It is time to re-establish practice goals

It is time to re-establish practice goals

In reviewing the article in the Contemporary Pediatrics 2022 November/December issue, by Krewson,¹ Gearing up for a triple threat, it is apparent that practice goals need to be revisited by pediatric nurse practitioners (PNPs) and all pediatric health care providers to improve the overall health of the children and adolescents that receive care every day. As I write this commentary, children throughout the United States are seeking care in emergency departments for respiratory infections including influenza, COVID-19, and respiratory syncytial viruses (RSV) resulting in pediatric hospital units being filled to capacity caring for children with one or a combination of these infections. The question all providers must ask is: How can my practice change the current course of infants, children, and adolescents from contracting influenza, COVID-19 and RSV? The answer requires a practice commitment and established goal to increase flu and COVID-19 coverage within the practice. The answer also requires practice providers to discuss ways to avoid RSV infections in young children.

Reviewing weekly data from the CDC on flu vaccine coverage

The Centers for Disease Control (CDC) presents weekly data on flu vaccine coverage throughout the United States.² These data support the absolute need for practices to establish new goals for vaccine coverage. Nationally, as of December 16, 2022, coverage for the flu vaccine is 46.7%. Thus, this low percentage is the reason that so many children and adolescents (and adults) have contracted influenza. Likewise, flu vaccination coverage was lower for pregnant persons for all race/ethnicity groups at the end of November 2022 when compared with data from November 2021, thus placing infants born to non-vaccinated pregnant persons at greater risk of contracting influenza.

New CDC recommendations for COVID-19 vaccine boosters

On December 9, 2022, the Centers for Disease Control published the updated COVID-19 bivalent booster for children aged 6 months to 5 years adding to the recommendations published in September for children aged 12 years and older and on October 12, 2022 for children aged 5 to 11 years.³ These new recommendations for infants 6 months old to children 5 years old require every provider to carefully review what vaccines the infant/child has received and to follow the guidance on which vaccine to administer to assure safety and prevention of medication errors.

In clinical trials: RSV vaccine for pregnant persons and RSV vaccine approved in Europe for infants

Krewson, in the article, “Gearing up for a triple threat,” talks about current clinical studies by Pfizer for their RSV vaccine to be administered to pregnant persons to reduce the incidence of RSV in infants in the first few months of life.¹ In addition, AstraZeneca and Sanofi have received approval for their single dose RSV vaccines for infants from the European Medicines Agency, even though it did not reduce RSV hospitalizations more than a placebo administered during the clinical trials.¹ While it takes time for vaccines to receive FDA approval, providers should follow the outcomes of the clinical trials to be prepared to talk with parents about the vaccines when approved.

Applying this information to clinical practice

The above detailed information supports establishing a goal for proactive practices in which each provider gives evidence-based information to parents about the vaccines and makes a strong recommendation for the vaccines to be given to avoid missed vaccine opportunities. The electronic medical records (EMRs) easily allow providers to access immunization data and reach out to parents to make appointments for vaccine updates for their children. Make the goals attainable by engaging all who work in the practice to participate in achieving the practice goals.

How can parents avoid exposure to RSV infections? Parents can ask day care centers and schools to have all staff who interact with their infants and children under 5 years old to wear masks. Any infant or child who has a cough, cold or flu symptoms should not attend the day care or school. Handwashing and social distancing have been shown to be effective strategies to reduce the spread of respiratory infections. Reinforce this information to the parents.

In summary, establish new practice goals, time lines for evaluating the progress on meeting the goals, and use continuous quality improvement measures to meet the established goals.

References

1. Krewson, C. Contemporary Pediatrics. Gearing up for a triple threat. November/December, 2022.

2. Centers for Disease Control. Weekly Flu Vaccination Dashboard. December 16, 2022. Accessed December 17, 2022. Retrieved from https://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-dashboard.html

3. Centers for Disease Control. Staying up to date with COVId-19 vaccines including boosters. December 9, 2022. Accessed December 17, 2022. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html