Pharmacology Vaccines

active immunity

antigen or pathogen enters the body

body produces antibodies (immunoglobulins) from a pathogen (may cause some S&S)

second invasion by pathogen results in quick pathogen-specific antibodies

Natural acquired active immunity

exposure to pathogen or disease

active acquired artificial immunity

weakened antigen or immunoglobulin is introduced to the body

vaccination

passive immunity

antibodies to fight a pathogen are given from another source

short-lived, lasting a few weeks to months

use when time does not allow active immunity, patient cannot develop active immunity, or patient is high risk for complications

natural passive immunity

receives antibodies from another natural source (mother--->child)

artificial passive immunity

recombinant DNA technology

community / herd immunity

when most of the community is immunized to a disease

allows protection of those not immunized

cocooning

focuses on immunizing adults in close contact with newborns and young infants to protect babies from contracting vaccine-preventable diseases in the months before they are eligible for immunizations (pertussis by administering Tdap vaccine) (flu vaccine)

vaccination

administration of a small amount of antigen to stimulate the immune response

does not cause the disease

types of vaccines

attenuated viruses

toxoids

conjugated vaccines

recombinant subunit vaccines

attenuated viruses (live-attenuated vaccines)

immunocompromised patients should avoid

example: varicella virus vaccine (Varivax)

toxoids (inactive)

example: Tetanus toxoid

conjugated vaccines (inactive)

example: Haemophilus influenzae type B

recombinant subunit vaccines (inactive)

example: Hepatitis B

immunocompromised patients SHOULD receive

inactive vaccines

what do many vaccines require

booster doses

vaccine schedules incorporate several doses within a certain time frame

Centers for Disease Control and Prevention (CDC)

recommendation for childhood immunizations

Immunization Action Coalition

summary of rules for childhood immunizations

vaccine preventable diseases

anthrax, diphtheria, Haemophilus influenzae type B (Hib), hepatitis, human papilloma virus, influenza, Japanese encephalitis, measles, meningococcal disease, mumps, pertussis, pneumococcal disease, poliomyelitis, rabies, rotavirus, rubella, smallpox, tetanus, tuberculosis, typhoid, varicella, yellow fever, herpes-zoster (shingles)

travel immunization

depend on age, area of travel, and immunization history

yellow fever, typhoid, meningococcal, hepatitis A and B, Japanese encephalitis

recommendations by the World Health Organization (WHO)

general side effects

swelling, pain, and redness at the injection site, low-grade fever, mild inflammatory reactions

live vaccines may produce what

higher fever

general contraindications

anaphylaxis to a component (egg with flue vaccine) or the vaccine itself

vaccine specific contraindications (pregnancy, disease history)

serious illness

vaccine safety

can be given in mild, acute illness, or even if on antibiotics

LIVE vaccines contraindicated in pregnancy

measles, mumps, rubella (combined together into the MMR vaccine), smallpox, varicella

adverse event reporting

healthcare workers are responsible for reporting vaccine-preventable diseases and vaccine-related adverse reactions

Vaccine Adverse Events Reporting System (VAERS)

nursing process for vaccines

assessment, administration, nursing interventions

nursing assessment for vaccines

barriers, medical history, drug history, adverse reactions, illness; previous vaccine history; determine complete allergy history

ask required screening questions for each vaccine being administered

nursing administration for vaccines

usually IM or subcutaneous injections

some are oral (rotavirus vaccine)

nursing interventions for vaccines

strict adherence to storage requirements

do not mix vaccines in the same syringe (commercial combination okay)

can give multiple at once, but give in separate sites

document date, expiration date, lot number, and manufacturer, injection site

observe patient for S&S of reaction - educate parents

keep epinephrine available for adverse reactions

Influenza "flu" vaccine

everyone 6 months and older should receive the flu vaccine

including pregnant patients

preservative free formulations

high-dose formulations for the elderly

different forms of the flu vaccine

inactivated vaccine: administered IM preferentially

live-attenuated vaccine (flutist): intranasal administration

trivalent and quadrivalent forms

trivalent and quadrivalent forms

number of types of influenza viral strains covered

contraindications and precautions for inactivated form of flu vaccine

previous severe allergic reaction to influenza vaccine

history of allergic reaction to egg protein

history of Guillain-Barre syndrome

contraindications and precautions for live-attenuated form of flu vaccine

children < 2 or adults > 49 years of age

children 2-17 receiving aspirin-containing therapy

common side effects of flu vaccine

low-grade fever, chills, malaise, headaches, myalgia, and redness/soreness/swelling at the injection site

pneumococcal vaccine

vaccine against the bacteria Streptococcus pneumonia

streptococcus pneumonia

a common cause of ear infections, sinus infections, meningitis, pneumonia, and sepsis

inactivated pneumococcal vaccine forms

pneumococcal polysaccharide vaccine (23-valent) - pneumovax 23

pneumococcal conjugate vaccine (13-valent) - Prevnar

typically given IM

who is pneumococcal polysaccharide vaccine recommended for

patients > 65 years of age or immunocompromised patients

who is pneumococcal conjugate vaccine recommended for?

in childhood immunizations as a 4 vaccine schedule

contraindications and precautions of pneumococcal vaccine

previous allergic reaction to pneumococcal vaccine or a vaccine containing diphtheria toxoid

common side effects of pneumococcal vaccine

redness/swelling/pain at the injection site

low-grade fever

malaise

headache

myalgia

haemophilus influenzae type B vaccine (Hib)

vaccine against the bacteria haemophilus influenzae (not the "flu" vaccine)

varicella vaccine

vaccine against the varicella virus

chicken pox

varicella vaccine drug interactions

avoid aspirin products for 6 weeks after (Reye syndrome), high dose immunosuppressants, do not take within 11 months after having blood transfusion

contraindications of varicella vaccine

previous anaphylaxis to vaccine or components (gelatin and neomycin), moderate acute

how is varicella vaccine given?

live-attenuated vaccine

given subcutaneously as a 2-series childhood vaccine