NIIW 2013 – Resources for Vax Educators

23 04 2013

It’s National Infant Immunization Week!

We put out the call for infant vaccination resources that groups were prepared to share, and this is what we received. If you have any tools or resources you can share with others, either hard copies or downloadables, just add them to the comments section.

Vaccinate Your Baby has a nice section on their website of video FAQs, featuring Dr. Paul Offit, Dr. Mark Sawyer, Alison Singer, and Dr. Mary Beth Koslap-Petraco. The videos are very short, and they each ask and answer a question about vaccines. Plus, they have the full transcripts available for download. Nice way to hear how other healthcare professionals answer questions, and something you can show patients.

AAP has a multitude of resources, as you would imagine.

Here’s the Childhood Immunization Support Program Best Practices Summary. Clinicians answer several questions, and their answers are compared to best practices for each question. Sample question: “How does your practice ensure that, whenever possible, immunization appointments are scheduled along with other appointments, to prevent missed opportunities?” Good opportunity to find out how others are overcoming issues related to best practices.

AAP also has a nice page with several provider resources listed for those wanting to communicate with parents of infants, or children of any age.

The Alliance for Immunization in Michigan has a toolkit available for download that addresses infant immunization, as well as immunization in other age groups.

The Illinois Maternal & Child Health Coalition has a Community Immunization Education Guide Toolkit available in English and Spanish. It provides background information that the trainee can use as they train fellow community workers and/or educate the public about immunizations. Key topics include: What is a vaccine preventable disease, what are the five key immunization messages, what do vaccine preventable diseases look like, how to give an excellent presentation.

The Hepatitis B Foundation has a downloadable flyer promoting hep B vaccination.

CDC has an entire infant/toddler immunization section on its website.

Stanford’s Asian Liver Center has a flyer available in multiple languages that addresses HBV and Moms-to-be

CHOP’s Vaccine Education Center has several resources available:

Print materials: – Vaccines and Your Baby booklet; Q and A sheets about related vaccines: rotavirus, hep A, chickenpox, influenza, pertussis; Vaccine safety q and a sheets – facts about childhood vaccines, aluminum, recommended immunization schedule, thimerosal, too many vaccines, vaccine ingredients, vaccines and autism; Clings of the immunization schedule.

Videos: – Vaccines and your baby (for new or expectant parents), Vaccines: Separating Fact from Fear (for parents concerned about vaccine safety)

Parents PACK program – website and monthly e-newsletter (sample)

IAC has several resources for those working with infants:

FOR PARENTS:

Immunizations for Babies  (also available in 8 translations)

Vaccinations for Infants and Children, Age 0–10 Years

Clear Answers & Smart Advice About Your Baby’s Shots by Dr. Ari Brown, MD, FAAP

Cocooning Protects Babies

Personal belief exemptions for vaccination put people at risk. Examine the evidence for yourself.

Questions Parents Ask about Baby Shots   (also available in 8 translations)

Reliable Sources of Immunization Information: Where to go to find answers!

What if you don’t immunize your child?

FOR PROVIDERS:

Vaccine Administration Record for Children and Teens

Summary of Recommendations for Child/Teen Immunization

Recommendations for Pneumococcal Vaccine Use in Children and Teens

Meningococcal Vaccination Recommendations by Age and/or Risk Factor

Screening Checklist for Contraindications to Vaccines for Children and Teens   (also available in 9 translations)

Decision to Not Vaccinate My Child (declination form)

Standing orders for all routine childhood vaccines

PKIDs has several infant-specific resources that anyone may use. There’s a nice section on pertussis with video and audio PSAs, , and other materials for use by providers and parents. For the Make On-Time Vaccination Easy program, there are radio PSAs available for download . There are also videos covering a variety of vaccine-preventable diseases that may be used by anyone as PSAs, or there are longer versions for showing in waiting rooms .





CDC – Working 24/7

20 04 2013

Welcome to NIIW!

Every 20 seconds, a child dies from a disease that could be prevented with a safe and effective vaccine. Millions more children survive, but are left severely disabled. Vaccines have the power not only to save, but also transform lives by protecting against disease – giving children a chance to grow up healthy, go to school, and improve their lives.  Vaccination campaigns sometimes provide the only contact with health care services that children receive in their early years of life.

Immunization is one of the most successful and cost-effective health interventions—it currently averts an estimated 2 to 3 million deaths every year in all age groups from diphtheria, tetanus, pertussis (whooping cough), and measles.

cdc blogImmunization is a global health priority at CDC focusing on polio eradication, reducing measles deaths, and strengthening immunization systems. CDC works closely with a wide variety of partners in more than 60 countries to vaccinate children and provide technical assistance to ministries of health to strengthen and expand countries’ abilities to create, carry out, and evaluate their national immunization programs.

Too few people realize that the health of Americans and the health of people around the world are inextricably linked. Viruses don’t respect borders, so they travel easily within countries and across continents. By helping to stop vaccine-preventable diseases (VPDs) globally, CDC is also helping to protect people in the United States against importations of VPDs from other countries.

For example, in 2011, there were 220 reported cases of measles in the United States—200 of the 220 cases were brought into the U.S. from other countries with measles outbreaks.

The most effective and least expensive way to protect Americans from diseases and other health threats that begin overseas is to stop them before they spread to our shores. CDC works 24/7 to protect the American people from disease both in the United States and overseas. CDC has dedicated and caring experts in over 60 countries. They detect and control outbreaks at their source, saving lives and reducing healthcare costs. In 2012, CDC responded to over 200 outbreaks around the world, preventing disease spread to the U.S.

CDC’s global health activities protect Americans at home and save lives abroad. They reduce the need for U.S. assistance and create goodwill and good relationships with global neighbors.

Thanks to the CDC for sharing this information.





Sports and Infectious Diseases – Part 3 of 3

17 04 2013

Guidelines for Before, During and After Each Sports Event

The NCAA and NATA and other sports organizations carefully spell out the standards athletic organizers, including coaches, teachers and others, should follow before, during and after an 558354119_c856022b30athletic event.

Before the Event Begins

As part of the “pre-game” education program, NATA encourages trainers to:

  • Educate athletes about bloodborne pathogens.
  • Discuss the ethical and social issues related to bloodborne pathogens.
  • Review the importance of prevention programs, including standard precautions and immunizations.
  • Educate athletes about the signs and symptoms of hepatitis B [and hepatitis C] and HIV.

Make sure the athletes know the rules concerning standard precautions, including reporting all wounds immediately if and when they occur.  This is part of the coach or trainer’s critical pre-game education.

Before the opening whistle, cover all wounds, abrasions, cuts or weeping wounds that may serve as a source of bleeding or as a port of entry for bloodborne pathogens.  Remember, protection is a two-way street.  No one wants germs entering or exiting these wounds or abrasions. The “cover” or bandages should be able to withstand the demands of competition.

Wear protective equipment over high-risk areas where bruising commonly occurs, such as elbows or hands.

Make sure the necessary equipment and supplies needed to comply with standard precautions are available, including latex [or other non-permeable] gloves, biohazard containers, disinfectants, bleach solutions, antiseptics, containers for soiled equipment and uniforms and sharps containers.

During the Event

Underscore the importance of early recognition and control of any cuts or bruises that bleed.  Coaches and athletes alike should be prepared for appropriate cleaning and covering procedures and changing of blood-saturated clothes.

Require all athletes to report all wounds immediately.  Players with active bleeding should be removed from the event as soon as practical.  Return to play should be determined by appropriate staff.

All personnel involved with sports should be trained in basic first aid and infection control, including standard precautions:

  • They should use sterile latex [or other non-permeable] gloves for direct contact with blood or body fluids containing blood.
  • Gloves should be changed after treating each individual participant.  After glove removal, hands should be washed.
  • Any surface or equipment contaminated with spilled blood should be cleaned with gloves on.  The spill should be contained in as small an area as possible.  After the blood is removed, the surface should be cleaned with a disinfectant or decontaminant.
  • Proper disposal procedures should be practiced to prevent injuries caused by needles, scalpels and other sharp devices.
  • Any equipment or uniforms soiled with blood should be laundered in accordance with hygienic methods.

Any life-saving equipment should be maintained in accordance with infection control guidelines.

After the Event

When the game is over, any wounds, cuts, and abrasions should be tended to.

Coaches and athletic personnel should constantly review the level of knowledge and implementation of standard precautions policies and recommend revisions and retraining where necessary.

Appropriate policy development with legal and administrative assistance of existing OSHA (Occupational Safety and Health Administration) and other legal guidelines and conference or school rules and regulations should be considered on an as needed basis.

Medical Records and Confidentiality

While many experts feel an athlete should not have to “disclose” an infection to a coach, trainer or teacher, some athletes may decide personally to share information about a bloodborne viral infection.

The security, record-keeping and confidentiality requirements and concerns that relate to athletes’ medical records generally apply equally to those portions of athletes’ medical records.

Because social stigma is sometimes attached to individuals infected with HIV or viral hepatitis, athletic officials should pay particular care to the security, record-keeping and confidentiality requirements that govern the medical records for which they have a professional obligation to see, use, keep, interpret, record, update or otherwise handle.

An Infected Trainer, Teacher or Coach

A coach, teacher or trainer infected with a bloodborne pathogen should practice his or her profession while taking into account all professionally, medically and legally relevant issues raised by the infection.

Depending on individual circumstances, the infected coach, trainer or official must take reasonable steps to avoid potential and identifiable risks to his or her own health and the health of his or her team.

More information may be found at PKIDs’ Infectious Disease Workshop

Image courtesy of PShanks





Bird Flu Out of China

11 04 2013

avian fluThe bird flu that’s been identified in China has an official designation: Avian influenza A (H7N9) virus. It’s a mouthful.

As of 12:00 p.m. today, there have been 38 cases identified in humans, and 11 deaths. When healthcare staff identify the infection, they hospitalize and quarantine the patient, no matter how mild the symptoms.

There are most likely people infected who do not have symptoms, and who have not yet been identified. It’s therefore hard to know the total number of infected.

The virus is showing up in four provinces in China, and positive test results have been found in market birds, including ducks, chickens, pigeons, and quails. The poultry markets have been closed in an attempt to arrest the spread of this disease.

So far, the virus has not been found in wild birds. What this means is that we don’t need to worry about wild birds migrating and bringing the disease with them to other geographic areas around the world.

There’s been no confirmed person-to-person transmission of the virus, although it may be going on in a limited fashion and no one is aware of it.

The Avian influenza A (H7N9) virus seems to impact those over 60 years of age more than the younger groups. About one-third of those infected are adults ages 18 to 59, and there has been at least one pediatric infection.

Diagnostic kits are being sent overseas first, and once the CDC has received FDA approval, those kits will be distributed in the US.

Here’s the website for up-to-date information: http://www.cdc.gov/flu/avianflu/h7n9-virus.htm

Thanks to the CDC for its teleconference this afternoon, during which this information was presented.

By Trish Parnell

Image courtesy of Phil @ Delfryn Design





Sports and Infectious Diseases – Part 2 of 3

10 04 2013

bloodborneWhat risk does an athlete with a bloodborne pathogen pose?

The American Academy of Pediatrics tackled this difficult issue in December, 1999, with a policy statement on HIV and Other Bloodborne Viral Pathogens in the Athletic Setting.  In it, the Academy made clear, “Because of the low probability of transmission of their infection to other athletes, athletes infected with HIV, hepatitis B or hepatitis C should be allowed to participate in all sports.”

That participation, however, assumes all athletes and coaches will follow standard precautions to prevent and minimize exposure to bloodborne viruses.  The Academy tackled each infectious disease individually:

HIV: The risk of HIV infection via skin or mucous membrane exposure to blood or other infectious bodily fluids during sports participation is very low . . . such transmission appears to require, in addition to a portal of entry, prolonged exposure to large quantities of blood.  Transmission through intact skin has not been documented: no HIV infections occurred after 2,712 such exposures in 1 large prospective study.  Transmission of HIV in sports has not been documented.  One unsubstantiated report describes possible transmission during a collision between professional soccer players.

Hepatitis B: HBV [hepatitis B virus] is more easily transmitted via exposure to infected blood than is HIV . . . the risk of infection [is] greater if the blood [is] positive for HBV e antigen . . . transmission of infection by contamination of mucous membranes or broken skin with infected blood has been documented, but the magnitude of risk has not been quantified.

Although transmission of HBV is apparently rare in sports, 2 reports document such transmission.  An asymptomatic high school sumo wrestler who had a chronic infection transmitted HBV to other members of his team.  An epidemic of HBV infection occurred through unknown means among Swedish athletes participating in track finding (orienteering).  The epidemiologists concluded that the most likely route of infection was the use of water contaminated with infected blood to clean wounds caused by branches and thorns.

An effective way of preventing HBV transmission in the athletic setting is through immunization of athletes.  The American Academy of Pediatrics (AAP) recommends that all children and adolescents be immunized.  Clinicians and the staff of athletic programs should aggressively promote immunization.

Hepatitis C: Although the transmission risks of HCV infection are not completely understood, the risk of infection from percutaneous [through the skin] exposure to infected blood is estimated to be 10 times greater than that of HIV but lower than that of HBV.  Transmission via contamination of mucous membranes or broken skin also probably has a risk intermediate between that for blood infected with HIV and HBV.

“There is clearly no basis for excluding any student from sports if they are infected,” said Dr. Steven J. Anderson, who was chair of the Academy’s Committee on Sports Medicine and Fitness when it drafted the Academy’s policy, “and we should also try to protect the confidentiality of each athlete.”

Dr. Anderson, a pediatrics professor at the University of Washington and a team doctor for many high school athletic teams, ballet companies and the U.S. Olympic Diving Team, suggests students should have access to any sport, except boxing, which the Academy opposes for all youths because of its physical risks.

“I personally feel parents have no obligation to disclose the infectious status of their children to anyone,” said Dr. Anderson.  Strict compliance with standard precautions is critical for this open-embrace of all athletes, regardless of their infectious status.  Coaches and teachers must have a plan in place to handle blood spills, said Dr. Anderson, including latex [or non-permeable] gloves, occlusive dressings, appropriate sterilizing solutions, disposal bags and even a printed protocol for coaches, athletes and officials.

The following is an excerpt of a sample school policy, used by numerous public school districts and in compliance with ADA that addresses HIV infection:

“The privilege of participating in physical education classes, programs, competitive sports and recess is not conditional on a person’s HIV status.  School authorities will make reasonable accommodations to allow students living with HIV infection to participate in school-sponsored physical activities.

“All employees must consistently adhere to infection control guidelines in locker rooms and all play and athletic settings.  Rulebooks will reflect these guidelines.  First aid kits and standard precautions equipment must be on hand at every athletic event.

“All physical education teachers and athletic program staff will complete an approved first aid and injury prevention course that includes implementation of infection control guidelines.  Student orientation about safety on the playing field will include guidelines for avoiding HIV infection.”

In addition to the Academy, several sports and other health organizations have also weighed in on this issue.  According to the NCAA, National Football League (NFL) and World Health Organization, athletes with HIV should be permitted to participate in all competitive sports at all levels.

These organizations all endorse immunization against hepatitis B for all athletes.

The National Athletic Trainers’ Association (NATA) echoes Dr. Anderson’s suggestion that coaches, trainers, athletic directors, school officials and others take the lead in educating themselves, their teams, parents and their communities about the importance of effective disease prevention.

Trainers and coaches, they suggest, should provide the following information in age-appropriate terms to all participants before or during any competition :

  • The risk of transmission or infection during competition.
  • The risk of transmission or infection generally.
  • The availability of HIV testing (for teens and adults).
  • The availability of hepatitis B vaccination and testing (for parents, teens and adults).

“Athletic trainers who have educational program responsibility should extend educational efforts to include those, such as the athletes’ families and communities, who are directly or indirectly affected by the presence of bloodborne pathogens in athletic competitions,” the NATA stated in a position paper.

See PKIDs’ Infectious Disease Workshop for more information.

Photo courtesy of Lolie Smith





Sports and Infectious Disease – Part 1 of 3

6 04 2013

exeterIf you coach a little league team, parent an active athlete or are an avid sportsperson yourself, it is important to know what health risks may be present during athletic events other than shin splints and bruised egos.

Close physical contact and a heightened chance of bleeding present a chance for disease transmission unless appropriate precautions are taken.

Athletes, trainers, coaches, parents, and teachers alike must know how to prevent the transmission of bloodborne viruses such as HIV and hepatitis B or C, or even skin-to-skin infections.

These infectious diseases, and others, pose complex problems for athletes of all ages and everyone involved in sports activities.  But following standard precautions to prevent bloodborne, skin-to-skin, and respiratory infections simplifies and safeguards sports events and ensures that everyone can participate safely.

Sports and Standard Precautions

Universal use of standard precautions is critical because many children, adolescents, and adults who are infected with viruses, such as HIV and hepatitis B or C, may not even know they have these viruses.  Estimates vary, but some predict that more than half of those infected with these viruses do not know they’re infected.

Standard precautions protect everyone, from those whose diseases have been identified, to those that have not yet been diagnosed, to those not infected.  When everyone follows standard precautions, no one who has an infection needs to be treated differently.  Essentially, standard precautions are the great equalizer; when followed, they allow everyone to fully and safely participate in sporting events.

The more serious bloodborne viruses that athletes need to be aware of are: HIV (the virus that causes AIDS), hepatitis B, and hepatitis C.  There is no recommendation that people infected with these viruses not be allowed to participate in most sports.

Although HIV and hepatitis C are not vaccine-preventable, there is a safe and effective vaccine that prevents hepatitis B infection.

Skin-to-Skin Infections

According to the NCAA Injury Surveillance System, “skin infections accounted for almost one-third of the practice time loss events” in wrestling during the 2001-2002 season.  As a result, the NCAA recommends that coaches, teachers and other sports officials be able to identify symptoms of skin infections.  Symptoms may include:

  • Crusting
  • Scaliness
  • Oozing lesions

Skin infections may include:

  • Bacterial skin infections including impetigo, erysipelas, carbuncle, staphylococcal disease, folliculitis and hidradenitis suppurativa.
  • Parasitic skin infections including pediculosis and scabies.
  • Viral skin infections including herpes simplex, chickenpox and molluscum contagiosum.
  • Fungal skin infections including ringworm.

In some cases, such as fungal infections, the skin conditions can be covered with a securely attached bandage or non-permeable patch to allow participation in the sporting event.

In addition to identification and treatment of individuals with skin infections, prevention can occur through proper routine cleaning of all equipment, including mats and shared common areas, such as locker rooms.

Respiratory Illnesses

Anyone with an infectious respiratory illness, such as flu, or whooping cough, or perhaps tuberculosis, should be prohibited from playing to prevent the spread of infections that are transmitted through respiratory routes.

Check back over the next couple of weeks for Parts 2 and 3 in this sports series. Part 2 gets into specifics on bloodborne pathogens, and Part 3 provides guidelines for sports teams to follow before, during, and after each event.

 

See PKIDs’ Infectious Disease Workshop for more information.

Photo courtesy of University of Exeter