N314.01 Vaccine preventable disease

immunity

Self vs. nonself

Protection from infectious disease

Usually indicated by the presence of antibody

Generally specific to a single organism

active immunity

Protection produced by the person's own immune system

Often lifetime

passive immunity

Transfer of antibody produced by one human or other animal to another

Temporary protection

Transplacental most important source in infancy

antigen

A live (e.g., viruses and bacteria) or inactivated substance capable of producing an immune response

antibody

Protein molecules(immunoglobulins) produced by B lymphocytes to help eliminate an antigen

sources of passive immunity

● Many types of blood or blood products

● Homologous pooled human antibody (immune globulin)

● Homologous human hyperimmune globulin

● Heterologous hyperimmune serum (antitoxin)

sources of active immunity

- Infection with disease causing form of organism

- Vaccination

What is a vaccination?

Active immunity produced by vaccine

Immunity and immunologic memory similar to natural infection but without risk of disease

classification of vaccines

Live attenuated (viral, bacterial)

Inactivated

inactivated vaccines

Cannot replicate

● Less affected by circulating antibody than live vaccines

● Always require multiple doses

● Immune response mostly humoral

● Antibody titer diminish with time

● May require periodic supplemental booster doses

Live attenuated vaccines

● Attenuated (weakened) form of the "wild" virus or bacterium

● Must replicate to produce an immune response

● Immune response virtually identical to natural infection

● Usually produce immunity with one dose*

● Severe reactions possible

● Interference from circulating antibody

Polysaccharide vaccines

inactivated subunit vaccine composed of long chains of sugar molecules that make up the surface capsule of certain bacteria.

Pure Polysaccharide Vaccines

Not consistently immunogenic in children younger than 2 years of age, no booster response, immunogenicity improved by conjugation to an immunogenic protein

ex. pneumococcal, meningococcal, Salmonella Typhi (Vi)

Conjugate Polysaccharide Vaccines

haemophilus influenza type b

pneumococcal

meningococcal

recombiant vaccine

a virulent virus or bacteria vector genetically modified to contain genes to create protein

ex. Viral: hepatitis B, human papilloma virus, influenza(one brand), live attenuated influenza

Bacterial: Salmonella Typhi (Vi)

General Rules for vaccination

1. The more similar a vaccine is to the disease-causing form of the organism, the better the immune response to the vaccine

2. Inactivated vaccines are generally not affected by circulating antibody to the antigen. Live attenuated vaccines may be affected by circulating antibody to the antigen.

3. All vaccines can be administered at the same visit as all other vaccines

4. Increasing the interval between doses of a multi dose vaccine does not diminish the effectiveness of the vaccine.*Decreasing the interval between doses of a multi dose vaccine may interfere with antibody response and protection.

Vaccine adverse reactions (3)

-3 categories: local, systemic and allergic

Vaccine adverse reactions (local)

- pain, swelling, redness at site of injection

- common with inactivated vaccines

- usually mild and self-limited

Vaccine adverse reactions (systemic)

- fever, malaise, headache

- nonspecific

- may be unrelated to vaccine

Vaccine adverse reactions (allergic/anaphylaxis)

-due to vaccine or vaccine component,

- rare

- risk minimized by screening

contraindication

A condition that increases the likelihood of a serious adverse reaction to a vaccine for a patient with that condition

precaution

A condition in a recipient that might increase the chance or severity of an adverse reaction, or

Might compromise the ability of the vaccine to produce immunity

vaccination of pregnant women

Live vaccines should not be administered to women known to be pregnant

In general inactivated vaccines may be administered to pregnant women for whom they are indicated

HPV vaccine should be deferred during pregnancy

Tdap recommendations for pregnant women

Healthcare personnel should implement a Tdap vaccination program for pregnant women who previously have not received Tdap

Administer Tdap during each pregnancy, preferably between 27 and 36 weeks gestation

If not administered during pregnancy, Tdap should be administered immediately postpartum

Vaccination of Immunosuppressed Persons

Live vaccines should not be administered to severely immunosuppressed persons

Inactivated vaccines are safe to use in immunosuppressed persons but the response to the vaccine may be decreased

Persons with isolated B-cell deficiency may receive varicella vaccine

Invalid Contraindications to Vaccination

Mild illness

Current Abx therapy

Previous local skin reaction (mild/mod)

Allergies: Bird feathers, PCN

Pregnancy (EXCEPT LIVE VACCINES)

Recent PPD

Immunosuppressed person in household

FH of ADR to vaccine

vaccines all contain

microbial antigens

vaccines may contain:

adjuvant or preservative

Fractional vaccines

vaccines made from parts of pathogens

1. protein-based (Toxoid or Subunit)

2. polysaccharide-based (Pure or Conjugate)

Routine childhood vaccines (US)

Hep A+B, MMR, TDAP, Pneumococcal, Polio, Rotavirus, Chickenpox (varicella), HPV, Haemophilus Influenzae type b (Hib), Meningococcal, Influenza

Routine adult vaccines

Pneumococcal, TDAP, Zoster, MMR, HPV, Influenza, Chickenpox (varicella)

asplenia

absence of a spleen or of spleen function

Hep B vaccine recommendations

Give 3-dose series (dose #1 now, #2 in 1 month, #3 approximately 5 months after #2). Give IM. Obtain anti-HBs serologic testing 1-2 months after dose #3

Influenza vaccine recommendations

Give 1 dose of influenza vaccine annually. Give inactivated injectable influenza vaccine intramuscularly or live attenuated influenza vaccine (LAIV) intranasally.

MMR vaccine recommendations

For healthcare personnel (HCP) born in 1957 or later without serologic evidence of immunity or prior vaccination, give 2 doses of MMR, 4 weeks apart. Give SC.

Varicella vaccine recommendations

For HCP who have no serologic proof of immunity, prior vaccination, or history of varicella disease, give 2 doses of varicella vaccine, 4 weeks apart. Give SC.

TDAP vaccine recommendations

Give a one-time dose of Tdap as soon as feasible to all HCP who have not received Tdap previously. Give Td boosters every 10 years thereafter. Give IM.

Meningococcal vaccine recommendations

Give 1 dose to microbiologists who are routinely exposed to isolates of N. meningitides. Give IM or SC.

Oral (PO) Route Rotavirus Vaccines

Administer oral vaccines, in general, prior to administering injections or performing other procedures that might cause discomfort

Intranasal (NAS) Route Live Attenuated Influenza Vaccine(LAIV)

Insert the tip of the sprayer and spray half the dose in one nostril then remove the dose divider clip and administer the other half-dose in the other nostril

Health-care personnel who are immunosuppressed and require protective isolation should not administer LAIV

Subcutaneous (subcut) Route (Sites)

thigh for infants younger than 12 months of age

upper outer triceps of arm for children older than 12 months and adults (can be used for infants if necessary)

Subcutaneous (subcut) Route (Needle gauge and Length)

23- to 25-gauge needle, 5/8- inch

Subcutaneous (subcut) Route (technique)

insert needle at 45° angle and inject

withdraw needle and apply light pressure to injection site for several seconds with gauze pad

Intramuscular (IM) Route Infants 12 Months and Younger (site)

vastus lateralis muscle (anterolateral thigh)

Intramuscular (IM) Route Infants 12 Months and Younger (Needle gauge and Length)

22- to 25-gauge

neonates and preterm infants: 5/8-inch

1 month and older: 1-inch

Intramuscular (IM) Route Toddlers 1 Year through 2 Years (site)

vastus lateralis muscle(anterolateral thigh) is preferred

deltoid muscle (upper arm)may be used if the muscle mass is adequate

Intramuscular (IM) Route Toddlers 1 Year through 2 Years (Needle gauge and Length)

22- to 25-gauge, 5/8 to 1-inch

Intramuscular (IM) Route Children/Adolescents 3 through 18 Years (site)

deltoid muscle (upper arm)is preferred

vastus lateralis muscle(anterolateral thigh) may be used

Intramuscular (IM) Route Children/Adolescents 3 through 18 Years (needle gauge and length)

22- to 25- gauge, 5/8 to 1-inch

Most young children in this age range require a 5/8 or 1-inch needle

In general, older children and adolescents require a 1-inch needle

Intramuscular (IM) Route Adults 19 Years and Older (site)

deltoid muscle (upper arm)is preferred

vastus lateralis muscle(anterolateral thigh) may be used

Intramuscular (IM) Route Adults 19 Years and Older (needle gauge)

23- to 25-gauge

What is the recommended needle length for IM injections in males weighing less than 130 pounds?

5/8 - 1-inch

What is the recommended needle length for IM injections in males weighing between 130 and 152 pounds?

1-inch

What is the recommended needle length for IM injections in males weighing between 153 and 260 pounds?

1 - 1½-inches

What is the recommended needle length for IM injections in males weighing 260 pounds or more?

1½-inches

What is the recommended needle length for IM injections in females weighing less than 130 pounds?

5/8 - 1-inch

What is the recommended needle length for IM injections in females weighing between 130 and 152 pounds?

1-inch

What is the recommended needle length for IM injections in females weighing between 153 and 200 pounds?

1 - 1½-inches

What is the recommended needle length for IM injections in females weighing 200 pounds or more?

1½-inches

When administering multiple vaccines

Administer each vaccine at a different anatomic site

Use anterolateral thigh for infants and young children

Use deltoid for older children and adults if muscle mass is adequate

Separate injections by at least1 inch, or more if possible

Use a separate limb for most reactive vaccines (e.g. ,tetanus toxoid-containing andPCV13), if possible

Use combination vaccines when appropriate to reduce the number of injections

Vaccines can be given, as appropriate to people who:

Has a mild illness

Is in the convalescent phase of an acute illness

Is taking antibiotics

Faintness/Syncope

temporary loss of consciousness caused by a decreased blood flow to the brain

Infection Control: Equipment disposal

place in puncture-proof container

dispose as infectious medical waste

NEVER detach, recap or cut a used needle

Infection Control: Hand hygiene

recommended between each patient

alcohol-based waterless antiseptic can be used

Infection Control: Gloves

not required by (OSHA) unless potential for exposure to blood or body fluids, open lesions on the hands, or agency policy

Other Vaccine Administration Issues

Not necessary to change needles between drawing or reconstituting vaccine and administration

injection sites in same limb should be separated by at least 1 inch if possible

Aspiration not required

confirmation bias

a tendency to search for information that supports our preconceptions and to ignore or distort contradictory evidence

selective exposure

tendency to favor information which reinforces their pre-existing views while avoiding contradictory information

Reinforcement theory

people seek out and remember information that provides cognitive support for their pre-existing attitudes and beliefs

prospect theory

people choose to take on risk when evaluating potential losses and avoid risks when evaluating potential gains

Truth-Testing Heuristics

People are more likely to believe new information if it satisfies five metacognitive criteria:

1. Compatibility: is it compatible with other things I know?

2. Coherence: is it an internally coherent and plausiblestory?3. Credibility: Does it come form a credible source?

4. Corroboration: is there a lot of supporting evidence?

5. Consensus: do others believe this?

Analytic ("slow") processing

searching one's memory for relevant information, and using logical reasoning to evaluate new information against one's prior knowledge

Intuitive ("fast") processing,

which relies on gut reactions to determine whether the new information "feels right."

Talking with Parents About Vaccine Safety

1. Take time to listen. Be Respectful

2. Validate their concerns. Find common ground: their child

3. Use a "heart and head" approach.

4. Balance risks and benefits.

5. Be flexible.

6. Direct them to reliable resources.

herd immunity

the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination.

Coocooning

people around vulnerable individuals get vaccinated to protect them from diseases.

For example, parents, siblings, and caregivers of babies might get vaccinated to keep the baby safe until they can get their own shots.