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CHAPTER 46
Immunizing Drugs and
Biochemical Terrorism
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IMMUNITY
 Immune response
… Antigens
… Antibodies
 Active immunization
 Passive immunization
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IMMUNIZING BIOLOGICALS
 Biological antimicrobial agents
… Also called biologicals
… Used to prevent, treat, or cure infectious
diseases
 Antitoxins
 Antisera
 Toxoids and vaccines (immunizing
biologicals)
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TOXOIDS
 Antigenic (foreign) preparations of
bacterial exotoxins
 Detoxified with chemicals or heat
… Weakened or “attenuated”
 Cannot revert back to a toxic form
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TOXOIDS (CONT’D)
 Stimulate one’s immune system to
produce a specific antibody
… Artificial active immune response
 These antibodies protect against
future exposures
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VACCINES
 Suspensions of live, attenuated
(weakened) or killed
(inactivated) microorganisms
 The weakened form prevents
the person from contracting the
disease
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VACCINES (CONT’D)
 Also stimulate the production of
antigens against a specific
antibody
 Vaccinations with live bacteria or
virus provide lifelong immunity
 Vaccinations with killed bacteria
or virus provide partial immunity,
and booster shots are needed
periodically
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ACTIVE IMMUNIZATION
 The body is exposed to a relatively
harmless form of an antigen
 The immune system is stimulated
and “remembers” this antigen if
subsequent exposures occur
 Do not cause a full-blown infection
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ACTIVE IMMUNIZING DRUGS: EXAMPLES
 BCG vaccine (tuberculosis)
 Diphtheria, tetanus, and pertussis toxoids,
several forms
 Haemophilus influenzae type B conjugate
vaccine
 Hepatitis A and B virus vaccines
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ACTIVE IMMUNIZING DRUGS: EXAMPLES
(CONT’D)
 Measles, mumps, and rubella virus
vaccine, live—several forms
 Pneumococcal bacterial vaccines
 Human papilloma virus vaccine
(Gardasil)
 Poliovirus vaccine; several forms
 Rabies virus vaccine
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ACTIVE IMMUNIZING DRUGS: EXAMPLES
(CONT’D)
 Smallpox virus vaccine
 Tetanus toxoid
 Varicella virus vaccine
(chickenpox)
 Yellow fever virus vaccine
 Many others
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PASSIVE IMMUNIZATION
 Serum or concentrated immune
globulins from humans or animals are
injected into a person
 The substances needed to fight off
invading microorganisms are given
directly to a person
 The immune system is bypassed
 Short-lived compared with active
immunization, but works faster
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PASSIVE IMMUNIZATION (CONT’D)
 Naturally acquired passive immunity
… From mother to fetus through the
placenta
… From mother to infant through breast
milk
 Artificially acquired passive immunity
… Acquired from an external source,
such as
… injection of antibodies or
immunoglobulins
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PASSIVE IMMUNIZING DRUGS
 Antitoxins
 Immunoglobulins
 Snake and spider antivenins
(antivenom)
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PASSIVE IMMUNIZING DRUGS:
EXAMPLES
 Antivenins
… Pit viper, coral snake
… Black widow spider
 Hepatitis B immune globulin
 Immunoglobulin, various
forms
 Rabies immunoglobulin
(human)
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PASSIVE IMMUNIZING DRUGS:
EXAMPLES (CONT’D)
 Rho(D) immune globulin
(RhoGAM)
 Tetanus immunoglobulin
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INDICATIONS
 Active immunization
… Prevents infection caused by
bacterial toxins or viruses
… Provides long-lasting or permanent
immunity
… “Herd immunity”
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INDICATIONS (CONT’D)
 Passive immunization
… Antitoxins, antivenins,
immunoglobulins
… Minimizes effects of poisoning by the
venoms of spiders and certain snakes
… Provides quick immunity before a
person’s own immune system has a
chance to make antibodies (such as in
cases of exposure to hepatitis B or
rabies viruses)
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INDICATIONS (CONT’D)
 CDC/Department of Health and
Human Services
recommendations for adult and
pediatric immunizations (U.S.)
… Provide specific dosages and
intervals for immunizations
… Refer to the CDC website for
current recommendations
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ADVERSE EFFECTS
 Range from mild and transient to
very serious or life threatening
 Minor effects
… Fever, minor rash, soreness at
injection site, itching, adenopathy
 Severe effects
… Fever higher than 103° F,
encephalitis, convulsions,
anaphylactic reaction, dyspnea,
others
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ADVERSE EFFECTS (CONT’D)
 Minor reactions
… Treated with acetaminophen and
rest
 Serious or unusual reactions
… Serum sickness
… Report serious or unusual reactions
to the Vaccine Adverse Event
Reporting System (VAERS)
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NURSING IMPLICATIONS
 Assess previous reactions and
responses to immunizations
 Assess for contraindications, including
immunosuppression
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NURSING IMPLICATIONS (CONT’D)
 Before giving any drug, recheck the
specific protocols for administration
and schedules for administration
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NURSING IMPLICATIONS (CONT’D)
 Encourage parents of young children to
keep a journal of the child’s immunization
status, with dates of immunizations and
reactions, if any
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ILLNESSES CAUSED BY POSSIBLE
BIOTERRORISM AGENTS
 Anthrax
 Smallpox
 Botulism
 Tularemia
 Viral hemorrhagic fever
 Plague
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POSSIBLE BIOTERRORISM AGENTS
 Sarin (nerve gas)
 Mustard (blistering agent)
 Cyanide (blood agent)
 Chlorine (choking agent)
 Radioactive elements
 Ricin
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