Immunizations

Question 1

What is an example of a killed (inactivated) vaccine?

Answer 1

Inactivated polio virus vaccine

Question 2

What is an example of a recombinant vaccine?

Answer 2

Hepatitis B

Question 3

What are some reasons why people don’t vaccinate?

Answer 3

1.) Wakefield study- claimed vaccines cause autism
-Study fully retracted and Wakefield’s name was erased from the medical registry

2.) Celebrity claims

3.) Not vaccinating due to poor information could cause people to get sick when it could be avoided
-Lack of understanding, education and promotion from GP, trust
-Fear
-Missed opportunities

Question 4

What is community (herd) immunity?

Answer 4

A situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community.

Question 5

What are the 3 things we do not do when administering a vaccine?

Answer 5

1.) No Z-tracking!
2.) No gloves
3.) DO NOT Aspirate!!!

Question 6

When should a patient with allergies not receive a vaccine?

Answer 6

If a patient has a reaction to a vaccine or who has a history of anaphylaxis to a component of the vaccine - should not receive the vaccine again

Refer to an allergist to determine specific cause and to assess if vaccines should be avoided and for how long

Question 7

During pregnancy what vaccines can be safely used/administered?

Answer 7

Inactivated viral vaccines, bacterial vaccines and toxoids can be used safely in pregnancy

Routinely recommended vaccines may be safely administered to breastfeeding women

Question 8

What is a conjugated form vaccine?

Answer 8

An altered organism joined with another substance to increase the immune response (A conjugate vaccine is a type of subunit vaccine which combines a weak antigen with a strong antigen as a carrier so that the immune system has a stronger response to the weak antigen)

Question 9

what are antigens?

Answer 9

Foreign substances (e.g. bacteria or viruses) in the body that are capable of causing disease. The presence of antigens in the body triggers an immune response, usually the production ofantibodies.

Question 10

What is Passive immunity? How long does its protection last for?

Answer 10

Protection against disease through antibodies produced by another human being or animal. Passive immunity is effective, but protection is generally limited and diminishes over time (usually a few weeks or months). For example, maternal antibodies are passed to the infant prior to birth. These antibodies temporarily protect the baby for the first 4-6 months of life.

Question 11

What must we do/provide during pre-vaccination cousnelling?

Answer 11

1.) Ensure the adult accompanying the child is the parent/legal guardian

2.) Provide information on risks of disease and risks and benefits of vaccine
Provide information on minor side effects and any adverse effects

3.) Determine if there are any precautions or contraindications

4.) Determine risk of anaphylaxis

5.) Discuss wait time post immunization
-Usually about 15 minutes
-Client with anaphylactic allergies, wait 30 minutes

6.) Provide opportunity to ask questions

Question 12

What is an example of a live virus vaccine?

Answer 12

MMR

Question 13

How do you manage anaphylaxis?

Answer 13

1.) Assess circulation, airway, breathing, mental status, skin and body weight. Secure an oral airway if necessary.

2.) Direct someone to call 911 (activate EMS)

3.) Initiate recumbent position

4.) Inject epinephrine (adolescent or adult: max. 0.5 mg; child max. Dose 0.3 mg)

5.) Record time of dose and repeat every 5-15 minutes as needed, for a max. of 3 doses

6.) Stabilize (CPR if necessary), O2

7.) Give adjunctive treatment, if indicated (diphenhydramine hydrochloride or Benadryl) Use to relieve itching, flushing, urticaria, and nasal and eye symptoms

8.) Monitor BP. Cardiac rate and function and respiratory status

9.) Transfer to hospital for observation

Question 14

What are the most common adverse reactions for the Hep B (Recombivax HB, Engerix-B) vaccine?

Answer 14

Common adverse reactions are rash, fever, erythema, swelling, and pain at injection site.

Question 15

When is a vaccine contraindicated?

Answer 15

A vaccine is contraindicated in a person with a history of anaphylaxis after previous immunization of the same vaccine or to any component of the vaccine or its container

Question 16

Does unconsciousness occur with syncope? How is it treated?

Answer 16

1.) Yes - person recovers in minutes

2.) Place patient in a recumbent position

Question 17

What are the precautions for those with significant immunosuppression (live vaccine only)?

Answer 17

If significantly immuno-compromised, live viral or bacterial vaccines may cause serious adverse events because of uncontrolled replication of the virus or bacteria

Question 18

What are the vaccine precautions for those with a history of Guillain-Barre syndrome (GBS) with onset within 8 weeks of a previous immunization?

Answer 18

Subsequent doses of the same vaccine should only be given if the benefit of vaccine outweighs the potential risk of recurrence of the GBS is vaccine is given

Question 19

When does syncope occur? What are its symptoms?

Answer 19

1.) Within seconds or minutes

2.) Pale, nausea, dizziness, ringing in ears, blurred vision, sweating, rhythmic jerking of limbs

Question 20

When should a vaccine not be used/administered?

Answer 20

When a treatment or drug, such as a vaccine, should not be used because the risk outweighs any potential therapeutic benefit

Question 21

What are the most common mild reactions a person could receive post vaccination?

Answer 21

With inactivated antigens, reactions could:
1.) happen within hours, or days
2.) Local tenderness
3.) Erythema (redness)
4.) Swelling
5.) Low grade fever
6.) Behavioural changes (drowsy, reduced appetite)

Question 22

What is a toxoid vaccine?

Answer 22

A toxin treated by heat or chemical to weaken its toxic effects but retains its antigenicity

Question 23

What is a vaccine precaution?

Answer 23

A condition that may increase the risk of an adverse reaction following immunization or that may compromise the ability of the vaccine to produce immunity

Question 24

What are Preservatives (thimerosal)?

Answer 24

Chemicals added to multidose vials to prevent serious secondary infections as a result of bacterial or fungal contamination

Question 25

What is an Adjuvant?

Answer 25

A substance added to a vaccine to enhance the immune response by degree and/or duration making it possible to reduce the amount of immunogen per dose or the total number of doses required to achieve immunity

Question 26

What are the vaccine precautions during pregnancy (live vaccines only)?

Answer 26

If a pregnant woman receives a live vaccine, the infection with the vaccine strain virus or bacteria might affect the fetus
Safety data for other live virus vaccines in pregnant women are very limited
They should not receive live vaccines during pregnancy unless their risk from the illness is clearly greater than the potential risk from the vaccine

Question 27

What are the vaccine precautions for those who have an underlying illness or who are immunocompromised?

Answer 27

Even a less than optimal response may provide important benefit to such patients, who are also at high risk of morbidity and mortality due to vaccine-preventable infection

Question 28

what are additives in vaccines?

Answer 28

Other substances added to vaccines to:
1.) Support growth and purification of specific immunogens and or the inactivation of toxins

2.) Confirm product quality or stability

E.g. Gelatin

Question 29

Why has there been a shift in weather or not we should be vaccinating?

Answer 29

As the incidence of vaccine-preventable diseases is decreasing, the attention of some of the public may shift from the disease and its potential adverse events following immunization.

This shift in focus has resulted, in some cases, in individuals questioning the need for immunization, leading to lower vaccine coverage and resurgence of some diseases

Question 30

What is immunological memory?

Answer 30

is the ability of theimmune systemto respond more rapidly and effectively to pathogens that have been encountered previously, and reflects the preexistence of a clonally expanded population ofantigen-specificlymphocytes

Question 31

Does unconsciousness occur with anaphylaxis? How is it treated?

Answer 31

1.) Not immediately

2.) Epinephrine (how much you’ve given and what time you’ve administered it)

Question 32

What is an example of a toxoid vaccine?

Answer 32

Tetanus toxoid

Question 33

In Canada what are the only marketed adjuvants?

Answer 33

aluminum salts (aluminum hydroxide, aluminum phosphate or potassium aluminum sulfate)

Question 34

What should infants who are breastfed still recive?

Answer 34

Infants who are breastfed should receive recommended vaccines according to the routine immunization schedule

Question 35

What occurs/happens if the cold chain is not properly maintained?

Answer 35

If it is not maintained, it can destroy or reduce the effectiveness of the vaccine

Question 36

What is a recombinant form vaccine?

Answer 36

An organism has been genetically altered for use in vaccines (use another organism to make the vaccine antigen.)

Question 37

How does immunization protect individuals? (on an individual/personal level)

Answer 37

Immunization directly protects individuals who receive vaccines

Question 38

What are antibodies?

Answer 38

A protein found in the blood that is produced in response to foreign substances (e.g. bacteria or viruses) invading the body. Antibodies protect the body from disease by binding to these organisms and destroying them.

Question 39

What is the cold chain and what do you need?

Answer 39

The process where the vaccine is kept at the appropriate temperature
Need: proper storage, equipment and trained personal

Question 40

Is active immunity permanent?

Answer 40

Active immunity is usually permanent, meaning an individual is protected from the disease for the duration of their lives.

Question 41

what is an example of a conjugated form vaccine?

Answer 41

Haemophilis influenzae type b

Question 42

How does vaccination affect/impact herd immunity?

Answer 42

Through herd immunity, immunization against many diseases also prevents spread of infection indirectly (i.e., protects newborns who have not been immunized yet or people who can not be immunized for medical reasons, e.g., immunosuppressed

Question 43

What is an example of a vaccine precaution?

Answer 43

if a patient comes in and they are sick (runny nose, fever, etc)

Body is already unwell so we do not want to give them an immunization because it can make it worse – ask the patient to reschedule or come back in when they are feeling better and no longer have any symptoms)

Question 44

What is a killed (inactivated) vaccine?

Answer 44

Contains micro organisms (bacteria/viruses) that have been killed, but still capable of inducing the body to produce antibodies

Question 45

What can a patient take to help alleviate mild symptoms from a vaccine?

Answer 45

Acetaminophen

Question 46

What is active immunity and how is it acquired?

Answer 46

The production of antibodies against a specific disease by the immune system. Active immunity can be acquired in two ways, either by contracting the disease or through vaccination.

Question 47

When are vaccines deferred?

Answer 47

In general, vaccines are deferred when a precaution exists

Question 48

What is a live virus vaccine?

Answer 48

Vaccine contains a microorganism in live, but attenuated, or weakened form

Question 49

When does anaphylaxis occur after a vaccination? What are some symptoms?

Answer 49

1.) Develops over several minutes

2.) Usually involves AT LEAST 2 body systems