Immunization protects people against diseases.
What is immunization?
Immunization is the process of giving a vaccine to a person to protect them against disease.
Immunity (protection) by immunization is similar to the immunity a person would get from
disease, but instead of getting the disease you get a vaccine. This is what makes vaccines
such powerful medicine. Most vaccines are given by needle (injection) but some are given
by mouth (orally) or sprayed into the nose (nasally). Immunizations are also called
vaccinations, needles, shots or jabs.
Background note on Immunization:-
Expanded Programme on Immunization was launched in 1978. It was renamed as Universal
Immunization Programme in 1985 when its reach was expanded beyond urban areas. In
1992, it became part of Child Survival and Safe Motherhood Programme and in 1997 it was
included in the ambit of National Reproductive and Child Health Programme. Since the
launch of National Rural Health Mission in 2005, Universal Immunization Programme has
always been an integral part of it.
Universal Immunization Programme (UIP) is one of the largest public health programmes
targeting close of 2.67 crore newborns and 2.9 crore pregnant women annually.
It is one of the most cost-effective public health interventions and largely responsible for
reduction of vaccine preventable under-5 mortality rate.
Under UIP, immunization is providing free of cost against 12 vaccine preventable diseases:
Nationally against 9 diseases – Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella,
severe form of Childhood Tuberculosis, Hepatitis B and Meningitis & Pneumonia caused by
Hemophilus Influenza type B
Sub-nationally against 3 diseases – Rotavirus diarrhoea, Pneumococcal Pneumonia and
Japanese Encephalitis; of which Rotavirus vaccine and Pneumococcal Conjugate vaccine
are in process of expansion while JE vaccine is provided only in endemic districts.
A child is said to be fully immunized if child receives all due vaccine as per national
immunization schedule within 1st year age of child.
The two major milestones of UIP have been the elimination of polio in 2014 and maternal
and neonatal tetanus elimination in 2015.
How do vaccines work?
Vaccines contain the same germ that causes disease. But the germs in the vaccine have
been killed or weakened so that they do not make you sick. Some vaccines contain only a
part of the germ that causes disease.
When you get immunized, your body is tricked into thinking that it has been infected with the
disease. It makes antibodies that kill the germs. These antibodies stay in your body for a
long time and remember how to fight the germ. If the germs from the disease enter your
body in the future, the antibodies destroy the germs before you can become sick. It is much
safer to get a vaccine than the disease.
Most people are fully protected against the disease after getting immunized. In rare cases,
people who are immunized can still get the disease because they only get partial protection
from the vaccine. This is more common in people with medical conditions that affect the
immune system. Although these people may still get the disease, they will most likely get a
milder sickness and not suffer serious complications.
What is herd immunity (community immunity)?
When enough people in a community are immunized against a disease, the chance of an
outbreak is greatly reduced. This type of community protection is known as ‘herd’ or
‘community’ immunity. To reach herd immunity against a disease, a community must have
between 74 to 95 per cent of the people immunized depending upon the disease.
Indian Government Initiative- Mission Indradhanush
Mission Indradhanush (MI) was launched in December 2014 and aims at increasing the full
immunization coverage to children to 90%.
Under this drive focus is given on pockets of low immunization coverage and hard to reach
areas where the proportion of unvaccinated and partially vaccinated children is highest.
A total of six phases of Mission Indradhanush have been completed covering 554 districts
across the country.
It was also identified as one of the flagship schemes under Gram Swaraj Abhiyan (16,850
villages across 541 districts) and Extended Gram Swaraj Abhiyan (48,929 villages across
117 aspirational districts).
While the first two phases of Mission Indradhanush resulted in 6.7% increase in full
immunization coverage in a year, a recent survey carried out in 190 districts covered in
Intensified Mission Indradhanush (5th phase of Mission Indradhanush) shows 18.5% points
increase in full immunization coverage as compared to NFHS-4 survey carried out in 2015-
16.
Fatty Liver
The liver, located on the upper-right side of the abdomen, is the largest internal organ of the human body. The main functions of the liver are to remove toxins and process food nutrients. Blood from the digestive system filters through the liver before travelling anywhere else in the body.
Fatty liver disease (steatosis) is the build-up of excess fat in the liver cells, and is a common liver complaint in Western countries. It affects about one in every 10 people. It is normal for the liver to contain some fat, but if fat accounts for more than 10 per cent of the liver’s weight, then you have fatty liver and you may develop more serious complications.
Fatty liver may cause no damage, but sometimes the excess fat leads to inflammation of the liver. This condition, called steatohepatitis, does cause liver damage. Sometimes, inflammation from a fatty liver is linked to alcohol abuse. This is known as alcoholic steatohepatitis. Otherwise, the condition is called non-alcoholic steatohepatitis, or NASH.
An inflamed liver may become scarred and hardened over time. This condition, called cirrhosis, is serious and often leads to liver failure. NASH is one of the top three leading causes of cirrhosis.
Causes of fatty liver disease
Eating excess calories causes fat to build up in the liver. When the liver does not process and break down fats as it normally should, too much fat will accumulate. People tend to develop fatty liver if they have certain other conditions, such as obesity, diabetes or high triglycerides.
Alcohol abuse, rapid weight loss and malnutrition may also lead to fatty liver. However, some people develop fatty liver even if they have none of these conditions.
Risk factors for fatty liver disease
Most, but not all fatty liver patients are middle-aged and overweight. The risk factors most commonly linked to fatty liver disease are:
- overweight (body mass index of 25-30)
- obesity (body mass index above 30)
- diabetes
- elevated triglyceride levels.
Metabolic syndrome and fatty liver disease
Many researchers now believe that metabolic syndrome – a cluster of disorders that increase the risk of diabetes, heart disease and stroke – plays an important role in the development of fatty liver.
Signs and symptoms of metabolic syndrome include:
- obesity, particularly around the waist (abdominal obesity)
- high blood pressure (hypertension)
- one or more abnormal cholesterol levels — high levels of triglycerides, a type of blood fat, or low levels of high-density lipoprotein (HDL) cholesterol, the ’good’ cholesterol
- resistance to insulin, a hormone that helps to regulate the amount of sugar in the blood.
Of these, insulin resistance may be the most important trigger of NASH. Because the condition can remain stable for many years, causing little harm, researchers have proposed that a ‘second hit’ to the liver, such as a bacterial infection or hormonal abnormality, may lead to cirrhosis.
How a liver becomes fatty?
It is unclear how a liver becomes fatty. The fat may come from other parts of your body, or your liver may absorb an increased amount of fat from your intestine. Another possible explanation is that the liver loses its ability to change fat into a form that can be eliminated. However, the eating of fatty foods, by itself, doesn’t produce a fatty liver.
Symptoms of fatty liver disease
A fatty liver produces no symptoms on its own, so people often learn about their fatty liver when they have medical tests for other reasons. NASH can damage your liver for years or even decades without causing any symptoms. If the disease gets worse, you may experience fatigue, weight loss, abdominal discomfort, weakness and confusion.
Diagnosis of fatty liver disease
Your doctor may see something unusual in a blood test or notice that your liver is slightly enlarged during a routine check-up. These could be signs of a fatty liver. To make sure you don’t have another liver disease, your doctor may ask for more blood tests (including liver function tests), an ultrasound, a computed tomography (CT) scan or medical resonance imaging (an MRI).
If other diseases are ruled out, you may be diagnosed with NASH. The only way to know for sure is to get a liver biopsy. Your doctor will remove a sample of liver tissue with a needle and check it under a microscope.
Some questions to ask your doctor after diagnosis include:
- What is the likely cause of my fatty liver?
- Do I have NASH? If not, how likely am I to develop NASH?
- Do I have cirrhosis? If not, how likely am I to develop cirrhosis?
- Do I need to lose weight? How can I do so safely?
- Should I be taking any medication to control my cholesterol and triglyceride levels?
- What medications or other substances should I avoid to protect my liver?
Prevention and reversal of fatty liver disease
There are no medical or surgical treatments for fatty liver, but some steps may help prevent or reverse some of the damage.
In general, if you have fatty liver, and in particular if you have NASH, you should:
- lose weight – safely. This usually means losing no more than half to one kilogram (one to two pounds) a week
- lower your triglycerides through diet, medication or both
- avoid alcohol
- control your diabetes, if you have it
- eat a balanced, healthy diet
- increase your physical activity
- get regular check-ups from a doctor who specialises in liver care.
Treatment for fatty liver disease
Fatty liver is currently the focus of intense research. Scientists are studying whether various medications can help reduce liver inflammation, including new diabetes medications that may help you even if you don’t have diabetes.
Several drug are being investigated such as a medication that blocks the absorption of some of the fat from your food and may reduce the amount of fat in the liver.