Tag Archives: Vaccine

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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Advisory Committee on Immunization Practices (ACIP) Update

The Advisory Committee on Immunization Practices (ACIP) meets quarterly to discuss, inform and determine how United States vaccines can best be utilized. Here are some brief notes about the decisions made by the ACIP in June. Full ACIP proceedings and recommendations can be found here: http://www.cdc.gov/vaccines/acip/index.html

Meningitis B vaccines: Rather than a blanket recommendation for routine vaccination, ACIP voted to enact a permissive recommendation “A serogroup B meningococcal (MenB) vaccine series may be administered to adolescents and young adults 16 through 23 years of age to provide short term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccines is 16 through 18 years.” http://www.cdc.gov/vaccines/programs/vfc/downloads/resolutions/2015-06-15-mening.pdf

Influenza: The spacing and number of doses for individuals six months through eight years of age was simplified: If a child between six months and nine years old has ever had two doses in any previous season(s), even if not consecutive seasons, only one dose is needed in the current season. CDC has no preference for any one flu vaccine brand or presentation over another.

Pneumococcal: The spacing of pneumococcal vaccines for adults 65 years and older has changed from a minimum of eight weeks, to 12 months between PCV 13 and PPSV23. This brings the recommendation into line with the Centers for Medicare and Medicaid Services (CMS) payment program. Adults 65 and older are recommended for a 2-dose series of one dose of each pneumococcal vaccine at least 12 months apart. CMS will fund one of each as long as the two doses are at least 11 months apart. Both pneumococcal vaccines cannot be given at the same visit. ACIP promotes giving adults 65 and older the recommended pneumococcal vaccine at the same visit as the flu vaccine. For details see page 8 and 10 of the pneumococcal vaccine standing orders.

Tdap: ACIP again considered routine TDAP boosters for adolescents and adults, but opted to maintain the recommendation for only one adult booster dose and a Tdap booster dose with each pregnancy.

Zoster (Shingles): Merck is proceeding with an application to the Federal Drug Administration for a new inactivated, adjuvanted 2-dose vaccine that shows 97% protection levels. This new vaccine may be recommended for stem cell recipients in the future. http://www.nejm.org/doi/full/10.1056/NEJMoa013441

HPV: No changes. Clinicians can complete any HPV 3-dose series with either HPV2, HPV4 or HPV9 for women and any HPV4 or HPV9 for men.

Yellow Fever: ACIP voted that a single primary dose of yellow fever vaccine provides long-lasting protection and is adequate for most travelers. See the MMWR for specifics on high-risk populations. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a5.htm

General Recommendations: ACIP approved the entire document. This is an update to the July 2011 issue. Some of the areas of change relate to Altered Immunocompetence based upon the IDSA Clinical Practice Guidelines published in 2013. New conditions, medications, and combination therapies were added as well as guidelines of when to withhold select vaccines, including both live and inactivated vaccines. http://www.pharmacist.com/updates-vaccine-recommendations-focus-acips-june-meeting?desktop_view=no

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HAPPY NATIONAL NURSES WEEK!

NURSES NOTES

Varicella: A Personal Story
By Jeanine Whitney, RN
varicella

EDITOR’S NOTE: A study recently published in Pediatrics confirms the chicken pox vaccine is effective and long-lasting. Read the LA Times coverage.

Jeanine Whitney, RN,  is a public health nurse for the Oregon Immunizaiton Program. What follows is her personal account of getting chicken pox as an adult:

Blindness doesn’t mean everything is dark and you can’t see. Blindness means that your visual sense has been literally turned ‘off.’ Your sight is suddenly absent. There is no light. There is no dark. There is only air touching your skin—sometimes bruising you when you run smack dab into the bedrail of your hospital bed. At least being hospitalized gave me time to review how I had gotten there.

Fourteen days before I had taken swab cultures of infected facial lesions on an older male gentleman. At the time I thought of him as borderline-ancient. He must have been at least 50 years old. Why was I doing the cultures? No one else wanted to go near him. There were whispers of shingles. My uneducated mind saw roofing tiles. Not having had chickenpox and not knowing what shingles was I volunteered to do the cultures.  After all, I was gowned, gloved, masked, and shoed.  All that remained open to the air was my hair. He wasn’t my patient and I wouldn’t be in his room that long.

The subsequent headache was unlike any I had ever had and believe me, I’ve had headaches all my life. It was late in the afternoon and my five-year-old daughter was playing outside. She had a golden halo around her, something I thought was a trick of the sunlight beneath the cloudy sky. I turned my head to see her more clearly and lightening exploded at the base of my skull. The next thing I knew I was on my knees searching for the phone.

When you’re a nurse you develop an awareness of those physicians around you whom you would like to take care of you if you got sick. I called Dr. S_____.  All I could say was that my head hurt. He must have asked me questions but I don’t remember them.  I don’t remember driving to the hospital either but I do remember the excruciating evening sunlight. The next thing I knew I was in the ED. One of my friends was sitting with Raven. She told me my father was on his way.

I was turned to my side and someone pulled my knees up to my chin. I must have passed out because my next awareness was the sharp pain of a needle being inserted into my lower back. 

I didn’t hear any voices. There was no conversation around me. I was floating somewhere quiet. When I opened my eyes there was nothing. I blinked. Still nothing.

The blindness lasted four days. People came and went; over four days they did blood tests every four hours. I came to detest the tightness of the blood pressure cuff as they searched for veins. A blood pressure of 60 over nothing didn’t help. They kept me flat after the spinal tap. I felt like I was always in slow motion, falling over a cliff.

On day five, everything began to lighten. I went from seeing nothing at all to a soft fuzzy gray. Dr. S____ came in (I recognized his voice). He checked me out and with an ironic smile in his voice said “you’ve got chicken pox!”

He must have seen the question in my unfocused eyes because his next words were “all your spots are on the inside.” That at least explained why all the young doctors had worked me up for Lyme disease and tick fever while Dr. S____ was out camping with his kids. Then Dr. S____ continued with “you can’t be here.” At first I thought he meant the hospital. He did, sort of. He really meant the med-surg floor as there was no isolation room available.

They literally double-bagged me and covertly took me out the service elevators.

Somewhere along the line my father had come for Raven and taken her home to my mother, who was a pediatrician. She figured if Raven was going to get sick she would be better off with her rather than me. Raven stayed with grandma for the next 3 months while I missed work. The blood bank people came and took my blood to make a vaccine for kids with cancer. At least I think that’s what they said.

The headaches came and went and then one day I tried the first Acyclovir. That’s when I realized that even though I never had any spots I had headaches due to varicella viral flares. 

I was lucky.

I can see and didn’t need glasses until I turned 50. I can usually keep the headaches away with regular doses of anti-virals. But the scarring in my brain will always be with me. I got my Zostavax vaccine (The Shingles Shot) on my 60th birthday! More than a year passed before I had another shingles headache.  Even now, I don’t have to take the anti-virals daily. 

Back in 1977, there was no vaccine for varicella.

I was healthy.

I spent less than 10 minutes in the room with the client.

The bottom line?

I lived.

Some do not.

For more information on chicken pox, please visit our website.

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Lorraine Duncan: Determined and dedicated

Lorraine Duncan

Lorraine Duncan

Sometimes a job defines the person, but in Lorraine Duncan’s case, the person defines the job. After 33 years as the Oregon Immunization Program’s manager, Lorraine is retiring. During her tenure—which has lasted exactly half her life—she has come to personify excellence in a state program that has risen to become a national leader.

Before starting her job with the state, Lorraine had a varied career in social services. Fresh out of college, she worked as an adult caseworker for Multnomah County Welfare for two years. “My caseload was on skid row,” she says. “It was a real eye opener for me.” She then worked in Las Vegas for a bit after her twin sister Lois lured her to live in Nevada. “My husband Robert couldn’t stand it! For someone from Oregon, it was impossible for him to live in a place where there isn’t a blade of grass except for Lake Mead. In the summer, when it got so hot the gas in our cars was boiling, he moved back to Oregon. I had to stay to finish out my contract.”

When she returned to Portland to reunite with Robert, Lorraine worked in a few venues, most notably as the director of special programs for the Portland Metropolitan Steering Committee on such projects as improving the health of African Americans and developing a healthcare precursor to the Oregon Health Plan.

On April 1, 1980, Lorraine became the program manager for OIP, a job that has lasted 33 years to the day. “We went from five employees with a tiny budget to 60 employees with a huge budget,” she says. When she started, there were only a few vaccines, no registry and no Vaccines for Children program. Some of Lorraine’s favorite accomplishments include helping to form coalitions and advisory groups such as the Oregon Partnership to Immunize Children (OPIC) as well as the Immunization Policy and Advisory Team (IPAT). “Those partnerships are so helpful. They’re a lot of work but they so pay off.” Lorraine is also proud of helping to build a statewide registry from scratch. Today, the ALERT IIS is considered one of the best immunization information systems in the country.

Lorraine is considered a superstar on the national immunization stage. “She has been a mentor to me in both program management and leadership in our national Association of Immunization Managers (AIM),” says Janna Bardi, Washington State’s immunization program manager. “I’ve really appreciated having one of the best immunization program managers in the nation right next door. Lorraine’s contributions to AIM are huge. She served as chair twice and made a suggestion for structuring quarterly leadership meetings with CDC that has greatly strengthened communication and relationships.”

Though Lorraine is well known and loved across the country, she is most admired and remembered by the people who have worked with her. Dr. David Fleming, public health officer for King County in Washington State, was OIP’s medical director before Dr. Paul Cieslak. “It’s hard to imagine that anyone could have done more to assure the health of Oregon children than Lorraine Duncan,” says Dr. Fleming. “And to have that dedication and skill packaged inside such a caring person brightened my day more times than I can count.”

The people who work with Lorraine on a daily basis feel very fortunate. Many mention her steadfast leadership and the way she pushes the program to achieve important new goals. “Lorraine’s mentorship has been invaluable. She’s taught me much about life in the world as a government agent with a real heart for those we serve. I will forever be grateful,” says Mimi Luther, OIP’s provider services manager who has worked with Lorraine for 15 years. “She’s an amazingly hard worker who truly values the input and creativity of those around her.” 

Lorraine is a notoriously dedicated supervisor. “I worked a lot of extra hours and I got a lot of flack for doing it,” she says. “But I liked doing it and I kept doing it.” She says that she is hardly ever sick and gets up every morning wanting to go to work. As proof of her dedication, she is retiring with an accumulation of 3,067 hours of sick leave!

 Lorraine also has a reputation for being extremely knowledgeable about all the complicated aspects of immunization. “I’m in awe of the number of details she’s able to keep in her head— about vaccines, grants, meeting deliberations, legislation. You’re going to have to hire three people to replace her,” says Dr. Paul Cieslak, OIP’s current medical director

Lorraine’s secret to her longevity in one job is simple: “I love coming to work. I love the people, I love my job. I love coming to work every day.” She isn’t worried about the program surviving after she leaves with such an “excellent staff.” But she does wonder what she will do in retirement when she leaves at the end of a six-month transition period in September. “Travel, of course (Lorraine and Robert are world travelers), but maybe I’ll find part-time work,” she says. “I can’t imagine not having a job.”

EDITOR’S NOTE: Get ready! Oregon Immunization Program’s ImmiNews e-newsletter will now be coming at you every single Wednesday, full of the latest immunization news from across Oregon and the world! Tell your colleagues and friends.

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Saluting Salud Medical Center: Improving rates by improving processes

Salud Medical Center in Woodburn is a large community and migrant health center, part of the Yakima Valley Farm Workers (YVFW) organization. Several years ago, YVFW leadership chose childhood immunization rates as a target for process improvement.

They placed protocols in every YVFW clinic that empowered licensed nurses and medical assistants to vaccinate all patients—at any visit—with all needed immunizations.

 

The responsibility for improving childhood immunization rates falls directly on the nursing supervisor at each clinic. They use CoCasa (CDC software available for free download) to run monthly rates and progress reports, which are then shared with the other clinics and upper management. The clinics have turned this process into a friendly competition with each vying to be number one in the organization. Their efforts are clearly paying off with a phenomenal jump in coverage rates from 43 percent in 2010 to 96 percent in 2012.

 

  

Salud’s single vaccine rates also show impressive improvements with every measured vaccine rate exceeding Healthy People 2020 goals.

 When asked about their immunization success, Salud’s Christine Wystock, RN, CSN, said it is important to designate a vaccine “champion” willing to live and breathe vaccines. Other keys to higher rates include integrating regular vaccine updates into staff meetings; requiring RNs, LPNs and MAs take an annual vaccine quiz; and pre-visit immunization forecasting for every child, from birth to age 18. Alert IIS is also used regularly to check patients with spotty or missing forecasts.

 Christine says that the reward for all this hard work is less about the rates (as nice as they are) and more about the real-world protection that vaccines offer the children and families in their community.

 

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Oregon Partnership to Immunize Children (OPIC) gets a new coordinator!

We would like to welcome Katherine McGuiness to the OIP family as the new OPIC Coordinator.

 Katherine has lived in Portland for five years, and just received her MPH and MSW from Portland State University (PSU).  Prior to joining OIP, she worked in the areas of reproductive and sexual health.  Her work at Planned Parenthood reduced barriers to reproductive healthcare for patients and reduced sexual health disparities. She has also participated in domestic violence counseling with mostly Spanish-speaking migrant women in Washington County.  Most recently, she helped teach undergraduate public health classes at PSU and also worked on HIV/AIDS projects that reduced homelessness in Portland’s HIV-positive population.  To complement her work experience, she has volunteered in many projects dealing with sexual assault advocacy and transit issues for low-income folks. 

  Katherine grew up in Latin America (she’s fluent in Spanish) and the East Coast of the United States, receiving her bachelor’s degree from Goucher College in psychology and women’s studies. She enjoys swimming in rivers, attempting the Friday and Saturday New York Times crossword puzzles, playing with her mini-dachshund Penelope and staying involved in social justice issues.

 Let’s all welcome Katherine to the team!!

 

Contact info:

 Katherine McGuiness, MPH, MSW
Coordinator, Oregon Partnership to Immunize Children (OPIC)
Oregon Immunization Program
971.673.0285
katherine.h.mcguiness@state.or.us

 

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