Al Hussein Bin Talal University Princess Aisha Bint Al-Hussein

College of Nursing and Health Sciences Nursing Department

Critical Care Nursing

PRESENTED By: Presented To :

Tamara Ghaith Ali Al-khlaifat
Ghoson Bani Hamdan
Balsam majdi
Majd Bani Hani
Weam Abdullah
Immanization &vaccination
Outlines
 Definition of Immunization and vaccination
 Type of immunity
 Stages of vaccine development
 Types of vaccine
 Interaction between vaccines
 Logistics Of Vaccine
Outlines
 Anti-vaccine activism
 Myths
 COVID-19 pandemic activism
 (MR) vaccine
 Jordanian society has been afraid of receiving vaccinations
in the last period
 The vaccine struggle: between the monopoly of rich
countries and the deprivation of poor countries
Definition of lmmunization
 Immunization is the process of introducing some form of
disease-causing organism, parts or its toxins into a
person’s system causing the development of antibodies
that will resist that disease and making the person immune
to that particular infectious disease
 Immunization: many of the immunizations can be give to
individuals of any age, the recommended primar yschedule
begins during infancy and, with the exception of boosters,
is completed during early childhood, Jordanian national
immunization program was initiated in 1979.
 Immunization: is an inclusive term denoting the process
of inducing or providing active or passive immunity
artificially by administering an immunobiologic. Is term is
often used interchangeably with vaccination or
inoculation.
Vaccination
 Vaccination is generally considered to be the most effective and cost-
effective method of preventing infectious diseases. (And considered the
most effective public health intervention after clean water)
 In 2018, about 86% of the world’s children received vaccines that would
protect them against polio, diphtheria, tetanus, pertussis, and measles.
 Immunizations currently prevent 2 million to 3 million deaths every
year.
 Despite this success, more than 1.5 million people worldwide die from
vaccine-preventable diseases each year.
Vaccination
 Vaccination is a method of giving antigen to stimulate the immune
response through active immunization..
 A vaccine is an immuno-biological substance designed to produce
specific protection against a given disease.
 A vaccine is “antigenic” but not “pathogenic”.
Type of Immunity
 Immunity refers to a host’s ability to resist a particular infectious
disease-causing agent. This occurs when the body forms antibodies and
lymphocytes that react with the foreign antigenic molecules and render
them harmless.
 Immunity either (natural or artificial ) :
 Four types of immunity are in community health:
1-Passive immunity.
2-Active immunity
3-Cross-immunity.
4-Herd immunity.
Types of immunity

 Passive immunity:
 Short term-natural or artificial
 Natural: mother to newborn-up to 6-12 months
Artificial: immunoglobulin infusion at time of acute
exposure (within hrs) to some diseases: hepatitis B
Types of immunity
 Active immunity :
 Is long-term and sometimes lifelong resistance that is
acquired either naturally or artificially. Naturally acquired
active immunity comes through host infection.
 Artificially acquired active immunity is attained through
vaccine inoculation.
Types of immunity

 Cross immunity:
 Cross-immunity :refers to a situation in which a person’s
immunity to one agent provides immunity to a related
agent as well. E.g. BCG for tuberculosis found to be
effective against leprosy
Herd immunity
 Herd immunity :
 Describes the immunity level that is present in a
population group.
 Level to achieve herd immunity depends on
 infectiousness of agent
 Either by natural due to infection or by vaccination or both
 Herd immunity can be determined by the percentage of people who
are immune either naturally or artificially and each infectious disease
has immunity rate may range between 60-95%
 Generally, populations with 80% or more immunity rate have a greater
overall protection because non immune persons are at less risk of
disease exposure.
 Herd immunity concept is applied in aggregates like schools and
travel vaccination.
 Herd immunity acquired by vaccination based on efficacy of the
vaccine and the vaccination rate – see next table
Stages of vaccine development:
 Stages of vaccine development:
1. Explanatory phase (Research stage):
Aim :the scientists identify natural or synthetic antigen that may
help to treat disease.
2.Preclinical phase:
Aim: to determine the whether the candidate vaccine will produce
immunity.
Medical professionals use cell-culture or tissue culture systems
and animals testing.
Stages of vaccine development:
3.Clinical development:
(Clinical trial phase) Involve at least three trials phases of
human testing.
Three trials phases of human testing:
 Three trials phases of human testing:
-Phase I: A small group of people is injected with this candidate
vaccine.
Aim: to determine how safe it is and to learn more about the responses
it provokes among test subjects.
-Phase ll: A group of more than hundreds of human test subjects are
injected.
Aim:to determine more information about immunogenicity, safety, dose
size, and immunization schedule.
Three trials phases of human testing:

-Phase III: In this phase, more than thousands of human test

subjects are injected.
Aim:to determine rare side effects which sometimes don’t
appear in smaller groups.
Stages of vaccine development:
4.Approval:
The sponsor of the vaccine follows an approval process after a vaccine
has successfully passed phase III trials. The vaccine is approved by the
governing authority only if it is safe and reliable, and the benefits
outweigh the risks it may pose to the patients.
5-Pharmacovigilance :
Pharmacovigilance once the vaccine is available to the public, the
vaccine manufacturer continues to monitor the vaccine’s efficacy to
avoid any adverse events. To ensure that the vaccine is healthy for the
public, the governing authority will also monitor the entire production
process.
Stages of vaccine development:

 Quality control:
Quality control to monitor the safety, per brmance, and
effective of an approved vaccine.
Types of Vaccine :

 Live attenuate Vaccines:

 Live vaccines are prepared from live organisms. These
organisms are attenuate till they lose their capacity to
induce the disease fully, but retain the capacity to
frigger off the defense mechanism.
 Live vaccines are usually more potent than inactivated
vaccines. They multiply within the host and produce
more antigens.
Types of Vaccine :

 Live vaccines (attenuated): are used for tuberculosis polio.

(BCG), measles and polio.
 Usually one dose of live vaccine is enough for immunity.
Some, as in the case of polio, need more. Vaccines made in
this way a are often the most successful vaccine However,
these live attenuated vaccines also carry the greatest risk
because they can mutate back to the virulent form at any
time.
Types of Vaccine :
 Inactivateria or killed vaccine:
 Certain organisms when killed by heat or chemicals and
then introduced into the body induce immunity.
 Killed vaccines are not as effective as live vaccines.
Inactivated vaccines may require two or three doses. These
are administered by injections.
 Diphtheria, pertussis, tetanus, cholera, rabies, and hepatitis
B are some diseases that are combated with killed vaccines
Types of Vaccine :
 Toxoid: is an exotoxin that has been inactivated by heat or
chemicals & thus can be injected safely to stimulate the
production of antibodies that are capable of neutralizing the
exotoxin pahtogen. E.g., Diphteria, tetanuns.
 Vaccines made from toxoids often induce low-level immune
responses and are therefore sometimes administered with an
“adjuvant”, an agent that increases the immune response. For
example, the diphtheria and tetanus vaccines are often combined
with the pertussis vaccine and administered together as a DPT
vaccination. The pertussis acts as an adjuvant in this vaccine.
Types of Vaccine :
 Cellular fractions:
 Some vaccines are prepared from fractions of the cell. E.g.
The meningococcal vaccine is produced from the
polysaccharide antigen on the cell wall. And hepatitis B
polypeptide vaccine. These vaccines are safe and effective
but for a limited duration.
Types of Vaccine :
 MRNA Vaccines:
 mRNA vaccines work by introducing a piece of mRNA that
corresponds to a viral protein, usually a small piece of a protein
found on the virus’s outer membrane. (Individuals who get an
mRNA vaccine are not exposed to the virus, nor can they
become infected with the virus by the vaccine.) By using this
mRNA, cells can produce the viral protein. As part of a normal
immune response, the immune system recognizes that the
protein is foreign and produces specialized proteins called
antibodies.
Types of Vaccine :

 Antibodies help protect the body against infection by

recognizing individual viruses or other pathogens,
attaching to them, and marking the pathogens for
destruction.
28 Disease are now Vaccine-preventabIe
National vaccination programmes
Depends on
Jordanian national vaccination
schedule
Interaction between vaccines
 Oral poliomyelitis vaccine should be given three weeks
before, or three months after, immunoglobulin (if needed)
to give maximum response.
 Live virus vaccines should be given either simultaneously,
or at least three weeks apart, to avoid the response to the
second vaccine being lowered by interferon produced in
response to the first.
 All the inactivated vaccines can be given in any
combination with any other vaccines
General Contraidications
 Moderate or severe illness with or without fever (> 38.5)
 Anaphylactic reaction to vaccine or vaccine constituent
Live attenuated vaccine.
 Pregnant women Immunocompromised children vaccine.
Delay giving for some vaccines for a certain time after
receiving immunoglobulin or blood products.
Invalid traindications
 Mild to moderate local reaction
 Mild acute illness with or without low grade fever (<38.5) or
diarrhea
 Current antimicrobial therapy
 Convalescent phase of illnesses
 Prematurity and low birth weight
 History of penicillin or other nonspecific allergies
 Family history of convulsions
 Malnutrition
Logistics Of Vaccine
 Logistics Of Vaccine :
 Logistics supportis critical to immunization serices to ensure the
availability of appropriate equipment and an adequate supply of
high quality vaccines and immunization-related materials to all
levels of the program.
 Poorly managed logistics systems can lead to high and/or
unnecessary vaccine wastage rates, stock outs, or improper
management of waste, resulting in significant operational program
costs, as well as a negative impact on Public health.
Logistics Of Vaccine

 1. Vaccine Storage and Handling

 Vaccines are fragile, biological substances. by can become
less effective or even destroyed if they are exposed to
temperatures outside the recommended storage range
between +2°C and +8°C.
 Also, some people are unable to be vaccinated due to
certain conditions such as immune suppression.
Logistics Of Vaccine
 Vaccine Cold Chain
 A cold chain is a temperature-controlled supply chain that
includes all vaccine- related equipment and procedures. a
cold chain begins with the cold storage unit at the
manufacturing plant, extends to the transpor tand deliver
of the vaccine and proper storage at the provider facility,
and ends with administration of the vaccine to the patient.
Essential steps in proper cold chain
management
 Essential steps in proper cold chain management:
 To be confident that you are maintaining vaccines’ potency, practices must:
 Have a reliable refrigerator capable of maintaining a stable temperature.
 Develop clearly documented processes to maintain the cold chain.
 Monitor and record the maximum and minimum temperature of refrigerators
used to store vaccines at least once a day and before using any vaccines.
 If errors in vaccine storage and administration occur, take corrective action
 immediately to prevent them from happening again and notify public health
authorities.
 2-Transporting of vaccine :
 Follow the cold chain steps like transporting the vaccine in
a vaccine cooler box or bags.
 Cold Chain Bags and Boxes, specially designed to hold
temperatures within essential safe temperature limits
without electricity during transport.
 Vaccine Cooler Box:
Vaccine administration

 3-Vaccine administration:
 Health care professionals should be knowledgeable about
appropriate techniques to prepare and care for patients
when administering vaccines.
 Administration involves a series of actions:
 A. Assessing patient vaccination status and determining needed
vaccines.
 Using the patient’s immunization history. We can obtain it from
immunization Information systeris (IISs) which are confidential,
population-based, computerized databases that record all
immunization doses administered by participating providers to
persons residing within a given geopolitical area.
 Health care providers should assess for all routinely recommended
vaccines as well as any vaccines that are indicated based on
existing medical condition(s), occupation, or other risk factors.
 B. Screening for contraindications and precautions.
 Before administering any vaccine, patients should be
screened for contraindications and precautions, even if the
patient has previously received that vaccine
 To assess patients correctly and consistently, health care
providers should use a standardized, comprehensive
screening tool.
Educating
 C. Educating:
 Some patients and parents may have questions or concerns
about vaccination. This does not necessarily mean they
will not accept vaccines.
Duration of protection by vaccine
 Duration of protection by vaccine:
 No vaccine is 100% ef fective, a small percentage of
people are not protected after vaccination and for others
the protection may wane over time. Also, some people are
unable to be vaccinated due to certain conditions such as
immune suppression.
 Maintaining immunity in those around these people
protects them from disease.
Anti-vaccine movement
 The anti-vaccination movement is a group of people who
oppose vaccinations and believe they are harmful or
unnecessary. Members of this movement rely on
misinformation or misleading information to support their
viewpoints. Some people in this group may believe that
vaccines cause serious side effects or are part of a wide-
scale conspiracy
Anti-vaccine movement
 Researchers now link falling immunization rates to recent
resurgences of vaccine-preventable diseases. In 2010,
California saw 9,120 cases of whooping cough, more than
any year since the whooping cough vaccine was
introduced in the 1940s. Ten infants too young to be
vaccinated died of whooping cough during the outbreak.
Te CDC warns that events like these will become more
frequent and harder to control if vaccination rates continue
to fall.
Anti-vaccine movement
 Fears over the safety of vaccines are understandable. Te
CDC vaccination schedule calls for children to receive up
to 14 inoculations by the age of six many of them vaccines
developed within the last twenty years. Many parents
distrust these vaccines; worried about the potential for
risks and long-term side ef écts. Research, however, shows
that most of our biggest fears about vaccinations are
unfounded. T lase eight major vaccine myths that research
has shown to be baseless:
Myths
 1. Vaccines cause autism.
 2. Infant immune systems can’t handle so many vaccines.
 3. Natural immunity is better than vaccine-acquired immunity.
 4. Vaccines contain unsafe toxins.
 5. Better hygiene and sanitation are actually responsible for decreased
infections, not vaccines.
 6. Vaccines aren’t worth the risk.
 7. Vaccines can infect my child with the disease it’s trying to prevent.
 8. We don’t need to vaccinate because infection rates are already so low
in the United States
COVID – 19 pandemic activism
 During the COVID-19 pandemic, anti-vaccine activists
undertook various efforts to hinder people who wanted to
receive the vaccines, with such activities occurring in
countries including including Australia, the United
Kingdom, and the United States. These included attempts
to physically blockade vaccination sites, and making false
reservations for vaccination appointments to clog up
vaccination booking systems. Protests were also organized
by the activists to raise awareness for their cause.
COVID – 19 pandemic activism
 In some instances, anti-vaccine rhetoric has been traced to
state sponsored internet troll activities designed to create
social dissension. Worldwide, foreign disinformation
campaigns have been associated with declining
vaccination rates in target countries.Anti- vaccine activism
online both before and during the pandemic has been
linked to extreme levels of falsehoods, rumours, hoaxes,
and conspiracy theories.
MR Vaccine
 The measles-rubella (MR) vaccine, provided for targeted
children in Jordan, is safe and effective at protecting
children from deadly disease and outbreaks, said the World
Health Organization (WHO) and the United Nations
Children’s Fund (UNICEF ), which support the Ministry
of Health’s national immunization campaign.
MR Vaccine

 Since the onset of the COVID-19 pandemic, the rate of

measles vaccination coverage in Jordan has declined
alarmingly. Approximately 112 000 children under 5 years
of age – more than 6 out of 10 children in this age group –
have missed their routine doses of measles-containing
vaccine. The high number of unvaccinated individuals has
already led to an outbreak of measles in Jordan, in April
2023, when 163 measles cases were reported in 7
governorates.
Jordanian society has been afraid of
receiving vaccinations in the last period
 The Jordanian Ministry of Health announced the start of a
huge campaign to vaccinate school students, kindergartens
and nurseries with the Indian vaccine (MR vaccine)
against measles and rubella, which sparked widespread
controversy in the Jordanian street and spread within hours
to social media sites.
 Among opposition supporters, Jordanians were divided
over the Indian measles vaccination amid allegations that
this vaccine is not approved by the World Health
Organization and is still under trial.
 The Indian measles vaccine is safe
 The World Health Organization and the United Nations
Children’s Fund (UNICEF) have confirmed that the
measles and rubella (MR) vaccine, which will be provided
to target groups in Jordan, is safe and effective in
protecting children from deadly diseases and the risk of
their spread.
- The two UN organizations said, in an official statement,
that since the outbreak of the “Covid-19” pandemic, the rate
of measles vaccination coverage in Jordan has decreased in a
very alarming manner, as nearly 112,000 children under the
age of five have missed their routine doses of vaccines
containing measles, that is, more than 112,000 children under
the age of five. 6 out of every 10 children in this age group.
The vaccine struggle: between the monopoly
of rich countries and the deprivation of poor
countries
 The Corona epidemic, which is still spreading and infecting
millions of people around the world, has revealed a global moral
crisis due to the continued scientific monopoly and national
discrimination, especially among rich Western countries, as these
countries give priority to their citizens in distributing medicines
and vaccines and prefer them over other peoples, while some
companies that produce vaccines refuse. Sharing scientific
techniques for making vaccines against the “Covid-19” virus,
which can protect hundreds of millions of people from death and
severe illness.
Some common concerns People Have about
vaccines here are afew reasons

 1. Side effects: Some people worry about experiencing

unwanted side effects after receiving a vaccine. However,
serious side effects are extremely rare, and most side effects are
mild and temporary.
 2. Effectiveness: Some individuals may be concerned about the
effectiveness of vaccines and whether they will provide
sufficient protection against the disease. However, approved
vaccines undergo rigorous clinical trials and have been proven
to be effective in preventing diseases.
 3. Credibility of information: Conflicting information and
rumors can impact people’s trust in vaccines. It’s important
to rely on reliable sources and consult with medical
experts to obtain accurate and trustworthy information.
 4. Personal fears: Some individuals may have personal
fears related to needles or concerns about potential
interactions with existing health conditions. It’s important
to address these concerns with healthcare professionals
who can provide personalized guidance
Thank you