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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 syndrome Myocarditis Death 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 years Pregnant women Adults greater then 50 years of age Healthcare workers Patients with history of chronic
diseases Patient 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