CDC Recommendations amp Why They are Important Jae L Hansen IMC NREMTP FPC Ret Ask yourself What can I do to protect myself What can I do to protect my patients What can I do to protect my family ID: 926696
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Healthcare Personnel Vaccines: CDC Recommendations&Why They are Important
Jae L. Hansen, IMC, NREMT-P, FP-C (Ret.)
Slide2Ask yourself…What can I do to protect myself?What can I do to protect my patients?
What can I do to protect my family?
Slide3Which HCP Need Vaccinations? Includes physicians, nurses, nursing/medical assistants, therapists, technicians, EMTs/Paramedics, dental, pharmacists, laboratory personnel, autopsy, students, trainees, contract staff, persons potentially exposed to infectious agents that can be transmitted to and from HCP
Settings include hospitals, nursing homes, skilled nursing facilities, physicians’ offices, urgent care centers, outpatient clinics, home healthcare, and emergency medical services
Slide4Adult Vaccines…Shingles (Herpes Zoster)One dose of Herpes Zoster Vaccine (Zostavax) at age 60 or olderEffective even if they’ve had a history of shingles
Pneumococcal
40,000 deaths & 500,000 cases every year in the USOne dose of PPV vaccine given at age 65 or older, OR in presence of chronic health condition
Slide5Adult Vaccines (cont.)Measles,
Mumps,
Rubella (MMR)Adults born before 1957 is considered immune to measles & mumps
2
nd
dose of MMR is recommended for HCP, or show lab evidence of immunity
Measles
– Highly contagious virus found throughout the world, can remain airborne for up to 2 hours
Transmission – coughing, sneezing or talking
Symptoms – high fever, rash, runny nose, watery eyes, cough, diarrhea & earache
Incubation – 10 to 14 days
Slide6Mumps – Acute viral disease, may spread even though they have no symptoms or their illness is mildTransmission – coughing & sneezingSymptoms – Low grade fever & swelling or tenderness of one or more salivary glands. In post pubertal males, up to 30% may experience testicular pain and swelling. May cause sterility in males.
Incubation – 12 to 25 days
Adult Vaccines (cont.)
Slide7Rubella – (German Measles) is a virus If a woman gets rubella during the 1st
trimester of pregnancy, her baby is at risk of having serious birth defectsTransmission – coughing or sneezing, direct contact with nasal or throat secretions
Symptoms – Rash, slight fever, aching joints, & reddened eyesMany people with rubella have few or no symptoms, and may not have rash
Incubation – 16 to 18 days
Adult Vaccines (cont.)
Slide8Varicella – (Chickenpox) highly contagious disease caused by the Varicella-zoster virusTransmission – airborne & also spread through contact with chickenpox blisters
Symptoms – rash, body aches, fever, fatigue, irritability & sore throat
Hospitalization & death increases with adultsIncubation – 10 to 21 daysIf no lab evidence or history, 2 doses of Varicella vaccine should be administered 4-8 weeks apart
Adult Vaccines (cont.)
Slide9Hepatitis A & Hepatitis BHepatitis disease is a virus that affects the liver:Hepatitis A is food-borne (oral-fecal)Hepatitis B is blood-borne (blood to blood)
Hep A vaccine – common childhood and travel vaccineHep B vaccine
– common childhood, travel vaccine and maybe required for healthcare personnel (HCP)Vaccines given in multiple doses (plan ahead, e.g., travel, new job, etc.)
Combined in Twinrix® (2 shots in 1)
Slide10HPVHuman Papillomavirus
≥ 100 strains and types≥
40 strains and types are sexually transmitted
FDA recently approved vaccine for males
Approved for ages 9 – 26 yrs
Protects against viruses that can cause
cervical, anal, penile & throat cancers
Source: CDC HPV Information
Slide11also known as the “flu”Influenza is a contagious viral infection of the nose, throat and lungs36,000 deaths and over 200,000 hospitalizations per year
Influenza
Slide122007-2008 San Diego Influenza SeasonThe first influenza detection occurred the second week of OctoberThe peak flu season occurred mid February
A total of 9 influenza-related deaths A total of 1,905 reports of influenza (lab results positive) were voluntarily reported to Public Health
Slide13H1N1 in San DiegoApril 2009 – January 20, 2010829 hospitalizations55 deaths – San Diego residents7 deaths – Visiting non-residentsMost recent death is a 29 y/o female with no underlying condition
Slide14Peak Influenza U.S. 1976-2006
13%
19%
45%
13%
3%
3%
3%
Source:
MMWR
2007;56 (RR-6)
Slide15Cold vs. FluCan you tell the difference?Fever Rare in adults and older children,
but can be as high as 102 degrees in infants and small childrenCOLD OR FLU?
Slide16COLD
Slide17Cold vs. FluCan you tell the difference?HeadacheSudden onset and can be severe
COLD OR FLU?
Slide18FLU
Slide19Cold vs. FluCan you tell the difference?Tiredness and weakness Can last two or more weeks
COLD or FLU?
Slide20FLU
Slide21Cold vs. FluCan you tell the difference?SneezingStuffy Nose
Sore ThroatCOLD or FLU?
Slide22COLD
Slide23Tiredness
Headache
Fever & Chills
Influenza Symptoms
Body Aches
Chest Discomfort
Slide24Flu PreventionGet vaccinated!Your best protection!
Practice good hygieneWash hands often
Cover your mouth/nose when you cough/sneezePut used tissues in waste basketClean your hands after you cough/sneeze
Avoid touching your face, eyes, nose or mouth
If you are diagnosed with the flu
Stay home
Avoid close contact with others, or wear a mask
Get rest and drink plenty of fluids
Slide25Slide26Transmission
Respiratory routeDirect contact
Communicability – 1 to 2 days pre-onset to, 4 to 5 days post-onsetReservoirHumans, swine (H1N1), and birds (H5N1)
Geographic distribution
Global
Incubation
1 to 5 days; usually 2 days
Influenza Virus
Slide27Nosocomial Influenza Transmission that occurs in a healthcare setting Can result from under-vaccinated healthcare personnel
Slide28In a tertiary care facility from 1987 to 2000: Staff influenza vaccination coverage4% >>> 67% Staff influenza disease
42% >>> 9%
Nosocomial Disease 32% >>> 0 cases
Salgado CD, Infection Control Hospital Epidemiology, 2004
Nosocomial Influenza
Slide29Influenza in the ElderlyKimura, et al. American Journal of Public Health, 2007
The elderly have
suboptimal
immunologic
response to the flu vaccine.
80% effective in preventing death
27% to 70% effective in preventing hospitalizations and pneumonia
30% to 58% effective in preventing flu
The flu shot is about…
Despite high vaccination rates among residents, influenza outbreaks still occur in LTCFs, triggered by unvaccinated HCP.
Slide30Influenza in LTCFInfluenza Attack Rates 25-60%Case-fatality 10-20%Randomized control study
Staff vaccination led to a 43% decrease in ILI44% decrease in mortality
Potter J, et. Al. J Infectious Disease 1997
Slide31Children between 6 months and 18 years of ageHealthcare personnel (HCP)Persons
> 50 years
Nursing home & chronic care residents with chronic medical conditionsPersons with chronic pulmonary or cardiovascular disorders, including asthmatic children
Pregnant women
Persons with immunosuppression including HIV
Who’s at Risk?
Slide32Facts vs. MythsI get sick from the vaccine Myth
The influenza vaccine is made from a
DEAD virusYou cannot get sick from itSide effects may include a low-grade fever and muscle aches
The flu shot can take up to two weeks to become effective so you can still get the flu or a flu-like illness during this time
Slide33Why I didn’t get a flu shot…My doctor didn’t recommend itI am afraid of needles The flu shot is given with a relatively small needle. Check with your doctor to see if you are eligible to receive FluMist® - a vaccine that is sprayed into your nose and does not require needles.
The Flu isn’t that bad
Influenza causes an average of 36,000 deaths and over 200,000 hospitalizations per year.
Source: CDC Influenza Information
Slide34Shot vs. Nasal SprayFlu Shot (TIV) Injectable – Trivalent inactivated influenza vaccine
70-90% effective in healthy persons ≤65 yrs
50-60% effective in preventing hospitalization80% effective in preventing deathFew side effects (sore arm, general malaise)
Nasal Spray (LAIV) - FluMist®
Live attenuated influenza vaccine
No needles – spray mist into the nose
Approved for healthy persons ages 2-49 years of age
Slightly more expensive
Slide35Novel H1N1 VaccineWho should receive the vaccine?EMS and HCPPregnant womenCaregivers of <6 months
6 mon – 24 yrs, 25 – 64 yrs w/ underling chronic conditionsNow open to everyone
Where can I get it?Your physicians officeLocal PHC, Mass Vax ClinicsHow many doses will I need?
Only one dose for 10 yrs and older
How much will it cost?
Free – Feds paid for all doses
Nominal administration fee
How safe is the vaccine?
Extremely safe! It is made using the same processes & facilities as the seasonal flu vaccine. It is very much like the seasonal flu vaccine.
Should I get the vaccine if I think I’ve already been infected?
Yes, the flu symptoms you had may not have been caused by the H1N1 virus.
Slide36also know as“Whooping Cough”
is a highly contagious bacterial infection of the lining and airways of the respiratory tract.
It is caused by the bacterium Bordetella pertussis.
Pertussis
Slide37Pertussis Cases in the U.S.
CDC. MMWR 1997;46(54):71-80. Murphy T. Data on file, personal communication, 2001. MMWR 2000;50:1175. MMWR 2001;50(33):725.
MMWR 2002;51:723. MMWR 2003;52:747. Bacterial Vaccine Preventable Disease Branch, National Immunization Program, 2005.
Cases (Thousands)
7,796
6,586
4,570
11,647
9,771
25,827
0
4
8
12
16
24
20
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
Slide38Pertussis in S.D. County
Slide39Pertussis in the U.S.Güri
ş et al. Clin Infect Dis. 1999;28:1230-1237.
CDC. MMWR. 2002;51:73-76, 2001;50(53):1-108, 2002;51(53):1-84, 2003;52(54):1-85
1990-1993
1994-1996
1997-2000
2001-2003
2004
8000
9000
0
4000
1000
5000
2000
6000
3000
7000
<1 yr
1-4 yrs
5-9 yrs
10-19 yrs
20+ yrs
Average Number
of Cases / Year
Age Group
18.8 fold
15.5 fold
Slide40Clinical Signs of PertussisCough 97% 3 weeks, 52% 9 weeksParoxysms 73% 3 weeks
Whoop in 69%
Post-tussive emesis in 65%
De Serres et al.
J Infect Dis
. 2000;182:174–9.
Teens missed average 5 days of school
Adults missed average 7 days of work
Average 14 days of disrupted sleep
Slide413 Stages of Pertussis Catarrhal
Runny nose, sneezing, low-grade fever, and a mild, nonproductive, occasional coughMost infectious during the this period and the first 2 weeks after cough onset (approximately 21 days)
Paroxysmal
Severe spasms of quick, short, coughs
May gag, gasp and/or expel thick mucus
“whoop”
Following attack
Vomiting and exhaustion
Slide42ConvalescentGradual recoveryCough frequency decreasesCough severity decreasesRecovery may be only partial
Source: www.pertussis.com
3 Stages of Pertussis
Slide43How is it diagnosed?Multiple tests may be required to accurately diagnose diseaseFrequent incorrect diagnoses:AsthmaGastroesophageal reflux
Post-viral bronchospasmChronic sinusitis
Tuberculosis
Slide44Culture and PCR
Nasopharyngeal (Dacron) swab or aspirate is the preferred sample
It’s the nasopharynx we’re after
Slide45Pertussis in AdultsAdults:Are the main reservoirs of disease in areas with high immunization coverage rates
Transmit primarily to non-immune children (≤ 1 year of age) or to adults whose immunity has waned
Experience the longest recovery time (median 93 days)
Slide46Slide47Slide48n=264 casesInfant Pertussis:
Who Was the Source?
Bisgard, K. PIDJ.
2004;23:985-9
.
Slide49Costs of an OutbreakSeptember 2003 – outbreak of pertussis in an acute care facility17 employees were infectedFollowing a one-day exposure to an infant with pertussis
Infection control measures were immediately implemented in hospitalStudy examined outbreak-related costs and estimated possible benefits to vaccination
Slide50Study ResultsCost incurred by the hospital: Cost incurred by the employees
:TOTAL COST incurred:
Cost of 1 dose of Tdap:
$74,870
$6,512
$81,382
$37.00
Slide51Estimated Benefits of VaccinationStudy model predicts:Vaccinating employees in hospital against pertussis would prevent ≥ 46% of exposures Cost of vaccination to benefit ratio is
2.38 : 1
Slide52CDC RecommendsAll HCP in hospitals, LTCF/SNF, ambulatory care and emergency medical services (EMS) settings also receive Tdap in place of Td boosterPriority groups:HCP in contact with infants less than 12 months
Emergency DepartmentsMaternal/Child Health
ICU/NICURespiratory Therapy
Slide53All adults receive Tdap in place of their tetanus booster Postpartum mothers and/or primary caregivers receive Tdap
CDC Recommends
Slide54Tdap VaccineTetanus
diphtheria
acellular p
ertussis
Licensed in 2005
Only one dose is required and it c
an be given in an interval as short as 2 years from the last Td booster
Slide55Tdap Adverse ReactionsLocalized pain, redness, swellingLow-grade feverAdverse reactions occur at approximately the same rate as Td alone
Source: CDC Pertussis Information
Slide56A True Story…
Slide57ConclusionsVaccinating ADULTS with Tdap:85% protection with vaccine!Protect your family from pertussisPrevent an outbreak in workplace thereby reducing costs and minimizing sick leave
Keeping adults up to date with their vaccines can minimize the effects of vaccine-preventable diseases
Slide58ResourcesCounty of San Diego Immunization Branchwww.SDIZ.orgCouncil of Community Clinics
(Referral to low-cost immunizations)
(619) 542-4300Immunization Action Coalition
http://www.immunize.org/hcw/
Center for Disease Control and Prevention
http://www.cdc.gov/ncidod/dhqp/wrkr_immune.html
Slide59Jae L. Hansen, IMC(619) 692-6644Jae.Hansen@sdcounty.ca.gov
Thank you for your time.