Tuesday, May 25, 2004

A Shot in the Arm

Today I gave the 2nd shot of my new practice to a 14 year old boy whom I saw for a check-up last week. I saw from his shot records that he had only had one MMR and advised his mother that he needed a 2nd one. I have not been stocking vaccines until I have a need for them, mainly because . . . have you seen how much vaccines cost???

A 10 dose order of MMR vaccine from Besse Medical costs $416.63. I figured I could use up 10 doses before they expire next summer. If not, I'll be wasting a lot of money. My other choice would have been to order a single dose vial of MMR for $51.49, but that's $10 more per dose. Anyways, I ordered it the same day I saw the boy, and it arrived on ice 2 days later.

Never having needed to give MMR shots before, I learned that the MMR vaccine comes in a powder inside the vial, and needs to be reconstituted with diluent (sterile water) before giving the vaccine. Fortunately, the order came with 10 bottles of diluent, too, so all I had to do was draw it out with a 25 gauge 5/8 inch needle and syringe and squirt it into the vial of MMR vaccine. The MMR vaccine has to be refrigerated between 36-46 degrees Fahrenheit, which is not a problem –– for now.

I got a mini-refrigerator with a separate freezer (even has a door lock!), just so I could keep vaccines. I got min-max thermometers for the separate refrigerator and freezer compartments and have been keeping a log recording the temperatures. That's kind of a pain to keep track of, since I have to make a special trip to the office to record the temperature even when I don't have any patient visits. I've read about low-tech ways to monitor the freezer, put a cup of ice with a penny on top in the freezer and check it daily. If the penny starts to sink down, you may have a problem. But I decided to go high-tech.

My problem is, when the refrigerator is just right, the freezer is too warm (meaning goes above 5 degrees, the maximum temperature for Varivax, the only vaccine that needs to be frozen). And when I turn it down so that the freezer is just right, then the main refrigerator gets too cold for the other vaccines.

I think my solution will be to do "just-in-time" ordering of Varivax, in case I ever need it. One dose costs $71.21, and I'm sure I can convince a parent to come back in 2-3 days for their child's shots. This way, I won't have to worry about a bunch of Varivax going bad. $71 dollars a shot! Still, that's not as expensive as the meningococcal vaccine ($84.77 per dose). Yet another reason college is so expensive.

Then there's the Vaccine Information Sheets (VIS) that you're required by Federal Law to hand out to parents/patients before they get the shot. I did remember to give the mother that. Plus you have to record the lot number and expiration date of the vaccine you gave, just in case it turns out later to be recalled, for some reason, like the Hep A vaccine was a few years ago.

This site has other helpful info on good immunization practices.

As for the actual administration, he was cooperative and didn't flinch when I poked his left deltoid. I'm sure they won't always be this easy and I'm anticipating with dread my first toddler shots. I plan to try using the Shot Blocker or maybe just using topical EMLA cream.

That reminds me. I should eventually get some lollipops and stickers, too! Adults get stickers like this and this. Then again, maybe not.