ImmunizationsImmunizationsBarriers and Strategies Barriers and Strategies

David M. Bendich, MD, FAAPDavid M. Bendich, MD, FAAPPresidentPresident

Essex Metro Immunization Essex Metro Immunization CoalitionCoalition

OBJECTIVESOBJECTIVES

have a better understanding of have a better understanding of existing barriers to timely and existing barriers to timely and complete immunization of children complete immunization of children

be aware of and have a greater be aware of and have a greater ability to utilize various tools and ability to utilize various tools and communication strategies to communication strategies to overcome these barriers overcome these barriers

Percentage of vaccinated Percentage of vaccinated childrenchildren

19-35 months old19-35 months oldNJNJ Nat’lNat’l

RankingRanking

%% %%

20062006 76.076.0 76.976.9 2626

20072007 62.362.3 77.577.5 3939

20082008 59.759.7 68.468.4 4545

20092009 64.664.6 70.970.9 4242

Patient Barriers to Patient Barriers to Accessible CareAccessible Care

– Uncertainty about how to access free vaccines

– Confusion about the vaccination schedule

– Vaccine safety concerns or misconceptions

Physician Barriers to Physician Barriers to Accessible CareAccessible Care

– Increasingly complex immunization schedule

– Increased staff time for documentation and patient education

– Large uninsured and/or underinsured patient populations

Physician Barriers to Physician Barriers to Accessible CareAccessible Care

– Low or delayed reimbursement – Missing/lost patient immunization record – Lack of centralized immunization registry– Vaccine delays or shortages

Strategies to Provide Strategies to Provide Accessible CareAccessible Care

– Vaccination-only visits available– The practice increases access during

periods of peak demand (i.e., flu season, back to school, etc.)

– The practice is accessible by public transportation

Strategies to Provide Strategies to Provide Accessible CareAccessible Care

Health care professionals review the vaccination and health status of patients at every encounter – Staff can review records to determine

if any vaccines were missed by the physician

– Staff can prepare immunizations while patients are with the physician

Maintain and prominently display vaccine storage and handling procedures and protocols

References: Accessible References: Accessible CareCare

1. Strickland B, McPherson M, Weissman G, Van Dyck P, Huang ZJ, and Newacheck P. Access to the Medical Home: Results of the National Survey of Children With Special Health Care Needs. Pediatrics. 2004;113:1485-1492

2. Cohen RA, Coriaty-Nelson Z. Health Insurance Coverage: Estimates from the National Health Interview Survey, 2003. Division of Health Interview Statistics, National Center for Health Statistics; 2004

3. Institute of Medicine. Vaccine Financing In the 21st Century. National Academies Press, Washington DC, 2004

4. National Vaccine Advisory Committee. Standards for Child and Adolescent Immunization Practices. Pediatrics. 2003;112:958-963

Immunization: Coordinated Immunization: Coordinated CareCare

Coordinated: All needed immunization services are facilitated through the medical home. Clinicians practice community-based approaches and work with community groups to develop appropriate vaccination services1

Each visit is an opportunity for vaccination Continually educate practice staff Regularly review and update immunization

procedures

Barriers to Coordinated Barriers to Coordinated CareCare

Parents/physicians may lack knowledge of immunization-related community resources

Poor communication among public and private health care and child care professionals (relevant state/federal agencies, school nurses, child care centers, etc.)

When possible, the practice participates in local or state-level immunization registries

Clinicians work with local and state public health departments on quality improvement measures, such as Assessment, Feedback, Incentives, eXchange (AFIX) and Comprehensive Clinic Assessment Software Application (CoCASA), to increase immunization rates

Strategies to ProvideStrategies to Provide Coordinated Care Coordinated Care

Cooperate with local public health department to monitor disease outbreaks and educate parents

Develop and train staff on vaccine and office protocols

A central immunization record, including immunizations, is maintained at the practice

Strategies to ProvideStrategies to Provide Coordinated Care Coordinated Care

Barriers to Coordinated Barriers to Coordinated CareCare

Children receive immunizations in multiple sites

Lack of state or local immunization registry

Complex and/or multiple vaccine supply sources

Delays and/or disruptions in vaccine supply

Strategies to ProvideStrategies to ProvideCoordinated CareCoordinated Care

Designate Immunization Champions The practice reports adverse events to

the Vaccine Adverse Events Reporting System (VAERS), and is aware of the National Vaccine Injury Compensation Program (VICP)1

References: Coordinated References: Coordinated CareCare

1. National Vaccine Advisory Committee. Standards for Child and Adolescent Immunization Practices. Pediatrics. 2003;112:958-963

2. Santoli JM, Rodewald LE, Maes EF, Battaglia MP, Coronado VG. Vaccines for Children Program, United States, 1997. Pediatrics. 1999;104(2)

3. Centers for Disease Control and Prevention. Immunization Registry Progress – United States, January-December 2002. MMWR Morb Mortal Wkly Rep. 2004;53:431-433

References: Coordinated References: Coordinated CareCare

4. Stokley S, Rodewald LE, Maes EF. The impact of record scattering on the measurement of immunization coverage. Pediatrics. 2001;107:91-96

5. Bell KN, Hogue CJR, Manning C, Kendal AP. Risk factors for improper vaccine storage and handling in private clinician offices. Pediatrics, 2001;107:100

Immunization: Continuous Immunization: Continuous CareCare

Improper record keeping can lead to increased costs and extra immunizations

Greater continuity of care is associated with higher quality of care as reported by parents2

Review vaccination and health status of patients at every encounter to determine which vaccines are indicated

Strategies to Provide Strategies to Provide Continuous CareContinuous Care

Regularly review patient records and conduct practice-wide vaccination coverage assessments annually– Identify children behind on

immunizations– Implement recall/reminder or other

strategies to increase immunization rates

Utilize standing orders to allow staff to independently screen patients, identify opportunities for immunization, and administer vaccines under physician supervision (in accordance with local regulations)

Promote immunization at both well and sick visits

Strategies to Provide Strategies to Provide Continuous CareContinuous Care

References: Continuous CareReferences: Continuous Care

1. Yusuf H, Adams M, Rodewald L, Lu P, Rosenthal J, Legum SE, Santoli J. Fragmentation of immunization history among clinicians and parents of children in selected underserved areas. Am J Prev Med. 2002 Aug;23(2):106-12

2. Christakis DA, Wright JA, Zimmerman FJ, Basset AL, Connell FA. Continuity of care is associated with high-quality care by parental report. Pediatrics. 2002;109:e54

3. Irigoyen M, Findley SE, Chen S, Vaughan R, Sternfels P, Caesar A, Metroka A. Early continuity of care and immunization coverage. Ambul Pediatr. 2004 May-Jun;4(3):199-203

Barriers to Barriers to Comprehensive CareComprehensive Care

Improperly deferring vaccination (i.e., not based on valid contraindications)

Increasingly complex vaccination schedule

Lack of reminder-recall system Improper storage and handling

procedures resulting in spoilage of vaccine

Missed opportunities (MOs) to vaccinate (i.e., vaccine-eligible child does not receive needed vaccines)

– Eliminating MOs could increase immunization coverage by up to 30% or more2, 3

Barriers to Barriers to Comprehensive CareComprehensive Care

MOs are frequently associated with3,4

– Inappropriate contraindications such as minor febrile illness

– Not giving vaccine at acute care visits

– Not giving all the shots needed at a visit

Barriers to Barriers to Comprehensive CareComprehensive Care

Reasons for MOsReasons for MOs

Deficits in clinician knowledge3,5

Vaccines delayed due to valid contraindication

Incorrect or overcautious interpretation of contraindications5

Failure to review the child’s vaccination status6

Incomplete vaccine records7

Reasons for MOsReasons for MOs

Physician reluctance to give multiple vaccines simultaneously7

Vaccine delays/shortages8 Practice requirement to

receive physical examination prior to vaccination

Mild illness Antibiotic therapy Disease exposure or convalescence Pregnancy in the household Breastfeeding Premature birth Allergies to products not in vaccine Family history unrelated to

immunosuppression Need for TB skin testing Need for multiple vaccines

InvalidInvalid Contraindications to Contraindications to Vaccination (not even Vaccination (not even

precautions!)precautions!)

Strategies to Improve Strategies to Improve Comprehensive CareComprehensive Care

Clinicians do not use false Clinicians do not use false contraindicationscontraindications to prevent immunizations to prevent immunizations

Practices adopt and implement the Standards for Child and Adolescent Immunization Practices established by the National Vaccine Advisory Committee (NVAC)

Vaccines are administered according to the Recommended Childhood and Adolescent Immunization Schedules; physician stays up-to-date about potential new vaccines

Strategies to Improve Strategies to Improve Comprehensive CareComprehensive Care

Use the recommended Catch-up Schedule for children who have missed or delayed immunization– It makes it easier for staff to figure out

who needs what– Proven to get children up-to-date faster

Practice staff who administer vaccines and staff who manage or support vaccine administration are knowledgeable and receive on-going education

Strategies to Improve Strategies to Improve Comprehensive CareComprehensive Care

Educational resources about all aspects of immunization are made available

Current Vaccine Information Statements (VISs) are provided and explained to patients/parents prior to vaccination

Strategies to Improve Strategies to Improve Comprehensive CareComprehensive Care

Staff should follow appropriate procedures for vaccine storage and handling

Staff should reduce vaccine liability and ensure proper coding/reimbursement

Health care professionals follow only medically accepted contraindications

Strategies to Improve Strategies to Improve Comprehensive CareComprehensive Care

Combination vaccines are utilized when appropriate

Practice staff should regularly conduct assessments to determine immunization coverage rates and incorporate quality improvement measures to raise rates

When possible, participate in a comprehensive state/local immunization registry or CHIS

References: Comprehensive References: Comprehensive CareCare

1. Santoli JM, Rodewald LE, Maes EF, Battaglia MP, Coronado VG. Vaccines for Children Program, United States, 1997. Pediatrics. 1999;104(2)

2. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases: 8th Edition; January 2005

3. Szilagyi PG, Rodewald LE. Missed opportunities for immunizations: a review of the evidence. J Public Health Manage Pract. 1996;2:18-25

4. Sabnis SS, Pomeranz AJ, Lye PS, Amateau MM. Do missed opportunities stay missed? A 6-month follow-up of missed vaccine opportunities in inner city Milwaukee children. Pediatrics. 1998;101:1-4

5. Wood D, Halfon N, Pereyra M, et al. Knowledge of the childhood immunization schedule and of contraindications to vaccinate by private and public clinicians in Los Angeles. Pediatr Infect Dis J. 1996;15:140-145

6. Ball TM, Serwint JR. Missed opportunities for vaccination and delivery of preventive care. Arch Pediatr Adolesc Med. 1996;150:858-861

7. Szilagyi PG, Rodewald LE, Humiston SG, et al. Immunization practices of pediatricians and family physicians in the United States. Pediatrics. 1994;94:517-523

8. Gindler JS, Cutts FT, Barnett-Antinori ME, et al. Successes and failures in vaccine delivery: evaluation of the immunization delivery system in Puerto Rico. Pediatrics. 1993;91:315-320

9. Rodewald L. Every medical home needs an immunization recall system. AAP News. February 2001:89

References: Comprehensive References: Comprehensive CareCare

Barriers toBarriers toFamily-Centered CareFamily-Centered Care

Parental concerns about vaccine safety or refusal to vaccinate

Patient and physician have differing beliefs regarding vaccination– 25% of parents believe immune

systems are weakened by too many vaccines2

– 19% of parents do not think vaccines were proven safe prior to use in the US2

Barriers toBarriers toFamily-Centered CareFamily-Centered Care

Patient and physician have access to both accurate and inaccurate immunization resources

Poor communication (i.e., differing education/literacy levels, language barriers)

Helping Families Locate Helping Families Locate Reliable Information on the Reliable Information on the

InternetInternetThe Internet can be a confusing place to The Internet can be a confusing place to navigate! To help parents locate factual navigate! To help parents locate factual vaccine information on the Web, practice vaccine information on the Web, practice staff should provide staff should provide information and resources about how to about how to locate and evaluate Web siteslocate and evaluate Web sites

Additional Reading: Content and Design Additional Reading: Content and Design Attributes of Antivaccination Web Sites. Attributes of Antivaccination Web Sites. Wolfe RM, Sharp LK, Lipsky MS.  JAMA Wolfe RM, Sharp LK, Lipsky MS.  JAMA 2002;287:3245-32482002;287:3245-3248

Strategies to Provide Strategies to Provide Family-Centered CareFamily-Centered Care

Treat the family as a partner in their Treat the family as a partner in their child’s care and promote shared child’s care and promote shared decision-makingdecision-making

Provide the parent with an Provide the parent with an immunization record book to track immunization record book to track their child’s vaccination history and their child’s vaccination history and gain better understanding of which gain better understanding of which vaccines are needed and whenvaccines are needed and when

Strategies to Provide Strategies to Provide Family-Centered CareFamily-Centered Care

When necessary, clinicians should document parent’s refusal to vaccinate in the patient’s record. Providers may utilize the AAP Refusal to Vaccinate Form.

Provider should be aware of local school and childcare immunization requirements

Strategies to Provide Strategies to Provide Family-Centered CareFamily-Centered Care

Be available to answer questions or Be available to answer questions or concernsconcerns

Educate parents about risks versus Educate parents about risks versus benefits of vaccination benefits of vaccination

Warn them about Warn them about inaccurate information on the Web

Strategies to Provide Strategies to Provide Family-Centered CareFamily-Centered Care

Use Use Vaccine Information Statements (available in simple wording, multiple (available in simple wording, multiple languages) languages)

Provide culturally-appropriate Provide culturally-appropriate educational materials at the necessary educational materials at the necessary literacy level literacy level

– Resource: American Academy of Pediatrics and Resource: American Academy of Pediatrics and National Perinatal Association. National Perinatal Association. Transcultural Aspects of Transcultural Aspects of Perinatal Health Care: A Resource Guide. Perinatal Health Care: A Resource Guide. Shah MA, ed. Shah MA, ed. National Perinatal Association; 2004National Perinatal Association; 2004

References: References: Family-Centered CareFamily-Centered Care

1.1. American Academy of Pediatrics, Committee on American Academy of Pediatrics, Committee on Hospital Care. Family-centered care and the Hospital Care. Family-centered care and the pediatrician’s role. pediatrician’s role. Pediatrics.Pediatrics. 2003;112:691-696 2003;112:691-696

2.2. Gellin BG, Maibach EW, Marcuse EK.Gellin BG, Maibach EW, Marcuse EK.Do parents understand immunizations? A national Do parents understand immunizations? A national telephone survey. telephone survey. PediatricsPediatrics. 2000;106:1097-1102 . 2000;106:1097-1102

3.3. American Academy of Pediatrics, Autism Expert American Academy of Pediatrics, Autism Expert Panel, Committee on Children with Disabilities. Panel, Committee on Children with Disabilities. Autism A.L.A.R.M. Website: Autism A.L.A.R.M. Website: www.medicalhomeinfo.org (Accessed October 11, (Accessed October 11, 2007).2007).

Immunization: Immunization: Compassionate CareCompassionate Care

Compassionate:Compassionate: Concern for the well- Concern for the well-being of the child and family is being of the child and family is expressed and demonstrated in verbal expressed and demonstrated in verbal and nonverbal interactions. Efforts are and nonverbal interactions. Efforts are made to understand and empathize with made to understand and empathize with the feelings and perspectives of the the feelings and perspectives of the family and childfamily and child

Immunization: Immunization: Compassionate CareCompassionate Care

A patient that feels understood is more A patient that feels understood is more likely to adhere to the physician’s likely to adhere to the physician’s recommendationsrecommendations11

Patients tend to judge the quality of Patients tend to judge the quality of treatment on the basis of physicians’ treatment on the basis of physicians’ “affective” behavior towards them“affective” behavior towards them22

Barriers to Barriers to Compassionate CareCompassionate Care

Limited time during patient visitLimited time during patient visit Cultural or racial/ethnic differences Cultural or racial/ethnic differences

between patients and physiciansbetween patients and physicians Ignoring or misinterpreting parents’ or Ignoring or misinterpreting parents’ or

patients’ nonverbal cuespatients’ nonverbal cues Operating from a medical modelOperating from a medical model

– ““Us versus them,” paternalisticUs versus them,” paternalistic

Strategies to Provide Strategies to Provide Compassionate CareCompassionate Care

Listen unhurriedly to family concerns Listen unhurriedly to family concerns and respond to them appropriatelyand respond to them appropriately

Honor or validate family experiences, Honor or validate family experiences, beliefs, questions and perspectivesbeliefs, questions and perspectives

Strategies to Provide Strategies to Provide Compassionate CareCompassionate Care

Address specific concerns directly:Address specific concerns directly:– Discuss myths or misconceptions Discuss myths or misconceptions

openly and dispassionatelyopenly and dispassionately– Offer them the pamphlet “Offer them the pamphlet “

Be There for Your Child During Shots” Ensure privacy/confidentiality for familiesEnsure privacy/confidentiality for families

References: Compassionate References: Compassionate CareCare

1.1. Bellett PS, Maloney MJ. The importance of Bellett PS, Maloney MJ. The importance of empathy as an interviewing skill in medicine. empathy as an interviewing skill in medicine. JAMA.JAMA. 1991;266:1831-1832 1991;266:1831-1832

2.2. Ben-Sira Z. Ben-Sira Z. Stress, Disease and Primary Medical Stress, Disease and Primary Medical Care.Care. Gower, England, 1986 Gower, England, 1986

3.3. Offit PA, et al. Addressing parents’ concerns: do Offit PA, et al. Addressing parents’ concerns: do multiple vaccines overwhelm or weaken the multiple vaccines overwhelm or weaken the infant’s immuneinfant’s immune s system? ystem? Pediatrics. Pediatrics. 2002;109:124-129. Available at: 2002;109:124-129. Available at: http://www.cispimmunize.org/fam/infant.html (Accessed: October 12, 2007)(Accessed: October 12, 2007)

4.4. Offit PA, Jew RK. Addressing parents’ concerns: do Offit PA, Jew RK. Addressing parents’ concerns: do vaccines contain harmful preservatives, vaccines contain harmful preservatives, adjuvants, additives, or residuals? Pediatrics. adjuvants, additives, or residuals? Pediatrics. 2003;112:1394-14012003;112:1394-1401

Barriers to Barriers to Culturally-Effective CareCulturally-Effective Care

Differences in cultural Differences in cultural backgrounds including backgrounds including differing perceptions and beliefsdiffering perceptions and beliefs

Language and communication barriersLanguage and communication barriers Lack of skilled staff or resourcesLack of skilled staff or resources Lack of appropriate services (i.e., Lack of appropriate services (i.e.,

patients that require interpretation vs patients that require interpretation vs translation services)translation services)

Strategies to Provide Strategies to Provide Culturally-Effective CareCulturally-Effective Care

Immunization clinicians should be aware Immunization clinicians should be aware of any differences between their own of any differences between their own cultural/religious values and those of the cultural/religious values and those of the patient/familypatient/family44

Foster mutual respect and understandingFoster mutual respect and understanding44

Determine the most effective way of Determine the most effective way of adapting professional interpretations and adapting professional interpretations and recommendations to the value system of recommendations to the value system of each familyeach family44

Strategies to Provide Strategies to Provide Culturally-Effective CareCulturally-Effective Care

Provide safe and realistic choices to Provide safe and realistic choices to patients/families within the least patients/families within the least restrictive environmentrestrictive environment44

Promote equity for all cultural/religious Promote equity for all cultural/religious backgroundsbackgrounds44

Strategies to Provide Strategies to Provide Culturally-Effective CareCulturally-Effective Care

Openly address cultural barriers with respect and demonstrate sensitivity to conflicts with child/family’s cultural patterns

Recognize, value, respect, and incorporate the child/family’s cultural background into care; including beliefs, rituals, and customs

Strategies to Provide Strategies to Provide Culturally-Effective CareCulturally-Effective Care

Listen to verbal and nonverbal cues, Listen to verbal and nonverbal cues, using translation or interpretation using translation or interpretation resources if necessaryresources if necessary

Ensure the child/family understands the Ensure the child/family understands the results of the medical encounterresults of the medical encounter

Consider medical, religious, and Consider medical, religious, and philosophical exemptions to immunization philosophical exemptions to immunization ((understanding state law and requirements))

Strategies to Provide Strategies to Provide Culturally-Effective CareCulturally-Effective Care

If possible, have bilingual staff/volunteers If possible, have bilingual staff/volunteers on handon hand

Display culturally diverse pictures, Display culturally diverse pictures, posters, magazines, etcposters, magazines, etc

Learn key words/phrases in the patient’s Learn key words/phrases in the patient’s languagelanguage

Strategies to Provide Strategies to Provide Culturally-Effective CareCulturally-Effective Care

Provide written materials, including VISs, Provide written materials, including VISs, in the family’s primary language and at in the family’s primary language and at the appropriate literacy level; supplement the appropriate literacy level; supplement with additional resources (i.e., visual aids, with additional resources (i.e., visual aids, videos) if necessaryvideos) if necessary

Educate and train immunization clinicians Educate and train immunization clinicians at all levels (medical school, residency at all levels (medical school, residency programs, and continuing medical programs, and continuing medical education)education)

References: References: Culturally-EffectiveCulturally-Effective

1.1. Klevens RM, Luman ET. US children living in and Klevens RM, Luman ET. US children living in and near poverty. Risk of vaccine-preventable diseases. near poverty. Risk of vaccine-preventable diseases. Am J Prev Med.Am J Prev Med. 2001;20:41-46 2001;20:41-46

2.2. Wood D, Donald-Sherbourne C, Halfon N, et al. Wood D, Donald-Sherbourne C, Halfon N, et al. Factors related to immunization status among inner-Factors related to immunization status among inner-city Latino and African American preschoolers. city Latino and African American preschoolers. Pediatrics.Pediatrics. 1995;96:295-301 1995;96:295-301

3.3. American Academy of Pediatrics, Committee on American Academy of Pediatrics, Committee on Pediatric Workforce. Culturally effective pediatric Pediatric Workforce. Culturally effective pediatric care: education and training issues. care: education and training issues. Pediatrics.Pediatrics. 1999;103:167-1701999;103:167-170

4.4. American Academy of Pediatrics. Preface. In: Shah American Academy of Pediatrics. Preface. In: Shah MA, ed. MA, ed. Transcultural Aspects of Perinatal Health Transcultural Aspects of Perinatal Health Care: A Resource Guide. Care: A Resource Guide. Elk Grove Village, IL: Elk Grove Village, IL: American Academy of Pediatrics; 2004, xv-xxixAmerican Academy of Pediatrics; 2004, xv-xxix

Additional Web-based Additional Web-based ResourcesResources

Childhood Immunization Support Program (CISP) is Childhood Immunization Support Program (CISP) is a joint program of the AAP and CDC. The CISP a joint program of the AAP and CDC. The CISP provides extensive information on immunizations provides extensive information on immunizations for health care professionals and families. Web site: for health care professionals and families. Web site: www.cispimmunize.org (Accessed: August 6, 2008) (Accessed: August 6, 2008)

Teaching Immunization Delivery and Evaluation Teaching Immunization Delivery and Evaluation (TIDE) is an internet-based continuing education (TIDE) is an internet-based continuing education program in childhood immunizations. Web site: program in childhood immunizations. Web site: www.musc.edu/tide (Accessed: August 6, 2008) (Accessed: August 6, 2008)

Centers for Disease Control and Prevention National Centers for Disease Control and Prevention National Center for Immunization and Respiratory Diseases Center for Immunization and Respiratory Diseases (NCIRD) provides leadership for the planning, (NCIRD) provides leadership for the planning, coordination, and conduct of immunization coordination, and conduct of immunization activities nationwide. Web site: activities nationwide. Web site: www.cdc.gov/vaccineswww.cdc.gov/vaccines (Accessed: August 6, 2008) (Accessed: August 6, 2008)

Immunization Action Coalition (IAC) creates and Immunization Action Coalition (IAC) creates and distributes educational materials for health distributes educational materials for health professionals and the public that enhance the professionals and the public that enhance the delivery of safe and effective immunization services. delivery of safe and effective immunization services. Web site: www.immunize.org (Accessed: August 6, Web site: www.immunize.org (Accessed: August 6, 2008)2008)

National Network for Immunization Information National Network for Immunization Information (NNII) (NNII) provides the public, health professionals, provides the public, health professionals, policy makers, and the media with up-to-date, policy makers, and the media with up-to-date, scientifically valid information related to scientifically valid information related to immunization. Web site: www.immunizationinfo.org immunization. Web site: www.immunizationinfo.org (Accessed: August 6, 2008)(Accessed: August 6, 2008)

Additional Web-based Additional Web-based ResourcesResources

Other ResourcesOther Resources Recommended Childhood, Adolescent Recommended Childhood, Adolescent

Immunization Schedule & Catch-up Immunization Schedule & Catch-up ScheduleSchedule

Guide to Contraindications Guide to Contraindications Summary of Rules for Childhood and Summary of Rules for Childhood and

Adolescent Immunization Adolescent Immunization VISs in over 30 languages VISs in over 30 languages AAP Refusal to Vaccinate FormAAP Refusal to Vaccinate Form Vaccine Management: Recommendations Vaccine Management: Recommendations

for Handling and Storage of Selected for Handling and Storage of Selected BiologicalsBiologicals

Vaccines for Children ProgramVaccines for Children Program

Other ResourcesOther Resources Immunization Registry Clearinghouse Vaccine-Preventable Diseases: Improving

Vaccination Coverage in Children, Adolescents, and Adults Report on Recommendations from the Task Force on Community Prevention Services

National Childhood Vaccine Injury Act Vaccine Injury Table

Immunization Coverage in the US, National Immunization Survey Data

About the Training ToolAbout the Training ToolLead Author:

David Wood, MD, MPH, FAAP, Council on Community Pediatrics (COCP) and Childhood Immunization Support Program Childhood Immunization Support Program (CISP) Project Advisory Committee(CISP) Project Advisory Committee

AAP Reviewers: Charles Onufer, MD, FAAP, Medical Home Project Advisory Committee Gilbert Handal, MD, FAAP, COCP and CISP Project Advisory CommitteeEdgar Marcuse, MD, MPH, FAAP, AAP Immunization Advisory Team

AAP Board of Directors Reviewer: Alan Kohrt, MD, FAAP

AcknowledgmentsAcknowledgmentsJill Ackermann, Manager, Medical Home Surveillance and Screening, Department of Community and Specialty Pediatrics

Carmen Mejia, Manager, Immunization Initiatives, Department of Practice

Elizabeth Sobczyk, Program Coordinator, Immunization Initiatives, Department of Practice

*The development of this training tool was supported by a grant from the CDC (Childhood Immunization Support Program, Cooperative Agreement No. U66/CCU524285)

About AAP Immunization About AAP Immunization Initiatives Initiatives

In an effort to help pediatricians address the barriers to increasing and maintaining national immunization coverage levels, the AAP, in collaboration with the CDC, established the Childhood Immunization Support Program (CISP). Since 1999, the Academy’s CISP grant has been working to improve the immunization delivery system for children across the nation.

CISP GoalsCISP Goals

Goal 1: Promote quality improvement and best immunization practices in community- and office-based primary care settings and other identified medical homes.

Goal 2: Enable pediatricians and pediatric health care professionals to communicate effectively with parents about vaccine benefits.

Goal 3: Promote system-wide improvements in the national immunization delivery system.

CISP ResourcesCISP Resources

Key Contact Network: A key contact network of immunization clinicians who are instrumental in promoting immunization delivery has been developed.

The AAP Immunization Initiatives Newsletter is disseminated electronically to members of the network. To receive a copy of this monthly publication, e-mail cispimmunize@aap.org

CISP ResourcesCISP Resources

Vaccine Safety Reports: The Measles -Mumps-Rubella Vaccine and Autistic Spectrum Disorder: Report From the New Challenges in Childhood Immunizations Conference, based on the conference convened in June 2000 was published in the May 2001 issue of Pediatrics.

*A variety of AAP Policy Statements, Clinical Practice Guidelines, and Technical Reports on immunizations and related topics are also available.

CISP ResourcesCISP Resources

Technical Assistance: Technical assistance on immunization issues is provided to pediatricians, other health care professionals, and others in an effort to support their efforts to communicate with parents around vaccine safety issues and immunize children within a medical home.

CISP ResourcesCISP ResourcesResource Publications: Fact sheets, brochures, educational posters, AAP policy statements and technical reports, and strategies on a variety of immunization related topics are provided for pediatric office practices.

CISP ResourcesCISP Resources

CISP Web siteCISP Web site: For fast, helpful and : For fast, helpful and accurate information on immunizations accurate information on immunizations for parents, the public, and all health care for parents, the public, and all health care professionals visit: professionals visit: www.cispimmunize.org www.cispimmunize.org or or www.aap.org www.aap.org and click the Immunization Information and click the Immunization Information button on the homepage.button on the homepage.

CISP ResourcesCISP Resources

The AAP Compendium of Immunization Resources and Organizations is an organized listing of national and state-based

organizations and initiatives, including AAP chapter immunization activities. In addition, the resource provides a compilation of immunization educational resources for parents and pediatricians. An on-line version of the Compendium is available on the CISP Web site.

Contact UsContact Us

For more information about the CISP, to receive copies of our materials, or to be added to the CISP key contact network, please contact:

American Academy of Pediatrics

Department of Practice

141 Northwest Point Blvd.

Elk Grove Village, IL 60007

Tel: 800/433-9016 ext 4271 Fax: 847/228-9651

E-mail: cispimmunize@aap.org