Immunization schedule

Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an infectious agent (known as the immunogen).

1. Presented by : Ms. Neha jaiswal Year:Bsc (n ) 4 yr Era college of nursing Immunization schedule Guided by : Dr.anjalatchi Vice principal Era college of nursing

2. World immunization day

3. objective To study about the history of immunization. To study about what is immunization. To study about how to describe vaccine. To study about types of vaccine . To study the various immunization schedules.

4. Beginning of history EDWARD JENNER (1749 – 1823) used the term vaccination Cow pox virus provided immunity in prevention of small pox.

5. INTRODUCTION IMMUNIZATION is a process of artificially inducing immunity or providing Protection from disease .

6. VACCINE VA CCINE is a immuno -biological substance designed to produce specific Protection against a given disease .

7. Types of Vaccines Scientists decide the best approach to design a vaccine depending on the disease-causing agent, how it infects the cell and how the immune system responds to it.  The following are the main type of options that currently exist:

8. Type of vaccine

9. World wide report

10. Attenuated (Live) Vaccines Live, attenuated vaccines currently recommended as part of the U.S. Childhood Immunization Schedule include those against measles, mumps, and rubella (via the combined MMR vaccine), varicella (chickenpox), and influenza (in the nasal spray version of the seasonal flu vaccine). In addition to live, attenuated vaccines, the immunization schedule includes vaccines of every other major type—see the table above for a breakdown of the vaccine types on the recommended childhood schedule . Examples of live vaccines include: The varicella -zoster vaccine, oral poliovirus (OPV) vaccine and yellow fever virus vaccine.

11. Charateristic

12. Live, Attenuated Vaccines Attenuated vaccines can be made in several different ways. Some of the most common methods involve passing the disease-causing virus through a series of cell cultures or animal embryos (typically chick embryos). Using chick embryos as an example, the virus is grown in different embryos in a series. With each passage, the virus becomes better at replicating in chick cells, but loses its ability to replicate in human cells. A virus targeted for use in a vaccine may be grown through—“ passaged ” through—upwards of 200 different embryos or cell cultures. Eventually, the attenuated virus will be unable to replicate well (or at all) in human cells, and can be used in a vaccine. All of the methods that involve passing a virus through a non-human host produce a version of the virus that can still be recognized by the human immune system, but cannot replicate well in a human host. When the resulting vaccine virus is given to a human, it will be unable to replicate enough to cause illness, but will still provoke an immune response that can protect against future infection.

13. Common vaccine

14. Sub-Unit ( acellular ) Vaccines These vaccines do not contain any whole bacteria or viruses at all.  Instead they contain some components, such as polysaccharides (sugars) or proteins, from bacteria or viruses.  These are the parts that our immune system recognizes as foreign, they are the antigens that trigger an immune response.  Even though the vaccine might only contain a few of the thousands of proteins in a bacterium they are enough in themselves to trigger an immune response which can protect against the disease. This method of creating vaccines is used for the Haemophilus influenzae type b vaccine and the acellular pertussis (whooping cough) vaccine.

15. Difference between live and killed vaccine

16. Inactivated (Killed) Vaccines To produce this type of vaccine, bacteria or viruses are killed or inactivated by a chemical treatment  or heat.  Inactivated vaccines are suitable for healthy individuals,  as well as people with weakened immune systems as they do not contain live forms of the microorganism which they are designed to protect against.  Inactivated vaccines do not always create a strong or long-lasting immune response, in the same way as live vaccines, so they usually require repeated doses or booster doses. Examples of inactivated vaccines include: inactivated poliovirus (IPV) vaccine, whole cell pertussis (whooping cough) vaccine, rabies vaccine and the hepatitis A virus vaccine.      

17. Toxoid Vaccines Some bacteria release toxins (poisonous proteins) when they attack the body.  The immune system recognises these toxins in the same way it recognises the antigens on the surface of bacteria. Some vaccines are made with inactivated versions of these toxins.  They are called “ toxoids ” because they look like toxins but are not poisonous.  Examples of vaccines utilising this approach include the diptheria and tetanus vaccine.

18. Types of vaccine Live , attenuated Measles , mumps, rubella (MMR combined vaccine) Varicella (chickenpox) Influenza (nasal spray) Rotavirus

19. 2 . INACTIVATED VACCINE Inactivated/Killed Rabies Hepatitis –A Influenza Polio ( IPV) Hepatitis A

20. 3. TOXOID VACCINE Toxoid (inactivated toxin ) Diphtheria , tetanus ( part of DTaP combined immunization)

21. Subunit/conjugate Hepatitis B Influenza (injection) Haemophilus influenza  type b ( Hib ) Pertussis (part of DTaP combined immunization) Pneumococcal Meningococcal

22. Other available vaccines Live, attenuated -Zoster ( shingles), Yellow fever Inactivated/Killed -Rabies Subunit/conjugate -Human papillomavirus (HPV)

23. Combination of vaccine The aim is to – simplify administration. - reduce costs -minimise the no. of contacts with the health system. Eg. DPT, DT, MMR, DPT& Hep.B, Hep B & Hib, Hep A & B etc.

24. TETANUS TOXOID Intramuscular– upper arm – 0.5 ml Pregnancy – 2 doses - 1st dose as early as possible and second dose after 4 weeks of first dose and before 36 weeks of pregnancy TT booster for both boys and girls at 10 years and 16 years .

25. The booster dose should be given a year after the initial doses. It should be stor ed between 4 and 1 0 deg C.

26. BCG Initial dose birth or as early as possible till one year of age ¨ 0.1 ml (0.05ml until one month of age) ¨ Intra-dermal ¨ Left upper arm ¨ Freeze dried is more stable. Diluent is Normal saline and injected within hrs. BCG Vaccine should be administered with a syringe of 1 ml .

27. HEPATITIS B Birth dose – within 24 hours of birth 0.5 ml Intramuscular Antero-lateral aspect of mid-thigh Rest three doses at 6 weeks, 10 weeks and 14 weeks It should be stored at 2 to 8 deg C. 1 ml in adults, 05ml in children <10 yrs, given IM.

28. ORAL POLIO VACCINE Zero dose – at birth 2 drops Oral First, second and third doses at 6,10 and 14 weeks with Pentavalent-1, 2 and 3 OPV booster with DPT booster at 16-24 months

29. PENTAVALENT VACCINE Simultaneous immunization against diphtheria, Pertuisis & Tetanus, Hep B, Hib. Stored at 4-8 degree C. Given 0.5 ml IM at antero lateral aspect of thigh. Primary 3 doses with a booster in 16 -24 months. DT 5-6 yrs C/I –progressive neurological diseases.

30. ROTAVIRAL VACCINE 3 doses given in 6th, 10th and 14th weeks. It Can be given till one year of age. Dose - 5 drops/0.5 ml orally for prevention of diarrhoea among infants due to rotavirus.

31. IPV 2 fractional doses given in 6th and 14th weeks. Dose – 0.1 ml Given intradermally in Right upper arm

32. MR VACCINE Bivalent Live atteunated against measles and rubella. Given 0.5 ml SC at 9-12 and 16-24 months. Stored 2-8 vial.

33. DPT Primary doses were in pentavalent vaccine. One booster at 16-24 m with OPV booster (antero-lateral side of mid-thigh) and second booster at 5-6 years (upper arm) 0.5 ml Intra-muscular

34. VITAMIN A 1st dose – 1 ml (1 IU) - along-with Measles first dose - Oral Subsequent 8 doses (2 ml or 2 lakh IU) every six months till 5 years of age starting with DPT first booster at 16-24 months Use only plastic spoon provided with Vitamin A solution

35. Japanese encephalitis vaccine

36. IPV vaccine

37. IMMUNIZATION SCHEDULE

38. Preparation of Client and mother Welcomes patient/family and establishes rapport. Explains what vaccines will be given and which type(s) of injection(s) will be given. Answers questions and accommodates language or literacy barriers and special needs of patient/parents to help make them feel comfortable.

39. Medical protocols Identifies the location of the medical protocols (e.g., immunization protocol, emergency protocol, reporting adverse events to the Vaccine adverse Event Reporting system [VAERS], reference material). Identifies the location of epinephrine, its administration technique, and clinical situations where its use would be indicated. Maintains up-to-date CPR certification.

40. Demonstrates knowledge of proper vaccine handling (e.g., maintains and monitors vaccine at recommended temperature and protects from light).

41. Preparation of vaccine Performs proper hand hygiene prior to preparing vaccine. When removing vaccine from the refrigerator or freezer, looks at the storage unit’s temperature to make sure it is in proper range. Checks vial expiration date. Double-checks vial label and contents prior to drawing up. Prepares and draws up vaccines in a designated clean medication area that is not adjacent to areas where potentially contaminated items are placed. Selects the correct needle size for IM and Subcut based on patient ageand/or weight, site, and recommended injection technique

42. Maintains aseptic technique throughout, including cleaning the rubber septum (stopper) of the vial with alcohol prior to piercing it. Prepares vaccine according to manufacturer instructions. Inverts vial and draws up correct dose of vaccine. Rechecks vial label. Prepares a new sterile syringe and sterile needle for each injection. Checks the expiration date on the equipment (syringes and needles) if present. Labels each filled syringe or uses labeled tray to keep them identified

43. Preparation of Article A clean tray containing – Kidney tray for collect wet waste . Paper bag for collect dry waste. Alcohol. A bowl containing cotton ball. Syringe. Sterile needle . Vaccination card. Inchtape.

44. VVM

45. Administering vaccine Verifies identity of patient. Rechecks the provider’s order or instructions against the vial and the prepared syringes. Utilizes proper hand hygiene with every patient and, if it is office policy, puts on disposable gloves. (If using gloves, changes gloves for every patient.) Demonstrates knowledge of the appropriate route for each vaccine. Positions patient and/or restrains the child with parent’s help.

46. Correctly identifies the injection site (e.g., deltoid, vastus lateralis, fatty tissue over triceps). Locates anatomic landmarks specific for IM or Subcut injections. Prepare the site with an alcohol wipe, using a circular motion from the center to a 2" to 3" circle. Allows alcohol to dry. Controls the limb with the non-dominant hand; holds the needle an inch from the skin and inserts it quickly at the appropriate angle (90º for IM or 45º for Subcut).

47. Injects vaccine using steady pressure; withdraws needle at angle of insertion. Applies gentle pressure to injection site for several seconds (using, e.g., gauze pad, bandaid). Uses strategies to reduce anxiety and pain associated with injections. Properly disposes of needle and syringe in “sharps” container. Properly disposes of vaccine vials

48. RECORD AND REPORTING Fully documents each vaccination in patient chart: date, lot number, manufacturer, site, VIS date, name/initials. If applicable, demonstrates ability to use state/local immunization registryor computer to call up patient record, assess what is due today, and update computerized immunization history. Ask for and updates patient’s vaccination record and reminds them to bring it to each visit.

49.   IF A DOSE IS MISSED…   Give the dose at the next opportunity irrespective of the time gap Do not start the schedule all over again

50. IMPORTANCE OF IMMUNIZATION Immunization has helped to reduced the impact of communicable disease on health and wellbeing. Stop vaccine may again lead to epidemic . Save money and time. Immunization is a proven tool for controlling and even eradicating disease .

51. Cold chain

52. DEFINITION The ‘cold chain’ is the system of transporting and storing vaccines at recommended temperature from the point of manufacture to the point of use. 

53. IMPORTANCE Obtaining the vaccines from the manufacturers Storing and transporting the vaccines Maintaining the supply of vaccines Having information about essential equipments, supply of electricity etc Keeping the vaccine at low temperature Protecting the vaccine from sunlight exposure Maintaining the potency of vaccines

54. TYPES OF EQUIPMENTS Vaccine carriers Cold packs Day carriers Refrigerators Walk in cooler

55. METHOD OF CONTROLLING COLD CHAIN Keep the vaccine in appropriate conditions as suggested by manufacturer Follow all the precautions while transporting vaccines Record the temperature of storage place twice a day and preparing the temperature chart Maintain the equipment of cold chain and the appropriate functioning of its components, conducting potency tests from time to time Keep communication system effective and latest

56. NURSING RESPONSIBILITIES Maintenance of cold chain system at immunization centre or during transportation of vaccines to home or clinics with necessary precautions to preserve the efficacy and potency of the vaccines. Care of cold chain equipment and maintenance of recommended temperature for vaccines are crucial aspects of the success of immunization program.

57. VVM monitor

58. References Sources Plotkin , S.A., Mortimer, E.  Vaccines . New York: Harper Perennial; 1988. Plotkin , S.A., Orenstein, W.A., Offit , P.A., eds.  Vaccines.  6th. ed. Philadelphia: Elsevier; 2013.