Immunizations for Special Populations

Immunity

Immunity is the ability to protect and resist infection or disease. It is a specific body response to an invasion of a foreign microorganism in the human body. The immune system is composed of specialized cells, proteins, tissues, and organs that attack and destroy these foreign microorganisms. The body can now “remember” the specific microorganism and fight it off if exposed to it again. This is described as immunity (Center for Disease Control, 2009).

How Vaccines Work

A vaccine, or immunization, is given to stimulate an individual’s immune system. A vaccine contains a foreign microorganism that has been killed or weakened. Once it is introduced to the body, the immune system triggers an immune response and thus builds immunity against future exposure. It is important for individuals to not miss opportunities to get immunized, especially populations at risk (Center for Disease Control, 2009).

Recommended Vaccines for All HIV positive Adults

Hepatitis B Vaccine

This vaccine provides protection against the disease Hepatitis B, which is described as viral infection causing inflammation of the liver. The vaccine is given over a series of three injections. The first injection can be given at any time followed by the second injection at least one month after the first. The third injection should be given six months after the first (Center for Disease Control, 2009).

Influenza Vaccine

Influenza vaccinations protect individuals against the seasonal Flu. This vaccine should be given once a year usually beginning in September. HIV positive adults should only the “flu shot” instead of the nasal spray flu vaccine. The nasal spray flu vaccine contains an activated virus that can cause harm to an immunosuppressed individual (AIDS info, 2009).

Polysaccharide pneumococcal

This vaccine is given to protect individuals against Pneumonia. Pneumonia is a respiratory condition causing inflammation of the lungs. The vaccine is given once and protects individuals up to five years. A second dose is usually given to people who received the first shot over the age of 65 or immnosuppressed individuals such as HIV patients (AIDS info, 2009).

Tetanus, Diphtheria (Td) or Tetanus, Diphtheria, Pertussis (Tdap)

These combined vaccines provide protection again Tetanus, or Lockjaw, Diphtheria, and Pertussis, or Whooping Cough. The Tdap vaccine, which was introduced in 2005, protects against all three diseases. Tdap is recommended for adults under the age of 64 and should be given in place of a Td booster that is routinely given every 10 years. Tdap is given as a single injection (AIDS info, 2009).

Recommendations for Some HIV Positive Patients

Hepatitis A Vaccine

This vaccine is given for patients needing protection again the Hepatitis A virus, which is a serious liver disease. A total of two shots are given over a 12 to 18 month period. HIV positive patients who fall under the following categories should receive this vaccine: men who have sex with men, healthcare workers, needle drug users, have chronic liver disease (including Hepatitis B and C), and people traveling to countries with a high prevalence of Hepatitis A (Center for Disease Control, 2009).

Meningococcal Vaccine

By receiving this vaccine, an individual can be protected against four types of meningococcal diseases. Meningococcal is a serious bacterial infection that is the leading cause of bacterial meningitis, a serious infection to the brain and spinal coverings that can lead to brain damage. The dosage for this vaccination is 1 or 2 shots and should be determined by your healthcare provider. The following HIV positive patients should receive this vaccine: college students, people traveling to countries with a high prevalence of meningococcal, people with a damaged or removed spleen, and military recruits (Center for Disease Control, 2009).

Haemophilus influenzae type b Vaccine (Hib)

Haemophilus influenzae type b is a bacterium that is responsible for meningitis, severe pneumonia, and other serious diseases (Center for Disease Control, 2009). This vaccine is given with a single shot. HIV positive patients should discuss with their healthcare providers to determine if this immunization is necessary (AIDS info, 2009).

Measles, Mumps, Rubella Vaccine (MMR Vaccine)

This combined vaccination provides protection again Measles, Mumps, and Rubella. All three are serious diseases that can lead to pneumonia, meningitis, or birth defects in pregnant women. The vaccine is given in a serious of two shots (AIDS info, 2009). Anyone born after 1956 should receive this vaccination. However, HIV positive patients should discuss with their healthcare provider to determine if their immune system is strong enough to handle this vaccine. Each component of the vaccine can be given individually if necessary (Center for Disease Control, 2009).

Varicella Vaccine

Varicella Vaccine is given to prevent the disease commonly known as Chickenpox, or Varicella. The disease is associated with itching, fever, and rashes. However, it can lead to skin infections, pneumonia, or brain damage (Center for Disease Control, 2009). Although it is usually known as a childhood disease, adults can experience severe complications for exposure. An HIV positive patient who has never been exposed to the chickenpox or received two doses of the vaccine should discuss with their healthcare provider about an appropriate time to receive this immunization (AIDS info, 2009)

Recommended Immunizations for all Postpartum Women

Hepatitis B Vaccine

This vaccine provides protection against the disease Hepatitis B, which is described as viral infection causing inflammation of the liver. The vaccine is given over a series of three injections. The first injection can be given at any time followed by the second injection at least one month after the first. The third injection should be given six months after the first. A postpartum mother should receive this whole series if she has not previously done so (Center for Disease Control, 2009).

Influenza Vaccine

Influenza vaccinations protect individuals against the seasonal Flu. If a mother has no received the Influenza vaccine during pregnancy it is highly recommended they do so early postpartum. Postpartum mothers should only receive the “flu shot” instead of the nasal spray flu vaccine. The nasal spray flu vaccine contains an activated virus that can easily spread to the infant (Center for Disease Control, 2009).

Tetanus, Diphtheria, Pertussis (Tdap) Vaccine

This combined vaccine should be given for a postpartum mother before even being discharged. It is recommended to all mothers, even if they are breastfeeding, who have not received Tdap previously. The vaccine provides protection again Tetanus, or lockjaw, Diphtheria, and Pertussis, or whooping cough. Tdap is given as a single dose injection (Center for Disease Control, 2009).

What are the benefits of getting vaccinated?

Because of immunization, the eradication of smallpox, polio and many other diseases in the developed world has been possible. The wide-spread availability of vaccines and immunization efforts “are by far the most well-recognized public health intervention” (Behrmann, 2010). However, because vaccines are so widely used, it is important to address any safety concerns there are regarding the safety of immunizations to preserve and restore trust in vaccinations (Behrmann, 2010).

What are the side effects of immunization?

The most common side effects of immunization are pain or inflammation at the injection site (Behrmann, 2010). With a small amount of patients, an allergic reaction can occur after the injection in reaction to the vaccine’s packaging, additives or trace contaminants. In some cases, the reaction is a severe anaphylactic reaction. Behrmann reports in his 2010 article that the frequency of these cases is 1 in every million administrations. To put this in perspective, this estimates that “approximately 180 deaths from vaccination occur each year, which is roughly equivalent to the number of traffic accident fatalities that occur every 1.5 days.” While it is certainly valid to be concerned about the safety of vaccinations, it is important to consider that the “population-level benefits that vaccination offers in preventing serious morbidity and mortality from infections as well as providing the ability to expand opportunities for healthcare by sparing resources that would otherwise be needed to care for individuals with preventable infectious diseases” (Behrmann, 2010).

Current issues regarding vaccination

While vaccines are an enormous accomplishment towards health promotion, many individuals are concerned about the safety of the immunization preparations. Some of the common concerns for adverse affects from vaccines include thimerosal, autism, syncope, and Sudden Infant Death Syndrome. (CDC, 2010). Separating the myths and truths about immunization is important for patients to understand the true benefits and risks. In his 2010 journal article, Behrmann addresses the current issues surrounding vaccination when he suggests that the “extreme and often unfounded fears and emotive discourse currently invoked in public debates concerning the safety of vaccines resembles mass-hysteria.” Because of this resistance towards vaccination, the local and world population is at a greater risk for contracting once uncommon infections. A current example of this is the recent return of pertussis and measles in developed parts of the world (Behrmann, 2010). Therefore, it is important to acknowledge the potential risks of immunization and address their frequency.

One of the most prominent issues regarding immunization safety today is the potential correlation between the preservative thimerosal and autism. Thimerosal is a mercury-containing preservative that was used in some vaccines at low doses. It was suggested that the increases in diagnoses of autism was correlated with the immunizations that were being administered to children. However, it is important to note that the Institute of Medicine published a scientific review that concluded there is no causal relationship between thimerosal-containing vaccines and autism (Institute of Medicine, 2004). As a precautionary measure in 1999, vaccine manufacturers agreed that thimerosal should be removed from vaccines.

Syncope, or fainting, is another possible adverse effect following an immunization. It is recommended that healthcare providers watch patients for 15 minutes following receiving an immunization. The 11 to 18 year old age group is where most of the syncope cases occur (Center for Disease Control, 2010). The cause for fainting is not completely known, but serious injuries can easily be prevented by monitoring patients after the vaccine for 15 minutes.

Sudden Infant Death Syndrome, or SIDS, has also been a perceived adverse affect from vaccinations. The newborn vaccinations begin around 2 to 4 months of age and this is when the highest rate of SIDS cases occur, so some people believed that there may be a causal relationship between vaccinations and SIDS (Center for Disease Contro, 2010). However, the Center for Disease Control led multiple studies that investigated this issue using the Institute of Medicine, the Vaccine Safety Datalink and the Vaccine Adverse Event Reporting System and they concluded that vaccinations are not a risk factor for SIDS (Center for Disease Control, 2010).

Where can I get immunized?

Center for Disease Control – Find a Clinic

http://wwwnc.cdc.gov/travel/content/travel-clinics.aspx

Influenza Vaccination Clinics

http://www.flushotsusa.com/

Help Prevent Disease – Find a Clinic

http://www.helppreventdisease.com/index.html?rotation=52960337&banner=228885477&src=1&kw=p

Where can I find more information?

National Network for Immunization Information

http://www.immunizationinfo.org/

National Vaccine Information Center

http://www.nvic.org/

Immunizations for High Risk Populations

http://www.medscape.com/viewarticle/421487_6

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http://www.surveymonkey.com/s/ZB929PZ References

AIDS Info. (2009). Immunizations. Retrieved November 10, 2010, from http://www.aidsinfo.nih.gov/HealthTopics/HealthTopicDetails.aspx?expandable=1&HealthTopicID=81&ClassID=54

Bastable S. B. (2008). Nurse as educator: Principles of teaching and learning for nursing practice, 3rd ed. Jones and Bartlett Publishers.

Behrmann, J. (2010). The anti-vaccination movement and resistance to allergen-immunotherapy: a guide for clinical allergists. Allergy, Asthma and Clinical Immunology, 6(26), 1-11.

Center for Disease Control. (2010). Vaccines & Preventable Diseases. Retrieved November 10, 	2010, from http://www.cdc.gov/vaccinesafety/Concerns/Index.html

Center for Disease Control. (2010). Vaccine Safety. Retrieved November 1, 2010, from http://www.cdc.gov/vaccinesafety/Concerns/Index.html

Institute of Medicine. (2004). Immunization Safety Review. Washington, DC: The National Academies Press. Retrieved from http://www.iom.edu/Reports/2004/Immunization- Safety-Review-Vaccines-and-Autism.aspx