Pneumo – It’s All About the Numbers

3 03 2014

DDWhen we are immunized, we usually have to get several shots, or doses, before we’re protected against a disease.

Nearly all vaccine-preventable diseases require more than one dose of vaccine to provide us with a strong immune response. It’s not fun, but it’s better than fighting all those infections.

Last summer, an article in Pediatrics described a study which looked at the cost-effectiveness of removing a primary dose of 13-valent pneumococcal conjugate vaccine (PCV13).

This vaccine helps to prevent pneumococcal infections, which can mean anything from an ear infection to pneumonia to meningitis. It can be a dangerous and deadly infection.

Right now, this vaccine is a four-dose series. The first three doses are primary doses, and the fourth dose is a booster.

A primary dose “primes” the immune system, allowing our bodies to develop stronger immunity with each primary dose we receive. The booster dose is the last shove to get us over the top, helping our bodies to develop long-lasting immunity against a particular disease.

The study in Pediatrics was the topic of conversation at PKIDs for several weeks, and, while we were surprised that removing a dose was up for consideration (and you’ll see why in a minute), we thought it was probably more of an intellectual exercise than a course of action that our public health leaders in the US would take.

After all, our tradition in the US is to use all of the tools we have to protect our citizens and prevent infections.

Come to find out, this is more than an exercise in “what if.”

In February, I attended the Advisory Committee on Immunization Practices (ACIP) meeting in Atlanta.

(As noted on their website, the ACIP “is a group of medical and public health experts that develops recommendations on how to use vaccines to control diseases in the United States. The recommendations stand as public health advice that will lead to a reduction in the incidence of vaccine preventable diseases and an increase in the safe use of vaccines and related biological products.”)

Based on that meeting, it sounds like they’re looking at removing a primary dose as a real option.

This may give us an opportunity to save money—$400 to $500 million—but it’s not a risk-free deal. In order to save that money, we have to be willing to see harm come to a lot of people.

This flies in the face of what we, as health advocates, say every day to the folks we meet, which is: Get immunized! Use the safe and effective prevention tools available to protect yourself and your family from unnecessary infections.

It’s easier to make this kind of money-saving decision if the conversation is all about the numbers: the dollar amount saved, the numbers of increased cases of disease, the numbers of hospitalizations and deaths.

Numbers are easy to talk about because they’re not personal.

But this decision to remove a primary dose of vaccine is personal. The consequences will be felt by our people, our loved ones, our friends, and our neighbors. We can’t dehumanize this process by just talking about the numbers.

If the third primary dose is removed, an average of 2.5 more people will die each year. Who are those people? One could be my niece, Millie, who’s just learning to crawl. Another could be your grandson, who loves cheerios and bananas.

Forty-four more people will get invasive pneumococcal disease. My daughter could get meningitis, and your son could get a bloodstream infection.

Fifteen hundred more people will be hospitalized for pneumonia. When my oldest was a toddler, she was hospitalized for pneumonia. It’s a terrifying experience and one that I would not have anyone else go through, if possible.

An additional 10,000 of our friends and neighbors and loved ones will have to be treated for pneumonia as outpatients.

Twenty-three hundred more ear tubes will have to be inserted into the tiny ears of children that we know.

A staggering 261,000 more children will get earaches, fevers, and possibly ruptured eardrums.

All of this happens if we decide to save money and remove a primary dose of PCV13.

It’s all about the numbers. We just have to decide which numbers are more important to us as a nation—the dollar amounts or our people?

by Trish Parnell





What’s New With Flu?

26 09 2013

CDC released lots of data today on last year’s flu season. This will help to inform all of us as we look at the coming season and determine our health messaging targets.

Take a look . . .

Flu vaccination is the best protection available against influenza.  All persons 6 months and older should receive a flu vaccination every year to reduce the risk of illness, hospitalization, and even death.

The 2012-13 influenza season is a reminder of the unpredictability and severity of influenza.  The 2012-13 season began early, was moderately severe, and lasted longer than average.

More children than ever before received a seasonal flu vaccination during the 2012-13 season.

  • 45.0% of people in the United States 6 months and older were vaccinated during the 2012-13 season,  less than half of the U.S. population 6 months and older.
  • Among children, coverage was highest for children aged 6-23 months (76.9%) with large increases in vaccination for children 5-12 years old (4.4 percentage points higher for the 2012-13 season compared to the 2011-12 season) and teens 13-17 year old (8.8 percentage points higher for the 2012–13 season compared to the 2011–12 season).
  • Among adults, coverage was highest for adults aged 65 years and older (66.2%) and lowest among adults aged 18-49 years (31.1%).
  • Among children, coverage was highest among non-Hispanic Asian children (65.8%), Hispanic children (60.9%), non-Hispanic black children (56.7%), and non-Hispanic children of other or multiple races (58.5%). Coverage among non-Hispanic white children was lower at 53.8%.
  • Among adults, differences in coverage among racial/ethnic populations remain, with coverage among adult non-Hispanic blacks (35%) and Hispanics (34%) far lower than their non-Hispanic white counterparts (45%).

Coverage by Age:

Coverage for children 6 months through 17 years of age was 56.6% in the 2012-13 season, an increase of 5.1 percentage points from the 2011-12 season.  State-specific flu vaccination coverage for children 6 months through 17 years ranged from 44.0% to 81.6%.

  • Coverage for children decreased with age:
    • 76.9% for children 6-23 months
    • 65.8% for children 2-4 years
    • 58.6% for children 5-12 years
    • 42.5% for children 13-17 years

• Coverage increased in the 2012-13 season:

    • Children 5-12 years: an increase of 4.4 percentage points from the 2011-12 season
    • Children 13-17 years: an increase of 8.8 percentage points from the 2011–12 season
    • Changes in coverage were not significant for other age groups

Coverage for adults aged 18 years and older was 41.5% in the 2012-13 season, an increase of 2.7 percentage points from the 2011-12 season.  State-specific coverage ranged from 30.8% to 53.4%.

  • Coverage for adults increased with increasing age:
    • 31.1% for adults 18-49 years
    • 45.1% for adults 50-64 years
    • 66.2% for adults 65 years and older
  • Coverage increased in the 2012-13 season:
    • Adults 18-49 years: an increase of 2.5 percentage points from the 2011-12 season
    • Adults 50-64 years: an increase of 2.4 percentage points from the 2011–12 season
    • Adults 65 years and older: an increase of 1.3 percentage points from the 2011–12 season
  • Among adults 18-49 years of age with at least one high-risk medical condition (asthma, diabetes, or heart disease), coverage for the 2012-13 season was 39.8%, an increase of 3 percentage points from the 2011-12 season coverage estimate of 36.8%  State-specific coverage ranged from 17.9% to 58.8%.

Coverage by Sex:

Children (6 months-17 years)

  • There were no differences in coverage for male and female children.

Adults (18 years and older)

  • Coverage was higher for females (44.5%) than for males (38.3%).

Coverage by Race/Ethnicity:

Children (6 months-17 years)

Coverage for Asian children (65.8%) was significantly higher than all other racial/ethnic groups.

  • Coverage for non-Hispanic Asian children (65.8%), Hispanic children (60.9%), non-Hispanic black children (56.7%), and non-Hispanic children of other or multiple races (58.5%) was significantly higher than for non-Hispanic white children (53.8%).
  • Coverage for non-Hispanic American Indian/Alaska Native children (52.5%) was similar to that for non-Hispanic white children (53.8%).
  • There were significant increases in coverage from the 2011-12 season for non-Hispanic white children (6.2 percentage points), non-Hispanic Asian children (7.6 percentage points), and non-Hispanic children of other or multiple races (8.5 percentage points).
  • Coverage for non-Hispanic black, Hispanic, and non-Hispanic American Indian/Alaska Native children did not change from the 2011-12 season.

Adults (18 years and older)

Coverage among adults aged 18 years and older increased across all racial/ethnic groups except for American Indian/Alaska Native adults and adults of other or multiple races in which coverage did not change.

  • Among adults, coverage for non-Hispanic Asians (44.8%), non-Hispanic whites (44.6%), and non-Hispanic American Indians/Alaska Natives (41.1%) was higher than coverage for non-Hispanic adults of other or multiple races (38.0%), non-Hispanic blacks (35.6%), and Hispanics (33.8%).

There is an opportunity to raise awareness of the important benefits that can be gained by increased vaccination among children and adults.

  • Continued efforts are needed to ensure those at higher risk of flu complications (i.e. elderly, young children, and persons with chronic health conditions) are vaccinated each year.
  • Access to vaccination should be expanded in non-traditional settings such as pharmacies, workplaces, and schools.
  • Health care providers should make a strong recommendation for and offer of vaccination to their patients and improve their use of evidence-based practices such as vaccination programs in schools and WIC settings and client reminder/recall systems.
  • Immunization information systems, also known as registries, should be used at the point of care and at the population level to guide clinical and public health vaccination decisions.

Pregnant women and healthcare workers

During the period of October 2012-January 2013, 50.5% of pregnant women reported they received the influenza vaccination before or during their pregnancy.

Overall, 72.0% of health care workers reported having had a flu vaccine for the 2012-13 season, an increase from 66.9% vaccination coverage during the 2011-12 season.





Reporters – Follow The Science (Please!)

12 12 2012

Immunizations are a perpetually hot topic. We’ve been getting questions from reporters for over a decade about the need for vaccines, the efficacy of vaccines, and invariably the safety of vaccines.

Reporters have been doing stories on vaccines for a lot longer than a decade, but I remember 1999 as the year that things kicked off on the national scene. The television program ‘20/20′ ran shows featuring parents who claimed that various vaccines caused SIDS, multiple sclerosis, autism, and a variety of other illnesses in themselves or their children.

All these years later, when study after study after hundreds of studies have proven the safety of vaccines, many reporters still insist on representing the “other” side of the story when the subject is vaccine safety.

When I get a call from a reporter asking to speak to a parent whose child has been affected by a vaccine-preventable disease, I ask if they are also speaking to parents who believe their child has been adversely affected by a vaccine.

The answer is always yes.

The reporter will say that he or she just wants to present a balanced story.

After all of these years, and after all of these studies, I can’t help but wonder what their definition of balanced may be.

When I read a story about the importance of wearing a helmet when riding a bicycle or a motorcycle, there is often included in the story an anecdote about someone not wearing a helmet while riding who was consequently harmed by the lack of said helmet.

Never, in the same story, do I read about riders who were saved from harm by not wearing helmets, although I’m sure there are people in this world who believe it is safer to ride without helmets. For some reason, reporters don’t feel the need to present the anti-helmet point of view in order to have a balanced story.

The use of seat belts in cars has been mandatory in all states since the 1980s. When writing about car accidents, reporters frequently include stories about the injuries sustained when so-and-so was not wearing a seat belt.

I don’t believe I’ve ever read such a story where the reporter also highlighted incidents of those saved from harm by not wearing seat belts. I know of at least one person who firmly believes that not wearing a seat belt is safer than wearing one, but I have not yet seen her anti-seat belt view used to provide balance in a car accident story.

Reporters who include opinions from parents who believe their children were adversely affected by vaccines, and who include junk science from those pretending to be scientists, all in the name of having a “balanced” piece on vaccines, simply haven’t done their homework.

They are behind on the science, and the stories they write end up creating fear and confusion on the part of parents.

If a reporter feels that it is important to present views not substantiated by science, they should do an opinion piece rather than a news story.

At PKIDs, we sincerely appreciate those writers who look for and use the facts. As parents of children affected by disease, it’s easy for us to have lab work done and determine by the results that our child is infected with a particular disease.

If there is a vaccine to prevent that particular disease, we can say that it’s probable that, had our child been vaccinated, he or she would not have become infected. But, since not all vaccines work for everyone, we cannot say for certain. We can only talk about what vaccine-preventable diseases have done to our families.

We’re not painting all reporters with the same brush. Many reporters follow the science and come back with a fact-based story.

For those who do not, we ask that you make clear in your next story which parts are unsubstantiated, and which are based on fact.

Let’s stop the unnecessary scaremongering of the public.

 
By Trish Parnell





Healthcare Professionals: Thanks for Vaccinating Yourselves!

3 12 2012

nurseI like nurses and doctors and technicians and assistants and all the folks who, one way or another, try to keep me healthy.

That needed to be said because, in a second, it’s going to seem like I don’t much care for them.

Every year, a few healthcare professionals complain when the order comes down to get a flu shot or wear a mask when seeing patients.

They don’t wanna. Not only don’t they wanna, but their excuses sound, well, uninformed is the most polite way I can think of to say it.

The vaccine isn’t necessary.
The masks scare people.
Nobody can tell them what to do.
The vaccine doesn’t prevent flu.
The vaccine is more dangerous than the flu.
The masks are stuffy.
They don’t wanna.

Kids are required to get certain vaccines to attend public school, and if they don’t, they can’t attend.

The CDC recommends everyone over the age of six months get an annual flu shot.

You can’t get influenza from the flu shot.

It’s puzzling to know what to say to people who are supposed to be more educated than you are about disease prevention.

Granted, there are people at work or shopping in the grocery store who didn’t get the flu shot. They are therefore at risk of getting influenza and passing it on to those who couldn’t get the shot. But, the risk we have to take out here in the big old world isn’t the same as the risk we should be expected to encounter in a healthcare setting.

I say yahoo for the hospitals and clinics holding firm on this issue. To the few in healthcare who skipped the classes on disease prevention: follow the science and provide the minimum standard of care by getting vaccinated or wearing a mask around patients.

Please.

By Trish Parnell

Image courtesy of Lower Columbia College (whose students and staff are all vaccinated, as far as I know)





Why Vaccinate? I Never Get Sick!

5 11 2012

No matter your age, if you’re sitting in a moving vehicle you’re required to wear a seatbelt or to be in a size-appropriate car seat.

Most states require that anyone riding a bicycle or a motorcycle wear a helmet. And again, it doesn’t matter what age you are.

Kids going to public schools are required to be immunized against several diseases for school entry. How many immunizations they’re required to get depends on the state they live in, and the school they attend.

I suppose I could think up a few public health scenarios that would require adults to be immunized against a particular disease. But as a rule, unless our jobs require it, we adults are exempt from this particular requirement.

There are lots of protections in place for kids, as there should be. For instance, if I don’t feed my daughters, or provide adequate shelter for them, they’ll be taken away from me and placed in a foster home, where they’ll get the care they need. We need that oversight in place, so that no kids fall through the cracks. The heartbreak is that there are still kids falling through the cracks, but we do know that the oversights in place keep that number from being astronomical.

Most adults don’t need that kind of micromanagement when it comes to their health. But, they do need information. Before I became involved with PKIDs, I wasn’t even aware that there were vaccines for adults, other than the flu vaccine.

Now I know.

I don’t have time to get sick. I get vaccinated for me. I also wash my hands, try to get enough sleep, make myself eat green vegetables, and generally do whatever I need to do to keep myself healthy. But because I’ve met and talked with so many families affected by preventable diseases and I know how awful those infections can be, one of my motivations for getting vaccinated is so that I don’t accidentally infect someone else.

For example, it’s the infected adults and teens around babies who infect them with whooping cough, and it’s the infected birth moms who infect their newborns with hepatitis B. Babies infected with whooping cough can end up hospitalized, or worse. And babies infected with hepatitis B usually stay infected for life. This can lead to liver cancer or transplantation—if they’re lucky.

If you’re one of those people who never gets sick and figures you don’t need to be vaccinated—well, who knows, you might be right. But not getting sick is not the same as not being infected. You can and do pass on those germs to little babies who haven’t gotten all of their vaccinations yet, and others whose immune systems are not robust, for one reason or another.

So, you know where I’m going with this. Take just a few minutes the next time you’re at the pharmacy or your doctor’s office and ask what vaccinations you need. Do it for you, but also do it for the vulnerable in your life.

By Trish Parnell





The Weeder, the Girl, and the Vaccine

12 07 2012

When we were but moppets, Dad paid a nickel for every weed my brothers and I and the neighborhood kids pulled out of our yard on Saturday mornings.

He’d appoint my oldest brother to be in charge, and then he would disappear into the house to watch a game.

One hot day, my best friend stepped on the pointy end of her hand weeder and a spike punctured her foot. I remember lots of yelling and blood and my dad suddenly being there in the yard, picking up Lori, and running with her into the house.

Mostly, though, I remember how afraid we all were that Lori would get tetanus. Well, we called it lockjaw, because most of us were under 10 years of age and didn’t know the word “tetanus.”

Tetanus goes way back in recorded history, all the way to the fifth century BCE, but it wasn’t until the late 1800s that the cause of tetanus was discovered.

By WWII, a tetanus toxoid was available and widely used to prevent tetanus. This toxoid was combined with a pertussis vaccine and a diphtheria toxoid in the mid-1940s to make up the DTP vaccine. Many years and versions later, we have several combination vaccines for use in preventing tetanus.

Tetanus disease happens when certain bacteria usually found in dirt or dust get into a cut on the skin and, once in the body, produce a toxin. It’s the toxin that causes the symptoms we associate with tetanus, including:

  • Headache
  • Tightening or spasms of the jaw
  • Muscle spasms
  • Fever
  • Difficulty swallowing

It can get serious, with spasms strong enough to break a child’s bones, and the fatality rate is high—10 to 20 percent.

Tetanus isn’t something that passes from person to person, and it can be prevented through regular vaccination. Which vaccine you get and when you get it depends on your age and immunization history.

Anyway, that was a thrilling day in our childhood. Lori hobbled around the rest of the summer, free of tetanus but banned from the creek and other of our favorite haunts.

Mom no longer allowed Dad to leave the wee weeders under the care of my brother. Instead, he sat in a lawn chair on our tiny porch and listened to the game on the radio while scanning the yard for potential hazards.

The upside to this was that Dad would overheat from the sun bouncing off that concrete porch, and he’d take us for ice cream after the weed-pulling was done.

To read more about tetanus, visit these links:

http://www.cdc.gov/Features/Tetanus/

http://www.cdc.gov/vaccines/vpd-vac/tetanus/fs-parents.html

http://www.chmkids.org/upload/docs/imed/TETANUS.pdf

http://www.sapj.co.za/index.php/SAPJ/article/view/911/835

http://www.immune.org.nz/diseases/tetanus

http://www.immunize.org/catg.d/p4220.pdf

http://www.immunizationinfo.org/vaccines/tetanus

By Trish Parnell

Image courtesy of Garden Guides





CDC Asks for Help

28 06 2012

(From the CDC and HHS)

June 26, 2012

Dear Pharmacists and Community Vaccinators,

Thank you all for your tremendous efforts this past year to raise immunization rates in the United States. Outbreaks of pertussis (“whooping cough”), influenza, and measles, and continued low vaccination rates for human papillomavirus (HPV), Tdap (tetanus, diphtheria, and pertussis), zoster vaccines and others are critical reminders of the ongoing efforts that are needed.

Pharmacists and community vaccinators are uniquely positioned to promote and provide vaccines to people in a wide range of communities. In addition, their extensive reach into diverse communities allows greater access to vaccines for those who may not have a medical home, and who traditionally have had lower rates of vaccine use.

The Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (DHHS) ask for your continued support and efforts to help address vaccination needs in your communities. We know you are asked to do a lot to help your patients, but as trusted health care professionals, research shows that your recommendation to receive needed vaccines is vital.

As just one example, only about 10 percent of adults living with an infant report having had Tdap vaccination.1 But, a 2012 survey conducted by Harris Interactive found that 45% of unvaccinated adults who have been in contact with babies under 2 years in the past 5 years or expect to be in contact with them in the next 12 months would consider getting Tdap vaccine if a family member asked. However, 83% would consider getting Tdap vaccine if they were asked by their doctor or other healthcare professional.2 These results underscore the importance of your recommendation for protecting your patients and their families.

Specifically, CDC and HHS are asking pharmacists and other vaccine providers to:

1. Increase awareness among their patients about recommended vaccines, especially for adults and adolescents where vaccination rates are lagging.

2. Ensure that the people who visit your pharmacies or clinics are aware of which vaccinations they need by assessing their vaccine needs and offering those vaccines, e.g.:

a. Offer Tdap vaccine to replace one dose of Td. This is especially important for anyone who will be around infants given outbreaks of pertussis in the United States.

b. Inform pregnant women that they are recommended to receive Tdap vaccine after week 20 of pregnancy and influenza vaccine anytime during pregnancy.

c. Offer yearly influenza vaccine for everyone 6 months and older.

d. Offer zoster vaccine for adults 60 years and older.

e. Offer pneumococcal polysaccharide vaccine for everyone 65 years and older.

3. For patients with certain medical conditions, recommend and offer vaccinations specifically recommended based on their high risk conditions, e.g.:

a. Remind patients with diabetes that they need influenza vaccine, pneumococcal polysaccharide vaccine, and hepatitis B vaccine.

b. Consider targeting immunization messages to patients within your prescription database based on their medications and/or age.

c. Incorporate immunization reminders to patients and caregivers during counseling and medication therapy management (MTM) encounters.

4. Enter adult immunizations into vaccine registries (i.e. immunization information systems) in states where this is possible and provide documentation to the patient (consent form and/or immunization card) and/or their primary care provider to ensure appropriate recording of immunizations.

5. Partner with state and local health departments, immunization coalitions, medical providers, and others in your communities to increase collaboration and outreach to those who need vaccines.

Details about the vaccines recommended for adults and for children can be found at:

http://www.cdc.gov/vaccines/ and an adult scheduler and “quiz” for patients to find out which vaccines they may need can be found at http://www.cdc.gov/vaccines/schedules/Schedulers/adult-scheduler.html. Additional information about pertussis for patients and healthcare professionals can be found at www.cdc.gov/pertussis/index.html.

Additional links to find contacts for state and local health department immunization programs and coalitions, and educational resources for vaccine providers and patients are included below.

Thank you, again, for your energy, enthusiasm, and efforts in improving the health of our communities.

Sincerely,

Anne Schuchat, MD

RADM, US Public Health Service

Assistant Surgeon General

Director, National Center for Immunization and Respiratory Diseases

Immunization education and outreach resources and links to identify contacts in state immunization programs and immunization coalitions

State immunization program managers

These individuals are the state point of contact for immunization efforts and are usually housed within the state health departments.

Further information is available at the following link: http://www.immunizationmanagers.org/about/index_about.phtml

Vaccines for Children (VFC) Program

The VFC program is a federal program that provides vaccines to uninsured children at no cost to the child or their family.

Information on contacts for the VFC program in each state and certain cities is available at the following link: http://www.cdc.gov/vaccines/programs/vfc/contacts-state.htm

Further information about Vaccines for Children Program is available at:

http://www.cdc.gov/vaccines/programs/vfc/default.htm.

Information addressing pharmacists and the VFC program is available at:

http://www.cdc.gov/vaccines/programs/vfc/projects/faqs-doc.htm#enroll

State vaccine registries/immunization information systems

Can your pharmacy participate in your state’s immunization registry? Contact the state immunization registry person to find out if this is an option in your state. Participating in state immunization registries can greatly help facilitate communication about vaccination between providers.

Further information is available at the following link:

http://www.cdc.gov/vaccines/programs/iis/contacts.htm

Immunization coalitions

There are numerous immunization coalitions around the country, pulling together partners from diverse sectors to unite efforts to improve immunization rates.

Further information about linking to coalitions is available at the following site:

http://www.izcoalitions.org/

Free communications resources

CDC produces a variety of resources to promote immunizations, such as print materials, audio/video tools and web tools that can be downloaded free of charge. Immunization campaign materials can be found at http://www.cdc.gov/vaccines/campaigns.htm and support childhood, adolescent and adult immunization with some materials also available in Spanish.

The Immunization Action Coalition has many different handouts on a variety of vaccines that can be downloaded free-of-charge from their website. More information can be found at: http://www.immunize.org/handouts/.

National, regional, and state Offices of Minority Health contact information

The US Department of Health and Human Services has both federal and regional Offices of Minority Health and states also have Offices of Minority Health.

Pharmacies interested in collaborating with these offices to reduce disparities in vaccination may contact these offices at the following links.

Office of Minority Health, Office of the Secretary:

http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=1&lvlID=7

Offices of Minority Health in Regional Offices:

http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=188

Offices of Minority Health in States:

http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=187

Interactive adult and child schedulers

Do you know about the interactive adult and child schedulers? Immunization schedules are complex….and always changing. The CDC website has tools that allow you to enter key patient information and produce an individualized immunization schedule. Patients really like to see that one-of-a-kind individualized, customized set of immunization recommendations, along with their pharmacist’s recommendations.

Further information regarding the schedulers is available at the following link: http://www.cdc.gov/vaccines/programs/default.htm.

Preventing Vaccine Administration Errors

As a refresher for healthcare providers on correct vaccine administration technique and vaccine-related adverse events, please consult these resources:

1. Guidance from the Pink Book:

http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/D/vacc_admin.pdf.

2. Quick Fact Sheet: http://www.immunize.org/catg.d/p3085.pdf.

3. Vaccine Administration Technique video: http://www.immunize.org/dvd/.

4. Institute of Medicine report on Adverse Effects of Vaccines: http://www.nap.edu/catalog.php?record_id=13164#toc.

To report adverse events, see the Vaccine Adverse Events Reporting System at: http://vaers.hhs.gov/index.

Immunization training offerings

CDC invites pharmacists to take advantage of CDC immunization training offerings. The most recent summary of all the new immunization developments and recommendations can be found in CDC’s Immunization Update 2012, scheduled for August 4, 2012.

Please visit the following link for further information:

http://www.cdc.gov/vaccines/ed/imzupdate/default.htm

These programs supplement pharmacist-specific immunization education programs provided by pharmacist associations. Check with your pharmacist association for additional training and support resources such as web-based immunization resources, discussion groups and electronic newsletters.

1 Centers for Disease Control and Prevention (CDC). Adult Vaccination Coverage — United States, 2010. Morb Mortal Wkly Rep 2012;61(04);66-72. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a2.htm.

2 Online survey of 4,247 adults ages 18 and older, of whom 237 were parents of children aged 2 and under, conducted by Harris Interactive on behalf of Sounds of Pertussis®, May 9-11 and May 11-15, 2012.





A Mother’s Legacy

25 06 2012

I would like to tell you about my mother and all mothers like her who suffered through the loss of a child from an infectious disease. Raising a family in the hills of Kentucky, where most people were too poor to pay for the little, if any, medical help available, my mother struggled to keep her family healthy.

When one of her babies became seriously ill, my mother and her parents did everything they could to try and help her. Despite their efforts, my mother watched her child, Patsy Lynn, die from whooping cough. While making arrangements for Patsy’s funeral my mother learned that another one of her children was gravely ill. Both children were buried on the same day, in the same casket, in the same grave next to my mother’s church.

After the death of two children, my family was able to relocate to the Cincinnati area where medical attention was more readily available. We all had our vaccines as my mother was determined not to lose another child to unseen viruses and she insisted on washing and boiling everything that we touched.

I lived through the effect the loss had upon my mother’s life. The fear of disease was so real then, but many of us today forget what it was like to live in a time when diseases like measles, polio and smallpox were so much more common and deadly.

I remember the time that I was not allowed to play with a friend because her mother had been sent to the “TB hospital” and I vividly remember the Sunday that we spent standing in the long lines to receive our sugar cubes laced with the polio vaccine.

During the early ’60s, I remember being put to bed in a dark room when it was thought I might have the measles. Most of all, I’ll never forget that several of my teachers wore braces because of the effects of polio.

My mother tried her best to prevent us from succumbing to any disease which may shorten our lives, so I’m thankful that when she died of cancer in 1982 she did not know that I had somehow contracted the hepatitis B virus.

In June 1995, I was diagnosed with hepatitis B about a week before my 25th wedding anniversary. A doctor told my husband that I had a sexually transmitted disease and that he should be tested and vaccinated. What the doctor failed to tell us at the time was that this hepatitis could be spread in many other ways. I had complete trust in my husband and, thank God he had faith and trust in me, so this suggestion of sexually promiscuity did not harm our marriage.

Within the week we were informed that my husband tested negative, as did my children, who have all been vaccinated.

I have tried for years to find out where I got the virus. Could it have been from my mother who died of liver cancer? Did I get it in grade school, or from dental work, surgeries? Did I get it in one of the hospitals or clinics where I have worked as an interpreter? Did I get it from a child who ran into me on the playground, or from the little girl who bit me while I was working in the Cincinnati Public Schools?

The only thing I can be sure of is that I did not get hepatitis B from sexual contact, drug use or tattoos. However, I have now arrived at a place of peace in my life by accepting the fact that I will never know the path of transmission—and I no longer search for that answer.

And this is my mother’s legacy to me: protect your children the best you can.

By Barbra Anne Malapelli Haun





Adults Young and Old Need Vaccines

21 05 2012

Adults know to wash hands and wear condoms to prevent infections. And we try to eat fruits and veggies to stay healthy. Some days, we even exercise.

One thing we don’t do enough of is get vaccinated.

Other than the flu vaccine in the autumn, I seldom think about vaccines for myself. I bet I’m not alone.

But, we should remember to vaccinate.

We make sure our kids wear seatbelts and helmets, cross the street at the light and keep a weather eye on the ocean for sneaker waves, and get all the vaccines they need.

For the most part, we follow the same safety rules, except for that one about vaccines.

I am determined to get myself fully vaccinated and to nag encourage friends to do the same. I don’t want to get sick and think “if only.”

If you’re like-minded, I’ve listed the diseases for which there are vaccines for adults 19 years of age and older. Not every adult will need every vaccine, so print out this post and take it to your provider, find out what vaccines you need, and realize that you may need more vaccines if you’re traveling outside the US:

  • Flu is a respiratory illness. It can cause fever, chills, sore throat, cough, muscle or body aches, headaches, tiredness, and a runny or stuffy nose. You get over it after several miserable days, unless you develop complications, some of which can be life-threatening.
  • Tetanus, diphtheria, and pertussis vaccines are combined for adults. Tetanus is caused by certain bacteria entering the body through a break in the skin. It’s the one that causes lockjaw, and can cause spasms and seizures. It has a surprisingly high death rate of 10 – 20% of cases. Diphtheria is caused by bacteria spread person-to-person and can damage the heart, kidneys and nerves. Pertussis, also called whooping cough, is a very contagious disease caused by bacteria. In some parts of the world, it’s called the 100-day cough. The “whoop” is most often heard from babies, for whom it can be a lethal infection.
  • Varicella, also called chickenpox, is a virus that spreads easily and causes a blistery rash, itching and fever. For some, it can cause severe complications including pneumonia or sepsis.
  • Human papillomavirus (HPV) is a sexually transmitted infection that is very common in the population. Most people get it and get over it, but some will develop genital warts or cervical or other types of cancers.
  • Zoster or shingles is caused by once having had chickenpox. The virus stays in the body after the chickenpox clears up and goes away, and years later can reactivate, causing pain and itching, followed by a rash.
  • Measles, mumps, rubella vaccines are also combined for adults. Measles is caused by a virus that makes you feel like you have a bad cold, along with a rash on the body and white spots in the mouth. It can develop into pneumonia or ear infections, sometimes requiring hospitalization. Rubella is also caused by a virus and brings with it a rash and fever. This infection can be devastating to the fetus if a woman is pregnant when infected. Mumps is caused by a virus with symptoms of fever, fatigue and muscle aches followed by the swelling of the salivary glands. Rarely it will cause fertility problems in men, meningitis or deafness.
  • Pneumococcal disease is caused by bacteria and can appear as pneumonia, meningitis, or a bloodstream infection, all of which can be dangerous.
  • Meningococcal disease is caused by various bacteria, and the available vaccines prevent many of these infections. The symptoms are varied and include nausea, vomiting, sensitivity to light and mental confusion. This disease can lead to brain damage, hearing loss, or learning disabilities.
  • Hepatitis A is caused by a virus. It’s generally a mild liver disease, but can rarely severely damage the liver.
  • Hepatitis B is also caused by a virus that damages the liver. Most adults are infected for a short time, but some become chronically infected. The infection can cause jaundice, cirrhosis or even liver cancer.

More information on these infections can be found on the CDC website.

Talk to your provider about these vaccines. Who can afford to get sick these days?

By Trish Parnell

Image courtesy of Lancaster Homes





Why You Have to Vaccinate

7 05 2012

In 2000, public health workers slapped high fives and declared measles eliminated in the U.S. This meant that the disease wasn’t being passed person-to-person in this country.

In 2011, we had 222 cases of measles in the U.S.—a 15-year high.

Most of the 222 infected individuals were either unvaccinated or their vaccination status was unknown.

How did this happen? The answer is, almost all of the infections were imported. They came from U.S. residents returning from trips outside the country, or from visitors from foreign lands. The travelers carried the germ and, in some cases, infected others once they arrived.

Almost half of these cases came from countries with easy access to vaccines; the WHO European Region. The rub is, there are some Europeans who choose not to vaccinate themselves or their children, and the same is true in this country.

When a disease is floating around a community, it finds those who are unprotected and boom, we have disease outbreaks.

Most of the time, most of the diseases that are vaccine-preventable are not going to kill a child. They might not hospitalize him, or even make him feel really bad.

But, no one can say which disease will harm which child, and how much harm it will cause.

Kids do die from measles and chickenpox and other vaccine-preventable diseases. Or they don’t die and they only lose a limb, or their hearing, or they just need a liver transplant. Or any number of other health problems may occur that are still better than dying.

But like I said, no one can say how one child will be affected by one disease. So when I answer the phone here at PKIDs, and a parent on the other end asks if they really need to vaccinate their child against XYZ disease, I don’t have a problem telling them: you really do.

By Trish Parnell

Image courtesy of Vox efx








Follow

Get every new post delivered to your Inbox.

Join 30 other followers