720 likes | 1.04k Views
EMS Vaccine Project. New Hampshire Division of Fire Standards and Training and Emergency Medical Services. http://dannymiller.typepad.com/blog/images/epidemic.jpg. Acknowledgments. Developed under the CDC Preparedness Grant Dr. Joseph Sabato Paramedic Chuck Hemeon
E N D
EMS Vaccine Project New Hampshire Division of Fire Standards and Training and Emergency Medical Services http://dannymiller.typepad.com/blog/images/epidemic.jpg
Acknowledgments • Developed under the CDC Preparedness Grant • Dr. Joseph Sabato • Paramedic Chuck Hemeon • Paramedic Vicki Blanchard • Paramedic/RN Clay Odell • Bureau Chief Sue Prentiss
Acknowledgments • This EMS Vaccine Program has been partly funded under an Agreement with the State of NH, Dept. of Health & Human Services, by the US Dept. of HHS • the Office of the Assistant Secretary for Preparedness and Response - the Hospital Preparedness Program.
Why are we here? • Diseases of greatest concern • CDC Guidelines and Federal Laws • Federally required documentation • How to assist State Health Officials • Not here for lessons on IM injections
Public health principles relative to infectious (communicable) diseases • Human populations • Demographic characteristics • Infectious disease dynamics • Population variations
Epidemic http://isiria.files.wordpress.com/2009/03/epidemic-nml.jpg
Pandemic http://www.zmangames.com/boardgames/files/pandemic/NotfinalPandemic_board.jpg
Influenza • “The Flu”: a highly contagious viral infection of the nose, throat and lungs • Influenza is an RNA virus • Type A & B • Respiratory symptoms, causing epidemics • Type C • Mild, do not cause symptoms
www.abc.net.au/health/library/influenza_ff.htm Type A • Hemagglutinin (H) • Neuraminidase (N) • These two proteins determine immunity, infection, severity and diagnosis of flu • Also infects horses, pigs, birds
Influenza Concerns • The influenza Type A viruses that are presently infecting humankind are: • A(H1N1) or "Spanish Flu“ • A(H1N1) or “Swine Flu” • A(H3N2)- or "Hong Kong Flu". • A(H1N2) a re-assortment of the above
Influenza Pandemic History • 1918 Spanish Flu • 1957 Asian Flu • 1968 Hong Kong Flu • 1997 Avian Flu • 2009 Swine Flu
1918 Spanish Flu A(H1N1) • Summer-Fall 1918 • AKA Spanish Flu • World War I • Influenza 1918 - 1919 • 20 million to 50 million deaths worldwide • 675,000 deaths in USA • Undiscovered virus at the time • Mass casualty in health facilities
1957 Asian Flu A(H2N2) • 1 – 2 million deaths worldwide • 70,000 USA deaths • Contraction rates greatest among school age • Death rates were highest among elderly • Science and technology advancement enabled vaccine
1968 Hong Kong Flu A(H2N2) • 700,000 deaths worldwide (34,000 USA) • Fewer people died because: • Improved medical care supported very ill • Antibiotics now available for secondary illnesses • Antigen N2 same as with 1957 Asian flu, severity probably reduced because people retained antibodies against N2 in their system from the 1957 pandemic
1997 Avian Influenza A(H5N1) • Avian (bird) influenza (flu) • Occurs naturally among birds • Infection can occur in humans • Most human infection result from contact with infected poultry or surfaces contaminated with secretion/excretions from infected birds • Very rarely spread from one ill person to another
Bird Flu (Avian Flu)1997 - 2009 • Slaughter of chickens occurred to removed source of infection to humans • World Health Organization (WHO) keeps surveillance on the Avian Flu • www.who.int/en/ for the most up to date information • Since June 2, 2009: 433 cases with 262 deaths from Avian Flu
Influenza Vaccine • Vaccine comes in two forms • inactivated virus for intramuscular administration • Live, antennuated virus for intranasal administration
Manufactured in eggs Takes six months to manufacture adequate vaccine Patient’s allergic to eggs should not receive the vaccine. Manufactured in eggs
Influenza Vaccine • Most effective if given within 2-4 months of illness • 90% effective in preventing illness in the healthy • 50-60% effective at preventing hospitalization in elderly • 80% effective at preventing death
Principals Vaccination • Active immunity produced by vaccine • Immunity similar to natural infection but without risk of disease
Live Attenuated Vaccine • Pathogen grown in animal or tissue culture under conditions that make it less virulent. • Nasal Spray Form
Influenza Clinical Features • Incubation period 2 days (range 1-5 days) • Severity of illness depends on prior experience with related variants • Abrupt onset of fever, myalgia, sore throat, nonproductive cough, headache
Influenza Complications • Pneumonia • secondary bacterial • primary influenza viral • Reye syndrome • Myocarditis • Death 0.5 -1 per 1,000 cases
Healthcare Flu Vaccination • Historic rates of 34% for healthcare workers • Leading cause of occupational illness and risk of spread to patients • In pandemic planning we need to increase
Protection for yourself & your EMS crew • Infection control policies & procedures • Proper respiratory protection • N-95 or HEPA filter mask • Fit-tested • Hand-hygiene policies • Cleaning of ambulance, stretcher and equipment
Influenza Vaccine Indications • Children > 6 month to 5 years • Pregnant women • Adults greater then 50 years of age • Healthcare workers • Patients with history of chronic diseases • Patient with immunocompromise
Influenza Vaccine Contraindications • Influenza vaccine is not approved for children < 6 months of age • Allergy to eggs, vaccine or thimerosal • Moderate to severe acute illness with fever • Previous adverse reaction • History of Guillain-Barre syndrome within 6 weeks of previous influenza vaccines
Influenza Vaccine (Injection)Side effects • The viruses in the flu shot are killed (inactive), so you CANNOT get the flu from the flu shot (CDC) • Soreness, redness or swelling where the shot was given • Fever (low grade) • Malaise
Influenza Vaccine Live Attenuated (Nasal-Spray) Side Effects • Per the CDC “The viruses in the nasal-spray vaccine are weakened and do not cause severe symptoms often associated with influenza illness. (In clinical studies, transmission of vaccine viruses to close contacts has occurred only rarely.) • Children: runny nose, headache, vomiting, malaise, fever • Adults: runny nose, headache, sore throat, cough
Influenza Vaccine Dose (Injection) • 0.5ml intramuscular injection in the deltoid with a 1 -1 1/2 inch 22-25 gauge needle
Pneumococcal Pneumonia • Common but serious pulmonary infection • The gram-positive, spherical bacteria, Streptococcus pneumoniae • Elderly, infants, cancer patients, AIDS patients, post-operative, alcoholics and diabetics at highest risk • CDC states the only way to prevent is with pneumococcal vaccine
An Ounce of Prevention • During the past decade many strains of pneumococcus have become resistant to antibiotics • Vaccination prevents contracting the disease
Polysaccharide Vaccines • Made from the sugar coating of the bacteria • Mediated by antibodies • Exposing the person to only part of the bacterium elicits a protective active immune response
Pneumococcal Polysaccharide Vaccine • The polysaccharide coating doesn’t mutate or change very often • There are only 23 subtypes • Vaccination lasts about 10 years • Reduces complications from pneumonia
Pneumococcal Polysaccharide Vaccine Indications • People over 65 years of age • Children over 2 years of age with chronic illness
Pneumococcal Polysaccharide Vaccine Contraindications • Allergy • Moderate to severe illness
Pneumococcal Polysaccharide Vaccine Side events • Local reaction • Myalgia and fever
Pneumococcal Vaccine Dose • 0.5ml intramuscular injection in the deltoid with a 1 -11/2 inch 22-25 gauge needle • Children receive a series of 4 shots with a different vaccine • Children with special needs should be referred to their pediatrician or medical specialist
Severe Adult Respiratory Syndrome (SARS) • Newly identified acute viral respiratory syndrome • Caused by a novel coronavirus (not Corona beer) • Corona means crown-like (under microscope the SAR-CoV looks crown-like) • 2002 – 2003 Epidemic involving 26 countries with 8098 cases and 774 death.
Required forms/documents • Its Federal Law • Screening Questionnaire • Do I Need a Vaccine Today? • Vaccine Information Sheets (VIS) • Vaccine Administration Record • Skills Checklist for Immunization
Vaccine Administration Procedure • Reference Appendix CDC Immunization Guide • CDCs “Pink Book” Epidemiology and Prevention of Vaccine-Preventable Diseases