Immunization

Presented By: DR/Amira Yahia

Learning outcomes

1. Explain ,with examples, the difference between active and passive immunity

2. Describe the community immunization program for preschool children ; school-aged children ,and adults.

3. Identify indication and contraindications for immunization

Cont…

4- Describe common reactions experienced following immunization .

5- Describe secondary nursing intervention to relieve the above common reactions.

6- Outline a teaching plan for parents of children being immunized

Definitions • A communicable disease is one that can

be transmitted from one person to another.

• It is caused by an agent that is infectious (capable of producing infection) and is transmitted from a source, or reservoir, to a susceptible host.

Horton & Parker: Informed Infection Control Practice

Chain of Infection

Means of transmissionDirect

Skin-skin Herpes type 1

Mucous-mucous STI

Across placenta toxoplasmosis

Through breast milk

HIV Sneeze-cough

Influenza

Indirect Food-borne

Salmonella Water-borne

Hepatitis A Vector-borne

Malaria Air-borne

Chickenpox Ting-borne

Scarlatina

Levels of Disease OccurrenceSporadic level: occasional cases occurring at irregular intervals Endemic level: persistent occurrence with a low to moderate level Hyperendemic level: persistently high level of occurrence

Cont….

• Epidemic or outbreak: occurrence clearly in excess of the expected level for a given time period

• Pandemic: epidemic spread over several countries or continents, affecting a large number of people

Immunity:

The host` ability to resist a particular infectious disease-causing agent.

Acquired immunity :

is the resistance acquired by a host as a result of previous exposure to an infection.

Nosocomial infection: in the episodic setting an infection that is not

present or incubating at the time of admission (hospital infection).

Vaccination

Vaccination is used to prevent specific

infectious disease .they must be given when

individual is immunologically capable and

before exposure to natural infections

Definition of vaccination

It is an effort to prevent or modify natural

infection by administration of antigen or an

antibody . Its aim is to build up resistance in

the child against certain infectious disease .

Cont…

Types Of Immunization

(I)-Passive immunityis short-term resistance to a specific

disease-causing organism; it may be acquired :

A-natural Passive Immunization: It include passage of maternal antibodies to fetus through the placenta (e.g antibodies against measles ,poliomyelitis ,diphtheria ,mumps ) .These antibodies disappear from the infant circulation at about 4 month of age

Cont….

B- artificially through inoculation with a vaccine that gives temporary resistance.

Such immunizations must be repeated periodically

to sustain immunity levels. An example is the influenza

vaccination.

(II)-Active immunity A long –term resistance to specific disease.

It is an entrance of antigen ,which stimulates formation of antibodies by the immune system

A-Natural active through exposure to infection in endemic areas,

Ex: Chicken poxB-Acquired active through vaccination ex. DPT

Immunization :Immunization :is the process of introducing some form of is the process of introducing some form of disease-causing organism into a person’s disease-causing organism into a person’s system to cause the development of antibodies system to cause the development of antibodies that will resist that disease.that will resist that disease.

A A vaccine:vaccine:is a preparation made from killed, living is a preparation made from killed, living attenuated, or living fully virulent organisms attenuated, or living fully virulent organisms that is administered to produce or artificially that is administered to produce or artificially increase immunity to a particular disease.increase immunity to a particular disease.

Types of Vaccines

• Live vaccine: small pox vaccine is the only live vaccine, made of live virus which is nonpathogenic, but antigenic and gives immunity for the disease.

• Live attenuated vaccine: virulent pathogenic organisms are so treated to become attenuated and a virulent, but antigenic. E.g. BCG vaccine, measles, mumps, rubella vaccine, yellow fever vaccine and sabin polio vaccine (oral vaccine).

Cont…..

• Killed vaccine: vaccines made of killed organisms which are in activated by heat or chemicals still remain antigenic as cholera vaccine, Pertussis vaccine.

• Polysaccharide vaccines: prepared from capsule of the organism as meningococcal vaccine & Pneumococcal vaccine.

• Toxoid: They stimulate formation of antitoxic humeral immunity as diphtheria and tetanus toxoid.

IMUNIZATION SCHEDULE

IMUNIZATION SCHEDULE

visit Vaccine At birth -BCG

-Hepatitis B

2Months -IPV

-DTP

-Hep B

-Hib

-PCV

4Months OPV

DTP

Hep B

Hib

PCV

Visit vaccine

6Months OPVDTPHep BHibPCV

9Months Measles (mono)

12months OPVMMRPCV

Visit Vaccine

18Months OPVDTPHibHepatitis A

2 Years Hepatitis A

For new child inter the school - first class

OPVDTP (DT)MMRVaricella

BCG:

• There is evidence that BCG provides

appreciable protection against tuberculosis.

• Intra-dermal injection

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BCG:

• Local lesion, papule, 2 weeks after vaccination.

• Small abscess might develop, 4-6 weeks.

• At 6 weeks (crust, detaches, ulcerates) ,then a scar (typically round and slightly depressed) remains

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BCG:• Complications:1. Local abscess2. “Not so serious” Lymphadenitis 3. Serious Lymphadenitis : Persistent, recurrent or multiple4. Disseminated BCG is in immune

compromised

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BCG:

• Contraindications:

only “symptomatic HIV infection (i.e. AIDS)” is a contraindication for BCG according to WHO.

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DTP Vaccine

DTP Vaccine:

• Inactivated whole organism vaccine DTP or Acellular vaccine DT

• Acellular type has less side effects

• After 6 years of age only DT is given

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DTP Vaccine:

Side effects :• Mild Problems (Common): Fever, Redness, swelling, Soreness Fussiness ,Tiredness or poor appetite

and Vomiting . These problems occur more often after

the 4th and 5th doses of the DTP series than after earlier doses.

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DTP Vaccine:• Moderate Problems (Uncommon): Seizure (1 in 14,000), Non-stop crying for 3

hours or more (1 in 1,000), High fever (1in 16,000)

• Severe Problems (Very Rare) : Serious allergic reaction (1 in a million dose) Long-term seizures, coma, or lowered

consciousness , Permanent brain damage. so RARE that it is hard to tell if they are

caused by the vaccine.

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DTP Vaccine:• Contraindications:

1. Encephalopathy (coma ,altered level of consciousness ,prolonged seizures ) within 7 days of previous dose

2. Progressive neurological disorder till neurological state is clarified.

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Precautions: 1. Fever more than 40.5,during 48 hrs of

previous dose 2. Collapsed or shock like state during 48

hrs of previous vaccine dose 3. Seizures during 3 days or less of

previous vaccine dose 4. Persistent inconsolable crying more than

3 hr during 48 hr of previous vaccine dose

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Hepatitis B vaccine

Hepatitis B vaccine:

• Is a very safe vaccine

• Very effective

• Infants born to HBsAg-positive mothers should receive the vaccine and HBIG within 12hr of birth.

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Hib Vaccine

• Hib Vaccine:

• Capsular polysaccharide conjugated to protein carrier

• Contraindicated in less than 6 weeks of age

• Children over 5 years old usually do not need Hib vaccine

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OPV, IPV

OPV, IPV:

• live attenuated oral polio vaccine (OPV)

• IPV is inactivated vaccine

• IPV elicit higher serum IgG antibody levels but OPV also produce mucosal IgA immunity and limit virus replication in gastrointestinal system

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OPV, IPV:

• Side effects : IPV has no adverse effects

OPV may cause (vaccine associated paralytic polio) in 1 in 6.2 million doses.

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Measles vaccine

Live attenuated freeze dried tissue culture vaccine.

A dose of 0,5 ml is administered sub cutaneously

Rotavirus Vaccine:

• An oral live vaccine

• Children should get 2 doses :

First Dose: 6 week of age

Second Dose: 10 week of age

• Contraindications :

immunodeficiency

• Minor side effects

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Vaccines and Cold Chain

Cold chainIs term referring to the system by which the vaccines are kept at optimum temperature from the manufacture to the user.Component of cold chain include-:

)a ( Walk in cold room, keep vaccine for 3 month

)b (Deep freezers & ice linked refrigerators

Used to make ice pack & store polio and measles

)C (Small deep freezer

Supplied to PHC center where vaccine kept in.

)d (Cold boxes.

)e (Vaccine carriers.

)f (Ice packs.

Vaccines

• All vaccines should be stored at plus 2 to plus 8 degrees ideally in Ice Lined Refrigerators/ Domestic Refrigerators

• All government supply vaccines come with Vaccine Vial Monitors (VVMs)

• BCG and Measles vaccines are in powder form and come with diluents. Reconstitution is needed before use.

Cont…

•Use reconstituted BCG and Measles vaccines within 4 hours of reconstitution and JE within 2 hours of reconstitution if

kept at +2 to +8 degrees

•Use separate 5 ml syringes for each reconstitution

Cold

Why have the Cold Chain?

If vaccines are exposed to excessive

they may lose their potency or effectiveness.

Heat

Light

ReactionsVaccine ReactionsBCG Oozing, redness, and swelling at siteDPT/DT/Tetanus (IM)

•Some local reaction such as pain, redness, or swelling after the first 3 doses of DTaP. •A temperature of 101° F or higher is reported in 3%-5% of DTaP recipients. •Less common reactions (persistent crying, higher fever, febrile seizure) are rare

Hepatitis B (IM) •a very mild reaction, such as soreness at the injection site •Adults are slightly more likely to experience such mild symptoms.

Hib (IM) •Redness, warmth, or swellingMeningococcal *

•Slight redness or pain at the injection site.

ReactionsVaccine/Route Reaction

MMR (SC) Fever, Mild rash, Seizure

Pneumococcal Up to about 1 infant out of 4 had redness, tenderness, or swelling where the shot was given. • Up to about 1 out of 3 had a fever greater than 100.4°F, and up to about 1 in 50 had a higher fever (over 102.2°F). • Some children also became fussy or drowsy, or had a loss of appetite. No serious reactions have been associated with this vaccine.

Varicella (SC) generally mild and include redness, stiffness, and soreness at the injection site

Vaccine Contraindications

Permanent contraindication: 1.Severe allergy to a vaccine.2.Encephalopathy.

• Temporary contraindication:1.Pregnancy.2.Immunosuppressant. 3.Severe illness.4.Recent recipient of blood products

Individual ContraindicationsDPT:• Acute febrile illness.• Exposure to disease• Severe allergic reaction.• Residual seizure attacks.

Measles: hypersensitivity to eggs.

Rubella: pregnant women.

Individual Contraindications

• MMR: • Recently acquired passive immunity.• Blood transfusion of immune serum globulin

within last 6 weeks because the presence of passive immunity prevent formation of antibodies to the vaccine.

• Pregnancy: potential risk to fetus from Rubella vaccine.

• OPV: • Gastroenteritis because it may interfere with

colonization of the virus in the intestines which is important for the immunity response to occur.

Adult Immunization

• Many people erroneously assume that vaccinations are for children only.

• Well-advertised influenza vaccination campaigns in recent years have helped somewhat to correct this notion.

Vaccines for Specific Occupations

• Health care– Hepatitis B– Influenza– Pneumococcal– MMR

• Animal Handlers– Rabies– Hepatitis B

Travelers–All routine vaccines plus: Yellow

Fever, Typhoid, Japanese Encephalitis, Meningitis, Rabies, & Malaria prophylaxis

–Cholera vaccine only in disaster situations with limited healthcare facilities

Heat sensitivity

• BCG (after reconstitution) • OPV• Measles (before and after

reconstitution) • DPT• BCG (before reconstitution) • DT• TT• HepB

LEAST SENSITIVE

MOST SENSITIVE

Sensitivity from Freezing

• HepB

• DPT

• DT

• TTLEAST SENSITIVE

MOST SENSITIVE

COMMUNICABLE DISEASECOMMUNICABLE DISEASEPREVENTIONPREVENTION

PRIMARY PREVENTION :

In the context of communicable disease control, two approaches are useful in achieving primary prevention:(1) education using mass media and targeting health messages to aggregates and(2) immunization.

SECONDARY

- Test and counsel for human immunodeficiency virus (HIV)– Monitor for outbreaks of endemic

disease– Monitor for outbreaks of pandemic

disease– Notify & screen people who have come

in contact with communicable disease

TERTIARY

– Educate parents about universal precautions

– Identify community resources for providing supportive care (e.g. funds for medications, etc.)

– Set up support groups for persons of HIV, etc.

References

Community health nursing ,Rector, Cherie. Warner , Kristine.D.7th edtion.LippincottWHO (2010) Immunization Schedule. Kuwait.

السعودية – العربية المملكة الصحة وزارة