Vaccination Considerations at End of Life

Vaccines protect against vaccine-preventable diseases. Despite the fact that the majority of adults receive the majority of recommended vaccinations as children, immunity from childhood vaccines loses effectiveness over time. Adults are also exposed to a variety of diseases as they grow older. People receiving hospice care are at a significantly higher risk of adverse complications if they contract a vaccine-preventable illness, which is why vaccination is important.

Vaccination Billing

“Can hospice bill Medicare for vaccine administration? Which ones, if any?”

Answer – The following vaccines may be billed to Medicare by hospice under the following conditions:

Influenza – There is one case per influenza season. Pneumococcal – A pneumococcal vaccine for patients who did not receive the vaccine through Medicare Part B.

Hepatitis B – For patients who are at intermediate or high risk of contracting hepatitis B, the following doses should be used:

• High-Risk Groups – ESRD patients, haemophiliacs who receive factor VIII or IX concentrates clients of institutions for the mentally retarded, people living in the same area as the Hepatitis B patient, Virus (HBV) carrier, homosexual men, illicit inject able drug abusers, and diabetes mellitus patients.
  

• Intermediate Risk Groups – Workers in institutions for the mentally disabled who work in health care professions and come into contact with blood or blood-derived body fluids on the job. Vaccines are also acceptable for a hospice patient based on their immunisation history and risk of contracting vaccine-preventable diseases. According to the Centers for Disease Control and Prevention.

The book “Immunizing Adult Patients: Standards for Practice” is an excellent resource.

Immune System Impairment

Can a cancer patient get a flu shot?

Vaccines are required in square measure for cancer patients. However, live vaccines and immunising agents should be avoided; management of ineffective vaccines is mostly done depending on the vaccine. Except for patients receiving Anti-B cell antibodies, adults with cancer should receive an annual inactivated contagion immunising agent (influenza vaccine) (i.e. rituximab). Although inactivated vaccines are typically avoided in patients undergoing intensive therapy, the administration will continue to be to protect against current seasonal strains of contagion. Protection of family members and hospice workers is also strongly advised.

Furthermore, cancer patients (with or without active chemotherapy), hospice patients with severe immunosuppression, and other patients for whom live vaccines should be considered include:

• Infection with HIV and a CD4 cell count of 200 cells/L

• 14 days of daily corticosteroid therapy with 20 mg of prednisone or equivalent

• Immunodeficiency syndrome (i.e., severe combined immunodeficiency or complement component deficiency).

Allergy to eggs

If the patient is allergic to eggs. “Will he be able to get the flu shot this season?”

Answer – Management of any licensed flu vaccine is important for any age and health, is beneficial in all patients who have a history of egg allergy, and patients do not have to wait 30 minutes after receiving the vaccine. It is expected that patients who have severe allergic reactions to eggs will need to take additional precautions:

• Allergy after egg exposure

• Specified in a medical context

Other than hives, symptoms of egg exposure include:

• Angioedema is a condition in which the skin becomes swoll

• Uncomfortable breathing

• Feeling dizzy

• Recurrent emesis or the need for epinephrine or other emergency medications medical assistance

• In a specific medical setting, under the supervision of a health care provider capable of detecting and managing acute allergic reactions (i.e. hospitals, clinics, health departments, and physician offices). Risk versus benefit is high.

Regardless of the medical setting, licensed vaccine providers should have an emergency medical protocol in place to control adverse reactions at the time of administration.

Most protocols include instructions on how to use equipment (such as syringes and stethoscopes) as well as medications such as epinephrine and antihistamines.

Using an Influenza Vaccine Past Its Expiration Date

“How long can you keep a single vial of influenza vaccine if a multi-dose vial is used?”

Answer – A multi-dose vial (MDV) contained more than one dose of vaccine because MDVs typically contained a preservative to prevent the spread of microorganisms, and microorganisms can enter and multiply multiple times. The vial should be discarded in the following circumstances:

• Following the withdrawal of a significant number of doses

• It is getting close to the expiration date listed on the vial.

• If the vaccine is contaminated or in any way inadequate,

Other important points to consider:

• Only make the vaccine at the time of administration.

• Used and unused vials should be stored in accordance with product storage and management guidelines (generally 35-46°F).

• It is not recommended that the vial be frozen.

• Light should be kept away from the vial.