuneSystem/UK/the_immune_system.pdf) granules with powerful chemicals. They are useful for attacking many types of unwanted cells. **Immunity** Overall, the immune system becomes stronger on exposure to different pathogens. By adulthood, most people have had exposure to a range of pathogens and developed more immunity. Once the body produces an antibody, it keeps a copy so that if the same antigen appears again, the body can deal with it more quickly. Some diseases, such as measles, can be severe if they occur, which is why experts  recommend vaccination. If a person has the measles vaccine, they are unlikely to get the disease. If an unvaccinated person has measles once, it is also [[rare]](https://www.nhs.uk/conditions/measles/) to get it again. In both cases, the body stores a measles antibody. The antibody is ready to destroy the virus next time it appears. This is called immunity. **There are three types of immunity in humans:** - innate - adaptive - passive **Innate immunity** People are born with some level of immunity that will attack invaders from day one. This innate immunity includes  the external barriers of our body --- the first line of defense against pathogens --- such as the [[skin]](https://www.medicalnewstoday.com/articles/320435) and mucous membranes of the throat and gut. This response is general and nonspecific. If pathogens manage to bypass the innate immune system, macrophages will attack them. Macrophages will also produce substances called cytokines, which increase the inflammatory response. **Adaptive (acquired) immunity** A person's protection from pathogens develops as they go through life. Thanks to vaccinations and exposure to various diseases, the body develops a range of antibodies to different pathogens. Doctors sometimes refer to this  as immunological memory because the immune system remembers previous enemies. **Passive immunity** This is a temporary type of immunity that derives  from another person. For instance, a newborn receives antibodies from the mother through the placenta before delivery and in breast milk following delivery. This passive immunity protects the infant from some infections during their early life. **Immunizations** Immunizations change the body in some way so it can respond effectively to various diseases. The most common method is to introduce antigens or weakened pathogens into a person so the individual produces antibodies and does not become sick. Because the body saves copies of the antibodies, it has protection if the threat should reappear later in life. Some diseases that doctors recommend immunization for include: - [COVID-19](https://www.medicalnewstoday.com/articles/covid-19-symptoms) - [flu](https://www.medicalnewstoday.com/articles/15107) - [rubella](https://www.medicalnewstoday.com/articles/164504) - [polio](https://www.medicalnewstoday.com/articles/155580) - [chickenpox](https://www.medicalnewstoday.com/articles/239450) - [shingles](https://www.medicalnewstoday.com/articles/154912) - [measles](https://www.medicalnewstoday.com/articles/37135) - [mumps](https://www.medicalnewstoday.com/articles/224382) - [meningitis](https://www.medicalnewstoday.com/articles/types-of-meningitis) - [hepatitis](https://www.medicalnewstoday.com/articles/hepatitis) - Hib (*Haemophilus influenzae type B*) - [diphtheria](https://www.medicalnewstoday.com/articles/159534) - [tetanus](https://www.medicalnewstoday.com/articles/163063) - [whooping cough](https://www.medicalnewstoday.com/articles/257706) - other diseases, such as [yellow fever](https://www.medicalnewstoday.com/articles/174372) and [typhoid](https://www.medicalnewstoday.com/articles/156859), depending on where the person lives or travels **Immune system disorders** There are many ways in which the immune system can go wrong. Types of immune disorders fall into three categories: **Immunodeficiencies** These arise when one or more parts of the immune system do not function. They can result from: - a condition that a person is born with, known as primary immunodeficiency - developments over time, for instance, older age - a disease that affects the immune system, such as HIV, [malnutrition](https://www.medicalnewstoday.com/articles/179316.php), [obesity](http://medicalnewstoday.com/info/obesity/how-much-should-i-weigh.php), or high [alcohol use](https://www.medicalnewstoday.com/articles/157163.php) - medical treatment, such as chemotherapy, drugs to treat an autoimmune condition, or medications to stop the body from rejecting a transplant These conditions can increase a person's risk of becoming sick or experiencing severe symptoms, as the COVID-19 pandemic has shown. **Autoimmunity** In autoimmune conditions, the immune system mistakenly targets  healthy cells rather than pathogens or faulty cells. It is unable to distinguish between healthy and unhealthy cells and tissue. Usually, this will occur in one part of the body, such as the pancreas. Destruction of pancreatic beta cells means the body cannot produce insulin. This is how [[type 1 diabetes]](http://medicalnewstoday.com/info/diabetes/type1diabetes.php) happens. Other autoimmune diseases include: - [celiac disease](https://www.medicalnewstoday.com/articles/38085.php) - [rheumatoid arthritis](http://medicalnewstoday.com/info/rheumatoid-arthritis/) - [Graves' disease](https://www.medicalnewstoday.com/articles/170005.php) **Hypersensitivity** With hypersensitivity, the immune system reacts in an exaggerated or inappropriate way. It attacks everyday substances, such as dust, as if they were pathogens. This happens with: - asthma - food allergies and sensitivities - atopic eczema A severe reaction can lead to [[anaphylactic shock]](https://www.medicalnewstoday.com/articles/216062.php), where the body responds to an allergen so strongly that it can be life threatening. **Specific and Non-specific Host Defenses** Specific Host Defense. Specific defense (sometimes called adaptive immunity) recognizes and coordinates attacks against specific pathogens. The system can also remember pathogens and produce a powerful response the next time a pathogen enters the body. Non-specific host defense mechanisms-these are general mechanisms (cellular functions and biochemical pathways) which become engaged after any kind of injury and protect against all pathogens in general. **VACCINES AND VACCINATION** **What are vaccines?** Vaccines are injections (shots), liquids, pills, or nasal sprays that you take to teach your body\'s [immune system](https://medlineplus.gov/immunesystemanddisorders.html) to recognize and defend against harmful germs. For example, there are vaccines to protect against diseases caused by: - [Viruses](https://medlineplus.gov/viralinfections.html), like the ones that cause the [flu](https://medlineplus.gov/flushot.html) and [COVID-19](https://medlineplus.gov/covid19coronavirusdisease2019.html) - [Bacteria](https://medlineplus.gov/bacterialinfections.html), including [tetanus, diphtheria, and pertussis](https://medlineplus.gov/tetanusdiphtheriaandpertussisvaccines.html) **What are the types of vaccines?** There are several types of vaccines: - **Live-attenuated vaccines** use a weakened form of the germ. - **Inactivated vaccines** use a killed version of the germ. - **Subunit, recombinant, polysaccharide, and conjugate vaccines** use only specific pieces of the germ, such as its protein, sugar, or casing. - **Toxoid vaccines** that use a toxin (harmful product) made by the germ. - **mRNA vaccines** use messenger RNA, which gives your cells instructions for how to make a protein (or piece of a protein) of the germ. - **Viral vector vaccines** use genetic material, which gives your cells instructions for making a protein of the germ. These vaccines also contain a different, harmless virus that helps get the genetic material into your cells. These vaccines may work in different ways, but they all spark an immune response. The immune response is the way your body defends itself against substances it sees as foreign or harmful. These substances include germs that can cause disease. **What happens in an immune response?** There are different steps in the immune response: - When a germ invades, your body sees it as foreign. - Your immune system helps your body fight off the germ. - Your immune system also remembers the germ. It will attack the germ if it ever invades again. This \"memory\" protects you against the disease that the germ causes. This type of protection is called immunity. **What are immunization and vaccination?** Immunization is the process of becoming protected against a disease. But it can also mean the same thing as vaccination, which is getting a vaccine to become protected against a disease. **Why are vaccines important?** Vaccines are important because they protect you against many diseases. These diseases can be very serious. So getting immunity from a vaccine is safer than getting immunity by being sick with the disease. For a few vaccines, getting vaccinated can actually give you a better immune response than getting the disease would. But vaccines don\'t just protect you. They also protect the people around you through community immunity. **What is community immunity?** Community immunity, or herd immunity, is the idea that vaccines can help keep communities healthy. Normally, germs can travel quickly through a community and make a lot of people sick. If enough people get sick, it can lead to an outbreak. But when enough people are vaccinated against a certain disease, it\'s harder for that disease to spread to others. This type of protection means that the entire community is less likely to get the disease. Community immunity is especially important for people who can\'t get certain vaccines. For example, they may not be able to get a vaccine because they have weakened immune systems. Others may be allergic to certain vaccine ingredients. And newborn babies are too young to get some vaccines. Community immunity can help to protect them all. **Are vaccines safe?** Vaccines are [safe](https://medlineplus.gov/vaccinesafety.html). They must go through extensive safety testing and evaluation before they are approved in the United States. **What is a vaccine schedule?** A vaccine, or immunization, schedule lists which vaccines are recommended for different groups of people. It includes who should get the vaccines, how many doses they need, and when they should get them. In the United States, the Centers for Disease Control and Prevention (CDC) publishes the vaccine schedule. It\'s important for both [children](https://medlineplus.gov/childhoodvaccines.html) and adults to get their vaccines according to the schedule. Following the schedule allows them to get protection from the diseases at exactly the right time. The **Expanded Program on Immunization** is a global health initiative launched by the [[World Health Organization]](https://en.wikipedia.org/wiki/World_Health_Organization) in May 1974, with the aim to make [[vaccines]](https://en.wikipedia.org/wiki/Vaccine) available to all globally **Introduction** Vaccination has been one of the most impactful public health interventions of the past century. Since the foundation of the Expanded Programme on Immunization (EPI) by the World Health Organization (WHO) in 1974, vaccines have provided single greatest contribution to improve health outcomes globally, particularly among children and infants. widespread immunization has substantially reduced the morbidity and mortality rates from diseases such as [[tuberculosis]](https://en.wikipedia.org/wiki/Tuberculosis), [[poliomyelitis]](https://en.wikipedia.org/wiki/Polio), [[measles]](https://en.wikipedia.org/wiki/Measles), [[diphtheria]](https://en.wikipedia.org/wiki/Diphtheria), [[tetanus]](https://en.wikipedia.org/wiki/Tetanus), [[pertussis]](https://en.wikipedia.org/wiki/Whooping_cough), [[hepatitis B]](https://en.wikipedia.org/wiki/Hepatitis_B), [[yellow fever]](https://en.wikipedia.org/wiki/Yellow_fever), [[meningitis A]](https://en.wikipedia.org/wiki/Meningitis) and many others.  Recent innovations have expanded the impact of vaccines in addressing not only childhood diseases but also adult and emerging diseases, such as COVID-19. **History** **Milestones in Global vaccination** **Year** **Milestone** **Description** -------------- ------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1974 EPI launch WHO established EPI to address certain diseases through vaccination such as smallpox, measles, poliomyelitis, tuberculosis and many others 1979 PAHO revolving fund The Pan American Health Organization launched a fund to facilitate vaccine procurement 1982 UNICEF child survival and development revolution UNICEF launched GOBI strategy which focused on growth monitoring, oral rehydration therapy, breastfeeding, and immunization 1984 EPI's First standardized schedule vaccination schedule was revised to include BCG, DTP, polio, and measles at specified ages  1990 Declaration of Manhattan, Children's Vaccine Initiative This Initiative aimed to accelerate vaccines development to enhance EPI performance 1999 Strategic Advisory Group of Experts (SAGE) on immunization SAGE was established to advise WHO on global immunization policies, strategies, and research  2000 Gavi, The Vaccine Alliance Was established to address market failure in certain countries and increase access to vaccines  2000-present Ongoing Acceleration of New Vaccine Introduction Included initiatives like pneumococcal conjugate vaccines (PCV), rotavirus vaccines, and meningococcal A conjugate vaccine, malaria vaccine to expedite introduction  2017 Coalition for Epidemic Preparedness Innovations (CEPI) CEPI was launched to as a response to Ebola, Zika, and SARS outbreaks to develop vaccines for emerging infectious diseases 2020 Immunization Agenda 2030 (IA2030) IA2030 was setup to ensure universal access to vaccines, strengthen health care systems, and support universal health coverage. 2020-2023 COVID-19 Vaccines Global Access (COVAX) Was established to accelerate the development, production, and equitable distribution of COVID-19 vaccines  2023-2024 The Big Catch-Up This Initiative focuses on restoring immunization coverage to pre-COVID-19 levels and strengthen routine immunization systems to achieve 2030 targets 2024 EPI Expansion EPI is expanded to cover vaccines against 13 global and 17 context-specific vaccine-preventable diseases  **Impact of vaccination on global Health** Since the establishment of EPI in1974, vaccination has prevented 154 million deaths, among which 146 million are in children younger than 5 years of whom 101 million are in infants younger than 1 year. Measles vaccination is the single greatest contributor of lives saved by vaccination, preventing 93.7 million deaths out of total 154 million deaths prevented by vaccination globally. The vaccination has contributed for 40% of the decline in global infant mortality, 52% in the African region. In 2024, a child younger than 10 years is 40% more likely to survive to their next birthday relative to a hypothetical scenario of no vaccination. Increased survival probability is observed into adulthood as well, individuals aged 25 years are 35% more likely, and those aged 50 years are 16% more likely to survive to their next birthday  **Ongoing disease eradication and elimination initiatives** After eradication of smallpox in 1980, nine other eradication and elimination strategies have been established: The Global Polio Eradication Initiative (1988) Maternal and Neonatal Tetanus Elimination (1989) The Measles & Rubella Initiative (2001) The End TB strategy (2015) The Global Health Sector Strategy on Viral Hepatitis (2016) The Global Technical Strategy for Malaria (2016) The Eliminate Yellow Fever Epidemics Strategy (2017) The Global Strategy to Accelerate the Elimination of Cervical Cancer (2020) The Global Roadmap to Defeat Meningitis (2020) The **Expanded Program on Immunization** **(EPI)** in the [Philippines](https://en.wikipedia.org/wiki/Philippines) began in 1976 through Presidential Decree No. 996 signed by President [Ferdinand Marcos](https://en.wikipedia.org/wiki/Ferdinand_Marcos). And, in 1986, made a response to the Universal Child Immunization goal. The four major strategies include: 1. 2. 3. 4. **Routine Schedule of Immunization** Every Wednesday is designated as immunization day and is adopted in all parts of the country. Immunization is done monthly in barangay health stations, quarterly in remote areas of the country. **Routine Immunization Schedule for Infants** The standard routine immunization schedule for infants in the Philippines is adopted to provide maximum immunity against the seven vaccine preventable diseases in the country before the child\'s first birthday. 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nos | | | | | | | | | have | | | | | | | | | Hepati | | | | | | | | | tis | | | | | | | | | B | | | | | | | | | infect | | | | | | | | | ion | +--------+--------+--------+--------+--------+--------+--------+--------+ | [Measl | 9 | 1 dose | 0.5 mL | none | Subcut | Upper | At | | es | months | | | | aneous | outer | least | | Vaccin | old | | | | | portio | 85% of | | e](htt | | | | | | n | measle | | ps://e | | | | | | of the | s | | n.wiki | | | | | | arms, | can be | | pedia. | | | | | | Right | preven | | org/wi | | | | | | deltoi | ted | | ki/Mea | | | | | | d | by | | sles_V | | | | | | | immuni | | accine | | | | | | | zation | | ) | | | | | | | at | | | | | | | | | this | | *(not | | | | | | | age. | | MMR)* | | | | | | | | +--------+--------+--------+--------+--------+--------+--------+--------+ **General Principles in Infants/Children Immunization** - - - - - - **Tetanus Toxoid Immunization Schedule for Women** When given to women of childbearing age, vaccines that contain tetanus toxoid (TT or Td) not only protect women against tetanus, but also prevent neonatal tetanus in their newborn infants. +-----------------+-----------------+-----------------+-----------------+ | **Vaccine** | **Minimum\ | **Percent\ | **Duration of | | | Age/Interval** | Protected** | Protection** | +=================+=================+=================+=================+ | TT1 | At 20th weeks | 0% | - | | | AOG | | | +-----------------+-----------------+-----------------+-----------------+ | TT2 | At least 4 | 80% | - - | | | weeks later | | | +-----------------+-----------------+-----------------+-----------------+ | TT3 | At least 6 | 95% | - - | | | months later | | | +-----------------+-----------------+-----------------+-----------------+ | TT4 | At least 1 year | 99% | - - | | | later | | | +-----------------+-----------------+-----------------+-----------------+ | TT5 | At least 1 year | 99% | - - | | | later | | | +-----------------+-----------------+-----------------+-----------------+ In June 2000, the 57 countries that have not yet achieved elimination of neonatal tetanus were ranked and the Philippines was listed together with 22 other countries in Class A, a classification for countries close to maternal and neonatal tetanus elimination. **Care for the Vaccines** To ensure the optimal potency of vaccines,a careful attention is needed in handling practices at the country level. These include storage and transport of vaccines from the primary vaccine store down to the end-user at the health facility, and further down at the outreach sites. Inappropriate storage, handling and transport of vaccines won\'t protect patients and may lead to needless vaccine wastage. A \"first expiry and first out\" (FEFO) vaccine system is practiced to assure that all vaccines are utilized before its expiry date. Proper arrangement of vaccines and/or labeling of expiry dates are done to identify those close to expiring. Vaccine temperature is monitored twice a day (early in the morning and in the afternoon) in all health facilities and plotted to monitor break in the [cold chain](https://en.wikipedia.org/wiki/Cold_chain). Each level of health facilities has cold chain equipment for use in the storage vaccines which included cold room, freezer, refrigerator, transport box, vaccine carriers, thermometers, cold chain monitors, ice packs, temperature monitoring chart and safety collector boxes.