Women’s Health: A realistic vaccination program for all patients, including gravidas

• There is no advantage to splitting the dose into 2 injections. Data suggest that splitting the dose may decrease antibody production.

Most widely used vaccines are safe and effective when given on the same day at separate sites. These include inactivated vaccines, toxoids, and live virus vaccines.

The antibody response to simultaneously administered live virus vaccines results in appropriate titers for each vaccine without an increase in adverse effects.

• Finally, draw the vaccine into the syringe only at the time of administration. Since most vaccines look the same once they are in a syringe, this policy helps avoid confusion.

STEP 4Ensure essential tasks are completed

The vaccination program advocate can be charged with these responsibilities:

• Order and reorder vaccines, inspect them upon delivery, and follow the manufacturer’s specifications for storage. These are not tasks to be taken lightly. Failure to meet the requirements for storage and handling can reduce a vaccine’s potency.
• Provide every patient with a vaccine information statement (VIS) for each drug. The VIS is a 1-page information sheet produced by the CDC to inform patients of the benefits and risks of specific vaccines.

The information sheets are available free of charge from the CDC’s National Immunization Program Web site, at www.cdc.gov/nip. The VIS should be given to the patient before the vaccine is administered.

• Record the following information in the patient’s chart:
  • VIS edition and date it was given
  • Name of the person who gave the vaccine
  • Date vaccine was given
  • Vaccine manufacturer
  • Vaccine lot number

STEP 5Identify contraindications

Anumber of conditions preclude the use of a vaccine, and should be elicited in the history. They include:

• Anaphylaxis with a previous vaccination.
• Egg allergy (for influenza, measles, mumps, and yellow-fever vaccines).
• Neomycin or streptomycin allergy (for MMR vaccine).
• Immunosuppression (for live virus vaccine).
• Temperature elevation exceeding 40.5°C after a previous vaccination.

Contraindications do NOT include mild, acute upper-respiratory or gastrointestinal illness with a fever of 38°C or less; current antimicrobial therapy or convalescence from a recent illness; pregnancy in another household contact; breastfeeding; personal history of “allergies” to penicillin; or family history of allergies, adverse reactions to vaccination, or seizures.

STEP 6Be prepared for adverse reactions

Proper screening is the key to preventing most adverse reactions.

Anaphylaxis. Asking the patient about contraindications and taking precautions greatly reduces the risk of anaphylaxis and other serious reactions. Nevertheless, the clinician administering the vaccine should have the necessary procedures in place to manage anaphylactic reactions, and should be certified in cardiopulmonary resuscitation.

Syncope is most common in adolescents and young adults. Between 1990 and August 2001, the Vaccine Adverse Event Reporting system recorded 2,269 instances of syncope; 40% occurred in 10- to 18-year-olds.¹¹

Most cases of vaccine-related syncope occur within 15 minutes of administration. Although syncope is uncommon, some authorities recommend that patients be observed for 15 to 20 minutes after administration. If syncope develops, observation can be continued until the symptoms resolve.

Dr. Gall reports no financial relationship with any companies whose products are mentioned in this article.