Category Archives: School Law

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

Why We Care About HPV

By Isabel Stock, Colorado State University

Oregon Immunization Program Intern

The idea immunizing your child to prevent a sexually transmitted infection may seem foreign to many parents. People across the world have different views regarding vaccination, but all can agree on cancer prevention. It is our duty as public health advocators, medical professionals and community stakeholders to promote the importance of the HPV vaccination. Here are some astounding numbers to show the impact Human Papilloma Virus has compared to other diseases that we commonly vaccinate children for:

  • 1,904 polio deaths in the U.S. in 1950 (near the height of the epidemic)
  • 450 measles deaths every year in the U.S. before the vaccine
  • 500 tetanus deaths every year before widespread use of the vaccine in the U.S.
  • 100 chickenpox deaths every year in the U.S. before introduction of the vaccine
  • 4,000 HPV-related cervical cancer deaths in the U.S. every year

With 12,000 women being diagnosed every year with cervical cancer, it’s noteworthy that 1 in 3 of them do not survive for five years, especially when the HPV vaccination and screening can prevent up to 93% of these cancers. Other than the cervix, HPV is associated with cancer of the anus, vulva, vagina, oropharynx and cervix in women and HPV related cancers in men are found in the anus, oropharynx and penis.

With 79 million people in the U.S. currently infected with HPV, 14 million new infections every year, the National Cancer Institute has released a Call to Action. In the U.S. 40% of females and 21% of males are receiving all three doses of the HPV vaccine. In Oregon, 36.4% of females and 20.6% of males are receiving all three doses of the HPV vaccine. It is clear that the U.S. will fail to meet the Healthy People 2020 goal of 80% HPV vaccination rate for all three doses. We are faced with a significant public health threat if we don’t take immediate action to improving our vaccination rates.

Here are the best ways to begin improving HPV rates in your clinic today:

  • Know how to frame your conversation regarding HPV with parents and provide them with educational resources
  • Start the vaccine on time; schedule wellness visits at age 11 and 12
  • Schedule follow-up visits before they leave the office
  • Practice reminder/recall for 2nd and 3rd doses
  • Provide walk-in or immunization only visits
  • Immunize at sports physicals

For more information on how to implement these actions, go to: https://public.health.oregon.gov/PreventionWellness/VaccinesImmunization/ImmunizationProviderResources/vfc/Documents/AFIXQIActionSteps.pdf
HPV kids

References:

https://karenvaxblog.wordpress.com/2016/01/14/im-pro-vaccine-but-that-hpv-vaccine/

http://www.cdc.gov/hpv/parents/vaccine.html

https://www.mdanderson.org/content/dam/mdanderson/documents/prevention-and-screening/NCI_HPV_Consensus_Statement_012716.pdf

www.cdc.gov/vaccines/teens

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Filed under Education, Nurses Notes, Oregon Immunization, Private Clinics, Public Clinics, Research, School Law, Social Media, VFC

Framing the HPV Conversation

By Isabel Stock, Colorado State University

Oregon Immunization Program Intern

Many parents who choose to vaccinate their children are faced with the worry, “Do I vaccinate my child for Human papillomavirus?” According to the 2012 National Teen Immunization Survey, one of the main reason parents that didn’t intend to vaccinate their children against HPV was a lack of healthcare provider recommendation. It’s time to frame the conversation between parents and providers on the importance of the HPV vaccination.

As a provider, it is important to recommend HPV vaccine as you would any other, especially on the same visit as other vaccinations. Here is a list of other important factors to highlight when discussing the HPV vaccine with parents:

  • It is one of the only vaccines available to prevent cancer.
  • HPV infection can be passed through any type of sexual activity, not just intercourse. Some types of HPV are spread by skin-to-skin contact.
  • Multiple research studies have shown that HPV vaccine does not make kids more likely to be sexually active.
  • HPV vaccine has a strong safety record. More than 62 million doses have been given in the United States, and there are no serious safety concerns.
  • Put HPV first when listing the vaccines that the child needs during the visit. For example, “Your child needs three shots today: HPV vaccine, meningococcal vaccine and Tdap vaccine.”
  • Vaccinate for HPV well before children might be exposed to it, just as you would for other diseases such as measles.
  • Emphasize your personal belief in the HPV vaccine, and let them know that you have given it to your son/daughter/family member/friend. This is a powerful tool to help parents feel more secure about their decision

All of these tips will help educate the parent to make a decision and avoid missed opportunities to increase HPV vaccination rates. There are many more resources available to frame the conversation between providers and parents on the CDC website. Below is a great resource for providers to start.

         HPV Tips FINAL

When talking with vaccine hesitant parents, it is helpful to use a communication approach that guides rather than directs and encourages the parent to ask questions. Engaging with good communication strategies allows parents to come to a decision on their own, using evidence based facts delivered by the provider. This technique has been shown to help families and providers address concerns in a way that allows the provider to convey respect and empathy while sharing medical information. For more information on effective communication strategies see, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480952/.

To help parents understand just how safe, effective, and necessary this vaccine is for their children check out the National Cancer Institute’s recent Call to Action at, https://www.mdanderson.org/content/dam/mdanderson/documents/prevention-and-screening/NCI_HPV_Consensus_Statement_012716.pdf. Now, more than ever, it is important we give parents all the necessary facts about HPV vaccination to give their child the best possible chance to live a cancer free life.

References:

http://www.cdc.gov/hpv/hcp/index.html

http://www.cdc.gov/hpv/hcp/answering-questions.html

http://www.cdc.gov/hpv/hcp/speaking-colleagues.html

http://www.cdc.gov/vaccines/who/teens/vaccines/vaccine-safety.pdf

https://www.mdanderson.org/content/dam/mdanderson/documents/prevention-and-screening/NCI_HPV_Consensus_Statement_012716.pdf

http://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-11-74

 

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Filed under Education, Oregon Immunization, Private Clinics, Public Clinics, Research, School Law, Social Media, VFC

Immunizations and SBHCs

Thirty years ago, five School-Based Health Centers (SBHC) opened their doors in Oregon with the goal of providing patient centered health care services for all students, whether or not they have health insurance coverage.  Today Oregon has 75 certified SBHC’s that operate in urban, suburban and rural school districts.  Oregon SBHC Map

SBHCs are medical clinics that offer primary care services within or on the grounds of a school.  Each SBHC is staffed by a primary care provider, other medical, mental, and/or dental health professionals and support staff.

SBHCs focus on reducing barriers that can keep youth from accessing health care such as transportation, cost and concerns about confidentiality.  SBHCs bill Medicaid and many are credentialed with private insurance, but students may not be denied service for inability to pay for services.

Since inception, preventative health services such as immunizations have remained a core function for Oregon SBHCs.  Certified SBHCs participate in the Vaccines for Children (VFC) program and offer all ACIP routinely recommended vaccines at each site.   Bringing vaccines to the school results in fewer missed opportunities for all vaccines as well as preventing school exclusion due to incomplete immunization status. Parent involvement and consent is managed by frequent communication between the SBHC and home.

Ceci Robe, manager for Rogue Community Health SBHCs in Jackson County, describes the importance SBHCs place on vaccine education and outreach.  “We get the word out to students and staff in many ways, such as targeting 11th and 12th graders for meningococcal vaccine and HPV. We also outreach for Hepatitis A, and offer immunizations to siblings of students.  We provide flu clinics for all district students and staff. We have a close partnership with the school’s registrar and create a system of referral.  We get going in September and by February all students are compliant and no one is excluded from school.  This is a great benefit to the student and schools.”

Ceci feels all encounters are an opportunity to evaluate and discuss vaccination status.  “It only takes about 15 minutes, so we can update a student at school, during lunch. We are constantly monitoring the immunization status of all students that come into the health center for any reason.  We update ALERT in a timely manner, so when the student transfers schools they have an updated record in hand.”

 

 

 

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Back to School Immunization Guide

Exemption Rates

 

Summer is winding down and it’s time to gear up for a new school year. That means more kids coming in for vaccines. What do you need to know about immunizations for back to school this year?

  • Old religious exemptions to immunization signed prior to March 2014 are no longer valid. Senate bill 895 removed the provision that allowed old religious exemptions that were in place before the implementation of the new nonmedical exemption process. This is a great opportunity to discuss vaccines with parents who claimed an exemption for their child years ago. Parents will have two options:
    1. If the child has received the vaccines, the parent needs to fill in the vaccine dates on the Certificate of Immunization Status, sign the form and turn it into the school.
    2. If the parent wants a nonmedical exemption for their child, they need to get education about the benefits and risks of immunization from a health care practitioner or the online vaccine education module. If you are a health care practitioner and provide education to the parent, print off and complete the Vaccine Education Certificate available at healthoregon.org/vaccineexemption (go to the “For Providers Only” section at the bottom of the page). Mark “yes” next to each vaccine you provided education about for which the parent wants to claim an exemption. The online vaccine education module is also available at the same web address.
  • Remind parents to update immunization records with their child’s school or daycare every time their child receives a vaccine.
  • Make sure to screen for and give all recommended vaccines when you give school-required vaccines. When a student comes in for Tdap vaccine, give HPV and meningococcal vaccines as well. Adolescents can be a hard population to reach, and you might not see the patient again for several years. And don’t forget about flu vaccine!

Update from the 2014-2015 school year

For the first time in more than a decade, Oregon’s nonmedical exemption rate decreased: 5.8% of kindergartners had a nonmedical exemption to one or more vaccine in 2015 compared to 7.0% in 2014. Check out the graph above to see the nonmedical exemption rate over time. Thank you to clinics, schools and child care programs for helping to implement the new process for claiming a nonmedical exemption, and helping protect more kids against vaccine preventable diseases!

 

 

 

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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

Farewell to our friend Sandy

SandyNewsum
Sandra Newsum, an Office Specialist with the Oregon Health Authority Immunization Program, died May 5 following a long illness. Sandy came to work with the Immunization Program in 2006. In addition to being a cheerful and helpful co-worker, she was a kind-hearted person who will be missed very much by her friends and co-workers.

Sandy provided support not just to the Oregon Immunization Program, but to Oregon’s vaccine providers. She was always ready to help. Quick to laugh, she was a positive presence in our often stressful work site. She was also an avid Oregon Ducks fan, who tried to never miss a game. When she did, she’d seek out a friend in the Program to give her the play-by-play.

We’ve been informed by her family that there will be no memorial service. For those who wish to contribute, we are collecting funds to donate to a charitable organization in her name. Please contact lorraine.duncan@state.or.us

Sandyshrine

2012-2013 religious exemption rates released

On May 1, the Oregon Immunization Program released this year’s religious exemption rates, which have continued to rise steadily over the last decade. During the 2012-2013 school year, a statewide average of 6.4 percent of kindergartners in Oregon had a religious exemption to one or more vaccines, which is an increase from last year’s average rate of 5.8 percent.

Local health departments issued 30,501 exclusion orders in 2013 and excluded 4,188 children, both decreases from last school year. See the final State Statistical Report for children’s facilities, kindergarten (public, private and combined) and 7th grade (public, private and combined). Also see how your county stacks up against the others. School law helped protect 664,543 kids in Oregon against vaccine preventable diseases!

Immie news you can use:
5/8/13: Salem Statesman Journal: Fewer Oregon children recieve vaccines

5/10/13: Philadelphia Inquirer: Vaccine to fight heroin addiction shows promise

5/12/13: 60 Minutes: Bill Gates 2.0

5/14/13: BBC: Swansea measles: cases rise by 20 to 1,094

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Filed under Oregon Immunization, School Law, VFC