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Vaccination and NCLEX

I thought that this timely season might call for a review of appropriate vaccinations. Because the NCLEX test writers love testing on that and nurses typically give vaccinations and use protocols to do so. Vaccine schedules are the most often quested topic among vaccine questions on the NCLEX. Focus your studying on vaccine schedules for newborns and the elderly. If you ever work as a medical-surgical nurse - you will commonly screen for two vaccines: influenza and pneumococcal. Because these are the most common vaccines provided, you should most thoroughly know the risks and benefits of these vaccines over others.

Influenza is pretty well known. Everyone should get it once a year between October - March (the flu season). Exclusions include those with a history of egg allergy, a history of a reaction to the flu vaccine, a history of Guillain-Barre Syndrome, and those with acute illness. The injection for the flu vaccine is not live and cannot make one sick, although sometimes people have minor aches and pains from their body preparing immunity.

The pneumococcal vaccine is much less well known. So here's what you need to know:

In 1907, pneumonia was the leading cause of death in the U.S. One hundred years later, it was the eighth leading cause of death. Healthy People 2010 states "vaccines are among the greatest public health achievements of the 20th century."

But this achievement's potential is unrealized when it comes to the 23-valent pneumococcal polysaccharide vaccine (PPSV23), which prevents at least 85 percent of the serotypes that cause invasive pneumococcal infection.

The Centers for Disease Control and Prevention (CDC) has estimated half of these deaths would be prevented through vaccination.

Streptococcus pneumoniae does not manifest as pulmonary disease alone. Its more than 90 serotypes cause an estimated 3,000 cases of meningitis, 50,000 cases of bacteremia, 500,000 cases of pneumonia, and 7 million cases of otitis media annually. Eckrode et al label it one of the leading infectious diseases in the U.S., killing more people annually than AIDS, tuberculosis, meningitis, and endocarditis combined. The case-fatality rate of pneumococcal-related disease is high. For example, 1 in 5 adults who develop pneumococcal bacteremia dies.

S pneumoniae is the leading culprit in community-acquired bacterial meningitis. Thus, the CDC has recommended administering the pneumococcal polysaccharide vaccine to people older than 65 who have not had the vaccine and for all others between ages 2 and 65 who have medical indications for the vaccine.

Healthcare providers have a responsibility to take steps to increase screening and administration of PPSV23 in the recommended populations.

Risk Factors

The CDC reports that 91 percent of adults with invasive pneumococcal infection have at least one of the risk factors to indicate vaccination. CDC recommendations are categorized as strong, moderate, and justified.
Strong evidence and clinical benefits exist for vaccination of patients older than 2 with the following risks: chronic cardiovascular or pulmonary disease, asthma, diabetes mellitus, tobacco use, sickle cell disease, or splenectomy.

Moderate evidence and benefits exist for patients older than 2 with the following risks: chronic liver disease, cerebrospinal fluid leaks, or alcoholism.

Justified vaccination based on the high risk for disease and the potential benefits of vaccination exists for patients older than 2 with the following risk factors:

  • HIV infection;
  • leukemia lymphoma;
  • Hodgkin's disease;
  • multiple myeloma;
  • generalized malignancy;
  • chronic renal failure;
  • nephrotic syndrome;
  • receiving immunosuppressive chemotherapy;
  • long-term systemic corticosteroid therapy;
  • organ/bone/cochlear transplantation; and
  • institutionalized status.

Access current adult immunization schedules online at https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html.

Thanks and Stay Well!