2017 Immunization Update for Pharmacy Professionals

Transcription

1 2017 Immunization Update for Pharmacy Professionals North Suburban Pharmacists of Chicagoland CPE Program May 3, 2017 Lauren B. Angelo, PharmD, MBA Associate Professor Rosalind Franklin University of Medicine & Science College of Pharmacy

2 Disclosure Lauren B. Angelo declares no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. 2

3 Learning Objectives (Pharmacists and Student Pharmacists) At the end of this CPE activity, pharmacists (and student pharmacists) will be able to: 1. Summarize key changes made to the 2017 immunization schedules 2. Discuss influenza season activity and influenza vaccine recommendations 3. Explain the current recommendations for the newly approved two-dose series for the HPV and meningococcal B vaccines 4. Describe travel health updates with regard to cholera and yellow fever prevention 5. Employ methods to reduce common vaccine administration errors 3

4 Learning Objectives (Pharmacy Technicians) At the end of this CPE activity, pharmacy technicians will be able to: 1. Summarize key changes made to the 2017 immunization schedules 2. Discuss influenza season activity and influenza vaccine recommendations 3. Explain the current recommendations for the newly approved two-dose series for the HPV and meningococcal B vaccines 4. Describe travel health updates with regard to cholera and yellow fever prevention 5. Employ methods to reduce common vaccine administration errors 4

5 Self-Assessment Question 1 Why was a column for a 16 year age group added to the childhood immunization schedule? a. This age group was accidentally left off the previous schedule b. To remind providers to give the meningococcal conjugate vaccine booster dose at age 16 c. To better identify when the HPV vaccine should be given d. This age group needs more vaccines than other adolescent age groups 5

6 Self-Assessment Question 2 According to a systematic review assessing the efficacy of the adjuvanted inactivated influenza vaccine in older persons, aiiv3 was more effective than which vaccine? a. Non-adjuvanted influenza vaccine given intramuscularly b. Non-adjuvanted influenza vaccine given intradermally c. Live attenuated influenza vaccine d. Another adjuvanted inactivated influenza vaccine licensed for use in Europe 6

7 Self-Assessment Question 3 For which age group is the two-dose series of 9vHPV vaccine recommended? a. 9 through 11 years b. 9 through 14 years c. 15 through 26 years d. 9 through 26 years 7

8 Self-Assessment Question 4 How is the live attenuated cholera vaccine administered? a. Intramuscularly b. Subcutaneously c. Orally d. Intranasally 8

9 Self-Assessment Question 5 According to a report by the CDC regarding vaccine administration errors, which two vaccines were given using inappropriate schedules? a. Pneumococcal polysaccharide and pneumococcal conjugate b. Meningococcal conjugate and hepatitis B c. DTaP and Hib d. HPV and rotavirus 9

10 2017 Immunization Schedules Available at: 10

11 Before We Begin... Note: If you previously downloaded the tool, check that you have version with 2017 schedules and footnotes 11

12 Children and Adolescents 12

13 Children and Adolescents by Medical and Other Indications 13

14 Adults, By Age Group 14

15 Adults, By Condition/Indication 15

16 Influenza Activity 16

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21 Influenza Virus Vaccine Composition A/California/7/2009 (H1N1)pdm09-like virus A/Hong Kong/4801/2014 (H3N2)-like virus B/Brisbane/60/2008-like virus (a B/Victoria lineage virus) Quadrivalent influenza also included: B/Phuket/3073/2013-like virus (a B/Yamagata lineage virus) World Health Organization. Weekly epidemiological record. Mach 11,

22 Circulating Strains (October 1 March 12) Type and subtype of positive specimens (n=37,992) Influenza A (H1N1) 3% 81% Influenza A (H3) 96% Influenza B Yamagata 53% 19% Influenza B Victoria 23% Viruses antigenically characterized by the CDC (n=1,444) A/California/7/2009 (H1N1)pdm09-like virus 251 (99%) A/Hong Kong/4801/2014 (H3N2)-like virus 609 (97%) B/Brisbane/60/2008-like virus 228 (92%) B/Phuket/3073/2013-like virus 312 (100%) 22

23 Influenza Virus Vaccine Composition Trivalent influenza vaccine A/Michigan/45/2015 (H1N1)pdm09-like virus A/Hong Kong/4801/2014 (H3N2)-like virus B/Brisbane/60/2008-like virus Quadrivalent influenza vaccine also includes B/Phuket/3073/2013-like virus World Health Organization. Recommended composition of influenza virus vaccines for use in the northern hemisphere influenza season. dation.pdf?ua=1 23

24 Influenza Vaccines Vaccine (manufacturer) IIV3 IIV4 Approved age indications Afluria (CSL) IIV3: 9 y IIV4: 18 y Fluad (Seqirus) adjuvanted 65 y Fluarix (GSK) 3 y Flublok (Protein Sciences) recombinant 18 y Flucelvax (Novartis) cell cultured 4 y FluLaval (GSK) 6 mo Fluvirin (Novartis) 4 y Fluzone (Sanofi Pasteur) 6 mo Fluzone High-Dose (Sanofi Pasteur) 65 y Fluzone Intradermal (Sanofi Pasteur) y 24

25 Influenza Vaccination for Children 2 8 Years If a child between 2 and 8 years presents to your pharmacy for a flu shot, which vaccine would you use? a. Inactivated influenza vaccine (IIV) b. Live attenuated influenza vaccine (LAIV) c. Either one is fine Grohskopf LA, et al. MMWR Recomm Rep. 2016;65(RR-5):

26 Dosing Algorithm for Children 6 Months 8 years ( Season) Grohskopf LA, et al. MMWR Recomm Rep. 2016;65(RR-5):

27 Guidance for Egg Allergy Egg allergy with only hives Severe egg allergy (other than hives) Any age-appropriate IIV or RIV may be given May receive IIV or RIV; administer the vaccine in an inpatient or outpatient medical setting and under the supervision of a healthcare provider who is able to recognize and manage severe allergic conditions 27

28 Information Recall: Influenza Vaccine Administration What influenza vaccine administration delivery methods are available and recommended for use in ? 28

29 Influenza Vaccination and Health Care Personnel CDC. Health Care Personnel and Flu Vaccination, Internet Panel Survey, United States, November

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34 Which two influenza vaccines are specifically approved for adults aged 65 and older? 34

35 Adjuvanted Inactivated Influenza Vaccine (aiiv3) 35

36 Fluad (Sequris) Approved November 24, 2015 Trivalent vaccine Prevention of seasonal influenza in people 65 years and older Adjuvanted with MF59, a squalene-based oilin-water emulsion /UCM pdf 36

37 Adverse Reactions (reported by 10% of participants) Fluad Agriflu Injection site pain 25% 12% Tenderness at injection site 21 % 11% Myalgia 15% 9% Fatigue 13% 10% Headache 13% 11% Frey SE, et al. Vaccine. 2014;32(39):

38 aiiv3 Efficacy in Older Patients (Meta-Analysis) Systematic review based on 11 studies Outcomes evaluated included: Hospitalization due to pneumonia and influenza Laboratory-confirmed influenza 5 studies compared aiiv3 to other nonadjuvanted influenza vaccines aiiv3 was effective against influenza-related outcomes in older patients aiiv3 was more efficacious than non-adjuvanted intramuscular influenza vaccines Dominch A, et al. Vaccine. 2017;35(4):

39 With influenza season approaching soon, what resource will you use to get the latest recommendations? 39

40 HPV Vaccine Recommendations 40

41 Which HPV vaccines are available? SELECT ALL THAT APPLY a. Bivalent (2vHPV) Cervarix b. Quadrivalent (4vHPV) Gardasil c. 9-valent (9vHPV) Gardasil 9 41

42 2-Dose Series for 9vHPV Approved October 2016 Population Immunocompetent persons aged 9 14 years Persons aged years or 9 26 years with immunocompromising conditions Doses Intervals 2 0, 6 12 mo 3 0, 1 2, 6 mo Meites E, et al. MMWR Morb Mortal Wkly Rep. 2016;65(49):

43 Meningococcal Vaccines 43

44 2-Dose Series for MenB-FHbp (Trumenba) Approved for healthy persons aged 16 through 23 years Two doses given at 0 and 6 months If 2 nd dose is given sooner than 6 months, then a third dose is needed at least 4 months after then 2 nd dose Three doses still needed if: Not healthy Increased risk for meningococcal disease During outbreaks 44

45 Meningococcal Conjugate Vaccine for Persons with HIV Those with HIV have a higher risk for meningococcal disease Majority of infections caused by A, C, W, and Y serogroups Give MenACWY-D (Menactra) or MenACWY-CRM (Menveo) to persons aged 2 months and older with HIV Doses depends on age and product used for persons less than 2 years Follow dosing schedule for primary series and booster doses recommended by the CDC 45

46 Tdap for Pregnant Patients

47 When should Tdap be given to a pregnant patient? a. First trimester b. Second trimester c. Third trimester d. Any time during pregnancy 47

48 Updated Tdap Recommendations Administer the vaccine during the early part of the gestational weeks 48

49 Travel Vaccines 49

50 Yellow Fever: Goodbye Booster Dose April 2013: The World Health Organization determined that a booster dose of yellow fever vaccine is not needed May 2014: The World Health Assembly decided to remove the 10-year dose requirement from the International Health Regulations by June 2016 February 2015: ACIP voted that a single primary dose of yellow fever vaccine provides long-lasting protection and is adequate for most travelers July 11, 2016: World Health Assembly amendment became legally binding Staples JE, et al. MMWR Morb Mort Wkly Rep 2015;64(23). 50

51 Cholera Vaccine (Vaxchora) Approved June 2016 or ages 18 through 64 Live attenuated oral vaccine Suspension must be reconstituted with 100 ml of purified bottled water Powder packets stored frozen and must be reconstituted within 15 minutes Suspension must be consumed within 15 minutes No food or drink 60 minutes before or after administration Do not give to patients who have received antibiotics in the previous 14 days Shed in stool for 7 days Mild adverse reactions (GI upset, fatigue, headache) Vaxchora [package insert]. Redwood City, CA: PaxVax, Inc.; June

52 Vaccine Errors

53 Mistakes Happen CDC Report 20,585 errors reported from 2000 to 2013 Inappropriate schedule (27%) HPV and rotavirus given at wrong time Storage errors (23%) Expired vaccine administered Incorrect storage and administered to patient Wrong vaccine administered (15%) Varicella Herpes Zoster DTaP Tdap PCV13 PPSV23 Hepatitis A Hepatitis B IIV and wrong age 53

54 Mistakes Happen ISMP Report Errors due to vaccine acronyms and abbreviations include: Tetanus, diphtheria, and pertussis (DT, DTaP, Td, Tdap) vaccines Measles, mumps, and rubella with and without varicella (MMR, MMRV) vaccines Pneumococcal vaccines 54

55 Errors with Rotavirus 66 reports between 2006 and (59%) due to vaccine being injected Note: Rotavirus is administered orally! 55

56 Institute for Safe Medication Practices (ISMP). 56

57 How can vaccine errors be prevented? Standardized Vaccine Acronyms dance/vac-abbrev.html 57

58 Documenting Vaccines Administered in Illinois

59 As Required by Law Section Vaccinations/Immunizations c) Recordkeeping and Reporting 1) All records regarding each administration of a vaccine must be kept for 5 years. These records shall include: A) The name, address and date of birth of the patient. B) Date of administration and site of injection of the vaccine. C) Name, dose, manufacturer, lot number and beyond use date of the vaccine. D) Name and address of the patient's primary health care provider named by the patient. E) The name or unique identifier of the administering pharmacist. F) Which vaccine information statement (VIS) was provided. 2) A pharmacist who administers any vaccine must report that administration, within 30 days after the date of administration, to the patient's primary healthcare provider named by the patient. Illinois Administrative Code. Part 1330 Pharmacy Practice Act 59

60 Illinois Comprehensive Automated Immunization Registry Exchange (I-CARE) Serves as Illinois immunization information system (registry) Allows for sharing and reporting of immunization records in Illinois To participate, fill out provider agreement form 60

61 Quiz: Keeping Current The CDC recently released a 2017 supplement to provide updated information on human papillomavirus, meningococcal disease, and pneumococcal disease. What resource is this updating? 61

62 Self-Assessment Question 1 Why was a column for a 16 year age group added to the childhood immunization schedule? a. This age group was accidentally left off the previous schedule b. To remind providers to give the meningococcal conjugate vaccine booster dose at age 16 c. To better identify when the HPV vaccine should be given d. This age group needs more vaccines than other adolescent age groups 62

63 Self-Assessment Question 2 According to a systematic review assesssing the efficacy of the adjuvanted inactivated influenza vaccine in older persons, aiiv3 was more effective than which vaccine? a. Non-adjuvanted influenza vaccine given intramuscularly b. Non-adjuvanted influenza vaccine given intradermally c. Live attenuated influenza vaccine d. Another adjuvanted inactivated influenza vaccine licensed for use in Europe 63

64 Self-Assessment Question 3 For which age group is the two-dose series of 9vHPV vaccine recommended? a. 9 through 11 years b. 9 through 14 years c. 15 through 26 years d. 9 through 26 years 64

65 Self-Assessment Question 4 How is the live attenuated cholera vaccine administered? a. Intramuscularly b. Subcutaneously c. Orally d. Intranasally 65

66 Self-Assessment Question 5 According to a report by the CDC regarding vaccine administration errors, which two vaccines were given using inappropriate schedules? a. Pneumococcal polysaccharide and pneumococcal conjugate b. Meningococcal conjugate and hepatitis B c. DTaP and Hib d. HPV and rotavirus 66

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