NU 352 - Exam 1 - PP 4 (Int. for Childhood Immunizations)

Why Immunize? The Stakes

• Vaccine-preventable diseases still hospitalize & kill children

• Community ( “herd”) immunity protects infants immunocompromised

• Resurgence risk when coverage drops (e.g., measles clusters)

• Nursing role: access, equity, education, systems workflow

How Vaccines Works

-Exposure to harmless antigen -> immune memory

-Body prepared for future infections

-Vaccine types:

• Live attenuated

• Inactivated

• Toxoid

• Conjugate/ recombinant

• mRNA

Core Principles (Timing & Spacing)

• Minimum ages/intervals matter (don’t “reset”; space correctly)

• Live injectable or intranasal vaccines: same day or > 28 days apart

• Inactivated vaccines: can co- administer with others

• Grace period rules (clinic pitfalls)

• Evidence of immunity may substitute for doses (MMR, Varicella

Combination Vaccines

-DTaP-HepB-IPV (Pediarix)

-Hib-MenCY-TT

-DTaP-IPV/Hib (Pentacel)

Benefits:

• Fewer shots

• Improved compliance

• Less missed doses

Hepatitis B (HepB)

• Protects against chronic hepatitis, cirrhosis, liver cancer

• Type: Recombinant

• Schedule: Birth, 1-2 months, 6-18months

Notes:

• First vaccine given at birth

• If mother is Hep B positive -> give HBIG +

vaccine within 12 hr

Rotavirus (RV)

• Protects against severe diarrhea, dehydration

• Type: Live attenuated, oral vaccine

• Schedule: 2 mo, 4 mo, (6 mo depending on brand)

band) Notes:

• Must start before 15 weeks, complete by 8 months

• Dramatically reduced hospitalization

DTaP/ Tdap

• Protects against: diphtheria, tetanus, pertussis

• Type: Inactivated toxoid & bacterial components

• Schedule:

• DTaP: 2, 4, 6, 15-18 mo, 4-6 yrs

• Tdap booster: 11-12 yrs

Notes:

• Pregnant women: Tdap every pregnancy

• Pertussis especially deadly in infants

Haemophilus influenzae type B (Hib)

• Protects against: Meningitis, epiglottitis, pneumonia

• Type: Conjugate

• Schedule: 2, 4, 6 mo + booster 12-15 mo

Notes:

• Major reduction in invasive Hib disease

• High risk: Immunocompromised or asplenic

Pneumococcal (PCV13/15/20)

• Protects against: pneumonia, meningitis, ear infections, sepsis

• Type: Conjugate

• Schedule: 2, 4, 6 mo + booster 12-15 mo

Notes:

• Prevents invasive pneumococcal disease

• Recommended for high-risk children/adults

Polio (IPV)

• Protects against paralytic poliomyelitis

• Type: Inactivated

• Schedule: 2, 4, 6-18 mo, 4-6 yrs

Notes:

• Eradicated in most countries

• Continued use prevents resurgence

MMR (Measles, Mumps, Rubella)

-Protects against:

• Measles: pneumonia, encephalitis

• Mumps: orchitis, meningitis

• Rubella: congenital rubella syndrome

• Type: Live attenuated

• Schedule: 12-15 mo, 4-6 yrs

• Contraindicates: pregnancy, immunocompromised

Varicella (Chickenpox)

• Protects against: chickenpox, shingles later in life

• Type: Live attenuated

• Schedule: 12-15 mo, 4-6 yrs

Notes:

• Reduces complications like pneumonia, encephalitis

• Prevents long-term shingles risk

Hepatitis A (HepA)

• Protects against food/waterborne hepatitis

• Type: Inactivated

• Schedule: 2 doses, 12- 23 mo + 6 months later

Notes:

• Prevents outbreaksfrom asymptomatic spread

Influenza

• Protects against seasonal flu, pneumonia, hospitalization

• Type: Inactivated or live attenuated (nasal spray > 2 yrs)

• Schedule: annual, starting at 6 months

Notes:

• First vaccination <9 yrs: 2 doses, 4 weeks apart

Meningococca l (MCV4, MenB)

• Protects against meningitis, sepsis

• Type: Conjugate/ recombinant

• Schedule:

• MCV4: 11-12 yrs, booster at 16 yrs

• MenB: 16-23 yrs (preferred 16-18)

Notes:

• Especially important in dormitory/ close livin

Human Papillomavirus (HPV)

• Protects against: cervical, throat, anal cancers; genital warts

• Type: Recombinant

Schedule:

• 11-12 yrs: 2 doses (<15 yrs)

• >15 yrs: 3 doses

Notes:

• Cancer-prevention vaccine

• Safe for boys and girl

*look at graph

Hesitancy -> Confidence (Communication Toolkit

• Common myths: autism, “too many shots,” natural immunity better

Nurse strategies:

• Listen

• Empathize

• Educate with evidence

Contraindications vs. Precaution

Do NOT give vaccine:

• Severe allergic reaction (anaphylaxis) to a prior dose or vaccine component

• Severe immunosuppression (live vaccines contraindicated: MMR, Varicella, RV)

• Pregnancy (live vaccines contraindication: MMR, Varicella)

• Hx of intussusception (RV)

Weigh risks/benefits:

• Moderate/severe acute illness with/without fever

• Recent blood product or IVIG administration (may interfere with live vaccines)

• Personal/family hx of seizures (for MMRV)

• Guillain-Barre syndrome within 6 wks of prior tetanus-toxoid vaccine

Adverse Events & Reporting

Mild/Expected Reactions:

• Soreness, redness, swelling at injection site

• Mild fever, fatigue, fussiness

• Loss of appetite or mild rash (MMR, Varicella)

Moderate Reactions:

• Persistent crying (>3 hours)

• High fever (>105F)

• Febrile seizures (rare, self-limiting)

Severe Reactions (Very Rare):

• Anaphylaxis (life-threatening allergic reactions)

• Encephalopathy after pertussis vaccine

• Intussusception (RV

Nursing Interventions - before administration

• Verify physician/provider orders & vaccine schedule

• Screen for contraindications & precautions

• Provide parent/caregiver education

• Obtain informed consent

Nursing Interventions - during Administration

• Use atraumatic care techniques

• Follow the 6 rights of medication administration

• Administer via correct route, site, needle size

• Use combination vaccines if available to reduce needle sticks

Nursing Interventions - after Administration

• Monitor for immediate adverse reactions

• Provide instructions for expected side effects

• Educate parents on when to seek care for concerning reactions

• Document vaccine: type, lot number, expiration date, site, and route in record + immunization registry