Vaccination
Definition
Vaccination is the use of vaccines to produce immunity to specific diseases.
Purpose
Many diseases that once caused widespread illness, disability, and death now can be prevented through the use of vaccines. Vaccines are medicines that contain weakened or dead bacteria, viruses, or pollen antigens. When a person takes a vaccine, his or her immune system responds by producing antibodies—substances that weaken or destroy disease-causing organisms. When the person is later exposed to live bacteria or viruses of the same kind that were in the vaccine, the antibodies prevent those organisms from making the person sick. In other words, the person becomes immune to the disease the organisms normally cause. The process of building up immunity by taking a vaccine is called immunization.
Vaccines are used in several ways. Some, such as the rabies vaccine, are given only when a person is likely to have been exposed to the virus that causes the disease, such as through a dog bite, for example. Others are given to travelers planning to visit countries where certain diseases are common. Vaccines such as the influenza vaccine, or "flu shot," are given mainly to specific groups of people—older adults and others whose health is at high risk if they develop influenza or its complications. Then, there are vaccines that are given to almost everyone, such as the one that prevents diphtheria.
Children routinely have a series of vaccinations that begin at birth. The American Academy of Pediatrics recommends that children be fully immunized before the age of two years in order for them to be protected during their most vulnerable period. Given according to a specific schedule that is issued every year by the Department of Health, these vaccinations protect against hepatitis B, diphtheria, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox), polio, and Hemophilus influenza type B (HiB). This series of vaccinations is recommended by the American Academy of Family Physicians, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention and is required in all states before children can enter school. All states will make exceptions for children who have medical conditions such as cancer that prevent them from having vaccinations, and some states also will make exceptions for children whose parents object for religious or other reasons.
Vaccines are also available for preventing anthrax, cholera, hepatitis A, Japanese encephalitis, meningococcal meningitis, plague, pneumococcal infection, tuberculosis, typhoid fever, and yellow fever.
Some vaccines are combined in one injection, such as the measles-mumps-rubella (MMR) or diphtheria-pertussis-tetanus (DPT) combinations.
Precautions
Vaccines are not always effective, and there is no way to predict whether a vaccine will "take" in any particular person. To be most effective, vaccination programs depend on whole communities participating. The more people who are vaccinated, the lower everyone's risk of being exposed to a disease. Even people who do not develop immunity through vaccination are safer when their friends, neighbors, children, and coworkers are immunized.
Like most medical procedures, vaccination has risks as well as substantial benefits. Anyone who takes a vaccine should make sure that he or she is fully informed about both the benefits and the risks. Any questions or concerns should be discussed with a physician or other health care provider. The Centers for Disease Control and Prevention, located in Atlanta, Georgia, is a good source of information.
Vaccines may cause problems for people with certain allergies. For example, people who are allergic to the antibiotics neomycin or polymyxin B should not take rubella vaccine, measles vaccine, mumps vaccine, or the combined measles-mumps-rubella (MMR) vaccine. Anyone who has had a severe allergic reaction to baker's yeast should not take the hepatitis B vaccine. Patients who are allergic to antibiotics such as gentamicin sulfate, streptomycin sulfate, or other aminoglycosides should check with their physicians before taking influenza vaccine, as some influenza vaccines contain these drugs. Also, some vaccines, including those for influenza, measles, and mumps, are grown in the fluids of chick embryos and should not be taken by people who are allergic to eggs. In general, anyone who has had an unusual reaction to a vaccine in the past should let his or her physician know before taking the same kind of vaccine again. The physician also should be told about any allergies to foods, medicines, preservatives, or other substances.
People with certain other medical conditions should be cautious about taking vaccines. Influenza vaccine, for example, may reactivate Guillain-Barre syndrome in people who have had it before. This vaccine also may worsen illnesses that involve the lungs, such as bronchitis or pneumonia. Vaccines that cause fever as a side-effect may trigger seizures in people who have a history of seizures caused by fever.
Certain vaccines are not recommended for use during pregnancy, but some may be given to women at especially high risk of getting a specific disease such as polio. Vaccines also may be given to pregnant women to prevent medical problems in their babies. For example, vaccinating a pregnant woman with tetanus toxoid can prevent her baby from getting tetanus at birth.
Women should avoid becoming pregnant for three months after taking rubella vaccine, measles vaccine, mumps vaccine, or the combined measlesmumps-rubella (MMR) vaccine as these could cause problems in the unborn baby.
Women who are breastfeeding should check with their physicians before taking any vaccine.
Description
Vaccinations can also be called shots or immunizations. Most vaccines are given as injections, but a few, such as the oral polio vaccine, are given by mouth.
The time involved in administering vaccinations is minimal; however, the nurse should allow time before and after the procedure for answering questions and for monitoring the patient for potential side-effects up to 30 minutes following a vaccination.
Most insurance companies cover routine vaccinations. The patient should be advised to check with their provider for their current list.
Recommended dosage
The recommended dosage depends on the type of vaccine and may be different for different patients. The health care professional who administers the vaccine will decide on the proper dose.
A vaccination health record will help parents and health care providers keep track of a child's vaccinations. The record should be started when the child has his or her first vaccination and should be updated with each additional vaccination. While most physicians follow the recommended vaccination schedule, parents should understand that some flexibility is allowed. For example, vaccinations that are scheduled for age two months may be given anytime between six and 10 weeks. When possible, follow the schedule. However, slight departures will not prevent the child from developing immunity, as long as all the vaccinations are given at around the right times. The child's physician is the best person to decide when each vaccination should be given.
Anyone planning a trip to another country should check with a health care provider to find out what vaccinations are needed. Some vaccinations must be given as much as 12 weeks before the trip, so getting this information early is important. Many major hospitals and medical centers have travel clinics that can provide this information. The Traveler's Health Section of the Centers for Disease Control and Prevention also has information on vaccination requirements.
Complications
Most side-effects from vaccines are minor and easily treated. The most common are pain, redness, and swelling at the site of the injection. Some people may also develop a fever or a rash. In rare cases, vaccines may cause severe allergic reactions, swelling of the brain, or seizures. Anyone who has an unusual reaction after receiving a vaccine should get in touch with a physician right away.
Results
Immunity to a particular disease is expected after one or more vaccinations, depending on the formula of the vaccine used. This immunity is usually permanent, but follow-up doses are required with certain diseases such as tetanus, which requires a booster every ten years.
Vaccines may interact with other medicines and medical treatments. When this happens, the effects of the vaccine or the other medicine may change or the risk of side effects may be greater. For example, radiation therapy and cancer drugs may reduce the effectiveness of many vaccines or may increase the chance of side-effects. Anyone who takes a vaccine should inform their physician about other medicines he or she is taking and should ask whether the possible interactions could interfere with the effects of the vaccine or the other medicines.
KEY TERMS
Anthrax—An infectious disease caused by a type of bacterium. The disease can be passed from animals to people and usually is fatal. Symptoms include sores on the skin.
Antibody—A type of protein produced in the blood or in the body tissues that helps the body fight infection.
Cholera—An infection of the small intestine caused by a type of bacterium. Drinking water or eating seafood or other foods that have been contaminated with the feces of infected people can spread the disease. It occurs in parts of Asia, Africa, Latin America, India, and the Middle East. Symptoms include watery diarrhea and exhaustion.
Encephalitis—Inflammation of the brain, usually caused by a virus. The inflammation may interfere with normal brain function and may cause seizures, sleepiness, confusion, personality changes, weakness in one or more parts of the body, and even coma.
Guillain-Barre syndrome—A disease of the nerves with symptoms that include sudden numbness and weakness in the arms and legs, sometimes leading to paralysis. The disease is serious and requires medical treatment, but most people recover completely.
Pertussis—Whooping cough.
Rubella—German measles.
Tuberculosis—An infectious disease that usually affects the lungs, but may also affect other parts of the body. Symptoms include fever, weight loss, and coughing up blood.
Typhoid fever—An infectious disease caused by a type of bacterium. People with this disease have a lingering fever and feel depressed and exhausted. Diarrhea and rose-colored spots on the chest and abdomen are other symptoms. The disease is spread through poor sanitation.
Yellow fever—An infectious disease caused by a virus. The disease, which is spread by mosquitoes, is most common in Central and South America and Central Africa. Symptoms include high fever; jaundice (yellow eyes and skin); and dark-colored vomit, a sign of internal bleeding. Yellow fever can be fatal.
Health care team roles
Vaccinations are the best way to be protected from life-threatening diseases. Because of the widespread use of vaccines, most of these illnesses are rarely seen in the United States. It is important that the nursing staff remain up-to-date with the current trends in immunization as outlined by the Department of Health. The immunization rates in the health department should be looked at for improvement to ensure that children and patients at risk are fully immunized. The nurse should be able to provide an overview of the principles of vaccination, general vaccination recommendations, routine vaccinations for travelers, and questions on impending flu epidemics. In addition, the nurse should explain the procedure to the patient and answer questions regarding a vaccine's efficacy and its possible side-effects. Brochures may also be available to give to patients to inform them about the reasons for vaccination as well as the risk of potential side-effects.
If a child is being vaccinated, the parent can bring along a favorite toy to help distract the child and make him or her more at ease if there is a delay in being seen. Seeing the same health care provider regularly will enable familiarity to become established, and a parent can hold the child in the lap while the vaccination is being given, making the situation less traumatic.
Needle-free jet injectors, which force the vaccine serum through the skin using a blast of air, are also available in some clinics. They are slightly faster than a needle and could be less painful for the patient, while eliminating the risk of needlestick injuries.
