Vaccinations have been a mainstay of public health for more than two centuries, and without them, millions might have been lost to preventable disease. As front-line healthcare providers, nurses regularly administer vaccines and have a responsibility to educate patients about immunization, the role vaccines play and how to stay safe. These are the basics.
What is a Vaccine and How Does it Work?
When a person contracts a bacterial or viral illness, the body attacks and neutralizes it. In the process, it creates unique proteins called antibodies that recognize and defend the host against future infection by the same pathogen. A vaccine is a solution containing a weaken or killed bacteria or virus. It can’t cause illness, but it provokes the same immune reaction and protects the host against that disease.
Vaccination vs Immunization
Vaccination and immunization are two terms that are often used interchangeably but mean different things. Vaccination is the physical administration of a vaccine; immunization is the process by which someone becomes immune to a particular illness.
Why the distinction? It’s two-fold. First, because immunity can be the result of actual illness, not a vaccine, non-lethal past exposure to disease can be a part of someone’s total level of resistance. Second, no vaccine is 100-percent effective, and there is significant variability in efficacy rates for a variety of reasons. Booster shots may be necessary for full immunity, and occasionally, less protection is conferred because of differences in people’s immune systems or because they were ill at the time they were vaccinated.
Are Vaccines Safe?
There is no shortage of controversy surrounding the safety of vaccinations, but the healthcare community is clear, they’re safe. The United States has one of the most comprehensive systems in the world for guaranteeing vaccine safety because they’re administered to millions of people each year.
All vaccines are subject to years of testing before the FDA licenses them and once in use, they’re continually monitored both for efficacy and adverse effects. Individual batches are tested for safety and quality, and the facilities where they are produced are routinely inspected. Like any medicine, allergic reactions are possible, but healthcare providers try to minimize that risk with careful patient screening.
Type of Vaccines
There four types of vaccines, each best-suited for certain types of pathogens including inactivated vaccines, live-attenuated vaccines, recombinant and conjugate vaccines and toxoid vaccines.
Inactivated vaccines are made with killed germs. They offer less immunity than vaccines made with weakened versions of a virus or bacterium, so patients may need booster shots to remain immune long-term. Vaccines for influenza, polio, pertussis, rabies and hepatitis A are inactivated.
Live vaccines use weakened pathogens, and they’re stronger than inactivated types. One or two doses is usually enough. They include smallpox, chickenpox, and the combined measles, mumps and rubella, or MMR vaccines.
Recombinant and Conjugate Vaccines
Recombinant and conjugate vaccines use a specific part of the germ to provoke immunity. Usually, the same the part the body’s immune system looks for to attack it. Booster shots may be required, but these vaccinations offer high levels of protection and are safe most patient populations. Vaccines for pneumonia, meningitis, hepatitis B and shingles are examples.
These vaccines promote an immune response to toxins germs create, not the whole pathogen. Examples are diphtheria and tetanus. Booster shots are required.
Vaccines Through Childhood
Childhood vaccines are particularly important because they provide immunity before children are the most likely to be exposed to potentially life-threatening illnesses. The most important are measles, mumps, rubella, polio, diphtheria, tetanus, pertussis, hepatitis a, rotavirus, chickenpox, and meningitis.
Measles, Mumps, Rubella (MMR) Vaccine
Measles, mumps and rubella, also known as the German measles, are all serious viral illnesses. Measles, characterized by a red, pinpoint rash and flu-like symptoms can lead to pneumonia, encephalitis and seizures. The mumps virus causes inflammation of the parotid glands in the neck. Before the widespread use of the vaccine, it was the leading cause of acquired deafness and can cause infertility in men. Rubella is relatively mild by comparison with a light rash and cold-like symptoms, but when contracted by pregnant women, it can lead to severe congenital disabilities. Today, children receive two doses of this vaccine between 12 months and six years of age.
Polio is a viral disease that was once the number-one cause of disability in the United States. While it’s been eradicated in the U. S. since 1955, in large part due to an aggressive vaccination program, it’s still prevalent in some parts of the world and vaccination is always recommended.
Diphtheria, Tetanus and Pertussis Vaccine
The diphtheria, tetanus and pertussis vaccine, or DTaP, protects against three serious bacterial illnesses. Diphtheria causes respiratory issues, heart failure and paralysis and was once responsible for tens of thousands of child deaths annually. Pertussis, or whooping cough, is less severe, but it can lead to pneumonia, respiratory failure and death. Tetanus, also known as “lockjaw,” causes severe muscle tightening and has a twenty-percent mortality rate.
Because diphtheria and pertussis are more often diseases of early childhood, infants and children receive five doses, and a booster may be required. Tetanus boosters should be received every ten years through adulthood and whenever possible exposure occurs.
Hepatitis A Vaccine
Hepatitis A is a severe inflammation of the liver caused by a virus. In this instance, because a child under six may not have symptoms of the disease despite being contagious, the vaccine not only protects children but also their adult caregivers. Two doses spaced six months apart are recommended starting at age 12 months.
Rotavirus is a leading cause of fatal diarrhea in children worldwide. It’s highly contagious, and although it’s not as prevalent in the United States as in other parts of the globe, it’s still responsible for tens of thousands of hospitalizations and can be fatal. Doses are given at two and four months.
Chickenpox (Varicella) Vaccine
Chickenpox was once a childhood rite of passage, but few parents know that it can have severe and even deadly complications including pneumonia. The CDC recommends two doses, one between the ages of 12 and 15 months and the other between four and six years.
Meningococcal disease is bacterial and is the leading cause of childhood meningitis in the U.S. This life-threatening disease is characterized by flu-like symptoms and can lead to brain swelling and death. Depending on the brand of vaccine used, pediatricians recommend it between the ages of 11 and 18.
Adults who are not sure if they are immune to certain high-risk diseases can request lab testing to find out, or they can simply be vaccinated. In most cases, it’s never too late to receive childhood vaccines. Routine vaccines for adults include varicella, pneumonia, shingles, influenza, and rubella.
Adults have a higher risk than children for complications from chickenpox, especially pregnant women. Two doses are given about six weeks apart for adults.
The adult pneumococcal vaccine protects against the most common types of bacteria that cause pneumonia. It does not prevent viral pneumonia. Pneumococcal pneumonia kills nearly 50,000 American annually and patients with chronic disease are at higher risk. The shot is recommended for healthy adults over 65, and any adult or child over the age of two with a chronic respiratory disease or a weaken immune system.
The same virus that causes chickenpox can return as a painful case of shingles in adult life. It produces a blistering rash that can damage the eyes and can stick around long-term as a condition called postherpetic neuralgia. One dose is recommended for adults over 60.
The seasonal influenza vaccine is based on several strains that researchers expect will be prevalent in the coming year. Occasionally, an unsuspected variant slips in, and the shot is not as effective as it could be. However, nearly a quarter of a million people annually are hospitalized due to influenza and more than 30,000 die. Of those, only a minority were vaccinated.
Because of the high risk of birth defects, women of child-bearing age may want to ensure they’re immune to rubella.
The Nurses Role
A patient looks to a nurse for education about vaccinations. In addition to the recommended schedules, clients usually want to know more about the disease they protect against and what the potential side effects of each shot may be.
Since vaccine formulas change frequently, nurses need to stay up-to-date in their knowledge and be ready to answer those questions. Epidemiologically, the medical reasons to get a vaccine rarely vary, and their side effects tend to be similar.
These are the seven most important points to share with patients:
- Vaccines are both safe and effective, and they do not cause illness. Allergic reactions are always a minimal risk for any patient, but they can be monitored for and treated.
- A localized reaction at the site of the shot may occur with any vaccine. Comfort measures such as ice, heat and over-the-counter pain relievers are usually enough to ease any discomfort.
- Certain vaccinations can cause short-lived flu-like symptoms, but this is not the disease and shouldn’t be a barrier to vaccination.
- In most cases, minor illnesses are not a contraindication for vaccination.
- If a vaccine is recommended for a patient, in most cases, the benefits far outweigh the risks.
- In other parts of the world, diseases that are not common in the U.S. are prevalent. Patients should talk to their physician at least eight weeks before going abroad.
- Vaccines are available at a physician’s office, through public health departments and in the case of certain adult vaccines, at the pharmacy. In some states, patients who can’t afford vaccines for their children may qualify to get them free of charge.
Explaining Herd Immunity
A common misconception about childhood diseases is that they’ve been eradicated, and vaccinations pose an unnecessary health risk. Nothing could be further from the truth. Illnesses like polio and mumps are only rare because of vaccinations, and as immunization rates fall, diseases like measles and pertussis are again surging, in part because of lower herd immunity.
Herd immunity is the concept that the greater the number of individuals in a group that are immune to an infection, the less likely it is that those without resistance will contract the disease. As a nurse, this is the simplest way to explain to parents how vaccinating their children protects the entire family, other children at daycare or school and the community at large.
Educating the public about the importance of vaccinations is a critical public health mission, and as front-line healthcare providers, it’s one in which nurses should take a leading role.
Did learning about vaccination and patient immunization interest you? The Associate of Science in Nursing degree program at Gwinnett College provides training to prepare college graduates to enter the nursing profession as a registered nurse. Classroom theory, challenging assignments, skill labs, simulations, and clinical experiences help to prepare college graduates for an entry-level nursing position.
Upon successful completion of the program and demonstrated nursing competence, the college graduates will be eligible to apply to take the NCLEX-RN licensure examination.* Upon graduation and licensure, college graduates will be eligible to seek employment in hospitals, clinics, private duty, urgent and acute care centers, and various other medical or business facilities requiring the services of registered nurses.
*While Gwinnett Institute provides test preparation and review assistance to college students, it cannot guarantee any college student will be able to take or pass any type of licensure exam. College students must be mindful throughout their entire training program that licensure is a pre-requisite for employment as a nurse and to diligently prepare themselves to meet this important requirement.
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