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EMS Vaccine Project

New Hampshire Division of Fire Standards and

Training and Emergency Medical Services

http://dannymiller.typepad.com/blog/images/epidemic.jpg

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Acknowledgments

Developed under the CDC Preparedness Grant

Dr. Joseph Sabato Paramedic Chuck Hemeon Paramedic Vicki Blanchard Paramedic/RN Clay Odell Bureau Chief Sue Prentiss

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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.

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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

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Public health principles relative to infectious (communicable) diseases

Human populations Demographic characteristics Infectious disease dynamics Population variations

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Worldwide Deaths

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Infectious Disease Mortality in the USA 1900 to 1996

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Epidemic

http://isiria.files.wordpress.com/2009/03/epidemic-nml.jpg

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Pandemic

http://www.zmangames.com/boardgames/files/pandemic/NotfinalPandemic_board.jpg

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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

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Type A

Hemagglutinin (H) Neuraminidase (N) These two proteins determine

immunity, infection, severity and diagnosis of flu

Also infects horses, pigs, birds

www.abc.net.au/health/library/influenza_ff.htm

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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

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Influenza Pandemic History

1918 Spanish Flu 1957 Asian Flu 1968 Hong Kong Flu 1997 Avian Flu 2009 Swine Flu

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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

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1918 Pandemic – Deaths per 1,000

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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

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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

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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

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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

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Great Reading

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Influenza Vaccine

Vaccine comes in two forms– inactivated virus for

intramuscular administration– Live, antennuated virus for

intranasal administration

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Influenza Vaccine

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Manufactured in eggs

Manufactured in eggs Takes six months to

manufacture adequate vaccine

Patient’s allergic to eggs should not receive the vaccine.

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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

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Principals Vaccination

Active immunity produced by vaccine

Immunity similar to natural infection but without risk of disease

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Live Attenuated Vaccine

Pathogen grown in animal or tissue culture under conditions that make it less virulent.

Nasal Spray Form

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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

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Influenza Complications

Pneumonia– secondary bacterial– primary influenza viral

Reye syndromeMyocarditisDeath 0.5 -1 per 1,000 cases

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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

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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

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Influenza Vaccine Indications

Children > 6 month to 5 yearsPregnant womenAdults greater then 50 years of ageHealthcare workersPatients with history of chronic diseasesPatient with immunocompromise

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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

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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

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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

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Influenza Vaccine Dose (Injection)

0.5ml intramuscular injection in the deltoid with a 1 -1 1/2 inch 22-25 gauge needle

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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

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An Ounce of Prevention

During the past decade many strains of pneumococcus have become resistant to antibiotics

Vaccination prevents contracting the disease

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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

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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

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Pneumococcal Polysaccharide Vaccine Indications

People over 65 years of age

Children over 2 years of age with chronic illness

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Pneumococcal Polysaccharide Vaccine Contraindications

Allergy Moderate to severe illness

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Pneumococcal Polysaccharide Vaccine Side events

Local reaction Myalgia and fever

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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

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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.

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So why are we here?

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NH Immunization Protocol 7.0

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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

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Vaccine Administration Procedure

Reference Appendix CDC Immunization Guide

CDCs “Pink Book” Epidemiology and Prevention of Vaccine-Preventable Diseases

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It’s Federal Law!

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Screen and complete CDC’s Questionnaires

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Each Patient is to Receive a Vaccine Information Sheet (VIS)

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Storage and administration of vaccine per CDC recommendation

If you are going to be involved in the storage and handling of the vaccine, you must follow federal guidelines.

http://www.immunize.org/catg.d/free.htm

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Influenza and Pneumococcal Vaccine Procedure

Obtain consent Proper BSI Influenza 0.5ml, 22-25 gauge needle Pneumococcal Vaccine 0.5ml, 22 - 25 gauge

needle Intramuscular injection 1 - 1 1/2 inch needle Location: Deltoid muscle

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Influenza and Pneumococcal Vaccine Procedure

Have available on site, agents to treat anaphylaxis including, but not limited to, epinephrine and necessary needles and syringes.

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Influenza and Pneumococcal Vaccine Procedure

Cleanse area with alcohol Spread skin tight between thumb and forefinger Insert the needle fully into the muscle at a 90

degree angle and inject the vaccine into the tissue.

Withdraw the needle and apply light pressure for several seconds with dry gauze/cotton ball

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Intramuscular Injection

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Caution

Some special situations that should be discovered during the pre-vaccine screening.– Bleeding disorders– Latex allergies– Limited sites

If in doubt, check with the clinic medical director

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Required Record

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Review of Record

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EMS Provider’s Skills Checklist for Immunization

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A Separate Skills Checklist for Pediatrics

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Summary

Historical perspective of influenza like illnesses Pattern of distribution and transmission Individual protection and prevention Vaccine development Vaccination administration

– Policies, procedures, documentation

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Review of 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

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Questions?

Certificate of completion What comes next?

– EMS unit application for approval

Where do I find a clinic that might need my professional skills?– Whoooo?

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EMS Unit Involvement

This is a prerequisite protocol EMS unit needs to request and file for unit

application– Involves: licensure level, completion of education,

medical direction approval, letters of recommendation, proof of experience and proficiency, quality management, etc

Contact Vicki Blanchard for application packet

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THANK YOU!!!

For your interest For taking the time to complete this

educational offering

Any further questions should be directed to the NH Dept. of Safety, Division of Fire Standards and Training and EMS, Bureau of EMS, ALS Coordinator - Vicki Blanchard!

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Sources

State of NH Immunization Quality Management Quarterly Report Adult Influenza Standing Orders http://www.immunize.org/catg.d/p3074.pdf Child Adolescent Influenza Standing orders http://www.immunize.org/catg.d/p3074a.pdf Adult Pnuemococcal Standing Orders www.immunize.org/catg.d/p3075.pdf Child Teen Pnuemococcal Polysaccharide Standing Orders www.immunize.org/catg.d/p3075a.pdf Adult Screening http://www.immunize.org/catg.d/p4065.pdf Child & Teen Screening http://www.immunize.org/catg.d/p4060.pdf Do I Need Any Vaccinations Today http://www.immunize.org/catg.d/p4036.pdf Adult Skills Checklist www.immunize.org/catg.d/2020skill.pdf Pedi Skills Checklist http://www.immunize.org/catg.d/p7010.pdf Adult Admin Record http://www.immunize.org/catg.d/p2023.pdf Child & Teen Admin Record http://www.immunize.org/catg.d/p2022.pdf Its Federal Law http://www.immunize.org/catg.d/p2027.pdf Most current Vaccine Information Statement http://www.cdc.gov/vaccines/pubs/vis/ Vaccine Information Statement (VIS) Influenza Live, Intranasal http://www.cdc.gov/vaccines/hcp/vis/vis-statements/flulive.pdf Vaccine Information Statement (VIS): Influenza Vaccine What I Need to Know http://www.cdc.gov/vaccines/hcp/vis/vis-statements/flu.pdf VIS: Pnuemococcal Polysaccharide What I Need to Know http://www.cdc.gov/vaccines/hcp/vis/vis-statements/ppv.pdf