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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 ; schoolaged 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.
Chain of Infection
Horton & Parker: Informed Infection Control Practice
Means of transmission
Direct
 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 Occurrence
Sporadic 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 immunity
is 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 pox
B-Acquired active through vaccination
ex. DPT
Immunization :
is the process of introducing some form of
disease-causing organism into a person’s
system to cause the development of antibodies
that will resist that disease.
A vaccine:
is a preparation made from killed, living
attenuated, or living fully virulent organisms
that is administered to produce or artificially
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
visit
Vaccine
At birth -BCG
-Hepatitis
B
2Months -IPV
-DTP
-Hep B
-Hib
-PCV
4Months OPV
DTP
Hep B
Hib
PCV
Visit
6Months
9Months
months12
vaccine
OPV
DTP
Hep B
Hib
PCV
Measles (mono)
OPV
MMR
PCV
Visit
Vaccine
Months18
OPV
DTP
Hib
Hepatitis A
2 Years
Hepatitis A
For new child inter the
school - first class
OPV
DTP (DT)
MMR
Varicella
BCG:
• There is evidence that BCG provides
appreciable protection against tuberculosis.
• Intra-dermal injection
24
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
25
BCG:
• Complications:
1. Local abscess
2. “Not so serious” Lymphadenitis
3. Serious Lymphadenitis :
Persistent, recurrent or multiple
4. Disseminated BCG is in immune
compromised
26
BCG:
• Contraindications:
only “symptomatic HIV infection (i.e. AIDS)”
is a contraindication for BCG according to
WHO.
27
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
29
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.
30
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.
31
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.
32
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
33
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.
35
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
37
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
39
OPV, IPV:
• Side effects :
IPV has no adverse effects
OPV may cause (vaccine associated
paralytic polio) in 1 in 6.2 million doses.
40
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
43
Vaccines and Cold Chain
Cold chain
Is 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
Why have the Cold Chain?
If vaccines are exposed to excessive
Heat
Cold
Light
they may lose their potency or effectiveness.
Reactions
Vaccine
BCG
Reactions
Oozing, redness, and swelling at site
DPT/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)
Meningococcal
*
•Redness, warmth, or swelling
•Slight redness or pain at the injection site.
Reactions
Vaccine/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 Contraindications
DPT:
• 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
MOST SENSITIVE
LEAST SENSITIVE
Sensitivity from Freezing
MOST SENSITIVE
• HepB
• DPT
• DT
• TT
LEAST SENSITIVE
COMMUNICABLE DISEASE
PREVENTION
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.
Lippincott
WHO (2010) Immunization Schedule. Kuwait.
‫وزارة الصحة –المملكة العربية السعودية‬