Immunizations: 101 A Clinical Refresher in Childhood Vaccine Administration

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Immunizations 101A Clinical Refresher in
Childhood Vaccine Administration

• Susan Chandler, R.N., MPH
• Immunization Nurse Consultant

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Impact of Vaccines in 20th Century

• Smallpox from 48,000 annual morbidity to 0
• Polio from 147,000 annual morbidity to 1
• Measles from 503,000 annual morbidity to 66
• HiB from 20,000 annual morbidity to 226
  (serotype B and unknown)

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Impact of HiB Vaccine
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Impact of Polio Vaccine
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Impact of Measles Vaccine
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Agenda

• Vaccine Issues
• Child Related Issues
• Documentation
• State Law and State Vaccine Program
• Learning Labs

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Vaccine Issues

• Schedules
• Product Recognition
• Minimum Ages/Minimum Intervals
• Administration
• Storage/Handling

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Recommended Schedule 2007

• By Vaccine
• By Ages
• Footnotes Dont forget the footnotes.
• Always read
• Always heed

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Catch-Up Schedule

• Children age 4 months through 6 years
• Children 7 years through 18 years

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Catch-Up Schedule
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Catch-Up Schedule
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Latest Age and Age Restrictions

• HiB Age 5 years
• PCV7 Age 5 years
• DTaP Age 7 years
• DT Age 7 years
• Polio Age lt18 years (US resident)
• Td Not before age 7 years
• Tdap Not before age 10 years (product related)

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Vaccine Issues Products Diphtheria/Tetanus

• DTaP
• DT
• Td
• Tdap Boostrix,
• Adacel

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Vaccine Issues Products

• HiB
• Hep
• Polio
• ppd
• PCV 7
• PPSV 23
• MCV-4
• MPSV-4

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Vaccine Issues Minimum Age

• At Birth
• At 4 weeks
• At 6 weeks-the case for HiB
• Live Virus Vaccines-MMR
• Varicella
• Rotavirus

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Vaccine Issues Minimum Intervals

• Recommended Minimum Intervals
• Interval between IG/Blood and Live Virus Vaccines
• Diphtheria/Tetanus containing vaccines-no more
  than 6 by 7
• Interval between MMR and ppd if not administered
  same day

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Vaccine Issues Administration

• Standing Orders
• For RNs
• For LPNs

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Vaccine Issues Administration

• Anatomical Sites
• Legs
• Arms
• Buttock
• Separation

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Vaccine Issues Administration

• Intramuscular Injections
• Infants
• Toddlers
• Older Child
• Subcutaneous Injections
• Infants
• Toddlers
• Older Child

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Vaccine Issues Handling

• Diluents
• Prefilled syringes
• Mixing vaccines
• Expiration dates

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Vaccine Issues Storage

• Temperatures
• Light
• Clinic Settings
• Disaster

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Child Related Issues

• Contraindications
• Teaching/Counseling
• After Care
• Emergency Care

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Contraindications

• Guide to Contraindications and Precautions for
  Childhood Vaccinations
• www.cdc.gov/vaccines
• Screening Questionnaire for Child and Teen
  Immunization
• www.immunize.org
• Package Inserts

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Contraindications

• State Law and medical exemptions
• Screening tools

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Contraindications

• Check and Double Check
• National Immunization Screening Questionnaire

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Teaching and Counseling

• Risks vs Benefits
• www.vaccinesafety.edu
• Adverse Reactions
• http//vaers.hhs.gov
• Law Requirements
• www.immunizenc.com

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After Care

• Wait or not to Wait?
• Analgesics
• Adverse reactions
• Parent call provider
• Provider notify VAERS

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Adverse Reactions

• Emergency Care
• Protocols
• Epinephrine
• Benadryl

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Documentation Issues

• Permanent Medical Record
• Certificate of Immunization

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Permanent Medical Record

• Patient identification
• Vaccine Name
• Date of Administration
• Manufacturer
• Lot Number
• Site (Anatomical)
• Immunizer
• VIS offered
• VIS publication date
• Route

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Documentation-continued

• Certificate of Immunization
• Vaccine Administration Log (VAL)
• NC Immunization Registry (NCIR)

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History
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Historical Record Sources

• Providers Office(s)
• Parents Records
• NCIR
• School Records

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Vaccine Issues State Law

• NC General Statues
• www.ncleg.net/Statutes/
• Statutes.asp
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• NC Administrative Code
• The Rules
• http//ncrules.state.nc.us

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State Law

• Follow ACIP Recommended Childhood Schedule
• Requires Certificate of Immunization presented
  for Child Care/School enrollment

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UCVDP

• Follows current medical recommendations of ACIP
• Requires Safeguarding of Vaccines
• Requires Fiscal Accountability

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Additional Resources

• Immunization Works
• CDCs Pink Book
• AAPs Red Book

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Additional Resources continued

• Tapes
• Immunization Techniques Safe, Effective, Caring
• Get the PictureStorage and Handling of Your
  Vaccine Supply

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Additional Resources continued

• Web Sites
• www.cdc.gov/nip
• www.immunize.org
• www.immunizenc.com
• www.immunizationinformation.org
• www.vaccinesafety.edu

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Additional Resources continued

• ACIP Recommendations
• General Recommendations December 2006
• Vaccine by Vaccine

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Additional Resources continued

• Regional Immunization Nurse Consultants

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Learning Labs