7/13/2016. Immunization Update Disclosures. Objectives. No financial disclosures to report

Transcription

1 Immunization Update 2016 Courtney A. Robertson, PharmD Clinical Assistant Professor University of Louisiana at Monroe School of Pharmacy Disclosures No financial disclosures to report Objectives Pharmacists Identify changes to most current vaccine recommendations. Apply changes in adult and pediatric immunization schedules to current pharmacy practice. Comply with Louisiana law regarding the provision of immunizations. Technicians Recognize current age-appropriate immunization schedules. Summarize changes to most current vaccine recommendations. Comply with Louisiana law regarding the provision of immunizations. 1

2 Vaccine-Preventable Diseases Epidemiology and Prevention of Vaccine-Preventable Diseases. 12th ed.; May 2012 JAMA. 2007;298: Vaccination Coverage Downfall Vaccine NHIS 2013 NHIS 2014 Healthy People 2020 Target Influenza ( % 43.2% 70% yrs) Influenza (HCP) 62.9% 65% 90% Pneumococca 59.7% 61.3% 90% l( 65 yrs) Pneumococca 21.2% 20.3% 60% l (19-64 yrs) Zoster ( 60 yrs) 24.2% 27.9% 30% HepB (HCP) 61.7% 60.7% 90% Tdap ( 19 yrs) 17.2% 20.1% Williams WW, Lu P, O Halloran A, et al. Surveillance of Vaccination Coverage Among Adult Populations United States, MMWR Surveill Summ 2016;65(No. SS-1): Estimated proportion of adults aged 19 years who received selected vaccinations, by age group and high risk status National Health Interview Survey, United States, MMWR Surveill Summ 2016;65(No. SS-1):

3 Estimated proportion of adults aged 19 years who received influenza and pneumococcal vaccination, by age group and high risk status NHIS, United States, MMWR Surveill Summ 2016;65(No. SS-1): Recommended Immunization Schedules for Persons Aged 0-18 Years-United States, ld-adolescent.html 3

4 Recommended Adult Immunization Schedule-United States, years or older, by vaccine and age group Recommended Adult Immunization Schedule-United States, years or older based on medical and other indications Child/Adolescent Schedule Changes Vaccine order change to group by age of administration Colors changed to improve readability Revise Meningococcal vaccine to separate routine and high risk Purple bar for high-risk individuals age 10 years and older Blue bar for individual clinical decision making Add 9-valent HPV Purple bar for children 9-10 years with history of sexual abuse Several footnote changes made to reflect ACIP recommendations 4

5 2016 Adult Schedule Changes 3 major updates Pneumococcal: For most healthy adults, the interval for PCV13 followed by PPSV23 is now at least one year 2015 recommendations 6-12 months Meningococcal: Schedule visual and footnote revised to reflect addition of new Meningococcal B (MenB) vaccines ACIP extended use of MenB vaccines to anyone 10 years and older at increased risk for MenB infection HPV: New 9-valent HPV vaccine is addressed in schedule Influenza Vaccine: Test Your Knowledge A patient walks into the pharmacy and would like you to administer the annual flu vaccine to her 10 year old daughter, Hannah. Hannah is healthy, has no chronic medical conditions, and is up to date on all of her childhood vaccinations. For the upcoming flu season, which is the most appropriate vaccine to use? A. Inactivated quadrivalent influenza vaccine (Fluzone ) B. Live attenuated influenza vaccine (Flumist nasal spray) C. Intradermal inactivated influenza vaccine (Fluzone Intradermal) Influenza Season Peak Activity 5

6 Influenza Vaccination Coverage Influenza Vaccine Effectiveness % Overall VE Influenza Season Receipt of Influenza Vaccination by Profession 6

7 Influenza Vaccination in Pediatrics Routine annual vaccination in all persons 6 months and older without contraindications First time influenza vaccination in children 6 months through 8 years need 2 doses, separated by at least 4 weeks MMWR Morb Mortal Wkly Rep. 2015;64(RR30): Revised: Influenza Vaccination and Egg Allergy Regardless of a recipient s allergic history, all vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis are available. A previous severe allergic reaction to influenza vaccine, regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine. Persons with a history of egg allergy who have experienced only hives after exposure to egg should receive influenza vaccine. Persons who report having had reactions to egg involving symptoms other than hives may receive influenza vaccine in a medical setting. MMWR Morb Mortal Wkly Rep. 2015;64(RR30): /22/16 Update: Flu Vaccine Nasal Spray NOT Recommended for ACIP voted against use of live attenuated influenza vaccine for upcoming flu season due to estimated 3% vaccine effectiveness rate against any virus in children 2-17 years The effectiveness of inactivated influenza vaccine was estimated to be 63% for the same group 7

8 Influenza Vaccine: Test Your Knowledge A patient walks into the pharmacy and would like you to administer the annual flu vaccine to her 10 year old daughter, Hannah. Hannah is healthy, has no chronic medical conditions, and is up to date on all of her childhood vaccinations. For the upcoming flu season, which is the most appropriate vaccine to use? A. Inactivated quadrivalent influenza vaccine (Fluzone ) B. Live attenuated influenza vaccine (Flumist nasal spray) C. Intradermal inactivated influenza vaccine (Fluzone Intradermal) Novel H5N1 Influenza Continued circulation Increasing occurrence in Egypt November 2014-April 2015: 165 cases including 48 deaths Infected birds in Canada and US New vaccine (Q-Pan ) available in 2017 Pneumococcal Vaccination: Test Your Knowledge JB is a 70 year old male who presents to your pharmacy for an initial MTM consult following discharge from the local hospital. PMH: HTN, Type II DM SH: Smokes 1 pack per week, drinks 1 beer/day Allergies: Lisinopril Immunization status: unknown/unavailable Which pneumococcal vaccine should JB receive at this time? 8

9 Pneumococcal Vaccines Pneumococcal Conjugate Vaccine (PCV13; Prevnar 13 ) ***All adults 65 years and older*** Routine vaccination for all children younger than 2 years FDA approved for adults 50 years (Not ACIP recommended for routine use) Adults 19 years with certain medical conditions, and who have not previously received PCV13 Single dose Pneumococcal Polysaccharide Vaccine (PPSV23; Pneumovax 23 ) All adults 65 years and older Adults years with risk factors (smoker or has asthma) Anyone 2-64 years with chronic illness 2 doses for adults with certain immunocompromising conditions Basics for Pneumococcal Vaccine For PCV-naïve adults 65 years and older: Give PCV13 first. After PCV13, wait at least 1 year to give PPSV23 For seniors who have already received PPSV23, wait at least 1 year before giving PCV13 For those who need PPSV23 revaccination: Wait at least 5 years after the last dose of PPSV23 and 12 months after receiving PCV13 to revaccinate with PPSV23 The interval between PCV13 followed by PPSV23 At least 12 months for seniors At least 8 weeks in immunocompromised patients Pneumococcal Decision Tree for Adults > 65 Years Old 9

10 Pneumococcal Vaccine for Adults years Select Conditions and Risks Chronic Heart Disease (excluding hypertension), Chronic Lung Disease (including COPD, emphysema, asthma), Diabetes, Alcoholism, and Cigarette Smoking, Residents of long term or nursing home facilities ACIP. MMWR. 2014;63: Pneumococcal Vaccine for Adults with Select Conditions Immunocompromised, functional or anatomic asplenia, CSF leaks, Cochlear Implants *The second dose of PPSV23 is not needed for patients with CSF leaks or Cochlear implants. ** A dose of PCV13 is not needed if patient has received a previous dose of PCV13. ACIP. MMWR. 2012;61: ACIP. MMWR. 2014;62: Pneumococcal Vaccination: Test Your Knowledge JB is a 70 year old male who presents to your pharmacy for an initial MTM consult following discharge from the local hospital. PMH: HTN, Type II DM SH: Smokes 1 pack per week, drinks 1 beer/day Allergies: Lisinopril Immunization status: unknown/unavailable Which pneumococcal vaccine should JB receive at this time? PCV13 followed by one dose of PPSV23 one year later 10

11 Meningococcal B (MenB) Vaccination Recommendations Routine use in persons at increased risk for serogroup B meningococcal disease Including outbreaks of MenB disease and college campuses recently experiencing MenB outbreaks 40% of Serogroup B cases occur in college age (50 cases/yr) ACIP recommends series administration to adolescents and young adults years to provide short-term protection against most MenB strains Preferred age is years (Category B) 11

12 MenB Vaccines 2 New MenB vaccines FDA approved for ages years Trumemba (Pfizer) 10/29/ dose series Bexsero (Novartis) 1/23/ dose series Either vaccine may be give at same time with other vaccines, different sites ***Approved for high-risk patients 10 years (complement deficiencies, asplenia, microbiologists, and exposure during disease outbreak) No recommendation for upper age limit during outbreak HPV is the most common STD In United States, more than 20 million people are infected with HPV Lifetime risk for sexually active adults > 50% Vaccines are FDA approved for males and females 9-26 years 3 dose series New HPV Vaccine 9 valent HPV (Merck) Serotypes 6, 11, 16, 18, 31, 33, 45, 52, 58 increases coverage rates for cervical cancer serotypes to 90% Same target age group with 3 dose series Comparable safety to HPV2 and HPV4 vaccines ***No recommendation to revaccinated HPV4 recipients 12

13 Parental Reasons for Not Getting HPV Vaccine No need/not necessary Safety concerns/side effects Lack of knowledge Not recommended Not sexually active HPV Vaccine Video for Health Care Providers /idepc/immunize/hcp/adol/hpvvid eos.html Tips and Timesavers for talking with parents about HPV ho/teens/for-hcp-tipsheet-hpv.pdf Zika Virus: Test Your Knowledge How many confirmed cases of Zika have been reported in the United States? A. 20 B. 200 C. 400 D. Over

14 Zika Virus Total Cases in US: 820 Locally acquired mosquito-borne cases reported: 0 Sexually transmitted: 11 No vaccine currently exists 1 in preclinical development (21 candidates) Preventative measures Avoid mosquito bites Wear protective clothing Climate controlled environment Sexual transmission protection Don t Forget! Stay Up to Date Renew Basic Life Support Provider status and send to LA Board of Pharmacy 1 hr annual immunization CE DOCUMENT, DOCUMENT, DOCUMENT LINKS and VAERS Types of Vaccine Pharmacists Can Administer Based on data collected by NASPA (July 2015) 14

15 Patient Age Limitations IN LOUISIANA Influenza vaccine: -may be administered without a Rx to anyone 7 years -may be administered with a Rx to anyone 3 years ANY vaccine: -may be administered without a Rx to anyone 17 years Based on data collected by NASPA (July 2015) References Centers for Disease Control and Prevention Vaccines and Immunizations - ACIP Vaccine-Specific Recommendations - Immunization Schedules for Health Care Professionals - Vaccination Coverage Rates and Data/NIS - American Pharmacists Association APhA Pharmacy-Based Immunization Delivery Certificate Training Program, 13th edition Questions 15