Vaccinator Orientation

1
Vaccinator Orientation

• Introduction

2
Welcome

• You will be working as a vaccinator at an
  upcoming community POD. Please complete this
  on-line orientation before coming to the POD.
  There will be a brief orientation the day of the
  POD to review the information in this course, to
  inform you of any updates, and to give you an
  opportunity to ask questions.

3
Format

• There are four sections to this orientation
• The introduction
• General information
• Information about administering inactivated
  vaccine
• Information about administering live,attenuated
  vaccine
• There are multiple choice questions at the end of
  each section. The correct answer to each
  question will be on the following slide, usually
  accompanied by a brief explanation.
• Please complete all four sections.

4
What is a POD?

• A POD is a point of dispensing/distribution
• A POD is designed to accommodate large numbers of
  people receiving medication and/or vaccine in a
  very short time.
• Some of the POD workers are public health
  professionals, others are volunteers.
• Local CERT (Community Emergency Response Team)
  members and community emergency planners (usually
  Fire Department employees) have planned and
  practiced activating their POD

5
Vaccine

• Vaccine is any preparation intended to produce
  immunity to a disease by stimulating the
  production of antibodies.
• This year two influenza vaccines are being
  offered
• seasonal flu vaccine and
• 2009 H1N1 vaccine
• Our PODs will be offering only the 2009 H1N1
  vaccine

6
Accountability

• All people working at a POD are expected to
  sign-in upon arrival and sign-out before they
  leave.

7
Vaccinator Safety

• Your safety is important
• Avoid behaviors that might result in injury to
  yourself or others

8
Safety of the person receiving vaccine

• Maintain a safe environment at your vaccination
  station
• Remove obstacles that may cause falls or other
  injuries
• Check the name and age of the person to be
  vaccinated before administering vaccine
• Take time to ensure that the person being
  vaccinated receives the correct vaccine and the
  correct dose, administered in the correct manner
• Document your actions for each patient

9
Vaccinators

• According to Ohio law, the following health care
  professionals are the only people who can
  administer vaccine
• RNs
• LPNs
• Physicians
• Physician assistants
• Pharmacists with special training
• EMT-Intermediates with training
• EMT-Paramedics with training

10
Question 1

• 1. To ensure patient safety, before administering
  the vaccine, the vaccinator must verify
• a. Name, age, vaccine, dosage, and route
• b. Name, age, vaccine, dosage, route, and time
• c. Age, vaccine, dosage, route, and time
• d. Age, vaccine, dosage, and route

11
Answer to question 1

• 1. To ensure patient safety, before administering
  the vaccine, the vaccinator must verify
• a. Name, age, vaccine, dosage, and route
• Check patients name against paperwork, verify
  age. Based on age and other criteria, decide
  which vaccine is appropriate and, if
  administering inactivated vaccine, determine dose
  based on patients age. Again, based on vaccine
  used and age of patient, decide on the
  appropriate route of administration.

12
Question 2

• 2. Licensed/certified individuals who can
  administer vaccine are
• a. RNs, LPNs, Physicians, Physician Assistants
• b. RNs, LPNs, Medical Assistants, Physicians,
  Physician Assistants
• c. RNs, LPNs, Physicians, Physician Assistants,
  Pharmacists with special training
• d. RNs, LPNs, Physicians, Physician Assistants,
  Pharmacists with special training,
  EMT-Intermediates and EMT-Paramedics with special
  training

13
Answer for question 2

• 2. Licensed/certified individuals who can
  administer vaccine are
• d. RNs, LPNs, Physicians, Physician Assistants,
  Pharmacists with special training,
  EMT-Intermediates and EMT-Paramedics with special
  training
• Other health care professionals have not been
  granted permission to administer influenza
  vaccines. The statutory authority to administer
  H1N1 influenza vaccine recently was granted to
  EMT-Intermediates and EMT-Paramedics. In October
  2009 Governor Strickland signed an emergency
  proclamation allowing designated EMT workers to
  administer H1N1 vaccine.

14
Vaccinator Orientation

• General information

15
Priority groups

• CDC identified priority groups in the population
  and made vaccine available to people in those
  groups first. CDC selected these groups based on
  information about which people are most likely to
  become infected, which people are most likely to
  develop complications and/or are in close contact
  with those at greatest risk of infection and/or
  complications. Now more vaccine is available and
  soon will be offered to the general population.
  However, people in the priority groups will
  remain a focus of public health activity.

16
Priority groups

• Pregnant women
• Household contacts and caregivers for children
  younger than 6 months of age
• Health care and emergency medical services
  personnel
• Children 6 months through 18 years of age, young
  adults 19 through 24 years
• Persons aged 25 through 64 years who have health
  conditions associated with higher risk of medical
  complications from influenza

17
Providing adequate protection

• One dose provides adults with adequate protection
• Children younger than 10 years of age need 2
  doses for adequate protection
• CDC recommends separating the doses by at least
  28 days, however a separation of not less than 21
  days is acceptable. The doses may be separated
  by longer than 28 days.

18
Screening patients for contraindications to
vaccine

• Some conditions increase the risk of serious
  adverse reactions to the vaccine. Generally
  people with these conditions should not be
  vaccinated in PODs. Those conditions include
• Moderate to severe acute illness with fever
• Allergy to eggs or other vaccine component
• Previous adverse reaction following an influenza
  vaccine
• History of Guillain-Barré Syndrome within 6 weeks
  of a previous influenza vaccine
• Reminder Influenza vaccine is not approved for
  children younger than 6 months of age

19
Storage and handling vaccine

• To maintain the potency of the vaccine, store and
  handle it with care
• Store all influenza vaccines at temperatures
  between 35 and 46 F
• Keep vaccine in a cooler with an ice pack
• Remove vaccine immediately before administering
• Keep cooler closed

20
Influenza vaccine two forms

• There are two forms of vaccine used in the PODs
• Inactivated vaccine is given intramuscularly. It
  is commonly referred to as the flu shot
• Live attenuated influenza vaccine (LAIV) is
  administered as a nasal spray.
• See the next slide for a chart comparing and
  contrasting the two forms of vaccine

21
IV and LAIV
22
Thimerosal

• Thimerosal is a mercury-based preservative that
  has been used for decades in the United States in
  multi-dose vials of some vaccines to prevent the
  growth of microorganisms which may contaminate
  the vaccine.
• Single dose vials and commercially pre-filled
  syringes do not contain Thimerosal

23
Additional information on Thimerosal

• http//www.cdc.gov/h1n1flu/vaccination/thimerosal_
  qa.htm
• http//www.cdc.gov/H1N1flu/vaccination/pregnant_qa
  .htm
• http//www.cdc.gov/h1n1flu/vaccination/vaccine_saf
  ety_qa.htm

24
Positioning

• The vaccinator must accommodate for patient
  comfort, safety, age, activity level, and site of
  administration.
• For a child, encourage the parent to hold the
  child securely during vaccine administration

25
Holding children securely for vaccination

• A young child can sit on the parents leg
• sitting on the parents right leg, facing the
  parents left side or sitting on the parents
  left leg, facing the parents right side
• The childs legs are placed between parents
  legs.
• The childs back arm goes around parents back
• The childs other arm is secured by parent

26
Alternate method of holding a child securely for
vaccination

• An older child can sit on parents lap with
  childs legs between parents legs
• Both parent and child face forward
• Parent crosses legs over childs legs
• Parent secures hands
• parents left hand securing childs right wrist
• parents right hand securing childs left wrist

27
Infection Control

• Follow appropriate precautions to minimize risk
  of spreading disease
• Wash your hands with soap and water or use an
  alcohol based hand sanitizer
• Before preparing vaccine
• Between patients
• Any time hands are soiled
• Gloves will be available but are not required
  unless the vaccinators hands have open lesions

28
Documentation

• All vaccinators MUST sign the CCBH Vaccinator
  sign-in sheet, available at the POD
• Read first page of the sign-in sheet
• The first page lists five questions to be asked
  of all patients
• Are you ill and have a temperature over 100F?
• Are you allergic to eggs?
• Have you been told you are allergic to
  Thimerosal?
• Have you had a flu shot in the past?
• Do you have a history of Guillain-Barré Syndrome?
  
• The first page also lists the vaccine
  manufacturers and lot numbers of the vaccine to
  be used in the POD

29
Documentation

• Sign the second sheet as follows
• First column - print first name and last name
• Second column - sign your name
• Third column provide your credentials
• Fourth column write your initials as you will
  sign them on patient consent form

30
Vaccine Information Sheet (VIS)

• After you finish vaccinating the patient, hand
  them the appropriate VIS
• There are separate Vaccine Information Sheets for
  live, attenuated (the nasal spray vaccine) and
  for inactivated vaccine (the flu shot)
• To view VIS for 2009 H1N1 vaccine, visit
  http//www.cdc.gov/vaccines/pubs/vis/h1n1live or
  http//dchealth.dc.gov/doh/lib/doh/h1n1/vis-h1n1-p
  relicensure.pdf
• The VIS provides information about 2009 H1N1
  influenza, the vaccine, who should get the
  vaccine, risks of the vaccine, severe reactions
  to the vaccine and resources for additional
  information.

31
Vaccination area set up

• To increase efficiency, there will be two
  sections in the vaccination area
• Complex stations will accommodate families that
  include children who are 18 years of age and
  younger
• Express stations are limited to individuals,
  families or other groups, all of whom are 19
  years of age or older
• Vaccination areas may differ from site to site,
  depending on the anticipated number of people who
  will attend and the configuration of the building
• Vaccination areas should be designed to
  accommodate people with special needs.

32
Patient registration

• Patients are encouraged to pre-register on-line
  and to bring a copy of the registration form with
  them
• Registration also will be available in the
  clinic.
• Patients should have appropriate paper work when
  they arrive in the vaccination area.
• See next two slides for examples of the two-page
  registration form
• You will document at the bottom of the second
  page

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35
Disposing of waste

• Dispose of syringes, nasal sprayers and empty
  vials in sharps containers
• Dispose of syringe caps, alcohol pads (with or
  without blood), cotton balls (with or without
  blood), gloves (with or without blood) in the
  regular trash.

36
Complaints after vaccination

• Localized
• Soreness, redness, itching, swelling, or bleeding
  at the injection site
• Psychological fright and syncope (fainting)
• Fainting may occur during vaccine administration
• If syncope develops, the provider should observe
  the patient and administer supportive care until
  the patient is recovered

37
Observation area

• Clinics will have an observation area for
• Patients who have not previously been vaccinated
  for influenza. Ask first time patients to wait
  for at least 10 minutes before leaving the
  vaccination area.
• Patients who report immediate itching
• Large PODs may have a staffed rescue squad parked
  near the building.

38
Complaints after vaccination

• If itching or swelling are confined to injection
  site, observe client closely for development of
  generalized symptom
• If the primary symptom is wheezing and/or
  urticaria (hives), but no signs of anaphylaxis,
  place the patient in a sitting or semi-recumbent
  position of comfort and continue to observe

39
Anaphylaxis

• Anaphylaxis is an emergency condition requiring
  immediate professional medical attention
• Symptoms
• Flushing,
• Facial edema,
• Urticaria (hives),
• Itching,
• Swelling of the mouth or throat,
• Wheezing,
• Difficulty breathing

40
Anaphylaxis

• ACTION Notify EMS
• ACTION place the patient in a recumbent
  position with the legs elevated
• Lead vaccinator will have epinephrine and
  Benadryl

41
Question 3

• 3. Which of the following individuals is not
  eligible to receive vaccine at this time?
• a. A 26-year-old mother with an 8-month-old
  child.
• b. A 35-year-old nurse in an intensive care
  unit.
• c. A 55-year-old with COPD.
• d. A 20-year-old with no known health problems.

42
Answer to question 3

• 3. Which of the following individuals is not
  eligible to receive vaccine at this time?
• a. A healthy 26-year-old mother with an
  8-month-old child
• This woman would be eligible for vaccine if she
  was 24 years old or younger or if her child was
  younger than 6 months. As more vaccine becomes
  available, healthy people 25 years of age through
  64 years of age will be eligible for vaccine.

43
Question 4

• 4. Which of the following statements about a
  second dose of vaccine is true?
• a. Individuals from 6 months to 18 years require
  a second dose.
• b. The second dose must be given no more than 30
  days after the first dose.
• c. The second dose should be given no earlier 21
  days after the first dose.
• d. A second dose given 35 days after the first
  dose will not be effective.

44
Answer to question 4

• Which of the following statements about a second
  dose of vaccine is true?
• c. The second dose should be given no earlier 21
  days after the first dose
• CDC recommends a second dose for children under
  10 years of age, and recommends the second dose
  be given 28 days or longer after the initial
  dose, however it is acceptable to give the second
  dose as early as 21 days after the initial dose.

45
Question 5

• 5. Contraindications for receiving the vaccine
  are
• a. Chronic respiratory illness (e.g., asthma,
  emphysema), allergy to eggs
• b. Acute illness with fever, allergy to eggs,
  adverse reaction to a previous vaccination,
  history of Guillain-Barré syndrome within six
  weeks of a previous influenza vaccination
• c. Chronic respiratory illness, compromised
  immune system, allergy to eggs, adverse reaction
  to a previous vaccination, history of
  Guillain-Barré syndrome
• d. Acute illness with fever, chronic respiratory
  illness, allergy to eggs, compromised immune
  system, history of Guillain-Barr? syndrome within
  six weeks of a previous influenza vaccination

46
Answer to question 5

• 5. Contraindications for receiving the vaccine
  are
• b. Acute illness with fever, allergy to eggs,
  adverse reaction to a previous vaccination,
  history of Guillain-Barré syndrome within six
  weeks of a previous influenza vaccination
• All other answers mention chronic respiratory
  illness as a contraindication for receiving the
  vaccine. People with chronic respiratory illness
  are considered high risk for complications of
  influenza and are listed as priority group
  members.

47
Question 6

• 6. Which of the following vaccine handling
  procedures is correct?
• a. Vaccine must remain frozen until 24 hours
  before use.
• b. Vaccine should be between 45 and 55 F at
  time of administration.
• c. Vaccine must remain in a cooler at 35 to 46
  F until use.
• d. Temperature is not a factor in vaccine
  storage and use.

48
Answer to question 6

• 6. Which of the following vaccine handling
  procedures is correct?
• c. Vaccine must remain in a cooler at 35 to 46
  F until use.
• Guidance from CDC directs vaccinators to maintain
  both live, attenuated vaccine and inactivated
  vaccine at 35F and 46F during shipping and
  storage. Keep all vaccine in a closed cooler to
  maintain the potency of the vaccine.

49
Question 7

• 7. Which of the following individuals may receive
  the nasal spray with the live virus?
• a. Pregnant women
• b. A healthy 74-year old
• c. A 1-year-old
• d. A healthy 30-year-old

50
Answer to question 7

• 7. Which of the following individuals may receive
  the nasal spray with the live virus?
• d. A healthy 30-year-old
• FDA has approved live attenuated influenza
  vaccine (LAIV) for people 2 year of age through
  49 years of age who are healthy (no underlying
  medical conditions pre-disposing them to
  complications of influenza) and women who are not
  pregnant

51
Question 8

• 8. Which of the following objects may be
  discarded in the regular trash?
• a. Syringes, nasal sprayers, empty vials,
  gloves, alcohol pads
• b. Syringe caps, alcohol pads, cotton balls,
  gloves
• c. Syringe caps, empty vials
• d. Syringe caps, empty vials, alcohol pads,
  cotton balls, gloves

52
Answer to question 8

• 8. Which of the following objects may be
  discarded in the regular trash?
• b. Syringe caps, alcohol pads, cotton balls,
  gloves
• Item that should be discarded in a sharps
  container include
• Used syringes
• Used nasal sprayers
• Empty vials
• Other items can be safely tossed in the regular
  trash.

53
Question 9

• 9. Which of the following are signs of
  anaphylaxis?
• a. Itching and swelling at the injection sight
• b. Fainting
• c. Fever
• d. Itching, wheezing, difficulty breathing,
  swelling of tongue or throat

54
Answer to 1uestion 9

• 9. Which of the following are signs of
  anaphylaxis?
• d. Itching, wheezing, difficulty breathing,
  swelling of tongue or throat
• Adverse reactions may include tenderness or
  itching at the vaccination site, fainting or,
  later, a mild fever. People who faint need
  supportive care, those with itching and swelling
  at the vaccination site need further observation.
  
• However, anaphylaxis is a medical emergency that
  is characterized by itching, wheezing, difficulty
  breathing, swelling of tongue or throat.

55
Question 10

• 10. How should adverse reactions be treated?
• a. Supportive care for minor reactions
  medication (epinephrine/Benadryl) and EMS for
  anaphylaxis
• b. No treatment necessary for minor reactions
  medication and EMS for anaphylaxis
• c. EMS for all reactions
• d. Medication (epinephrine/Benadryl) for all
  reactions

56
Answer to question 10

• 10. How should adverse reactions be treated?
• a. Supportive care for minor reactions
  medication (epinephrine/Benadryl) and EMS for
  anaphylaxis
• EMS does not need to be called for minor
  complaints. For patients with anaphylaxis, it is
  important to call for emergency medical
  assistance quickly.

57
Vaccinator Orientation

• Inactivated vaccine

58
Storage and handling inactivated vaccine
pre-filled syringes

• Some syringes may be filled on site from
  multi-dose vials
• These syringes will be in a plastic bag with a
  label identifying them
• Administer vaccine in these syringes as soon as
  possible
• Store these syringes in the cooler until vaccine
  is administered
• Unused syringes will be discarded at the end of
  the session
• Commercially pre-filled syringes
• Keep in original packaging
• Store in cooler until vaccine is administered
• You will need to attach the appropriate needle
  before administering vaccine

59
Administering inactivated vaccine Intramuscular
injection

• Vaccinate adults and older children in the
  deltoid muscle.
• Use a 1 inch needle or longer
• Needles of less than 1 inch might be of
  insufficient length to penetrate muscle tissue
• When injecting into the deltoid muscle in
  children with adequate deltoid muscle mass, use a
  1 inch needle.
• 2009 H1N1 Monovalent Influenza Vaccine Dosage,
  Administration, and Storage, CDC, November 24,
  2009

60
Administering inactivated vaccine Intramuscular
injection

• Vaccinate young children in the anterolateral
  aspect of the thigh.
• Use a 1 inch for children younger than 12 months
  of age
• 2009 H1N1 Monovalent Influenza Vaccine Dosage,
  Administration, and Storage, CDC, November 24,
  2009

61
Doses by age

• Inactivated
• Pediatric dose (6 months through 35 months)
• 0.25 mL., given IM
• Adult dose (administered to those who are 3 years
  of age and older, including adults)
• 0.5 mL., given IM
• Note Sanofi produces vaccine in pre-filled
  syringes, packaged as adult doses and pediatric
  doses. The packaging is similar, green and
  white. Be very careful about distinguishing
  between the Sanofi pediatric dose (0.25 mL.) and
  the adult dose (0.5 mL.)

62
Intramuscular injection

• Wipe the area where the shot is going to be given
  with an alcohol pad
• Allow to dry (a few seconds)
• For infants, gently grab the outer thigh area to
  make a bulge and Insert the needle in the bulge
  at a 90 degree angle
• For adults, mark 2 finger widths down from top of
  shoulder and insert needle at a 90 degree angle
• To reach deep into the muscle tissue
• For infants use a 1 needle.
• For children and adults use a 1 needle or
  longer.
• Press plunger until all vaccine is dispensed.
  Remove needle after injecting medication and
  dispose of syringe in a sharps container.
• Apply band-aid if needed

63
Documentation of vaccine information
Inactivated vaccine

• Record in the lower section (Vaccine Administered
  Information) of the second page of the
  registration form (see next slide)
• If administering vaccine (adult dose) from a
  commercially pre-filled syringe, remove the label
  from the barrel of the syringe and place it on
  form
• If administering vaccine (pediatric dose) from a
  commercially pre-filled syringe, the label is on
  the cover of the tray
• If administering vaccine drawn up on-site, check
  with the lead vaccinator about recording

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65
Documentation of site of injection Inactivated

• Again record on the second page of the
  registration form, to the right of where you
  placed the label
• Record the site of the injection as follows
• RD for right deltoid
• LD for left deltoid
• RT for right thigh
• LT for left thigh
• Write your initials on the space provided at the
  bottom of this sheet.

66
Question 11

• 11. What size needle should be used for the
  injectable vaccine?
• a. 1" for all ages
• b. 1" for infants and children 1" or longer for
  adults
• c. 1" for infants 1" or longer for children and
  adults

67
Answer for question 11

• 11. What size needle should be used for the
  injectable vaccine?
• c. 1" for infants 1" or longer for children and
  adults
• CDC recommends using a needle of sufficient
  length to deliver the vaccine into the muscle.

68
Question 12

• 12. Correct dosages are
• a. 0.25 ml for 6-12 months and 0.50 ml for 13
  months and older
• b. 0.25 ml for 6-24 months and 0.50 ml for 25
  months and older
• c. 0.25 ml for 6-35 months and 0.50 ml for 36
  months and older
• d. 0.25 ml for 6-47 months and 0.50 ml for 48
  months and older

69
Answer for question 12

• 12. Correct dosages are
• c. 0.25 ml for 6-35 months and 0.50 ml for 36
  months and older
• The pediatric dose is intended for children
  younger than 3 years of age. The adult dose (0.5
  ml.) is for people 3 years of age and older

70
Question 13

• 13. Which of the following injection sites are
  correct?
• a. Infants in thigh and adults in deltoid
• b. Infants in thigh or deltoid and adults in
  deltoid
• c. Infants in thigh and adults in thigh or
  deltoid
• d. Thigh or deltoid for all ages

71
Answer to question 13

• 13. Which of the following injection sites are
  correct?
• a. Infants in thigh and adults in deltoid
• Infants and young children should be vaccinated
  in the anterolateral aspect of the thigh. Adults
  and older children should be vaccinated in the
  deltoid muscle.

72
Question 14

• 14. Which of the following information must the
  vaccinator document?
• a. Medication label, injection site, initials of
  vaccinator
• b. Medication label, injection site, initials of
  vaccinator, date
• c. Medication label, injection site, vaccinator
  signature
• d. Medication label, injection site, vaccinator
  signature, date, time, location

73
Question 14

• 14. Which of the following information must the
  vaccinator document?
• a. Medication label, injection site, initials of
  vaccinator
• Remember to take the label either from the barrel
  of the syringe (adult dose) or the cover of the
  tray (pediatric dose) and attach it the patients
  sheet.

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Vaccinator Orientation

• Live attenuated influenza vaccine

75
Live Attenuated Influenza Vaccine (LAIV)

• The 2009 H1N1 monovalent LAIV contains the same
  vaccine antigen as the inactivated vaccine.
• The antigen is constituted as a live, attenuated,
  cold-adapted, temperature-sensitive vaccine
  virus.
• LAIV is made from an attenuated virus that is
  able to replicate efficiently only at
  temperatures present in the nasal mucosa.
• LAIV does not cause systemic symptoms of
  influenza in vaccine recipients
• Some recipients may experience nasal congestion
  or fever, probably as a result of the effects of
  intranasal vaccine administration or local viral
  replication.
• 2009 H1N1 Monovalent Influenza Vaccine Dosage,
  Administration, and Storage, CDC, November 24,
  2009

76
Doses by age

• Live, attenuated vaccine (LAIV)
• LAIV is approved for use only in people
• Who are 2 years through 49 years of age
• Who have no underlying medical conditions that
  would increase their risk of complications of
  influenza
• Women who are not pregnant
• All eligible people receive the same dose

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Contraindications for LAIV (nasal spray)

• Younger than 2 years of age or older than 49
  years of age
• Pregnancy
• Diagnosis of asthma
• Or children younger than 5 years with one or more
  episodes of wheezing during the past year
• Diabetes
• Heart disease
• Lung disease
• Kidney or liver disease
• Anemia or other blood disorders
• Cerebral palsy or other muscle or neuromuscular
  disease
• Anyone in contact with a person with a severely
  weakened immune system, such as a bone marrow
  transplant recipient
• Weakened immune system (HIV, AIDS, chemotherapy)
• Children or adolescents on long term aspirin
  therapy
• Has received a live vaccine such as MMR,
  Varicellla (chickenpox), LAIV seasonal flu within
  28 days

78
2009 H1N1 LAIV and other live vaccines

• Other live vaccines should be separated from 2009
  H1N1 LAIV by at least 28 days. If administered
  1-27 days apart repeat the vaccine administered
  second, at least 28 days from the invalid
  (second) vaccine.
• Other live vaccines include MMR, varicella
  (chickenpox), or nasal seasonal flu

79
Taking antiviral medicine before or after LAIV

• If a person is taking an influenza antiviral
  drug, postpone LAIV until at least 48 hours after
  final dose
• If a person takes antiviral drugs within two
  weeks after getting LAIV, revaccination is
  necessary.
• The antiviral drugs will have killed the vaccine
  viruses that are supposed to cause the immune
  response against those viruses.
• Note Antiviral medications can be taken with
  inactived vaccine
• The Nasal-Spray Flu Vaccine (Live Attenuated
  Influenza Vaccine LAIV)Questions Answers
• http//www.cdc.gov/FLU/about/qa/nasalspray.htm

80
Intranasal Administration

• For each patient, review Screening Questionnaire
  for Intranasal Influenza Vaccination (see next
  slide)
• If person answered no to all questions, check
  form for patients or parents signature, and
  sign form.
• This patient is eligible for LAIV

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Intranasal Administration

• Question patient about responses that are
  answered yes or dont know
• Consult Information for Health Professionals
  about the Screening Questionnaire for Intranasal
  Influenza Vaccine for detailed information about
  questions (see next slide) this form will be
  available in the POD
• Determine if intranasal vaccine is appropriate
• If person is eligible for intranasal vaccine,
  check form for patients or parents signature,
  and sign form.
• If patient is not eligible for intranasal
  vaccine, offer inactivated vaccine if appropriate

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Intranasal administration

• Patient should be in an upright position
• No need to sniff during administration
• Each sprayer contains a single dose.
• Half the contents of the sprayer should be
  administered in each nostril (see next slide for
  more detail)
• For additional information from the manufacturer
  visit http//www.medimmune.com/assets/pdfs/flumis
  t_pi.pdf

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Intranasal Administration

• Remove rubber tip protector
• Place tip just inside nostril
• Depress plunger rapidly until dose-divider clip
  prevents pushing further
• Pinch and remove dose-divider clip from plunger
• Place tip just inside other nostril
• Depress plunger rapidly
• Dispose of sprayer in sharps container

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Documentation - LAIV

• Record at the bottom of the second page of the
  registration form Vaccine Administered
  Information (see next slide)
• If administering LAIV, simply write Nasal
• Write initials the administration sheet

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Other resources

• For more information on LAIV see
• http//www.cdc.gov/h1n1flu/vaccination/nasalspray_
  qa.htm

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Question 15

• 15. What side effects may occur with the live,
  attenuated vaccine?
• a. Itching and redness at administration site
• b. Nasal congestion and fever
• c. Nasal swelling and itching
• d. Generalized itching and hives

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Answer for question 15

• 15. What side effects may occur with the live,
  attenuated vaccine?
• b. Nasal congestion and fever
• The vaccine recipient may experience these
  symptoms as the result of the effects of
  intranasal vaccine administration or local viral
  replication.

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Question 16

• 16. The dosage of the live, attenuated vaccine
• a. Varies with weight
• b. Varies with age
• c. Is the same for all ages
• d. Is not recommended for children

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Question 16

• 16. The dosage of the live, attenuated vaccine
• c. Is the same for all ages
• The nasal spray measures the dose for all people
  who are eligible for LAIV, people 2 years of age
  to 49 years of age.

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Question 17

• 17. Which of the following is not a
  contraindication for administration of the live,
  attenuated vaccine?
• a. Children with asthma
• b. All ages with diabetes
• c. Adults with COPD
• d. Adults on aspirin therapy

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Answer for question 17

• 17. Which of the following is not a
  contraindication for administration of the live,
  attenuated vaccine?
• d. Adults on aspirin therapy
• Children (under 19 years of age) who are on
  aspirin therapy are at risk for developing Reyes
  Syndrome if they become infected with influenza.
  CDC recommends that these patients receive
  inactivated vaccine.
• CDC further recommends that aspirin or products
  containing aspirin not be given to any child
  younger than 19 years of age with flu-like
  symptoms, but recommends substituting
  acetaminophen or ibuprofen.

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Question 18

• 18. Administration of vaccine by nasal spray
• a. Requires the recipient to sniff during
  administration
• b. Requires the administration of half the
  sprayer in each nostril
• c. Requires the administration of the entire
  contents of the sprayer in one nostril
• d. Requires recipients to hold their breath for
  5 seconds after administration

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Answer for question 18

• 18. Administration of vaccine by nasal spray
• b. Requires the administration of half the
  sprayer in each nostril
• Each sprayer contains enough vaccine for an
  entire dose. The clip on the plunger prevents
  administration of more than half of the vaccine.
  Place the syringe just inside the first nostril
  and rapidly push the plunger until the clip
  prevents pushing further. Remove the clip and
  place the tip of the syringe just inside the
  other nostril. Rapidly push the plunger to
  discharge the remaining vaccine into the second
  nostril.

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Question 19

• 19. Which of the following information must the
  vaccinator document after the administration of
  the live, attenuated virus?
• a. Vaccinator signature, date, time, location
• b. Medication label, vaccinator signature, date
• c. Medication label, vaccinator initials, date,
  time
• d. The word "nasal," vaccinator initials

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Answer for question 19

• 19. Which of the following information must the
  vaccinator document after the administration of
  the live, attenuated virus?
• d. The word "nasal," vaccinator initials

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Thank you

• You have completed the on-line vaccinator
  orientation. If you have questions about the
  content of this orientation, call the Cuyahoga
  County Board of Health at 216-201-2000 and ask to
  talk with a nurse who is working with the H1N1
  vaccination program.
• We value your volunteer service and look forward
  to seeing you at the POD.