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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Immunize Oregon 2014 Mini Grant Cycle: Now Open!

Immunize Oregon is pleased to announce that we are now accepting applications for the 2014 cycle of Mini Grants. These grants are available to organizations interested in promoting and educating about immunizations, strengthening immunization infrastructure, or holding immunization related events. The maximum award is $4,000. 

More information and the application can be found at www.healthoregon.org/immunizeoregon 

Applications are due June 20th, 2014.

For any questions, please contact Katherine McGuiness at katherine.h.mcguiness@state.or.us

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Antibiotic Resistance: We’re part of the problem and the hope for the solution

by Tessa Jaqua

The subject of antibiotic resistance comes up frequently in the news media. Now considered one of the world’s most pressing public health issues, antibiotic resistance is sadly becoming an everyday reality for communities near and far. Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply causing more harm. Antibiotic use promotes development of antibiotic-resistant bacteria. Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria.

Here in the US, and especially in Oregon, many are quick to dismiss the threat of antibiotic resistance because of increased access to healthcare and better sanitation. While it’s true that most people in Oregon are not at great risk for Methicillin-resistant Staphylococcus aureus (MRSA) orCarbapenem-resistant enterobacteriaceae (CRE), this doesn’t mean that antibiotic resistance doesn’t affect us or put us at risk. There is a sweeping misconception that antibiotic resistance is an individual issue and that if one person is resistant that the resistance stays within that person’s body and affects only them. This couldn’t be farther from the truth. Antibiotic resistance is not just a problem for the person with the infection. There are resistant bacteria that have the potential to spread to others, thus spreading antibiotic‐resistant infections throughout the community. The startling reality is that every time a person takes antibiotics, whether it’s for the right reason or the wrong reason, sensitive bacteria are killed, and resistant germs may be left to grow and multiply. Repeated and improper use of antibiotics is the primary cause of the increase in drug-resistant bacteria and most of us contribute to the problem.  

Antibiotic resistance causes some of the most costly and significant danger for people who have basic, common infections that once were easily treatable with antibiotics. When it takes multiple courses of antibiotics to kill an infection or at worst, they fail to work; the consequences are longer-lasting illnesses, more doctor visits or extended hospital stays, and the need for more expensive and toxic medications. 

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Image source:http://www.mphonline.org/

In the past, when common antibiotics started to show waning effectiveness or growing resistance scientists stepped in and developed newer and stronger antibiotics. Yet, during last decade, the number of bacteria resistant to antibiotics has increased dramatically. Many of these resistant bacteria affect us commonly throughout the year. The cost and time to develop new antibiotics has become too great a burden and development has almost all but stopped. 

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Image source:http://www.cdc.gov/getsmart/campaign-materials/week/downloads/gsw-factsheet-future.pdf

Yet, even if or when new antibiotics are developed, bacteria will evolve and find ways of resisting them. This is why awareness and action is needed to prevent new resistance and the resistance that already exists from spreading. 

According to the CDC, improperly prescribed antibiotics cost us and our health system $1.1 billion every year in unnecessary adult upper respiratory infection antibiotic prescriptions. It is estimated that more than 50% of antibiotics are unnecessarily prescribed in office settings for viral upper respiratory infections (URIs) like cough and cold illness.  In hospitals, up to 50% of antibiotic use is either unnecessary or inappropriate. It’s important for healthcare providers to stay up to date on best practices and utilize strategies to delay or eliminate the use of antibiotics for viral or inappropriate infections. We as patients and individuals make a difference. One study showed that doctors prescribe antibiotics 62% of the time if they perceive parents expect them and 7% of the time if they feel parents do not expect them. There is a common belief that antibiotics work for every illness, but they don’t. Antibiotics are lifesaving drugs that can and do cure bacterial infections.  Treating viruses with antibiotics does not work, and it increases the likelihood that you will become ill with an antibiotic-resistant bacterial infection.

The measures for preventing the development and spread of antibiotic resistance are simple:

Practice good hand washing, cover your cough, and get plenty of rest and good nutrition. A healthy body is the best prevention against any type of infection.

Get your recommended vaccines and your flu shot every year. Antibiotics may not help against viruses but vaccines do!

If you have a cold, flu, or other viral illness don’t ask for antibiotics. Instead, stay home from work or school, get plenty of rest, drink lots of fluids, avoid cigarette smoke, and remember that it takes time to get better, often 10 to 14 days.

If you are given antibiotics take them exactly as the doctor prescribes. Do not skip doses. Complete the prescribed course of treatment, even when you start feeling better. Just because you feel better does not mean that all of the infection causing bacteria are gone.

Do not save antibiotics for the next illness. Discard any leftover medication once the prescribed course of treatment is completed.

Only take antibiotics prescribed for you; do not share or use leftover antibiotics. Antibiotics treat specific types of infections. Taking the wrong medicine may cause serious complications, delay correct treatment and allow bacteria to multiply.

Do not ask or pressure your provider for antibiotics. Antibiotics are serious medications that have side effects. When your doctor says you don’t need an antibiotic, taking one may do more harm than good. 

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If you want to learn more about antibiotic resistance, get free educational materials for your organization or clinic, or take advantage of our free CME/CE for healthcare providers then visit the Oregon Alliance Working for Antibiotic Resistance Education’s (AWARE) website at www.healthoregon.org/antibiotics

References:

National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases. “Get Smart: Know When Antibiotics Work.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 21 Jan. 2011. Web. 01 Apr. 2014.

Mangione-Smith R, McGlynn EA, Elliott MN, et al: The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics103:711-718, 1999.

Scott JG, Cohen D, DiCicco-Bloom B, Orzano AJ, et al: Antibiotic use in acute respiratory infections and the ways patients pressure physicians for a prescription. J Fam Pract: 50(10): 853-8, 2001.

Fendrick AM, Monto AS, Nightengale B, Sarnes M: The economic burden of non-influenza related viral respiratory tract infection in the United States. Arch Int Med: 163(4): 487-94, 2003.

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Know Your Wire

By Albert Koroloff

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Lately the Oregon VFC program has noticed an increase in provider calls about wild temperature fluctuations on continuous tracking logs.

Usually these types of calls lead us to suspect a bad compressor or fan, but not even the worst equipment failure could explain a drop to -150C in less than 10 minutes. No…these temperature anomalies seem to be coming from the data loggers themselves.

Through some keen investigational work (e.g. calling the vendor) we found that thermocouple wires bundled with some loggers are too fragile for commercial use. These thin wires tend to kink in the refrigerator/freezer door which leads to reading errors, most often presenting as impossibly large temperature jumps or dips.

Check to see if you’re using this style of wire by closely inspecting the outer sheath. If it’s a thin, loosely woven white nylon material, you win the prize. Unfortunately, the prize in this case is the recommendation to upgrade to a more robust wire. 

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Better thermocouple probes can be purchased from many online vendors including Control Soultions at 888-311-0636.

If you’re a VFC clinic experiencing abnormal temperature events, take immediate action to secure your vaccine stock and then call your VFC health educator. We will help you troubleshoot the issue and rule out/in equipment failure as a cause.  

 Happy logging!  

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April 15, 2014 · 10:05 pm