• Introduction

• Vaccinations, or immunizations, work by stimulating the

immune system, the natural disease-fighting system of the
body. The healthy immune system is able to recognize
invading bacteria and viruses and produce substances
(antibodies) to destroy or disable them.
• Immunizations prepare the immune system to ward off a
disease. To immunize against viral diseases, the virus
used in the vaccine has been weakened or killed.
• In addition to the initial immunization process, it has been
found that the effectiveness of immunizations can be
improved by periodic repeat injections or "boosters”.
• Hepatitis “A” Vaccine (HAV)
• Is a vaccine against the hepatitis A virus. The first
successful vaccine against it was invented by Maurice
Hilleman at Merck. The vaccine protects against the virus
in more than 95% of cases and provides protection from
the virus for at least ten years.
Name: HARVIX , VAQTA , TWINRIX
Nature: Killed vaccine
Dose: 0.5 mL
Route: I.M
Site: Middle Thigh
Booster: 6-18 month after 1st dose.
Effectiveness: 94:100%
 Complications:
Local reaction
Systemic reaction( malaise, fatigue)
NO series adverse reaction attributed to vaccine.
Contraindications:
People have allergy from this vaccine.
Pregnant women (particularly those in the second and third
trimesters).
Immunosuppressed individuals.
Infants (<2 years).
Cold Chain:
first shelf of the fridge.
To Whom Given:
1. Recommended for all children beginning at 1
year of age.
2. Two separate doses are given at least 6 months
apart, when a community outbreak of the
disease has recently occurred.
Hepatitis “E” Vaccine (HEV)
Nature: Live attenuated .
Dose: 30 μg
Route: IM
Booster: No dose after 3 doses
Effectiveness: 95:100%.
Cold Chain: First Shelf of the fridge.
Complications:
• Soreness, redness, and swelling at the injection site.
• Headache.
• Tiredness,
• Fever,
• Nausea.
Contraindications:
1. People have allergy from this vaccine.
2. Pregnant women
3. Immunosuppressed patients.
4. Infants (<2 years).
• To Whom Given:
1. When travel to endemic area
2. when a community outbreak of the disease
has recently occurred.
• MEASLES, MUMPS,& RUBELLA
VACCINE.
• Dose:
0.5ml +
Vit. A Capsule 100,000 IU.
Route: S.C
Site: RT. Upper Arm.
Booster: 18 month + 200.000 IU Vitamin A
Cold Chain: Top Shelf of the Fridge.
# NOTE:-
If vaccination has been saved in the freezer, it will
become corrupt.
Effectiveness: 98:100% together.
Complications:
1. Fever, rash,
2. Joint symptoms,
3. Thrombocytopenia,
4. Encephalopathy.
• Redness or swelling of the face.
• Hives or a rash that spreads over the body.
• Hives are red, itchy bumps that may cause the skin to feel
like it is burning.
• Weakness or dizziness.
• welling of the mouth and throat.
• Wheezing or trouble breathing.
• Loss of consciousness (passing out).
• Contraindications:
• Severe allergic
• Reaction to prior
• Dose or vaccine component,
• Pregnant women,
• Immunosuppressant,
• Acute illness.
 • To Whom Given:
• In Egypt it is compulsory at age of 9 month.
• Maternal passive immunity interferes with the
effective value of the vaccine.
• Thus it is recommended to revaccinate children
at 18 month to guard against vaccine failure
commonly in the form of MMR and vitamin A.
• Nursing Care during & after immunization
• Adequate treatment provisions including epinephrine
injection (1:1000), should be available for immediate use
should an anaphylactic or anaphylactoid reaction occur.
• Special care should be taken to ensure that the injection
does not enter a blood vessel.
• Children and young adults who are known to be infected
with human immunodeficiency viruses and are not
Immunosuppressed may be vaccinated. However,
vaccines who are infected with HIV should be monitored
closely for vaccine-preventable diseases because
immunization may be less effective than for uninfected
persons.( or may be cause disease )
• Vaccination should be deferred for
3 months or longer following blood or plasma transfusions, or
administration of immune globulin (human).

Diphtheria Vaccination
Introduction
Classical diphtheria is an acute communicable respiratory
infection. Vaccination confers protection against disease by
production of antibodies to the diphtheria toxin. When treated
with formaldehyde and heat, diphtheria toxin loses its ability
to bind to cells and its enzymatic activity, but retains its
immunogenicity. This treatment converts diphtheria toxin to a
toxoid. The vaccine is produced from purified inactivated
toxin from a strain of Corynebacterium diphtheriae.
The vaccine that prevents the potentially deadly disease
diphtheria is one of the oldest and safest vaccines available. It
was introduced in 1921 and has been in widespread use since
the 1930s.and in1940 it was given in DPT vaccine
1-Name:-Diphtheria vaccine
2-Nature:-Inactivated vaccine the diphtheria vaccine is a
toxoid. Toxoid vaccines are made by treating the toxins (or
poisons) produced by the bacterium that causes the disease (in
this case Corynebacterium diphtheriae) with heat or
chemicals, such as formalin. While this process destroys the
toxin's ability to cause illness, the toxin is still able to stimulate
the immune system to make antibodies that will help protect
the person if she is ever exposed to the actual bacterium
3-Available vaccines and their doses:-
Diphtheria vaccines are available in 2 strengths according to
dose of toxoid:
High-dose - vaccines contain >30 IU of diphtheria toxoid and
are used to achieve satisfactory primary immunization of
children - as in DTaP vaccine (capital D = high-dose). Low-
dose - vaccines contain only 2 IU of toxoid and are used for
primary immunization of those aged over 10 years and for
subsequent boosters (lower case d signifies low-dose as in
dTaP).
Monovalent diphtheria vaccine is not available. Vaccination
should only given as a component of the following
combination products :
• Diphtheria/tetanus/a cellular pertussis/inactivated
polio/Haemophilus influenzae type b vaccines
(DTaP/IPV/ Hib).
• Diphtheria/tetanus/acellular pertussis/inactivated polio
vaccines (DTaP/IPV or dTaP/IPV).
• Tetanus/ diphtheria/inactivated polio (Td/IPV).
4-Cold chain:-Should be preserved at(2-8)c liquid
formulations of vaccine and shouldn’t be frozen
5-Route:-Intramuscular
6-Administration (site)
• Five doses of a diphtheria-containing vaccine are given
intramuscularly
• Upper arm or anterolateral thigh sites are recommended
to minimise risks of local reactions. The DTaP and DT
preparations are all given as an injection in the
anterolateral thigh muscle (for infants and young
toddlers) or in the deltoid muscle (for older children and
adults). Tdap and Td are given in the deltoid muscle for
children and adults age 7 years and older.
• Other vaccinations such as measles, mumps and rubella
(MMR), meningitis C or hepatitis B can be given at the
same time but should be injected at an alternative site and
preferably in a different limb.
• 6-Who should get the vaccine?
• Primary immunization
 • All infants should receive the primary immunization
course involving 3 doses of diphtheria-containing
vaccine.
• It is recommended that DTaP/IPV/ Hib be given at 2, 3
and 4 months of age as levels of passively acquired
maternal antitoxin decline.
• However, if necessary, the same dosing schedule can be
used in children up to 10 years of age.
• Older individuals should receive 3 doses of a d-
containing preparation (usually Td/IPV) at monthly
intervals.
• Be aware that recent research has shown that Caucasian
infants are less likely to have received the triple vaccine
than most ethnic minority groups
7-Boosters
The first booster dose is given to children between the ages
of 3½ and 5 years.
Either DTaP/IPV or dTaP/IPV will elicit an adequate
immune response.
If primary immunization has been delayed, the first booster
dose must be given at least one year after completion of the
initial course.
All individuals aged over 10 years who require a first
booster should be given a dose of Td/IPV.
The second booster dose is offered to 13 to 18 year-olds by the
school health service:
The Td/IPV preparation should always be used.
If previous doses have been delayed, the second booster
should be given at least 5 years after the first booster.
 Note that patients may have inadvertently already received
a diphtheria booster associated with tetanus toxoid.
Adults with an incomplete primary series may also benefit
from a booster dose, if long-term protection is required. A
second booster dose raises immunity to 92%.
Other recipients
1-Immigrants
2-Travellers
3-Laboratory and healthcare workers
4-Contacts
• 8-How effective are these vaccines?
After a properly spaced primary series of DTaP or Td/Tdap,
approximately 95% of people will have protective levels of
diphtheria antitoxin and 100% will have protective levels of
tetanus antitoxin in their blood. However, antitoxin levels
decrease with time so routine boosters with tetanus and
diphtheria toxoids are recommended every 10 years.
Estimates of a cellular pertussis vaccine efficacy range from
80% to 85%—a level believed to be far more efficacious
than the previously-used whole cell pertussis vaccine
• 9-Contra-indications
The diphtheria vaccination should not be administered to
patients with Confirmed anaphylactic reaction to diphtheria
toxoid-containing vaccine.
Confirmed anaphylactic reaction to neomycin, streptomycin
or polymyxin B.
Acute illness with systemic upset and fever.
Evolving or undiagnosed, deteriorating neurological
abnormalities.
• 10-Situations that do not prohibit diphtheria vaccination
The following situations do not prohibit diphtheria
vaccination:
History of a stable neurological condition, seizures or febrile
convulsions (without neurological deterioration).
Fever, persistent screaming, severe local reactions or
hypotonic-hyporesponsive episodes following previous
diphtheria vaccinations.
Immunosuppression including HIV infection (but
individuals may not achieve an adequate immunological
response)
Pregnancy or breast-feeding
• 11-Adverse reactions
These should be reported via the Yellow Card Scheme.
Pain, swelling, redness or a transient nodule at the injection
site may occur.
Fever, convulsions, screaming, pallor, cyanosis and
hypotonic-hyporesponsive episodes.
Allergic reactions and very occasional anaphylactic
episodes.
There is no evidence for any association between the DTaP
vaccine and autism.

• Name of vaccine Tetanus vaccine

• Nature not contain live bacteria inactivated toxin, which
is calle Doses 0.5 ML d toxoid.
• Booster dose,
recommended between age 4 and 6 yearboosters of Td are
needed every ten yearsRouteIntra muscular
injectionsiteAnterolateral thigh muscle (for infants and
young toddlers) or in the deltoid muscle (for older children
and adults
• Effectiveness
100% will have protective levels of tetanus antitoxin in their
blood
• side effects
Local reactions, such as fever, redness and swelling at the
injection site, soreness and tendernessgeneralized body
aches, and tiredness
• To WHOM GIVEN
• for infants AT four doses of DTaP given at 2, 4, 6, and
15–18 months of age It should be given to a pregnant
woman who is in contact with an infant younger than age
12 months
• Cold chain Each of these products must be stored at 35°
to 46°F (2° to 8°C). They should not be frozen or exposed
to freezing temperatures.
DT and TT vaccines are very resistant to heat and are
shipped from the manufacturer
damaged by temperatures above +48C, and
the device is therefore used to monitor temperatures during
shipment. One indicator
is included with each shipment of 3000 doses of DT and TT.
The shipping indicator should be kept with DT and TT
vaccines if they have to be
stored outside the cold chain. This device consists of a blue
card with a temperature-sensitive dot in the centre. It
does not require activation and the dot turns from silver-
grey to black instantaneously
pertussis or whooping cough •
• name:-
pertussis vaccines available in combination with diphtheria
and tetanus toxoids as "diphtheria,pertussis, tetanus"
"D.P.T"
• nature:-
newer cellular -whole cell pertussis vaccine
1- the newer cellular vaccine known as D.P.T has greatly
reduced the incidence of adverse effects observed with the
earlier whole -cell pertussis vaccine.
2-A cellular"whole cell"pertussis vaccine consisting of
purified heamagglutinins "HAS:filamentous strep throat
and leucocytosis promoting factor HA".
-An acellular vaccine preparation for adults and adolescents
has been approved in Canda,Europea and The united state.
• Dose:-
0,5 ml.
children need five D.P.T shots ,the first three vaccinations
are given at 2,4,6 months of age.
the fourth vaccination is given between 15 and 18 months of
age, and the fifth is given when a child enter the school at 4-
6 yrs of age.
Route:- Intra muscular or deep subcutaneous.
• Site:-
1- the altero lateral muscle of the thigh of the infant .
2- the upper outer lateral area of the left arm (muscle)
cold chain :- -Temperature rate :from 2 to 8 c, and do not
freeze .
• Bostre:-
the later booster dose at 3 yrs and 4 months old.at 11-12 yrs
and every 10 yrs thereafter.
• Effectiveness:-
pertussis vaccines are highly effective, strongly
recommended and save many lives each year, the duration
of protection is between 5 to 10 yrs which covers child hood
.time of greatest risk and exposure.
-the immunization is given in combination with
tetanus,diphtheria,polio and haemophillus influenza type B
immunization.
Complications:-
1-a vaccine like any medicine capable of causing serious
problems:
1+mild:-
* fever "up to about 1 child in 4 "
*redness or swelling where the shot given " up to 1 child in
4"
*soreness or tenderness where the shot was given " up to 1
child in 4 "
*fussiness "up to 1 child in 3 "
* tiredness or poor appetite "up to 1 child in 10 "
* vomiting "up to 1 child in 5 "
-these problems generally occur 1 to 3 child after the shot.
2- moderate problems:-
-seizures "1 in 14,000 child "
-Non stop crying for 3hrs or more "1 in 1000 child "
- high fever
3- severe problems "very rare "
-long term seizure, coma.
- lowered consciousness.
- permenant brain damage.
• contraindications:-
- when occur severe reaction to the first dose of vaccine
such as severe reaction to the vaccine or inflammation in the
brain when the child had previously suffered a heart
convulsion or progressive neurological illness.
-the parents should tell the doctor before recieving the child
for vaccine.
• to whom given :-
- for maximum protection against pertussis the children
need five D.P.T shots, the first 3 vaccinations are given at
2,4,6 months of age,the fourth vaccination is given between
15 and 18 months of age, and fifth is given when child
enters the school at 4-6 yrs of age ,preteens going to the
doctor for their regular check up at 11 or 12 yrs of age.
should get dose of the D.P.T booster and adults who didnot
get D.P.T as preteen or teen should get one dose of D.P.T,
the easiest way for adults to ensure immunity is to get the
Td ap vaccine instead of their regular tetanus booster "the
D.P.T shots is recommended every 10 years"-most pregnant
women who were not previously vaccinated with D.P.T
should get one dose of D.P.T post partum before leaving
the hospital or birthing center.-getting vaccinated with
D.P.T is submission important for mothers and families with
new infants as well as all people caring for newborns,
women planning pregnancy may also choose to get
vaccinated with D.P.T prior to becoming pregnant..
Name of vaccine: poliomylitis
• Nature of vaccine
The first polio vaccine was an inactivated, or killed, vaccine
(IPV) developed by Dr. Jonas Salk and licensed in 1955.
In 1961, a live attenuated (e.g., weakened) vaccine was
developed by Dr. Albert Sabin. This vaccine was given as
an oral preparation instead of as a shot.
Dose of vaccine |;(3drops by oral) Booster dose of the
vaccine
• booster dose is given at 4-6 years (before or at school
entry), unless the primary series was given so late that the
third dose was given on or after the fourth birthday. doses
of either OPV or IPV), he or she may be given another
dose of IPV to ensure protection. Only one "booster" dose
of polio vaccine in a person's lifetime is recommended. It
is not necessary to receive a booster dose each time a
person travels to an area where polio may still occur.
• Rout of vaccine
• IPV is given as a shot in the arm or leg.
OPV is given as an oral liquid . Oral
• .site
Intramuscular in arm and leg.
• Effectiveness of the vaccine
IPV is very effective in preventing polio, but only when all
recommended doses
are completed. A single dose of IPV produces little or no
immunity, but 99% of recipients are immune after three
doses
• Adverse affect of vaccine
• The IPV vaccine is very safe; no serious adverse reactions
to IPV have been documented.
• Possible side effects include minor local reactions at the
site of injection (e.g., pain, redness)
. Contraindication
• Anyone who has ever had a life-threatening allergic
reaction to neomycin, streptomycin, or polymyxin B
should not get the IPV shot because it contains trace
amounts of these antibiotics.
• Anyone who has had a severe allergic reaction to a dose
of polio vaccine should not get another one.
• Anyone who is moderately or severely ill at the time the
shot is scheduled should usually wait until they recover to
get vaccine
• To whom given this vaccine?
• All infants should get this vaccine unless they have a
medical reason not to. A primary series of IPV consists of
 three properly spaced doses, usually given at two months,
four months, and 6-18m
• cold chain
• storge in +8:20c
BCG VACCINE
• NA ME
(The vaccine is known as BCG because a strain of the
bacterium known as Bacillus Calmette-Guerin)
• NATURE OF VACCINE
LIVE ATTIENUTDE VACCINE
• DOSE
The standard dose of BCG vaccine is 0.1mg in 1 ml
T though manufacturers of certain strains of BCG
• ROUTE
INTRA DERMAL
• SITE
The vaccine is given as one dose by injection into the skin
of the upper arm. The length of time that the immunity lasts
i s not known, but revaccination is not recommended
• BY WHOME
BCG VACCINE TAKE S FROM 1 DAY OF BIRTH TO
3 MONTHS
• Booster dose
AT SCHOOL AGE (6 YEARS)
• COLD CHAIN
Experimental evidence indicates that (BCG vaccine)
viability is unaffected
by storage at -20C or -30C
FREEZING and thawing up to 10 times
CONTRA INDICATION
• Fever (pyrexia)
• Generalised infected skin conditions
• People who have had tuberculosis
• People with positive skin reaction to tuberculin (Mantoux
test)
• Newborn children in a household where an active TB
case is suspected or confirmed
• HIV infection
• Infants born to HIV positive mothers
• Malignant conditions such as leukaemia and lymphoma
• People who are or who have recently received treatment
that suppresses the activity of the immune system, eg
long-term oral corticosteroids, chemotherapy,
radiotherapy, medicines to prevent transplant rejection
• People who are receiving preventative anti-tuberculous
medicines
• People with decreased defences against disease or
infection (impaired immune response) due to disease or
treatment
Complication
 Local hypersensitivity
 Abscess or ulcer at injection site
 Regional lymphadenitis
 Distant lesion
 Disseminated BCG infection
Side effects
• Medicines and their possible side effects can affect
individual people in different ways. The following are
some of the side effects that are known to be associated
with this medicine. Because a side effect is stated here, it
does not mean that all people using this medicine will
experience that or any side effect.
• Headache
• Fever (pyrexia)
• Hardening of skin at injection site, followed by a lesion
that may ulcerate and heal over some months, leaving a
small flat scar
• Swelling of the lymph nodes near the injection site