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Prevention Plan: Hepatitis A VaccinationJenni StracenerUniversity of Alabama: NUR 735

2+Introduction to the Prevention Plan Hepatitis A vaccine Focusing on Adolescents

Overall Goal: Implement the requirement of the Hepatitis A vaccine

for 7th grade entry in the state of Tennessee

3+Health Risk of Hepatitis A Hepatitis A Virus

Fecal/Oral transmission 14-50 day incubation period

Symptoms Fatigue, vomiting, diarrhea, headaches, myalgia Dark Urine, clay colored stools, jaundice

Vaccine: Vaqta and Havrix most effective way of preventing the spread of disease

Clinical Outcome Symptoms more prominent in children >6, adolescents and adult

(Craig and Schaffner, 2004; Karali, Basaranoglu, Karali, Oral, & Killic, 2011; Matheny & Kingery, 2012; WHO, 2013)

4+Health Risk of Hepatitis A

5+Hepatitis A in Adolescents Low Vaccination Rates (Dorell, Yankey, Byrd, &

Murphy, 2012; Sakou, et. al., 2011) 42-60% started the series 70% completion rate

Rates higher in states with Vaccination requirements (Dorell, Yankey, Byrd, & Murphy, 2012)

Tennessee (Dorell, Yankey, Byrd, & Murphy, 2012) 34.6% rate in adolescents 14+, with 64.3% completion

Lack of Education (Gowda, Schaffer, Dombkowski, & Dempsey, 2010) Both parental and medical staff

6+History and Current Recommendations 1996 (Dorell, Yankey, Byrd, & Murphy, 2012; Klevens, et. al., 2011)

Recommended for age> 2 in high risk communities

1999 (Dorell, Yankey, Byrd, & Murphy, 2012; Klevens, et. al., 2011) Recommended for increase number of states recommending vaccination

2006 (Dorell, Yankey, Byrd, & Murphy, 2012; Klevens, et. al., 2011) Vaccination of ALL children at 12 months of age Maintain existing programs for children 2 to 18 years of age Areas without existing programs could consider vaccination for

unvaccinated children 2 to 18 years of age Recommended for any person wishing to obtain immunity

Still remains lower than other recommended vaccines (Byrd, Santibanez, & Chaves, 2011)

7+Primary Prevention Hepatitis A Vaccination

ProtectsPromotesPrevents

8+Primary Prevention

(CDC, 2013)

9+Interdisciplinary Plan Propose new recommendation Approval for implementation from Tennessee Department

of Health Lobby for revision of Immunization Laws Collaboration with Tennessee Department of Education for

timeline Collaboration with Pharmaceutical Companies for supplies Education of Health Care Professionals on new laws Implementation

10+Prevention Plan Timeline

Proposal • Fall, 2014

Law Reform

• Spring, 2015

Collaboration• 2015

-2016

Implementation

• Fall, 2017

11+

Disciplines Involved Epidemiology Education Nursing Medicine Politics

12+Epidemiology

Discussed importance of vaccination Explain the nature of the Hepatitis A Virus Explain transmission of disease

13+Nursing and Medicine UTD with recommendations (CDC, 2013)

ACIP and State Laws

Review vaccine records of adolescents (Lai, Faye, & Bocchini, 2011)

Educate families; Recommend Vaccine (Gowda, Schaffer, Dombkowski, & Dempsey, 2010; Dorell, Yankey, Byrd, & Murphy, 2012; Raczniak, et. al, 2013)

Lobby for coverage and reimbursement (Dorell, Yankey, Byrd, & Murphy, 2012; Singer, Davis, Gebremariam, & Clark, 2012)

14+Education School Administrators

Agree to and collaborate on new laws Educate employees

School Nurses Enforces School Entry Laws Review Vaccine Records

15+Policy Makers

VFC Program (Dorell, Yankey, Byrd, & Murphy, 2012)

Insurance Coverage (Singer, Davis,, Gebremariam, & Clark, 2012)

State Laws

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EmpowermentDecision Making

Delegation

LeadershipCompetencie

s

+ 17

Empowerment

ScheduleSide EffectsVaccine

Information

Informed and Accurate Decisions

Prevention Plan: Hepatitis A

KnowledgeSkillsResources

+ 18

Delegation

Talents Skills Strengths Coordination

School Nurses Administrators Policy Makers Medical

Professionals

Develops and Contributes

Prevention Plan: Hepatitis A

+ 19

Decision Making

When Where How much

Costs Protocols Meeting with

interdisciplinary team

Implementation

Input from Others Prevention Plan: Hepatitis A

20+Evaluating the Intervention

Baseline rates Hepatitis A diagnosis in TNImmunization rates in 7th graders

Follow upDecline in diagnosis?

21+Summary Increase immunization rates of Hepatitis A

(Heo, et al, 2013) Prevent viral Hepatitis A Prevent spread of the disease Involves Interdisciplinary Approach Requires Leadership

22+ReferencesByrd, K. K., Santibanez, T. A., & Chaves, S. S. (2011). Predictors of Hepatitis

A Vaccination Among Young Children in the United States. Vaccine, 17(12), 3254-3259.

Craig, A. S. & Schaffner, W. (2004). Prevention of Hepatits A with the Hepatitis A Vaccine. New England Journal of Medicine, 305, 476-481. DOI: 10.1056/NEJMcp031540

CDC. (2013). Hepatitis A Vaccination. Retrieved from http://www.cdc.gov/Vaccines/vpd-vac/hepa/default.htm

Dorell, C. G., Yankey, D., Byrd, K. K., & Murphy, T. V. (2012). Hepatitis A Vaccination Coverage Among Adolescents in the United States. Pediatrics, 129(2): 213-221. doi: 10.1542/peds.2011-2197

Gowda, C., Schaffer, S. E., Dombkowski, K. J., & Dempsey, A. F. (2012). Understanding Attitudes Toward Adolescent Vaccination and the Decision-making Dynamic Among Adolescents, Parents Heo, J. Y., Song, J. Y., Noh, J. Y., Seo, Y. B., Kim ,I. S., Choi, W. S., Kim, W. J., Cho, G. J., Hwang, T. G., & Cheong, H. J. (2013). Low Level of Immunity Against Hepatitis A Among Korean adolescents: Vaccination rate and related factors. American Journal of Infection Control, 41(10), e97-e100.

Karali, Z., Basaranoglu, S. T., Karali, Y., Oral, B., & Killic, S. S. (2011). Autoimmunity and Hepatits A Vaccine in Children. Journal of Investigational Allergology and Clinical Immunology, 21(5): 389-393.

Klevens, R. M., Moran, D. K., Wasley, A., Gallagher, K., McQuillan, G. M.. Kuhnert, W., Teshale, E. H., Drobeniuc, J., & Bell, P.B. (2011). Seroprevalance of Hepatitis A Virus Antibodies in the I. S.: Results from the National Health and Nutrition examination survey. Public Health Reports, 126(4): 522-532.

23+ReferencesLai, J., Faye, K. E., & Bocchini, J. A. (2011). Update on Childhood and

Adolescent Immunizations: Selected review of US recommendations and literature: Part 2. Current Opinions in Pediatrics, 4, 470-481. doi: 10.1097/MOP.0b013e3283488160.

Matheny, S. C. & Kingery, J. E. (2012). Hepatitis A. American Family Physician, 86(11): 1027-1034.

Raczniah, G. A., Thomas, T. K., Bulkow, L. R., Negus, S. E., Zanis, C. L., Bruce, M. G., Spradling, P. R., Teshale, E. H., & McMahon, B. J. (2013). Duration of Protection against Hepatitis A for the Current Two-dose Vaccine Compared to a Three-dose Vaccine Schedule in Children. Vaccine, 31(17), 2152-2155. http://dx.doi.org/10.1016/j.vaccine.2013.02.048

Sakou, I., Tsitsika, A. K., Papaevangelou, V., Tzavela, E. C., Greydanus, D. E., & Tsolia, M. N. (2011). Vaccination Coverage Among Adolescents and Risk Factors Associated with Incomplete Immunization. Euopean Journal of Pediatrics, 170 (11) ,1419-1426.

Sartori, A. M., de Soarez, P. C., Novaes, H. M., Amaku, M., de Azevedo, R. S., Mareira, R. C., Pereira, L. M., Ximenes, R. A., &Martelli, C. M. (2012). Cost-Effectiveness Analysis of Universal Childhood Hepatitis A Vaccination on Brazil: Regional analyses according to the endemic context. Vaccine, 30(52), 7489-7497. http://dx.doi.org/10.1016/j.vaccine.2012.10.056

Singer, D. C., Davis, M. M., Gebremariam, A., & Clark, S. J. (2012). Underinsurance for Recently Recommended Vaccines in Private Health Plans. Jounral of Community Health, 37(6), 1164-1167.

World Health Organization. (2012). WHO Position Paper on Hepatitis A Vaccines – June 2012. Weekly Epidemiological Record, 87, 261-276