MODULE 6

Benefits of widespread vaccination

5 Vaccine-Preventable Diseases (VPDs) are virtually gone from the USDiphtheriaSmall poxPoliomyelitisRubellaMeasles measles & wild-type polio are gone from the Western hemisphere smallpox is gone from the planet The incidence of several other VPDs has been greatly reduced. Although vaccines are very safe, mild reactions are common, and serious reactions can occur rarely.

A. innate immunity The epithelial cells of the skin are a part of innate immunity. Adaptive immunity is represented by the normal flora of the bowel. Specific immunity is a type of adaptive immunity and is not associated with a break in skin integrity. Active immunity occurs when the body responds to a foreign substance such as a microbe.

A 20-year-old male received a knife wound to the arm during an altercation. Which of the following types of immunity was compromised? a. Innate immunity b. Specific immunity c. Adaptive immunity d. Active immunity

at birth.

A public health nurse is teaching the community about health promotion. Which information should the nurse include for innate immunity? Innate immunity is gained:

A patient has developed a local infection at an IV insertion site. Before the IV was inserted, the site was cleansed with a product with an ethanol concentration of 70%. The nurse will report the local infection to the provider and expect to receive an order to: a. administer a systemic antimicrobial agent. b. apply a topical antiseptic agent to the infected area. c. culture the site to assess for C. difficile. d. use a topical agent containing 95% ethanol.

A. Once an infection has occurred, systemic antimicrobials are recommended as treatment. Topical antiseptics will not be as effective. C. difficile occurs in the intestines. Concentrations of ethanol greater than 70% are less effective, and ethanol should not be applied to open wounds because of the risk of tissue damage and coagulation of proteins.

The parent of a 2-month-old infant who has just received the first dose of DTaP asks the nurse about expected reactions to the vaccine. The nurse will respond by saying that: a."Mild reactions, including a low-grade fever, are common." b."Most children do not experience any reaction." c."Seizures are common and may require anticonvulsant medication." d."The most common reaction is a rash that develops into itchy vesicles."

A. Mild reactions to the first dose of the DTaP vaccine are common and most often are manifested by a low-grade fever, fretfulness, drowsiness, and local reactions of swelling and redness. At least 50% of children experience reactions. Seizures are not common. Itchy vesicles do not appear with the DTaP vaccine.

A nurse is teaching a nursing student how to care for patients in the perioperative period. Which statement by the student about preventing postoperative infections indicates a need for further teaching? a. Applying hexachlorophene to the operative site preoperatively will help prevent infection. b. It is important to ensure that all surgical instruments have been sterilized appropriately. c. Operating room personnel should all perform a presurgical scrub with antimicrobial soap. d. Preventing contamination by microorganisms in the environment is the most important perioperative measure.

A. Although bathing a patient's skin area with antiseptic agents reduces the number of surface bacteria, this measure has not been shown to reduce the incidence of postoperative infection. Disinfecting surgical instruments, antimicrobial surgical scrubbing for operating room personnel, and disinfection of other surfaces in the environment have been shown to be effective measures for preventing postoperative infection

Antiseptic

Applied to living tissue

Disinfectant

Applied to objects Too harsh for living tissue Applied most frequently to instruments and facilities

Client teaching

Avoid taking acetaminophen, ibuprofen, and other analgesic-antipyretics. They can reduce the immune response to vaccines, and hence should generally be avoided as prophylaxis for fever or pain before vaccination.

While planning care for an elderly patient, the nurse remembers that increased age is associated with: (select all that apply) [mark all correct answers] a. increased T-cell function. b. decreased immune function. c. decreased ability to fight infection. d. increased production of antibodies. e. decreased numbers of circulating immune complexes.

B C E Increased age is associated with diminished T-cell function, decreased immune function, diminished production of antibody responses, decreased circulating immune complexes, and decreased ability to fight infection

An 11-year-old boy received all childhood immunizations before attending school as a kindergartner. Which vaccines are recommended for this child at his current age? a.DTaP, MCV4, Varivax b.PCV-23, Td, MMR c.Tdap, MCV4, HPV d.Tdap, Varivax, hepatitis B

C. At age 11, both males and females should receive a booster of diphtheria, tetanus, and pertussis (Tdap); the Menactra vaccine against meningitis (MCV4); and the human papilloma virus (HPV) vaccine. A Varivax booster is not recommended at this age. The PCV-23 vaccine is indicated only in high-risk patients. The Td can be given, but a vaccine with a pertussis component is preferred. The MMR is not given at this age. The hepatitis B vaccine is not given at this age.

Which of the following individuals would be at greatest risk for an opportunistic infection? a. 18-year-old with diabetes b. 70-year-old with congestive heart failure c. 24-year-old with aquired immunodeficiency syndrome d. 30-year-old with pneumonia

C. Opportunistic microorganisms can cause disease if the individual's defenses are compromised, such as clients with aquire immunodeficiency syndrome. Diabetes, congestive heart failure, and pneumonia are not associated with immunocompromised disorders.

Neuroinflammation

CNS's response to infections, diseases and injuries

Hepatitis A vaccine

Composed of inactivated hepatitis A viruses.

Route of transmission of an agent

Contact: Direct or Indirect Airborne (droplet) Vector transmission - Insects:FleasTicksMosquitos

For which patient would a topical antiseptic be most appropriate? a. A patient with a systemic infection b. A patient with a medium-sized abscess c. A patient who has a wound with moderate exudate d. A patient who needs to have wounds cleansed for prophylaxis

D. Antiseptics are useful as prophylaxis; when applied properly, they can help cleanse wounds and reduce microbial contamination. A patient with a systemic infection is treated with a systemic anti-infective drug. An abscess must be incised and drained, and a topical agent cannot significantly penetrate the skin to be effective. A wound with moderate exudates requires antibiotic therapy.

Which vaccine should the nurse avoid administering to a child with an immune deficiency disorder? a. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine b. Haemophilus influenzae type b (Hib) vaccine c. Polio injection d. Varicella virus vaccine

D. The varicella vaccine should be avoided by individuals who are immunocompromised, which includes those infected with the human immunodeficiency virus (HIV) and those who have a congenital immunodeficiency. The DTaP vaccine, Hib vaccine, and polio injection may be administered to immunocompromised individuals, because these are not live vaccines.

A nursing student asks a nurse why systemic antibiotics and not topical antiseptic agents are used to treat localized skin infections. Which statement by the student indicates a need for further teaching? a. Systemic agents penetrate to the site of infection. b. Systemic agents are not affected by wound exudates. c. Topical agents can damage inflamed or abraded tissues. d. Topical agents work only against established local infections.

D. Topical antiseptics are not used to treat established local infections. Systemic agents are more effective, because they are not affected by wound exudates. They penetrate to the site of infection, and they do not damage inflamed or abraded tissues.

The nurse observes a patient care assistant (PCA) about to leave a patient's room. The patient has been placed on isolation precautions because of a C. difficile infection. Which action observed by the nurse should prompt giving further instruction to the PCA? a. Washing hands b. Removing gloves c. Discarding a gown d. Using hand sanitizer

D. Hand sanitizers are ineffective against the spores of c. difficile. Washing hands with soap and water after contact is the best way to prevent spreading the infection.

The parents of a 1-year-old ask the nurse to give their child acetaminophen before administering the vaccine to reduce the pain. How should the nurse respond to these parents? a.Children don't remember pain, so it isn't necessary to give acetaminophen. b.The small needles used to inject the vaccines cause hardly any discomfort. c.You can apply a topical anesthetic when you get home to reduce pain from the injection. d.Your child's immune response may not be as effective if I give acetaminophen before the vaccine.

D. Giving analgesic/antipyretic medications before or shortly after vaccines can reduce the immune response, so giving them to prevent pain or fever is not recommended. Children do remember pain, and it is important to provide other comfort measures and to give the injections rapidly. Small needles cause less discomfort, and it is important to reassure the parents about this; however, it is more important to explain why acetaminophen is not recommended. Topical anesthetics are useful before giving the injections, not afterwards.

Chemical innate immunity

Epithelial cell-derived chemicals like sweat, tears, saliva, and ear wax.

Influenza

Haemophilus influenzae type b vaccine is one of our safest vaccines. No serious adverse events have been reported. Annual influenza vaccination is recommended for all children age 6 months to 18 years.

The nurse is assessing a patient with a diagnosis of inflammation. The nurse would expect to find which of the following signs and symptoms consistent with acute inflammation? (select all that apply) a.Heat b.Erythema c.Pain d.Swelling e.Paleness f.Loss of function

Heat Erythema Pain Swelling Loss of function

Which vaccination should an infant receive at birth? a.Hepatitis B b.Hepatitis A c.Rotavirus d.Inactivated poliovirus

Hepatitis B

Clostridium difficile

IMPORTANT: Alcohol-based handrubs do NOT kill spores of Clostridium difficile, Bacillus anthracis, and other spore-forming bacteria

why shouldnt an Immunocompromised child not receive a live vaccines?

Immunocompromised children are at special risk from live vaccines and should not receive them.

Stages of Infection

Incubation period: Is the period from initial exposure to the onset of the first symptoms; could last from hours to years Prodromal stage: The occurrence of initial symptoms are often very mild with feelings of discomfort and tiredness. Acute stage Resolution stage: Recovery occurs and symptoms decline, or the disease is fatal, or has a period of latency.

Temperature Regulation Changes at Age Extremes Infants:

Infants:Produce sufficient body heat but are unable to conserve heat producedSmall body size and high body surface-to-weight ratioThin subcutaneous layer Elderly:Slow blood circulation, vasoconstrictive response, and decreased metabolic rateDecreased sweating, shivering, and perception of heat and cold

Hepatitis B vaccine (HepB)

It contains hepatitis B surface antigen (HBsAg), the primary antigenic protein in the viral envelope. Administration of HepB promotes synthesis of specific antibodies directed against hepatitis B virus. HepB is one of our safest vaccines. The only contraindication is a prior anaphylactic reaction either to HepB itself or to baker's yeast. All infants should receive monovalent HepB within 12 hours of birth (except in rare circumstances). Infants whose mothers are HBsAg-positive should also receive hepatitis B immune globulin (HBIG).

Measles, mumps, and rubella virus vaccine (MMR)

It is a combination product composed of three live virus vaccines. Rarely, MMR causes thrombocytopenia and anaphylactic reactions. Until recently, anaphylactic reactions were thought to result from allergy to eggs, but now we think they result from allergy to gelatin. MMR is contraindicated during pregnancy and should be used with caution in children with a history of either thrombocytopenia or anaphylactic reactions to gelatin, eggs, or neomycin.

Common target diseases for immunization

Measles Mumps Rubella Diphtheria Tetanus (lockjaw) Pertussis (whooping cough) Poliomyelitis (polio or infantile paralysis) Haemophilus influenzae type b Varicella (chickenpox) Hepatitis B Hepatitis A Pneumococcal infection Meningococcal infection Influenza Rotavirus gastroenteritis Genital human papillomavirus infection Respiratory syncytial virus

Specific vaccines and toxoids used for immunization

Measles, mumps, and rubella virus vaccine (MMR) Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) Poliovirus vaccine H. influenzae type b conjugate vaccine Varicella virus vaccine Hepatitis B vaccine Hepatitis A vaccine Pneumococcal conjugate vaccine Meningococcal conjugate vaccine Influenza vaccine Rotavirus vaccine Human papillomavirus vaccine

Meningitis

Meningococcal conjugate vaccine (MCV4) is more effective in children than meningococcal polysaccharide vaccine (MPSV4), approved in the 1970s.

Diphtheria, Tetanus, Pertussis (DPT)

One vaccine exists for protection against diphtheria, tetanus, and pertussis. DTaP is recommended for all children. Rarely, DTaP causes acute encephalopathy.

Respiratory Syncytial Virus (RSV): 2 vaccines

PanAd3-RSV is administered intranasally and IM. MVA-RSV is given only IM.

Microorganisms: Sources of infection Mechanisms of Transmission

Penetration Direct Contact IngestionInhalation

Recall: Fever/temperature regulation was part of the SECOND Line of Defense previously mentioned. Temperature Regulation

Peripheral and central thermoreceptors Hypothalamic control Heat production and conservationChemical reactions of metabolismSkeletal muscle contractionChemical thermogenesisVasoconstrictionShiveringVoluntary mechanisms (putting a blanket on you - also called behavioral thermoregulation)

Pneumococcal pneumonia

Pneumococcal conjugate vaccine is the first vaccine for preventing invasive pneumococcal disease in infants and toddlers.

Classifications of infections

Primary infection Secondary infection Yeast infection after taking antibiotics Opportunistic infection is a condition that would normally not cause disease but do so when immune systems are: WeakenedSuppressedDeficient

How we lose heat?

Radiation - heat radiates off of the skin into the environment Conduction - heat transfers to another surface when the temperatures are different (burning your hand on a cooking pan) Convection - air is a gas fluid; hot air has a lighter density so it rises; cooler air has a heavier density so it is pulled downward by gravity: heat transfer occurs here due to gas density Vasodilation - heat will relax the smooth muscles and cause vascular dilation (makes the vessels wider) Reduced muscle tone - heat relaxes muscles Evaporation - heat in water is released when it evaporates Increased respirations - you transfer heat into the environment when you breath Voluntary measures (behavioral actions, such as taking off a sweater) Adaptation to warmer climates (your cells reduce the amount of cholesterol embedded within the cell membranes, which makes you more adapted to warmer climates)

Acquired Immunity

Recall that __________________ is also referred to as Adaptive Immunity.

involution

Return of the uterus to a nonpregnant state after birth

Ideal antiseptics are not real. It is a standard to strive for. Characteristics include:

Safe - non-toxic to the individual being treated, but toxic to the microbes to be irradicated Effective - fast (rapid germicidal activity), persistent Selective - Minimal absorption into the individual being treated, maximal absorption to the microbe Germicidal - kills germs (doesn't just arrest their development) Broad spectrum of antimicrobial activity - kills a wide variety of different microbes Other properties - active in blood/organic, non-irritating to the individual being treated examples: substances that approach being an ideal antiseptic Ethanol 70% reduces bacterial count by 50% in 36 seconds Benzalkonium chloride requires 7 minutes for same effect

Autism

Several large, high-quality studies have failed to find a causal link between thimerosal-containing vaccines and autism

Active immunity

The client has had the disease and recovered from it - renders life time protection The client has been vaccinated - renders protection for many years

FIRST LINE OF DEFENSE: Innate immunity

The natural barriers (physical, mechanical, biochemical) that form the First Line of Defense at the surfaces of the body. These are in place at birth and they are nonspecific defense mechanisms that come into play immediately or within hours of an antigen's appearance in the body. These mechanisms include physical barriers such as skin, chemicals in the blood, and immune system cells that attack foreign cells in the body.

Polio

There is one vaccine against polioviruses: inactivated poliovirus vaccine (IPV, Salk vaccine).

Mechanisms of Disease Production Virulence Factors

Toxins Adhesion factors Evasive factors Invasive factors

Rotavirus

Two rotavirus vaccines are available: RotaTeq and Rotarix. Both vaccines do not carry a risk of intussusception, a life-threatening complication. Older vaccines once did.

Immunizations:

Using your immune system to build protection against illness WITHOUT having to have the illness

Varicella (chicken pox)

Varicella virus vaccine is composed of live, attenuated varicella viruses. All children receiving varicella vaccine are fully protected against severe varicella (chickenpox), although some get mild disease. The children who get mild chickenpox despite vaccination develop far fewer lesions than unvaccinated children, experience less fever, and recover more quickly. Varicella vaccine is very safe; no serious adverse events have been reported. Varicella vaccine is contraindicated for pregnant women, individuals hypersensitive to neomycin or gelatin, and immunocompromised people.

Human Papilloma Virus (HPV)

We have two HPV vaccines: a quadrivalent vaccine sold as Gardasil, and a 9-valent vaccine sold as Gardasil 9. Gardasil 9 can prevent cancers unique to females (cervical, vaginal, and vulvar), as well as anal cancer and genital warts in females and males. Gardasil and Gardasil 9 do not protect against all the types of HPV that can cause cervical cancer, and they do not protect against HPV infection that was present before vaccination. Vaccinated women should still undergo routine Pap screens to detect precancerous cervical lesions, thereby permitting timely treatment before cancer develops.

attenuated (which means weakened)

When only a portion of the virus used to create the vaccine, this is referred to as

cellular memory.

Whenever someone gets ill, their body's immune system fights the disease. As it fights, it REMEBERS the substance that created the illness. This is called

Passive Natural Immunity

You acquire immunity as a fetus through your mother's placenta or as a baby through your mother's breast milk. It is passive - your body did not have to do anything to get this type of immunity.

Active Artifical Immunity

You acquire immunity from having had a vaccine from the disease. Example: MMR, HepB series

Active Natural Immunity

You acquire immunity from having had the disease and recovering from it. Example: Chicken pox, mumps

Passive Artificial Immunity

You acquire immunity from receiving an intravenous transfusion of antibodies (like immunoglobulin G or IgG) that can fight an infection. For example, IgG antibodies are found in all body fluids. They are the smallest but most common antibody (75% to 80%) of all the antibodies in the body. IgG antibodies are very important in fighting bacterial and viral infections.

normal microbiota

___________ is also called "normal flora" - it is your body's natural baterial presence (ie, gut bacteria needed for digestion).

Immunity

a human defense mechanism that helps an individual to resist a particular disease especially through preventing infection from development of a pathogenic microorganism or by counteracting the effects of its products.

THIRD LINE OF DEFENSE: Adaptive Immunity

a subsystem of specialized, systemic cells and processes that eliminate pathogens by preventing their growth.

Passive immunity is conferred by

administering preformed antibodies (immune globulins like IgG). Protection is immediate but lasts only as long as the antibodies remain in the body.

Vaccines promote synthesis of

antibodies directed against bacteria and viruses

Toxoids promote synthesis of

antibodies directed against toxins that bacteria produce, but not against the bacteria themselves.

Antibodies

are what your body's B cells (in plasma cells) make to fight foreign antigens. Example of Foe antigens = you do not have these antigens in your body, so it recognizes them as an enemy (like ragweed, viruses).

Vaccination

as the administration of any vaccine or toxoid. Vaccination produces active immunity. Antibodies develop over weeks to months and then persist for years.

Innate immunity is present at.....

birth. It is not dependent on illness or injection

The immune complex is a term used to refer to the

combination of an antibody and an antigen.

Immune complexes must be removed from tissue and kept from accumulating in the circulation and forming deposits throughout the body because...

failure to clear them can lead to autoimmune disease.

Which patient will develop active immunity? A patient who:

has natural exposure to an antigen or receives an immunization. Active immunity occurs either after natural exposure to an antigen or after immunization, not with preformed antibodies or the transformation of T cells into B cells or as a result of receiving immunoglobulin.

The Second Line of Defense includes

inflammation, phagocytosis, fever, complement system, interferon. These are NONSPECIFIC immune defenses. This means that they fight for you in general, but they are not personalized to the offending antigen, like antibodies are.

Infection

is the invasion and multiplication of a disease pathogen within the body. It prompts inflammation, so we will address it in this module in terms of a disease process caused by an infection. Remember that infection is sufficient but unnecessary to promote inflammation.

Live virus vaccines are composed of

live microbes that have been weakened (attentuated) or rendered completely avirulent.

The immune system recognizes these complexes as substances needing removal by

phagocytes (white blood cells that act as the garbage men of the immune system).

Antibodies are made by your

plasma cells (also called B cells).

A foreign antigen is

something that your body does NOT recognize as belonging in your body. It will fight to kill it and get it out by forming complexes with it.

The immune system also helps to bind the immune complexes to red blood cells (the 18-wheelers of the body) for transport to the _______where phagocytes can dispose of them

spleen and the liver

Antigens

substances from the environment that interact with the body. They can be either Friend or Foe. Example of Friendly antigens = surface antigens on your blood (like A, B, or Rh). You were born with these.

immunosenescence

the aging of the immune system

Inflammation: The Second Line of Defense of the Immune System

the body's protective response against infection (a pathogen) or against damage/trauma a complex process involving various types of immune cells, clotting proteins, and signaling molecules infection is not necessarily present (i.e., sun burn, an uninfected surgical wound) Rubor, calor, dulor, tumor, funtio laesa

Toxicity to microbes/organisms is determined by

the duration of exposure to the antiseptic/disinfectant.

Biochemical innate immunity

the normal microbiome (or normal flora). This is an array of microorgamisms that serve to defend the individual from infection. Examples: Gut bacteria for digestion and staphylococcus aureus on the skin.

Purpose of immunization is

to protect against infectious diseases Most effective method is to create a highly immune population (why everyone should get vaccinated) Universal vaccine is the goal Vaccines carry risk, but risks of disease are much greater

Killed vaccines are composed of

whole killed microbes or isolated microbial components