- Live vaccines may confer life-long immunity but cannot be administered to the immunosuppressed.
- Inactivated and subunit vaccines and toxoids often require multiple doses to protect from infection and generally booster doses are needed following the primary series.
- Children less than 2 years of age are unable to mount T-cell–independent immune responses that are elicited by polysaccharide vaccines.
- Severely immunocompromised individuals should not receive live vaccines, and their responses to inactivated, polysaccharide, toxoid, and recombinant vaccines may be poor.
- The childhood, adolescent, and adult immunization schedules are updated frequently and published annually. These documents can be used to develop an immunization plan for children.
- Immunoglobulin (Ig) provides rapid postexposure protection from measles, hepatitis A, varicella, and other infections that wanes over time.
- Ig adverse effects are often secondary to infusion rate. Slowing the IV infusion rate ameliorate chills, nausea, and fever that may develop during administration.
- Rho(D) Ig prevents Rh-negative mothers from mounting an immune response against hemolytic disease of the newborn. Hemolytic disease of the newborn results when Rh-negative mothers are sensitized to the Rh(D) antigen on the red blood cells of their fetuses.
On completion of the chapter, the reader will be able to:
Distinguish among vaccines, toxoids, and immunobiologics.
Discuss the issues associated with live vaccines and inactivated vaccines, including whole inactivated, polysaccharide, and conjugate vaccines.
Evaluate patient characteristics as potential risk factors for poor immune response to vaccines.
Identify precautions for and contraindications to immunization.
Assess the effect of pregnancy on immunization risk.
Interpret immunization schedules for children and adolescents and determine how best to use these guidelines.
Interpret immunization guidelines for adults and determine how best to use these guidelines.
Compare and contrast immunization schedules for adults and children.
Develop an immunization plan for an immunocompromised patient.
Formulate a plan to increase immunization of the public against Streptococcus pneumoniae.
Recommend appropriate use of immunoglobulin for a variety of disease states.
Formulate a plan for postexposure prophylaxis for an individual exposed to rabies.
Identify reliable sources for current vaccine information.
Immunization is defined as rendering a person protected from an infectious agent. Immunity to an infectious agent can be acquired by exposure to the disease, by transfer of antibodies from mother to fetus, through administration of immunoglobulin (Ig), and from vaccination. Immunization is the process of introducing an antigen into the body to induce protection against the infectious agent without causing disease. An antigen is a substance that induces an immune response. An antibody produced by the humoral arm of the immune system usually is the response that is measured as evidence of successful vaccination. However, the cellular immune response, which is more difficult to measure, is also an important aspect of vaccine response.
This chapter introduces three groups of agents: vaccines, toxoids, and immune sera (together known as immunobiologics). Agents with a limited scope of use, such as agents for bioterrorism or travel, are beyond ...