1. Immunizations – Everyone Every Age Joan Bowe, RN, BSN Director, Personal Health Division Chair, AICCO

2. j Vaccine4me.com

3. Historical Perspective “Baby” shots, tetanus boosters, flu and outbreak related efforts 1970’s: OPV, DTP, M, M, R and Td 1980’s: MMR Vaccinations valued because diseases still seen as worse threat

4. Current Scenario Vaccine-preventable diseases not seen much in U.S. but still common elsewhere – just an airplane away Numerous combination vaccines ACA and first dollar coverage

5. Infant/Childhood Vaccines

6. 1983 Immunization Schedule

7. 1996 Schedule

8. 2010 schedule 2005 immunization schedule

9. How Many Vaccines Can A Baby Handle? Given an estimate of the B cells required to protect against a protein – 10,000 vaccines at one time. Giving 11 vaccines at one time uses.1% of the immune capabilities Offit, Quarles, Berger, et al Pediatrics, 109:1, 2002, 124-129

10. So How Good/Bad Are We? For children’s vaccination status – getting all shots recommended by age 2 by age 3 Ohio ranks in bottom third of country. 68.1% Highest is Maine 84.7% Herd or community immunity is considered achieved at ~90%

13. Adolescent Vaccines

14. Best Age/Need for Boosters Identified need for boosters has added many of the vaccines to the adolescent – age 12 – 17 Risk behaviors have determined the rest Routinely scheduled doctor visits also play a part in the vaccine schedule

15. Adult Vaccines

16. 2002-03 adult schedule – first one published.

17. Compared to Children: Adults age 65 and over are 100x more likely to die of a vaccine preventable disease. McLaughlin, Pfizer, State Immun Conf 2015

18. Direct and Indirect Costs of VPD Age 50 and Older in Ohio - 2013 DiseaseDir. Cost $M Indirect Cost $M Flu 498.3 128.0 Pneumo 183.4 17.6 H. Zoster 72.9 125.3 Pertussis 6.6 9.0 Total $761.2M $279.8M

19. Vaccination rates - national Pneumococcal vaccine <60% adults 65 and older High risk 50 – 64 years 32% High risk 18 – 49 years 14% Tetanus 56-64% Tdap 29% with infant Zoster 24% HPV – 37% women 6% men

22. Effectiveness of Vaccine Zoster – 51% against shingles, 66% against PHN and almost 80% against prolonged PHN Pneumococcal PCV 13 – 45% pneumonia 75% against invasive disease Flu - 60-70% younger, 30% older than 65

23. HBV Vaccine Hepatitis B vaccine: 90% effectiveness after completing a 3-dose series, though lower in persons with diabetes, e.g. 90% with diabetes and age <40 years, 80% with diabetes and 41 ‒ 59 years, 65% if 60 ‒ 69 years and <40% if 70 years or older

24. Influenza Vaccination Rates

25. We Are Not Alone! j

26. Storytime Eco-challenges Mission Trips Vacations Business Trips

28. VPD Around the World Endemic in some areas No strong prevention ethic in others Access to vaccine and care an issue in some regions

29. More Diseases Coming!VPD? Dengue Chikungunya MERS Malaria

30. Why Should You Care/ What Can You Do? Persons with co-morbidities at higher risk for complications. - Diabetes - Obesity - Heart/lung disease - Kidney, Immune…..and more

31. Healthcare Provider Recommendation Number 1 most effective method to increase immunization rates.

32. National Adult Immunization Standards Updated and released September 2013. Aimed at ALL providers, not just those who give vaccine

33. Adult Immunization Standards  Stresses that all providers, including those that don’t provide vaccine services, have a role in ensuring patients are up-to-date on vaccines  Acknowledges that:  Adult patients may see many different healthcare providers, some of whom do not stock some or all vaccines  Adults may get vaccinated many places now  Aim is to avoid missed opportunities

34. What Can You Do? ASSESS RECOMMEND ADMINISTER/REFER DOCUMENT

35. Assess At every encounter assess for vaccine need Personal health and risk behaviors change Follow up on whether they got the recommended vaccines Your EHR can help with this – you can adjust the settings for vaccines you want to track

36. Recommend Cannot be stressed enough – healthcare provider recommendations work! Share personal stories/viewpoints “I recommended this to my mother”

37. Provide or Refer If you have it give it. It helps no one in the fridge. If you don’t have it, make yourself aware of referral options. Be specific with your referrals. “The Health Dept. is hosting a clinic at the Sr. Ctr. Tues.” “Walgreens is a block from your house.”

38. Need Referral Resources? Vaccine4me.com Vaccine.healthmap.org Local Health Department website

39. Good vs Bad Vaccine Websites

42. Some Reputable Sites CDC.gov - info on all ages including travel vaccines Immunize.org – handouts, assessment tools, vaccine information sheets Pkids.org Healthychildren.org – from AAP Vaccine Education Center

43. Document Can be the most difficult State registry access: ODH.Ohio.gov Search for IMPACT SIIS Use your HER, so if in a system everyone can see. Give the client something to keep themselves

44. Immunization Rates Are In Our Hands Will we rise to the challenge and help?

45. TEST YOUR KNOWLEDGE! j

46. Contact Information Joan Bowe, RN Director, Personal Health Division jbowe@delawarehealth.org 740-203-2032