Vaccines

What is this condition

Small Pox • Eradicated May 8th , 1980 • EDWARD JENNER • English PhysicianDiscovered Vaccination in 1796 • Born: May 17, 1749,  Berkeley, United Kin gdom • Died: January 26, 1823, Berkeley, United Kingdom

What am I going to talk • Basics of immunology • Basics of Vaccine • Vaccines Available • How is it administered • How is it stored • Complications • Immunization Schedule

What is a vaccine How does it act • To understand vaccines we need to know Basics of Immunology

Immune System • Derived from stem cells into Neutrophils, Macrophages, Lymphocytes (T & B Cells ), • Innate Immunity vs Adaptive Immunity

Characteristics of the ideal vaccine • • • • • •

Good immunit at all ages Long lasting protection Easy delivery system Minimal or no side effects Easy to manufacture Maintains potency under variable field conditon • Affordable

TYPES OF VACCINES • KILLED VACCINES • LIVE VACCINES • DNA VACCINES

Characteristics of killed vaccine • Unable to replicate in the host • Advantages – – – –

Will not multiply or revert to pathogenicity No transmissable Less reactogenic in general Easier to produce

• Disadvantages – Little cellular immunity but ok with humoral – Needs multidose series for full protection

Characteristics of Live Vaccine • Replicates in the host, but attenuated in pathogenicity • Advantages – Humoral plus cellular immunitiy produced – Fewer doses required in general – Longer lasting protection

• Disadvantages – – – –

Rarely may revert to pathogenicity May be more reactogenic Infection may be transmissable from vaccineee More complex production

BCG

DIPTHERIA

PERTUSSIS

TETANUS

H.INFLUENZA

POLIOMYELITIS

HEPATITIS A & B

MEASLES

MUMPS

RUBELLA

CHICKENPOX

INFLUENZA

DISEASES COVERED BY ROUTINE VACCINE SCHEDULE

TYPHOID

ROTAVIRUS

HUMAN PAPPILLOMA VIRUS

VACCINES NOT IN SCHEDULE

RABIES

MENINGOCOCCUS

JAPANESE ENCEPHALITIS VACCINE

CHOLERA VACCINE

YELLOW FEVER

ADMINISTRATION OF VACCINEEQUIPMENT REQUIRED • • • •

medical waste (sharps) container vaccine, plus diluent if reconstitution is required 2 or 3 mL syringe (unless vaccine is in pre-filled syringe) appropriate drawing-up needle (19 or 21 gauge needle if required, to draw up through rubber bung and for reconstitution of vaccine) • appropriate injecting needle (see Table 2.2.2 Recommended needle size, length and angle for administering vaccines) • clean cotton wool and hypoallergenic tape to apply to injection site after vaccination • a rattle or noisy toy for distraction after the injection.

•

• • • • •

ADMINISTRATION OF VACCINE-PREPARING VACCINE Ensure that the minimum/maximum thermometer displays temperatures within the +2°C to +8°C range before removing vaccine from the refrigerator. Ensure that the correct vaccine is taken from the refrigerator and that it is within the expiry date. Check that there is no particulate matter or colour change in the vaccine. Ensure that the diluent container is not damaged and potentially contaminated. Wash hands with soap and water or use a waterless alcohol-based hand rub.2 Prepare the appropriate injection equipment for the vaccine to be administered.

ADMINISTRATION OF VACCINEInjectable vaccines that do not require reconstitution • If the vaccine is in a vial, remove the cap carefully to maintain sterility of the rubber bung. There is no need to wipe the rubber bung of single-dose vials with an alcohol swab if it is visibly clean. If there is visible contamination, the bung should be cleaned with a single-use swab, allowing time to dry before drawing up the contents.3 • Use a 19 or 21 gauge needle to draw up the recommended dose through the bung (or through the top of the ampoule), if required. • Change the needle after drawing up from a vial with a rubber bung or ampoule, before giving the injection. If using a safety needle system, once the vaccine has been drawn up, draw back on the syringe to ensure as much vaccine as possible is removed from the tip of the needle, and then eliminate any air to the tip of the syringe without re-priming the needle.

ADMINISTRATON OF VACCINEInjectable vaccines that require reconstitution • •

•

• •

•

Reconstitute the vaccine as needed immediately before administration. Use a sterile 21 gauge needle for reconstitution and a separate 23 or 25 gauge needle, 25 mm in length, for administration of the vaccine in most circumstances. Use only the diluent supplied with the vaccine; do not use sterile water for injection instead of a supplied diluent. Ensure that the diluent and vaccine are completely mixed. 4 Check reconstituted vaccines for signs of deterioration, such as a change in colour or clarity. Administer reconstituted vaccines as soon as practicable after they have been reconstituted as they may deteriorate rapidly. Refer to individual vaccine product information for recommended times from vaccine reconstitution to administration. Never freeze a vaccine after it has been reconstituted.

ADMINISTRATION OF VACCINESPRECAUTION FOR ALL INJECTABLE VACCINES • Do not extrude small air bubbles through the needle for injection. However, in the rare instance of a large air bubble in a pre-filled syringe, first draw back on the needle to ensure no vaccine is expelled along with the air, and then expel the air through the needle, taking care not to prime the needle with any of the vaccine, as this can lead to increased local reaction. • Never mix other vaccines together in the one syringe (unless that is the manufacturer’s registered recommendation, e.g. Infanrix hexa). 4 • Never mix a local anaesthetic with a vaccine .

ROUTE OF ADMINISTRATION OF VACCINES • Routes of administration vary for different vaccines • For the same vaccine different routes are available depending upon the manufacture / brand- e.g influenza is available as nasal drops and injection form. Polio as oral and injectable form. • In general most of the vaccines are administered by Intramuscular ( IM) but for the following

• BCG- INTRADERMAL- ON THE LEFT ARM AT THE INSERTION OF DELTOID • MEASLES, MUMPS, RUBELLA, CHICKENPOX- SUBCUTANEOUS ROUTE • ROTAVIRUS VACCINES- ORAL • ORAL POLIO GRADUALLY REPLACED BY IM POLIO

ADMINISTRATION OF VACCINE- IM ROUTE

ROUTE OF ADMINISTRATION 90 deg perpendicular 45 degree angle

20 degree angle

VACCINE STORAGE • Stability of vaccine varies with environmental temperature

Vaccine Stability MOST SENSITIVE

• Sensitivity to HEAT

BCG Varicella MMR MenC Hepatitis B DT and/or aP/IPV/HIB LEAST SENSITIVE

Immunisation Department, Centre for Infections

•

Sensitivity to COLD

HepB and combination DTand/or aP/IPV/HIB Influenza MenC *MMR *Varicella *BCG (*Freeze dried)

Light Sensitive Sensitive to strong light, sunlight, ultraviolet, fluorescents (neon) Vaccines should always be stored in their original packaging until point of use to protect them from light

BCG MMR Varicella Meningococcal C Conjugate Most DTaP containing vaccines

Immunisation Department, Centre for Infections

Vaccine Storage X No food or medical specimens

 Use a dedicated vaccine fridge  Safeguard electricity supply

X Do not place fridge in direct sunlight or near heat source

 No more than 50% full  Place vaccines in clearly labelled plastic mesh baskets

X Do not remove vaccines from original boxes until ready to use



X Do not store vaccines in fridge doors or in solid plastic trays/containers within the fridge X Keep vaccines away from fridge walls and cold air vents

Group vaccines by type (Paediatric, Adult, Adolescent)

 Defrost/calibrate fridge regularly

Picture taken from www.medisave.co.uk

 Ensure back up facilities are available in the event of fridge failing

Immunisation Department, Centre for Infections

Temperature Monitoring  Use max/min thermometer  Probe should be placed in the centre of fridge  Temperature should be recorded at least once a day  Reset daily  Calibrate as recommended  Take immediate action if temperature is outside recommended range

Immunisation Department, Centre for Infections

Storage temperature •

•

•

Never exceed 8ºC or fall below 2ºC

Aim for 5ºC

• Aim to maintain vaccine fridge as close as possible to 5˚C as this gives a safety margin of + or – 3˚c

Immunisation Department, Centre for Infections

Ordering and Delivery

• Named trained designated person and deputy who have overall responsibility for ordering, receipt and care of vaccines. • Responsibilities include:  Ensuring cold chain has been maintained during transport and managing receipt of vaccines directly into refrigeration  Checking delivery for leakage, damage and discrepancies  Rotation of stock  Maintaining stock information system to keep track of orders, expiry dates and running total of vaccines  Ensuring adequate supply/ Minimising over ordering or stockpiling Immunisation Department, Centre for Infections

AGE

VACCINE

AT BCG BIRTH OPV (0 Dose) Hepatitis B ( 1st Dose) 6 Weeks

DTwP/DTaP (1st Dose) IPV (1st Dose) Hib (1st Dose)

DUE DATE

DATA BATCH GIVEN NO.

Pneumococcal Conjugate (1st Dose) Rotavirius (1st Dose) Hepatitis B (2nd Dose) 10 DTwP/DTaP Weeks (2nd Dose) IPV (2nd Dose) Hib (2nd Dose)

Pneumococcal Conjugate (2nd Dose) Rotavirius (2nd Dose) 14 DTwP/DTaP Weeks (3rd Dose) IPV (3rd Dose) Hib (3rd Dose) Pneumococcal Conjugate (3rd Dose)

Rotavirius (3rd Dose) 6 Months Hepatitis B (3rd Dose) OPV (1st Dose) 9 Months Measles OPV (2nd Dose) 12 Months

Hepatitis A1 ( 1st Dose)

15 Months

Chickenpox ( 1st Dose)

MMR(1st Dose) Pneumococcal Conjugate (Booster) 16 to 18 DTwP/DTaP Months (1st Booster Dose) IPV (1st Booster Dose) Hib (1st Booster Dose) 18 Months

Hepatitis A (2nd Dose)

2 Years Typhoid (1st Dose) 4.5 to 5 Years

DTwP/DTaP (2nd Booster Dose) OPV (3rd Dose) MMR (2nd Dose) Typhoid (2nd Dose) Chickenpox (2nd Dose)

8 Years Typhoid (3rd Dose) 10 to 12 Tdap Years 0 Months

Human Pappilloma Virus (1st Dose)

1-2 Months

Human Pappilloma Virus (2nd Dose)

6 Months

Human Pappilloma Virus (3rd Dose)

OTHER VACCINES >6 Flu Vaccine Months ( 1st Dose) of Age Flu Vaccine ( 2nd Dose) for Children < 9 Years