Childhood Immunization Update Presented by: Deanna Brown, IPC, State Immunization Program Patty...
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Childhood Immunization Update Presented by: Deanna Brown, IPC, State Immunization Program Patty Portwood, IC, South Central Health District Date: April 22, 2015
Childhood Immunization Update Presented by: Deanna Brown, IPC, State Immunization Program Patty Portwood, IC, South Central Health District Date: April
Childhood Immunization Update Presented by: Deanna Brown, IPC,
State Immunization Program Patty Portwood, IC, South Central Health
District Date: April 22, 2015
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Conflicts of Interest and Disclosures Neither the planners or
presenters indicated that they have any real or perceived vested
interest that relate to this presentation nor any relationships
with pharmaceutical companies, biomedical device manufacturers,
and/or other corporations whose products and services are related
to the vaccines we discuss. There is no sponsorship or commercial
support being received for this activity. The mention of specific
brands of vaccines in this presentation is for the purpose of
providing education and does not constitute endorsement by the
provider or ANCC of any commercial products. For certain vaccines
this may represent a slight departure from or off-label use of the
vaccine package insert guidelines.
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Objectives Explain vaccine preventable diseases and morbidity
rates for preventable diseases in GA Discuss GA immunization law
and DPH rules and regulations for GA immunization certificates;
including the new seventh grade school requirements Review the
provider, school and parent responsibility to enforce the law
Describe standards for issuing and filing certificates of
immunizations Review the public health assessment process Identify
common errors seen on GA Immunization certificates
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The Impact of Vaccines N/A = Data not available * MMWR
48(12);243-248 April 2, 1999 ** MMWR 63(32);702-715 August 15,
2014
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Herd Immunity Immunized individuals block infection from
reaching those who are unimmunized INFECTED UNIMMUNIZED INFECTED =
immunized
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Advisory Committee on Immunization Practices (ACIP) 15 voting
members with expertise in one or more of the following: Vaccinology
Immunology Infectious diseases Pediatrics Internal Medicine
Preventive medicine Public health Consumer perspectives and/or
social and community aspects of immunization programs ACIP develops
recommendations and schedules for the use of licensed vaccines
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Indications Recommendations Requirements Indication -
Information about the appropriate use of the vaccine Recommendation
- ACIP statement that broadens and further delineates the
Indication found in the package insert -Basis for standards for
best practice Requirement - Mandate by a state that a particular
vaccine must be administered and documented before entrance to
child care and/or school
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Immunization Schedules All staff must use the same immunization
schedule Four Schedules: Children & Adolescents 0 through 18
years Catch-up schedule for ages 4 months -18 years Adult 19 years
and older Adult based on medical and other indications READ THE
FOOTNOTES
http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
http://www.cdc.gov/vaccines/schedules/hcp/adult.html
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ITs The Law!
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Observe the Guidelines Route of administration Number of doses
required 4-day grace period Minimal age for immunization Minimal
interval between doses
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General Recommendations Simultaneous Administration
Non-Simultaneous Administration Two live-vaccines Violation of
minimal time interval for live vaccines Minimum time and age
intervals Violation of minimum time and age intervals/grace period
Administration of vaccines later than recommended schedule Vaccine
Administration principles Administering combination vaccines
Contraindications and Precautions
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Diphtheria Pertussis Tetanus Required for school and child care
attendance
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Hepatitis B
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Hepatitis A Required for school or child care attendance for
children born on or after 1-1-06
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Haemophilus influenzae Type b (Hib) Required only for child
care and pre-K attendance
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Polio Ref. MMWR 2009; 58 (30);829-830 (August 7, 2009) Source:
World Health Organization Required for school and childcare
attendance
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Measles (M) Mumps (M) Rubella (R) Congenital Rubella (R)
Measles, Mumps, Rubella Source: Creative Commons Source: American
Academy of Pediatrics Red Book On Line Visual Library
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Varicella (Chickenpox) Copyright American Academy of
Pediatrics
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Spacing of Live Virus Vaccines and Other Products PPD and live
virus vaccine Apply PPD at same visit as MMR If MMR given first,
delay PPD 4 weeks or longer Apply PPD first, then give MMR when
skin test read Spacing with antibody-containing products such as
immune globulin (IG)
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Pneumococcal Disease Required for child care and pre-K
attendance
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Influenza Vaccine Not required for school or child care
attendance
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Flucelvax (Novartis) Approved for persons 18 yrs and older
Vaccine viruses are not propagated in eggs; however, initial
reference strains have been passaged in eggs Cannot be considered
egg-free, though expected to contain less egg protein than other
IIVs Abbreviated ccIIV FluBlok (Protein Sciences) Approved for
persons 18 and older Vaccine contains recombinant influenza virus
hemagglutinin Protein is produced in insect cell line No eggs or
influenza viruses used in production Egg-free Abbreviated (RIV)
Influenza Vaccines Produced via Non-Egg-Based Technologies
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Influenza Vaccine and Egg Allergy Recommendations regarding
influenza vaccination of persons who report allergy to eggs ACIP
201415 influenza season
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Meningococcal Disease New 7 th Grade School Requirement
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Types of Human Papilloma Virus (HPV) Mucosal/Genital ~40 types
Cutaneous ~60 types Cervical cancer Anogenital cancer Oropharyngeal
Cancer Cancer precursors Low grade cervical disease Genital Warts
Laryngeal Papillomas Low grade cervical disease Skin warts Hands
and Feet High risk types 16, 18, 31, 33, 45, 52, 58 (and others)
Low risk types 6, 11 and others Ref: 1.Epidemiology and Prevention
of Vaccine Preventable Diseases 12 th Edition, May 2012 2. Red Book
AAP 2012 Report of the Committee on Infectious Diseases
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Just as a reminder Regardless of: the availability of vaccine
the funding of the vaccine (VFC, state- supplied, or private stock)
whether the vaccine is required for school or child care or not.
FOLLOW ACIP Recommendations !!!
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Requirements for School and Childcare Attendance
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Vaccines Required for School and Childcare Attendance:
Consistent with the Recommended Childhood and Adolescent
Immunization Schedule Require children to be age appropriately
immunized against each of the specified vaccine preventable
diseases
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Goal Vaccines work Goal 100 % compliance rate Immunization Laws
work Partnerships work
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DPH Rules and Regulations Provide definition of terms Stipulate
the specific requirements List required vaccines or Acceptable
proof of immunity Define medical and religious exemptions Provide
directions for issuing, maintaining, and inspecting certificates GA
Rules and Regulations updated for the 2014-2015 school year to
reflect the new school requirements. (511-2-2)
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3231 REQ
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3231 INS
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Form 3231
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Certificate of Immunization (Form 3231) A child must have a
certificate on file at each facility or school he attends
Photocopies of appropriately completed and signed certificates are
acceptable If a certificate is not on file for each child
attending, the facility is held legally responsible A licensed
Georgia physician, APRN, PA or public health official is
responsible for the interpretation of and compliance with the
requirements for vaccines and completing the certificate Only
physician offices and health clinics can obtain blank
certificates
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X Marks the Spot If child is under four years of age, a
certificate: Must be marked with a Date of Expiration Must have
vaccine administration dates, year of disease diagnosis, positive
serology, disease history, or medical exemption If child is over
four years of age, a certificate must be completed with: Vaccine
administration dates, year of disease diagnosis, positive serology,
disease history, or medical exemption; and An x in the Complete for
K-6 th Grade box along with a Date of Expiration; or An x in the
Complete for 7 th Grade or higher box and K-6 th Grade box if all
required vaccines for school attendance have been documented
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Certificate Expiration Date Expires on the date entered as
Expiration Date Must be replaced with a current certificate within
30 days after the expiration date, or child is excluded from
attending Allows for a child who does not meet all the immunization
requirements to attend child care or school while he is catching up
Required for all children four years and older who have not
completed vaccine requirement for 7 th grade Required if a medical
exemption for a vaccine(s) is marked Should not be completed if
Complete for 7 th Grade or higher is marked
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Complete for School Attendance Do not expire May be issued only
to children who: Are four years of age or older; and Have met all
the requirements for school attendance as outlined in the Policy
Guide 3231REQ; and Have all the required vaccine administration
dates or natural immunity dates filled in; and Do not have a Date
of Expiration completed
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Immunity and Medical Exemptions Diagnosed Serology History
Medical Exemption
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Exemptions Medical: Should be used only when there is a
physical disability or condition that contraindicates immunization
for that specific vaccine Should be documented in the medical
exemption box indicated for each vaccine Should be reviewed
annually
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Exemptions Religious: Not documented on the certificate No
special certificate available or needed Documented by a notarized
affidavit stating that immunization conflicts with the
parent/guardians religious belief Notarized statement should be
kept on file by the school or facility in lieu of a Certificate of
Immunization Do not expire
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Child Care Vaccine Requirements The number of doses for each
required vaccine depends on the childs age at the time of child
care attendance. If under 4 years of age, child will always need
more doses and Certificate of Immunization should have a current
Expiration Date indicated. If 4 years or older, and has met all
requirements for school entry, the Certificate of Immunization is
marked as Complete for K through 6 th Grade, with a Date of
Expiration indicated for 7 th Grade vaccination requirements.
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School Vaccine Requirements A new entrant enrolling in a
Georgia school at any grade or level, must be age appropriately
immunized with all the required vaccines. The number of doses for
each vaccine depends on the childs age at the time of school entry
Once enrolled and a Complete for 7 th Grade or higher certificate
is on file further immunizations may be recommended but are not
required. Reminder: Check for one dose of Tdap and one dose of MCV4
at entry into 7 th grade for those students born on or after
1-1-2002 and all new entrants 8 th through 12 th grades Also double
check for 2 doses of measles, mumps, and varicella or immunity
status
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Immunization Assessments The following information is recorded
during the immunization assessment: Number of children enrolled
Number of children who have valid current certificates Number of
children with expired certificates Number of children with current
30-day waivers Number of children with religious exemptions Number
of children with medical exemptions Number of children with
certificates marked complete but missing required doses Number of
children with no documentation on file
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School Immunization Assessments Children entering kindergarten,
7th grade and all new entrants, must adhere to new school
requirements based on the revised rules and regulations. Students
K-6 that have a Form 3231 that is marked as Complete for School
Attendance must obtain a new 3231 prior to 7 th grade reflecting
all new required vaccines. Children who have certificates that will
expire after 7-1-14 are considered to be current until the Date of
Expiration. They should obtain a new 3231. Children in 7th grade or
higher born prior to January 1, 2002 and have a Complete for School
certificate on file, do not need to obtain a revised
certificate.
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3: Completing both boxes: When all requirements have not been
met 10: Complete for School checked for child under age 4 9: No
dose DTaP after 4th birthday 2: Doses Hep B spaced incorrectly 7:
1st dose MMR given before age 1 yr. 6: 1st dose varicella given
before age 1 yr. 8: No 2nd dose varicella documented 5: Varicella
Immunity not documented by vaccine or hx/dx/serology date 4:
Address and/or contact information not completed 1: No physician,
APRN or PA signature 11. No dose of Tdap or MCV4 for students born
on or after 1-1-2002 entering 7 th grade or new entrants
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Maintenance of Certificates To be valid, certificates must be
current Certificate becomes invalid on the Date of Expiration Child
must submit a current certificate within 30 days after the
expiration date or be excluded from attendance Facility or school
is responsible for notifying parent/guardian of an upcoming
expiration date and requesting a current certificate be submitted
Any school/facility official who does not enforce the requirements
shall be guilty of a misdemeanor
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Filing of Certificates All children enrolled must have a valid
Certificate of Immunization on file Certificates must be available
for inspection by health officials If child attends more than one
facility, a photocopy to the second facility is acceptable If child
leaves or transfers to another school or facility, the certificate
should be given to a parent/guardian or sent to the new
school/facility In the case of religious exemption, a dated
notarized statement must be on file
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Tickler Filing System Immunization Guidelines for Child Care
Facility Operators & School Personnel (Form 3258) provides how
to instructions Tickler system is method for filing and maintaining
current certificates (set up by month and year) Remind parents or
care givers Give parents information sheet about requirements
Document follow-up Enforce requirements
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Georgia Registry of Immunization Transactions and Services
(GRITS)
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Responsibilities Physicians and Public Health Clinics: Know
current legal requirements for attendance and accurately completing
the certificate Administering immunizations according to the
current Recommended Childhood and Adolescent Immunization Schedule
Report the occurrence of any disease listed on the Notifiable
Disease List Report any adverse event following the administration
of a vaccine to VAERS Child Care and School : Review the
certificates for validity prior to accepting Develop a system for
immunization certificate management/Tickler system Have
certificates available for inspection and audit by health officials
Report the occurrence of any disease listed on the Notifiable
Disease List Parent/Caregiver: - Stay on immunization schedule
Obtain immunization certificate Provide copy of certificate to each
facility
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Critical Elements for Immunization Services
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Every Office and Clinic Needs A Vaccine Champion! Lead your
immunization team. Educate all staff about new vaccines and
recommendations. Teach new staff about vaccine storage, handling,
& administration. Initiate processes to improve immunization
rates in your practice/facility. Assure immunizations of all staff
are up-to-date.
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Standards for Child, Adolescent, and Adult Immunization
Practices Availability of vaccines Assessment of clients
vaccination status Effective communication with client or parent
Proper storage and handling of vaccines Accurate documentation of
vaccinations Implementation of strategies to improve rates
Developing partnerships and community-based approaches to vaccine
delivery
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VAERS
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Vaccine Injury Compensation Program (VICP) National Vaccine
Injury Compensation Program provides compensation to individuals
found to be injured by or have died from certain childhood
vaccines. Established in 1988 by NCVIA Federal no fault system to
compensate those injured Claim must be filed by individual, parent
or guardian Must show that injury is on Vaccine Injury Table
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Notifiable Disease Reporting
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IT STARTS WITH YOU!
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Healthcare Personnel (HCP) Need These Immunizations: Annual
influenza vaccine Tdap or Td Hepatitis B (exposure risk) Check
immunity Validate immune status of: Varicella Measles, Mumps &
Rubella(MMR) Are YOU up to date?
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Resources for Factual & Responsible Vaccine Information
www.immunize.org
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Stay Current! Sign up for listserv sites which provide timely
information pertinent to your practice
www.immunize.org/resources/emailnews.asp
www.immunize.org/resources/emailnews.asp AAP Newsletter CDC
immunization websites (32 in all) CHOP Parents Pack Newsletter IAC
Express Websites specific to particular vaccines
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Internet Resources Georgia Department of Public Health
http://dph.georgia.gov/immunization-section CDC Immunization
information http://www.cdc.gov/vaccines/ CDC Flu information
http://www.cdc.gov/flu/ Immunization Action Coalition
www.immunize.org
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Resources Local health department District Immunization
Coordinator GA Immunization Program Office On call Help line:
404-657-3158 GRITS Help Line:1-866-483-2958 VFC Help
Line:1-800-848-3868 Website
http://dph.georgia.gov/immunization-section Your local Immunization
Program Consultant (IPC) Epidemiology: 1-866-782-4584 GA Chapter of
the AAP GA Academy of Family Physicians
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http://dph.georgia.gov/immunization-section
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Its a Team Effort! High Immunization rates begin with a team
designed plan! What can your team do to improve rates?