1. Rosemary Spence, RN MA Adult/Adolescent Immunization Coordinator Colorado Immunization Program Home Care Advisory Meeting November 4, 2009

2. Presentation Overview What immunizations are recommended for healthcare workers, and what diseases are prevented? What immunizations are recommended for patients, and what diseases are prevented? Where are low-cost immunizations available? What can be expected after receiving an immunization?

3. Healthcare Worker (HCW) Immunization Recommendations Hepatitis B vaccine Influenza (both seasonal and H1N1) vaccines MMR (measles, mumps, rubella) vaccine Varicella (chickenpox) vaccine Td or Tdap (tetanus, diphtheria, pertussis-aka “whooping cough”) vaccine

4. Hepatitis B Serious disease that affects liver Caused by hepatitis B virus (HBV) Can cause acute (short-term) illness: Loss of appetite Tiredness Diarrhea and vomiting Jaundice (yellow skin or eyes) Muscle, joint, and stomach pain

5. Hepatitis B Some develop chronic HBV infection Chronic HBV infection often leads to: Liver damage (cirrhosis) Liver cancer Death Those infected can spread HBV to others, even if they don’t appear sick HBV is spread through contact with blood or body fluids of an infected person

6. Hepatitis B Hepatitis B vaccine can prevent hepatitis B Hepatitis B vaccine is usually given as a series of 3 or 4 immunizations

7. Seasonal Influenza Caused by influenza virus, which can be spread by coughing, sneezing, or nasal secretions Can occur any time from November through May Influenza can cause: Fever Cough Sore throat Chills Muscle aches Fatigue Headache

8. Seasonal Influenza For most people, influenza lasts only a few days Some people, such as infants, older adults, and those with certain health conditions, can get much sicker Can cause high fever and pneumonia, and make existing medical conditions worse Influenza vaccine can prevent influenza

9. Seasonal Influenza Two types of seasonal influenza vaccine: Inactivated vaccine or “flu shot” Live, attenuated (weakened) influenza vaccine is sprayed into nostrils and may be given to non-pregnant, healthy HCWs ages 49 years and younger These vaccines do not protect against H1N1 influenza Influenza vaccines are updated every year and an annual immunization is recommended It takes up to 2 weeks for protection to develop after immunization and protection lasts for up to a year Can’t get influenza from influenza immunization

10. H1N1 Influenza Very contagious-appears to be spreading from human to human more easily than typical seasonal influenza Symptoms include: Fever Cough Sore throat Body aches Headache Chills Fatigue Diarrhea (in some people)

11. H1N1 Influenza May make underlying chronic medical conditions worse Risk for infection among people 65 years or older less than risk for younger age groups Priority groups when vaccine first becomes available: Pregnant women Caretakers of children younger than 6 months of age Healthcare and emergency medical services personnel People 6 months-24 years of age People 25-64 years with chronic health disorders or compromised immune systems

12. LAIV Questions Can contacts of people with weakened immune systems get the nasal-spray flu vaccine LAIV (FluMist®)? People who are in contact with others with severely weakened immune systems when they are being cared for in a protective environment (for example, people with hematopoietic stem cell transplants), should not get LAIV (FluMist®). People who have contact with others with lesser degrees of immunosuppression (for example, people with diabetes, people with asthma taking corticosteroids, or people infected with HIV) can get LAIV (FluMist®). Additional information: http://www.cdc.gov/FLU/about/qa/nasalspray.htm

13. Measles, Mumps, Rubella Measles, mumps, and rubella are serious diseases Measles virus causes rash, cough, runny nose, eye irritation, and fever Measles can lead to: Ear infection Pneumonia Seizures (jerking and staring) Brain damage Death

14. Measles, Mumps, Rubella Mumps virus causes fever, headache, and swollen glands Mumps can lead to: Deafness Meningitis (infection of brain and spinal cord covering) Painful swelling of testicles or ovaries Death (rarely)

15. Measles, Mumps, Rubella Rubella (German Measles) virus causes rash, mild fever, and arthritis (mostly in women) If a woman gets rubella while she is pregnant, she could have a miscarriage or her baby could be born with serious birth defects Measles, mumps, and rubella spread from person to person through the air Measles, mumps, rubella vaccine can prevent these diseases

16. Measles, Mumps, Rubella Adequate evidence of immunity to measles, mumps, rubella for persons who work in health care facilities: Measles and mumps: Documented administration of 2 doses of live virus measles and mumps vaccine or Laboratory evidence of immunity or laboratory confirmation of disease or Born before 1957 (caveats apply and are available at: http://www.cdc.gov/vaccines/recs/provisional/default.htm)

17. Measles, Mumps, Rubella Rubella Documented administration of one dose of live rubella virus vaccine or Laboratory evidence of immunity or laboratory confirmation of disease or Born before 1957 (except women of childbearing age who could become pregnant)((caveats apply and are available at: http://www.cdc.gov/vaccines/recs/provisional/default.htm)

18. Varicella (Chickenpox) Usually mild, but can be serious, especially in young infants and adults Causes rash, fever, and tiredness Can lead to: Severe skin infections and scars Pneumonia Brain damage Death

19. Varicella (Chickenpox) Can be spread from person to person through air, or by contact with fluid from chickenpox blisters Person who has had varicella can get painful rash called “shingles” years later Varicella vaccine can prevent varicella

20. Varicella (Chickenpox) Anyone who is not fully vaccinated, and never had varicella, should receive 1 or 2 doses of varicella vaccine

21. Tetanus, Diphtheria, Pertussis Tetanus (lockjaw) causes painful muscle spasms, usually all over the body Tetanus can lead to tightening of the jaw muscles so the victim can’t open his mouth or swallow Diphtheria causes a thick covering in the back of the throat Diphtheria can lead to breathing problems, paralysis, heart failure, and even death Pertussis (whooping cough) causes severe coughing, vomiting, and disturbed sleep

22. Tetanus, Diphtheria, Pertussis Tetanus enters body through cuts, scratches, or wounds Diphtheria and pertussis are spread from person to person

23. Tetanus, Diphtheria, Pertussis All adults should get a booster of Td every 10 years Adults under 65 who have never gotten Tdap should substitute it for next booster dose HCWs under 65 who have direct patient contact should get Tdap

24. Immunization Recommendations for Older Adults Zoster (shingles) vaccine Pneumococcal vaccine Seasonal influenza vaccine Tdap (tetanus, diphtheria, pertussis) vaccine

25. Zoster (Shingles) Shingles-painful skin rash, often with blisters Rash usually appears on 1 side of face or body and lasts from 2 to 4 weeks Other symptoms: Fever Headache Chills Upset stomach

26. Zoster (Shingles) Rarely, shingles infection can lead to pneumonia, hearing problems, blindness, brain inflammation, or death Post-herpetic neuralgia: severe pain continues even after rash disappears Chickenpox virus stays in body and can reappear many years later to cause shingles Can’t catch shingles form another person with shingles

27. Zoster (Shingles) More common in people 50 and older More common in people whose immune systems are weakened due to cancer, etc. Single dose of shingles vaccine is indicated for adults 60 year of age or older

28. Pneumococcal Pneumococcal disease can lead to serious infections of: Lungs (pneumonia) Blood (bacteremia) Brain covering (meningitis)

29. Pneumococcal Some at greater risk of getting disease: 65 years and older Very young People with certain health problems People with weakened immune system Smokers

30. Pneumococcal Usually only 1 dose of pneumococcal vaccine is needed for those 65 and over, but under some circumstances a second dose may be given

31. After Immunizations Common events after receiving an immunization: Redness, soreness, swelling at injection site Varies somewhat by immunization Information for each immunization available at: http://www.immunize.org http://www.immunize.org

32. After Immunizations Unusual events after receiving an immunization: Signs of serious allergic reaction can include: Difficulty breathing Hoarseness or wheezing Hives Paleness Weakness A fast heart beat Dizziness Usually occur within first few hours after immunization

33. After Immunizations If an unusual event occurs: Call doctor or get person to doctor right away Tell doctor what happened, date and time it happened, and when immunization was given

34. Resources Low cost immunizations are often available at local health departments and nursing services Visit Centers for Disease Control and Prevention’s (CDC) website: www.cdc.gov/vaccines or call them at: 1-800-CDC-INFOwww.cdc.gov/vaccines Visit Colorado Immunization Program’s website at: http://www.cdphe.state.co.us/dc/immunization/ H1N1 questions: CO HELP 1-877-462-2911 Flu Clinic Locator: www.immunizecolorado.orgwww.immunizecolorado.org Contact Rosemary Spence at 303/692/2798 or rosemary.spence@state.co.us