13th Annual Medical Assistant Immunization Update CENTRAL VALLEY IMMUNIZATION COALITION
Tom Booth, RN, BSN, PHN Supervising Public Health Nurse County of Fresno Department of Public Health Immunization Program (559) 600-3550 firstname.lastname@example.org
Disclosures • The speaker has no financial conflict with manufacturers of any product named in this presentation. • The use of trade names and commercial sources during this presentation is for identification only, and does not imply endorsement by the presenter, the Central Valley Immunization Coalition, Vaccines for Children, or the County of Fresno.
SINCERE THANKS TO: • ANTHEM BLUE CROSS • CDPH- CAIR TEAM • CDPH- IMMUNIZATION BRANCH • CHDP • FRESNO COUNTY IMMUNIZATION PROGRAM • GLAXOSMITHKLINE • HEALTH NET • KINGS COUNTY IMMUNIZATION PROGRAM • MADERA COUNTY IMMUNIZATION PROGRAM • MEDIMMUNE • MERCK • NOVARTIS • PFIZER • SANOFI-PASTEUR • TULARE COUNTY IMMUNIZATION PROGRAM • TULARE COUNTY PROFESSIONAL DEVELOPMENT CENTER • UNITED HEALTH CENTERS • VFC
Resources • Central Valley Immunization Coalition http://centralvalleyiz.org/ • Vaccines for Children (EZIZ) http://eziz.org/ • Immunization Action Coalition http://www.immunize.org/ • The Pink Book onlinehttp://www.cdc.gov/vaccines/pubs/pinkbook/index.html
USA Childhood and Adolescent Vaccine Recommendations • National (federal) recommendations are developed and harmonized by American Academy of Pediatrics (AAP), American Academy of Family Practice (AAFP) and the Advisory Committee on Immunization Practices (ACIP) • ACIP Meetings and recommendations • Schedule published yearly (February) • Requirements are state specific • child care • school laws
Vaccine Quality Office Management • Vaccines and vaccine management should be a part of all office staff meetings • Many new vaccines and preparations • More coming! • Competency in all aspects of immunization should be documented for all staff • Don’t assume anything!
Vaccine Management • The right storage equipment 2009 VFC storage equipment requirements • For questions, check with VFC reps. • Staff education • Involve everyone in the office • Storage temperatures • Monitoring protocols or policies (twice a day documentation) • Thermometer maintenance • Plan to handle storage problems
Refrigerator 35°- 46° F (2°-8° C) Freezer Varicella, MMR, MMRV + 5°F (-15° C) or colder Recommended Vaccine Storage Temperatures 32° is freezing
Be Prepared! Have anEmergency Vaccine Plan If the patient has a reaction to a vaccine… • Call for MD • Call 911 • Simple medical protocol
Freezers • Inexpensive • Available in a variety of sizes
Patient Encounter • Have an exact vaccine order in writing • Order must be written • Check and double check! • Prepare vaccines carefully • Stay focused and undisturbed, set it up as a quiet room • Read labels and expiration dates • Ask someone if you do not understand • When using new vaccines all staff need education before using the vaccine
Quiz: Which are Contraindications? • MILD UPPER RESPIRATORY INFECTION • CURRENT ANTIBIOTIC TREATMENT • TEMPERATURE OF 100 F • MILD DIARRHEA
False Contraindications • Mild illness • Low grade fever • Antibiotics “Get them while you’ve got them”
Parent Education/Concerns http://www.cdc.gov/vaccinesafety/Concerns/Index.html • Autism? • Mercury in thimerisol? • Won’t all these shots overwhelm the immune system? ASK PARENTS: TO WHICH DISEASES DO YOU WANT YOUR CHILD LEFT VULNERABLE???
Number of Vaccines in the Routine Childhood and Adolescent Immunization Schedule 2008 Measles RubellaHep B Varicella Mumps Diphtheria Pneumoccal Influenza Tetanus Meningococcal Pertussis HepA Polio Rotavirus Hib (infant) HPV 1995 Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Hib (infant) Hep B Varicella 1985 Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio 7 16 10
Check expiration dates Month/Day/Year Day/Month/Year
The Five Rights • RIGHT PATIENT • RIGHT ROUTE • RIGHT DOSE • RIGHT TIME • RIGHT MEDICATION
Are you using these? You should it is Federal Law http://www.immunize.org/vis/
2012 ADULT SCHEDULE FIGURE 1. Recommended adult immunization schedule, by vaccine and age group1— United States, 2012 Centers for Disease Control and Prevention. Recommended adult immunization schedule—United States, 2012. MMWR 2012;61(4).
2012 ADULT SCHEDULE FIGURE 2. Vaccines that might be indicated for adults, based on medical and other indications1 — United States, 2012 Centers for Disease Control and Prevention. Recommended adult immunization schedule—United States, 2012. MMWR 2012;61(4).
Adult Patients • Annual Flu Vaccine • Tdap (new baby) • Pneumococcal • Hepatitis A and/or Hepatitis B • Shingles • Vaccines for Foreign Travel
Two Rotavirus Vaccines THREE DOSE 2,4,6 Months TWO DOSE 2 & 4 Months
Many DTaP, Tdap containing products Know how to read the vials and syringes
Replaced by …,.. COMPANY WHO MAKES THE VACCINE PFIZER (WYETH)
Prevnar 13 (PCV 13) Complicated catch-up recommendationsAll children under 4 years and 6 months should have at least one dose of PCV 13