Page 41 - Christiana Care Focus June July 2018

nine times lower infection rate than did those who had received a second dose 13 years or more before the outbreak. The infection rate was lower among the recipients of three doses than among the recipients of two doses (6.7 vs. 14.5 cases per 1000 population). Administration of a third vaccine dose was associated with a 78.1 percent lower risk of mumps than receipt of a second dose. The apparent effectiveness of the third dose ranged from 60 percent at seven days after vaccination to 78.1 percent at 28 days after vaccination. The increased effectiveness at 28 days after the vaccine suggests that time is needed to develop an immune response after administration. If a third dose is implemented into the series, students would likely benefit most if the dose was administered a month prior to starting college or moving into the dorms. This data demonstrates the possible effectiveness of a third dose of the MMR vaccine in the face of an outbreak.
The increase in outbreaks among vaccinated individuals should not be interpreted as vaccine ineffectiveness. The effectiveness of the vaccine is assessed by comparing the infection rate in people who are vaccinated with the increased infection rate and those who have not been vaccinated. The extent of the above outbreak at the University of Iowa was likely limited by the strict university requirement that all students receive two doses of MMR vaccine prior to spring enrollment. The above findings suggest a third dose of MMR vaccine may boost declining immunity that is seen with only two doses of the vaccine, and therefore improve outbreak control. 
References
1. Cardemil, Cristina V., et al. “Effectiveness of a third dose of MMR vaccine for mumps outbreak control.” New England Journal of Medicine 377.10 (2017): 947-956.
2. “Mumps.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 16 Feb. 2018, www.cdc.gov/mumps/hcp.html.
3. “Mumps.” History of Vaccines, www.historyofvaccines.org/content/articles/mumps
Use/Indication Comment
| Pharmacy Services
Formulary Update | April 2018
Medication – Generic/Brand Name
Amino Acid Injection/ TrophAmine
Etoposide Phosphate Injection/Etopophos
Hydroxyprogesterone Caproate Injection/Makena
Lacosamide Oral Solution/ Vimpat
Pregabalin Oral Solution/ Lyrica
Rho(D) Immune Globulin Injection
Albuterol Syrup 2 mg/5mL
Hydroxyprogesterone Caproate Injection/ Makena 5 mL vial
Strength/Size
10% 500 mL
100 mg vial
250 mg/mL, 1 mL
10 mg/mL, 200 mL bottle
20 mg/mL, 473 mL bottle
50 mcg, Prefilled Syringe
Protect kidneys from effects of radiation
Treatment of some types of cancer
Reduce risk of preterm birth
Treatment of partial onset seizures
Treatment of partial onset seizures
Treatment of immune thrombocytopenia
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Removed because of infrequent use 5 mL vial replaced with 1 mL vial
Clobazam Prescribing
Only neurologists and neurosurgeons can initiate treatment with clobazam. All prescribers can order treatment with clobazam to continue upon patient admission to a hospital.
Amiodarone Injection 150 mg/100 mL premixed IV solution
Phenobarbital Injection
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ADDITIONS DELETIONS
MEDICATION POLICY CHANGE
RECENT ADDITIONS TO ACUDOSE OVERRIDE LIST