Immunity can be induced in 2 ways
• Active immunity Induced using inactivated or attenuated live organisms or their products. Acts by inducing cell-mediated immunity and serum antibodies. Generally long-lasting
• Passive immunity Results from injection of human immunoglobulin. The protection afforded is immediate but lasts only a few weeks.
Storage of vaccines: Follow manufacturers’ instructions. Do not store vaccines in the door of a vaccine fridge and make sure there is a maximum and minimum thermometer in the fridge. Record readings regularly and discard vaccines if not stored at the correct temperature.
Administration of vaccines: Only suitably trained GPs/nurses should give immunizations. Check immunization is needed and the patient is fit. Check consent has been obtained and that immunizations are the correct ones and in date. Ensure resuscitation facilities are available. Record vaccine expiry date/batch number. Reconstitute vaccine (if necessary) and give according to manufacturer’s instructions. Record date and site in the medical notes.
Influenza and pneumococcal vaccination: Available as a Directed Enhanced Service—existing practices do not have preferred provider status. Additional payments are available through the Quality and Outcomes Framework for ensuring at-risk patients receive vaccination.
Other necessary vaccinations: Can be provided as an Additional Service. Opting out incurs a 2% d in global sum. Travel vaccinations that do not fall into these criteria can be administered as a private service.
Contraindications to vaccination: For specific contraindications to individual vaccinations consult the Green Book. General rules:
• Acute illness Delay until fully recovered. Minor ailments without fever or systemic upset are not reasons to postpone immunization
• Severe local reaction to previous dose Extensive area of redness/ swelling that involves much of the antero-lateral surface of the thigh or a major part of the circumference of the upper arm
• Severe generalized reaction to a previous dose Fever ≥39.5°C <48h after vaccination; anaphylaxis, bronchospasm, laryngeal oedema, and/ or generalized collapse; prolonged unresponsiveness; prolonged
high-pitched or inconsolable screaming for >4h; convulsions or encephalopathy <72h after vaccination.
Contraindications to live vaccines: (BCG; shingles; measles; mumps; oral typhoid; rubella; yellow fever). Do not give live vaccines:
• To pregnant women or immunocompromised patients—those on IMMUNIzATION high-dose steroids for >1wk (>1mg/kg/d prednisolone for children or ≥40mg/d for adults); if haematological malignancy; if radiotherapy/
chemotherapy within 6mo; or another immunodeficiency syndrome
• <3wk after another live vaccine (but 2 live vaccines may be given together at different sites), or
• With immunoglobulin (from 3wk before to 3mo after)