Tag Archives: Immunization

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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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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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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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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Filed under Nurses Notes, Oregon Immunization

Why I Vaccinate: HPV

By Amanda Timmons, Oregon Immunization Program

I have two beautiful children whom I love so much that sometimes I could burst with it. I’m sure many other parents know that feeling. I would do anything in my power to protect them, just like other parents. But, unlike many American parents, I am vaccinating my children against HPV.

The statistics from the CDC are clear. Although the HPV vaccine has been routinely recommended for females since 2006,recent data show that just over half of teenage girls aged 13-17 had received one dose of HPV vaccine and only a third had received all three recommended doses (National Center for Immunization and Respiratory Diseases, CDC). Vaccine uptake by boys is even lower. This is something I don’t really understand. Among parents who choose not to vaccinate their child against HPV, many have concerns about vaccine safety or that vaccinating their child will encourage sexual activity. Others simply don’t think the vaccine is necessary. The data suggests otherwise.

 

HPV vaccine is safe.

Between June 2006 and March 2013, there were over 56 million doses of HPV vaccine distributed and just 21,194 adverse events reported. Ninety two percent of these were considered minor (Shannon Stokley, 2013). Another way of looking at it, for every 1,000 doses of vaccine distributed there are about 4 adverse events reported. For every 100,000 doses of vaccine distributed there are about 3 serious adverse events reported.  HPV vaccine is safe.

 

Being vaccinated does not lead to sexual activity or risky sexual behavior.

Vaccinating girls with HPV doesn’t increase the likelihood that they will engage is risky sexual behavior or initiate sexual behavior, according to a 2014 study (Allison Mayhew, 2014). Among girls with sexual experience, vaccination with HPV vaccine did not increase their likelihood for initiating sex, even if they erroneously believed that the HPV vaccine protected them against more sexually transmitted infections than just HPV.

 

HPV vaccine prevents disease.

Some parents say their children don’t need the vaccine because they are “too young” or because they are not sexually active. My kids are young, too. They are not sexually active. But, I am a realist. I know they will grow older and that someday they will have sex.  A study (Winer RL, 2008) conducted by the University of Washington between 2000 and 2006 showed that women between the ages of 18-22 years with one lifetime sexual partner had a 28% chance of contracting HPV in their first year of sexual activity. Within three years, 50% of the same women who still only had one partner had been infected. Intercourse is not necessary to become infected, and condom use does not prevent the spread of HPV. It’s clear that this disease affects almost everyone.

Vaccinating children against HPV when they’re young, before they ever become exposed, protects them from developing certain cancers later in life. HPV infections are responsible for greater than 90 percent of cervical cancers, 90 percent of anal cancers, and 50 percent of vaginal, vulvar, and penile cancers. HPV vaccination is the best way to protect my children from developing these cancers twenty or thirty years from now.

I love my children and I want to protect them. I am protecting them with HPV vaccine because it is the right thing to do.

 

References

Allison Mayhew, B. T. (2014). Risk Perceptions and Subsequent Sexual Behaviors After HPV Vaccination in Adolescents. Pediatrics , 133 (3), 404-411.

National Center for Immunization and Respiratory Diseases, CDC. (n.d.). Retrieved from http://www.cdc.gov/vaccines/imz-managers/coverage/nis/teen/data/tables-2012.html

Shannon Stokley, M. C. (2013). Human Papillomavirus Vaccination Coverage Among Adolescent Girls, 2007–2012, and Postlicensure Vaccine Safety Monitoring, 2006–2013 — United States. Morbidity and Mortality Weekly Report (MMWR) , 62 (29), 591-595.

Winer RL, F. Q. (2008). Risk of female human papillomavirus acquisition associated with first male sex partner. Journal of Infectious Diseases , 197 (2), 279-282.

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New Staff at OIP

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Lydia Emer is OIP’s new section manager

Oregon Immunization Program (OIP) is excited to welcome Lydia Emer back to the family as the new section manager to replace Lorraine Duncan, who is retiring. Lydia started working for the Public Health Division (PHD) in 2000 as an administrative assistant for OIP. Since then, she has worked in a variety of different positions and departments including fiscal analyst in both Maternal and Child Health and OIP. Most recently, she served as PHD’s performance management and quality improvement manager.

Lydia is excited to be back in OIP and to be closer to service delivery and the community. Originally from Portsmouth, Great Britain, Lydia moved to the U.S. after college. She enjoys spending time with her family and her pets and working in her vegetable garden. Please join us in welcoming Lydia back into the immunization family.

Lorraine is staying on as a temp until September 30th to assist in Lydia’s transition.

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Yuliya Goldman joins OIP as a CDC Public Health Associate for one year

Yuliya Goldman will spend the next year with OIP as part of the CDC’s Public Health Associate Program (PHAP). PHAP is a two-year fellowship that provides recent college graduates with a varied public health experience by placing associates at county, state or tribal health agencies. Yuliya just finished her first year of PHAP working at Public Health Division’s Health Security, Preparedness and Response Program. There she focused on Crisis Emergency Risk Communications developing communication plans, conducting media analysis, and contributing to website communications.

Yuliya is excited to begin her second year of PHAP as part of OIP, where she will be working on a variety of projects including developing materials to comply with SB132, the new law that requires parents to receive vaccine safety information before signing a non-medical exemption to immunization.

Yuliya grew up in St. Paul, Minnesota and has spent the past year in Portland. In her spare time, she enjoys exploring Oregon’s hiking trails and playing tennis when the rain allows.

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