Category Archives: VFC

Updates, news and fun facts related to the Vaccine for Children Program (VFC).

NURSES NOTES

MeaslesRubella

Tribute to Maurice Hilleman (1919-2005): Immunization pioneer
By David Glassman, RN, MPH

This spring marks an unheralded milestone in immunization history. The work of one man 50 years ago has improved the health and well-being of people worldwide; a man who at the age of eight nearly died from diphtheria, a disease that would later be virtually eradicated in the United States through immunization. After Maurice Hilleman’s death, Ralph Nader wrote “Yet almost no one knew about him, saw him on television, or read about him in newspapers or magazines.” The name Maurice Hilleman is unfamiliar to most of us, but now in the 21st century, 95 percent of American children receive the MMR vaccine that Dr. Hilleman developed, starting with the mumps strain he collected from his daughter when she became ill in 1963.

In fact, this was most certainly not his only contribution. Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, credits him with having saved more lives than any other scientist in the 20th century. Over his career, Hilleman devised or substantially improved more than 40 experimental and licensed animal and human vaccines, including eight of the routinely recommend children’s immunizations: measles, mumps, hepatitis A, hepatitis B, varicella, meningitis, pneumonia and Haemophilus influenzae (including Hib). He also played a role in the discovery of the cold-producing adenoviruses, the hepatitis viruses, and the cancer-causing virus SV40, and was the first to purify interferon, as well as discovering the genetic changes that occur when the influenza virus mutates, known as shift and drift.

In the spring of 1963, the FDA awarded the first license for a measles vaccine. This was based on the early work done by John F. Enders at Boston Children’s Hospital, but Dr. Hilleman’s contribution was instrumental in decreasing side effects by giving gamma globulin in one arm and the measles vaccine in the other. At the time of this development, in the U.S. the disease sickened a reported average of 400,000 people (although the actual number of cases was much higher, as virtually all children acquired measles) and killed more than 500 children every year. Dr. Hilleman continued to refine the vaccine over the next four years, culminating in the much safer Moraten strain that is still in use today. It was the beginning of the end of the disease in this country.

At the same time, an epidemic of rubella began in Europe and quickly swept around the globe. According to the CDC, in this country rubella’s devastating effect on first-trimester pregnancies caused about 11,000 newborns to die and an additional 20,000 suffered birth defects. As the epidemic ended in 1965 Dr. Hilleman was already testing his own vaccine and by 1969 had obtained F.D.A. approval and prevented another rubella epidemic. As 1971 was beginning he put vaccines for measles, mumps and rubella together to make MMR, replacing a series of six shots with just two. Then in 1978, having found a better rubella vaccine than his own, Dr. Hilleman asked its developer, Dr. Stanley Plotkin, if he could use it in the MMR.

By all accounts Dr. Hilleman’s was obsessed with safety and effectiveness. It must have been a surprise when in 1998, toward the end of his life, his vaccine became the focus of scrutiny after The Lancet’s publication of Dr. Andrew Wakefield’s now-infamous article alleging that MMR caused autism. Parents began to stop immunizing. In place of a Noble Prize in Medicine he received hate mail and death threats. Dr. Wakefield’s work has been widely discredited after numerous independent studies demonstrated that there is no link between MMR and autism. The Lancet retracted the 1998 article and in 2010 the British medical authorities stripped Wakefield of the right to practice medicine. Sadly, Dr. Hilleman died of cancer in 2005 before being vindicated.

However, there are reasons to be encouraged, particularly by large-scale initiatives aimed at eradicating these common but easily preventable childhood diseases. The Measles and Rubella Initiative (MRI) is a global partnership devoted to “ensuring no child is born with congenital rubella syndrome or dies from measles.” It’s led by the United Nations Foundation, UNICEF, the World Health Organization, the American Red Cross, and the U.S. Centers for Disease Control and Prevention. The MRI has given the MMR vaccine to a billion children in this century, in 80 countries, preventing millions of deaths from measles alone. The Initiative is focused on supporting the goals of reducing global measles mortality by 95 percent by 2015 and eliminating measles and rubella in at least five of the six World Health Organization regions by 2020.

As a postscript, in this country, the strain that Dr. Hilleman collected from his daughter in 1963 has reduced the incidence of mumps from 186,000 cases a year to fewer than 1,000. For more on this incredible pioneer read co-inventor of the rotavirus vaccine Dr. Paul Offit’s 2007 biography of Hilleman, Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases.

dr-hilleman

Dr. Hilleman (Courtesy of Hilleman Laboratories)

Top image source: The Measles and Rubella Initiative
Sources:

http://www.cdc.gov/

http://www.measlesinitiative.org

http://en.wikipedia.org/wiki/Maurice_Hilleman

http://www.nytimes.com/2013/05/07/health/maurice-hilleman-mmr-vaccines-forgotten-hero.html?_r=0

http://www.hillemanlabs.org/

http://www.nature.com/nm/journal/v11/n4s/full/nm1223.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC557162/

http://www.montana.edu/news/10468/msu-grad-s-vaccines-save-millions

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H7N9 and the 3 Ps of Pandemic Flu Preparedness

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By Tessa Jaqua
H1N1 will forever live in infamy in the minds of public health professionals and healthcare providers alike. It stands as the pinnacle of pandemic preparedness and lessons learned. When it was over and the dust had settled, state and county public health departments put all those quickly developed plans on the shelf to—hopefully—sit, unused for a good long while.

Then, in March of 2013, rumors started crossing the seas, whispers of H7N9 and human infection grew louder, and by April the World Health Organization announced that avian influenza A (H7N9), a type of flu usually seen in birds, has been identified in a number of people in China. Human infections with a new avian influenza A (H7N9) virus continue to be reported in China, with 131 cases and 36 deaths as of May 17. There was some mild illness in humans, however most patients have had severe respiratory distress. There have been no cases of H7N9 reported outside of China, and the CDC is not sounding the alarm quite yet, but this is an excellent time to dust off those plans and review the lessons we learned from the H1N1. If for no other reason, it’s always good to be prepared, just in case.

3 Ps of pandemic flu preparedness:
Plan Review: Remember all those notebooks, excel documents, word files, etc. that were filled to the brim with pressing and important preparedness and response information during H1N1 and possibly H1N5? Get them out, open them up, and review them. H7N9 may become pandemic in the fall, or maybe in 2015, or possibly never, but when you’ve planned and prepared for this before, it’s always important to review and update regularly.
Partner Check-up: We have lists and lists of push partners and community resources, but when was the last time they were updated? Are you sure that Tracy Smith is still the administrator of that residential care facility? Refresh the list, update numbers, addresses, and add or delete partners. These lists hold the key to true community response so it is integral that they be as current and as useful as possible.
Public Prevention: The best time to prepare for a pandemic outbreak is before it happens. Redouble your efforts to communicate disease prevention strategies to the public and communicate regularly with partners. Provide health literate, continual, easy access to preparedness tips and flu facts in redundant locations. Remember there is no such thing as being over-prepared.

H7N9 might not be a big bad pandemic flu strain yet, but the risk reminds us that preparation is our best defense.

For more information about the H7N9 strain visit the CDC website HERE.

    Second 2013 coalition roundtable scheduled

Immunize Oregon is excited to announce their second 2013 Round Table. This free, full day event will be held in La Grande, Oregon on Wednesday, June 19th from 9-4:30. Immunization updates including ALERT IIS, statewide immunization rates, and VFC developments will be covered. Dr. Jay Rosenbloom will give his keynote presentation: “Addressing Vaccine Resistance.”

The roundtable event is a wonderful opportunity for providers and interested stakeholders to learn more about immunizations. For more information, please visit our website, http://www.healthoregon.org/immunizeoregon or click here to register.

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Welcome Dawn and Jenny to OIP

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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

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Farewell to our friend Sandy

SandyNewsum
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

Sandyshrine

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

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Immunize Oregon: Improving community immunity

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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.

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Two coalitions unite

Alison and Katherine

Oregon Immunization Program’s two coalitions— the Oregon Adult Immunization Coalition (OAIC) and the Oregon Partnership to Immunize Children (OPIC) —are merging into one. The new lifespan coalition, yet to be named, will continue to engage partners in meaningful projects to promote immunization in Oregon. Alison Alexander and Katherine McGuiness (coordinators for OAIC and OPIC respectively) will team up to lead the coalition.

“One lifespan coalition will be more efficient,” says Alison. “We won’t be duplicating work and members can be more meaningfully involved.” She believes the coalition will be able to do even more projects geared toward adults like Free, Local and Underserved (FLU) that works with nursing and pharmacy students to provide adult immunizations for those who can’t afford them.

Katherine is looking forward to involving a wide-range of members to the new coalition including people who may not be currently associated with the immunization world, such as representatives from non-profit organizations that work on health issues as well as the community-at-large. “Our new structure will allow people from different walks of life to be involved in different levels,” she says. “We will have subcommittees that people can join, depending on their interest. Anyone is welcome; we’re interested in hearing what coalition members would like to work on.”

The new lifespan coalition will continue with the more popular projects that OAIC and OPIC have sponsored in the past, such as the Round Tables and annual Flu Summit. Alison and Katherine think the entire coalition membership will meet three or four times a year, with a core executive committee meeting every two or three months. The first meeting of the merged coalition is January 29th

For more information, please contact Alison Alexander (971-673-0472 , Alison.ALEXANDER@state.or.us) or Katherine McGuiness (971-673-0285, KATHERINE.H.MCGUINESS@state.or.us).

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Saluting Salud Medical Center: Improving rates by improving processes

Salud Medical Center in Woodburn is a large community and migrant health center, part of the Yakima Valley Farm Workers (YVFW) organization. Several years ago, YVFW leadership chose childhood immunization rates as a target for process improvement.

They placed protocols in every YVFW clinic that empowered licensed nurses and medical assistants to vaccinate all patients—at any visit—with all needed immunizations.

 

The responsibility for improving childhood immunization rates falls directly on the nursing supervisor at each clinic. They use CoCasa (CDC software available for free download) to run monthly rates and progress reports, which are then shared with the other clinics and upper management. The clinics have turned this process into a friendly competition with each vying to be number one in the organization. Their efforts are clearly paying off with a phenomenal jump in coverage rates from 43 percent in 2010 to 96 percent in 2012.

 

  

Salud’s single vaccine rates also show impressive improvements with every measured vaccine rate exceeding Healthy People 2020 goals.

 When asked about their immunization success, Salud’s Christine Wystock, RN, CSN, said it is important to designate a vaccine “champion” willing to live and breathe vaccines. Other keys to higher rates include integrating regular vaccine updates into staff meetings; requiring RNs, LPNs and MAs take an annual vaccine quiz; and pre-visit immunization forecasting for every child, from birth to age 18. Alert IIS is also used regularly to check patients with spotty or missing forecasts.

 Christine says that the reward for all this hard work is less about the rates (as nice as they are) and more about the real-world protection that vaccines offer the children and families in their community.

 

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The new health educators are here!

As many of you know, the Oregon Immunization/Vaccines for Children Program has been short staffed since last fall, but we finally received approval to fill the vacant public health educator positions. After reviewing and interviewing many highly qualified applicants, three rose to the top.  Please join us in welcoming our three newest team members:

Since August 2006, Tuesday Johnson served as a health educator with Deschutes County Health Department. As the program coordinator for HIV/hepatitis prevention, she was responsible for all things related to HIV and HCV testing, education and outreach. She ran the needle exchange program and conducted several educational presentations on HIV, viral hepatitis, STDs, communicable disease and harm reduction to various organizations in the community including drug treatment centers. During her last year with Deschutes, she took on communicable disease reporting and investigation.

Tuesday enjoys traveling and walking Roxie, her 6-year-old Maltipoo. She is excited to be in Portland as a new OIP team member, and most of all, she looks forward to getting to know all of our great immunization partners.
 
Tuesday will be assigned the counties of Clatsop, Tillamook, Yamhill, Polk and Marion. She will also be the contact for Providence Health System and Yakima Valley Farm Workers.

Phone: 971-673-0317

Email: Tuesday.a.johnson@state.or.us

 

Rex Larsen graduated from Portland State University with a BS in health studies focusing on physical activity and health education. Rex is passionate about preventive health and most recently was a health educator in residential psychiatric care covering a broad range of topics from hygiene and STI prevention to chronic disease management.

Rex is also an avid cyclist, racing short-track, mountain and cyclocross, as well as a coach for road cyclists and triathletes. Rex has long had an interest in infectious disease and epidemiology; as a youth his two favorite books were The Hot Zone and Deadly Feasts. He is very excited about his new position with OIP and looks forward to working with all of his new partner clinics.

Rex will be assigned the counties of Douglas, Klamath, Lake, Lincoln, Benton and Linn.

 Phone: 971-673-0298

Email: Rex.a.larsen@state.or.us

 

Mallory Metzger moved to Oregon almost four years ago to complete her MPH internship at Deschutes County Health Services. She thought her time in Oregon would be brief, but her 300-hour internship turned into two terms as an AmeriCorps HOPE member, an interim position as the HIV/hepatitis prevention coordinator, and some time with emergency preparedness—all in Deschutes County. Before moving to Oregon, she studied at Indiana University and worked at the Center for Sexual Health Promotion.

Mallory hails from a small town in western Massachusetts. Outside of work, Mallory enjoys cooking, backpacking, traveling, yoga and spending time with great friends.  She is very excited to join OIP and is looking forward to meeting everyone and doing great work! 

Mallory will be assigned the counties of Umatilla, Union, Baker, Malheur, Wallowa and Lane.

Phone: 971-673-0480

Email: Mallory.s.metzger@state.or.us

 

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Providence Medical Group: A proactive approach to vaccine education

When it comes to educating their staff about vaccine, Providence Medical Group is breaking new ground. They recently rolled out a four-hour Immunization Skills Training course that focuses on vaccine administration, storage/handling and documentation. Laura Garner works as Providence Medical Group’s RN Clinical Educator and has been instrumental in creating this excellent course. 

 “When we looked at what we were doing right and wrong [regarding immunizations], we realized that some of the vaccine-specific information wasn’t making its way to clinic-level staff,” says Garner. “Losing vaccine can be extremely costly and, for the most part, totally preventable. Administration errors are also something we take seriously and want to minimize as much as possible. We felt that a specific, targeted training would make a bigger impact than small dribs and drabs sprinkled amongst other trainings.”

The training is comprised of several lecture-style modules taught by different experts within Providence, followed by skill station exercises where learners can get hands-on with the material. Garner utilized Immunization Skills Institute (ISI) workshop content and format, but tailored the PowerPoint presentation and skill stations to fit Providence Medical Group. 

Oregon Immunization Program Nurse Maria Grumm and Health Educator Albert Koroloff participated in the initial development of the training and assisted with the first few classes. As a health educator, Koroloff was especially happy to see the variety of presentation styles and methods, “Each student learns differently,” he says. “The mixed-method approach effectively teaches to multiple learning styles. It’s great to see a large organization like Providence prioritizing immunization training.”

Grumm adds, “The skill stations are a great hands-on opportunity for medical assistants to demonstrate their learning by practicing how to prepare and administer vaccines with an instructor available for support and teaching best practice techniques.”

The Oregon Immunization Program would like to recognize Providence Medical Group (and all of the staff involved) for the great work they are doing around immunization staff training! Stay tuned to ImmieNews this summer for information on no-cost vaccine stewardship training that is in the works.

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Printing a Certificate of Immunization Status (CIS) form

Do you print copies of immunization records for parents to take to their children’s schools? ALERT IIS can help! The Certificate of Immunization Status (CIS) is the official form for school and child care immunization records in Oregon. You can print a child’s immunization record on a CIS form through ALERT IIS. To print this form, first find a child’s record and click on Reports.

Then choose the last report, Certificate of Immunization Status.

The immunization dates in ALERT IIS will autofill onto the CIS form and you can print this form. In addition, parents may update the form by writing the dates of additional immunizations received and signing the form. 

Still need help? Ask the friendly folks at the ALERT IIS help desk: Portland Metro: 971-673-0275 or Statewide: 1-800-980-9431.

 

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