l2.1 Immunization Cold Chain
l2.1 Immunization Cold Chain
l2.1 Immunization Cold Chain
I. IMMUNIZATION
II. COLD CHAIN
Learning Outcomes
At the end of this session, students should be able to:
define immunization
describe immunity, active and passive immunity
explain primary and secondary response
describe the factors that reduce the potency of the
vaccine
describe the live attenuated, killed vaccine and their
advantages and disadvantages
describe the side effects of immunization
explain the ‘cold chain’
Learning Outcomes
Describe the Malaysian immunisation schedule
Describe the expanded programme on
immunisation
Define the nursing aspect in the responsibilities in
the management of immunisation, cold chain and
the process of immunisation sessions
Maintain cold chain during an immunisation
session
Advise the mother and maintain records keeping
Introduction of Immunization
Immunization is a process of protecting an individual
from a disease through the introduction of live, killed or
partial components of the organism (bacteria or virus).
The individual acquires immunity by the production of
the antibodies in the body.
Immunization is one of the most effective and efficient
ways to prevent infectious diseases.
The infant is protected from infections through the
mother’s antibodies during the early months of his life.
Introduction of Immunization
The antibodies are transmitted through the placenta
to the infant.
• The maternal antibodies will remain in the infant for
several months. By the time the infant reaches 1 year,
the antibodies are no more effective and the infant
therefore has to start developing his own antibodies.
Thus vaccines are introduced to the infant to make
him/her build and produce own antibodies.
Vaccines are used to immunize children and adults
from the occurrence of diseases through the
production of antibodies in the individual.
Classification of Immunity
Immunity is classified into innate
immunity and acquired immunity.
The innate immunity is the
immunity that an individual
possesses due to genetic make up
and his constitution. It is well
known that certain races are
immune to certain diseases due to
innate immunity.
The acquired immunity can further
be classified as active immunity
and passive immunity.
Classification of Immunity
Active immunity
Is the immunity when an individual develops as a result of
infection or by specific immunization.
Active immunity can be humeral or cellular or a
combination of both. It is associated with antibodies or
cells having specific action on the microorganisms
concerned.
It can be acquired after:
• An infection like chicken pox, measles and rubella
• A subclinical infection as in polio, pertussis and
diphtheria
• An immunization using killed vaccines, live attenuated
vaccines or a toxoid
Classification of Immunity
Passive immunity
The vaccine is produced by one’s body (human or
animal) and then transferred to another to induce
protection.
In this case, therefore, the body does not produce the
antibodies. The antibodies are produced elsewhere and
given to an individual.
The passive immunity can be induced by:
• Administering an immunoglobulin or antiserum which is an
antibody containing preparation.
• Placental transfer of maternal antibodies through the
placenta to the baby
• Breast milk also contains some antibodies
Classification of Immunity
Comparison of active & passive immunity
When compared with active immunity, passive
immunity is rapidly established but the immunity is
only temporary and the body does not have a
mechanism to remember it.
Herd Immunity
It is the immunity of a group or community.
It is referred to the resistance of a group to invasion and
spread of an infectious agent.
This is based on the premise that a high proportion of
individuals are immunized and so the group is resistant to
infection.
Herd immunity provides an immunological barrier to the
spread of disease in the community.
If diseases attack a population which has no herd
immunity or has not been immunized, the chances are
that the population may experience many cases and the
mortality rate will increase.
It is very difficult to define the exact percentage of
cases that need to be immunized, but 80–90% is
considered good herd immunity.
Herd Immunity
Antibody
concentration
IgM
2–3 days
Primary Response
The primary response to an antigen depends on a few
factors:
• Nature of antigen
• Dose of antigen
• Adjuvant (substance which enhances
the body's immune response to an antigen)
• Route of administration
• Nutritional status of the host
Secondary Response
Is the response to the immunization given for the
second time to the body.
Because of past immunological memory, the response
in the production of antibodies is much faster.
Differences between the primary response and the
secondary response:
• The latent period is shorter.
• The production of the antibody is much faster.
• Antibody is produced in large quantities.
• The antibody response is maintained at higher levels for a
longer period of time.
• The antibody has greater avidity to bind the antigen.
• There is a short period of IgM production and then a
much longer and larger production of IgG antibody.
Factors that can Influence
the Outcome of Vaccination
i. Age of the infant
• The newborn is able to produce antibodies to
vaccines.
• Premature baby may be too immature to take the
vaccine, so the vaccine should be given at the
appropriate time.
ii. Dosage of the vaccine
• The vaccine dosage must be adequate to provide the
protection.
Factors that can Influence
the Outcome of Vaccination
iii. Temperature of the vaccine
• The vaccines lose their potency if not kept in appropriate
temperatures (2 ⁰C– 8 ⁰C).
• The vaccines have to be kept at low temperatures from
the production facility to the site of use (cold chain).
iv. Timing of vaccination
• Some vaccines require more than one dose for full
protection. This will increase the immunity by secondary
response.
Vaccines
Vaccines are immuno-biological substances
designed to produce specific protection against a
given disease.
Vaccines stimulate the production of antibodies and
other immune mechanisms in the body.
Classification Vaccines
1. Live attenuated vaccines
• Live attenuated vaccines are generally from live
organisms which are weakened and thus do not have
the virility to cause the disease.
• The organisms have been cultured in the laboratory
repeatedly on tissue culture and they have lost the
capacity to produce the disease.
• However, they retain the immunogenicity.
• Live vaccines are better than killed vaccines because
they are more potent.
• Must be properly stored at the right temperature
Classification Vaccines
2. Killed vaccines
• These vaccines are those from organisms that are
killed but can still be used to produce antibodies in
the body.
• The organisms are killed by heat or chemicals.
• They are safe but less effective than live vaccines.
Classification Vaccines
Organisms Live attenuated Killed vaccines Toxoids
vaccines
Bacterial BCG Typhoid Diphtheria
Typhoid Cholera Tetanus
Pertussis
Meningitis
18 month DTaP
Hib
IPV Booster
Hepatitis B
21 month JE (Dose 2) (Sarawak) Japanese Encephalitis
National Immunization Programme
Umur (Bulan)
(Tahun)
VAKSIN
0 1 2 3 4 5 6 8 9 12 15 18 21 7 13 15
Dos
BCG
1
Dos
Hepatitis B
1
DTaP-IPV- Dos Dos Booste
Dos 3
HepB-Hib 1 2 r
Sabah
Measles
sahaja
Dos
MMR Dos 2
1
Dos
JE
1 Dos 2
DT Booster
1
MR Booster
Perempu
HPV an sahaja
(2 dos)2
Boost
Tetanus
er
National Immunization Programme
Record of giving
vaccination in the
Hexa Dos 1
Children's Health
Records Book 0-6 years
Hexa Dos 2 • Hexa Dos 1 given at the age of 2 month is
recorded in the Hep B (1 month) space and
DTaP-IPV//HiB (2 month).
Dial thermometer
Cold Box
Maintain Cold Chain during an Immunization
Session in the Clinic
The cold chain is maintained during the clinic session
by:
• Taking out the exact quantity of vaccines from the main
refrigerator/top loading required for the session.
• The number of vaccines required for the session will be
known since the clinic follows the appointment system.
Take the vaccine from the cold box and administer after
assessing the child and explaining to the mother.
After the session, the remainder of the vaccines are put
back in the refrigerator/top loading.
Health Education to the Mother
The mother must be informed regarding all the
vaccinations and the side effects and possible
complications of any vaccinations.
After the immunization, the mother may need some
counselling regarding the child. She needs to be
informed when to come for the next immunization.
The records and the immunization card are kept by the
mother. The public health nurse should explain
regarding the growth and development charts on the
card and the milestones on the card.
The immunization record is maintained so that the child
gets the full immunization
Documentation