Prevention Plan: Hepatitis A Vaccination

1. Prevention Plan: Hepatitis A Vaccination Jenni Stracener University of Alabama: NUR 735

2. Introduction to the Prevention Plan • Hepatitis A vaccine • Focusing on Adolescents • Overall Goal: • Implement the requirement of the Hepatitis A vaccine for 7th grade entry in the state of Tennessee

3. Health Risk of Hepatitis A • Hepatitis A Virus • Fecal/Oral transmission • 14-50 day incubation period • Symptoms • Fatigue, vomiting, diarrhea, headaches, myalgia • Dark Urine, clay colored stools, jaundice • Vaccine: Vaqta and Havrix • most effective way of preventing the spread of disease • Clinical Outcome • Symptoms more prominent in children >6, adolescents and adult (Craig and Schaffner, 2004; Karali, Basaranoglu, Karali, Oral, & Killic, 2011; Matheny & Kingery, 2012; WHO, 2013)

4. Health Risk of Hepatitis A

5. Hepatitis A in Adolescents • Low Vaccination Rates (Dorell, Yankey, Byrd, & Murphy, 2012; Sakou, et. al., 2011) • 42-60% started the series • 70% completion rate • Rates higher in states with Vaccination requirements (Dorell, Yankey, Byrd, & Murphy, 2012) • Tennessee (Dorell, Yankey, Byrd, & Murphy, 2012) • 34.6% rate in adolescents 14+, with 64.3% completion • Lack of Education (Gowda, Schaffer, Dombkowski, & Dempsey, 2010) • Both parental and medical staff

6. History and Current Recommendations • 1996 (Dorell, Yankey, Byrd, & Murphy, 2012; Klevens, et. al., 2011) • Recommended for age> 2 in high risk communities • 1999 (Dorell, Yankey, Byrd, & Murphy, 2012; Klevens, et. al., 2011) • Recommended for increase number of states recommending vaccination • 2006 (Dorell, Yankey, Byrd, & Murphy, 2012; Klevens, et. al., 2011) • Vaccination of ALL children at 12 months of age • Maintain existing programs for children 2 to 18 years of age • Areas without existing programs could consider vaccination for unvaccinated children 2 to 18 years of age • Recommended for any person wishing to obtain immunity • Still remains lower than other recommended vaccines (Byrd, Santibanez, & Chaves, 2011)

7. Primary Prevention • Hepatitis A Vaccination • Protects • Promotes • Prevents

8. Primary Prevention (CDC, 2013)

9. Interdisciplinary Plan • Propose new recommendation • Approval for implementation from Tennessee Department of Health • Lobby for revision of Immunization Laws • Collaboration with Tennessee Department of Education for timeline • Collaboration with Pharmaceutical Companies for supplies • Education of Health Care Professionals on new laws • Implementation

10. Prevention Plan Timeline

11. Disciplines Involved Epidemiology Education Nursing Medicine Politics

12. Epidemiology • Discussed importance of vaccination • Explain the nature of the Hepatitis A Virus • Explain transmission of disease

13. Nursing and Medicine • UTD with recommendations (CDC, 2013) • ACIP and State Laws • Review vaccine records of adolescents (Lai, Faye, & Bocchini, 2011) • Educate families; Recommend Vaccine (Gowda, Schaffer, Dombkowski, & Dempsey, 2010; Dorell, Yankey, Byrd, & Murphy, 2012; Raczniak, et. al, 2013) • Lobby for coverage and reimbursement (Dorell, Yankey, Byrd, & Murphy, 2012; Singer, Davis, Gebremariam, & Clark, 2012)

14. Education • School Administrators • Agree to and collaborate on new laws • Educate employees • School Nurses • Enforces School Entry Laws • Review Vaccine Records

15. Policy Makers • VFC Program (Dorell, Yankey, Byrd, & Murphy, 2012) • Insurance Coverage (Singer, Davis,, Gebremariam, & Clark, 2012) • State Laws

16. Leadership Competencies EmpowermentDecision MakingDelegation

17. Empowerment Informed and Accurate Decisions Prevention Plan: Hepatitis A • Schedule • Side Effects • Vaccine Information • Knowledge • Skills • Resources

18. Delegation Develops and Contributes Prevention Plan: Hepatitis A • Talents • Skills • Strengths • Coordination • School Nurses • Administrators • Policy Makers • Medical Professionals

19. Decision Making Input from Others Prevention Plan: Hepatitis A • When • Where • How much • Costs • Protocols • Meeting with interdisciplinary team • Implementation

20. Evaluating the Intervention • Baseline rates • Hepatitis A diagnosis in TN • Immunization rates in 7th graders • Follow up • Decline in diagnosis?

21. Summary • Increase immunization rates of Hepatitis A (Heo, et al, 2013) • Prevent viral Hepatitis A • Prevent spread of the disease • Involves Interdisciplinary Approach • Requires Leadership

22. References Byrd, K. K., Santibanez, T. A., & Chaves, S. S. (2011). Predictors of Hepatitis A Vaccination Among Young Children in the United States. Vaccine, 17(12), 3254-3259. Craig, A. S. & Schaffner, W. (2004). Prevention of Hepatits A with the Hepatitis A Vaccine. New England Journal of Medicine, 305, 476-481. DOI: 10.1056/NEJMcp031540 CDC. (2013). Hepatitis A Vaccination. Retrieved from http://www.cdc.gov/Vaccines/vpd-vac/hepa/default.htm Dorell, C. G., Yankey, D., Byrd, K. K., & Murphy, T. V. (2012). Hepatitis A Vaccination Coverage Among Adolescents in the United States. Pediatrics, 129(2): 213-221. doi: 10.1542/peds.2011-2197 Gowda, C., Schaffer, S. E., Dombkowski, K. J., & Dempsey, A. F. (2012). Understanding Attitudes Toward Adolescent Vaccination and the Decision-making Dynamic Among Adolescents, Parents Heo, J. Y., Song, J. Y., Noh, J. Y., Seo, Y. B., Kim ,I. S., Choi, W. S., Kim, W. J., Cho, G. J., Hwang, T. G., & Cheong, H. J. (2013). Low Level of Immunity Against Hepatitis A Among Korean adolescents: Vaccination rate and related factors. American Journal of Infection Control, 41(10), e97-e100. Karali, Z., Basaranoglu, S. T., Karali, Y., Oral, B., & Killic, S. S. (2011). Autoimmunity and Hepatits A Vaccine in Children. Journal of Investigational Allergology and Clinical Immunology, 21(5): 389-393. Klevens, R. M., Moran, D. K., Wasley, A., Gallagher, K., McQuillan, G. M.. Kuhnert, W., Teshale, E. H., Drobeniuc, J., & Bell, P.B. (2011). Seroprevalance of Hepatitis A Virus Antibodies in the I. S.: Results from the National Health and Nutrition examination survey. Public Health Reports, 126(4): 522-532.

23. References Lai, J., Faye, K. E., & Bocchini, J. A. (2011). Update on Childhood and Adolescent Immunizations: Selected review of US recommendations and literature: Part 2. Current Opinions in Pediatrics, 4, 470-481. doi: 10.1097/MOP.0b013e3283488160. Matheny, S. C. & Kingery, J. E. (2012). Hepatitis A. American Family Physician, 86(11): 1027-1034. Raczniah, G. A., Thomas, T. K., Bulkow, L. R., Negus, S. E., Zanis, C. L., Bruce, M. G., Spradling, P. R., Teshale, E. H., & McMahon, B. J. (2013). Duration of Protection against Hepatitis A for the Current Two-dose Vaccine Compared to a Three-dose Vaccine Schedule in Children. Vaccine, 31(17), 2152-2155. http://dx.doi.org/10.1016/j.vaccine.2013.02.048 Sakou, I., Tsitsika, A. K., Papaevangelou, V., Tzavela, E. C., Greydanus, D. E., & Tsolia, M. N. (2011). Vaccination Coverage Among Adolescents and Risk Factors Associated with Incomplete Immunization. Euopean Journal of Pediatrics, 170 (11) ,1419-1426. Sartori, A. M., de Soarez, P. C., Novaes, H. M., Amaku, M., de Azevedo, R. S., Mareira, R. C., Pereira, L. M., Ximenes, R. A., &Martelli, C. M. (2012). Cost-Effectiveness Analysis of Universal Childhood Hepatitis A Vaccination on Brazil: Regional analyses according to the endemic context. Vaccine, 30(52), 7489-7497. http://dx.doi.org/10.1016/j.vaccine.2012.10.056 Singer, D. C., Davis, M. M., Gebremariam, A., & Clark, S. J. (2012). Underinsurance for Recently Recommended Vaccines in Private Health Plans. Jounral of Community Health, 37(6), 1164-1167. World Health Organization. (2012). WHO Position Paper on Hepatitis A Vaccines – June 2012. Weekly Epidemiological Record, 87, 261-276