Vaccines and Adults

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					 Hosting an On-Site Flu Clinic:
How to Make Flu Immunization
Convenient for Your Employees

       Vaccinate for Life.
    The Texas Department of State Health Services
                Immunization Branch
       Adolescent/Adult Immunization Program
          Presentation Objectives
   Agency Wellness Coordinator’s will be able
       Explain the benefits of employee influenza
        vaccination programs.
       Assess the need and capacity for an on-site
        influenza vaccination program.
       Identify potential contract agencies for on-site
        influenza vaccination programs.
       Screen potential contractors for quality and
        appropriateness of medical care.
                 Flu Symptoms
   Sudden onset symptoms           runny or stuffy nose
    of flu include :                muscle aches
      fever (usually high)         Stomach symptoms,
      headache                      such as nausea,
      extreme tiredness             vomiting, and diarrhea,
      dry cough
                                     also can occur but are
                                     more common in
      sore throat
                                     children than adults

Complications of Flu: Complications of flu can include
bacterial pneumonia, ear infections, sinus infections,
dehydration, and worsening of chronic medical conditions,
such as congestive heart failure, asthma, or diabetes.
                               The Impact of Flu
    Every year in the United States, on average:
       5% to 20% of the population gets the flu;
       more than 200,000 people are hospitalized from flu-
         related complications; and
       about 36,000 people die from flu-related causes.
    Some people, such as older people, young children, and
     people with certain health conditions (such as asthma,
     diabetes, or heart disease), are at high risk for serious
     flu complications.

    Impact of Flu at the Workplace
   Lost productivity by employee out sick and
    by those filling in the gap.
   Average number of days away from the
    office is 2-4 days (if not hospitalized).
   Hospitalized employees away from work
    for 1-2 weeks.
   Employees with children more likely to
    contract the flu (if not vaccinated).
         Assessing the Need
   Questions your agency needs to ask
    before hiring a contractor:

     Do you want to hold an Employee
      Immunization Clinic?
     Do your employees want a clinic?

     Is the clinic open to the employee’s
      family members?
            Assessing the Need
   More questions your agency needs to ask
    before hiring a contractor:
      Are you planning to contract out the
      If you are contracting the clinic out, are
       there any special circumstances
       required for you to do so?
      Are there agencies in the area which
       you could hire for their services?
Identify Potential Contract Agencies

   Home health agencies.
   Local health agencies such as a hospital,
    group medical practice, or health
   Other medical service organizations who
    specialize in giving vaccines to companies.
Screening potential contractors for
  quality and appropriateness of
           medical care.

   Finding the least expensive is not always
    the best idea.

   Ask the following questions when
    approaching a potential contractor:
    Potential Contractor Questions
    Do you conduct Employee immunization
     clinics on site?
    How long have you been doing this type
     of clinic?
    Who are some of the agencies you have
     conducted clinics for? (Local References)
    Who is your Medical Director and where
     are they licensed?
    Do they have privileges to practice in
    Potential Contractor Questions
   What vaccines are you able to administer?
   What is the charge per shot (to the
   Is there a price break for larger number of
    persons receiving shots?
   Would you be able to vaccinate the
    employee’s family members? (what ages)
   How many employees/family members
    could you vaccinate in what period of
    Potential Contractor Questions

   Are you able to schedule our agency for
    an immunization clinic by________?
   Who will be administering the shots?
   What are their credentials? (they all must
    be licensed in Texas)
   How will the cold chain be maintained?
   Do you have Standing Delegating Orders
    and can you submit a copy for
    Potential Contractor Questions

   What emergency arrangements will be
   Will you be responsible for set up and tear
    down on the day of the clinic?
   How will payment need to be made?

For further technical assistance contact:
         Susan Belisle, RN, BSN
            Nurse Consultant
          Immunization Branch
         512-458-7111 ext 3802
Recommended Adult Vaccines
Adult and Adolescent Immunization Program
               Vaccines For Adults
    Who Should Get The Following Vaccines?

        Td/Tdap
        Influenza
        Shingles/Zoster
        Varicella
        Pnuemococcal
Adult and Adolescent Immunization Program
            Vaccines For Adults
    Who Should Get The Following Vaccines?

       HPV
       MMR

       Meningococcal

       Hepatitis A

       Hepatitis B
  Vaccine Adverse Event
Reporting System (VAERS)
                               VAERS Background
          US postlicensure vaccine safety surveillance
                Collects voluntary reports of adverse events
                 following immunization
                Co-managed by CDC and the Food and Drug
                 Administration (FDA)
          Healthcare providers are encouraged to
           report clinically significant adverse events
           after vaccination*
                Anyone can submit a report to VAERS
          Receives ~23,000 reports per year (2005-
           2008 average)
          Data publicly available

*Clinically significant means of concern to the healthcare provider or vaccinee/ care giver or
other VAERS reporter;
                  VAERS Strengths

   Can detect very rare adverse
   Generates hypotheses
       Helps identify new and/or rare
        adverse events following
       Helps determine if further
        investigations are needed
   Monitors trends of already known
    adverse events
   Monitors vaccine lot safety
                   VAERS Limitations
   Risk of underreporting
   Stimulated reporting due to media
    attention and other factors
   Possibly incomplete and inaccurate
    data on report form
   Lack of availability of denominator
       No information on number of persons
       No information on background rates of
        adverse events in the population
   VAERS generally cannot determine if
    an adverse event was coincidental
    or caused by a vaccine
                 What to Report to VAERS

     Report any clinically significant adverse event
      following immunization (
        Adverse event of concern to the healthcare provider
          or vaccinee/caregiver or other VAERS reporter

     The National Childhood Vaccine Injury Act of 1986
      mandates that healthcare providers report specific
      adverse events that occur after immunization for some
          Events listed in the vaccine package insert
          Events listed in the Table of Reportable Events

*The National Childhood Vaccine Injury Act does not apply to 2009 H1N1 vaccines
           What to Report to VAERS (cont.)

   Submit reports of adverse
    events, even when not              demographics
    sure whether the vaccine
    caused the adverse event
   Include as much
    information as possible in                AE
    the report (e.g.,
    vaccination location, date,
    vaccine type, lot number                   vax
    and dose number)
       Reports with incomplete
        information accepted
   Report as soon as possible
    but no time limit on
    VAERS definition of “Serious” Reports*

   Death
   Life-threatening illness
   Hospitalization
   Prolonged existing
   Persistent or significant
   Certain other medically
    important conditions
                                Box 8 of VAERS form

*Code of Federal Regulations
Title 21 (21CFR 314.80)
                                            VAERS Reports*
                                   Serious and Non-Serious
     92% of VAERS                                        8% of VAERS reports are
      reports are “Non-                                    “Serious”*
      Serious”                                            Most frequent serious
                                                           adverse events**
     Most frequent                                             Fever
      adverse events**                                          Vomiting
           Local reactions                                     Headache
           Fever                                               Dyspnea
           Rashes or itching                                   Convulsions
           Headache                                            Pain
                                                                Diarrhea
           Dizziness
                                                                Weakness

    *Data from 91,669 VAERS reports received during 2005 through 2008
    Source: VAERS , CDC Wonder
** A vaccinee may have had more than one adverse event listed in the report