Healthcare Personnel Vaccines: CDC Recommendations & Why They are Important
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Transcript of Healthcare Personnel Vaccines: CDC Recommendations & Why They are Important
County of San Diego, Health and Human Services AgencyImmunization Branch
Healthcare Personnel Vaccines:
CDC Recommendations&
Why They are Important
Jae L. Hansen, IMC, NREMT-P, FP-C (Ret.)
Ask yourself…
What can I do to protect myself?
What can I do to protect my patients?
What can I do to protect my family?
Which HCP Need Vaccinations?
Includes physicians, nurses, nursing/medical assistants, therapists, technicians, EMTs/Paramedics, dental, pharmacists, laboratory personnel, autopsy, students, trainees, contract staff, persons potentially exposed to infectious agents that can be transmitted to and from HCP
Settings include hospitals, nursing homes, skilled nursing facilities, physicians’ offices, urgent care centers, outpatient clinics, home healthcare, and emergency medical services
Adult Vaccines… Shingles (Herpes Zoster)
One dose of Herpes Zoster Vaccine (Zostavax) at age 60 or older
Effective even if they’ve had a history of shingles
Pneumococcal 40,000 deaths & 500,000 cases every year in the US One dose of PPV vaccine given at age 65 or older, OR
in presence of chronic health condition
Adult Vaccines (cont.) Measles, Mumps, Rubella (MMR)
Adults born before 1957 is considered immune to measles & mumps
2nd dose of MMR is recommended for HCP, or show lab evidence of immunity
Measles – Highly contagious virus found throughout the world, can remain airborne for up to 2 hours Transmission – coughing, sneezing or talking Symptoms – high fever, rash, runny nose, watery eyes, cough,
diarrhea & earache Incubation – 10 to 14 days
Mumps – Acute viral disease, may spread even though they have no symptoms or their illness is mild Transmission – coughing & sneezing
Symptoms – Low grade fever & swelling or tenderness of one or more salivary glands. In post pubertal males, up to 30% may experience testicular pain and swelling. May cause sterility in males.
Incubation – 12 to 25 days
Adult Vaccines (cont.)
Rubella – (German Measles) is a virus If a woman gets rubella during the 1st trimester of
pregnancy, her baby is at risk of having serious birth defects Transmission – coughing or sneezing, direct contact
with nasal or throat secretions Symptoms – Rash, slight fever, aching joints, &
reddened eyes Many people with rubella have few or no symptoms, and
may not have rash Incubation – 16 to 18 days
Adult Vaccines (cont.)
Varicella – (Chickenpox) highly contagious disease caused by the Varicella-zoster virus Transmission – airborne & also spread through contact
with chickenpox blisters Symptoms – rash, body aches, fever, fatigue, irritability &
sore throat Hospitalization & death increases with adults Incubation – 10 to 21 days If no lab evidence or history, 2 doses of Varicella vaccine
should be administered 4-8 weeks apart
Adult Vaccines (cont.)
Hepatitis A & Hepatitis B Hepatitis disease is a virus that affects the liver:
Hepatitis A is food-borne (oral-fecal) Hepatitis B is blood-borne (blood to blood)
Hep A vaccine – common childhood and travel vaccine Hep B vaccine – common childhood, travel vaccine
and maybe required for healthcare personnel (HCP) Vaccines given in multiple doses
(plan ahead, e.g., travel, new job, etc.)
Combined in Twinrix® (2 shots in 1)
HPV
Human Papillomavirus ≥ 100 strains and types ≥ 40 strains and types are sexually transmitted FDA recently approved vaccine for males Approved for ages 9 – 26 yrs Protects against viruses that can cause
cervical, anal, penile & throat cancers
Source: CDC HPV Information
also known as the “flu”
Influenza is a contagious viral infection of the nose, throat and lungs
36,000 deaths and over 200,000 hospitalizations per year
Influenza
2007-2008 San Diego Influenza Season
The first influenza detection occurred the second week of October
The peak flu season occurred mid February
A total of 9 influenza-related deaths
A total of 1,905 reports of influenza (lab results positive) were voluntarily reported to Public Health
H1N1 in San Diego
April 2009 – January 20, 2010 829 hospitalizations 55 deaths – San Diego residents 7 deaths – Visiting non-residents
Most recent death is a 29 y/o female with no underlying condition
Peak Influenza U.S. 1976-2006
13%
19%
45%
13%
3% 3%3%
Source: MMWR 2007;56 (RR-6)
Cold vs. FluCan you tell the difference?
Fever Rare in adults and older children,
but can be as high as 102 degrees in infants and small children
COLD OR FLU?
COLD
Cold vs. FluCan you tell the difference?
Headache
Sudden onset and can be severe
COLD OR FLU?
FLU
Cold vs. FluCan you tell the difference?
Tiredness and weakness
Can last two or more weeks
COLD or FLU?
FLU
Cold vs. FluCan you tell the difference?
SneezingStuffy NoseSore ThroatCOLD or FLU?
COLD
Tiredness
HeadacheFever & Chills
Influenza Symptoms
Body Aches
Chest Discomfort
Flu PreventionGet vaccinated! Your best protection!
Practice good hygiene Wash hands often Cover your mouth/nose when you cough/sneeze Put used tissues in waste basket Clean your hands after you cough/sneeze Avoid touching your face, eyes, nose or mouth
If you are diagnosed with the flu Stay home Avoid close contact with others, or wear a mask Get rest and drink plenty of fluids
Transmission Respiratory route Direct contact Communicability – 1 to 2 days pre-onset to,
4 to 5 days post-onset Reservoir
Humans, swine (H1N1), and birds (H5N1) Geographic distribution
Global Incubation
1 to 5 days; usually 2 days
Influenza Virus
Nosocomial Influenza
Transmission that occurs in a healthcare setting
Can result from under-vaccinated healthcare personnel
In a tertiary care facility from 1987 to 2000:
Staff influenza vaccination coverage 4% >>> 67%
Staff influenza disease 42% >>> 9%
Nosocomial Disease 32% >>> 0 cases
Salgado CD, Infection Control Hospital Epidemiology, 2004
Nosocomial Influenza
Influenza in the Elderly
Kimura, et al. American Journal of Public Health, 2007
The elderly have suboptimal immunologic response to the flu vaccine.
80% effective in preventing death 27% to 70% effective in preventing
hospitalizations and pneumonia 30% to 58% effective in preventing flu
The flu shot is about…
Despite high vaccination rates among residents, influenza outbreaks still occur in LTCFs, triggered by unvaccinated HCP.
Influenza in LTCF
Influenza Attack Rates 25-60%
Case-fatality 10-20%
Randomized control study Staff vaccination led to a
43% decrease in ILI 44% decrease in
mortality
Potter J, et. Al. J Infectious Disease 1997
Children between 6 months and 18 years of age Healthcare personnel (HCP) Persons > 50 years Nursing home & chronic care residents with chronic
medical conditions Persons with chronic pulmonary or cardiovascular
disorders, including asthmatic children Pregnant women Persons with immunosuppression including HIV
Who’s at Risk?
Facts vs. Myths I get sick from the vaccine
MythThe influenza vaccine is made from a DEAD virusYou cannot get sick from itSide effects may include a low-grade fever and
muscle achesThe flu shot can take up to two weeks to
become effective so you can still get the flu or a flu-like illness during this time
Why I didn’t get a flu shot… My doctor didn’t recommend it
I am afraid of needlesThe flu shot is given with a relatively small needle. Check with your doctor to see if you are eligible to receive FluMist® - a vaccine that is sprayed into your nose and does not require needles.
The Flu isn’t that badInfluenza causes an average of 36,000 deaths and over 200,000 hospitalizations per year. Source: CDC Influenza Information
Shot vs. Nasal SprayFlu Shot (TIV) Injectable – Trivalent inactivated influenza vaccine 70-90% effective in healthy persons ≤65 yrs 50-60% effective in preventing hospitalization 80% effective in preventing death Few side effects (sore arm, general malaise)
Nasal Spray (LAIV) - FluMist® Live attenuated influenza vaccine No needles – spray mist into the nose Approved for healthy persons ages 2-49 years of age Slightly more expensive
Novel H1N1 VaccineWho should receive the vaccine?• EMS and HCP• Pregnant women• Caregivers of <6 months• 6 mon – 24 yrs, 25 – 64 yrs w/ underling chronic conditions• Now open to everyone
Where can I get it?• Your physicians office• Local PHC, Mass Vax Clinics
How many doses will I need?• Only one dose for 10 yrs and older
How much will it cost?• Free – Feds paid for all doses• Nominal administration fee
How safe is the vaccine?• Extremely safe! It is made using the
same processes & facilities as the seasonal flu vaccine. It is very much like the seasonal flu vaccine.
Should I get the vaccine if I think I’ve already been infected?
• Yes, the flu symptoms you had may not have been caused by the H1N1 virus.
also know as“Whooping Cough”
is a highly contagious bacterial infection of the lining and airways of the respiratory tract.
It is caused by the bacterium Bordetella pertussis.
Pertussis
Pertussis Cases in the U.S.
CDC. MMWR 1997;46(54):71-80. Murphy T. Data on file, personal communication, 2001. MMWR 2000;50:1175. MMWR 2001;50(33):725.MMWR 2002;51:723. MMWR 2003;52:747. Bacterial Vaccine Preventable Disease Branch, National Immunization Program, 2005.
Cas
es (T
hous
ands
)
7,7966,586
4,570
11,6479,771
25,827
0
4
8
12
16
24
20
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004
Pertussis in S.D. County
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
0
50
100
150
200
250
300
350
400
CasesDeaths
Pertussis in the U.S.
Güriş et al. Clin Infect Dis. 1999;28:1230-1237.CDC. MMWR. 2002;51:73-76, 2001;50(53):1-108, 2002;51(53):1-84, 2003;52(54):1-85
1990-1993 1994-1996 1997-2000 2001-2003 2004
8000
9000
0
4000
1000
5000
2000
6000
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7000
<1 yr 1-4 yrs 5-9 yrs 10-19 yrs 20+ yrs
Aver
age
Num
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of C
ases
/ Ye
ar
Age Group
18.8 fold
15.5 fold
Clinical Signs of Pertussis Cough 97% 3 weeks,
52% 9 weeks Paroxysms 73% 3 weeks Whoop in 69% Post-tussive emesis in 65%
De Serres et al. J Infect Dis. 2000;182:174–9.
Teens missed average 5 days of school Adults missed average 7 days of work Average 14 days of disrupted sleep
3 Stages of Pertussis Catarrhal
Runny nose, sneezing, low-grade fever, and a mild, nonproductive, occasional cough
Most infectious during the this period and the first 2 weeks after cough onset (approximately 21 days)
Paroxysmal Severe spasms of quick, short, coughs May gag, gasp and/or expel thick mucus “whoop” Following attack
Vomiting and exhaustion
ConvalescentGradual recoveryCough frequency decreasesCough severity decreasesRecovery may be only partial
Source: www.pertussis.com
3 Stages of Pertussis
How is it diagnosed? Multiple tests may be required to accurately
diagnose disease Frequent incorrect diagnoses:
Asthma Gastroesophageal reflux Post-viral bronchospasm Chronic sinusitis Tuberculosis
Culture and PCR
Nasopharyngeal (Dacron) swab or aspirate is the preferred sample
It’s the nasopharynx we’re after
Pertussis in AdultsAdults: Are the main reservoirs of disease in areas
with high immunization coverage rates
Transmit primarily to non-immune children (≤ 1 year of age) or to adults whose immunity has waned
Experience the longest recovery time (median 93 days)
15
7
3
0 0 0 0
1
12
5
0
1
0 00
2
4
6
8
10
12
14
16
0 1 2 3 4 5 6
age (months)
num
ber o
f cas
es
Death Encephalopathy
The majority of severe pertussis disease complications occurred among infants 0-2 months of age, California 1995 - 2004
California Dept of Health ServicesImmunization Branch
n=264 cases
Infant Pertussis: Who Was the Source?
Bisgard, K. PIDJ. 2004;23:985-9.
Costs of an Outbreak September 2003 – outbreak of pertussis in an
acute care facility 17 employees were infected Following a one-day exposure to an infant with
pertussis
Infection control measures were immediately implemented in hospital
Study examined outbreak-related costs and estimated possible benefits to vaccination
Study Results
Cost incurred by the hospital:
Cost incurred by the employees:
TOTAL COST incurred:
Cost of 1 dose of Tdap:
$74,870
$6,512
$81,382
$37.00
Estimated Benefits of Vaccination
Study model predicts:
Vaccinating employees in hospital against pertussis would prevent ≥ 46% of exposures
Cost of vaccination to benefit ratio is 2.38 : 1
CDC Recommends All HCP in hospitals, LTCF/SNF, ambulatory care and
emergency medical services (EMS) settings also receive Tdap in place of Td booster
Priority groups: HCP in contact with infants less than 12 months Emergency Departments Maternal/Child Health ICU/NICU Respiratory Therapy
All adults receive Tdap in place of their tetanus booster
Postpartum mothers and/or primary caregivers receive Tdap
CDC Recommends
Tdap Vaccine
Tetanus diphtheria acellular pertussis Licensed in 2005
Only one dose is required and it can be given in an interval as short as 2 years from the last Td booster
Tdap Adverse Reactions
Localized pain, redness, swelling Low-grade fever Adverse reactions occur at
approximately the same rate as Td alone
Source: CDC Pertussis Information
A True Story…
Conclusions Vaccinating ADULTS with Tdap:
85% protection with vaccine! Protect your family from pertussis Prevent an outbreak in workplace thereby reducing
costs and minimizing sick leave
Keeping adults up to date with their vaccines can minimize the effects of vaccine-preventable diseases
ResourcesCounty of San Diego Immunization Branch
www.SDIZ.org
Council of Community Clinics(Referral to low-cost immunizations)
(619) 542-4300
Immunization Action Coalitionhttp://www.immunize.org/hcw/
Center for Disease Control and Preventionhttp://www.cdc.gov/ncidod/dhqp/wrkr_immune.html
Jae L. Hansen, IMC(619) [email protected]
Thank you for your time.