3.1 Immunization

Question 1

Precautions and Contraindications

Answer 1

Precautions - Conditions in a recipient that increases risk for serious adverse reactions
(Do benefits outweigh the costs)

Contraindications - Conditions in which vaccines should not be administered

Using screening questionnaires for contraindications/precautions should be used before each dose of vaccine is administered.

• IMMUNOCOMPROMISED PATIENTS should generally not receive live vaccines
• PREGNANT WOMEN should not receive live vaccines due to risk to fetus
• ENCEPHALOPATHY (neurological dysfunction) 7 days within administration of pertussis containing vaccines should not receive any other pertussis vaccines.
• SEVERE COMBINED IMMUNODEFICIENCY (SCID) disease and history of INTUSSUSCEPTION are both contraindicated to receive ROTOVIRUS vaccine.

Question 2

Precautions of Vaccines

Answer 2

• Anaphylaxis with previous vaccines (neomycin, streptomycin, gelatin, yeast)
• Pregnancy
• Immunosuppression/deficiency
  (chemo, radiation, SCID, transplant)
• Age < recommended
• Hx of Intussusception
• Severe febrile (fever) illness

Question 3

Contraindications of Vaccines

Answer 3

• Pregnancy
• Cancer
• Anaphylaxis (eggs, gelatin, neomycin, latex, yeast)
• Moderate - Severe illness
• Inconsolable cry (that lasts for hours)
• Seizure
• Shock like syndrome within hours or days of vaccine administration
• Transfusion of blood products within 11 months
• Steroids
• Encephalopathy within 7 days of previous dose (pertussis)

Question 4

Precautions/Contraindications

Answer 4

Precautions
- Immunosuppression (chemo, radiation, SCID, transplant)
- Age < recommended
- Hx (medical history) of intussusception
- Severe febrile (fever) illness

Contraindications
- Cancer
- Moderate-severe illness
- Inconsolable cry
- Seizures
- Shock like syndrome within hours/days of vaccine
- Treatment (Tx) with steroids within 2 weeks
- Encephalopathy within 7 days of pertussis dose

Question 5

Live Vaccines

Answer 5

• MMR
• Varicella
• Rotavirus
• LAIV (Live Attenuated Influenza Vaccine) - sprayed in nose

Question 6

Giving Vaccines to Children

Answer 6

• GO FAST!
• Pre-medications
  (Parents can consider pre-medicating their child before coming in for a shot)
  (Tylenol - Any age)
  (Motrin - 6+ months)
  (Aspirin - Not given to children due to risk of Reye syndrome)
• Comfort Measures

Question 7

Injection Sites for Vaccines

Answer 7

Young children
- Vastus Lateralis (outer thigh)

Older children
- Deltoid

Question 8

Reducing Pain/Anxiety

Answer 8

• Provide support for parents (seeing their child hurt can be traumatic)
  (Educate parents on what’s about to happen, the steps you take, what vaccines you are giving, and the site you will administer it)
• Show parents how to hold their child during the injection
  (Hold child in lap and wrap arm around child’s arms)
  (Infants can be swaddled and leave out one leg)
• Normally parents can be anxious
• Nursing Stregies
  (Distractions, breastfeed, bottle feed, praise children for being cooperative, offer a reward, gently move extremities after giving vaccine)

Question 9

Other Pain Management Strategies

Answer 9

• Coach parent’s to talk to child about comfort positions
• Use pacifier or Non-nutritive sucking
• Dip pacifier in sugar water
• Encourage parent’s to comfort child after injection
• Skin-to-skin contact (kangaroo hold)
• 2 injections at the same time in different sites

Question 10

Immunization Reactions

Answer 10

NORMAL
- Low grade fever
- Slightly decreased appetite
- Tenderness/Redness/Swelling/Rash around injection site

SEVERE
- Anaphylaxis
- Neurologic symptoms

Question 11

Risk of Lower Immunization Rates

Answer 11

• Economic factors
• Limited access to healthcare
• Lack of health services at hours convenient for working parents
• Inadequate information about importance of immunization
• Religious prohibitions
• Philosophical factors

Question 12

Common Reasons Why Parents Dont Immunize

Answer 12

• Concerns about too many vaccines and the dangers of it
• Believe they don’t work
• Disagree with government regulations and monitoring of immunizations
• Child is not at risk for certain diseases so what’s the point
• Internet misinformation
• Popular media influences
• Belief that getting the disease is better for immunity
• Fear of vaccine safety

Question 13

VACCINE SCHEDULE

Answer 13

Hep B - Birth, 2 months, 6-18 months
Rotavirus - 2, 4, 6 months
DTap - 2, 4, 6 months, 15-18 months, 4-6 years
Hib - 2, 4, 6, 12-15 months
PCV13 - 2, 4, 6, 12-15 months
IPV - 4, 6, 12-15, 20 months
Flu - 6 months or greater every year
MMR - 12-15 months, 4-6 years
Varicella - 12-15 months, 4-6 years
Hep A - 2 doses between 12-14 months (6 months apart)
Meningitis - 11-12 years, 16 years
Tdap - 11-12 years, 16 years
HPV - 11-12 years