Immunity & Vaccination Nursing

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Specializes in Medical Surical Issues.

IMMUNITY & VACCINATION

Immuniology: Is the science that study the body defence mechanisms.

The body defence mechanisms is classified into two major heading:

I- Non-specific defence

II- Specific defence

1 -Non-specific defence includes:

First line of defence ( physical resistance and chemical resistance ).

Second line of defence ( phagocytosis and inflammation).

2- Specific defence which consider third line of defence "immunity" that includes:

Celullar immunity = Cell mediated immune response "T cells".

Humoral immunity = Antibody mediated immune response "Immunoglobulins".

There are two types of immunity :

1. Inborn" inherited ": species, racial, and individual immunity.

2. Acquired includes natural and artificial immunity :

Natural immunity : active"disease exposure" and passive"colostrum".

Artificial immunity: active"vaccines" and passive"antisera".

Vaccines and Antisera are artificial preventive measures that usually taken to provide protection against certain diseases.

Vaccine: Is an antigenic preparation used to establish immunity to a disease.

Types of vaccine:

1. live attenuated virus as OPV "Sabin", BCG, Measles.

2. Inactiviated or Killed virus as IPV "Salk", Hib vaccine, Hep. B vaccine.

3. Toxins as Diphtheria toxoid, and Tetorifice toxoid.

Antisera" Immune serum": Its preparations gives short lived but effective protection against certain disease.

Some types of Antisera:

1. Antisnake bite sera.

2. Tetorifice immunoglobulins.

3. Immunoglobulins " Rh -ve mother/Rh +ve infant".

4. Diphtheria antitoxin.

History of Vaccination:

The idea of vaccinations to prevent disease dates back to 1796. In that year Edward Jenner, a British physician, noted that dairymaids who had caught cowpox (a minor disease), could not catch smallpox (an often fatal disease in humans).

Jenner took infected matter from the hand of Sarah Nelmes, a local dairymaid who had become infected with cowpox, and inserted this ooze into the cut arm of James Phipps, a healthy eight-year-old boy. The boy then caught cowpox.

Forty-eight days later Jenner injected smallpox matter into the boy. Miraculously, it had no effect. This was the first recorded vaccination.

The term "vaccination" is now generalized to refer to any germ, disease, or injection given to people to prevent a more serious disease from striking the individual.also "vaccine" is a reference to the origin of vaccination. "Vacca" is the Latin word for cow.

A few key dates in the history of vaccination:

1798 Smallpox \\1885 Rabies \\1897 Plague \\1923 Diphtheria \\1926 Pertussis \\1927 Tuberculosis (BCG) \\1927 Tetorifice \\1935 Yellow Fever \\1955 Inactivated Polio Vaccine (IPV) \\1962 Oral Polio Vaccine (OPV)\\1964 Measles \\1967 Mumps \\1970 Rubella \\1981 Hepatitis B.

Contraindications and Precautions

Read the manufacturer's insert for each vaccine before administration.

1. Contraindications to all vaccines:

- Anaphylactic reaction to vaccine or its constituent.

- Moderate or severe illnesses with or without fever.

2. All lived virus vaccines"OPV, MMR, Varicella" are contraindicated in:

- Pregnancy

- Immunodeficiency

3. Diphtheria, tetorifice, and pertussis (DTP)/DTaP :

- Encephalopathy within 7 days of administration of previous dose.

4. Inactivated Polio Vaccine (IPV) :

- Anaphylactic reaction to neomycin, streptomycin, or polymyxin B.

5. MMR and Varicella :

- Anaphylactic reaction to neomycin or gelatin.

6. Influenza :

- Anaphylactic reaction to eggs.

7. Hepatitis B vaccine (HBV) :

- Anaphylactic reaction to baker's yeast.

Misconceptions concerning vaccine contraindications

Some health care providers inappropriately consider certain conditions to be contraindications to vaccination.

Conditions most commoly regarded such as:

- Mild acute illness with low-grade fever or mild diarrheal illness in an otherwise well child.

- Reaction to previous DTaP dose that involve only soreness, redness, swelling, fever.

- Prematurity.

- Person using aerosolized steroids , short course of oral steroids ( less than 14days), or topical storoids.

- Pregnant mother.

- Recent exposure to infectious disease.

- Breast-feeding.

- History of nonspecific allergy.

- Allergy to penicillin or other antibodies except anaphylactic reaction to neomycin or streptomycin.

- Family history of seizures in people considered for pertussis or measles vaccination.

- Family history of sudden infant death syndrome in children considered for DTaP vaccination.

- Family history of an adverse event, unrelated to immunosuppression, after vaccination.

- Malnutrition cases.

Vaccine Administartion Considerations

1. Strict adherence to the manufacturer's storage and handling recommendation is vital. failure to observe these precautions and recommendations may reduce the potency and effectivness of vaccine.

2. Health care personnel administering vaccines should be immunized.

3. Good Hand washing should be done before and after administration of vaccines.

4. Gloving is necessary to decrease contamination.

5. Do not try to recap needles.

6. Sterile, disposable needles and syringes should be discarded in biohazard containers.

7. Parentral vaccines should be administered in the anterolateral aspect to the upper thigh in infants and in the deltoid area of the upper arm in older childern and adolecents.

8. Before administering a subsequent dose of any vaccine question parents about adverse effect and possible reactions from pervious doses of vaccine.

9. Routine vaccines can be safely and effectively adminstared simultaneously.

10. Check for right client name, type, dose, time, and route of vaccine before administartion.

Vaccines commonly administered in Palestine

BCG Vaccine :

- Type of vaccine (Live bacteria)

- Number of doses (1)

- Adverse reactions (local abscess and soreness)

- Contraindication (Symptomatic HIV infedction)

- Precautions (correct intradermal administration is essential)

- Dose (0.05 ml)

- Injection Site and Type (Outer upper let arm intradermally)

- Storage (Between 2C - 8C, may frozen)

DPT Vaccine :

- Type of vaccine (Diphtheria and tetorifice as toxiods. Pertussis as killed whole cell bacterium)

- Number of doses (4 doses, the fourth dose is boostering dose)

- Adverse reactions (Mild local or systemic reactions are common)

- Contraindication (Anaphylactic reaction to pervious dose)

- Precautions (Not usually gien over 6 years of old)

- Dose (0.5 ml)

- Injection Site and Type (Outer mid-thigh in infants and outer upper arm if older given intramuscular)

- Storage (Between 2C - 8C, Never frozen)

Measles, Mumps, and Rubella (MMR) Vaccine :

- Type of vaccine (live attenuated virus)

- Number of doses (1)

- Adverse reactions (Malaise, fever, rash - 12 days later ,and anaphylactic reaction my occur)

- Contraindication (Anaphylactic reaction to pervious dose, pregnancy, congenital or acquired immune disorder not HIV)

- Precautions (non)

- Dose (0.5 ml)

- Injection Site and Type (Outer mid-thigh in infants and outer upper arm if older given subcutaneuosly)

- Storage (Between 2C - 8C, may be frozen)

Measles Vaccine :

- It's generally as (MMR) Vaccine in details.

Oral Polio Vaccine (OPV) :

- Type of vaccine (live attenuated virus)

- Number of doses (4 doses, the fourth dose is boostering dose)

- Adverse reactions (none)

- Contraindication (none)

- Precautions (Childern with congenital immune deficiency syndromes should receive IPV rather than OPV)

- Dose (2 drops)

- Route (Oral)

- Storage (Between 2C - 8C, may be frozen)

- To reduce risk of vaccine induced polio, it given as OPV and IPV.

- OPV should not be administered to infants and childern living in households with an immunodeficient person due to Live OPV is excreted in stool for up to 1 month after vaccination.

Inactivated Polio Vaccine (IPV) :

- Type of vaccine (Inactivated or live attenuated virus)

- Number of doses (2)

- Adverse reactions (Malaise, fever, rash - 12 days later ,and anaphylactic reaction my occur)

- Contraindication (Anaphylactic reaction to pervious dose)

- Precautions (Childern with congenital immune deficiency syndromes should receive IPV )

- Dose (0.5 ml)

- Injection Site and Type (Outer mid-thigh in infants and outer upper arm if older given subcutaneuosly)

- Storage (Between 2C - 8C, may be frozen)

Haemophilus influenzae Type B (HiB) Vaccine :

- Type of vaccine (Conjugate)

- Number of doses (3)

- Adverse reactions (local pain, redness, or swelling for less than 24 Hours)

- Contraindication (Anaphylactic reaction to pervious dose)

- Precautions (none)

- Dose (0.5 ml)

- Injection Site and Type (Outer mid-thigh in infants and outer upper arm if older given intramuscular)

- Storage (Between 2C - 8C, Never frozen)

- Protect against H. influenzae Type B virus.

- There are different types of Hib vaccines are available.

Hepatitis type B Vaccine :

- Type of vaccine (Recombinant DNA or plasma derived)

- Number of doses (3)

- Adverse reactions (Malaise, fever, rash - 12 days later ,and anaphylactic reaction my occur)

- Contraindication (Anaphylactic reaction to pervious dose)

- Precautions (Birth dose must be given if there is a risk of perinatal transmission)

- Dose (0.5 ml)

- Injection Site and Type (Outer mid-thigh in infants and outer upper arm if older given intramuscular)

- Storage (Between 2C - 8C, Never frozen)

- Protect against Hepatitis type B virus.

Other vaccines:

Pneumococcal Vaccines

- Protect against pediatric pneumnia infection which affect the lungs.

Influenza Vaccine

- Protect against upper respiratory and chest infection caused by Influenza virus.

Rotavirus Vaccine

- Protect against the most common cause of pediatric diarrhea.

Japannese Encephalitis (JE) Vaccine

- Protect against Japannese Encephalitis .

Meningococcal Vaccine

- Protect against different types of meningococcal meningitis (A,C,Y, and W).

Mumps Vaccine

- Mumps Vaccine administared in combination with measles and rubllea vaccine between ages 12 and 15 month.

Yellow Fever Vaccine

- Protect against Yellow Fever virus which carried by mosquitoes.

Varicella Vaccine

- Protect against Varicella Zoster Virus (VZV).

Hepatitis type A Vaccine

- Protect against Hepatitis type A virus.

Rubella Vaccine

- Usually administared in two doses to prenvent consequences such as an congenital rubella syndrome.

- Important to postpubertal individuals to be immunized.

- Women should avoid pergnancy within 3 months of vaccine to pervent theoretical risk to fetus.

References

Community Health Nursing, Vaccination Chapter,College's Handout: pp119

Pediatric Nursing, Immunization in Practice, College's Handout: pp360-379,382

Sandra M. Nettina (2006), Manual of Nursing Practice, 8th Edition, Lippincott Williams & Wilkins, A Wolters Kluwer company, New York, London: PP 1349 - 1951

Plotkin SA & Mortimer EA (Eds). Vaccines.Philadelphia WB Saunders, 1994.

Websites references/

http://en.wikipedia.org/wiki/Vaccination

http://en.wikipedia.org/wiki/Immunization

http://www.who.int/gpv-dvacc/history/history.htm

http://www.imss.macrobiotic.net/vaccinehistory.html

http://www.liberty-page.com/issues/healthcare/vaccines/main.html

Prepared by student :

Adham Ahmed.

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Specializes in IM/Critical Care/Cardiology.

Thank you for such a nicely detailed desription.

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Specializes in Medical Surical Issues.

thank you very much for your nice reply

hope to help others more and more

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