Source: Hayney MS. Vaccines, Toxoids,
and Other Immunobiologics. In: DiPiro, JT, Talbert RL, Yee GC, Matzke
GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach.
8th ed. http://accesspharmacy.com/content.aspx?aid=8006646.
Accessed July 26, 2012.
- Immunization: process of introducing antigen into body
to induce protection against infectious agent without causing disease.
- Antigens: substances that induce immune response.
- Humoral immune response produces antibodies that can be measured.
- Cellular immune response important but not measurable.
- Vaccines: substances administered to generate protective immune
- Can be live attenuated or killed.
- Toxoids: inactivated bacterial toxins that retain ability
to stimulate formation of antitoxins, antibodies
directed against bacterial toxin.
- Adjuvants: inert substances, such as aluminum salts (i.e.,
alum), which enhance vaccine antigenicity by prolonging antigen
- Immune sera: sterile solutions containing antibody derived
from human (immunoglobulin [Ig]) or equine (antitoxin)
- CDC has comprehensive immunization schedules for children and adults.
- Factors affecting response to immunization
- Viability of antigen (live attenuated vs. inactivated)
- Total dose
between immunization doses
- Number of doses given
- Route and site of administration
- Host factors
- Increasing age
- Underlying disease
- Genetic background
general, inactivated vaccines can be administered simultaneously
at separate sites.
- Inactivated and live attenuated vaccines may be administered
simultaneously at separate sites.
- If live vaccines not administered simultaneously, their administration
should be separated by at least 4 weeks.
- Live vaccines not administered
until maternal antibodies have waned, generally by age 12 months.
- Premature infants should be vaccinated at same chronologic
age using same schedule and precautions for full-term infants (Table 1).
- Pregnant women and postpartum immunization
- Most vaccines are pregnancy category C due to lack of information.
- Administration of live attenuated vaccines should not be done
during pregnancy; inactivated vaccines may be administered to pregnant
women when benefits outweigh risks.
- Universal influenza
immunization recommended for women who will be or are pregnant during influenza
- Administration of live vaccines, such as rubella or varicella,
deferred until postpartum.
- Immunocompromised hosts
- In general, severely
immunocompromised individuals should not receive live vaccines.
- Patients with chronic conditions that cause limited immunodeficiency
(e.g., renal disease, diabetes, liver disease, and asplenia) and
who are not receiving immunosuppressants may receive live attenuated
and killed vaccines, as well as toxoids.
- Patients with active malignant disease can receive killed
vaccines or toxoids but should not be given live vaccines.
- Glucocorticoids may cause suppressed responses to vaccines.
- Wait 1 month to administer live vaccines if on high-dose
corticosteroids or treatment course longer than 2 weeks.
- HIV patients
- Responses to live
and killed vaccines generally suboptimal for HIV–infected
patients and decrease as disease progresses.
- Transplant patients
- General contraindications
- History of anaphylactic
reaction to vaccine or component of vaccine.
- Unexplained encephalopathy occurring within 7 days of dose
of pertussis vaccine is contraindication to future doses.
- Immunosuppression and pregnancy temporary contraindications
to live vaccines.
- Precautions for diphtheria, tetanus toxoids, and acellular
- Hypotonic hyporesponsive episode
- Fever of ≥40.5°C (≥104.9°F)
- Crying lasting >3 hours within 48 hours of previous dose
- Seizures with or without fever ...