Immunization Assignment

Brandie Ingram Chamberlain University College of Nursing NR-566 Pharmacology for Primary Care Dr. Angela Thompson November 2020

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Introduction

Immunizations play a critical role in maintaining public health by providing protection against various infectious diseases. The process of immunization involves stimulating the immune system to develop resistance to specific infections through the administration of vaccines. Vaccines have been instrumental in controlling and eliminating diseases that once caused significant morbidity and mortality. This paper explores two important vaccines—Pneumococcal 23-valent polysaccharide vaccine (PPSV23) and the vaccine for diphtheria, tetanus, and pertussis (DTaP). It will provide a detailed discussion on the diseases these vaccines prevent, the composition of the vaccines, their administration guidelines, contraindications, precautions, and potential adverse reactions.

Pneumococcal Disease and PPSV23

Pneumococcal disease is caused by the bacterium Streptococcus pneumoniae, which can lead to serious infections such as pneumonia, meningitis, and bacteremia. These infections are particularly dangerous for young children, older adults, and individuals with compromised immune systems. The Pneumococcal 23-valent polysaccharide vaccine (PPSV23), commercially known as Pneumovax 23, is designed to protect against 23 types of pneumococcal bacteria. This inactivated vaccine is an essential tool in preventing pneumococcal disease, particularly in vulnerable populations.

Composition and Administration

PPSV23 is composed of purified capsular polysaccharide antigens from 23 different serotypes of Streptococcus pneumoniae. These antigens stimulate the immune system to produce antibodies that provide protection against pneumococcal infections. The vaccine is administered as a single dose of 0.5 mL, either intramuscularly or subcutaneously. The minimum age for administration is 2 years, and the vaccine is recommended for all individuals aged 65 years and older, as well as those aged 2 to 64 years who have certain underlying medical conditions that increase their risk of pneumococcal disease (Centers for Disease Control and Prevention [CDC], 2020).

Contraindications and Precautions

PPSV23 is contraindicated in individuals with a history of anaphylactic or severe allergic reactions to any component of the vaccine or to a previous dose of the vaccine. Additionally, the vaccine should not be administered to individuals with a cochlear implant or a chronic cerebrospinal fluid leak, as these conditions increase the risk of invasive pneumococcal disease, and alternative vaccination strategies may be more appropriate (Micromedex, 2020).

Patients who are immunocompromised may not have an adequate antibody response to PPSV23, and caution should be exercised when considering vaccination in this population. For patients with acute illnesses, vaccination should be deferred until the illness has resolved, particularly in those with severe cardiovascular or respiratory dysfunction, as systemic reactions could occur (Micromedex, 2020). Furthermore, if PPSV23 is to be administered along with the Zoster vaccine (Zostavax®), the two vaccines should be given at least four weeks apart to avoid a reduced immune response to the Zoster vaccine (CDC, 2020).

Adverse Reactions

The most common adverse reactions to PPSV23 include erythema and tenderness at the injection site, myalgia, and fatigue. While these side effects are generally mild and self-limiting, it is important to monitor patients for any signs of more serious reactions, such as anaphylaxis. In special situations, such as for patients who have never received any pneumococcal vaccines, it is recommended to first administer a dose of the pneumococcal conjugate vaccine (PCV13), followed by PPSV23 at least eight weeks later to enhance the immune response (CDC, 2020).

Diphtheria, Tetanus, and Pertussis (DTaP)

Diphtheria, tetanus, and pertussis (DTaP) are serious bacterial infections that can cause significant morbidity and mortality, particularly in young children. The DTaP vaccine is a combination vaccine that protects against all three diseases. It is one of the most critical immunizations given during childhood, ensuring protection against these potentially life-threatening conditions.

Diphtheria

Diphtheria is caused by the bacterium Corynebacterium diphtheriae, which produces a toxin that can lead to severe respiratory problems, heart failure, paralysis, and even death. The diphtheria component of the DTaP vaccine contains inactivated diphtheria toxin, which stimulates the immune system to produce antibodies against the toxin.

Tetanus

Tetanus, also known as lockjaw, is caused by the bacterium Clostridium tetani. The bacterium produces a toxin that affects the nervous system, leading to painful muscle contractions, particularly in the jaw and neck. The tetanus component of the DTaP vaccine is made from inactivated tetanus toxin, which triggers the immune system to produce protective antibodies.

Pertussis

Pertussis, commonly known as whooping cough, is caused by the bacterium Bordetella pertussis. It is highly contagious and can cause severe coughing fits, difficulty breathing, and in infants, it can be fatal. The pertussis component of the DTaP vaccine is acellular, meaning it contains purified inactivated components of the bacterium, which help the immune system develop protection against the disease without causing the disease itself.

Administration Guidelines

The DTaP vaccine is administered in a series of five doses at specific intervals during early childhood, typically at 2, 4, 6, and 15-18 months of age, with a booster dose at 4-6 years of age. It is essential to adhere to this schedule to ensure optimal immunity against all three diseases. In some cases, catch-up vaccination schedules may be necessary if a child misses one or more doses (CDC, 2020).

Contraindications and Precautions

The DTaP vaccine is contraindicated in individuals who have had a severe allergic reaction to a previous dose of the vaccine or to any of its components. Additionally, the vaccine should not be administered to individuals who have experienced encephalopathy within seven days of a previous dose of DTaP that cannot be attributed to another identifiable cause. Precautions include the presence of moderate or severe acute illness with or without fever, in which case vaccination should be postponed until the patient has recovered (CDC, 2020).

Adverse Reactions

The most common adverse reactions to the DTaP vaccine include mild fever, irritability, drowsiness, and local reactions such as redness and swelling at the injection site. These side effects are typically mild and resolve on their own. However, rare but serious adverse events, such as anaphylaxis or prolonged seizures, may occur, and healthcare providers should be prepared to manage these reactions if they arise.

Conclusion

Immunizations are a critical component of preventive healthcare, providing protection against a wide range of infectious diseases. The PPSV23 and DTaP vaccines are essential tools in the fight against pneumococcal disease, diphtheria, tetanus, and pertussis. Understanding the composition, administration guidelines, contraindications, precautions, and potential adverse reactions associated with these vaccines is vital for healthcare providers to ensure safe and effective immunization practices. By adhering to recommended vaccination schedules and educating patients about the importance of immunizations, healthcare providers can help protect individuals and communities from the devastating effects of these diseases.

References

Centers for Disease Control and Prevention. (2020). Pneumococcal Vaccination: Summary of Who and When to Vaccinate. Retrieved from https://www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html

Centers for Disease Control and Prevention. (2020). Diphtheria, Tetanus, and Pertussis (DTaP) Vaccine Information Statement. Retrieved from https://www.cdc.gov/vaccines/hcp/vis/vis-statements/dtap.html

Micromedex. (2020). Pneumococcal 23-Valent Polysaccharide Vaccine (PPSV23): Drug Information. Retrieved from https://www.micromedexsolutions.com