At the end of this session, the student nurse will be able

Define immunization. Identify different types of immunization. Describe routine vaccination schedule. List common side effects of different vaccines. Identify the proper storage and transportation of
vaccine.

INTRODUCTION

Vaccination

is used to prevent specific infectious diseases. They must be given when individual is immunologically capable and before exposure to natural infections.

Types of immunization

(1) Passive immunization

(2) Active immunization

A. Natural Passive Immunization

A. Natural Active immunization:

B. Artificial Passive immunization

B. Acquired Active immunization:

It is classified into:
Natural Passive Immunization:
It includes passage of maternal antibodies to the fetus through the placenta (e.g.,antibodies against measles, poliomyelitis, diphtheria, scarlet fever and mumps). These antibodies disappear from the infant circulation at about the fourth month of age.

Artificial Passive immunization:

It is an administration of immunoglobulin (Gamma
globulins)which contains antibodies in such preparations may be antiviral, antibacterial, or antitoxins.

The artificial passive immunization has short duration. So, it is used in emergency cases and for contacts.

In measles vaccine administration of gamma

globulins within 3 days after exposure to a known case may prevent or modify the disease.

In case of Tetanus if the patient is non-immune,

give 1,500- 2,000 units of antitoxin if the patient is seen in the day of injury, otherwise give double this dose.

If the patient is previously immunized, give a

single booster dose of the toxoid immediately on the day of injury.

It is an entrance of antigens, which stimulates formation of antibodies by the immune system. It is

classified into:
Natural Active immunization:
By acquiring the infection either sub clinically or clinically. It is life long in measles, German measles, chicken pox and mumps.

Acquired Active immunization: By vaccines

Routine vaccination schedule

One month of age . Oral polio 2 drops (zero dose) (1) . B.C.G 0.05 mg ID on the left upper arm

2 month 4 month

Oral polio 2 drops (2) . D.P.T + Hepatitis B (1) 0.5 ml IM into left thigh . Oral polio 2 drops (3) . D.P.T + Hepatitis B (2) . Polio Salk 0.5 ml IM (1)
. Oral Polio 2 drops (4) . D.P.T +Hepatitis B (3) . Polio Salk 0.5 ml IM (2) Oral Polio 2 drops (5) . Measles 0.5 ml S.C in the right arm . Booster dose: Oral Polio 2 drops (6)

6 month

9 month 12 months 18 month

It is live attenuated strain of mycobacterium tuberculosis. It is given intradermally at the left deltoid muscle.

Side effects:
Regional Lymphadenitis.
abscess Osteomyelitis. Disseminated B.C.G infection (if immune deficient)

Diphtheria and tetanus vaccines are toxoid, while pertussis vaccine is killed organism. These combinations are used to decrease the number of injections and also to increase the immune response.

Side effects:
The side effects are due to the pertussis and include: Mild side effects: Local swelling and tenderness, slight fever but fever may reach to 40 oc and disappears in few days. Moderate side effects: shock.

Severe side effects: Convulsions, encephalopathy, and brain damage but are rare. If one of severe complications occurred do not give the pertussis again, but we will give D.T vaccine only. Also the pertussis vaccine is not given after 6 years of age for the fear of complications so D.T is given.

Contraindications of D.P.T:
1- Acute febrile illness. 2-Neurologic illness in patient or in family as epilepsy.

N.B: - In case of neurological illness or severe pertussis reaction DT is given only.

- The vaccine should not be frozen and not be given cold (may form an abscess).

A: sabin (oral) vaccine:

It is now the preferred agent for prophylaxis. It is a vaccine containing live attenuated viruses. The vaccine is clear pink liquid and is kept at 0C to +8C at the Health Center on the top shelf of the refrigerator.

Keep the vaccine in a cup containing ice during the vaccination session. Throw away the vaccine that remains in the vial after every vaccination session even if this vial was opened for a single child, and do not keep it in the refrigerator. Let the mother hold the infant lying on his back and open the infant mouth by squeezing cheeks gently between your fingers then put two drops of the vaccine straight from the dropper into the child tongue.

Remember:
Repeat the dose if the child spits out the drops. Lactation has no effect on the potency of the vaccine. The vaccination may be not effective if the child has diarrhea. So, after giving the vaccine it must be repeated. There is no harm in repeating the vaccination

Advantages:
This immunization protects not only the individual but also gives mass immunization to the community because the immune person is less likely carry the wild virus in his intestine and acts as a vector to the others due to the gained gastrointestinal immunity.
Ease of administration.

Disadvantages:
Short life of the vaccine (need proper refrigeration)

B: Salk vaccine (inactivated vaccine)

Advantages:
1- Effective in prevention of polio. 2-The vaccine has longer life span than Sabin.

Disadvantages:
1- It has to be injected so, it is difficult to be used in mass immunization 2-The immunized person cannot carry the wild virus in his G.I.T and transmit the disease.

Complication:
None except if there is immune deficiency disease. In this case, killed vaccine (Salk) is used.

Viral Hepatitis:
It is the most common vaccine against viral hepatitis B. It is killed and made by genetic engeinering.

Immunocompromised children: In general, children who are immunological compromised should not receive live bacterial or viral vaccines (e.g., MMR).

Immunization Programme:
High immunization coverage (not less than 80%) with at least three doses of oral polio vaccine (OPV) is the key to successful poliomyelitis eradication. This coverage should be attained at national, governorate or district area levels through out Egypt. The programme target should have all infants completely vaccinated before they reach the end of their first year.

Assessment of immunization coverage

Assessment can be made using immunization records when and where valid accurate record on routine immunization and dose are available. In this case, monthly reviews of the immunization records of infant population will show whether they were fully immunized according to vaccination schedule reasons for non-compliance.

Coverage surveys are used to confirm the validity of routine records.

The monthly renews are generally carried out by visiting homes, asking about vaccinations received, generally carries them out or by examining immunization cards if they are available.

Drop-outs:
Drop-out is a term referring to those who use immunization services at one point but they do not return for subsequent dose to complete the vaccination schedule. Related causes of drop-out: Lack of knowledge among parents about the need for further vaccine doses. Community fears about post-vaccination side effects. Immunization sessions not being at convenient times and places resulting in long waiting times and lack of vaccine supplies. These reasons should be investigated and actions must be taken.

Storage and transportation of vaccine:

The cold chain and vaccine supply and handling: All vaccines supplied by WHO/UNICEF have a certificate to prove safety, potency and efficacy. In recent years; WHO and UNICEF have adopted standards for the safe shipping of vaccines. These require that vaccines be properly insulated during international shipment advanced notice of shipment is sent to receiving authorities and a time/ temperature monitor (called a cold chain monitor) is included with each vaccines.

When the vaccine is exposed to a temperature above 10C, a blue color appears on the monitor, indicating a cold chain break. The monitor also provides an indication of the extent of the break and what to do. Ensuring that no breaks occur in the cold chain requires continuous monitoring of the transport and storage condition of vaccines.

Always check the following: Thermometer:

There must be one in the refrigerator: A daily check should be made that it is functioning properly.

Refrigerator:
It should be in good working order. The temperature should be checked at the time of inspection and the daily temperature record must be examined.

Cold boxes:
These should be available in sufficient numbers for the services rendered. They should be closed properly and sealed.

Cold Packs: These should be available in adequate number for cold boxes in use.
Shipment status: The shipment should be received with cold packs surrounding it on all sides and the temperature recorded.

Remember:
Do not put any food or drink into the vaccine storage refrigerator.

Do not put any vaccine in the door shelves.

Do not put any vaccine in the freezer compartment. Do not keep any vaccine or partly used vaccine vials in the refrigerator.

Role of the nurse:

Case finding. Early detection.

Education. Monitoring, follow up, referral of cases.

Training for personal on the field of health.