Case Study of Immunization

This case study discusses the importance of vaccination, consent procedure, anaphylaxis, and adverse events following immunization. It provides expert advice on immunization and how to communicate with parents regarding vaccination. The subject is immunization, and the course code and college/university are not mentioned.

Running head: CASE STUDY OF IMMUNIZATION
Case study of immunization
Name of the student:
Name of the university
Author note:

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1) Response to the first question:
Valid consent for any medical procedure defined as a verbal agreement of an individual
in the specific method after receiving a detailed explanation of risk factors, health benefits and
potential side effects. As a part of the consent procedure, sufficient information about the disease
and some information about the protocols of health centers should be given to the patient to
receive consent from the individual to be vaccinated. According to Australian Immunization
Register Act 2015, it was stated that before 18 years both the parents could permit on behalf of
children for proceeding with vaccination (Humanservices.gov.au. 2018). Moreover, family act
law (1975), which predominately deals with divorced or separated parents define that the power
of deciding for child exclusively given to the parent who has custody of the child
(Legislation.gov.au. 2018).In that context, Albert, father of Mia and Rose, mother of Mia both
equally share legal custody for Mia. Therefore, both the parent holds the hierarchy for deciding
on behalf of Mia. In that context, consent of Albert without Mia’s mother will not get prime
priority for vaccination procedure.
It is suggested to proceed with vaccination process after completing the pre-vaccination
assessment and obtaining consent from Mia’s father. The prime reason for this decision solely
revolves around the health of the child. To protect the health and safety of children Government
of Australia has given authority to one of the parents to provide the consent of vaccination for
severe outbreak such as Pertussis. In all possible cases, the government of Australia legislated
rules where the physician should solely focus on the best interest of children, which supported by
scientific evidence of risk factors mentioned by a physician (Australian Technical Advisory
Group on Immunisation 2017.)In this above scenario, Mia who is five years old is in custody of
both parents. Therefore, both the parents share the same rights on Mia in consent for vaccination

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of severe disease. Therefore, approval of Albert is not enough to proceed with treatment. On a
contradictory, due to a severe outbreak of Pertussis in the locality where 72% coverage of
vaccination observed, high chances for Mia to be infected with Borrelia pertussis, which causes
whooping cough. In case of children vaccination for younger than ten years DTap (Diphtheria,
tetanus and pertussis) should be recommended for preventing wide spread of deadly diseases for.
Besides, the vulnerability degree of Mia also extremely high as last vaccination she has received
two years ago. There are chances that Mia will be infected with influenza as the secondary
disease. Moreover, Mia’s stepmother Talia is a first week pregnant with a child. There are
probabilities that a newborn will also be infected due to low immunity. Antibodies produced by
injecting vaccination protect women and passes to the newborn in the first week of the
pregnancy where newborns are most vulnerable (Australian Government Department of Health
2018). Therefore, for the best interest of Mia, Stepmother and newborn, supported by all shreds
of evidence and records, histories of vaccination it is preferable to proceed with Albert's consent.
2) Response to the second question:
In recent years, Countries such as the USA and Australia has faced many outbreaks of
many severe diseases that threatened many lives. On a different note, Refusal of vaccination also
increases simultaneously. A considerate number of parents requested to modify the technique of
vaccination in addition to the composition of the vaccine to avoid the side effects of vaccines. In
most of the scenario, parents become paranoid to give consent for vaccination due to negative
side effects, some them think vaccinations are not that important for curing severe diseases like
influenza, whooping cough and varicella (Dube, Vivion, and MacDonald 2015). A small portion
of the community also suspected chemical compositions of vaccines as the culprit of negative

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side effects such as anaphylaxis reaction or general allergy (Ward et al. 2017). Moreover, the
internet has a huge effect on the refusal of consent vaccination. Majority of individuals with no
sound knowledge about biology show prime dependence on the internet as a result of which they
hold on to old believes of vaccination. The Internet may show negative impacts of vaccination
which become believe of parents in the recent era of technology. Bided by the rules, there is
almost no probability for medical experts to go beyond the protocol for the proper medical
procedure unless patient suffers for a disease that shortens lifespan, in that case, immediate
action should be taken. Therefore, immunization and prevention of killer diseases become more
difficult to cure. However, researchers found out several different ways of communicating with
parents regarding vaccination and gain their trust to proceed with the certain medical procedure.
Communication can be verbal where patient or family of the patient can interact, or explanation
of benefits of vaccination can be done using writing materials, kits to provide sound knowledge
about the disease to family members (Kahan 2016). In the above scenario, the situation is quite
similar. In the above scenario, Mia is 5years child whose mother refuses to give to consent for
vaccination who might have erogenous information about vaccination or previous unpleasant
experiences involving vaccination. As a consultant or physician of Mia, I will communicate with
Mia's mother. First, as a medical officer, I will pay attention and response to the emotional
narrative of Mia's mother, Rose. After that, I will try to address her specific concerns then I will
explain her different perspectives on vaccination. I will explain her benefits of vaccination for
vaccine-preventable disease such as pertussis, diphtheria, influenza. I will explain the major risks
of untreated pertussis and epidemiology of influenza and all the necessary information to make a
rational decision for vaccination. Besides, I will explain the concept of herd immunity to Mia’s
mother. Herd immunity is an immunization process, which limits the spreading of the disease

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within peers (Mallory, Lindesmith and Baric 2018). Besides, herd immunity has a huge
contribution to curing life-threatening disease in children younger than 5years. In this context,
Mia's vaccination will help many another individual in surroundings to fight diseases like
influenza and Pertussis.
3) Response to the third question:
Anaphylaxis is a life-threatening multi-organ involving acute disease that observed due to
the release of an inflammatory mediator. In children, it is a response triggered by food allergen
or administration of vaccination, which eventually leads to IgE mediated anaphylaxis reaction
(Palmiere, Tettamanti and Scarpelli 2017). Anaphylaxis is a sudden onset reaction where the
cardiovascular system and respiratory system are a prime location for a shock. Generally,
bronchoconstriction and laryngeal oedema observed in severe cases of anaphylaxis along with
the involvement of the central nervous system, mainly hypoxia (McNeil et al. 2016).Early signs
that observed in anaphylaxis involved skin where urticaria, erythema and other adverse effects in
subsequent tissues. Other common symptoms for this shock are abdominal pain, vomiting and
diarrhea. In routine vaccination, anaphylaxis is rare but fetal. Fainting (vasovagal episode) is also
a widespread phenomenon in adolescence, but children rarely faint. However, in children,
sudden loss of consciousness consider as major physical identification of anaphylaxis, especially
if the physician observed that central pulse is not present where central pulse present in fainting
during vaccination. Biochemistry also confirms the anaphylaxis phenomenon during the routine
course of vaccination. For the identification of the prime biomarker, mast cell tryptase of serum
to be measured (Mercurio et al. 2018). For measurement of the severity of the reaction, Meuller
grading system will be used to severity. In the first stage, malaise, itching along with
generalized urticaria observed. In the second stages, the symptoms such as tightness of the throat

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or chest, vomiting, nausea, abdominal pain observed. In the third stages, hoarseness, dysphagia,
confusion, weaknesses are key symptoms. In forth stage or severe most stage, collapse,
hypotension and loss of consciousness observed (Klaver et al. 2016).
In order to manage the anaphylaxis, immediate administration of first-line drug
adrenaline should be recommended as a physician. Anaphylaxis is life threatening if non treated
correctly and overtreatment leads to allergy. If the patient is unconscious, then keeping him or
her in the leftward for receiving clear airways should be recommended. If the patient is
conscious then keeping him or her supine should be recommended. If any respiratory or
cardiovascular symptoms observed, then injection 1: 1000 adrenaline into the anterolateral thigh
with the dose of 0.01 mL/kg body weight up to a maximum of 0.5 mL should be recommended.
This injection helps to disperse systemically. Adrenaline auto-injector also recommended for
those individuals who have an exceptionally high risk of anaphylaxis due to existing allergy from
food, and it should be administrated in mid-thigh (Umasunthar et al. 2015). However, an auto-
injector should not be used for the underweight child. Oxygen mask should be used in case of
absence of oxygen. The repeated dose of adrenaline in every five minutes should be used in case
of no improvement. To check the stability of breathing performing cardiopulmonary
resuscitation (CPR) should be recommended (Fleming et al. 2016).For optional drug,
antihistamines are used to management anaphylactic patient (Dhami et al. 2014). Besides, other
drugs such as diphenhydramine should be administrated orally. It also used as intramuscular
injections with the standard dose is 1–2 mg/kg body weight for managing the severe case
(Arruda et al. 2017)
4) Response to the fourth question:

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Vaccination is a process that induces the immunization into the body so that it can
strongly response to antigens. Sometimes, vaccination through attenuated or living biological
entities manages to induce the predictable mild adverse reaction. However, there is a high
probability of undetectable effects of vaccination in individuals. Therefore world health
organization classified those adverse effects as “adverse events following immunization
(AEFIs)”( World Health Organization 2018).Adverse effect defined as any unwanted symptoms
or an unpleasant sign of a particular disease. Anaphylaxis is one of the rare adverse effects that
mostly observed in vaccination, which can be fatal. Adverse events following immunization can
be divided into two key categories; one is common expected AEFI and another one is rare and
unexpected AEFI. All drugs give rise to few side effects that sometimes similar with symptoms
of other diseases ,which excepted to observe in few individual such as redness, pain, swelling,
itching and burning sensation (Mahajan et al. 2015). In order to avoid such events as a physician
it is recommended that Before giving consent to any immunization process, detailed information
of clinical symptoms should be clarified from the medical expert. Registration of vaccination
should be clarified from experts. Biological characteristics of vaccines and carrier molecule such
as adjuvant should be noted to get the proper vaccination. In order to avoid any adverse reaction,
any other medical histories or disability in any part of the body should be rectified, and detailed
information about medical procedure should be rectified from healthcare experts. Ensuring the
appropriate vaccination and detailed information proper dose of vaccination should be taken.
Parents should confirm that Vaccinations that provided to patients should be strictly for that
specific age group. Medical experts should clarify the dilutions of vaccination in proper amount.
Health care expert should provide correct intervals for additional vaccination. Parents should
ensure that vaccines that administrated to the patient should be properly stored in low

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temperature. Even after successful vaccination if patient experience fever, in that case,
appropriate dose or ibuprofen or paracetamol should be given to the patient( World Health
Organization, 2016).The local reaction to vaccination generally does not require the assistance of
a medical expert. However, the systematic reaction in the body requires assistance trained
medical experts. On the other hand, the occurrence of the adverse event following immunization
rarely observed and it actively involved neurology, immunology. Mostly observed effects in
vulnerable individuals are seizures, hypotonic-hyporesponsive episodes (HHE),
thrombocytopenic, allergic reaction and anaphylaxis (Gore et al. 2016). In order to avoid this
adverse effect thorough check-up of individuals should be recommended. Examination of Any
food habits or pollen allergy from health expert should be recommended. Inappropriate route of
immunization should be avoided. To avoid further infection disposal of clinical waste, as well as
sharps and immunizing agent vials should be recommended. After vaccination, it should be
recommended to cover the side of vaccination. By following this guideline, parents will be able
to feel secure about vaccination for their child and avoid any traumatic experience of
vaccination.

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References:
Australian Government Department of Health. (2018). Free whooping cough and influenza
vaccines for pregnant women | Australian Government Department of Health. [online] Available
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vaccines-for-pregnant-women [Accessed 17 Jul. 2018].
Australian Technical Advisory Group on Immunisation (ATAGI) 2017, The Australian
immunisation handbook, 10th edn (2017 update), Australian Government Department of Health,
Canberra, 17 January 2018, Retrivedfrom:
http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-
home
Dhami, S., Panesar, S.S., Roberts, G., Muraro, A., Worm, M., Bilò, M.B., Cardona, V., Dubois,
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anaphylaxis: a systematic review. Allergy, 69(2), pp.168-175.
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Fleming, N.T. and Haruta, S., G2B Pharma Inc., 2016. Intranasal Formulation for the Treatment
of Cardiopulmonary Resuscitation (CPR), Cardiac Life Support (CLS), Anaphylaxis and/or
Anaphylactoid Reactions. U.S. Patent Application 14/916,098.
Gore, R.S., Garg, Y.R., Jain, S. and Dahiya, A., 2016. A rare side effect to pentavalent
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Humanservices.gov.au. (2018). Australian Immunisation Register - Australian Government
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Kahan, D.M., 2016. Protecting the Science Communication Environment: The Case of
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Klaver, C.C., Moriyama, M., Shinohara, K., Kawasaki, Y. and Yamazaki, M., 2015.
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