immunizing pharmacist Flashcards
is a biologically derived substance to produce a protective immune response when administered to humans
vaccine
is the act of introducing a vaccine into the body. The desired outcome is to produce immunity against a specific infection or disease
vaccination
is the process by which the vaccination confers protection to the individual
immunization
the extent to which the vaccine prevents disease, and possibly also transmission under ideal and controlled conditions when comparing a vaccinated group with a placebo group
vaccine efficacy
the extent to which the vaccine provides beneficial results under real-world conditions
vaccine effectiveness
measured through randomized control trials
efficacy
measured through observational studies
effectiveness
participants are choses or given specific instructions to reduce the risk
efficacy
in clinical trials, the condition for vaccine immunity are carefully designed and do not represent real human interactions
efficacy
represents how the vaccine will perform in the real world when different variables are at play, such as age, underlying chronic conditions and vaccine storage and administration
effectiveness
allows the public access to vaccines, especially when doctor’s clinics or health centers are inaccessible due to work hours or location
Pharmacy-based Immunization
FDA Advisory
2014-067
Republic Act
10918
is an innovative and interactive practice-based educational program that provides Filipino pharmacists with the skills necessary to become primary sources for vaccine advocacy, education, and administration
Philippine Pharmacists Association, Inc. - IPCP
Level 2
DOH Covid-19 Vaccination Principles
Level 1
General vaccination principles
Level 3
Basic Pre-Clinical skills training
Level 4
Clinical skills training
Roles of a pharmacist
- Educator
- Facilitator
- Immunizer
- ability of the body to tolerate the presence of material
indigenous to the body (self) and to eliminate foreign material (non-self).
Immunity
this ability provides protection from infectious diseases, usually indicated by the presence of an ________
antibody
produced by the person’s own immune system
(Acquisition of
protection)
active immunity
transferred from another person or animal
(Acquisition of
protection)
passive immunity
permanent (duration)
active immunity
temporary (duration)
passive immunity
occurs after infection or vaccination through the production of immunologic memory
(Source)
active immunity
- transplacental
- blood products
- homologous pooled human antibody (immunoglobulin)
- homologous human hyperimmune globulin
- plasma products
- heterologous hyperimmune serum (antitoxin)
(Source)
passive immunity
involves exposure to the organism
(types of active immunity)
Naturally acquired active immunity
develops upon exposure to the antigen during vaccination
(types of active immunity)
Artificially acquired active immunity
includes transfer of IgG antibodies from mother to
fetus during pregnancy, transfer of lgA antibodies from mother to baby during breastfeeding
Naturally acquired passive immunity
involves IV injection of immunoglobulins or antibodies
Artificially acquired passive immunity
○ weakened form of the “wild” virus or bacteria
○ must replicate to be effective
○ immune response similar to natural infection
○ usually effective with one dose; lasts lifetime
○ severe reactions are possible
○ interference from circulating antibody
○ heat labile
Live attenuated vaccines
weakened form of the “_____” virus or bacteria
(Live attenuated vaccines)
wild
must ______ to be effective
(Live attenuated vaccines)
replicate
immune response similar to ____________
(Live attenuated vaccines)
natural infection
usually effective with ____ dose; lasts _______
(Live attenuated vaccines)
one; lifetime
______ reactions are possible
(Live attenuated vaccines)
severe
interference from circulating _______
(Live attenuated vaccines)
antibody
heat labile
Live attenuated vaccines
○ cannot replicate, and not live
○ minimal interference from circulating antibody
○ not as effective as live vaccines
○ require multiple (3 to 5) doses
○ antibody titer falls over time requiring booster
doses
Inactivated vaccines
_____ replicate, and not live
cannot
_______ interference from circulating antibody
minimal
require multiple (_____) doses
3 to 5
antibody titer falls over time requiring ________
booster doses
Subtypes of inactivated vaccines:
- Whole cell vaccines
- Fractional
- Toxoids
- Polysaccharide vaccines
from whole organisms that have been inactivated by chemical, thermal, or other means.
(Subtypes of inactivated vaccines)
Whole cell vaccines
from components of the whole organism
(Subtypes of inactivated vaccines)
Fractional
inactivated toxins of toxin-producing bacteria
(Subtypes of inactivated vaccines)
Toxoids
polysaccharide is linked to
proteins to increase effectiveness.
(Subtypes of inactivated vaccines)
Polysaccharide vaccines
Type of vaccine
- Live-attenuated
- Inactivated whole cell
- Fractional
- Toxoid
- Conjugate polysaccharide
Only live-attenuated would likely be _____, the remaining categories would usually be IM
SC
Viral: influenza, polio, rabies, hepatitis A, Japanese encephalitis
Inactivated whole cell
viral: measles-mumps-rubella, varicella, herpes zoster, yellow fever. oral polio, influenza nasal spray,
rotavirus, dengue virus
Live-attenuated
Viral: hepatitis B (IM), influenza, acellular pertussis, human
papillomavirus
Fractional
Diphtheria toxoid, tetanus toxoid
Toxoid
pneumococcal, meningococcal,
Haemophilus Influenzae type b (Hib)
Conjugate
polysaccharide
For multi-dose vaccines, vaccine doses administered ______ prior to the minimum interval are considered VALID. This is known as the
○ exception: rabies vaccine (do this ASAP)
≤4 days; “grace period”
Doses of any vaccine administered ≥5 days earlier than the minimum interval or age are _________ and should be
repeated as age appropriate
INVALID
○ refers to the administration of more than one vaccine on the same clinic day, at different
anatomic sites and not combined in the same syringe.
○ increases the probability that the patient will
be fully vaccinated.
Simultaneous administration of vaccines
Any ____________ can be administered either
simultaneously or at any time before or after a
different inactivated or live vaccine
inactivated vaccine
Simultaneous administration of vaccines: rates for adverse reactions are like those observed when vaccines are administered
separately (t or f)
T
Two live vaccines should always be administered on
_________. Otherwise, the live vaccines should be
separated by at least _____ to minimize the
potential risk for interference
the same day;4 weeks
○ If separated by <4 weeks, the second vaccine
administered becomes ________ and the dose
should be repeated at least 4 weeks later.
○ Exception: ________(can be
given <4 weeks after MMR or univalent varicella vaccine.
INVALID; yellow fever vaccine
Live-live
observe spacing
inactivated vaccines interfere ____ with
antibody-containing products
less
administration of inactivated vaccines and
_____ either simultaneously with or at any interval before or after receipt or an antibody-containing product should not substantially impair development of a
protective antibody response.
toxoids
Simultaneous
(Product administered)
- Antibody-containing
products and inactivated
antigen Non-simultaneous - Antibody-containing
products and live antigen
Type of administration
- Simultaneous (during the
same clinic day) - Non Simultaneous
Can be administered
simultaneously at different anatomic sites or at any time interval between doses
Antibody-containing
products and inactivated
antigen Non-simultaneous
No interval necessary
- Antibody containing
products > Inactivated
antigen - Inactivated antigen > Antibody-containing
products
Should not be administered simultaneously
Antibody-containing
products and live antigen
2 weeksb
MMR vaccine, varicella vaccine, and combined
MMRV vaccine antigens > Antibody-containing
products
If simultaneous
administration of
measles-containing
vaccine or varicella
vaccine is unavoidable…….
administer at different
sites and revaccinate
or test for seroconversion after the recommended
interval
Dose relatedb,c
Antibody containing
products > MMR vaccine,
varicella vaccine and combined measles-mumps-rubella varicella (MMRV)
vaccine antigens
- Wait time is at least 3 months or longer before getting MMR, MMRV or varicella vaccine. The time interval allows the antibody
levels to go down thereby decreasing the chance of interfering with vaccine activity.
○ For some cases, the wait could be as long as 11 months, depending on the concentration of antibody in the product that the patient has received.
Blood products given first (before a live vaccine)
- is a series of vaccinations,
including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence.
● It provides a guide for the immunization provider to determine the vaccines needed by a patient.
vaccination schedule
● Advisor Committee
on immunization
Practices (ACIP)
● Centers for Disease
Control and Prevention (CDC)
United States
● Philippine Foundation for
Vaccination (PFV)
● Philippine Society
for Microbiology and infectious Diseases
Philippines: For adult vaccination
● Pediatric infectious
Diseases society of
the Philippines
(PIDSP)
● Philippine Foundation for Vaccination (PFV)
● Philippine Pediatric Society (PPS)
Philippines: For childhood/pediatric
vaccination
is a condition in a recipient which greatly increases the chance of a serious adverse reaction, hence should not be given
contraindication
Permanent contraindications to receiving vaccines:
- severe allergic reaction
- encephalopathy
- severe combined immunodeficiency (SCID)
- history of intussusception
when a part of
intestine slides on the adjacent parts
of the intestine so it blocks food from
passing through
Intussusception
history of intussusception – specific for _______
rotavirus
Signs and symptoms of a severe allergic reaction
- Generalized urticaria (hives)
- Swelling of the mouth and throat
- Difficulty in breathing
- Wheezing
- Hypotensive shock
Common vaccine allergens
- Egg protein
- Gelatin
- Thimerosal (aka thiomersal)
- Neomycin
- Latex
preservative
Thimerosal (aka thiomersal)
present in vaccines prepared using embryonated chicken eggs
Egg protein
used as vaccine stabilizer
Gelatin
prevent microbial growth in multi-dose vaccines
Neomycin
gloves, pre-filled syringe caps, rubber stopper of vials
Latex
is a condition in a recipient which may
increase the chance or severity of an
adverse event, might cause diagnostic confusion, or might
compromise the ability of the vaccine to produce immunity. If present, the vaccine may be deferred
precaution
(true for MMR and
varicella-containing vaccines, but not for
zoster vaccine)
Recent recipient of an antibody-containing
blood product
Temporary precautions to receiving vaccines
- Moderate or severe acute illness
- Recent recipient of an antibody-containing
blood product
Temporary precautions to receiving LIVE vaccines
- Pregnancy
- Immunosuppression
Causes of severe immunosuppression
- Congenital
immunodeficiency, leukemia, lymphoma, or generalized malignancies - Cancer treatment
- Long-term use of high-dose steroid
- HIV infection
- Hematopoietic cell transplant (HCT) recipients
avoid live vaccines
(Causes of severe immunosuppression)
- Congenital
immunodeficiency, leukemia, lymphoma, or generalized malignancies - Long-term use of high-dose steroid
avoid live vaccines; inactivated vaccines may be given
(Causes of severe immunosuppression)
HIV infection
wait for at least 3 months
(Causes of severe immunosuppression)
Cancer treatment
