Transcript 5th Annual Advocacy Project: ImmuneWise Section on Medical Students, Residents, and Fellowship Trainees 2009-2010

5th Annual Advocacy Project:
ImmuneWise
Section on Medical Students,
Residents, and Fellowship Trainees
2009-2010
Case Presentation
Case Presentation
• 4 year old female is
on the illness clinic
schedule
• Her mom reports 2
days of fever and
decreased energy
level
Case Presentation
• Review of Systems
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–
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–
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Temp to 102°F
Mild headache
Eye redness
Mild congestion
Non-productive cough
No GI complaints
No rash
• PMHx
– Healthy
– Due for 4-5 year old
immunizations
• SHx
– Lives with parents
– No known sick
contacts
– Recent travel to
Disney World (about
10 days ago)
Case Presentation - Exam
• General: Cooperative, NAD but appears ill
• HEENT: PERRL, bilateral conjunctival
erythema and watery eyes, nares patent,
MMM without lesions, neck supple, no
lymphadenopathy
• Chest: CTA bilaterally, no
wheeze/rales/rhonchi; RRR, no
murmur/rub/gallop
• Abd: Active BS, soft, non-tender, no HSM
• Skin: No rash or lesions noted
Case Presentation
• Diagnosed with a viral
upper respiratory
infection
• Supportive care was
discussed with the
patient’s mother
Case Presentation
• The 4 year old returns
the next day with a
new rash…
• Exam is unchanged
except for a blotchy,
blanching
erythematous
maculopapular rash
on her face and neck
Differential Diagnosis
- Discussion
Management
Measles
Epidemiology
• Humans are the only natural host
• Transmitted by direct contact with droplets
– may contract from airborne droplets too
• Most common in preschool and early
school-aged children with a late winter
peak
• Vaccine licensed in 1963
• Vaccine failure rate of 5% in those with
only a single dose
Measles
Epidemiology
Measles
Epidemiology
Measles
Clinical Presentation
• Incubation period of 8-12 days
• Symptoms and signs include:
– Fever, malaise, cough
– Conjunctivitis, coryza, +/- photophobia
– Koplik spots on soft palate (often occur before
the rash and are diagnostic)
– Rash, usually day 2-3 of illness
• Contagious for 1-2 days before onset of
symptoms until ~4 days after rash appears
Measles
Clinical Presentation
Measles Diagnosis
• Serum sample positive for measles IgM
antibody on initial presentation
– Sensitivity varies - low in first 72 hours of rash
– If the initial test is negative, consider
repeating after the rash is present > 72 hours
• Significant rise in measles IgG in paired
acute – convalescent samples
• Measles RNA in blood, throat,
nasopharyngeal or urine samples (by
PCR)
Measles
Complications
• Complications include:
– Otitis media
– Croup or bronchopneumonia
– Diarrhea
• Severe complications:
– Acute encephalitis in 1/1000 cases
– Death in 1-3/1000 cases
• Usually due to respiratory or neuro complications
– Subacute sclerosing panencephalitis (SSPE)
• Degenerative CNS disease
Measles Treatment
• Supportive care
• Vitamin A
– Give if vitamin A deficiency is endemic
– Give in the U.S under certain conditions
Consult Red Book
• Ribavirin
– Not FDA approved, but may help those
severely affected and immunocompromised
Measles
Infection Control
• Vaccine given within 72 hrs of exposure
my provide protection in susceptible
individuals
• Immune globulin given within 6 days of
exposure may prevent or modify measles
ImmuneWise
Advocacy
ImmuneWise
• 5th Annual Advocacy Project
• SOMSRFT partnered with Section for Seniors
Members
• Goal: Educate providers and parents
• Goal: Improve immunization rates
• Goal: Foster advocacy interest among
SOMSRFT members
Why?
Who Else?
• Within the AAP, many are concerned
Paul Offit, M.D.
What about You?
• Many levels of advocacy
– Individual level
– Residency program / Clinic level
– State level
– Federal level
Individual Level
Individual Advocacy
• Talk to the Press
– Write a letter to the editor
– Make yourself available to the media
• Contact your state legislators
– Write a letter or an email
– Provide them with information
• Discuss the issue with parents
– Provide parents with info on Myths vs. Facts
– Answer questions about vaccine components,
side effects, and alternate schedules
Myths vs. Facts
Program / Clinic Level
Program-Wide Advocacy
• Implement a quality improvement project
focused on improving immunization rates
• Implement an immunization education
curriculum
Quality Improvement
ACGME Program Requirement
on Practice Based Learning
and Improvement states,
“systematically analyze
practice using quality
improvement methods, and
implement changes with the
goal of practice improvementResidents are expected to
participate in a quality
improvement project.”
QI Project
Immunization Rates
• QI projects focused on improving
immunization rates can target
– Particular vaccine (eg, influenza)
– Target population (eg, 2-24 month olds)
– Entire population served
• An example of how to
do QI for immunization
rates comes from TIDE – Teaching
Immunization Delivery and Evaluation
Designing QI – Step 1
• Assess Immunization Rates (“Plan”)
• Assessment methods:
– Chart method
– Active method
– Consecutive method
• Record the assessment data collected
• There is a sample to download
Designing QI – Step 2
• Implement Change (“Do”)
– Describe and analyze key office routines
related to immunizations using an office
immunization practices questionnaire
• There is a sample to download
– Based on findings…
• Select an intervention likely to improve
immunization rates
• Focus on the “vital few” interventions rather than
the “useful many”
Office Immunization
Practices Questionnaire
Designing QI – Step 3
• Assess the Effects of Change (“Study”)
– Assess the immunization rates again (after a
set period of time)
– Continue to improve your effort after noting
barriers / set-backs
– Celebrate successes
Community Level
Community Advocacy
• Find community
supporters and
leaders
• Speak to parent
groups
• Post ImmuneWise
posters in key
locations
• Utilize national PSAs
at the local level
PSA
Every Child By Two
State Level
State Advocacy
Each state has their own reimbursement issues
State Advocacy
• Statewide campaigns are an opportunity to
partner with AAP Chapters
• The activities available/needed vary by
state, so for more information turn to:
– ImmuneWise CD-ROM
– AAP Committee on State
Government Affairs
National / Federal
Level
national Advocacy
• National media campaigns underway
– Every Child by Two
– The Vaccinate
Your Baby Web site:
www.vaccinateyourbaby.org
Federal Advocacy
• Other opportunities for involvement:
– Attend AAP Advocacy Institute
• March 10-12, 2010 in Chicago
– Familiarize yourself with AAP position papers
– Become a Key Contact for the AAP Federal
Affairs Advocacy Network (FAAN)
You Can Make a
Difference!
• Find out the special needs of your clinic or
community
• Develop a project YOU have a passion for
• Return the Project Outcome Report for
ImmuneWise. This will help us improve
future advocacy projects!
• Let us know what you have accomplished.
We want to recognize you in district
newsletters and
!
Brought to You By:
• SOMSRFT Executive Committee
Advocacy Subcommittee
– Co-Chairs
• Drs. Katie Snyder and Jennifer Williams
– Members
• Drs. Shawn Batlivala, Clara Filice, Jenni
Linebarger, Christina Robinson, Sara Slovin, Josh
Smith, Amy Starmer, David Tayloe
–Other Contributors/Supporters
• Lucy Crain, MD, FAAP, Buz Harlor, MD, FAAP,
Michael Warren, MD, FAAP, Julie Raymond,
Ian Van Dinther