DHA’s Vaccine Safety Hubs emphasize safety

“It’s very, very easy to do vaccines wrong; it’s very hard to do it right.”

When Dr. Bruce McClenathan, medical director of the South Atlantic Region Vaccine Safety Hub for the Defense Health Agency’s Immunization Healthcare Division, teaches courses on vaccine safety, he often makes this statement to his students.

To do it right, according to McClenathan, is to know the exceptions to every rule and the nuances of delivering high-quality immunization health care. Within the Military Health System that job falls on the four regional vaccine safety hubs of the DHA, which are strategically located throughout the U.S.

“The vaccine safety hubs are designed to place immunization experts in the field and assist stakeholders with various needs; this could be recommendations on clinical care, education and training, answering questions on policy, providing recommendations on clinic operations, best practices, vaccine hesitancy, conducting vaccine research, etc.,” said McClenathan. “Our team helps with all things related to vaccines.”

A physician serves as medical director in leading each hub, which includes nurse practitioners, registered nurses, immunization health care specialists, education experts, and research assistants, as well as a hub administrator, each having various areas of responsibility.

“For example, the South Atlantic Region Vaccine Safety hub, which is based out of Fort Bragg, North Carolina, is responsible for taking care of CENTCOM, SOUTHCOM, and SOCOM, as well as the major commands on Fort Bragg proper, such as the U.S. Army Forces Command, the U.S. Army Special Operation Command, Joint Special Operations Command, and XVIII Airborne Corp. In addition, the hub supports the entire southeastern part of the United States,” he said. “If a stakeholder in any of these Commands or geographic areas has a question or concern about immunizations, we are available to assist and help resolve their issues.”

Behind the scenes, the regional vaccine safety hubs conduct training and quality assurance checks to ensure the delivery of a safe and effective vaccine to the patient. “If you go in to get a vaccine and everything is fine, that means we’ve done our job well,” said McClenathan. “All of the details that a patient doesn’t need to know about vaccines—but your clinic staff who provide it do have to know...we make sure folks are trained.”

While the military medical treatment facilities oversee and manage their day-to-day operations in patient care, such as ordering and managing vaccines, if they run into a problem, the regional immunization health care specialist is there to help. Recently, McClenathan and his team helped an MTF secure enough yellow fever vaccine just before a short-notice deployment of troops; they otherwise would have faced a supply shortage.

“We redistribute vaccines anywhere in the DoD and ensure they go where they are needed so that vaccines don’t go to waste,” he said, adding that by doing so, the hubs save the Department of Defense hundreds of thousands of dollars each year.

Staff from the hub also support the 24/7 vaccine call centerline where clinic staff, patients and other beneficiaries can ask an expert vaccine-related questions.

“Our hubs are critical to the success of our organization and the DoD immunization program as a whole,” said McClenathan. “We are a one-stop shop for all things immunization so that those who do provide the immunizations can do their jobs competently, professionally, and to the standard of care, if not exceeding the standard of care.”

The majority of vaccines do not change frequently, with exception of the flu vaccine that is updated every year to adapt to new virus strains, but vaccine research is evolving, said McClenathan. For example, the Food and Drug Administration recently expanded approval of an HPV vaccine for men and women up to age 45 to prevent certain cancers and diseases; previously the maximum age was 26.

“As more data and research are completed and assimilated, the recommendations for use of a vaccine may change, even though vaccine itself may not be changing,” he said.

The regional vaccine safety hubs also contribute to the overall vaccine research community, especially as it relates to military health beneficiaries. The research topics can vary from genetics to vaccine adverse reactions to the efficacy of vaccines. McClenathan’s team recently completed a five-year clinical trial studying the impact of ibuprofen on a patient’s immune response to the flu vaccine. The results of the study will soon be published in a peer-reviewed journal.

“It’s really never been studied, especially in adults,” he said. “But we give a lot of ibuprofen and we give a lot of vaccines in the military, so we need to know if giving ibuprofen impacts how people respond to the vaccine.”

Currently, all four regional vaccine safety hubs within the DHA are participating in a major study, in collaboration with the federal government’s Infectious Disease Clinical Research Program to assess which form of the flu vaccine is most effective and providing immunity against the virus, whether egg-based, cell-based, or recombinant flu vaccine. “That’s going to be a pivotal study that will change not only which flu vaccine is given in the military but hopefully globally,” said McClenathan.