immunizations
Giving a child multiple vaccinations for different diseases at the same time increases the risk of harmful side effects and can overload the immune system.
-not necessarily true -research has indicated this is safe
Monosodium glutamate (MSG) :
used as stabilizer to help the vaccine remain unchanged when the vaccine is exposed
measles post exposure prophylaxis: within 72 hours? within 6 days?
w/in 72 hours-vaccine; IG w/in 6 days
Vaccine risks: MMR- DTaP-
- MMR = encephalitis 1 in 1,000,000 - DTaP = crying with recovery - 1 in 1000 convulsions with full recovery - 1 in 14,000 encephalitis- 0-10.5 in 1,000,000 death - none
Treatment if someone has Diptheria
- start treatment immediately!!! -isolate for 48 hours - antitoxin! - antibiotics - resp. support and airway management - close contacts given toxoid booster
HIB Vaccine: who gets is? how many doses? dosing schedule?
-All children < 5 years old, infants starting at 2 months 1st dose: 2 months 2nd: 4 months 3rd: 6 months (if needed depending on brand of vaccine) Final: 12-15 months of age
Who should not get DTaP? (2)
-Children with moderate or severe illness, wait until recovery -Children who had life threatening illness within 7 days of a dose of DTaP
Adenovirus Who should not get?
-Pregnant or nursing mothers -Anyone unable to swallow tablets whole without chewing -younger than 17 - older than 50
required documentation (EMR) 5 things
-The edition date of the VIS (found on the back at the right bottom corner). - office address and name and title of the person who administers the vaccine -date -manufacturer and lot number
When are live attenuated vaccines contraindicated? (2)
Children with weakened immune systems Undergoing chemotherapy
HIB Risk populations?
-sickle cell** -asplenia -HIV -those on chemotherapy -radiation or post transplant
Diptheria transmission Transmitted respiratory droplets (or on contaminated objects) Symptoms: weakness, sore throat, fever, swollen glands in neck Thick coating builds up on throat or nose in 2-3 days (pseudomembrane: formed from dead tissue) making it hard to breath May cause damage to heart, kidneys and nerves, paralysis, 1 in 10 with tx die Diagnosis: throat swab or skin lesion
-transmitted by respiratory droplets or contaminated objects; symptoms are swollen glands in the neck with psudomembrane formation in 2-3 days making it hard to breath 1 in 10 will die
Pertussis incidence (recently)
2000: rarely seen in developed countries 2012: 50,000 cases, 20 deaths
Lyme s/s initial and delayed
3-30 days post bite rash, erythema migrans (EM), fatigue, chills, muscle joint aches months: palsy, arthritis, neurologic s/s/
How many diptheria vaccines?
4
Diptheria dosing schedule for children?
5 doses - 2 months - 4 months - 6 months - 15 months - 4-6 yo
Vaccine
A product that produces immunity therefore protecting the body from the disease. Vaccines are administered through needle injections, by mouth and by aerosol
Immunization Rates for Adolescents/ Teens (13-17 yrs)
BEST WITH KIDS.... then they taper off
Anthrax
Bacteria found in soil and animals Inhalation/contact of spores ; ingestion
Inactivated Vaccine and 2 examples
Bacteria or virus isolated Pathogen inactivated using heat or chemicals Inactivated pathogen injected Immune response evoked Inactivated viruses or bacteria cannot cause infection, but do stimulate B cells to produce antibodies. Several doses or booster shots are typically required to create an effective immune response. ex: Polio, Hepatitis A
Subunit/Conjugate Vaccines and 2 examples
Complete virus or bacteria selected Part of pathogen that evokes immune response is isolated Part of pathogen is presented or used to create a recombinant vaccine (perhaps attached to a carrier) Vaccine injected Immune response is evoked ex:Haemophilus Influenzae (Hib) Pertussis
disease risk: rubella
Congenital Rubella Syndrome: 1 in 4 (if woman becomes infected early in pregnancy)
vaccine risk: DTap
Continuous crying, then full recovery: 1 in 1000 Convulsions or shock, then full recovery: 1 in 14,000 Acute encephalopathy: 0-10.5 in 1,000,000 Death: None proven
Diptheria vaccine for children less than 7?
DTaP and DT
4 combinations of vaccines for Diphtheria, Tetanus, & Pertussis
DTaP, DT: (children <7) Tdap, Td: older children, adults
disease risk: tetanus
Death: 2 in 10
disease risk of death: Diphtheria
Diphtheria Death: 1 in 20
DTaP:
Diphtheria, Tetanus, & acellular Pertussis
Tetanus (lockjaw) - spread? - where it's found? - symptoms? - dx?
Does not spread person/person Bacteria found in soil, dust and manure Enter body through skin break S/s: headache, jaw cramping, sudden involuntary muscle tightening, trouble swallowing, seizures, fever Dx: clinical exam, no lab tests
vaccine risk: MMR
Encephalitis or severe allergic reaction: 1 in 1,000,000
Immunization Schedules are? (5)
Evidence based Risk of adverse event (A/E's) Benefit Cost updated yearly
Active Natural Immunity
From having or recovering from the actual disease: Risk of disease morbidity and mortality Life-long immunity
Passive Artificial Immunity
Immune Globulin or disease specific globulins - antibodies in a serum injected. Human or animal products. Protection 1-2 months Preformed Antibodies
Active Artificial Immunity
Immunization: Altered disease antigen introduced and body makes antibodies against antigen
Measles - Reporting?
Healthcare workers must report suspected measles to health department within 24 hours
healthcare workers (6)
Hepatitis B: If you don't have serologic evidence of immunity; 3-dose series (dose #1 now, #2 in 1 month, #3 approx. 5 months after dose 2) Tdap: HCP, regardless of age, should receive a single dose of Tdap if they have not previously received Tdap and regardless of the time since last Td dose; Td booster every 10 years Influenza:-All HCP MMR:- Born 1957 or later and not had MMR or no serologic immunity Varicella (chickenpox): If no serologic evidence of immunity; 2 doses, 4 weeks apart Meningococcal: If routinely exposed to N. meningitidis
Herd Immunization
Herd immunity is resistance of spread of infection in community because there are few people susceptible to the infection. CDC goal is 95% vaccination rates. Herd immunity can fail if < 95% rates
why do infants need multiple vaccines?
Infants unable to produce high levels of antibodies. need an active immune system
Anthrax S/S
Inhalation s/s: fever, chills, chest pain, confusion, cough, sweat, headaches GI s/s: swelling, sore throat, painful swallowing, bloody diarrhea, pain Injection: blisters, painless skin sores (black center), swelling, abscesses
vaccination
Injection of a killed or weakened infectious organism in order to prevent the disease
measles Tx
Isolation Supportive Care
Tetanus Treatment-
Medical emergency: Hospitalization -Immediate human tetanus immune-globulin (TIG) or equine antitoxin -Tetanus vaccine -Drugs to control muscle spasm -Aggressive wound care -Antibiotics -Supportive care (intubation may be needed)
Passive Natural Immunity
Maternal-infant Transmission: Infant acquires antibodies from mother. Short livespan of antibodies leaves infant unprotected @ 2-3 months
Sufficient antibody titer needed to
PREVENT DISEASE Vary by vaccine May need multiple doses Individuals vary in mounting a response to vaccine - check titers to determine if person is immune
disease risk: pertussis
Pneumonia: 1 in 8 Encephalitis: 1 in 20 Death: 1 in 1,500
Side effect of measles disease
Pneumonia: 6 in 100 Encephalitis: 1 in 1,000 Death: 2 in 1,000
Barriers to Immunizations (5)
Poor access to health care resources Lack of transportation to appointments Fear of vaccines/needles Cost (real or perceived) Possible shortages of vaccines
Lowest rates of immunization are
children living at or below the poverty level
Pertussis during pregnancy? (Tdap)
Recommended during pregnancy at 28th to 36th week - third trimester
HIB S/S initial and proceeds to?
S/S: fever, cough, sob, chills, sweating, headache, muscle pain, excessive tiredness, anxiety, proceeds to Alt MS!
Measles Dx:
Serology lab confirmation, throat, nasopharyngeal swab
Pertussis spread? when most contagious? s/s? who is it most severe for? How long does it last? Diagnosis?
Spread air droplets Most contagious immediately and up to 2 weeks after cough starts S/s: develop within 5-10 days after exposure; runny nose, low grade fever, violent rapid cough, vomiting, exhaustion, apnea Most severe in infants/children May last 10 weeks or more Dx: swab of secretions back of throat or nasopharyngeal flush
Diptheria tx course
Start TX immediately; Without it 1 in 2 will die DAT antitoxin only available as IND by CDC
Healthy People 2020 Targets
Target coverage of 90% for most vaccines Rotavirus 80% Hepatitis A 85%
Diptheria vaccine for older children and adults?
Tdap and Td
Tetanus (Td) - booster? - what is contains? - who should not receive?
Tetanus-diphtheria Booster every 10 years. Tdap: also contains pertussis - dont give to someone with prior life threatening reactions -Any nervous system disease in 7 days.
Pertussis most contagious when?
caterrhal stage (1-2 wks) - vague symptoms
immunization
The process by which a person or animal becomes protected against a disease. This term is often used interchangeably with vaccination or inoculation.
Lyme - Transmission
Ticks; perhaps through placenta
HIB Tx
Treatment Antibiotics for 10 days Even with treatment, 3%-6% of children with meningitis die
Pertussis (Whooping cough) treatment and when to start? (4) Will cough syrup work?
Treatment-Strongly recommended before test results -Antibiotics -Vaporizer to loosen secretions -Cough syrup: WILL Not Help -Suctioning
Lyme Tx
Tx: oral antibiotics Vaccine: no longer available in the US due to low demand and protection was not long lasting
Haemophilus Influenza Type B (HIB) -types and transmission?
Types of Haemophilus influenza are Bacteremia, meningitis, cellulitis Transmission: droplets, cough
Vaccine Components (4)
Vaccine Suspending Fluids Preservatives/stabilizers Enhancers or Adjutants *often people are allergic to other things in the vaccine rather than the pathogen
Live Attenuated Vaccine and 2 examples
Virus is isolated, grown in culture Weakened strain of virus extracted, purified Live weakened strain is injected Immune response evoked by stimulating both memory B and memory T cells. Humans can often gain long-term immunity from an attenuated vaccines after just one or two doses Produces infection without symptoms ex: Measles, mump and rubella (MMR) Varicella (chicken pox)
Passive immunity interferes with
active immune production
Tdap dosing for adolescents and adults?
adolescents : age 11- 18 adults: 19 and older
Adenovirus Transmission:
air droplets, contact
Measles - transmission - when you can transmit? - incubation period? - how long does it live on objects?
aka Rubeola -Transmission via droplet 4 days before to 4 days after rash -Incubation 7 to 21 days -Lives on objects for 2 hours
Anthrax Prevention: Vaccine not available for general public High Risk groups: Laboratory workers with anthrax Animal handlers US military Vaccine: 5 shots over 18 months, annual boosters Bioterrorism: Vaccination Antitoxin: limited once infected
antibiotics if exposed
Measles S/S sequence
classic prodrome of fever (as high as 105°F) and malaise 3 c's: cough coryza (inflammation mucous membranes & loss of smell) conjunctivitis (pink eye) a pathognomonic enanthema (Koplik spots-white spots in mouth) followed by a maculopapular rash
what are required by law
consent pt education document consent
Adenovirus Vaccine:
contains live adenovirus Type 4 and Type 7; Two tablets, swallowed whole
Adenovirus S/s:
cough, fever, runny nose, headache, sore throat, eye infections. May last 10 days
Mumps transmission;
droplet
mumps Complications
encephalitis/ meningitis; oophoritis and mastitis
Vaccine-preventable diseases have been virtually eliminated from the United States, so there is no need for my child to be vaccinated.
nope: need 95% for herd immunity
HIB Dx
one or more lab tests -Blood, spinal fluid
mumps S/S:
fever, headache, muscle aches, tiredness, loss of appetite, swelling of salivary glands
S/e of DTaP:
fever, site irritant, fussiness
Uppercase
full strength
Tdap in pregnancy?
give during each pregnancy in the 3rd trimester
mumps Incubation
is 12-25 days after exposure
Thimerosal
is a mercury-containing preservative that is added to vials of vaccine that contain more than one dose to prevent contamination and growth of potentially harmful bacteria. - thought to be linked to autism
Egg protein
is found in influenza and yellow fever vaccines, which are prepared using chicken eggs.
Formaldehyde
is used to inactivate bacterial products for toxoid vaccines, (these are vaccines that use an inactive bacterial toxin to produce immunity.) It is also used to kill unwanted viruses and bacteria that might contaminate the vaccine during production. Most formaldehyde is removed from the vaccine before it is packaged.
Anthrax CXR/CT
mediastinal widening, pleural effusions
Adenovirus Who:
military personnel 17 to 50 years of age.
a
partial organism
Measles Complications:
pneumonia, hearing loss, encephalitis
preg immun sched - contra indications
recommended TDAP (28-36 wks) 2nd, 3rd trimesters: flu vaccine (inactivated) - no Live attenuated vaccines (flu or Varicella, MMR) or HPV vaccine during pregnancy
lowercase
reduced dose
What is diptheria classified as?
respiratory, cutaneous
Lyme Dx
serologic testing, may need repeat testing; if you test too early you won't be diagnosed
Anthrax Dx
serum test, skin/throat swab, secretions;
When does the whooping cough begin?
stage 2: presents in 2 weeks in the paroxysmal stage and lasts up to 10 weeks - rapid cough followed by whoop sound
Antibiotics :
to prevent the growth of germs (bacteria) during production and storage of the vaccine. No vaccine produced in the United States contains penicillin.
Aluminum gels or salts:
which are added as adjuvants to help the vaccine stimulate a better response.