Welcome Dawn and Jenny to OIP

Dawn Lee and Jenny Nones

OIP welcomes two new members to the family. Dawn Lee is the new grant administrative specialist and back-up for the ALERTIIS helpdesk. Dawn has a varied background that includes clerking for the Superior Court of Clark County, 20 years in construction engineering and working for the Vancouver School District. She is a native Washingtonian and lives in Clark County with her husband and three dogs. Her family also includes three boys and two grandkids. Dawn’s favorite activity is donning her leathers, climbing on her hog and riding into the sunset. That’s correct: Dawn is a Harley-ridin’ biker chick. Her favorite recent trip was the Laughlin River Run in Nevada where she also visited the Grand Canyon. Her dream ride is to someday participate in the Sturgis Motorcycle Rally in South Dakota’s Black Hills.

Jenny Nones is a fiscal analyst who will divide her work time between OIP and the State Public Health Laboratory. Jenny just finished her Master of Public Administration in Healthcare Administration. She moved around a lot as a kid, but calls Salt Lake City her hometown. Jenny moved to Oregon about three years ago and has embraced quilting and wine touring. Her favorite winery is Anne Amie, which she says has the best parties. Jenny is also an avid traveler. Her most memorable trip recently was walking 350 miles in 30 days along the Camino de Santiago in Spain. She says she always travels alone and that adventure is perfect for solo travelers.

More staff news: Congratulations to Jody Anderson. She has been promoted from her provider services team administrative support role to full-fledged health educator! Jody’s territory includes:
• Washington County
• Crook County
• Harney County
• Deschutes County
• Jefferson County
• all Indian Health Service/Tribal clinics
• all Planned Parenthood clinics
• all Virginia Garcia clinics

Farewell to our friend Sandy

Sandra Newsum, an Office Specialist with the Oregon Health Authority Immunization Program, died May 5 following a long illness. Sandy came to work with the Immunization Program in 2006. In addition to being a cheerful and helpful co-worker, she was a kind-hearted person who will be missed very much by her friends and co-workers.

Sandy provided support not just to the Oregon Immunization Program, but to Oregon’s vaccine providers. She was always ready to help. Quick to laugh, she was a positive presence in our often stressful work site. She was also an avid Oregon Ducks fan, who tried to never miss a game. When she did, she’d seek out a friend in the Program to give her the play-by-play.

We’ve been informed by her family that there will be no memorial service. For those who wish to contribute, we are collecting funds to donate to a charitable organization in her name. Please contact lorraine.duncan@state.or.us

2012-2013 religious exemption rates released

On May 1, the Oregon Immunization Program released this year’s religious exemption rates, which have continued to rise steadily over the last decade. During the 2012-2013 school year, a statewide average of 6.4 percent of kindergartners in Oregon had a religious exemption to one or more vaccines, which is an increase from last year’s average rate of 5.8 percent.

Local health departments issued 30,501 exclusion orders in 2013 and excluded 4,188 children, both decreases from last school year. See the final State Statistical Report for children’s facilities, kindergarten (public, private and combined) and 7th grade (public, private and combined). Also see how your county stacks up against the others. School law helped protect 664,543 kids in Oregon against vaccine preventable diseases!

Immie news you can use:
5/8/13: Salem Statesman Journal: Fewer Oregon children recieve vaccines

5/10/13: Philadelphia Inquirer: Vaccine to fight heroin addiction shows promise

5/12/13: 60 Minutes: Bill Gates 2.0

5/14/13: BBC: Swansea measles: cases rise by 20 to 1,094

HAPPY NATIONAL NURSES WEEK!

NURSES NOTES

Varicella: A Personal Story

By Jeanine Whitney, RN

EDITOR’S NOTE: A study recently published in Pediatrics confirms the chicken pox vaccine is effective and long-lasting. Read the LA Times coverage.

Jeanine Whitney, RN,  is a public health nurse for the Oregon Immunizaiton Program. What follows is her personal account of getting chicken pox as an adult:

Blindness doesn’t mean everything is dark and you can’t see. Blindness means that your visual sense has been literally turned ‘off.’ Your sight is suddenly absent. There is no light. There is no dark. There is only air touching your skin—sometimes bruising you when you run smack dab into the bedrail of your hospital bed. At least being hospitalized gave me time to review how I had gotten there.

Fourteen days before I had taken swab cultures of infected facial lesions on an older male gentleman. At the time I thought of him as borderline-ancient. He must have been at least 50 years old. Why was I doing the cultures? No one else wanted to go near him. There were whispers of shingles. My uneducated mind saw roofing tiles. Not having had chickenpox and not knowing what shingles was I volunteered to do the cultures.  After all, I was gowned, gloved, masked, and shoed.  All that remained open to the air was my hair. He wasn’t my patient and I wouldn’t be in his room that long.

The subsequent headache was unlike any I had ever had and believe me, I’ve had headaches all my life. It was late in the afternoon and my five-year-old daughter was playing outside. She had a golden halo around her, something I thought was a trick of the sunlight beneath the cloudy sky. I turned my head to see her more clearly and lightening exploded at the base of my skull. The next thing I knew I was on my knees searching for the phone.

When you’re a nurse you develop an awareness of those physicians around you whom you would like to take care of you if you got sick. I called Dr. S_____.  All I could say was that my head hurt. He must have asked me questions but I don’t remember them.  I don’t remember driving to the hospital either but I do remember the excruciating evening sunlight. The next thing I knew I was in the ED. One of my friends was sitting with Raven. She told me my father was on his way.

I was turned to my side and someone pulled my knees up to my chin. I must have passed out because my next awareness was the sharp pain of a needle being inserted into my lower back. 

I didn’t hear any voices. There was no conversation around me. I was floating somewhere quiet. When I opened my eyes there was nothing. I blinked. Still nothing.

The blindness lasted four days. People came and went; over four days they did blood tests every four hours. I came to detest the tightness of the blood pressure cuff as they searched for veins. A blood pressure of 60 over nothing didn’t help. They kept me flat after the spinal tap. I felt like I was always in slow motion, falling over a cliff.

On day five, everything began to lighten. I went from seeing nothing at all to a soft fuzzy gray. Dr. S____ came in (I recognized his voice). He checked me out and with an ironic smile in his voice said “you’ve got chicken pox!”

He must have seen the question in my unfocused eyes because his next words were “all your spots are on the inside.” That at least explained why all the young doctors had worked me up for Lyme disease and tick fever while Dr. S____ was out camping with his kids. Then Dr. S____ continued with “you can’t be here.” At first I thought he meant the hospital. He did, sort of. He really meant the med-surg floor as there was no isolation room available.

They literally double-bagged me and covertly took me out the service elevators.

Somewhere along the line my father had come for Raven and taken her home to my mother, who was a pediatrician. She figured if Raven was going to get sick she would be better off with her rather than me. Raven stayed with grandma for the next 3 months while I missed work. The blood bank people came and took my blood to make a vaccine for kids with cancer. At least I think that’s what they said.

The headaches came and went and then one day I tried the first Acyclovir. That’s when I realized that even though I never had any spots I had headaches due to varicella viral flares. 

I was lucky.

I can see and didn’t need glasses until I turned 50. I can usually keep the headaches away with regular doses of anti-virals. But the scarring in my brain will always be with me. I got my Zostavax vaccine (The Shingles Shot) on my 60^th birthday! More than a year passed before I had another shingles headache.  Even now, I don’t have to take the anti-virals daily. 

Back in 1977, there was no vaccine for varicella.

I was healthy.

I spent less than 10 minutes in the room with the client.

The bottom line?

I lived.

Some do not.

For more information on chicken pox, please visit our website.

DataPokes: May 2013

An Introductory Note

DataPokes is an ongoing monthly forum for the Oregon Immunization Program’s Evaluation & Surveillance team. We will use this as a place to talk about our work and highlight some local, national and international research about immunizations. Even though we can’t promise baskets of kittens or vaccine refrigerators transforming into giant robots, we’ll find some interesting things for you here.

-Steve Robison, Oregon Immunization Program Epidemiologist

Staff Publication: Priming with Whole Cell Pertussis Vaccine

Our own Juventila Liko (et al.) examined whether children who started their early pertussis immunizations with a whole-cell vaccine (DTwP) had less pertussis than those who only had an acellular DTaP vaccine. Using ALERT data for kids born between 1998 and 2000, Liko et al. found that those primed with DTwP had substantially lower pertussis rates, including into their teen years. This benefit to DTwP priming was observed regardless of how many DTaPs a child got or whether they had a tdap booster. Despite these advantages, the whole-cell pertussis vaccine was replaced by acellular DTaP in the United States because of concerns about higher rates of side effects with the whole-cell vaccine. Because of these side effects, returning to the whole-cell vaccine is not a likely option.

(Source: Liko, J., Robison, S., & Cieslak, P. (2013). Priming with whole-cell versus acellular pertussis vaccine, New England Journal of Medicine. 386, 581-582) 

Why We Immunize Teens for HPV

A recent study from Australia has found that the prevalence of genital warts among teens and young adults has drastically been reduced since the introduction of the human papillomavirus (HPV) vaccine in 2007. The reduction was stronger for girls than boys, but both were substantial. In 2007 before the introduction of the HPV vaccine, 11 percent of Australian women under age 21 who visited a sexual health service were diagnosed with genital warts. After the introduction of the HPV vaccine, this prevalence fell to under 1 percent, followed by no reported diagnoses of genital warts in 2011. During the same period, rates for genital warts among adults age 30 and up who did not participate in the Australian HPV program did not change. This study provides good evidence that the HPV vaccine is working.

So what did it take to achieve this result in Australia? In 2010 the Australian HPV vaccine coverage rates for their school-based programs was 83 percent HPV vaccine initiation among 12–13-year-old girls, with a 73 percent series completion rate. In contrast, here in Oregon 45 percent of 12–13-year-old girls have started on HPV vaccine, and only 16 percent have had all three shots, according to ALERT data. We have made progress, but we have a long way to go.

(Source: Ali, H., Donovan, B., Wand, H., et al. (2013). Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data. British Medical Journal, 346:f2032.)

A Vaccine for Staph? Try and Try Again

One long-running failure in immunology is the inability to develop an effective vaccine against staph bacteria. The evolution of Methicillin-resistant Staphylococcus aureus (MRSA) has led to near panic among some medical authorities, who worry that soon we won’t have any antibiotic options left. In 2012 one more potential staph vaccine failed in human trial. The vaccine was intended for surgery patients two weeks prior to being admitted.

While no adverse effects were seen initially and recipients built resistance to a staph surface protein, the trial was halted early due to adverse surgical outcomes among those who received the vaccine.

This is not the first vaccine failure for staph; historically many have been developed with failure as a uniform result. The ability of staph to acquire and express factors to specifically thwart the human immune system has meant that lab and animal testing cannot reliably guide vaccine development. As staph is a common and harmless colonizer of over a third of the world’s population, disease eradication is not likely anytime soon even if a vaccine for hospital use is found.

(Source: Keller, D. (2012, Oct 22). Staph vaccine linked to multi-organ failure and death. Medscape Medical News. Available at http://www.medscape.com/viewarticle/773037).

Immunize Oregon: Improving community immunity

Immunize Oregon, OIP’s lifespan coalition,  is excited to announce we are restructuring the way we offer our FLU  (Free, Local, Underserved) Clinics. The coalition partners with area clinics, health systems, non-profits, and nursing and pharmacy schools to provide immunization clinics that offer no-cost vaccines to uninsured individuals. We work in conjunction with nursing or pharmacy students as vaccinators if necessary, and with partners who host the clinic and do outreach to people who need vaccines. 

If you are interested in hosting a FLU Clinic during the 2013-2014 season (September-April) please click here or contact Alison.alexander@state.or.us 

 We are also elated to announce a notable expansion of our mini-grants–one of OAIC’s most popular programs.  This year we are able to offer $30,000 of grant funds, with a maximum award of $4,000!  These grants are for organizations looking to improve immunization rates in Oregon.  Last year, OAIC had $48,000 in requests for mini-grants with a budget of only $14,000. This year the coalition hopes to make a greater impact on the health of our communities by expanding this wildly successful program.

Immunization projects that focus on populations across the lifespan will be considered for grants, with special consideration to those that work to raise adult immunization rates (which are the lowest).

If you are interested in applying, please look at our website, www.healthoregon.org/immunizeoregon for the request for proposals and application materials. If you have any questions, please contact Katherine.h.mcguiness@state.or.us

If you are interested in getting involved in Immunize Oregon, have any general questions about the coalition’s work or have an idea for a project, we would love to hear from you! Please email either Alison or Katherine at the addresses listed above.

Alert on ALERT – What’s new in the IIS

 by Erin Corrigan

ALERT IIS—Oregon’s immunization information system, or registry—has been going through a lot of changes lately, and we’re excited to share some of them with you. The really big thing is that after over a year of planning, development, and testing we are now live with the CDC’s vaccine ordering and tracking system (called in that inimitable CDC way, of course, VTrckS). This means that we send orders of state-supplied vaccine directly out of ALERT into CDC’s system, and ALERT IIS is able to download shipping information that McKesson and Merck send to the CDC. Electronic data about orders of VFC and 317 vaccine will appear in a clinic site’s queue as transfers; providers simply go in and accept the shipment to move all the items into their inventory. We hope you enjoy this new feature – from our perspective, it was a long time coming!

Another change is being rolled out more slowly but is just as important: We are beginning to provide a function for clinics who send us data from their EHRs to subtract doses from ALERT’s inventory module, a process often known as “decrementing inventory via data exchange.” This means that as we receive data electronically in real time or batch loads, the shots are entered into patient records and taken out of inventory at the same time. Previously, these clinics had to manually subtract these doses from inventory, which can be a time-consuming process. Because of the requirements around using ALERT related to Oregon’s Vaccine Stewardship law, this is an important step for many of Oregon’s largest health care providers. We’re so pleased that we’re able to help our partners meet the state requirements more easily and to be better vaccine stewards.

Other goings on in ALERT include participation on some of the country’s national standards boards and workgroups related to work in Immunization Information Systems. We’ve also recently completed our annual reporting to the CDC about who participates in the registry and updated our strategic plan to map our way going forward for the next five years. We’ll update you about that in future ImmiNews Alerts on ALERT.

Community Adult Immunization Clinic

Friday, April 19, 2013 • 8:00 am to 3:00 pm
Oregon Convention Center Plaza • Portland, Oregon
777 NE MLK, Jr. Blvd. 98232

Immunize Oregon will participate in an adult vaccination clinic with Linfield’s Good Samaritan School of Nursing students. Adults can receive flu, Tdap and pneumococcal vaccinations. Other health services will be available as well.

Editors note: Oregon ImmiNews is now coming to you each and every Wednesday! Tell your colleagues and friends!

Welcome Carol Easter, RN: Donning many hats

“Many hats, many hats, many hats” is Carol Easter’s response when asked what her work was before she came to the Oregon Immunization Program. With an early career as a wedding coordinator, followed by 28 years as a registered nurse, Carol has definitely worn many hats.

Right out of nursing school, Carol started as a critical care and labor & delivery nurse. Critical care quickly became her focus, and she ultimately worked as a nurse at most of the larger hospitals in the Portland area. Later, in her position as a service coordinator for medically fragile children for the state, Carol was able to have an impact on the rules that were written for medically fragile children who are served by the Oregon Health Plan.

Carol worked in that position for over 12 years, and during that time she became more and more interested in vaccines. It was in the period that “autism was being related to vaccines, and I waited and I waited, and I read and I read, and I thought, ‘huh?’ I just got more interested in vaccines. I’ve always been an advocate for vaccines. My kids were the first in line for the HPV vaccine. I didn’t hesitate and neither did my daughter.”

Carol is excited about the work she will be doing in the immunization program. She just finished updating the standing orders and has been learning more about the Advisory Committee on Immunization Practices (ACIP). She’s fascinated by the process: “who gets involved, how recommendations happen.”

Carol has two daughters, a 19-year-old college undergrad and a 23-year-old in law school. She is passionate about animals and has spent many years volunteering off and on at the Oregon Humane Society. She has also volunteered for school events and fundraisers as well as at community events for emergency preparedness. Carol still occasionally coordinates weddings. She loves history and travel. When she’s off work, she’s likely to be found at a local library or museum studying up on the past. 

Carol brings a wealth of experience to the Oregon Immunization Program, but more importantly she brings passion for the work of immunization. And of course there are all those hats.

 NURSES NOTES

Whoop Whoop Whooping Cough is not as funny as it sounds

By Carol Easter, RN

Pertussis (whooping cough) can have serious effects on infants ≤12 months of age. The loud “whooping” sound can be heard in some infants along with violent and rapid coughing that repeats over and over*. Still other infants may have a barely noticeable cough while others might even experience apnea (where they stop breathing for a time), which can be a life-threatening event.

More than 41,000 cases of pertussis were reported across the United States during 2012, including 18 deaths.¹

The Advisory Committee on Immunization Practices (ACIP) has been considering how best to prevent pertussis in very young infants. DTaP** vaccines are not given until 2 months of age and this leaves a gap in coverage.

In  2012, the ACIP voted to recommend giving one dose of Tdap*** with every pregnancy between 27 and 36 weeks gestation.² The Tdap vaccine given to pregnant women will stimulate the development of maternal antibodies. The antibodies will then pass through the placenta and help protect the newborn against pertussis.

Cocooning is another recommendation from the ACIP. People in close contact with infants ≤ 12 months of age should be vaccinated to protect against pertussis. The cocooning people might include parents, siblings, grandparents, child-care providers and health-care personnel.

Immunization in the third trimester of pregnancy along with cocooning efforts are steps that can be accomplished with education efforts and cooperation. The goal is that prevention will stop life-threatening events related to pertussis.

Notes

*The recording is of a young girl with whooping cough. You hear her paroxysmal cough first without a whoop, but she is a little sick. You then hear two more paroxysms, both followed by the distinctive whooping sound. It is the noise of breathing in, and it comes from the larynx (voice box).

**DTaP – Diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed (Pediatrics). Trade names: Daptacel and Infanrix for 2 months to 6 years of age. (In some cases it may be given at 6 weeks.)

***Tdap – Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, adsorbed (Adults). Trade names: Adacel for ≥ 11-64 years of age, Boostrix for ≥ 10 years of age.³

References

1. Centers for Disease Control and Prevention. (2013). Pertussis (Whooping Cough): what you need to know. Retrieved from http://www.cdc.gov/features/Pertussis/
2. Centers for Disease Control and Prevention. (2013, March 22). Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 62(2), 1–28. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6202a1.htm
3. Centers for Disease Control and Prevention. (2013). ACIP abbreviations for vaccines. Retrieved from www.cdc.gov/vaccines/acip/committee/guidance/vac-abbrev.html

EDITOR’S NOTE: Get ready! Oregon Immunization Program’s ImmiNews e-newsletter is now coming at you every single Wednesday, full of the latest immunization news from across Oregon and the world! Tell your colleagues and friends.