Immunization update 2013
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Immunization Update 2013. Liza Chapman, Pharm.D . GPhA Annual Meeting. Faculty disclosure. Liza Chapman has no disclosures to declare at this time. objectives. Review the changes/developments made to the immunization recommendations during the past year

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Immunization Update 2013

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Immunization update 2013

Immunization Update 2013

Liza Chapman, Pharm.D.

GPhA Annual Meeting


Faculty disclosure

Faculty disclosure

  • Liza Chapman has no disclosures to declare at this time


Objectives

objectives

  • 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


U s adult vaccination rates 2011

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


Recent disease outbreaks

Recent Disease Outbreaks

  • 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 Epidemic3

    • 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

APhA IMZ CTP, 04.2013

1. Measles. www.cdc.gov/measles

2. MMWRMorb MortalWkly Rep. 2012;61:986-989

3. CDC Pertussis Report (www.cdc.gov/pertussis)


Recap from 2013 national adult and influenza immunizations summit

Recap from 2013 National adult and Influenza Immunizations Summit


Hepatitis b

Hepatitis b


Hepatitis b1

Hepatitis b

  • 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)

New ACIP recommendation


Self assessment

Self-Assessment

  • How many doses must a patient receive to complete the Hepatitis B series?

    • 1 Dose

    • 2 Doses

    • 3 Doses

    • 4 Doses


Self assessment1

Self-Assessment

  • 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?

    • Influenza

    • Pneumococcal

    • Zoster

    • Hepatitis B

    • All of the above


Influenza

Influenza


Review of 2013 13 influenza season

Review of 2013-13 Influenza Season


Hcp s and influenza vaccinations

HCPsand Influenza vaccinations

http://www.cdc.gov/flu/fluvaxview/hcp-ips-nov2012.htm


Hcp s and influenza vaccinations1

HCPsand Influenza vaccinations

http://www.cdc.gov/flu/fluvaxview/hcp-ips-nov2012.htm


Hcp s and influenza vaccinations2

HCPsand Influenza vaccinations

http://www.cdc.gov/flu/fluvaxview/hcp-ips-nov2012.htm


Hcp s and influenza vaccinations3

HCPsand Influenza vaccinations

http://www.cdc.gov/flu/fluvaxview/hcp-ips-nov2012.htm


2013 14 influenza vaccine strains

2013-14 Influenza Vaccine Strains

  • 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 presentations

2013-14 Influenza presentations

http://www.cdc.gov/flu/protect/vaccine/vaccines.htm


New manufacturing technologies

New Manufacturing Technologies

  • Cell cultured vaccine

  • Recombinant HA vaccine


Selecting the best product for your patient

Selecting the best product for your patient

  • 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


Influenza vaccine and egg allergies

Influenza Vaccine and Egg Allergies

  • 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

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6132a3.htm#egg_allergy


Influenza vaccine and egg allergies1

Influenza Vaccine and Egg Allergies

APhA IMZ CTP, 04.2013


Self assessment2

Self-assessment

  • Which influenza vaccine would you recommend for R.J.?

    • LAIV

    • IIV3

    • IIV4

    • Fluzone HD

    • Fluzone ID


Meningitis

Meningitis


Meningococcal vaccine

Meningococcal Vaccine

  • 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


Pneumococcal

Pneumococcal


Pneumococcal vaccine

Pneumococcal Vaccine

  • 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 pneumoniaeserotypes

    • For the prevention of otitis media caused by 7 Streptococcus pneumoniaeserotypes

  • FDA approved for adults aged 50 years and older (Not ACIP recommended for routine use)

  • Dose and route: 0.5 mL IM


Pcv 13

PCV 13

  • 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

APhA IMZ CTP, 04.2013


Pcv 13 and adults

PCV 13 and Adults

  • 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

APhA IMZ CTP, 04.2013


Pcv 13 and immunocompromised adults

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


Self assessment3

Self-Assessment

  • 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?

    • No wait

    • 4 weeks

    • 8 weeks

    • 12 weeks


T dap

Tdap


Pertussis surveillance

Pertussis Surveillance

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


Pertussis outbreaks

Pertussis Outbreaks

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


T dap1

Tdap


Self assessment4

Self-assessment

  • 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?

    • Yes

    • No


Travel vaccines

Travel vaccines

  • 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


Make sure you are up to date

Make sure you are up to date

  • www.cdc.gov

    • MMWR

    • Epidemiology and Prevention of Vaccine-Preventable Diseases

    • 2012 Yellow Book

  • www.immunize.org

    • IAC Express

    • Current VISs

  • www.pharmacist.com/immunization-center


Questions

Questions

  • Liza Chapman

    • [email protected]


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