National Immunization Partners Program'

1
National Immunization Partners Program.

• Interamerican College of Physicians and Surgeons

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Agenda

• Interamerican College of Physicians and Surgeons
  (ICPS)
• Major Programs
• Immunization Program
• Summary

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ICPS

• Not for Profit (501-C-3)
• Established in 1979
• Incorporated in the District of Columbia
• National Hispanic Medical Society
• Monthly Medical Journal
• Monthly Health Awareness Digest
• Grants - Government and Private

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Major Programs

• Continuing Medical Education
• Academic Detailing
• National Immunization Partners Program
• Meetings and Congresses
• National Summit on Health Disparities
• Interamerican Medical Summit
• National Hispanic Academic Network
• National Hispanic Youth Initiative
• Electronic Medical Records
• Physician Recognition Awards
• PBS Series on Minority Health Disparities
• Database and Website Update
• Hispanic Research Network
• Health Link for the Americas
• Know Your Numbers

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Continuing Medical Education
The Interamerican College of Physicians and
Surgeons has been surveyed by the Accreditation
Council For Continuing Medical Education and has
been awarded accreditation as a sponsor of
continuing medical education for physicians
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Immunization Program

• Continuing Medical Education Program sponsored by
  the Center for Disease Control and Prevention
  (CDC)
• 8 hours of category 1 credit toward the AMA
  Physicians Recognition Award
• Target Population Hispanic physicians and
  physicians who serve the Hispanic community

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Program Evaluation

• Pre- and Post- Course Practice Surveys
• Pre- and Post- Course Attitudinal Survey

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Educational Objectives

• To educate at least 4,500 Hispanic physicians
  about the Immunization Partners Program
• To improve the participation of at least 3,000
  Hispanic physicians in providing increased
  immunization services for the Hispanic community

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Summary

• 2 Visits 1 hour each
• Independent Study - 6 hours
• 8 hours of category 1 credit toward the AMA
  Physicians Recognition Award
• Physicians should claim only the hours spend on
  the program.

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Program Visits

• FIRST VISIT -
• Data and Statistics
• Principles of Vaccination
• General Recommendations on Immunization
• 2009 Child Adolescent Immunization Schedules
• The Vaccine Adverse Event Reporting System
• SECOND VISIT
• Catch-up Immunization Schedule for Persons Aged 4
  Months Through 18 Years Who Start Late or Who Are
  More Than 1 Month BehindUnited States 2009
• Immunization Schedules for Adults
• Diseases Vaccines Facts
• Vaccines for Children Program (VFC)
• Vaccine Myths
• Immunization Resources
• Independent Study Material
• Website Recommended to book mark in your Computer

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National Estimated Vaccination Coverage
Immunization Survey
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National Estimated Vaccination Coverage with
Children 19-35 Months of Age by Poverty Level,
2003-2007 NIS
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Impact of Influenza

• 36,000 influenza-associated pulmonary and
  circulatory deaths occurred during each influenza
  season
• Persons 65 years of age and older account for
  more than 90 of deaths
• More than 200 thousand influenza-related
  hospitalizations per year

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Avian Influenza (H5N1)

• 271 human infections with 165 (61) deaths
• More than half of the cases in 2006, and almost
  all of the cases in 2007 have occurred in
  Indonesia
• To date, no infections caused by the highly
  pathogenic form of H5N1 have been reported in the
  United States
• Contact with dead or sick birds is the principal
  source of human infection

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Principles of Vaccination

• Immunity The immune system
• Active Immunity
• Passive Immunity
• Factors may influence the immune response to
  vaccination
• Classification of Vaccines
• Live attenuated vaccines
• Inactivated vaccines

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2 Types of IMMUNITY

• ACTIVE IMMUNITY
• Protection produced by the person's own immune
  system
• Usually permanent
• Another way to produce active immunity is by
  vaccination
• PASSIVE IMMUNITY
• Protection transferred from another person or
  animal
• Temporary protection that wanes with time
• Transplacental most important source in infancy

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The Immune system complex

• ANTIGEN
• A live or inactivated substance (e.g., protein,
  polysaccharide) capable of producing an immune
  response
• ANTIBODY
• Protein molecules (immune-globulin) produced by B
  lymphocytes to help eliminate an antigen

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Factors may influence the immune response to
vaccination

• Presence of maternal antibody
• Nature and dose of antigen
• Route of administration
• Presence of adjuvant (e.g., aluminum-containing
  materials added to improve the immunogenic of the
  vaccine)
• Host factors such as age, nutritional factors,
  genetics, and coexisting disease, may also affect
  the response.

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Classification of Vaccines

• There are two basic types of vaccines live
  attenuated and inactivated
• Their characteristics are different, and these
  determine how the vaccine is used

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Classification of Vaccines

• Inactive
• Whole
• Virus
• Bacterial
• Fractional
• Protein based
• Polysaccharide
• based

• Live attenuated
• Viral
• Bacterial

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Live attenuated vaccines

• Virus measles, mumps, rubella, vaccinia, yellow
  fever, intranasal influenza, Rotavirus and oral
  polio (no in US)
• Bacterium BCG, oral Typhoid.

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Live Attenuated Vaccines Characteristic

• The resulting vaccine organism retains the
  ability to replicate and produce immunity, but
  does not cause illness.
• Must replicate to be effective.
• Immune response similar to natural infection.
• Usually effective with one dose, except those
  administrated orally.
• Can have interference from circulating antibody.
• Must be stored and handled carefully.

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Inactivated vaccines

• Whole
• Whole viruses
• polio,
• hepatitis A,
• rabies,
• Influenza
• Whole bacteria
• (Pertussis) (typhoid)
• (cholera),
• (plague)

• Fractional
• Protein Based
• Toxoid Diphtheria
• Tetanus
• Subunit Hepatitis B
• Influenza A
• Cellular Pertussis
  (Lyme), (HPV)
• 2. Polysaccharide based
• Pure Pneumococcal
• Meningococcal
• Salmonella Typhi (VI)
• 3. Conjugate H influenzae Type b
• Pneumococcal
• Meningococcal

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Inactivated vaccines Characteristic

• Cannot replicate
• Generally not as effective as live vaccines
• Less interference from circulating antibody than
  live vaccines
• Generally require 3-5 doses
• Immune response mostly humoral
• Antibody titer may diminish with time

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AntibodyVaccine Interactions

• Inactivated vaccines generally are not affected
  by circulating antibody to the antigen
• Live attenuated vaccines may be affected by
  circulating antibody to the antigen.
• When give vaccine first wait 2 weeks before
  giving antibody
• When give antibody first wait more than 3 months
  before giving antibody vaccine
• Except rotavirus vaccine, which should be
  delayed for 6 weeks

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Interval between subsequent doses of the same
vaccine

• Increasing the interval between doses of a
  multidose vaccine does not diminish the
  effectiveness of the vaccine.
• Decreasing the interval between doses of a
  multidose vaccine may interfere with antibody
  response and protection.
• Vaccine doses should not be administered at
  intervals less than the recommended minimum
  intervals or earlier than the minimum ages.

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Number of Doses

• Live attenuated vaccines generally produce
  long-lasting immunity with a single dose.
• Inactivated vaccines require multiple doses and
  may require periodic boosting to maintain
  immunity.

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Adverse Reactions Following Vaccination

• Vaccines are intended to produce active
  immunity to specific antigens.
• A vaccine adverse event refers to any adverse
  event that occurs following vaccination. Vaccine
  adverse reactions fall into three general
  categories
• Local the most common such as pain, swelling,
  and redness at the site of injection.
• Systemic include fever, malaise, myalgias,muscle
  pain, headache, loss of appetite, and others.
• Allergic is the most severe and least frequent.

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Contraindications and Precautions

• Severe allergic reaction to a vaccine component
  or following a prior dose
• Encephalopathy not due to another identifiable
  cause occurring within 7 days of pertussis
  vaccination

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Vaccination of Pregnant

• Live vaccines should not be administered to women
  known to be pregnant
• In general inactivated vaccines may be
  administered to pregnant women for whom they are
  indicated
• HPV vaccine should be deferred during pregnancy

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Immunosuppression

• Disease
• congenital immunodeficiency
• leukemia or lymphoma
• generalized malignancy
• Chemotherapy
• alkylating agents
• antimetabolites
• radiation

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Invalid Contraindications to Vaccination

• Mild illness
• Antimicrobial therapy
• Disease exposure or convalescence
• Pregnant or immunosuppressed person in the
  household
• Breastfeeding
• Preterm birth
• Allergy to products not present in vaccine or
  allergy that is not anaphylactic
• Family history of adverse events
• Tuberculin skin testing
• Multiple vaccines

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Screening Questions

• Is the child (or are you) sick today?
• Does the child have an allergy to any
  medications, food, or any vaccine?
• Has the child had a serious reaction to a vaccine
  in the past?
• Has the child had a seizure, brain or nerve
• problem?
• Does the child have cancer, leukemia, AIDS, or
  any other immune system problem?
• Standardized screening questionnaires are
  available at http//www.immunize.org

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Immunization Registries

• Single data source for all providers
• Reliable immunization history
• Produce records for patient use
• Key to increasing immunization levels

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Reminders and recall to Patients

• Reminder- notification that immunization is due
  soon
• Recall-notification that
• immunization are past due
• Content of message and technique of delivery vary
• Reminders and recall have been found to be
  effective

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Reminders and recall to Providers

• Communication to healthcare providers that an
  individual clients immunizations are due soon or
  past due
• Example
• Computer-generated list
• Stamped note in chart
• Immunization due clip on chat

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Reasons for Missed Opportunities

• Lack of simultaneous administration
• Unaware child needs additional vaccines
• Invalid contraindications
• Inappropriate clinic policies
• Reimbursement deficiencies

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Reduction to barriers to Immunization

• Physical barriers
• -waiting time
• -distance
• Psychological barriers
• -unpleasant experience
• -safety concerns

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2009 Child Adolescent Immunization Schedules
www.cdc.gov/vaccines/recs/schedules/child-schedul
e.htm

• Recommended Immunization Schedule for Persons
  Aged 0 Through 6 Years
• Recommended Immunization Schedule for Persons
  Aged 7 Through 18 Years

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Recommended Immunization Schedule for Persons
Aged 0 Through 6 Yearswww.cdc.gov/vaccines/recs/s
chedules/child-schedule.htm
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Recommended Immunization Schedule for Persons
Aged 7 Through 18 Years
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The Vaccine Adverse Event Reporting System

• The Vaccine Adverse Event Reporting System
  (VAERS) is a national reporting system, jointly
  administered by CDC and FDA.
• http//vaers.hhs.gov
• Phone at 800-553-6847
• Mail to VAERS
• P.O. Box 1100
• Rockville, MD 20849-1100

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Independent Study Material

• Epidemiology and Prevention of Vaccine-
  Preventable Disease, The Pink Book, 10Th edition,
  National Immunization Program
• Chapters 1 through 4, Appendices F, G, H and I
• www.cdc.gov/vaccines/recs/schedules/child-schedul
  e.htm
• www.cdc.gov/nip/ed/
• www.cdc.gov/vaccines/ www.cdc.gov/vaccines/pubs/p
  inkbook/pink-chapters.htm