Discuss the importance of adult vaccination, immunization updates and resources, adult immunization practice and Seize opportunities in adult immunization and discussion

1. UPDATEUPDATE
Talking PointsTalking Points andand ResourcesResources
for Busy Healthcare Professionalsfor Busy Healthcare Professionals
Presenter: Jackie Hartley-Langille, RN, BScNPresenter: Jackie Hartley-Langille, RN, BScN
Occupational Health/Travel HealthOccupational Health/Travel Health

2. At the end of this presentation, participants will be
able to:
1.Discuss the importance of adult vaccination
2.Be aware of immunization updates and resources
3.Discuss adult immunization practice
4.Seize opportunities in adult immunization and
discussion
Learning ObjectivesLearning Objectives

3. Impact of Vaccine Preventable Diseases in PeopleImpact of Vaccine Preventable Diseases in People

4. ““WHEN MEDITATING OVER A DISEASE, IWHEN MEDITATING OVER A DISEASE, I
NEVER THINK OF FINDING A REMEDY FOR IT,NEVER THINK OF FINDING A REMEDY FOR IT,
BUT, INSTEAD, A MEANS OF PREVENTION.”BUT, INSTEAD, A MEANS OF PREVENTION.”
LOUIS PASTEURLOUIS PASTEUR

6. Diseases for Which Vaccination isDiseases for Which Vaccination is
Routinely RecommendedRoutinely Recommended

7. Other Diseases for Which Vaccines areOther Diseases for Which Vaccines are
Used in Special SituationsUsed in Special Situations

8. Ten Great Public Health AchievementsTen Great Public Health Achievements
1900 - 19911900 - 1991

10. MYTH:MYTH: Disease rates have droppedDisease rates have dropped
due to factors other than vaccinationdue to factors other than vaccination
•• Better living conditions (less crowded housing, better nutrition, etc.)Better living conditions (less crowded housing, better nutrition, etc.)
have had an impact on disease rates. BUT, the only real decrease in ahave had an impact on disease rates. BUT, the only real decrease in a
VPD has occurred after the introduction of a vaccine to prevent it.VPD has occurred after the introduction of a vaccine to prevent it.
•• This is also true for newer vaccines like Hib (1987) and varicellaThis is also true for newer vaccines like Hib (1987) and varicella
(1995), which were introduced during times of modern hygiene.(1995), which were introduced during times of modern hygiene.
•• When some developed countries (U.K., Sweden, Japan) stopped usingWhen some developed countries (U.K., Sweden, Japan) stopped using
DTP vaccine, their pertussis rates jumped dramatically.DTP vaccine, their pertussis rates jumped dramatically.
•• Several recent outbreaks of measles, pertussis, and varicella in theSeveral recent outbreaks of measles, pertussis, and varicella in the
U.S. have been traced to pockets of unvaccinated children in statesU.S. have been traced to pockets of unvaccinated children in states
that allow personal belief exemptions. When vaccinationthat allow personal belief exemptions. When vaccination
rates go down, disease rates go uprates go down, disease rates go up.

11. Why Should Adults Vaccinate?Why Should Adults Vaccinate?

12. Adult VaccinationAdult Vaccination
ChallengesChallenges

13. RESOURCES FOR IMMUNIZERSRESOURCES FOR IMMUNIZERS
NACI – National Advisory Committee on Immunizations
(Canada)
PHAC – Public health Agency of Canada (Canada)
CATMAT - Committee to Advise on Tropical Medicine and
Travel
Canadian Immunization Guide (Canada)
Immunize Canada (Canada)
IPAC – Infection Prevention and control Canada (Canada)
ICID – International Centre for Infectious Diseases
(Canada)
CRNNS – College of Registered Nurses Nova Scotia
(Canada)
- Care Directives: Guidelines for Registered Nurses
- Immunization Guidelines for Registered Nurses
Nova Scotia Communicable Disease Prevention and
Control (Canada)
Nova Scotia Immunization Manual (Canada)
ICPNS – Infection Prevention and Control Nova Scotia
(Canada)
Canadian Pediatric Society (Canada)
CDC – Centre for Disease Control (United States)
WHO – World Health Organization (International)

14.  NACI is a national advisory committee of experts in the fieldsNACI is a national advisory committee of experts in the fields
of pediatrics, infectious diseases, immunology, medicalof pediatrics, infectious diseases, immunology, medical
microbiology, internal medicine and public health.microbiology, internal medicine and public health.
 The Committee reports to the Assistant Deputy Minister ofThe Committee reports to the Assistant Deputy Minister of
Infectious Disease Prevention and Control, and works withInfectious Disease Prevention and Control, and works with
staff of the Centre for Immunization and Respiratorystaff of the Centre for Immunization and Respiratory
Infectious Diseases of the Public Health Agency of Canada toInfectious Diseases of the Public Health Agency of Canada to
provide ongoing and timely medical, scientific and publicprovide ongoing and timely medical, scientific and public
health advice.health advice.
 NACI makes recommendations for the use of vaccinesNACI makes recommendations for the use of vaccines
currently or newly approved for use in humans in Canada,currently or newly approved for use in humans in Canada,
including the identification of groups at risk for vaccine-including the identification of groups at risk for vaccine-
preventable diseases for whom vaccination should bepreventable diseases for whom vaccination should be
targeted.targeted.
 NACI knowledge syntheses, analyses and recommendationsNACI knowledge syntheses, analyses and recommendations
on vaccine use in Canada are included in published literatureon vaccine use in Canada are included in published literature
reviews, statements and updates. NACI recommendations arereviews, statements and updates. NACI recommendations are
also published in thealso published in the Canadian Immunization Guide.
About NACIAbout NACI
http://www.phac-aspc.gc.ca/naci-ccni/

15. Table of Updates
http://healthycanadians.gc.ca/healthy-living-vie-saine/immunization-
immunisation/canadian-immunization-guide-canadien-
immunisation/updates-mises-a-jour-eng.php

16.  Hepatitis A vaccineHepatitis A vaccine New recommendation: Hepatitis A (HA) vaccine may beNew recommendation: Hepatitis A (HA) vaccine may be
administered to persons six months of age and older. 2016-Septemberadministered to persons six months of age and older. 2016-September
 Hepatitis A vaccineHepatitis A vaccine New recommendation: For post-exposure prophylaxisNew recommendation: For post-exposure prophylaxis
within 14 days of exposure of susceptible adults 60 years of age and olderwithin 14 days of exposure of susceptible adults 60 years of age and older
who are household or close contacts of a case, Ig may be provided inwho are household or close contacts of a case, Ig may be provided in
addition to HA vaccine. 2016-Septemberaddition to HA vaccine. 2016-September
 Hepatitis A vaccineHepatitis A vaccine New recommendation: Immunization with HA vaccineNew recommendation: Immunization with HA vaccine
may be considered for all individuals receiving repeated replacement ofmay be considered for all individuals receiving repeated replacement of
plasma-derived clotting factors. 2016-Septemberplasma-derived clotting factors. 2016-September
 Hepatitis A vaccineHepatitis A vaccine New recommendation: For post-exposure prophylaxis ofNew recommendation: For post-exposure prophylaxis of
susceptible individuals with chronic liver disease, Ig should be providedsusceptible individuals with chronic liver disease, Ig should be provided
within 14 days of exposure in addition to HA vaccine. 2016-Septemberwithin 14 days of exposure in addition to HA vaccine. 2016-September

17.  Influenza Vaccine Updated recommendation:Influenza Vaccine Updated recommendation: The current evidenceThe current evidence
does not support a recommendation for the preferential use of LAIV indoes not support a recommendation for the preferential use of LAIV in
children and adolescents 2–17 years of age. 2016-Septemberchildren and adolescents 2–17 years of age. 2016-September
 Influenza Vaccine New recommendation:Influenza Vaccine New recommendation: egg allergic individuals may beegg allergic individuals may be
vaccinated against influenza using the low ovalbumin–containing livevaccinated against influenza using the low ovalbumin–containing live
attenuated influenza vaccine (LAIV) licensed for use in Canada.attenuated influenza vaccine (LAIV) licensed for use in Canada.
Chapter(s) revised to reflect this change: Contraindications, PrecautionsChapter(s) revised to reflect this change: Contraindications, Precautions
and Concerns and Anaphylactic Hypersensitivity to Egg and Eggand Concerns and Anaphylactic Hypersensitivity to Egg and Egg
Related Antigens. 2016-SeptemberRelated Antigens. 2016-September
 Influenza Vaccine New productInfluenza Vaccine New product:: Fluzone® High-Dose influenza vaccineFluzone® High-Dose influenza vaccine
has been approved for use in Canada in adults ≥65 years of age. 2016-has been approved for use in Canada in adults ≥65 years of age. 2016-
MayMay
 Influenza Vaccine New recommendation:Influenza Vaccine New recommendation: NACI now includes adults withNACI now includes adults with
neurologic or neurodevelopment conditions among the groups forneurologic or neurodevelopment conditions among the groups for
whom influenza vaccination is particularly recommended. 2016 - Maywhom influenza vaccination is particularly recommended. 2016 - May

18.  Human papillomavirus vaccine New recommendation:Human papillomavirus vaccine New recommendation: Gardasil®9 (HPV9Gardasil®9 (HPV9
vaccine) has recently been authorized for use in Canada for the preventionvaccine) has recently been authorized for use in Canada for the prevention
of HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58 -related cancers andof HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58 -related cancers and
anogenital warts 2016-Julyanogenital warts 2016-July
 Human papillomavirus vaccine New recommendation:Human papillomavirus vaccine New recommendation: Any of the currentlyAny of the currently
authorized HPV vaccines in Canada can be used according to theauthorized HPV vaccines in Canada can be used according to the
recommended HPV immunization schedules. 2016-Julyrecommended HPV immunization schedules. 2016-July
 Pneumococcal vaccine New recommendation:Pneumococcal vaccine New recommendation: On an individual basis,On an individual basis,
PNEU-C-13 vaccine may be recommended to immunocompetent adultsPNEU-C-13 vaccine may be recommended to immunocompetent adults
aged 65 years and older not previously immunized against pneumococcalaged 65 years and older not previously immunized against pneumococcal
disease, for the prevention of community acquired pneumonia anddisease, for the prevention of community acquired pneumonia and
invasive pneumococcal disease caused by the 13 pneumococcal serotypesinvasive pneumococcal disease caused by the 13 pneumococcal serotypes
included in the conjugate vaccine. When it is given, it should precedeincluded in the conjugate vaccine. When it is given, it should precede
PNEU-P-23 vaccine. 2016-OctoberPNEU-P-23 vaccine. 2016-October

19.  Pneumococcal vaccine New recommendation: If both PCV13 and
PPSV23 are indicated, these vaccines should not be given at the same
visit. For adults age 19–64 who are receiving both vaccines due to a
high-risk condition, the PCV13 should be given first followed by PPSV23
at least 8 weeks later. If PPSV23 has already been given, wait 8 weeks
(for a child) or 1 year (for an adult age 19 years or older) before giving
PCV13 to avoid interference between the 2 vaccines.
For adults age 65 and older who are receiving both PCV13 and
PPSV23 as part of the routine recommendation, PCV13 should be given
first and PPSV23 at least 8 weeks after .
** In Nova Scotia currently only the PPSV23 vaccine is publically
funded.

20.  Varicella vaccine A clarificationVaricella vaccine A clarification on the minimum interval between twoon the minimum interval between two
varicella-containing vaccines has been made in accordance with thevaricella-containing vaccines has been made in accordance with the
information available in the Health Canada approved product monographs.information available in the Health Canada approved product monographs.
NACI considers the minimum interval of 4 weeks to be acceptable inNACI considers the minimum interval of 4 weeks to be acceptable in
exceptional circumstances. If the second dose of varicella-containing vaccine isexceptional circumstances. If the second dose of varicella-containing vaccine is
administered at an interval of less than 4 weeks, it should be repeated. NACIadministered at an interval of less than 4 weeks, it should be repeated. NACI
continues to recommend an interval between two varicella-containingcontinues to recommend an interval between two varicella-containing
vaccines of at least 3 months for children less than 13 years of age and 6vaccines of at least 3 months for children less than 13 years of age and 6
weeks for individuals 13 years of age and older. 2016-Septemberweeks for individuals 13 years of age and older. 2016-September
 Varicella vaccine Updated recommendation:Varicella vaccine Updated recommendation: Susceptibility and ImmunitySusceptibility and Immunity
section updated to provide further information about individuals who requiresection updated to provide further information about individuals who require
immunization with varicella vaccine 2016-Septemberimmunization with varicella vaccine 2016-September
 Varicella vaccine Updated recommendation:Varicella vaccine Updated recommendation: Varicella immune globulinVaricella immune globulin
recommendations updated to allow for product administration up to 10 daysrecommendations updated to allow for product administration up to 10 days
since last exposure for the purpose of disease attenuation 2016-Septembersince last exposure for the purpose of disease attenuation 2016-September

21. Canadian Immunization GuideCanadian Immunization Guide
http://healthycanadians.gc.ca/healthy-living-vie-saine/immunization-
immunisation/canadian-immunization-guide-canadien-immunisation/index-
eng.php
The Canadian Immunization Guide is a comprehensive resource onThe Canadian Immunization Guide is a comprehensive resource on
immunization. It was developed based on recommendations andimmunization. It was developed based on recommendations and
statements of expert advisory committees, including the:statements of expert advisory committees, including the:
••National Advisory Committee on Immunization (NACI)National Advisory Committee on Immunization (NACI)
••Committee to Advise on Tropical Medicine and Travel (CATMAT)Committee to Advise on Tropical Medicine and Travel (CATMAT)

22. Care Directives: Guidelines forCare Directives: Guidelines for
Registered NursesRegistered Nurses
http://crnns.ca/publication/care-directives-guidelines-for-registered-nurses/

23. http://crnns.ca/publication/immunization-guidelines-for-registered-nurses/
Immunization
Guidelines for
Registered Nurseses

24. Care Directive:
Influenza Vaccine
Indication: For immunization against infection caused by influenza viruses for patients meeting
the criteria per the Canadian Immunization Guidelines.
Adults:
Administer Influenza vaccine 0.5 ml I.M per product monograph.
Children:
Administer Influenza vaccine 0.5 ml I.M. per NACI recommendations.
Schedule: 6 months to 8yrs. Initial vaccine: 2 doses 0.5ml - 4 weeks apart
Prior vaccine: 1 dose 0.5ml
Administer to patients who meet the criteria as per The Canadian Immunization Guide
Evergreen Edition section, Part 4 Active Vaccines: http://www.phac-aspc.gc.ca/publicat/cig-
gci/p04-eng.php
Note: Epinepherine HCl 1:1000 must be available for immediate use in case of anaphylaxis or
hypersensitivity reaction. (See Epinepherine Care Directive)
_______________________ ________________________________
Date Physician Signature
_______________________ ________________________________
Date Clinic Manager Review
Care Directives

25. Care Directive:
Epinephrine HCl – Adrenalin 1:1000
Indication: For the relief of respiratory distress due to bronchospasm to provide rapid relief of
hypersensitivity reaction to vaccines, drugs and other allergens per the Canadian Immunization
Guidelines.
For Adults:
Administer Epinephrine 0.01mg/kg (maximum 0.5ml) I.M. for anaphylaxis.
For post vaccination anaphylaxis administer in mid-anterolateral aspect of the thigh, not the
deltoid.
Dosing can be repeated twice at 5 - 15 minute intervals to a maximum of 3 doses if symptoms
persist.
All vaccine recipients receiving emergency epinephrine must be transported to hospital
immediately, via ambulance, for evaluation and observation.
Ensure patient remains in a recumbent position following receipt of epinephrine injection and is
monitored closely.
For Children:
Administer dose: Epinephrine 1:1000, 1 mg/ml solution, by age or weight.
Table 1: Dose of epinephrine (1:1000, 1 mg/mL solution), by age or weight
Age WeightTable 1 - Footnote 1
Dose by injection Dose by autoinjector
0 – 6 months Up to 9 kg (20 pounds) 0.01 mg/kg body weight Not applicable
7 - 36 months 9 - 14.5 kg (20 - 32 lb) 0.1 - 0.2 mg Not applicable
37 - 59 months 15 - 17.5 kg (33 – 39 lb) 0.15 - 0.3 mgTable 1 - Footnote 2 Junior dose of 0.15 mg
5 - 7 years 18 - 25.5 kg (40 – 56 lb) 0.2 - 0.3 mgTable 1 - Footnote 2
Junior dose of 0.15 mg
8 - 12 years 26 - 45 kg (57 – 99 lb) 0.3 mgTable 1 - Footnote 2 - If , less than 30 kg (66 lbs) give Junior dose
- If 30 kg or more: Give standard dose
13 years and older 46 + kg (100 + lb) 0.5 mgTable 1 - Footnote 3
Give standard dose of 0.3mg
Adapted from Immunization Action Coalition. Medical Management of Vaccine Reactions in Children and Teens (PDF document) .
Accessed June 2012.
Table 1 - Footnote 1
Rounded weight at the 50th percentile for each age range
Table 1 - Footnote 2
Maximum dose for children 12 years of age and younger
Table 1 - Footnote 3
Maximum dose for adolescents
Administer to patients who meet the criteria described in the Anaphylaxis policy and as per The
Canadian Immunization Guide Evergreen Edition section: Anaphylaxis: Initial Management in
Non-Hospital Settings. http://www.phac-aspc.gc.ca/publicat/cig-gci/

26. Care Directive:
Benadryl® (Diphenhydramine hydrochloride) Administration
Indication: As an optional adjunct to epinephrine per the Canadian Immunization Guidelines.
Administer Benedryl® 50mg P.O. or I/M per product monograph.
May be given as an adjunct to epinephrine to relieve itching, flushing, uticaria, and nasal and
eye symptoms.
Not recommended for infants under 12 months of age.
When given to children, dosage should be determined by weight (1 mg/kg)
Refer to dosing guidelines in Table 2:
Table 2: Dose of diphenhydramine hydrochloride, by age
Age Weight (pounds) Dose of diphenhydramine hydrochloride
12-23 monthsTable 2 - Footnote 1
7-12 kg (15-25 lbs) 6.25 - 12.5 mg
2 to 4 years 12-25 kg (25-55 lbs) 12.5 - 25 mg
5 to 11 years 25-45 kg (55-99 lbs) 25 - 50 mg
12 years and older 45 kg + (99 lbs or more) 50 mg
1
Use with caution in children 12 - 23 months due to risk of sedation or paradoxical excitement.
Administer to patients who meet the criteria described per The Canadian Immunization Guide
Evergreen Edition section: Anaphylaxis: Initial Management in Non-Hospital Settings.
http://www.phac-aspc.gc.ca/publicat/cig-gci/
_______________________ ________________________________
Date Physician Signature
_______________________ ________________________________
Date Clinic Manager Review

27. IMPORTANT RULE:IMPORTANT RULE:
Vaccine doses should not beVaccine doses should not be
administered at intervals less than theadministered at intervals less than the
recommended minimal intervals orrecommended minimal intervals or
earlier than the minimal ages.earlier than the minimal ages.
But there is no maximumBut there is no maximum interval!interval!
And the classic error :And the classic error :
Re‐starting a vaccine seriesRe‐starting a vaccine series
because of a longer‐than recommendedbecause of a longer‐than recommended
interval.interval.

28. Required information toRequired information to
documentdocument
•• Type of vaccine (e.g., MMR or Hib)Type of vaccine (e.g., MMR or Hib)
•• Vaccine name and lot numberVaccine name and lot number
•• Date the vaccination was givenDate the vaccination was given
•• Name, office address, and title of the healthcareName, office address, and title of the healthcare
provider administering the vaccineprovider administering the vaccine

30. SummarySummary