Independent Insights, a Health Mart Podcast

Increased Incidence of Pediatric Pneumonia and Pertussis

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Join us as we discuss the alarming rise of pediatric pneumonia and pertussis cases, unpacking the latest clinical insights and prevention strategies essential for today’s pharmacists. In this episode, we’ll explore the factors driving these trends, discuss how pharmacists can play a crucial role in patient education, and review updates to vaccine recommendations. Don’t miss this opportunity to stay at the forefront of patient care—tune in and be a proactive advocate in safeguarding children's health!
 
HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Mona Ligvani, PharmD, APh
Clinical Pharmacist
Children’s Health Initiative for Medication Education (CHIME)

Pharmacists, REDEEM YOUR CPE HERE!
CPE is available to Health Mart franchise members only
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CPE INFORMATION
 Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe the recent trends in pediatric pneumonia and pertussis incidence and their contributing factors.
2. Identify key vaccination recommendations and prevention strategies for pediatric pneumonia and pertussis.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-315-H06-P
Initial release date: 12/16/2024
Expiration date: 12/16/2025
Additional CPE details can be found here.

Jen Moulton 

Hi Health Mart Pharmacists from your education partner CEimpact, this is Game Changers. Each week we have a conversation on a hot clinical topic that will keep you current in practice and position you as a resource for prescribers and patients. Thanks for listening in!

Josh Kinsey

Welcome to the Game Changers Clinical Conversations podcast. I'm your host, Josh Kinsey, and as always, I'm super excited about our conversation today. Pediatric cases of pneumonia and pertussis are surging, posing serious risks to children's health and highlighting gaps in prevention efforts. Pharmacists are uniquely positioned to address these challenges through vaccination advocacy and patient education, making their role crucial and reversing these troubling trends. And on that note, it is so great to have our guest expert for today, Mona Ligvani. Um, welcome. Thanks so much for joining us!

Mona Ligvani

Thank you. Hi. 

Josh Kinsey

 Before we jump in, uh, Mona, I'd love for you to just introduce yourself to our learners and our listeners. So, if you could just tell us a little bit about your current role and your practice site and maybe also, why you're passionate about pedes patients and the topic that we're going to talk about today. 

Mona Ligvani

 Sure. And thank you so much for having me on the podcast. I'm excited to be here. Again, my name is Mona Ligvani. I'm a clinical pharmacist. I founded a nonprofit called Chime, the Children's Health Initiative for Medication Education. I'm also a clinical pharmacy manager of Calabasas Pharmacy in Southern California. And essentially, my role in both areas is to help support families, especially in keeping their kiddos healthy. Um, and so my passion for pediatrics really came about when I became a mom. And I'm a mom to two kids, and one is medically complex, and the other one has a disability. And so, this is an area of our practice as pharmacists that I am so passionate about, because I've been on the receiving end of getting cared for by awesome pharmacists. 

Josh Kinsey

 Yeah. That's awesome. That's great. Well, thanks for that introduction. And again, welcome. We're so glad to have you. Um, Mona was recommended by a colleague and I'm super excited. I always love having new guests and new experts on the call. So, we're thrilled to have you, Mona. Thanks for joining. As I mentioned earlier, some of these trends are troubling. So, I really want to dig into, the recent surge that we've seen in pneumonia and pertussis cases, particularly in our pedes patients, but before we do that, I always like to lay a foundation for our learners just to make sure that we're all on the same page. So just to remind us, Mona, of pneumonia and pertussis and kind of how they affect our, our patients and even our adult patients. And you know what it is that why is this surge a concern? You know, what are what are we dealing with here? 

Mona Ligvani

Sure, and it's a good question. And it's important to lay the foundation. So, what's important to remember about pneumonia is that we're looking at a respiratory infection. It does impact our alveoli. So, our cells inside of our lungs. And what we know about pneumonia is that it can be caused by a virus. It can be caused by bacteria. Or we can have an atypical presentation of pneumonia, which is what the surge is of. Now, what makes this pneumonia outbreak unique is that we're seeing the mycoplasma pneumonia. Now, when we compare that to pertussis or whooping cough, pertussis is really characterized in hallmarked by coughing fits. Coughing fits that can be very troubling to a person's body, not just the respiratory system, but, you know, it can be a cough that lasts so long. It has a big impact. And pertussis is caused by a bacteria. So, knowing the differences in what causes both of these is really important, because it kind of tells us what opportunities we have as pharmacists when we're brainstorming with our families or with our providers in trying to find out what the best course could be for our patients. 

Josh Kinsey

 Yeah, yeah that's great. So, it's interesting, I didn't fully realize that the surge that we're seeing is not really bacterial or viral. So, what is that whole area a new version of pneumonia, or have we seen it in the past? It's just what's surging right now?

Mona Ligvani

We have seen it in the past. And just to be clear, the mycoplasma is an atypical pathogen, and it is a bacteria. So, it is responsive to antibiotics. Um, and we see yeah, we see cycles of um, pneumonia every 3 to 7 years. And what's interesting right now is that the mycoplasma pneumonia, like I mentioned, is what's at the forefront. Usually, it's not usually it's atypical. That's how I described it. And it's not the common presentation. And by the way mycoplasma pneumonia, you might have heard it as walking pneumonia. Um, and so. 

Josh Kinsey

Oh yeah. So yeah, I'm super old. Mona. So yeah. You got to use old terms for me. Yeah. That makes so much sense. I'm very familiar with walking pneumonia. 

Mona Ligvani

 So yeah. So, it's walking pneumonia, and we don't see walking pneumonia as often and as commonly in these cycles. So right now, we see a surge of pneumonia in general. We see a surge of mycoplasma pneumonia. And the time frame that we're comparing 2024 two is about pre-pandemic. So, about 2019 2018. And our numbers are very different. 

Josh Kinsey

 Got it. Okay. That's great. That's really great. So, um, what are some of the contributing factors to this recent surge that we've seen? Um, in these two obviously, vaccination rates are probably going to be something that you're going to that you're going to mention. But, you know, maybe even what has led to the vaccination rates decreasing. So just if you can touch on a few things that you feel have really impacted this surge, that would be great

Mona Ligvani

 Sure. So according to the CDC and some other research that is out there, one of the reasons why we're seeing a surge of the mycoplasma pneumonia or the walking pneumonia, it could be because of some risk factors that are modifiable. You mentioned one, vaccines. Um, so our vaccination rates are lower. It could be because during the pandemic, families, especially families of little ones, couldn't get out to their pediatrician’s office for their routine vaccines, so they might not have a full, immunization done. They may have partial immunization. And it's not just of that child, but it's also of everybody else in the family. Right, so that's something for us to consider, something else for us to consider that's really important is that with the closure of schools, with the closure of daycares, with the closure of some areas that families would often go to restaurants, churches, libraries, all these kinds of places are immune system. And especially for our kids, it didn't get exposed to just the natural environment where we would build a little bit more natural immunity through just exposure. So, we see that as well as being a big contributing factor. 

Josh Kinsey

 Yeah, do you also think that potentially going back to the vaccination rates as being low and your points make perfect sense as to difficulty getting to, pediatricians and, and increasing, those rates and missing out on some of the sequences of the doses that were needed. But do you also feel that vaccine hesitancy and a sense of anti-vaxxers and things like that, is that also contributing potentially here? 

Mona Ligvani

 Yeah. And, I'm in community practice and so I take care of all kinds of people, people who are on board for themselves and their children to be vaccinated and people who are not on board. I personally don't use the word anti-vaxxer because I don't want to put a characterization on them that I feel like I can't change through education. Um, so just as a side, what I really like to look for is these opportunities. What I've noticed the most in in Calabasas, where my practice site is and this, San Fernando Valley of Los Angeles. We have a lot of highly educated people that live here, and these are people that are listening to, you know. People they think are qualified physicians, researchers, scientists. So unlike before the pandemic, before the pandemic, what I could say about vaccine hesitancy was that people were citing, you know, the debunked, study and find like that was easier to kind of get somebody to turn around and see the fallacies in that mindset. But now we have people saying, but I heard this doctor say that this about the vaccine, and I heard that pediatrician doesn't do vaccines on this schedule. So, it's a little bit more challenging because we have prominent figures at our health care providers that are sharing what I call half-truths. So, a lot of what I notice in people who don't want to vaccinate their kids, or they're hesitant to vaccinate their kids or on the schedule that's recommended by the CDC, they have taken in and they believe half-truths. And so sometimes as pharmacists, we have this really awesome opportunity to say, okay, I can see why you think this. I can see why you think that today children are getting more vaccines as when we were kids. But this is why. 

Josh Kinsey

And so trying to help them finish painting the picture so that they can come. Yeah. Fully providing the education. Yeah. 

Mona Ligvani

 Yeah. And so that's a big difference in 2024 compared to before the pandemic I would say. 

Josh Kinsey

Yeah, that's very interesting Mona. Thanks for sharing that perspective. You know, as I've mentioned before, for our learners, it's been a few years since I've been in clinical practice. And so, you know, I feel like, it certainly was, before the pandemic. And I feel like the landscape has changed so much. And so, it's interesting to hear this perspective and then it makes total sense. On that note, as you kind of alluded to, but let's dig deeper into that, you know, what is the opportunity there for pharmacists? Because clearly, it's education. It's also, as you mentioned, and I was guilty of it by saying anti-vaxxer, not stereotyping and not labeling, but, you know, being, open and responsive and listening to their concerns so that you can formulate an appropriate response. So, so tell us a little bit more about, you know, the education opportunities or ways that pharmacists can kind of jump in.

Mona Ligvani

Yeah. You hit the nail on the head. It's listening. It's listening and not jumping to, trying to prove the need for vaccines with hard data. Um, it's really having a softer conversation that is evidence base that is providing science and the numbers and the details. Yes. But, you know, we learn about motivational interviewing in pharmacy school. And if you haven't learned about motivational interviewing in school, I'm certain you've heard of it before. And essentially motivational interviewing is just that it's motivating or bringing your patient or your caregiver or your parent to a place of understanding where they're going to come and say, okay, I got it. I understand now, um, and I think that by leading with a softer approach of, hey, I understand why you think this, I can see why you think that. I want you to know that this is the full picture that I need you to consider for your health, for your kid’s health. So, pharmacists have a really great opportunity if you work in community practice. What I like to do is I like to check in with my, pharmacy software. I just do when I'm doing my final check if I haven't done this. And I think for those of us in community practice, if you work in, um, a community practice that has a large patient population, this is a little bit hard. So, use your notes feature on your pharmacy software. That's what I have to do. I certainly can't remember all of my patients, but I leave a note of when I reviewed their profile for vaccines. And I'm looking for my adults. I'm looking for did they get Tdap every ten years? It's kind of this new thing where people are surprised. I'm surprised when people are surprised that they need to get a Tdap vaccine every ten years. And I think that's because before we were telling individuals, you know, you can get TD, which is the tetanus and diphtheria, it didn't include pertussis. But now the recommendation also does include pertussis. So really recommending for individuals that are adults to get their Tdap vaccination every ten years. Um, of course speaking to moms that come in that are pregnant and asking them, hey, have your parents gotten vaccinated or your primary child caregivers that are going to be helping you? Are they vaccinated? Um, and including them in the conversation, I found that, pregnant moms are one of our best advocates because they're advocating for their babies. And when they advocate for their babies, you know, they got their mama bear or their daddy bears, you know? Yeah, and so on. And parents are really good resources to help and spreading the word. And they talk to their friends and, you know, and that's how kind of that goes.  

Josh Kinsey

Yeah, that's very interesting to that. You know, and we, we kind of got hung up on walking pneumonia earlier and the surge and that, and we kind of forgot to come back to pertussis. That's my fault. But just reminding patients as well. And you alluded to it, but I want to be sure that we reiterate it, that, um, pertussis, while we may be seeing the surge in our pediatric patients, um, that is not just a pediatric concern, right? So maybe reset the stage a little bit for us. And because you alluded to the fact of pregnant moms wanting to be sure that caregivers and parents and whatnot were vaccinated. So let's refresh foundational memories of our learners as to why that's important for pertussis as well. 

Mona Ligvani

So, pertussis is also on the rise. And we know that pertussis also comes in cycles. So, this is also something that we're not entirely surprised by. Is it alarming. Yes. But as pharmacists we keep our cool with this right. And so, what we do is we educate our patients and our families. The reason why it's so important for people that are pregnant or around children to get their pertussis vaccines or their Tdap vaccine is because our, our kids, especially our kids that are younger than one years old, pertussis is life threatening. It's something that definitely could land them in the hospital and its life threatening. And I think that when we lead with this conversation of it's not just to protect your kid by hoping that they have a less severity of symptoms, this is this can be lifesaving. So, vaccine preventable diseases are really important, but also reminding our pharmacists and reminding our families that vaccines can save lives. 

Josh Kinsey

 Mhm. Yeah, for sure for sure. And how far does that reach go. Like what is the recommendation. Obviously, you mentioned for everyone it's every ten years. But if you if you are let’s, say that my parents are going to have a new grandchild and they just had one five years ago. But it's a new grandchild. Do they have to get another one if they're going to be caregivers for it or be around it often, or are they still covered in that in that time? 

Mona Ligvani

 That's a great question. And it's something I see a lot. I even see, um, pregnant moms arguing with their parents at the pharmacy counter over this. Sometimes if you've been vaccinated within the ten-year period, you're good. That's what the data tells us, that you have enough of that immunity that you're good. Um, interestingly enough, when we talk about, uh, tetanus vaccines for travelers, I know this is totally unrelated, but kind of trying to create a parallel for travelers. What we tell travelers is, well, if you're going to be traveling in a tetanus vaccine is recommended. And you got it five years ago. You should be okay if you got it eight years ago, you should probably re vaccinate. So, you can certainly pull titers if somebody has gotten a vaccine within the last let's say 5 to 10 years and they are hesitant and they want to pull titers, go ahead pull antibody titers, see how you're doing. Maybe that will help give a more informed decision. But generally speaking, if let's say a grandparent was vaccinated within ten years, generally speaking they, they are protecting their baby that's coming into the world. 

Josh Kinsey

 Yeah. That's great. That's great to know. And like you mentioned, you know, it's more than just a cough. Like it's something that can really cause issues wreak havoc on other organs. And, and just in general, um, be a very life-threatening issue. How does pertussis, display in adults like is it more mild or is it of a concern in our older population as well? 

Mona Ligvani

 It is a concern in our older population. But pertussis is something that an otherwise healthy adult will get through. Pertussis and otherwise healthy, even elderly person will get through it. There's antibiotics that treat pertussis. We're talking about amoxicillin or Augmentin. Um, and, you know, the hard part is that cough, it used to be called the 100-day cough. It would cause a cough that lasts so long. And we're talking about coughing fits that are so strong and violent. It can crack ribs. It can cause, even the intercostal area between ribs to slip. Um, it can cause coughing so hard that vomiting, even fainting. Um, so this is the hard part. The hardest part of pertussis is the recovery from the cough. 

Josh Kinsey

 Mhm. Interesting. And you know as you mentioned, I don't want to be the Debbie Downer in the conversation. But if you crack a rib, you could puncture an organ or I mean, it could, it could be this, this you know effect that just continues to make things worse. So, it's more than just, oh man, I have an annoying cough like it actually can. Oh yeah. It's, you know, be detrimental. Yeah. And you know, it's whooping cough. So, at the end of that, the hallmark of it is at the end of a cough, you hear someone whoop or gasp for air. So there. Yes. 

Mona Ligvani

 And that is exhausting. That cough is exhausting 

Josh Kinsey

 for sure. Yeah, for sure. I mean, when we are, you know, when we're, um, sick with, with the flu or cold or whatever, and, you know, you have, you know, just a very simple cough. I'll call it simple, but, uh, in comparison to pertussis, it's still very annoying and it's still very difficult to like to catch a breath and to breathe through and to not always feel like you're, you know, gasping for air, breathing. So and especially, we saw that post-Covid too, with a lot of patients, you know, still having issues catching their breath. So. Okay, so we've talked a little bit about, countering the misinformation that some of our patients may have and our role as a pharmacist and the importance of that, as a pharmacist. Let's talk a little bit about some of the reasons that vaccinations may not have occurred is not because of a decision or what was perceived as an informed decision, but because access to care. Um, so let's talk a little bit about, underserved communities or communities that have, very rural where there's not a lot of pharmacies. Um, what are some ways that pharmacists can help bridge these gaps and those particular types of settings? 

Mona Ligvani

 What an excellent question. And what an important one to so what we know about our families that live in more rural areas or even areas where there could be a pharmacy desert or a healthcare desert where they may not even have easy access to physicians? Um, what we know is that there are there are opportunities for us to go out there. And so, um, I work in independent pharmacy. It's not just independent pharmacy. We see some academic institutions; we see some chain farm retail chain pharmacies. They're creating more of a mobilized effort. So really working with organizations and, churches and schools to do health fairs, to do vaccine clinics, even helping to support pediatricians. So, something that we do is we let our local pediatricians know, hey, on this day and this day, we're going to run a vaccine clinic, have all your patients come to us for their flu shots, for their, um, whooping cough shots, for really anything that there is. So really supporting the health care providers in the area is important now to kind of back up and address your question. What we know is that the pandemic caused us all to stay inside. It caused us all to avoid going to the doctor, not just because of limitations, such as only one person allowed in the waiting room, only one parent allowed to go in with the kid. These were all very serious barriers. When we're talking, for example, about a family that is, let's say, mom and dad and four kids, well, if they need to take one kid or 2 or 3 to the doctor's office and only one adult is allowed to go with them, that's really hard for that one adult. That will certainly cause a person to say, hey, maybe we should just hang back. Maybe we should split up. It's. A barrier. And so, these barriers to access were real. And then the next thing that I would say is there was a lot of, fear instilled in people and a lot of distrust instilled in people. And that causes, especially people who live in areas that don't have a strong, prominent pharmacist or pharmacy figure or physician or pediatrician, there was so much on the internet and so much on the TV that really swayed people in different ways. So, I think getting out there and getting into those more rural areas and having a presence does such a big service to all communities. 

Josh Kinsey

 Yeah. So, I think it, you know, boils back down to education as a cornerstone and making sure that any misinformation is, you know, guided differently. And then it also, as you mentioned, boils down to thinking outside the box, um, doing some clinics and, you know, um, advertising that out to different maybe it's public health entities or maybe it is, um, the free clinics in the area or just, you know, prescriber offices. But one thing I will say, too, and this is a whole nother conversation, we could have probably a three-hour podcast on state regulations and making sure that you know what you can and can't do in your state. But I would just highlight remembering, you know, that it is important for you as a pharmacist to know, what age patients you can vaccinate based on where you're located. So yes, encourage you and that you know, has is going to be changing soon. Whereas we were kind of all encompassed under the Prep act and all that's changing at the end of this year. So, it's important just to go back and make sure that, you know, we don't have that free reign to vaccinate any pedes patient. You know, you're going to have to go back to your original state, laws and regulations there and make sure that you are vaccinating within the scope of your practice. So just a reminder there to everyone out there. But do that. Yeah. Do that so that you can offer these services because they are important. So um, okay, so in the few minutes that we have left Mona, I'd love to talk about. So, we've discussed what are some of those key cornerstone things that pharmacists can do, and its expanded services and it's education. And it's really looking at those things to help, prevent the infections, prevent the surges. Right. You know, right. The right, the surge where it's going upward. Let's move it back downward. Um. There are concerns in practice, and I'm sure you are coming from community practice, you know, time concerns, implementation of something in workflow, just the simple act of double checking your state's immunization registry like that takes extra minutes. And sometimes we don't have those extra minutes as pharmacists. So do you have any tips and tricks to share with our listeners about this is doable. This is feasible and it's important to make that time like as if there's anything you can share. The learners would love it.

Mona Ligvani

 So sure, I love bringing my pharmacy technicians into the mix. My pharmacy technicians are trained so well they check care for me. So that's what ours is called, the California Immunization Registry. And so utilize your team. Utilize your team to also have start these conversations. It's not a consultation. It's just a conversation. “Hey, have you gotten your flu shot.” Have you gotten this or “Oh, I see that you have a little kid. How are things going?” Just starting conversations. Having your team involved really helps alleviate the pressure that's on the pharmacist. And like I said, utilize the notes on your pharmacy software. I've been in many pharmacies where I go in and help people, and I see that people don't utilize their notes and they try to keep it up here, but it's. It's so hard. 

Josh Kinsey

 Yeah. Well, documentation is key. So, you know, that's what I took away from that is being sure that you're documenting, and being sure that you are sharing all the information so that if someone does follow up behind you and is not it's not their normal store, it's not their normal day to work or whatever, that they also know what's going on with patients. And I love the idea of bringing technicians in. We're it's the impact. We are strong advocates of utilizing technicians to the top of, of their scope of practice. And it's super important. And you're right, it is. It is just a conversation. So when it turns into, uh, no, I haven't or I don't believe in flu shots or, you know, when the clinical education or evidence needs to come in, then, yeah, the pharmacists can be tapped. But you're right. Having the technician start that and it could just be as simple as no, I haven't. Go ahead and sign me up for it. You know, like that could be what's needed versus the pharmacist. 

Mona Ligvani

 And I just want to say one more thing that could be helpful in our pharmacies that are slammed. Try to implement an appointment-based system. Having an appointment-based system really does help free up your, um, your time and you get to manage based on the appointments for the week, what staffing you need. So, if you're not using appointments yet, if you're doing the more reactive form of pharmacy care where someone approaches you to the counter, hey, I'm here, I want to get a flu shot. That is hard. That is so hard. Yeah. If you get it on appointments and you're more proactive, um, time just. It just opens up for you. So, it's more feasible. 

Josh Kinsey

 Yeah. It's a yeah, that's a great tip. Mona, I mean it. I am a schedule person. I, I'm the person that if a new task comes at me and I complete it quickly and it never got on my to do list, I still write it on my to do list so I can check it off. So, I love a good schedule and I love a good task list. And so that makes perfect sense. And I think that's a great tip is, you know, if you struggle with that in your practice setting, if that is a concern, if that workflow is a problem, you know, consider switching to that appointment-based model. I think that that that's a great tip. So well we're running out of time. This is great. And I feel like we could continue on for forever. But, um, as we wrap up Moana, what I always like to ask our expert is, um, to summarize, like, what's the game changer here? So in other words, what's the main point you want to leave with our listeners and our learners? Um, from the conversation today?

Mona Ligvani

The main point that I want to leave for our learners is that pharmacists are in such a prime position to provide education and to help the landscape of trust, building that trust back up with our patients. So, taking the time to educate and even having printed materials, if that's helpful. Um, but just get out there as educators, you know, try to help your community get back to a place of, trust. And I'm certain that with that, vaccines will come back into rotation and will people will be caught up and then we'll see the rates drop down. 

Josh Kinsey

 Yeah. That's great. And on that note, I will challenge our listeners and learners as well, in order to properly and effectively utilize evidence-based research to educate your patients, you're going to have to make sure that you're up to date on that information. So, the challenge for today is to be sure that you yourself, as a pharmacist and practitioner out there are up to date on the on the current information. And be sure that you're utilizing evidence-based research as well, so that when you do have these conversations with patients, you are knowledgeable in the topic and know what's going on. So that's my challenge. Back to everyone. Yeah, well, that's all we have time for this week. Mona, thank you so much for joining us. This was such a great episode. I learned a lot, and it's just always great to hear from someone an expert in the field and really get to kind of get that perspective. So thanks for joining us!

Mona Ligvani

Thank you so much for having me. 

Jen Moulton

And that’s it for this week, be sure to login to health mart university to claim your CE credit for this episode. As always have a great week and keep learning – we’ll talk to you next week!