NUR 5401

ADVANCED COMMUNITY HEALTH NURSING I

IMMUNITY
Immunity refers to a host’s ability to resist a particular infectious disease–causing agent. This
occurs when the body forms antibodies and lymphocytes that react with the foreign antigenic
molecules and render them harmless. For public health nursing, this concept has significance in
determining which individuals and groups are protected against disease and which may be
vulnerable. Four types of immunity are important in community health: passive immunity,
active immunity, cross-immunity, and herd immunity.

Passive Immunity
Passive immunity refers to short-term resistance that is acquired either naturally or artificially.
New born children, through maternal antibody transfer, have natural passive immunity that lasts
up to 1 year for certain disease. This maternally provided protection seems to work best with
measles and rubella

Artificial passive immunity is attained through inoculation with antibody products to provide
temporary resistance. Examples of such products include immune globulin (hepatitis A and
measles), hyperimmune globulins (hepatitis B, rabies, tetanus, and varicella), and hyperimmune
serum (equine antitoxin for use with botulism and diphtheria). These products are used to boost a
susceptible person’s immunity, and administration must be repeated periodically to maintain
immunity levels.

Active Immunity
Active immunity is long-term and sometimes lifelong resistance that is acquired either naturally
or artificially. Naturally acquired active immunity comes through host infection. That is, a person
who contracts a disease often develops long-lasting antibodies that provide immunity against
future exposures.
Artificially acquired active immunity is attained through vaccine inoculation. Such vaccines

1
are prepared from live attenuated (weakened) or killed (inactivated) organisms administered to
artificially produce or increase immunity to a particular disease. The concept of active immunity
underlies public health immunization programs that have successfully kept polio, diphtheria,
smallpox, and other major vaccine preventable diseases under control worldwide.

Cross-immunity
Cross-immunity refers to a situation in which a person’s immunity to one agent provides
immunity to a related agent as well. The immunity can be either passive or active. Sometimes,
infection with one disease, such as cowpox, gives immunity to a related disease, such as
smallpox. The concept of cross-immunity has also been useful in the development and
administration of vaccines. Inoculation with a vaccine made from one disease-causing organism
can provide immunity to a related disease-causing organism. Field trials in Uganda and Papua,
New Guinea and a study in India in the 1990s examined the administration of bacille Calmette-
Guérin (BCG) vaccine, which is used to prevent tuberculosis, to people who had been exposed to
Hansen disease (leprosy). The vaccine against Mycobacterium tuberculosis appeared to provide
these individuals with a degree of cross-immunity to the related infectious agent, Mycobacterium
leprae, and prevented their contracting disease.

Herd Immunity
Herd immunity describes the immunity level that is present in a population group. A population
with low herd immunity is one with few immune members; consequently, it is more susceptible
to a particular disease. Non immune people are more likely to contract the disease and spread it
throughout the group, placing the entire population at greater risk. Conversely, a population with
high herd immunity is one in which the immune people in the group outnumber the susceptible
people; consequently, the incidence of a particular disease is reduced. The level of herd
immunity may vary with diseases. For instance, a level of community immunity of between 85%
and 90% may be necessary for rubella, but for diphtheria a level of 70% may be effective
Mandatory preschool immunizations and required travel vaccinations are applications of the herd
immunity concept.

2
IMMUNIZATION

Immunization is process whereby individuals are made immune to infectious diseases through

the administration of vaccines. It is the process of protecting an individual from disease through

the introduction of a live attenuated (weakened), killed (inactivated) or partial component of the

invading organism into the individuals system.

Vaccine Preventable Diseases

These are diseases for which vaccines are available and can proffer partial or complete

protection. Diseases for which vaccines are available include; diphtheria, tetanus, pertussis

(whooping cough), poliomyelitis (polio), measles, mumps, rubella, hepatitis B, influenza,

pneumococcal infections, meningococcal disease, yellow fever and tuberculosis.

Concept of Routine Childhood Immunization

Routine childhood immunization is considered as one of the most cost-effective public health

interventions protecting children from deadly infectious diseases such as diphtheria, Measles and

bacterial meningitis. A major cause of childhood morbidity and mortality globally is vaccine

preventable diseases.

In 1974, the World Health Organization (WHO) established the Expanded Programme on

Immunization (EPI) to ensure all children had access to routinely recommended vaccines.

Initially, those vaccines were limited to Bacilli Calmate-Guerin vaccine (BCG) Diphtheria-

Pertusis-Tetanus (DPT), Oral Polio Virus vaccine (OPV), and Measles Containing Vaccine

(MCV). This initiative has resulted to reduction of death of over two million children each year

even though an estimated 3 million deaths still occur each year (World Health Organization,

2012).

3
In 2005, the WHO and the United Nations Children’s Fund (UNICEF) developed the Global

Immunization Vision and Strategy (GIVS) to improve national immunization programmes and

decrease vaccine preventable disease associated with morbidity and mortality. Beyond the

traditional four EPI vaccines, several newer vaccines are increasingly utilized by the national

immunization programmes.

The global immunization vision and strategy was;

 To ensure that by 2010 every country reaches at least 90% national vaccination coverage

and at least 80% vaccination coverage in every district or equivalent administrative unit;

 To reduce measles mortality globally by 90% compared to the 2000 level.

 In addition, the vision by 2015 aims to sustain vaccination coverage goal in 2010;

 To reduce morbidity and mortality due to vaccine preventable diseases by at least two

thirds compared to 2000 levels;

 To ensure that every person eligible for immunization has access to vaccines of assured

quality;

 To ensure that the entire eligible population has access to new vaccines within five years

of the introduction of these vaccines in national programmes.

Vaccination coverage is calculated as the percentage of those in the target age group who

received a dose of a recommended vaccine by a given age. Administrative coverage estimates

are derived by dividing number of vaccine doses administered to children in the target age group

by the estimated target population. These are reported annually to WHO and UNICEF by 194

WHO member states through the Joint Reporting Form. More precise estimates of vaccination

coverage can be obtained from coverage surveys of a representative sample of households to

4
identify children in the target age group. Dates of receipt of vaccine doses are copied from the

child's vaccination card. If the card is not available, a caregiver is asked to recall whether the

child received a particular vaccine dose. WHO and UNICEF derive national estimates of

vaccination coverage through an annual country-by-country review of all available data, which

can lead to revision of past coverage estimates. These estimates are updated and published

annually on the WHO website.

Immunization Programme in Nigeria

Nigeria has the twelfth highest under- five mortality rate in the world with 143 child death per

1,000 live births in 2010(International Vaccine Access Centre IVAC, 2012). Approximately one

in four of those deaths are preventable through routine immunization, but coverage of routine

childhood vaccines remains lower than the global benchmark in Nigeria (International Vaccine

Access Centre IVAC, 2012).

In Nigeria, the National Programme on Immunisation (NPI) was inaugurated by the Federal

Ministry of Health under decree 12 of 1997 as the country’s initiative that took root from the

WHO/UNICEF expanded programme on immunization (National Primary Health Care

Development Agency NPHCDA, 2009). NPI proscribes 5 visits to receive one dose of Bacille

Calmatte Guerine (BCG), four doses of Oral Polio Vaccine, three doses of Diphtheria, Pertusis

and Tetanus, and one dose of Measles Vaccine. In 2004, the country included Hepatitis B and

Yellow fever vaccines in its schedule, recommending the receipt of 3 doses of hepatitis B, at six

weeks of age, 10 weeks of age, and at 14 weeks of age while yellow fever should be given at

nine months of age, along with Measles vaccine (World Health Organization/ United Nations

Children Fund WHO/UNICEF, 2005)

5
The Nigeria Expanded Programme on Immunization mirrors the international recommendations

of the World Health Organization. A child is considered fully vaccinated if she or he has

received BCG vaccination against tuberculosis; three doses of vaccine to prevent diphtheria,

pertussis, and tetanus; at least three doses of polio vaccine; and one dose of measles vaccine.

These vaccines should be received during the first year of life. In order to improve the coverage

of immunization, Nigeria in 2006 began to implement polio vaccination campaigns through the

immunization plus days (IPDs) (NPC, 2014). Furthermore, in 2012, the country began the

phased replacement of diptheria, pertussis and tetanus (DPT) vaccine with the Pentavalent

vaccine which contains more antigen (Diptheria, Pertusis, Tetanus, Haemophilus influenza type

B and Hepatitis B). The phase I which started in May 2012 covered 13 states which are;

Adamawa, Akwa Ibom, Anambra, Bauchi, Edo, Ekiti, Enugu, Jigawa, Kaduna, Kwara, Lagos,

Plateau, Rivers and the Federal Capital Territory-Abuja. The phase II which was commenced in

May 2013 covered an additional 12 states while phase III which started in May 2014 covered 11

states (NPC, 2014).

6
Table 1 Routine Childhood Immunization Schedule for Nigeria

Vaccine Doses When to give (Age) Disease Prevention Route of Dose Vaccination
Administration site
BCG 1 At Birth or as soon Tuberculosis Intradermal 0.05ml Left Upper
as possible till one Arm
year
Oral Polio Vaccine 4 At birth and at 6, 10 Poliomyelitis Oral 2 drops Oral
(OPV) and 14 weeks
Pentavalent 3 At 6, 10 and 14 Diphtheria, Tetanus, Pertussis, Intramuscular 0.5ml Left Outer
weeks Hepatitis B and Hemophilus Thigh
Influenza type b
Hepatitis B 1 At birth or as early Hepatitis Intramuscular 0.5ml Left Outer
as possible within 2 Thigh
weeks of age
Measles 1 At 9 months of age Measles Subcutaneous 0.5ml Right Upper
Arm
Yellow Fever 1 At 9 months of age Yellow Fever Subcutaneous 0.5ml Right Upper
Arm
Vitamin A 2 9 months & 15 Improvement of Sight Oral 100,000IU Oral
months 200,000IU
Inactivated Polio 1 14 weeks of age Poliomyelitis Intramuscular 0.5ml Right Outer
Vaccine* (IPV) Thigh
Pneumococcal 3 At 6, 10 and 14 Pneumonia Intramuscular 0.5ml Left Outer
Conjugate Vaccine weeks Thigh
(PCV)
Rota*** 2 At 6 and 10 weeks Diarrheal diseases Oral 1.2ml Oral