Transcript Immunization News

K-12 REQUIREMENTS: SNAPSHOT
Already Required
New Requirements
DTaP/DT and/or Td (Tdap)
Meningococcal grades 7-12
Polio
Tdap instead of Td grades 7-12
Hepatitis B
MMR
Varicella
Changes to previous requirements
DTaP for K: last dose on/after 4 years
Polio for K: last dose on/after 4 years
Hepatitis B: expanded K-12
MMR: expanded K-12
Varicella: expanded K-12
GIVE ADOLESCENTS ALL RECOMMENDED VACCINES
• Tdap
• HPV
• Meningococcal
• Influenza
PERTUSSIS IN MINNESOTA, 2013
PERTUSSIS PREVENTION
Early diagnosis and treatment: think, test, treat
Reduce morbidity and mortality to most vulnerable –
children under 1 year of age
TDAP RECOMMENDATIONS
Tdap at 11-12 y, then Td every 10 years (2006)
One Tdap for person 13 years or older not previously
vaccinated, then Td every 10 years
 Give Tdap regardless of interval since last Td
Tdap in incompletely or unvaccinated persons 7-9 y
 ACIP off-label recommendation: use Tdap as one of the
doses in the series
 Update: Adacel now licensed to age 10 years, (Boostrix
has been since first licensed)
TDAP RECOMMENDATIONS
Pregnant women
 Tdap during every pregnancy regardless of the
number of doses previously received,
Give between 27-36 weeks gestation
KEY TDAP LAW IMPLEMENTATION ISSUES
Tdap not necessary if dose given between ages 7-10
Don’t need to consider waiting between last Td and Tdap
Can assume Td/Tdap documentation of older ages is
likely Tdap
Serogroups C and Y account for the majority of meningococcal
cases in adolescents
RECOMMENDATIONS FOR ROUTINE
MENINGOCOCCAL VACCINATION
Vaccines:
Menactra (MCV4-D) or Menveo (MCV4-CRM)
Schedule:
Routine adolescent
 Give MCV4 at age 11-12 (2005)
 MCV4 booster at age 16 (2011)
 If first dose given at 13-15 years, give
booster between 16-18 years
 Minimum interval between doses is 8 weeks
 If first dose given on of after age 16, a booster dose
is not necessary
 Catch-up through age 21 years if person is a first year college student
living in residential housing
UPDATE: Two vaccine candidates for serogroup B under FDA review
KEY MENINGOCOCCAL LAW IMPLEMENTATION ISSUES
Phased AISR reporting
No booster dose reporting
Doses given before age 10 years
not considered compliant (won’t
protect through risk years)
Rates for upcoming 7th graders are
sobering
Comparison of 1+ MCV4 in Adolescents
13-17 years versus 11-13 years, MN
70
60
50
40
30
32
20
10
0
2012 MN NIS
13-17
2012 MIIC
13-17
2014 MIIC
11-13
Phased AISR Reporting for Meningococcal Vaccine
Grade
2014-15
School
Year
2015-16
School
Year
2016-17
School
Year
2017-18
School
Year
2018-19
School
Year
20192020
School
Year
7th
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
1 MCV4
dose
8th
9th
10th
11th
12th
1 MCV4
dose
INFLUENZA
Return of H1N1 since 2009 pandemic
Incidence declining but still seeing B strains circulating
Less hospitalizations than last year but higher
than recent years
Severe disease seen mostly in young and
middle age adults
INFLUENZA LABORATORY SURVEILLANCE
MN Lab System (MLS) Laboratory Influenza Surveillance Program
Influenza week 17, 2014
NEW INFLUENZA VACCINE PRODUCTS
1. Flumist Quadrivalent (LAIV4), MedImmune
2. Fluarix Quadrivalent (IIV4), GSK
3. Fluzone Quadrivalent(IIV4), Sanofi Pasteur
4. Flulaval Quadrivalent (IIV4), ID Biomedical /GSK
5. Flulaval (IIV3) age expansion to 3 years, ID Biomedical/GSK
6. Flucelvax, a cell culture-based trivalent inactivated influenza
vaccine (ccIIV3) ), Novartis
7. Flublok, a trivalent recombinant HA influenza vaccine (RIV3),
Protein Sciences
OTHER KEY FLU MESSAGES
Efficacy
 50% give or take - mostly in healthy adults and children
 Current flu vaccines are the most specific tool we have to reduce
morbidity and mortality of influenza
Timing of vaccination
 Ideal: 2 weeks before onset of flu season
 Real: impossible to predict the start of
flu season!
 Real: millions to vaccinate every season
 Don’t miss the opportunity to vaccinate,
there may not be another chance to do it
PNEUMOCOCCAL VACCINATION – GOOD TO KNOW
Pneumococcal conjugate vaccine, 13 valent
 Routinely recommended in infancy 2m, 4m, 6, 12-15m
Two vaccines, many older at-risk children need both
 Pneumococcal conjugate vaccine (PCV13)
Conjugated technology allows for longer protection
and more responsive boosting effect
 Pneumococcal polysaccharide vaccine (PCV23)
Covers strains not included in 13-valent product
Preferable to give after conjugated product
Risk Group
Immuno
competent
Functional or
anatomic asplenia
Immuno
compromised
Underlying Medical Condition
Chronic heart or lung disease
Diabetes mellitus
CSF fluid leak
Cochlear implants
Chronic liver disease
Alcoholism
PCV13
PPSV23
X
X
X
X
X
X
X
X
Has asthma
X
Smokes cigarettes
X
Sickle cell disease/other hemaglobinopathies
X
X
Congenital or acquired asplenia
X
X
Congenital or acquired immunodeficiencies
X
X
HIV infection
X
X
Chronic renal failure/nephrotic syndrome
X
X
Leukemia/lymphoma/Hodgkin
disease/generalized malignancy
X
X
X
X
X
X
X
X
Iatrogenic immunosuppression
Solid organ transplant
Multiple myeloma
CHILD CARE & EARLY CHILDHOOD
PROGRAM REQUIREMENTS: A SNAPSHOT
Already Required
DTaP/DT
Polio
Hib
(through age 4 years)
Pneumococcal
(to age 24 months)
MMR
Varicella
New Requirements
Hepatitis B
Hepatitis A
School-based early childhood
programs added
Changes to previous requirements
Varicella required starting at
15 months (instead of 18 m)
HEPATITIS A
Number of Hepatitis A Cases per Year,
MN 1998 - 2013
250
200
150
100
50
0
Included an outbreak
that involved schoolaged children
HEPATITIS A RECOMMENDATIONS
Products: Havrix (GlaxoSmithKline) and Vaqta (Merck)
Age recommended: 12 Months
Schedule: 2 doses, at least 6 months apart
Immunization Rule: required for children in child care
and early childhood education programs through
Pre-kindergarten
• Extended-day programs (K and up) are not included
in this requirement
SCHOOL-BASED EARLY CHILDHOOD
PROGRAMS
Early childhood special education (ECSE) - has been
included in the law for a couple decades
School-based early childhood programs
Children from birth through pre-kindergarten
Meet at least once a week for 6 or more weeks
during the year
Vaccine requirements are the same as for child care
EARLY CHILDHOOD LAW IMPLEMENTATION Q/A
Q: Do the new requirements only apply to newly enrolling kids?
A: No. Any child enrolled in child care or early childhood programs
needs to meet the new requirements effective Sept 1, 2014.
Q: Are early childhood programs required to complete the Annual
Immunization Status Report?
A: No, the Annual Immunization Status Report (AISR) is for K-12.
Q: How often should we check immunization records of children
enrolled in Early Childhood programs?
A: Once during the school year is adequate.
CHANGES TO IMMUNIZATION LAW
Implementation: September 1, 2014
Immunization Law Communications
Target audiences/ mechanism
Resources
Other promotional projects
Schools/school
nurses/daycare/early education:
• SNOM conference
• Email listservs
• Formed advisory team
• WebEx sessions
• School nurse meetings
Updated:
• Student Immunization Form
• Child Care Immunization Form
• Early Childhood Immunization
Form
• Schedules that include law
• Are Your Kids Ready?
HPV Grant: focuses on all
recommended adolescent vaccines
• Public information campaign
• Postcard reminder mailing to
123,000 families of 11-12 y o
• Clinician outreach and education
Local public health:
• Monthly calls
• Workspace updates
New resources:
• Factsheet on the Law changes
• School software vendor
guidance sheet
• Frequently Asked Questions
Mass vaccination exercises – certain
LPHA in collaboration with emergency
planning staff
• Vaccines include meningococcal,
and Tdap; some include HPV
Providers/clinics:
• Broadcast faxes
• Got Your Shots newsletter
• MIPAC partner communication
• Professional organization
messages/venues
• Mailings
• Health systems contacts
• MIIC Adolescent Assessment
tool
• MIIC Reminder/recall feature
Resources
Forms: www.health.state.mn.us/divs/idepc/immunize/tracking.html
Updates: Sign up for GovDelivery updates - click on the little red envelope on each of
these pages:
 School Health Personnel:
www.health.state.mn.us/divs/idepc/immunize/school/
 Minnesota Immunization Rule Revisions:
www.health.state.mn.us/divs/idepc/immunize/immrule/
Webex: https://health-state-mn-ustraining.webex.com/
 Select Recorded Sessions in the left navigation
Questions? Call MDH: 651-201-5503 or 800-657-3970 or
Email: [email protected]
QUESTIONS?