Greetings to all of you wonderful Oregon providers, vaccine administrators and Oregon Immunization Program (OIP) partners who work so hard to keep the children, adolescents and adults in our state well protected from vaccine-preventable diseases.
Before I say farewell and head toward my next great adventure in retirement, I want to share three things I have learned from my 10 years as a public health nurse consultant at OIP.
Lesson #1) The public health field of childhood, adolescent and adult immunizations is dynamic and ever-changing. When I arrived in 2002, the Advisory Committee on Immunization Practices (ACIP) recommended most vaccines for specific age groups most vulnerable to a particular disease. (i.e. PCV for infants and toddlers, PPV23 for adults 65 years and older and in 2005 when Menactra, the first conjugate meningococcal vaccine, was licensed for adolescents). Now as we near the end of 2012, ACIP recommendations continue to expand to high-risk conditions across the lifespan. Here are examples of just three such vaccine expansions:
1. PCV13 is now recommended: for healthy children 2-5 yrs, people ≥5 yrs old immuno-compromised with HIV, asplenia, CSF leaks or cochlear implants; and for adults ≥19 years immune-compromised with Leukemia, lymphoma, hodgkin disease, solid organ transplants and multiple myeloma.1
2. PPV23 is recommended: for people ≥65 years of age as well as those 2─64 year olds with chronic illnesses like cardivovascular disease, pulmonary disease, diabetes, alcoholism or liver disease; and persons ≥2 yrs old who are immuno-compromised with HIV, renal failure, Hodgkin’s disease, generalized malignancy, organ transplants and asplenia.1
3. MCV4 is recommended: for high risk infants 9 months─23 months with complement component deficiencies; when part of an institutional outbreak; for people traveling to epidemic meningitis areas; college freshmen; people with asplenia; high-risk lab personnel and travelers to high endemic meningococcal disease countries.
Lesson #2) Clinical staff and health educators spend many hours educating others about the importance and safety of vaccines to control vaccine-preventable diseases in their communities. However, behavior change and the willingness for adults to be vaccinated—or allow their children to be immunized with ACIP-recommended vaccines—seems to occur in higher numbers as a response to policies or procedures that require certain vaccines for K─12 school or college admissions, and professional health care jobs. An example of change promoted by policy: Oregon’s 2011 vaccine stewardship legislation will require training to better clinic staff competency in vaccine administration and increase storage and handling skills.
1CDC.Use of 13- valent pneumococcal conjugate vaccine and 23 valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions. MMWR 2012 available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6140a4.htm?s_cid:mm6140a4_e
Lesson #3) While offering vaccine administration and other educational trainings across Oregon in both public and private settings these past 10 years, I have learned that clinic staff who handle and administer vaccines appreciate time away from the clinic to attend immunization updates. This could be workshops on new ACIP recommendations, or information regarding the latest tools available to make monitoring vaccines in refrigerators and freezers as efficient as possible. Clinicians want their patients to be well protected against vaccine-preventable diseases and work hard to make that happen. We at OIP are available to partner with your clinics to make these trainings happen, so call your health educator if you want to schedule something.
We at OIP thank you for the important work you do every day to protect Oregon kids and adults from unnecessary vaccine-preventable diseases.
Don’t forget these three important references to consult and help you stay current with the constantly changing field of immunizations. You have questions? These have answers!
1) May 2012, 12 edition “Pink Book” on Epidemiology and Prevention of Vaccine-Preventable Diseases. Available at: http://www.cdc.gov/vaccines/pubs/pinkbook/index.html
2) 1/28/11 MMWR General Recommendations on Immunization, recommendations of the Advisory Committee on Immunization Practices(ACIP) Available at: http://www.cdc.gov/mmwr/pdf/rr/rr6002.pdf (every vaccine administrator needs this copy)
3) November 2012 edition of the CDC “Vaccine Storage and Handling Toolkit.” Available at: http://www.cdc.gov/vaccines/recs/storage/toolkit/storage-handling-toolkit.pdf