CHAPTER 46CHAPTER 46

Immunizing Drugs andImmunizing Drugs and Biochemical Terrorism Biochemical Terrorism

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IMMUNITY

Immune response… Antigens

… Antibodies

Active immunization Passive immunization

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IMMUNIZING BIOLOGICALS

Biological antimicrobial agents… Also called biologicals

… Used to prevent, treat, or cure infectious diseases

Antitoxins

Antisera

Toxoids and vaccines (immunizing biologicals)

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TOXOIDS

Antigenic (foreign) preparations of bacterial exotoxins

Detoxified with chemicals or heat… Weakened or “attenuated”

Cannot revert back to a toxic form

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TOXOIDS (CONT’D)

Stimulate one’s immune system to produce a specific antibody… Artificial active immune response

These antibodies protect against future exposures

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VACCINES

Suspensions of live, attenuated (weakened) or killed (inactivated) microorganisms

The weakened form prevents the person from contracting the disease

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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

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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

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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

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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

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ACTIVE IMMUNIZING DRUGS: EXAMPLES (CONT’D)

Smallpox virus vaccine Tetanus toxoid Varicella virus vaccine

(chickenpox) Yellow fever virus vaccine Many others

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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

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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

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PASSIVE IMMUNIZING DRUGS

Antitoxins Immunoglobulins Snake and spider antivenins

(antivenom)

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PASSIVE IMMUNIZING DRUGS: EXAMPLES

Antivenins… Pit viper, coral snake

… Black widow spider

Hepatitis B immune globulin Immunoglobulin, various

forms Rabies immunoglobulin

(human)

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PASSIVE IMMUNIZING DRUGS: EXAMPLES (CONT’D)

Rho(D) immune globulin (RhoGAM)

Tetanus immunoglobulin

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INDICATIONS

Active immunization… Prevents infection caused by

bacterial toxins or viruses

… Provides long-lasting or permanent immunity

… “Herd immunity”

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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)

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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

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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

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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)

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NURSING IMPLICATIONS

Assess previous reactions and responses to immunizations

Assess for contraindications, including immunosuppression

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NURSING IMPLICATIONS (CONT’D)

Before giving any drug, recheck the specific protocols for administration and schedules for administration

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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

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ILLNESSES CAUSED BY POSSIBLE BIOTERRORISM AGENTS

Anthrax Smallpox Botulism Tularemia Viral hemorrhagic fever Plague

04/22/23 25Winter 2013

POSSIBLE BIOTERRORISM AGENTS

Sarin (nerve gas) Mustard (blistering agent) Cyanide (blood agent) Chlorine (choking agent) Radioactive elements Ricin

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