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The Vac-Scene Newsletter
Volume 6, No. 6 - November-December 2000
Flu Season Info Now Available Online!
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Interested in getting the latest information on influenza in King County? The new Flu Season Update web page can be found at www.metrokc.gov/health/immunization/fluseason.htm. The website gives the public and health care providers regularly updated information on influenza surveillance in King County, as well as updates on the availability of influenza vaccine at Public Health clinics.
As of December 19th, there has been one culture-confirmed case of influenza in King County detected through Public Health's lab surveillance system. Only a few sporadic cases have been reported elsewhere in the United States, which is typical for this time of year. Flu season in King County normally begins in January.
Production delays caused late delivery of about half of the area's shipments of vaccine this flu season. Despite the delays, most health care providers in King County now have an adequate supply.
Please remember that those at high risk for influenza-related complications may also need immunization against pneumococcal pneumonia. The vaccine to protect against pneumococcal disease is usually only needed once in a lifetime, and is recommended for:
- people over age 65;
- those who have certain chronic illness or immune deficiencies;
- residents of long term care facilities, or
- certain Native American/Alaskan Native populations.
More information on influenza and pneumococcal pneumonia immunizations can be found on the Public Health website at http://www.metrokc.gov/health/prevcont/influenza.htm. Additional information about influenza vaccine availability may also be obtained from the American Lung Association's Hotline (206-441-5100, ext. 83) and the Centers for Disease Control and Prevention's website at http://www.cdc.gov/ncidod/diseases/flu/weekly.htm.
News From The Public Health Vaccine Distribution Program
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PRIORITIZING Td USAGE
The Td (tetanus/diphtheria) vaccine shortage in the U.S. is expected to continue until at least spring 2001. In light of this vaccine shortage, the Centers for Disease Control and Prevention has recently issued guidelines for prioritizing its use. The CDC recommends that "clinics experiencing shortages of Td may need to prioritize their use of available supplies. If administration of Td is delayed, clinics should implement a call-back system when vaccine is available. Recommendations for use (highest to lowest priority) of Td are:
- Persons traveling to a country where the risk for diphtheria is high.
- Persons requiring tetanus vaccination for prophylaxis in wound management.
- Persons who have received <3 doses of vaccine containing Td.
- Pregnant women and persons at occupational risk for tetanus-prone injuries who have not been vaccinated with Td within the preceding 10 years.
- Adolescents who have not been vaccinated with a vaccine containing Td within the preceding 10 years.
- Adults who have not been vaccinated with Td within the preceding 10 years."
(See www.cdc.gov/mmwr/preview/mmwrhtml/mm4945a3.htm for full text).
For children who are referred to your practice by school nurses, you may choose to defer the Td until Spring 2001 if they have completed a primary series containing tetanus and diphtheria toxoids. Recall these patients when the regular supply of Td vaccine resumes.
STATE SUPPLIED FLU VACCINE
All state-supplied influenza vaccine for high-risk children in King County has been distributed. King County received their allotment in late October and therefore could complete distribution of most of the vaccine within the first two weeks of November. Thank you to all providers for your patience during distribution. For further questions about this please call Vaccine Program staff at 206-296-4782.
CONTRACT RENEWAL FOR STATE-SUPPLIED VACCINE
Providers receiving state-supplied vaccines need to renew Outside Provider Agreements annually to remain in the Vaccine Program. This year, Agreement Renewal packets will go out in January. Clinics must return signed copies of the Agreement by the end of February in order to continue to receive state-supplied vaccines. Clinics should instruct staff who receive and route mail to look for this packet in early January and bring it to the attention of the clinic manager or medical director. Providers are advised to read the Agreement carefully. The Agreement contains important requirements. These requirements need to be incorporated into the clinic protocols and routines to assure that all staff understand and comply.
BENCHMARKING IN MAY 2001
Providers receiving state-supplied vaccines are asked to participate in an annual benchmarking activity. This statewide survey provides valuable information needed for continued federal funding to purchase vaccines. In 2001, benchmarking will occur during the month of May. In prior years, benchmarking was held in August. Because August is one of the busiest immunization months in the year, benchmarking is being held earlier this year to make it easier for providers to collect the required information. In addition, the Washington State Immunization Program selected May as a month that may more accurately reflect the age distribution of children routinely receiving immunizations. Please watch for the arrival of benchmarking training materials and supplies in late March. Your participation is greatly appreciated and vital to the sustainability of the program.
Web-Based Training on Hepatitis C
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The Centers for Disease Control and Prevention's Hepatitis Branch has a new web-based training program for health professionals on hepatitis C. The program offers continuing education credits to physicians and nurses while they learn about the epidemiology, diagnosis, and management of hepatitis C virus (HCV) infection and HCV-related chronic disease.
If you are interested in a fun and informative review of hepatitis C-related issues, go to the following website: www.cdc.gov/ncidod/diseases/hepatitis/ and click on "Hepatitis C, online training." The name of the training is "Hepatitis C: What Clinicians and Other Health Professionals Need to Know."
National Survey Reveals Parents Misconceptions About Immunization
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Health professionals play an important role in helping parents make informed immunization decisions for their children. This is the conclusion of a study highlighted in the November 2000 issue of Pediatrics: "Do Parents Understand Immunizations? A National Telephone Survey" by Bruce Gellin, MD, MPH, Edward Maibach, MPH, PhD and Edgar Marcuse, MD, MPH.
The study found that while a majority of parents understand the benefits of immunization, many have misconceptions that could erode their confidence in vaccines. For example:
- 25% of respondents were concerned that their child's immune system could be weakened by too many immunizations
- 23% believed that children get more immunizations than are good for them
According to the article, "To compete effectively in today's information marketplace, clinicians and public health officials must understand parents' thinking about vaccine-preventable diseases, vaccines, and immunization policies to design effective public education programs that assist parents to make informed decisions about their children's health." Because parents identified their children's health care providers as their most important source of information about immunizations, physicians, nurses, and other providers of primary care have an excellent opportunity to educate parents. An online abstract of this article can be found at: www.pediatrics.org/cgi/content/abstract/106/5/1097
"Plain Talk About Childhood Immunizations" is a 32-page booklet that responds to parents' concerns and addresses misperceptions about immunizations. King County providers can order a packet of 25 free copies by calling 206-296-4774. Outside of King County, please call the Washington Department of Health materials warehouse at (360) 664-8797. The booklet is also online at www.metrokc.gov/health/immunization/childimmunity.htm.
The above was excerpted from IAC Express #213, sponsored by the Immunization Action Coalition (IAC), publishers of Needle Tips and Vaccinate Adults. The IAC website can be found at www.immunize.org.
Want to find out when the latest Vac Scene newsletter becomes available online? Subscribe to the Vac Scene Alert by clicking here. Submit your email address and you automatically become an online Vac Scene subscriber (this will not cancel your hardcopy subscription).
Physician Prompts Increase Use of Vaccines
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According to a study reported in the Archives of Internal Medicine, prompting physicians to provide preventive care, such as a flu shot, can significantly increase the rate at which patients receive these services.
The investigators identified 33 studies involving over 55,000 patients that assessed the effects of physician prompts on the use of a variety of preventive care procedures. Physician prompts, such as checklists attached to patient's charts, tagged notes or stickers, and computerized forms, increased the use of influenza vaccine by more than 18 percent.
"Vigorous application of this simple and effective information intervention could save thousands of lives annually," according to the investigators. "The results of this study document that prompting physicians can lead to a significant improvement in health maintenance. The many prompting tools offer a wide selection of options that are equally effective and easily applicable in most healthcare organizations."(Archives of Internal Medicine 2000; 160:301-308).
Use of DTaP As a Five-Dose Series
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Four vaccines containing diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) are currently licensed in the United States for use among infants and young children.
The CDC's Advisory Committee on Immunization Practices has reported increasing local reactions with the administration of the fourth and fifth consecutive doses. Increases in the frequency and magnitude of local reactions at the injection site have occurred for all currently licensed DTaP vaccines. Extensive swelling of the injected limb, sometimes involving the entire thigh or upper arm, after receipt of the fourth and fifth doses of DTaP vaccines has been demonstrated for multiple products from different manufacturers.
Increases in erythema, swelling, and pain at the injection site and increases in fever have been reported with the fourth dose as compared with the first dose for each of the currently licensed DTaP vaccines. These reactions typically have onset within 2 days of vaccination and resolve completely without sequelae. Available data demonstrate further increases in the local reaction with the fifth dose compared with the fourth dose. Swelling involving the entire thigh or upper arm has been reported after booster doses of all types of acellular pertussis vaccines. Swelling began within 48 hours of booster dose administration, and lasted an average of 3.9 days. For a limited number of children who received the shot in the thigh, the swelling interfered with walking; but for the majority of children, no limitation of activity was experienced.
A history of extensive swelling after the fourth dose should not be considered a contraindication for the receipt of the fifth dose of the DTaP series. Reports to date indicate that the reactions are self-limited and there is recognized benefit of the preschool dose of DTaP. Because data are insufficient regarding the safety, immunogenicity, and efficacy of using DTaP vaccines from different manufacturers in a mixed sequence, ACIP continues to recommend that, whenever feasible, the same brand of DTaP vaccine be used for all doses in the vaccination series. However, when the vaccine provider does not know or does not have available the type of DTaP vaccine previously administered, any licensed DTaP vaccine can be used to complete the series.
Parents or caregivers of children receiving the fourth and fifth doses of the DTaP series should be informed of the possible increase of these local reactions. Reactions should be reported to the provider for evaluation as they may be clinically indistinguishable from other conditions (e.g. cellulitis) that require treatment.
The above article was excerpted from the November 17, 2000 issue of MMWR Recommendations and Reports "Use of Diphtheria Toxoid-Tetanus Toxoid- Acellular Pertussis Vaccine as a Five-Dose Series". It is also available on-line at: www.cdc.gov/mmwr/preview/mmwrhtml/rr4913a1.htm.
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key sites
Flu Season Update
 Learn about the latest case results affecting King County residents, fact sheets and where to get your flu shot.
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