Category Archives: Ask Maria

Articles contributed by Maria Grumm, Immunization Public Health Nurse.

Maria Grumm: Lessons learned

Maria Grumm

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

 

 

 

 

 

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Vaccine Adverse Event Reporting: Whose job is it?

“ASK MARIA”  

 

What is the Vaccine Adverse Event Reporting System (VAERS)?

VAERS is a national vaccine safety surveillance program co-sponsored by CDC and the Food and Drug Administration (FDA). VAERS serves as the U.S. “early warning” system for potential safety concerns. The program collects and analyzes information from reports of adverse events following vaccination. The reported data is monitored to:

    1. Detect new, unusual or rare vaccine adverse events.
    2. Monitor increases in known adverse events.
    3. Identify potential patient risk factors for particular types of events.
    4. Assess the safety of newly licensed vaccines.

Who can report to VAERS?

  • Healthcare providers (even if causal relation to vaccination is not certain)
  • Hospitals or Emergency Departments
  • Military
  • Pharmacists and vaccine manufacturers
  • Vaccine recipients, parents or anyone who chooses to make a report.

What is a vaccine adverse event?

  • Any side effect or event following a vaccination.
  • The event may be true adverse reaction.
  • The event may be only coincidental.

What events should you report?

  1. Any adverse event listed by the vaccine manufacturer as a contraindication to further doses of a vaccine.
  2. Any adverse event listed in the VAERS table of Reportable Events Following Vaccination that occurs within the specified time period after vaccination.

 Where to Report:

Oregon private providers can report on line through the secure VAERS web reporting system or FAX reports to VAERS in Rockville, MD– online link: http://vaers.hhs.gov/esub/index

Oregon public providers (e.g. health departments; delegate agencies of health departments; Federally Qualified Health Clinics (FQHC); Indian Tribal Health Clinics; Rural Health Clinics; School Based Health Centers; and state agencies that use vaccine, such as the Oregon Youth Authority, Oregon State Hospital and Department of Corrections.) 

Public Providers Report Here:  http://flu.oregon.gov/articles/Documents/PublicClinicVAERSform.pdf  

Pubic providers can send their completed report via fax (971-673-0278) or mail directly to Maria Grumm at:

ATTN: Oregon Immunization Program
Oregon Health Authority
Public Health Division
PO BOX 14450
Portland, OR 97293-9929

    A  VAERS Reporting Form: 

On the back of this blank report form there are specific instructions on how to fill in each box. While a serious event would be a life threatening illness, a permanent disability, hospitalization or death following vaccination, you can report any event you feel is unusual to your practice or concerning to your patients. VAERS receives around 30,000 reports annually, with 13 percent classified as serious.

For additional information, call Maria Grumm at 971-673-0289.

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In the United States, whooping cough (pertussis) remains poorly controlled despite continued high coverage for childhood pertussis vaccination. In 2010, there were 285 reported cases of whooping cough in Oregon. Starting in 2005, the Advisory Committee on Immunization Practices (ACIP) recommended tetanus, diphtheria and acellular pertussis (Tdap) vaccine for adolescents and adults. But in the U.S., Tdap coverage is only 56% among adolescents and <6% among adults. In order to increase protection across the lifespan, ACIP extended their recommendations for Tdap in October 2010 to include off-label use in children 7 to 10 years of age and for adults 65 years and older.  

Common Questions about Administering Tdap Off-Label

Q: What is the off-label ACIP recommendation for children 7 to 10 years of age?

A: One dose of Tdap should be given to children 7 to 10 years of age* who:

  1. have an incomplete childhood DTP or DTaP schedule, or
  2. received only DT or Td (instead of DTaP or DTP) as their primary series doses, or
  3. have no records of previous pertussis-containing vaccines.
  • If Tdap was given at 7 years of age or older, a second Tdap dose is not (currently) recommended at any age. Additional Td boosters should be given at 10-year intervals.
  • One dose of Tdap may be given as a booster with no minimum interval after the previous tetanus/diphtheria-containing vaccine.

*Off-label use of Tdap for children 7–9 years of age will be covered for VFC-eligible children in public and private clinics.

Q: What is the off-label ACIP recommendation for individuals 65 years of age or older?

A: Adults age 65 years and older who have not previously received a dose of Tdap and want one, or who have or anticipate having close contact with children younger than 12 months (e.g., grandparents, other relatives, child care provider, and healthcare personnel), should receive a one-time dose to protect infants.

  • A single dose of Tdap will replace a routine Td booster for those who have not yet received Tdap.
  • There is no longer a minimum interval required between Tdap and the last Td dose.
  • 

Reference:
CDC. MMWR: Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine from the Advisory Committee on Immunization Practices, 2010
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6001a4.htm?s_cid=mm6001a4_w

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