This study aims to determine the exposure effect of insecticide with the azadirachtin active ingredient on the immunity of nile tilapia. This research was conducted in March and August for the preliminary test and September-October 2022 for the main test at Ciparanje Inland Aquaculture Hatchery, Padjadjaran University. This study used the experimental method of Complete Randomized Design with five treatments and three repeats. The nile tilapia used is 6-7 cm. The treatment used is exposure to insecticide with different doses, namely A (0 ppm), B (26.25 ppm), C (52.5 ppm), D (78.75 ppm), E (105 ppm). Parameters observed included red blood cell count, white blood cell count, feed response, shock response, and macroscopic symptoms up to day 14. Red blood cell and white blood cell data were analyzed in a quantitative descriptive manner. Data on feed response, shock response, and macroscopic symptoms were carried out in a qualitative descriptive manner. Water quality data were analyzed in a quantitative descriptive manner. The results showed that exposure of insecticide with azadirachtin active ingredient interfered fish health by increasing white blood cell count, lowering red blood cell count, disrupting feed response and shock response. The higher the concentration of insecticide given, the more it affects the immunity of tilapia. Treatment without the addition of insecticides is the best treatment in this study.