IMMUNIZATION

RCM
 Immunization is the process whereby a person is made immune or resistant
to an infectious disease, typically by the administration of a vaccine. (WHO)
 Immunization is a global health and development success story, saving
millions of lives every year. It is also a key component of primary health care
and indisputable human right

DEFINITION
A. Active immunization
▪ The protection of the host in which either the altered organism or its product
induces the host to produce antibodies. It involves stimulating the immune
system to produce antibodies and cellular immune responses that protect against
the infectious agents.
B. Passive immunization
▪ The protection of the susceptible host by administration of protective antibodies
produced by another host, e.g. tetanus antitoxin. It consists of providing
temporary protection through administration of exogenously produced antibody
such as immune globulin.

TWO TYPES OF IMMUNIZATION

IMMUNITY
Live Attenuated Vaccines (LAV)
 Live Attenuated Vaccines are derived from wild viruses or bacteria which are
modified or weakened in laboratories. Immunity is elicited by replication of
the attenuated organism in the vaccinated person. The immune response to a
live attenuated vaccine is identical to that induced by natural infection.
• Currently available live attenuated vaccines are those for TB (BCG), Oral
Polio, measles, mumps, rubella, and JE.

TYPES OF VACCINES
 Inactivated Vaccines
Inactivated Vaccines are produced by growing the bacteria or virus in culture
media which are then subjected to heat or chemical agents. In fractional or sub-
unit form of these vaccines, organisms are treated to be able to derive those
components needed to produce the vaccines.

Both the inactivated or sub-unit preparations must contain sufficient antigenic

mass to stimulate the desired response since it is incapable of replicating inside
the host.

TYPES OF VACCINES
Forms of inactivated vaccines include:
• Whole viruses (e.g. influenza, IPV, rabies)
• Whole bacteria (e.g. pertussis, typhoid, cholera )
• Subunit or fractional vaccines (e.g. influenza, hepB, etc.)
• Pure polysaccharides and conjugates (e.g. Hib, PPV, PCV, etc.)
• Toxoids: diphtheria, tetanus.

TYPES OF VACCINES CONTD.

Appropriate method of vaccination is a critical component of the EPI. As a
vaccine provider, you must observe utmost professional care to ensure the
optimal immune response of the recipient.

ADMINISTRATION OF VACCINES
 IMPORTANT: Always screen clients for possible contra-indications every
time you administer a vaccine.
• Explain to the client how the vaccines work, including safety and risk. Establish
an atmosphere in which clients and their parents can freely evaluate information,
discuss vaccine concerns and make informed decisions regarding the vaccination.

1. CLIENT PREPARATION AND CARE

• Make the vaccination least stressful to the client and their parents or guardians.
This can be done through:
› A positive attitude through your facial expression, body language and
comments.
› A soft and calm tone of voice.
› Eye contact even with small children.
› Explaining why vaccines are needed.
› An honest explanation of what to expect. Never say that injection won’t hurt.
• Wash your hands thoroughly before and after each new client contact.
• It is not necessary to wear gloves when administering vaccines unless you have
open lesions or are likely to come in contact with potentially infected body fluids.
• Properly dispose of used needles and syringes to prevent needle stick injury and
reuse.

2. INFECTION CONTROL
The route of administration is the path by which a vaccine (or drug) is brought
into contact with the body. This is a critical factor for success of the
immunization. A substance must be transported from the site of entry to the part
of the body where its action is desired to take place

ROUTES OF VACCINE
ADMINISTRATION
 The route recommended for administration of a particular vaccine is primarily
based on clinical trials, practical experience and theoretical considerations.
This is usually indicated in the packaging and in the manufacturer’s product
information of each vaccine. There are five acceptable routes used in the
administration of vaccines.

 Non-compliance to recommended route of administration may reduce vaccine

efficacy or may result in exaggerated local adverse reaction.

ROUTES OF VACCINE
ADMINISTRATION
PARENTERAL ROUTES OF VACCINE
ADMINISTRATION
(SOURCE: HTTPS://EN.WIKIPEDIA.ORG/WIKI/ROUTE_OF_ADMINISTRATION)
Intramuscular (IM) injection
 Administers the vaccine in to the muscle mass. Vaccines containing adjuvants
should be injected IM to reduce adverse local effects to reduce abscess
formation. IM should be 90 degrees

ROUTES OF VACCINE
ADMINISTRATION
 Vaccines are administered into the muscle tissue below the dermis and the
subcutaneous tissue.
 Mostly inactivated vaccines are administered by intramuscular route
 . The anterolateral thigh (vastus lateralis muscle, lower left photo) and upper
arm (deltoid muscle, lower right photo) are the two routinely recommended
sites for intramuscular route of administration.
 There is less chance of hitting nerves or blood vessels through this route

INTRAMUSCULAR ROUTE
Subcutaneous (SC) injection
 Administers the vaccine into the subcutaneous layer above the muscle and
below the skin. SC should be 45 degrees.
 Recommended sites are the upper outer triceps
 of the arm.
Intradermal (ID) injection
 Administers the vaccine in the top most layer of the skin. BCG is the only vaccine with this
route of administration. Intradermal injection of BCG vaccine reduces the risk of neurovascular
injury.

 For intradermal injection, insert a small thin needle (25 or 27 gauge) and 3/8 to 3/4 inch (1-2
cm) underneath the skin to introduce the vaccine. The bevel should be facing upward.

ROUTES OF VACCINE
ADMINISTRATION
 Commonly oral polio, rota and oral cholera vaccines are the licensed-vaccines
administered by the oral route.
 Oral vaccines should be administered first before giving injectable vaccines or
performing other procedures that might cause discomfort especially in
children.
 • Administer the liquid agent slowly down one side of the inside of the cheek
toward the back of the infant’s mouth.
ROUTINE IMMUNIZATION
What is BCG vaccine?
 BCG vaccine protects infants against tuberculosis. The letters B, C, G stand
for Bacillus Calmette-Guérin. Bacillus describes the shape of a bacterium
while Calmette and Guérin are the names of the people who developed the
vaccine.
 BCG vaccine comes in powder form. BCG vaccine is freeze-dried, so it must
be reconstituted with a diluent before use.

BCG VACCINE
Contraindications
▪ Immunosuppression. BCG vaccination should not be given to persons who are
immunosuppressed (e.g., persons who are HIV infected) or who are likely to
become immunocompromised (e.g., persons who are candidates for organ
transplant).

▪ Pregnancy. BCG vaccination should not be given during pregnancy. Even

though no harmful effects of BCG vaccination on the fetus have been observed,
further studies are needed to prove its safety.

BCG
Type of Vaccine Live Bacterial
Form of Vaccine Freeze Dried
Minimum age at 1st dose Given at the earliest possible age after birth preferably within
the
first 2 months of life.
Number of doses to 1st dose: at birth
complete 2nd dose: school entrants
the Immunization
Reason BCG is given at earliest possible age protects the possibility
of TB
meningitis and other TB infectious in which infants are
prone.
Dosage At birth: 0.05 ml ; At school age: 0.10 ml
Route of Administration Intradermal (ID) (a special syringe and needle is used for the
administration of BCG Vaccine.)
Storage Temperature 2℃ to 8℃ (in the body of the refrigerator)
BCG Note: Freezing does not damage it but ampules may break.
Diluents should also keep cold before using.
Special Consideration Correct intradermal administration is essential. A syringe and
needle is used for administration of BCG vaccine.
 Oral polio vaccine (OPV) gives protection against the three types of virus that
cause polio.

 It is a liquid that comes in two types of containers: small plastic bottles that
work like droppers, and glass vials with droppers in a separate plastic bag. As
from January 1996 all OPV vials supplied by WHO/UNICEF have had a
vaccine vial monitor (VVM) attached. The VVM shows health workers
whether the OPV in the vial to which the monitor is attached is safe to use.

ORAL POLIO VACCINE

Type of Vaccine Attenuated
Form of Vaccine Liquid
Number of doses to complete OPV Dose 1 - 6 weeks
the OPV Dose 2 - 10 weeks (after 4 weeks of the 1st dose)
Immunization OPV Dose 3 - 14 weeks (after 4 weeks of the 2nd dose)
Reason This protects the individual against polio paralysis by
preventing the spread of poliovirus to the nervous
system.
Dosage 2 drops
Route of Administration Oral
Storage Temperature -15℃ to -25℃ (should be frozen)
Special Consideration 1. A maximum of 10 freeze- thaw cycles are permissible
provided the total cumulative duration of thaw does not
exceed
24 hours and provided the temperature does not exceed 8
ORAL POLIO VACCINE C (46
F) during the period of thaw.
2. Rotate stock so that the shortest dated vaccine is used
first.
Type of Vaccine Killed
Form of Vaccine
Number of doses 1 dose: 14 week
Reason IPV protects children against polioviruses types 1, 2 and 3. IPV
use will help maintain immunity to poliovirus type 2.
Dosage 0.5 ml
Route of Adm Intramuscular (IM), thigh area
Storage 2℃-8℃. Do not freeze
Temperature
Special 1. Shelf Life after Reconstitution, Thawing, or Opening Ampoule:
Consideration Discard if not used immediately.
2. Rotate stock so that shortest dated vaccine is used first. The vaccine
should be perfectly clear and pink or red in color. Any vaccine
showing particulate matter, turbidity, or change of color should be
discarded.
INACTIVATED POLIO VACCINE
3. A booster dose should be given on or after the 4th birthday and at
least 6 months from the previous dose
Hepatitis B vaccine is a cloudy liquid that comes in a vial or a prefilled syringe. It
does not have to be reconstituted.

If hepatitis B vaccine stands for a long time it separates from the liquid and looks
like fine sand at the bottom of the vial. It must be mixed by shaking.

HEPATITIS B VACCINE
Type of “Monovalent Vaccine” contain only one antigen
Vaccine
Form of Cloudy liquid vaccine
Vaccine
Minimum Age Administer the first dose of monovalent HBV to all newborns >2kgs
at 1st dose within 24 hours of life
Number of dose 1 at birth
doses dose 2 – 6 weeks interval after 1st dose
dose 3 – 8 weeks interval after 2nd dose
Reason An early start of Hep B vaccine reduces the chance of being infected
and becoming a carrier. Prevent liver cirrhosis and liver cancer.
Dosage 0.5 ml
Route Intramuscular (IM), upper outer portion of the thigh (vastus lateralis) in
infant.
Storage Temp. 2℃ - 8℃ (in the body of refrigerator). Both heat and freezing damage
the vaccine
HEPATITIS
1. BirthB
Special VACCINE
dose must be given if there is a risk of perinatal transmission.
Precautions 2. A combination vaccine should not be given at birth, only monovalent
Hep B vaccine
 Pentavalent Vaccine is a vaccine that contain five antigens (diphtheria,
pertussis, tetanus, and hepatitis B and Haemophilus influenzae type b).
 As per National Immunization Schedule, Pentavalent Vaccine should be
started for any child aged more than 6 weeks and can be given up to 1 year of
age.
 If a child has received at least one dose of pentavalent vaccine before his/her
first birthday then the child should be administered the due pentavalent doses
at a minimum interval of four weeks, at the earliest available opportunity.

PENTAVALENT VACCINE
Form of Vaccine Liquid vaccine
Minimum Age at 1st
dos
Number of doses to 3 doses
complete 1st dose – 6 weeks after birth; 2nd dose – 10 weeks (4 weeks after
Immunization the 1st dose)
3rd dose – 14 weeks (4 weeks after the 2nd dose)
Reason It provides protection to a child from 5 life-threatening diseases –
Diphtheria, Pertussis, Tetanus, Hepatitis B and Hib.
Dosage 0.5 ml
Route Intramuscular injection (IM), right thigh
Storage Temperature 2℃ - 8℃. Do not freeze.
Special Precautions 1. Not applicable for pregnant and lactating women.
2. Conditions like convulsion/ seizure or abnormal cerebral signs
in the newborn period or serious neurological abnormalities are
contraindication of pertussis component.
PENTAVALENT VACCINE
 The pneumococcal vaccine protects against serious and potentially fatal
pneumococcal infections. It's also known as the pneumonia vaccine.
 Pneumococcal infections are caused by the bacterium Streptococcus
pneumoniae and can lead to pneumonia, septicemia (a kind of blood
poisoning) and meningitis.
 Pneumococcal conjugate vaccine (PCV) is used to vaccinate children
under 2 years old as part of the childhood vaccination program. It's
known by the brand name Prevenar 13.
 The childhood vaccine (PCV) protects against 13 strains of the
pneumococcal bacterium.

PNEUMOCOCCAL CONJUGATE VACCINE (PCV)

Form of Vaccine
Minimum Age at 6 weeks of age
1st dose
Number of doses to 3 doses
complete 1st dose – 6 weeks after birth
Immunization 2nd dose – 10 weeks (4 weeks after the 1st dose)
3rd dose – 14 weeks (4 weeks after the 2nd dose)
Reason It helps protect against the 13 types of pneumococcal bacteria that
most commonly cause serious infections in children and adults. It can
also help prevent ear infections and pneumonia caused by those 13
types of pneumococcal bacteria
Dosage 0.5 ml using prefilled syringe
Route Intramuscular injection only, (IM), The preferred sites for injection
are the anterolateral aspect of the thigh in infants and the deltoid
muscle of the upper arm in toddlers, children and adults.
Storage 2℃ - 8℃. Do not Freeze
PENTAVALENT VACCINE
Temperature
Special Precautions Apnea following intramuscular vaccination has been observed in
some infants born prematurely.
 Routine measles vaccination for children, combined with mass immunization
campaigns in countries with low routine coverage, are key public health strategies to
reduce global measles deaths.

 The measles vaccine has been in use since the 1960s. It is safe, effective and
inexpensive. WHO recommends immunization for all susceptible children and adults
for whom measles vaccination is not contraindicated.

 Reaching all children with 2 doses of measles vaccine, either alone, or in a measles-
rubella (MR), measles-mumps-rubella (MMR), or measles-mumps-rubella-varicella
(MMRV) combination, should be the standard for all national immunization programs

MEASLES VACCINE (MCV 1)

Type of Vaccine Monovalent Measles
Minimum Age at 1st dose 9 months
6 months if there is an outbreak
Number of doses to 1 dose
complete 1st dose – 9 months old up to 11 month (for Measles Vaccine
the Immunization only)
Reason • Provide at least 85% protection against measles infection.
When
given 1 year and older provides 95% of protection.
• An infant with known suspected HIV infection should
receive
measles vaccine at 6 months and then again at 9 months.
Dosage 0.5 ml
Route of Administration Subcutaneous (SC), Upper outer portion of the arm, Right
deltoid.
Storage Temperature -15℃ to -25℃, at the freezer
MEASLES VACCINE (MCV 1)
Special Precaution Women are advised not to receive any live virus vaccine
during
pregnancy as a safety precaution based on the theoretical
possibility
of a live vaccine causing disease (e.g., rubella virus leading
 According to Center of Disease Control and Prevention MMR vaccine is
very effective at protecting against measles, mumps, and rubella, and
preventing the complications caused by these diseases.

 CDC recommends all children get two doses of MMR (measles-mumps-

rubella) vaccine, starting with the first dose at 12 through 15 months of
age, and the second dose at 4 through 6 years of age

 Children can receive the second dose earlier as long as it is at least 28

days after the first dose.

MEASLES, MUMPS & RUBELLA (MMR)

-MCV2
Type of Vaccine Attenuated Measles Virus
Number of doses to 2 doses
complete 1st dose – 12 to 15 months
the Immunization 2nd dose – 4 to 5 years old
Reason It gives 95% protection to measles, mumps and rubella
Dosage 0.5 ml
Route of Administration Subcutaneous (SC), Upper outer portion of the arm
Storage Temperature 2℃ - 8℃. Can be stored in freezer or refrigerator
Special Precaution Precautions for MMR or MMRV vaccine include—
1. Moderate or severe acute illness with or without fever
2. Recent (within 11 months) receipt of antibody-containing
blood
product (specific interval depends on product).
3.History of thrombocytopenia or thrombocytopenic purpura
4.Need for tuberculin skin testing
MEASLES, 5.Personal
MUMPS or family history
& RUBELLA (MMR)of seizures
-MCV2
 According to DOH Philippines, the child is considered as Fully Immunized
Child when he/she has completed the vaccines, BCG, Pentavalent, OPV, IPV
and Measles before 1 year of age.

 Unimmunized children are those without primary series and booster dose or
those without at least one dose of the vaccine after 14 months of age.
 Provide immunization to all infants and children
 Nurses provide the public with accurate and correct information about the
vaccines
 Educate caregivers or patients on vaccines’ efficacy and safety.
 Ensure safe handling, storage, and administration of vaccines
 Involve community leaders to attract people for immunization
 Collaborate with school officials
 Conduct home visit. Follow up immunized infants and children

NURSING RESPONSIBILITIES
“All children, no matter where they live or what their circumstances are, have the
right to survive and thrive, safe from deadly diseases.”

 Dr. Robin Nancy

Chief of Immunization
UNICEF
 https://www.cdc.gov/tb/publications/factsheets/vaccines.htm
 https://www.cdc.gov/tb/publications/factsheets/prevention/BCG.pdf
 https://www.unicef.org/philippines/stories/routine-immunization-children-Phili
ppines
Centers for Disease Prevention. Retrieved from:
 https://www.cdc.gov/vaccines/vpd/mmr/public/index.html#what-is-mmr
 www.vitology.co

REFERENCES