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CENTRAL VALLEY IMMUNIZATION COALITION 13 th Annual Medical Assistant Immunization Update CENTRAL VALLEY IMMUNIZATION COALITION.

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Presentation on theme: "CENTRAL VALLEY IMMUNIZATION COALITION 13 th Annual Medical Assistant Immunization Update CENTRAL VALLEY IMMUNIZATION COALITION."— Presentation transcript:

1 CENTRAL VALLEY IMMUNIZATION COALITION 13 th Annual Medical Assistant Immunization Update CENTRAL VALLEY IMMUNIZATION COALITION

2 Tom Booth, RN, BSN, PHN Supervising Public Health Nurse County of Fresno Department of Public Health Immunization Program (559)

3 CENTRAL VALLEY IMMUNIZATION COALITION The speaker has no financial conflict with manufacturers of any product named in this presentation. The use of trade names and commercial sources during this presentation is for identification only, and does not imply endorsement by the presenter, the Central Valley Immunization Coalition, Vaccines for Children, or the County of Fresno. Disclosures

4 CENTRAL VALLEY IMMUNIZATION COALITION SINCERE THANKS TO: ANTHEM BLUE CROSS CDPH- CAIR TEAM CDPH- IMMUNIZATION BRANCH CHDP FRESNO COUNTY IMMUNIZATION PROGRAM GLAXOSMITHKLINE HEALTH NET KINGS COUNTY IMMUNIZATION PROGRAM MADERA COUNTY IMMUNIZATION PROGRAM MEDIMMUNE MERCK NOVARTIS PFIZER SANOFI-PASTEUR TULARE COUNTY IMMUNIZATION PROGRAM TULARE COUNTY PROFESSIONAL DEVELOPMENT CENTER UNITED HEALTH CENTERS VFC

5 CENTRAL VALLEY IMMUNIZATION COALITION Resources Central Valley Immunization Coalition Vaccines for Children (EZIZ) Immunization Action Coalition The Pink Book online

6 CENTRAL VALLEY IMMUNIZATION COALITION USA Childhood and Adolescent Vaccine Recommendations National (federal) recommendations are developed and harmonized by American Academy of Pediatrics (AAP), American Academy of Family Practice (AAFP) and the Advisory Committee on Immunization Practices (ACIP) ACIP Meetings and recommendations Schedule published yearly (February) Requirements are state specific  child care  school laws

7 CENTRAL VALLEY IMMUNIZATION COALITION Vaccines in the Office

8 CENTRAL VALLEY IMMUNIZATION COALITION Vaccine Quality Office Management Vaccines and vaccine management should be a part of all office staff meetings  Many new vaccines and preparations  More coming! Competency in all aspects of immunization should be documented for all staff Don’t assume anything!

9 CENTRAL VALLEY IMMUNIZATION COALITION Vaccine Management The right storage equipment 2009 VFC storage equipment requirements For questions, check with VFC reps. Staff educationStaff education  Involve everyone in the office Storage temperatures  Monitoring protocols or policies (twice a day documentation)  Thermometer maintenance Plan to handle storage problems

10 CENTRAL VALLEY IMMUNIZATION COALITION Recommended Vaccine Storage Temperatures Refrigerator 35°- 46° F (2°-8° C) Freezer Varicella, MMR, MMRV + 5° F (-15° C) or colder 32 ° is freezing

11 CENTRAL VALLEY IMMUNIZATION COALITION Call for MD Call 911 Simple medical protocol Have an Emergency Vaccine Plan Be Prepared! If the patient has a reaction to a vaccine…

12 CENTRAL VALLEY IMMUNIZATION COALITION Materials

13 CENTRAL VALLEY IMMUNIZATION COALITION Organized!

14 CENTRAL VALLEY IMMUNIZATION COALITION Freezers  Inexpensive  Available in a variety of sizes

15 CENTRAL VALLEY IMMUNIZATION COALITION New Separate Temp Logs

16 CENTRAL VALLEY IMMUNIZATION COALITION Monitor Temps Twice Daily

17 CENTRAL VALLEY IMMUNIZATION COALITION Patient Encounter Have an exact vaccine order in writing  Order must be written  Check and double check! Prepare vaccines carefully  Stay focused and undisturbed, set it up as a quiet room  Read labels and expiration dates Ask someone if you do not understand When using new vaccines all staff need education before using the vaccine

18 CENTRAL VALLEY IMMUNIZATION COALITION Quiz: Which are Contraindications? A.MILD UPPER RESPIRATORY INFECTION B.CURRENT ANTIBIOTIC TREATMENT C.TEMPERATURE OF 100 F D.MILD DIARRHEA

19 CENTRAL VALLEY IMMUNIZATION COALITION False Contraindications Mild illness Low grade fever Antibiotics “Get them while you’ve got them”

20 CENTRAL VALLEY IMMUNIZATION COALITION Parent Education/Concerns Autism? Mercury in thimerisol? Won’t all these shots overwhelm the immune system? ASK PARENTS: TO WHICH DISEASES DO YOU WANT YOUR CHILD LEFT VULNERABLE???

21 CENTRAL VALLEY IMMUNIZATION COALITION Number of Vaccines in the Routine Childhood and Adolescent Immunization Schedule 1985 Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Hib (infant) Hep B Varicella Measles Rubella Hep B Varicella Mumps Diphtheria Pneumoccal Influenza Tetanus Meningococcal Pertussis Hep A Polio Rotavirus Hib (infant) HPV 16

22 CENTRAL VALLEY IMMUNIZATION COALITION Read your vials and syringes!

23 CENTRAL VALLEY IMMUNIZATION COALITION Make sure the vaccine order matches the vaccine

24 CENTRAL VALLEY IMMUNIZATION COALITION Read the vial or syringe

25 CENTRAL VALLEY IMMUNIZATION COALITION Check expiration dates Month/Day/Year Day/Month/Year

26 CENTRAL VALLEY IMMUNIZATION COALITION The Five Rights 1.RIGHT PATIENT 2.RIGHT ROUTE 3.RIGHT DOSE 4.RIGHT TIME 5.RIGHT MEDICATION

27 CENTRAL VALLEY IMMUNIZATION COALITION Organized!

28 CENTRAL VALLEY IMMUNIZATION COALITION

29 CENTRAL VALLEY IMMUNIZATION COALITION ORGANIZED!

30 CENTRAL VALLEY IMMUNIZATION COALITION ORGANIZED!

31 CENTRAL VALLEY IMMUNIZATION COALITION

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35 CENTRAL VALLEY IMMUNIZATION COALITION 2012 SCHEDULE 0-6 YEARS

36 CENTRAL VALLEY IMMUNIZATION COALITION Schedule Using Combinations

37 CENTRAL VALLEY IMMUNIZATION COALITION 2012 SCHEDULE 7-18 YEARS

38 CENTRAL VALLEY IMMUNIZATION COALITION 2012 ADULT SCHEDULE FIGURE 1. Recommended adult immunization schedule, by vaccine and age group 1 — United States, 2012 Centers for Disease Control and Prevention. Recommended adult immunization schedule — United States, MMWR 2012;61(4).

39 CENTRAL VALLEY IMMUNIZATION COALITION 2012 ADULT SCHEDULE FIGURE 2. Vaccines that might be indicated for adults, based on medical and other indications1 — United States, 2012 Centers for Disease Control and Prevention. Recommended adult immunization schedule—United States, MMWR 2012;61(4).

40 CENTRAL VALLEY IMMUNIZATION COALITION Adult Patients Annual Flu Vaccine Tdap (new baby) Pneumococcal Hepatitis A and/or Hepatitis B Shingles Vaccines for Foreign Travel

41 CENTRAL VALLEY IMMUNIZATION COALITION 2012 SCHEDULE 0-6 YEARS

42 CENTRAL VALLEY IMMUNIZATION COALITION 2012 SCHEDULE 0-6 YEARS

43 CENTRAL VALLEY IMMUNIZATION COALITION Two Rotavirus Vaccines THREE DOSE 2,4,6 Months TWO DOSE 2 & 4 Months

44 CENTRAL VALLEY IMMUNIZATION COALITION

45 Many DTaP, Tdap containing products Know how to read the vials and syringes

46 CENTRAL VALLEY IMMUNIZATION COALITION

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48 Replaced by …,.. COMPANY WHO MAKES THE VACCINE PFIZER (WYETH)

49 CENTRAL VALLEY IMMUNIZATION COALITION Complicated catch-up recommendations All children under 4 years and 6 months should have at least one dose of PCV 13 Prevnar 13 (PCV 13)

50 CENTRAL VALLEY IMMUNIZATION COALITION

51 Inactivated Polio Vaccine If 4 doses are administered prior to age 4 years a fifth dose should be administered at age 4 through 6 years. See MMWR 2009;58(30):829–30.

52 CENTRAL VALLEY IMMUNIZATION COALITION

53 Influenza Virus Vaccine Influenza vaccine composition: A/California/04/2009 (H1N1) A/Victoria/361/2011 (H3N2)-like B/Wisconsin/1/2010-like A/California/04/2009 (H1N1) A/Perth/10/2009 (H3N2)-like B/Brisbane/60/2008-like A/California/04/2009 (H1N1) A/Perth/10/2009 (H3N2)-like B/Brisbane/60/2008-like

54 CENTRAL VALLEY IMMUNIZATION COALITION Live Attenuated Influenza Vaccine (LAIV) Inactivated Influenza Vaccine (TIV)

55 CENTRAL VALLEY IMMUNIZATION COALITION ~July, 2011

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61 Number of reported pertussis cases by year of onset ― California, * * Includes cases reported to CDPH as of 3/9/2011 Year Cases per 100,000 Acellular DTaP licensed Tdap licensed PCR available DTP widely used 0

62 CENTRAL VALLEY IMMUNIZATION COALITION Pertussis resurgence since the 1990s Genetic changes in B. pertussis; greater virulence? Variable vaccine efficacy – acellular vaccines licensed in 1991 for 4 th /5 th doses, entire series in 1996; estimates of vaccine efficacy for DTaP typically range from 75-85% depending on the case definition that is used Waning of vaccine-induced immunity General availability of more sensitive laboratory tests

63 CENTRAL VALLEY IMMUNIZATION COALITION Number of reported pertussis cases by year of onset -- California *

64 CENTRAL VALLEY IMMUNIZATION COALITION California Pertussis Epidemic, fatal cases in 2010 (all infants), ~9000 cases Most cases since 1950’s The mean WBC of fatal cases in was 75,000 (range 15, ,000);  Pertussis toxin elicits a dose-dependent leukocytosis

65 CENTRAL VALLEY IMMUNIZATION COALITION Tdap Must increase the number of adolescents and adults vaccinated Decrease barriers Staff misunderstanding over use and complex recommendations “Fear “ of using the vaccine Access barriers

66 CENTRAL VALLEY IMMUNIZATION COALITION CDPH Tdap Recommendations July 2010 Immunize pre-teens, teens and adults with Tdap vaccine 7-9 year olds who are under immunized Those >10 years of age who have not yet received Tdap, especially women of childbearing age, preferably before, or else during or immediately after pregnancy others with close contact with young infants includes persons >64 years of age No minimum interval between Td and Tdap Same recommendations adopted nationally

67 CENTRAL VALLEY IMMUNIZATION COALITION New Pertussis School Law – all students in 7 th -12 th grade must have one dose Tdap on or after 7 th birthday 2012 and after- 7 th grade Tdap requirement Information to LHD’s to schools ShotsforSchool.org

68 CENTRAL VALLEY IMMUNIZATION COALITION

69 Two Human Papillomavirus Vaccines (HPV) Gardasil™ Cervarix™ Males & Females Females Only

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71 QUIZ: TRUE OR FALSE? ALL DILUENTS CAN BE STORED AT ROOM TEMPERATURE

72 CENTRAL VALLEY IMMUNIZATION COALITION MCV 4 Currently available vaccines: Menactra® (sanofi-pasteur) Liquid ready to use formulation Menveo (Novartis) Menveo requires dilution

73 CENTRAL VALLEY IMMUNIZATION COALITION A routine 2-dose schedule of quadrivalent meningococcal conjugate vaccine (MCV4) for certain persons at high risk for meningococcal disease, and recommendations for a booster dose of MCV4 have been added (6).

74 CENTRAL VALLEY IMMUNIZATION COALITION THANK YOU!


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