Issue
Number 424
November 10, 2003
CONTENTS OF THIS ISSUE
- Looking for ideas to increase your state's
immunization rates for seniors? Then take a lesson from Alabama's Betsy
Frazer
- New: Fourth edition of "Vaccines" now available
for order
- Updated: IAC makes major revision to its
patient-education sheet "Hepatitis A, B, C: Learn the Differences"
- "Pediatrics" article reports on the use of
immunization reminder and recall messages by pediatric providers
- Latest version of CDC's Adult CASA program
includes four new reports
- New: Latest issue of GAVI's "Immunization Focus"
quarterly publication is available online
- New VIS translations: Five VISs now available in
Hindi on IAC's website
- Revised Turkish translations for three
educational sheets now available on IAC's website
- CDC reports on recent progress toward polio
eradication in Ethiopia, Somalia, and Sudan
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November 10, 2003
LOOKING FOR IDEAS TO INCREASE YOUR STATE'S IMMUNIZATION RATES FOR SENIORS?
THEN TAKE A LESSON FROM ALABAMA'S BETSY FRAZER
Last week was a banner one for Betsy Frazer, RN, BS, Quality Improvement
Specialist at the Alabama Quality Assurance Foundation (AQAF). She received
a phone call from Mike Hudgens, MS, the National Immunization Program's
adult immunization coordinator for Alabama. He told her that in Alabama's
history, people couldn't remember using as much influenza vaccine in such a
short time as they have in the last several weeks. The demand for influenza
vaccination has been so great, and so many were immunized by the first week
of November, that the vaccine supply is fast disappearing. This is
phenomenal given that this year the state department of public health
purchased more influenza vaccine than ever before--208,000 doses compared
with last year's 124,000 doses.
At a time when public health professionals are stymied in their efforts to
increase adult influenza immunization rates, Alabama has begun to convince
its population of Medicare recipients that getting immunized against the flu
is as much a part of fall as swatting mosquitoes is of summer. How can this
be?
One possible answer may lie in the work of Frazer and her colleagues at "IZ
Alabama Covered? Flu & Pneumococcal Prevention Campaign." The campaign is a
three-year program begun in October 2002 after two years of research and
development. Its major goals are to "help protect more than 700,000 senior
citizens in Alabama from two serious and vaccine-preventable illnesses"
(influenza and pneumococcal disease) and to "raise awareness and increase
flu and pneumonia immunization rates through leadership volunteerism."
Since the program began, Frazer has made 98 presentations to groups of
nurses, other health professionals, volunteers, community leaders, and
senior citizens throughout the state. The result: the program now has almost
900 volunteers; 47 of Alabama's 67 counties are involved; 55 hospitals
participate, and more than 240,000 Medicare card covers have been
distributed.
MEDICARE CARD COVERS
Calling the Medicare card cover the campaign's "cornerstone product," Frazer
explained the cover is a plastic two-pocket organizer intended to hold the
user's Medicare and insurance cards, as well as a list of the user's
doctors, allergies, and/or prescription medications.
Small enough to fit in a wallet, the cover includes an adult immunization
record card (supplied by the Immunization Action Coalition) and a note
explaining how to use the cover (to hold your important medical papers) and
how to use the immunization record card (to remind you to talk with your
doctor about making sure your immunizations are up to date).
The centrality of the Medicare card cover and immunization record card to
the campaign cannot be overstated. According to campaign literature, "when
anyone starts a discussion about adult immunization, it must start with an
accurate and accessible [immunization] record." Because the Medicare card
cover keeps the user's immunization record card together with other Medicare
and insurance cards, the user's immunization record is always accessible to
medical personnel.
"All people, even homeless people, keep their Medicare and insurance cards
with them; it's the first thing they're asked for in a doctor's office or
clinic" Frazer explained. "Even soldiers in battle carry important medical
papers, including their immunization records."
Attesting to the importance of the card cover, a nurse practitioner in a
gerontology practice in Birmingham, AL, keeps a basket of card covers (each
stuffed with a campaign note and immunization record card) in the waiting
room and offers one to every Medicare patient. "It's a fresh opportunity to
educate and vaccinate," she said.
THE "FIVE Rs"
Just as the Medicare card cover is the campaign's cornerstone product, its
guiding philosophy is what the Centers for Disease Control and Prevention
(CDC) terms the "five Rs". These are five strategies that lead to high
immunization levels in a practice. The versatility of the "five Rs" leads
Frazer to believe campaigns similar to Alabama's could operate anywhere in
the United States.
Listed and explained in the first printing of the current edition of
"Epidemiology and Prevention of Vaccine-Preventable Diseases" (the "Pink
Book," pages 32-36), the five strategies are
- Record keeping
- Recommendations and reinforcement
- Reminder and recall to patients
- Reminder and recall to providers
- Reduction of missed opportunities
To access the strategy section in the "Pink
Book," go to:
http://www.cdc.gov/nip/publications/pink/Strategies-sm.pdf and see
pages 9-13. (Note the second printing of the "Pink Book," which was
completed in February 2003, adds a sixth strategy, "Reduction of barriers
within the practice." The URL above includes information about the sixth
strategy.)
VOLUNTEERS
If card covers are the campaign's cornerstone product and the "five Rs" its
guiding philosophy, volunteers are its soul. Ranging in age from 10 to 82,
volunteers are relied on to "distribute card covers to raise awareness and
increase flu and pneumonia immunization rates." The commitment the campaign
asks of volunteers is simple and straightforward: (1) think of a senior
adult group you truly care about; (2) schedule time to stuff at least one
box of 250 card covers with campaign notes and immunization record cards;
(3) distribute the stuffed covers to the senior group.
Of course, many volunteers do more, such as Rosa Feltman, the woman Frazer
calls her "famous volunteer." Feltman, a ventriloquist, has developed a
routine that's popular at senior gatherings. Arriving on stage with Gilbert,
her vaccine-hesitant dummy, she proceeds to talk him though all the
objections he raises to being vaccinated. Feltman engages the audience in
her give-and-take with Gilbert, entertaining them while educating them about
immunization.
IZZIE, THE CAMPAIGN ICON
Another well-liked figure at presentations is Izzie, the campaign's cartoon
icon. Half turtle, half armadillo, the geriatric Izzie claims she's "double
protected" with a hard-shell back and hard-shell belly. One of her messages
is that Alabama's seniors will also be double protected if they get a
pneumococcal vaccination and annual influenza vaccinations. Her image
appears on every "IZ Alabama Covered?" Medicare card cover.
FRAZER'S DREAM
With her strong belief that pairing immunization record cards with Medicare
cards is a way to reduce vaccine-preventable diseases, Frazer and her
colleagues are hoping the federal government will redesign the Medicare card
to include a panel for the user's immunization record. The effect could be
dramatic in terms of disease prevention. The campaign's literature states
that if the Medicare card is redesigned to include the immunization record,
it "will begin to answer the need for accurate and accessible adult
immunization documentation. It will allow immunization issues back on the
table as a normal part of every adult preventive health conversation."
To learn more about the campaign from the AQAF website, go to:
http://www.aqaf.com and click on the
button titled "IZ Alabama Covered?"
You can contact Betsy Frazer by email at
bfrazer@alqio.sdps.org
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November 10, 2003
NEW: FOURTH EDITION OF "VACCINES" NOW AVAILABLE FOR ORDER
The fourth edition of "Vaccines" by Stanley A. Plotkin, MD, Walter A.
Orenstein, MD, and 105 contributing experts, is now in stock and available
for order from the publisher, Elsevier Science.
Completely revised and updated, the book offers authoritative information
on vaccine production, available preparations, efficacy and safety of
vaccines, recommendations for vaccine use, data on the impact of
vaccination programs on morbidity and mortality, and more. The new edition
contains current information on smallpox, anthrax, poliomyelitis, and
hepatitis; analyzes the cost-benefit and cost-effectiveness of vaccines;
and features the latest in vaccine research.
The book is hardbound, has 1696 pages, and costs $249. For more
information or to place an online order, go to the Elsevier website at
http://www.us.elsevierhealth.com/product.jsp?isbn=0721696880
To place a phone order, call (800) 545-2522.
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November 10, 2003
UPDATED: IAC MAKES MAJOR REVISION TO ITS PATIENT-EDUCATION SHEET
"HEPATITIS A, B, C: LEARN THE DIFFERENCES"
The Immunization Action Coalition (IAC) recently updated its
patient-education sheet "Hepatitis A,B,C: Learn the Differences." The
sheet now contains information on adefovir, which the Food and Drug
Administration recently licensed for treatment for hepatitis B.
To access a web-text (HTML) version of the updated sheet, go to:
http://www.immunize.org/catg.d/p4075abc.htm
To access a ready-to-copy (PDF) version, go to:
http://www.immunize.org/catg.d/p4075abc.pdf
The sheet has been translated into Turkish. IAC gratefully acknowledges
Mustafa Kozanoglu, MD, and Murat Serbest, MD, for the translation. To
access a ready-to-copy (PDF) version in Turkish, go to:
http://www.immunize.org/catg.d/p4075tu.pdf
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November 10, 2003
"PEDIATRICS" ARTICLE REPORTS ON THE USE OF IMMUNIZATION REMINDER AND
RECALL MESSAGES BY PEDIATRIC PROVIDERS
In its November issue, the journal "Pediatrics" published "Adoption of
Reminder and Recall Messages for Immunizations by Pediatricians and Public
Health Clinics." The purpose of the study described in the article was to
"determine the proportions of pediatric practices and public clinics that
currently use practice-based reminder or recall messages and routinely
undergo immunization assessment efforts," to "evaluate barriers and
supports to implementing these practices," and to "identify predictors of
either current use or plans for future adoption of these practices." The
concluding paragraph of the article abstract follows.
************************
Conclusions. Reminder and recall messages remain underused by both
pediatricians and public health clinics. Promising strategies to promote
adoption of these approaches in both the private and the public sectors
include identifying and training champions to promote immunization
delivery improvement efforts and helping practices develop methods to
identify children at specific ages.
************************
The full article is available to subscribers only. To access the abstract,
go to:
http://pediatrics.aappublications.org/cgi/content/abstract/112/5/1076
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November 10, 2003
LATEST VERSION OF CDC'S ADULT CASA PROGRAM INCLUDES FOUR NEW REPORTS
On September 17, the National Immunization Program, Centers for Disease
Control and Prevention (CDC) posted a revised version of its Adult and
Adolescent Clinical Assessment Software Application (Adult CASA) program.
Like CASA, its pediatric counterpart, Adult CASA is a tool for assessing
immunization practices within a clinic, private practice, or other
environment where immunizations are provided.
Following are the four new reports:
- Provider patient listing
- Provider patient immunization listing
- Free-text questions summary report
- Individual patient immunization card
To access the updated Adult CASA program, go
to:
http://www.cdc.gov/nip/casa/acasa/acasa_features.htm#rpts
For more information about Adult CASA, go to:
http://www.cdc.gov/nip/casa/acasa/acasa.htm
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November 10, 2003
NEW: LATEST ISSUE OF GAVI'S "IMMUNIZATION FOCUS" QUARTERLY PUBLICATION
IS AVAILABLE ONLINE
The current issue of "Immunization Focus," a quarterly publication of
the Global Alliance for Vaccines and Immunization (GAVI), is available
on line. It covers the spread of polio from Nigeria to several nearby
countries, an Africa-wide initiative against measles, and the health
service brain drain in developing countries.
To access the issue, go to:
http://www.vaccinealliance.org and click on "Immunization Focus"
in the left column.
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November 10, 2003
NEW VIS TRANSLATIONS: FIVE VISs NOW AVAILABLE IN HINDI ON IAC'S WEBSITE
The Immunization Action Coalition recently posted five Vaccine
Information Statements (VISs) in Hindi on its website. The VISs are for
the following vaccines: varicella, hepatitis A, hepatitis B,
measles-mumps-rubella (MMR), and pneumococcal conjugate (PCV7). IAC
gratefully acknowledges the California Department of Health Services for
providing the Hindi translations.
To access the VIS for varicella vaccine, go to:
http://www.immunize.org/vis/hi_var98.pdf
To access the VIS for hepatitis A vaccine, go to:
http://www.immunize.org/vis/hi_hpa98.pdf
To access the VIS for hepatitis B vaccine, go to:
http://www.immunize.org/vis/hi_hpb01.pdf
To access the VIS for MMR vaccine, go to:
http://www.immunize.org/vis/hi_mmr03.pdf
To access the VIS for PCV7 vaccine, go to:
http://www.immunize.org/vis/hiPCV7.pdf
For information about the use of VISs, and for VISs in a total of 30
languages, go to:
http://www.immunize.org/vis
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November 10, 2003
REVISED TURKISH TRANSLATIONS FOR THREE EDUCATIONAL SHEETS NOW AVAILABLE
ON IAC'S WEBSITE
The Immunization Action Coalition (IAC) recently posted revised Turkish
translations of three of its educational sheets. The three are "If You
Have Chronic Hepatitis B Virus Infection . . .," "Summary of Rules for
Childhood Immunization," and "Summary of Recommendations for Adult
Immunization." IAC gratefully acknowledges Mustafa Kozanoglu, MD, and
Murat Serbest, MD, for the translations.
To access the Turkish translation of "If You Have Chronic Hepatitis B
Infection . . .," go to:
http://www.immunize.org/catg.d/p4120tu.pdf
To access the Turkish translation of "Summary of Rules for Childhood
Immunization," go to:
http://www.immunize.org/catg.d/p2010tu.pdf
To access the Turkish translation of "Summary of Recommendations for
Adult Immunization," go to:
http://www.immunize.org/catg.d/p2011tu.pdf
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November 10, 2003
CDC REPORTS ON RECENT PROGRESS TOWARD POLIO ERADICATION IN ETHIOPIA,
SOMALIA, AND SUDAN
The Centers for Disease Control and Prevention (CDC) published "Progress
Toward Poliomyelitis Eradication--Ethiopia, Somalia, and Sudan, January
2002-August 2003" in the November 7 issue of "Morbidity and Mortality
Weekly Report" (MMWR). A summary made available to the press is
reprinted below in its entirety.
***********************
Ethiopia and Sudan have not reported wild poliovirus cases in over a
year and Somalia is approaching 1 year without evidence of wild
poliovirus transmission.
Since the World Health Assembly of the World Health Organization (WHO)
resolved in 1988 to eradicate poliomyelitis worldwide, the estimated
number of polio cases has declined more than 99%, and the number of
countries from which reports of polio were received declined from 125 to
seven. Ethiopia and Sudan have not reported wild poliovirus cases in
over a year and Somalia is approaching 1 year without evidence of wild
poliovirus transmission. This report provides an update of progress made
in these countries during January 2002–August 2003 and describes
remaining challenges to polio eradication. To maintain this progress,
continued funding and improved access to children, particularly in the
greater Mogadishu area in Somalia, are required.
***********************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5244a6.htm
To obtain a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5244.pdf
HOW TO OBTAIN A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR:
To obtain a free electronic subscription to "Morbidity and Mortality
Weekly Report" (MMWR), visit CDC's MMWR website at:
http://www.cdc.gov/mmwr Select
"Free Subscription" from the menu at the left of the screen. Once you
have submitted the required information, weekly issues of the MMWR and
all new ACIP statements (published as MMWR's "Recommendations and
Reports") will arrive automatically by email.
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