IMMUNIZATION EDUCATION Are Vaccines Safe and Effective?

IMMUNIZATION EDUCATION

Are Vaccines Safe and Effective?

IMMUNIZATION EDUCATION

Pam Strohfus, RN, MA

Associate Chair of Pre-Licensed Baccalaureate Program

Boise State University

pamstrohfus@boisestate.edu

Central District Health Department Teresa Collins, RN – Immunization Program Manager

Boise State University Faculty Gail Gerding, PhD, Bonnie Lind, PhD

Acknowledgements cont…..

Boise State University-Senior Nursing StudentsLaury Roper, RN, Whitney Gochnour, RN, Jessica Ferguson, RN, Jeanette McCown, RN, Heidi Massengale, RN, Amy Ransom, RN, Alyson Logan, RN, Victoria Lewis, RN, Terry Woychik, RN, Lisa Hines, RN, Sue Oaks, RN, Cara Williamson, RN, Carmen Garnier, RN, Laura Hein, RN, Victor Hernandez, RN, Amber Marsh, RN, Cheryl Suhr, RN, JoRae Thorne, RN, Melissa Blazer, RN, Gaylene Monroe, RN, Amanda Crutchfield, RN, Carissa Baron, RN, Becky Crawford, RN, Angela Morgan, RN, Vicki Williams, RN, Sheri Gates, RN, Taryn Hoffman, RN, Larisa Kogan, RN, Monica Mendoza, RN, Ainoa Autele Douglass, RN, Chantell Nelson, RN, and Rebekah Canfield, RN.

Partnership between Boise State University & Central District Health Department

Enhance safe immunization practices Healthy People 2010 - 90% immunization coverage

rates in the State of Idaho Increase accountability and safe immunization

delivery: Promoting legislative changes to follow the ACIP’s

immunization recommendations Educating physicians, nurses, medical assistants,

school nurses, and child care providers, many of whom are responsible for the administration and delivery of immunizations

Problem Identification

Idaho is 49th in the US for immunization coverage!

Why is Idaho so low?

What if the vaccines we give are ineffective?

Increase the risk of disease Decrease immunization coverage Inappropriately stored vaccine results in

less vaccine availability Cost for vaccine to re-immunize 1 million

children = $20 million to $36 million

Invalid Immunizations:Literature Review

Common immunization errors: Injection of the wrong vaccine, improper time interval

between doses, and route of administration, and missed opportunities resulting in a late or missing immunization (Mell, et al., 2005; Stokely, Maurice, Smith, & Klevens, 2004)

Medical office personnel each give 6-20 vaccines per day

Vaccines to triple by the year 2020

10.5% of all children nationally receive at least one invalid dose

12% or more of Idaho children receive at least one invalid dose

Invalid Immunizations - Midwest USA

In Iowa, 224 children received Varivax inappropriately stored.

Titers & reimmunized 42% of the children 6% had evidence of chicken pox like rash on

their medical records but not diagnosed as such

32 occasions of incorrect storage Cost = $750,000 (Welte, 2007)

Invalid Immunizations cont…..

30% of vaccine errors resulted from inappropriate scheduling (CDC, 2007)

Out of 16,211 children only 9% received immunizations at recommended ages

(Lumin, McCauley, Stokely, Chu, and Pickering. 2002)

53-82% of all vaccine shipments in the world are compromised in some way (Techathawat, Varinsathien, Rasdjarmrearnsook, & Tharmaphornpilas, 2007)

Forty five percent of all immunizations expire before they are used (JAMC, 2004)

Invalid Immunizations cont…..

Storage and handling issues are directly related to the personnel managing vaccines in the medical offices

(Bell, Hogue, Manning, & Kendal, 2001; Welte, 2007)

Failure to adhere to recommended specifications for storage and handling can reduce vaccine potency, resulting in inadequate immune response in the recipient

(Kroger, Atkinson, Marcues, & Pickering, 2006)

Craig (2008) reports diminished potency of the vaccine affects natural immune response, inadequately protects against diseases, and increases risk of adverse reactions

Research Questions

Research question(s):

1. What proportion of health care providers in Idaho have adequate knowledge regarding administration and storage of the MMR (measles, mumps, rubella) vaccines?

2. Are there significant differences among health care provider types in the proportion with adequate knowledge regarding administration and storage of the MMR (measles, mumps, rubella) vaccine?

Survey Conducted in August 2009 N=344

Cross-sectional study Survey hard copy Distributed by mailings to 350 volunteer

VFC provider offices in Idaho Sample size of 740 344 Respondents

23 questions Benchmark set at 82% or 5 wrong

Methodology

Descriptive study utilizing assessment research methods in order to evaluate knowledge related to the delivery and storage of the MMR immunization. Descriptive statistics used to describe the sample. Means examined to determine level of knowledge among respondents; ANOVAs and t-tests used to determine differences between groups. SPSS used for data analysis.

Reliability

•Idaho Survey •N = 344•Chronbach Alpha .794

Age Group of Personnel

0

5

10

15

20

25

30

20-29 30-39 40-49 50-59 > 60

Age of Personnel

Years of Education

Survey Participant Percent by Job Title

27%29%

26%

10% 9%

0%

5%

10%

15%

20%

25%

30%

35%

Mas LPNs RNs MDs/NPs Other,

Practice Type by Job Title

MA0

20

40

60

80

100

Family Practice

Pediatrics Other

MA

LPN

RN

MD/NP

Other

Self Proclaimed Knowledge Level about MMR (p<.001)

0%10%20%30%40%50%60%70%80%90%

A little Some Sufficient Above Average

Expert

nonPassPass

Gender Self Proclaimed Knowledge Level

60% Competency in MMR Delivery(Cronback Alpha .731)

0

10

20

30

40

50

60

70

Passed Not Passed

Health Care Personnel

Health Care Personnel

Survey Participants Passed vs. non Passed (Asymp Sig .001)

0

10

20

30

40

50

60

70

MAs LPNs RNs MD/NP

nonPassedPassed

Categories pass/non pass

0

20

40

60

80

100

nonpass

pass

Route(Asymp. Sig. .000)

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

LPN/MA RN MD/NP/Other

Percent 2/3 Wrong

Storage

Schedule(Asymp. Sig. 020)

0102030405060708090

% Right

MAsLPNsRNsMDs/NPsOther

Health Districts

Health District 6

Central District (4)

District nonPass/Pass

Results of Immunization Survey

Educational opportunities: Route Storage

Physicians, Nurse Practitioners and “other” category, i.e., pharmacists, require the most information and education

Immediate access to timely information is essential

Increased understanding increases compliance and greater immunization coverage

Recommendations for Further Study…

Research disease outbreaks & causes Connect to storage and administration

Standardize immunization education & training Change Idaho legislation to follow ACIP

recommendations Nationwide study on health care personnel

administering immunizations Peer education interventions to significantly

improve provider immunization knowledge and behaviors (Boom, et. al, 2007)

Immunization Education Program through Central District Health Department

Identify individual personnel educational needs, urban vs. rural educational needs, district educational needs

Education and training will be provided to 30 medical offices compared to 30 offices without training over the next 2 years

Grants received Jekker Trust Fund - $20,000 Regence Foundation – $49,000 Central District Health Department - $20,000

QUESTIONS?

References

Bell, K.N., Hogue, C.J.R., Manning, C., Kendal, A.P. (2001). Risk factors for improper vaccine storage and handling in private providers offices. Pediatrics. 107(6).

Bird, S. (2006, September). Medication errors: immunization. Australian Family Physician. 35, (9).

Boom, A.J., Nelson, C.S., Laufman, L.E., Kohrt, A.E., Kozinetz, C.A. (2007). Improvement in provider immunization knowledge and behaviors following a peer education intervention. Clinical Pediatrics. 46 (8), 706-717.

Centers for Disease Control and Prevention (CDC). (2010). Department of Health and Human Services. Retrieved January 10, 2010 from: www.cdc.gov .

Centers for Disease Control and Prevention (2008).  Morbidity and Mortality Weekly Report. 57(35). 961-966. Retrieved on December 30, 2009 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5735a1.htm.

Centers for Disease Control and Prevention (2008). National Immunization Survey July 2007 - June 2008 (Excel spreadsheet). Retrieved on December 30, 2009 from www.cdc.gov/vaccines/stats-surv/imz-coverage.htm#nis.

Centers for Disease Control. (2009). Epidemiology and prevention of vaccine-preventable diseases. Atkinson, W., Hamborsky, J., McIntyre, L., Wolfe, C., (Eds). (9th ed.). Washington DC: Public Health Foundation.

References

Centers for Disease Control and Prevention. (2010). Estimated vaccination coverage with individual vaccines and selected vaccination series among children 19-35 months of age by state – US, National Immunization Survey, A1/2005-Q4/2005 [Data file]. Available from National Immunization program Web site, http://www.cdc.gov/nip/coverage/NIS/05/tab03_antigen-state.xls

Central District Health Department, (CDHD), (2010). Retrieved February, 2010 from http://www.cdhd.idaho.gov

Craig, L. (2008). Keeping it cool: Maintaining the vaccine cold chain. Practice Nurse. November 21, 2008. Retrieved on 3/31/2009 from CINALH database through Albertson’s Library, Boise Idaho.

Cohen, N.J., Lauderdale, D.S., Shete, P.B., Seal, J.B., & Daum, R.S. (2003, May). Physician knowledge of catch-up regimens and contraindications for childhood immunizations. Pediatrics 3, (5).

Kroger, A.T., Atkinson, W.L., Marcuse, E.K., & Pickering, L.K. (2006). General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 55(RR-15); 1-48.

Lumin, E.T., McCauley, M.M., Stokely, S., Chu, S.Y., and Pickering, L.K. (2002). Timeliness of childhood immunizations [Electronic version]. Pediatrics, 110(5), 95-939.

Mell, L.K., Ogren, D.S., Davis, R, L., Mullooly, F.P., Black, S.B., Shinefield, H.R., et al. (2005). Compliance with national immunization guidelines for children younger than 2 years,

References

Petridou, E., Kouri, N., Vadala, H., Dalamaga, M., & Sege, R. (2004). Frequency and nature of recorded childhood immunization-related errors in Greece. Journal of Toxicology. 42(3), 273-276.

Phillips, T, Strohfus, P., Deckys, C, Thorne, J, Hernandez, V, Marsh, A, Suhr, C, Blaser, M,

(2008). “SHOT LINE” Reveals unregulated & unsafe practices. Presentation at the National Immunization Conference, Atlanta, Georgia.

Pickering, L., Wallace, G., & Rodewald, L. (2006). Too hot, too cold: issues with vaccine

storage. Pediatrics. 118, 1738-1739. Pigott, N., Novelli, V., Pooboni, S., Firmin R., Goldman A (2002). "The

importance of herd

Immunity against infection". The Lancet (British edition), 360(9333), p. 645. Preventing cold chain failure: vaccine storage and handling. (2004). JAMC,

2004, 171(9), 1050. 1996-1999 [electronic version]. Pediatrics, 115(2), 461-467. Shefer, A., Santoli, J., & Singleton, J. (2007). Measuring vaccination coverage:

Where are we now and where are we going? Journal of Public Health Management and Practice. Nov-Dec, 13 (6), 541-543.

References

Stokely, S., Maurice, E., Smith, P.J., and Klevens, R. M. (2004). Evaluation of invalid vaccine doses. (Electronic version]. American Journal of Preventive Medicine, 26(1), 34-40 Strohfus, P. (2008). Shot Line: An Immunization Resource. RN Idaho, 31(1), 17-18.

Strohfus, P., Gerding, A, Collins, T., & Lind. (2009). Idaho Immunization

Knowledge Assessment Tool survey. Manuscript in preparation. Techathawat, S., Varinsathien, P., Rasdjarmrearnsook, A., Tharmaphornpilas,

P. (2007). Exposure to heat and freezing in the vaccine cold chain in Thailand. Vaccine. 25, 1328-1333.

Welte, M. (2007). Poorly refrigerated vaccines force parents to get new shots for their children. North County Times. Retrieved January 10, 2010 from: http://www.nctimes.com/lifestyles/health-med-fit/article_37d633f4-e2a6-55e3-8d0c-5e4007ba8566.html

US Department of Health and Human Services, (DOH). Healthy People 2010: Understanding and Improving Health, (2nd edition). Washington, DC. US Government Printing Office, November 2000.

Varricchio, F. (2002) Medication errors reported to the vaccine adverse event reporting system (VAERS) [Electronic version]. Vaccine, 20(2002), 3049-051.