Immunization Case Study
Case #1(a): Vaccination of a Newborn Baby
Vaccination of newborns is important in strengthening their immune systems and protecting them from different diseases. The Center for Disease Control and Prevention (2020) stipulates that a newborn weighing 2000 grams or more should receive the first dose of Hepatitis B vaccine within the first 24 hours after birth. The hepatitis B vaccine is meant to offer lifelong protection against hepatitis virus infection, once the recommended three doses are received.
Case #1(b): Newborn Vaccination in Case of a Hep B positive Mother
Additional precautions should be taken to protect a newborn baby in the event that the mother tests positive for the Hep B virus (CDC, 2021). This additional precaution includes giving the infant Hep B immune globulin (HBIG) in addition to the Hepatitis B vaccine within the first 12 hours after birth inconsiderate of the infant’s weight.
However, as a precaution, infants weighing less than 2000 grams should receive the second dose of the Hep B vaccine at the beginning of the first month of age, followed by the remaining 2 doses as scheduled. Testing of the infant’s Hep B status between the age of 6 and 9 months is recommended to rule out the disease or start the necessary management. This could be done by testing for the child’s HBsAg and anti-HBs (CDC, 2021).
Case #1(C): Newborn vaccination in a mother with unknown Hep B status
Infants born to mothers with unknown Hep B virus status should be treated similarly to those born to Hep B positive mothers. However, the Hep B immune globulin (HBIG) is only given to infants weighing less than 2000 grams together with the Hep B vaccine within the first 12 hours of birth. Infants equal to or greater than 2000 grams born to mothers with unknown Hep B status receive the Hep B vaccine only within the first 12 hours of birth.
The infant should receive the first dose of the three-serial Hep B vaccines at the beginning of the first month. The mother should then undergo a test for the Hep B virus. If the test comes positive, infants equal to or greater than 2000 grams in weight should receive the Hep B immune globulin (HBIG) immediately, not later than the first week after birth (CDC, 2021).
Case #2(a): Vaccination of a 2-month-old Baby
It is necessary to vaccinate infants by giving them the legible vaccines for their age, including those that they might have missed earlier in their lives. According to the Centers for Disease Control and Prevention (2021), a baby aged 2 months is eligible for the following vaccines: Hepatitis B vaccine (HepB) (2nd dose), Diphtheria, Tetanus, and Whooping Cough Vaccine (DTaP) (1st dose), Haemophilus influenzae type B vaccine (Hib) (1st dose), polio (IPV) (1st dose), pneumococcal vaccine (PCV13) (1st dose), and rotavirus vaccine (RV) (1st dose) (CDC, 2021). These vaccines are meant to protect them against the respective diseases.
Case #2(b): Vaccines given at 4 months of age
Once receiving the necessary vaccines at the age of 2 months, the next visit for vaccination should be by 4 months of age. During this visit, the child should receive the following vaccines: Oral rotavirus (second dose), Diphtheria, Tetanus, and Whooping Cough Vaccine (DTaP) (second dose), Haemophilus influenzae type B vaccine (Hib) (second dose), pneumococcal vaccine (PCV13) (second dose), and IPV (second dose).
The rotavirus vaccination should take into consideration the indicated serial dosage. In cases of this kid, the 2-dose series dose should be indicated, unlike in individuals with unknown vaccination status where the 3-dose series is indicated. In either case, the last dose should be received not later than 8 months (CDC, 2021).
Case #2(c): Vaccine combinations to reduce number of injections at 2 months of age
Combination vaccinations can be administered to reduce the number of shots that an infant receives. This helps in reducing the physical trauma associated with receiving many shots. Examples of combination vaccinations that can be administered at 2 months of age include the Pediarix, Proquad, Kinrix, and Pentacel combination vaccines (Domachowske, 2021). Pediarix is a single shot combination vaccination containing diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus, and hepatitis B vaccines.
On the other hand, Pentacel contains diphtheria and tetanus toxoids, acellular pertussis adsorbed, inactivated poliovirus, and haemophilus influenzae type b conjugate. The Kinrix combination vaccine contains diphtheria and tetanus toxoids and acellular pertussis adsorbed and inactivated poliovirus. Lastly, the Proquad is an attenuated live virus vaccine containing measles, mumps, rubella (MMR), and varicella viruses (Domachowske, 2021).
Question #3(a): Vaccination for a 5-year-old who has never received influenza vaccine
A 5-year-old with up-to-date routine vaccines and who has never received an influenza vaccine can receive DTaP (5th dose), MMR (2nd dose), annual influenza vaccine, IPV (4th dose), and varicella vaccine (2nd dose), according to the CDC (2021).
Question #3(b): Anticipatory guidance for a 5-year-old receiving a flu vaccine for the first time
According to the CDC (2021), it is recommended that a 5-year-old who is receiving the flu vaccine for the first time be given an additional two doses of the vaccine, four weeks apart. It is also recommended for 5-year-olds to take the flu vaccine every year. Side effects of the vaccine such as swelling or redness at the point of injection, headache, fever, nausea and vomiting should also be anticipated and never be confused with other illnesses.
Question #3(c): Contraindications for the vaccines indicated in Question #3(a)
Although flu vaccines are recommended for individuals from birth to age, some can be contraindicated for special individuals due to unwanted effects or damage they can cause such individuals. As Opri et al. (2018) notes, live attenuated influenza vaccine, MMR, and varicella vaccines are contraindicated for immunocompromised individuals, with the exception of those with HIV infection.
However, for those with HIV infection, their CD4 count should be taken into account when excluding or including them for vaccines, with those with extremely low CD4 counts being excluded. Individuals who were allergic to the first dose of attenuated influenza vaccine should avoid receiving subsequent doses. In addition, the live attenuated influenza vaccine is contraindicated in several instances, such as patients taking salicylate-containing medications, pediatric patients ages 2-4 with a history of asthma or wheezing, asplenia patients, patients with cochlear implants, cerebrospinal fluid-oropharyngeal communication, close contact with immunocompromised individuals, and in pregnancy (Nypaver et al., 2021).
Question #4(a): Vaccination of a 11-year-old with immunizations that is up-to-date
Since she is well, her immunizations are up to date, and there are no contraindications, annual flu vaccine, DTaP, first dose of Meningococcal ACWY Vaccines (MenACWY), first dose of an HPV 2 or 3-dose vaccination series can be recommended at this age. The second dose of the 3-dose series or the final dose of the 2-dose series should then be administered later between 6-12 months (CDC, 2021).
Question #4(b): Counselling of the mother and patient on the importance of additional vaccines
During counselling, education on the prevalence and the individuals at risk of getting infected by HPV would be necessary. Pointing out the benefits of the vaccine to the girl is necessary to convince the mother to protect her daughter. According to Davies et al. (2021), it is proven that the HPV vaccine offers protection against infection by the virus. Informing the mother of the ability of the vaccine to protect her daughter would be necessary to impact their attitudes about the vaccine positivel.
Question #4(c): Additional vaccines to be given and at what time.
The additional vaccine that could be given to the girl is the HPV vaccine for protection against the human papillomaviruses (CDC, 2021). This would be the case if the vaccine was initiated between the last six and twelve months. In that case, the second dose would be administered during this time. In the case of a 3-dose series, the final dose could be given when the child is above the age of 15 (CDC, 2021).
References
- CDC. (2021, October 27). Vaccine for Flu (Influenza). Cdc.Gov. Accessed from https://www.cdc.gov/vaccines/parents/diseases/flu.html
- Davies, C., Stoney, T., Hutton, H., Parrella, A., Kang, M., Macartney, K., Leask, J., McCaffery, K., Zimet, G., Brotherton, J. M. L., Marshall, H. S., Skinner, S. R., & HPV.edu Study Group. (2021). School-based HPV vaccination positively impacts parents’ attitudes toward adolescent vaccination. Vaccine, 39(30), 4190–4198. https://doi.org/10.1016/j.vaccine.2021.05.051
- Domachowske, J. (2021). Combination Vaccines. In Vaccines (pp. 409–415). Springer International Publishing.
- Nypaver, C., Dehlinger, C., & Carter, C. (2021). Influenza and influenza vaccine: A review. Journal of Midwifery & Women’s Health, 66(1), 45–53. https://doi.org/10.1111/jmwh.13203
- Opri, R., Zanoni, G., Caffarelli, C., Bottau, P., Caimmi, S., Crisafulli, G., Franceschini, F., Liotti, L., Saretta, F., Vernich, M., & Peroni, D. G. (2018). True and false contraindications to vaccines. Allergologia et Immunopathologia, 46(1), 99–104. https://doi.org/10.1016/j.aller.2017.02.003