Learning Outcomes
By the end of this section, you should be able to:
- 6.2.1 Define immunity.
- 6.2.2 Differentiate between natural and active acquired immunity.
- 6.2.3 Describe the difference between active and passive immunity.
- 6.2.4 Explain the importance of vaccination in the immunity process.
- 6.2.5 Identify common diseases that can be prevented with vaccines.
- 6.2.6 Describe the difference between vaccines and immunizations.
- 6.2.7 Review vaccination recommendations based on age and travel.
- 6.2.8 Describe nursing implications related to vaccines and immunizations.
- 6.2.9 Explain the client education related to vaccines and immunizations.
Vaccine-preventable diseases are infectious illnesses caused by viruses or bacteria that can be effectively prevented using vaccines, which stimulate the immune system to develop specific immunity against these pathogens (Centers for Disease Control and Prevention [CDC], 2023a). Vaccines are biological preparations containing weakened or inactivated pathogens or their components, prompting the body to produce protective antibodies and memory cells. Immunizations involve administering vaccines to clients, providing them with the necessary immunity to ward off specific diseases, thus reducing the risk of infection and its potential severe consequences while contributing to vital public health efforts to control and eradicate these preventable diseases.
Immunity
Immunity is the ability of an organism to resist or defend against harmful pathogens such as microorganisms or toxic substances (CDC, 2023a). It is an essential defense mechanism that helps protect the body from infections and diseases. There are different types of immunity, including natural, active acquired, active, and passive immunity, which are discussed below.
Natural Immunity
Natural immunity, also known as innate immunity, is the inborn resistance to certain diseases that a client possesses without prior exposure to the causative agent. This type of immunity is non-specific, meaning it provides a general defense against a wide range of pathogens. Natural immunity is the first line of defense and includes physical barriers (e.g., skin), chemical barriers (e.g., stomach acid), and cellular responses (e.g., macrophages and natural killer cells).
Acquired Immunity
An acquired immunity is the immunity that develops after exposure to a foreign antigen. The immune system recognizes the antigen as foreign, and a specific response is generated to target and eliminate it. This type of immunity is long lasting and involves the production of memory B cells, which “remember” the encountered antigen and can mount a faster and stronger response upon subsequent exposures (Grubbs & Kahwaji, 2022). Active acquired immunity can be achieved through two main ways:
- Naturally acquired active immunity: This occurs when a client is exposed to a pathogen in the environment and develops immunity as a result. For example, getting infected with a virus and recovering from the infection leads to natural active acquired immunity.
- Artificially acquired active immunity: This type of immunity is induced through vaccination. Vaccines contain weakened or inactivated forms of pathogens or their components, which stimulate the immune system to produce a response without causing the actual disease. The immune system then develops memory cells to provide protection against future infections by the same pathogen.
Active Immunity
Active immunity, in a broad sense, refers to immunity that is generated by the body’s immune system actively responding to a foreign antigen. It encompasses both natural and active acquired immunity. This type of immunity enables a rapid and potent response upon subsequent exposures to the same pathogen.
Passive Immunity
Passive immunity is the temporary protection against a specific pathogen that is conferred to a client by receiving pre-formed antibodies rather than producing them internally (Slifka & Amanna, 2018). Unlike active immunity, passive immunity does not involve the production of memory B cells, and the protection is short-lived. Passive immunity can be acquired through two main ways:
- Natural passive immunity: This occurs when antibodies are passed from a pregnant person to the fetus through the placenta during pregnancy or through breast milk during breastfeeding. These antibodies provide the newborn with some protection during the early stages of life until their own immune system matures.
- Artificial passive immunity: This type of immunity is achieved by administering pre-formed (synthetic or pooled from donors) antibodies obtained from another individual or animal. For example, in certain medical situations, such as treating some viral infections or providing immediate protection against specific diseases, purified antibodies can be given as a treatment. The protection offered by artificial passive immunity diminishes as the administered antibodies are gradually cleared from the body.
Vaccines and Immunizations
Vaccines and immunizations are related concepts, but they differ in their scope and application. Vaccines are biological substances designed to stimulate the immune system and generate a protective response against specific pathogens (CDC, 2023a). They can be composed of weakened or inactivated forms of the disease-causing agent (virus, bacteria, or toxin) or subunits of the pathogen. When administered, vaccines prompt the immune system to recognize the antigens present in the vaccine and produce antibodies, memory cells, and other immune responses. These immune responses prepare the body to defend against future infections by the actual pathogen.
Immunization is the process of administering vaccines to clients, aiming to establish immunity against certain diseases (CDC, 2023a). It is a preventive measure to protect clients from infections, especially those that can cause severe illness, disability, or death. Through immunizations, clients build immunity without experiencing the full-blown disease, which reduces the risk of infection and contributes to public health by controlling the spread of disease.
Vaccines employ various mechanisms of action, and there are different types including:
- Live attenuated vaccines: These vaccines contain weakened but live forms of the pathogen. These weakened strains can still replicate within the body but are rendered less virulent, so they do not cause the disease in healthy individuals. Examples of live attenuated vaccines include the measles, mumps, rubella (MMR) vaccine and the oral polio vaccine (OPV). These vaccines generally provide long-lasting immunity with a single or few doses.
- Inactivated vaccines: These vaccines contain killed versions of the pathogen, meaning the virus or bacteria have been rendered nonfunctional and cannot replicate. As a result, they do not cause disease in recipients. Inactivated vaccines often require multiple doses or booster shots to build and maintain immunity. Examples of inactivated vaccines include the hepatitis A vaccine and the injectable polio vaccine (IPV).
- Subunit, recombinant, and conjugate vaccines: These vaccines contain only specific antigens or parts of the pathogen rather than the whole microorganism. Recombinant vaccines use genetically engineered antigens to trigger an immune response. Conjugate vaccines combine a weak antigen with a strong antigen to enhance the immune response, especially in young children. Examples of subunit, recombinant, and conjugate vaccines include the hepatitis B vaccine, human papillomavirus (HPV) vaccine, and some meningococcal vaccines.
- mRNA vaccines: These vaccines do not contain any live or inactivated virus or bacteria. Instead, mRNA vaccines contain genetic instructions (mRNA) that instruct the cells in the body to produce a specific viral or bacterial protein. This protein then triggers an immune response, leading to the production of antibodies and memory cells. mRNA vaccines, like the Pfizer-BioNTech and Moderna COVID-19 vaccines, have shown high efficacy and can be developed more rapidly than traditional vaccines.
Not only do vaccines and immunizations protect clients, but they also play a role in herd immunity. Herd immunity is a state where a significant portion of a population becomes immune to a specific infectious disease through vaccination or previous exposure (McDermott, 2021). Herd immunity works as a barrier against the transmission of the disease because the pathogen has fewer susceptible individuals to infect. The threshold required for achieving herd immunity depends on the contagiousness of the disease. For highly contagious infections like measles, a large proportion (around 95%) of the population needs to be immune to prevent outbreaks. For less contagious diseases, the threshold may be lower. Therefore, herd immunity is a crucial aspect of public health strategies and vaccination campaigns.
Vaccine hesitancy is a concerning issue and refers to the delay or refusal of vaccination despite its availability (Shen & Dubey, 2019). It is driven by factors like safety concerns, distrust in vaccines or health care providers, and misinformation. Vaccine hesitancy poses a public health challenge, as it can lead to outbreaks of preventable diseases. Addressing it requires evidence-based communication, education, and building trust to promote vaccination and protect public health.
Safety Alert
Vaccines and Immunizations
The CDC and FDA monitor the safety of vaccines after they are approved. If a problem is found with a vaccine, the CDC and FDA will inform health officials, health care providers, and the public through the Global Rapid Response Team (GRRT) and through public health announcements and communications.
Vaccine-Preventable Diseases
Vaccine-preventable diseases (CDC, 2023a) are illnesses that can be avoided through vaccination. Some common vaccine-preventable diseases include measles, mumps, rubella, pertussis, polio, hepatitis A and B, varicella, human papillomavirus (HPV), pneumonia, and influenza. Vaccination against these diseases is a crucial public health measure that not only protects clients but also helps to establish herd immunity, reducing the overall prevalence and transmission of these infectious agents within communities.
Vaccine Recommendations
Vaccines are an important tool to prevent the spread of infectious diseases and protect public health. The World Health Organization (WHO, 2021; CDC, 2021) recommends routine vaccination for children against several diseases such as measles, polio, diphtheria, tetanus, pertussis (whooping cough), and hepatitis B. Vaccination is also recommended for adults against influenza, pneumococcal disease, shingles, COVID-19, and other illnesses depending on their age, health status, occupation, travel plans, and other factors.
Vaccines have guidelines on immunization schedules for different age groups and populations based on scientific evidence and expert opinion (see Table 6.1). It is important to follow these recommendations to ensure that clients receive the appropriate vaccines at the right time and in the correct doses.
Some vaccines, such as hepatitis A and B vaccines, varicella vaccine, and MMR vaccine, require titers to assess immunity levels. A titer is a blood test that measures the level of antibodies against the virus in the bloodstream. Checking titers after completing the vaccination or the vaccination series helps to determine if a client has developed sufficient immunity to the virus. A positive titer indicates protective antibodies are present in the body, and the client is considered immune. If the titer is negative or below the protective level, a booster dose of the vaccine may be recommended to enhance immunity. Titers are drawn at different intervals depending on the vaccine, when vaccinated, and the client’s need.
Table 6.1 provides additional information on common recommended vaccines and illustrates their indications, routes, and dosing for pediatric and adult clients.
| Name | Indications for Use | Recommended Routes, Dosages, and Time |
|---|---|---|
| H. influenza type b (Hib) vaccine (ActHIB) |
Prevention of invasive disease caused by Haemophilus influenzae (H. influenzae) type b, for use in children 2 months through 5 years of age | A 4-dose series (0.5 mL per dose) intramuscular: A primary 3-dose series of a single dose at 2, 4, and 6 months of age. A single booster dose at 15–18 months of age. |
| Hepatitis A vaccine (Havrix) |
Active immunization against disease caused by hepatitis A | Children (12 months through 18 years): Intramuscular 0.5 mL dose and a 0.5 mL booster dose administered anytime between 6 and 12 months later. Adults (19 years and older): A single 1 mL intramuscular dose and a 1 mL booster dose administered anytime between 6 and 12 months later. |
| Hepatitis B vaccine (Recombivax HB) |
Prevention of infection caused by all known subtypes of hepatitis B virus | Children (0–19 years of age, pediatric/adolescent formulation): 5 mcg (0.5 mL) intramuscularly, 3 doses at 0, 1, and 6 months. Adolescents (11–15 years of age, adult formulation): 10 mcg (1 mL) intramuscularly, 2 doses at 0 and 4–6 months. Adults (≥20 years, adult formulation): 10 mcg (1 mL) intramuscularly, 3 doses at 0, 1, and 6 months. Predialysis and dialysis clients: 40 mcg (1 mL) intramuscularly, 3 doses at 0, 1, and 6 months. |
| Human papillomavirus (HPV) vaccine (Gardasil, Cervarix) |
Females 9–45 years of age: for the prevention of cervical, vulvar, vaginal, anal, oropharyngeal, and other head and neck cancers and genital warts caused by human papillomavirus 6, 11, 16, 18, 31, 33, 45, 52, and 58 Males 9–45 years of age: For the prevention of anal, oropharyngeal, and other head and neck cancers, and genital warts caused by human papillomavirus 6, 11, 16, 18, 31, 33, 45, 52, and 58 |
Children (9–14 years): 2 doses (0.5 mL each) intramuscularly at 0 and 6–12 months or 3 doses at 0, 2, and 6 months. Teens and adults (ages 15–45 years): 3 doses (0.5 mL each) intramuscularly at 0, 2, and 6 months. |
| Influenza vaccine (Afluria, Fluzone) |
Active immunization for the prevention of influenza caused by influenza A subtype viruses and type B viruses contained in the vaccine | Children (6–35 months): 1 or 2 doses (0.25 mL each) intramuscularly; if 2 doses, schedule at least 1 month apart. Children (36 months–8 years of age): 1 or 2 doses (0.50 mL each) intramuscularly; if 2 doses, schedule at least 1 month apart. Children (9–17 years of age): 1 dose (0.5 mL) intramuscularly. Adults (18–64 years of age): 1 dose (0.5 mL) intramuscularly. Adults ≤65 years: High-dose quadrivalent intramuscular, 1 dose (0.7 mL). |
| Measles, mumps, and rubella (MMR) vaccine (M-M-R-II) |
Active immunization against MMR diseases | Children: (12–15 months and 4–6 years): 2 doses (0.5 mL each) intramuscularly (CDC, 2021). |
| Meningococcal group B vaccine (Bexsero) |
Active immunization to prevent invasive disease caused by Neisseria meningitidis serogroup B | Children (≥5 years): 2 doses (0.5 mL each) intramuscularly at least 1 month apart. |
| Pneumococcal polyvarent vaccine (Pneumovax 23) |
Active immunization for the prevention of pneumococcal disease caused by the 23 serotypes contained in the vaccine | Adults and children (≥2 years): 1 dose (0.5 mL) intramuscularly as indicated based on the client’s age and clinical condition. |
| Pneumococcal 13-variant vaccine (Prevnar 13) |
Active immunization for the prevention of pneumonia and invasive disease caused by the 13 serotypes of S. pneumoniae contained in the vaccine | Children (infants and toddlers): 4-dose series (0.5 mL each) given intramuscularly at 2, 4, 6, and 12–15 months of age. Children (unvaccinated, 7 months to 5 years): 7–11 months, 3 doses (0.5 mL) intramuscularly; 12–23 months, 2 doses (0.5 mL each) intramuscularly; 24 months through 5 years, 1 dose (0.5 mL) intramuscularly. Doses are at least 4 weeks apart. Children and adults (≥6 years): 1 dose (0.5 mL) intramuscularly. |
| Inactivated poliovirus vaccine (IPOL) |
Active immunization of infants (as young as 6 weeks of age), children, and adults for the prevention of poliomyelitis caused by poliovirus types 1, 2, and 3 | Children: 3 doses administered intramuscularly or subcutaneously 8 weeks apart at ages 2, 4, and 6–18 months. The first immunization may be administered as early as 6 weeks of age. Booster dose is administered at 4–6 years of age. Adults: 2 0.5 mL doses, given intramuscular or subcutaneously at a 1- to 2-month interval and a third dose given 6–12 months later. |
| Rotovirus vaccine (Rotarix, RotaTeq) |
Indicated for the prevention of rotavirus gastroenteritis caused by G1 and non-G1 types | Children: 2-dose (1.5 mL) series orally beginning at 6 weeks of age at an interval of at least 4 weeks between first and second dose. The dose series should be completed by 24 weeks of age; or 3-dose (1.5 mL) series orally starting at 6–12 weeks of age with subsequent doses at 4- to-10-week intervals and completed no later than 32 weeks of age. |
| Varicella vaccine (Varivax) |
Active immunization for the prevention of varicella in clients 12 months of age and older | Children (12 months–12 years): Initial dose: 0.5 mL intramuscularly at 12–15 months of age but may be given any time through age 12; second dose administered at 4–6 years of age; at least 3 months should elapse between doses. Teens and adults (≥13 years): 2 doses (0.5 mL each) administered intramuscularly at least 4 weeks apart. |
| Zoster vaccine (Shingrix) |
Indicated for prevention of herpes zoster (HZ) (shingles): in adults aged 50 years and older and in adults aged 18 years and older who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy | Adults: 0.5 mL administered intramuscularly 2–6 months apart. For clients who are or will be immunodeficient or immunosuppressed and who would benefit from a shorter vaccination schedule: First dose at month 0 followed by a second dose administered 1–2 months later. |
| Diphtheria, tetanus toxoid, and acellular pertussis vaccine (DtaP [diphtheria, tetanus, and acellular pertussis vaccine] given to infants and young children; tDaP [tetanus, diphtheria, and acellular pertussis], a booster shot given to older children, adolescents, and adults) (Adacel, Daptacel) |
Indicated for active immunization against diphtheria, tetanus, and pertussis as a 5-dose series in infants and children 6 weeks through 6 years of age (prior to seventh birthday) | DtaP: Children: 5-dose series (0.5 mL each) intramuscularly at 2, 4, and 6 months of age at intervals of 6–8 weeks, at 15–20 months of age, and at 4–6 years of age. tDaP (booster): 0.5 mL administered intramuscularly 5 years or more after the last dose of DtaP or 5 years of more after a dose of tetanus toxoid adsorbed (Td). A second dose may be administered 8 years or more after the first dose or tDaP. |
| COVID-19 vaccine, mRNA (Comirnaty, Spikevax) |
Indicated for active immunization to prevent coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in clients 12 years of age and older | For Comirnaty: ≥12 years: 2 doses (0.3 mL each) intramuscularly 3 weeks apart. For Spikevax: ≥18 years: 2 doses (0.5 mL each) intramuscularly 1 month apart. Booster doses as recommended per season. |
Adverse Effects and Contraindications
Vaccines are generally safe and effective in preventing infectious diseases (CDC, 2023b). However, like any medical intervention, they can have adverse effects. It is important to remember that the benefits of vaccination far outweigh the risks for most people. Vaccine adverse effects commonly involve local and systemic reactions.
Local reactions including tenderness, erythema, induration, and swelling at injection site. Systemic reactions include fever, irritability, drowsiness, anorexia, and vomiting. Other reactions include anaphylactic reactions, such as urticaria and angioedema, as well as nervous system reactions such as convulsions and syncope.
Contraindications to vaccines include hypersensitivity to the vaccine or any of its constituents.
International Travel Considerations
When planning international travel, it is important for clients to consider the possible health risks and ensure all vaccinations are up to date. Vaccines protect against many infectious diseases such as typhoid, yellow fever, hepatitis A and B, meningitis, measles, mumps, rubella, and polio (WHO, n.d.). Some countries may require proof of certain vaccinations for entry. Clients should allow enough time for multiple doses or immunity to develop. An International Certificate of Vaccination may be required by clients traveling abroad.
Clients should consider personal health factors and consult a health care provider before getting vaccinated. Practicing good hygiene and taking preventative measures against foodborne and waterborne illnesses and insect-borne diseases assists in decreasing risk factors for diseases. It is essential for clients to plan and prioritize immunizations to ensure a safe and healthy travel experience. Consulting a travel health specialist can provide valuable guidance.
Clinical Tip
Vaccine Administration
Administration of vaccinations should follow appropriate precautions to minimize risk for disease exposure and spread. The nurse should cleanse their hands with an alcohol-based waterless antiseptic hand rub or wash them with soap and water before preparing vaccines for administration and between each client contact. The nurse should draw up vaccines in a designated clean medication area that is not adjacent to areas where potentially contaminated items are placed. Multi-dose vials to be used for more than one client should not be kept or accessed in the immediate client treatment area.
Nursing Implications
The nurse should do the following for clients who are taking vaccines:
- Review the client’s medical history and immunization record to assess for allergies and previous vaccinations to identify any contraindications or precautions for the specific vaccine being administered.
- Educate the client about the vaccine’s purpose, potential side effects, and benefits to help the client make an informed decision and reduce vaccine hesitancy.
- Confirm informed consent from the client or their legal guardian before administering the vaccine.
- Check the vaccine’s storage and handling to verify that the vaccine has been stored at the appropriate temperature and that it is within the expiration date to maintain its potency and efficacy.
- Prepare and administer the vaccine safely following the guidelines for the vaccine, including the appropriate route, dosage, and injection site. Proper aseptic technique should be maintained throughout the procedure to prevent infections and ensure client safety.
- Provide client teaching regarding vaccines and when to call the health care provider. See below for client teaching guidelines.
Client Teaching Guidelines
The client receiving a vaccine should:
- Discuss their medical history with the health care provider and discuss the vaccine prior to immunization.
- Report any reaction caused by the vaccine to the health care provider including local reactions such as tenderness, erythema, and swelling at the injection site; systemic reactions such as fever, irritability, drowsiness, and vomiting; anaphylactic reactions such as urticaria and angioedema; and CNS reactions such as convulsions and syncope.
- Ask questions, seek clarification, and fully understand the information provided before giving their consent for vaccination.
The client receiving a vaccine should not:
- Withhold information about their medical history or any known allergies to vaccine components.
- Rush through informed consent.
- Disregard post-vaccination care instructions, as these guidelines can help manage potential side effects and ensure a smooth recovery after vaccination.