1. Vaccination Training Student Run Homeless Clinics Winter 2011

2. Your Role in Vaccination Assess if patient is up to date Assess if patient is up to date If not, what vaccines are needed If not, what vaccines are needed Inform the clinic chief Inform the clinic chief Provide vaccine information sheet and go over the side effects and contraindications Provide vaccine information sheet and go over the side effects and contraindications Bring signed waiver form to attending to be co- signed Bring signed waiver form to attending to be co- signed Prepare vaccines and necessary supplies Prepare vaccines and necessary supplies Administer the vaccine Administer the vaccine

3. Vaccination Training Video

4. REMEMBER SAFETY FIRST!!! WASH YOUR HANDS!!! WASH YOUR HANDS!!! USE GLOVES USE GLOVES CLEAN SKIN AREA WITH ALCOHOL CLEAN SKIN AREA WITH ALCOHOL DO NOT RECAP NEEDLES DO NOT RECAP NEEDLES DISPOSE OF NEEDLES IN SHARPS CONTAINER DISPOSE OF NEEDLES IN SHARPS CONTAINER

5. Injection Method Intramuscular (IM) Intramuscular (IM) Hep B Hep B DTaP, DT, Td DTaP, DT, Td Hib Hib IPV IPV PCV PCV Influenza Influenza Hep A Hep A Subcutaneous (SC) IPV Varicella MMR

6. Intramuscular Method Needle goes through the skin and into the muscle Needle goes through the skin and into the muscle Deltoid, thigh, hip, upper outer quadrant of gluteus muscle Deltoid, thigh, hip, upper outer quadrant of gluteus muscle Supplies Supplies Alcohol pad, sterile gauze, needle and syringe with medicine Alcohol pad, sterile gauze, needle and syringe with medicine

7. Adult Vaccines

10. Pediatric Vaccines

15. Common Reactions Mild to moderate fever (up to 1-3 days) Mild to moderate fever (up to 1-3 days) Soreness, tenderness, redness and swelling at injection site Soreness, tenderness, redness and swelling at injection site Fussiness Fussiness Vomiting Vomiting Tiredness Tiredness

16. Severe allergic reactions parents should be warned about : (these reactions are VERY rare) (Usually occur within minutes to hours after shot given) High fever (up to 1 week) High fever (up to 1 week) Unusual behavior Unusual behavior Weakness Weakness Paleness Paleness Dizziness Dizziness Nonstop crying (over 3 hours) Nonstop crying (over 3 hours) Difficulty breathing Hoarseness Wheezing Fast heart beat Seizures (up to 1 week)

17. CDC Vaccine Information Form Must be provided to parents prior to vaccination Must be provided to parents prior to vaccination Contains vaccine safety information Contains vaccine safety information Referral information Referral information

18. Routine Vaccines for Children Hepatitis B Hepatitis B Diptheria, Tetanus, Pertussis (DTaP or DT) Diptheria, Tetanus, Pertussis (DTaP or DT) Haemophilus Influenzae type B (Hib) Haemophilus Influenzae type B (Hib) Inactivated Poliovirus (IPV) Inactivated Poliovirus (IPV) Measles, Mumps, Rubella (MMR) Measles, Mumps, Rubella (MMR) Varicella Varicella Pneumococcal (PCV) Pneumococcal (PCV) Influenza Influenza

19. Hepatitis B Need 3 doses Need 3 doses May be given at the same times as other vaccines May be given at the same times as other vaccines CONTRAINDICATIONS CONTRAINDICATIONS Life threatening allergic reaction to Baker’s Yeast OR to previous dose of Hep B vaccine Life threatening allergic reaction to Baker’s Yeast OR to previous dose of Hep B vaccine Moderately or severely ill children should reschedule for a later date Moderately or severely ill children should reschedule for a later date

20. Diptheria, Tetanus, Pertussis (DTaP) 5 Doses 5 Doses 2 months, 4 months, 6 months, 15-18 months, and 4-6 years 2 months, 4 months, 6 months, 15-18 months, and 4-6 years If has cold, CAN be vaccinated but should reschedule if child has moderate to severe illness If has cold, CAN be vaccinated but should reschedule if child has moderate to severe illness CONTRAINDICATIONS CONTRAINDICATIONS Any of the following reaction to pervious DTaP: severe life threatening allergic reaction, seizure, collapsed, cried nonstop for over 3 hours, or fever over 105°F [these kids should just get DT vaccine (no pertussis)] Any of the following reaction to pervious DTaP: severe life threatening allergic reaction, seizure, collapsed, cried nonstop for over 3 hours, or fever over 105°F [these kids should just get DT vaccine (no pertussis)] Should NOT be given to anyone over age of 7 Should NOT be given to anyone over age of 7

21. Diptheria, Tetanus (Td) For age 7 or older For age 7 or older Tetanus booster Tetanus booster Lacks pertussis component Lacks pertussis component Used as a booster every 10 years after 3 rd dose of DTaP/DTP/or DT Used as a booster every 10 years after 3 rd dose of DTaP/DTP/or DT Severe Problems: Severe Problems: Deep, aching pain and muscle wasting in upper arms, starting 2 days to 4 weeks after shot and lasting many months Deep, aching pain and muscle wasting in upper arms, starting 2 days to 4 weeks after shot and lasting many months

22. Haemophilus influenza type b 4 Doses given before age 5 4 Doses given before age 5 2 months, 4 months, 6 months, and 12-15 months 2 months, 4 months, 6 months, and 12-15 months Given to some immunocompromised when over 5 years old Given to some immunocompromised when over 5 years old Prevents bacterial meningitis, pneumonia, severe swelling of throat, infections of joints, blood, or bone Prevents bacterial meningitis, pneumonia, severe swelling of throat, infections of joints, blood, or bone

23. Inactivated Polio Vaccine 4 doses of IPV 4 doses of IPV 2 months, 4 months, 6-18 months 2 months, 4 months, 6-18 months Booster at 4-6 years Booster at 4-6 years Adults who have never been vaccinated will need 3 doses Adults who have never been vaccinated will need 3 doses Adult vaccination if in certain high risk groups Adult vaccination if in certain high risk groups OPV no longer given in US because can cause Polio (1 in 2.4 million) OPV no longer given in US because can cause Polio (1 in 2.4 million) CONTRAINDICATIONS CONTRAINDICATIONS Prior severe allergic reaction to streptomycin, neomycin or polymyxin B Prior severe allergic reaction to streptomycin, neomycin or polymyxin B

24. Measles, Mumps, Rubella Children need 2 doses Children need 2 doses 12-15 months and 4-6 years of age ( or at least 28 days after 1 st dose) 12-15 months and 4-6 years of age ( or at least 28 days after 1 st dose) Some adults also require MMR Some adults also require MMR CONTRAINDICATIONS CONTRAINDICATIONS Severe life-threatening allergy to gelatin, neomycin, or a previous dose of MMR Severe life-threatening allergy to gelatin, neomycin, or a previous dose of MMR Pregnant women (females should wait 3-4 weeks before getting pregnant) Pregnant women (females should wait 3-4 weeks before getting pregnant) Other Reactions Other Reactions Mild rash, swelling of glands in cheek or neck Mild rash, swelling of glands in cheek or neck

25. Varicella One dose between 12 and 18 months of age or at any age after that if they have never had the chicken pox One dose between 12 and 18 months of age or at any age after that if they have never had the chicken pox If 13 years or older will need 2 doses, 4-8 weeks apart If 13 years or older will need 2 doses, 4-8 weeks apart CONTRAINDICATIONS CONTRAINDICATIONS Severe life-threatening allergy to gelatin, neomycin, or a previous dose of varicella Severe life-threatening allergy to gelatin, neomycin, or a previous dose of varicella Pregnant women (females should wait 3-4 weeks before getting pregnant) Pregnant women (females should wait 3-4 weeks before getting pregnant) Other reactions Other reactions Mild rash that may be contagious to others (very rare) Mild rash that may be contagious to others (very rare)

26. Pneumococcal Prevents some meningitis, blood infections and ear infections Prevents some meningitis, blood infections and ear infections 2 types: 2 types: Pneumococcal Conjugate Vaccine (PCV) Pneumococcal Conjugate Vaccine (PCV) 4 doses for children under 2 years of age 4 doses for children under 2 years of age 2 months, 4 months, 6 months, and 12-15 months 2 months, 4 months, 6 months, and 12-15 months Children ages 2-5 with certain high risk conditions Children ages 2-5 with certain high risk conditions Sickle cell, asplenic, HIV, diabetes, Cancer, chemotherapy, etc Sickle cell, asplenic, HIV, diabetes, Cancer, chemotherapy, etc Pneumococcal Polysaccaride Vaccine (PPV) Pneumococcal Polysaccaride Vaccine (PPV) All adults 65 years or older All adults 65 years or older Anyone over 2 years of age with long term health problem Anyone over 2 years of age with long term health problem Anyone on long term steroid treatment, chemotherapy, or radiation Anyone on long term steroid treatment, chemotherapy, or radiation One dose is sufficient but some circumstances require 2 nd dose One dose is sufficient but some circumstances require 2 nd dose No facts about PPV and pregnancy yet No facts about PPV and pregnancy yet

27. Influenza 2 types: Inactivated and activated 2 types: Inactivated and activated Yearly dose Yearly dose Children younger than 9 getting the vaccine for 1 st time should have 2 doses at least 1 month apart Children younger than 9 getting the vaccine for 1 st time should have 2 doses at least 1 month apart CONTRAINDICATIONS CONTRAINDICATIONS Egg allergy (vaccine grown in eggs) Egg allergy (vaccine grown in eggs) Guillan-Barre Syndrome Guillan-Barre Syndrome Children and adolescents on long term aspirin syndrome (risk of Reyes syn) Children and adolescents on long term aspirin syndrome (risk of Reyes syn) Season Season Best time is from October to November Best time is from October to November

28. Influenza Inactivated Influenza Vaccine (shot) Inactivated Influenza Vaccine (shot) All children ages 6-23 months All children ages 6-23 months 65 years or older 65 years or older Women who will be pregnant during flu season Women who will be pregnant during flu season Anyone at high risk Anyone at high risk Live, attenuated influenza vaccine (Intranasal spray) Live, attenuated influenza vaccine (Intranasal spray) Healthy children and adults ages 5-49 Healthy children and adults ages 5-49 CONTRAINDICATIONS CONTRAINDICATIONS Pregnant women Pregnant women Younger than 5, or older than 50, immunocompromised, long term health problems Younger than 5, or older than 50, immunocompromised, long term health problems

29. Other Information

30. Autism and Vaccines Theory posed that MMR vaccine might play a role in autism Theory posed that MMR vaccine might play a role in autism Weight of scientific evidence does not support Weight of scientific evidence does not support American Academy of Pediatrics Review and Institute of Medicine Review conclude no association American Academy of Pediatrics Review and Institute of Medicine Review conclude no association

31. Mercury and Vaccines Federal Act to reduce mercury exposure Federal Act to reduce mercury exposure Thimiserol -mercury based preservative Thimiserol -mercury based preservative Vaccine schedule prior to 1999 for some infants could exceed 1 federal mercury guideline Vaccine schedule prior to 1999 for some infants could exceed 1 federal mercury guideline No evidence of harm No evidence of harm US vaccines now virtually mercury-free US vaccines now virtually mercury-free

32. Are Additives Contained in Vaccines Safe? Additives are thoroughly tested. Tiny amounts are used Additives are thoroughly tested. Tiny amounts are used Precautions – check manuf. Info., patient hx, and NIP’s Guide to Contraindications Precautions – check manuf. Info., patient hx, and NIP’s Guide to Contraindications Additives Used: Additives Used: a. adjuvants – enhance immune system response b. antibiotics – prevent bacterial & fungal growth c. stabilizers – maintain effectiveness in face of adverse conditions d. preservatives – prevent spoilage

33. Can vaccines overload the immune system? Giving multiple vaccines at the same time is safe Giving multiple vaccines at the same time is safe People are exposed daily to hundreds of antigens People are exposed daily to hundreds of antigens Multiple vaccines work with the immune system to boost it Multiple vaccines work with the immune system to boost it Simultaneous vaccination Simultaneous vaccination protects against several diseases quickly Combo vaccines reduce discomfort and costs Combo vaccines reduce discomfort and costs

34. Challenges Few diseases are Few diseases are eradicable eradicable No vaccines are 100% safe or effective No vaccines are 100% safe or effective Increased complexity Increased complexity Universally recommended Universally recommended

35. National Vaccine Hotline

36. Additional Resources Centers for Disease Control and Prevention website: www.cdc.gov Centers for Disease Control and Prevention website: www.cdc.gov National Immunization Hotline: 1-800-CDC-INFO National Immunization Hotline: 1-800-CDC-INFO For information on vaccine testing and licensing: www.fda.gov For information on vaccine testing and licensing: www.fda.gov For information about local health care resources: www.naccho.org or look under “public health” in the blue pages of your local phone book For information about local health care resources: www.naccho.org or look under “public health” in the blue pages of your local phone book For information on children’s health insurance: www.insurekidsnow.gov For information on children’s health insurance: www.insurekidsnow.gov Immunization

37. References 1. Center for Disease Control Website http://www.cdc.gov/vaccines/default.htm http://www.cdc.gov/vaccines/default.htm 2. Basic Vaccine Safety Course, CDC Website: http://www.cdc.gov/vaccinesafety/index.html http://www.cdc.gov/vaccinesafety/index.html 3. Vaccine Information Statements, CDC Website: http://www.cdc.gov/vaccines/pubs/vis/default.htm http://www.cdc.gov/vaccines/pubs/vis/default.htm