Lana Hudanick RN, BSN Public Health Consultant Nurse Bureau of Immunization Assessment and Assurance Missouri Department of Health and Senior

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1 Lana Hudanick RN, BSN Public Health Consultant Nurse Bureau of Immunization Assessment and Assurance Missouri Department of Health and Senior Services

2 Identify the appropriate vaccines and the Advisory Committee for Immunization Practices recommendations for adults Explain the difference in various preparations for similar vaccines and any special indications for their use Demonstrate knowledge of special indications for vaccines through ShowMeVax

3 Tdap Td Influenza HPV4 MMR Varicella MPSV4 MCV4 Hepatitis A Hepatitis B PPSV23 PCV13 Shingles

4 Advisory Committee on Immunization Practices (ACIP) Recommends One dose of Tdap All pregnant women should receive a dose between 27 th and 36 th week of each pregnancy Administer Tdap vaccine regardless of last Tetanus containing vaccine Presentations Boostrix and Adacel Storage and Handling Keep vaccine refrigerated Do not freeze vaccine

5 ACIP Recommends Td booster every 10 years If injury occurs greater than 5 years after vaccination booster dose of Td is recommended Presentations Decavac, Tenivac and generic Td Storage and Handling Keep refrigerated Administer intramuscularly Tetanus Toxoid no longer available

6 ACIP Recommends Yearly vaccination for everyone 6 months of age and older Pregnant women should receive a preservative free vaccine Types IIV3 Inactivated Influenza Vaccine 3 component IIV4 Inactivated Influenza Vaccine 4 component RIV Recombiant Influenza Vaccine 3 component cciv Cell Cultured Influenza Vaccine 3 component LAIV Live Attenuated Influenza Vaccine 4 component

7 Presentations Intra-muscular (6 months and older) Intra-dermal (18 through 64 years of age) Intra-nasal (2 through 49 years of age) High-dose (65 years of age and older) Egg free (18 through 49 years of age)

8 Storage and Handling Store in refrigerator Pre-filling syringes is not recommended Administer per package insert guidelines ACIP has not made a specific recommendation for trivalent or quadravalent PPD (tuberculin skin testing) should be done at same time/ day or wait 28 days after vaccination when administering the LAIV (Flu Mist) vaccine

9 ACIP Recommends Adults 19 through 26 years of age Immune-compromised individuals HIV infections Men who have sex with men Persons with chronic health problems Presentations Guardasil HPV4 males & females Protects against types 6, 11, 16 and 18 Cervarix HPV2 females only Protects against 16 and 18

10 Storage and Handling Keep refrigerated Administer intramuscularly Schedule is 3 doses over a six month period 4 weeks between dose 1 and 2 16 weeks between dose 2 and 3 24 weeks between dose 1 and 3

11 ACIP recommends most adults will need only 1 dose of MMRII Adults born during 1957 or later and do not have two documented doses of measles vaccine or MMR vaccine need at least one dose Persons who were vaccinated in with killed or unknown measles vaccine should be revaccinated ACIP recommends two doses of MMRII if not previously vaccinated Travelers Healthcare workers College students The two doses should be separated by at least 28 days

12 Presentations MMRII Single dose vials of lyophilized vaccine Reconstitute with the sterile water Storage and Handling Keep refrigerated or frozen Very light sensitive Once reconstituted use within 8 hours PPD (tuberculin skin testing) should be done at same day or wait 28 days after vaccination

13 ACIP Recommendations Adults who have not had a documented case of chickenpox or laboratory proof of immunity should receive the vaccination Teachers, child care employees, residents and staff members of institutional settings, college students, military recruits, adults living with children, nonpregnant females and international travelers Adults need two doses spaced 28 days apart Presentations Varivax Single dose lyophilized vaccine vials Must be reconstituted with sterile water

14 Storage and Handling Must be kept frozen Once reconstituted use within 30 minutes Do not freeze reconstituted vaccine PPD (tuberculin skin testing) should be done at same day or wait 28 days after vaccination

15 ACIP Recommends First year college student living in a residence hall Military recruits Persons with functional or anatomical asplenia Persons with terminal compliment deficiency Persons traveling to or living in countries in which the disease is common Microbiologists who are routinely exposed to isolates Both vaccines contain strains A, C, Y and W-135

16 Presentation Menomune Polysaccharide Storage and Handling Must reconstitute both single vial and multi-dose vial Licensed for persons over 55 years of age Administered subcutaneously Use multi-dose vial within 35 days of reconstituting

17 Presentations Menactra and Menveo Conjugate vaccines Storage and Handling Licensed for persons up to 55 years of age Administered intramuscularly Protect from light Menveo must be reconstituted with accompanied diluient Do not freeze either vaccine

18 ACIP Recommends Adults who live in a community with a high rate of hepatitis A Travelers to countries who have high rates of hepatitis A Adults with long-term liver disease Adults with blood clotting disorders Men who have sex with men Adults who work with hepatitis A infected animals or in a lab with hepatitis A

19 Presentations Havrix and Vaqta are single antigen hepatitis A vaccines Twinrix is a combination vaccine of pediatric hepatitis A antigen and adult hepatitis B antigen Prefilled syringes and single dose vials Storage and Handling Keep refrigerated Twinrix is not to be given in response to hepatitis A disease exposure Twinrix and single antigen hepatitis A vaccine are not interchangeable

20 ACIP Recommends Persons with chronic liver disease Diabetics under 60 years of age Persons with end-stage renal disease or on dialysis Persons who are HIV positive Persons who seek treatment for sexually transmitted diseases, HIV testing and treatment for drug treatment Men who have sex with men Residents and staff of institutions for the developmentally disabled Occupations that have contact with blood and body fluids

21 Presentations Recombivax and Energix are single antigen hepatitis B vaccine Twinrix is a combination vaccine includes a pediatric hepatitis A vaccine and an adult hepatitis B vaccine Prefilled syringes and single dose vials Storage and Handling Vaccine should be refrigerated Administer vaccine intramuscularly

22 ACIP Recommends Adults 65 years of age or older Residents of long-term care and nursing homes Smokers A booster dose five years after the first dose of PPSV23 if younger than 65 years of age and if they have certain medical conditions Presentations Pneumovax 23 Storage and Handling Do not freeze Can be administered Intramuscularly or Subcutaneously

23 ACIP Recommends Adults 65 years of age and older are recommended to receive a one-time dose Adults 19 through 64 years of age with certain medical conditions are recommended to receive a one-time dose Presentations Prevnar13 Storage and Handling Do not freeze vaccine Administer intramuscularly

24 ACIP Recommends Adults 60 years and older should receive the vaccine Regardless of past history of varicella Even if person has had a course of shingles Presentations Zostavax Storage and Handling Must be kept frozen Administer subcutaneously Contains more antigen than varicella PPD (tuberculin skin testing) should be done at same day or wait 28 days after vaccination

25 Adult immunization standards of practice Assess Recommend Administer Document

26 Assess your patient s immunization record at all visits Well visits Sick visits Adult vaccinations are be based on Age Lifestyle Medical condition

27 Share the reason why vaccination is a benefit for the patient Highlight positive experiences regarding vaccination Address patient concerns regarding safety of vaccination Vaccines protect not only the patient but also their loved ones Vaccination saves money

28 Administer the vaccine in the office during the visits Studies show that patients who receive a recommendation and are offered the vaccine during the visit are more likely to get vaccinated Educate office staff on vaccination practices Properly store and handle vaccine Have the correct Vaccine Information Statements available Refer for vaccination if vaccines are not available in the office Pharmacy Urgent care Local public health agency

29 Document that vaccine has been given Why document Prevents unnecessary vaccinations Provides a record as to what diseases patient is protected against Where to document Patient s health or medical record State immunization registry (ShowMeVax) Give patient a copy of record

30 Missouri Immunization Registry health.mo.gov/immunizations

31 Missouri s Immunization Registry Free Connect through your existing electronic medical system or Web-based requiring only a computer with high speed internet access Over 36 million doses Over 4 million clients 720 providers

32 Benefits Makes immunization records easily attainable Assists providers in complying with ACIP guidelines Ensures that patients are properly and fully immunized Reduces duplication and over immunizing Reduces missed opportunities for vaccination Centralizes required information for vaccine administration Meaningful Use Incentive Payment Program

33 Benefits to your clients Vaccination records are safe in a secure network Providers retire, quit or leave the practice Natural disasters Easy access to immunization record Doctor offices Pharmacies Local public health agencies

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