immunization nursing

1. guidelines for administration of vaccines

  • In the U.S., the recommended age for beginning primary immunizations of infants is at birth. Children born preterm should receive the full dose of each vaccine at the appropriate chronological age (실제 산 햇수).
  • Follow the manufacturer’s recommendations for the route of administration, storage, and reconstitution of the vaccine. If refrigeration is necessary, store on a central shelf and not on the door; frequent temperature changes from opening the refrigerator door can alter the vaccine’s potency. Check the expiration date on the vaccine bottle.
  • A vaccine information statement needs to be given to the parents or individual, and informed consent for administration needs to be obtained.
  • Parenteral vaccines are given in separate syringes in different injection sites. Vaccines administered intramuscularly are given in the vastus lateralis muscle (best site) or ventrogluteal muscle. The deltoid can be used for children 36 months of age and older. The dorsogluteal site (buttocks) is avoided. Vaccines administered subcutaneously are given into the fatty areas in the lateral upper arms and anterior thighs.
  • Adequate needle length and gauge are as follows; intramuscular, 1 inch, 23 to 25 gauge; subcutaneous, 5/8 inch, 25 gauge. Needle length may vary depending on the child’s size.
  • Children who began primary immunizations at the recommended age but failed to receive all the required doses do not need to begin the series again; they need to receive only the missed doses. If there is suspicion that the parent will not bring the child to the pediatrician or health care clinic for follow-up immunizations according to the optimal immunization schedule, any of the recommended vaccines can be administrated simultaneously.
  • A vaccine is contraindicated if the child experienced an anaphylactic reaction to a previously administered vaccine or a component in the vaccine.
  • administration of vaccines during pregnancy: influenza, tetanus/diphtheria/pertussis
  • avoidance of vaccine during pregnancy: rubella, varicella, live virus, pregnant within 4 weeks
  • A vaccine is administered with caution to an individual with a moderate or severe acute illness, with or without fever. Live virus vaccines generally are not administered to individuals with severely deficient immune systems, individuals with a severe sensitivity to gelatin, or pregnant women.
  • Mild side effects include fever, soreness, swelling, or redness at the injection site.
  • A topical anesthetic may be applied to the injection site before the injection. For painful or red injection sites, advise the parent to apply cool compresses for the first 24 hours, and then use warm or cold compresses as long as needed. An age-appropriate dose of acetaminophen (Tylenol) or ibuprofen (Motrin IB), per HCP’s preference may be administered every 4 to 6 hours for vaccine-associated discomfort.
  • Maintain an immunization record. Document day, month, year of administration; a manufacturer and lot number of vaccine; name, address, the title of person administering the vaccine; and site and route of administration. A vaccine adverse event report needs to be filed and the health department needs to be notified if an adverse reaction to an immunization occurs.

2. immunization

1) hepatitis B vaccine (HepB) 0, 1, 6mo
  • Administered by the IM route
  • contraindications: severe allergic reaction to a previous dose or vaccine component (components include aluminum hydroxide, yeast protein)
  • HBsAg-positive mothers: Infant should receive HepB vaccine and hepatitis B immunoglobulin within 12 hours of birth. The infant should be tested for HbsAg and antibody to HBsAg after completion of the HepB series (9 to 18 months age).
  • Mother whose HBsAg status is unknown: Infant should receive the first dose of the hepatitis vaccine series within 12 hours of birth. Maternal blood should be drawn as soon as possible to determine the mother’s HBsAg status. If the mother’s HbsAg test result is positive, the infant should receive HBIG as soon as possible (no later than 1 week of age).
2) rotavirus vaccine (RV) 2, 4mo
  • Two vaccines are available (RotaTeq and Rotarix) and are administered by the oral route because the vaccine must replicate in the infant’s gut.
  • The vaccine may be withheld if an infant is experiencing severe vomiting and diarrhea. It is administered as soon as the infant recovers.
3) diphtheria, tetanus, acellular pertussis (DTaP: 소아),
tetanus toxoid, reduced diphtheria toxoid, acellular pertussis (Tdap: 성인)
  • Administered by IM route 2, 4, 6, 15mo, 4y / 11y, q 10y
  • contraindications: Encephalopathy within 7 days of a previous dose or a severe allergic reaction to a previous dose or to a vaccine component.
  • The Tdap (adolescent preparation) is recommended at 11 to 12 years of age for children who have completed the recommended childhood DTaP series but have not received tetanus and diphtheria toxoid (Td) booster dose. Children 13 to 18 years old who have not received Tdap should receive a dose. Td does not provide protection against pertussis. Td is used as a booster every 10 years after Tdap is administered at 11 to 18 years of age. 임신 27∼36주 여성도 가능.
4) Haemophilus influenzae type b conjugate vaccine (Hib) 2, 4, 12mo
  • Administered by IM route
  • contraindications: severe allergic reaction to a previous dose or vaccine component
5) pneumococcal conjugate vaccine (PCV) 2, 4, 6, 12mo
  • Administered by IM route
  • contraindications: severe allergic reaction to a previous dose or vaccine component
6) inactivated poliovirus vaccine (IPV) 2, 4, 6mo, 4y
  • Administered by SC route. It may also be given by the IM route.
  • contraindications: severe allergic reaction to a previous dose or vaccine component; components may include formalin, neomycin, streptomycin, or polymyxin B
7) influenza vaccine 6mo부터 q 1y
  • Administered by  IM (deltoid○, dorsal gluteal ⅹ)
  • The vaccine is recommended annually for children beginning at age 6 months. (특히, 20주 이상 산모, 천식pt., AIDS pt., long-term aspirin 아이)
8) measles, mumps, rubella vaccine (MMR) 12mo, 4y
  • Administered by SC route.
  • contraindications: severe allergic reaction to a previous dose or vaccine component (gelatin, neomycin, eggs), pregnancy, known immunodeficiency
  • If the child received immunoglobulin, the MMR vaccine should be postponed for at least 3 to 6 months. Immunoglobulin can inhibit the immune response to the MMR vaccine.
9) varicella vaccine 12mo, 4y
  • Administered by SC route.
  • contraindications: severe allergic reaction to a previous dose or vaccine component (gelatin, neomycin, bovine albumin), significant suppression of cellular immunity, pregnancy
  • Children receiving the vaccine should avoid aspirin or aspirin-containing products because of the risk of Reye’s syndrome.
10) hepatitis A vaccine (HepA) 12mo
  • Administered by IM route
  • contraindications: severe allergic reaction to a previous dose or vaccine component
11) human papillomavirus vaccine (HPV) 0, 1, 6 mo
  • Administered by the IM route.
  • Depending on the type of vaccine used (HPV 2 or HPV 4), the HPV vaccine guards against diseases that are caused by HPV types 6, 11, 16, and 18, such as cervical cancer, cervical abnormalities that can lead to cervical cancer, and genital warts.
  • The vaccine is administered as three injections over 6 months; first dose at age 11 to 12 years, the second dose 2 months after the first dose, and the third dose 6 months after the first dose.
  • The vaccine is contraindicated in individuals with a reaction to a previous injection and in pregnant women.
12) meningococcal vaccine (MCV) 11y
  • Administered by the IM route.
  • It is contraindicated in children with a history of Guillain-Barre syndrome.
  • MCV4 should be administered to all children at age 11 to 12 years and to unvaccinated adolescents at high school entry (age 15 years). Revaccination is recommended for children who remain at increased risk after 3 years or after 5 years.


3. reactions to a vaccine

1) local reaction • low-grade fever

• erythema, swelling, tenderness at the injection site

• Inject into the appropriate recommended site.

• Select a needle of adequate length to deposit the vaccine deep into the muscle or subcutaneous mass.

2) anaphylactic reaction

3) intervention when administering a parenteral vaccine: Verify the prescription for the vaccine. Obtain an immunization history from the parents and assess for allergies. Provide information to the parents about the vaccine. Obtain informed consent. Check the lot number and expiration date and prepare the injection. Select the appropriate site for administration. Administer the vaccine. Document the administration and site of administration and lot number and expiration date of the vaccine. Provide a vaccination record to the parents.

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