Chapter 10 immunizations

Copyright © 2017, Elsevier Inc. All Rights Reserved.
Immunization
Chapter 10
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Learning Objectives
Lesson 10.1: Immunization
1. State the importance of immunization in the
health care field and identify vaccine-
preventable diseases.
2. Describe the diagnosis, microbiology, onset
and symptoms, and immunization and
boosters of tetanus.
3. List the types of influenza, symptoms,
process of influenza vaccinations, and the
CDC recommendations for influenza
vaccinations.
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4. Discuss how hepatitis is transmitted, the
occupational hazards of hepatitis B, and the
importance and process of hepatitis B
vaccinations.
5. Discuss the risks associated with missing
important vaccines.
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Learning Objectives
Lesson 10.1: Immunization (Cont.)

Immunization and Health Care
 Health care workers in hospitals and offsite
locations are at risk for the occupational
acquisition of infectious diseases
 Ensuring that personnel are immune to
vaccine-preventable diseases is an essential
part of a successful infection control plan
 Optimal use of vaccines can prevent transmission
of disease
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 The compliance with a vaccination scheme is
known to be greater when the program is
mandatory rather than voluntary.
 When the employer pays for the vaccinations,
compliance is known to be significantly higher
than if the employees must pay all or part of
their immunization costs.
 .
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 Types of health care provided, characteristics
of the patient pool, and the age and
experience of the health care workers
influence the decision as to which vaccines
should be included in an immunization
program.
 In some cases, screening can help determine
susceptibility to certain vaccine-preventable
diseases. Hepatitis B is an example
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Missing Vaccines
 Vaccines do not exist for all diseases
 Important “missing vaccine” for dentistry in
the U.S.
 Hepatitis C
 HIV type 1
 Tuberculosis
 Some forms of human herpesviruses
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Missing Vaccines
 Refer to Table 10.1 for recommended
immunization schedule.
 To have the most effective and efficient office/clinic
infection control program, personnel health
elements must be an essential component.
 In addition, immunization, education and training,
postexposure management, identification of
medical conditions, work-related illnesses and
work restriction, maintenance of records, data
management, and confidentiality are important
components.
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Tetanus
 Tetanus (“lockjaw”) is a severe disease with a
high case-fatality ratio
 Tetanus can be an infectious complication of
any cut or puncture wound and is caused by
the toxins of Clostridium tetani
 Tetanus endospores are resistant to disinfection
 Control of their spread requires overt effort
 Preventable disease
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Tetanus
 Primarily a disease of older adults unvaccinated or
poorly vaccinated in U.S.
 Tetanus is usually a clinical diagnosis based on
acute onset of hypertonia or painful muscular
contractions (usually of the muscles of the jaw and
neck first) and generalized muscle spasms.
 Death is often an expected outcome of infection.
 Common regimen of injections is 2, 4, and 6
months. Routine boosters are recommended
through childhood and then every 10 years.
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Influenza
 Influenza (the flu) is an acute respiratory
disease caused by influenza type A or B virus
 Incubation ranges 1 to 4 days
 Transmitted via aerosolized or droplet
transmission from the respiratory tract of
infected persons
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Influenza
 Often confused for the common cold.
 Vaccines consist of the three strains of
influenza viruses (two type As and one type
B) that are most likely to cause disease that
season.
 For example, the 2011-2012 vaccine
protected against an influenza H3N2 type A
virus, an influenza B virus, and the H1N1 type
A virus that emerged in 2009 to cause a
pandemic.
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Influenza
 There are now three types of trivalent
influenza vaccines available. One is an
inactivated (killed) influenza vaccine
administered as a single dose
intramuscularly, one is a recombinant
influenza virus (RIV), and the other is a live,
attenuated (weakened) influenza vaccine
(LAIV) administered intranasally.
 See Table 10.2 to see differences between a
cold and the flu.
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Influenza Vaccination
 The CDC recommends that all health care
workers be vaccinated annually against
influenza
 A preventive approach will help eliminate the
spread of the influenza virus from health care
workers to their patients
 Vaccination must be repeated annually
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Influenza
 Health care workers who work with severely
immunocompromised patients who require a
protected environment should not receive
LAIV.
 If the employee initially declines vaccination
but at a later date, while still covered under
the standard, decides to accept the offer, the
employer must make the vaccine available at
no charge at that time.
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Influenza
 Annual vaccination of persons at high risk (and their
close contacts) for influenza-associated
complications is the most effective means of
reducing the impact of influenza.
 New influenza vaccines are developed annually two
times a year.
 Persons with an egg allergy should not have the
vaccine.
 Inactivated influenza vaccine is approved for all
persons older than age 6 months who lack vaccine
contraindications including those with high-risk
conditions. 16

Transmission of HBV
 The hepatitis B virus (HBV) is an infectious
agent associated with acute and chronic
inflammation of the liver
 Has potential for indirect transmission such
as contact with contaminated instruments
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Transmission of HBV
 Hepatitis B virus can be found primarily in blood and
blood products but also can be present in other body
fluids, such as semen, tears, feces, urine, vaginal
secretions, and saliva.
 Hepatitis B virus is a bloodborne pathogen
transmitted by percutaneous or mucosal exposure,
by sexual contact, and from mother to fetus or infant.
Hepatitis B virus is environmentally stable,
especially when surrounded by blood.
 Most frequently reported vaccine-preventable
diseases in U.S.
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HBV Occupational Hazards
 Hepatitis B is a major occupational hazard for
dental personnel
 Attack rates among unvaccinated individuals are 3
to 10 times the 4% rate present in the general
population
 PPE cannot eliminate all body fluid
exposures, especially sharps injuries
 The best protection against HBV infection is
immunization
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HBV Occupational Hazards
 Hepatitis B is an especially difficult problem
because many dental workers have repeated
intimate contact with patient body fluids and
with items soiled with such fluids.
 Hepatitis B virus infection appears to be
related more to the extent of exposure to
blood than to the number or type of patients
treated.
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HBV Vaccinations
 All at-risk dental personnel need to be
vaccinated, including clinicians, laboratory
workers, and associated cleanup crews
 Employers must assume all costs associated
with HBV vaccination
 Not all health care workers have complied;
dentistry among highest rate of compliance
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HBV Vaccinations
 A person such as an office receptionist may
be considered as not being at risk. However,
many dental offices practice multitasking
because when an emergency or special
patient need arises, “office workers”
temporarily participate in chairside dentistry.
 Complete protection against HBV includes
postscreening for antibody (anti-HBsAg)
levels. This procedure should be conducted 1
to 2 months after completion of the 3-dose
vaccination series.
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HBV Vaccinations
 Employees have the right to refuse
vaccination. However, the employee must
read and sign a declination statement.
 What are some reasons for noncompliance?
(Concerns expressed include vaccine safety,
cost, efficacy, pregnancy-related issues, and
considering oneself to be at low risk.)
 Refer to Box 10.1 and Table 10.3.
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Missing Important Vaccines
 Immunization programs successful in
preventing diseases among children
 Continuing need for vaccinations during
adulthood
 Many diseases are considered more severe when
contracted as adults
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Missing Important Vaccines
 Dental personnel should discuss their
immunity schedule with primary care
physicians and keep all vaccinations current.
 Screenings for infectious diseases exist.
 CDC estimates that vaccinations will prevent
more than 21 million hospitalizations and
732,000 deaths among children born in the
last 20 years.
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Chapter 10 immunizations

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