Category Archives: Flu

ACIP drops recommendation of LAIV/nasal spray for 2016-2017 flu season

 

As many of you already know, ACIP voted to remove Flumist® from the list of recommended flu presentations for the 2016-2017 season. More specifically:

“CDC’s Advisory Committee on Immunization Practices (ACIP) today voted that live attenuated influenza vaccine (LAIV), also known as the “nasal spray” flu vaccine, should not be used during the 2016-2017 flu season. ACIP continues to recommend annual flu vaccination, with either the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV), for everyone 6 months and older. ACIP is a panel of immunization experts that advises the Centers for Disease Control and Prevention (CDC). This ACIP vote is based on data showing poor or relatively lower effectiveness of LAIV from 2013 through 2016.”

-www.cdc.gov/media/releases/2016/s0622-laiv-flu.html

 

To help you better communicate this message to your patients and staff, here are two excellent primer articles:

1. “No Flu Nasal Spray Next Season: Why Is This Vaccine Not Working?” Livescience.com, June 23, 2016, www.livescience.com/55176-flu-nasal-spray-not-working.html

2. “Intranasal FluMISSED its target.” aappublications.org, July 12, 2016, www.aappublications.org/news/2016/07/12/LAIV071216

If you have further questions about how this will affect your clinic’s state-supplied flu order, please call Jennifer Steinbock at 971-673-0309.

 

 

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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

2015-2016 Flu Season Update

Fall has arrived and along with the shorter days, colder weather and rain comes the season for influenza-like-illnesses (ILI) and pneumonia. This article includes updates from the Oregon Health Authority (OHA), Centers for Disease Control and Prevention (CDC), and flu-related highlights from the Advisory Committee on Immunization Practices’ (ACIP) final meeting of 2015.

OHA Flu Season Activity Findings

The OHA monitors flu activity in Oregon and reports weekly on the number of incidents and spread of ILI throughout the state from the first day of the 40th week of the year through the last day of 20th week of the following year. This year flu activity reporting began on September 28, 2015 and will end May 22, 2016.

The FluBites report for week 44, ending November 7, 2015, reported no positive influenza tests, a minimal level of ILI activity, and no reported outbreaks.

CDC Flu Season Activity Findings

The CDC monitors flu and pneumonia activity in the United States all year long but they report weekly on the incidents and spread of these illnesses throughout flu season.  There is a lot of good news this flu season. Here are a few of the highlights from the CDC weekly report as of week 44, ending November 7, 2015.

  • This year’s flu vaccine offers significantly more protection than last year’s vaccine because it includes two or three additional flu strains in the vaccine mix and those strains are similar to the circulating strains of flu this year.
  • The percentage of respiratory specimens testing positive for influenza in clinical laboratories is low. Of the 10,271 specimens tested in week 44, only 1.2% of the specimens were positive for influenza viruses.
  • None of the 2015 tested influenza viruses in circulation were found to be resistant to the three major anti-viral medications.

Flu graphic

http://www.cdc.gov/flu/weekly/index.htm#S1

 

ACIP Meeting Highlights Related to Flu

The October ACIP meeting included a presentation on the cost-effectiveness of high-dose influenza vaccine in adults aged 65 years and older.  The presenters concluded that high-dose flu vaccine is more cost effective than standard doses of flu vaccine based on the reduction in cardiovascular complications seen in patients 65 years and older who received the high-dose vaccine versus those who received the standard flu vaccine dose.1,2

A new influenza vaccine currently under FDA review was discussed.  The new vaccine, an adjuvanted trivalent vaccine, is expected to enhance immune response and have a safety profile similar to other licensed vaccines.

 

1 DiazGranados C A, et al: Efficacy of high–dose versus standard–dose influenza vaccine in older adults. New England Journal of Medicine: 2014;371:635–45. Available at:  http://www.nejm.org/doi/full/10.1056/NEJMoa1315727?query=featured_home&  Accessed 5 November 2015.

2CDC. Fluzone High-Dose Seasonal Influenza Vaccine. Questions and answers. Available at http://www.cdc.gov/flu/protect/vaccine/qa_fluzone.htm  Accessed 5 November 2015.

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Know Before You Immunize – Advice From A Breast Cancer Survivor

– By Lisa Stember, RN, BSN

It’s hard to avoid the color pink during the month of October when even football stadiums are decorated to raise awareness of breast cancer. As a two-time survivor of the disease, I don’t need pink ribbons to raise my awareness, but the pink ribbons do help me to stay focused on prevention of one of the more devastating side effects of cancer treatment: lymphedema.  This is especially important during flu season when I’m thinking about getting my annual flu vaccine.

Surgery to remove breast cancer frequently includes removal and examination of axillary lymph nodes for spread of disease.  The removal of or damage to lymph nodes can result in lymphedema, the abnormal buildup of fluid in soft tissue due to a blockage in the lymphatic system.  Lymphedema can develop immediately after surgery or radiation, but it may occur months or years after cancer treatment has ended. Swelling can cause pain, numbness and limit movement in the affected limb.  In severe cases, the skin becomes tight and the scarring causes hyperkeratosis.  Although treatment to reduce the swelling and relieve symptoms is available, once symptoms have occurred it’s usually a lifelong condition.

As a breast cancer survivor I have been instructed to avoid any blood draws, injections or blood pressure measurements on the affected side, as well as taking steps to avoid skin infections. This advice presents a dilemma when getting a vaccination because the Advisory Committee on Immunization Practices (ACIP) recommends the deltoid muscle area of the upper arm as the best route for adult vaccines. So what is the solution?

While ACIP discourages variations from the recommended route, site, volume, or number of doses of any vaccine1, when a patient has either lymph node removal or damage to the lymph system, using the thigh muscle as the vaccine injection site might become necessary.  If the vaccine needed is for hepatitis B or rabies, use of any site other than the deltoid muscle is considered an invalid dose.  For these vaccines, doses given in a nonstandard site can be verified by titer for efficacy.

After my first occurrence of breast cancer, I carefully protected my arm, avoided injuries, promptly treated cuts, and redirected health care personnel to my unaffected side for immunizations. When my breast cancer reoccurred on the opposite side resulting in the loss of more lymph nodes, I decided it was in my control to ask for help in preventing lymphedema and made a plan.   Although it isn’t always convenient, I now ask for immunizations in an alternate site.   Blood pressure can be done on a lower extremity.  Although not many women and men are bilateral breast cancer survivors, any person with loss of lymph nodes needs consideration.  If you are a breast cancer survivor or have loss of lymph nodes, check with your personal care provider for what adult vaccines you need, and where best to have them administered.

http://www.cancer.net/navigating-cancer-care/side-effects/lymphedema

http://www.breastcancer.org/treatment/lymphedema/reduce_risk/avoid

Lisa Stember is a registered nurse. She graduated with her nursing degree in 1986 from OHSU School of Nursing and also holds a Bachelor of Science degree in health education from Oregon State University. She is currently a public health nurse on the certification team for the Oregon School-Based Health Centers, Adolescent and School Health Program. Prior to that she worked for 17 years as a school nurse and spent 11 years in inpatient care in maternal and pediatrics at OHSU.

1 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm

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Flu Season Update

The 2014-2015 flu season brought a new, drifted A strain of influenza that was not in the virus selection for the season’s vaccine. As a result, the effectiveness of the vaccine was lower than expected.  This has many people asking, “Why bother with a flu shot each season?”

Each year  the A strains that begin on the East Coast die out over the Mid-West allowing the B strains to take the lead somewhere over the Rockies en route to the West Coast. Every year the Centers for Disease Control and Prevention (CDC) begins tracking the influenza (flu) season in early October and select the vaccine strains that will be used to manufacture vaccine around February. If  a strain drifts into a new influenza virus after the vaccine manufacturing process begins, the new strain will not be included in the current season’s vaccine, but the  vaccine will still protect against the other most deadly strains identified during the winter season in the southern hemisphere.

The CDC reported that among the 2014-2015 seasonal influenza A viruses, 52,518 (50.1%) were subtyped; 52,299 (99.6%) were influenza A (H3N2) viruses, and 219 (0.2%) were A (H1N1) pdm09 viruses. In addition, three variant influenza A viruses (one H3N2v and two H1N1v) were identified.  In response to the CDC findings, this year the 2015-2016 flu vaccine mix has two or three new strains included.


 

Vaccine Strains included
FluMist® (live) nasal

flu vaccines

·A/Bolivia/559/2013 (H1N1)
(an A/California/7/2009 (H1N1)pdm09-like virus)·A/Switzerland/9715293/2013 (H3N2)-like virus

·B/Phuket/3073/2013-like (B/Yamagata lineage) virus

·B/Brisbane/60/2008 (B/Victoria/2/87 lineage)

Inactivated (injectable)

trivalent vaccines

·A/California/7/2009 (H1N1)pdm09- like virus

·A/Switzerland/9715293/2013 (H3N2)-like virus

·B/Phuket/3073/2013-like (B/Yamagata lineage) virus

Inactivated (injectable)

quadrivalent vaccines

·Same three strains as the injectable trivalent, plus:

·B/Brisbane/60/2008-like (B/Victoria lineage) virus


Here at the Oregon Immunization Program our flu season takes off with the delivery of the first available flu vaccines, sometime in late summer or early fall. The CDC recommends an annual flu vaccine for all individuals without contraindications ages 6 months and older.  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6421a5.ht
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Immunizing as a Pharmacy Student

jscovell
by Jennifer Scovell
I decided on the profession of pharmacist when I was in high school. I liked the health care field but I didn’t think I could handle the “yucky stuff” involved in nursing, or the very long academic career of a physician, but pharmacy seemed like it could work. I was good at math, science, and communicating with people so I thought I would give it a shot (no pun intended). The more I learned about the pharmacy profession, the more I fell in love with it. I am very fortunate to still feel this way over 8 years later and I hope my passion only grows in the future.
I did not know that pharmacists were giving immunizations when I first started thinking about pharmacy as a career. And that’s a good thing, if I did I probably would have listed that under my “yucky stuff” category and ruled it out as a future job. When I did learn of the immunizing pharmacists, I wondered if I would be able to handle it. I, like many people, am not very fond of needles. Honestly, I don’t know of anyone who LOVES getting vaccines but I avoided the flu shot every year and the topic produced a great deal of anxiety for me.
So, when the time finally came to start my immunization training at the end of my first year of pharmacy school, I was nervous, to say the least. Our skills lab for vaccine administration came after our live lecture and self-study modules on immunization training. And the best part… as students, we had to practice giving injections on each other! This meant that not only did we have to get (and give) a couple of injections in two different sites, we KNEW that the other person had never done it before! “Exposure therapy” can be used in certain anxiety disorders or phobia disorders and I would classify this experience as such. It was my own personal “Fear Factor” episode and guess what… IT WORKED! While vaccines are still not my favorite thing to receive, I do not get anxious and I certainly do not avoid them. Just this last weekend I received my first dose of Havrix (Hepatitis A vaccine) from my local pharmacist.
Immunizing is now one of my favorite activities when interning at community pharmacies or volunteering at outreach immunization clinics. It is a great opportunity to have one-on-one time with patients to answer their questions and talk about their health. Working and volunteering at different sites with pharmacists and nurses has given me the opportunity to improve my immunization technique and learn best practices. With each vaccine I administer, I have the chance to promote immunization as the best way to protect the public from certain diseases, like the flu. As a pharmacy intern at the Oregon Health Authority Immunization Program, I have seen the passion and dedication of the people in this program and I hope that I can help strengthen the relationship between the Oregon Immunization Program and all immunizing pharmacists.

Editor’s Note: Jennifer’s last day as an intern at the Oregon Immunization Program is on Friday. She has been a fantastic addition to the team, and we will miss her!

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Filed under ALERT IIS, Flu, Immunize Oregon

Immi News You Can Use

cropped-ramona-falls-mount-hood-wilderness-oregon-30.jpg

Welcome Summer!
Here is some great immunization news to start the season right!!

PBS: HPV vaccine dramatically cuts number of infections in teen girls

NBC: Dr. Paul Offit takes on the alternative medicine industry

OPB: Oregon lawmakers approve vaccine education bill

US News Healthday: Flu vaccine protects millions annually

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Filed under All Posts, CDC, Flu, Oregon Immunization, School Law

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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Flu vaccine: let’s use it until we lose it!

By Kate Parker-Shames, VFC Health Educator
 

It’s the end of flu season. Often it seems like a lost cause, vaccinating patients against flu at this time of year. Many clinics around the state have a small amount of short-dated flu vaccine in their refrigerator, and in some clinics, that vaccine will just fill space until they expire.  It is still possible to administer flu vaccine, even this late in the season! Last week, while on a visit to Samaritan Pediatrics, I was reminded of how we should still encourage families to get immunized for flu- even though it is late in the season. When I asked the clinic how they were doing getting through their short-dated flu stock, I was told that the clinic was having no problem using up their flu stock; as they were still immunizing for flu. While the clinic’s rate of administering flu vaccine had slowed down a little since the winter months, they were still giving quite a few doses per day. The clinic told me that they thought they would probably use all their doses before the end of the month. Wow, I thought, I wonder how they do this. So many of our providers around the state have difficulty getting flu vaccines into patients this late in the season; so, how does this clinic do it?

My curiosity piqued, I asked clinic staff, and they told me:

Clinic staff said that it was almost a non-issue for them. Their attitude towards administering flu vaccine is straightforward:  it is still flu season, we have flu vaccine available, and anyone who is eligible should get the vaccine. Any eligible patient who sets foot in their clinic should get flu vaccine. 

First reason: children should get the flu vaccine every year. If they have not gotten their vaccine for this flu season, they should get it. The clinic screens every kid who comes to the clinic to see if they have yet received their flu vaccine for this season. Just because flu season is ending doesn’t mean that, (1) a kid can’t still get the flu, or (2) that they shouldn’t have access to the long-term immunity against this year’s flu strain for protection in future flu seasons. 

Second reason: a lot of pediatric patients require two doses of flu (children under 9 years old getting flu vaccine for the first time should have two doses in their first season of being immunized), so every kiddo fitting this category is screened when they come to the clinic to see if they have had their second dose of the season, and if they haven’t had their second dose already this year, they get it….even in June. 

Keys to successful late-season flu vaccine administration:

Attitude: the clinic treats late season immunization as a non-issue. People need the flu vaccine, should get it, and therefore, the clinic offers it whenever patients are eligible. 

Screening: the clinic is screening every patient who comes into their office to see if they are due for a flu vaccine

We can all learn a little from Samaritan Pediatrics! Let’s use these last few days of flu season 2010/11: screen all patients who walk through your doors for flu eligibility. Let’s use these flu doses before we lose them!

 

 

 

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