Category Archives: Oregon Immunization

General Immunization news that addresses Immunization efforts at a state-wide level.

Adult Pneumococcal Recommendations in Practice

by Kerry Nolan, Oregon Immunization Program Pharmacy Intern

This is part one of our two part pneumococcal vaccination series. 

Update: This post was edited on 2/5/2015 for clarification.

Situation: A 65 year-old patient has come to our clinic today for a pneumococcal vaccination following her first dose of Pneumovax at age 62.

What vaccination should she receive today? If and when will she need another one? Will it be covered? Since the Advisory Committee on Immunization Practices (ACIP) introduced their latest pneumococcal recommendations for patients 65 and older, both providers and patients have been asking the right questions.

What are the new recommendations?

Adults aged 65 and older should now receive one dose each of Prevnar 13 and Pneumovax 23. Previously, a single dose of Pneumovax 23 alone was recommended for this age group. Although Prevnar 13 has been FDA approved for adults 50 years and over since 2011, it just earned the ACIP recommendation for adults age 65 and up last September. ACIP recommends that adults 19–64 years receive PCV13 if they have an identified health risk.  Healthy individuals age 50–64 may have a dose of Prevnar 13 per FDA approval, however, this dose may not be covered by insurance.  Sounds simple enough, but determining when and who should receive which vaccine gets a bit more complicated. The recommended pneumococcal vaccination schedule separates patients ≥65 years into those who have:
1. Never received any pneumococcal vaccine, and should receive Prevnar 13 first then Pneumovax 23 between 6 to 12 months later
2. Received one (or more) doses of Pneumovax 23, and should receive Prevnar 13 at least one year after their last Pneumovax 23 vaccination
3. Received Pneumovax 23 before turning 65, and should still wait at least one year since their last Pneumovax 23 vaccination to receive Prevnar 13, but must also wait at least 5 years between Pneumovax 23 doses to receive one final dose at ≥65.

In this diagram provided by the ACIP, the latest adult pneumococcal vaccination schedules are summarized:
Pneumococcal vaccine
Image: Sequential administration and recommended intervals for PCV13 and PPSV23 for adults aged ≥65 years — Advisory Committee on Immunization Practices, MMWR 2014

So- which should our patient receive and when? She received a dose of Pneumovax 23 prior to turning 65, which places her in the third category. It has been 3 years since Pneumovax was given, so she should receive Prevnar 13 today. However, when considering the best time for her to return for the final Pneumovax dose, we find that even in 12 months, only a total of four years (not the recommended five) will have passed since her last dose. What should we do? In this situation, the patient should wait the full five years since her Pneumovax dose before receiving the final one. In other words, she will receive Prevnar 13 today and a final Pneumovax 23 dose in about two years.

Will the new vaccine be covered?
On December 31st the Center for Medicaid and Medicare Services (CMS) released a statement announcing that an update to pneumococcal vaccine coverage requirements would be in effect as of September 19, 2014 to align with ACIP recommendations. Effective February 2nd, two pneumococcal vaccines and their administration will be covered under Medicare part B: the first for patients who have never received any pneumococcal vaccine and a second (different) vaccine one year after the first was administered. This coverage is not perfectly aligned with ACIP’s recommendations, but captures where vaccination schedules overlap at the one-year mark. Additionally, Medicare will adjust previously denied claims for qualifying pneumococcal vaccinations administered September 19th or later if the claim is resubmitted. Our patient is more likely to have her second vaccination covered if she is insured privately. As part of the Affordable Care Act, health plans are now required to cover ACIP-recommended vaccines without co-pays or cost-sharing.

As we become comfortable with the nuances of these recommendations, we are better able to provide vaccine protection and education. Tricky timing, different vaccines and varying coverage are each good reasons for giving pneumococcal vaccines in older adults your careful consideration.

References:

1. CDC. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR 2014; 63 (37); 822-825. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6337a4.htm. Accessed 26 Jul 2015.
2. Centers for Medicare & Medicaid Services (CMS). Modifications to Medicare Part B Coverage of Pneumococcal Vaccinations. MLN Matters 2014; p1-3. Available at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9051.pdf. Accessed 26 Jan 2015.

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Antibiotics and Public Health: A Collaborative Elective for Students and Community

by Tessa Jaqua, AWARE Program Coordinator

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As fall ushered in a change of season, the Oregon AWARE program once again armed itself for the onslaught  of colds, flus, and other viral illnesses that contribute to the overuse of antibiotics in our community. The Oregon Alliance Working for Antibiotic Resistance Education (AWARE) is the state’s coalition whose mission is to encourage the appropriate use of antibiotics and aims to reduce the problem of antibiotic-resistant bacteria in Oregon.

As a statewide coalition, Oregon AWARE takes advantage of the amazing resource and fresh minds from the innumerable educational and community organizations that are committed to the health and wellness of Oregonians. Two of these long time partners are conveniently located right across the river in the AWARE program’s backyard. While the Oregon State University School of Pharmacy and Oregon Health and Science University’s Physician Assistant (PA) program made themselves at home in the new collaborative sciences building on the south Portland waterfront, 15 students from both programs decided to honor the name of their new home by participating in a new collaborative elective course; Antibiotics and Public Health.

These pioneering students spent 10 weeks learning about the effects of antibiotic resistance globally and locally, the benefits of judicious antibiotic use, preventive vaccinations, and educational techniques for reducing overuse to preserve this life-saving resource. Each topic was presented with consideration and professional feedback from PAs, pharmacists, and immunization and antibiotic resistance educators.

Students were charged with completing not only lessons and projects,  but also organizing and running the Oregon AWARE program’s annual Get Smart About Antibiotics Week event, AWARE on the Square. Students organized everything from volunteering, logistics and vaccination provision, to media and community outreach for this event in Portland’s Pioneer Square. Working in interdisciplinary groups to maximize efficiency and promote participation from fellow students, these students assured that the event was a rousing success. Students educated or surveyed over 725 Oregonians and provided no cost flu shots to 46 uninsured/underinsured adults.

At the end of the term, students reflected on the course with positivity and excitement at getting to work with students from other programs and disciplines. They credited their success on final projects and AWARE on the Square to having varied and unique input from their fellow students and instructors. Many hope to carry interdisciplinary cooperation into other areas of their programs.

Oregon AWARE, the OSU School of Pharmacy, and OHSU PA program are pleased with the student’s success and the service they were able to provide to the community through events and student projects.  The programs hope to continue the elective in the fall of 2016 and plan to expand registration up to graduate nursing and medical students as well.

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HPV: Same Way, Same Day

Source: CDC Preteen Vaccines

Did you know that the female Hispanic patients in your practice have a greater chance of developing cervical cancer later in life than non-Hispanic patients? United States Cancer Statistics on cancer incidence show Hispanic women have the highest rates of cervical cancer in the United States. You can reduce this disparity and protect your patients’ future health with HPV vaccination.

You are the key to cancer prevention. Research shows that an effective recommendation from a healthcare professional is crucial to a parent’s decision to get the HPV vaccine for their child. One way to make an effective recommendation is to recommend all routine adolescent vaccines—Tdap, meningococcal, and HPV—at the same time without singling out HPV vaccine or presenting the vaccine as optional. If parents ask why HPV vaccination is needed, remind them that HPV vaccine is for cancer prevention.

Prevention is easier than treatment. More than 4,000 women die of cervical cancer every year, even with screening and treatment. Over 27,000 men and women in the U.S. are diagnosed with a cancer caused by HPV every year—that’s a new case every 20 minutes! HPV vaccine could prevent the majority of these cancers from ever developing, but only 57 percent of adolescent girls and 35 percent of adolescent boys have received the first dose, according to the most recent data from the Centers for Disease Control and Prevention (CDC). . In comparison, 86% of teens have received Tdap and 78% have received meningococcal vaccines.

Recommend HPV vaccine the same way and the same day you recommend the Tdap and meningococcal conjugate vaccines. For example, start your vaccine discussion with the parents of preteen patients by saying: “Your child needs three shots today—meningococcal, HPV, and Tdap vaccines.”

For more information on having successful conversations with parents about HPV vaccination, and to learn how to answer common questions, download CDC’s Tips and Timesavers factsheet at www.cdc.gov/vaccines/YouAreTheKey. This site also has patient education materials in Spanish that your staff can download and print for the parents of your Hispanic patients.

If parents have concerns about paying for vaccines, the Vaccines for Children (VFC) program may be able to assist. The VFC program provides vaccines for children ages 18 years and younger who are uninsured, Medicaid-eligible, and/or American Indian or Alaska Native. Send parents to www.cdc.gov/Features/VFCprogram/ to learn more about the VFC program.

You can find out more about the Oregon VFC Program by clicking here.

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Oregon HPV vaccine quarterly report

by Sara Beaudrault

The Centers for Disease Control and Prevention (CDC) now provides quarterly human papillomavirus vaccine (HPV) reports to state and local immunization programs to document progress toward reaching the Healthy People 2020 goal of 80% coverage with three doses. Since the HPV vaccine’s introduction, coverage at the national level and in most states, including Oregon, has increased at a very slow pace.

Oregon’s first quarterly HPV report is available on the Oregon Immunization Program’s Adolescent Immunizations webpage. Other reports and resources are also available on this page, including a link to CDC’s You Are the Key to Cancer Prevention toolkit for healthcare providers.

With over 14 million new HPV infections each year, most acquired during the teen years and 20s, increasing HPV vaccination uptake among today’s young people is critical to prevent future HPV-associated cancers.

CDC and the Oregon Immunization Program urge healthcare providers to strongly recommend all adolescent vaccines recommended for boys and girls aged 11-12 years. We encourage providers to recommend and promote HPV vaccine just as they recommend Tdap, meningococcal, and influenza vaccines.

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The Journey to Become a Certified Medical Assistant

by Jeanine Whitney RN, MSN, NHE-C

Did you ever wonder about the qualifications of the person who holds the power of the needle? Vaccines are being given more and more by healthcare workers other than a Registered Nurse. In fact, chances are good that the person holding the syringe is not an RN but could well be an immunizing pharmacist or a Medical Assistant (MA). There are many categories of MAs, each with its own education and certification requirements. In this article, we explore the unique education and certification requirements for Certified Medical Assistants (CMA).

All MAs undergo a rigorous course of study, but the American Association of Medical Assistants (AAMA)-required course of study for CMAs must be certified by the Commission on Accreditation of Allied Health Education Programs (CAAHEP: http://www.caahep.org/) and/or the Accrediting Bureau of Health Education Schools (ABHES: http://www.abhes.org/). This is different from many MA programs, whose accreditation falls under the school, and it means that CMA students everywhere receive standardized training that conforms to CAAHEP requirements.

The CMA training curriculum ensures that CMA students gain competency in a wide variety of areas. I contacted Virginia Chambers1, CMA (AAMA), BS, MHA, who is the Medical Assisting Department Co-Chair at Portland Community College (PCC). She shared the list of required competencies for a CMA. By the time students sit for their exams, they are well-versed in basic practice finances, communication, managed care and insurance, medical coding, legal issues, and of course, patient care. CMAs are able to step in and fill any number of roles for their employers because of this comprehensive training.

CMA certification exams also differ from those for other MAs. I took the opportunity to speak with Paula Purdy2, CMA (AAMA), who is Director of Operations for Medical Society Services, Inc., about these differences.

“The one big difference,” according to Ms. Purdy, “is that the AAMA certifying board is the only medical assisting certifying agency that uses the National Board of Medical Examiners (NBME) as the consultant for its certification examination.  CMA (AAMA) exam scoring metrics are processed by the same professional psychometricians who provide this service for United States Medical Licensing Exam (USMLE) candidates. The CMA (AAMA) exam is a highly valid and reliable indicator of the knowledge necessary to be a competent medical assistant.” The AAMA exam is not easy. The overall student pass rate is 67 percent.  At the time of this writing, PCC is the only school in the Portland metropolitan area that has a 95 percent or above student pass rate.

The AAMA requires recertification every 5 years. In those five years, the CMA (AAMA) must earn 60 continuing education units (CEU).These CEUs must reflect the breadth of training areas.  Ten CEUs must be administrative; ten CEUs must be general; and ten CEUs must be clinical. The CMA can choose how to fulfill the remaining thirty CEUs. If the CMA (AAMA) doesn’t complete the CEUs on time, they have six months from the expiration date to do so or they must sit for the exam again.

Keep in mind that all MAs are under the direct delegation of the hiring physician. An RN can observe and teach an MA. RNs can also supervise an MA and delegate tasks to them according to Oregon State Board of Nursing (OSBN) Nurse Practice Act Division 45 and 47. RNs can delegate several types of tasks to MAs, but immunization injections are not one of the tasks. The hiring practitioner delegates immunization injections to the MA.

Are any Oregon employers putting credentialed healthcare workers to work? Yes. Cathy Cassata in CMA Today magazine3 (Nov-Dec 2013) talks about CMAs and the Oregon Health and Science University ambulatory care services. “As of April 1, 2013, all newly hired medical assistants are required to become CMAs (AAMA) within six months of being hired.”  We can add Providence, Legacy, Kaiser, and Adventist to the list of employers that actively recruit AAMA-certified individuals for their practice sites. Oregon has approximately 1,200 CMAs (AAMA) in practice.

The next time you get a vaccine, take a good look at the initials after the name of the person holding the needle. If there are none, then ask. It may well be a CMA (AAMA). If so, you are in well-educated and credentialed hands.

1PCC-Willow Creek:  http://www.pcc.edu/about/locations/willow-creek/.

 2 Certified Medical Assistant (CMA) American Association of Medical Assistants (AAMA) ®, the current Public Affairs Liaison Team Manager and past State President (2013) of the River Cities Chapter of Medical Assistants (CMA,AAMA): http://www.aama-ntl.org/) Ms. Purdy currently serves on the AAMA Board of Trustees.

3Cassata, Cathy. Trailblazers: Oregon employer hitches its wagon to CMAs (AAMA) (OM). Nov-Dec 2013. CMA Today. Listed at http://www.aama-ntl.org/docs/default-source/index/2013index.pdf?sfvrsn=2

Note: The following original sentence was corrected on 12/8/14 in the text below: An RN can observe, teach and report on an MA but cannot delegate tasks or duties to an MA. More information on the Nurse Practice Act, which is mentioned in the corrected sentence, can be found at: http://www.oregon.gov/OSBN/pages/adminrules.aspx

Jeanine Whitney is an active member of the PCC Willow Creek Education Advisory Team and has worked with the Program Advisory Committee at Anthem College.

For additional certification information, please contact individual institutions or the Accrediting Bureau of Health Education Schools at http://www.abhes.org/news/show/291.

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Upcoming Portland Metro Area Flu Vaccine Clinics

The following flu vaccine clinics are taking place in the Portland Metro Area. All of these clinics will provide no cost flu vaccine to adults, regardless of insurance status. We will also be posting about upcoming clinics on the Flu Oregon and Oregon Immunization Program Facebook pages

November 5, 2014 from 12pm-5pm at Transition Projects, 650 NW Irving St, Portland Or (sponsored by Family Care)

November 11, 2014 varying times at 6 Legacy Health Locations (please visit http://www.legacyhealth.org/our-legacy/stay-connected/newsroom/search-news-releases/2014/2014-10-veterans-day-flu-shot-clinics.aspx to find more details, ages served and vaccines provided)

November 19, 2014 from 1pm-4pm at JOIN, 1435 NE 81st Ave, Portland Or (sponsored by Family Care)

November 21, 2014 from 7:30am-4:30pm in Pioneer Courthouse Square in Portland, Or (sponsored by AWARE- please visit http://public.health.oregon.gov/PreventionWellness/SafeLiving/AntibioticResistance/Pages/getsmartweek.aspx for more details)

November 22, 2014 from 9am-5pm at the American Diabetes Expo at the Oregon Convention Center (sponsored by Family Care)

If you have an upcoming flu clinic anywhere in Oregon or bordering areas you would like to promote, please email katherine.h.mcguiness@state.or.us

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Open Invitation to Immunize Oregon Coalition Meeting on July 29th

Please join us for Immunize Oregon’s July meeting on July 29th, 2014 from 11:45-2pm! The meeting will take place at the Portland State Office Building, 800 NE Oregon St, Portland OR 97232 in room 1B.

We are excited to have Fred Troutman and Karen Tetz, professors at Walla Walla School of Nursing talk about an initiative to bring nursing students to rural India to provide vaccines. We will also hear from Scott Jeffries from the Oregon Immunization Program about using Reminder/Recall to raise a clinic’s immunization rates, specifically focused on adolescents. Alison Alexander from Immunize Oregon will be talking about the new National Adult Vaccination Standards and other ways to improve community immunity. Lunch will be provided.

If you are interested in attending in person or by phone/webinar, please RSVP by Friday, July 25th to Katherine.h.mcguiness@state.or.us

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