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The Vaccination Times, They are A’ Changin’. . .

Does this sound familiar?  Guess Mass. PHNs aren’t the only ones experiencing the frustrations of being unable to protect their communities.  This story is from Greenfield Wisconsin…

This underscores why we PHNs need to take the lead and think outside the traditional public health box in order to keep our populations vaccinated.  Please feel free to post comments…


Farewell to an Exceptional PHN!

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As you may have heard, Framingham PHN Laurie Courtney is leaving public health nursing to take a fabulous new job in the private sector.   Laurie has been a dedicated advocate and exceptional asset to public health nursing.  I hope you will join me in wishing her well!

The Irresponsible Media and Vaccination

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TLC channel, one that many lay people depend on to deliver “educational” tips and advice, recently posted a one-sided, unresearched article on its How Stuff Works page about the dangers of vaccinating your kids.  You can read about the situation in this link from Shot of Prevention:

As parents go more and more to the Internet and other media for information before they even consult their health providers, it becomes more and more alarming that they are getting “stuff” based on entertainment value rather than evidence-based public health.

As PHNs, I believe it is our crucial responsibility to actively educate and keep our population accurately informed about the importance of keeping our kids vaccinated.  We owe it to our patients!


Day in the Life: Jornada de Vacunación

Attached is a blog entry posted by a Peace Corps volunteer currently in Nicaragua. She is the daughter of one of the HS nurses. She graduated college and wanted a job in PH, but there were none to be had, so she went into the Peace Corps. What a young lady!

Laurie Courtney



New post on Nicaraguan Lauren




Day in the Life: Jornada de Vacunación

by Lauren

Last March during my site visit, I was thrown into a truck that traversed rivers and mountains until we ended up in several rural communities that I haven’t seen since.  It was an exciting and confusing time.  I spent the day trying to get my bearings: where were we, who were we working with, what could I do to help, and for the love of god why did I decide to wear my beautiful H&M black and white skirt with heals when I would be spending the day hiking up steep muddy hills to deliver vaccines to far out communities?

Though I have adjusted my wardrobe since last year, one fact remains unchanged: March is the country-wide vaccination campaign.  Here’s a look at what a typical day is like during the campaign:

Monday, March 12

I headed down to the hospital around 7:30am. We all gathered in the conference room as Dory dictated who would be going to which communities.


At 8:00am, we climbed into the ambulance.  The first stop was my house.  Apparently puppies aren’t allowed on vaccination campaigns.


My team arrived in a little community called El Cielo (sky, heaven).  On our way up, I had to grip my seat with both hands while simultaneously squeezing the vaccine cooler with my legs to steady it while the ambulance trekked ever skyward over rocky terrain and rivers.  We passed by jovenes and viejitos alike along the side of the road who had to make their way to their respective communities by foot.  This picture is of Janet, one of the nurses I worked with, who is posing in front of the primary school in El Cielo where we held the campaign.


Eva, the Brigadista from El Cielo, is posing with the free backpacks that they’re giving to all the school children.  They also all get notebooks and pencils.


Some kids hanging out before the campaign.  Okay, okay, you got me–class was in session when we arrived, and we had to take over their classroom for the vaccination campaign.  These are some of the kids getting ready to go.


Janet administering a vaccine.  We vaccinated every child in El Cielo.


Since I can’t inject vaccines, I helped out by giving vitamin A drops, anti-parasite pills, and the polio vaccine.


This is the capsule that contains vitamin A drops.  Simply cut off the top and squeeze it into the child’s mouth.  Vitamin A cures night blindness.  I was so excited to distribute vitamin A because a vitamin A campaign in Southeast Asia was one of the first large-scale public health success stories that I learned about in school.  The idea that something so inexpensive can cure a disease so debilitating is empowering.  What other public health breakthroughs will we see in the future?


After a full day of vaccinations, we were still missing some kids from El Cielo and another nearby community.  So around 3pm, we ventured out to find them.


The views were outstanding.


And we found all of them–in one house!  We hung out there for a while giving vaccines, anti-parasite pills, and vitamins.  In turn, the family gave us coffee and chicharrón (fried big skin).


And on the way back, we raided a lone orange tree.  We hoarded as many oranges as we could into our backpacks.  That tree didn’t stand a chance.


By 5pm we had made it back to the school and were waiting for the ambulance. This little guy hung out with us all day, took a bunch of pictures for me, and lastly, drew a picture:


It’s a drawing of his community.  It was so good that I put it on my wall.

At around 6pm, the ambulance left us at a town about a half hour away from site because the driver had to go towards Matagalpa to pick up another team.  So together, my team and I hitched a ride and made it back to town.


Mani was very happy to see me.

And so ends a typical day during the vaccination campaign.  It’s a busy time, but there’s something liberating about climbing into a rickety old vehicle and venturing out into new communities in the mountains.   Some of these places are so inaccessible that MINSA only goes out to them during this time of year.  As such, these vaccination campaigns are vital to the health of Nicaraguan children–without it, many wouldn’t get vaccinated at all.  This is why I love public health.

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Disease Investigation – Protecting the public’s health!!

 Laurie C. offers this entry, in the hope that other PHNs will share some of their stories as well.  After all, we need to justify that we are about more than doing Blood Pressures or giving Flu Shots…  Please send your comments!

Disease Investigation – Protecting the public’s health!!

(Part of a Typical Day in the Life of a Public Health Nurse)


Laurie Courtney, BSN, RN

Salmonellosis refers to disease caused by any serotype of bacteria in the Salmonella genus, other than Salmonella Typhi. It is a common GI illness in the US with 40,000 reported cases, and many more unreported cases, a year.

Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. In the United States about 400 cases occur each year, and 75% of these are acquired while traveling internationally. Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year (1).

This case unfolds as follows –

The local hospital’s IC nurse calls me to report a blood culture positive for Salmonella Paratyphi A. She has little information at the moment. The case is a 32 year old male who is inpatient. We discuss the difference between S. Typhi and non-S. Typhi, look up S. Paratyphi, and determine that it is not S. Typhi therefore this will be a case of Salmonellosis, not typhoid fever. The IC nurse tells me she will fax the lab report and MD note.

Once I receive the fax I enter the case in MAVEN. I also find out that the case traveled to India with family, became ill with diarrhea x 24 hours the last day of his trip, and has had a febrile illness (max 103.4 PO) since returning home a week ago. He was admitted to the hospital, worked up, and has been receiving IV antibiotics. He is not employed as a food handler. No other members of his family are ill. There is no info regarding his wife’s employment.

I attempt to reach the case, but am unable to.

At this point I have a case of salmonellosis; however the case’s symptoms more closely resemble typhoid fever.

In my follow up two days later I find that the case was discharged from the hospital, is receiving daily IV antibiotics in the ED, and is being treated for typhoid fever.

I call the ID physician treating the case to clarify whether this is a Salmonellosis case or a typhoid fever case. I receive a message back that it is a “typhoid fever illness”.

I call the epidemiology department at MA DPH and ask for an epi to call me back. I want to determine if this case should be labeled salmonellosis or typhoid fever. In consultation with the epi it is confirmed that since this is a case of positive S. Paratyphi it is Salmonellosis. Only S. Typhi is typhoid fever.

I then do a brief search on the CDC website and find that S. Paratyphi A can cause a syndrome similar to typhoid fever, and that it causes 1-15% of enteric fever cases in India (2). CDC has been conducting surveillance of typhoid fever cases since 1975 and in 2008 expanded its surveillance to include paratyphoid fever (3).

I am finally able to reach the case by telephone. He confirms the information I have already obtained. His wife does not work outside the home. No other family members are or have been ill. He has never had an illness like this before and has never been vaccinated against typhoid fever (there is no vaccine for paratyphoid fever). He also reports that the IV antibiotics have been discontinued and he will now be on PO antibiotics for an as yet undetermined amount of time. He will also be followed by the ID physician. His symptoms have almost fully resolved – he still has a low grade (99.2 PO) fever at night. I provide him with some basic information about salmonella infection and give him my contact information should he want to contact me for any reason.

I complete the case report form in MAVEN and close the case, having learned something new, as I do most days in my role as a public health nurse.


1. Centers for Disease Control and Prevention (CDC). 2011.

2. Chandel DS, Chaudhry R, Dhawan B, Pandey A, Dey AB. Drug-Resistant

Salmonella enterica

Serotype Paratyphi A in India. Emerging Infectious Diseases. 2000, Aug. Available from DOI: 10.3201/eid0604.000420

3. Centers for Disease Control and Prevention (CDC). National Typhoid and Paratyphoid Fever Surveillance System Overview. Atlanta, Georgia: US Department of Health and Human Services, CDC, 2011. Available from



For the Herd’s Sake, Vaccinate


Happy New Year!  Please share this message with all you know…

Op-Ed Contributor

For the Herd’s Sake, Vaccinate

Published: December 27, 2011

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West Hartford,Conn.

I HAVE chronic lymphocytic leukemia. Three months ago, I underwent an allogeneic stem-cell transplant, in which my wise, 52-year-old white blood cells were replaced by bewildered, low-functioning cells from an anonymous European donor. For the next seven months or so, until those cells mature, I have a newborn’s immunity; I am prey to illnesses like chickenpox, the measles and the flu.

These diseases are rarely fatal, unless you’re a newborn or someone with a suppressed immune system like me. My newborn buddies and I do have some protection, however: the rest of you.

Young babies, the immuno-compromised and people who get chemotherapy are not able to process most vaccinations. Live vaccines in particular, like those for measles and chickenpox, can make us sick. But if 75 percent to 95 percent of the population around us is vaccinated for a particular disease, the rest are protected through what is called herd immunity. In other words, your measles vaccine protects me against the measles.

It’s the reasoning of Clarence, the angel from “It’s a Wonderful Life”: If you are vaccinated, you won’t pass a disease on to someone else, who won’t pass it on to six more people, and on and on. To quote Clarence, “Strange, isn’t it? Each man’s life touches so many other lives.”

Unfortunately, vaccination rates for many diseases in Europe and in areas of the United Statesare falling. This is partly due to Andrew Wakefield, a British doctor who published a paper, now discredited, in 1998 in The Lancet tying childhood vaccines to autism. Celebrities like Jim Carrey have also taken a strong antivaccine view. As a result of these unwarranted fears, childhood diseases are returning. The rate of whooping cough cases has spiked over the past 20 years. In 1990, the incidence was 2 per 100,000 people; in 2000 it was 3; by last year, it had risen to nearly 10.

Measles cases are also increasing. For each year between 2001 and 2008, the median number of cases in theUnited Stateswas 56. In the first six months of this year alone, there were more than 150 reported cases — the most since 1996. A vast majority of those who were sickened had not been vaccinated or had uncertain vaccination histories. Before the vaccine was introduced in 1963, 400 to 500 Americans died of measles every year.

During last year’s flu season there were 55,403 reported cases of influenza A and B; 116 children died of the disease. And now flu season is back.

The truth is, we should not get vaccinated for ourselves alone; we should do it for one another. Having cancer has taught me the value of living in a community. We assist the infirm, pay our taxes and donate to charity, and getting vaccinated — for the flu, for adult whooping cough, for pneumonia — is just another important societal responsibility. After all, we’re in the same herd.

Steven L. Weinreb, an internist who is certified in oncology and hematology, is on medical leave from his job at a private practice.

A version of this op-ed appeared in print on December 28, 2011, on page A23 of theNew Yorkedition with the headline: For the Herd’s Sake, Vaccinate.

Our PHNs featured in Advance for Nurses Magazine!

Pat Zingarello from Northeast chapter and  Kitty Mahoney are featured in this aticle posted today in Advance for Nurses

Public Health Nurses

Often-unseen advocates provide education and resources to promote healthier communities

By Catlin Nalley

Posted on: November 29, 2011

Where were you during Hurricane Irene? Did you have to evacuate your home? Did you have to take refuge in an emergency shelter? If you did, did you think about who was responsible for preparing for this emergency?

The impact of public health nurses often goes unnoticed except in cases of extreme disasters and even then, the public may not realize what has to be done to be prepared for the worst.

“The general public doesn’t know we actually exist, that we are behind the scenes making sure things are running smoothly,” said Pat Zingariello, BSN, RN, a public health nurse with the Beverly Health Department, Beverly, MA. “Most people don’t know we are working hard to make sure there isn’t an outbreak or major illness. We make the community a safer place to live without people really knowing that.

“It is different from hospital nursing because in public health nursing we care for the entire community instead of one patient at a time,” Zingariello added. “Instead of being happy your one patient recovered, you’re happy people didn’t get sick in the first place, but it’s hard for people to see that.”

Many Faces

The day-to-day work of public health nurses depends on individual health departments, but critical responsibilities include investigating causes of communicable diseases, inspection of immunization records and emergency preparedness.


Their responsibilities include, but are not limited to, monitoring health trends through active and passive surveillance and data analysis, designing and implementing health promotion education campaigns and provision of disease prevention education and activities, as well as advocating at the local, state, regional and national levels to sustain or improve community health services.


Photo Gallery

See shots of public health nurses in New Jersey and New England on the job.


Investigations of food-borne illnesses and communicable diseases, distribution of vaccines, researching grants and funding, and implementing wellness clinics are just few of the jobs with which Zingariello is tasked.

“I am a resource for residents, public and private healthcare providers and the school nurses,” Zingariello said. “We do an annual medication take-back program and a household hazardous waste day. And then our particular health department runs a dental clinical for school age children, which is very rare. You wouldn’t see that in other communities.

“We had a flu pandemic a couple of years ago, H1N1. So we were able to get our emergency site open and start to communicate to the public about how we were going to vaccinate and a lot about the vaccination and when,” Zingariello added. “We talked to people who called to relieve them of their fears.”

 Beyond Extreme Disasters

“Public health is about education and intervening in small ways to make a difference,” said Flo Rice, EdD, RN, director of public health nursing with the Madison Health Department, Madison, NJ. “It is about helping the community as a whole live a healthier lifestyle.”

Efforts include promoting and providing vaccinations, as well as medical education, while other programs promote a healthier lifestyle, such as the implementation of bike lanes or offering supervision to children walking to school, and keeping an eye on elderly residents.

“Mobility is often a problem for the elderly. We have a program in town called Madison Access, where the stores uptown are alerted to put signs in their door that they will pay special attention to the elderly, people on crutches or wheelchairs,” Rice said. “If they can’t get into the store, employees will come out and help them make it easier to get around town.”

Madison Health Department also aims to reduce chronic diseases like heart and lung disease in the elderly and prevent breathing problems among its younger residents.

“Another program eliminated cars idling in front of the YMCA or any public gathering place, where they pick up children,” Rice said. “All those fumes are not particularly good in the air. So that was stopped.”

Communities United

The success of public health nursing lies in the ability to work together with community entities. There must be communication, collaboration and cooperation.

“We need to reach out and get community partners like the YMCA or the universities or the churches. Everyone has a vested interest in the same things. You would all put the pieces together and have something greater than the whole,” Rice said.

Publicity and funding are two challenges for public health departments and public health nurses. If the community members aren’t aware of this critical component of their healthcare, they will not be a source of support.

PROTECTING THE PUBLIC: Public Health Nurses Tina Zanni, RN, and Fran De Vos, RN, vaccinate community members during the H1N1/seasonal flu mass immunization clinic in Clifton, NJ.

“It is very difficult because public health is more of prevention, and it is very difficult to be able to put a figure or number to quantify prevention,” Zingariello said. “We can talk about it and we know the work we did kept people out of the hospital, kept them in their own home, kept them from getting sick. But, we don’t have any figures to prove that.”

In times of economic downturn, public health nurses are faced with an increase in community health challenges. “Those are times when we see escalations in communicable disease” – with more people sharing living space – “substance abuse, homelessness, domestic violence, hunger” said Kitty Mahoney, MS, BSN, RN, chief public health nurse with the Town of Framingham, MA, and president of the Massachusetts Association of Public Health Nurses. “When a job loss translates into lost health insurance, many will go without medication, visits to practitioners or have recommended screenings. That is when our work really begins.”

Toward the Future

At its midyear meeting in Chicago last June, the American Public Health Association (APHA) discussed the direction of community prevention and made plans for this coming June’s meeting, “The New Public Health: Rewiring for the Future.”

The 2012 meeting will address how to strengthen the nation’s investment in prevention and public health in the face of declining budgets, more demands, an aging and shrinking workforce, changing skill sets, technology hurdles, integration of public health into primary care, as well as a lack of understanding of the role of public health by the public, opinion leaders and policy-makers, according to APHA.

“It does need to get rewired and get a new face on it so people have a better understanding because we have to change our skills set, we have to use the technology that will make a difference,” Rice said. “Public and policy members join in and are an active part in providing for the safety and health of the community.”

Catlin Nalley is editorial assistant at ADVANCE.

Minutes of Chapter Meeting October 6, 2011

Minutes of Chapter Meeting

October 6, 2011  Blumer Room, Framingham Memorial Building

12 Noon, Call to Order

Present: Jane Brown, Ruth Mori, Karen D’Angelo, Pat Gallier, Kitty Mahoney, David Neylon, Nancy Cleary

Minutes for September Meeting: approved

Finance Report: none submitted

New Business:

Karen D’Angelo attended her first meeting on Monday, October 3rd as the new Chapter Representative to the MAPHN Board. In her report she said that it had been decided that if members had not paid their dues by October 15th, their names will be dropped from the roster. It was also reported that Lexington has contracted with a disposal company for 4 syringe drop off days per year, so their sanitation workers do not get stuck with needles.

Southeast Chapter – have signs available advertising Flu Clinics.


Discussion of our upcoming flu clinics and how we are to use the state-supplied flu vaccine as the guidelines are so narrow. Any leftover vaccine due to expire, must be reported to the State as each BOH will be responsible for the cost. Kitty has made a chart which lists the various types of flu vaccines and when they expire. The Coalition for Public Health has said that 15 to 20 communities have given the flu vaccine back to the state. Preference for the state-supplied flu vaccine must be for those with no insurance, or are underinsured and with a medical condition. MassHealth is considered “underinsured”. Healthy adults are encouraged to get their flu vaccine at their PCP’s office.

It was mentioned that possibly BsOH should give their vaccine back to the state. It was finally decided that we need clarification from the State regarding their memo relating to the flu vaccine guidelines.

Kitty said they are using a camera at the Framingham BOH flu clinic, to take pictures of a person’s insurance card. She also said that she traded 20 doses of the multidose flu vaccine for the intradermal vaccine.

Adjourn 2PM – Next meeting Thursday, November 3, 12 noon.

Respectfully submitted,

Nancy Cleary

Minutes of Chapter Meeting September 1, 2011

Minutes of Chapter Meeting

September 1, 2011   Blumer Room,FraminghamMemorialBuilding

Training  Fluzone Intradermal Vaccine by Sanofi’s Jim Leger

12 Noon, Call to Order

Present: Leila Mercer, Kitty Mahoney, Jane Brown, David Neylon, Maureen Sendrowski, Debbie Chaulk, Ruth Mori, Laurie Courtney, Pat Gallier, Karen D’Angelo, Joyce Chen, Pat Duffy,NancyCleary

Minutes for August meeting: approved

Finance Report for July to September approved.


Old Business:

Calendar Update:

Kitty Mahoney is working with a graphic artist for the calendar

We may surrender one of our months to a new Chapter –Barnstable

We will post our meetings on the calendar. The calendar will go to press in October and be mailed in November

Operation Stand Down:

The 17 volunteers were nurses & MRC non-medical volunteers for foot care. A total of 200 veterans were cared for. Toiletries and socks were given to each vet. The Standards for Foot Care is on the MAPHN website for anyone who is interested in volunteering next year. There was discussion about ways to find other volunteers to help with this project as it has grown in the last 2 years. Suggestions were to contact the Medical Reserve Corps (MRC) for volunteers, and contact the American Podiatry Association to request Fellows to assist with foot care. It was also suggested that MRC canopies could be used as shelters for veterans waiting in the hot sun outside.

New Business:

Karen D’Angelo was appointed as the New Chapter Representative to the Board

Chapter picture was taken for the MAPHN Calendar


Discussion of the upcoming flu season and how to obtain funds to pay for the vaccine we have to purchase, as the state has decreased allotments to Boards of Health (BOH) due to budget cuts. Commonwealth Medicine is working with 12 insurance companies to obtain reimbursement for the cost and the administration

of the vaccine. BOH accounts earmarked for flu funds would assure that the funding is there to pay for the vaccine that is purchased and for other costs that arise due to the flu season. BOH can use the Commonwealth Medicine Form for roster billing for Medicare B.

Minute Clinics (CVS) give flu and other vaccines (not live vaccines) and do TST.

Leila Mercer is collaborating with Merck’s Public Sector manager, Mike Goldstein, to set up a Zoster vaccine program at the Natick BOH.

Adjourn 2PM – Next meeting Thursday, October 6, 12 noon.

Respectfully submitted,

Nancy Cleary

Canine Flu Care…

Did you know that there is a dog influenza?

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