Category Archives: VFC

Updates, news and fun facts related to the Vaccine for Children Program (VFC).

A few new faces at Oregon VFC

The Oregon Vaccines for Children (VFC) Program has transformed the way compliance site visits will be conducted around the state. Routine site visits and unannounced visits will now be administered by one of our friendly new compliance specialists.

This new structure will help Oregon meet the Center for Disease Control (CDC) program requirements. The VFC health educators will now be available for primarily new VFC clinic enrollment, education and quality improvement projects. Please join us in welcoming Gil, Marc, Isabel and Gaby to the VFC compliance team! In addition to our four new compliance specialists, we are also excited to introduce our newest health educator, Sara Kiely!

 

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Gillis Garrott- Compliance Specialist

Before joining the VFC team, Gil served as a chemical officer in the United States Army. He graduated from the University of Colorado, Boulder with a degree in Integrative Physiology. Gil is excited to be living in Portland Oregon and supporting the immunization compliance program. He was interested in this position because it offered the opportunity to help people gain access to proven and fundamental healthcare. He looks forward to seeing more of Oregon and getting to experience some of its many hiking trails. He also plans on increasing his current level 9 trainer status in Pokémon GO, go red team!

 

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Marc Taylor- Compliance Specialist

Marc is a Compliance Specialist who has worked for the State of Oregon for over four years.  He comes to the VFC team from the Department of Human Services where he investigated assisted living facility complaints. Marc has a diverse background, ranging from Oregon Paramedic to Law Enforcement officer. He is active in amateur radio, photography, Search & Rescue, and is excited to join a group dedicated to the health and safety of all Oregonians.

 

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Isabel Stock- Compliance Specialist

After interning with the Immunization Program to improve HPV vaccination efforts across the state, Isabel is now a Compliance Specialist who will be conducting unannounced storage and handling visits. Isabel is a Eugene native and a recent graduate from Colorado State University, where she studied Health and Exercise Science with a concentration in Health Promotion and a minor in Business Administration. In her free time she enjoys hanging out with her friends and family and traveling the world.

 

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Gabriela Tanaka- Compliance Specialist

Gaby is a Compliance Specialist who has worked with the Oregon Health Authority for three years. She comes to the VFC team with experience in many different facets of healthcare, having worked with insurance companies, home health care agencies, and with Biomerieux, a life sciences company. A native Bostonian, Gaby enjoys bicycling around Portland, Visual Arts and Theatre. She has bicycled from Seattle to Portland and has her sights set on one day completing a bicycle tour from NYC to Niagara Falls.

 

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Sara Kiely- Health Educator

Sara joined the Immunization Program as a Health Educator in November of 2016.  She is a native Oregonian who comes to us with a strong background in Public Health Education and Human Resources. Sara recently returned to Oregon after spending two years in West Africa working at a Nutrition Center for Liberian refugees. She has experience in health education, volunteer management, nutrition counseling, human resource services, and working with diverse populations. She has a passion for public health and for serving the underserved. She is looking forward to working with our partners across the state to improve the health of all Oregonians.

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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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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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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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NURSES NOTES

MeaslesRubella

Tribute to Maurice Hilleman (1919-2005): Immunization pioneer
By David Glassman, RN, MPH

This spring marks an unheralded milestone in immunization history. The work of one man 50 years ago has improved the health and well-being of people worldwide; a man who at the age of eight nearly died from diphtheria, a disease that would later be virtually eradicated in the United States through immunization. After Maurice Hilleman’s death, Ralph Nader wrote “Yet almost no one knew about him, saw him on television, or read about him in newspapers or magazines.” The name Maurice Hilleman is unfamiliar to most of us, but now in the 21st century, 95 percent of American children receive the MMR vaccine that Dr. Hilleman developed, starting with the mumps strain he collected from his daughter when she became ill in 1963.

In fact, this was most certainly not his only contribution. Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, credits him with having saved more lives than any other scientist in the 20th century. Over his career, Hilleman devised or substantially improved more than 40 experimental and licensed animal and human vaccines, including eight of the routinely recommend children’s immunizations: measles, mumps, hepatitis A, hepatitis B, varicella, meningitis, pneumonia and Haemophilus influenzae (including Hib). He also played a role in the discovery of the cold-producing adenoviruses, the hepatitis viruses, and the cancer-causing virus SV40, and was the first to purify interferon, as well as discovering the genetic changes that occur when the influenza virus mutates, known as shift and drift.

In the spring of 1963, the FDA awarded the first license for a measles vaccine. This was based on the early work done by John F. Enders at Boston Children’s Hospital, but Dr. Hilleman’s contribution was instrumental in decreasing side effects by giving gamma globulin in one arm and the measles vaccine in the other. At the time of this development, in the U.S. the disease sickened a reported average of 400,000 people (although the actual number of cases was much higher, as virtually all children acquired measles) and killed more than 500 children every year. Dr. Hilleman continued to refine the vaccine over the next four years, culminating in the much safer Moraten strain that is still in use today. It was the beginning of the end of the disease in this country.

At the same time, an epidemic of rubella began in Europe and quickly swept around the globe. According to the CDC, in this country rubella’s devastating effect on first-trimester pregnancies caused about 11,000 newborns to die and an additional 20,000 suffered birth defects. As the epidemic ended in 1965 Dr. Hilleman was already testing his own vaccine and by 1969 had obtained F.D.A. approval and prevented another rubella epidemic. As 1971 was beginning he put vaccines for measles, mumps and rubella together to make MMR, replacing a series of six shots with just two. Then in 1978, having found a better rubella vaccine than his own, Dr. Hilleman asked its developer, Dr. Stanley Plotkin, if he could use it in the MMR.

By all accounts Dr. Hilleman’s was obsessed with safety and effectiveness. It must have been a surprise when in 1998, toward the end of his life, his vaccine became the focus of scrutiny after The Lancet’s publication of Dr. Andrew Wakefield’s now-infamous article alleging that MMR caused autism. Parents began to stop immunizing. In place of a Noble Prize in Medicine he received hate mail and death threats. Dr. Wakefield’s work has been widely discredited after numerous independent studies demonstrated that there is no link between MMR and autism. The Lancet retracted the 1998 article and in 2010 the British medical authorities stripped Wakefield of the right to practice medicine. Sadly, Dr. Hilleman died of cancer in 2005 before being vindicated.

However, there are reasons to be encouraged, particularly by large-scale initiatives aimed at eradicating these common but easily preventable childhood diseases. The Measles and Rubella Initiative (MRI) is a global partnership devoted to “ensuring no child is born with congenital rubella syndrome or dies from measles.” It’s led by the United Nations Foundation, UNICEF, the World Health Organization, the American Red Cross, and the U.S. Centers for Disease Control and Prevention. The MRI has given the MMR vaccine to a billion children in this century, in 80 countries, preventing millions of deaths from measles alone. The Initiative is focused on supporting the goals of reducing global measles mortality by 95 percent by 2015 and eliminating measles and rubella in at least five of the six World Health Organization regions by 2020.

As a postscript, in this country, the strain that Dr. Hilleman collected from his daughter in 1963 has reduced the incidence of mumps from 186,000 cases a year to fewer than 1,000. For more on this incredible pioneer read co-inventor of the rotavirus vaccine Dr. Paul Offit’s 2007 biography of Hilleman, Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases.

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Dr. Hilleman (Courtesy of Hilleman Laboratories)

Top image source: The Measles and Rubella Initiative
Sources:
http://www.cdc.gov/
http://www.measlesinitiative.org
http://en.wikipedia.org/wiki/Maurice_Hilleman
http://www.nytimes.com/2013/05/07/health/maurice-hilleman-mmr-vaccines-forgotten-hero.html?_r=0
http://www.hillemanlabs.org/
http://www.nature.com/nm/journal/v11/n4s/full/nm1223.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC557162/
http://www.montana.edu/news/10468/msu-grad-s-vaccines-save-millions

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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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Welcome Dawn and Jenny to OIP

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Dawn Lee and Jenny Nones

OIP welcomes two new members to the family. Dawn Lee is the new grant administrative specialist and back-up for the ALERTIIS helpdesk. Dawn has a varied background that includes clerking for the Superior Court of Clark County, 20 years in construction engineering and working for the Vancouver School District. She is a native Washingtonian and lives in Clark County with her husband and three dogs. Her family also includes three boys and two grandkids. Dawn’s favorite activity is donning her leathers, climbing on her hog and riding into the sunset. That’s correct: Dawn is a Harley-ridin’ biker chick. Her favorite recent trip was the Laughlin River Run in Nevada where she also visited the Grand Canyon. Her dream ride is to someday participate in the Sturgis Motorcycle Rally in South Dakota’s Black Hills.

Jenny Nones is a fiscal analyst who will divide her work time between OIP and the State Public Health Laboratory. Jenny just finished her Master of Public Administration in Healthcare Administration. She moved around a lot as a kid, but calls Salt Lake City her hometown. Jenny moved to Oregon about three years ago and has embraced quilting and wine touring. Her favorite winery is Anne Amie, which she says has the best parties. Jenny is also an avid traveler. Her most memorable trip recently was walking 350 miles in 30 days along the Camino de Santiago in Spain. She says she always travels alone and that adventure is perfect for solo travelers.

More staff news: Congratulations to Jody Anderson. She has been promoted from her provider services team administrative support role to full-fledged health educator! Jody’s territory includes:
• Washington County
• Crook County
• Harney County
• Deschutes County
• Jefferson County
• all Indian Health Service/Tribal clinics
• all Planned Parenthood clinics
• all Virginia Garcia clinics

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