Presentation on theme: "Vaccinate for Life. The Texas Department of State Health Services"— Presentation transcript:
1Adolescent/Adult Immunization Program: Update for School Nurses, January 2009 Vaccinate for Life.The Texas Department of State Health ServicesImmunization BranchAdolescent/Adult Immunization Program
2Presentation Objectives Describe the Texas Adolescent/Adult Immunization (AAI) ProgramDescribe changes to the Recommended Immunization Schedules for Persons Aged 0 Through 18 Years – U.SDescribe changes to the Recommended Adult Immunization Schedule – U.S. 2009Identify adolescent & adult vaccines, indications and useDiscuss HPV vaccine and communication challengesIdentify vaccine myths and describe vaccine factsDescribe proposed school rules for 2009 and beyond
3Presentation Overview Adolescent/Adult Immunization (AAI) ProgramChanges to CDC Recommendations for Adolescent and Adult Immunization SchedulesAdolescent and Adult VaccinesVaccines and Healthcare WorkersHPV vaccine communication challengesVaccine myths vs. factsSchool rules for 2009 and beyond
4The 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.
5The AAI Program: Background Early Focus on ChildrenNew Vaccines and RecommendationsIncreased FundingPersonnel
6Vaccines Work!Vaccines are recognized as one of the top 10 most effective public health interventions
710 Greatest Public Health Achievements 1900-1999 Vaccines Work!10 Greatest Public Health AchievementsHealthier momsand babiesSafer workplaceSafer andhealthierfoodsTobacco as ahealth hazardDecline in deaths fromcoronary heart diseaseFluoridation ofdrinking waterMotor-vehicle safetyFamily PlanningVaccinations&Control ofInfectious DiseaseThe 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.
9Pakistan - 118Nigeria - 788India - 549Retrieved January 7, 2009 from
10Vaccines Aren’t Just for Kids Sometimes vaccines do not provide lifelong protectionSometimes the virus or bacteria changes through timeSometimes the aging immune system becomes susceptible to diseases that were less of a threat at an earlier ageAs 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, influenzaViruses and bacteria change over time – influenzaOlder age groups more susceptible – shingles, pneumococcus
11Changes to Recommended Immunization Schedules for Persons Aged 0 Through 18 Years – United States, 2009Recommendations 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.
12Changes to Recommended Immunization Schedules for Persons Aged 0 Through 18 Years – United States, 2009The 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.
13Changes to Recommended Immunization Schedules for Persons Aged 0 Through 18 Years – United States, 2009Catch-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)
14Recommended Adolescent Immunization Schedule by Age, 2009
18Recommended Adult Immunization Schedule by Medical Indication
19Recommended 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.
21Td 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 breathPertussis – bacterium that causes thick, sticky mucus that clogs the windpipe, also known as whooping cough in childrenTetanus – 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 notyet 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 18receive a Tdap booster, which also protects against tetanus and diphtheria It is also recommended that adults ages receive a single dose of Tdap for pertussisprotection, especially those who have close contact with infants less than 12 months of age.
22Td or TdapTdap should replace a single dose of Td for adolescents and adults aged 64 years and younger who have not previously received a dose of TdapThere are two Tdap products.Adacel® manufactured by Sanofi Pasteur for ages 11-64Boostrix® manufactured by GlaxoSmithKline for agesOne dose of Tdap (substitute for Td)Three dose series if never vaccinated at 0 and 4 weeks, the third 6-12 months after secondOne dose booster of Td every 10 yearsAn interval of less than 5 years may be used if pertussis immunity is needed.** Consult package insert, schedule,and providerIntramuscular (IM) Injection Technique
23Human Papillomavirus (HPV) A virus that infects the genitals and the lining of the cervixThere are many different types of HPV – some cause cervical cancerHPV vaccine is the second vaccine to prevent a form of cancer (cervical)C E R V I C A LC A N C E R
24Human Papillomavirus (HPV) Recommended for femalesages 9 – 26Ideally, vaccine should be given before potential exposure to HPV through sexual activity; however, females who are sexually active should still receive the vaccineThree 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
25Measles, mumps, rubella (MMR) Measles – Infects the lining of the back of the throat and nose; can infect lungs and brain causing permanent damage or deathMumps – Painful swelling of the parotid glands; infects lining of brain/spinal cordRubella – Causes swelling of glands, rash, and fever; can cause permanent and severe birth defectsMeasles - Very contagious – coughing and sneezingMumps - 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.
26Measles, 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 vaccinePeople entering collegeHealthcare workersInternational travelersSpecific guidelines from the schedule should be followedTwo doses (consult provider)Subcutaneous (SC) Injection Technique
27Varicella (chickenpox) Very contagious coughing/sneezingFever and many small blistersComplications include pneumonia, brain swelling, and severe skin infectionsApproximately 35 of every 100 deaths from chickenpox are in adultsPicture of 30 year old female.
28Varicella (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 weeksSC
29Influenza (flu) Infects the respiratory system Complications include pneumonia, fever, croup, and bronchitisPeople with asthma, chronic diseases of the lungs, heart, or kidneys are at greater riskMost deaths from flu occur in people 65 or older
30Influenza (flu) Annual vaccine Recommended for children 6 months through 18 yearsChronic disease of cardiovascular or pulmonary systems, renal dysfunctionHealthcare personnelResidents of long-term care facilitiesAnyone wanting to decrease their chance of catching the fluSome benefit should a Pandemic flu outbreak occurAnnual doseIM
31Pneumococcal (polysaccharide) Several types of pneumococcal disease; pneumonia, bacteremia, and meningitisPneumonia most common; high fever, cough, rapid, difficult breathingPeople with asthma, chronic diseases of the lungs, heart, or kidneys are at riskPeople without a spleen, undergoing chemotherapy, infected with AIDS virus, or organ transplantation are also at greater riskApproximately 175,000 people are hospitalized each year with pneumoniaPneumonia – LungsBacteremia – BloodMeningitis – brain and spinal cordSpread person to person by coughing and sneezing
32Pneumococcal (polysaccharide) Adults 65 years of age and olderHigh risk; chronic cardiovascular and pulmonary disease (including asthma), cigarette smokers and diabetesPeople without a spleen, undergoing chemotherapy, infected with the AIDS virusThere may be occasions where a second dose is given (consult provider)One doseIMorSC
33Hepatitis A Virus infects the liver Symptoms include loss of appetite, vomiting, nausea, fatigue and jaundiceCan cause rapid overwhelming infection of the liver and deathSpread person to person or by contaminated food and waterPeople who catch hepatitis A often don’t have any symptoms.
34Hepatitis APersons with chronic liver disease and persons who receive clotting factor concentratesPersons traveling to or working in countries that have high or intermediate endemicity of hepatitis AMen who have sex with men and persons who use illegal drugsTwo doses 6-12 months apartIM
35Hepatitis B Virus infects the liver Spread by sexual contact, blood, saliva, or other body fluidsAbout 100,000 people catch hepatitis B each year in the U.S.High risk populations most at riskFirst 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), includingSex with an infected partnerInjection drug use that involves sharing needles, syringes, or drug-preparation equipmentBirth to an infected motherContact with blood or open sores of an infected personNeedle sticks or sharp instrument exposuresSharing items such as razors or toothbrushes with an infected personThe 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.
36Hepatitis 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 diseaseOccupational indications: Health-care personnel and public-safety workers who are exposed to blood or other potentially infectious body fluidsBehavioral 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 whohave sex with menThree doses at 0, 1-2, 4-6 months apartIM
37MeningococcalBacterium that lives on the lining of the nose and throat of some peopleApproximately 2,500 people in the U.S. get this disease each year; some 300 dieApproximately 400 people a year who survive have permanent disabilities such as seizures, loss of limbs, deafness, and mental retardationOne 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 complicationAnyone 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).
38MeningococcalAdults 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 infectionOne or more doses (consult with provider)IM
39Herpes zoster (shingles) Shingles is caused by a reawakening of the chickenpox virusSymptoms – rash usually along nerve pathwaysVery painful and debilitating20-30 of every 100 people can expect to get shingles in their lifetime
40Herpes zoster (shingles) Recommended for adults aged >60 years regardless of whether they report a prior episode of herpes zosterPersons with chronic medical conditions may be vaccinated unless a contraindication or precaution exists for their conditionSingle doseSC
41Recommended Vaccines for Healthcare Workers Healthcare workers should maintain an immunization history for:Hepatitis BInfluenza *MMRVaricella (chickenpox)Tetanus, diphtheria, pertussisMeningococcal*** Receive annually** For specific healthcare personnel
42Vaccine Handling and Storage Maintain cold chain – check temperatures twice dailyKnow where vaccines go – refrigerator/freezerRotate stock – expiration datesFollow all manufacturer guidelines for storage and handlingConsult TVFC Tool Kit
43Screening Patients for Vaccines Screen every patient regardless of reason for visitUtilize screening tools; H-A-L-OHealth conditionAgeLifestyleOccupation
44DocumentProvide copy of Vaccine Information Statement (VIS) from CDC to patientDocument: date vaccine given, vaccine manufacturer, lot number, date of VIS, date VIS was given to patient, site vaccine was given, vaccinator’s initialsRequired by law
45Vaccine Administration Ensure you are properly trainedAlways prepare and check the following for every injection or medication you give:Right PatientRight Drug (vaccine)Right DoseRight Route (intramuscular, intradermal)Right Time (is scheduling correct)
46HPV 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.
47HPV 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.
48Proposed School RulesProposed changes to school rules were originally published in the Texas Register August 22, 2008Proposed changes have not been approved or adopted (anticipate January or February 2009)When adopted the proposed changes will not take effect until August 1, 2009Changes synchronize school rules with the Advisory Committee on Immunization Practices (ACIP) age appropriate immunization schedules
49Proposed School RulesMeningococcal Vaccine* Beginning School Year (SY) , 7th grade requirementVaricella Vaccine Beginning (SY) , 2 dose requirement for kindergarten and 7th grade entryTdap Vaccine Beginning SY , a booster dose requirement for Tdap for 7th gradeMMR Vaccine Beginning SY , 2 dose requirement of MMR vaccine for kindergarten entryHepatitis A Vaccine Beginning SY , 2 dose requirement for kindergarten entry statewideGeneral revisions incorporated that clarify or simplify language throughout the rules relating to the school and child care requirements.
50Vaccinate for Life! Presented by: John Gemar Adolescent/Adult Immunization CoordinatorFor more information contact:Texas Department of State Health Services