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Course: Pediatric Nursing

Topic: Immunity

The Nurses International Community

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Module Goals

Learners will be able to:

Demonstrate knowledge of principles of immunization
Identify the current recommended immunization schedule for children (0-17 years), components of the immunization card, and the immunization routes
List the possible side effects of vaccines, precautions and contraindications
Discuss barriers and facilitators to immunization
Discuss the nurse’s role concerning immunization

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Immunity

National Cancer Institute, n.d

“The immune system’s way of protecting the body against an infectious disease”

Three types of immunity

Innate
Adaptive/Active
Passive

Other types of immunity

Herd

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Innate Immunity

Inborn defence system
The first line of defense of the immune response
Protects against all antigens
Involves barriers that keep harmful materials from entering the body
Examples include:

Cough reflex
Enzymes in tears and skin oils
Mucus, which traps bacteria and small particles
Skin
Stomach acid

Medline Plus, 2022

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Adaptive/Active Immunity

Occurs when exposure to a disease produces antibodies to the disease
Can last for a lifetime
Acquired through natural immunity or vaccine-induced immunity

Natural immunity:

Acquired from exposure to the disease organism through infection with the actual disease

Vaccine-induced immunity:

Acquired through the vaccination of a killed or weakened form of the disease organism

CDC, 2021

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Passive Immunity

Occurs when an individual receives antibodies to a disease
Provides immediate protection
Only lasts a few weeks or months
Example:

A newborn baby acquires immunity from its mother through the placenta
Through antibody-containing blood products such as immune globulin, which may be given when immediate protection from a specific disease is needed

CDC, 2021

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Herd/Community Immunity

Occurs when a high percentage of the community is immune to a disease (through vaccination and/or prior illness), making the spread of this disease from individual to individual unlikely.

Even individuals not vaccinated (such as newborns and the immunocompromised) are offered some protection because the disease has little opportunity to spread.

Association for Professional in Infection Control and Epidemiology, 2021

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Critical Thinking Question

A nurse is presenting education on vaccines and immunity to parents in the community. What should the nurse include in their presentation? (Select all that apply)

Vaccine-induced immunity produces an immune response that can prevent future infection
Parents who choose not to vaccinate can trust herd immunity to protect their children from vaccine-preventable diseases
Active immunity from vaccines is long-lasting with the immunity from some vaccines lasting a lifetime
Passive immunity from vaccines provides immediate protection from disease
Innate immunity is the immune system’s first line of defense against all antigens

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Immunization Schedule (WHO)

Recommended Routine Immunizations for Children:

Please click the link below to see in detail:

https://cdn.who.int/media/docs/default-source/immunization/immunization_schedules/immunization-routine-table2.pdf?sfvrsn=3e27ab48_9&download=true

WHO, 2022

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Immunization Card

Contains information about the child and immunization history:

A unique identification number (card number)
Name of the infant
Its birth date/sex
Name and address of mother/parent
Date that infant was protected at birth (PAB) from neonatal tetanus
Date of each subsequent immunization and vitamin A supplement given
Date when the next immunization is due

OpenLearn Create, 2017

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Immunization Routes

WHO, 2022

Intramuscular (IM) injection
Subcutaneous (SC)
Intradermal (ID) injection
Oral administration
Intranasal spray application: through the nasal mucosa

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Immunization Routes

WHO, 2022

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Vaccine Types

Live Attenuated Vaccine (LAV):

Derived from disease-causing pathogens that have been weakened

Inactivated vaccine:

Made from microorganisms that have been killed through physical or chemical processes

Subunit vaccine:

They differ from inactivated whole-cell vaccines, by containing only the antigenic parts of the pathogen

Toxoid Vaccine:

Based on the toxin produced by certain bacteria

WHO, 2022

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Vaccine Types Examples

WHO, 2022

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Vaccine Safety and Stability

WHO, 2022

Live Attenuated Vaccine (LAV):

Attenuated pathogen can revert to original form and cause disease
Potential harm with compromised immune system
Sustained infection (BCG -local lymphadenitis)
Contamination of tissue culture

Inactivated Whole Cell Vaccine:

No risk of inducing disease

Subunit Vaccine:

No risk of inducing disease

Toxoid Vaccine:

Does not cause disease, very rare local reaction

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Common Side Effects After Immunization

Better Health, 2022

Fever (temperature over 38.5 °C)
Redness, swelling and tenderness around injection sites
Infants may be unsettled or sleepy
A small, hard lump (nodule)may form at the injection site

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Adverse Reactions Associated with LAV

WHO, 2022

Rare and severe form of Adverse Reactions:

Tuberculosis (BCG):

Fatal dissemination of BCG infection
Very rare at 1.56–4.29 per million doses

Oral polio vaccine (OPV):

Vaccine-associated paralytic poliomyelitis (VAPP)

Measles Vaccine:

Febrile seizures
Transient thrombocytopenia
Anaphylaxis

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Adverse Reactions Associated with LAV

WHO, 2022

Rotavirus vaccine:

Intussusception

Yellow Fever:

Hypersensitivity or anaphylactic reactions
Vaccine Associated Neurotropic Disease (Encephalitis)
Vaccine-associated viscerotropic disease

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Adverse Reactions Associated with Inactivated Vaccines

WHO, 2022

Pertussis (WP):

Prolonged crying and seizures
Hypotonic, hyporesponsive episodes (HHE)

Inactivated Polio Vaccine (IPV):

None known

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Adverse Reactions Associated with Toxoid Vaccine

WHO, 2022

Rare and more severe Reactions:

Tetanus Toxoid:

Anaphylaxis (1.6 per million doses)
Brachial Neuritis (0.69 cases per 10 million)

Diphtheria Toxoid:

Temperature in excess of 40.5 °C (0.3%)
Febrile seizures (8 per 100,000 doses)
Hypotonic–hyporesponsive episodes (0 – 291 per 100,000 doses)

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Contraindications to Vaccines

WHO, 2022

LAV:

Pregnancy (Determine with care provider)
Clients following cancer treatment and for who have finished a cancer treatment for less than 6 months
Anaphylaxis after previous dose
Severe allergy to vaccine component
Severely immunocompromised

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Contraindications to Vaccines

HepB: Anaphylaxis after previous dose, severe allergy to vaccine component and severely immunocompromised.
Rotavirus: Anaphylaxis after previous dose, severe allergy to vaccine component and severely immunocompromised.
Hib: Anaphylaxis after previous dose, severe allergy to vaccine component and severely immunocompromised.
PCV7: Anaphylaxis after previous dose, severe allergy to vaccine component and severely immunocompromised.
Yellow fever: Anaphylaxis, pregnancy and immunocompromised.

WHO, 2022

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Contraindications to Vaccines

BCG: Anaphylaxis (previous dose), severe allergy to vaccine component and severely immunocompromised.
DTwP: Anaphylaxis after previous dose, severe allergy to vaccine component and severely immunocompromised.
DTaP: Anaphylaxis after previous dose, severe allergy to vaccine component.
OPV: Anaphylaxis after previous dose, severe allergy to vaccine component and pregnancy.
IPV: Anaphylaxis after previous dose.
Measles: Anaphylaxis after previous dose, severe allergy to vaccine component and pregnancy.

WHO,2022

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Precautions Related to Vaccines

Some LAVs come in lyophilized (powder) form and must be reconstituted with a specific diluent before administration, which carries the potential for programmatic errors if the wrong diluent or a drug is used.

Many require strict attention to the cold chain for the vaccine to be active and are subject to programme failure when this is not adhered to.

WHO, 2022

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Barriers to Immunization

Anderson, 2014

Lack of knowledge about importance of vaccines on prevention of disease.
Inconvenient and limited clinic hours for immunization.
Inadequate access to health care.
Vaccine administration fees.

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Recommendations to Improve Vaccine Rates

Anderson, 2014

Increase knowledge about importance of vaccination.
Stay up-to-date on latest vaccination recommendations.
Become familiar with new vaccines.
Assure office staff are friendly and supportive of families and encourage vaccination at every opportunity, including mild illness visits.
Reminder/recall systems for clients, families and providers.
Reduce out-of-pocket costs.
Standing orders for immunizations.

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Nurses Role in Immunization

The Chicago School, 2022

Communication:

Provide the public with information and care that guides parental health care decisions.
Educate parents on vaccines’ efficacy and safety.

Administrative Safety:

Ensure the safe handling, storage, and administration of vaccinations.
Take a comprehensive child medical history.
Be aware of any allergies in order to ensure a safe vaccination.

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Nurses Role in Immunization

The Chicago School, 2022

Follow-up:

Responsible for managing the vaccination process post-administration

Recognition and manage of any physical or emotional reactions to vaccines.
Provide necessary medical care to clients with underlying health conditions, collate vaccination data, and maintain clients records.

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Case Study

A mother brought her 6 month old baby to a clinic to be seen for a rash and fever. The nurse noted that the child has not received any vaccinations.

The mother states this is because she heard that vaccines “put the disease in your body” and is afraid that they will make her baby sick or possibly even die.

How should the nurse respond?

What should the nurse explain about vaccinations to the mother?

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The best way for the nurse to respond in this situation is in a non-judgemental and non-condescending manner. However, because the mother does not fully understand how vaccinations work, which is affecting her ability to make an informed decision regarding vaccinating her child, the nurse should explain how vaccinations work. The nurse should include the following key points in their explanation of how vaccines work:

Vaccines need to introduce a dead or weakened form of the disease organism into the body in order to cause the body to have an immune response to that disease. The body’s immune response creates special proteins (antibodies) that are designs specifically to recognize and kill that disease organism if the body is ever exposed to it again. For example, if a child receives a pertussis vaccine, their body will create antibodies to immediately kill the pertussis bacteria if it is detected in the body again, before it has a chance to make the child very sick or sick at all.
There is no chance of getting sick with the disease when the organism in the vaccine is dead (inactivated vaccine) or it is a toxoid based vaccine
There is a chance of getting ill when the disease organism is live (live attenuated vaccine), but because the organism is weakened, this is rare and the illness is usually much milder than the actual disease. The only time the live attenuated vaccines can cause severe or fatal illness is in an individual with a weakened immune system (e.g., from leukemia, treatment with certain drugs, or human immunodeficiency virus [HIV] infection), so the healthcare team makes sure the immune system is not compromised when giving the live vaccine.

(Wodi & Morelli, 2021)

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Red Flags

Severe allergic reactions
Anaphylaxis after immunization
Febrile Seizures
Poliomyelitis

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur
Health customs: In some cultures family members play a large role in health care decision-making
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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References

Anderson E. L. (2014). Recommended solutions to the barriers to immunization in children and adults. Missouri medicine, 111(4), 344–348.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179470/

Association for Professional in Infection Control and Epidemiology (2021). Herd immunity. https://apic.org/monthly_alerts/herd-immunity/

Better Health. (2022). Immunization side effects. https://www.betterhealth.vic.gov.au/health/healthyliving/immunisation-side-effects

CDC. (2021, September 24). Immunity types. https://www.cdc.gov/vaccines/vac-gen/immunity-types.htm

Health Direct. (2021). Immune system. https://www.healthdirect.gov.au/immune-system

Medline Plus. (2022, February 18). Immune response. https://medlineplus.gov/ency/article/000821.htm#:~:text=INNATE%20IMMUNITY,defense%20in%20the%20immune%20response

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References

National Cancer Institute. (n.d). Immunity. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunity

The Chicago School. (2022). What role do nurses play in the vaccination process?. https://www.thechicagoschool.edu/insight/health-care/what-role-do-nurses-play-in-the-vaccination-process/#:~:text=They%20are%20accountable%20for%20post,data%2C%20and%20taking%20patient%20records

The OpenLearn Create. (2017). Infant immunization cards. https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=53371&section=1.3.1

WHO. (2022). Vaccine safety basics: E-learning course. Introduction to Vaccine Safety. https://vaccine-safety-training.org/overview-and-outcomes-1.html

Wodi, A.P., & Morelli, V. (2021, August 18). Principles of vaccination. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/pubs/pinkbook/prinvac.html

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