Applied Science University

Faculty of Nursing
Department Of community Nursing

Community Nursing course

Clinical sitting ( UNRWA ) MCH center

Prepared by :

Raed H. Gazawi 200510548

Malek Ahmmad
Mutaz Al lawzi

Submited to :

Dr. Reda AL Mawafi

Accademic year 2009

 Outline

1- Objectives

2- Introduction

3- Defintion

4- Types of vaccines

5- Recommended immunization

6- Storage of vaccine

7- Role of nurse

8- Vaccination schedule (( Roster ))

9- References
Objectives:

At the end of this presentation, the nurse student will be able to:

1- Define vaccination.

2- List different types of vaccines.

3- Describe the cold chain of storage.

4- Explain routine vaccination schedule.

Introduction:

Vaccination is key to preventing disease among the general

population.Vaccines benefit both the people who receive them, and

the unvaccinated people around them, because the infection can no

longer spread.In addition, vaccenation reduce the number of deaths

and disability from infection, such as measles and chickenpox.

Definition of vaccination:

Injection of akilled microbe in order to stimulate the immune

system, the natural disease - fighting system of the body against

the microbe, thereby preventing disease.

Types of vaccines:

Inactivated vaccines: are produced by killing the disease-causing

microorganism with chemicals or heat. Such vaccines are stable
and safe; they cannot return to the virulence ((disease-causing)) form.
They often do not require refrigeration, a quality that makes them
accessible to the people of many developing countries, as well as
practical for vaccinating people who are highly mobile, such as
members of the armed forces. However, most inactivated vaccines
stimulate a relatively weak immune response and must be given
more than once. A vaccine that requires several doses ((boosters)) has a
limited usefulness, especially in areas where people have less access to
regular health care. The flu shot is an inactivated vaccine, as are the vaccines
for cholera, plague, and hepatitis A.

Live, Attenuated Vaccines: To make a live, attenuated vaccine, the disease-causing organism
is grown under special laboratory conditions that cause it to lose its virulence. Although live
vaccines require special handling and storage in order to maintain their potency, and
generally require only one boost, or additional dose. Most live vaccines are injected; some
others, such as the polio vaccine, are given orally. While there are advantages to live vaccines,
there is one caution. There is a remote possibility that the organism may return to a virulent
form and cause disease. It is for this reason that live vaccines continue to be carefully tested
and monitored. For their own protection, people with compromised immune systems such as
people who are taking immunosuppressive drugs, people who have cancer or people living
with HIV are usually not given live vaccines. The vaccines for measles, rubella, and mumps
are all produced from live, attenuated vaccines.

Toxoid vaccines: is an inactivated toxin, the harmful substance produced by a microbe. For
example, the bacterium that causes tetanus is found everywhere in nature, and in an
environment with plenty of oxygen, it is harmless. If that same organism is put into an
environment without oxygen, the organism starts to change and produce tetanus toxin, a
substance far more potent than the well-known poison sodium cyanide. To inactivate such
powerful toxins, vaccine manufacturers treat them with materials to completely cripple any
disease-causing ability. Formalin, a solution of formaldehyde and sterile water, is most often
used to inactivate toxins and produce Toxoids. Toxoids are used to immunize people against
diphtheria.

Conjugate Vaccines: The bacteria that cause some diseases, such as pneumococcal
pneumonia and certain types of meningitis, have special outer coats. These coats disguise
antigens so that the immature immune systems of infants and younger children are unable to
recognize these harmful bacteria. In a conjugate vaccine, proteins or toxins from a second
type of organism, one that an immature immune system can recognize, are linked to the outer
coats of the disease-causing bacteria. This enables a young immune system to respond and
defend . Currently, conjugate vaccines are available to protect against a type of bacterial
meningitis caused by Haemophilus Influenza type B (( HIB )).

Subunit Vaccines: Sometimes vaccines developed from antigenic fragments are able to evoke
an immune response, with fewer side effects than might be caused by a vaccine made from
the whole organism. Subunit vaccines can be made by taking apart the actual microbe, or
they can be made in the laboratory using genetic engineering techniques. Today, subunit
vaccines are used to protect against pneumonia caused by Streptococcus pneumonia. A
recombinant subunit vaccine for hepatitis B virus infection is now licensed for use. The
recombinant vaccine is made by inserting a tiny portion of the hepatitis B virus genetic
material into common baker’s yeast. This process induces the yeast to produce an antigen,
which is then purified. The purified antigen, when combined with an adjuvant, a substance
that stimulates the immune system, results in a safe and very affective vaccine.

Recommended immunization:

Bacille Calmette Guerin (( BCG of Tuberculosis )) : Is the most widely used vaccination
in the world. This vaccine is made of a live, weakened strain of mycobacterium bovis, ((
a cousin of mycobacterium tuberculosis, the tuberculosis bacteria )). It was developed
in the 1930's and it remains the only vaccination available against tuberculosis
today. Reaction: Swelling or slight discharge at the site of injection.

Poliomyelitis (( Polio )): is a highly contagious infectious disease caused by three poliovirus.
The poliovirus affect the whole body, including muscles and destruction to the nervous
system causing paralysis or death. The majority of individuals who are infected with polio,
have no symptoms and few have mild symptoms such as anorexia, vomiting, abdominal pain.
There are two type of polio vaccine:
A: Oral vaccine: It is a vaccine containing live attenuated viruses.
B: Salk vaccine: It is an inactivated injectable form of vaccine.
Reaction: Diarrhea, headache, and/or muscle pain. In countries using IPV, no increased risk
for serious adverse events has been observed. Some people who get IPV get a sore spot where
the shot is given.

Haemophilus Influenza B (( HIB )): This vaccine protects us from the HIB bacteria. This
bacteria causes meningitis, and may cause brain damage. Also this bacteria can infect the
blood, joints, bones, muscles, throat and the cover surrounding the heart. This is especially
dangerous for children because Children can carry this bacteria without showing any signs
of the disease but they can infect others. Reaction: mild fever, unsettled, swelling or soreness
at the injection site

Diphtheria, Pertussis and Tetanus (( DPT )):

Diphtheria: is an infection that attacks the throat, mouth and nose. This is a very contagious
disease, but rare ever since the vaccine was created. Diphtheria can form a gray web that
may completely cover the windpipe and cause someone to stop breathing. Also, if this disease
is not treated right away it could cause pneumonia, heart failure or paralysis.

Pertussis: also called Whooping Cough, is a bacteria that clogs the lungs with mucus . This
can cause a severe cough that sounds like a whoop and allows for other bacteria such as
pneumonia and bronchitis attack the body.

Tetanus: is an infection caused by a bacteria found in dirt and rusty metal. It usually enters
the body through a cut. Tetanus bacteria causes the muscles to spasm. If tetanus attacks the
jaw muscles it causes lockjaw, Tetanus can also cause the breathing muscles to spasm. That
can be deadly.

Reaction: Mild fever, unsettled, swelling or soreness at the injection site.

Measles, Mumps and Rubella (( MMR )):

Measles: Measles is a highly contagious disease that causes a high fever, cough, and a spotty
rash all over. It may also cause ear infections and pneumonia.

Mumps: It is acute virus infectious disease , which may involve many organs
But commonly affects the salivary gland (( mainly parotids glands )).

Rubella: Also called German measles. It is most dangerous for women who are pregnant.
Rubella can cause a mother to have a miscarriage or deliver a baby with heart disease,
blindness, hearing loss or learning problems

Reaction: Mild fever, rash, unsettled, swelling of glands in the cheeks.

Hepatitis B: Is a viral disease that cause acute and chronic liver damage.
It is transmitted by contact with blood of an infected person
Reaction: Mild fever, unsettled, soreness at the injection site, nausea, malaise, muscle or joint
pain.

Hepatitis A: This is not anew vaccine, it has been in use for years, but has
Not been part of the standard recommended vaccine schedule until now.
This viral disease is very mild in infants and children.
Reaction: soreness where the shot was given, loss of appetite and tiredness.

Storage of vaccine: To provide safe storage and transportation for the vaccine, and
maintain their potency we should take into consideration :
1- Don't break the cold chain. The cold chain is the system of transporting
and storing vaccines within the safe temperature range of 2˚C to 8˚C.
2- Use a dedicated vaccine fridge to store all vaccines .
3- Don’t store food, drinks and medical samples in the vaccine fridge.
4- Don’t store vaccines on the door shelves of the vaccine fridge.
5- Don’t place the vaccine fridge in direct sunlight or near heat source.
6- Don’t keep any used vaccine vials in the vaccine fridge.
7- Don’t over filled the vaccine fridge (( less than 55 % )).
8- Monitor and record maximum / minimum and current temperature daily.
9- Rotating stock so that vaccines with the shortest expiry date are used first.

Role of nurse:

1- Welcomes patient/family, establish intimacy and answer any questions.

2- Explain what vaccine will be given and which type of injection.
3- Chick vial expiration date and double chick for label and content.
4- Maintain Aseptic technique while injecting the vaccine.
5- Applies gentle pressure to injection site for several seconds.
6- inform the patient and his family about the reaction.
7- Fully document each immunization in patient chart.
8- Ask the patient to bring with him this chart to each visit.
References:

- Wong's. Essentials of Pediatric Nursing , 2001, 6the edition, Mosby.

- Research: SmithKline Beecham, 2000 childhood immunization.

- Research: U. S. Department of Health and Human Services. Standards for

Pediatric Immunization Practice. Centers for Disease Control and
Prevention (CDC). Atlanta: National Immunization Program.

- www.moh.gov.jo (Statistics of poliomyelitis related to Jordan).