Trisha Williams (Host 1): Hi, guys. Welcome to the Advanced Practice Perspectives Podcast. I'm Trisha Williams.

Tobie O’Brien (Host 2): And I'm Tobie O'Brien. This is a podcast created by Advanced Practice Providers for Advanced Practice Providers. Our goal is to provide you with education and inspiration. We will be chatting with pediatric experts on timely key topics and giving you an inside look at the various Advanced Practice roles at Children's Mercy.

Host 1: Today, we are so pleased to have Maria Martinez. She is a Registered Nurse who is the IImmunization Program Manager for the Patient Care Services Department at Children's Mercy Hospital. Welcome to the podcast, Maria.

Maria Martinez, RN, BSN, MSN, MBA, CPN: Hi, Trisha. Thank you so much for your warm welcome. As you stated, I'm the Immunization Program Manager for Children's Mercy Kansas City, and I've been a nurse for 15 years now. I have previously worked on the inpatient cardiac liver unit, nurse advice line, and the bulk of my time most recently has been spent in primary care as the nurse manager of Operation Breakthrough, which is a nonprofit early learning center in the urban core of Kansas City.

Host 2: Well, Maria, we are excited that you are joining us today. So I was, we actually polled some of our Advanced Practice Providers and kind of asked what they would like to hear more about, and a yearning came up and people wanted to hear a little bit more about immunizations, kind of some updates, as well as this new RSV vaccine. So I am going to just have you start off by telling us about this new RSV vaccine.

Maria Martinez, RN, BSN, MSN, MBA, CPN: Yes. So, with the new RSV product that it's out, it's actually not a vaccine. The one for pediatrics, it's a monoclonal antibody. It provides passive immunity because it is a monoclonal antibody. So it provides protection for approximately five months. It has been approved for all infants younger than 8 months of age, and it helps prevent severe illness from RSV.

And as we know, RSV is the leading cause of hospitalization and illness in infants. And then, for high risk infants aged 8 to 19 months, they're eligible for a second season of nirsevimab which is also known as Beyfortis. So that is the new product that you're referring to that is for infants and children. And if they meet that criteria, they get the second season for those high risk infants.

Host 1: With this new immunization, I bet the onboarding process and getting education out there and getting patients to receive the immunization has been a little bit challenging. Would you be able to speak on the behalf on kind of what bringing a new immunization to light is like?

Maria Martinez, RN, BSN, MSN, MBA, CPN: Yeah, so anytime you bring a new product on, it definitely comes with some challenges. You first want to evaluate the data. You want to look at the research that was done and the studies, all the clinical trials. So we are very lucky that we have an ID pharmacist within our organization that reviews that data and puts together a presentation. So that, that later gets reviewed by the immunization committee for the hospital and our pharmacy and therapeutics committee. That gets put through for a vote on whether or not, based on the clinical data and the clinical trials whether or not we want to bring that to our organization and then we need to evaluate, do we have any products that need to be discontinued now that we're bringing this new product on?

So lots of logistics and thought that has to go into it. Usually we work with the pharmacy team, nursing, information systems to coordinate the logistics for storage. Do we have enough storage space? That's something that maybe doesn't even cross people's minds. We have commercial refrigerators that are for vaccines. But the more and more vaccines we bring on, it does pose some challenges into how many can we keep in one unit. Then we look at implementation and education. You want to make sure that you're pushing out the education that providers and nursing need so that they can be well educated on advising on that new product to the families that we serve.

Host 2: I remember reading that this particular immunization had been delayed. Is it? Do we have it now? Or is it still kind of on back order or is it something that we have right now?

Maria Martinez, RN, BSN, MSN, MBA, CPN: Yes. So, we do currently have both the 100 milligram concentration within our organization and the 50 milligram concentration. We do expect to run out of the 100 milligram concentration. It is just a matter of time. The manufacturer was not able to keep up with the demand. They stated that they had an unprecedented demand for this product and they are not taking any more orders.

So it is very possible that whatever we received with our initial order is all that we had. And I think a lot of other organizations are going through the same thing just dealing with limited inventory and supply. So then when it comes to that, you have to think, okay, I've got a limited quantity.

What, how can I make sure that the patients that we serve, the ones that are at highest risk, receive it. So, we have referenced the AAP guidelines that they posted on what to do during limited shortage. So that is what we have gone off of just to make sure that we have enough inventory to meet the highest needs of those that are at highest risk. So, it's been tricky.

Host 1: Yeah, I bet. And it's like taking the highest risk patients first, right? And kind of prioritizing those high risk patients that, that have a bigger risk of having life threatening sequelae from the virus, right? That would be my understanding. Yeah. So the overall arching goal of having this immunization come to fruition would be to like decrease the severity of the disease process and like decrease the need for hospitalization. Am I understanding that correctly?

Maria Martinez, RN, BSN, MSN, MBA, CPN: Correct. So, anytime you give a vaccine, that is the goal, is to decrease severe illness and death that can result from that disease. So it doesn't mean that you're not going to get sick at all. Some people don't get sick at all. Everybody's body is so different. But the goal is to keep people out of the hospital, keep them as healthy as possible and reduce transmission.

Host 2: Okay, now is this immunization oral or is it a shot?

Maria Martinez, RN, BSN, MSN, MBA, CPN: It is an injection. The 50 milligram and the 100 milligram doses come in pre filled syringes. And so they are administered just like you would any other immunization. And so in our infants, which is who's targeted in this for this product you would do the vastus lateralis for administration.

Host 2: Okay, so we'll hope that like when we look back at this next year and kind of look back and maybe we'll see less hospitalizations due to RSV?

Maria Martinez, RN, BSN, MSN, MBA, CPN: Yes I was, before we knew that this was going to be, that we were going to come across some supply issues and not be able to have what we needed on hand to serve all of the intended patients, I was really interested to see, okay, once we've brought this product on board, are we going to see fewer urgent care visits, fewer clinic visits, fewer hospitalizations, because people are getting immunized with this monoclonal antibody.

Host 1: I can't wait to see the data. It'll be very interesting.

Maria Martinez, RN, BSN, MSN, MBA, CPN: Yes.

Host 1: Okay. Let's switch gears a little bit. I feel like ever since 2020, the big three, that's what I like to call them, the big three viruses of the healthcare industry is RSV, flu, and COVID. I like to call them the big three, but let's switch to COVID and the recommendations that are currently out for the COVID boosters.

Maria Martinez, RN, BSN, MSN, MBA, CPN: Yes, so the latest with COVID, everyone six months and older should be getting vaccinated against COVID. So, the CDC recommends that everyone receive the updated 2023-2024 formulation. It's actually not considered a booster. It is a new formulation and it's a monovalent product that's made to protect against severe disease from the Omicron XBB .1.5 sub variant. So yes, definitely, definitely a mouthful and for most individuals, depending on the product, I know we've got a lot of individuals that have received the mRNA products, so you're talking about Pfizer and Moderna. Most healthy individuals five years of age and older just need one dose and they're done.

But doses and the schedule will vary by vaccine manufacturer, product and previous vaccination status. So I can't even state a specific one because they can all vary so much. Like your littles have your six month old to four year old, depending on the product that they choose, have multiple doses.

So, it is still recommended. COVID is still around and it's probably going to be around to stay. On average, we're seeing daily hospitalizations at 4,493 in the United States, and weekly death rates from November 19th to the 25th were 960. Yes, so I think we

Host 1: My goodness.

Maria Martinez, RN, BSN, MSN, MBA, CPN: Right, I think we all want to forget about it because it was such a difficult time, but we can't and we have to continue to emphasize to our patients how important it is to still get vaccinated.

Host 2: Absolutely, well will you fill us in on the flu updates too? Do you have the numbers for that information of people who have been hospitalized with influenza and or death rates?

Maria Martinez, RN, BSN, MSN, MBA, CPN: I don't have the recent ones for this year, but I do have an average that goes back to from I believe, 2011 to 2021, if I'm not mistaken. So, influenza is the second most frequent cause of death from a vaccine preventable disease in the United States. And that's after COVID-19. So when you think about that, that's serious.

On average, we're seeing four to 21 million medical visits for the flu, 140 to 810 hospitalizations and 12,000 to 61,000 deaths per year. It really varies on, did we get the right variants when we created the flu vaccine? Are people getting vaccinated against the flu? So many factors play into how bad a flu season can be. And then for pediatric patients, we average 37 to 199 deaths per year.

Host 1: From a vaccine preventable disease process. You know, I often think and get questioned about, well, how do they know they even got the right variant this year? And I'm like, they don't, but I like my odds. So I'm getting the vaccine. So that's what I try to tell, like, my friends and my husband and people that are not so into getting the flu vaccine.

Maria Martinez, RN, BSN, MSN, MBA, CPN: That's right. And even if we didn't get the right strains or variants, even if we didn't guess them right, having the vaccine will still provide you some protection because it's still going to look similar to the infection that you're up against, so your body should still be able to fight it off better than having not been vaccinated at all.

Host 1: Good point.

Host 2: Now, is there a timeline between the COVID and flu vaccines that people should wait? Remind me.

Maria Martinez, RN, BSN, MSN, MBA, CPN: Nope, you can get them at the same time like Travis Kelce said in his commercial, which I love so much, do two things at once.

Host 2: Yeah, he made that popular, if that's good, I,

Host 1: Yeah he did, two things at once. And then I feel like we got to give him a shout out on our podcast because he has his own podcast too, right? Give a shout out to Travis Kelce.

Host 2: Maria, with one of our recent podcasts, we had hosted one a Primary Care Nurse practitioner that is in our community. And one of the biggest challenges she voiced to us was parents coming in asking for like modified immunization schedules and such, or even she feels like she spends a lot of her time just having to educate on actual facts of immunizations. Do you feel like that is still an issue that you have to deal with or, you spend a lot of your time trying to educate people about the facts of why they need to vaccinate or immunize?

Maria Martinez, RN, BSN, MSN, MBA, CPN: Yes, I think there has been a lot of vaccine hesitation that, has only increased after COVID-19 vaccine came around. And I think that mis-education and those myths that are out there have done a lot of damage to our vaccination rates. We've actually seen decreasing vaccination rates especially in our kiddos that are kindergarten bound.

So making sure that we are educated as providers and healthcare members on some of those myths and being able to address those myths with our families and doing it in a way where we're really connecting with them is so, so important especially our families that we have strong relationships with, which when I was working at Operation Breakthrough and the COVID-19 vaccine came about there was a lot of hesitation and a lot of doubt.

But because of the relationship that our clinic team had with those families, eventually we were able to turn some of those no's into yes's because they trusted us and because we were telling them the same thing over and over again. So those relationships are so important. So even if you're not a provider that's working in an area where you administer vaccines, letting your families know how important vaccinations are, especially ones that they have concerns about, makes such a big difference. If they're hearing it over and over and over again, you can change people's minds and really make a difference in vaccination.

Host 1: Very good advice. I love that. I'm wondering if there is some resources out there that you would recommend to kind of help debunk myths for providers to be able to get talk to their families and things. Do we have those resources readily available?

Maria Martinez, RN, BSN, MSN, MBA, CPN: We do. So, my go to website is immunize.org. So shout out to immunize.org because I am on their website at least once a day. Um, and they have just redone their website. It's amazing. Anything that you want to find out about vaccines, that's my go to place. The CDC also has great resources on vaccine hesitancy and myths. But my favorite is probably immunize.org. So that is where I tell people to go to get those additional resources.

Host 1: Perfect. Thank you for that. I know a lot of our listeners will be jotting that down right now so they can reference those resources. So thank you for that.

Maria Martinez, RN, BSN, MSN, MBA, CPN: Yes, you're welcome.

Host 2: And Maria, what about any updates to the immunization schedule that might be helpful for our listeners who a lot of times are primary care providers?

Maria Martinez, RN, BSN, MSN, MBA, CPN: Yes, so with all of the updates that happened over the last year, the CDC and the ACIP were actually able to get those updated in the immunization schedule that's available on the CDC website. I highly recommend everybody, if you have an immunization schedule printed that you usually reference, it's probably out of date.

Go to the CDC website and print off the new one because anything that was updated or changed for 2023, they've actually gone ahead and gotten it updated sooner than when they usually do, which is usually February. So, things that you'll see in that are the RSV monoclonal antibody in infants, the RSV vaccine during pregnancy, PCV15, PCV20, COVID-19 recommendations.

And the reason that they did this is, one of the reasons is insurance reimbursement. So, insurance has up to 12 months to cover a vaccine after it's been approved by the ACIP. And so, sometimes they don't start that until it's been posted on the immunization schedule.

And then also healthcare providers, when they know these changes have happened, but they don't have that updated schedule, it's tricky to keep up with everything. You guys have so much that you guys are juggling all the time. So just having that Information updated in real time, they understand that that's critical, so they have gone ahead and made all those updates to make sure that providers have the most up to date information on hand.

Host 1: Well, thank you for that, Maria. You have been just a wealth of knowledge, discussing RSV, COVID, flu, and then some of the immunization updates. I know as a provider that functions in a subspecialty role, I don't give vaccines or nor do I order them, but you have taught me today that I can definitely make a difference in the immunization status of our children and the overall general health of our greater well being of humans, I guess is the way to say it. So thank you for that.

Maria Martinez, RN, BSN, MSN, MBA, CPN: Absolutely. Yes. And that's my goal. You know, I know a lot of areas struggle to administer vaccines because you have to see so many patients and you have such limited time with them. But if you can at least tell them how important they are, you are one more advocate that is working towards saving lives because that's really what vaccines do. They help save lives. And that work is so critical.

Host 2: Thank you so much for joining us. You really have provided us with lots of information and clearly I am sort of out of date to a lot of this, like Trisha said, working in a subspecialty area, but it has motivated me to kind of re-engage with that so I can provide some better education and advocacy, as you mentioned.

So, thank you for all of this information. And as we close we like to ask all of our guests one final question. And so it's kind of a personal question, but we, the question for this season is what would your younger self high five you for now?

Maria Martinez, RN, BSN, MSN, MBA, CPN: Okay so I had the opportunity when COVID-19 vaccine came out and it became available for school aged kiddos, I had the opportunity to partner with the National Association of Hispanic Nurses, our, which is our National Association of Hispanic Nurses, local Kansas City chapter here in Kansas City, the KC Care Clinic as well as the Kansas City Health Department.

And we brought COVID-19 vaccination to a local elementary school. And we did, I want to say we did four different sessions. We had mass vaccination events there, and we were able to vaccinate 40 percent of the student population including their caregivers. So, when you look at COVID-19 vaccination in children, we definitely surpassed the average vaccination rate and helped save lives and keep kiddos healthy and their families. So, that's one of things that I'm really the proudest of.

Host 1: Yeah. High five. That's huge. Proud, shiny moment. You should definitely be proud.

Maria Martinez, RN, BSN, MSN, MBA, CPN: Yes, thank you so much.

Host 1: You're so welcome. Well, again, Maria, thank you so much for coming on our podcast today. We truly enjoyed having you.

Maria Martinez, RN, BSN, MSN, MBA, CPN: Thank you. I appreciate being here today. Have a great day.

Host 2: You too, Maria.

Maria Martinez, RN, BSN, MSN, MBA, CPN: Thank you.

Host 2: If you have a topic that you would like to hear about, or you're interested in being a guest, you can email us at tdobrien@cmh.edu or twilliams@cmh.edu. Once again, thanks so much for listening to the Advanced Practice Perspectives podcast.