For more information about OCIC please contact:
Jody Nguyen, RN
Welcome to the Fall 2020 Edition of the
OCIC Newsletter!

Our goals are to provide you with the latest and most useful information on vaccines, immunizations and other related programs by searching news stories, medical articles and a variety of updates, gathered from national and international partners; and to do so by using technology in a way that reduces the use of paper.
In This Issue
Well-Care Visits and Vaccinations During a Pandemic
By Michelle Doan

Local influenza activity has significantly increased in Orange County in recent weeks. As of January 24, one influenza-associated death and 22 ICU cases have been reported in persons under 65 years of age in Orange County this season. At the state level, influenza activity is widespread and is expected to continue for several more weeks. Staying at home during the COVID-19 pandemic has helped to slow the spread of the virus. Yet, it has also caused some children and adults to delay getting their recommended shots. It is very important that families continue to protect themselves by staying up to date on routine well-care visits and vaccinations. COVID-19 has many people feeling anxious and nervous about going in for doctor visits.

We encourage our community partners to spread the word to their constituents "Don't Wait - Vaccinate." Have them talk with their doctors about the extra steps they are taking to see patients safely before scheduling their routine office visits and vaccinations.

It is still very important for families to continue to stay healthy and protect themselves. When social distancing starts to ease up, infants and children who are not vaccinated could be at more risk for diseases like influenza, measles and whooping cough. Adults who are not vaccinated may now be at more risk for diseases like shingles, influenza and pneumonia.

Postponing routine well-care visits and shots puts the community at more risk for infection from deadly diseases that are preventable. People should contact their doctor and ask questions about needed exams, labs and vaccinations.

Hospitals, clinics and other health care settings across the state have taken extra care to make sure patients are safe during visits. There may be longer wait times for office visits since many people may need to catch up on their shots. Some offices have taken extra safety steps such as:
  • Scheduling separate visit times for sick and for healthy patients
  • Requiring patients to wear a mask to their visit
  • Disinfecting areas in between patient visits
  • Providing physical distancing in waiting rooms
  • Asking patients to stay outside until they are called into their visit to avoid crowded waiting rooms
  • Offering different locations for routine visits than for sick visits

Providers can find resources to promote vaccinations at the following links:

  1. California Immunization Coalition: eziz.org/assets/other/DontWait-TOOLKIT.pdf
  2. American Academy of Pediatrics www.aap-oc.org/
Vaccines and Immunity
By Jasjit Singh, MD

There is concern based on polls that a COVID vaccine may not have good uptake. As you know, a certain level of population immunity would be required to prevent transmission.

Here is one story from CNN describing the anti-vax movement contribution, with some pretty bizarre conspiracy theories. There is also talk about more concerted vaccine education being needed. This could also be said for flu vaccine for this winter: www.cnn.com/2020/08/12/health/anti-vaxxers-covid-19/index.html
New Flu Vaccination Requirement for
UC Students, Faculty and Staff 
By Marc Lerner, MD

The University of California will require all members of the UC community to receive an influenza immunization this fall. The university already has a clear policy on immunizations and influenza is now added to the existing requirements for all students. The action is an extension of the current requirement for UC health care workers faculty and staff to receive influenza vaccine. Now all employees working at a University of California location will need influenza immunization by November 1, 2020. A process will be put in place for faculty and staff to request exemptions. This requirement is designed to avoid a surge of flu cases at health care facilities across the state during the unprecedented public health crisis caused by the coronavirus.
#CallYourOCPediatrician Resources
By Jamie McDonald, MPH

Over the past 6 months, AAP-Orange County Chapter has been working to ensure our pediatric members and collaborative partners are receiving accurate information and resources. While safety of our community members has been paramount, ensuring that children are getting regular visits with their primary care pediatricians is also essential, and most importantly, safe. AAP-OC Chapter has developed materials for pediatric offices and schools to promote getting back into the pediatricians' offices for essential well care, including immunizations.

These flyers can be downloaded immediately in multiple languages including English, Spanish, Vietnamese, Chinese, Korea, Farsi and Arabic: www.aap-oc.org/covid-19-resources. Members of AAP-OC Chapter may contact us for a personalized version of the materials to use in their practice. Please contact [email protected] for more information.
Orange County Immunization Improvement Project (OCIIP)
By the American Academy of Pediatrics - Orange County Chapter (AAP-OC)

The AAP-OC implemented the Orange County Immunization Improvement Project (OCIIP) to employ quality improvement techniques and clinical education/training to increase immunization rates in OC clinical practices, using the Model for Improvement. The primary goal was to increase rates of the CIS Combo 10 immunizations across 15 practices by 5% for patients under age two. Physicians utilized the Model for Improvement and conducted at least one Plan-Do-Study-Act (PDSA) cycle to test interventions which could improve immunization rates within their practice. Practices reviewed and submitted Combo 10 immunization data for 9 months. Four learning sessions were held - two in-person and two webinars.

Methods to improve immunization rates included reviewing vaccination status at all visits and flagging patients, clinician and staff education sessions, implementing recall systems, utilizing comfort measures for vaccine delivery, utilizing the California Immunization Registry (CAIR) to cross-check electronic medical records, and creating standing orders. As a result of the 9 months of collected data, the Combo 10 immunization rates increased by 5.96% across all 15 practices. As a result of this project, a list of the top 10 best practice interventions for improving immunization rates was complied. These 10 items were selected because over the course of the project, the 15 participating practices shared experiences, examples and reiterated that some of these interventions were implemented and these are what helped make sustainable changes in the workflow.
  1. Establish Office Policy: Require vaccine records at 1st appointment
  2. Review Vaccine Records at Every Visit
  3. Vaccinate at Acute Visits: Every visit is an opportunity to vaccinate
  4. Create a Culture of Immunization with every Office Touchpoint: Messaging from office space, staff, website, social media platforms
  5. Use Non-Confrontational Communication with Parents
  6. Implement Reminder & Recall Systems
  7. Utilize Evidence-based Comfort Measures for Immunization Delivery
  8. Implement Standing Orders for "Vaccination Only" visits
  9. Train Staff & Clinicians: Science & Schedule of Vaccines
  10. Institute a Culture of Quality Improvement: PDSA Strategy
A final reflection survey was completed by all 15 practices and the findings were utilized to encourage future quality improvement projects within practices. The momentum from the OCIIP led to the formation of an immunization task force through the AAP-OC Chapter.