Rosemary Spence, RN MAAdult/Adolescent Immunization Coordinator

Colorado Immunization ProgramHome Care Advisory Meeting

November 4, 2009

Presentation OverviewWhat 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?

Healthcare Worker (HCW) Immunization Recommendations

Hepatitis B vaccine Influenza (both seasonal and H1N1) vaccinesMMR (measles, mumps, rubella) vaccineVaricella (chickenpox) vaccineTd or Tdap (tetanus, diphtheria, pertussis-aka

“whooping cough”) vaccine

Hepatitis BSerious disease that affects liverCaused by hepatitis B virus (HBV)Can cause acute (short-term) illness:

Loss of appetiteTirednessDiarrhea and vomitingJaundice (yellow skin or eyes)Muscle, joint, and stomach pain

Hepatitis BSome develop chronic HBV infectionChronic 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

Hepatitis BHepatitis B vaccine

can prevent hepatitis B

Hepatitis B vaccine is usually given as a series of 3 or 4 immunizations

Seasonal Influenza Caused by influenza virus, which can be spread

by coughing, sneezing, or nasal secretionsCan occur any time from November through MayInfluenza can cause:

FeverCoughSore throatChillsMuscle achesFatigueHeadache

Seasonal InfluenzaFor most people, influenza lasts only a few

daysSome 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

Seasonal InfluenzaTwo 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

H1N1 InfluenzaVery contagious-appears to be spreading from

human to human more easily than typical seasonal influenza

Symptoms include:FeverCoughSore throatBody achesHeadacheChillsFatigueDiarrhea (in some people)

H1N1 InfluenzaMay make underlying chronic medical conditions worseRisk for infection among people 65 years or older less

than risk for younger age groupsPriority groups when vaccine first becomes available:

Pregnant womenCaretakers of children younger than 6 months of ageHealthcare and emergency medical services personnelPeople 6 months-24 years of agePeople 25-64 years with chronic health disorders or

compromised immune systems

LAIV QuestionsCan 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

Measles, Mumps, RubellaMeasles, mumps, and rubella are serious

diseasesMeasles virus causes rash, cough, runny

nose, eye irritation, and feverMeasles can lead to:

Ear infectionPneumoniaSeizures (jerking and staring)Brain damageDeath

Measles, Mumps, RubellaMumps virus causes fever, headache, and

swollen glandsMumps can lead to:

DeafnessMeningitis (infection of brain and spinal cord

covering)Painful swelling of testicles or ovariesDeath (rarely)

Measles, Mumps, RubellaRubella (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

Measles, Mumps, RubellaAdequate 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)

Measles, Mumps, RubellaRubella

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)

Varicella (Chickenpox)Usually mild, but can be serious, especially in

young infants and adultsCauses rash, fever, and tirednessCan lead to:

Severe skin infections and scarsPneumoniaBrain damageDeath

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

Varicella (Chickenpox)Anyone who is not

fully vaccinated, and never had varicella, should receive 1 or 2 doses of varicella vaccine

Tetanus, Diphtheria, PertussisTetanus (lockjaw) causes painful muscle spasms,

usually all over the bodyTetanus 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

Tetanus, Diphtheria, PertussisTetanus enters body through cuts, scratches,

or woundsDiphtheria and pertussis are spread from

person to person

Tetanus, Diphtheria, PertussisAll 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

Immunization Recommendations for Older Adults

Zoster (shingles) vaccinePneumococcal vaccineSeasonal influenza vaccineTdap (tetanus, diphtheria, pertussis) vaccine

Zoster (Shingles)Shingles-painful skin rash, often with blistersRash usually appears on 1 side of face or

body and lasts from 2 to 4 weeksOther symptoms:

FeverHeadacheChills Upset stomach

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

Zoster (Shingles)More common in people 50 and olderMore 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

Pneumococcal Pneumococcal

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

(meningitis)

PneumococcalSome at greater risk of getting disease:

65 years and olderVery youngPeople with certain health problemsPeople with weakened immune systemSmokers

PneumococcalUsually only 1 dose

of pneumococcal vaccine is needed for those 65 and over, but under some circumstances a second dose may be given

After ImmunizationsCommon 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

After ImmunizationsUnusual 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

After ImmunizationsIf an unusual event occurs:

Call doctor or get person to doctor right awayTell doctor what happened, date and time it

happened, and when immunization was given

ResourcesLow cost immunizations are often available at

local health departments and nursing servicesVisit Centers for Disease Control and Prevention’s

(CDC) website: www.cdc.gov/vaccines or call them at: 1-800-CDC-INFO

Visit Colorado Immunization Program’s website at: http://www.cdphe.state.co.us/dc/immunization/

H1N1 questions: CO HELP 1-877-462-2911Flu Clinic Locator: www.immunizecolorado.orgContact Rosemary Spence at 303/692/2798 or

rosemary.spence@state.co.us