Shoot Me with Immunizations

Ugh.  Immunizations.  I don't know why they make us memorize this when every freaking pediatrician's office has charts in every checkup room.  But ok.  Here's the ones that ALWAYS pop up on exams.

@Birth
The only vaccine you give at birth is Hep B with a 5/8" needle.  Hep B requires 3 immunization rounds--you have to give it 2 more times, at 1 month, and 6 months.

@2, 4, 6 (mos) with 1" needles:
Rotavirus (RV)
diptheria-tetanus-pertussis (DTaP)
haemophilus influenza B (HiB)
pneumococcal conjugate vaccine (PCV)
inactivated polio virus (IPV)
**remember HepB @ 1 & 6 months too
**annual influenza as early as 6 months

@1 year, the motherload with 5/8" (deltoid) - 11/4" (anterolateral thigh) needles--these needle lengths remain the same from year 1 on:
haemophilus influenza B
pneumococcal conjugate vaccine
inactivated polio
measles, mumps, rubella***
varicella***
hepA


***Rubella (from the MMR) and Chickenpox (Varicella) are live viruses. You can't give it until 12 months because the baby's immune system isn't strong enough to fight off the live virus.  Also, egg derivative, so watch out for allergies.

@15 months
diptheria-tetanus-pertussis

@4 years
diptheria-tetanus-pertussis
inactivated polio virus
measles-mumps, rubella
varicella

According to the Lippincott-RN 2015 edition, simultaneous injections of vaccines is preferred to serial injections because the anticipation of the next injection can cause heightened "trauma" (I think they mean, anxiety).  Also, (and this really surprised me considering every instructor I've ever known harped on aspirating for blood return with IM injections) "aspirating for blood return does not confirm needle placement and is no longer recommended by the American Council on Immunization Practices for vaccine administration." (page 196)  Apparently, the Public Health Agency of Canada doesn't recommend it either.  I'm not sure the NCLEX has caught up to that, yet.  If it pops up on a multiple answer question, I guess, go with your gut and accept that you will get some answers wrong on the test.  *shrug*  Eh.  Just keep it in your back pocket for when you practice.

Vaccines, Herd Immunity, and the Flu

Ever since Andrew Wakefield's fraudulent medical research paper showing "evidence" that the MMR vaccine was linked to autism, people have been refusing to vaccinate their children.  In light of the measles outbreak, here are a few good articles to read:

Measles Are Back: Key Questions and Answers on Disease, Vaccinations
The Scariest Fact About the Disneyland Measles Outbreak
Forever Young: 14 Reasons Why People 100 Years Ago Died So Much Younger Than We Do Now
5 Reasons You Should Worry Way More About Flu than Ebola
To Protect His Son, A Father Asks School To Bar Unvaccinated Children
Pen and Teller Destroy Anti Vaxxer's Arguments in 90 Seconds
Demand for Measles Vaccine Sends Crowds Even to Anti-Vax Docs

And out of those articles, the one that caught my eye was the second one: The Scariest Fact About the Disneyland Measles Outbreak, in which the author explains, that six infants died not because their parents necessarily chose to not vaccinate them, but because they were too young to be vaccinated.  And it suddenly hit me: there are a lot of infants, and those infants are all unvaccinated.  So, this means, as soon as they stop being inside of momma, and as soon as they stop drinking her breast milk, these little mewling things are susceptible to all of these things that can kill it.  And then I started thinking: what vaccines, exactly, are their little bodies unable to incorporate yet?  So I researched and compiled a list of vaccinations that cannot be administered to infants at birth, and the age at which they are administered:

-Rotavirus @ 2 mos.

-Diphtheria, tetanus, acellular pertussis (DTaP) @ 2 mos.

-H. influenzae type b (Hib) @ 2 mos.

-Pneumococcal conjugate (PCV13) 2 mos.

-Pneumococcal polysaccharide (PPSV23) @2 years.

-Polio @ 2 mos.

-Annual Influenza @6 mos.

-Measles Mumps and Rubella (MMR) @ 12 mos.

-Varicella (VAR) @ 12 mos.

-Hep A @ 12 mos.

-HPV @ 11 years.

-Meningococcal @ 2 mos.

-P. polysaccharide.  Given at 2 years.

These vaccination dates are taken from the CDC, and can be seen at this location: http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-schedule-bw.pdf

You might wonder to yourself, "It's not like babies have ever been able to be completely vaccinated at birth, so how is it possible that people in the Millennial Generation didn't hear about babies dying from measles before this latest outbreak?"  The answer is herd immunity.  If you've never heard of it, click here to watch a very short, but very clear video on how herd immunity works.  I had to make it a link because, for some reason, Blogger seems to be blind to this particular YouTube video.  Also, enjoy this selection of great teaching videos:

"Vaccines and Herd Immunity" by Healthcare Triage

"Should You Get Vaccinated?" by PHD Comics

"Penn and Teller on Vaccinations" by UltraMiraculous

Live Attenuated Vaccines

Oh my goodness, why did I never think to do this before?  Here's a very short list of live attenuated vaccines.  A live attenuated vaccine should not be administered to those who are immunosuppressed or pregnant.  There are also some other categories, like people who have heart conditions or people with an autoimmune disorder.

Adenovirus
Herpes Zoster
Flumist
MMR
Polio
Rotavirus
TB
Varicella
Vaccinia (Smallpox)
Yellow Fever


Feel free to add more if I've missed any.  There are a lot of vaccinations out there, and I believe these are only the ones regularly given in the U.S.

Tangentially related, this is a pretty good way to administer vaccines, 

if you can avoid stabbing yourself:

Resources:
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/us-vaccines.pdf
http://vaccine-safety-training.org/live-attenuated-vaccines.html
http://www.cdc.gov/vaccines/vpd-vac/should-not-vacc.htm
http://www.cdc.gov/flu/about/qa/nasalspray.htm
http://www.cdc.gov/vaccines/schedules/hcp/imz/adult-contraindications-shell.html
http://www.health.ny.gov/publications/7020/