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Preventing Influenza

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Preventing Influenza Prevent all the Disease You Can Then Treat the Rest. John D. Grabenstein * * * * * * * * * * * * Obtain Informed Consent Provides ... – PowerPoint PPT presentation

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Title: Preventing Influenza


1
Preventing Influenza
  • Prevent all the Disease You Can Then Treat the
    Rest.
  • John D. Grabenstein

2
Seasonal Influenza Vaccines
  • Live Attenuated Influenza Vaccine (LAIV)
  • (Flu Mist)
  • Trivalent Inactivated Influenza Vaccine (TIV)
  • (Fluzone, Fluviron, Fluarix, FluLaval, Afluria)
  • -not all created equal

3
Target groups for Influenza Vaccination
  • Children age 6 months through 18 years old
  • Pregnant women
  • Caregivers
  • Healthcare workers
  • Elderly (gt 50 years old!) (ACIP not me!)
  • Nursing home patients
  • People with chronic pulmonary, cardiovascular,
    renal, hepatic, immuno-supression,
    neuro-muscular, hematological or metabolic
    conditions.
  • Any person who wishes to reduce the likelihood of
    becoming ill with or transmitting influenza to
    others.

4
Can the vaccine cause the Flu?
  • NO!
  • TIV (the shots) cannot cause influenza because it
    is an inactivated vaccine.
  • LAIV (the spray) cannot cause influenza because
    it cannot replicate in the temperature of the
    lower respiratory tract and dies at temps gt38C.
    It only lives in the upper respiratory tract and
    and can cause Influenza-like Illness, but not
    the full blown disease.

5
Flu Mist (Live Attenuated Vaccine)
  • Intranasal spray
  • Healthy, non-pregnant patients aged 2-49 years.
  • Not recommended within 7 days of taking care of
    severely immunocompromised patients (Not
    recommended for HCW!)
  • Dose Total of 0.2ml (0.1ml in each nostril) for
    all patients aged 2-49 years

6
Children aged 2-8 years
  • If child aged 2- 8 years is receiving Influenza
    vaccine for the first time, they should get a
    second dose at least 4 weeks after the initial
    dose within the same flu season.
  • If child being vaccinated for the first time and
    receives only one dose-but does not return for
    the second dose that year, how many doses should
    that child receive the next year if still lt 9
    years old?

7
Start all over again!
  • Administer 2 doses (at least 4 weeks apart) to
    children age 9 years or younger who are receiving
    influenza vaccine for the first time or who were
    vaccinated for the first time during the previous
    influenza season but only received 1 dose for
    that year.
  • ACIP (Advisory Committee on Immunization
    Practices) www.cdc.gov/vaccines/recs/acip

8
Who should NOT get LIVE vaccine?
  • Allergic to eggs
  • Children less than 2 years of age
  • Children aged 2-4 years with asthma or wheezing
  • Children or adolescents on long-term aspirin
    therapy
  • Adults gt 50 years of age
  • Patients with chronic medical conditions
  • Pregnant women
  • Immunosuppressed/Immunodeficiency patient
  • Close contacts of these patients (some shedding
    of vaccine virus occurs though transmission to
    others is rare.)
  • Previous history of Guillain-Barre syndrome

9
Inactivated Influenza Vaccine
  • Age 6-35 mon (lt3 years) 0.25ml IM
  • (2 doses if first time, 1 month apart)
  • Age 3 to lt 9 years 0.5ml IM
  • (2 doses if first time, 1 month apart)
  • gt 9 years adults 0.5ml IM

10
Not All IM Vaccines Created Equal!
  • Only Fluzone approved for all ages (6
    months through adult)
  • Fluvirin only approved for age gt 4 years
    through adult
  • Afluria, Fluarix, FluLaval only for age
  • gt18 years to through adult

11
Who should not get TIV shots?
  • Allergic to eggs
  • Younger than 6 months old

12
How do I store my flu shots and Spray?
  • Refrigerated at 2-8C (35-46F)
  • Do not Freeze

13
H1N1 Vaccines
  • Monovalent Vaccine
  • A/Calif/07/2009(H1N1)
  • Made by the same manufacturers and by same
    processes as the Trivalent Vaccine for seasonal
    influenza
  • 250 million doses purchased by US Govt.
  • Producing about 20 million doses/week

14
Who gets H1N1 vaccine?
  • Same indications as for seasonal influenza

    (especially children gt 6mon-24yrs, care providers
    to children, pregnant women, healthcare
    emergency personnel, high risk conditions age
    25-64yrs)
  • Shots recommended for ages gt 6mon
  • Spray recommended for ages gt 2 years

15
H1N1 Quick Facts
  • 98 of current circulating influenza cases
  • Only 1 of cases are gt 65 years old
  • 4x risk of miscarriage if pregnant

16
Offering Other Vaccines?
  • Pneumococcal 23-valent (Pneumovax)?
  • Streptococcus Pneumoniae
  • Not just for pneumonia!
  • More efficacious for bacteremia than pneumonia
    (85-90 of serotypes)

17
Who Gets Pneumococcal Vaccine?
  • Adults gt 65 years old
  • Age 19-64 who smoke or have asthma
  • Age 2-64 years with chronic illnesses
  • -Cardiovascular, Pulmonary, Metabolic,
    Immunosupression, Asplenia, Hepatic, Renal
    Disease
  • ACIP recommendations
  • www.cdc.gov/vaccines/pubs/acip-list.htm

18
Dosing of Pneumococcal Vaccine
  • 0.5ml IM (or SQ if you like the pain!)
  • For ages gt 65 years one time dose if 1st time
    receiving.
  • For patients who got 1st dose PRIOR to age 65
    years, should get a 2nd dose at age 65years or
    after, once 5 years have passed since 1st dose.

19
Can vaccines cause Guillain-Barre Syndrome?
  • Immune Dysfunction where system attacks itself
    causing nerve damage.
  • Can cause permanent nerve damage, paralysis or
    death.
  • Rare but can happen with any infection.
  • Finding with some vaccines
  • BUT NOT at a higher rate in people being
    vaccinated (no causual data found)
  • www.iom.edu

20
Statistically ?
  • 1976-increased risk by 1 in 100,000 people who
    received swine flu vaccine
  • (reason undetermined.)
  • Recently 1 in 1,000,000 vaccinated for seasonal
    flu may be at risk.

21
Institute of Medicine Safety Review
  • Vaccines and autism
  • Thimerosal-containing vaccines and
    neurodevelopmental disorders
  • Vaccines and Sudden Infant Death
  • Multiple vaccines and immune dysfunction
  • Influenza and neurological complications

22
  • www.iom.edu/CMS/2955.aspx
  • Look at executive summaries for information on
    each

23
Credible Vaccine Websites
  • www.cdc.gov/vaccines
  • www.immunize.org
  • www.who.int/immunization_safety_quality/approved_v
    accine_safety_websites/en/index.html

24
Anti-Vaccine Groups
  • National Vaccine Information Center
  • Alliance for Informed Choice in Vaccination
  • Healthy Alternatives
  • People Advocating Vaccine Education
  • Vaccine Information Resource Center
  • Natural Immunity Information Network

25
Lets Go Vaccinate!
  • Patients make vaccine decisions based on
  • Perceived susceptibility to the disease
  • Perceived seriousness of the disease
  • Perceived vaccine benefits
  • Perceived barriers (adverse reactions, access,
    cost, time)
  • Social Influence (friends, family, healthcare
    workers)

26
Misconceptions About Vaccines
  • Diseases were disappearing before vaccines
  • No need to continue vaccinating
  • Vaccines cause harmful effects
  • People with disease were vaccinated
  • Hot lots of vaccine exist
  • Multiple vaccinations cause system overload
  • www.who.int/immunization_safety/aefi/immunization_
    misconceptions

27
Adverse Events Following Influenza Vaccination
  • TIV shots- Injection Site soreness
  • LAIV spray mild form of natural disease
  • Syncope
  • Anaphylaxis

28
Treating Serious Adverse Events
  • Allow for fainting without injury, plus access to
    hard surface if need CPR
  • Epinephrine 0.01mg/kg up to 0.5mg repeat every
    5-10min
  • Train staff and practice emergency plan
  • 911 (EMS) epinephrine CPR/BLS

29
True vs. False Allergy
  • True Immediate hypersensitivity (typically
    within minutes)
  • -itching, erythema, hives, urticaria symptoms
    progressing toward anaphylaxis
  • (shock, angioedema, severe bronchospasm,
    cardiovascular collapse)
  • False allergy
  • Fever, GI upset, neurologic events

30
Vasovagal Syncope
  • Loss of consciousness
  • Extreme paleness
  • Sweating
  • Coldness of hands and feet
  • Nausea
  • Light-headedness
  • Dizziness
  • Visual disturbances

31
Frequency and timing
  • 63 with lt 5 minutes post-vaccination
  • 8 within 15 minutes of vaccination
  • 35 reported in patients age 10-18 years
  • 71 reported in women
  • 14 of episodes result in hospitalization
  • (from injuries.)
  • Observe patient for suitable time after
    vaccination. ACIP guidelines 15 minutes

32
Screening and Consulting
  • Have you ever reacted to a vaccine?
  • Do you have allergies to food, medications
    vaccines? (Especially EGGS for influenza)
  • Do you have any medical conditions?
  • Do you or anyone in your care or household have
    cancer, HIV, take prednisone?
  • Hare you sick today?

33
Vaccine Information Statement
  • Provide to each patient/caregiver
  • -updated annually
  • -provides an overview of benefits and risks of
    vaccination
  • -required by law to provide patients with most up
    to date version
  • www.cdc.gov/vis
  • www.immunize.org

34
Obtain Informed Consent
  • Provides documentation
  • Provides record for patient (must be kept for the
    patients lifetime)
  • Decreases liability/litigation

35
Documentation Requirements
  • Name of patient
  • Date vaccine administered
  • Vaccine Manufacturer
  • Vaccine Lot Number
  • Name, address, title of person administering the
    vaccine
  • Date printed on VIS
  • Date the VIS given to patient or representative

36
National Vaccine Injury Compensation Program
  • Act passed in 1986
  • Excise tax levied each dose of vaccine sold in
    the United States.
  • No fault insurance fund to cover vaccine-related
    injuries.
  • If patient experiences an event listed, the
    patient can be awarded damages through the VICP
    fund.
  • Must file a claim with the VICP, satisfy
    eligibility requirements to receive compensation.

37
  • The reward for work well done is the opportunity
    to do more.
  • -Jonas Salk

38
VAERS
  • Vaccine Adverse Events Reporting System
  • Alerts manufacturers and CDC of adverse events
  • www.vaers.hhs.gov
  • Or www.cdc.gov/vaccinesafety
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