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Vaccine
Aka: Vaccine, Vaccination, Immunization, Vaccine Safety, Immunization Contraindication
- See Also
- Primary Series (Pediatric Vaccination)
- Adult Immunization
- Immunization Status Unknown
- Background
- Vaccination was described by Edward Jenner in England, 1796
- Demonstrated Cowpox innoculation prevented Smallpox
- Vaccination is derived from vacca (cow)
- Vaccination is based on the development of active Immunity
- Active Immunity is a function of the adaptive immune sytem and occurs after recovering from an illness
- Vaccination exposes patients to an attenuated microbe or its Antigens and results in similar Immunity
- Vaccines offer Immunity without the risk of mortality or morbidity associated with the natural infection
- Allergen Immunotherapy
- Immunotherapy with allergan extracts is based on the same active Immunity process as for Vaccination
- Passive Immunity, in contrast, relies on an infusion of antibodies from others
- Mothers (trans-placental lasting for the first 3-6 months, Breast Feeding)
- Intravenous Gamma Globulin (IVIG) from pooled donors
- Specific antibodies
- Mechanism
- Primary immune response
- Onset in the first week of exposure to infection or Immunization
- IgM Antibody to microbe peaks after the first 2 weeks and then gradually decreases
- Secondary immune response
- Memory cells (B Cell type) form after the primary immune response
- IgG high affinity Antibody to microbe increases to high, sustained levels on second Antigen exposure
- Types
- Live Attenuated Vaccine
- Highly effective, resulting in prolonged or even life-long Immunity
- Contains live, but attenuated organism from which immunocompromised patients may become ill
- Killed Bacteria Vaccine
- Shorter duration of protection than with Live Attenuated Vaccine
- Vaccine contains either whole killed Bacteria or its subunit Antigens (e.g. toxins, DNA)
- Bacterial Polysaccharide Vaccine
- Bacterial polysaccharide (e.g. pneumococcus) is conjugated with a carrier protein (e.g. toxoid molecule)
- Carrier protein conjugation allows for T Helper Cell Activation
- Toxoid Vaccine
- Attenuated Bacterial exotoxins (e.g. Tetanus Toxoid) stimulate active Immunity against the organism's toxins
- Precautions: Safety
- Vaccines are safe
- Serious Allergic Reaction occur in less than 4 in one million with DTaP Vaccine, MMR Vaccine, Varicella Vaccine
- Most pediatric Vaccines do not contain thimerosol (and thimerosol)
- Of the 6000 daily Antigen exposures daily, a full Primary Series only exposes children to a total of 150 Antigens
- Vaccines prevent life threatening illness
- Tetanus will kill one child in 10 who contract the infection
- Measles will kill one child in 1000 who contract the infection
- Varicella will kill one older child in 100,000 who contract the infection
- Undervaccination puts community health at risk
- Take every opportunity to catch up Vaccinations
- Undervaccination associated with the 2020 Coronavirus pandemic is a significant risk for other outbreaks
- Santoli (2020) MMWR Morb Mortal Wkly Rep 69:591-3 [PubMed]
- https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e2.htm?s_cid=mm6919e2_w
- Undervaccination has been associated with resurgence of Measles
- Gahr (2014) Pediatrics 134(1): e220-8 +PMID:24913790 [PubMed]
- Adolescents frequently miss Vaccines with significant preventive potential
- HPV Vaccine (Gardasil Vaccine)
- Meningococcal Vaccine (Menactra, Menveo)
- Tdap Vaccine (Adacel)
- Influenza Vaccine
- Vaccine refusal
- Listen to concerns without minimizing concerns
- Explain risks and benefits
- Consider asking parents to sign a "Refusal to Vaccinate"
- Consider applying appropriate billing codes
- V64.05 Vaccine refusal by Caregiver
- V64.07 Vaccine refusal for religious reasons
- Avoid prophylactic Analgesics and antipyretics at the time of Immunization (per CDC)
- Antipyretics do not reduce the risk of Febrile Seizure
- Risk of decreased immunogenic response to Vaccination
- Prymula (2009) Lancet 374(9698): 1339-50 [PubMed]
- References
- (2015) Presc Lett 22(3): 13
- Contraindications: Vaccination
- True contraindications to Vaccination
- Current moderate to severe illness
- Anaphylaxis to Vaccine or Vaccine constituent (see below)
- Anaphylaxis to Vaccination is rare (<1 in one million doses)
- Obtain immediate type allergy Skin Testing if Vaccination is suspected for severe allergy or Anaphylaxis
- Conditions that do not contraindicate Vaccine
- Moderate inflammation at prior Immunization site
- Moderate fever following prior Vaccination
- Current antibiotic usage
- Recovering from illness or recent exposure to illness
- Prematurity (no change in dosage)
- Unvaccinated household contact
- Pregnancy of household contact
- Preparations
- Primary Series Vaccines
- See Immunization Schedule in Children
- HaemophilusInfluenzae type B (Hib Vaccine)
- Inactivated Polio Vaccine (EIPV)
- Pneumococcal Conjugate Vaccine (PCV, Prevnar)
- Measles Mumps Rubella Vaccine (MMR)
- Varicella Vaccine
- Rotavirus Vaccine
- DiphtheriaTetanus acellular Pertusis (DTaP Vaccine)
- Hepatitis B Vaccine (HepB Vaccine)
- Hepatitis A Vaccine
- Teen Vaccines
- Tetanus Diptheria acellular Pertussis (Tdap Vaccine)
- Meningococcal Conjugate Vaccine (MCV4)
- Human Papillomavirus Vaccine
- Adult Vaccines
- Tetanus Diptheria Vaccine (Td Vaccine)
- Tetanus Diptheria Acellular Pertussis Vaccine (Tdap, Adacel, Boostrix)
- Human Papillomavirus Vaccine
- Older adult Vaccines
- Pneumovax 23 Vaccine
- Shingles Vaccine
- Annual Vaccines
- Influenza Vaccine
- Precautions: Vaccine Additives
- Potential allergans for those with known Anaphylaxis to these agents
- Neomycin
- Varicella Vaccine
- Measles Mumps Rubella Vaccine (MMR Vaccine)
- Inactivated Polio Vaccine
- Gelatin
- Varicella
- Measles Mumps Rubella Vaccine (MMR Vaccine)
- Egg protein
- Inactivated Influenza Vaccine (use egg-free trivalent Inactivated Influenza Vaccine instead)
- Egg allergy is not a contraindication to Measles Mumps Rubella Vaccine (MMR Vaccine)
- Thimerisal
- Preservative in Vaccinations used since 1930s
- Contains small amount of Mercury, but no association with any neurologic disorder including Autism
- Removed from all Vaccinations in U.S. except for multi-dose Inactivated Influenza Vaccine
- Latex
- Infarix (DTaP Vaccine)
- Menomune, Bexsero (Meningococcal Vaccine)
- Rotarix (Rotavirus Vaccine oral applicator)
- Precautions: Maintaining Vaccine efficacy
- Maintain the cold chain prior to Vaccine administration
- Most Vaccines must be maintained in a tightly Temperature controlled refrigerator to ensure Vaccine efficacy
- Consider a back-up generator to protect Vaccines if power fails
- Manufacturers can give guidance if vaccine Temperatures varied from those recommended
- Use a refrigerator designed for Vaccines
- Monitor refrigerator Temperature twice daily or more with buffered probe Thermometer (e.g. glycol-encased)
- Continuous monitoring and automatic recording is preferred
- Thermometer ideally alarms when Temperature falls out of safe range
- Keep Vaccines on the middle of the shelves (not in the door or along the back wall) to maintain consistent Temperature
- Water bottles or freezer packs can help stabilize the Temperature (but do not store food with Vaccines)
- References
- (2012) Presc Lett 19(12): 70
- Resources
- WHO Vaccine Safety
- https://www.who.int/vaccine_safety/initiative/tools/vaccinfosheets/en/
- CDC Vaccine Safety
- https://www.cdc.gov/vaccinesafety/index.html
- Healthy Children (AAP) Vaccine Safety
- https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Vaccine-Safety-The-Facts.aspx
- CDC Immunization Schedules
- https://www.cdc.gov/vaccines/schedules/
- References
- Mahmoudi (2014) Immunology Made Ridiculously Simple, MedMaster, Miami, FL
- Spencer (2017) Am Fam Physician 95(12): 786-94 [PubMed]