Chapter 9 General Immunization Practices

Question 1

What are the two (2) preferred appliances for vaccine storage? Why?

Answer 1

1. Refrigerators without freezers
2. Standalone freezers

These are preferred because they are better at maintaining precise temperatures.

Question 2

Name seven (7) procedures to follow in order to maintain the cold chain.

Answer 2

1. Monitoring and logging tempratures twice a day (current, minimum and maximum temperatures)
2. Shipping containers must be sturdy, of the appropriate size and contain temperature monitors.
3. Use appropriate insulation and cold source.
4. Avoid dry ice unless specified.
5. Reconstitute the vaccine only immediately before use.
6. Keep diluents at room or refrigerator temperature; never freeze them.
7. Never refreeze live vaccines that have been thawed (except OPV).

Question 3

Name nine (9) elements of information that must be recorded upon administration of a vaccine dose.

Answer 3

1. Patient identification information.
2. Date of vaccination.
3. Product administered.
4. Manufacturer.
5. Lot number.
6. Expiration date.
7. Site of administration.
8. Route of administration.
9. Healthcare provider identification information.

Question 4

Name procedures to follow to avoid transmission of an infection during vaccination.

Answer 4

1. Disinfect skin prior to injection.
2. Use sterile syringes/needles.
3. Avoid recapping needles.
4. Avoid prefilling syringes.
5. Discard single-use syringes/needles immediately after use in proper containers.

Question 5

Name the five (5) routes of vaccine administration.

Answer 5

1. Intramuscular.
2. Subcutaneous.
3. Intradermal.
4. Intranasal.
5. Oral.

Question 6

Which route of administration is generally preferred for adjuvant-containing vaccines? Why (name five (5) elements)?

Answer 6

Intramuscular route, because subcutaneous or intradermal injections can cause :

1. Local irritation.
2. Local induration.
3. Local skin discoloration.
4. Local inflammation.
5. Local granuloma formation.

Question 7

What is the main risk associated with intramuscular injection?

Answer 7

Neurovascular injury.

Question 8

What are the two (2) main sites of administration for the intramuscular route?

Answer 8

1. Deltoid muscle in children able to walk and adults.
2. Quadriceps muscle mass in infants.

Question 9

Why is the gluteal muscles generally not recommended for intramuscular vaccination?

Answer 9

Risk of injury to the sciatic nerve.

Question 10

Name the three (3) vaccines that are approved for intradermal injection.

Answer 10

1. BCG vaccine.
2. One influenza vaccine.
3. Smallpox vaccine.

Question 11

What is the main criteria for a successful oral vaccination.

Answer 11

Oral vaccines must be swallowed and retained for success.

Question 12

Which vaccine is administered by intranasal route?

Answer 12

Live attenuated influenza vaccine.

Question 13

Name five (5) methods to reduce pain caused by vaccination.

Answer 13

1. Topical lidocaine.
2. Topical refrigerant spray.
3. Oral administration of sweet-tasting fluid.
4. Breastfeeding.
5. Distraction techniques.

Question 14

Describe the recommendations for minimum interval between vaccine doses.

Answer 14

1. Two or more inactivated vaccines can be administered simultaneously or at any interval between doses.
2. One inactivated and one live vaccine can be administered simultaneously or at any interval between doses.
3. Two or more live intranasal or injectable vaccines should be administered with a 4 week minimum interval between doses if not administered simultaneously.

Question 15

By what mechanism are immunoglobulins thought to interfere with live virus vaccines?

Answer 15

Immunoglobulins neutralize the vaccine virus, inhibiting its replication and prevents reaching sufficient antigenic mass to induce immunologic memory.