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| Volume 1, Issue 27 | APRIL 2007 |
| Inside This Issue | |||||
| 1 | |||||
| 2 | Updates and Announcements | ||||
Medical Information Fact Sheet
Thirteen Diseases and the Nine Corresponding Vaccines:
Part one of a two part series.
Introduction:
This newsletter will cover a basic description of immunity and how vaccines work. Then the different types of diseases and their corresponding vaccines will be discussed. All the diseases and vaccines in this issue relate to infants and young children. The next issue will cover vaccines that address adolescent and adult illnesses.
Attached to this newsletter is a copy of the immunization schedule for children. This schedule shows which vaccines are needed and at what intervals. This attachment can be downloaded and printed at Centers for Disease Control and Prevention (CDC) website at http://www.cdc.gov/nip/recs/child-schedule.htm#Printable
Thirteen diseases along with nine vaccines will be described in this issue. This is a lot of information to cover so much of the information will be an overview. Many of the specific details cannot be explained, for example, less common side effects specific to each vaccine. All of this information can be obtained at the CDC National Immunization Program Website at http://www.cdc.gov/nip/.This website has all the information for consumers and health care professionals in regards to all vaccines and their corresponding diseases. There are information sheets as well as a parent’s guide to understanding the topic. The website is user friendly and the materials are easy to understand and are available in Spanish.What is Immunity?
When disease germs enter your body, they start to reproduce. Your immune system recognizes these germs as foreign invaders and responds by making proteins called antibodies. These antibodies’ first job is to help destroy the germs that are making you sick. They can’t act fast enough to prevent you from becoming sick, but by eliminating the attacking germs, antibodies help you to get well. The antibodies’ second job is to protect you from future infections. They remain in your bloodstream, and if the same germs ever try to infect you again — even after many years — they will come to your defense. Only now that they are experienced at fighting these particular germs, they can destroy them before they have a chance to make you sick. This is immunity. It is why most people get diseases like measles or chickenpox only once, even though they might be exposed many times during their lifetime.This is a good system for preventing disease. The only drawback is obvious — you have to get sick before you become immune.
Vaccines to the Rescue
Vaccines offer a solution to this problem. They help you develop immunity without getting sick first. Vaccines are made from the same germs (or parts of them) that cause disease — measles vaccine is made from measles virus, for instance, and Haemophilus influenzae type B (Hib) vaccine is made from parts of the Hib bacteria. But the germs in vaccines are either killed or weakened so they won’t make you sick. Vaccines containing these weakened or killed germs are introduced into your body, usually by injection. Your immune system reacts to the vaccine the same as it would if it were being invaded by the disease — by making antibodies. The antibodies destroy the vaccine germs just as they would the disease germs — like a training exercise. Then they stay in your body, giving you immunity. If you are ever exposed to the real disease, the antibodies are there to protect you.
Immunizations help your child’s immune system do its work. The child develops protection against future infections, the same as if he or she had been exposed to the natural disease. Except with vaccines your child doesn’t have to get sick first to get that protection.
The Thirteen Diseases:
Why do we vaccinate?
The purpose of immunizations is to prevent disease. Today, children in the United States routinely get vaccines that protect them from 13 diseases.
All of these diseases have, at one time or another, been a serious threat to children in this country. Most of them are now at their lowest levels in history, thanks to years of immunization.1. Diphtheria
Diphtheria caused by a bacterium called Corynebacterium diphtheriae. It lives in the mouth, throat and nose of an infected person and can be spread to others by coughing or sneezing. A child with diphtheria
can infect others for about 2 to 4 weeks. It can initially cause a sore throat, fever and chills. But if it is not
properly diagnosed and treated it produces a toxin (poison) in the body that can cause serious complications such as heart failure or paralysis. About 1 person out of 10 who get diphtheria dies from it. Diphtheria used to be a major cause of childhood illness and death. Through the 1920s about 150,000 people a year got diphtheria in the United States, and about 15,000 of them died.2. Hepatitis A
Hepatitis A is a liver disease caused by the hepatitis A virus. It is the most frequently reported type of hepatitis in the United States, causing an estimated 125,000–200,000 cases each year. About a third of
these cases occur in children younger than 15. The virus is found mainly in bowel movements and is spread through personal contact or by eating contaminated food or drinking contaminated water. Children under 6 often don’t show any signs of illness, but for older children signs include fever, loss of appetite, tiredness, stomach
pain, vomiting, dark urine, and yellow skin or eyes (jaundice). Hepatitis A does not cause long-term illness or liver damage, but about 100 people die each year from liver failure caused by severe hepatitis A.3. Hepatitis B
Hepatitis B is also a liver disease. It is caused by the hepatitis B virus. It is spread through contact with the blood, or other body fluids, of an infected person. Adolescents and adults can be infected through sharing used needles or through unprotected sex, and health-care and public safety workers are often exposed to blood in the course of their jobs. Pregnant women can infect their newborn babies. People infected with hepatitis B might not feel sick, or might suffer loss of appetite or tiredness, muscle or stomach pains, diarrhea or vomiting, or yellow skin or eyes (jaundice). People usually recover from hepatitis B after several weeks, but others may become “chronically infected.” They might not feel sick themselves, but they continue to carry the virus and can infect other people. A baby who is born to a chronically infected mother has a 70%–90% chance of being infected at birth, unless they are vaccinated against Hepatitis B (this will greatly reduce their risk). Many people who are chronically infected will suffer from serious problems such as cirrhosis (scarring of the liver) or liver cancer. In the United States there are more than 1 million people who are chronically infected. In 1996 an estimated 200,000 people became infected, and 4,000 to 5,000 people die each year from hepatitis B.4. Hib Disease (Haemophilus influenzae type b)
Hib disease (Haemophilus influenzae type b) used to be the leading cause of bacterial meningitis in children less than 5 years old. As recently as the mid-1980s it struck one child out of every 200 in that
age group. About 1 in 4 of these children suffered permanent brain damage, and about 1 in 20 died.
Hib disease is spread through the air by coughing, sneezing, and even breathing. If the bacteria stay in a child’s nose and throat, the child will probably not get sick. But if they spread to the lungs or bloodstream, the child can get meningitis (inflammation of the
covering of the brain), pneumonia, epiglottitis (inflammation in the throat), arthritis, or other problems. A child who is infected can spread the disease to others for as long as the bacteria remain in the
body. Antibiotics can stop spread in 2 to 4 days. A person is considered to be non-communicable 24-48 hours after starting appropriate antibiotics.5. Influenza (Flu)
Influenza (Flu) is a seasonal illness, occurring mainly during the winter. It is caused by influenza virus. Influenza viruses are continually changing, meaning that immunity you acquire one year will not necessarily protect you in future years. This makes influenza different from most diseases, in that you can get it more than once. It also means that annual immunizations are recommended. Influenza is spread from person to person through sneezing, coughing or breathing. Signs and symptoms include fever, sore
throat, cough, headache, chills and muscle aches. Young children might also have vomiting and diarrhea. Complications can include ear and sinus infections, pneumonia, myocarditis (inflammation of the heart), and death. Influenza causes more deaths (about 36,000 per year) than any other vaccine-preventable disease. Most of these are among the elderly, but some children also die.6. Measles
Measles is a viral illness that causes a rash all over the body. It also causes fever, runny nose and cough. About 1 out of 10 children with measles also gets an ear infection, and up to 1 out of 20 gets pneumonia. About 1 out of 1,000 gets encephalitis, and 1 or 2 out of 1,000 die. While measles is almost gone from the United States, it still kills about half a million people a year around the world. Measles can also make a pregnant woman have a miscarriage or givebirth prematurely. Measles spreads through the air by breathing, coughing or sneezing. It is so contagious that any child who is exposed to it and is not immune will probably get the disease. Before measles vaccine, nearly all children got measles by the time they were 15. Each year about 450 people died because of measles, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness. Today there are only about 50 cases a year reported in the United States, and most of these originate outside the country.
7. Mumps
Mumps is best known for the swelling of the cheeks and jaw that it causes, a result of inflammation of the salivary glands. Mumps also causes a fever and headache. It is usually a mild disease, but it leads to meningitis in about 1 child in 10 who gets the disease. It can occasionally cause
encephalitis, deafness (about 1 in 20,000 cases), or even death (about 1 in 10,000 cases). Mumps is caused by the mumps virus, which is spread from
person to person through the air. Before a vaccine was available mumps was a very common childhood illness. About 152,000 cases were reported each year. Now mumps is very uncommon, with only
231 cases reported in 2003.8. Pertussis
Pertussis (Whooping Cough) is caused by a bacterium called Bordetella pertussis. If you have ever seen a child with pertussis you won’t forget it. The child coughs violently and rapidly, over and
over, until the air is gone from her lungs and she is forced to inhale with the loud “whooping” sound that gives the disease its nickname, whooping cough.
Pertussis is a very contagious disease, and one that is fairly common in the United States, even today. In 2004, over 25,000 cases were reported. While this is down considerably from the approximately 150,000 cases a year before the vaccine, it still makes it one of the most common vaccine-preventable childhood diseases in the country. It is spread from person to person through personal contact, coughing and sneezing. At first pertussis behaves like a common cold, with sneezing, runny nose, fever and a mild cough. But after 1 or 2 weeks the severe coughing spells begin. Pertussis is most severe in infants less than 1 year old. More than half of these infants who get the disease must be hospitalized. Older children and adults can get pertussis too, but it is usually not as serious. Many infants who get pertussis catch it
from their older brothers and sisters, or from their parents — who might not even know they have the disease. About 1 child in 10 who get pertussis also gets pneumonia, and about 1 in 50 will have convulsions. The brain is affected in about 1
person out of 250 (this is called encephalopathy). Pertussis causes about 10–20 deaths each year in the United States.9. Pneumococcal Disease
Pneumococcal disease caused by Streptococcus pneumoniae bacteria. It is usually thought of as a disease of the elderly, but it also takes its toll among our children. In 1998, before a vaccine for children was licensed, about 188 of every 100,000 children younger than 2 years of age developed invasive pneumococcal disease (for instance, meningitis or blood infections). It is the leading cause of bacterial meningitis in the country, hitting children under 1 year old the hardest. About 200 children die from invasive pneumococcal disease each year. Pneumococcal disease is also a common cause of ear infections. Pneumococcal disease is spread through the air. It can be spread by anyone who is infected, even if they don’t have symptoms. It is most common during the winter and early spring.10. Polio
Polio is a disease that has caused paralysis in millions of children worldwide over the years. In the United States, 6,000 people died and another 27,000 were paralyzed during a major epidemic in 1916. Polio reached a peak in the United States in the 1950s, when parents
were terrified that the disease would leave their children unable to walk or force them to spend the rest of their life in an iron lung. With the appearance of the Salk and Sabin polio vaccines the disease began to disappear, and there is no longer any wild polio in the country. Polio is caused by a virus that lives in the throat and intestinal tract. It is spread mainly through contact with the feces of an infected person (for instance, by changing diapers). Some children who
get polio don’t feel ill at all. For others, it might resemble a common cold, sometimes accompanied by pain and stiffness in the neck, back and legs. But some children get severe muscle pain, and within a week can be paralyzed — in other words, lose the use of their muscles. Usually paralysis affects a child’s legs, but it can also affect other muscles, including those that control breathing. There is no
treatment for polio, and some children die from it. Even though there is no polio in the United States, it is still common in some parts of the world. We are working towards eliminating it from the rest of the world within the next few years.11. Rubella (German Measles)
Rubella is sometimes called German Measles or 3-day Measles. It is a generally mild disease caused by the rubella virus. It usually strikes in the winter and spring, and causes a slight fever, a rash on the face and neck, and (when teenagers or adults get the disease) swollen glands in the back of the neck and arthritis-like symptoms in the
joints. It is spread from person to person through the air, by coughing, sneezing or breathing. The greatest danger from rubella is to unborn babies. If a woman gets rubella in the early months of her pregnancy, there is an 80% chance that her baby will be born deaf or blind, with a damaged
heart or small brain, or mentally retarded. This is called Congenital Rubella Syndrome, or CRS. Miscarriages are also common among women who get rubella while they are pregnant. The last major rubella epidemic in the United States was in 1964–1965, when about 12.5 million people got the disease and 20,000 babies were born with CRS. Several years later a vaccine was licensed, and the disease has been disappearing ever since. Today there are fewer than 20 cases reported each year.12. Tetanus (Lockjaw)
Tetanus (lockjaw) differs from other vaccine-preventable diseases in that it is not contagious. It does not spread from person to person. Clostridium tetani bacteria are usually found in soil, dust, and
manure, and they enter the body through breaks in the skin. Children usually become infected through deep puncture wounds or cuts, like those made by nails or knives. But the bacteria can enter through even a tiny pinprick or scratch. Children can also get
tetanus following severe burns, ear infections, tooth infections, or animal bites. When tetanus gets into the body it can take up to 3 weeks for the first symptoms to appear. These are usually a headache, crankiness,
and spasms of the jaw muscles. The bacteria produce a toxin (poison), which spreads throughout the body, causing painful muscle spasms in the neck, arms, legs, and stomach. These can be strong enough to break a child’s bones. Children with tetanus might have to spend several weeks in the hospital under intensive care. The number of tetanus cases in the United States has fallen from about 500 a year in the 1940s to only about 50 cases a year today. But 1 out of every 10 people who get tetanus dies from it.13. Varicella (Chickenpox)
Varicella (Chickenpox) was, until recently, one of the most common of childhood diseases. Before there was a vaccine, almost everyone got it — there were about 4 million cases a year in the United States. Chickenpox is caused by the varicella zoster virus. Its most recognizable feature is an itchy rash all over the body. It also causes fever and drowsiness. It is spread from person to person through the air, by coughing, sneezing or breathing, and can also be spread by contact with fluid from the blisters. It usually takes 2–3 weeks from the time of exposure to become ill, and an infected person is contagious
from 1 or 2 days before the rash appears until all the blisters are dried up, usually 4 to 5 days after.
Chickenpox is usually mild, but it occasionally causes serious problems. The blisters can become infected, and some children get encephalitis. Among infants less than 1 year old who get the disease, about 4 in 100,000 die. For older children, about 1 in 100,000 dies. If a woman gets chickenpox just before or after giving birth, her baby can get very sick, and about 1 in 3 of these babies will die if not treated quickly. About 1 child in 500 who gets chickenpox is hospitalized (this figure increases to about 1 in 50 for adults). Varicella can result in serious illness in adults resulting in hospitalization. After a person has chickenpox the virus stays in the body. Years later it can cause a painful disease called herpes zoster, or shingles.
Vaccine Side effects:
While vaccines are very safe, like any medicine they do sometimes cause reactions. Mostly, these are mild “local” reactions (soreness or redness where the shot is given) or a low-grade fever. They may last a day or two and then go away. Sometimes more serious reactions
are associated with vaccines. These are much less common. Some of them are clearly caused by the vaccine; some have been reported after vaccination but are so rare that it is impossible to tell if they were caused by the vaccine or would have happened anyway. Some children also have allergies, and occasionally a child will have a severe allergy to a substance that is component of a vaccine. There is a very small risk (estimated at around one in a million) that any vaccine could trigger a severe reaction in a child who has such an allergy. Should one of these allergic reactions occur, it would happen within several minutes to several hours after the vaccination, and would be characterized by hives, difficulty breathing, paleness, weakness, hoarseness or wheezing, a rapid heart beat, and dizziness. Doctors’ offices are equipped to deal with these reactions. Always tell your provider if your child has any known allergies.Vaccine Precautions
A child who has had a severe (life-threatening) allergic reaction to a previous dose of any vaccine should not get another dose of that vaccine. A child with a known severe (life-threatening) allergy to any vaccine component should not get a vaccine containing that component. If a child has any moderate or severe illness on the day any vaccine is scheduled, it should probably be delayed until the child
has recovered. A mild illness or fever is usually not a reason to delay an immunization.For Vaccine Schedule, please visit Riverside County Disease Control Program
1. DTaP Vaccine
DTaP combines vaccines against three diseases, Diphtheria, Tetanus and Pertussis into one shot. (The small “a” in the name stands for “acellular,” which means that the pertussis component of the vaccine contains only parts of the pertussis bacterium rather than the whole cell.) The diphtheria and tetanus components of the vaccine
are not technically vaccines, but “toxoids.” In other words, they help the immune system develop protection against the toxins produced by the diseases rather than against the disease bacteria themselves. All three components of DTaP are “inactivated” (killed). Tetanus, diphtheria and pertussis (DTP) vaccines have been in common use
since the 1940s. DTaP vaccine (with the acellular pertussis component) was first licensed in 1991. Children need five DTaP shots for maximum protection. When it is given according to this schedule, DTaP protects most children from all three diseases (80%–85% from pertussis, 95% from diphtheria, nearly 100% from tetanus). Protection can fade with time, so booster doses (using Td or Tdap vaccine, see below) are recommended every 10 years. Tetanus toxoid is also sometimes given when a person gets a serious wound that could contain tetanus bacteria.Other Related Vaccines
■ DT is a tetanus/diphtheria vaccine, which does not contain pertussis. It is used for children younger than 7 years old who should not get pertussis vaccine (for example, because they have had a reaction to pertussis vaccine in the past).
■ Td is a version of DT for children 7 years old and older and for adults. It has a lower concentration of diphtheria toxoid than DT. It is used for routine 10-year boosters. For wound management, a booster is needed if has been 5 years or more since last shot.
■ Tdap was licensed in 2005. It contains a full concentration of tetanus and lower concentrations of both diphtheria and pertussis. It is the first pertussis-containing vaccine licensed in the United States for children 7 years of age and older, adolescents, and adults. It is currently recommended as a once-only
booster for adolescents.2. Hepatitis A Vaccine
Hepatitis A vaccine is made from inactivated (killed) hepatitis A virus. It is 94%–100% effective in preventing hepatitis A. Because it has been available only since 1995, we don’t know yet how long immunity will last, but mathematical modeling suggests that it
should protect for 20 years or more. The vaccine is not licensed for children younger than 1 year of age.
Two doses of hepatitis A vaccine are recommended, the second dose given 6–18 months after the first. For travelers who don’t have time to get the second dose before their departure, one dose provides
good short-term protection.3. Hepatitis B Vaccine
Hepatitis B vaccine is an inactivated (killed) vaccine that is made from a small, non-infectious part of the hepatitis B virus, called hepatitis B surface antigen. The vaccine was licensed in 1986, and 98%–100% of children who get the vaccine develop immunity. Some parents question why infants and young children should be vaccinated against hepatitis B when they don’t have the risk factors (drug use, sexual activity, professional risk) that lead to many infections. There are two reasons. One is that babies and children can become infected too. If a mother infects her baby during birth, for example, and the baby is not immunized (usually within 12 hours of birth is acceptable practice), it will probably become chronically infected too. One out of four of these children will eventually die from cirrhosis or liver cancer. The other reason is that vaccinating only high-risk adolescents and adults has proved not to be a very effective way to control the disease. It was only after we began routine childhood vaccination that rates of disease began to drop significantly. Three doses of hepatitis B vaccine are needed for full protection. The first dose is usually given at birth. This is particularly important for children whose mothers are chronically infected. No additional booster doses are needed.4. Hib Vaccine
There are several brands of Haemophilus influenzae type b (Hib) vaccine used in the United States. They are all inactivated (killed) vaccines,
made from only a small part of the Hib bacterium. All
brands work equally well, protecting 95%–100% of children from Hib disease. The first Hib vaccine was licensed in 1985, and several improved versions have become available since then. Children should get either 3 or 4 doses of Hib vaccine, depending on which brand your doctor uses.5. Influenza Vaccine
There are two types of influenza vaccine. The first is an inactivated (killed) vaccine given as a shot, which has been used for many years. It can be given to anyone 6 months of age and older. The second is a
live, attenuated (weakened) vaccine, which is sprayed into the nose and was licensed in 2003. It is not licensed for children younger than 5 years old. Because influenza viruses change from year to year, new
vaccines must also be formulated each year, and annual vaccination is recommended. The inactivated influenza vaccine is 70%–90% effective in healthy children, and the live, intranasal vaccine is about 87% effective in healthy children 5–7 years of age. Many other infections have the same symptoms as influenza and are often mistakenly called “flu.” Neither vaccine is effective against infections that are not actually caused by influenza viruses. One dose of vaccine (either type, depending on age) is recommended annually, beginning around October or November. For children
younger than 9 who are getting influenza vaccine for the first time, 2 doses are recommended, at least a month apart (inactivated vaccine) or 6–10 weeks apart (live vaccine).6. MMR Vaccine
MMR combines vaccines for Measles, Mumps and Rubella into one shot. MMR has been around since 1971, although its three components were licensed separately during the 1960s. It is a live vaccine,
containing measles, mumps and rubella viruses that have been “attenuated” (weakened), so they won’t cause disease. Most children who get the vaccine develop immunity to all three diseases (over 99% for measles and 95% for mumps and rubella). Protection
is believed to be life-long. Two doses of vaccine are recommended. No boosters are needed. Measles, mumps and rubella vaccines may be given separately, although these individual vaccines are not always readily available. Doctors usually prefer not to give the vaccines this way because it means giving a child 3 shots instead of one.7. Pneumococcal Vaccine
Pneumococcal conjugate vaccine was licensed in 2000. It is an inactivated (killed) vaccine, which gives immunity against the 7 strains of the pneumococcal bacterium that have caused most of the serious
infections in children. It is more than 90% effective against invasive disease (for example, blood infections and meningitis). Some ear infections are caused by Streptococcus pneumoniae, but many are caused by other organisms, and the vaccine will not prevent these. Four doses of pneumococcal vaccine are recommended. Children who are late starting the series may need fewer doses. Check with your doctor or clinic for the recommended schedule if your child starts late. Children 5 years old and older should usually not get pneumococcal conjugate vaccine. But some older children (those with certain chronic diseases or damaged immune systems) should still get a pneumococcal vaccine. There is a different vaccine — called pneumococcal polysaccharide vaccine — that can be given to these children and to adults. Pneumococcal vaccine may be given at the same time as other childhood vaccines.8. Polio Vaccine
The polio vaccine used in the United States contains 3 types of inactivated (killed) polio virus. It is sometimes called IPV (Inactivated Polio Vaccine). We once used another type of polio vaccine — a liquid
that was swallowed, called OPV (Oral Polio Vaccine). This vaccine is no longer available in the United States but is still used in other parts of the world. The first inactivated polio vaccine (the Salk vaccine) was licensed in 1955, and the vaccine we use today (an
improved version) has been in use since 1987. The vaccine protects 99% of children who get at least 3 doses. Children should get four doses of polio vaccine.9. Varicella Vaccine
Varicella vaccine is made with live, attenuated (weakened) varicella virus. It has been used in some parts of the world, such as Japan, for more than 20 years. It was licensed in the United States in 1995. It
prevents chickenpox in 70%–90% of people who get it, and it prevents severe chickenpox in more than 95%. It is expected to provide life long immunity. The vaccine used in Japan is still protecting people who were vaccinated 20 or more years ago, and in the United
States, people who were vaccinated during testing, before the vaccine was licensed, are still immune.
A single dose of varicella vaccine is recommended for children at 12–18 months of age. Children who miss this shot can still get a single dose of the vaccine until their 13th birthday. After the 13th birthday, 2 doses are
recommended, given 4 to 8 weeks apart. Anyone who has had chickenpox does not need the vaccine. Each year, about 1% of people who have gotten varicella vaccine develop chickenpox in spite of having responded to the vaccine. This is called “breakthrough” infection. Breakthrough infections are much milder than normal chickenpox.Patients generally have fewer than 50 lesions, which do not form blisters. They also do not get a fever and have no complications. We don’t know why breakthrough infections occur.
Combination Vaccines
Several vaccines are sometimes combined into a single shot. These are called combination vaccines. Some combination vaccines are used routinely — DTaP is a combination; so is MMR. There are currently four other combination vaccines available for children. One
combines DTaP and Hib vaccines; the second Hib and hepatitis B; the third combines DTaP, hepatitis B, and polio, and the fourth combines measles, mumps, rubella and varicella. The advantage of combination vaccines is, of course, that your children get the protection of all the component vaccines while getting fewer injections. Each of these vaccines has certain restrictions, and not all
providers carry them. But ask your provider about them if you are interested in reducing the number of shots your child must get for complete vaccine coverage.Centers for Disease Control and Prevention. (2007). National Immunization Program. Retrieved on April 22, 2007, from the World Wide Web: http://www.cdc.gov/nip
Attachment obtained from: Centers for Disease Control and Prevention. (2007). 2007 Childhood & Adolescent Immunization Schedule. Retrieved on April 22, 2007, from the World Wide Web: http://www.cdc.gov/nip/recs/child-schedule.htm#Printable
Further information regarding some of these diseases can be found in previous issues of this newsletter on the County of Riverside Public Health Nursing website: http://www.rivcoph.org/phn/newsltr.htm
HCPCFC PROGRAM UPDATES and ANNOUNCEMENTS!!!
First of all I would like to Congratulate Hermia Parks on her promotion to Director of Public Health Nursing. This is great news to the staff of public health nursing. Hermia is an asset to the department and to the county.
I would like to say Happy Administrative Professionals Day to all those who provide support to us everyday.
Editor: Kristen Thompson, PHN
Contributors: Nicole Boyd, PHN, Assistant Nurse Manager and
Hermia Parks, MA, Director of Public Health Nursing.
Special thanks to:
Barbara Cole, RN, PHN, MSN, Branch Chief, Disease Control Branch,
for her input on this topic.
