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Vaccinate for Life. The Texas Department of State Health Services

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Presentation on theme: "Vaccinate for Life. The Texas Department of State Health Services"— Presentation transcript:

1 Adolescent/Adult Immunization Program: Update for School Nurses, January 2009
Vaccinate for Life. The Texas Department of State Health Services Immunization Branch Adolescent/Adult Immunization Program

2 Presentation Objectives
Describe the Texas Adolescent/Adult Immunization (AAI) Program Describe changes to the Recommended Immunization Schedules for Persons Aged 0 Through 18 Years – U.S Describe changes to the Recommended Adult Immunization Schedule – U.S. 2009 Identify adolescent & adult vaccines, indications and use Discuss HPV vaccine and communication challenges Identify vaccine myths and describe vaccine facts Describe proposed school rules for 2009 and beyond

3 Presentation Overview
Adolescent/Adult Immunization (AAI) Program Changes to CDC Recommendations for Adolescent and Adult Immunization Schedules Adolescent and Adult Vaccines Vaccines and Healthcare Workers HPV vaccine communication challenges Vaccine myths vs. facts School rules for 2009 and beyond

4 The AAI Program: Basic Goals
Increase adolescent and adult vaccine coverage levels in the State of Texas. Increase knowledge and awareness among providers and the public concerning age appropriate vaccination. Identify, facilitate, coordinate, and support the efforts of Texas-based adolescent and adult immunization stakeholders where possible. Increase access to/availability of resources such as free vaccines made available through the Texas Vaccines for Children (TVFC), the Texas Adult Safety-Net Vaccine Program, and other services such as ImmTrac (immunization registry) for adolescent and adult populations.

5 The AAI Program: Background
Early Focus on Children New Vaccines and Recommendations Increased Funding Personnel

6 Vaccines Work! Vaccines are recognized as one of the top 10 most effective public health interventions

7 10 Greatest Public Health Achievements 1900-1999
Vaccines Work! 10 Greatest Public Health Achievements Healthier moms and babies Safer workplace Safer and healthier foods Tobacco as a health hazard Decline in deaths from coronary heart disease Fluoridation of drinking water Motor-vehicle safety Family Planning Vaccinations & Control of Infectious Disease The top 10 list include all of these public health achievements, many of these we find are so much a part of our daily lives, we hardly give them a second thought…flouridation of our drinking water is a perfect example….or our traffic laws which we deal with and follow on a daily basis. Could you imagine what getting around would be like and how many unnecessary deaths would occur if we did not have agreed upon laws directing traffic flow? It would be quite chaotic.

8 Vaccines Work! Polio >21,000 cases of paralytic polio in the U.S. Polio vaccine licensed in 1955 Incidence of disease: In 1960, a total of 2,525 paralytic cases were reported, compared with 61 in 1965 Last case of wild-virus polio acquired in the U.S. was in 1979 Polio is not eradicated from the world Disease has no border! ** Picture of little girl from WHO – Severely deformed leg Dianne Odell, a woman who spent 58 years of her life in an iron lung after being diagnosed with polio as a child, died May 28, 2008 after a power failure shut down the iron lung. Odell, 61, had been confined to the 7-foot-long machine since she was stricken by polio at 3 years old. Young boy stricken with polio. Photo: Courtesy of World Health Organization Photo: Helen Comer/AP Photo: Encyclopædia Britannica; © Steve Raymer/Corbis  

9 Pakistan - 118 Nigeria - 788 India - 549 Retrieved January 7, 2009 from

10 Vaccines Aren’t Just for Kids
Sometimes vaccines do not provide lifelong protection Sometimes the virus or bacteria changes through time Sometimes the aging immune system becomes susceptible to diseases that were less of a threat at an earlier age As adults our immune systems have been bombarded by many viruses and bacteria. In response, the immune system develops memory cells. However there are reasons why vaccines are still needed for adults. Not always lifelong protection – diphtheria, tetanus, pertussis, influenza Viruses and bacteria change over time – influenza Older age groups more susceptible – shingles, pneumococcus

11 Changes to Recommended Immunization Schedules for Persons Aged 0 Through 18 Years – United States, 2009 Recommendations for rotavirus vaccines include changes for the maximum age for the first dose (14 weeks 6 days) and the maximum age for the final dose of the series (8 months 0 days). Routine annual influenza vaccination is recommended for all children aged 6 months through 18 years. Children aged younger than 9 years who are receiving influenza vaccine for the first time or who were vaccinated for the first time during the previous season but only received 1 dose should receive 2 doses of influenza vaccine at least 4 weeks apart. Healthy non-pregnant persons aged 2 through 49 years may receive either live attenuated influenza vaccine or inactivated influenza vaccine.

12 Changes to Recommended Immunization Schedules for Persons Aged 0 Through 18 Years – United States, 2009 The minimum interval between tetanus and diphtheria toxoids (Td) and tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) for persons aged 10 through 18 years is addressed. An interval less than 5 years may be used if pertussis immunity is needed. Information about the use of Haemophilus influenzae type b (Hib) conjugate vaccine among persons aged 5 years and older at increased risk for invasive Hib disease has been added. Use of Hib vaccine for these persons is not contraindicated.

13 Changes to Recommended Immunization Schedules for Persons Aged 0 Through 18 Years – United States, 2009 Catch-up vaccination with human papillomavirus (HPV) vaccine is clarified. Routine dosing intervals should be used for series catch-up (i.e., the second and third doses should be administered 2 and 6 months after the first dose). The third dose should be given at least 24 weeks after the first dose. Abbreviation changes for: rotavirus (now RV), pneumococcal polysaccharide (now PPSV), pneumococcal conjugate vaccine (still PCV), meningococcal polysaccharide vaccine (now MPSV) meningococcal conjugate vaccine (still MCV)

14 Recommended Adolescent Immunization Schedule by Age, 2009

15 Recommended Adolescent Immunization Schedule Footnotes

16 Catch-Up Schedule for Persons Aged 7 Through 18 Years

17 Recommended Adult Immunization Schedule by Age

18 Recommended Adult Immunization Schedule by Medical Indication

19 Recommended Adult Immunization Schedule Footnotes
Due to the length and complexity of the footnotes please consult the following CDC web site for the Recommended Adult Immunization Schedule, United States – 2009.

20 Vaccines for Adolescents & Adults
Tetanus, diphtheria, pertussis (Td/Tdap) X Human papillomavirus (HPV) Varicella Zoster N/A Measles, mumps, rubella (MMR) Influenza Pneumococcal (polysaccharide) Hepatitis A Hepatitis B Meningococcal Inactivated Poliovirus

21 Td or Tdap Tetanus-diphtheria-pertussis (Td or Tdap)
Tetanus – bacterium that causes severe and painful muscle spasms, including the muscles of the jaw “lock-jaw” Diphtheria – bacterium that causes a thick coating on the back of the throat making it difficult to swallow and breath Pertussis – bacterium that causes thick, sticky mucus that clogs the windpipe, also known as whooping cough in children Tetanus – The Tetanus vaccine is the only vaccine that protects against a disease not transmitted from one person to another. Diphtheria – The bacteria that cause diphtheria are found only in people, whereas most other bacteria are found in some animals as well as people. Pertussis – Also known as the 100-day cough because even with treatment it takes many days to clear. Often misdiagnosed in adults. Two-thirds of cases in 2005 were in adolescents and adults Protection from childhood whooping cough vaccination wears off by adolescence Whooping cough can be passed from adolescents and adults to vulnerable infants who have not yet received any or all of their vaccines A new booster vaccine called Tdap is available to protect adolescents and adults against whooping cough The Centers for Disease Control and Prevention now recommends that adolescents age 11 to 18 receive a Tdap booster, which also protects against tetanus and diphtheria It is also recommended that adults ages receive a single dose of Tdap for pertussis protection, especially those who have close contact with infants less than 12 months of age.

22 Td or Tdap Tdap should replace a single dose of Td for adolescents and adults aged 64 years and younger who have not previously received a dose of Tdap There are two Tdap products. Adacel® manufactured by Sanofi Pasteur for ages 11-64 Boostrix® manufactured by GlaxoSmithKline for ages One dose of Tdap (substitute for Td) Three dose series if never vaccinated at 0 and 4 weeks, the third 6-12 months after second One dose booster of Td every 10 years An interval of less than 5 years may be used if pertussis immunity is needed. ** Consult package insert, schedule, and provider Intramuscular (IM) Injection Technique

23 Human Papillomavirus (HPV)
A virus that infects the genitals and the lining of the cervix There are many different types of HPV – some cause cervical cancer HPV vaccine is the second vaccine to prevent a form of cancer (cervical) C E R V I C A L C A N C E R

24 Human Papillomavirus (HPV)
Recommended for females ages 9 – 26 Ideally, vaccine should be given before potential exposure to HPV through sexual activity; however, females who are sexually active should still receive the vaccine Three dose series – second dose two months after the first and third dose administered six months after the first (at least 24 weeks after first dose) IM

25 Measles, mumps, rubella (MMR)
Measles – Infects the lining of the back of the throat and nose; can infect lungs and brain causing permanent damage or death Mumps – Painful swelling of the parotid glands; infects lining of brain/spinal cord Rubella – Causes swelling of glands, rash, and fever; can cause permanent and severe birth defects Measles - Very contagious – coughing and sneezing Mumps - Parotid glands are located just below the ear. Can cause fetal death and hearing loss. Rubella - Usually mild in children. Women infected with rubella during pregnancy – can cause birth defects or miscarriage.

26 Measles, mumps, rubella (MMR)
People born during or after 1957 who have not had measles, mumps, or rubella or the MMR vaccine should get the MMR vaccine People entering college Healthcare workers International travelers Specific guidelines from the schedule should be followed Two doses (consult provider) Subcutaneous (SC) Injection Technique

27 Varicella (chickenpox)
Very contagious coughing/sneezing Fever and many small blisters Complications include pneumonia, brain swelling, and severe skin infections Approximately 35 of every 100 deaths from chickenpox are in adults Picture of 30 year old female.

28 Varicella (chickenpox)
All adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine unless they have a medical contraindication. What constitutes evidence of immunity? Two doses at 0 then 4-8 weeks SC

29 Influenza (flu) Infects the respiratory system
Complications include pneumonia, fever, croup, and bronchitis People with asthma, chronic diseases of the lungs, heart, or kidneys are at greater risk Most deaths from flu occur in people 65 or older

30 Influenza (flu) Annual vaccine
Recommended for children 6 months through 18 years Chronic disease of cardiovascular or pulmonary systems, renal dysfunction Healthcare personnel Residents of long-term care facilities Anyone wanting to decrease their chance of catching the flu Some benefit should a Pandemic flu outbreak occur Annual dose IM

31 Pneumococcal (polysaccharide)
Several types of pneumococcal disease; pneumonia, bacteremia, and meningitis Pneumonia most common; high fever, cough, rapid, difficult breathing People with asthma, chronic diseases of the lungs, heart, or kidneys are at risk People without a spleen, undergoing chemotherapy, infected with AIDS virus, or organ transplantation are also at greater risk Approximately 175,000 people are hospitalized each year with pneumonia Pneumonia – Lungs Bacteremia – Blood Meningitis – brain and spinal cord Spread person to person by coughing and sneezing

32 Pneumococcal (polysaccharide)
Adults 65 years of age and older High risk; chronic cardiovascular and pulmonary disease (including asthma), cigarette smokers and diabetes People without a spleen, undergoing chemotherapy, infected with the AIDS virus There may be occasions where a second dose is given (consult provider) One dose IM or SC

33 Hepatitis A Virus infects the liver
Symptoms include loss of appetite, vomiting, nausea, fatigue and jaundice Can cause rapid overwhelming infection of the liver and death Spread person to person or by contaminated food and water People who catch hepatitis A often don’t have any symptoms.

34 Hepatitis A Persons with chronic liver disease and persons who receive clotting factor concentrates Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A Men who have sex with men and persons who use illegal drugs Two doses 6-12 months apart IM

35 Hepatitis B Virus infects the liver
Spread by sexual contact, blood, saliva, or other body fluids About 100,000 people catch hepatitis B each year in the U.S. High risk populations most at risk First vaccine to prevent cancer (liver) High risk populations include: HBV is transmitted through activities that involve percutaneous (i.e., puncture through the skin) or mucosal contact with infectious blood or body fluids (e.g., semen, saliva), including Sex with an infected partner Injection drug use that involves sharing needles, syringes, or drug-preparation equipment Birth to an infected mother Contact with blood or open sores of an infected person Needle sticks or sharp instrument exposures Sharing items such as razors or toothbrushes with an infected person The rate of new HBV infections has declined by approximately 80% since 1991, when a national strategy to eliminate HBV infection was implemented in the United States. The decline has been greatest among children born since 1991, when routine vaccination of children was first recommended. Information Source is CDC.

36 Hepatitis B First vaccine to prevent cancer
Persons with end-stage renal disease, including patients receiving hemodialysis; persons seeking evaluation or treatment for a sexually transmitted disease (STD); persons with HIV infection; and persons with chronic liver disease Occupational indications: Health-care personnel and public-safety workers who are exposed to blood or other potentially infectious body fluids Behavioral indications: Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than 1 sex partner during the previous 6 months); current or recent injection-drug users; and men who have sex with men Three doses at 0, 1-2, 4-6 months apart IM

37 Meningococcal Bacterium that lives on the lining of the nose and throat of some people Approximately 2,500 people in the U.S. get this disease each year; some 300 die Approximately 400 people a year who survive have permanent disabilities such as seizures, loss of limbs, deafness, and mental retardation One of the most common complications is deafness , which affects around one in ten people, and can either be temporary or permanent.  Blindness is also a possible complication Anyone who has had bacterial or viral meningitis should have a hearing test – this is especially important for young children where hearing loss is often more difficult to detect. Children’s hearing tests are arranged through your GP or through your local hospital’s ear, Nose and Throat Department. During the illness, septicemia (blood poisoning) can occur, and in extreme cases can result in a diminished blood supply to the feet, toes, hands and fingers. This may result in the need for skins grafts or even amputation. Young lady is from Australia – was struck with the disease at age 18 and lost one leg (amputated).

38 Meningococcal Adults with anatomic or functional asplenia, or terminal complement component deficiencies. First-year college students living in dormitories; Persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic (e.g., portions of Africa during the dry season) Meningococcal conjugate vaccine is preferred for adults with any of the preceding indications who are aged <55 years, although meningococcal polysaccharide vaccine (MPSV4) is an acceptable alternative. Revaccination after 3–5 years might be indicated for adults previously vaccinated with MPSV4 who remain at increased risk for infection One or more doses (consult with provider) IM

39 Herpes zoster (shingles)
Shingles is caused by a reawakening of the chickenpox virus Symptoms – rash usually along nerve pathways Very painful and debilitating 20-30 of every 100 people can expect to get shingles in their lifetime

40 Herpes zoster (shingles)
Recommended for adults aged >60 years regardless of whether they report a prior episode of herpes zoster Persons with chronic medical conditions may be vaccinated unless a contraindication or precaution exists for their condition Single dose SC

41 Recommended Vaccines for Healthcare Workers
Healthcare workers should maintain an immunization history for: Hepatitis B Influenza * MMR Varicella (chickenpox) Tetanus, diphtheria, pertussis Meningococcal** * Receive annually ** For specific healthcare personnel

42 Vaccine Handling and Storage
Maintain cold chain – check temperatures twice daily Know where vaccines go – refrigerator/freezer Rotate stock – expiration dates Follow all manufacturer guidelines for storage and handling Consult TVFC Tool Kit

43 Screening Patients for Vaccines
Screen every patient regardless of reason for visit Utilize screening tools; H-A-L-O Health condition Age Lifestyle Occupation

44 Document Provide copy of Vaccine Information Statement (VIS) from CDC to patient Document: date vaccine given, vaccine manufacturer, lot number, date of VIS, date VIS was given to patient, site vaccine was given, vaccinator’s initials Required by law

45 Vaccine Administration
Ensure you are properly trained Always prepare and check the following for every injection or medication you give: Right Patient Right Drug (vaccine) Right Dose Right Route (intramuscular, intradermal) Right Time (is scheduling correct)

46 HPV Vaccine; the Communication Challenges
Vaccine recommendations (minimum age 9) Administer the first dose to females at age 11 or 12 years. Administer the second dose 2 months after the first dose and the third dose 6 months after the first dose (at least 24 weeks after the first dose). Administer the series to females at age 13 through 26 years if not previously vaccinated.

47 HPV Vaccine; the Communication Challenges
Basic Facts: HPV vaccine does not appear to cause any serious side effects. However, a vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. The risk of any vaccine causing serious harm, or death, is extremely small. Several mild problems may occur with HPV vaccine: Pain at the injection site (about 8 people in 10) Redness or swelling at the injection site (about 1 person in 4) Mild fever (100 degrees Fahrenheit) (about 1 person in 10) Itching at the injection site (about 1 person in 30) Moderate fever (102 degrees Fahrenheit) (about 1 person in 65) These symptoms do not last long and go away on their own. Life-threatening allergic reactions from vaccines are very rare. If they do occur, it would be within a few minutes to a few hours after the vaccination. Like all vaccines, HPV vaccine will continue to be monitored for unusual or severe problems.

48 Proposed School Rules Proposed changes to school rules were originally published in the Texas Register August 22, 2008 Proposed changes have not been approved or adopted (anticipate January or February 2009) When adopted the proposed changes will not take effect until August 1, 2009 Changes synchronize school rules with the Advisory Committee on Immunization Practices (ACIP) age appropriate immunization schedules

49 Proposed School Rules Meningococcal Vaccine* Beginning School Year (SY) , 7th grade requirement Varicella Vaccine Beginning (SY) , 2 dose requirement for kindergarten and 7th grade entry Tdap Vaccine Beginning SY , a booster dose requirement for Tdap for 7th grade MMR Vaccine Beginning SY , 2 dose requirement of MMR vaccine for kindergarten entry Hepatitis A Vaccine Beginning SY , 2 dose requirement for kindergarten entry statewide General revisions incorporated that clarify or simplify language throughout the rules relating to the school and child care requirements.

50 Vaccinate for Life! Presented by: John Gemar
Adolescent/Adult Immunization Coordinator For more information contact: Texas Department of State Health Services


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