Immunizations

Donna Hills APN EdD Ball & Bindler

National Goals• Reducing number of preventable

diseases is a major national goal in Healthy People 2010

• Eliminate: rubella, cong. rubella synd., diptheria, Haemophilus influenza b, measles, mumps, polio and tetanus.

• Reduce: pertussis, hepatitis b, varicella, food-borne pathogens, and HIV infection.

Purpose of a Vaccine• to stimulate active immunity by

provoking a response from the person’s immune system

• requires B cells (and T cells) to spring into action

• create a memory within the immune system

• exposure to active disease will stimulate a specific immune response

Vulnerability of Newborns and Infants

• Immune systems not fully mature• Passive acquired immunity from

maternal antibodies provides limited and short-term protection

• Disease protection thru immuniz is incomplete.

• Poor hygiene behaviors in young children.

Characteristics of a Vaccine

• inactivated (killed) antigen: Flu shot, Hep. A

• live attenuated (weakened) antigen: MMR, Varicella

• synthetic (laboratory synthesized) microbial materials:Toxoids DTaP

• conjugate vaccines use outer- coats of the bacteria: Hib, PCV

• recombinant vaccines use the virus genetic material: Hep B

Side Effects: Vaccine specific.

• low grade fever• soreness at site• body aches x 24 hrs• minor side effects are preferable to

the disease.• (U.S. Department of Health and

Human Services: NIH, 1998).

True Contraindications to all Vaccines

• Serious allergic reaction, ie.anaphylaxis after a previous vaccine dose

• Serious allergic reaction, ie. anaphylaxis to a vaccine component

• Moderate to severe illness

Specific Contraindications for Individual Vaccines• IPV: severe allergic reaction to neomycin,

streptomycin or polymyxin B.• DTaP: seizure, encephalopathy, fever

>105o with previous DTaP• Varicella & MMR: severe allergic reaction

to gelatin, neomycin, pregnant women, immunosuppressed individuals, treated with steroids for >2wks., have cancer or under going cancer treatment.

• HIB: children less than 6 wks of age.

• Hep.B: severe allergic reaction to Baker;s yeast (used in bread).

Specific Contraindications (cont.)

• High fever• Behavior changes• Seizures• Allergic reaction:diffic. Breathing,

weakness, hoarseness, wheezing, rapid heart rate, hives, dizziness, paleness, or mucus membrane swelling.

• Reported by parent and/or provider using a Vaers form from the CDC.

Adverse Reactions

Misconceptions about Vaccines

• Diseases disappeared before vaccines were introduced

• Most people who get sick have been vaccinated

• Many vaccines cause serious adverse events

• Vaccines cause illness and deaths.• Vaccine-preventable diseases are rare• Multiple vaccinations overload the immune

sx.

Misconceptions about Vaccines cont.

• Children with a mild illness can’t be immunized

• Concurrent multiple vaccinations shouldn’t be given

Vaccine Truths• Vaccines are one of the most important

public health achievements• Public concern about vaccines is pervasive• Fear of vaccines can lead to public harm• Vaccines are not 100% safe• Parents want what is best for their children• The public has little understanding of the

vaccine development process

• Risk perception is critical• There are anti-vaccine champions• Questions remain• The decision not to vaccinate is an

active decision to accept the risk of the disease.

• (Marshall, G. 2003).

Vaccine Truths continued

Thimerisol and Autism• Ethylmercury: mercury in sufficient

doses is neurotoxic, and more toxic to the immature brain.

• Studies have failed to conclude a causative relationship between thimerisol and autism

• previously used as a preservative in the HIB, HepB, DTaP.

• Removed as of July 1999 as prudent action to reduce mercury exposure to infants;not because a causal relationship was determined.

• Still remains in the Influenza A vaccine and meningococcal, but greatest concern is exposure in infancy.

Thimerisol and Autism (cont.)

MMR and Autism• Likewise, results of three large

studies in Britain and the U.S. have failed to find a causal relationship between the MMR vaccine and Autism.

• MMR has never contained thimerisol• Signs of Autism often surface during

the second year of life, when the MMR is given.

Vaccine Schedule

• Ball & Bindler top of p. 602• CDC website: www.CDC.gov

• Click on most current immuniz sched. Available.

• Print for easy reference for clinical worksheets.• Follow yellow ranges for recommended

ages