EMS World

SEP 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 30 of 51

30 SEPTEMBER 2018 | EMSWORLD.com ISSUE FOCUS: MANAGEMENT & OPERATIONS Pre-, Postexposure Issues In response to the current outbreak of HAV in the San Diego area, vaccines are being offered to at-risk persons and EMS personnel. The HAV vaccine first became available in 1995. Since then the case num- bers for HAV in this countr y have dropped dramatically. There were 31,000 ca ses repor ted each year before the vaccine; now there are about 1,500. It is an inac- tivated (killed) virus vaccine given in two doses six months apar t. About 95% of vaccinated persons will develop protective antibodies within four weeks of a single dose of the vaccine; that extends to 100% after the second dose. Pos t vaccin e s erolog y te s ting is n ot indicated or recommended. Side effects are minimal and might include soreness at the site of injection, low-grade fever, headache, and feeling tired. These usu- ally last 1–2 days. It is currently believed that the vaccine is protective for at least 20 years and may be protective for life. If an unprotected exposure were to occur, h ep atitis A p re s er vati ve -f re e im mun e globulin (IG) may be of fered by IM injec - tion. GamaSTAN S/D is the only immune globulin approved by the FDA for HAV pro- phylaxis in the United States. Using the hepatitis A vaccine for post- exposure prophylaxis provides numerous public health advantages, including the induction of active immunity and longer protection, greater ease of administration, higher acceptability and availability, and a cost per dose similar to IG. The vaccine is also easy to administer, which may help increa se the number willing to receive postexposure prophylaxis. There are two hepatitis A vaccines available, Havrix and Vaqta. Both are equally effective. Public Health Over Politics This outbreak is unfortunate, but hopefully national efforts can reduce the issue of the homeless in this county and prevent occur- rences. It will require public health inter- ests taking priorit y over politics. That's being demonstrated in this outbreak. San D iego ha s implem ented a n ew program called the Alpha Project, which is built on a program established in Albu- querque. The new approach begins by placing the homeless in shelters or tents and "hiring" them at a rate of $11.50 an hour to clean up the streets. This plan started with a donation from an emergency phy- sician that will fund the program for six months. Homeless persons are also given work and assistance in finding jobs, as well as in dealing with the circumstances that led to their homelessness. In addition San Diego County plans to allocate $22 million to provide healthcare to the homeless over the next three years. Ser vices focus on those who have been frequent users of emergency care ser vices. These ef for ts demonstrate what can b e achieved w hen communit y groups and politicians come together to combat a public health threat. This will benefit ever yone. RESOURCES California Department of Pesticide Regulation. Pesticide Regulatory Guidance on Control of Hepatitis A with Sodium Hypochlorite, Applicator Licensing, and Business Licensing Requirements, www.cdpr.ca.gov/docs/county/cacltrs/exec/2017/ ppd/ppd1702.pdf. California Department of Public Health. Hepatitis A Outbreak in California, www.cdph.ca.gov/Programs/CID/DCDC/Pages/ Immunization/Hepatitis-A-Outbreak.aspx. Centers for Disease Control and Prevention. 2017—Outbreaks of hepatitis A in multiple states among people who are homeless and people who use drugs, www.cdc.gov/hepatitis/ outbreaks/2017March-HepatitisA.htm. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th ed. Atlanta: Centers for Disease Control and Prevention, 2015, pp. 135–48. Centers for Disease Control and Prevention. Hepatitis A Questions and Answers for Health Professionals, www.cdc.gov/ hepatitis/hav/havfaq.htm. Centers for Disease Control and Prevention. Immunization Recommendations for Disaster Responders, www.cdc.gov/ disasters/disease/responderimmun.html. Centers for Disease Control and Prevention. Vaccine Information Statements: Hepatitis A VIS, www.cdc.gov/vaccines/hcp/vis/vis- statements/hep-a.html. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Hierarchy of Controls, www. cdc.gov/niosh/topics/hierarchy/default.html. Department of Labor, Occupational Safety and Health Administration. Recommended Practices for Safety and Health Programs, www.osha.gov/shpguidelines/. Warth G. New program puts San Diego's homeless to work. San Diego Union-Tribune, 2018 Feb 26; www.sandiegouniontribune. com/news/homelessness/sd-me-trashpickup-program- 20180226-story.html. Warth G. Program aims to save money by paying homeless healthcare. San Diego Union-Tribune, 2018 Feb 6; www. sandiegouniontribune.com/news/homelessness/sd-me- homeless-healthcare-20180205-story.html. ABOUT THE AUTHOR Katherine West, RN, BSN, MSEd, is an infec tion- control consultant with Infec tion Control/Emerging Concepts in Clear water, Fla., and a member of the EMS World editorial advisor y board. MORE ONLINE! How prepared are EMS workers to handle infectious-disease scenarios? www.emsworld.com/article/220501 Source:CDC/NIOSH

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