ENA Topic Brief. Adult Immunizations. Key Information

Transcription

1 ENA Tpic Brief Key Infrmatin Immunizatins are vital fr d isease preventin and health prmtin. The CDC prvides recmmendatins fr adult immunizatins. Infrmatin n vaccines are available at n cst frm the CDC. Nurses shuld be knwledgeable abut vaccine use and safety. A natinal vaccine surveillance system exists that track adverse events related t vaccines. Adult Immunizatins Purpse The purpse f this ENA Tpic Brief is t prvide infrmatin abut adult immunizatins s that nurses are knwledgeable abut recmmended prtectin against vaccine- preventable diseases. Immunizatins are an excellent and effective way t prtect neself against many cmmunicable diseases. Immunizatin schedules are ften assciated nly with infants and children, but recmmendatins fr adult immunizatins are als available. The Advisry Cmmittee n Immunizatin Practices (ACIP) f the Centers fr Disease Cntrl and Preventin (CDC) annually reviews and updates the Adult Immunizatin Schedule that is designed t infrm health care prviders abut evidence- based guidelines regarding necessary immunizatins. Overview The understanding f hw immunity t disease is achieved has advanced significantly in the last century. Immunity is accmplished thrugh the presence f antibdies prteins prduced by the bdy t destry disease- carrying rganisms. These antibdies are disease specific. Immunity can be prduced actively by expsure t an actual disease r by intrductin f a dead r weakened frm f the disease- prducing rganism by vaccinatin. S, if the individual cmes int cntact with the same disease at a future pint, the immune system recgnizes the threat and prduces specific antibdies against it. Immunity can als be achieved by a passive mechanism when an individual is given the antibdies t the disease rather than prducing them. Passive immunity is immediate but nly lasts fr a shrt time. Individuals wh d nt have active immunity t a specific disease may have a prtective barrier arund them if a large ppulatin is present that has a high vaccinatin rate against that disease.1 This may inhibit disease spread. Thus vaccinatin may nt nly prtect the individual but thers in the envirnment as well. The infrmatin n immunity is incmplete withut a lk at the histry f vaccines. The first successful vaccine was develped ver tw centuries ag t cmbat smallpx, which was a cause f epidemics wrldwide. The success f this first vaccine in reducing disease spread and preventing staggering death rates frm this cmmunicable disease led the way fr the develpment f new vaccines that remain in use tday. Befre the develpment and use f vaccines, millins f American children died frm childhd diseases such as pli, diphtheria, and pertussis. These childhd diseases and many thers are rarely seen due t the prevalence f immunizatin amng children. Frnt line effrt in the cntinuing develpment f effective vaccines centers Emergency Nurses Assciatin 915 Lee Street Des Plaines, IL July 2013 Page 1 f 10

2 ENA Tpic Brief arund the understanding f the battle between the human immune system and viral diseases. Viruses need a hst t survive and are capable f cntinuing mutatin and adaptatin. This adaptatin causes the virus t lk different, s antibdies develped frm a prir infectin r vaccinatin may nt effectively fight the presenting virus. Seasnal influenza is ne f thse viruses. It is a simple entity belnging t ne f three main types A, B, and C but in cmmn jargn all three are referred t as the flu. Certain strains f influenza have higher rates f serius cmplicatins than ther strains. Tday vaccines are the mst successful and cst- effective public health tls fr preventing deaths frm cmmunicable disease.2 Vaccines are recmmended fr adults n the basis f age, prir vaccinatins, health cnditins, lifestyle, ccupatin, and travel. Unfrtunately, the incidence f vaccine preventable diseases in the United States is still high, and nearly 50,000 adults die annually frm diseases that culd have been prevented by vaccinatin.3 Accrding t Healthy Peple 2020, vaccine- preventable diseases such as influenza and pneumcccal pneumnia cntinue t be leading causes f hspital admissins, medical csts, and mrbidity and mrtality.4 An ptimal respnse t vaccine is dependent n multiple factrs such as age r ther medical cnditins. In 2013, vaccines are available t prtect children and adults against 17 diseases that can cause death and serius lng- term disabilities such as paralysis, hearing lss, and infertility. Current levels f apprpriate vaccinatin in the adult ppulatin remain lw, and health care prviders shuld rutinely assess a patient s vaccinatin histry and immunizatin status. 5 The current lw vaccinatin rate in adults is cmpunded by an increase f glbal travel. Nurses attentin t their persnal immunizatin needs als is key t creating that prtective pl f vaccinated individuals in the envirnment which can help inhibit cmmunicable disease spread. Adverse events d ccur with vaccinatin just like they d ccur with the use f any medicatin. Sme f these adverse events may be cnsidered as side effects f medicatin administratin such as redness at the site f inculatin, lw- grade fever, r muscle sreness. All vaccines are tested in clinical trials. There is a natinal vaccine safety surveillance prgram that cllects and analyzes reprts f adverse events that happen after vaccinatin. This Vaccine Adverse Event Reprting System (VAERS) is managed by bth the CDC and the U.S. Fd and Drug Administratin.6 VAERS serves t alert scientists develping vaccines that a fcused study may be needed t determine if the adverse event has a medical link t that particular vaccine. Anyne can submit a reprt t VAERS by accessing the website at and fllwing the directins. Many myths exist abut the safety and effectiveness f vaccines. Nurses are frequently in an ptimal psitin t have a fact filled cnversatin with patients related t the rle f vaccinatin in preventing diseases, s they need t be knwledgeable abut the rle and need f vaccinatin. Accurate evidence based facts related t vaccine safety are available frm the CDC. The CDC als prvides research studies and fact sheets n vaccine- preventable diseases that address the cmmn myths that appear in ther surces. Emergency Nurses Assciatin 915 Lee Street Des Plaines, IL July 2013 Page 2 f 10

3 ENA Tpic Brief Tls The 2013 ACIP recmmendatins fr adult immunizatins as well as the clarifying ftntes are prvided. These recmmendatins must be read with the ftntes that fllw. Vaccine Age Grup years years years Influenza2,* Tetanus, diphtheria, pertussis (Td/Tdap)3,* Human papillmavirus (HPV) Male5,* years 65 years 1 dse annually Substitute 1-time dse f Tdap fr Td bster; then bst with Td every 10 yrs Varicella4,* Human papillmavirus (HPV) Female5,* years 2 dses 3 dses 3 dses Zster6 1 dse Measles, mumps, rubella (MMR)7,* 1 r 2 dses Pneumcccal plysaccharide (PPSV23)8,9 1 r 2 dses Pneumcccal 13-valent cnjugate (PCV13) 10,* 1 dse 1 dse Meningcccal11,* 1 r mre dses Hepatitis A12,* 2 dses Hepatitis B13,* 3 dses *Cvered by the Vaccine Injury Cmpensatin Prgram Fr all persns in this categry wh meet the age requirements and wh lack dcumentatin f vaccinatin r have n evidence f previus infectin; zster vaccine recmmended regardless f prir episde f zster Recmmended if sme ther risk factr is present (e.g., n the basis f medical, ccupatinal, lifestyle, r ther indicatin) Nt rutinely recmmended Ftntes: Additinal infrmatin Additinal guidance fr the use f the vaccines described in this supplement can be fund in the ACIP Recmmendatins. Emergency Nurses Assciatin 915 Lee Street Des Plaines, IL July 2013 Page 3 f 10

4 ENA Tpic Brief Infrmatin n vaccinatin recmmendatins when vaccinatin status is unknwn and ther general immunizatin infrmatin can be fund in the General Recmmendatins n Immunizatin. Infrmatin n travel vaccine requirements and recmmendatins (e.g., fr hepatitis A and B, meningcccal, and ther vaccines). Influenza vaccinatin Annual vaccinatin against influenza is recmmended fr all persns aged 6 mnths and lder. Persns aged 6 mnths and lder, including pregnant wmen, can receive the inactivated influenza vaccine (IIV). Healthy, nnpregnant persns aged 2 49 years withut high- risk medical cnditins can receive either intranasally administered live, attenuated influenza vaccine (LAIV) (FluMist), r IIV. Health- care persnnel wh care fr severely immuncmprmised persns (i.e., thse wh require care in a prtected envirnment) shuld receive IIV rather than LAIV. The intramuscularly r intradermally administered IIV are ptins fr adults aged years. Adults aged 65 years and lder can receive the standard dse IIV r the high- dse IIV (Fluzne High- Dse). Diphtheria and tetanus txids and acellular pertussis (Td/Tdap) vaccine. (Minimum age: 6 weeks) Administer ne dse f Tdap vaccine t pregnant wmen during each pregnancy (preferred during weeks' gestatin), regardless f number f years since prir Td r Tdap vaccinatin. Administer Tdap t all ther adults wh have nt previusly received Tdap r fr whm vaccine status is unknwn. Tdap can be administered regardless f interval since the mst recent tetanus r diphtheria- txid cntaining vaccine. Adults with an unknwn r incmplete histry f cmpleting a 3- dse primary vaccinatin series with Td- cntaining vaccines shuld begin r cmplete a primary vaccinatin series including a Tdap dse. Fr unvaccinated adults, administer the first 2 dses at least 4 weeks apart and the third dse 6 12 mnths after the secnd. Fr incmpletely vaccinated (i.e., less than 3 dses) adults, administer remaining dses. Refer t the Advisry Cmmittee n Immunizatin Practices (ACIP) statement fr recmmendatins fr administering Td/Tdap as prphylaxis in wund management (see ftnte #1). Varicella vaccinatin All adults withut evidence f immunity t varicella (as defined belw) shuld receive 2 dses f single- antigen varicella vaccine r a secnd dse if they have received nly 1 dse. Special cnsideratin fr vaccinatin shuld be given t thse wh have clse cntact with persns at high risk fr severe disease (e.g., health- care persnnel and family cntacts f persns with immuncmprmising cnditins) r are at high risk fr expsure r transmissin (e.g., teachers; child care emplyees; residents and staff members f institutinal settings, including crrectinal institutins; cllege students; military persnnel; adlescents and adults living in husehlds with children; nnpregnant wmen f childbearing age; and internatinal travelers). Pregnant wmen shuld be assessed fr evidence f varicella immunity. Wmen wh d nt have evidence f immunity shuld receive the first dse f varicella vaccine upn cmpletin r terminatin f pregnancy and befre discharge frm the health- care facility. The secnd dse shuld be administered 4 8 weeks after the first dse. Emergency Nurses Assciatin 915 Lee Street Des Plaines, IL July 2013 Page 4 f 10

5 ENA Tpic Brief Evidence f immunity t varicella in adults includes any f the fllwing: dcumentatin f 2 dses f varicella vaccine at least 4 weeks apart; U.S.- brn befre 1980 except health- care persnnel and pregnant wmen; histry f varicella based n diagnsis r verificatin f varicella disease by a health- care prvider; histry f herpes zster based n diagnsis r verificatin f herpes zster disease by a health- care prvider; r labratry evidence f immunity r labratry cnfirmatin f disease. Human papillmavirus (HPV) vaccinatin Tw vaccines are licensed fr use in females, bivalent HPV vaccine (HPV2) and quadrivalent HPV vaccine (HPV4), and ne HPV vaccine fr use in males (HPV4). Fr females, either HPV4 r HPV2 is recmmended in a 3- dse series fr rutine vaccinatin at age 11 r 12 years, and fr thse aged 13 thrugh 26 years, if nt previusly vaccinated. Fr males, HPV4 is recmmended in a 3- dse series fr rutine vaccinatin at age 11 r 12 years, and fr thse aged 13 thrugh 21 years, if nt previusly vaccinated. Males aged 22 thrugh 26 years may be vaccinated. HPV4 is recmmended fr men wh have sex with men (MSM) thrugh age 26 years fr thse wh did nt get any r all dses when they were yunger. Vaccinatin is recmmended fr immuncmprmised persns (including thse with HIV infectin) thrugh age 26 years fr thse wh did nt get any r all dses when they were yunger. A cmplete series fr either HPV4 r HPV2 cnsists f 3 dses. The secnd dse shuld be administered 1 2 mnths after the first dse; the third dse shuld be administered 6 mnths after the first dse (at least 24 weeks after the first dse). HPV vaccines are nt recmmended fr use in pregnant wmen. Hwever, pregnancy testing is nt needed befre vaccinatin. If a wman is fund t be pregnant after initiating the vaccinatin series, n interventin is needed; the remainder f the 3- dse series shuld be delayed until cmpletin f pregnancy. Althugh HPV vaccinatin is nt specifically recmmended fr health- care persnnel (HCP) based n their ccupatin, HCP shuld receive the HPV vaccine as recmmended (see abve). Zster vaccinatin A single dse f zster vaccine is recmmended fr adults aged 60 years and lder regardless f whether they reprt a prir episde f herpes zster. Althugh the vaccine is licensed by the Fd and Drug Administratin (FDA) fr use amng and can be administered t persns aged 50 years and lder, ACIP recmmends that vaccinatin begins at age 60 years. Persns aged 60 years and lder with chrnic medical cnditins may be vaccinated unless their cnditin cnstitutes a cntraindicatin, such as pregnancy r severe immundeficiency. Althugh zster vaccinatin is nt specifically recmmended fr HCP, they shuld receive the vaccine if they are in the recmmended age grup. 7. Measles, mumps, rubella (MMR) vaccinatin Adults brn befre 1957 generally are cnsidered immune t measles and mumps. All adults brn in 1957 r later shuld have dcumentatin f 1 r mre dses f MMR vaccine unless they have a medical cntraindicatin t the Emergency Nurses Assciatin 915 Lee Street Des Plaines, IL July 2013 Page 5 f 10

6 ENA Tpic Brief vaccine, r labratry evidence f immunity t each f the three diseases. Dcumentatin f prvider-diagnsed disease is nt cnsidered acceptable evidence f immunity fr measles, mumps, r rubella. Measles cmpnent: A rutine secnd dse f MMR vaccine, administered a minimum f 28 days after the first dse, is recmmended fr adults wh are students in pstsecndary educatinal institutins; wrk in a health-care facility; r plan t travel internatinally. Persns wh received inactivated (killed) measles vaccine r measles vaccine f unknwn type during shuld be revaccinated with 2 dses f MMR vaccine. Mumps cmpnent: A rutine secnd dse f MMR vaccine, administered a minimum f 28 days after the first dse, is recmmended fr adults wh are students in a pstsecndary educatinal institutin; wrk in a health-care facility; r plan t travel internatinally. Persns vaccinated befre 1979 with either killed mumps vaccine r mumps vaccine f unknwn type wh are at high risk fr mumps infectin (e.g., persns wh are wrking in a health-care facility) shuld be cnsidered fr revaccinatin with 2 dses f MMR vaccine. Rubella cmpnent: Fr wmen f childbearing age, regardless f birth year, rubella immunity shuld be determined. If there is n evidence f immunity, wmen wh are nt pregnant shuld be vaccinated. Pregnant wmen wh d nt have evidence f immunity shuld receive MMR vaccine upn cmpletin r terminatin f pregnancy and befre discharge frm the health-care facility. HCP brn befre 1957: 8. Fr unvaccinated health-care persnnel brn befre 1957 wh lack labratry evidence f measles, mumps, and/r rubella immunity r labratry cnfirmatin f disease, health-care facilities shuld cnsider vaccinating persnnel with 2 dses f MMR vaccine at the apprpriate interval fr measles and mumps r 1 dse f MMR vaccine fr rubella. Pneumcccal plysaccharide (PPSV23) vaccinatin Vaccinate all persns with the fllwing indicatins: all adults aged 65 years and lder; adults yunger than age 65 years with chrnic lung disease (including chrnic bstructive pulmnary disease, emphysema, and asthma); chrnic cardivascular diseases; diabetes mellitus; chrnic renal failure; nephrtic syndrme; chrnic liver disease (including cirrhsis); alchlism; cchlear implants; cerebrspinal fluid leaks; immuncmprmising cnditins; and functinal r anatmic asplenia (e.g., sickle cell disease and ther hemglbinpathies, cngenital r acquired asplenia, splenic dysfunctin, r splenectmy [if elective splenectmy is planned, vaccinate at least 2 weeks befre surgery]); Emergency Nurses Assciatin 915 Lee Street Des Plaines, IL July 2013 Page 6 f 10

7 ENA Tpic Brief 9. residents f nursing hmes r lng-term care facilities; and adults wh smke cigarettes. Persns with immuncmprmising cnditins and ther selected cnditins are recmmended t receive PCV13 and PPSV23 vaccines. See ftnte #10 fr infrmatin n timing f PCV13 and PPSV23 vaccinatins. Persns with asymptmatic r symptmatic HIV infectin shuld be vaccinated as sn as pssible after their diagnsis. When cancer chemtherapy r ther immunsuppressive therapy is being cnsidered, the interval between vaccinatin and initiatin f immunsuppressive therapy shuld be at least 2 weeks. Vaccinatin during chemtherapy r radiatin therapy shuld be avided. Rutine use f PPSV23 is nt recmmended fr American Indians/Alaska Natives r ther persns yunger than age 65 years unless they have underlying medical cnditins that are PPSV23 indicatins. Hwever, public health authrities may cnsider recmmending PPSV23 fr American Indians/Alaska Natives wh are living in areas where the risk fr invasive pneumcccal disease is increased. When indicated, PPSV23 shuld be administered t patients wh are uncertain f their vaccinatin status and there is n recrd f previus vaccinatin. When PCV13 is als indicated, a dse f PCV13 shuld be given first (see ftnte #10). Revaccinatin with PPSV23 One-time revaccinatin 5 years after the first dse is recmmended fr persns aged 19 thrugh 64 years with chrnic renal failure r nephrtic syndrme; functinal r anatmic asplenia (e.g., sickle cell disease r splenectmy); and fr persns with immuncmprmising cnditins. Persns wh received 1 r 2 dses f PPSV23 befre age 65 years fr any indicatin shuld receive anther dse f the vaccine at age 65 years r later if at least 5 years have passed since their previus dse. N further dses are needed fr persns vaccinated with PPSV23 at r after age 65 years. 10. Pneumcccal cnjugate 13-valent vaccinatin (PCV13) Adults aged 19 years r lder with immuncmprmising cnditins (including chrnic renal failure and nephrtic syndrme), functinal r anatmic asplenia, CSF leaks r cchlear implants, and wh have nt previusly received PCV13 r PPSV23 shuld receive a single dse f PCV13 fllwed by a dse f PPSV23 at least 8 weeks later. Adults aged 19 years r lder with the afrementined cnditins wh have previusly received ne r mre dses f PPSV23 shuld receive a dse f PCV13 ne r mre years after the last PPSV23 dse was received. Fr thse that require additinal dses f PPSV23, the first such dse shuld be given n sner than 8 weeks after PCV13 and at least 5 years since the mst recent dse f PPSV23. When indicated, PCV13 shuld be administered t patients wh are uncertain f their vaccinatin status histry and there is n recrd f previus vaccinatin. Althugh PCV13 is licensed by the Fd and Drug Administratin (FDA) fr use amng and can be administered t persns aged 50 years and lder, ACIP recmmends PCV13 fr adults aged 19 years and lder with the specific medical cnditins nted abve. 11. Meningcccal vaccinatin Administer 2 dses f meningcccal cnjugate vaccine quadrivalent (MCV4) at least 2 mnths apart t adults with functinal asplenia r persistent cmplement cmpnent deficiencies. HIV-infected persns wh are vaccinated als shuld receive 2 dses. Emergency Nurses Assciatin 915 Lee Street Des Plaines, IL July 2013 Page 7 f 10

8 ENA Tpic Brief Administer a single dse f meningcccal vaccine t micrbilgists rutinely expsed t islates f Neisseria meningitidis, military recruits, and persns wh travel t r live in cuntries in which meningcccal disease is hyperendemic r epidemic. First-year cllege students up thrugh age 21 years wh are living in residence halls shuld be vaccinated if they have nt received a dse n r after their 16th birthday. MCV4 is preferred fr adults with any f the preceding indicatins wh are aged 55 years and yunger; meningcccal plysaccharide vaccine (MPSV4) is preferred fr adults aged 56 years and lder. Revaccinatin with MCV4 every 5 years is recmmended fr adults previusly vaccinated with MCV4 r MPSV4 wh remain at increased risk fr infectin (e.g., adults with anatmic r functinal asplenia r persistent cmplement cmpnent deficiencies). 12. Hepatitis A vaccinatin a. b. Vaccinate any persn seeking prtectin frm hepatitis A virus (HAV) infectin and persns with any f the fllwing indicatins: i. men wh have sex with men and persns wh use injectin r nninjectin illicit drugs; ii. persns wrking with HAV-infected primates r with HAV in a research labratry setting; iii. persns with chrnic liver disease and persns wh receive cltting factr cncentrates; iv. persns traveling t r wrking in cuntries that have high r intermediate endemicity f hepatitis A; and v. unvaccinated persns wh anticipate clse persnal cntact (e.g., husehld r regular babysitting) with an internatinal adptee during the first 60 days after arrival in the United States frm a cuntry with high r intermediate endemicity. (See ftnte #1 fr mre infrmatin n travel recmmendatins). The first dse f the 2-dse hepatitis A vaccine series shuld be administered as sn as adptin is planned, ideally 2 r mre weeks befre the arrival f the adptee. Single-antigen vaccine frmulatins shuld be administered in a 2-dse schedule at either 0 and 6 12 mnths (Havrix), r 0 and 6 18 mnths (Vaqta). If the cmbined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 dses at 0, 1, and 6 mnths; alternatively, a 4-dse schedule may be used, administered n days 0, 7, and 21 30, fllwed by a bster dse at mnth Hepatitis B vaccinatin a. Vaccinate persns with any f the fllwing indicatins and any persn seeking prtectin frm hepatitis B virus (HBV) infectin: i. sexually active persns wh are nt in a lng-term, mutually mngamus relatinship (e.g., persns with mre than ne sex partner during the previus 6 mnths); persns seeking evaluatin r treatment fr a sexually transmitted disease (STD); current r recent injectin-drug users; and men wh have sex with men; ii. health-care persnnel and public-safety wrkers wh are ptentially expsed t bld r ther infectius bdy fluids; iii. persns with diabetes yunger than age 60 years as sn as feasible after diagnsis; persns with diabetes wh are age 60 years r lder at the discretin f the treating clinician based n increased need fr assisted bld glucse mnitring in lng-term care facilities, likelihd f acquiring hepatitis B infectin, its cmplicatins r chrnic sequelae, and likelihd f immune respnse t vaccinatin; iv. persns with end-stage renal disease, including patients receiving hemdialysis; persns with HIV infectin; and persns with chrnic liver disease; Emergency Nurses Assciatin 915 Lee Street Des Plaines, IL July 2013 Page 8 f 10

9 ENA Tpic Brief v. husehld cntacts and sex partners f hepatitis B surface antigenpsitive persns; clients and staff members f institutins fr persns with develpmental disabilities; and internatinal travelers t cuntries with high r intermediate prevalence f chrnic HBV infectin; and vi. all adults in the fllwing settings: STD treatment facilities; HIV testing and treatment facilities; facilities prviding drug-abuse treatment and preventin services; health-care settings targeting services t injectin-drug users r men wh have sex with men; crrectinal facilities; end-stage renal disease prgrams and facilities fr chrnic hemdialysis patients; and institutins and nnresidential daycare facilities fr persns with develpmental disabilities. b. Administer missing dses t cmplete a 3-dse series f hepatitis B vaccine t thse persns nt vaccinated r nt cmpletely vaccinated. The secnd dse shuld be administered 1 mnth after the first dse; the third dse shuld be given at least 2 mnths after the secnd dse (and at least 4 mnths after the first dse). If the cmbined hepatitis A and hepatitis B vaccine (Twinrix) is used, give 3 dses at 0, 1, and 6 mnths; alternatively, a 4-dse Twinrix schedule, administered n days 0, 7, and fllwed by a bster dse at mnth 12 may be used. c. Adult patients receiving hemdialysis r with ther immuncmprmising cnditins shuld receive 1 dse f 40 µg/ml (Recmbivax HB) administered n a 3-dse schedule at 0, 1, and 6 mnths r 2 dses f 20 µ/ml (Engerix-B) administered simultaneusly n a 4-dse schedule at 0, 1, 2, and 6 mnths. Cnclusin Immunizatin rates fr adults are less than adequate and lack f knwledge abut the safety and efficacy f current vaccines may cntribute t the failure f adults t seek apprpriate level f prtectin against vaccine- preventable diseases. The 2013 recmmendatins fr adult immunizatins with the explanatry ftntes shuld be reviewed by all individuals wh need t make an infrmed chice abut immunizatins fr themselves and thse recmmended fr their patients. Definitins f Terms Adult: 19 years f age and lder per CDC immunizatin guidelines. Immunizatin: The prcess by which a persn becmes prtected against a disease. Vaccine: A prduct that prduces immunity therefre prtecting the bdy frm a disease. Authrs ENA IQSIP Staff Kathy Szumanski, MSN, RN, NE- BC, Directr f the Institute fr Quality, Safety and Injury Preventin (IQSIP) Catherine Olsn, MSN, RN, Senir Assciate, IQSIP Briana Quinn, MPH, BSN, RN, Senir Assciate, IQSIP Dale Wallerich, MBA, BSN, RN, CEN, Senir Assciate, IQSIP ENA 2012 Bard f Directrs Liaisn Matthew F. Pwers, MS, BSN, RN, MICP, CEN Emergency Nurses Assciatin 915 Lee Street Des Plaines, IL July 2013 Page 9 f 10

10 ENA Tpic Brief ENA 2013 IQSIP Advisry Cuncil Jesse A. DeWaard, MSN, RN B. Teresa Gmez, MSN, RN, CPEN Kenneth H. Grubbs, MBA, RN Cynthia Wright- Jhnsn, MSN, RN Kendra M. Lehman, MS, RN, FNP, FNP- BC References 1. Stephens, D. S. (2008). Vaccine fr the unvaccinated: Prtecting the herd. Jurnal f Infectius Disease, 16, Pickering, L., Baker, C., Freed, G., Gall, S., Grss, S., Pland, G., Grenstein, W. (2009). Immunizatins prgrams fr infants, children, adlescents, and adults: clinical practice guidelines by the Infectius Diseases Sciety f America. Clinical Infectius Diseases, 49, Centers fr Disease Cntrl and Preventin. (2013, June 14). Vaccines & immunizatins: ACIP recmmendatins. Retrieved frm list.htm. 4. U.S. Department f Health and Human Services, Healthy Peple 2020, (2013). Immunizatins and Infectius Diseases. Retrieved frm 5. Grm, H. C., Zhang, F., Fisher, A. K., & Wrtley, P. M. (2013). Differences in adult influenza vaccine- seeking behavir: the rles f race and attitudes. Jurnal f Public Health Management Practices. [Epub ahead f print]. 6. Centers fr Disease Cntrl and Preventin. (2013, June 19). Vaccines and immunizatins. Retrieved frm Disclaimer This tpic brief, including the infrmatin and recmmendatins set frth herein (i) reflects ENA s current psitin with respect t the subject matter discussed herein based n current knwledge at the time f publicatin; (ii) is nly current as f the publicatin date; (iii) is subject t change withut ntice as new infrmatin and advances emerge; and (iv) des nt necessarily represent each individual member s persnal pinin. The psitins, infrmatin and recmmendatins discussed herein are nt cdified int law r regulatins. Variatins in practice and a practitiner s best nursing judgment may warrant an apprach that differs frm the recmmendatins herein. ENA des nt apprve r endrse any specific surces f infrmatin referenced. ENA assumes n liability fr any injury and/r damage t persns r prperty arising frm the use f the infrmatin in this tpic brief. Develped: Apprved by the ENA Bard f Directrs: July, Emergency Nurses Assciatin, Emergency Nurses Assciatin 915 Lee Street Des Plaines, IL July 2013 Page 10 f 10