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Vaccine
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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
Antigen
s 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
Antigen
s (e.g. toxins, DNA)
Bacteria
l Polysaccharide Vaccine
Bacteria
l 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
Bacteria
l 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
Antigen
s
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
Analgesic
s 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
Haemophilus
Influenza
e type B (
Hib Vaccine
)
Inactivated Polio Vaccine
(
EIPV
)
Pneumococcal Conjugate Vaccine
(PCV,
Prevnar
)
Measles Mumps Rubella Vaccine
(MMR)
Varicella Vaccine
Rotavirus Vaccine
Diphtheria
Tetanus
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
Temperature
s 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]
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