Immunizations

Definition: is the process in which a person made immune or

resistant to an infectious disease, typically by administration of
a vaccine. Vaccines stimulate the body's own immune system
to protect the person against subsequent infection or disease.
 Immunity
It is a resistance that an individual has against disease.
Types of Immunity:
A- Innate Immunity. B- Acquired Immunity.
Acquired Immunity:
1- Natural 2- Artificial
1- Natural:
Passive:
- Transplacental:
During pregnancy, maternal Abs passes through the placenta
to the fetus and
disappears from infant circulation after 4-6 month.
- Mother's milk:
Colostrum contains maternal Abs.
Active:
Acquiring the infection either subclinical infection, clinical
infection or disease
attack.
2- Artificially:
Passive:
Introducing the immune serum that contains already formed Abs to
the body by administration of:
a. Human immunoglobulin's.
b. Animal antisera "Antitoxins".

Active:
It is the administration of antigenic organism or toxin to stimulate
immune response to produce active immunity against it.
 Vaccination
Types of vaccines:
 Live vaccine:
Only small pox vaccine.
 Live attenuated vaccine:
- It is prepared after attenuation of living organism.
- Oral polio vaccine "Sabin" is against poliomyelitis.
- B.C.G is against T.B.
- Measles & Mumps vaccine
 Killed vaccine "In activated vaccine":
- The organism is killed by heat or chemicals.
- Salk vaccine is against poliomyelitis.
- Hepatitis B vaccine.
- Pertussis vaccine is against "whooping cough".
 Toxoids:
- It is prepared from exotoxins produced by certain organism after
destruction of their
toxic effect with preservation of their antigenicity.
- Diphtheria toxoid and Tetanus toxoid.
 Combined or mixed vaccine:
- D.P.T "Diphtheria, Pertussis & Tetanus".
- M.M.R "Measles, Mumps & Rubella
Contraindications to child immunization:
 There are almost no contraindications to vaccination.
 It is safe to immunize children even if they are mild or
moderately ill.
 Absolute contraindications are:
 Anaphylaxis following a previous dose of the relevant
vaccine.
 Live vaccines shouldn't be administered to child who is
significantly immuno compromised
 Age Vaccine Dose
Vaccination Schedule Route
At birth HBC 0.5 ml Intramuscular in the
right thigh
0-3 months BCG (TB 0.05 ml Intradermal in the left
The 1st 7 days vaccine) 2-3 drops upper arm.
Polio On the tongue
2,4,6 months Polio 2-3 drops On the tongue.
DPT vaccine 0.5 ml Intramuscular in the
HIB (homophiles right thigh
influenza b)
Hepatitis B vaccine
Salk vaccine 0.5 ml Intramuscular in the
right thigh
9 months polio 2-3 drops On the tongue
12 months Capsule of vit A Vit A Oral.
MMR capsule Subcutaneous in the
Polio 0.5 ml right arm.
18-24 months Booster DPT 0.5 ml Intra muscular
Polio 2-3 drops in the left thigh.
MMR 0.5 ml Oral
S.C in the right
arm.

At school entry BCG 0.1 ml Intradermal

age (5-6 years) DT 0.5 ml Deep I'm
Polio Drops 2-3 drops Oral
Meningitis 0.5 ml S.C
 1) BCG vaccine:
Characteristics:
*Protects against tuberculosis.
*It is given intradermal.
Type: Live attenuated. Dose: 0.05-0.1cc.
Time: Before 3 months.
Reactions to vaccine:
- Hypersensitivity reaction:
- After injection, circle appears with diameter (8ml) then, disappears after half
an hour.
- After 2-4 weeks, red spots appear converted to ulcer then, healed after six
weeks by itself leave mark pointed to vaccination.
Nursing care:
- Instruct mother that it is normal and do not put any antibiotic or cream.
- Apply dry gauze on it.
- Tell her if scare not present, vaccination must be repeated after 3 months
 2) Polio vaccine:
Reactions to vaccine:
No reactions to vaccine.
Types of polio vaccine:
Sabin vaccine: (Trivalent oral polio vaccine TOPV).
Salk vaccine: (Inactivated polio vaccine IPV).
3) DPT vaccine and Hepatitis B:
Reactions to vaccine:
Fever:
It continues for one day. If it appears after 24 hours, it is not from
vaccination but from other disease.
Nursing actions:
- Give antipyretic medication such as acetaminophen 15mg/kg given
every 4 hours of injection and also to increase the immune response
by adjuvant effect.
N.B: Do not give aspirin because it potential causes gastrointestinal
bleeding and recent links with Reyes' syndrome.
- Child should have light clothes.
- Bathing child by tape water and cloth piece.
Local ulcer:
Nursing actions:
Reassurance until the local ulcer disappears after 3-4 days.
Abscess:
If pain and swelling begin after week, it is due to abscess which may
result from:
- Non sterilized needle.
- Vaccine is not deep enough.
- The syringe is on unclean place.
Nursing actions:
Refer the child to the doctor
Convulsions and shock:
Result from pertussis vaccine. Instruct the mother if this appears
during 3 days of injection, do not give DPT again but give DT.
 4) Measles vaccination:
Reactions to vaccine:
Fever, rash, joint pain and encephalitis.
Nursing actions:
Give antipyretic medication.
Assurance.
Contra indications:
Immuno-suppressed patients.
Children with a history of seizures
 5) Homophiles influenza vaccine b (HIB)
HIB vaccine prevents serious infections caused by a type of bacteria
called Homophiles influenza type b such as meningitis which added
to obligatory vaccine in Egypt at January, 2008
The HIB vaccine is available as:
1) HIB (alone)
2) HIB in combination with DPT (Diphtheria-Tetanus Pertussis)
vaccine
3) HIB in combination with DPT (Diphtheria-Tetanus- Pertussis) and
IPV
(Inactivated Polio) vaccines
4) HIB in combination with recombinant hepatitis B (HBV) vaccine
5) HIB in combination with meningococcal vaccine
 Administration of vaccination
Equipment:
1- Alcohol pads. 2- Appropriate size syringe with needle. 3- The required vaccine.
Assessment:
1- Assess child for history of illness or exposure to infections, illness, or childhood
disease.
2- Assess the child for the following special circumstances:
- Prematurity: premature infant should be immunized at the usual chronologic age.
- Immune deficient or immunosuppressed children: live virus vaccines of all types
are contraindicated in patients with congenital disorders of immune system.
- HIV infection: live viral and bacterial vaccines are contraindicated in children
with symptomatic HIV infection because of the risk of serious adverse effects;
Asymptomatic HIV-seropositive children should be immunized according to
schedule.
3- Assess for allergic reaction to previous immunization or sensitivity to egg
 Steps Rationale
1-Perform hand washing. Reduces transmission of microorganisms
2-Prepare equipment for the Labeling the vaccine insures correct
administration of the immunization vaccine given by the correct route.
Preparation can reduce child and parent
anxiety

3-Check vaccine bottle for color, clarity

and expired date
4-Have epinephrine (1:1000) available
for immediate use as an anaphylactic or
allergic reaction occur (0,01ml/kg).
5-Wear gloves Reduces transmission of microorganisms
6-Obtain the vaccine and draw up in syringe

7-Adequately restrain the child before the injection.

8-Select site of injection according to type of vaccine
9-Inject the vaccine in a site as free as possible from the
opportunity for a local neural, vascular, or tissue injury
10-Comfort the child after immunization.
11-Institute pain relief measures using a topical anesthetic
according to manufacturer's instruction.
12-Record the following data into the child's medical record
and the child personal record: Month, day, and year of
administration, Vaccine administered Site and route of
administering vaccine, Adverse reactions and provider of
administering vaccine
13-Evaluate child for immediate
response to vaccine
administration

14-Keep the child in the health If the child is going to have a

facility for 20 minutes after the life-threatening reaction to the
injection immunization
 The cold chain
Is a system of storage and transport of vaccines at recommended
temperature from the manufacturer to the actual vaccination site.
The Cold Chain storage equipment:
Cold chain storage equipment consists of :
a) Walk in cold rooms: They are located at regional level, meant to
store vaccines up to 3 months.
b) Deep freezers (300 ltr): supplied to all districts and the PHC level. At
PHC used
only for preparation of ice packs. Temperature is -15 o to -25o.
c) Ice lined refrigerator: supplied to districts and the PHC level.
Temperature is +2 o to +8 o. Top opening is better than front opening
refrigerator.
Instructions regarding vaccine storage:
Don't place fridge in direct sunlight
Don’t store vaccine in fridge door
Place the fridge in well ventilated room
Fridge should be placed 10-15cm away from wall.
The Cold Chain transporting equipment:
a) Cold boxes: These are used for transportation of large amount of
vaccines.
Ice packs should be placed on all sides and bottoms.
b) Vaccine carriers: are used to carry small quantities of vaccines (16-
20 vials). 4 fully frozen ice packs are used for lining the sides.
c) Day carriers: carry very small amount of vaccine (6-8 vial). 2 ice
packs are used for 2hr.