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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
                   800-252-9152
             www.ImmunizeTexas.com
          Presentation Objectives
   Agency Wellness Coordinator’s will be able
    to:
       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.

Source: http://www.cdc.gov/flu/keyfacts.htm
    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
       clinic?
      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
    department.
   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
     Texas?
    Potential Contractor Questions
   What vaccines are you able to administer?
   What is the charge per shot (to the
    employee)?
   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
    time?
    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
    examination?
    Potential Contractor Questions

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

For further technical assistance contact:
         Susan Belisle, RN, BSN
            Nurse Consultant
          Immunization Branch
         512-458-7111 ext 3802
     susan.belisle@dshs.state.tx.us
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; www.vaers.hhs.gov
                  VAERS Strengths

   Can detect very rare adverse
    events
   Generates hypotheses
       Helps identify new and/or rare
        adverse events following
        immunization
       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
    data
       No information on number of persons
        vaccinated
       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 (www.vaers.hhs.gov)
        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
      vaccines.*
          Events listed in the vaccine package insert
          Events listed in the Table of Reportable Events
           http://vaers.hhs.gov/pdf/ReportableEventsTable.pdf

*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
    reporting
    VAERS definition of “Serious” Reports*

   Death
   Life-threatening illness
   Hospitalization
   Prolonged existing
    hospitalization
   Persistent or significant
    disability
   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 http://vaers.hhs.gov/index , CDC Wonder http://wonder.cdc.gov/
** A vaccinee may have had more than one adverse event listed in the report