CHAPTER 46 Immunizing Drugs and Biochemical Terrorism 1/7/20161Winter 2013

IMMUNITY  Immune response … Antigens … Antibodies  Active immunization  Passive immunization 1/7/20162Winter 2013

IMMUNIZING BIOLOGICALS  Biological antimicrobial agents … Also called biologicals … Used to prevent, treat, or cure infectious diseases  Antitoxins  Antisera  Toxoids and vaccines (immunizing biologicals) 1/7/20163Winter 2013

TOXOIDS  Antigenic (foreign) preparations of bacterial exotoxins  Detoxified with chemicals or heat … Weakened or “attenuated”  Cannot revert back to a toxic form 1/7/20164Winter 2013

TOXOIDS (CONT’D)  Stimulate one’s immune system to produce a specific antibody … Artificial active immune response  These antibodies protect against future exposures 1/7/20165Winter 2013

VACCINES  Suspensions of live, attenuated (weakened) or killed (inactivated) microorganisms  The weakened form prevents the person from contracting the disease 1/7/20166Winter 2013

VACCINES (CONT’D)  Also stimulate the production of antigens against a specific antibody  Vaccinations with live bacteria or virus provide lifelong immunity  Vaccinations with killed bacteria or virus provide partial immunity, and booster shots are needed periodically 1/7/20167Winter 2013

ACTIVE IMMUNIZATION  The body is exposed to a relatively harmless form of an antigen  The immune system is stimulated and “remembers” this antigen if subsequent exposures occur  Do not cause a full-blown infection 1/7/20168Winter 2013

ACTIVE IMMUNIZING DRUGS: EXAMPLES  BCG vaccine (tuberculosis)  Diphtheria, tetanus, and pertussis toxoids, several forms  Haemophilus influenzae type B conjugate vaccine  Hepatitis A and B virus vaccines 1/7/20169Winter 2013

ACTIVE IMMUNIZING DRUGS: EXAMPLES (CONT’D)  Measles, mumps, and rubella virus vaccine, live—several forms  Pneumococcal bacterial vaccines  Human papilloma virus vaccine (Gardasil)  Poliovirus vaccine; several forms  Rabies virus vaccine 1/7/201610Winter 2013

ACTIVE IMMUNIZING DRUGS: EXAMPLES (CONT’D)  Smallpox virus vaccine  Tetanus toxoid  Varicella virus vaccine (chickenpox)  Yellow fever virus vaccine  Many others 1/7/201611Winter 2013

PASSIVE IMMUNIZATION  Serum or concentrated immune globulins from humans or animals are injected into a person  The substances needed to fight off invading microorganisms are given directly to a person  The immune system is bypassed  Short-lived compared with active immunization, but works faster 1/7/201612Winter 2013

PASSIVE IMMUNIZATION (CONT’D)  Naturally acquired passive immunity … From mother to fetus through the placenta … From mother to infant through breast milk  Artificially acquired passive immunity … Acquired from an external source, such as … injection of antibodies or immunoglobulins 1/7/201613Winter 2013

PASSIVE IMMUNIZING DRUGS  Antitoxins  Immunoglobulins  Snake and spider antivenins (antivenom) 1/7/201614Winter 2013

PASSIVE IMMUNIZING DRUGS: EXAMPLES  Antivenins … Pit viper, coral snake … Black widow spider  Hepatitis B immune globulin  Immunoglobulin, various forms  Rabies immunoglobulin (human) 1/7/201615Winter 2013

PASSIVE IMMUNIZING DRUGS: EXAMPLES (CONT’D)  Rh o (D) immune globulin (RhoGAM)  Tetanus immunoglobulin 1/7/201616Winter 2013

INDICATIONS  Active immunization … Prevents infection caused by bacterial toxins or viruses … Provides long-lasting or permanent immunity … “Herd immunity” 1/7/201617Winter 2013

INDICATIONS (CONT’D)  Passive immunization … Antitoxins, antivenins, immunoglobulins … Minimizes effects of poisoning by the venoms of spiders and certain snakes … Provides quick immunity before a person’s own immune system has a chance to make antibodies (such as in cases of exposure to hepatitis B or rabies viruses) 1/7/201618Winter 2013

INDICATIONS (CONT’D)  CDC/Department of Health and Human Services recommendations for adult and pediatric immunizations (U.S.) … Provide specific dosages and intervals for immunizations … Refer to the CDC website for current recommendations 1/7/201619Winter 2013

ADVERSE EFFECTS  Range from mild and transient to very serious or life threatening  Minor effects … Fever, minor rash, soreness at injection site, itching, adenopathy  Severe effects … Fever higher than 103° F, encephalitis, convulsions, anaphylactic reaction, dyspnea, others 1/7/201620Winter 2013

ADVERSE EFFECTS (CONT’D)  Minor reactions … Treated with acetaminophen and rest  Serious or unusual reactions … Serum sickness … Report serious or unusual reactions to the Vaccine Adverse Event Reporting System (VAERS) 1/7/201621Winter 2013

NURSING IMPLICATIONS  Assess previous reactions and responses to immunizations  Assess for contraindications, including immunosuppression 1/7/201622Winter 2013

NURSING IMPLICATIONS (CONT’D)  Before giving any drug, recheck the specific protocols for administration and schedules for administration 1/7/201623Winter 2013

NURSING IMPLICATIONS (CONT’D)  Encourage parents of young children to keep a journal of the child’s immunization status, with dates of immunizations and reactions, if any 1/7/201624Winter 2013

ILLNESSES CAUSED BY POSSIBLE BIOTERRORISM AGENTS  Anthrax  Smallpox  Botulism  Tularemia  Viral hemorrhagic fever  Plague 1/7/201625Winter 2013

POSSIBLE BIOTERRORISM AGENTS  Sarin (nerve gas)  Mustard (blistering agent)  Cyanide (blood agent)  Chlorine (choking agent)  Radioactive elements  Ricin 1/7/201626Winter 2013