It’s interesting that something so small and minuscule can pack such a big punch. Vaccines have been around since 1796, when Edward Jenner developed a procedure that protected individuals against small pox. Because coxpox is also known as vaccinia that is how we came to get the name Vaccine for this procedure. In 1879 Louis Pastuer constructed experiments and came up with a vaccine against the organism Pasturella multicida. He proceeded to perfect his experiments until he understood the vaccine procedure worked. He produced vaccines against rabies and anthrax, both diseases that if left untreated have deadly outcomes. In the 1890’s, over 200 years ago, German researchers found what vaccines actually targeted. They discovered that the vaccines provided protection by using antibodies. These researchers developed a technique called passive immunology, where protective antibodies are transferred to individuals.
Since the 1900’s there have been remarkable strides in reducing the amount of infectious diseases and it all falls back on the introduction of vaccines. To vaccinate an individual against a pathogen is to help protect them from getting a serious illnesses or complications of a vaccine-preventable disease. The public and health officials call receiving your vaccinations immunization. It’s related to the administration of antigenic inoculum otherwise known as vaccines.
Vaccines today are in large quantities. Manufactures grow bacteria in lab culture vessels. Some labs use sterile eggs to help the virus reproduce in the culture. In nursing we are taught that individuals that are allergic to eggs should not receive certain vaccines (ex. flu vaccine). There are several stages to vaccine preparation. They involve Inactivation; this is making the antigen preparation, Purification where the antigen is made pure and Formulation where the purified antigen is combined adjuvants, preservatives and stabilizers to make the final vaccination. Production begins with growing the virus or microbe in cells chicken eggs, cell lines or human cells that have been cultured. Some bacteria are grown in bioreactors. Antigens can be toxins from the bacteria like tetanus. It can even be part of the genetic make up of a pathogen. Proteins can be taken from organisms that are grown in cultures. Polio which has been eradicated from the United States has heat or chemicals used to make the vaccine. After the antigen is engineered, the vaccine has adjuvants, preservatives and stabilizers added to it. There is plenty of controversy around the preservatives that are added to vaccinations.
All over the world there are individuals, groups and even some doctors that link the use of vaccines (because they contain certain preservatives like Thimerosal a mercury compound) to Autism. Adjuvant job is to makes the immune response more efficient in response to the antigen. Stabilizers help to keep the vaccine longer (meaning shelf life) and preservatives are used for multi-dose vials. For example this is when a doctor’s office buys a 20ml vial that contains 20 doses of a vaccine at 1ml each. The vaccine can be given to 20 different people as long as the vaccine remains sterile and there isn’t any cross contamination. Combination vaccines are harder to develop and process because of incompatibility between the antigens and substance in the vaccines. In the production part, special care must be taken to prevent the contamination of the vaccine and there are environmental policies in place to protect the environment, like rivers, lakes, streams and oceans, from spillage or dumping.
In 2001, the World Health Organization started a program for Vaccine Research. This was to help stream line vaccine research and development projects. IVR is an international group whose job is to help the development of vaccines against infectious disease, to help improve our already existing vaccine technology and to make sure that the people/groups or demographics that need a certain vaccine the most have supplies available to them. Development is not as easy as it was in the 1700’s. Today’s development is strictly regulated by establishing a concern- then discovery, the process engineering, toxicology and animal studies before it can even progress to human trials. That process alone can take up to 10 years complete. That being said the large focus of vaccine research is on effective vaccines for HIV and AIDS, TB, malaria, leishmanias and other diseases, not to mention how to make all ready existing vaccines more effective.
When health care individuals talk about the route of administration they are talking about the path in which a vaccine is brought into an individual. This step is critical, because the substances must be moved or brought from the entry site to the place the action is supposed to occur. IM otherwise known as intramuscular injections, is when the when the vaccine is injected into the muscle mass. This can consist of the deltoid (below the shoulder above the armpit outer part of the arm), the gluteus which is the large buttocks (the dorsogluteal muscle and the ventrogluteal is used more for medications) and in infants or children immunizations are given in the vastus lateralis (the anterolateral part of the thigh). IM shots are given at a 90 degree angle to insure that they enter the muscle and not the subcutaneous tissue. IM shots in large muscles are used to help reduce the possibilities of side effects. Some side effects include soreness or redness at the injection site, low grade fever, stiffness and joint pain. This usually will go away in a few days.
More serious side effects like a high fever or shortness of breath etc. should be reported to a health care official right away. The next type of injection is a ID or intradermal shot (its administered in to the top layer of skin). TB tests, BCG and some flu shots can be given this way. Its small needle and only goes right under the skin, when injecting for example the TB test you use 0.1ML of Tuberculin into the lower inner part of your arm, just under the skins surface. The needle is held at a 10-15 degree angle. With this test- we are not looking for a side effect but a reaction from the injection. A red raised area larger (almost like a welt) greater than 15mm is a positive. The BCG vaccination when given to an infant is the only time that we use the arm since the mass is so small and the muscle is underdeveloped. The next injection is a sub Q- subcutaneous injection is usually given in the deltoid. This injection is done at a 45 degree angle with a shorter needle than the IM injection. SQ shots if given to an infant or toddler should be given in the fatty area of the upper arm or the fatty area of the thigh. On individuals age 3 and older a SQ shot is given by pinching your finger and thumb together, think pinch an inch” and given in the upper arm. Vaccines are not given IV (intravenously).
The easiest way to give a vaccine would be oral, because it would be simple to take by mouth and the cost would be less than an injection. One of the most used vaccines in the world use to be the oral polio vaccine. The vaccine is a live-attenuated vaccine. This is when a vaccine uses a live virus, but it’s changed so it is not as potent. Since its alive the person receives the immunity for life. Another way a vaccine can be given nasal spray- an example of this is the flu-mist vaccine. It’s also a live attenuated vaccine; it’s given to healthy no pregnant individuals ages 2-49. Side effects or adverse reactions are always possible with any type of vaccine, but with the all of the guidelines and regulations in place the majority of people will only suffer mild effects at the injection site or some slight discomfort. No longer is it a possibility that people can develop polio from an incorrectly attenuated virus, like in polio. That disease is something that we use a dead virus. But like health care providers suggest people who have weakened immune systems or are sick should avoid getting any type of immunization until speaking with their doctor.
Vaccine controversy is always a touchy subject, whether you are for or against them, it seems as though it causes some type of drama when it’s brought up. I for one am all for vaccinations and have a hard time understanding people’s thought to not vaccinate their children. All lot of groups and individuals blame vaccinations or the ingredients involved in the solution for autism and a multitude of other medical issues. But I can see that when people have never lived through a time where diseases where were rampant and the lives were lost, that they wouldn’t understand the value or need to get vaccinations. In the United States we had eradicated the measles, now since people are using religious and personal reasons not to vaccinate it has come back with a vengeance! Washington State in the last month has had a measles outbreak and it’s not the only place that is having measles show up.
Anti-vaccination movements have been around since the 1800’s. Edward Jenner’s experiments were highly controversial in the 1800’s. There was large spread criticism that ranged from sanitary, to religious to scientific to political objections. Some parents had concerns about the vaccination and the scar it left, while members of the church thought the vaccination was unclean and unchristian like because it came from a cow. Some felt that the vaccination violated their personal rights, especially when the government developed a mandatory vaccine policy. It seems that even after 200 years people don’t change. In the 19th century there was controversy regarding small pox. In the 1970’s controversy over the DTP immunization occurred. 25 years later MMR was in the hot seat, fear mongering ran thru the population. There was a Doctor in Britain that linked bowel disease and autism to the MMR vaccine. Later it was found that this doctor had received payment for his results. But the damage has already been done.
Many people today still point to Dr. Wakefield’s paper as undeniable truth for a link in vaccinations causing autism. One of today’s controversies regarding autism is the need to “green” our vaccines. Anti-vaccers are trying to link the mercury or thimerosal, aluminum parts that used in the the preservation of vaccines as a cause to autism. Even with scientific evidence showing that the small amounts used in vaccinations don’t cause autism people still believe. In the United States we can thank Jenny McCarthy for that. Celebrity Influence is a powerful thing in the States. A star saying something gives an issue a lot more attention. As a health care professional, what we can do is to provide information on the benefits of vaccines and to show scientific proof that they do work.
