INFLUENZA and PNEUMOCOCCAL VACCINATION

1
INFLUENZA and PNEUMOCOCCAL VACCINATION

• Pennsylvania Department of Health
• Bureau of Communicable Diseases
• Division of Immunizations
• Joeanne Maljevac RN, BC BSN
• July 13, 2004

2
Influenza

• Highly infectious viral illness
• Epidemics reported since at least 1510
• At least 4 pandemics in 19th century
• Estimated 21 million deaths worldwide in pandemic
  of 1918-1919
• Virus first isolated in 1933

3
Influenza

• Respiratory (airborne) transmission of virus.
• Virus replicates in respiratory tract.
• Shedding of the virus occurs in respiratory
  secretions (mucus) for 5-10 days.

4

• Influenza virus

5
Influenza Antigenic Changes

• Structure of hemagglutinin (H) and neuraminidase
  (N) periodically change
• Shift major change, new subtype
• Exchange of gene segment
• May result in pandemic
• Drift minor change, same subtype
• Point mutations in gene may result in
  epidemic

6
Influenza Epidemiology

• Human and animal hosts
• Seasonal pattern peaking between December and
  March
• Transmitted 2-3 days before and 4-5 days after
  symptom onset

7
Influenza Clinical Features

• Incubation period is usually 2 days (range is 1-5
  days)
• Severity of illness depends on prior influenza
  exposure
• Abrupt onset includes fever, muscle aches, sore
  throat, dry cough, and headache

8
Influenza Complications

• Pneumonia and bacterial infections
• Reye syndrome
• Respiratory and cardiac ailments
• Death (0.5-1 per 1,000 cases)

9
Impact Of Influenza

• Most hospitalizations occur in young children and
  those ? 65 years
• Average of 114,000 flu-related hospitalizations
  annually
• More young children are hospitalized, but older
  persons have a higher mortality from
  influenza-related complications

10
Influenza Vaccine

• Trivalent
• Efficacy
• Immunity
• Schedule

• Type A (2) and type B (1)
• Varies depending on circulating strain,
• age, and underlying illness
• One dose annually

11
2004 2005 Influenza Manufactures

• EvansFluvirin
• Aventis PasteurFluzone
• WyethFlumist?

12
Flu VIS 2004-2005
13
Influenza VaccineStrategies to Improve Coverage

• Ensure systematic and automatic offering of
  vaccine to high-risk groups
• Educate health care providers and patients
• Address concerns about adverse events
• Emphasize physician recommendation

14
Vaccine Efficiency

• 70-90 for persons
• 30-40 for the frail, elderly
• 50-60 preventing hospitalization
• 80 preventing death

15
Influenza Vaccine Recommendations

• Persons at increased risk for influenza-related
  complications including those ? 65, children 6-23
  months, pregnant women, those with certain
  chronic conditions
• Persons aged 50 -64
• Persons who live with or care for those at high
  risk

16
Influenza Vaccine 2004-2005

• Vaccine licensed to predict next seasons
  prevalent strain
• A/Fujian/411/2002/(H3N2)-like
• A/New Caledonia/20/99 (H1N1)-like
• B/Shanghai/361/2002-like
• Inactivated influenza vaccine (injection)
• Live attenuated influenza vaccine (nasal spray)

17
Pneumococcal Pneumonia Clinical Features

• Abrupt onset
• Fever
• Shaking chill

• Productive cough
• Pleuritic chest pain
• Dyspnea, tachypnea, hypoxia

18
Pneumococcal Pneumonia

• Estimated 175,000 hospitalized cases per year
• Up to 36 of adult community-acquired pneumonia
  and 50 of hospital-acquired pneumonia
• Common bacterial complication of influenza and
  measles
• Case-fatality rate 5-7, higher in elderly

19
Pneumococcal Vaccines

• 1977 14-valent polysaccharide vaccine licensed
• 1983 23-valent polysaccharide vaccine licensed
• 2000 7-valent polysaccharide conjugate vaccine
  licensed

20
Pneumococcal Polysaccharide Vaccine

• Purified capsular polysaccharide antigen from 23
  types of pneumococcus
• Account for 88 of bacteremic pneumococcal
  disease
• Cross-react with types causing additional 8 of
  disease

21
Pneumococcal Polysaccharide Vaccine
Recommendations

• Adults 65 years of age
• Persons 2 years with
• Chronic illness
• Anatomic or functional asplenia
• Immunocompromised (disease, chemotherapy,
  steroids)
• HIV infection
• Environments or settings with increased risk

22
Pneumococcal Polysaccharide Vaccine Revaccination

• Routine revaccination of immunocompetent persons
  is not recommended
• Revaccination recommended for persons age 2
  years at highest risk of serious pneumococcal
  infection
• Single revaccination dose 5 years after first
  date

23
Pneumococcal Polysaccharide Vaccine Candidates
for Revaccination

• Persons 2 years of age with
• Functional or anatomic asplenia
• Immunosuppression
• Transplant
• Chronic renal failure
• Persons vaccinated at

24
Pneumococcal Vaccines Adverse Reactions

• Local reactions
• Polysaccharide 30-50
• Conjugate 10-20
• Fever, myalgias
• Polysaccharide
• Conjugate 15-24
• Severe adverse reactions rare

25
Pneumococcal Vaccines Contraindications and
Precautions

• Severe allergy to vaccine component of following
  prior dose of vaccine
• Moderate to severe acute illness

26
Pneumococcal Polysaccharide Vaccine Coverage

• Healthy People 2010 goal 90 coverage for
  high-risk persons
• 1999 BRFSS 54 of persons 65 years of age ever
  vaccinated
• Vaccination levels lower for black (32) and
  Hispanic (30) persons

27
Pneumococcal Polysaccharide Vaccine Missed
Opportunities

• 65 of patients with severe pneumococcal disease
  had been hospitalized within preceding 3-5 years
  but had not been immunized
• May be administered simultaneously with influenza
  vaccine

28
Provider Education Article Pneumococcal Vaccine
Payment Increase Effective October 1, 2003
Effective October 1, 2003, the Medicare Part B
payment for the pneumococcal vaccine will be
increased to the lower of the charge billed to
Medicare or 18.62. Annual Part B deductible and
coinsurance amounts do not apply. All
physicians, non-physician practitioners, and
suppliers who administer the pneumococcal
vaccination must take assignment on the claim for
the vaccine. For additional information about
immunizations, refer to the Immunizations Quick
Reference Guide at www.cms.hhs.gov/medlearn/refim
mu.asp
29
Influenza Vaccination of HCWs

• Educate HCWs about the benefits of vaccination
  for themselves, their families, and their
  patients
• Educate staff about vaccine adverse reactions
• Provide free vaccine at the work site to all
  employees, including night and weekend staff

30
Call to Action
31
When Should You Vaccinate?

• Influenza activity usually peaks from late Dec to
  early Mar
• Optimal timing for vaccination clinics is Oct to
  Nov
• First vaccine shipment should go to healthcare
  providers in clinical setting then highest risk
  clients

32
Partnering with Community Groups

• State Health Improvement Plans (SHIP)
• Local immunization coalitions
• DOH immunization consultants (1-877 PAHEALTH)
• Hospitals
• Visiting Nurse Associations

33
(No Transcript)
34
PA DOH Influenza Program Goal

• To achieve healthy people 2010 objective
• Assist grass roots organizations in the community
• Provide technical information and assistance
• Distribute 150,000 doses of influenza vaccine
  throughout the state

35
Allowing for Standing Orders
36
Standing Orders for Influenza
37
Standing Orders for Pneumonia
38
Billing Medicare
39
Billing Medicare Cont.
40
For more information http//www.umd.nycpic.com/Gu
ide-Medicare_Roster_Billing.html
41
Medicare Billing
42
CDC Flyers
43
PA Dept of Health Brochures
44
Analysis

• Reaching 2010 objectives
• Increase in Immunizations Grant for future
  projects.
• Reports for DPA

45
Pennsylvania Department of Healthwww.health.stat
e.pa/immunizations(717) 787-5681

• Centers for Disease Control and Prevention
• www.cdc.gov/flu

46
Thank You!