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

 





Spring Break!

19 03 2012

Health tips from our friends at CDC:

Going to another country for spring break? Follow these tips to reduce your risk of illness or injury abroad.

Spring break means an escape from the daily grind. For high school and college students, it can be a rite of passage or an annual tradition. This is your time. It is all about you, and YOU are in charge of your health, safety, and well-being.

Getting ready for spring break is more than just picking a destination.

While you’re choosing among an exotic island getaway, a ski vacation, or just a short ride down the highway, follow these steps to ensure you have a healthy and safe spring break trip.

For those Going Abroad

Vaccination before vacation. Before you go abroad, find out about vaccines and any health concerns at your destination. Check with the local health department or a travel medicine specialist 6 to 8 weeks before you leave the United States.

It’s still flu season, and vaccines are the most important tool we have for preventing the flu. Talk with your doctor about getting a flu shot.

Travel health insurance. Consider health insurance if you’re traveling outside the United States, because your regular carrier might not cover expenses. Coverage for emergency medical evacuation can be useful, particularly if you do extreme sports, such as mountain climbing or heli-skiing.

Active vacations. Whether your sport is ice climbing or reef diving, depend on reliable outfitters for success. When making reservations, ask questions to make sure you will be with properly trained guides and will be using well-maintained equipment. Don’t take chances that might cause injuries—or worse.

You are what you eat. Tempted to indulge in the local cuisine? Food can be the best or the worst part of your international trip. In developing countries, eat only food that has been fully cooked and served hot. Avoid eating fresh vegetables and fruits, unless you can peel them yourself. Drink only bottled, sealed beverages, and steer clear of ice—it was probably made with tap water.

Is it worth the risk? The phrase “what happens on spring break stays on spring break” can imply that it is okay—even expected—to engage in risky behaviors that you would not normally consider in your daily life, but you should take your healthy behaviors on vacation with you:

  • Use latex condoms if you have sex (see Sexually Transmitted Diseases).
  • To prevent infections such as HIV and hepatitis B, don’t get tattoos or piercings.
  • Drink alcohol responsibly and be sure to have a designated driver.
  • Remember the basics of safe driving: wear seatbelts, maintain the speed limit, and avoid distractions such as talking on the phone or texting while driving. (Using a cell phone while driving is illegal in many countries.)

Travel wise. Here are a few other reminders to ensure smart traveling:

  • Wear sunscreen. Avoid overexposure to the sun by wearing protective clothing and limit time in the sun during the hottest part of the day, 10 am–4 pm.
  • Swim in safe places. Before jumping in, ask about bacterial contamination, water depth, and other hazards, such as sharp rocks or coral, riptides, and dangerous sea animals.
  • Pack smart and remember that prevention can be travel-sized. Carry your own stash of first-aid supplies and medications. Insect repellent and antidiarrheal medicine are musts.

Politics, politics. The US Department of State website, www.travel.state.gov, helps travelers gauge the political climate of unstable countries.

You have been busy, you have worked hard, so now relax and have a good time—you deserve it!

More Information:
CDC Travelers’ Health