Immunizations

Question 1

what are immunizations/vaccines?

Answer 1

highly regulated,
complex biologic products designed to
induce a protective immune response
effectively and safely & economically

Question 2

what is in a vaccine?

Answer 2

immunogen, adjuvant, additives, preservatives

Question 3

immunogen (antigen)

Answer 3

the part of the vaccine that stimulates an immune response; biologically treated to be safe; also basis for the classification of vaccine type

Question 4

adjuvant

Answer 4

added to vaccines to enhance immune response; makes it possible to reduce the dose or number of doses (ie. aluminum salts shown safe over 7 decades)

Question 5

additives

Answer 5

substances to SUPPORT GROWTH of immunogens; confirm product quality; example: gelatin

Question 6

preservatives:

Answer 6

chemicals added to multidose, killed, or subunit vaccines to prevent serious secondary infections
ie. phenol; thimerosal (ethyl mercury) no longer used

Question 7

NOTE re mercury:

Answer 7

no vaccine made in CAN since march 2001 for routine use in children (except flu) contains thimerosal
- DTaP, polio, and Hib vaccines have not contained this preservative since 1997-8 and MMR used in canada has never contained thim

Question 8

live (attenuated) vaccines

Answer 8

vaccine contains whole, living bacteria or viruses that produce immunity by actively replicating in the host; since it replicates within the host is more closely resembles natural infection; longer lasting and broader immunity; caution = immunosuppressed or pregnant

Question 9

killed vaccines

Answer 9

the antigen has been rendered inactive, but the presence of it will still cause an immune response to be built; you need multiple doses of killed vaccines because they take more to be effective; use of live vaccines is preferredo

Question 10

herd immunity

Answer 10

population is immunized to point when the carrier-disease process is interrupted (~90%); protects population; highly significant for vulnerable groups; different dxs have different levels of population vaccination needed to reach herd immunity; most around 85-90

Question 11

what agencies in canada are involved in immunization?

Answer 11

NACI (national advisory committee on immunization)
biologics & genetic therapies directorate
provincial ministries

Question 12

what problems are created by canadas immunization strategy?

Answer 12

no national program
each province sets own program
safety concerns
equity concerns
added expense
- wasted time checking things that should be automated
- cant order completely in bulk
- only developed country without a national immunization program

Question 13

role of RN

Answer 13

have legislative authority to immunize
require: direct order (specific pt) or medical directive (population)
medical directives should be available to treat adverse rxns
clients with known risks for adverse reactions (ie. immuno-comprimised) require RN (EC) or MD assessment
- risk communication
- education
- guidance re: legitimate information sources

Question 14

evaluating health information on the web

Answer 14

NACI *** Best site to go to
Health on the Net
MedCIRCLE (the collaboration for internet rating, certification, labeling and evaluation of health information)
WMA (health-related content websites accreditation programme)
discern.org.uk – has quality criteria for consumer health information

Question 15

what to look at in sites

Answer 15

• evaluate qualifications of authors
• information only to support the MD-pt relationship
• cites the sources of published information
• must back up claims relating to benefits and performance
• accessible presentation, accuracte email contact
• identify funding resources
• clearly distinguish advertising from editorial content

Question 16

googling children’s health: reliability of medical advice on the internet

Answer 16

study structure, results, conclusion & recommendations

Question 17

risk communication

Answer 17

making sure parents understand the pros of immunization and understands their child will be at risk for these things w/o immunization; and can also carry dxs to others

Question 18

guidane re: legitimate information sources for parents

Answer 18

Health on the Net (regularly updated, continuously checked for scientific accuracy)

1. Certification (HON, etc)
2. Government sites (are accurate, may not have the most cutting edge info but will not give bad information) are fine; look at board of directors
3. sites that are selling something are less accurate

Question 19

implications for vaccine refusal

Answer 19

puts population at risk

if too many refusals, especially when based on false data, herd immunity drops below required level