Why immunizations and antibiotics matter for patient safety Published Nov. 2, 2017 DoD Patient Safety Program FALLS CHURCH, Va. -- As the temperature gets cooler, contagious illness like influenza (flu) begin to spread. To help prevent illness in the first place, many awareness campaigns in November and December focus on the use of vaccines and antibiotics. Antibiotic Awareness Week, National Handwashing Awareness Week and National Influenza Vaccination Week are a few campaigns that will be trending in social media in the coming weeks. The proper use of both immunizations and antibiotics in the Military Health System plays a unique role in supporting military readiness by keeping beneficiaries safe through appropriate prevention and treatment strategies, at home or abroad. As flu season approaches, MHS’s Director of Quality Improvement Studies Dr. Diana Jeffery has advice for everyone: “Get vaccinated now.” Although the exact timing and strain make-up of every flu season is not precisely known in advance, we do know that our peak period typically begins in the wintertime. Nonetheless, Jeffery’s advice to staying healthy this flu season is as follows: Get vaccinated one month ahead of peak season (usually January-February in North America). Vaccinate all family members, not just the service member. There is even good evidence for vaccinating pregnant women. Report vaccination administration to your primary care manager, especially if you get it on your own, as a way of documenting future benefit from protection and risk with exposures. “It’s up to all of us to be vigilant,” Jeffery said. “We need to be mindful of the US flu season as well as seasonal variations where troops may be deployed.” Overall, immunizations prevent illnesses resulting from either a viral or bacterial infection which, without prevention, can lead to more doctor visits, medical treatments and time away from work. “The influenza vaccine can help reduce the incidence of upper respiratory illnesses during flu season, which then limits unnecessary antibiotic use,” explained Army Lt. Col. Paige Waterman, an infectious disease physician and co-chair of the DoD Antimicrobial Stewardship Working Group. “Vaccinations against pneumococcal pneumonia and H. flu, both bacteria, have also been shown to lower infection rates, especially among children. Before vaccines, these bacteria were becoming more resistant to usual antibiotic therapies. Vaccines have the double benefit of reducing both disease and antibiotic resistance.” The MHS’s Antimicrobial Stewardship Program is committed to improving the understanding of appropriate antimicrobial use through surveillance of bacteria and antibiotic prescribing practices. Combined with DoD efforts to develop new diagnostics and therapeutics, the ASP aims to optimize patient safety through prudent use of antimicrobials and education of providers and patients. “We’re not the antibiotic police,” Waterman said. “Instead, we are asking providers to consider both the risks and benefits of prescribing antibiotics, recognizing that risks from antibiotics can often outweigh benefits. Some physicians prescribe antibiotics up front to avoid patients returning for a second visit. However, the cost of rising resistance and serious antibiotic-associated diarrhea far outweighs the benefit of convenience. It’s clear that we already over-prescribe antibiotics for a number of routine illnesses like upper respiratory infections.” In short, antibiotics do nothing to treat a virus and, in fact, can cause more harm. As a result, educational efforts for both patients and prescribers need to increase, Waterman says. Non-antibiotic symptom-targeting therapies have far greater benefits for viral diseases. “As a health care system, however, we must be able to support return visits in the event clinical improvement does not occur in a reasonable time period,” Waterman said. Although employed throughout the MHS, the DoD has never had a formal antimicrobial stewardship policy. In 2014, an Executive Order aimed at Combating Antibiotic Resistant Bacteria was issued and was followed by the CARB National Action Plan. In both, the DoD was required to develop a stewardship policy. “Many military treatment facilities did have stewardship programs, but there was no coordinated effort,” Waterman said. “Antibiotic stewardship was just an additional duty for physicians or pharmacists. Unfortunately, with many competing priorities and expenses, the scope and impact of such programs were often limited.” While pending final signature, the formal DoD-Instruction for antimicrobial stewardship will mandate all DoD MTFs stand up a stewardship program. In draft form now is the corresponding implementation guidance document (DHA-Procedural Instruction), which will aid facilities to put the policy into practice. Neither document is overly prescriptive, allowing for natural variability in disease, treatment, and prescribing patterns across the MHS, Waterman says. The ASP Working Group is now receiving both antibiotic resistance (the disease-causing bugs) and antibiotic use data from collaborators at the Navy Marine Corps Public Health Center/Epi Data Center and the Army Pharmacovigilance Center, respectively. The ASP WG has tri-service staff to help MHS facilities identify trends and follow through with antibiotic stewardship. “It is too early to demonstrate the impact of the MHS’s antibiotic stewardship programs on readiness,” Waterman said. “We have baseline data and will be collecting more from across the MHS for evaluation; something never done before. With our federal government-wide coordination, it is an exciting time to see the whole picture and finally have a measurable impact on the health, safety and readiness of our MHS population.” To learn more about Antibiotics Awareness Week (Nov. 14-20) and National Influenza Week (Dec. 4-10), follow the DoD PSP’s Facebook page.