FIP 2011 Hyderabad. CL/pharmaSuisse 1. Vaccinations when travelling. Which vaccinations? Vaccinations when travelling Last News!

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1 To help protect your privacy, PowerPoint prevented this external picture from being automatically downloaded. To download and display this picture, click Options in the Message Bar, and then click Enable external content. FIP 2011 Hyderabad Vaccinations when travelling Which vaccinations? HEALTHY TRAVELLING? ASK YOUR PHARMACIST! Vaccinations when travelling Thursday 8 th September 2011 Claudine Leuthold, Pharm. D, Swiss Society of Pharmacists Department of Sciences, Education & Quality Do you ever feel we re having too many inoculations forced on us? travel.nytimes.com/2011/07/31/travel/vaccinations-for-traveling-abroad.html July 27, 2011 Vaccinations when travelling Last News! Agenda WHO Since April WHO recommends all travellers to be up to date with routine vaccinations and - for travellers to and from Europe, to be immunized against Measles El Salvador From July 1, 2011, El Salvador requires proof of vaccination against rubella and measles from travellers arriving from, or travelling to Europe Other Central American countries may follow El Salvador s lead after the Pan American Health Organization recently recommended all travelers heading to and from the region be vaccinated against the two highly contagious viruses. 1. Epidemiology and Travel vaccinations Some examples and proposed vaccinations for the practical case 2. Information Resources and Tools examples 3. Vaccinations in Switzerland A. Specific resources and tool B. The Immunization scheduler and checker program viavac for the Swiss health professionals website C. Project of Vaccination Certificate for Pharmacists Introduction Some facts Since 2007: Urban population > Rural population Urbanization is progressing more in developing countries, especially in Asia and in Africa Increase of urban population impacts on health and diseases profile Travel begins usually with an urban stay Therefore It is essential for Pharmacists to give the right vaccination information to the public Community Pharmacy has a key role to play because of its easy access conditions Evolution within the 20 past years Number of available vaccines for travellers grew considerably Most vaccines can be administered up to departure date Common diseases (e.g. tetanus, measles) still do occur in most countries Knowledge of vaccines needs to be constantly updated Practical tools and websites are easily available to assist health practitioners CL/ 1

2 Pre-travel Evaluation (Interview) Travel Plans Where? Destination, Itinerary, visited country(ies) When? Personal Data Departure date, duration, characteristics Conclusion epidemiological evaluation personal risk assessment immunization schedule Conclusion Who? Age Possible contraindications Medical History Which? Vaccine history Which? History of hepatitis, measles Which? Chronic illness, medications, allergies, pregnancy, nursing, thymus problems Conclusion necessary vaccinations unnecessary vaccinations Contraindications? Evaluate early to minimize patient adverse events and allow time for immunity development Incidence Rates and Impact Priorities = Incidence + Impact R. Steffen, Vaccine preventable diseases, 15th Swiss International Short Course on Travellers Health, Pre-Travel Evaluation Categories 3 Rs 1. Routine 2. Recommended 3. Required Procedure : Verify immunization status (vaccination records) Verify if routine vaccines are up to date Consider any other vaccines according to risk, illness incidence rate, individual s health status, occupation or lifestyle Verify specific travel vaccines Vaccinations to be considered 1. Routine vaccines = Childhood or adult immunizations contained in the National Immunization Schedules In most countries : Diphtheria, Tetanus, Pertussis, Hepatitis B, Haemophilus influenzae type b (Hib), Poliomyelitis, Measles, Mumps, Rubella, Influenza, Pneumococcal, Varicella In some countries: BCG, Hepatitis A, Human Papillomavirus, Neisseria Meningitis, Rotavirus, Tick-Borne Encephalitis (TBE) Vaccinations to be considered 2. Recommended - Travel-related vaccines Aim Protect travellers from illnesses present in other parts of the world Prevent import of infectious diseases across international borders (e.g. Yellow fever) Depend on destination, length, type of travel / traveller, and previous immunizations Main vaccines considered: Cholera, Hepatitis A, Hepatitis B, Japanese encephalitis, Meningococcal Meningitis, Poliomyelitis, Rabies, Tick-Borne Encephalitis (TBE), Typhoid fever, Yellow fever Vaccinations to be considered 3. Required Vaccines An International Certificate of Vaccination or Prophylaxis (ICVP) is required to enter some countries Yellow fever vaccine Is required for travels to certain countries in sub-saharan Africa and tropical South America Meningococcal vaccine Is required by the government of Saudi Arabia for pilgrims during the Hajj (Meningitis ACYW135 vaccine) CL/ 2

3 Required Yellow Fever Distribution Map 2011 Required Yellow Fever recommendations required recommended not recommended Diseases with specific repartition and/or risks Meningococcal Meningitis Meningitis Belt in Africa Japanese Encephalitis Asia, Oceania Tick-borne Encephalitis Europe, Eastern countries, Russia Far Eastern, also known as Russian Spring- Summer Encephalitis (RSSE) European: also known as Central European Encephalitis (CEE) Influenza Influenza Cause 3 types of Influenza virus A, B, C; A ad B: epidemic Transmission Respiratory infection, person-to-person Risks for Travelers Vaccination Important morbidity and mortality factor for risk groups and seniors > 65 years old Acute exposition risk: Cruise, travel for 24 hours or more in a bus or a train, organized group travel, pilgrimage Several live inactivated vaccines, egg culture contra-indications! Influenza viruses change vaccine composition changes every year revaccination Efficacy: 6 months best vaccination period : North hemisphere: October to March South hemisphere: Mai to August Yearly for Tropical zone Case Study Recall Previous History Mrs AD is 45 years old 5 years ago 2 weeks holiday in Goa, India Single dose of hepatitis A Itinerary Booked through a company specialized in an adventurous travel days in Tanzania, travelling overland with a group of 10 people, visiting game parks and other places of interest, including mount Kilimanjaro feet (5 791 m) cross into Rwanda to see the mountain gorillas and other destinations away from the usual tourist routes. In total she will be away for 8 weeks. Case Study Suggested Recommended Vaccinations Vaccination CH D UK USA YF Rwanda: REQUIRED Tanzania, United Republic of : generally NOT RECOMMENDED for travelers to Tanzania REQUIRED if traveling from a country with risk of YFV transmi., from 1 year Diphtheria combination combination combination combination Tetanus RECOMMENDED RECOMMENDED as RECOMMENDED as RECOMMENDED Poliomyelitis (IPV) as a boostervaccinatiovaccinatiovaccination a booster- a booster- as a boostervaccination Measles born after 1963 Hepatitis A Hepatitis B Typhoid Fever Rabies Meningococcal Men. Tick-Borne-Encephalitis Japanese Encephalitis Cholera Influenza Born after 1970 Born after nd dose RECOMMENDED if not yet immunized: - RECOMMENDED for more than 1 mo exposure standard schedule: 0, 1 and 6 months accelerated schedule: 0, 7, days + 1 year - combined vaccine Hepatitis A and Hepatitis B could be RECOMMENDED RECOMMENDED because outside usual tourist routes Could be recommended because rural areas and animal parks but expensive, on a low budget, < 3 months Instructions: not to feed monkeys NO born after 1957 RECOMMENDED CL/ 3

4 Resources for International and National References International World Health Organization (WHO) International Travel and Health: Links to National travel and health websites: Americas CDC Yellow Book CND Public Health Agency of Canada Travel Medicine UK National Travel Health Network and Centre D Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit (DTG) dtg.org/ Resources for Vaccinations Websites and Tool State Websites Website of the Federal Office of Public Health Information on infectious diseases and vaccinations Website: = Swiss Electronic Vaccination Record Tool viavac : Immunization scheduler Specialized Travel medicine websites (public, free of charge) (under subscription) viavac Help for Vaccinations Management! Great tool to manage individuals vaccinations Gives the official recommendations for various types of vaccination, risks groups and situations Take into account individual factors: e.g. travel, pregnancy, risk factors, etc. List of vaccines available on the Swiss market (including old ones) Allow the selection of vaccines by antigen Calculate an individual catch-up plan to print and to give to the patient Immunization Record done with viavac replace the multiple records accumulated during lifetime Program viavac Brings Vaccinations also in the Pharmacy viavac for Physicians viavac for Pharmacists Help to manage complex situations Individualized catch-up plans Ease and speed (during the consultation) Respect of the Vaccination State of the art Help to Manage the patients schedule (ex: delays) New service to the customers Fast and effective vaccination records control Allow individual recommendation: is there a need for a vaccination s update? Extension of services and skills (image) Collaboration pharmacists / physicians Intensification of individual and public health Campaigns "Check your vaccines viavac - Patient s Vaccination status viavac Vaccination and Catch-up plans Vaccine s antigen up-to-date to do optionnal not recommended Vaccination s date Missing vaccinations Catch-up Plan Future doses Printed version of Immunization Record is considered as official when validated by a health professional CL/ 4

5 Swiss Electronic Vaccination Record Personal Vaccination Record with individual vaccines Secured file with password Possible access for authorized health professional to verify / complete the vaccines Link to the viavac tool: To identify missing vaccinations (red code) To access to detailed information To exchange data (files export/import) Electronic Vaccination Record Patient s view Electronic Vaccination Record Health professional view Vaccination in the Community Pharmacy The Swiss project Create a Certificate of post-graduated training "Vaccination and blood sampling This Certificate should allow to administer vaccines in pharmacies Prerequisite Modify political legal bases to allow to immunize and administer parenteral drugs Vaccination in the Community Pharmacy The Swiss project s added Value Easy access to pharmacy infrastructure No need to book an appointment Guaranteed cold chain: vaccines management Reach customers without family doctors Restrictions Population target : Healthy adults and adolescents Begin with Influenza, possibly Measles CL/ 5

6 Vaccination in the Community Pharmacy Certificate «Vaccination and blood sampling» Program split in 3 parts 1. Practical course including theory on «Injection s techniques and blood sampling» 2. Theoretical course on «Vaccinations» 3. CPR* or BLS** certification obtained = Requirement to participate to the practical part and to obtain the Certificate Each module validated by an exam Certificate granted if all exams passed *CPR: Cardio Pulmonary Resuscitation **BLS: Basic Life Support Certificate «Vaccination and blood sampling» Next steps Recognition of the potential: The pharmacists can contribute to improve the rate of vaccination Training of the pharmacists Creation of the necessary legal conditions Creation of a quality management system (QMS) Module «Vaccination» Thanks to FIP Community Pharmacy Section ISTM Pharmacist Professional Group and its president: Dominique Jordan Thank you for your attention! For more information, please contact: claudine.leuthold@pharmasuisse.org CL/ 6