Update on Adult Immunizations and Recommendations

Transcription

1 Update on Adult Immunizations and Recommendations NMSHP BALLOON FIESTA MEETING OCTOBER 4, 2015 JENNIFER BLAKE, PHARMD BCPS CLINICAL PHARMACY SUPERVISOR, VA MEDICAL CENTER Objectives - Pharmacist Describe 3 key differences between innate and adap9ve immunity. Iden9fy 3 specific pa9ent popula9ons at increased risk for vaccine preventable diseases. Specify the current CDC recommenda9ons for the high- dose flu vaccine. Define appropriate vaccina9on recommenda9ons for preven9on of pneumococcal disease. 1

2 Objectives - Technician Explain 1 difference between live and inac9ve vaccines. Iden9fy 2 specific pa9ent popula9ons at increased risk for vaccine preventable diseases. Iden9fy 1 difference between the high- dose and the standard- dose flu vaccines. Iden9fy 1 major difference between the PCV13 and PPSV23 pneumococcal vaccines. Vaccines and Immunity 2

3 Innate Immune System Not specific to pathogens Physical Skin Epithelial and mucus layers Cellular aspects Neutrophils and macrophages Natural killer cells Biochemical Inflammatory response Cytokines trigger fever and recruit neutrophils Complement system Enhances phagocytosis Recruits phagocytes and lymphocytes Pathogen lysis (membrane asack complexes) Understanding How Vaccines Work hsp:// ed/conversa9ons/downloads/vacsafe- understand- color- office.pdf; Alberts B, Johnson A, Lewis J, et al. Molecular Biology of the Cell. 4th edi9on. New York: Garland Science; Innate Immunity. Available from: hsp:// Adaptive Immune System Involves ability to recognize and remember specific pathogens Two classes An9body responses B- cell an9body produc9on Cell- mediated responses Ac9vated T- cells Mounts stronger asacks each 9me the pathogen is encountered (adap9ve in nature) This is how vaccines work Understanding How Vaccines Work hsp:// ed/conversa9ons/downloads/vacsafe- understand- color- office.pdf; Alberts B, Johnson A, Lewis J, et al. Molecular Biology of the Cell. 4th edi9on. New York: Garland Science; Innate Immunity. Available from: hsp:// 3

4 Innate vs. Adaptive Immunity INNATE Non- specific response ADAPTIVE Specific response Exposure leads to immediate maximum response Delay between exposure and maximum response Cell- mediated with humoral components Cell- mediated with humoral components No memory Immunological memory develops Understanding How Vaccines Work hsp:// ed/conversa9ons/downloads/vacsafe- understand- color- office.pdf; Alberts B, Johnson A, Lewis J, et al. Molecular Biology of the Cell. 4th edi9on. New York: Garland Science; Innate Immunity. Available from: hsp:// Innate vs. Adaptive Immunity hsp:// infographic/ 4

5 Active Immunity Produc9on of an9bodies in response to exposure to an an9gen of a pathogen or vaccine Generally long- term and involves B cell and T cell ac9va9on B- cell ac+vity humoral immunity T- cell ac+vity cell mediated immunity Understanding How Vaccines Work hsp:// ed/conversa9ons/downloads/vacsafe- understand- color- office.pdf; The Pink Book (13 th edi9on) hsp:// Passive Immunity Transfer of ac9ve immunity Ready- made an9bodies Naturally from one individual to another Ar9ficially Prevent infec9on when there is insufficient 9me for the body to mount an immune response Reduce the symptoms of ongoing or immunosuppressive diseases Provides immediate protec9on No memory is formed Understanding How Vaccines Work hsp:// ed/conversa9ons/downloads/vacsafe- understand- color- office.pdf; The Pink Book (13 th edi9on) hsp:// 5

6 Putting it together Understanding How Vaccines Work hsp:// ed/conversa9ons/downloads/vacsafe- understand- color- office.pdf; The Pink Book (13 th edi9on) hsp:// Patients At-risk for Vaccine Preventable Diseases 6

7 At-risk Populations Persons with func9onal or anatomic asplenia Includes sickle cell disease Children Infants may retain some passive immunity through transfer of maternal an9bodies Elderly Weaker immune system Waxing of ac9ve immune response Immunocompetent pa9ents Chronic heart disease (excluding hypertension) Chronic lung disease Diabetes Cochlear implant Chronic liver disease CigareSe smoking Group living situa9ons The Pink Book (13 th edi9on) hsp:// At-risk Populations Immunocompromised pa9ents Congenital or acquired immunodeficiencies HIV infec9on Chronic renal failure Cancer Solid organ transplanta9on Diseases requiring treatment with immunosuppressive drugs including long- term, systemic steroids or radia9on therapy The Pink Book (13 th edi9on) hsp:// 7

8 Types of Vaccines Live / attenuated Live / A9enuated Live microbes with virulent proper9es removed Typically provoke more durable immunological responses Preferred type for healthy adults CAN cause disease (typically mild) Vaccines Measles, mumps rubella (MMR) Varicella (chickenpox) Zoster Influenza (nasal spray only) Rotavirus Yellow Fever Understanding How Vaccines Work hsp:// ed/conversa9ons/downloads/vacsafe- understand- color- office.pdf; The Pink Book (13 th edi9on) hsp:// Types of Vaccines Killed / inactivated Killed / inac+vated Killed, but previously virulent microbes Unable to cause the disease Vaccines Polio (IPV) Hepa99s A Rabies Toxoid Made from inac9vated toxin that cause illness rather than the microorganism itself Type of killed / inac9vated vaccine Tetanus Diphtheria Understanding How Vaccines Work hsp:// ed/conversa9ons/downloads/vacsafe- understand- color- office.pdf; The Pink Book (13 th edi9on) hsp:// 8

9 Types of Vaccines Conjugate Conjugate Less immunogenic components linked to more immunogenic components (e.g. toxic proteins) Facilitates immune response against an otherwise poorly immunogenic an9gen Vaccines Influenza Pneumococcal Pertussis Human papillomavirus (HPV) Hepa99s B Haemophilus influenza type b (Hib) Meningococcal Understanding How Vaccines Work hsp:// ed/conversa9ons/downloads/vacsafe- understand- color- office.pdf; The Pink Book (13 th edi9on) hsp:// Vaccines - Path to the Patient 9

10 Approval Organizations Food and Drug Administra9on (FDA) Responsible for protec9ng public health by assuring the safety, efficacy and security of human and veterinary drugs, biological products, medical devices, our na9on s food supply, cosme9cs, and products that emit radia9on Approves all vaccine products before they can be marketed in the US Advisory CommiSee on Immuniza9on Prac9ces (ACIP) A group of medical and public health experts that develop recommenda9ons on use of vaccines in the civilian popula9on of the United States. Part of the Centers for Disease Control and Preven9on (CDC) Holds 3 annual mee9ngs (February, June and October) where recommenda9ons are discussed Morbidity and Mortality Weekly Report (MMWR) Publica9on of the CDC Publishes FINAL vaccina9on schedules (usually in February of each year) Fda.gov/AboutFDA/WhatWeDo; hsp:// hsp:// Influenza Vaccine 10

11 History Highly infec9ous viral illness Name originated in 15 th century Italy from an epidemic asributed to influence of the stars First worldwide epidemic (pandemic) in 1580 Spanish influenza pandemic caused an es9mated 21 million deaths worldwide First pandemic of the 21 st century occurred in Peaked in October million Americans became ill 270,000 hospitaliza9ons 12,500 deaths The Pink Book (13 th edi9on) hsp:// Virus Single- stranded, helically shaped, RNA virus Three basic an9gen types Type A: typically causes moderate to severe disease in all age groups Three types of hemagglu9nin surface an9gens (H1, H2, and H3) Two types of neuramidase surface an9gens (N1 and N2) Type B: typically causes more mild disease primarily in children Type C: rarely reported in humans The Pink Book (13 th edi9on) hsp:// 11

12 Impact Incuba9on period 1 to 4 days (average of 2 days) Only about 50% of infec9ons persons will develop clinical symptoms Nearly 90% of deaths and 63% of hospitaliza9ons are in pa9ents 65 and older Generally see higher number of hospitaliza9ons when A(H3N2) is the major strain School- aged children are a major source of disease transmission The Pink Book (13 th edi9on) hsp:// Impact Variable Es+mated Annual Impact Cases 24.7 million Outpa9ent visits 31.4 million Hospitaliza9ons 334,185 Hospitalized days 3.1 million Days of produc9vity lost due to illness 44.0 million Deaths 41,008 Life years lost 610,656 Medical costs $10.4 billion Lost earnings due to illness and loss of life $16.3 billion Total economic burden $87.1 billion Molinari NA, et al. Vaccine. 2007;25:

13 Influenza Vaccination Coverage Vaccina+on Coverage (%) yrs yrs 65 yrs Pregnant Women Health Care Personnel 90% HP: Healthy People CDC. MMWR 2011;60(32): CDC. MMWR 2011;60(32): CDC. hsp:// Influenza Vaccine Types Inac9vated influenza vaccine (IIV) Live, asenuated influenza vaccine (LAIV) Route of administra9on Intramuscular Intradermal Intranasal Number of strains Trivalent type A(H1N1), type A(H3N2) and type B Quadrivalent Introduced for the season Trivalent strains plus an addi9onal type B strain MMWR August 7, 2015 / 64 (30);

14 Influenza Vaccine Expected to have 171 to 179 million doses available this year in the US 40 million doses have already been distributed Strains an A/California/7/2009 (H1N1)- like virus an A/Switzerland/ /2013 (H3N2)- like virus a B/Phuket/3073/2013- like virus. a B/Brisbane/60/2008- like virus. quadrivalent only MMWR August 7, 2015 / 64 (30); Influenza Recommendations Recommended for EVERYONE age 6 months and older without contraindica9ons Changes: Feb 2015 ACIP did not renew their preferen9al recommenda9on for LAIV in healthy children age 2 through 8 years old for the season Dec 2014 FDA approved Fluzone intradermal quadrivalent. It replaces the previous trivalent intradermal product. Oct 2014 RIV3 (Flublok) received expanded indica9on. Now approved for all adults age 18 and older Addi9onal published data on high- dose vaccine MMWR August 7, 2015 / 64 (30);

15 Influenza Vaccine Type Trade Name Inac9vated influenza vaccine, quadrivalent (IIV4), standard dose (SD) Fluarix Quadrivalent FluLaval Quadrivalent Fluzone Quadrivalent Fluzone Intradermal Quadrivalent Inac9vated influenza vaccine, trivalent (IIV3), SD Afluria Fluvirin Fluzone Inac9vated influenza vaccine, trivalent (IIV3), high dose (HD) Fluzone High- dose Inac9vated influenza vaccine, cell- culture based (cciiv3), SD FluceIvax Recombinant influenza vaccine, trivalent (RIV3), SD FluBlok Live asenuated influenza vaccine, quadrivalent (LAIV4) FluMist Quadrivalent hsp:// vaccines- table pdf Is the type of vaccine important Live versus inac9vated Inac9vated (IIV4) versus recombinant (RIV3) with egg allergy High dose versus standard dose 15

16 Case 72 year old male comes see you in your primary care medica9on therapy management clinic. He states that he was briefly hospitalized last year with the flu. He is interested in being vaccinated this year. He has never received a flu vaccine and reports no known food or medica9on allergies. Your clinic has the following products available: LAIV IIV4 standard dose IIV3 high dose RIV3 What do you recommend? LAIV vs. IIV Both are effec9ve. Most studies showed similar efficacy or that IIV was more effec9ve Vaccina9on should not be delayed to obtain a specific product Do not use LAIV in the following groups: Age less than 2 or greater than 49 Pregnant women Immunocompromised History of egg allergy Received influenza an9viral medica9ons within the previous 48 hours Precau9on in pa9ents with asthma MMWR August 7, 2015 / 64 (30);

17 Egg Allergy Tolerance to egg- containing foods does not exclude the possibility of an egg allergy Pa9ents who can eat lightly cooked eggs are unlikely to be allergic. Pa9ents who can eat eggs in baked products may s9ll be allergic. If pa9ent develop hives only IIV or RIV3 should be used; limited data on LAIV in this pa9ent group. If IIV is used, observe pa9ent for at least 30 minutes for signs of a reac9on. Provider should be familiar with signs of allergy. If severe symptoms (angioedema, respiratory distress, require epinephrine or other emergency response RIV3; only approved for age 18 and older Consult physician if pa9ent less than 18 years old. MMWR August 7, 2015 / 64 (30); High Dose vs. Standard Dose IIV3 high dose (HD) Contains 180 mcg of influenza virus hemagglu9nin Standard dose contains 45 mcg of influenza virus hemagglu9nin Why Older pa9ents tend to have a weaker immune system Lower rates of immunity (seroconversion) seen with standard dose BUT does HD prevent infec9ons and/or related complica9ons Reports of more frequent injec9on- site and systemic reac9ons Fluzone vaccine [Prescribing Informa9on]. Swixwater, PA: Sanofi Pasteur Inc.; Falsey A, et al. J Infect Dis. 2009;200(2):

18 Efficacy of High-Dose versus Standard-Dose Influenza Vaccine in Older Adults Mul9- center, randomized, double- blind, ac9ve controlled trial IIV3 HD vs. IIV3 SD Adults age 65 and older; n=31, and influenza seasons Results No difference in rate of laboratory- confirmed influenza; 1.4% HD vs 1.9% in SD Rela9ve risk of at least 1 serious adverse event with HD vs. SD was 0.92(95% CI ) Hemagglu9na9on- inhibi9on (HAI) 9ters were significantly higher in the HD group N Engl J Med 2014;371: Comparative Effectiveness of High-dose versus Standard-dose Influenza Vaccines in US Residents Aged 65 years and older from 2012 to 2013 using Medicare Data Retrospec9ve cohort trial of IIV3 HD vs. IIV3 SD Medicare beneficiaries age 65 and older; n=2,545, influenza season Results A 22% (95% CI 15-29%) reduc9on in probable influenza infec9ons with HD vs. SD A 22% (95% CI 16-27%) reduc9on in influenza related hospital admissions Lancet Infect Dis 2015;15:

19 Comparative Effectiveness of High-dose versus Standard-dose Influenza Vaccination in Community-Dwelling Veterans Retrospec9ve cohort trial of IIV3 HD vs. IIV3 SD Pa9ents receiving primary care at Veteran Health Administra9on (VHA) medical centers age 65 and older; n=165, influenza season Results No reduc9on in risk of hospitaliza9on; rate 0.3% RR 0.98 (95% CI ) Subgroup analysis showed lower rate of hospitaliza9on in pa9ents 85 years or older; rate 0.3% vs. 0.66%. RR 0.52 (95% CI ) CID 2015;61:171-6 High Dose vs. Standard Dose No recommenda9on from CDC or ACIP that HD is preferred over SD in any popula9on Vaccina9on should not be delayed to obtain a specific product No evidence to support booster dose of SD in elderly pa9ents 19

20 Case 72 year old male comes see you in your primary care medica9on therapy management clinic. He states that he was briefly hospitalized last year with the flu. He is interested in being vaccinated this year. He has never received a flu vaccine and reports no known food or medica9on allergies. Your clinic has the following products available: LAIV not approved for 49 or older IIV4 standard dose appropriate IIV3 high dose appropriate RIV3 no indica9on that egg- free product would be beser than IIV What do you recommend? Pneumococcal THE TALE OF 2 VACCINES 20

21 Pneumococcal Disease Caused by Streptococcus pneumoniae More than 90 serotypes; 10 are responsible for invasive disease Fatality rate for pneumococcal bacteremia is about 15% overall and as high as 60% among adults 65 and older Highest mortality rate compared with all other vaccine- =preventable illnesses in the US About 18,000 fatal cases of pneumococcal disease each year in the US among adults age 65 and older The Pink Book (13 th edi9on) hsp:// Changes in Overall Invasive Pneumococcal Disease, Cases/100,000 Popula+on PCV7 introduced Age Group (years) < vs baseline* (% reduc+on) *Baseline Year Pilishvili T, et al. J Infect Dis. 2010;201:

22 Invasive Pneumococcal Disease Among Adults 65 Years, PCV7 introduced Cases/100,000 Popula+on Serotype group PCV7 type Non- PCV7 type 19A Included in PCV Year Pilishvili T, et al. J Infect Dis. 2010;201: Two Vaccines Available Pneumococcal 13- valent Conjugate Vaccine (PCV13) Inac9vated conjugate vaccine Invokes a stronger immune response Protects against 13 serotypes 12 serotypes are included in PPSV23 1 serotype (6A) is unique to PCV13 Pneumococcal Polysaccharide Vaccine (PPSV23) Inac9vated polysaccharide vaccine Invokes a weaker immune response Protects against 23 serotypes 12 serotypes are included in PCV13 11 serotypes are unique to PPSV23 The Pink Book (13 th edi9on) hsp:// 22

23 Case 66 year old female is admised to your hospital for scheduled knee replacement surgery. While speaking to her as part of your rou9ne Medica9on Reconcilia9on process, she reports he received a vaccine to prevent pneumonia last year on the advise of his primary care provider. She asks if she needs a dose again this year like the flu vaccine. You check in your medical record and determine that she received the PPSV23 vaccine 9 months ago. What do you recommend? PPSV23 Adults 19 to 64 with specific chronic condi9ons Immunocompromising condi9ons HIV, malignancies, transplanta9on, chronic renal failure Func9onal or anatomic asplenia (e.g. sickle cell disease) CSF leak Cochlear implants Diseases requiring immunosuppressive therapy, including steroids Current smoker Asthma Adults 65 years of age and older Revaccina9on 19 to 64 years: one- 9me revaccina9on axer 5 years Func9onal or anatomic asplenia Chronic renal failure or nephro9c syndrome Persons with immunocompromising condi9ons 65 years: one- 9me revaccina9on if vaccinated 5 years previously and < 65 years at 9me of primary vaccina9on Those who receive PPSV23 at or axer age 65 should receive only a single dose No indica9on for more than 3 doses The Pink Book (13 th edi9on) hsp:// 23

24 PPSV23 in Adults Meta-analysis Results from 15 RCTs (N = 48,656) Invasive pneumococcal disease (IPD) Ø Strong evidence of protec9on (74%) Ø OR 0.26 (95% CI ); P < All- cause pneumonia Ø Inconclusive efficacy (29%) [Substan9al sta9s9cal heterogeneity] Ø OR 0.71 (95% CI ); P = All- cause mortality Ø No evidence of protec9on (other factors may contribute) Ø OR 0.87 (95% CI ); P = 0.25 Adults with chronic illness Ø Evidence is less clear Moberley S, et al. Cochrane Database Syst Rev. 2008;(1):CD PPSV23 in Adults 65 and Older Cohort studies suggest protec9on against IPD Some cohort studies suggest protec9on against pneumonia, while others do not No randomized trials have demonstrated efficacy against pneumonia in the elderly ***Need iden9fied for a beser vaccine** 24

25 PCV13 Approved by the FDA in December Recommended single dose for at risk adults with specific chronic condi9ons Immunocompromising condi9ons HIV, malignancies, transplanta9on, chronic renal failure Func9onal or anatomic asplenia (e.g. sickle cell disease) CSF leak Cochlear implants Diseases requiring immunosuppressive therapy, including steroids Required to conduct post- approval, randomized, controlled trial in adults age 65 and older. ACIP deferred recommenda9ons for adults 65 and older un9l data was published. The Pink Book (13 th edi9on) hsp:// CAPITA Trial Randomized, double- blind, placebo- controlled trial Adults age 65 and older; n=84,496 September7 15, 2008 to January 30, 2010 Results Vaccine efficacy 45.6% (95% CI 21.8 to 62.5%) for community- acquired pneumonia due to vaccine- type strains Vaccine efficacy 75.0% (95% CI 41.4 to 90.8%) for invasive pneumococcal disease due to vaccine- type strains Aug 2014 ACIP recommended rou9ne use in adults 65 years and older N Engl J Med 2015;372: ; ACIP June

26 Pneumococcal Vaccine PCV13 and PPSV23 should NOT be given together Recommend to give PCV13 FIRST Wait 6 to 12 months (at least 8 weeks) to give PPSV23 IF PPSV23 given first Wait 12 months to give PCV13 CONFUSING??? hsp:// New Spacing Recommendation Sept 4, 2015 hsp:// 26

27 Case 66 year old female is admised to your hospital for scheduled knee replacement surgery. While speaking to her as part of your rou9ne Medica9on Reconcilia9on process, she reports he received a vaccine to prevent pneumonia last year on the advise of his primary care provider. She asks if she needs a dose again this year like the flu vaccine. You check in your medical record and determine that she received the PPSV23 vaccine 9 months ago. What do you recommend? No need to repeat the PPSV23 vaccine. Will need one dose of PCV13 vaccine, but need to wait at least 1 year from PPSV23. Advise pa9ent to ask vaccine provider for PCV13 vaccine in 3 months. Human Papilloma Virus (HPV) 27

28 HPV About 79 millions Americans are currently infected 14 million people infected each year Most common sexually- transmised disease in the US Most people do not know that they are infected Leading cause of cervical cancer (> 80%) hsp:// vac/hpv/vac- faqs.htm; hsp:// HPV Vaccines Three vaccines available 2vHPV (Ceravix) HPV 16,18 Prevents cervical cancer 4vHPV (Guardasil) HPV 6, 11, 16 and 18 Prevents cervical cancer, vulvar cancer, vaginal cancer, anal cancer and anal warts 9vHPV (Guardasil 9) HPV 6, 11,16, 18, 31, 33, 45, 52 and 58 Prevents cervical cancer, vulvar cancer, vaginal cancer, anal cancer and anal warts hsp:// updates- in- hpv- vaccines 28

29 9 Valent HPV (9vHPV; Guardasil 9) FDA approved on 12/10/14 Targets 5 addi9onal HPV types which account for about 15% of cervical cancers HPV 16, 18 account for about 60-80% of cervical cancers and majority of other HPV- asributable cancers in the US Expected to replace quadrivalent HPV vaccine (4vHPV) Same schedule as 2vHPV and 4vHPV 3 dose series 2 nd dose 1 month axer the first dose 3 rd dose 6 months axer the first dose Indica9on for females Age 11 to 26; may be started at age 9 Indica9on for males Age 11 to 21; may be started at age 9 Age 22 to 26 Men who have sex with men Immunocompromised disease (including HIV) MMWR March 27, 2015 / 64 (11); Meningitis 29

30 Bacterial Meningitis Usually severe Can cause brain damage, hearing loss and death In the US, about 4,100 cases of bacterial meningi9s (including 500 deaths) are reported each year Causes vary by age Neisseria meningifdes is a leading cause in young adults Infec9ons can spread in community sengs such as college residence halls and military training centers Time between first symptom and death can be rapid (24 hours or less) Classic triad of symptoms = fever, headache and s9ff neck hsp:// Meningitis Vaccine 2005 FDA approved vaccine against serogroups A, C, W and Y Two FDA approved vaccines Meningococcal conjugate vaccine (MenACWY [Menactra]) Meningococcal polysaccharide vaccine (MPSV4 [Menomune]) ACIP recommenda9on for MenACWY Age 11 and older with the following At risk due to serogroup A, C, W or Y outbreak Func9onal or anatomic asplenia (e.g. sickle cell disease); 2- dose primary series Persistent complement component deficiency; 2- dose primary series Microbiologist working with N. meningifdes Military recruits First- year college students through age 21 who are living in residence halls if have not received a dose at age 16 or later Recommend revaccina9on every 5 years with MenACWY for adults who remain at increased risk for infec9on hsp:// 30

31 Meningococcal Disease on US College Campuses, hsp:// content/uploads/2015/06/college- Cases- Map.pdf Meningitis Serotype B Vaccine 2013 Princeton University Outbreak with serogroup B March 2013 first reported case November 2013 seventh reported case FDA approve importa9on of vaccine against serogroup B Vaccine approved for use in Europe and Australia Unknown how many students received the vaccine; 8 total cases reported during this outbreak Two FDA approved vaccines for serogroup B October 2014 (MenB- FHbp [Trumenba, Wyeth]; 3- dose series) January 2015 (MenB- 4C [Bexsero, Novar9s]; 2- dose series) June 2015 ACIP recommenda9ons for age 10 and older with the following At risk due to serogroup B disease outbreak Func9onal or anatomic asplenia (e.g. sickle cell disease) Persistent complement component deficiency Taking eculizumab Microbiologist working with N. meningifdes MAY be given to anyone 16 to 23 to protect from infec9on Awai9ng recommenda9ons for revaccina9on hsp:// usa- princeton- meningi9s- idusbre9af08h ; MMWR June 12, 2015 / 64(22);

32 Herpes Zoster Vaccine (HZV) HSV 2006 FDA approve HSV vaccine 2008 ACIP recommended use in adults age 60 and older March 2011 FDA approved indica9on for adults age 50 and older June 2011, ACIP reviewed data but declined to expand recommenda9on to this group Limited vaccine supply Limited data on long- term protec9on October 2013, ACIP reviewed long- term protec9on data Protec9on wanes within 5 years; protec9on beyond 5 years is uncertain Vaccina9on at age 60 prevents the most cases of shingles followed by vaccina9on at age 70 and age 50 Cost for rou9ne vaccina9on of all age is likely not cost effec9ve ACIP will con9nue to evaluate op9mal age for vaccina9on and need for revaccina9on MMWR August 22,2014 / 63(33);

33 Pharmacist and Technician Roles Pharmacist and Technician Roles Know the facts Recommend vaccina9ons to your pa9ents Use a systema9c approach Offer vaccines Assist with protocol development Work with electronic clinical decision support systems Get vaccinated! Protect our pa9ents especially those vulnerable popula9ons that aren t able to receive vaccines U9lize the New Mexico Statewide Immuniza9on Informa9on System (NMSIIS) Immediately access a pa9ents validated immuniza9on history Prevent over- vaccina9on hsps://nmsiis.health.state.nm.us/pr/ portalinfomanager.do 33

34 Technology Free app for iphone and Android as well as web browser ACP Immuniza9on Advisor FREE app for iphone or downloadable guide Technology CDC Vaccines and Immuniza9ons FREE updates ( Immuniza9on Ac9on Coali9on FREE updates (immunize.org/subscribe) 34

35 Patient Education Handouts Immunize.org Vaccines Work ( hsp:// Vaccina9ons for Adults ( hsp:// Evidence Shows Vaccines Unrelated to Au9sm (hsp:// CDC Understanding How Vaccines Work ( hsp:// ed/ conversa9ons/downloads/vacsafe- understand- color- office.pdf) Ensuring the Safety of Vaccines in the United States ( hsp:// ed/ conversa9ons/downloads/vacsafe- ensuring- color- office.pdf) 3 Important Reasons for Adults to Get Vaccinated ( hsp:// ed/ adults/downloads/fs- three- reasons.pdf) Report Vaccine Adverse Events Vaccine Adverse Event Repor9ng System (VAERS) Na9onal vaccine safety surveillance program Co- sponsored by the CDC and the FDA Collects post- marke9ng safety informa9on about adverse events that occur axer vaccine administra9on Linked to the na9onal Vaccine Injury Compensa9on Program Vaccine Injury Compensa9on Program (VICP) Created on October 1, 1988 Established to Ensure adequate vaccine supply Stabilize costs Establish and maintain no- fault system for resolving vaccine injury claims hsps://vaers.hhs.gov/index; hsp:// 35

36 Questions? 36

37 37