Immunizations Exam Study Guide PDF

Intro to immunizations Immunity -​ Immunity can be acquired by: -​ Exposure to a disease -​ Transfer of antibodies from mother to baby -​ Administration of immunoglobulin -​ Immunization -​ Immunization -​ Provides protection from infectious di...

Intro to immunizations Immunity -​ Immunity can be acquired by: -​ Exposure to a disease -​ Transfer of antibodies from mother to baby -​ Administration of immunoglobulin -​ Immunization -​ Immunization -​ Provides protection from infectious diseases -​ Passive immunity -​ Patient is given antibodies to a disease vs producing antibodies themselves -​ Protection is immediate but short lived (weeks to months) -​ Acquired through -​ Maternal transmission -​ Newborn baby will acquire antibodies through the placenta -​ Immunoglobulin -​ IVIG -​ Blood products -​ May contain antibodies which would provide protection from a sp disease -​ Active immunity -​ Exposure to a disease organism triggers the immune system -​ Protection takes time (weeks) -​ Long lasting protection -​ Acquired through -​ Natural immunity -​ Exposure to the disease organism through infection with the actual disease -​ Vaccine-induced immunity Antigen vs antibody -​ Antigen -​ Substance that induces an immune response -​ Bacteria or virus -​ Antibody -​ Made by your immune system to fight infections -​ Produced by the humoral arm of the immune system  -​ Part of the immune system that uses antibodies to protect your body from harmful germs -​ Can be measured to show evidence of successful vaccination or previous infection conferring immunity -​ Immunoglobulin (another name for antibodies) Immunoglobulins (antibodies) -​ IgA -​ Found in mucous membranes -​ Prevent colonization by pathogens -​ IgE -​ Involved in allergic response and anaphylaxis -​ IgD -​ Appears on the surface of B cells -​ May help to signal when immature B cells are ready to be activated -​ IgM -​ 1st antibody to appear in response to antigen exposure -​ Antigen non-specific -​ Large structure keeps in the intravascular space only -​ IgG -​ Antigen specific -​ Found in intravascular and extravascular spaces -​ Provides majority of immune response and measured in titers Booster doses -​ Often required to maintain immunity with inactivated vaccines] -​ Elicit memory responses from B cells that produce IgG -​ Results in a rapid, intense antibody response that is long lasting Vaccine types -​ Inactivated -​ Created by invacinating (killing) a pathogen -​ Heat or chemicals such as formaldehyde or formalin -​ Destroys pathogen’s ability to replicate, but keeps it “intact” so that the immune system can still recognize it -​ Unable to replicate = unable to revert to a more virulent form  -​ Difference -​ Multiple doses usually needed to gain immunity -​ Booster doses -​ EXAMPLES: hep a, influenza, polio, rabies -​ Live attenuated : **need to know live vaccines** -​ Contain live organisms -​ Weakened (attenuated) form -​ Achieved by passing the disease-causing virus through a series of cell cultures or animal embryos -​ With each passage, the virus becomes better at replicating in chick cells and loses its ability to replicate in human cells -​ Undergo limited replication after administration -​ Can confer lifelong immunity with one dose -​ Concerns with immunocompromised patients -​ EXAMPLES: measles/mumps/rubella, rotavirus, smallpox, chicken pox, yellow fever -​ Messenger RNA -​ mRNA is enveloped in a lipid (fat) sphere -​ Causes the body’s immune cells to take up the vaccine particles and revel the mRNA -​ Gives the cell “code” to make proteins to trigger an immune response -​ Allows for shorter manufacturing time -​ EXAMPLE: COVID 19 -​ Subunit, recombinant, polysaccharide, and conjugate -​ Contains pieces of the pathogen (protein, capsule) -​ Elicit a strong immune response that's triggered to key parts of the pathogen -​ Multiple doses usually needed (booster) -​ Age can impact which version will elicit the best immune response -​ EXAMPLES: hiv, hep b, hpv, pertussis, pneumococcal, meningitis, shingles -​ Toxoid -​ Use an inactivated toxin made by the pathogen to create immunity to the parts of the pathogen that cause disease -​ A toxoid vaccine is a type of vaccine that uses a harmless version of a toxin (poison) produced by certain bacteria. The toxin is treated so it can't make you sick, but your immune system still learns to recognize it and fight it if the real toxin shows up  -​ Immune response is targeted to the toxin vs the whole germ/pathogen, as the disease is caused by the toxin (not pathogen itself) -​ Inactivation is the result of chemical treatment, heat, etc -​ EXAMPLES: diphtheria, tetanus -​ Viral vector -​ Use a modified version of a different virus as a vector to deliver protection -​ A viral vector vaccine uses a harmless virus (not the one you're being vaccinated against) to carry a piece of genetic material from the virus that causes the disease you're being protected from. This "vector" virus delivers the information to your cells, teaching your immune system how to recognize and fight the real virus if it shows up. It’s like a delivery system that helps your body learn how to defend itself -​ Engineered to not replicate (is just a carrier for the gene) -​ EXAMPLES BEING STUDIED: zika, flu, hiv, covid 19 Other vaccine components -​ Adjuvants -​ Stimulate a strong, but short lived inflammatory response -​ Strengthens immune response -​ Vaccines containing adjuvants should be given intramuscularly -​ Can cause irritation when given subcutaneously or intradermally -​ Suspending agents -​ Water, saline or complex fluid containing proteins (albumin) -​ Used as the vehicle for the vaccines -​ Preservatives, stabilizers and antibiotics -​ May be added to help maintain the integrity of the product Adjuvants and vaccines -​ Adjuvant is used in some vaccines to help create a stronger immune response -​ Can cause more local reactions (redness, swelling, and pain at the injection site) and more systemic reactions (fever, chills, and body aches) -​ Albumin -​ Newer adjuvants are being developed to target specific components of the body’s immune response, resulting in stronger and longer protection Vaccine safety Thimerosal -​ Mercury based preservative -​ Contains ethylmercury -​ Used in multi-dose vials of medicines and vaccines  -​ Shown to be safe when used in vaccines -​ Most common side effect is redness and swelling at injection site -​ Removed from childhood vaccines in the US in 2001 -​ Methyl mercury is found in fish and can be toxic to people at high doses -​ Ethylmercury is cleared from the human body more quickly and is less likely to cause any harm Prevention of adverse effects -​ Ask screening questions at each visit -​ Provide aftercare instruction -​ Required to have an emergency kit containing: -​ Epi pens -​ Diphenhydramine -​ Resuscitation mask -​ CPR summary sheet Tdap vs DTap -​ DTap -​ Higher diphtheria and pertussis antigen dose; used for children less than 7 years -​ Tdap -​ Lower diphtheria and pertussis antigen dose; used for booster doses in older children and adults Conjugate vs polysaccharide vaccines -​ Polysaccharide vaccines -​ These use sugar molecules (polysaccharides) from the surface of bacteria. While they help trigger an immune response, they may not work as well in very young children, since their immune systems don’t respond strongly to these sugars alone. -​ EXAMPLES: hib, PCV13, MenACWY -​ Conjugate vaccines -​ These also use the same sugar molecules (polysaccharides), but they are attached (conjugated) to a protein. This helps boost the immune response, especially in young children, and makes the vaccine more effective. -​ EXAMPLES: PPSV23, MPSV4 OSHA requirements (occupational safety and health administration) -​ Agencies who pay staff and assign them to work in healthcare facilities are responsible for: -​ Exposure control plan -​ All body fluids are potentially infectious -​ Use safety-enabled syringes -​ Use designated containers for disposal -​ Do not overfill disposal containers -​ Plan for storage and disposal -​ Employees expected to perform CPR must have appropriate resuscitator devices readily available and accessible -​ Hep b vaccination -​ To be provided to the employee at no cost if there is potential to be in contact with blood -​ Employee may decline vaccination -​ Recommended to do antibody testing 1-2 months after vaccination series and revaccinate if titer is low -​ Post exposure evaluation and follow up -​ Recordkeeping and training -​ Required for anyone giving vaccinations -​ Documented participation in education of -​ Bloodborne pathogens -​ Handling and disposal of biohazard material -​ Hiv, hep b, hep c -​ Exposure control plan ND legal requirements Who is authorized to administer vaccines and what is required of authorized immunizers -​ ND pharmacist or intern license -​ Completed an appropriate training -​ Maintain CPR or BLS certification -​ Complete attestation with board and provide documentation upon request -​ Maintain continued competency -​ An authorized pharmacist may delegate subq or intramuscular injectable medication to a qualified pharmacy tech -​ Completed a board approved practical training program -​ Maintain a continuing competency injections of medications which are expected to be performed  -​ Maintains CPR or BLS training Which patient population can pharmacists authorize -​ Patients 3 years or older -​ Any age per a practitioners order to protocol Which vaccines can pharmacists administer -​ Any immunization recommended by ACIP that is included in the patients approved vaccination schedule -​ Any immunization recommended by cdc for international travel -​ Any other emergency immunization response to a public health emergency What are the requirements regarding physical locations for vaccine administration -​ Must ensure privacy, aseptic conditions, and access to emergency response equipment -​ Can be administered in a pharmacy or community setting What are the legal obligations regarding documentation and patient education -​ Must document vaccinations in NDIIS within 14 days -​ Report any adverse effects to VAERS -​ Notify PCP of adverse effects from vaccinations -​ Maintain records of all vaccines ordered and administered through the protocol for 5 years -​ Provide VIS before administration What is included in an emergency kit -​ Epi pens -​ Diphenhydramine -​ Resuscitation mask -​ BP cuff, stethoscope, and oxygen -​ Emergency contact numbers and protocol for managing reactions VICP -​ Vaccine injury compensation program -​ Compensation for loss or damage to the injured -​ Protection of vaccinator from personal liability -​ Does not absolve provider negligence -​ Mandates vaccine information statements (VIS) before each dose of vaccines -​ Special “vaccine court” determines compensation amount in injury/death cases -​ Baked on needs and injury -​ May include lost wages, pain and suffering, attorney fees Effectively communicate with vaccine hesitant individuals -​ CASE approach -​ C: corroborate -​ Acknowledge the parents concern and find some point on which you can agree -​ Set tone for a respectful successful talk -​ A: about me -​ Describe what you have done to build you knowledge base and expertise -​ S : science -​ Relate to what the science says -​ E : explain / advise -​ Explain your advice to patient, based on science -​ Motivational interviewing techniques -​ When they decline, consider the following -​ Asking what they are specifically afraid of -​ Summarize their thought (without agreeing or disagreeing) -​ Saying, you are really worried that your child might get sick after their vaccines -​ Saying, it sounds like you think kids get too many shots