module 16 - immunization principles

what are the strategies for preventing diseases and their spread?

• standard precautions

• hand hygiene

• safe injection practice

• transmission precautions (droplet, contact, airborne)

• immunization

• abx/antitoxins

what are the various vaccine routes?

• IM

• intradermal

• subq

• po

what are the vaccine classifications?

• live attenuated

• polysaccharide based

• inactivated

describe the characteristics of live attenuated vaccines

• from a wild virus

• response is identical to the actual virus

• IM injection produces 1 dose immunity

• affected by circulating antibodies

• fragile

• uncontrolled growth may cause severe/fatal rxn

• do not give to immunocompromised pts

live attenuated vaccines are used for which viruses?

• MMR

• varicella

• yellow fever

• rotavirus

• intranasal flu

• oral polio

live attenuated vaccines are used for which bacterial infections?

• BCG

• oral typhoid

describe the characteristics of inactivated vaccines

• bacteria/virus deactivated by chems/heat

• cannot replicate

• less affected by circulating antibodies

• need multiple doses (first vaccine = primer)

• mainly humoral response

• can’t measure titers

• requires boosters

what are some examples of inactivated whole viruses?

• polio

• hep A

• rabies

what are some examples of inactivated fractional viruses?

• hep b

• influenza

• acellular pertussis, HPV, anthrax

describe the characteristics of polysaccharide based vaccines

• made of sugar chains that mimic bacterial capsules (pneumococcal, meningococcal, salmonella)

• stimulates B cells w/o T helper cells

• vaccine is improved when joined with a protein

describe the characteristics of recombinant vaccines

genetically engineered vaccine by inserting a viral segment into another gene.

describe the characteristics of mRNA vaccines

• no live virus, does not replicate

• does not interact with DNA

• side effects both local/systemic, inc reaction after 2nd dose

why is timing and spacing important to consider in live attenutated vaccinations?

administering live vaccines too close together may reduce or eliminate the immune response to the vaccine.

how does spacing affect immunization efficacy?

• not affected by prolonged time

• is affected by shortened time between doses

what is the 4 day rule?

you are allowed four days before your next vaccine dose to get vaccinated.

vaccine administration considerations

• are there allergies to the vaccine preservatives?

• is there latex in the vial stopper?

• does the pt have egg protein allergies?

• is thimerosal being used?

• is the needle length correct?

describe the nursing interventions for vaccination pain

• use right needle length/guage

• topical anesthetic

• correct position

• BF before or during

• remain calm

• do not rub or apply pressure

• use distractions

what are the adverse effects of vaccine administration?

• redness

• swelling

• anthrus rxn (response to toxoid)

• mild systemic response

• more noticeable in inactivated vaccine

describe the systemic response to vaccines

• occurs in response to live vaccines

• occurs 3-21 days after administration

• immune response similar to similar disease

• cannot be transmitted (varicella transmission)

common vaccine contraindications

• severe fever

• immunocompromised pts should not get live vaccines

• Hx of anaphylactic rxn to neomycin, gelatine, or vaccine

• contraindicated for rotavirus: severe combined immunodeficiency and intussusception Hx

which vaccines can you give to pregnant people?

• flu

• tdap

• inactivated vaccines (except HPV)

which vaccines cannot be given to pregnant people?

• smallpox

• no live vaccine

live attenuated vaccines are contraindicated in…

• disease/congentical suppression

• leukemia/lymphoma

• chemo

• malignancy

• radiation

• oral corticosteroids (20mg or more for 14 days, no inhaln, topical, or short course)