|
|
|
The Vac-Scene Newsletter
Volume 7, No. 2 - March-April 2001
News from the Public Health Vaccine Distribution Program
|
- RESTRICTED USE OF Td (TETANUS/DIPHTHERIA) VACCINE
On April 13, 2001, the Vaccine Distribution Program sent a broadcast fax to health care providers in King County who receive state-supplied vaccine. The fax informed providers that the national shortage of Td vaccine has led Public Health to make some changes in how Td vaccine is ordered, and to restrict the use of this vaccine to: 1) persons traveling to a country where the risk for diphtheria is high, and/or 2) individuals who require tetanus vaccination for prophylaxis in wound management. State-supplied Td will be given only to individuals ages 7 through 18 years who are in one of these two priority categories.
Clinics that do not have Td vaccine may refer patients to Public Health; however, Td vaccine will be administered only to patients who are in the priority categories described above.
If you have further questions about the restricted use of Td vaccine, call 206-296-4782.
- MANAGEMENT OF DTaP and PNEUMOCOCCAL CONJUGATE (PCV) SUPPLIES
DTAP: Recently, the discontinuation of two DTaP vaccine brands has resulted in the potential for a temporary national shortage of this vaccine. Supplies in Washington State are sufficient at this time. In the future, if supplies of DTaP vaccine become limited, the CDC recommends that providers give priority to: 1) vaccinating infants with the initial three doses at 2, 4, and 6 months (because pertussis is most severe among children younger than one year of age), and 2) vaccinating children who are due for their preschool booster between ages 4-6 years, in order to maintain immunity during the early elementary years. Children who are due for their 4th dose of DTaP (15-18 months) should be deferred until adequate supplies are available. Providers should recall all children who did not receive DTaP-4 once supplies are replenished.
The CDC, FDA and state health departments are monitoring the DTaP vaccine supply situation closely and will provide more guidance should significant supply problems occur.
PCV: Until the WA State legislature approves the continued funding for PCV, providers are being asked to carefully manage their PCV inventory. The routine use of state-supplied PCV is recommended for:
- all children younger than 2 years, and
- children 24-59 months who are at high risk for pneumococcal disease complications (e.g. asplenia, sickle cell, nephrotic syndrome, cerebral spinal leaks, immunosuppression, etc.).
The vaccine should be made available to "healthy" children 24-59 months of age upon request by the parent or guardian. However, PCV should not be actively promoted to "healthy" children in the 24-59 month age group until additional funding has become available.
- BENCHMARKING IN MAY
Healthcare providers who receive state-supplied vaccines are participating in benchmarking during the entire month of May this year. The completed surveys must be returned to the Washington Department of Health by June 15th. The benchmarking data could result in increased federal funding for vaccines for the entire state. An advance "Thank you!" goes out to providers and administrative staff for their commitment to implementing this important activity.
Referring clients to Public Health - Seattle & King County
|
Health care providers occasionally need to refer clients to Public Health for immunizations and various other services. In order for Public Health to obtain reimbursement from insurers and health plans for such services, a referral letter is required. Please provide a referral letter to clients who you are sending to Public Health. The letter should specify the: 1) name of the referring provider; 2) type of service being requested, and 3) the address to which claims should be sent.
Please remember that with regard to immunization services, Public Health staff will determine which immunizations to administer to a client based upon ACIP guidelines--not by a prescription from a health care provider.
Are your staff protected?
|
During the recent measles outbreak in King County, many clinics were confronted with potential measles exposures to staff whose immunity to measles was not known. People who are ill with a communicable disease often present at a medical facility before the cause of their symptoms is obvious (e.g. during the measles prodrome); their illness may be transmitted to all patients and staff who are susceptible. The CDC's Advisory Committee on Immunization Practices (ACIP) recommends that everyone who works in a health care facility have proof of immunity to measles, mumps, rubella, and varicella to prevent airborne spread of these diseases. This also applies to employees who do not have direct patient contact, such as administrative and facilities maintenance staff.
Persons born in 1957 or later can be considered immune to measles, mumps, or rubella if they have: 1) at least one dose of live mumps and rubella vaccines and documentation of receipt of two doses of measles-containing vaccine (usually MMR) given on or after the first birthday in 1968 or later, OR 2) laboratory evidence of immunity (an "indeterminate" level of immunity should be considered nonimmune); OR 3) documentation of physician-diagnosed measles or mumps (documentation of rubella vaccine or lab evidence of rubella immunity still required).
Generally, staff born before 1957 are considered immune to measles and rubella; however, if there are staff in your facility who do not have a history of measles disease or laboratory evidence of immunity to measles or mumps, then a single dose of MMR is recommended. Rubella vaccination or laboratory evidence of immunity to rubella is especially important for female workers born before 1957 who can become pregnant.
All employees should ensure that they are immune to varicella. Proof of immunity can be provided by: 1) a reliable history of varicella disease, or 2) documentation of two doses
of varicella vaccine, or 3) laboratory evidence of immunity to varicella.
Health care workers who have potential exposure to blood and body fluids should be immune to hepatitis B. Health care workers should also be vaccinated against influenza every fall. This protects the health care worker from patients who have influenza AND it protects high-risk patients from exposure to influenza from infected health care workers. You can find the full text of these ACIP Guidelines at ftp://ftp.cdc.gov/pub/publications/mmwr/rr/rr4618.pdf.
True or False? Longer needles hurt less.
|
True! According to a recent study reported in the British Medical Journal, local reaction to immunization can be significantly reduced by using a 23-gauge, 25-mm (one inch) needle rather than a 25-gauge, 16-mm (5/8 inch) needle (BMJ 2000;321:931-933).
Doctors from the University of Oxford, UK, studied 119 four-month-old infants. Sixty-one of the infants were vaccinated using a 5/8 inch needle and 58 were vaccinated using a 1-inch needle. The rate of redness with the one-inch needle was initially two-thirds the rate with the shorter needle, and by the third day decreased to a seventh. The investigators also found that the initial rate of swelling in the longer needle group was about a third of that in the shorter needle group. This difference, they say, "remained for all three days."
On average, for every five infants vaccinated, use of the longer needle instead of the shorter needle would prevent one infant from experiencing any local reaction. Dr. Zuckerman, a senior lecturer from the Royal Free and University College Medical School in London, suggests in the November 18th issue of the British Medical Journal, that the abundant blood supply and drainage channels in muscle versus adipose (fat) tissue may explain this reduction in local reactions.
"To make sure the needle reaches the muscle and that vaccine does not seep into subcutaneous tissue (for an IM injection), the decision on the size of the needle and injection site should be made individually for each person. The volume of vaccine, patient age, and muscle size are also important determinants. The wider bore needle may allow greater dispersion of the vaccine and thereby reduce local adverse effects."(BMJ 2000;321:1237-1238).
Providers may be reassured that using a longer needle for IM injections will be less painful for their patients AND be more effective in producing an immunogenic response.
The following needle selection criteria may be useful in determining what size needle to use for intramuscular (IM) injections in patients of all ages:
Age Group/
IM Injection Site
|
Needle
Length*
|
Needle
Gauge**
|
| Infants1 (anterolateral thigh) |
Minimum 7/8" |
22-25 |
| Children1 (anterolateral thigh) |
Minimum 7/8" |
22-25 |
|
(deltoid)
|
Minimum 5/8" |
22-25 |
| Men2 Ave. Adult (deltoid) |
1"-1½" |
20-25 |
|
Obese (deltoid)
|
Perhaps 2" |
20-25 |
| Women2 <70 kg |
1" |
20-25 |
|
70-100 kg
|
1¼" |
20-25 |
|
>100 kg
|
Perhaps 2" |
20-25 |
This table combines guidelines from 1 Booster Shots (2/98) and 2 Needle Tips (4/98).
*NOTE: Needle length on some pre-filled syringes may not be long enough for an injection to be deposited into the muscle of larger people.
**Needle gauge depends on volume injected and viscosity of solution.
- 2001 laminated immunization card for healthcare providers
The new pocket-sized immunization card containing the current Recommended Childhood Immunization Schedule and footnotes, minimum age/interval table, and immunization resources is now available. The panel entitled, "General Rules of Childhood Vaccination," offers
some fundamental immunization guidelines for the vaccine provider.
The Immunization Card is a collaborative project of the Immunization Action Coalition of Washington; Healthy Mothers, Healthy Babies Coalition of Washington; Public Health - Seattle & King County, Snohomish Health District and the Washington State Department of Health. Funding for printing has been graciously provided by: Aventis Pasteur; Merck, Inc.; SmithKline Beecham Vaccines and Wyeth-Lederle Vaccines.
To order cards, healthcare providers in King County may call 206-205-5803. Providers outside of King County, please call the Healthy Mothers, Healthy Babies Coalition of Washington at 800-322-2588.
- Plain Talk About Childhood Immunizations, Third Edition (English AND Spanish)
This newly revised 40-page booklet responds to parents' concerns about vaccines, e.g. side effects, risks versus benefits, and legal requirements, and addresses misinformation as portrayed by the media and groups advocating against childhood vaccines. It has received national and international recognition by groups such as the World Health Organization and the Bill and Melinda Gates Children's Vaccine Program.
The Immunization Program staff at Public Health - Seattle & King County would like to express appreciation to the Program for Appropriate Technology in Health (PATH) and the Bill and Melinda Gates Children's Vaccine Program for providing funding for the Spanish translation and printing of Plain Talk.
To order a free packet of 25 booklets (English version):
King County providers may call Public Health, 206-205-5803; providers outside of King County should call the Washington Department of Health (DOH) materials warehouse: 360-664-8797. The Spanish translation of Plain Talk is also available through the DOH warehouse to all providers in WA State. Supplies are limited! The booklet is also accessible via the Public Health website: http://www.metrokc.gov/health/immunization/safety.htm (in English only. The Spanish online version is forthcoming).
- "Is Your Baby Protected?"
This double-sided, colorful Fact Sheet provides the 2001 Recommended Childhood Immunization Schedule and basic facts for parents regarding childhood immunizations. Key messages emphasize the importance of timely immunizations, clarification on common misperceptions regarding vaccine safety, and vaccine information resources. Call the DOH materials warehouse at 360-664-8797 to place your order.
Public Health launches new immunization website!
|
The commencement of Public Health Week (April 2-8) also marked the introduction of Public Health - Seattle & King County's immunization website, at: www.metrokc.gov/health/immunization
The website offers up-to-date information on:
- Vaccine recommendations for children and adults
- Hours and locations for Public Health immunization clinics
- Travel immunization resources
- Training opportunities and immunization resources Health Advisories & Resources
- Vaccine safety issues
- Tuberculin testing and treatment
- General vaccine issues and current events
We'd appreciate receiving your comments on our new website! Please email your opinions/suggestions to: lauren.greenfield@metrokc.gov . Thank you!!
|
get focused
Measles fact sheet
Measles is a respiratory disease caused by a virus that normally grows in the cells that line the back of the throat and in the cells that line the lungs.
|
|
|
|
