Oregon HPV vaccine quarterly report

by Sara Beaudrault

The Centers for Disease Control and Prevention (CDC) now provides quarterly human papillomavirus vaccine (HPV) reports to state and local immunization programs to document progress toward reaching the Healthy People 2020 goal of 80% coverage with three doses. Since the HPV vaccine’s introduction, coverage at the national level and in most states, including Oregon, has increased at a very slow pace.

Oregon’s first quarterly HPV report is available on the Oregon Immunization Program’s Adolescent Immunizations webpage. Other reports and resources are also available on this page, including a link to CDC’s You Are the Key to Cancer Prevention toolkit for healthcare providers.

With over 14 million new HPV infections each year, most acquired during the teen years and 20s, increasing HPV vaccination uptake among today’s young people is critical to prevent future HPV-associated cancers.

CDC and the Oregon Immunization Program urge healthcare providers to strongly recommend all adolescent vaccines recommended for boys and girls aged 11-12 years. We encourage providers to recommend and promote HPV vaccine just as they recommend Tdap, meningococcal, and influenza vaccines.

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The Journey to Become a Certified Medical Assistant

by Jeanine Whitney RN, MSN, NHE-C

Did you ever wonder about the qualifications of the person who holds the power of the needle? Vaccines are being given more and more by healthcare workers other than a Registered Nurse. In fact, chances are good that the person holding the syringe is not an RN but could well be an immunizing pharmacist or a Medical Assistant (MA). There are many categories of MAs, each with its own education and certification requirements. In this article, we explore the unique education and certification requirements for Certified Medical Assistants (CMA).

All MAs undergo a rigorous course of study, but the American Association of Medical Assistants (AAMA)-required course of study for CMAs must be certified by the Commission on Accreditation of Allied Health Education Programs (CAAHEP: http://www.caahep.org/) and/or the Accrediting Bureau of Health Education Schools (ABHES: http://www.abhes.org/). This is different from many MA programs, whose accreditation falls under the school, and it means that CMA students everywhere receive standardized training that conforms to CAAHEP requirements.

The CMA training curriculum ensures that CMA students gain competency in a wide variety of areas. I contacted Virginia Chambers1, CMA (AAMA), BS, MHA, who is the Medical Assisting Department Co-Chair at Portland Community College (PCC). She shared the list of required competencies for a CMA. By the time students sit for their exams, they are well-versed in basic practice finances, communication, managed care and insurance, medical coding, legal issues, and of course, patient care. CMAs are able to step in and fill any number of roles for their employers because of this comprehensive training.

CMA certification exams also differ from those for other MAs. I took the opportunity to speak with Paula Purdy2, CMA (AAMA), who is Director of Operations for Medical Society Services, Inc., about these differences.

“The one big difference,” according to Ms. Purdy, “is that the AAMA certifying board is the only medical assisting certifying agency that uses the National Board of Medical Examiners (NBME) as the consultant for its certification examination.  CMA (AAMA) exam scoring metrics are processed by the same professional psychometricians who provide this service for United States Medical Licensing Exam (USMLE) candidates. The CMA (AAMA) exam is a highly valid and reliable indicator of the knowledge necessary to be a competent medical assistant.” The AAMA exam is not easy. The overall student pass rate is 67 percent.  At the time of this writing, PCC is the only school in the Portland metropolitan area that has a 95 percent or above student pass rate.

The AAMA requires recertification every 5 years. In those five years, the CMA (AAMA) must earn 60 continuing education units (CEU).These CEUs must reflect the breadth of training areas.  Ten CEUs must be administrative; ten CEUs must be general; and ten CEUs must be clinical. The CMA can choose how to fulfill the remaining thirty CEUs. If the CMA (AAMA) doesn’t complete the CEUs on time, they have six months from the expiration date to do so or they must sit for the exam again.

Keep in mind that all MAs are under the direct delegation of the hiring physician. An RN can observe and teach an MA. RNs can also supervise an MA and delegate tasks to them according to Oregon State Board of Nursing (OSBN) Nurse Practice Act Division 45 and 47. RNs can delegate several types of tasks to MAs, but immunization injections are not one of the tasks. The hiring practitioner delegates immunization injections to the MA.

Are any Oregon employers putting credentialed healthcare workers to work? Yes. Cathy Cassata in CMA Today magazine3 (Nov-Dec 2013) talks about CMAs and the Oregon Health and Science University ambulatory care services. “As of April 1, 2013, all newly hired medical assistants are required to become CMAs (AAMA) within six months of being hired.”  We can add Providence, Legacy, Kaiser, and Adventist to the list of employers that actively recruit AAMA-certified individuals for their practice sites. Oregon has approximately 1,200 CMAs (AAMA) in practice.

The next time you get a vaccine, take a good look at the initials after the name of the person holding the needle. If there are none, then ask. It may well be a CMA (AAMA). If so, you are in well-educated and credentialed hands.

1PCC-Willow Creek:  http://www.pcc.edu/about/locations/willow-creek/.

 2 Certified Medical Assistant (CMA) American Association of Medical Assistants (AAMA) ®, the current Public Affairs Liaison Team Manager and past State President (2013) of the River Cities Chapter of Medical Assistants (CMA,AAMA): http://www.aama-ntl.org/) Ms. Purdy currently serves on the AAMA Board of Trustees.

3Cassata, Cathy. Trailblazers: Oregon employer hitches its wagon to CMAs (AAMA) (OM). Nov-Dec 2013. CMA Today. Listed at http://www.aama-ntl.org/docs/default-source/index/2013index.pdf?sfvrsn=2

Note: The following original sentence was corrected on 12/8/14 in the text below: An RN can observe, teach and report on an MA but cannot delegate tasks or duties to an MA. More information on the Nurse Practice Act, which is mentioned in the corrected sentence, can be found at: http://www.oregon.gov/OSBN/pages/adminrules.aspx

Jeanine Whitney is an active member of the PCC Willow Creek Education Advisory Team and has worked with the Program Advisory Committee at Anthem College.

For additional certification information, please contact individual institutions or the Accrediting Bureau of Health Education Schools at http://www.abhes.org/news/show/291.

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Upcoming Portland Metro Area Flu Vaccine Clinics

The following flu vaccine clinics are taking place in the Portland Metro Area. All of these clinics will provide no cost flu vaccine to adults, regardless of insurance status. We will also be posting about upcoming clinics on the Flu Oregon and Oregon Immunization Program Facebook pages

November 5, 2014 from 12pm-5pm at Transition Projects, 650 NW Irving St, Portland Or (sponsored by Family Care)

November 11, 2014 varying times at 6 Legacy Health Locations (please visit http://www.legacyhealth.org/our-legacy/stay-connected/newsroom/search-news-releases/2014/2014-10-veterans-day-flu-shot-clinics.aspx to find more details, ages served and vaccines provided)

November 19, 2014 from 1pm-4pm at JOIN, 1435 NE 81st Ave, Portland Or (sponsored by Family Care)

November 21, 2014 from 7:30am-4:30pm in Pioneer Courthouse Square in Portland, Or (sponsored by AWARE- please visit http://public.health.oregon.gov/PreventionWellness/SafeLiving/AntibioticResistance/Pages/getsmartweek.aspx for more details)

November 22, 2014 from 9am-5pm at the American Diabetes Expo at the Oregon Convention Center (sponsored by Family Care)

If you have an upcoming flu clinic anywhere in Oregon or bordering areas you would like to promote, please email katherine.h.mcguiness@state.or.us

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Open Invitation to Immunize Oregon Coalition Meeting on July 29th

Please join us for Immunize Oregon’s July meeting on July 29th, 2014 from 11:45-2pm! The meeting will take place at the Portland State Office Building, 800 NE Oregon St, Portland OR 97232 in room 1B.

We are excited to have Fred Troutman and Karen Tetz, professors at Walla Walla School of Nursing talk about an initiative to bring nursing students to rural India to provide vaccines. We will also hear from Scott Jeffries from the Oregon Immunization Program about using Reminder/Recall to raise a clinic’s immunization rates, specifically focused on adolescents. Alison Alexander from Immunize Oregon will be talking about the new National Adult Vaccination Standards and other ways to improve community immunity. Lunch will be provided.

If you are interested in attending in person or by phone/webinar, please RSVP by Friday, July 25th to Katherine.h.mcguiness@state.or.us

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Take a Peek Inside Two Local Health Department Immunization Programs

by Yuliya Goldman

Local health department (LHD) immunization programs all strive to achieve the same goal: prevent disease by providing timely and accessible immunizations. Consequently, programs carry out many similar activities. Still, each county in Oregon is unique, with its own population, geography, and economy.  Local Health Department staff are skilled at building their programs to meet the unique needs of the people they serve. Here we take a look at two immunizations programs located in very different settings: one urban and one rural.

Multnomah County

Introduction to Multnomah County Immunization Program

Multnomah County has the distinction of being the smallest county geographically, but the largest when looking at population. More than 750,000 people live in Multnomah County, according to the 2013 census. The Immunization Program in Multnomah County strives to meet the needs of its large and diverse population through direct services, partnerships, and outreach.  

The Multnomah County Health Department is comprised of two large divisions:  the primary care branch called Integrated Clinical Systems (ICS); and the public health branch called Community Health Services (CHS).  The ICS clinics, consisting of 8 primary care sites, 13 School Based Health Centers and 3 corrections-based facilities, all provide childhood, adolescent, and adult immunization services to their patients.   Immunizations are also provided at the STD Clinic and the safety net Community Immunization Program (CIP). Ginni Schmitz and Liem Hoang of the CIP provide technical support to all the clinics that provide immunization services to the public. 

Community Outreach

With a diverse population of over three quarters of a million people, identifying community needs plays an important part in providing appropriate services. This is where Melissa McKinney comes in. She serves as the Communicable Disease Services Community Liaison and works closely with the Community Immunization Program to ensure that community needs are identified and met.  “We want to figure out how we can help you, instead of just enforce” Melissa says.

Melissa’s work includes a variety of tasks.  One project that she helps coordinate are the flu clinics for uninsured, underserved adult populations.  Melissa works with community partners to hold successful flu clinics for Multnomah County residents who would not otherwise have access to flu vaccine. This past flu season, more than  500 doses were administered at these flu clinics.   Some of Melissa’s work also involves liaising with community partner organizations that serve Oregon’s refugee population. Over 80 percent of the refugee population in Oregon live in Multnomah County and receive their initial health screenings and immunization services from the county. 

School Exemptions

Multnomah County has among the highest kindergarten  nonmedical exemption rates in Oregon (9.6 percent for the 2013-14 school year). The Community Immunization Program applied for and received a NACCHO grant to develop vaccine education materials to educate parents about the benefits of immunization. These are available on the  CIP website at:  web.multco.us/health/immunizations under the “Vaccine Information” tab. They have also created a pamphlet for providers on how to communicate with vaccine hesitant parents.  For a copy of this pamphlet, please email Ginni directly at virginia.s.schmitz@multco.us.  In addition to the work that all the Health Department clinics do to increase childhood immunization rates throughout the year, the CIP hosts several immunization clinics in the community in February, to help keep kids in school. 

Rewarding Work

It’s evident that Ginni and Melissa enjoy serving the community. They shared some of their favorite things about their jobs.  “Working with diverse populations is an interesting aspect of my job” says Ginni. Melissa adds that it is a good feeling “knowing the work you are doing matters and is preventing disease.”

Morrow County

Introduction to Morrow County Immunization Program

Morrow County is located in Eastern Oregon, flanked by the Columbia River Gorge to the North and the Blue Mountains to the South. Just under 12,000 residents live among its gently rolling plains and broad plateaus. The immunization program serves the residents of this rural county out of its two offices located in Heppner and Boardman. 

WIC Clinic Partnership

Morrow County Immunization Program staff, Sheree Smith and Vickie Turrell, were looking for an opportunity to increase their infant immunization rates. They decided to partner with the WIC program to provide screening and immunizations to WIC clinic participants. Although the county doesn’t have its own WIC clinic, they used this as an opportunity to build a relationship with the Umatilla Morrow Headstart and WIC Program.  This partnership has been a success. Not only do they reach more infants through WIC, but they offer to screen and immunize anyone who accompanies the kids to the WIC clinic.  This partnership helped kids and their caregivers get timely vaccines, meeting an important need in the community.

Community Outreach

The Morrow County Immunization Program staff tends to keep their boots on the ground with a variety of community outreach projects. They are working on increasing adult immunization rates by holding clinics at local plants and other businesses throughout the county. They are also striving to decrease school exclusion rates for 7th graders by hosting clinics at school registration. Sheree attributes the program’s success to its abundant presence in the community. “We have a lot of visibility,” she says.  

Sheree’s and Vickie’s passion for their work is apparent. The people they serve are ready for their visits and they are ready to serve them “We love what we do!” they both explain.

Although the communities in Morrow and Multnomah County have different needs, the immunization program staff for both counties are committed to serving their communities in the best way possible, through service provision, partnerships, and community outreach.

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Why I Vaccinate: HPV

By Amanda Timmons, Oregon Immunization Program

I have two beautiful children whom I love so much that sometimes I could burst with it. I’m sure many other parents know that feeling. I would do anything in my power to protect them, just like other parents. But, unlike many American parents, I am vaccinating my children against HPV.

The statistics from the CDC are clear. Although the HPV vaccine has been routinely recommended for females since 2006,recent data show that just over half of teenage girls aged 13-17 had received one dose of HPV vaccine and only a third had received all three recommended doses (National Center for Immunization and Respiratory Diseases, CDC). Vaccine uptake by boys is even lower. This is something I don’t really understand. Among parents who choose not to vaccinate their child against HPV, many have concerns about vaccine safety or that vaccinating their child will encourage sexual activity. Others simply don’t think the vaccine is necessary. The data suggests otherwise.

 

HPV vaccine is safe.

Between June 2006 and March 2013, there were over 56 million doses of HPV vaccine distributed and just 21,194 adverse events reported. Ninety two percent of these were considered minor (Shannon Stokley, 2013). Another way of looking at it, for every 1,000 doses of vaccine distributed there are about 4 adverse events reported. For every 100,000 doses of vaccine distributed there are about 3 serious adverse events reported.  HPV vaccine is safe.

 

Being vaccinated does not lead to sexual activity or risky sexual behavior.

Vaccinating girls with HPV doesn’t increase the likelihood that they will engage is risky sexual behavior or initiate sexual behavior, according to a 2014 study (Allison Mayhew, 2014). Among girls with sexual experience, vaccination with HPV vaccine did not increase their likelihood for initiating sex, even if they erroneously believed that the HPV vaccine protected them against more sexually transmitted infections than just HPV.

 

HPV vaccine prevents disease.

Some parents say their children don’t need the vaccine because they are “too young” or because they are not sexually active. My kids are young, too. They are not sexually active. But, I am a realist. I know they will grow older and that someday they will have sex.  A study (Winer RL, 2008) conducted by the University of Washington between 2000 and 2006 showed that women between the ages of 18-22 years with one lifetime sexual partner had a 28% chance of contracting HPV in their first year of sexual activity. Within three years, 50% of the same women who still only had one partner had been infected. Intercourse is not necessary to become infected, and condom use does not prevent the spread of HPV. It’s clear that this disease affects almost everyone.

Vaccinating children against HPV when they’re young, before they ever become exposed, protects them from developing certain cancers later in life. HPV infections are responsible for greater than 90 percent of cervical cancers, 90 percent of anal cancers, and 50 percent of vaginal, vulvar, and penile cancers. HPV vaccination is the best way to protect my children from developing these cancers twenty or thirty years from now.

I love my children and I want to protect them. I am protecting them with HPV vaccine because it is the right thing to do.

 

References

Allison Mayhew, B. T. (2014). Risk Perceptions and Subsequent Sexual Behaviors After HPV Vaccination in Adolescents. Pediatrics , 133 (3), 404-411.

National Center for Immunization and Respiratory Diseases, CDC. (n.d.). Retrieved from http://www.cdc.gov/vaccines/imz-managers/coverage/nis/teen/data/tables-2012.html

Shannon Stokley, M. C. (2013). Human Papillomavirus Vaccination Coverage Among Adolescent Girls, 2007–2012, and Postlicensure Vaccine Safety Monitoring, 2006–2013 — United States. Morbidity and Mortality Weekly Report (MMWR) , 62 (29), 591-595.

Winer RL, F. Q. (2008). Risk of female human papillomavirus acquisition associated with first male sex partner. Journal of Infectious Diseases , 197 (2), 279-282.

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Introducing Aaron Dunn

by Yuliya Goldman

The Oregon Immunization Program (OIP) is very pleased to welcome Aaron Dunn as its interim section manager.  He comes to OIP from a position at the Oregon State Hospital where he has gained an extensive background in research and project management.  He has developed a research program, revamped the IRB, and most recently managed a project to increase meaningful data use. Aaron participated in the state Leadership Academy where, incidentally, he also met his wife.

Aaron grew up in Portland. He enjoys spending time with his wife and two stepdaughters aged 7 and 10 in a variety of family activities including hiking and playing board games. He follows sports, particularly the Blazers.  Aaron also participates in a men’s group that focuses preventing sex trafficking. Currently, the group is working on disrupting the on-line sex-trafficking demand.

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Aaron holds an MPH from The University of North Carolina, Greensboro and is excited to get back to his public health roots while at OIP. He is glad to have an opportunity to “jump in with both feet and support the work that is happening at OIP and providing a different lens to help staff succeed.”

Please join us in welcoming Aaron to the Oregon Immunization Program!

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