Immunity and Immunizations Lecture Notes

Immunity: An Overview

  • Reflection: Even small acts of caring can create a large impact.

Agenda

  • Review learning outcomes.

  • Discuss common communicable diseases in pediatrics.

  • Discuss immunizations against these diseases.

  • NCLEX-style review questions.

  • Summary.

Learning Outcomes

  • Describe the protective role of immunization.

  • Identify immunizing agents for communicable diseases.

  • Discuss controversies related to immunizations.

  • Identify best immunization practices.

  • Discuss the nurse's role in health promotion and immunization.

  • Identify reliable educational resources.

  • Identify community resources.

  • Examine the epidemiological impact of inadequate immunization.

  • Identify classification and mechanism of action for immunizing agents.

Immunity Basics

  • Immunity: Ability of body tissue to protect itself from illness or disease.

  • Resistance to infections, toxins, and antibodies.

  • Resistance to disease processes.

Types of Immunity

  • Natural Active Immunity: Antigen enters the body, and the body creates antibodies.

    • Occurs naturally against an active infection.

  • Natural Passive Immunity: Antibodies passed from mother to fetus.

    • Through placenta, colostrum, or breast milk.

    • Not created through active illness, but passively given.

  • Artificial Active Immunity: Immunity through vaccination or immunization.

    • Artificially induced; not naturally occurring.

  • Artificial Passive Immunity: Through special transfusion (e.g., immunoglobulin transfusion).

Goal of Immunization

  • Create resistance to disease spread.

  • Herd Immunity: A certain percentage of the population is immune.

    • Less likely for disease to spread person to person.

Immunization Controversies

  • Vaccines: Choice or requirement?

    • Some areas require vaccines (hospitals, military, schools, businesses).

    • Others are by choice.

    • Waivers may be available but are often required.

Reasons for Required Immunizations

  • Protect the public.

  • Protect immunocompromised individuals.

  • Protect high-risk groups (infants, children, elderly).

Exemptions

  • Allergies to the vaccine.

  • Religious objections.

Addressing Vaccine Hesitancy

  • Non-judgmental perspective.

  • Educate properly.

Myths vs. Facts

  • Myth: All vaccinations made from aborted fetuses.

    • Fact: Some vaccines use fetal cells to grow vaccine viruses, but these are purified with no human genetic material.

  • Myth: MMR vaccine linked to autism.

    • Fact: Multiple studies show no association between autism and vaccines.

  • Myth: Vaccine cannot be given if a client is sick with a mild illness.

    • Fact: Vaccines can be given with mild illnesses (low-grade fever, cold, ear infection, mild diarrhea).

  • Myth: Vaccines are dangerous.

    • Fact: Mild side effects may occur, but they are usually minor and temporary.

Nurse's Role in Immunization Education

  • Health promotion and disease prevention.

  • Assess client’s immunization status.

  • Remove barriers to receiving immunizations.

  • Provide detailed information regarding schedules.

  • Keep accurate immunization records.

  • Provide evidence based education verbally and in writing.

  • Help families understand contraindications.

Reliable Information Sources

  • Credible sources (health departments, hospitals, healthcare provider offices).

  • CDC.

  • World Health Organization.

  • Peer reviewed and science-based.

Best Practices for Immunizations

  • AHRQ: Agency for Healthcare Research and Quality.

Vaccine Evaluation

  • Each vaccine evaluated individually.

  • Contraindications:

    • Allergy to components.

    • Severe immunosuppression (live vaccines).

    • Pregnancy (live vaccines).

Epidemiological Impact of Inadequate Immunization

  • Epidemiology: Study of health and illness distribution within a population.

  • Assessment, evaluation of communicable disease.

  • Control and implement strategies.

Example: Measles Outbreak in Disneyland (2015)

  • Large percentage of population un-vaccinated against measles.

Community Resources

  • Vaccines for Children program.

  • Local health departments.

Communicable Diseases

Four Types of Immunity

  • Natural active immunity.

  • Natural passive immunity.

  • Artificial active immunity.

  • Artificial passive immunity.

Stages of Infectious Disease

  • Incubation period.

  • Prodromal period.

  • Illness.

  • Convalescent stage.

Incubation Period

  • No signs or symptoms of the disease.

  • Exposure to organism and when first signs/symptoms are apparent.

Prodromal Period

  • Symptoms start.

  • Vague and generalized (body aches, mild cough).

Illness Stage

  • Most severe signs and symptoms.

  • Differentiate communicable disease from another.

  • Rash, pain, sore throat.

Convalescent Stage

  • No signs or symptoms.

  • Recovering and regaining strength.

Communicable Diseases: Specific Diseases

Pertussis (Whooping Cough)

  • Infectious Agent: Bordetella pertussis (gram-negative bacillus).

Clinical Manifestations

  • Incubation Period:

    • 9-20 days after exposure.

    • Transmission through respiratory droplets.

    • Most common in summer/fall.

  • Prodromal Stage:

    • Upper respiratory symptoms, low-grade fever.

    • Lasts 1-2 weeks.

    • Most communicable stage.

  • Illness Stage:

    • Productive cough, worse at night.

    • Short, rapid cough followed by high-pitched whoop. Coughing might happen constantly until they clear the mucus.

    • Vomiting possible.

  • Convalescent Stage:

    • Symptoms persist but are less severe.

    • Duration is six to ten weeks.

Diagnostic Testing

  • Nasopharyngeal culture.

Treatment

  • Antibiotics, droplet precautions.

  • Hospitalization, especially if under six months.

  • Oxygen, suction, fluids for dehydration.

Prevention

  • DTaP vaccine (pediatric).

  • Tdap vaccine (adult).

  • DTaP given at 2, 4, 6 months, 15-18 months, and 4-6 years.

  • Tdap booster for 11-12 year olds.

Nursing Considerations

  • Immunization history and exposures.

  • Assess respiratory and fluid status.

  • Check neurologic status.

  • Continuous monitoring if hospitalized.

  • Have suction and oxygen close to the bedside.

  • Stay calm.

  • Small, frequent feedings.

Complications

  • Apnea, pneumonia, seizures, encephalopathy, dehydration if under six months old.

  • Respiratory compromise is priority risk; next is central nervous system involvement.

Varicella Zoster (Chickenpox)

  • Infectious Agent: Varicella zoster virus.

    • Can lay dormant and cause shingles later.

Clinical Manifestations

  • Incubation Period:

    • 10-21 days.

    • Most infectious a day or two before rash and until all lesions are crusted over.

  • Prodromal Stage:

    • Low grade fever, malaise, anorexia during the first 24-48 hours.

  • Illness Stage:

    • High fever (104−105104-105°F).

    • Itchy skin rash that spreads centripetally (extremities to trunk); can start on scalp.

    • Teardrop shaped, red at base.

    • Different stages of healing; contagious until lesions are crusted over.

Diagnostic Testing

  • Polymerase Chain Reaction (PCR) test; sample of lesion.

Treatment

  • Antiviral (acyclovir).

  • Control fever, but avoid aspirin (Reye’s syndrome).

  • Antipyretic.

  • Airborne and contact precautions.

Prevention

  • Varivax (chickenpox vaccine), live vaccine (attenuated).

  • Contraindicated for pregnant women and immunocompromised clients.

Nursing Considerations

  • Private room (negative pressure).

  • Instruct the client and their parents or guardians about skin care and infection prevention.

  • Short fingernails, clean hands.

  • Lukewarm oatmeal bath.

  • The children cannot return to school until all the lesions are crusted over.

Complications

  • Bacterial infection of skin lesions.

  • Pneumonia. Encephalitis, Reye Syndrome are pretty serious complications that can occur from chickenpox.

Reye Syndrome

  • Encephalopathy (toxic condition affecting brain).

  • Not a clear cause, commonly after viral illness or when someone has taken Aspirin with the virus.

  • Affects kids/teenagers recovering from viral infection.

  • Profound central nervous system issues and liver issues.

  • Symptoms:

    • Confusion, loss of consciousness, seizures.

  • Kids/teenagers recovering from flu-like illness should never take aspirin.

Rubiola (Measles)

  • Infectious Agent: Rubeola virus.

Clinical Manifestations

  • Incubation Period:

    • 8-12 days.

    • Occurs in winter/spring.

  • Prodromal Stage:

    • Fever, runny nose, cough, conjunctivitis; contagious.

  • Illness Stage:

    • Rash begins behind ears and hairline/upper neck; spreads down towards feet.

    • Red rash turns brown and lasts 6-7 days.

    • Koplik spots (bluish-white lesions) on buccal mucosa.

  • Convalescent Stage:

    • Rash disappears top to bottom.

    • Brown Spots and Thin Peeling Skin

Diagnostic Testing

  • Blood and respiratory specimens looking for IgM antibodies.

Treatment

  • Rest, fluids, antipyretics, humidifier, antitussives, antihistamines.

Precautions

  • Airborne isolation.

Prevention

  • MMR vaccine.

Nursing Considerations

  • Short fingernails.

  • Long sleeves/pants to assist with not scratching.

  • Avoid sunlight/heat.

  • Protect eyes (conjunctivitis).

  • Encourage hydration.

  • Treat fever over 100.4 and avoid aspirin because of Reye's Syndrome.

Complications

  • Otitis media, pneumonia (most common cause of death), miscarriage, spontaneous abortion, premature birth in pregnant women.

Rubella (German Measles)

  • Infectious Agent: Rubella virus.

Clinical Manifestations

  • Incubation Period:

    • 14-21 days.

    • Infectious during incubation.

  • Prodromal Stage:

    • Mild; low grade fever.

    • Swollen lymph nodes (lymphadenopathy), runny nose, sore throat, malaise, headache, chills, aches.

  • Illness Stage:

    • Pink rash that starts scalp/face/neck and is itchy.

    • Spreads to entire body over one to three days and lasts for about five to seven days.

Diagnostic Testing

  • Nasal or throat swab (viral culture).

Treatment

  • Rest, fluids, antipyretics, antihistamines.

  • Kids stay out of school for seven days after rash begins.

  • Airborne Isolation, and potentially contact

Prevention

  • MMR vaccine.

Complications

  • Can cause miscarriage or infant death/serious birth defects (heart problems, hearing loss, intellectual disability, liver/spleen damage). This is known as Congenital Rubella Syndrome.

  • Arthritis, thrombocytopenia, encephalitis.

Mumps

  • Infectious Agent: Paramyxovirus.

Clinical Manifestations

  • Incubation Period:

    • 16-18 days.

  • Transmission: Through Droplets

  • Prodromal Stage:

    • Low grade fever, muscle pain, loss of appetite, fatigue, headache; infectious.

  • Illness Stage:

    • Swelling of salivary glands (pain, tenderness). Pushes angle of the ear. Can be unilateral or bilateral.

    • Swelling peaks in one to three days and subsides over a week.

    • Males can have swollen testicles (sterility).

Diagnostic Testing

  • Blood samples (IgM antibody).

Treatment

  • Hydration, avoid acidic foods, avoid aspirin (viral).

  • Bed rest, ice for orchitis (ice to keep swelling down).

  • Droplet isolation.

Prevention

  • MMR vaccine.

Nursing Considerations

  • Immunization/exposure history.

  • Complete neuro assessment.

  • Mumps virus can be spread through semen.

  • Educate patients about the use of condoms, because a male can transmit mumps to a partner for up to 14 days.

  • Assess for encephalitis and Meningitis

Complications

  • Orchitis, oopheritis (inflammation of ovaries), mastitis, pancreatitis, hearing loss, miscarriage during pregnancy

  • Encephalitis, meningitis.

Combination Vaccines

  • They decrease the number of injections that someone has to get.

  • Common side effect: slight redness, warmth, or swelling at the injection site + irritability.

  • Comfort measures: acetaminophen, cool compresses.

Modes of Transmission for Vaccine Antigens

  • Inactivated Vaccines: No live vaccine; dead version of the virus.

    • Hepatitis A, flu shot, polio shot.

  • Live Vaccines: Small amount weakened form of virus.

    • MMR, rotavirus, chickenpox. Sometimes these can cause a little bit of symptoms.

  • Messenger RNA (mRNA) Vaccine:

  • Subunit Recombinant Polysaccharide and Conjugate Vaccine:

  • Toxoid: Uses a toxin.

    • Diphtheria and Tetanus

  • Viral Vector: Uses a different virus as a vector.

2024 Vaccine Schedule (CDC)

  • Nmemonic for vaccine schedule when up to 6 years old: B to be doctor hip, four doctor hip, be doctor hip in six months, one very mad hipster, very dim between four and 6PM.

  • At birth: Get one dose of hepatitis B

  • At two months: 2B Doctor. Hip. Doctor is DTaP and rotavirus, and hip is HIV polio, which is IPV, and pneumococcal vaccine

  • At four months: Four Doctor. Hip. Same thing as two months, just no hepatitis B.

  • At six Months: Be Doctor. Hip in six months. Again, you've got a hepatitis B, rotavirus, DTaP, Hib, pneumococci, polio

  • Then at one year old: one, very mad hipster. Very mad is new. So if you look at V and M, those are very mad. So chickenpox is also known as varicella. And M stands for the MMR. And then you've got hip because we've talked about that frequently.

  • Finally four to six: very dim between four and 6PM. So V for varicella, dim for DTaP, IPV, or polio, M for MMR.

For Later Age vaccines: tweens have money (THM, Tdap, HPV, and the meningococcal vaccine).

Vaccine Information Sheet (VIS)

  • Why get vaccinated?

  • Who should get it/not get it?

  • Reasons to talk to a healthcare provider (allergies, neuro changes, seizure disorder, Guillain-Barre syndrome, severe pain/swelling).

  • Risks of reaction and when to contact provider.

  • What if there's a serious problem?

  • Additional information.

Medication Sheets

  • Erythromycin, trimethorphan sulfamethoxazole, acyclovir.

Preclass Assignment Questions

Which of the following are killed or inactivated vaccines? Select all that apply.

  • Hepatitis A and IPV (Inactivated Polio Vaccine).

Which vaccines mimic the actual disease? Select all that apply.

  • Varivax (chickenpox) and MMR.

Which vaccines are given by the subq route? Select all that apply.

  • Varivax, MMR, and IPV.

After which vaccine would aspirin be contraindicated for six weeks?

  • Varivax (chickenpox vaccine).

Compare and contrast the difference between airborne and droplet precautions.

  • Droplets are heavy and travel about three feet.

    • Mask, gloves, and gown.

  • Airborne are microdroplets and can travel up to six feet.

    • Negative pressure room, N95 mask, eye covering, gown, and gloves.

  • What is the dosing of the hepatitis B, Engerix, and recombinant's HV vaccine?* A 12 old has been exposed to chickenpox two days ago. The child is due for the Vero-vax today and is afebrile. Are there any contraindications to administering the vaccine today? Why or why not?

There is not contraindication to administering the vaccine today, since the child isn't inside the incubation period yet. Also the vaccine won't do anything given the fact that the chickenpox have an incubation period.

Which Childhood Communicable Diseases Require Droplet Precautions

  • Rubella, Mumps, Pertussis, Scarlet Fever and Diptheria (specifically Pharyngeal Diptheria)

Which combination vaccine has DTaP, HIB, and IPV as its components

PentaCel. This is given at 6 months and over 7years.

Can Tdap be given during pregnancy?

Yes, in the third trimester or postpartum.

Who can get the HPV Vaccine
Both males and females (up to the age of 40.
How many Vaccines and a 15 year old be eligible to receive at a well child visit
Seven (Tdap, IPV, HPV, MenACWY, MenB, hib)

What Vaccines might are 65-Year-Old person be able to receive:

Tdap, Herpes Zoster, and HIB

What is a common Volumne for immunizations that are admitted for SubQ routes:
0.5

NCLEX-Style Review Questions

A child who has a pertussis infection is admitted to the pediatric unit. After reviewing the chart, select the four infection control measures the healthcare provider should use when caring for the patient.

  • Hand hygiene, gown, mask, gloves.

A four year old child is recovering from chickenpox (varicella). The parents would like to have the child return to day care as soon as possible. In order to ensure that the illness is no longer communicable, indicate which symptoms are relevant or irrelevant.

  • Relevant: All lesions are crusted, presence of vesicles.

  • Irrelevant: Elevated temperature, rhinorrhea and chorizo.

The medical resident admits a four year old with complications related to chickenpox. Which prescribed medication is most important for the nurse to question?

  • Question aspirin/acetylsalicylic acid.

A nonunionized child appears at the clinic with a visible rash. Which of the following observations indicates that the child may have rubiola or measles?

  • Small blue-white spots on the oral mucosa - Koplik Spots

You're preparing to administer a rubella vaccine to a two day postpartum patient. Which of the following potential risks would you identify for this patient?

  • Pregnancy (avoid getting pregnant within two to three months).

Other vaccine ingredients

  • Preservatives prevents contaminations

  • Adjuvants aluminum salts, that helps stimulate the response in vaccine

    Nurse promotion, health promotion to present disease.

Social Determinants for getting to see a doctor(Economic and social conditions that influence individual and group differences in health status) - what social issues may impede the individuals from getting healthcare.

A father is concerned about whether he should give his child the varicella, he hears rumor it causes Shingles because he had it earlier.
A discussion of shingles, complication and varicella vaccine and how it doesn't give someone shingles