Category Archives: Oregon Immunization

General Immunization news that addresses Immunization efforts at a state-wide level.

ALERT IIS Kicks Off Statewide Recall

This month, ALERT IIS reached another milestone when it kicked off statewide recall for 22 month olds. “Oftentimes parents simply don’t know that their child is past due for immunizations,” said Mary Beth Kurilo, Director of ALERT IIS. “Reminding parents that immunizations are needed through recall is a proven strategy to improve immunization coverage.”

ALERT IIS will send notices each month to the parents or guardians of 22 month olds who are past due for immunizations. Some significant improvements have been made over ALERT’s previous statewide recall process. First, clinics now receive their list of 22 month olds who need immunizations through ALERT IIS. There’s less paper to shuffle, and it’s easy for staff to make corrections to records directly in ALERT IIS. Second, ALERT IIS now sends a letter to parents or guardians with their child’s immunization record and a list of which specific vaccines are needed, instead of a generic postcard to all parents.

Below are answers to common questions about reminder/recall, and steps you can take within your own clinic to improve immunization coverage through reminder/recall. 

What is reminder/recall?

Notifying patients that immunizations are due (reminder) or past due (recall). Reminder/recall can occur at the state level, like ALERT IIS’s 22 month recalls, or at the individual clinic level. ALERT IIS has many tools available to providers who want to do reminder/recall.

Typically, clinics that conduct reminder/recall target a segment of their patient population with lower immunization rates. For example, clinics may opt to conduct reminder/recall for adolescents who have not completed the HPV series, or kindergartners who are missing a second dose of MMR.  These clinics use ALERT IIS or their electronic health record (EHR) to create a list of patients who are due or past due. These patients are then contacted and encouraged to schedule an appointment to be immunized. Clinics can choose to contact patients by telephone, letter, email, or text message – whatever makes the most sense for the clinic and its patients.

Why is reminder/recall important?

Oftentimes patients simply don’t know that they need immunizations. Reminder/recall makes them aware, and provides them with information about where to go to receive immunizations.

Since 1997, many studies have demonstrated the impact of clinic-based reminder/recall. Reminder/recall improves immunization coverage for children, adolescents, or adults, and across a wide span of clinical settings[i].

Also, doing reminder/recall for immunizations is a great way to identify patients who need to come in for well child visits or other services[ii].

If the state immunization program does recall, should my clinic do reminder/recall on its own?

Absolutely!

The ALERT IIS statewide recall only catches 22 month olds who are not up-to-date on immunizations.

You can conduct reminder/recalls for any segment of your patient population – 18 month olds who have not received a 4th DTaP, 13 year olds who need a meningococcal vaccine, or adults who have only received one dose of hepatitis A. And you can choose the reminder/recall schedule for your clinic that makes the most sense. While monthly notices are great, your clinic may opt to send notices quarterly, or even just a couple times each year. The possibilities are endless.

Can you tell us about a clinic in Oregon that has successfully used reminder/recall to improve immunization rates?

Sure!

The quiet, historic town of Dallas, Oregon is nestled amidst the vineyards and wineries of the Willamette Valley. Dallas Family Medicine has been providing primary care services to the community for more than 60 years.

Dallas Family Medicine has used a recall system for many years, sending post card reminders to patients. Under HIPAA laws, Dallas Family Medicine staff could no longer send specific patient information on a post card, and they found their system to be less effective than in the past.

Faith Shinn, an RN who has worked at Dallas Family Medicine for over 22 years, recently decided to attend a webinar to learn about the ALERT IIS reminder/recall system.

“After attending the webinar,” said Shinn, “I realized that our adolescents were falling through the cracks.” Faith worked with ALERT IIS staff to run a reminder/recall report on her adolescent patients and to send out letters with their immunization history and needed immunizations.

Dallas Family Medicine took the opportunity to also recommend an adolescent well visit for these patients. As Faith explained, many of these patients hadn’t been seen in many years because they were generally healthy, and parents sometimes forget that well visits are due.

Approximately 30 percent of the adolescents who received a reminder/recall notice scheduled an appointment for immunizations and a well visit. “This was a huge success for our clinic,” said Shinn. “Many of these patients had a well visit, and many are now completely up-to-date on recommended vaccinations.”

The staff at Dallas Family Medicine are keeping the momentum going by using a new software program to recall children and adolescents, along with the ALERT IIS 22 month recall and their postcard system. Said Shinn, “Immunization status is used for benchmarking and reporting, but most importantly to keep our kids healthy. A good recall system is imperative to keeping our kids and families immunized.”

Kudos to the staff at Dallas Family Medicine! We appreciate all you do to keep your patients and community healthy.

Do you have resources to help?

Yes!

ALERT IIS routinely offers reminder/recall webinars to train clinic staff on how to use these reports in ALERT. Sign up for a webinar at: http://public.health.oregon.gov/PreventionWellness/VaccinesImmunization/alert/Pages/Reports-Training.aspx

Interested in conducting reminder/recall for your adolescent patients? Oregon Immunization Program is currently conducting a special project to support clinics doing adolescent reminder/recall. And, even better, by participating in this project, we’ll help cover the cost of postage for reminder/recall letters sent to your patients.

Or, contact your Oregon immunization program health educator. They can help you identify patient populations within your clinic with lower immunization rates, generate reminder/recall reports in ALERT IIS, and develop workflows for how to integrate reminder/recall into your day-to-day work.

Interested in the research? Check out the Guide to Community Preventive Services at: http://www.thecommunityguide.org/vaccines/clientreminder.html

 


[i] The Guide to Community Preventive Services, Increasing Appropriate Vaccination: Client Reminder and Recall Systems, http://www.thecommunityguide.org/vaccines/clientreminder.html, (December 24, 2013).

[ii] Christina A. Suh, Alison Saville, Matthew F. Daley, Judith E. Glazner, Jennifer barrow, Shannon Stokley, Fran Dong, Brenda Beaty, L. Miriam Dickinson, and Allison Kempe, Effectiveness and Net Cost of Reminder/Recall for Adolescent Immunizations, Pediatrics, http://pediatrics.aappublications.org/content/early/2012/05/02/peds.2011-1714.full.pdf+html (December 24, 2013).


 

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CDC Issues Health Advisory “Notice to Clinicians: Early Reports for pH1N1-Associated Illnesses for the 2013-14 Influenza Season”

Re-Post from Immunization Action Coalition Weekly Immunization News

On December 24, the CDC Health Alert Network (HAN) issued a CDC Health Advisory titled Notice to Clinicians: Early Reports of pH1N1-Associated Illnesses for the 2013–14 Influenza Season. The “Summary” and “Recommendations for Health Care Providers” sections are reprinted below.

Summary

From November through December 2013, CDC has received a number of reports of severe respiratory illness among young and middle-aged adults, many of whom were infected with influenza A (H1N1) pdm09 (pH1N1) virus. Multiple pH1N1-associated hospitalizations, including many requiring intensive care unit (ICU) admission, and some fatalities have been reported. The pH1N1 virus that emerged in 2009 caused more illness in children and young adults, compared to older adults, although severe illness was seen in all age groups. While it is not possible to predict which influenza viruses will predominate during the entire 2013–14 influenza season, pH1N1 has been the predominant circulating virus so far. For the 2013–14 season, if pH1N1 virus continues to circulate widely, illness that disproportionately affects young and middle-aged adults may occur.

Seasonal influenza contributes to substantial morbidity and mortality each year in the United States. In the 2012–13 influenza season, CDC estimates that there were approximately 380,000 influenza-associated hospitalizations. Although influenza activity nationally is currently at low levels, some areas of the United States are already experiencing high activity, and influenza activity is expected to increase during the next few weeks.

The spectrum of illness observed thus far in the 2013–14 season has ranged from mild to severe and is consistent with that of other influenza seasons. While CDC has not detected any significant changes in pH1N1 viruses that would suggest increased virulence or transmissibility, the agency is continuing to monitor for antigenic and genetic changes in circulating viruses, as well as watching morbidity and mortality surveillance systems that might indicate increased severity from pH1N1 virus infection. In addition, CDC is actively collaborating with state and local health departments in investigation and control efforts.

CDC recommends annual influenza vaccination for everyone 6 months and older. Anyone who has not yet been vaccinated this season should get an influenza vaccine now. While annual vaccination is the best tool for prevention of influenza and its complications, treatment with antiviral drugs (oral oseltamivir and inhaled zanamivir) is an important second line of defense for those who become ill to reduce morbidity and mortality. Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who is hospitalized; has severe, complicated, or progressive illness; or is at higher risk for influenza complications.

Recommendations for Health Care Providers

  • Clinicians should encourage all patients 6 months of age and older who have not yet received an influenza vaccine this season to be vaccinated against influenza. There are several flu vaccine options for the 2013–2014 flu season, and all available vaccine formulations this season contain a pH1N1 component; CDC does not recommend one flu vaccine formulation over another.
  • Clinicians should encourage all persons with influenza-like illness who are at high risk for influenza complications to seek care promptly to determine if treatment with influenza antiviral medications is warranted.

Read the whole CDC HAN Health Advisory here.

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A Linfield Nursing Student’s Perspective on working with the Oregon Immunization Program

by Judi Majors

After practicing bedside nursing for 30 years at the same hospital, I was given a unique and somewhat rare opportunity to intern in a public health rotation. At the Oregon Immunization Program under Jeanine Whitney’s guidance, I gained a newfound knowledge about vaccines and how vaccination impacts community, national and global health. This opportunity was truly a profound privilege. Two other Linfield College of Nursing students joined me in this enlightening adventure. We agreed that this experience changed us forever as nurses and citizens. The learning environment was incredibly detailed, supportive and encouraging. Jeanine’s feedback on required writing assignments furthered my understanding of vaccines, various cultural views of vaccination, health promotion and about building my cultural humility in working with vulnerable populations.

The required reading Jeanine assigned, including Vaccine (Allen, 2007), Vaccinated (Offit, 2007), the Pink Book and various authoritative websites, was eye-opening. Working in two pop-up vaccination clinics, writing a standing order update and benefiting from the knowledge of all Immunize Oregon staff, enabled the three of us to grow immeasurably. 

How did all three interns (with 52 combined years of nursing experience) know so little about the immense impact of vaccines on the health of populations and the security of our nation? I felt embarrassed. Jeanine reassured me that I was not alone in understanding the magnitude and value of vaccination.

As a nurse, this was significantly important for me to recognize. With the help of Jeanine Whitney, Carol Easter and Alison Alexander, I have had an experience that most nurses need and would be thankful for.

I return to work in the hospital with knowledge of the ALERT Immunization Information System which I plan to promote at my hospital, the knowledge that comes with a newfound responsibility to promote vaccination, and the discovered voice to advocate for increased focus on public health in the United States for the health and well-being of its citizens. The interns and I are indebted to the collaboration of Linfield College and Immunize Oregon in providing this clinical experience: thank you. 

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National Influenza Vaccination Week

 

National Influenza Vaccination Week (NIVW), scheduled for December 8-14, 2013, provides an opportunity to remind everyone 6 months and older that it is not too late to get a flu vaccine. NIVW is a national observance established in 2005 by the Centers for Disease Control and Prevention (CDC) to highlight the importance of continuing influenza vaccination after the holiday season into January and beyond.

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Flu vaccination coverage estimates from past years have shown that influenza vaccination activity drops quickly after the end of November. CDC and its partners want to remind you that even though the holiday season has arrived, it is not too late to get your flu vaccine.

As long as flu viruses are spreading and causing illness, vaccination can provide protection against the flu and should continue. Even unvaccinated people who have already gotten sick with one flu virus can still benefit from vaccination since the flu vaccine protects against three or four different flu viruses (depending on which flu vaccine you receive) expected to circulate each season.

The CDC has a National Influenza Vaccination Week website full of information and resources (including customizable posters and brochures) which can be found here.

Oregon Health Authority maintains an influenza resource located at http://flu.oregon.gov. It includes information for parents, providers, schools, businesses and health care workers.

 

Employment Opportunities

To share any employment opportunities, please email katherine.h.mcguiness@state.or.us

Nurse Manager/Care Coordinator

Sunset Pediatrics, a four physician pediatric clinic on Portland’s west side, is currently seeking a full time Nurse Manager/Care Coordinator.  Responsibilities include support, training and management of clinical staff, organization and optimization of new and special services, monitoring and reporting of quality measures, support of Clinic Administrator and Providers, and care coordination and maintenance of current Tier 3 Medical Home responsibilities.

The Nurse Manger performs all duties in a manner which promotes teamwork and continuity of care and practicesRequired skills and credentials to successfully perform Nurse Management duties include but are not limited to: Current BSN with 3-5 years experience, current CPR/PALS certification, excellent triage skills, strong verbal and organizational skills, and patient centered focus.  Preferred skills that would help in the Nurse Management role include but are not limited to: Pediatric experience, management experience, business background.

Salary: Negotiable

Fax Resume, with cover letter, to 503-291-1584 Attention: Jennifer

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Understanding the Personal Impact of a Vaccine Preventable Disease (Rubella and Congenital Rubella Syndrome)

by Jeanine Whitney

Growing up, my cousin Tim looked a lot different than the rest of the children in my family. Comparatively, he was boney and had really scary scars on his chest.  He was knock-kneed and had to wear glasses so thick it looked like they had Vicks® VapoRub® on them.  You could count his ribs, too! And he was always going into the hospital for something or other. 

Twenty some years later we would better understand why.  Tim was a CRS (congenital rubella syndrome) baby from the early 1950’s. His mom, Aunt Betty, had been exposed to rubella (three-day measles) during the first trimester of her pregnancy. All in all, Tim was one of the luckier ones.  He lived—but not without life-long problems.

Tim had multiple eye surgeries so he could see. Congenital cataracts are a common problem with CRS. Then he had open heart surgery, chest tubes and more knee surgeries than any of us wanted to count, the last one during his second year of college.

Did all these medical problems slow Tim down? Not really. He could ride a bicycle, skate board, snow ski and even water ski but he got tired faster than the rest of us so we waited for him to catch up. Tim was lucky. He lived, he could hear just fine, wasn’t blind, had a great mind and never developed diabetes.

Why is Tim’s story so important?  1950 was bad but 1964-19654 was worse with 12.5 million cases of rubella and 20,000 newborns with CRS. What about today? In countries where MMR (measles, mumps, and rubella) vaccine went by the wayside because they vaccinated only girls in 19891 and again in 19982 when most kids vaccines went by the wayside along with the Wakefield paper, those unvaccinated boys and girls are now in their child-bearing years. Rubella is alive and well.

Poland is a good example. Between January 2013 and April 2013 there were 21,283 cases of rubella (an average of 5.8 per 100,000 inhabitants), a 10-fold increase compared to the 2,224 cases in 2012. In some communities the rate range was 7.4—151.1 per 100,000 inhabitants. The male to female ratio was 10:1 with 15-19 year old males representing 57% of the cases.

During this time there were 2 cases of CRS reported whereas there were only 4 cases total reported in the 9 years between 2003 and 2012.

In Romania in 2011-2012, rubella cases totaled 20,772 with 11 cases of CRS.

          While this is more prevalent in Europe, it is a concern to those of us living in the United States. The US total rubella cases through September 2013 are 6 and all of them are imports.

          If you want to look at US measles, 98% of 163 cases are imports from Africa, Pakistan, Sudan, Turkey, Germany, UK, Poland, Italy, Azerbaijan, Belgium, Israel, Republic of Georgia, Ukraine, Europe, Mexico, India, Indonesia, Korea, Thailand, and China.

          Rubella and CRS may only be a plane trip away. It maybe someone else who is doing the travelling or you could come back a silent carrier.  

          If you know someone who may become pregnant, ask about their MMR vaccine or titer. It really is important. And before you leave home? Get your travel vaccines up to date.

 

 

1, 3In 1989, Poland started to administer monovalent rubella vaccine to 13 year-old girls but not boys.

2, 3In 1998 Wakefield’s paper caused a reduction in MMR vaccination in both boys and girls.

3 Paradowska-Stankiewicz, I., Czarkowski, M.P., Derrough, T., & Stefanoff, P.(2013) Ongoing outbreak of rubella among young male adults in Poland: Increased risk of congenital rubella infections. Eurosurveillance, Vol 18, Issue 21.  Retrieved from  http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20485

4Rubella. In: Epidemiology and Prevention of Vaccine Preventable Diseases (“Pink Book”). Atkinson W, Hamborsky J, Wolfe S, eds.12th ed Second Printing. Washington, DC: Public Health Foundation, 2012:275-290

Available at http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/rubella.pdf

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Immunize Oregon Coalition Meeting- You are Invited!

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Immunize Oregon Coalition Meeting- All Are Invited!

This will be a great opportunity to learn the basics about vaccine preventable diseases and the importance of immunizations, as well as to connect with other partners doing health work in the state.

October 29th

11:45am-2pm

800 NE Oregon St, Portland OR 97232

Room 1A

Lunch Provided: Please RSVP by October 24 to katherine.h.mcguiness@state.or.us

Call-In Information: 888-431-3632

4901986

 

At this meeting:

Learn about Immunize Oregon, a new lifespan Immunization coalition formed by  the merging of the Oregon Adult Immunization Coalition and Oregon Partnership Immunization Coalition.

Help Immunize Oregon select a LOGO!

A special screening of Invisible Threat, a documentary produced by high school students  examining why parents decide not to vaccinate their children, and the consequences that can follow. 

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Immunization Public Provider Conference and Flu Summit Wrap Up

This year, the Public Provider Conference, hosted by the Oregon Immunization Program, and the Oregon Flu Summit, hosted by Immunize Oregon, were held back to back at the Ambridge Center in Portland on September 24th and 25th. Here is a quick summary of what was covered at the events.

 

Public Provider Conference 2013

The 2013 Public Provider Immunization Conference was held on September 24th at the Ambridge Event Center.  More than 120 attended and were provided updates on 10 separate grants currently being completed at the state level as well as ongoing programs.   Topics included ALERTIIS, the Billable Vaccine Project and Immunization Programs and Oregon’s Transforming Health System.  Adolescent Immunization data and reminder recall was also shared with teen vaccination rates being the focus over the next few years.  The Research, Data, and Surveillance Team provided an exciting opportunity to discuss reports and statistics in the session Data Dreams to explore what reports best provide support to county programs and direction.   The increasing number of non-medical exemptions was also discussed as well as implementation on new legislation requiring parents to be informed about the vaccine-preventable diseases before submitting a non-medical exemption for one or more vaccines for their child’s attendance at schools/children’s facilities.

The conference also provided an opportunity for county and other public provider staff to extend their best wishes for the future to Lorraine Duncan who recently retired as Program Manager of the Immunization Program after 33 years of service.  Thank you to all who attended and made the conference a success.

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Flu Summit

With event registration reaching 325 people this year, we knew that there was a big need in Oregon for knowledge about the flu. The theme for the 2013 Flu Summit was “Reaching New Heights for Prevention”, which guided an expanded topic selection for this year’s event. Dr Paul Cieslak, the medical director for the Oregon Immunization Program, and Dr Erin Kennedy, a medical epidemiologist from the CDC gave updates and clarifications on changes to flu vaccine presentations, an epidemiological look at flu last year state and nationwide, and some thoughts about what is in store for this season. Steve Robison, an epidemiologist with the Oregon Immunization Program spoke about using Oregon’s immunization registry, ALERT IIS, to do near real time tracking of flu. Health care policy was addressed in a panel discussion, helping to demystify the process of how policy change happens and how to become an advocate for change in your community. The Vaccines for Children program and ALERT IIS both had breakout sessions, which were a great opportunity for participants to learn more about changes that are happening. Dr James Mason, director of Providence Health Service’s Culturally Competent Care Giving spoke about cultural beliefs around health and illness, and gave the audience tips on how to navigate cultural differences and still provide the best care to patients possible. The day ended on an inspirational note, with a panel consisting of a long term care facility and a hospital, both with incredibly high employee flu vaccine rates talking about how they have been so successful in maintaining those levels of protection for staff and patients. They shared about why they thought health care worker flu vaccine rates were so important, and how they inspired change in their organizations to work towards the goal of flu prevention. Thank you to everyone who participated, spoke, and attended!

 

Job Postings

To submit employment opportunities to be posted on ImmiNews, please email katherine.h.mcguiness@state.or.us

Oregon Health Authority – Immunization Health Educator  

Lane County- Public Health Manager

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