Академический Документы
Профессиональный Документы
Культура Документы
Principles of Vaccination
•
• Antigen
• - A live of inactivated substance capable of producing an immune
response
•
• Antibody
Active immunity
- Protection produced by the person’s own system
- Administration of all or a part of the microorganism to evoke an
immunologic response
- Developed after infection with disease-causing organism or after
vaccination
- Usually long term
Passive immunity
- Protection transferred from another human or animal
- e.g. maternal antibody transfer through placenta
- Temporary protection that wanes with time
Vaccination
- Active immunity produced by vaccine
— Vaccine delivers a killed or attenuated form of the pathogen
- Immunity and immunologic memory similar to natural infection but without
risk of disease
— Immunologic memory allows for an anamnestic response after the primary
immune response, so that antibody reappears when the antigen is
introduced
- Primary antibody response and memory cells formed (IgM)
- Secondary antibody response and rapid and effective response (IgG) in
response to pathogen
Classification of Vaccines
- Live attenuated
- Viral
- Bacterial
- Inactivated
- Whole (e.g. DPT)
- Fractional (e.g. DTaP)
- Protein based
- Polysaccharide-based
Inactivated vaccines
- Cannot replicate
- Less interference from circulating antibodies than live vaccines —> less
effective
- Always require multiple doses
- Immune response mostly humoral
- Antibody titer diminishes with time
- May require periodic supplemental doses
- Inactivated whole cell vaccines
- Viral: polio, hep A, rabies, influenza
- Bacterial: pertussis, typhoid, cholera, plague
- Inactivated fractional vaccines (protein based)
- Subunit: hep B, influenza, acellular pertussis, HPV, anthrax
- Toxoid: diphtheria, tetanus
- Polysaccharide Vaccines
- Unique type of inactivated subunit vaccine composed of long chains of
sugar molecules that make up the surface capsule of certain bacteria
- no booster response
- antibody with less functional activity
- pure polysaccharide vaccines are not immunogenic in children <2
years of age
- Immunogenicity improved by conjugation
- Inactivated fractional vaccines (protein based)
- Pure polysaccharide vaccines
- Pneumococcal
- Meningococcal
- Salmonella typhi (IV)
- Conjugate polysaccharide
- Pneumococcal
- Meningococcal
- Hib
General Rules
- Inactivated vaccines generally are not affected by circulating antibody to
the antigen
- Live attenuated vaccinees may be affected
Storage Don’t
- Do not store vaccines near wall, coils, cooling vents, top shelf, ceiling, door,
floor, and back of unit
- Do not store with food
About diluents
- Diluents are not interchangeable
- Diluents made by one manufacturer cannot be used for reconstituting the
same vaccine produced by another manufacturer
- Diluents must never be frozen or allowed to be in contact with any frozen
surface
Vaccine Preparation
- Only open a single dose vial when ready to use
- Once protective cap is removed, vaccine should be used. If not used,
discard it at end of workday
- Once a manufacturer-filled syringe is activated, vaccine should be used or
discarded at end of work day
- Do not pre-draw vaccines because it increases risk for administration errors,
wasted vaccine, and microbe growth
- General use administration syringes are not for storage
Vaccine Expiration Dates
- Monitor at least 1 time each week and each time vaccines are delivered,
check and arrange vaccines and diluents in storage unit according to
expiration dates
- Exceptions: reconstitution with a beyond use date or time (BUD)
- Multidose vial with BUD once opened
- Manufacturer-shortened expiration date
Vaccine Administration
- Explain to caregiver what the procedure is
Identify site and route of vaccine administration
Demonstrate aseptic technique
Before administration
- Obtain complete immunization history
- Use recommended schedule to determine vaccines needed based on age,
medical condition, risk factors
Administration techniques
- IM 90 into anterolateral thigh if less than 12 months or deltoid if > 12
months
- Deep subcutaneous 45 angle into thigh or deltoid
- Intradermal 0 —> volar surface of forearm, deltoid, or buttock
Multiple vaccinations
- Separate injections by at least 1 inch (or more if possible)
Documentation (PHOTO)
Vaccine Safety
- Vaccinations are universally recommended
What is Safe?
- No vaccine is 100% safe
- No vaccine is 100% effective
- Remind parents that doing nothing is to take a risk, but safety also means
being preserved from a real danger
- In this sense, benefits outweigh risks
Screening
- Specific questions intended to identify contraindications or precautions to
vaccination
- Screening must occurs at every immunization
- Does the child have any cancer, leukemia, AIDS, or any other immune
problem?
- Steroid intake?
- Irradiation therapy?
- Blood product and IG transfusion
Permanent contraindications
- Severe allergy to a prior dose of a vaccine or to a vaccine component (all
vaccines)
- Rotavirus: SCID, history of intussusception
- Pertussis vaccines: encephalopathy not due to another identifiable cause
within 7 days of administering pertussis
Anaphylaxis
- is a very rare allergic reaction
BCG
- < 12 months: 0