1
Annual Flu Season 2013-2014 Training
Goal: Participants will be able to identify current recommendations and changes for the 2013-14
annual flu season.
Objectives
Participants will be able to:
1. Explain the difference between trivalent and quadrivalent influenza vaccine
What’s
2. List new flu vaccine abbreviations
New in
3. Identify vaccine recommendations for 2013-14 flu season
Flu?
4. Identify available flu vaccine products for 2013-14 flu season
5. List at least 3 key points regarding H7N9 bird flu
Protocol &
Procedures
Needle
Safety
6. Describe Vermilion County Health Department (VCHD) protocol related to influenza
vaccination (especially pregnant women and children)
7. Describe (VCHD) Emergency Procedures related to influenza vaccine administration
8. List at least 2 steps to increase needle safety during VCHD adult influenza clinics
9. Identify needle safety mechanism being used at VCHD for the 2013-14 flu season & explain
how to appropriately activate needle safety mechanism
Continuing Education Credits
Participants are eligible for .5 CEUs upon completion of this training module.
In order to receive your CEU certificate please do the following:
 Read the training module
 Complete the Post Test
 Complete the Evaluation
 Turn in the Post-Test & Evaluation to Community Health Service Director, Jenny
Trimmell
Note**
This training module is eligible for CEU’s for the time period of August 12, 2013- October 31, 2013
CEU’s are being provided through the Illinois Public Health Nurse Administrator’s Association
(IPHNA)
Questions:
Contact Jenny Trimmell RN BSN
Director of Community Health Services
200 S. College St.
Danville, Illinois 61832
217-431-2662 ext 229
jtrimmell@vchd.org
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Section I: What’s New in Flu?
Quadrivalent vs Trivalent vaccine
Seasonal Flu vaccine has traditionally been a trivalent formulation containing 2 types of Influenza A
strains (H1N1 and H3N2) and one type of Influenza B strain (Victoria or Yamagata). These strains
represent the viruses predicted to be in circulation in the United States during the influenza season.
During the influenza season there may be two different B strains circulating at the same time that
are different enough that vaccination against one will not provide protection against the other, or
the B strain selected for inclusion in the trivalent influenza vaccine may not be the influenza B strain
that eventually circulates causing illness.
Until 1985, the trivalent influenza vaccine had been adequate. However in 1985, the Influenza B
virus diverged into 2 strains; Y- Yamagata and V- Victoria. The advisory committee made its best
“guess” each year as to which B strain would likely circulate in the upcoming flu season however,
past history shows that recommendations have been about 50% correct.
In 2012, the FDA approved the first quadrivalent influenza vaccine. The quadrivalent vaccine
contains four (two A and two B) influenza virus strains. Inclusion of the second B strain increases
the likelihood for adequate protection against circulating strains. The FDA approved the
quadrivalent influenza vaccine after determining that it was safe and effective.
Quadrivalent vaccine is available from manufacturers for the 2013-14 flu season. It is estimated that
the quadrivalent vaccine however, may be in short supply. The 3 brands of quadrivalent vaccine
that have been FDA approved include: FluMist (approved 2/29/12); Fluarix (approved 12/14/12) and
Fluzone (6/7/13 approved).
(See section on flu vaccine products)
The U.S. trivalent formulation of the influenza vaccine for 2013-14 includes the following virus
strains:
 an A/California/7/2009 (H1N1)-like virus
 an (H3N2) virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011
 a B/Massachusetts/2/2012-like virus
The quadrivalent influenza vaccines contain the above three strains and the following additional B
strain for 2013-14:
 a B/Brisbane/60/2008-like virus
(Source FDA.gov: Vaccines, Blood & Biologics)
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Flu Vaccine Abbreviations
Certain U.S.vaccine abbreviations have been revised by the Advisory Committee on Immunization
practices (ACIP) to refer to currently available influenza vaccines. The revisions are as follows:
 The abbreviation TIV (trivalent influenza vaccine, previously used for inactivated influenza
vaccines) has been replaced with the abbreviation IIV (inactivated influenza vaccine). For
2013-14, IIVs as a class will include 1) egg-based and cell culture-based trivalent inactivated
influenza vaccine (IIV3), and 2) egg-based quadrivalent inactivated influenza vaccine (IIV4).
 RIV refers to recombinant hemagglutinin influenza vaccine, which will be available as a
trivalent formulation (RIV3) for 2013-14.
 LAIV refers to live, attenuated influenza vaccine, which will be available as a quadrivalent
formulation (LAIV4) for 2013-14.
 LAIV, IIV, and RIV denote vaccine categories; a numeric suffix specifies the number of
influenza virus antigens contained in the vaccine.
 Where necessary to refer specifically to cell culture-based vaccine, the prefix “cc” is used
(e.g., “ccIIV3”).
(Source CDC MMWR Prevention and Control of Influenza with Vaccines: Interim Recommendations of the Advisory
Committee on Immunization Practices (ACIP), 2013. May 10, 2013/ 62(18);356.)
Flu Vaccine Recommendations for 2013-14 flu season
Routine annual influenza vaccination is recommended for all persons aged 6 months and older.
(This statement is from the Interim Recommendations from CDC. If there are any updates or
changes from CDC or ACIP you will be advised)
See following chart for Flu Vaccines products ……………..>
4
Flu Vaccine products for 2013-14 flu season
Source of Table: CDC Interim Recommendations: Prevention & Control of Influenza with Vaccines
http://www.cdc.gov/flu/professionals/acip/2013-interim-recommendations.htm#table1
TABLE 1. Influenza Vaccines — United States, 2013–14 influenza season*
Vaccine
Presentation
Mercury
content
Age
(mcg
Route
indications
Hg/0.5
mL)
0.5 mL
single-dose
prefilled
syringe
0.0
5.0 mL
multidose vial
24.5
Fluarix®
GlaxoSmithKline
0.5 mL
single-dose
prefilled
syringe
Trade name
≥9 yrs.***
IM†
0.0
≥3 yrs.
IM†
Flucelvax®§§§
0.5 mL
single-dose
Novartis Vaccines
prefilled
syringe
0.0
≥18 yrs.
IM†
FluLaval®
ID Biomedical
Corporation of
5.0 mL
Quebec
multidose vial
(distributed by
GlaxoSmithKline)
<25.0
≥18 yrs
IM†
0.5 mL
single-dose
prefilled
Novartis Vaccines syringe
≤1
≥4 yrs.
IM†
6 through
35 mo.
IM†
Afluria®
Inactivated Influenza
Vaccine, Trivalent†††
(IIV3), Standard Dose
VCHD flu vaccine for
adults for 2013-14
Manufacturer
Fluvirin®
Fluzone®
CSL Limited
Sanofi Pasteur
5.0 mL
multidose vial
25.0
0.25 mL
single-dose
prefilled
syringe
0.0
5
Fluzone®
Intradermal§
Inactivated Influenza
Vaccine, Trivalent†††
(IIV3), High Dose
Fluzone®
High-Dose**
Fluarix®
Quadrivalent
0.5 mL
single-dose
prefilled
syringe
0.0
≥36 mo.
IM†
0.5 mL
single-dose
vial
0.0
≥36 mo.
IM†
5.0 mL
multidose vial
25.0
≥6 mo.
IM†
Sanofi Pasteur
0.1 mL
prefilled
0.0
microinjection
system
18 through
64 yrs.
ID
Sanofi Pasteur
0.5 mL
single-dose
prefilled
syringe
0.0
≥65 yrs.
IM†
GlaxoSmithKline
0.5 mL
single-dose
prefilled
syringe
0.0
≥3 yrs.
IM†
0.25 mL
single-dose
prefilled
syringe
0.0
6 through
35 mo.
IM†
0.5 mL
single-dose
prefilled
syringe
0.0
≥36 mo.
IM†
0.5 mL
single-dose
vial
0.0
≥36 mo.
IM†
0.5 mL
single-dose
vial
0.0
18 through
49 yrs.
IM†
0.2 mL
prefilled
intranasal
sprayer
0.0 (per
0.2 mL)
2 through
49 yrs.§§
IN
Inactivated Influenza
Vaccine, Quadrivalent†††
(IIV4), Standard Dose
Fluzone®
Quadrivalent
Recombinant Influenza
Vaccine, Trivalent†††
(RIV3)
FluBlok®
Sanofi Pasteur
Protein Sciences
Live-attenuated
FluMist®
Influenza Vaccine,
MedImmune
Quadrivalent††
†††
Quadrivalent (LAIV4)
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Abbreviations: IIV=Inactivated Influenza Vaccine; IIV3=Inactivated Influenza Vaccine, Trivalent; ccIIV3=Cell
Culture-based Inactivated Influenza Vaccine, Trivalent; IIV4=Inactivated Influenza Vaccine, Quadrivalent;
RIV3=Recombinant Influenza Vaccine, Trivalent; LAIV4=Live, Attenuated Influenza Vaccine, Quadrivalent;
IM=intramuscular; ID=intradermal; IN=intranasal.
* Immunization providers should review Food and Drug Administration-approved prescribing information for 2013-2014
influenza vaccines for the most updated information, including (but not limited to) indications, contraindications, and
precautions. Table listing reflects vaccines expected as of this writing to be available during the 2013-2014 influenza season.
This information is subject to change. Updated information will be presented in the updated 2013 ACIP Influenza Vaccination
Statement when available.
† For adults and older children, the recommended site of intramuscular administration is the deltoid muscle. The preferred site
for infants and young children is the anterolateral aspect of the thigh. Specific guidance regarding site and needle length for
intramuscular administration can be found in ACIP's General Recommendations on Immunization [5].
§ Trivalent inactivated vaccine, intradermal: A 0.1-mL dose contains 9 mcg of each vaccine antigen (27 mcg total).
** Trivalent inactivated vaccine, high-dose: A 0.5-mL dose contains 60 mcg of each vaccine antigen (180 mcg total).
†† It is anticipated that the quadrivalent formulation of FluMist® will replace the trivalent formulation for the 2013-2014
season. FluMist® is shipped refrigerated and stored in the refrigerator at 35°F--46°F (2°C--8°C) after arrival in the vaccination
clinic. The dose is 0.2 mL divided equally between each nostril. Health-care providers should consult the medical record, when
available, to identify children aged 2 through 4 years with asthma or recurrent wheezing that might indicate asthma. In
addition, to identify children who might be at greater risk for asthma and possibly at increased risk for wheezing after receiving
LAIV, parents or caregivers of children aged 2-through-4 years should be asked: "In the past 12 months, has a health-care
provider ever told you that your child had wheezing or asthma?" Children whose parents or caregivers answer "yes" to this
question and children who have asthma or who had a wheezing episode noted in the medical record within the past 12 months
should not receive FluMist.
§§ Flumist® is indicated for healthy, non-pregnant persons aged 2-through 49 years. Persons who care for severely
immunosuppressed persons who require a protective environment should not receive FluMist® given the theoretical risk of
transmission of the live, attenuated vaccine virus.
*** Age indication per package insert is ≥5 years; however, the ACIP recommends Afluria® not be used in children aged 6
months through 8 years because of increased risk of febrile reactions noted in this age group with CSL’s 2010 Southern
Hemisphere TIV. If no other age-appropriate, licensed inactivated seasonal influenza vaccine is available for a child aged 5through-8 years who has a medical condition that increases the child's risk for influenza complications, Afluria® can be used;
however, providers should discuss with the parents or caregivers the benefits and risks of influenza vaccination with Afluria®
before administering this vaccine. Afluria® may be used in persons aged ≥9 years.
††† Trivalent influenza vaccines contain three different vaccine viral antigens, one each from an influenza A(H1N1) virus, an
influenza A(H3N2) virus, and an influenza B virus. Quadrivalent influenza vaccines contain the same three antigens as
trivalent vaccines, along with an antigen from a second influenza B vaccine virus strain.
§§§ Cell culture-based trivalent inactivated influenza vaccine (ccIIV3)
7
Flu Vaccine products for 2013-14 flu season
NOTE** Currently FluBlok® is the only FDA approved cell culture-based flu vaccine. It has
been approved for use in persons 18 through 49 years of age. Per the FluBlok package
insert: Flublok contains no egg proteins, antibiotics, or preservatives. The stoppers used for
the single-dose vials do not contain latex. Flublok contains purified HA proteins… that is
derived from the Sf9 cells of the fall armyworm.
++++
Vermilion County Health Department (VCHD) Flu Vaccine Specifics




For the 2013-14 flu season, VCHD will utilize
Fluvirin® Influenza Vaccine for the Adult Flu
clinics.
o This is a trivalent, inactive vaccine given IM in the deltoid.
o This vaccine will be in a multi-dose vial and therefore contains a minute amount of
preservative (thimerosol).
o Is indicated for 4 years of age and older
VCHD Adult Flu clinics are for individuals 9 years of age or older. It is preferred that children
( ≤ 18 years) be referred to the VCHD Immunization dept.
Flu vaccination for infants & children will be available through the VCHD Immunization
Department VFC program. VCHD Immunization program will order an inactivated form of
flu vaccine in a single-dose prefilled syringe (age appropriate dosing for infants & children)
Typically, Fluzone® brand is ordered (if available) by the VCHD Immunization program.
Fluzone provides formulations appropriate both for the infant & child. In addition, by using
the single-dose prefilled syringe no preservative is required. Currently, only the inactive
(shot) form of flu vaccine will be available in VCHD Immunization Dept.
For the 2013-14 flu season, VCHD will refer individuals to their own Medical Provider
should they request 1) high-dose flu vaccine, 2) intranasal spray flu vaccine, 3) a
quadrivalent formulation (as available and appropriate) , 4), intradermal flu vaccination ,or
5) a cell culture-based (non-egg) formulation (Flublok®).
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H7N9 Bird Flu update
A new strain of H7N9 bird flu has been found in birds and people in China. No ongoing person-toperson spread of this virus has been found at this time. This will be an ongoing situation followed
closely by CDC and the World Health Organization (WHO). For the most up-to-date information see
the CDC website:
http://www.cdc.gov/flu/avianflu/h7n9-faq.htm
Key points regarding H7N9 (Source: CDC FAQs 5/22/2013)

H7N9 is the designation for one subtype of influenza viruses that is sometimes found in
birds, but that does not normally infect humans.

Beginning at the end of March 2013, China reported human and bird (poultry) infections
with a new strain of H7N9 that is very different from previously seen H7N9 viruses.

This new H7N9 virus has infected humans. As of May 8, 2013, China reported more than
131 confirmed cases of human infection with 32 deaths.

Available evidence suggests that most people have been infected with the virus after having
contact with infected poultry or contaminated environments.

Most of the reported cases of human infection with this virus have had very serious illness.

Symptoms have started with high fever and cough. A lot of cases have progressed to very
serious illness, including severe pneumonia, acute respiratory distress syndrome (ARDS),
septic shock and multi-organ failure leading to death.

There has been person-to-person spread of this virus but so far there has not been any
evidence of ongoing spread of this virus from person-to-person.

CDC and WHO continue to monitor the situation to determine whether this virus gains the
ability to spread easily from one person to another. (As this is a “novel” virus, if there is
sustained human-to-human transmission, this could become the next flu pandemic event.)
They key to watch for is sustainable, human-to-human spread.

There is no vaccine to protect against this new H7N9 virus currently.

Most of the H7N9 viruses that have been studied are likely susceptible (sensitive) to the two
influenza antiviral drugs that are used to treat seasonal flu.

No cases of human or bird infection with this H7N9 virus have been detected in the U.S. at
this time. However it is possible that could change.
9

There are currently no tests available over the counter or at a doctor’s office that can
quickly detect and distinguish between the H7N9 virus and other flu viruses. However, a
more sophisticated test that specifically detects H7N9 virus has been developed by CDC for
use by qualified public health laboratories in the U.S. and internationally.

Currently WHO has not recommended any travel restrictions to or from China.

Anyone with fever, coughing, or shortness of breath within 10 days of traveling to
China should see a doctor and tell the doctor about the recent travel to China.
As this is an ongoing, fluid situation, updates will be provided as the situation changes.
10
Section II:
PROTOCOL and PROCEDURES related to Influenza vaccination
VCHD Protocol for influenza vaccination
VCHD standing orders for adult flu clinic will be signed annually by VCHD Medical Director and will
reflect the following :
Flu shots may be given to any individual provided:






Age 9 or older (younger than age 9 may require additional dosing if first time flu
vaccination). [Individuals 18 and younger may be referred to VCHD Immunization
Dept. for immunization through the Vaccine For Children (VFC) program.]
Individual appears well (exclude those with fever and/or rash)
Individual has no medical contraindications (see list below)
Individual has a valid signed consent form
The parent/guardian has signed the consent form for the clients under age 18
Pregnant/Breastfeeding women must have a written order from their physician
Medical Contraindications for Flu Vaccination:
a. allergy to eggs
(refer client to their private medical provider)
b. fever or feel ill
(request client return on another date at least 24 hours after fever has subsided
and/or see their private medical provider)
c. a history of Guillain-Barre
(refer client to their private medical provider)
d. a previous serious reaction to the flu shot
(refer client to their private medical provider)
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Additional protocol and procedure information
1
Flu shots can be given to anyone age 9 or older in our scheduled “Adult” Flu clinics
(per our standing order from our medical director)
2. Individuals age 6 months through 18 years of age may be referred to the VCHD
Immunization Dept to receive Flu vaccine through the Vaccine for Children (VFC)
program. Cost for a flu shot for those 18 and younger is only $15.00 through the
Immunization Dept. Cost in our “Adult” Clinics is $30.00.
3. Flu shots given in the Immunization Dept are done by appointment so instruct
parent/s guardians to contact the Immunization Dept to schedule. (Also, please note
that a parent or legal guardian must sign paperwork).
4. It is a Federal requirement that a Vaccine Information Sheet (VIS) be provided to all
clients receiving a Flu shot.
5. Many or most clients do not read the VIS information. Please ask the following
questions prior to giving the injection: (there will also be signs posted with this
information)
a. Do you have an allergy to eggs? (if yes, refer to private medical provider)
b. Do you have a fever or feel ill today? (if yes, delay injection or refer to private
medical provider)
c.
d.
Do you have a history of Guillain-Barre? (if yes, refer to private medical provider)
Have you ever had a previous serious reaction to the flu shot? (if yes, refer to
private medical provider)
6. If a client does not receive the vaccination please let Flu Clinic clerical staff know so
that the client’s name is removed from the computer so that the client’s insurance is
not billed or for the client to be refunded his/her money if they were a self-pay.
7. All injections should be given intramuscularly in the Left Deltoid unless
contraindicated. This will be documented in the computer as given in the Left
Deltoid unless otherwise noted as an exception. Please mark on the client’s
paperwork if injection is given in other than Left Deltoid. All paperwork should be
turned in to Susan Pacot at the end of the clinic. (Please separate those clients
paperwork who received injection in other than Left Deltoid.)
8. According to ACIP, aspiration is not recommended when administering vaccines as
no data exists to justify the need for this practice. IM injections are not given in areas
where large vessels are present.
9. VCHD uses multi-dose vials. There is a small amount of Thimerosol (used as a
preservative) in the multi-dose vials. (Vaccine given through VFC in Immunization
Dept. generally does NOT contain Thimerosol)
12
10. Multi-dose vials should be inspected for particulate matter or discoloration. If these
conditions exist, the vaccine should not be used. Shake vial well before use. Do not
use vaccine if it cannot be re-suspended with thorough agitation.
11. Vaccine should be kept at a temperature between 35 to 46 degrees. Do not allow
vaccine to freeze. Vaccine also, should not be allowed to warm to room temperature
either in the vial(s) or in any syringes that have been filled ahead. Make sure that
vials and pre-filled syringes remain on cooling packs. (additional vials should remain
in cooler provided with lid closed)
12. Vaccine should be administered shortly after withdrawal from the vial. Vaccine that
has been drawn up into a syringe should not be returned to the vial. (So take note not
to pre-fill too many syringes in advance.)
13. Many clients will ask about availability for the Pneumonia shot. We will not be
giving the Pneumonia shot during Flu clinics but the Pneumonia shot is available
through our Immunization Department (client needs to schedule an appointment).The
VCHD Immunization Dept. follows ACIP guidelines for giving Pneumonia vaccine.
Pneumonia shot recommendations changed as of October 2012.
Immunocompromised adults may need two types of pneumonia vaccination (PCV13
& PPSV 23). If clients receive PCV13 & PPSV 23 there should be at least 8 weeks
between doses. If a client receives PPSV23 and requires a 2nd dose of PPSV 23 there
should be 5 years between PPSV doses. As this can be confusing and time
consuming to explain, please refer clients to an Immunization RN for further
explanation of details. For your information see Appendix A. A client handout that
answers the basic pneumonia questions can be viewed in Appendix B.
(See Appendix A for Pneumococcal Recommendations)
(See Appendix B for Pneumonia Vaccine Handout for clients)
VCHD currently stocks PPSV 23 for adult pneumonia, private pay clients.
(Cost for Pneumonia shot for 2013-2014 is: $60.00)
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VCHD Emergency Procedures
VCHD’s Annual Flu Standing Order will also reflect the following information regarding
management of a medical emergency:
MANAGEMENT OF MEDICAL EMERGENCY RELATED TO
ADMINISTRATION OF VACCINE:
For Fainting:
 Keep crowd away from person
 Place person in supine position with feet elevated
Severe Allergic Shock (including anaphylactic shock and angioneurotic edema):
When no physician is present:
 Stay with person while a second person calls 911
 Administer Adrenalin per standing orders:
(0.4cc of Adrenalin Chloride Solution 1:1000 deep sub-q or IM)
If no response (patient still in shock or has respiratory difficulties), may repeat the above
dosage of Adrenalin Chloride Solution in 10 minutes if Emergency Personnel has not yet
arrived on the scene.
Additional emergency procedure information includes:
See next page………….>
14
Emergency Medical Management of Vaccine Reactions
All vaccines have the potential to cause an adverse reaction. To minimize adverse reactions, clients should be
carefully screened for precautions and contraindications before vaccine is administered. Even with careful
screening, reactions can occur. These reactions can vary from trivial and inconvenient (e.g. soreness, itching) to
severe and life threatening (e.g., anaphylaxis). If reactions occur, staff should be prepared with procedures for
their management. The table below describes procedures to follow if various reactions occur. (Resource:
Immunization Action Coalition; www.immunize.org
Reaction
Localized
Psychological
fright and
syncope
(fainting)
Symptoms
Soreness, redness, itching, or
swelling at the injection site
Slight bleeding
Continuous bleeding
Fright before injection is given
Extreme paleness, sweating,
coldness of the hands & feet,
nausea, light-headedness,
dizziness, weakness, or visual
disturbances
Fall, without loss of consciousness
Loss of consciousness
Anaphylaxis
Sudden or gradual onset of
generalized itching, erythema
(redness), or urticaria (hives);
angioedema (swelling of the lips,
face, or throat); shortness of breath;
shock; abdominal cramping; or
cardiovascular collapse
Management
Apply a cold compress to the injection site.
Apply bandaid over the injection site
Place thick layer of gauze pads over site and
maintain direct and firm pressure; raise the
bleeding injection site (e.g., arm) above the
level of the client’s heart
Have client sit or lie down for the vaccination
Have client lie flat or sit with head between
knees for several minutes. Loosen any tight
clothing and maintain open airway. Apply
cool, damp cloths to client’s face and neck.
Examine the client to determine if injury is
present before attempting to move the client.
Place client flat on back with feet elevated.
Check the client to determine if injury is
present before attempting to move the client.
Place client flat on back with feet elevated.
Call 911 if client does not recover
immediately
Follow VCHD Standing Orders: Management
of Medical Emergency Related to
Administration of Vaccine.
 Stay with person; while a second
person
calls 911
 Administer Adrenalin 1:1000 (utilize
appropriate dose for client age and
weight)
 Adrenalin dose may be repeated in 10
min. May be repeated only once
without a physician’s order.
T:\MSWord\Flu Project Annual\FLU PROJECT ANNUAL 2013-14\Emergency Medical Management of
Vaccine Reactions.doc
1. If itching and swelling are confined to the injection site where the vaccination was given, observe
client closely for development of generalized symptoms.
15
2. If symptoms are generalized, active the emergency medical system (call 911). This should be done
by a second person while the primary nurse assesses the airway, breathing, circulation, and level of
consciousness of the client.
3. Administer aqueous epinephrine (adrenalin) 1:1000 dilution, (standard dose is 1 mg/kg body
weight), up to 0.3 mg maximum single dose in children and 0.5 mg maximum in adolescents and
adults.
4. Monitor the client closely until EMS arrives. Perform CPR if necessary and maintain airway. Keep
client in supine position (flat on back) unless he or she is having breathing difficulty. If breathing is
difficult, client’s head may be elevated, provided blood pressure is adequate to prevent loss of
consciousness. If blood pressure is low, elevate legs. Monitor blood pressure and pulse every 5
minutes.
5. If EMS has not arrived and symptoms are still present, may repeat dose of epinephrine in 10
minutes. Per VCHD standing order, may only be repeated 1 time without further physician order.
6. Record all vital signs, medications administered to the client, including time, dosage, response, and
the name of the medical personnel who administered the medication, and other clinical information.
(Complete VCHD Incident Report).
Vermilion County Health Department
Epinephrine Dosing Chart
Suggested Dosing Of Epinephrine
Age Group
Weight*
Weight (lbs)*
Dose
in kg
in lbs
Epinephrine Dose
1mg/mL injectable
(1:1000 dilution)
intramuscular
1 – 6 months
4 – 8.5 kg
9 – 19 lbs
0.05 mL (or mg)
7 – 36 months
9 – 14.5 kg
20 – 32 lbs
0.1 mL (or mg)
37 – 59 months
15 – 17.5 kg
33 – 39 lbs
0.15 mL (or mg)
5 – 7 years
18 – 25.5 kg
40 – 56 lbs
0.2 – 0.25 mL (or
mg)
8 – 10 years
26 – 34.5 kg
57 – 76 lbs
0.25 - 0.3 mL (or mg)
11 – 12 years
35 – 45 kg
77 – 99 lbs
0.35 - 0.4 mL (or mg)
13 years & older
46+ kg
100+ lbs
0.4 mL (0.4 mg) **
**Per VCHD Standing Order do not exceed 0.4 mg
* If weight is not available use client age for dosing.
Source: Immunize.org revised 7/20/12
16
Section III: Needle Safety
Syringe and needle availability:
VCHD has the BD SafetyLok 3ml syringe with a Luer-Lok 23G x 1 needle available for use.
While these syringes meet OSHA safety standards, please note these safety syringes require a twohanded method to engage the locking mechanism. These syringes may be utilized for adult flu
clinics, but please review the manufacturers instruction on engaging the locking mechanism prior to
use with a client.
NOTE:
It is PREFERRED that the needle on the BD 3ml syringe be removed and replaced with the BD
SafetyGlide Needle (25G x 1). Activation of the SafetyGlide safety mechanism requires a one-handed
technique. Please review the manufacturers’ instruction on activating the safety mechanism prior
to use with a client. (see next page)
Needle safety:









When changing needles make sure the Luer-lok needle is snugly connected to the syringe.
Be sure to maintain sterile technique during the needle change process.
Needles removed from the BD 3ml syringe should be immediately discarded into an
approved sharps container.
A small quantity of syringes may be pre-filled prior to the start of a flu clinic but OSHA
standards require that recapping of the clean needle must use a passive recapping
technique.
A needle used on a client should never be recapped.
Activate the safety mechanism immediately after removal from the client.
Used syringes/needles should be discarded after single use in an approved sharps container.
Sharps containers should not be filled past the “fill” line indicated on the container.
Filled sharps containers should be closed and the locking mechanism engaged.
Filled sharps container should be placed in the VCHD bio-hazard room following VCHD
protocol. Volunteers and students will need to request the assistance of VCHD RN staff to
place filled sharps containers in the bio-hazard room as this room is kept locked at all times.
17
BD SafetyGlide Needle Instructions
Per BD SafetyGlide Brochure via:
http://www.bd.com/hypodermic/pdf/BD_SafetyGlide_Brochure.pdf
1. Attachment
Attach the BD SafetyGlide™ needle to any standard BD
Luer-Lok™ or luer slip hypodermic syringe. Twist until firmly
seated. Pull shield straight off needle to avoid damaging
needle point.
2. Aspiration
Draw up medication in accordance with established protocol.
3. Injection
Administer medication in accordance with established protocol.
For user convenience, the needle “bevel-up” position is oriented
to the lever arm.
4. Activation
Activate safety mechanism immediately after injection by
pushing the lever arm forward until needle tip is completely
covered.
NOTE: Activate away from self and others. Visually confirm
needle tip is fully covered.
Discard after single use in an approved sharps collector.
18
Quiz for Flu Training Module 2013-2014
Host Name:
Jenny Trimmell RN BSN
Name:
Dir. Community Health Services
Date:
Vermilion County Health Dept.
Results:
Instructions
Place the letter of the correct answer in the blank next to each question. Return the test (and the
evaluation) to the host, Jenny Trimmell, in order to receive CEU’s for this training module.
1)
Select the TRUE statement regarding quadrivalent flu vaccine:
a.
Quadrivalent flu vaccine contains 3 influenza virus strains
b.
Quadrivalent flu vaccine contains three “A” and one “B” virus strains
c.
Quadrivalent flu vaccine contains two “A” and two “B” virus strains
2)
The abbreviation LAIV4 refers to:
a.
Long acting, inactive virus; 4th dose
b.
Live attenuated influenza vaccine - quadrivalent formulation
c.
Live attenuated influenza virus; 4th dose
3)
Multi-dose vials of flu vaccine most likely contain a preservative such as thimerosol.
a.
True
b.
False
4)
H7N9 is a new strain of bird flu recently discovered in birds and humans in China
a.
True
b.
False
19
H7N9 continues to be closely monitored by CDC and the World Health Organization. The
biggest concern regarding this virus is:
5)
a.
It is suspected to be linked to bioterrorism
b.
There is no concern as it has not spread to the United States.
c.
The virus has “high pathogenicity” in chickens.
d.
It is a “novel” virus, and if there is sustained human-to-human transmission this could
become the next pandemic flu event
6)
Medical contraindications for flu vaccination include all of the following EXCEPT:
a.
History of heart disease
b.
Fever or feel ill
c.
Allergy to eggs
d.
Previous serious reaction to flu shot
e.
History of Guillain-Barre
7)
Flu vaccine should be allowed to warm to room temperature before giving
a.
True
b.
False
8)
The preferred needle for flu vaccination for adults is a:
a.
BD SafetyGlide 25G X 1 inch
b.
BD SafetyGlide 20G X 1 ½ inch
c.
BD SafetyGlide 18G X 1 inch
9)
All of the statements are true regarding needle safety EXCEPT:
a.
You should activate the BD Safety Glide mechanism immediately after injection
b.
You should activate the BD Safety Glide mechanism away from yourself and others
c.
If the BD Safety Glide mechanism has been engaged you may discard the used syringe in
the regular trash.
20
EVALUATION FORM
Course:
Annual Flu Training Module 2013
Date(s):
Instructor’s Name: Jenny Trimmell
Location: VCHD
Strongly
Agree
Agree
Neither
Agree nor
Disagree
Disagree
Strongly
Disagree
1. The content was clear, understandable, and well organized.
5
4
3
2
1
2. The format was appropriate for the subject matter.
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
Please circle the appropriate response to each of the
following.
3. The training will assist in improving my performance/
competence during annual Adult Flu Clinics.
4. Objective 1 was met: Explain the difference between
Trivalent and Quadrivalent influenza vaccine.
5. Objective 2 was met: List new flu vaccine abbreviations.
6. Objective 3 was met: Identify vaccine recommendations
for 2013-2014 flu season.
7. Objective 4 was met: Identify available flu vaccine
products for 2013-2014 flu season.
8. Objective 5 was met: List at least 3 key points regarding
H7N9 bird flu.
9. Objective 6 was met: Describe VCHD protocol related to
flu vaccination (esp. pregnant women & children).
10. Objective 7 was met: Describe VCHD Emergency
Procedure related to flu vaccine administration.
11. Objective 8 was met: List at least 2 steps to increase
needle safety during VCHD adult flu clinics.
12. Objective 9 was met: Identify needle safety mechanism
being used at VCHD for 2013-14 flu season & explain
how to appropriately active needle safety mechanism.
13. I would recommend this training to others.
Please rate your overall impression of this training:
□ Excellent
□ Good
□ Average
□ Below Average
□ Poor
Please give any suggestions you have for improving the training.
________________________________________________________________________
________________________________________________________________________
What was the most beneficial part of the training?
________________________________________________________________________
21
APPENDIX
A
2013-14 Pneumococcal Vaccine
Recommendations
201-3
201-
Appendix B
22
VCHD Pneumonia Handout
VERMILION COUNTY HEALTH DEPARTMENT
SHIRLEY HICKS, BS, SPHR, CPHA
PUBLIC HEALTH ADMINISTRATOR
PUBLIC HEALTH IS PRICELESS
HEALTH AND EDUCATION BUILDING
200 SOUTH COLLEGE, SUITE A
DANVILLE, IL 61832
PHONE/TDD 217 431-2662
FAX 217 431-7483
www.vchd.org
ADULT PNEUMONIA VACCINE
DO I NEED A PNEUMONIA SHOT?
A healthy adult, who is a non-smoker, should receive a pneumonia shot at age 65.
DO I NEED 2 PNEUMONIA SHOTS?
You may receive a pneumonia shot prior to age 65 if you have certain medical
conditions or other risk factors. A second pneumonia shot may be given at age 65 or
older (if 5 or more years have passed since that 1st dose).
I HAVE A CHRONIC HEALTH CONDITION. SHOULD I RECEIVE A
PNEUMONIA SHOT EVERY 5 YEARS?
The Vermilion County Health Department follows the Advisory Committee on
Immunization Practices (ACIP) guidelines which does not currently recommend a
pneumonia shot every 5 years. If your medical provider recommends a plan otherwise,
please see your medical provider.
WHAT IS THE COST OF A PNEUMONIA SHOT?
Vermilion County Health Department charges $60.00 or we bill Medicare for the
pneumonia shot.
IF YOU HAVE FURTHER QUESTIONS
OR
TO SCHEDULE AN APPOINTMENT CALL:
Vermilion County Health Department
Immunization Department
217-431-2662 ext 249
7/13 revised