Vaccination immunization history

According to the CDC, every health care visit, regardless of its purpose, should be viewed as an opportunity to review a patient s immunization status and to administer needed vaccines. Immunization is perhaps the most cost-effective medical practice available. Each visit should encompass assessment of individuals vaccine needs, administration of indicated agents, and documentation of immunization histories. The outcome measurement of what percentage of patients in a particular practice site is completely immunized is extremely important because the benefits of optimal vaccine use extend beyond the individual patient to the public as a whole. 

Vaccines are used in either the general population of children or adults or for special groups. Recommendations for vaccine usage are made by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control. The Committee on Infectious Diseases of the American Academy of Pediatrics (Redbook Committee) also makes recommendations for infants through adolescents, and the American Academy of Family Physicians makes recommendations for adults. An excellent review of vaccine history, development, usage, and related regulatory issues is available (2). 

Empirical therapy should be directed at the most likely pathogen (s) for a specific patient, taking into account age, risk factors for infection (including underlying disease and immune dysfunction, vaccine history, and recent exposures), CSF Gram stain results, CSF antibiotic penetration, and local antimicrobial resistance patterns. 

Rubella component Administer 1 dose of MMR vaccine to women whose rubella vaccination history is unreliable or who lack laboratory evidence of immunity. For women of childbearing age, regardless of birth year, routinely determine rubella immunity and oounsel women regarding congenital rubella syndrome. Women who do not have evidence of immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge from the health-care facility. 

General contraindications to vaccine administration include a history of anaphylactic reaction to a previous dose or an unexplained encephalopathy occurring within 7 days of a dose of pertussis vaccine. Immunosuppression and pregnancy are temporary contraindications to live vaccines. Whenever possible, transplant patients should be immunized before transplantation. Live vaccines generally are not given after transplantation. 

The terms vaccination, inoculation and immunisation are used synonymously they are used to describe the processes for the production of immunity by artificial means. Vaccination has a long history and is a fascinating topic (Box 17.5). The term vaccine is dehned as an infectious agent that is either dead or attenuated, and which is introduced into the body with the object of increasing the ability of the immune system to resist or get rid of a disease. 

Booster dose In previously immunized persons, a booster dose of 0.5 ml IM should be given every five years to maintain adequate level of immunity. The need for tetanus vaccine in wound management depends both on the condition of the wound and immunisation history of the patient. For tetanus prone wound, tetanus immunoglobulin may also be required. 

In December 1997, Secretary of Defense William Cohen announced a departmentwide anthrax immunization program for high-risk military personnel. Implementation began in March 1998. On May 18, 1998, the Secretary authorized the vaccination of all military forces (Cohen, 1998). Almost 2.5 million troop-equivalent doses of vaccine were required to implement the Secretary s decision, much more than had ever been produced by the licensed manufacturer in its entire history. Prior to Desert Storm, the primary vaccine users had been veterinary, laboratory, and industrial workers at risk of infection, for whom an estimated 60,000 doses of Anthrax Vaccine Absorbed (AVA) were distributed between 1974 and 1989, an average of 4,533 doses per year (foellenbeck et al., 2002). During Desert Storm, approximately 150,000 troops received 300,000 doses of AVA, without accurate recording of recipients or adverse reactions. 

The threat of a bioterrorist attack with smallpox is especially disturbing since the eradication of smallpox remains one of the great achievements in human history. Unfortunately, since routine vaccination against smallpox was discontinued in 1978, few people retain immunity today. Although there are only two official repositories of the smallpox virus today, it is still possible that terrorists will be able to obtain the virus. Thus, the government has had to stockpile supplies of the vaccine, and there is some debate about whether to resume routine smallpox vaccinations. Although the smallpox vaccine was discovered by accident, the story of how Louis Pasteur developed the first anthrax vaccine and his use of unvaccinated animals as controls remain as excellent lessons about the process of science (Trachtman 2002). 

Eight cases of nervous system diseases suspected to be either recurrent disseminated encephalitis or multiple sclerosis after hepatitis B immunization have been reported (21). Symptoms started in four cases at 4—14 days after vaccination, and in the other four cases 42-70 days after vaccination. There was a family history of multiple sclerosis in two patients, one of whom had had symptoms compatible with optic neuritis before immunization. In a third patient, there was a history of an episode compatible with Lhermitte s sign. The authors concluded that the risk of demyelinating diseases is unknown. They recommended avoiding hepatitis B immunization in individuals with a personal or familial history of sjmptoms suggestive of an inflammatory or demyelinating disease. 

To increase immunogenicity, the hepatitis A vaccines commercially available are coupled to adjuvant aluminium phosphate or aluminium hydroxide. However, alum precipitates provoke inflammatory responses at the injection site. Immunostimulating reconstituted influenza virosomes have therefore been used as an alternative adjuvant. In 1994, a hepatitis A vaccine using the new adjuvant was licensed in Switzerland, and it was later approved for use in other countries the vaccine was well tolerated and highly immunogenic (SEDA-20,290) (SEDA-22,344). Nine people with a history of ocular sensitivity were immunized with hepatitis B, without untoward reactions. However, this result in such a small series should not be overestimated (75). There have been reports of three cases of inflammatory nodular reactions after hepatitis B immunization aluminium allergy was confirmed (76-78). 

The Advisory Committee on Immunization Practices (ACIP) has recommended that vaccinees should be observed for 30 minutes after immunization and that medications to treat anaphylaxis should be available (12) [http //www.cdc.gov/mmwr/PDF/rr/rr4201.pdf]. A personal history of allergic disorders should be considered when weighing the risks and benefits of the vaccine for an individual. Japanese encephahtis vaccine should not be given to persons who had a previous adverse reaction after receiving Japanese encephalitis vaccine or a previous hypersensitivity reaction to other vaccines of neural origin. 

The (US) Immunization Practices Advisory Committee (ACIP) has recommended that a personal history of a prior convulsion should be evaluated before initiating or continuing immunization with vaccines containing a... 

Following the swine-flu immunization campaign in 1916111 in the USA there was a significant increase in the incidence of Guillain-Barre syndrome in immunized versus non-immunized people, from 2.6 per million to 13.3 per million (69). Peak time of onset was 2-3 weeks after receiving the vaccine, and cases among vaccinees were less likely to have a history of antecedent infection than were cases in unvaccinated persons. Since 1977 the risk of influenza vaccine-induced syndrome appears to be the same as the risk in the non-immunized population. 

Immunization against infectious disease has saved more lives than any other health intervention in the history of modern medicine. The success of continued disease prevention, however, directly correlates to continued im-munobiological research, vaccine availability, and those clinicians who administer vaccinations. 

Appendices 122-1 and 122-2 show the recommended schedules for routine immunization of children and adults. Many states require children to be fuUy immunized prior to entering elementary school however, optimal protection is achieved by immunizing at the recommended ages, which requires special attention to children younger than 2 years of age. Adults and adolescents also require vaccination and often are unaware of this need. Adults should receive routine tetanus-diphtheria boosters and be immune to measles, mumps, rubella, and varicella by either immunization or history of infection. Certain individuals with conditions or lifestyles that put them at high risk for vaccine-preventable diseases also should be immunized as described in the text that follows and outlined in the immunization schedules in the appendices. 

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