calling the shots: addressing vaccination concerns the... · 2020. 9. 14. · michigan cases since...
TRANSCRIPT
Calling the Shots: Addressing vaccination concernsShelby Kelsh, PharmD, BCPS
Assistant Professor, Ferris State University
Conflicts of interest
Shelby Kelsh has no conflicts of interest to disclose.
Objectives
Recall the current state of measles and hepatitis A outbreaks in Michigan
Describe the recent changes to Advisory Committee for Immunization Practices (ACIP) recommendations for select vaccines.
Educate patients about the benefits of vaccines and address common concerns about vaccines.
Outbreak Status
Hepatitis A in Michigan
Michigan cases since August 2016
Total Cases 918
Hospitalizations 737 (80.3%)
Deaths 28 (3.1%)
MDHHS. Michigan Hepatitis A 2016-2019 Outbreak Summary. ww.michigan.gov/documents/mdhhs/HepA_Summ_County_SEMI2016_updated91517_601552_7.pdf
HepA Vaccination and Cases
Michigan Pharmacists Association. MDHHS pharmacy white paper. Oct 2018.
Measles cases in the USA
CDC. Measles Cases and Outbreaks. July 22, 2019. Website: https://www.cdc.gov/measles/cases-outbreaks.html. Accessed July 23, 2019.
Measles by State in 2019
CDC. Measles Cases and Outbreaks. July 22, 2019. Website: https://www.cdc.gov/measles/cases-outbreaks.html. Accessed July 23, 2019.
Childhood immunization 4313314 Series
MDHHS. Childhood immunization 4313314 series by zip code. Website: https://www.michigan.gov/documents/mdhhs/child_zip1_530331_7.pdf
4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 HepB, 1 Var, 4 PCV
Adolescent immunization 132321 Series
MDHHS. Adolescent immunization 132321 series by zip code. Website: https://www.michigan.gov/documents/mdhhs/adol_zip1_530333_7.pdf
1 Tdap, 3 Polio, 2 MMR, 3 HepB, 2 Var, 1 MenACWY
County Immunization Report Card
MDHHS. County Immunization Report Card: Kent. Website: https://www.michigan.gov/documents/mdch/Kent_447463_7.pdf
Updates to the Immunization Schedule
Influenza
Live, attenuated influenza vaccine AVAILABLE
oEligible patients are age 2 to 49
oContraindications Immunocompromised Anatomical/functional asplenia Pregnant Cerebrospinal fluid leak or cochlear implant 2-4yo diagnosed with asthma or wheezing within
the preceding 12 months Influenza antiviral in previous 48 hours
oPrecaution: Asthma age 5 years and older
Robinson CL, Bernstein H, Romero JR, Szilagyi P. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2019. MMWR Morb Mortal Wkly Rep 2019;68:112–114. Kim DK, Hunter P. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2019. MMWR Morb Mortal Wkly Rep 2019;68:115–118.
Hepatitis A
oNew indication: Homelessness
oClarification for International travel Age 6-11 months: 1 dose before departureRevaccinate with 2 doses between 12-23
months Unvaccinated age >12 months: 1st dose as soon as travel considered
oCombined HepA-HepB 3 dose series Adults only
Robinson CL, Bernstein H, Romero JR, Szilagyi P. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2019. MMWR Morb Mortal Wkly Rep 2019;68:112–114. Kim DK, Hunter P. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2019. MMWR Morb Mortal Wkly Rep 2019;68:115–118.
Hepatitis B
oNew product: CpG- adjuvanted HepB vaccine (Heplisav-B) 2 doses given at least 4 weeks apart Only in adults Do not use in pregnancy
oPrevious 3 dose product monovalent HepB vaccine (Engerix-B or Recombivax HB)
Kim DK, Hunter P. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2019. MMWR Morb Mortal Wkly Rep 2019;68:115–118.
Human Papillomavirus (HPV)
oNew 2 dose series 9-14yo at initial vaccination 0, 6-12months
oOriginal 3 dose series• 15-26yo at initial vaccination• 0, 1-2 month, 6 months
oExpanded age eligibility up to age 45 Will not become official until approved by CDC
director and published in MMWR
Immunization Action Coalition. Ask the experts about Human Papillomavirus (HPV). June 28, 2019. Website: http://www.immunize.org/askexperts/experts_hpv.asp. Accessed July 23, 2019.
Addressing Common Misconceptions
MYTH: I got sick from the flu vaccine
TRUTH: most vaccines are inactivated and cannot cause infection
Timing of vaccine efficacy vs onset of illness
Common cold vs influenza infection
Live attenuated vs inactivated vaccines
Ezeanolue E, Harriman K, Hunter P, Kroger A, Pellegrini C. General Best Practice Guidelines for Immunization. Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP) [www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf]. Accessed on 3/15/2019.
MYTH: You can’t vaccinate sick patients
TRUTH: OK to vaccinate if mild illness
Mild vs moderate illness
Inactivated vs Live attenuated
Risk with deferring vaccination
Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preven tab le Diseases. Ham borsky J, Kroger A, Wolfe S, eds. 13th ed . Washington D.C. Public Health Foundation , 2015.
MYTH: The flu vaccine doesn’t work
Truth: Flu vaccine reduces risk of flu illness 40-60% when well matched
Strain matching
Patient factors
CDC. Flu Vaccines Work. Website: https://www.cdc.gov/flu/vaccines-work/index.html Accessed July 23, 2019
MYTH: I’m not at risk for those diseases
Truth: Vaccination schedule developed with risks in mind
Local vs world prevalence
Comorbidities
Herd immunity
MYTH: Vaccines cause autism
TRUTH: no causation between MMR or thimerosal and autism
Falsified journal article
Timing association
Newer research MMR Before and after thimerosal in vaccine
Am Fam Physician. 2017;95(12):786-794 Human vaccines & immunotherapeutics 2018, VOL. 14, NO. 1, 218–224
MYTH: Spacing out vaccines is best
Truth: timing of schedule is best
Deferring delays immunity
Will not overwhelm immune system
Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preven tab le Diseases. Ham borsky J, Kroger A, Wolfe S, eds. 13th ed . Washington D.C. Public Health Foundation , 2015.
Helpful Resources
oCDC Vaccines website and app https://www.cdc.gov/vaccines/hcp/index.html
oMichigan Pharmacists Association (MPA) Immunization Page http://www.michiganpharmacists.org/PracticeResources/communitypr
actice
oI vaccinate https://ivaccinate.org/
oMichigan Care Improvement Registry (MCIR) https://www.mcir.org/
oMichigan Department of Health and Human Services (MDHHS) Vaccine resources https://www.michigan.gov/mdhhs/0,5885,7-339-
73971_4911_4914---,00.html Local health departments https://www.michigan.gov/mdhhs/0,5885,7-
339-73970_5461_74040---,00.html
Test your knowledge
Question 1
What is a contributing factor to the measles outbreak?
A. Ineffective vaccine
B. Resistant changes to virus
C. Increased travel of infected hosts
D. Vaccine shortage
Question 2
Who is eligible for the Live attenuated influenza vaccine?
A. 57yo health woman
B. 35yo hypertensive male
C. 3yo girl newly diagnosed with asthma
D. All of the above
Question 3
Which is the appropriate vaccination schedule for hepatitis B in an adult?
A. Heplisav-B 0, 1, 6 months
B. Engerix-B 0, 1 months
C. Engerix-B 0, Heplisav-B 1 month, Engerix-B 6 months
D. Heplisav-B 0, Engerix-B 1 month
Question 4
How can you address a patient’s concern about receiving multiple vaccines in one day?
A. Not delaying leads to faster immunity
B. Does not affect efficacy of most vaccine
C. Not a significant increase in antigen exposure
D. All of the above.
Question 5
Which patient should you defer vaccination for?
A. Observation unit for CHF exacerbation
B. Admitted to hospital for pneumonia
C. Complaining of runny nose and itchy eyes
D. Picking up antibiotic for UTI
Questions?Shelby Kelsh, PharmD, BCPS
Assistant Professor of Pharmacy, Ferris State University