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Liza Chapman, Pharm.D. GPhA Annual Meeting IMMUNIZATION UPDATE 2013.

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Presentation on theme: "Liza Chapman, Pharm.D. GPhA Annual Meeting IMMUNIZATION UPDATE 2013."— Presentation transcript:

1 Liza Chapman, Pharm.D. GPhA Annual Meeting IMMUNIZATION UPDATE 2013

2  Liza Chapman has no disclosures to declare at this time FACULTY DISCLOSURE

3  Review the changes/developments made to the immunization recommendations during the past year  Discuss cases and provide vaccine recommendations based upon the ACIP/CDC current schedules  Identify new developments in practice that impact immunizing pharmacists’ practices OBJECTIVES

4 Vaccine (Target Group)Vaccination Rate (%) Influenza (50–64 years)47.2 Influenza (>65 y/o)64.9 Influenza (health care personnel (HCP))66.9 Pneumococcal (>65 y/o)64.5 Pneumococcal (19-64 y/o high risk)20.1 Tdap in past 6 years (19–49 y/o)12.5 Tdap (HCP) 2005-201126.8 Hepatitis B (> 3 doses 19-49 y/o35.9 Hepatitis B (HCP)63.2 HPV Females (>1 dose)21.5 Zoster vaccine (>60 y/o)15.8 U.S ADULT VACCINATION RATES, 2011 APhA IMZ CTP, 04.2013 National Health Interview Survey –2011 (http://www.cdc.gov/mmwr/pdf/wk/mm62e0129.pdf) National Immunization Survey 2011-2012 http://www.cdc.gov/MMWR/preview/mmwrhtml/mm6138a1.htm

5  Measles Outbreak (2011) 1  222 cases reported  Five times the number of cases in 2007  28,000 cases in Europe  Mumps Outbreak (2011) 2  29 Mumps cases on University campus in California  Source – unvaccinated student – all cases linked  22 (76%) vaccinated with 2 doses MMR  2 with 3 doses, 2 with 1 dose, and 2 unknown  Pertussis Epidemic 3  41,880 cases reported in 2012  18 related deaths  4,783 in Washington State (965 in 2011)  18,719 cases total reported in U.S. in 2011  27,555 in 2010 RECENT DISEASE OUTBREAKS APhA IMZ CTP, 04.2013 1. Measles. www.cdc.gov/measles 2. MMWR Morb Mortal Wkly Rep. 2012;61:986-989 3. CDC Pertussis Report (www.cdc.gov/pertussis)

6 RECAP FROM 2013 NATIONAL ADULT AND INFLUENZA IMMUNIZATIONS SUMMIT

7 HEPATITIS B

8  Target groups for HBV  Infants  Adolescents who have not been previously vaccinated  High-risk adults  Multiple sex partners  Patients seeking treatment for STDs  HIV patients  IV drug users  Dialysis patients  Patients with chronic liver disease  Health care providers  All diabetics 19-59 years old  Diabetics >60 years (permissive) HEPATITIS B New ACIP recomm endation

9  How many doses must a patient receive to complete the Hepatitis B series? A. 1 Dose B. 2 Doses C. 3 Doses D. 4 Doses SELF-ASSESSMENT

10  It is October and R.J. is 82 y.o. male patient that is moving into an ALC. His medical conditions include: CHF, COPD, and T2DM. R.J.’s PCP cannot locate his vaccination records. Which vaccines would you recommend R.J. receive? A.Influenza B.Pneumococcal C.Zoster D.Hepatitis B E.All of the above SELF-ASSESSMENT

11 INFLUENZA

12 REVIEW OF 2013-13 INFLUENZA SEASON

13 HCP S AND INFLUENZA VACCINATIONS http://www.cdc.gov/flu/fluvaxview/hcp-ips-nov2012.htm

14 HCP S AND INFLUENZA VACCINATIONS http://www.cdc.gov/flu/fluvaxview/hcp-ips-nov2012.htm

15 HCP S AND INFLUENZA VACCINATIONS http://www.cdc.gov/flu/fluvaxview/hcp-ips- nov2012.htm

16 HCP S AND INFLUENZA VACCINATIONS http://www.cdc.gov/flu/fluvaxview/hcp-ips- nov2012.htm

17  Influenza vaccine contains:  A/California/7/2009 (H1N1)–like virus  A/Texas/50/2012 (H3N2)–like virus  B/Massachusetts/2/2012–like virus  Yamagata lineage  Quadrivalent Addition:  B/Brisbane/60/2008-like virus  Victoria lineage 2013-14 INFLUENZA VACCINE STRAINS

18 Vaccine (manufacturer)Approved Age Indications Inactivated Influenza Vaccine Fluzone (sanofi pasteur)>6 months Fluvirin (Novartis)>4 years Fluarix (GSK)>3 years FluLaval (GSK)>18 years Afluria (CSL Biotherapies)>9 years Agriflu (Novartis)>18 years Fluzone High-Dose (sanofi pasteur)>65 years Fluzone Intradermal (sanofi pasteur)18-64 years Flucelvax (Novartis) – cell cultured (not eggs)>18 years Flublok (Protein Sciences Corp) -recombinant18-49 years Live Attenuated Influenza Vaccine FluMist (MedImmune)2 years to 49 years 2013-14 INFLUENZA PRESENTATIONS http://www.cdc.gov/flu/protect/vaccine/vaccines.htm

19  Cell cultured vaccine  Recombinant HA vaccine NEW MANUFACTURING TECHNOLOGIES

20  It is up to the health care provider to determine the best influenza vaccine product for the patient based on patients’ needs  Patient Age  Preservative vs. preservative free  Administration  ID  IM  IN  IIV3 or IIV4 SELECTING THE BEST PRODUCT FOR YOUR PATIENT

21  According to ACIP, individuals who have only reported hives as a result of vaccination with influenza vaccine should be vaccinated by following these safety measures:  Use IIV rather than LAIV  Vaccine should be administered by a health care professional familiar with egg allergies  Observation after vaccination should be at lease 30 minutes INFLUENZA VACCINE AND EGG ALLERGIES http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6132a3.htm#egg_allergy

22 INFLUENZA VACCINE AND EGG ALLERGIES APhA IMZ CTP, 04.2013

23  Which influenza vaccine would you recommend for R.J.? A.LAIV B.IIV3 C.IIV4 D.Fluzone HD E.Fluzone ID SELF-ASSESSMENT

24 MENINGITIS

25  As of March, 2013, now an recommended vaccine for high-risk infants  Complement deficiencies  Asplenia  Travel to certain countries  Community outbreaks  Not recommended for routine use  FDA approved vaccines for infant use  Menactra (sanofi-pasteur) – high risk infants only  2 dose series 8 weeks apart (9-23 months of age)  Dose 0.5mL IM  Menhibrix (GSK)  4 dose series (2,4,6,12-15 months of age)  Dose: 0.5 mL IM  Used if Hib vaccine needed  Not for travel (only 2 serotypes)  Community outbreaks only if serotypes C and Y  If used, must complete all 4 doses http://www.cdc.gov/mmwr/pdf/rr/rr6202.pdf MENINGOCOCCAL VACCINE

26 PNEUMOCOCCAL

27  PCV 13 (Prevnar)  Indicated for the active immunization of children ages 6 weeks to 5 years old  For the prevention of invasive disease caused by 13 Streptococcus pneumoniae serotypes  For the prevention of otitis media caused by 7 Streptococcus pneumoniae serotypes  FDA approved for adults aged 50 years and older (Not ACIP recommended for routine use)  Dose and route: 0.5 mL IM PNEUMOCOCCAL VACCINE

28  Target groups for vaccination  Infants and children  Routine schedule: 2, 4, 6, 12–15 months  Any PCV series begun with PCV7 should be completed with PCV13  Administer a single supplemental dose of PCV13 for:  Children aged 14–59 months who have received an age-appropriate series of PCV7  Children aged 60–71 months with underlying medical conditions who have received an age-appropriate series of PCV7 PCV 13 APhA IMZ CTP, 04.2013

29  FDA Approved adults >50 years  Approval based upon serology  ACIP  No recommendations for routine use in all adults at this time  Not enough data to evaluate  Studies currently ongoing  Recommended for:  Immunocompromising conditions  Functional or anatomical asplenia  CSF leaks  Cochlear implants PCV 13 AND ADULTS APhA IMZ CTP, 04.2013

30 PCV 13 AND IMMUNOCOMPROMISED ADULTS It is possible that these patients could receive three doses of PPSV23 in their lifetime. APhA IMZ CTP, 04.2013

31  If a patient has already had PPSV23 for a high-risk condition and also needs PCV13 for the same condition, how long should you wait before administering PCV13? A.No wait B.4 weeks C.8 weeks D.12 weeks SELF-ASSESSMENT

32 T DAP

33 PERTUSSIS SURVEILLANCE http://www.cdc.gov/pertussis/images/incidence-graph-age.jpg

34 PERTUSSIS OUTBREAKS http://www.cdc.gov/pertussis/images/pertussis-graph-2012-lg.jpg

35 Age of Patient Recommendation 6 weeks to 6 years old Use DTaP to complete the primary series 7 years to 10 years old who are not fully vaccinated against pertussis Give a single dose of Tdap 11 to 64 years old If there is no record of a Tdap dose, give a single dose of Tdap followed by one dose of Td every 10 years >65 years oldIf there is no record of a Tdap dose, give a single dose of Tdap followed by one dose of Td every 10 years Health Care Providers If there is no record of a Tdap dose, give a single dose of Tdap. Pregnant women (every pregnancy) Give a dose of Tdap after 20 weeks of gestation. (27-36 weeks optimal) T DAP

36  Some women have closely spaced pregnancies. Should Tdap be given during each pregnancy, even if it means such women would get 2 doses within 12 months? A.Yes B.No SELF-ASSESSMENT

37  Japanese Encephalitis (Ixiaro)  Approved age now includes children 2 months and over  2 Dose vaccine series  0 and 28 days  2 months to 35 months  0.25 ml  36 months and older  0.5 ml  Yellow Fever (YF-VAX)  WHO has determined there is no need for booster vaccination TRAVEL VACCINES

38  www.cdc.gov www.cdc.gov  MMWR  Epidemiology and Prevention of Vaccine-Preventable Diseases  2012 Yellow Book  www.immunize.org www.immunize.org  IAC Express  Current VISs  www.pharmacist.com/immunization-center www.pharmacist.com/immunization-center MAKE SURE YOU ARE UP TO DATE

39  Liza Chapman  liza.chapman@kroger.com QUESTIONS


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