Immunization

Immunization

Immunization

Immunization is a process of deliberate inoculation of live attenuated or dead vaccines and toxoids to induce immunity against a specific disease.

Immunization against a specific disease provides artificially acquired active immunity.
Artificially acquired immunity against some diseases may require periodic booster injections to keep an adequate antibody level (or antibody titer) circulating in the blood.

A booster injection is the administration of an additional dose of the vaccine to boost the production of antibodies to a level that will maintain the desired immunity. The booster is given months or years after the initial vaccine and may be needed because the life of some antibodies is short.

Types of immunization agents
  1.  Toxoids: is a toxin that is attenuated (or weakened) but still capable of stimulating the formation of antitoxins.
  2. Vaccines
  3. Immune globulins.

Vaccines

Vaccine: Vaccines are special preparations of antigenic materials that can be used to stimulate the development of antibodies and thus confer active immunity against a specific disease or a number of diseases capable of causing fatal consequences.

Types of vaccines
  1.  Live attenuated vaccines: These vaccines contain live microbes that have been weakened (attenuated). Live attenuated vaccines usually confer immunity with a single dose which is of long duration. They may be dangerous in recipients who are immune-compromised because these patients are unable to mount an effective immune response.
    Examples;
    >   Mumps vaccines
    >   Measles vaccines
    >   BCG vaccines
  2.  Killed or inactivated vaccines: This type of vaccines contains whole inactivated microbes. e.g. polio vaccines. Inactivated vaccines may require a series of injections in order to produce an adequate body response and in most cases booster doses are required.
    Examples
    >  DPT (diphtheria, pertussis, tetanus) Vaccine.
    >  PCV(Pneumococcal Conjugate Vaccine)
Indications of vaccines and toxoids:
  1.  Routine immunization of infants and children
  2.  Immunization of adults against tetanus
  3.  Immunization of adults at high risk for certain diseases (e.g., pneumococcal and influenza vaccines)
  4. Immunization of children or adults at risk for exposure to a particular disease (e.g., hepatitis A for those going to endemic areas)
  5.  Immunization of pre-pubertal girls or non-pregnant women of childbearing age against rubella and cervical cancer.

Adverse reactions of Vaccines and Toxoids

Adverse reactions from the administration of vaccines or toxoids are usually mild.

  •  Chills, Fever, muscular aches and pains, rash, and lethargy may be present.
  •  Pain and tenderness at the injection site may also occur.
  •  Although rare, a hypersensitivity reaction may occur.

Contraindications and Precautions of Vaccines and Toxoids
  •  Hypersensitivity
  • Vaccines and toxoids are contraindicated during acute febrile illnesses, leukemia, lymphoma, immunosuppressive illness or drug therapy, and non-localized cancer.
  •  The measles, mumps, rubella, and varicella vaccines are contraindicated in patients who have had an allergic reaction to gelatin, neomycin, or a previous dose of one of the vaccines.
  •  The measles, mumps, rubella, and varicella vaccines are contraindicated during pregnancy, especially during the first trimester, because of the danger of birth defects. Women are instructed to avoid becoming pregnant at least 3 months after receiving these vaccines
POLIO VACCINE

This is a live attenuated vaccine that gives protection against the three types of poliomyelitis that is: type 1, 2 and 3. It is a liquid that comes in two types of vials which have their fixed droppers.

STORAGE

It is stored at the temperature of +2 to +8 degrees centigrade.

INDICATION

  • Active immunization against poliomyelitis.

DOSE

  • It is given two drops orally.
  • If the child has diarrhea, give as usual but administer an extra dose, when administering polio vaccines the dropper should not touch the child’s lips.

KEY ISSUES:

  • Live polio vaccines loses potency opened, therefore any used preparation should be discarded after use.
  • Breast feeding dose not interfere with immunization even though polio vaccine may excreted in the breast milk
  • If vaccines are vomited repeat the dose immediately
INACTIVATED POLIO VACCINES (IPV)

This was introduce by World Health Organization (WHO) to supplement the Oral Polio Vaccine (OPV) due to resistance of poliomyelitis virus of type 2.

STORAGE

  • IPV is sensitive to heat and freezing, it should be stored at +2 to +8 degrees centigrade at all levels of cold chain.
  • Note: freezing and heating of IPV vaccine will lead to the loose of its potency.

DOSAGE

  • It’s given once at the fourteenth week (14 weeks). It is given together with OPV 3, PCV 3, DPT Hep Hib 3.
  • 5mls is administered intramuscularly in the outer aspect of right thigh 2.5cm away from PCV site.
  • IPV is first administered before PCV – because PCV is more painful than IPV.

CONTRAINDICATION

  • Should not be given to children who had previous reaction to streptomycin, poliomixin B, which are components of polio vaccines

ADVERSE EFFECTS of IPV

  • Redness at the injection site
  • Swelling
  • Fever
  • Pain / irritability
BACILLUS CALMATTE GUARIN (BCG) VACCINE
  • BCG vaccine is a vaccine primarily used against tuberculosis. Or it’s used to prevent and protect against tuberculosis. It comes in powder form and it is reconstituted with its diluents of the same company or manufacturer before used
  • It should be given soon after birth or during the first contact.

INDICATION

  • Active immunization against Tuberculosis

CONTRAINDICATION

  • Immune suppressed patients
  • Previous TB infection
  • Generalized edema
  • Generalized skin diseases

STORAGE

  • It should be stored under a temperature of +2 to +8 degrees centigrade.
  • The reconstituted BCG vaccine should be discarded after 6 hours or at the end of the immunization/ session

DOSAGE

  • 05ml are given to infant under 12 month or at births
  • 1ml to children above 12 month.

ROUTE

  • It is given intradermal of the right upper Arm

SIDE EFFECTS

  • Pain at the injection site
  • Keloid formation
  • Localized necrotic ulceration
  • Lymphadenitis

DRUG INTERACTION

Concomitant administration with immune suppressant drugs

 

   PNEUMOCOCAL CONJUGATE VACCINE (PCV)

It is a vaccine which protects children against (pneumonia) pneumococcal infections bacteremia and meningitis.

STORAGE

  • It is stored at the temperature of +2 to +8 degrees centigrade

INDICATION

  • Sickle cell disease in children above 2 years
  • Immune compromised patients above 5 years

CONTRAINDICATIONS

  • It should not be given to infants who had severe allergic reactions previous to the vaccine

DOSE

  • The first dose at 6 weeks.
  • Its given 0.5ml deep subcutaneous in the upper outer aspect of the thigh
  • The Second dose at 10 weeks
  • The third dose at 14 weeks

ADVERSE EFFECTS

  • Pain
  • Redness and swelling
  • Fever (38 degrees centigrade)
  • Drowsiness
  • Irritability and crying
  • Loss of appetite
  • Hardness at the site of injection
DPT-HEPB-HIB VACCINE

This vaccine protects the children against the five diseases, that’s why it’s called a prevalent vaccine. And the five diseases include

  • Diphtheria
  • Pertussis (whooping cough)
  • Tetanus
  • Hepatitis B
  • Hemophilus influenza of type B infection

SIDE EFFECTS

  • Fever
  • Head ach
  • Irritability
  • Swelling of the limb
  • Loss of appetite

STORAGE

  • It should be store at the temperature of +2 to +8 degrees centigrade. The vaccine should not be freezed because it can be damaged by freezing and it separated away from the freezing compartment
  • Mark the date of opening and should not exceed 4 weeks from the date of opening to avoid contamination   

DOSE

  • 5ml intramuscularly on the mid upper aspect of the left thigh.
  • It’s given in the first contact at 6 weeks
  • Second dose at 10th week
  • Third dose at 14th week  
  • Note NEVER give DPT-HEPB-HIB vaccine to the buttocks because it can damage the nerves in the injection site

CONTRAINDICATIONS

  • Every sick children who are admission should receive their vaccination at the time of discharge
  • Children with the history of convulsions within 2 day or 48hourse fallowing the vaccination of previous same vaccine
  • Children one year of age

ADVERSE EFFECTS

  • Fever
  • Sore at the site of injection
  • Abscess may be formed a week or more after vaccination because of abnormal reaction which is takes place due to
  • The use of un sterile needles
  • The may not have been injected to the muscle
  • Improper insertion of the needle during the vaccine administration
  • Failure to hold the baby well
  • None cleaning and wiping of the site well

The side effects are managed like;

  • Fever by tepid sponging the child and giving Paracetamol
  • Abscess by giving antibiotics

  Mother or the care taker is also health educated on how to be responsible following the health talk before discharge

 

TETANUS TOXOID VACCINE

The vaccine is an inactivated tetanus toxoid toxin that protects against Tetanus. It is an injection which comes in a vial containing 10 or 20 doses

STORAGE

  • It should be stored at the temperature of +2 to +8 degrees centigrade
  • It not be frozen and it should be kept away from the freezing chamber (fridge)
  • If it freezes shake test is performed

INDICATION       

  • Active immunization against tetanus and Neonatal tetanus

DOSE

  • It is given to all women of child bearing age between 15 to 45 years  
  • First dose;
  • It is given 0.5mls deep subcutaneous or intramuscular injection on the upper arm at the first contact or as early as possible during pregnancy (TT 1).
  • Second dose
  • 5mls at least 4 weeks after (TT 1) or during subsequent pregnancy
  • Third dose
  • 5mls at least 6 month after (TT 2) or during subsequent pregnancy
  • Fourth dose
  • 5mls at least 1 year after TT 3
  • Fifth dose
  • 5mls at least 1 year after TT 4

ADVERSE EFFECTS

  • Mild pain
  • Redness
  • Warmth or swelling for 1 to 3 days
  • All children should be immunized against because the antibodies transferred from the mother before birth lasts for a short time about 6 weeks
  • To have a long life protection against tetanus is to make you complete the five doses of tetanus toxoid vaccines required and ensure safe delivery practice
MEASLES VACCINES
  • It is a live attenuated vaccine that protects children against measles.
  • It must be reconstituted with its diluent from the same manufacturer

INDICATION

  • Active immunization against measles

STORAGE

  • It should be stored between the temperatures of +2 to +8 degrees centigrade
  • It can be stored at freezing temperature and it diluent kept at room temperature

CONTRAINDICATION

  • Hypersensitivity to any antibiotic present in the vaccine like neomycin and kanamycin.
  • Hypersensitivity to ages
  • Pregnant mothers
  • Immune suppressed patients

 SIDE EFFECTS 

  • Fever
  • Restlessness

ADVERSE EFFECTS

  • Pain within the 24 hours of immunization.
  • Tenderness at the injection site within the 24 hours of immunization which will resolve after 2-3 days without any medication or treatment.
  • Fever which may occur after 1-3 days of immunization
  • All children in the age between 6-9 month are admitted to the hospital should be given the dose of measles vaccine during the outbreak of measles

Cold Chain

Cold chain a system that ensures safe storage and maintenance of vaccines from the manufacturer to the consumer.

Vaccines are different from medical supplies because they are easily damaged by heat or sunlight therefore they need special care to keep them safe until they are used.
What does a cold chain consist of? It consists of the following;
– People
– Equipment/tools
– Procedure
The people
These organize and manage vaccines, they transport vaccines from;
– The manufacturer to Entebbe airport
– To National Medical Stores
– To the Hospitals, Health Centre, Dispensaries, sub-dispensaries and
maternity units
– Mobile clinics and outreach sessions.
Equipment
– Needed to store and transport vaccines.
– It keeps the vaccines properly cold at every place it is stored.
The procedures
– These set rules for the people and equipment on how to take care of
vaccines.
– Part of the procedures are records of how much vaccines have been
received and used.
– These records help people who supply in monitoring these vaccines.
– It also helps them find out problems in handling and wastage of vaccine.

Care of vaccines


a) When being delivered in Respective Places

– Vaccines are carried in Refrigerators from the manufacturer to Entebbe.
– From there vaccines are passed down through cold chain by vehicles to
District Medical Stores for supply to the Hospitals, Health Centres and
other lower units.
Note
– Make sure that the proper vaccines in the proper quantities are in place
where they are needed at the right time.
– Keep vaccines out of sunlight and heat.
– Keep vaccines at a temperature + 2 – + 8 o c
– Care properly for equipment by keeping it clean and in good working
order.


b) At Health Facility
– Vaccines are kept in a refrigerator and temperature monitored morning to evening and charted.
– Vaccines should be arranged in proper order in the fridge i.e.
>   First in first out
>   Polio, BCG, Measles should be near the deep freezer.
>   DPT, Hep B, Hib, PCV, Tetanus toxoid should be a distance away
from the deep freezer.

– Vaccines that are to be used that day should be removed at once to
avoid over opening of the fridge.
– A vaccine control book should be used to register vaccines in and out of
the Refrigerator.


c) At the Immunization site
– Vaccine carriers are used to store vaccines for use at the site or outreach.
– Frozen ice packs are put in vaccine carriers to keep the vaccines at the
right temperature.
– A sponge is put on top of the vaccine carrier to prevent the ice packs
from getting hot and keep the right temperature.
– During the immunization session, the vaccine vial monitor should be
looked at/monitored to assess whether vaccines are still potent.

– After the immunization session DPT and polio vaccine if the Vaccine vial monitor (VVM) is still
white, they are put back in the fridge BUT they should be used first on the
net session.
– Measles, BCG and PVC should not be put back in the fridge for the next
use/session.
NB. While withdrawing the vaccine from the vial, we should ensure that the
vial is handled with care to prevent wastage of vaccine.

Defrosting the fridge/cleaning
– The fridge is supposed to be cleaned and more so if it is frozen.
– Remove all the vaccines and pack them in polythene bags with ice packs.
– Switch off the fridge and let the ice get defrosted then clean the fridge.
– Switch it on and place the thermometer in the fridge, so that the right
temperature is reached.
– When the right temperature is reached ( + 2 – + 8 o c) the vaccines are put back
and in proper order and according to expiry date (first in first out).

 IMMUNOGLOBULINS

Immunoglobulins are proteins produced by the plasma cells and lymphocytes and have characteristic of these types of cells     OR

Immunoglobulins are solutions obtained from human or animal blood containing antibodies that have been formed by the body to specific antigens

The five substances of antibodies are;

(1) Immunoglobulin A (IgA) which is found in high concentration in the mucus membrane particularly those lining the respiratory passages and gastrointestinal tract as well as saliva and tears

(2) Immunoglobulin G (IgG) is the most abundant type antibody found in all body fluids and protects against bacterial and viral infections.

(3) Immunoglobulin M (IgM) it’s found mainly in blood and in the lymph fluids is the first antibody to be made by the body to fight against new infections

(4) Immunoglobulin E (IgE) it’s mainly associated with allergic reaction (when the immune system overreact to environmental antigens such as pollen or pet dander) it is found in the lungs skin and mucous membranes.

(5)  Immunoglobulin D (IgD) it exists in small amount in the blood, it is the least understood antibody.

Note IgA, IgG and IgM are often measured together that way they can give the doctor important information about the immune system functioning especially relating with infection or auto immune diseases.         

Adverse effects
  • Fainting or feeling light head ach
  • Pain at the site of injection

 

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