ADULT IMMUNIZATION

PROF. DR SYED AZHAR SYED SULAIMAN

SCHOOL OF PHARMACEUTICAL SCIENCES
USM
 The word vaccine is derived from the Latin word vaccinus,
which means “pertaining to cows” and originates from a
procedure developed by Edward Jenner in 1796, in which he
scraped the scabs from cowpox lesions on a milkmaid’s hand
into a cut on a young boy’s skin, which resulted in the boy’s
immunity to smallpox.
IMMUNIZATION
 Immunization,
or immunisation, is the
process by which an
individual's immune
system becomes fortified
against an agent (known as
the immunogen).
 By exposing to an
immunogen in a controlled
way, the body can learn to
protect itself: this is called
active immunization.
 Immunization is done
through various techniques,
most commonly vaccination
 Vaccines
against microorganisms that
cause diseases can prepare the
body's immune system, thus
helping to fight or prevent
an infection
Examples of strategies for protecting individuals
from vaccine-preventable diseases include the
following:
• Improving both the quality and quantity of the delivery of
vaccination services

• Minimizing financial burdens for needy persons

• Increasing community awareness, participation, education,

and partnership

• Improving disease monitoring and vaccination coverage

• Developing new or improved vaccines and improving the

use of vaccines
PRINCIPLES OF IMMUNIZATION
 A number of factors are
important when administering
vaccines to healthy adults.
 These issues include the type of
immunization to be used, safety,
the responsibilities of the
individual giving the
vaccination, and proper storage
 Type of immunization — Most
vaccinations induce active
immunity by promoting the
development of antibody in the
recipient, a response which is
expected to be durable.
 Passive immunization, which
usually involves the
administration of a globulin
product, produces transient
immunity for a specific
exposure through the transfer of
antibody directly.
ADULT IMMUNIZATION
 Active — The goal of active
immunization of a vaccine or toxoid is
to stimulate the host to produce a
primary immune response (usually by
inducing B-cell proliferation, antibody
response, and T-cell sensitization).
 If an individual is subsequently exposed
to the pathogen against which the
vaccine is directed, the exposure results
in a secondary response that includes
increased proliferation of Bcells and
formation of antibodies.
 The secondary response protects the
individual from developing disease,
ideally for life
 Vaccines used for active immunization
are derived from whole killed bacteria,
live attenuated bacteria or viruses, or
antigenic subunits of organisms.
 Vaccines recommended for healthy
adults are the pneumococcal, influenza,
hepatitis B, MMR(measles, mumps and
rubella), varicella, and hepatitis A
vaccines.
 Toxoids used for active immunization
are bacterial toxins that are modified to
render them nontoxic
 Toxoids recommended for healthy
adults are tetanus and diphtheria toxoid
ADULT IMMUNIZATION
 Passive — Passive immunization
involves administration of antibodies (as
intramuscular immune globulin derived
from pooled human serum or antitoxin
derived from serum harvested from
immunized animals).
 Passive immunization offers short-term
protection to people who have been or
will be exposed to a specific pathogen
and is typically used by
immunocompromised patients who are
unable to produce an effective immune
response with active immunization.
 Passive immunization is not routinely
recommended for healthy adults
 Administration — The recommended method of
storage, preparation, and route of administration of
each vaccine is described in the package insert
 Most adult vaccines are administered
intramuscularly or subcutaneously, usually in or
over the deltoid muscle. Deltoid intramuscular
injections should be given with a 1 to 1.5 inch
needle, to achieve at least 5 mm of muscle
penetration
 The buttock should be avoided for routine vaccine
administration, except for large volume injections
of immune globulin, because immunogenicity of
the hepatitis B vaccine, at least, is significantly
lower when given in the buttock.
 Most widely used vaccines can be administered
simultaneously at different sites, without
compromising efficacy.
 For adults of all ages, coadministration of the
pneumococcal and influenza vaccine appears safe
and does not compromise efficacy of either vaccine
ADULT IMMUNIZATION
 Limitations of coadministration of
vaccines include:
 Live virus vaccines should either be
administered on the same day, or
subsequent immunization with live
virus vaccines should be delayed
one month to avoid the theoretical
concern that the immune response
to one or both might be impaired.
 Immune globulins should not be
administered along with live virus
vaccines because the passively
administered antibodies can
interfere with the vaccine response
(this limitation does not apply to
inactivated vaccines or oral polio
and yellow fever vaccines).
 Safety — Most vaccines are safe to
administer, causing only minor side effects.
The more common problem with
immunization is the missed opportunity to
vaccinate based in part upon public
misconceptions about the safety of
immunization.
 Many vaccines and toxoids cause side effects
such as fever, local reactions at the site of
injection, or even serum sickness-like
reactions.
 These adverse reactions can be caused by
the immunogenic moiety in the vaccine or by
trace amounts of antibiotics, preservatives,
stabilizers, and residual animal proteins
 These side effects are not considered true
contraindications to vaccination.
ADULT IMMUNIZATION
 True contraindications to
vaccination are rare and
include severe
hypersensitivity reactions,
such as anaphylaxis and
severe neurologic
complications.
 Administration of live virus
vaccines to
immunocompromised
patients is also
contraindicated
 The following are NOT
contraindications to
immunization:
 Current or recent mild
illness, with or without low
grade fever
 Current or recent antibiotic
therapy
 Previous mild to moderate
local tenderness, redness,
swelling, or fever less than
40.5ºC after any vaccination
 Personal history of allergies
 Family history of adverse
reactions to immunization
PHARMACIST’S ROLE:
 Pharmacists can play an  Address the pharmacist’s
important role in disease role in promoting and
prevention by advocating conducting proper
and administering immunization of patients
immunizations. in all organized health care
settings.
 Such activities are
consistent with the  The pharmacist’s role in
preventive aspects of promoting disease
pharmaceutical care and prevention through
have been part of pharmacy participation in community
practice efforts
Immunization Administration
 Pharmacists can administer
vaccines or host other health
care professionals who can
administer vaccines.
 Pharmacists must understand
the legal and professional
mechanisms by which
authorization to administer
vaccines is granted, as well as
the additional responsibilities
and considerations that
accompany this expanded role
 The structure of a vaccine
administration program must
also provide for storage and
disposal of injection supplies,
disposal of and prevention of
exposure to biological hazards as
dictated by the Occupational
Safety and Health
Administration (OSHA), and
emergency procedures (e.g.,
BCLS and ACLS).
 Pharmacists should be fully
immunized to protect their
health and the health of their
patients
 Pharmacists who do not administer
vaccines can promote immunization
through six types of activities: (1)
history and screening,
 patient counseling,
 documentation,
 formulary management,
 administrative measures, and
 public education
 These promotional activities can
also be integrated into or
accompany a pharmacy-based
immunization program
 Immunization screening should be a
component of all clinical routines,
regardless of the practice setting.
 All health care institutions should
implement consistent, systematic
monitoring systems and quality
indicators to ensure that all patients
are assessed for immunization
adequacy before they leave the
facility
 Screening can be done through:
 Occurrence screening. With this
type of screening, vaccine needs
are identified at the time of
particular events
 Diagnosis screening. This
screening reviews the vaccine
needs of patients with conditions
that increase their risk of
preventable infections.
 Procedure screening. Immunization
needs are assessed on the basis of
medical or surgical procedures
using this type of screening.
 These procedures include
splenectomy, heart
 or lung surgery,
 organ transplantation,
antineoplastic therapy,
 radiation therapy,
immunosuppression of other
types,
 dialysis, and
 prescription of certain
medications used to treat
conditions that increase patients’
risk of preventable infections
 Periodic mass screening. This  Screening for contraindications
type of screening is a and precautions.
comprehensive assessment of  After candidates for
immunization adequacy in immunization have been
selected populations at a given identified, they should be
time. screened for contraindications
and precautions.
 Such screening may be
conducted, for example,:
 during autumn influenza
programs
 or outbreaks of certain vaccine-
preventable illnesses (e.g.,
measles and meningococcal
disease)
Patient Counseling
 Patients in need of  Chart notes, consultations,
immunization should be messages to patients, one-on-
advised of their infection risk one conversations, and
and encouraged to accept the similar means can be used to
immunizations they need. communicate with inpatients
and institutional patients
 Patient concerns about
vaccine safety and efficacy
should be discussed and
addressed.

 Health care providers can

influence patients’ attitudes
regarding immunization
Documentation
 The recipient’s permanent medical record (or the equivalent)
must state:
 the date the vaccine was administered,
 the vaccine’s manufacturer and lot number,
 and the name, address, and title of the person administering the
vaccine.

 Pharmacists in organized health care settings may encourage

compliance with this requirement by providing reminder
notices each time doses of vaccines are dispensed
Formulary Management.
 Formulary systems in organized health care
settings should include vaccines, toxoids,
and immune globulins available for use in
preventing diseases in patients and staff.
 Decisions by the pharmacy and therapeutics
committee (or its equivalent) on
immunologic drug choices require
consideration of relevant immunologic
pharmaceutics, immunopharmacology, and
disease epidemiology.
 Because of their expertise and training,
pharmacists are well equipped to provide
information and recommendations on which
these decisions may be based.
 The pharmacist should establish and
maintain standards to ensure the
quality, proper storage, and proper use
of all pharmaceuticals dispensed.
 Pharmacists must choose between
single dose or multidose containers of
vaccines on the basis of efficiency,
safety, economic, and regulatory
considerations.
 Pharmacists in institutions should
develop guidelines on the routine
stocking of immunologic drugs in
certain high-use patient care areas
Formulary Management.
 Proper transportation and storage are  It is important that methods be
an important consideration for established for detecting and properly
immunologic drugs, including vaccines, disposing of outdated and partially
because many require storage at administered immunologic agents.
refrigerated or frozen temperatures.
 Live viral (e.g., varicella, yellow fever,
 Pharmacists have an important and smallpox) and live bacterial (e.g.,
responsibility to maintain the “cold bacille CalmetteGuérin) vaccines
chain” in the handling of these drugs. should be disposed of in the same
manner as other infectious
biohazardous waste.
 Storage considerations include the
conditions in all areas in which
immunologic drugs are kept, as well as
a method for ensuring that
immunologic drugs received by the
pharmacy have been transported under
suitable conditions.
Administrative Measures and
Education
 Pharmacists are key  Public Education.
committees (e.g., infection Pharmacists have ample
control and risk opportunities to advance the
management) in organized public health through
health care settings can immunization advocacy.
promote :
 adequate immunization
 Pharmacists can facilitate
delivery among staff
disease prevention strategies,
 and patients by encouraging
- potential victims of
the development of sound
influenza and pneumococcal
organizational policies on
immunization.
disease
True contraindications to vaccine
administration
 Previous anaphylactic reaction
to a specific Vaccine - Avoid
revaccination with the specific
vaccine because of risk of
recurrence
 History of anaphylaxis to eggs or
egg-protein - Avoid measles,
mumps, influenza and yellow-
fever vaccine because these
vaccines are prepared in
embryonated chicken eggs or
cultures and vaccines may
contain residual egg protein
 Previous anaphylactic reaction
to neomycin or streptomycin -
Avoid measles, mumps, rubella
(MMR) vaccine because the
MMR vaccine contains trace
amounts of neomycin
 History of severe systemic
reactions to the cholera, typhoid
or plague vaccine - Avoid
revaccination with the specific
vaccine because of risk of
recurrence
True contraindications to vaccine
administration
 Adults who are  This concern does not apply to
immunocompromised as a result the MMR vaccine because
of disease or its treatment - infection with vaccine strain
Avoid live virus vaccines because measles, mumps or rubella is
there is an increased risk of viral not transmitted to others
replication in
immunocompromised individual
 Pregnant women - Avoid all live
 Household members of virus vaccines because of the
immunocompromised patients - potential risk to the fetus
Avoid oral polio because vaccine
induced disease (if it occurs)
could be transmitted to the
immunocompromised
individual.