Medical Assistant Exam: Clinical Procedures - Immunizations

Immunization refers to the process by which the body is made immune, or unsusceptible, to a certain disease. The body uses its own immune system to protect against certain diseases, but immunization can also be introduced to the body in the form of vaccines. Vaccines work in one of two ways.
- Active immunity: the introduction of the small amounts of a weakened or dead version of organism that produces the disease, which results in the ability of immune system to produce antibodies that will fight disease if the individual is exposed; this method is slow-acting, in that it takes a while to become effective, but long-lasting, in some cases lasting a lifetime

Examples: Vaccines against cholera, polio, and influenza.
- Passive immunity: the direct introduction of antibodies to fight the disease, not relying on the immune system to create the antibodies, as with active immunity; in contrast to active immunity, the effects can be quick, but not long-lasting

Examples: Vaccines for botulism, rabies, and tetanus.
Natural immunity is a kind of active immunity that occurs frequently in the body; it refers to cases in which an individual is exposed to organisms of a disease, and develops the ability to fight it off in the future.

Childhood Vaccines
Routine childhood immunizations are state mandated and required for all children who attend public schools. When a patient comes to the office for immunizations during a well-child examination, the medical assistant should provide the parent with a recommended immunization schedule and a vaccine information sheet (VIS) for each vaccine administered during that visit.
The VIS explains the safety and efficacy of the vaccine as well as possible adverse reactions and when to contact a physician if the parent is concerned. The pediatrician is obligated by law to provide parents with a VIS statement that outlines the risks and benefits associated with vaccines. Some states also have informed consent laws that require a parent’s signature before administration of a vaccine.

Adult Vaccines
The Centers for Disease Control and Prevention recommends the following immunizations for all adults:
- Tetanus booster every ten years, or sooner if the patient has an open wound.
- Measles, mumps, rubella (MMR) in one or two doses between the ages of 19 and 49 years for patients who do not have documentation of having the vaccine or for those who have never had the disease.
- The varicella vaccine (chickenpox) should be given in two doses between the ages of 19 and 49 years for patients who do not have documentation of having the vaccine or for those who have never had the disease.
- One injection of pneumococcal vaccine should be given at age 65.
- After age 50, an annual influenza vaccine should be given.
- Some doctors also recommend a series of three hepatitis B injections for any adult patient who has not received this immunization.

Storage and Record Keeping
Vaccine storage should follow specific manufacturer’s guidelines. Some vaccines’ preparations require refrigeration, freezing, reconstitution, or protection from light. The medical assistant must check the temperature settings to ensure proper storage of the vaccines.
Parents should be provided with an immunization record card at their infant’s first well-child visit. They should be instructed to bring the card to every visit so that their child’s immunization can be recorded.

An immunization flow sheet is used to account for vaccines given in the office, and according to federal law, information about a patient’s vaccination history must be kept in his or her medical record. It must include:
- type of vaccine given
- date given
- route of administration
- vaccine lot number and manufacturer
- publication date of the VIS (found on a lower corner of each VIS)