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Chapter 16
Immunizations and the Immune
System
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Learning Objectives
Defining various types of agents used in
active and passive immunity and their
appropriate routes of administration.
Describing public health guidelines for
immunizations and the indications for
administering and contraindications to each
agent.
Discussing agents that provide passive
immunity.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Learning Objectives (cont’d.)
 Describing use of immunoglobins following the
Rh-O incompatible birth of mother and child.
 Describing why immunosuppressants are
necessary after transplantation of organs and for
autoimmune and allergic conditions.
 Discussing medical needs for immunostimulants.
 Providing patient education for compliance with
medications used as immunizations in the
immune system.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Introduction
Antibodies: proteins; body’s defense system
against invaders
Immunity: protection against disease;
selective
Antigen: any foreign substance entering
body
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Inborn versus Acquired Immunity
Inborn immunity is genetically conferred.
Acquired immunity results from introduction
of antigens that produce antibodies.
 artificially acquired immunity—vaccines or toxoids
 naturally acquired immunity—exposure to
pathogens or disease process
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Types of Natural Immunity
Figure 16-2 Types of active and natural immunity. (From Applegate E: The anatomy and physiology learning system, ed 4, St Louis, 2011, Saunders.)
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Types of Acquired Immunity
Figure 16-2 Types of active and natural immunity. (From Applegate E: The anatomy
and physiology learning system, ed 4, St Louis, 2011, Saunders.)
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Inborn versus Acquired Immunity
Naturally acquired passive
 mother to child (placenta and breast milk)
 does not last long; temporary
Artificially acquired active (immunization from
vaccine)
 introduced by attenuated or reduced vaccines
 allows patient to produce antibodies without
serious illness
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Artificial Active Immunity
Figure 16-3 Artificial active immunity and the response to disease processes.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Artificial Passive Immunity
Provides patient with antibodies from another
source
 immediate, but short-lived
 immune serum globulins
 antiserum—contains antibodies to specific antigen
Sera are often derived from animals
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Artificial Passive Immunity
Figure 16-4 Artificial passive immunity and the response to disease processes.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Types of Active and Passive
Immunizing Agents
Dramatically reduce infectious disease rates
Vaccines: suspension of microorganisms
that cause immune system to establish
resistance to infectious diseases
 killed—made from whole killed microbes
(pertussis, rabies)
 live or live attenuated—live, weakened microbes
(polio, MMR)
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Types of Active and Passive
Immunizing Agents
Toxoids: toxins changed to a nontoxic state
for immunization
Immune globulins: blood products
containing disease-specific antibodies
Antitoxins: antibodies produced in response
to a specific toxin
 have ability to neutralize the toxin (for example,
diphtheria, tetanus)
 used for short-term prophylaxis
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Who Should be Immunized?
Adolescents
New parents
Debilitated persons
Migrant workers, new
immigrants
Healthcare workers
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Who Should be Immunized?
Antibody Titers
Lab test used to determine quantity of viable
antibodies available to respond to a given
quantity of antigen
Common titers—varicella, hepatitis B
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Contraindications to Immunizations
No live vaccines should be given to:
 patients receiving steroids, radiation, or
chemotherapy
 immunosuppressed patients
 patients with certain infections
 patients with prior reactions to vaccines (seizures,
high-pitched screams in infants and young
children)
Some vaccines are made with eggs—check
for allergies.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Adverse Reactions to
Immunizations
Mild reactions—fever, rashes, soreness at
injection site, joint pain, malaise, vomiting,
diarrhea, headache
Serious side effects—anaphylaxis,
thrombocytopenia, teratogenicity in
pregnancy, encephalitis, convulsions,
Guillain-Barré syndrome
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Adverse Reactions to
Immunizations
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Documentation of Immunizations
National Childhood Vaccine Act
Parent or guardian must be provided with copy of
Vaccine Information Statement (VIS).
Documentation must include:
 date
 vaccination route, site
 vaccine type, manufacturer, lot number,
expiration date
 name, address, title of person administering vaccine
 delivery of VIS
 consent
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Agents for Artificial Active Immunity
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Agents for Artificial Active Immunity
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Agents for Artificial Active Immunity
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Agents for Artificial Active Immunity
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Agents for Artificial Active Immunity
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Chickenpox
From Lemmi FO, Lemmi CAE (2000). Physical assessment findings CD-ROM.
Philadelphia: Saunders.
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Agents for Artificial Active Immunity
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Agents for Artificial Active Immunity
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Proper Administration Routes for
Immunizations
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Agents for Artificial Passive
Immunity
Vaccine of preformed antibodies found in
immune globulins
Protection immediate
Protection persists for only short period
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Immune Globulins for Specific
Conditions
RhoGAM
Prevents hemolytic disease in infant whose
Rh-negative mother has been exposed to
Rh-positive fetus
Figure 16-5 RhoGAM is necessary to prevent hemolytic disease in an infant whose Rh-mother has been exposed to an Rh-positive
fetus. (From Applegate E: The anatomy and physiology learning system, ed 4, St Louis, 2011, Saunders.)
Copyright © 2012, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Education Concerning
Immunizations
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Immunosuppressants
Agents that interfere with normal reaction of
immune system to an antigen
Organ transplantation, immunosuppression
Adverse reactions—nausea, vomiting, decrease
in blood cells, depression of bone marrow
Agents may be:
 mutagenic—changing genes
 teratogenic—changing normal development of
embryo or fetus
 carcinogenic—cancer-causing agents
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Immunostimulants
Agents used to stimulate activity of immune
system
Used in treatment of cancer and AIDS
Help to control pain and suffering—prevent
further tissue destruction
Alpha-interferon, Proleukin
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