You’re An Adult, So Get Vaccinated!

29 01 2013

adults onlyOnce we leave our family home and go off to college or the military or the workforce, how healthy we are is up to us.

For our first couple of decades, mom and dad do all the work. They get us in for our immunizations, tell us to wash our hands, nag us to eat our greens—well, the nagging about our health never ends. But the point is, we don’t worry about that stuff because we know someone else is doing that for us.

Then, in our 20s, 30s, and 40s, we’re hauling our own kids to the clinic for shots and sniffles, or nagging them to eat their greens. We haven’t the time for a long shower; forget finding time to take care of our own health.

In our 50s, we’re working hard and at the peak of our careers, or getting laid off and stressing about that. Plus, we’re watching out for our parents’ health. We have no time for check-ups or even basic immunizations. Even if we have the time, we have no idea what we’re supposed to take care of and might not have a “medical home,” a physician we see when we need to see one.

Our 60s and 70s are when we wake up to the fact that we have to take care of our bodies. Most of the time, we do that by reacting to health issues that pop up rather than working to prevent problems.

After 80, we’re bossed around by our middle-aged children who can find us a specialist in 10 minutes, but have no idea that we need a Tdap vaccine.

Adults 19 and older in the US are not taking advantage of vaccines, and that’s an easy place to start taking care of ourselves. Each of us should check in with a healthcare provider and find out what vaccines we need. Nobody has time to do it, so just do it anyway.

Here’s a list from the CDC, although it’ll be much simpler to ask a physician. But, if you love the details (full recommendations for each vaccine can be found here):

  • Pneumococcal Vaccine Information
    • Pneumococcal polysaccharide vaccine is recommended for all adults aged 65 years and older.
    • In addition, certain adults younger than 65 years should be vaccinated if they have certain high-risk conditions such as cardiovascular disease, pulmonary disease, diabetes, alcoholism, cirrhosis, cerebrospinal fluid leak, or a cochlear implant, or if they have a suppressed immune system.
    • Adults aged 19 years and older should also get a pneumococcal polysaccharide vaccine if they have asthma or smoke cigarettes.
    • Preliminary data report approximately 37,000 cases of invasive pneumococcal disease in 2011. Of those cases, there were about 4,000 deaths.
    • The majority of cases and deaths occur among adults 50 years or older, with the highest rates among those 65 years or older. Almost everyone who gets invasive pneumococcal disease needs treatment in the hospital.
    • Overall, pneumococcal polysaccharide vaccine (PPSV23) is 30% to 70% effective in preventing invasive pneumococcal disease, such as meningitis and bloodstream infections.
      • Effectiveness is highest among otherwise healthy adults.
      • Effectiveness is lowest among adults with significant underlying illness.
    • There is not consensus regarding the effectiveness of PPSV23 against non-invasive pneumococcal pneumonia.
    • Certain adults with significant underlying illness should also get the pneumococcal conjugate vaccine (PCV13), which has proven highly effective among children.
      • A large clinical trial is underway in the Netherlands that is studying the effectiveness of PCV13 against pneumococcal pneumonia among adults.
    • Adults at high risk for pneumococcal disease who haven’t gotten the vaccine yet should talk with their doctor about getting it now.
  • Tetanus and Tdap Vaccine Information
    • Tdap vaccine is recommended for adults aged 19 years and older to protect against tetanus, diphtheria, and pertussis (whooping cough).
    • Tdap vaccine is especially important for adults who will have close contact with infants less than 1 year old.
    • In addition, pregnant women are recommended Tdap vaccination during each pregnancy, preferably at 27 through 36 weeks’ gestation, to help protect their newborns from whooping cough.
      • Tdap vaccine can be safely given at any time during pregnancy, but is recommended during the third trimester to pass the most amount of protection to the baby.
    • Tetanus, diphtheria, and pertussis are all caused by bacteria.
      • Both diphtheria and pertussis are spread from person to person.
      • Tetanus enters the body through cuts, scratches, or wounds. • Provisional data report nearly 42,000 cases of pertussis during 2012, a nearly 60-year high.
    • Our current estimate is that Tdap vaccination protects 7 out of 10 people who receive it.
    • Since Tdap vaccines were only licensed in 2005, we don’t yet have results on long-term vaccine protection.  We’re still working to understand how that protection declines over time.
    • CDC is conducting an evaluation in collaboration with health departments in Washington and California to better understand how long Tdap vaccines protect from pertussis.  The data from these evaluations will help guide discussions on how best to use vaccines to control pertussis.
    • Adults who haven’t gotten a Tdap shot yet should talk to their doctor about getting it as soon as possible, no matter when they last got a tetanus (Td) booster.
    • After receiving the Tdap shot, adults should continue to get a Td booster every 10 years.
    • Adults need to get Tdap even if they were vaccinated as a child or have been sick with pertussis in the past; neither provides lifelong protection.
  • Hepatitis A Vaccine Information
    • Hepatitis A vaccine is recommended for adults who are working in or traveling to any area of the world outside of Canada, Western Europe and Scandinavia, Japan, New Zealand, and Australia.
    • Other adults that should get the vaccine include men who have sex with men, people who use illegal drugs, people who have clotting factor disorders, people with chronic liver disease, and people who might be exposed to hepatitis A on the job (such as those who work with hepatitis A virus in laboratory settings or with hepatitis A-infected primates).
    • Hepatitis A is caused by a virus and spreads primarily by oral contact with fecal matter, either through person-to-person or by contaminated food or water.
    • More than 95% of adults will develop immunity within one month of a single dose of hepatitis A vaccine, and nearly 100% will develop immunity after receiving two doses.
  • Hepatitis B Vaccine Information
    • Hepatitis B vaccination is recommended for adults at high risk of infection by sexual or blood exposure to hepatitis B virus.
    • People at high risk of sexual exposure include sex partners of people who are positive for Hepatitis B, people who’ve had more than one sex partner in the last six months, people seeking evaluation or treatment for a sexually transmitted disease, and men who have sex with men.
    • People at risk of blood exposure include current or recent injection-drug users, household contacts of people who are positive for Hepatitis B, residents and staff of facilities for the developmentally disabled, people with end stage renal disease, and some health-care and public safety workers.
    • Other groups at risk include international travelers to regions with high or intermediate levels of Hepatitis B infection and people with HIV infection.
    • Hepatitis B is caused by a virus and is spread from person to person primarily through blood or semen. • In healthy adults, the vaccine is 80% to 95% effective in preventing infection or clinical hepatitis in those who complete a hepatitis B vaccine series (usually 3 doses).
  • Herpes Zoster Vaccine Information
    • Herpes zoster (shingles) vaccine is recommended for adults aged 60 years and older.
    • Shingles occurs when latent varicella zoster (chickenpox) virus reactivates later in life.
    • Pain from shingles lesions, called post-herpetic neuralgia, can be very severe and last a year or more.
    • 50% of people who live until age 85 will develop shingles.
    • In people 60 years of age and older, the shingles vaccine:
      • Reduces the risk of shingles by about half (51%)
      • Reduces the risk of post-herpetic neuralgia (prolonged pain at the rash site) by 67%
    • The shingles vaccine is effective for at least six years but may last longer; research is being done in this area.
  • HPV Vaccine Information
    • HPV vaccine is recommended for routine vaccination of females and males at age 11 or 12 years.  Vaccination is also recommended for females 13-26 years of age and for males 13-21 years of age, if not previously vaccinated.  Males aged 22-26 years may be vaccinated.
    • HPV2 or HPV4 is recommended for females; HPV4 is recommended for males.
    • Men who have sex with men (MSM) may especially benefit from vaccination to prevent condyloma and anal cancer.  HPV4 is recommended for MSM through age 26 years who did not get any or all doses when they were younger.
    • HPV is a common virus that is primarily spread through sexual contact.
    • There are approximately 40 types of genital HPV.
      • Some types can cause cervical cancer and other kinds of cancer in both men and women.
      • Other types of HPV can cause genital warts in both males and females.
    • About 6 million people become infected with HPV each year.
    • Studies found vaccine efficacy of over 93% against disease due to HPV vaccine types if a female had not already been infected with that type.
    • HPV vaccine is not therapeutic and does not treat existing infection or disease.
    • Prior infection with one HPV type did not lessen the effectiveness of the vaccine against other vaccine HPV types.
    • There are 2 vaccines licensed by the Food and Drug Administration (FDA) and recommended by CDC to protect against HPV-related illness; these vaccines are Cervarix (made by GlaxoSmithKline) and Gardasil (made by Merck).
      • Both vaccines are very effective against HPV types 16 and 18, which cause most cervical cancers, so both vaccines prevent cervical cancer in women.
      • Only Gardasil protects against HPV types 6 and 11 – the types that cause most genital warts in females and males.
      • Only Gardasil has been tested and shown to protect against cancers of the vulva, vagina, and anus.
      • Only Gardasil has been tested and licensed for use in males.
  • Vaccine Safety
    • All vaccines used in the United States are required to go through years of extensive safety testing before they are licensed by the U.S. Food and Drug Administration (FDA).
    • FDA and CDC work with health-care providers throughout the United States to monitor the safety of vaccines, including for any adverse events, especially rare events not identified in pre-licensure study trials.
    • There are three systems used to monitor the safety of vaccines after they are licensed and being used in the U.S.
      • These systems can monitor side effects already known to be caused by vaccines as well as detect rare side effects that were not identified during a vaccine’s clinical trials.
      • One of the three systems used to monitor the safety of vaccines after they are licensed and used in the U.S. is called the Vaccine Adverse Event Reporting System (VAERS).
      • VAERS accepts reports from health professionals, vaccine manufacturers, and the general public and receives about 28,000 U.S. reports per year, compared with millions of vaccine doses given to adults.

By Trish Parnell





Flu Season Is Finally Here – Get Vaccinated

2 01 2013

Flu was a slow starter this season, but it’s finally here. Those who track such things say it’s going to be a doozy of a season. It’s time to get vaccinated, and to make sure everyone in your family is protected!





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





Gastro Bugs

17 09 2012

There is no such thing as “stomach flu,” despite the cavalier use of the phrase in some circles. What’s really going on is usually viral gastroenteritis.

Viral gastroenteritis isn’t caused by just one thing—it can be the result of any one of many different viruses, such as norovirus or rotavirus.

A gastro bug, as I like to call it, can be in the food or water we consume and will most commonly cause diarrhea, nausea and vomiting, and/or abdominal pain or discomfort.

Sometimes, it can also cause you to have a fever or chills, clammy skin, muscle or joint pain, and may put you off your feed. (That’s a “duh,” isn’t it!)

With liquids of various sorts pouring out of you, dehydration is a concern. Here are the signs, symptoms, and potential treatments to consider, as specified by NIH:

Signs and tests

The healthcare provider will look for signs of dehydration, including:

  • Dry or sticky mouth
  • Lethargy or coma (severe dehydration)
  • Low blood pressure
  • Low or no urine output; concentrated urine that looks dark yellow
  • Markedly sunken soft spots (fontanelles) on the top of an infant’s head
  • No tears
  • Sunken eyes

Tests that examine stool samples may be used to identify which virus is causing the sickness. This is usually not needed for viral gastroenteritis. A stool culture may be done to find out whether diarrhea are causing the problem.

Treatment

The goal of treatment is to prevent dehydration by making sure the body has enough water and fluids. Fluids and electrolytes (salt and minerals) that are lost through diarrhea or vomiting must be replaced by drinking extra fluids. Even if you are able to eat, you should still drink extra fluids between meals.

  • Older children and adults can drink sports beverages such as Gatorade, but these should not be used for younger children. Instead, use the electrolyte and fluid replacement solutions or freezer pops available in food and drug stores.
  • Do NOT use fruit juice (including apple juice), sodas or cola (flat or bubbly), Jell-O, or broth. All of these have a lot of sugar, which makes diarrhea worse, and they don’t replace lost minerals.
  • Drink small amounts of fluid (2-4 oz.) every 30-60 minutes. Do not try to force large amounts of fluid at one time, which can cause vomiting. Use a teaspoon or syringe for an infant or small child.
  • Breast milk or formula can be continued along with extra fluids. You do NOT need to switch to a soy formula.

Food may be offered often in small amounts. Suggested foods include:

  • Cereals, bread, potatoes, lean meats
  • Plain yogurt, bananas, fresh apples
  • Vegetables

People with diarrhea who are unable to drink fluids because of nausea may need intravenous (directly into a vein) fluids. This is especially true in small children.

Antibiotics do not work for viruses.

Drugs to slow down the amount of diarrhea (anti-diarrheal medications) should not be given without first talking with your healthcare provider. DO NOT give these anti-diarrheal medications to children unless directed to do so by a healthcare provider.

People taking water pills (diuretics) who develop diarrhea may be told by their healthcare provider to stop taking the diuretic during the acute episode. However, DO NOT stop taking any prescription medicine without first talking to your healthcare provider.

The risk of dehydration is greatest in infants and young children, so parents should closely monitor the number of wet diapers changed per day when their child is sick.

You can buy medicines at the drugstore that can help stop or slow diarrhea.

  • Do not use these medicines without talking to your healthcare provider if you have bloody diarrhea, a fever, or if the diarrhea is severe.
  • Do not give these medicines to children.

Viral gastroenteritis can become a serious illness, so watch for the symptoms and alert your healthcare provider if symptoms worsen.

Washing hands is the best prevention, along with vaccination when available (babies can be vaccinated against rotavirus).

Visit these websites for more information on gastro bugs

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001298/
http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm
By Trish Parnell (really by the NIH with a few asides from me)

Image courtesy of Examiner





NIVS Weekly Call

10 09 2012

The National Influenza Vaccine Summit was created about a dozen years ago to address and resolve “influenza and influenza vaccine issues.” The CDC, the AMA, and 400+ other partners work together in this year-round effort.

During the flu season, there are weekly calls to keep all of the partners updated on the ups and downs of influenza in the US. And, just last spring in May 2011, there was held in Brussels, Belgium, the first European Influenza Summit. The two groups are now working collaboratively to reduce influenza infections.

The calls are brief and to the point. We thought you might find use for these few notes from the 6 September US call:

  • Scott Epperson from the CDC reported on flu surveillance. He said that there are low numbers of seasonal flu and most of those are H3N2 and influenza B viruses. However, there are 288 confirmed cases of the H3N2v (variant) virus, which is a swine flu strain. (New numbers are posted every Friday, so this figure may change by the time this post runs.) Sixteen of those infected were hospitalized and there was a death—an older individual with multiple, high-risk medical conditions which led to complications of influenza infection. Ninety-three of those infected were under the age of 18, with an average age of six years. Fifty-two percent were female and 48% were male, and of those with a known antiviral treatment status, 60% had been treated, and of those with a known vaccination status, 53% reported being vaccinated within the last year.
  • Harvard has now taken over the Flu Shot Finder started by Google, and they’ve done an excellent job expanding its capabilities. John Brownstein provided slides on the new features and the new site can be found at http://flushot.healthmap.org. There’s a widget available for use on your own websites that will allow people to put in their zip codes to find flu vaccine near them.
  • Christine Harding from the National Council on Aging’s Flu + You campaign presented on their program and the many free resources available to flu educators and healthcare providers. Stop by their site and take a look—there’s bound to be something you can use.

That’s it for this week. We didn’t cover everything, but what’s left out has been covered extensively elsewhere.

Do you have any flu educational resources you’d like to share? Let folks know about them in the comments, and thanks!

By Trish Parnell
Image courtesy of NIVS





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.





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





Shot at Life

23 04 2012

Remember SARS? That virus popped up in China in 2003 and quickly coughed and sneezed its way to dozens of other countries. And the 2009 H1N1 virus made its introductory appearance in Mexico, when a pig infected a human. It then traveled the globe with a speed that shocked us.

The world is enormous, but nowadays it’s also quite small.

Long ago, when people were mostly nomadic in nature, diseases were not easily spread, at least not outside of one’s group or tribe.

Then we formed societies, lived closer together, traded wheat and pelts, and passed germs like nobody’s business. But it still took months and sometimes years for diseases to become widespread.

Today, with air travel, diseases can spread from country to country in a matter of days, and sometimes, within a few hours.

These diseases are not all new; many are vaccine-preventable. But, when the immunity in a community is low due to reluctance to vaccinate or lack of access to vaccines, these diseases which science has bested scatter anew, bringing illness and sometimes death.

The United Nations Foundation’s Shot@Life campaign targets Americans with the hope that we will be inspired to advocate for those with little or no access to vaccines.

That inspiration isn’t too hard to find, if you’re a mom or dad. Once you’re a parent, you acquire a faint and nagging voice that compels you to “parent” all kids, anyone’s kids, every kid.

There are numerous self-serving reasons to ensure everyone is vaccinated, and that’s OK. Who wants to get sick? There are some of us for whom this or that vaccine simply doesn’t work, or we can’t use a vaccine due to allergies or for other reasons. We’re unprotected and we depend on those around us to not get sick and, so, not infect us.

There are also simple, human reasons for wanting everyone vaccinated. There are boys and girls in need who should grow up laughing and being naughty sometimes, who should go to school and raise families. This one will clean toilets for 30 years and then retire to enjoy his grandchildren. That one will discover life on another planet. Another will be the teacher who changes the lives of hundreds of students, who in turn go on to do wondrous deeds.

It’s a really small world, when you think about it. Protecting other children will protect our own children. And, it’s what we do for neighbors.

Check out Shot@Life. Do something this week to help your neighbors in Nigeria, Laos, Bangladesh, and elsewhere.

By Trish Parnell

Image courtesy of Shot@Life





Hey Mom and Dad. Get Vaccinated!

12 04 2012

When I was 32 I got married, had braces put on my teeth, acquired my first pair of reading glasses, and erupted in pimples the size of which I’d not seen on any adolescent.

I was something to look at.

The pimples turned out to be chickenpox. On hearing the news, my shiny new husband smirked, explaining he’d been infected as a child; as if I was somehow lame to get such a disease at my age.

The source of my infection turned out to be my sweet, sick young nephew.

The varicella vaccine was not yet routinely recommended for kids at that time, so I couldn’t blame anyone for not vaccinating the boy. I did try, though.

All this is to say that adults get sick, and sometimes their infections are preventable. It’s now recommended that adults get vaccinated against chickenpox if they have never been infected. And there are a host of other vaccines available to us, although if you are like me, you rarely think about getting immunized against anything other than influenza. We think about the kids, and we worry about our parents, but for ourselves, no.

It’s time to think about us. The National Foundation for Infectious Diseases (NFID) revamped their adult vaccination website and it’s worth a look. On the site you’ll find specifics about the vaccines you may need and details about the diseases those vaccines prevent.

Healthcare professionals weren’t forgotten. There’s a toolkit of ready-to-use resources and listings of more such items, should they be needed.

Bonus: much of the site’s information is presented in English and Spanish.

Take a few minutes this week to email or call your healthcare provider. Find out which vaccines you need and then go in, get vaccinated. Vaccines don’t work 100% of the time on 100% of those who are vaccinated. If we as adults get vaccinated, we will stop many of the incidents of parent-to-child infection. So, if you don’t want to take time for yourselves, take time to get vaccinated for your family.

By Trish Parnell

Image courtesy of sheknows.com





Why Nurses Should Get Vaccinated

9 04 2012

(Welcome to guest blogger Dr. Mary Beth Koslap-Petraco. She is a nurse practitioner in New York and a frequent guest speaker around the country on the topic of vaccines.)

Nursing organizations are opposed to mandatory immunization for nurses. I wonder why? We mandate vaccines for children to attend school to protect not only the children who are immunized, but those children who cannot be immunized for medical reasons. 

We nurses have a moral responsibility to protect our patients and our families, as well as ourselves. There would be much less chatter about mandatory vaccination for health care workers (i.e. nurses) if nurses ALL stepped up to the plate and were vaccinated themselves.

All of the arguments to encourage nurses to be immunized against not just influenza but pertussis (whooping cough) have fallen on deaf ears in one community hospital. Seems the nurses see no need to be immunized themselves. These same nurses do not have a very good track record for encouraging new mothers to be immunized against pertussis before discharge. 

The Advisory Committee on Immunization Practices (ACIP) recommends that all new mothers be immunized against pertussis with a Tdap shot before they are discharged, if they have not been immunized during pregnancy. 

Some of the mothers who delivered at this hospital said they either did not remember being asked if they wanted a Tdap shot, or it was presented to them with little or no explanation, which made them refuse the vaccine.

And I know of another community hospital which has a policy to offer Tdap to its postpartum moms but does not seem to be following its own recommendation. Two moms on two different occasions were asked if they were offered Tdap before they went home with their babies. The answer from the moms was that the vaccine was never offered. 

Meanwhile, the discharge paperwork from the hospital noted the moms ‘refused’ the vaccine, and a nurse had signed both notes. Seems it was the same nurse who had treated both of these moms. Was this nurse too busy to take a few minutes to explain the need for the vaccine to these moms, or was the nurse not ‘a nurse who vaccinates?’

If this occurred with these two moms, you can be sure it happened with other moms. Moms went home with their newborn babies without the protection they need to prevent their babies from contracting pertussis. Their babies were too young to be immunized themselves.

Recently, an incident occurred at one of these community hospitals that houses a very large mother/baby unit. There can be extremely serious consequences when nurses do not accept vaccination for themselves. A nurse working on a mother/baby unit in the hospital developed pertussis. Thankfully, no infants were infected, nor were any moms or other staff members. I think this hospital was VERY lucky. One would think that following such a scare the hospital would become pro-active about getting their staff immunized against pertussis, but it didn’t happen.

Educational programs have been aimed at this hospital, but there is still no organized program to get the nursing staff immunized. But, there is hope!  At least one of the nurses is actively encouraging her colleagues to be immunized. Kudos to this nurse ‘who vaccinates!’ The nurses need to be advocates for the vaccine for themselves . . . because it is the right thing to do.

There are lessons to be learned here. Will nurses heed these lessons?

By Dr. Mary Beth Koslap-Petraco