Transcript IMMUNIZATIONS - My Illinois State

What you need to know about sequencing,
indications and contraindications
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CDC Website with current recommendations
Immunizations quiz to test your knowledge from
CDC
Another great website: http://nip-it.org/
Begun within first 2 wks of birth (HepB)
Most are completed before starting school
Premies receive full dose @ appropriate
chronologic age
Difference between recommended and required
 Required differ from state to state
 Entry to schools and preschool programs require
certain immunizations
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Injections given in separate syringes at
different injection sites
Most important: adequate penetration of the
muscle so vaccine is deposited IM, not SQ
(i.e. DTP) if it is an IM injection (CDC Table)
Dorsogluteal muscle never used
CDC states NO NEED TO ASPIRATE on IM’s
Great table on p. 507(9 ed.)!
May give one at a time or 2 RNs give at same
time in 2 different sites
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Disease can lead to cirrhosis or liver CA as adults
High percent infected before age 5 become carriers
1st injection given before leaves hospital
Newborns – IM vastus lateralis
Older children – IM deltoid
Low antibody seroconversion with dorsogluteal site at
any age
 3 dose series – 3rd dose not before 6 mos.
 If mom is Hepatitis B Antigen POSITIVE in pregnancy,
baby must receive Hep B vaccine AND immune
globulins within 12 hr of delivery.
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Disease caused by bacteria: affecting the mucous
membranes of your nose and throat.
Vaccine combined with tetanus and pertussis (DTaP,
DT, Td, or Tdap) or combined with conjugate H.
influenzae type B (HIB) vaccine
Can be given alone if others are not indicated
DTaP contains alum to retain the antigen at the
injections site so must have excellent IM technique to
avoid irritation, inflammation or possible abscess
Series of 5 doses 2, 4, 6, 12-15mos, 4-6yrs,
Boosters needed every 10 years
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Tetanus toxoid used for routine vaccines
Used with diptheria
Need booster every 10 yrs.
Wound management: TIG (immune globulin)
given if person has received less than 2 doses
of tetanus toxoid or it has been > 10 yrs. since
last dose
See p. 500 Table 12-6(9 ed.)
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Both vaccines contain inactivated forms of the toxin produced by the
bacteria that cause the three diseases. Inactivated means the substance
no longer produces disease, but does trigger the body to create
antibodies that give it immunity against the toxins. DTaP is approved for
children under 7 years. Tdap, which has a reduced dose of the diphtheria
and pertussis vaccines, is approved for adolescents starting at the age of
11 or 12 and adults ages 19 to 64.
Immunity wears off over time. So the current recommendation is that
everyone needs a booster shot for tetanus and diphtheria every 10 years
after first being immunized. That booster comes in the form of a vaccine
called Td. But since immunity to pertussis also wears off during
childhood, a weaker form of the pertussis vaccine has been added to the
booster to make the vaccine Tdap. The current recommendation is that
one dose of the Tdap vaccine be substituted for one dose of the Td
vaccine between the ages of 11 and 64 years.
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Children ages 7 through 10 who aren't fully vaccinated
against pertussis, including children never vaccinated or with
an unknown vaccination status, should get a single dose of
the Tdap vaccine. Teens 13 through 18 who haven't gotten
the Tdap vaccine yet should get a dose, followed by a
booster of tetanus and diphtheria (Td) every decade.
All children entering the 6th grade are required to receive a
Tdap at this time in the state of Illinois.
Given to children 8wks to 6 yrs
Old: not given past 7th birthday – risk from vaccine
increases and risk from illness decreases
 Now: Acellular pertussis recommended for the
1st 5 injections d/t fewer local and systemic reactions
– should be from same manufacturer (DTaP)
 New vaccine for older children/adults: Tdap
 Tetanus, diphtheria, acellular pertussis; 1 time
dose
 Recommended to new mothers in postpartum
and dads encouraged to get it to protect newborn
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In 1999 recommended all IPV (Inactivated Polio
Vaccine) for routine immunizations in US.
IM given at 2, 4, 6-18 mos, & 4-6 yrs.
Formerly used OPV (Oral Polio Vaccine)– oral is
live virus vaccine–only required 3 immunizations.
Still used in many 3rd world countries because it
is less expensive than IM and easier to inoculate
large numbers of children.
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Sub Q – given @ 12-15 mos.
Measles outbreak – give if > 6mos. and
revaccinate after 12 mos.
2nd recommended @ 4-6 or 11-12 – in IL
required to have 2nd before entering school
Can be given alone or with Mumps and
Rubella
LIVE vaccine—passes through the stool.
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2 dose series: Given at 12-15 mos and 4-6yrs.
Any earlier, maternal antibodies interfere
with immune response
Recent outbreaks noted due to less
immunizations, less “herd immunity” (95% of
population immunized)
Dz may lead to male sterility
Recommended for everyone born after 1957
with no history of the disease or the vaccine
LIVE vaccine—passes through the stool.
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Disease: mild infection in child
Serious to developing fetus—most injurious if
mom contracts virus in 1st trimester of
pregnancy. May lead to congenital heart
disease, deafness, mental retardation in
fetus
May cross placenta – not given if pregnant
May give to child if mom is pregnant
LIVE Vaccine—passes through the stool.
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Disease is spread by fecal-oral route, person to
person, contaminated water – rarely through blood
transfusion
 GI symptoms, jaundice, dark urine, abrupt onset – often
asymptomatic if < 6
IM in deltoid; >12months, 2 doses at least 6 mos.
apart; it is an inactivated vaccine.
 All DCFS children receive this series at 12 & 18mos.
 Recommended for children in communities with
high infection rates. Required in certain states i.e.
AZ, OK, AK, NM, SD, ID, NV, OR.
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Used to prevent diarrhea and dehydration in
young children.
Was withheld due to fear of increased risk of
intussuception.
Given orally at
 2,4, and 6 mo.(Rotateq),
 2 & 4 months (RotaRix)
May cause mild temporary diarrhea or vomiting,
and irritability
 Hold administration of vaccine if child has moderate
to severe vomiting or diarrhea
 Contraindicated after 8 months of age
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Protects against: bacterial meningitis, epiglottitis,
bacterial pneumonia, septic arthritis, sepsis
Conjugate vaccines – connects Hib to a nontoxic
form of another organism such as meningococcal
protein which improves antibody response to Hib
Whatever conjugate vaccine used at 1st vaccination
should be used for subsequent ones
Given IM – 3 or 4 dose series complete by 12 – 15
months
This is an inactivated vaccine
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Minimum 12 months up to 13 yrs.
Two doses given sub Q at 12-15 mo with booster
before entering kindergarten (4-6 yr)
Must be kept frozen and used within 30 min. of
being reconstituted
Given simultaneously with MMR but in separate
syringes and separate sites, or must wait 1
month between
This is a live attenuated vaccine & is therefore
contraindicated in immunocompromised
individuals (e.g. HIV, ALL) and pregnant women
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13-valent Streptococcus pneumoniae
conjugate vaccine (PCV13)—4 dose series
IM to children < 2 yrs
Used to prevent: septicemia, meningitis,
otitis media, sinusitis, pneumonia – esp.
problematic in day care children
Who gets it? All < 2 yrs. And older children 2459 mos. with chronic illnesses, immune
deficiencies, etc. (p. 503(9 ed))
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6 mos. and older with risk factors and others
whose parents request it (p. 505(9 ed))
Don’t give if Hx of hypersensitivity to eggs
1st time give 2 separate doses 2 wks apart for
those < 8 yrs.
Given in early fall, repeated yearly
IM
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Children 6mo- 9 years of age should get two doses of
vaccine, about a month apart.
 Older children and adults need only one dose.
 Reactions
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 Mild problems: • soreness, redness, tenderness, or
swelling where the shot was given • fainting (mainly
adolescents) • headache, muscle aches • fever • nausea
If these problems occur, they usually begin soon after
the shot and last 1-2 days.
 Severe problems: • high fever or behavior changes,
difficulty breathing, hoarseness or wheezing, hives,
paleness, weakness, a fast heart beat or dizziness.
 http://www.cdc.gov/vaccines/hcp/vis/visstatements/flu.pdf 2014-15 info
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Patient Education
 You should not get Influenza vaccine if you have a
severe (life-threatening) allergy to eggs, or to any
other substance in the vaccine. Tell the person
giving you the vaccine if you have any severe
allergies. Also tell them if you have ever had: • a lifethreatening allergic reaction after a dose of seasonal
fl u vaccine, • Guillain Barré Syndrome (a severe
paralytic illness also called GBS).
 Pregnant or breastfeeding women can get inactivated
flu vaccine.
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Recommended for children >2yr-49yrs old.
Do not give Influenza LAIV (live attenuated influenza vaccine)
 pregnant women
 anyone with a weakened immune system
 anyone with a long-term health problem such as - heart disease 
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kidney or liver disease - lung disease - metabolic disease such as
diabetes - asthma - anemia and other blood disorders
children younger than 5 years with asthma or one or more episodes
of wheezing during the past year
anyone with certain muscle or nerve disorders (such as cerebral
palsy) that can lead to breathing or swallowing problems
anyone in close contact with a person with a severely weakened
immune system (requiring care in a protected environment, such as a
bone marrow transplant unit)
children or adolescents on long-term aspirin treatment.
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Mild problems: Some children and adolescents
2-17 years of age have reported mild
reactions, including: • runny nose, nasal
congestion or cough • fever • headache and
muscle aches • wheezing • abdominal pain or
occasional vomiting or diarrhea
Some adults 18-49 years of age have reported: •
runny nose or nasal congestion • sore throat •
cough, chills, tiredness/weakness • headache
CDC link on LAIV
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HPV— new vaccine approved 12/2014.
 Most commonly acquired STD in US for 16-24 yo.
 Linked to cervical cancer: CDC Handout
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Vaccine offered to girls 9-26 yr old and boys.
More effective if not already sexually active
 Series of 3 injections with second and third doses
to be given at 2 and 6 months after initial dose
 cost exceeds $300
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Inactivated (DTaP): within hours – days:
Common: local tenderness, redness, swelling, low-grade
fever, behavioral changes (fussy).
Severe reactions: seizure, fever > 105 F, non-stop crying
(>3hr)
 Local reactions decreased when needle is sufficient length for IM
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Live attenuated (MMR & Varicella): Multiply for days or
weeks, reactions could occur 30-60 days later – usually
mild (MMR, varicella)
 Rash: often occurs 1-2 weeks after administration of MMR
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VAERS-vaccine adverse event reporting system
http://vaers.hhs.gov/index
http://www.cdc.gov/vaccinesafety/Activities/vaers.html
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Severe febrile illness on day of immunization
Severe fever >105, seizure or nervous system dz,
severe allergic response to vaccine with previous
dose
 Common cold is NOT a problem
 Breastfeeding is NOT a problem
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Live virus vaccines (MMR, Varicella, OPV) not given
to anyone
 With altered immune system or
 With recently acquired passive immunity
 If Pregnant
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Severe allergic reaction to neomycin or
streptomycin
Rotavirus not given after 8 mo due to risk of
intussusception.
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Proper storage of vaccine
Proper needle length & site & route
Providing accurate information, answering
questions before giving shots. Stress need for
immunizations records
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Use Vaccine Information Sheet (VIS)
http://www.cdc.gov/vaccines/pubs/vis/default.htm
 Accurate documentation: day, mo, yr, lot #,
manufacturer, exp. date, your name & title, clinic
address & phone #, site & route, evidence of
informed consent, adverse reactions
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http://www.cdc.gov/vaccines/ CDC site
www.ashastd.org National Immunization
Hotline Program
www.aap.org Amer. Academy of Ped.
www.vaccinesafety.edu John Hopkins –
Institute for Vaccine Safety
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Pediarix= DTap/IPV/HepB
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Pentacel= DTap/IPV/HiB
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Comvax= HiB/HepB
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TriHiB= DTap/HiB
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ProQuad= MMR/Varivax