VACCINES for the COMMON GOOD

1. VACCINES for the COMMON GOOD Central College Health Association Conference March 25-27, 2013 Susan Even, MD

2. Vaccine Accomplishments “Vaccines - One of the 10 great public health achievements” • Global eradication of smallpox • Elimination of polio in most of the world • Measles elimination in US and Americas

3. Vaccines –The Basic Goals • Reduce susceptible population • Stop transmission

4. From 8 to 16 1990 – 8 diseases prevented • Polio • Measles, Mumps, Rubella • Diphtheria, Pertussis, Tetanus • Hepatitis B 2010 – increased to 16 • Meningitis • Pneumococcal • Varicella • HPV • Hepatitis A • HiB • Influenza • Rotavirus

5. Affordable Care Act • Continues Vaccines For Children (VFC) • Supports private insurance • Covers ACIP recommended vaccines • Increases immunization administration fees

6. Stresses to Immunization System • Vaccine and vaccination financing • Vaccine supply • Delivery of vaccines to adolescents • Vaccine safety • Vaccine of adults

7. Updates in Adult Immunization Recommendations ACIP - Publishes updates every February CDC - Usually adopts recommendations from ACIP ACHA - Highlights recommendations relevant to colleges and universities

8. CDC Updates Immunization Schedule Birth to 18 yrs – adopted concurrently by ACIP, AAP, AAFP Age 19 and older – ACIP, AAFP,ACOG, ACP

9. Recommended Vaccinations Indicated for Adults Based on Medical and other Indications Clarifies vaccines advised for: • Pregnancy • Immune compromise • HIV • MSM • Heart, lung and other chronic diseases • Diabetes • Healthcare personnel

10. Notable updates TdaP – every adult needs one, booster for each pregnancy Pneumococcal – asthma, chronic lung and other diseases, HIV, asplenia plus smokers MMR – for those born after 1956, no longer accept physician diagnosis Meningitis – booster if first before 16 yrs Influenza– everyone over 6 months annually

11. CDC Vaccine and Immunization Contact Information • Tel 800.CDC.INFO • Email nipinfo@cdc.gov (for providers) • Web www.cdc.gov/vaccine/ • Safety www.CDC.gov/vaccinesafety/

12. Public Health Policies Increase and support adolescent/young adult immunization rates • RIPI (ACHA) • Higher Ed. Institutional policies • State Laws

13. Barriers to Adolescent Immunizations • Access • Reimbursement • Consent • Tracking immunization history • Education, including safety

14. Society Adolescent Health and Medicine Statement Ideal visit sequence: 11-12 yr –Primary immunization platform 14-15 yr– Catch up or complete multi-dose 17-18 yr– Update missed or start new series

15. SAHMS Statement Supports: • State mandates • Alternative immunization sites • Change consent laws • Stronger reimbursement • Insurance reform

16. Strategies to Improve Immunization Rates Vaccine Quick Visits Outreach Clinics Electronic medical records • Improve tracking • Reminder system

17. Immunization Compliance Targets Current levels range from 10 – 47% Healthy Campus 2020 goals: 80 -90% • TdaP • 2 dose Varicella • 1 dose QuadrivalentMeningococal (MCV4) • 3 dose HPV • Annual influenza

18. The Exemption Issue Three Types of Exemptions • Medical • Religious • Personal/philosophical

19. Personal Belief Exemptions Cluster geographically Associated with outbreaks of measles, pertussis and Hib

20. Opting out -Exemptions The harder the process, the lower the rate of exemptions Easier exemptions - associated with increased pertussis rates

21. Valid Exemptions True medical exemptions • Documented allergies • Immune compromise Institutional religious beliefs • How to verify?

22. Parental Attitudes Have Impact Influenza vaccine more likely if : • parent recalled physician recommendation • believed vaccine works • easy access and reminder HPV accepted more if parent rec’d education on HPV and HPV vaccine

23. Minority of people are Anti-Vaccine Survey published – Largent, M. “The Modern American Vaccine Debate,”Academy of Natural Sciences, 4/24/12 • Vaccine Acceptors - over 57% • Vaccine Hesitant – 41% • Anti-Vaccine - 1-3%

24. Attitudes Regarding Vaccines

25. What can providers do? • Increase their knowledge of vaccine recommendations and safety • Educate parents and students about vaccines and safety

26. Vaccine Safety “US Vaccine Safety System – safest, most effective….in our history.”

27. Vaccine Safety FDA monitors: • Safety • Effectiveness • Availability Prior to vaccine approval: • Reviews studies by scientists, physicians • Inspects manufacturing sites to verify adherence to strict guidelines

28. Why Monitor Safety? • May uncover rare reactions that can lead to withdrawal of vaccine • Monitor high risk groups that researchers may have intentionally eliminated –elderly, chronic illness, pregnancy • Increase public confidence

29. VAERS Vaccine Adverse Events Reporting System • Safety monitoring system after FDA licensure • Requires participation of providers who administer vaccine • Interpretation of reports over time may result in recalls or safety advisory

30. Adverse Events • True reactions to the vaccine • Events that occurred but are unrelated • Reactions due to mistakes in vaccine preparation, handling or administration • Events that cannot be related directly to vaccine, from an unknown cause

31. Provider Strategies Implement practices to increase immunizations • Screening tools • Standing orders • Immunization tracking • Quick visits – outreach

32. Key Players - Office staff Educate regarding: • Simultaneous administration of vaccines • True contraindications

33. More Office Participation Adopt immunization goals Healthy Campus 2020 Go beyond institutional policy

34. Important Components of Communication Address risks and safety Debunk myths

35. Effective Strategy 3 essential components: • Listen and acknowledge • Counter with facts and recommendation • Contextualize Avoid extremes!

36. Listen and Acknowledge Provider: “What are your concerns about getting the flu shot?” Student: “I heard you get sick from it. Since I’ve never had the flu I don’t need it.” Provider: “I can understand why you’d be concerned. You have a lot of important school and other activities to accomplish. How fortunate that you’ve never had the flu.

37. Counter with Facts and Recommendations Provider: “The flu vaccine contains no live virus so cannot transmit the infection. Also the amount of circulating flu and your exposure is variable each year which may explain why you’ve never been sick. However, CDC recommends this for everyone over 6 months to increase reduce number of people getting sick as well as reducing exposures.

38. Contextualize Provider: “The infection consists of high fever, body aches and cough for 5 days or longer which can have a negative impact on your academic work and your personal activities (including winter and spring vacations). We can give it to you right now in the clinic. I strongly recommend this for you.”

39. My final charge to you--- • You have a community to protect • You can have an impact on policy • You have good resources and strategies • You have contact with students and parents Now, just do it!