Chapter 36 Vaccines Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Immunity Active immunity Acquired immunity Passive immunity Body produces antibodies. Natural immunity Acquired immunity Exposed to antigen Passive immunity Receives antibodies from another source Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Vaccines Antigen Attenuated virus Toxoids Conjugate vaccines Recombinant subunit vaccines Adjuvant Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Examples of Vaccine Preventable Diseases Anthrax Diphtheria Haemophilus influenzae type B (Hib) Hepatitis Human papillomavirus Influenza Japanese encephalitis Measles Meningococcal disease Mumps Pertussis Pneumococcal disease Poliomyelitis Rabies Rotavirus Rubella Smallpox Tetanus Tuberculosis Typhoid Varicella Yellow fever Zoster Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Childhood Immunizations Centers for Disease Control and Prevention (CDC) Recommendation for childhood immunizations: www.cdc.gov/vaccines Immunization Action Coalition Summary of rules for childhood immunizations: www.immunize.org/catg.d/p2010.pdf Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Adult Immunizations Centers for Disease Control and Prevention (CDC) Recommendation for adult immunizations: www.cdc.gov/vaccines Immunization Action Coalition Summary of rules for adult immunizations: www.immunize.org/catg.d./p2011.pdf Cocooning Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Immunization Before Foreign Travel All immunizations indicated based on age and/or immunization history Typhoid Yellow fever Meningococcal disease Rabies Japanese encephalitis www.cdc.gov/travel Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Reporting of Disease and Adverse Reactions All health care providers responsible for reporting vaccine-preventable diseases  Contraindications for vaccines Report adverse reactions (VAERS): http://vaers.hhs.gov/index Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Varicella Vaccine Pharmacodynamics Contraindications Mode of action/therapeutic effects Drug interactions Side effects/adverse reactions Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Future of Vaccines Anthrax: www.anthrax.osd.mil Smallpox Pertussis: Adacel, Boostrix Herpes zoster: Zostavax Rotavirus: RotaTeq Human papillomavirus: Gardasil Pneumococci: Prevnar Neisseria meningitides and Haemophilus influenza type B: Menhibrix Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Vaccines Assessment Nursing diagnoses Planning Nursing interventions Patient teaching Cultural considerations Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #1 A patient receives a vaccine that contains components of an inactivated (killed) microorganism. The nurse identifies the type of vaccine as traditional vaccine. attenuated virus. toxoid. recombinant subunit vaccine. Answer: A Rationale: Traditional vaccines contain the whole or components of an inactivated (killed) microorganism. Other vaccines are attenuated viruses composed of live, attenuated (weakened) microorganisms. Toxoids are inactivated toxins, the harmful disease-causing substance produced by some microorganisms. Recombinant subunit vaccines involve the insertion of some of the genetic material (e.g., deoxyribonucleic acid [DNA]) of a pathogen into another cell or organism, where the antigen is then produced in massive quantities. These antigens are then used as a vaccine in place of the whole pathogen. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #2 A physically and medically neglected 15-month-old child has been placed in foster care. The foster parents bring the child to the clinic for immunization updates. They have no idea what, if any, vaccines the child has previously received. The nurse anticipates administering which vaccines? No vaccines; assume the child is up to date DTaP #4, Hib #4, and MMR #1 MMR, IPV, PCV, hepatitis B, and varicella DTaP, Hib, hepatitis B, MMR, IPV, PCV, and varicella Answer: D Rationale: Recommended vaccines for children are diphtheria-tetanus-acellular pertussis, inactivated polio, varicella, measles-mumps-rubella, Haemophilus influenzae type B, hepatitis A, hepatitis B, pneumococcal conjugate, influenza, meningococcal conjugate, human papillomavirus, and rotavirus. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #3 The procedure of immunizing adults in close contact with newborns and young infants to protect the babies from contracting vaccine-preventable diseases in the months before they are eligible to receive the vaccine themselves is called swaddling. isolating. stabilizing. cocooning. Answer: D Rationale: A strategy called cocooning focuses on immunizing adults in close contact with newborns and young infants to protect the babies from contracting vaccine-preventable diseases in the months before they are eligible to receive the vaccine themselves. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #4 Newborns receive immunities via the transfer of maternal antibodies across the placenta. This is known as natural, passive immunity. acquired, passive immunity. natural, active immunity. acquired, active immunity. Answer: A Rationale: Passive immunity occurs when an individual receives antibodies against a particular pathogen from another source. Newborn infants naturally receive passive immunity via the transfer of maternal antibodies across the placenta. Passive immunity may also be acquired through the administration of antibodies pooled from several human or animal sources that have been exposed to disease-causing pathogens. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #5 Before administering the varicella vaccine, it is most important for the nurse to assess the patient for a history of allergy to penicillin. eggs. neomycin. milk. Answer: C Rationale: Varicella vaccine should be avoided in patients with a history of previous anaphylaxis to this vaccine or to any of its components, including gelatin and neomycin. It is also contraindicated in the presence of moderate to severe acute illness or active untreated tuberculosis. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #6 Which statement about Zostivax does the nurse identify as being true? Zostivax is indicated for the treatment of patients at age 40 years. Zostivax is a live attenuated vaccine. Zostivax should be administered every other year. Zostivax prevented the development of zoster in 90% of the people who received the vaccine. Answer: B Rationale: Zostivax is a live attenuated vaccine. Zostavax is licensed for use as a one-time injection in adults age 50 years and older. The vaccine has been shown to boost VZV immunity among vaccine recipients. In clinical trials, Zostavax prevented zoster in about 50% of people who received the vaccine. Effectiveness appears to decrease with increasing age of the vaccine recipient. In those who received the vaccine yet went on to develop zoster, the duration of pain was reduced. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #7 Which is the first vaccine developed to prevent cancer? RotaTeq Prevnar Menhibrix Gardasil Answer: D Rationale: Gardasil, the human papillomavirus (HPV) vaccine, has been called the first vaccine designed to prevent cancer. Prevnar is the first pneumococcal conjugate vaccine, which provides protection against seven serotypes of pneumococci. Menhibrix, a combination vaccine for infants and children age 6 weeks through 18 months, is used for prevention of invasive disease caused by Neisseria meningitides and Haemophilus influenza type b. Rotavirus is a leading cause of severe acute gastroenteritis in infants and young children. RotaTeq, a live oral vaccine containing five strains of rotavirus, is effective in protecting against severe gastroenteritis and significantly reduces the need for hospitalization among infected children. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.