Eliminate missed vaccination opportunities

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Despite well-documented evidence regarding effectiveness and safety, overall adult vaccination rates in the United States fall short of national public health goals. Efforts to increase vaccine uptake have largely focused on reducing the number of so-called missed opportunities (eg, patients who visit health care providers without being vaccinated). All health care professionals, whether in public or private practice, should take advantage of every patient visit to ask about immunization history and provide patients with the recommended vaccines they need or refer them to providers who can offer the vaccines. While this may occur in some practices, I see missed opportunities all the time, particularly in speciality practices.

Whether it is the cardiologist who fails to recommend pneumococcal vaccination for their patient with cardiac disease or a physician in a tuberculosis clinic that doesn’t offer influenza vaccine —opportunities to make sure adults are immunized against vaccine-preventable diseases are being missed.

Paul Etkind, MPH, senior analyst for immunizations at the National Association of County and City Health Officials (NACCHO), said, “[While] it is not unusual for STD clinics to be offering HPV, Hepatitis B and Hepatitis A immunizations to their patients, it is more unusual for TB clinics to routinely offer flu and/or pneumonia vaccinations to their patients.” However, NACCHO supports the concept that rather than having TB clinics administer vaccines themselves, another possibility would be for TB clinic staff to routinely ask patients about their flu and pneumonia immunization histories and prompt the under- or unvaccinated patient to see their primary care provider or local health department to receive the appropriate immunization(s).

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The ultimate goal is to have every patient fully immunized, and that includes the entire array of vaccines recommended for adults by the CDC’s Advisory Committee on Immunization Practices: influenza, pneumococcal, Tdap, shingles, hepatitis B, hepatitis A and HPV. Achieving this goal will require the involvement of all health care professionals in both private and public health venues. And I challenge you to help meet this public health goal by leaving no opportunity behind.

Source:https://www.healio.com

Infectious Diseases Conference 2019

Facts about flu

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What are the symptoms? 

Common clinical symptoms for both influenza A and B may present with sudden onset of fever, cough, sore throat, myalgia/myositis, fatigue, and gastrointestinal (GI) presentations such as vomiting and diarrhoea. Fever is more common in children than in adults. Although clinical presentations are indistinguishable between influenza A and B infections, some studies report differences by age groups. Influenza A tends to cause more severe illness, although influenza B can be severe in children. In adults, influenza B infections more frequently present with vomiting, diarrhoea, abdominal pain, headache, general weakness and rhinorrhoea compared to influenza A. It was found that cases with influenza B infection presented more with upper respiratory tract infections, myosotis and gastroenteritis compared to influenza A in children. Without a test, however, you cannot prove influenza infection, as there are over 90 other cold and cough viruses which circulate in winter.  However, when an epidemic of flu is occurring, flu-like illness is more likely to be flu.

How does it spread?  

Influenza infection can be transmitted through droplets, aerosol and direct contact with the infected person. Whilst droplet is the main mode of spread, numerous studies have documented airborne transmission. In one US study, viable influenza virus was detected in the air of the emergency department 3 hours after the infected patient had left.

Who is affected?  

Influenza infects all ages, with peaks at the extremes of age – the very old and the very young. In 2017 the peak has been in older adults >80 years and over and children 5-9 years.  Males and females are equally affected. Up to a quarter of people can get infected in a severe epidemic.

What are the complications? 

Influenza can result in primary viral pneumonia, which occurs early in the course of illness, or secondary bacterial pneumonia, with onset later (1-2 weeks after initial symptoms). Bacterial pneumonia is the most common influenza-associated complication, especially in children and the elderly. Bacterial infection can be complicated by antibiotic resistance and there is are vaccines available for the most common bacterial complication, pneumococcal infection. Unfortunately, despite being provided free to people over 65 years and other risk groups, rates of vaccination against pneumonia are low. Other complications can be worsening of asthma and respiratory diseases and exacerbation of underlying comorbidities in persons who are at risk of the infection. Heart failure, precipitation of heart attacks and sinusitis may also occur. Occasionally encephalitis and complications of other organ systems may occur.

Influenza vaccine: 

Primary prevention is with vaccination with influenza vaccine annually. The mutation of the virus year to year requires annual vaccination. The vaccine is safe and effective, but effectiveness can vary depending on how well the vaccine is matched to circulating strains. People aged 65 years and over, and those with medical or other risk factors are recommended and funded for a free vaccine in Australia. The quadrivalent vaccine, introduced in 2016, allows protection against four strains, which gives better effectiveness against flu.  Research is underway for a universal flu vaccine which will remove the need for an annual jab.

Other prevention & control measures: 

Neuraminidase inhibitors (NAIs) can be used as prophylaxis or treatment, and when used as prophylaxis can curtail outbreaks.  Cough etiquette, hand hygiene and infection control measures are also vital to prevent further spread of infection. Personal protective equipment such as masks is recommended for healthcare workers. Guidelines recommend “droplet precautions” for seasonal influenza, however, airborne transmissions well documented for influenza.

Ebola and Zika Viral Infections

Debut of preventive use of Ebola Virus Disease (EVD) vaccine for health care and frontline workers in Uganda before an outbreak

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For the first time, an unlicensed Ebola vaccine tested in clinical trials during the West African outbreak was offered to health care workers (HCWs) and other front line workers (FLWs) working in facilities bordering the outbreak areas in the Democratic Republic of Congo (DRC) under “compassionate use.”   Nearly 90,000 community members, HCWs and FLWshave been vaccinated in DRC using a ring vaccination protocol (as of March 24, 2019).

Also for the first time, in countries bordering DRC, preparedness efforts include offering the Ebola vaccine to HCW and FLW working at health facilities and border crossings just across the border from Ebola hotspots in DRC. WHO and the ministries of health lead the vaccination program. CDC is providing technical expertise and our experience continues to be valued in each new country undertaking Ebola vaccination. By April 2019, more than 4,100 HCWs and FLWs in 13 districts in Uganda, and nearly 1,500 in 3 states in South Sudan have been vaccinated.

Successfully implementing an experimental vaccine in field conditions and convincing HCW and FLW to receive a vaccine before a case occurred in Uganda was a major achievement. Not everyone offered vaccine took it and we learned a lot along the way and honed communication messages. On the first day of vaccination at the first site in Ntoroko District, a health centre in a remote area near Lake Victoria, we had the usual “first-day” challenges with staff new to their roles, and logistical challenges in getting all the required supplies to the sites. Several hours after we opened the site we successfully vaccinated the first participant, a senior clinical officer at the Health Center.   During the 30-minute post-vaccination observation period, I sat down to chat with him and thank him for his patience. 

When I asked why he had decided to take the vaccine he responded: “I was a medical officer during the 2008 outbreak of Ebola Bundibugyo in the next District. We did not have a vaccine then and I watched people die. Now you bring me a vaccine. Of course, I want it. In addition, I am making sure all my staff at the health centre are getting it today. It will make us feel safe if this Ebola comes to our facility.”   

Throughout the day, he brought all of the nurses, clinical officers and laboratory staff to the vaccination site and stayed with them, providing emotional support for those who were scared and encouraged. It was an incredible display of leadership and caring—while also respecting individual-level decision-making and the right of each person to consent to the vaccine or not.   It was a stressful time for the team supervising the work, but the inspiration of this first vaccination carried me through many long days and nights to come as we continued to roll out to new sites and new Districts.

Because the vaccine is unlicensed, it must be used under a trial protocol with vaccination teams trained in good clinical practices, and individuals must provide informed consent. Because pregnant and breastfeeding women are excluded from vaccination, programs offered pregnancy testing onsite.

With a new, unlicensed vaccine, there is a small pool of staff with field experience. Many of the WHO staff who worked on the vaccine trial in Guinea were fully engaged with the vaccination work in DRC.   CDC’s experience with the Ebola vaccine as part of the STRIVE vaccine trial in Sierra Leone created a small cadre of epidemiologists who have provided valuable assistance in the field for the current outbreak on delivering vaccine in health care facilities.

Because the Ebola vaccine trials conducted during the 2014-2016 West Africa outbreak in Guinea, Liberia and Sierra Leone demonstrated the safety and efficacy of the rVSV-ZEBOV (Merck) vaccine, the vaccine is now a standard part of an Ebola outbreak response.

Source: https://blogs-origin.cdc.gov