Published on March 10, 2008
EMS Vaccine Project: EMS Vaccine Project New Hampshire Division of Fire Standards and Training and Emergency Medical Services EMS Vaccine Project: EMS Vaccine Project The Immunization Protocol, also known as, "EMS Vaccine Project" is intended as a training and implementation for paramedic for the intramuscular injection of approved vaccines under strict medical control. The training is intended to prepare, test and evaluate NH Paramedics in the event of a mass vaccination emergency. The vaccines that are to be used are influenza and pneumococcus. Acknowledgments: Acknowledgments Developed under the CDC Preparedness Grant Dr. Joseph Sabato Paramedic Chuck Hemeon Paramedic Vicki Blanchard Bureau Chief Sue Prentiss Why are we here?: Why are we here? You are here to review and be updated on infectious diseases of greatest concerns associated with immunization You are here to learn the CDC guidelines and federal laws associated with immunizations You are here to learn how to properly administer the federally required documentation. You are here learn how to assist State Health Officials in the event of a public health crisis or under the written order of a physician. You are NOT here to learn how to give IM injections, however you will be demonstrating your skill proficiency Cognitive Objectives: Cognitive Objectives Discuss public health principles relevant to infectious/ communicable disease. Identify public health agencies involved in the prevention and management of disease outbreaks. Discuss the importance of immunization. Discuss influenza and pneumococcal, including causative organisms, the body system affected, mode of transmission, susceptibility and resistance, signs and symptoms, patient management and protective measures, and immunization. Cognitive Objectives– cont.: Cognitive Objectives– cont. Discuss the importance of properly following the Centers for Disease Control (CDC) guidelines Discuss the importance of proper reporting Discuss the importance of proper performance evaluation Affective Objectives: Affective Objectives Value the importance of immunization, especially in children and populations at risk. Value the importance of infectious/ communicable disease control. Consistently demonstrate the use of body substance isolation. Defend the need to prevent equipment contamination and maintain as sterile an environment as possible. Psychomotor Objectives: Psychomotor Objectives Demonstrate the ability to comply with body substance isolation guidelines. Participate in local clinic supervised by medical director or RN Demonstrate ability to follow all CDC Guidelines in regards to vaccine administration Demonstrate proper administration of influenza and pneumococcal vaccines Demonstrate ability to properly complete CDC documentation Demonstrate proper procedure for reporting and evaluating performance Public health principles relative to infectious (communicable) diseases: Public health principles relative to infectious (communicable) diseases Infectious diseases affect entire populations of humans Important to understand the demographic characteristics of the population The relationships between populations is important when studying the dynamics of infectious diseases The study of an infectious disease cluster (a discrete population which is infected in a defined span of time in a defined geographical area) is, by its nature, regional; however, the consequences of that cluster becoming infected may be international Public health principles relative to infectious (communicable) diseases: Public health principles relative to infectious (communicable) diseases Populations display varying susceptibilities to infection, and conversely, varying degrees of susceptibility When dealing with infectious diseases, the paramedic needs to consider the needs of the patient and the potential consequence on public health Worldwide Deaths: Worldwide Deaths Infectious Disease Mortality in the USA 1900 to 1996: Infectious Disease Mortality in the USA 1900 to 1996 Epidemic: Epidemic Outbreak of disease that affects a much greater number of people than is usual for the locality or that spreads to regions where it is ordinarily not present Pandemic: Pandemic Epidemic over a wide geographic area and affecting a large proportion of the population Breeding Ground for Pandemic: Breeding Ground for Pandemic Places where people come in contact with sick animals that are ill due to viruses or bacteria that can be transmitted to humans If the illness then can be transmitted person to person you have the ingredients for a pandemic In 1918 social disruption, cramped military quarters, exposure to new viruses all led to the creation of a pandemic Influenza: Influenza “The Flu” Highly contagious viral infection of the nose, throat and lungs Types of Influenza Viruses: Types of Influenza Viruses Influenza is an RNA virus Type A & B Cause respiratory symptoms Cause the most hospitalizations and death Changes each year Type C Mild, do not cause symptoms Type A: Type A Categorizes according to 2 proteins that determine infection Hemagglutinin (H) which attaches to cell leading to infection Neuraminidase (N) penetrates into cell These two proteins determine immunity, infection, severity and diagnosis of flu Also infects horses, pigs, birds Influenza Concerns: Influenza Concerns The influenza Type A viruses that are presently infecting humankind are: A(H1N1)- or "Spanish Flu" and A(H3N2)- or "Hong Kong Flu". A(H1N2)-a re-assortment of the above Influenza Pandemic History : Influenza Pandemic History 1918 Spanish Flu 1957 Asian Flu 1968 Hong Kong Flu 1997 Avian Flu 1918 Spanish Flu A(H1N1) : 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 1918 Pandemic – Deaths per 1,000: 1918 Pandemic – Deaths per 1,000 1957 Asian Flu A(H2N2): 1957 Asian Flu A(H2N2) 1 – 2 million deaths worldwide 70,000 USA deaths Attack rates greatest among school age Death rates were highest among elderly Science and technology advancement enabled vaccine 1968 Hong Kong Flu A(H2N2): 1968 Hong Kong Flu A(H2N2) 700,000 deaths worldwide (34,000 USA) 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 1997 Avian Influenza A(H5N1): 1997 Avian Influenza A(H5N1) Avian (bird) influenza (flu) Occurs naturally among birds Infection can occur in humans 1997 Avian Influenza A(H5N1): 1997 Avian Influenza A(H5N1) Most cases of 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 and with limited, inefficient sustainability Bird Flu (Avian Flu)1997 - 2007: Bird Flu (Avian Flu)1997 - 2007 Slaughter of chickens occurred to removed source of infection to humans Since May 31, 2007: 309 cases with 187 deaths from Avian Flu Currently World Health Organization (WHO) is keeping surveillance. www.who.org for the most up to date information Great Reading: Great Reading Influenza Vaccine: Influenza Vaccine Vaccine is an inactivated virus, except in new nasal spray where it is a live virus Manufactured in eggs Takes six months to manufacture adequate vaccine Most effective if given within 2-4 months of illness Manufactured in eggs: Manufactured in eggs Influenza Vaccine: Influenza Vaccine 90% effective in preventing illness in the healthy 50-60% effective at preventing hospitalization in elderly 80% effective at preventing death Influenza Vaccine: Influenza Vaccine Includes 2 likely "A" strains and one "B" strain Because of viral changes year to year, vaccination only effective against this years likely strain May protect against severe illness in similar strains 2006 – 2007 Vaccine: 2006 – 2007 Vaccine A(H1N1), A(H3N2) and B antigen Because A(H1N2) viruses are re-assortments of A(H1N1) and A(H3N2) viruses, antibodies directed against A(H1N1) and A(H3N2) vaccine strains should provide protection against the circulating influenza A(H1N2) Principles of Vaccination: Principles of Vaccination A live or inactivated substance (e.g., protein, polysaccharide) capable of producing an immune response Protein Molecules (immunoglobulin) produced by B lymphocytes to help eliminate an antigen (antibodies) Vaccination: Vaccination Active immunity produced by vaccine Immunity and immunologic memory similar to natural infection but without risk of disease Principles of Vaccination: General Rule: The more similar a vaccine is to the disease-causing form of the organism, the better the immune response to the vaccine. Principles of Vaccination Inactivated Vaccines: Inactivated Vaccines Influenza Vaccine is an inactivated vaccine Virulent virus grown in tissue culture then treated with formaldehyde so it cannot reproduced in humans Injection form Live Attenuated Vaccine: Live Attenuated Vaccine Pathogen grown in animal or tissue culture under conditions that make it less virulent. Nasal Spray Form Influenza Clinical Features: Influenza Clinical Features Incubation period 2 days (range 1-4 days) Severity of illness depends on prior experience with related variants Abrupt onset of fever, myalgia, sore throat, nonproductive cough, headache Influenza Complications: Influenza Complications Pneumonia secondary bacterial primary influenza viral Reye syndrome Myocarditis Death 0.5 -1 per 1,000 cases Healthcare Flu Vaccination: 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 Healthcare Flu Vaccination: Healthcare Flu Vaccination Goal is to replicate the published Mobility and Mortality Weekly Report (MMWR), where hospitals were able to raise vaccination rates to near 90% Influenza vaccine 90% effective in preventing disease in healthy and effective at reducing deaths and hospitalizations in elderly and children Influenza vaccinations provides for real time opportunity for real time practice in annual flu clinics Influenza Vaccine Indications: 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 Influenza Vaccine Contraindications: 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 Influenza Vaccine (Injection)Side effects: 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 Influenza Vaccine Live Attenuated (Nasal-Spray) Side Effects: 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 Influenza Vaccine Dose (Injection): Influenza Vaccine Dose (Injection) 0.5ml intramuscular injection in the deltoid with a 1 -11/2 inch 22-25 gauge needle Pneumococcal Pneumonia: 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 An Ounce of Prevention: An Ounce of Prevention During the past decade many strains of pneumococcus have become resistant to antibiotics Vaccination prevents contracting the disease Polysaccharide Vaccines: 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 immune response Pneumococcal Polysaccharide Vaccine: Pneumococcal Polysaccharide Vaccine 23 subtypes will result in immune response in 80% 88% protective 8% additional cross reaction Lasts for 10 years Reduces complications from pneumonia Pneumococcal Polysaccharide Vaccine Indications: Pneumococcal Polysaccharide Vaccine Indications People over 65 years of age Children over 2 years of age with chronic illness Pneumococcal Polysaccharide Vaccine Contraindications: Pneumococcal Polysaccharide Vaccine Contraindications Allergy Moderate to severe illness Pneumococcal Polysaccharide Vaccine Side events: Pneumococcal Polysaccharide Vaccine Side events Local reaction Myalgia and fever Pneumococcal Polysaccharide Vaccine Dose: Pneumococcal Polysaccharide 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 Severe Adult Respiratory Syndrome (SARS): 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. Severe Adult Respiratory Syndrome: Severe Adult Respiratory Syndrome Believed to have crossed the species barrier recently from animals to humans Himalayan masked palm civet, Chinese ferret badger and raccoon dog, all consumed as delicacies in southern China have shown evidence of infection So why are we here?: So why are we here? Why are we here?: Why are we here? You are here to review and be updated on infectious diseases of greatest concerns associated with immunization You are here to learn the CDC guidelines and federal laws associated with immunizations You are here to learn how to properly administer the federally required documentation. You are here learn how to assist State Health Officials in the event of a public health crisis or under the written order of a physician. You are NOT here to learn how to give IM injections, however you will be demonstrating your skill proficiency NH Immunization Protocol 5.15: NH Immunization Protocol 5.15 Required forms/documents: 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 Vaccine Administration Procedure: Vaccine Administration Procedure Reference Appendix CDC Immunization Guide CDCs “Pink Book” Epidemiology and Prevention of Vaccine-Preventable Diseases Each Patient is to Receive a Vaccine Information Sheet (VIS): Each Patient is to Receive a Vaccine Information Sheet (VIS) It’s Federal Law!: It’s Federal Law! VIS Resourcehttp://www.cdc.gov/nip/publications/VIS/default.htm: VIS Resource http://www.cdc.gov/nip/publications/VIS/default.htm Screen and complete CDC’s Questionnaires: Screen and complete CDC’s Questionnaires Storage and administration of vaccine per CDC recommendation: 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 Influenza and Pneumococcal Vaccine Procedure: 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 - 11/2 inches needle Location: Deltoid muscle Influenza and Pneumococcal Vaccine Procedure: 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 Influenza and Pneumococcal Vaccine Procedure: Influenza and Pneumococcal Vaccine Procedure Have available on site, agents to treat anaphylaxis including, but not limited to, epinephrine and necessary needles and syringes. Intramuscular Injection: Intramuscular Injection Intramuscular Injection: Intramuscular Injection Caution: Caution Special situations are to be avoided in pre-vaccine screening. (bleeding disorders, latex allergies, limited sites,) Documentation: Documentation Date Name Vaccine lot number Manufacturer Site Vaccine information sheet Information of those refusing vaccine Required Record: Required Record Review of Record: Review of Record Paramedic’s Skills Checklist for Immunization: Paramedic’s Skills Checklist for Immunization A Separate Skills Checklist for Pediatrics: A Separate Skills Checklist for Pediatrics Require forms/documents: Require forms/documents Its Federal Law Screening Questionnaire Do I Need a Vaccine Today? Vaccine Information Sheets (VIS) Vaccine Administration Record Skills Checklist for Immunization Sources: Sources State of NH Immunization Quality Management Quarterly Report Adult Influenza Standing Orders www.immunize.org/catg.d/p3074.pdf * item #P3074 (8/05) Child Adolescent Influenza Standing orders www.immunize.org/catg.d/p3074a.pdf * item #P3074a (8/05) Adult Pnuemococcal Standing Orders www.immunize.org/catg.d/p3075.pdf * item #P3075 (06/04) Child Teen Pnuemococcal Polysaccharide Standing Orders www.immunize.org/catg.d/p3075a.pdf * item #P3075a (5/06) Adult Screening www.immunize.org/catg.d/p4065scr.pdf * item #P4065 (2/06) Child & Teen Screening www.immunize.org/catg.d/p4060scr.pdf * item #P4060 (5/06) Do I Need Any Vaccinations Today www.immunize.org/catg.d/4036need.pdf * item #P4036 (8/06) Adult Skills Checklist www.immunize.org/catg.d/2020skill.pdf IMM-694B (9/01) Pedi Skills Checklist www.cdc.gov/nip/publications/pink/appendices/D/skills-checklist.pdf Adult Admin Record www.immunize.org/catg.d/p2023b.pdf item #P2023 (10/05) Child & Teen Admin Record www.immunize.org/catg.d/p2022b.pdf item #P2022 (5/06) Its Federal Law http://www.immunize.org/catg.d/2027law.pdf item #P2027 (4/06) Vaccine Information Statement (VIS): Influenza Vaccine What I Need to Know http://www.cdc.gov/nip/publications/VIS/vis-flu.pdf VIS: Pnuemococcal Polysaccharide What I Need to Know http://www.cdc.gov/nip/publications/VIS/vis-ppv.pdf Most Current VIS: http://www.cdc.gov/nip/publications/VIS/default.htm Questions?: Questions?