Pediatrics Pearls: VACCINATION
Q 01: What is the derivation of the word “vaccination”?
Q 02: When administering an IM vaccination, is aspiration necessary before injection?
Q 03: What is the “grandparent effect” of vaccination?
Q 04: What are the recommendations regarding the administration of live-virus vaccines to patients receiving corticosteroid therapy?
Q 05: Why are the buttocks a poor location for intramuscular (IM) injections in infants?
ANSWERS:
ReplyDeleteWhat is the derivation of the word “vaccination”?
Edward Jenner, an eighteenth century British physician, had observed that dairymaids were protected naturally from smallpox, the infectious scourge of the world at that time, after they had developed cowpox, a milder blistering disease. In 1796, he inoculated a young boy with material from fresh cowpox lesions that had been taken from a dairymaid. Two months later, he again inoculated the boy, but with matter from a fresh smallpox lesion. No disease developed and the science of immunization was born. Because the Latin word for cow was vacca and for cowpox was vaccinia, Jenner called his new procedure vaccination.
When administering an IM vaccination, is aspiration necessary before injection?
Traditionally, the plunger has been withdrawn to verify that the needle tip is not in a vein. However, when vaccinations are given as recommended in the anterior lateral thigh in an infant or in the deltoid in toddlers >18 months, aspiration before injection is not required because no large blood vessels are located at those preferred sites. Additionally, the process of aspiration before injection is more painful and it takes longer to administer the vaccine.
What is the “grandparent effect” of vaccination?
The rate of invasive pneumococcal disease has declined in people >65 years since the introduction of the conjugate pneumococcal vaccine in 2000. Meningitis rates have declined by 54%. Decreased nasopharyngeal carriage among vaccinated infants has likely reduced transmission to older individuals caring for them. This type of “herd effect” in elderly people is referred to as the grandparent effect.
What are the recommendations regarding the administration of live-virus vaccines to patients receiving corticosteroid therapy?
Children receiving corticosteroid treatment can become immune-suppressed. Although some uncertainty exists, there is adequate experience to make recommendations about the administration of live-virus vaccines to previously healthy children receiving steroid treatment. In general, live-virus vaccines should not be administered to children who have received prednisone or its equivalent in a dose of 2 mg/kg/day or greater (or _20 mg per day for individuals whose weight is >10 kg) for more than 14 days. Treatment for shorter periods, with lower doses, or with topical preparations, local injections, orinhaled corticosteroids should not contraindicate the use of these vaccines. However, immune suppression is possible with these medications and that should be taken into account at the time of vaccination.
Why are the buttocks a poor location for intramuscular (IM) injections in infants?
The gluteus maximus is not a good choice for injections because of the following:
• The gluteal muscles are incompletely developed in some infants.
• There is a potential for injury to the sciatic nerve or the superior gluteal artery if the injection is misdirected.
• Some vaccinations may be less effective if they are injected into fat (e.g., vaccines for rabies, influenza, and hepatitis B).
If injections into the buttocks are given to older children, the proper site is the gluteus medius in the upper outer quadrant rather than the gluteus maximus, which is more medial.
What will be the preferable site for IM inj in infants .
ReplyDeleteAnterolateral thigh muscle.
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