Category Archives: DataPokes

Pharmacists Impact on Immunization

Quynh Tran, Pharm.D Candidate 2016

Pacific University School of Pharmacy

The role of pharmacists has come a long way from the classical “lick, stick, and pour” dispensary role (that is, “lick and stick the label, count and pour the pills”) and is experiencing significant growth and development. With the expansion in the scope of practice, community pharmacists are able to take on a stronger role in support of public health to improve vaccination rates and reduce the burden of vaccine preventable diseases. According to the American Pharmacist Association, three proposed roles that pharmacists can play in improving immunization rates include acting as immunization advocates, acting as facilitators and hosting other health care professionals to provide immunizations to the public, and lastly, taking on active roles as immunizers.

Pharmacists in all states are permitted to administer vaccinations, and the role of pharmacists in adult immunizations has increased significantly over the past few years. In 2011, Oregon pharmacy law allowed pharmacists to immunize adolescents down to age 11, and then in January of 2015, the law further lowered the age to 7. With less than half of adolescents receiving their yearly influenza vaccination, this change in pharmacy law can help more children get vaccinated and provide better access to immunizations.

The Oregon Immunization Program evaluated the impact of this change in the Oregon pharmacy law by using data from the Oregon ALERT Immunization Information System (IIS) limited to Clackamas, Marion, Multnomah, Polk, Washington and Yamhill Counties. The program compared influenza immunization rates before 2011 (2001 – 2010) and after the law was passed in 2011 (2011 -2014), between adolescents aged 11 -17 and those aged 7 – 10. Results revealed that between 2007 and 2014, adolescent influenza immunizations at community pharmacies increased from 36 to 6,372, with the largest increase happening after the law change, from 262 in 2010 to 2,083 in 2011. This evaluation demonstrated that expanding the scope of the pharmacist in immunizing adolescents can provide better accessibility to an adolescent population who may otherwise be unlikely to receive immunizations at clinics. This in turn can substantially help increase adolescent influenza immunization rates.

References

  1. Robison, Steve G. (2016). Impact of Immunizing Pharmacists on Adolescent Influenza Immunizations. Manuscript submitted for publication.
  2. Rothholz, Mitchel C. (2013). Role of community pharmacies/pharmacists in vaccine delivery in the United States [PowerPoint slides]. Retrieved from http://www.pharmacist.com/role-community-pharmaciespharmacists-vaccine-delivery-united-states-0

 

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Filed under ALERT IIS, DataPokes, Education, Flu, Oregon Immunization, Research, School Law, VFC

DATA POKES: June 2013

Adam
Staff Update- Adam Boyette

The Oregon Immunization Program (OIP) is pleased to announce the hiring of Adam Boyette as a research analyst. Adam recently finished a PhD in anthropology from Washington State University. His dissertation work focused on children’s social learning among hunting and gathering societies in Africa. Despite his Indiana Jones-like appearance, Adam professes little experience with dangerous relics and obscure temples. Instead his main area of academic focus was on how ideas and culture are transmitted between individuals. Adam believes in an ‘epidemiology of ideas’ to explain how ideas, like diseases, can spread.

Adam is replacing Scott Jeffries, whose new role in OIP is working on an adolescent immunization grant. Adam will be in charge of the Population-Based Rates program and other special projects. Adam is looking forward to applying his research experience to public health and immunizations in Oregon. He is also extremely excited to talk about the birth of his now month-old daughter, Delphine. (Baby pictures on request).

Staff Publications
Steve Robison. Sick visit immunizations and delayed well-baby visits. Pediatrics, June 3rd, 2013.

Sick visits is one of the hardest barriers to address when trying to keep kids on an immunization schedule. Many kids are likely to be sick during one or more of the periods when shots are due in early childhood, and having a sick visit when immunizations are due is a common reason for infants falling behind.

AAP/ACIP policy calls for giving immunizations on sick visits for mild or moderate illnesses such as otitis media (earaches), regardless of whether there is a fever or not. However some providers worry that giving due immunizations on sick visits may discourage further shot seeking, or discourage returning to make-up missed well-baby checks.

A new study by Steve Robison in Pediatrics looked at whether giving sick visit shots discouraged returning for make-up well baby visits or further immunization seeking. Using ALERT and DMAP data, this study found that giving sick visit shots was not a risk for lower immunization or well baby visit rates. In contrast over a third of those who did not get a sick visit immunization failed to return for a make-up visit, and had significantly lower immunization rates and lower numbers of well-baby visits by age two. So avoiding sick visit shots has little benefit and carries a risk of children falling behind and not catching up on immunizations.

As a take-away message, if a child presents sick when shots are due consider giving them their immunizations. If you can’t, make sure that the parent has a make-up appointment scheduled before they leave the clinic.

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DataPokes: May 2013

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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).

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