‫الدرس االول‬

Immunization

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 Introduction
Immunization is a global health and development success story, saving millions of lives every year.
Vaccines reduce the risks of getting a disease by working with your body’s natural defenses to build
protection. When you geta vaccine, your immune system responds .We now have vaccines to
prevent more than 20 life-threatening diseases, helping people of all ages live longer, healthier
lives. Immunization currently prevents 2-3 million deaths every year from diseases like diphtheria,
tetanus, pertussis, influenza, and measles.
The terms ‘vaccination’ and ‘immunization’ don’t mean quite the same thing. Vaccination is the
term used for getting a vaccine — that is, actually getting the injection or taking an oral vaccine
dose. Immunization refers to the process of both getting the vaccine and becoming immune to the
disease following vaccination

Definition of immunity
A condition of being able to resist a particular disease especially through preventing the
development of a pathogenic microorganism or by counteracting the effects of its products.

Immunity is the ability to resist infection by an invading pathogen (bacteria and virus)

Primary immune response means: Immune response with the first exposure to pathogen
recognize the antigen and form antibodies and lymphocyte(memory cells) with the ability to
confer long-lasting immunity by rapid recognize antigen and respond faster and more
effectively than on the first exposure( secondary immune response).

Types of immunity:

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 1. Innate immunity:

The innate immune system is made of defenses against infection that can be activated
immediately once a pathogen attacks. The innate immune system is essentially made up of
barriers that aim to keep viruses, bacteria, parasites, and other foreign particles out of your
body or limit their ability to spread and move throughout the body.

The innate immune system includes:

Physical Barriers

such as skin, the gastrointestinal tract, the respiratory tract, the nasopharynx, cilia,
eyelashes and other body hair.

Defense Mechanisms

such as secretions, mucous, bile, gastric acid, saliva, tears, and sweat.

General Immune Responses

such as inflammation, complement, and non-specific cellular responses. The inflammatory

response actively brings immune cells to the site of an infection by increasing blood flow to
the area.

2. Adaptive immunity:

Adaptive (or acquired) immunity develops throughout our lives. We develop adaptive
immunity when we're exposed to diseases or when we're immunized against them with
vaccines.

Active Immunity
• Active Immunity results when exposure to a disease organism triggers the immune
system to produce antibodies to that disease. Active immunity can be acquired through
natural immunity or vaccine-induced immunity.
• Natural immunity is acquired from exposure to the disease organism through infection
with the actual disease.
• Vaccine-induced immunity is acquired through the introduction of a killed or weakened
form of the disease organism through vaccination.

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 Passive Immunity
• Passive immunity is provided when a person is given antibodies to a disease rather than
producing them through his or her immune system.
• A newborn baby acquires passive immunity from its mother through the placenta.
• People can also get passive immunity through antibody-containing blood products such
as immune globulin, which may be given when immediate protection from a specific
disease is needed.

Definition of immunization
Immunization is the process of becoming protected against a disease. But it can also mean
the same thing as vaccination, which is getting a vaccine to become protected against a
disease

Types of vaccines

Live attenuated vaccines

The virus or bacteria is functional/alive but has been weakened so it can replicate in the
body several times and generate an immune response without causing the diseases

Live attenuated vaccines do not usually cause disease in vaccine recipients who have a
healthy immune system. If a live attenuated vaccine does cause disease, e.g. chickenpox
disease from the vaccine virus, it is usually more mild than disease caught from another
person in the community.

Live vaccines are used to protect against:

▪ Measles, mumps, rubella (MMR combined vaccine)

▪ Oral polio sabin.

▪ Rotavirus

▪ Smallpox

▪ Chickenpox

▪ Yellow fever

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 Inactivated or killed vaccines

Inactivated vaccines do not contain live viruses or bacteria. Viruses in these vaccines are
inactivated or killed.

These types of vaccine can be safely given to a person with an impaired immune system
response. However, a person with an impaired immune system response may not develop
the same amount of protection after immunization as a healthy person receiving the
vaccine.

Example: Salk vaccine and pertussis vaccine.

Toxoid vaccines

The toxins secreted by bacteria are inactivated to make toxoid vaccines. This technique is
reserved for diseases in which the secreted toxins are the main cause of the illness.
Scientists inactivate the toxin by using a diluted chemical solution called formalin. The
resulting inactivated toxin, which is called a toxoid, is harmless.

Examples include tetanus toxoid and diphtheria vaccines.

Toxoid vaccines do not offer lifelong immunity and need to be topped up over time.

Subunit vaccine

Only the portions of the germ that cause an immune response are used to create subunit
vaccines. These portions of the germ are called antigens. Subunit vaccines can contain
from 1 to 20 antigens.

Since only the specific, necessary parts of the germ are used for this type of vaccine, the
adverse events risk is lower.

Examples include the Hepatitis B vaccine.

Scientists can use the following methods to identify and then obtain the antigens:

grow the germ and break it apart to harvest the necessary antigens.

create antigen molecules using DNA technology, Research is continuing on a recombinant

subunit vaccine against hepatitis B.

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 Conjugated vaccines

• Conjugated vaccines: If a bacterium possesses an outer coating of sugar

molecules called polysaccharides, as many harmful bacteria do, researchers may try
making a conjugate vaccine for it. Polysaccharide coatings disguise a bacterium's
antigens so that the immature immune systems of infants and younger children can't
recognize or respond to them. Conjugate vaccines, a special type of subunit vaccine,
get around this problem.

• When making a conjugate vaccine, scientists link antigens or toxoids from a

microbe that an infant's immune system can recognize to the polysaccharides. The
linkage helps the immature immune system react to polysaccharide coatings and
defend against the disease- causing bacterium.

Example: Hemophilus influenzae type B (HIB).

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 Expanded Program of Immunization (EPI)
The Expanded Program on Immunization remains committed to its goal of universal access to
all relevant vaccines for all at risk. The program aims to expand the targeted groups to include
older children, adolescents and adults and work in synergy with other public health programs
in order to control disease and achieve better health for all populations, particularly the
underserved populations

Objectives of expanded Program of Immunization (EPI)

o Sustaining polio-free status
o Eliminating maternal and neonatal tetanus
o Eliminating measles
o Accelerating control of hepatitis B
o Eliminating rubella
o Introducing new vaccines
o Meeting regional vaccination coverage targets

Component of EPI

Within24 hours after birth

Name of vaccine Type of Dose Route Site Storage Side effects

vaccine
HB recombinant 0.5 ml IM Right nd
2 shelf of Redness,
DNA vaccine Thigh swelling, itching,
refrigerator
stuffy nose

1 -3 weeks after Birth

Name of vaccine Type of Dose Route Site Storage Side effects

vaccine
Polio (Sabin) live attenuated 2 drop Oral On tongue In freezer None
vaccine
BCG Live attenuated 0.05 ml ID Deltoid In first shelf Normal Reaction:
vaccine muscle in swelling, abscess,
the left ulcer about 10 MN
upper arm across this ulcer heal
scare Severe
Reaction: deeper
abscess, severe local
inflammation,
swelling of the
axillary lymphatic
gland. This results
from large doses, in
sterile technics.

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 2,4,6 Month

Name of vaccine Type of Dose Route Site Storage Side effects

vaccine
Polio (Sabin) live attenuated 2 drop Oral On tongue In freezer None
vaccine

Fifth vaccine D-T ( toxid ) 0. 5 ml IM Right Second shelf Normal reaction:

(DPT - Diphtheria, P(killed) thigh fever(24h) ,after
Pertussis and HIB(conjugate vaccine pain, swelling
Tetanus) + HB+HIB vaccine. soreness and redness
HB: subunit at the site of infection
vaccine Abnormal reaction:
convulsion due to
pertussis only it is
rare but common in
children with family
history of convulsion,
local pain, swelling
begin week or more
at the sit of injection
due to abscess

Salk vaccine Inactivated polio 0.5 ml IM Left thigh The second It is very safe. Mild
vaccine shelf redness or pain may
be in the site of
injection

6 Months

Name of vaccine Type of Dose Route Site Storage Side effects

vaccine

Vitamin A 1 cap Oral On

tongue

9 months

Name of vaccine Type of Dose Route Site Storage Side effects

vaccine

Polio (Sabin) Live 2 Oral On In freezer None

attenuated drops tongue
vaccine

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 12 months

Name of vaccine Type of Dose Route Site Storage Side effects

vaccine
Polio (Sabin) Live attenuated 2 drops Oral On tongue In freezer None
vaccine

MMR Live attenuated 0.5 ml S.C Right First shelf Normal reaction:-
( Mumps, Rubella, vaccine upper arm Fever (1-3 days) after
Measles ) vaccination, loss of
appetite, Mild rash
may appear.
Abnormal reaction:
after 3-4 weeks, may
develop a mild form
of mumps, swelling-of
gland of checks and
neck under the jaw
that last for1-2 days
Vitamin A 2 cap oral On tongue

18 months

❖ Every six months give the child one capsule of Vitamin A oral for 5 years
Name of vaccine Type of Dose Route Site Storage Side effects
vaccine
Polio (Sabin) live attenuated 2 drop Oral On tongue In freezer None
vaccine

DPT D,T P (killed) 0. 5 ml IM Left thigh Second shelf Normal reaction:

(Diphtheria, fever(24h),after
Pertussis, Tetanus,) vaccine ,pain,
swelling ,soreness
and redness at the
site of Injection
Abnormal reaction:
convulsion due to
pertussis only it is
rare but common in
children with family
history of convulsion,
local pain, swelling
beg in week or more
at the site of injection
may due to abscess.
vitamin A 2capsule oral On tongue

MMR (mumps, Live attenuated 0.5 ml SC Right First shelf As mentioned above.
measles, Rubella) vaccine upper arm

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 Tetanus toxoid vaccine

Number time of dose Duration of Percentage

protection
1 After the first trimester of None 0%
pregnancy.
2 At least 4 weeks after the first 3 years 80-85 %
dose.
3 At least 6months after the second 5 years 85-90 %
dose or during the subsequent
pregnancy.
4 At least 1 year after the third dose 10 years 90-95 %
or during the sub pregnancy.
5 At least 1 year after the fourth During All 99%
dose or during the subsequent childbearing age
pregnancy.

Contraindication of immunization

Absolute contraindication:
• A severe allergic reaction (e.g., anaphylaxis) to a vaccine, the component is a
contraindication to any vaccine containing that component, and a severe allergy following
a dose of vaccine is a contraindication to subsequent doses of that vaccine.
• Severe immunosuppression is a contraindication to live, attenuated vaccines.
• Encephalopathy not due to another identifiable cause and occurring within days of
pertussis vaccination is a contraindication to subsequent doses of pertussis- containing
vaccine.

Relative contraindication:
• Fever.
• Severely ill child.
• Recent transfusion of blood containing antibodies.
• Pregnancy.
• Use of aerosolized steroids, such as inhalers for asthma, is not a contraindication to
vaccination; nor are alternate- day, rapidly tapering, and short (less than 14 days) high-
dose schedules, topical formulations, and physiologic replacement steroid dose
schedules

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 Arrangement of vaccines in the refrigerator:
• Freezer: opv and ice packs to keep vaccines in the refrigerator.

• 1st shelf: MMR and BCG vaccine.

• 2nd shelf: fifth vaccine (DPT+ HB +Hib) , DPT and HB.

• 3rd shelf: DT and TT vaccine.

• Below the third shelf there are solution ampoules for vials and bottles of colored water.
Vaccination session:

Who should be present during the vaccination session and the role of each other?

1. Physician:
• Checks the child medical condition and decide that the child can receive
vaccination.
• Observe the nurses during administration of vaccine.
2. Nurse:
• Give the vaccine to the child and provide health education to the mother about
normal and sever reaction and management of the received vaccines as well as the
appointment of the next visit.
3. Health observer:
• Check records to make sure that the child deserve vaccination and not received it
before anywhere.
• Ensure that the vaccine is valid.

Cold chain
The cold chain is a set of rules and procedures that ensure the proper storage and distribution
of vaccines to health services from the national to the local level. The cold chain is
interconnected with refrigeration equipment that allows vaccines to be stored at
recommended temperatures to protect vaccines from heat and direct sunlight and maintain
their potency and effectiveness.

Safe storage of vaccine

• Keep the refrigerator temperature between (+2°C to+8°C).
• Freezer temperature (-25 to -15C)
• don't store the vaccine in the door shelves.
• Open the door only when necessary.
• Thermometer to monitor temperature.
• Put a notice “warning“ stickers on the box to avoid the wrong use.

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 Cold chain can break by
• Partial/complete failure of The fridge making it unable to hold temperatures between 2°c to
8°c.
• Loss of electrical power to the fridge motor
• Cold chain handling issue as unqualified staff

When cold chain breakdown

• Do not discard vaccines.
• Store exposed vaccines in separate bag or container.
• Return the container/bag to the refrigerator or cold box.
• Once determination is made that this vaccine shouldn't be used, mark the products as
being exposed to cold chain break.

How to prevent break of cold chain:

• check and log temperature twice a day.
• Store only vaccine in refrigerator.
• Open the door only when necessary.
• Never leave vaccine outside the refrigerator.
• Keep fridges away from hot equipment and out of direct sunlight
• Make sure all staff are qualified for vaccine handling

Nursing Roles and Responsibilities in Immunization

Before immunization

• Assess expired date before using the vaccine.

• Maintain a list of capable children for immunization.
• Tell them other about importance of vaccine.
• Ensure right vaccine, right route, right site

During immunization

• Use aseptic techniques and implement infection control ( one syringe for one
Child )
• Nurse should repeat dose of polio of child spit out the drops.
• Educate mother about that lactation has no effect on the potency of vaccines.
• If a child has diarrhea give the vaccine and repeat an extra dose 4-8 weeks.

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 After immunization

• Inform mother about the normal and abnormal reactions of vaccination.

• Inform mother that fever is normal reaction and should make compresses at
the site and give antipyretic
• Inform mother after BCG don't touch injection site, don’t cover or open it,
don't appointment.
• Inform mother to check for the presence of ulcer per scar after BCG vaccine
and if there is no scar repeat dose after 3 months of the previous dose.
• Inform mother about The date of next vaccine for her child.
• Document the date, name, and dose of vaccine given to the child in his record.

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