What if Sherlock Holmes had to prepare your facility for Influenza?

Transcription

1 What if Sherlock Holmes had to prepare your facility for Influenza? Gregory Gahm, MD, MS, FACP Elizabeth Schulte Mullins, MSW, NHA - Program Specialist November 2, 2017 Employee-Owned Employee-Owned

2 What if Sherlock Holmes had to prepare your facility for Influenza? Telligen webinar November 2017 Gregory Gahm, MD

3 5 Ws H Who? What? Where? When? Why? How?

4 Holmes, why should the yanks care so much about this influenza thing? It seems such a small and impertinent little bugger, this flu virus?

5 Who gets influenza?

6 Why care about Influenza?

7 What does the virus look like?

8 The Influenza A Virus

9 How does flu spread?

10 How can you tell clinically if someone has Flu? Sudden HIGH Fever Nonproductive Cough

11 How can you tell clinically if someone has Flu?

12 How does Flu get into the lungs?

13 Viral Replication

14 Viral Replication

15 Viral Replication

16 Does this explain how Neuraminidase Inhibitors work?

17 What Neuraminidase inhibitors are available? Oseltamivir (Tamiflu) what Zanamivir (Relenza)

18 Multiplication & Migration of the Virus

19 When are people contagious? From about 24 hours before symptoms start until their fever has subsided and the influenza cough has stopped.

20 How do Flu vaccines work?

21 Can you get the Flu from the vaccine?

22 Making a Vaccine Step 1

23 Making a Vaccine Step 2

24 Making a Vaccine Step 3

25 Making a Vaccine Step 4

26 Making a Vaccine Step 5

27 Making a Vaccine Step 6

28 Making a Vaccine Step 7

29 Who should not be vaccinated? Those who have had: Documented serious reaction to a previous vaccine Guillain-Barre associated with the vaccine

30 What are the common vaccine side effects? Redness Soreness swelling Less common: fever / body aches Egg allergy is NOT a contraindication and there is a recombinant vaccine made without eggs My comment to every patient I vaccinate: It is good to have redness, Soreness, and or swelling at the injection site! (Signs of a healthy immune system that recognizes the antigen)

31 How effective is the vaccine? References: 1. Monto AS, et al. Vaccine. 2009;27(37): Legrand J, et al. Vaccine. 2006;24(44-46):

32 What vaccines are available? and How do we choose which to use? Standard Trivalent [H 3 N 2 ; H 1 N 1 ; B 1 ] Quadrivalent [H 3 N 2 ; H 1 N 1 ; B 1; B 2 ] High Dose Fluzone (>65) 4 X [H 3 N 2 ; H 1 N 1 ; B 1 ] Adjuvant Vaccine (>65) [H 3 N 2 ; H 1 N 1 ; B 1 ] + MF59 RIV3 = Recombinant, egg-free vaccine (18 49) [H 3 N 2 ; H 1 N 1 ; B 1 ]

33 Reduction in mortality risk (%) What benefit(s) are vaccines to seniors? Stroke 65% Renal disease 60% Diabetes 55% Total study population: 102,698 elderly Pneumonia 53% COPD All causes 40 45% 44% Malignancy 26% Heart disease 22% 0 Cause of mortality Influenza vaccine is strongly associated with a lower mortality risk, not only for pneumonia and COPD, but also for other major cause-specific mortalities, which indicates that influenza vaccination might reduce the domino effects of complications from influenza in the elderly. Reference: 1. Wang CS, et al. Vaccine. 2007;25(7):

34 Why don t vaccines work as well in seniors?

35 Do High Dose / Adjuvant vaccine work better?

36 GMT GMT In the lab Antibody Response: Fluzone HD vs Trivalent Vaccine (Phase III Trial) 1,2 Fluzone High-Dose Vaccine a Superiority of immune responses achieved for A (H1N1) and A (H3N2); non-inferiority for B. All comparisons, P < Fluzone Trivalent Vaccine b A (H1N1) B 0 A (H3N2) a N = 2576 Fluzone High-Dose vaccine. b N = 1275 Fluzone vaccine. 1. Falsey AR, et al. J Infect Dis. 2009;200(2): Fluzone High-Dose vaccine. Swiftwater, PA: Sanofi Pasteur Inc.; 2016.

37 Clinical efficacy 1,2 Randomized and blinded trial 32,000 participants 65 in 126 study sites in US / Canada over 2 (mild) influenza seasons ( and ) Participants randomized to High or Standard Dose vaccine

38 Hospitalizations lower in the facilities (409) that received the High Dose Vaccine (12% RR Reduction) 7/20/17;

39 Adjuvant Vaccine Despite having the higher risk group, hospitalization or pneumonia was 25% lower in Adjuvant Vaccine group Mannino, S, et al. Effectiveness of Adjuvanted Influenza Vaccination in Elderly Subjects in Northern Italy; American Journal of Epidemiology, Vol 176, No 6; 8/31/12

40 How much does Medicare pay for vaccinating? Vaccine Appx Cost Charge Code Revenue Code Reimbursement (per dose) Trivalent $ or $16 - $19 High Dose $ $42.72 Bonus: What is Medicare Part C? Administration Fee $25.15 $25.15

41 When should we collect vaccination consents? F883 Influenza and Pneumococcal Immunizations Influenza each resident or the resident s representative receives education regarding the benefits and potential side effects of the immunization The resident s medical record includes documentation that indicates, at a minimum, the following

42 When should we vaccinate?

43 What about Rapid Testing?

44 Where can we get more information

45 Holmes, I m exhausted. Is there anything else we really need to know?

46 A few last thoughts & reminders 1) Antivirals only work if started <2 days from symptoms start When in doubt, start treatment using only clinical clues the virus has left behind 4) Don t use antibiotics unless a real secondary pneumonia is documented! 6) Prolonged cough often due to secondary Asthma triggered by flu

47 What questions are still unanswered?

48 What are your unanswered questions?

49 Please Contact any of our Quality Innovation Network Representatives to Learn More Lisa Bridwell Stacy Gordon Nell Griffin Deanna Curry Elizabeth Schulte Mullins Gina Anderson Kristen Ives NHSN Support Sarah Wendelboe NHSN Support This material was prepared by Telligen, the Medicare Quality Improvement Organization for Colorado, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy 11SOW-QIN-C2-10/13/