McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 8  Vaccines and sera

VACCINES Bacterial vaccines

diphtheria and tetanus toxoid, and hepatitis B, pertussis and poliomyelitis vaccine diphtheria and tetanus toxoid, and hepatitis B, pertussis, poliomyelitis and Haemophilus influenzae vaccine Viral vaccines H1N1 pandemic influenza vaccine hepatitis A vaccine, inactivated hepatitis A vaccine, inactivated, with hepatitis B recombinant vaccine hepatitis B vaccine human papillomavirus recombinant vaccine influenza virus vaccine

Japanese encephalitis vaccine measles, mumps, rubella vaccine poliomyelitis vaccine rabies vaccine rotavirus vaccine, live, oral smallpox vaccine varicella zoster vaccine, live attenuated vibrio cholerae vaccine- cholera toxin B yellow fever vaccine IMMUNE SERA Anti Rh(D) immunoglobulin antithymocyte globulin

immunoglobulin, normal (human) rabies immunoglobulin tetanus immunoglobulin zoster immunoglobulin ANTITOXINS AND ANTIVENINS black snake antivenom box jellyfish antivenom brown snake antivenom death adder antivenom funnel web spider antivenom polyvalent snake antivenom red back spider antivenom sea snake antivenom stonefish antivenom taipan antivenom tiger snake antivenom

BCG (tuberculosis) vaccine Coxiella burnetii (Q fever) vaccine Haemophilus B conjugate vaccine Neisseria meningitidis (meningococcal) vaccine pneumococcal vaccine Salmonella typhi (typhoid) vaccine Toxoids diphtheria and tetanus toxoid diphtheria and tetanus toxoid and pertussis vaccine diphtheria and tetanus toxoid, and pertussis and poliomyelitis vaccine

cytomegalovirus immunoglobulin hepatitis B immunoglobulin

V accines and immune sera, including antivenins and antitoxins, are usually referred to as biologicals . They are used to stimulate the production of antibodies, to provide preformed antibodies to facilitate an immune reaction, or to react specifically with the toxins produced by an invading pathogen or venins injected by poisonous snakes or spiders. Stimulating the production of antibod- ies to specific antigens with vaccines provides the person with immunity to that antigen. Vaccines are frequently called immunisations because they stimulate immunity. Many diseases that were once devastating or fatal can now be prevented by stimulating an immune response and the development of antibodies without the need for the person to actually contract the disease. Prudent, prophy- lactic medical care requires the routine administration of certain vaccines to prevent diseases. The immune sera provide treatments for specific antigens, toxins or venins. They are used after exposure to antigens or toxins or after bites from poisonous snakes or spiders to make diseases less invasive and aggressive or to prevent clinical problems from developing at all. Box 18.1 discusses the use of biologicals among various age groups. IMMUNITY Immunity is a state of relative resistance to a disease that develops after exposure to the specific disease-causing agent. People are not born with immunity to diseases, so they must acquire immunity by stimulating B-cell clones to form plasma cells and then antibodies.

Active immunity occurs when the body recognises a foreign protein and begins producing antibodies to react with that specific protein or antigen. After plasma cells are formed to produce antibodies, specific memory cells that produce the same antibodies are created. If the specific foreign protein is introduced into the body again, these memory cells react immediately to release antibod- ies. This type of immunity is thought to be life-long. Passive immunity occurs when preformed antibod- ies are injected into the system and react with a specific antigen. These antibodies come from animals that have been infected with the disease or from humans who have had the disease and have developed antibodies. The circulating antibodies act in the same manner as those produced from plasma cells, recognising the foreign protein and attaching to it, rendering it harmless. Unlike active immunity, passive immunity is limited. It lasts only as long as the circulating antibodies last because the body does not produce its own antibodies. In some cases, the host human responds to the cir- culating injected antibodies, which are foreign proteins to the host’s body, by producing its own antibodies to the injected antibodies. This results in serum sickness , a massive immune reaction manifested by fever, arthritis, flank pain, myalgia and arthralgia. IMMUNISATION Immunisation is the process of artificially stimulating active immunity by exposing the body to weakened