Vaccine Champion Training Course, Module 1, Overview of Immunizations. The American College of Occupational and Environmental Medicine Vaccine Initiative is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services as part of a financial assistance award to the Council of Medical Specialty Societies with 100% funded by CDC and HHS. The contents are those of the authors and do not necessarily represent the official views of, nor endorsement by, CDC, HHS, or the U.S. government. Hello, my name is Arthur Sanchez and I'm a nurse informaticist and nurse practitioner at UC San Diego Health. I have a background in occupational medicine and health informatics. As part of this project, I am collaborating with the American College of Occupational and Environmental Medicine to develop these educational modules to help you become a vaccine champion. In the past 24 months, I have not had any financial relationships with any ineligible companies. Module 1 Agenda. In this module, we will review specialty societies advancing adult immunizations program initiatives. We will review the CDC standards for adult immunization practices. We will conduct a brief review of recommended vaccines for adults, including health benefits, safety, and timing with a focus on work-related vaccines. Module 1 Learning Objectives. At the end of this module, you will be able to describe the CDC's standards for adult immunization practice and summarize recommended vaccines in an occupational setting. Specialty Societies Advancing Adult Immunizations Program Initiatives Overview. The purpose of this project is to ensure that all adults, especially high-risk adults with comorbidities, receive up-to-date vaccinations for influenza, COVID-19, and all applicable vaccines. Since 2021, ACOEM has partnered with CMSS and CDC to advance outreach, education, and develop quality improvement initiatives. ACOEM partnered with health care systems and employers to develop, promote, and implement quality improvement programs to improve adult vaccination. ACOEM's health system and employer partners include Health Partners Institute, University of California San Diego, 3M, Albertson's Companies, Freudert Health, and Conservative Care Occupational Health. ACOEM's partners are implementing a variety of quality improvement initiatives to increase adult immunizations. Some examples include vaccine clinics and health fairs, employee focus groups, motivational interviewing and training, distributing immunization records to patients, educational brochures, clinic workflow improvements, and connecting electronic health records to immunization information systems. Now let's review the CDC standards for adult immunization practices. Assess, stay informed, implement protocols and procedures, recommend, tailored reasons why vaccinations are important, address patient questions and concerns, administer or refer, offer the available vaccines, refer patients, document, participate in your state's immunization registry, and follow up. The following chart is available on the CDC's website and lists recommended vaccines for adults aged 19 and over. In the following slides, we will review vaccinations commonly recommended in the occupational setting. The following vaccines are commonly offered in the workplace setting. Measles, mumps, and rubella, varicella, tetanus, diphtheria, and acellular pertussis or Tdap vaccine, hepatitis B, influenza, COVID-19, and rabies. Let's talk about the MMR vaccine. The vaccine protects against measles, mumps, and rubella, which is spread through infected respiratory droplets. It is a live attenuated vaccine. The weakened virus causes the development of immune response but does not cause disease. However, mild disease is considered an adverse reaction. Two doses of MMR vaccine are 97% effective against measles and rubella and 88% effective against mumps. The MMR vaccine is contraindicated in immunosuppressed and pregnant patients. MMR in adults has been associated with the following rare adverse events. With 1 to 3.5 occurrences per million doses, thrombocytopenia, rash, and joint pain may occur transiently after MMR vaccination. There is no evidence to support hearing loss, retinopathy, optic neuritis, Guillain-Barre syndrome, type 1 diabetes, Crohn's disease, or autism. Healthcare professionals without evidence of immunity should get two doses at least four weeks apart. Evidence of immunity is a positive antibody test or two documented doses of MMR vaccine. History of disease is not considered adequate evidence of immunity. The varicella vaccine protects against the spread of the chickenpox virus. Chickenpox is highly infectious and spreads through direct contact with vesicular skin lesions or most commonly through respiratory droplets. Primary infection remains dormant in the sensory nerve ganglia and can lead to shingles later on in life. The varicella vaccine is a live attenuated vaccine. The weakened virus triggers the development of an immune response. Typically, it will not cause disease, however mild disease can occur and is considered an adverse reaction. Healthcare workers without evidence of immunity should receive a two-dose series at least four weeks apart. Please note that evidence of immunity is a positive antibody test or two documented doses of the varicella vaccine. Two doses of the varicella vaccine are about 90% effective at preventing chickenpox. The vaccine is contraindicated in immunosuppressed and pregnant patients. The majority of adverse events in adults were injection site complaints. The Tdap vaccine protects from diphtheria, tetanus, and pertussis. Pertussis is a highly contagious respiratory tract infection that is aerosolized. The vaccine consists of inactivated, non-infectious bacterial proteins. Healthcare professionals regardless of age should receive a single dose of Tdap if they have not received a dose of Tdap within the last 10 years. Mild adverse events from the vaccine include pain, redness, and swelling at the injection site, mild fever, headache, feeling tired, nausea, vomiting, diarrhea, and stomach ache. Additional doses are recommended during pregnancy to prevent infants from pertussis. The Hepatitis B Vaccine. Hep B can be transmitted by percutaneous, mucosal, or non-intact skin exposure. The OSHA Bloodborne Pathogen Standard is a federal regulation designed to protect workers from occupational exposure to bloodborne pathogens. It applies to any employee who may be exposed to blood or other potentially infectious materials. The standard requires that employers offer vaccination at no cost to the employee. In addition to, should an employee be exposed, the employer must provide a medical evaluation, post-exposure prophylaxis, and counseling at no cost. This applies to healthcare workers, but also janitors, researchers, police officers, and any other workers who may come in contact with other potentially infectious materials. The Hep B Vaccine is administered as either a three-dose series or as a two-dose series. Engarix B and Recombivax are given at 0, 1, and 6 months. Heplisav B is given at 0 and 1 months, but it is not recommended for pregnant women. Most side effects are generally mild and resolve within a few days. Some examples of these side effects include mild fever, headache, and fatigue. The Influenza Virus Vaccine prevents the three influenza viruses that are expected to be most prevalent during the influenza season. This is determined based on the study of epidemiological and surveillance data, viral genetic data, and human serological data. The strains in the vaccine vary based on geographical location. The vaccine is available as an inactivated virus vaccine or live attenuated influenza virus vaccine. The live attenuated influenza virus vaccine has some benefits including administration to those with needle phobias, but also has some drawbacks. Weakened influenza virus can replicate in the nasal mucosa for up to 7 days and poses a theoretical risk of transmission to severely immunocompromised individuals. Most common side effects include mild soreness, redness, and or swelling where the shot was given. Severe allergic reactions are rare, and Guillain-Barre syndrome is very rare. The COVID-19 Vaccine. An updated version of the vaccine was released for the 2024-2025 fall and winter season. It reduces the risk of severe illness, hospitalization, and death. Common side effects include pain, swelling, and redness where the shot was given, tiredness, headache, muscle pain, chills, nausea, and fever. Severe side effects are rare. As healthcare professionals, we should assess, recommend, administer, and document immunizations at every encounter. Each organization has taken different approaches to improve standards for adult immunization practices. Each healthcare professional can take the opportunity to provide information about immunizations and dispel misinformation. All medicine settings provide a unique opportunity to promote the importance of immunizations.

adult immunizations

CDC standards

vaccine clinics

quality improvement

healthcare professionals