What’s New with Vaccines Lana Hudanick Public Health Consultant Nurse Bureau of Immunizations Missouri Department of Health and Senior Services What’s New with Vaccines

Objectives of Presentation Identify vaccine recommendations, specific spacing and age requirements for infants, children, adolescents and adults Identify new recommendations for adult vaccinations Identify best practices to raise immunization rates

Advisory Committee on Immunization Practices (ACIP) Comprised of medical and public health experts Meets throughout the year Makes recommendations for vaccinations Makes changes in the vaccination schedule

ACIP Infant and Child Schedule

Infant Vaccination Hepatitis B should be started at birth Start infant vaccination between 6 and 8 weeks of age Infants who are more than one month behind should be on a catch-up vaccination schedule Complete vaccination series before the age of two

Rotavirus Infants 6 weeks through 8 months of age Start vaccination 6 weeks through 15 weeks Complete vaccination series no later than 8 months of age Effective at preventing serious disease Intussesception with the administration of the first dose of vaccine

Hepatitis B Infant’s first dose can be administered either Birth dose at hospital, or Between 6 and 8 weeks of age Three dose series First and second dose separated by at least 28 days Second and third dose separated by at least eight weeks First and third dose separated by at least 16 weeks Infants should be at least 24 weeks of age for third dose

Diphtheria, Tetanus and Pertussis (DTaP) Child needs four doses for protection Doses one, two and three all separated by at least 28 days Fourth dose can be given at one year visit if separated from previous dose by 6 months

Diphtheria, Tetanus and Pertussis (DTaP) Four to five doses required for school entry Last dose must be given on or after the 4th birthday DTaP only licensed for infants and children under 7 years of age DT is available for children who cannot have the pertussis component

Influenza All infants 6 months of age and older Must use preservative-free vaccine for infants and children up to 3 years of age Two doses of influenza 6 months through 8 years of age No influenza vaccination doses since July 2010

Measles, Mumps, Rubella (MMR) Live vaccine Administer at 12 months of age If infant traveling internationally, may administer as early as 6 months of age Early dose does not provide adequate protection Two doses of MMR still needed after 12 months of age

Measles, Mumps and Rubella (MMR) Two doses of MMR are required for children entering school Required for children kindergarten through 12th grade Dose one and two must be spaced at least 28 days apart

Varicella (Chickenpox) Live vaccine Administer at 12 months of age One dose required for preschool /daycare Give at same time as MMR or space the two vaccines apart by 28 days

Varicella (Chickenpox) Two doses required for children kindergarten through 5th grade Doses one and two should be spaced at least 28 days apart Exempt if proof of disease from medical provider One dose required for children 6th through 10th grade Recommended that all children have two doses of varicella vaccine

Polio (IPV) Three to four doses required for school entry Last dose on or after the 4th birthday Last dose of polio must be spaced at least 6 months from previous dose

ACIP Adolescent Schedule

Tetanus, Diphtheria and Pertussis (Tdap) Recommended for children 11 and older Required for all children in Missouri entering 8th grade Children who cannot have the pertussis component can receive Td vaccine instead

Meningococcal (MCV4) Protects against strains: A, C, Y and W-135 Two dose series 11 through 15 years of age 16 years and older Required for the 2016-2017 school year 8th grade entry 12th grade entry

Meningococcal B (MenB) Provisional recommendation for children 16 years of age and older Outbreaks of meningococcal disease serogroup b Individuals with a higher risk of disease Damaged spleen Spleen removed Sickle Cell Disease

Human Papillomavirus (HPV) Recommended for adolescents beginning at 11 years of age HPV4 and HPV9 can be administered to both boys and girls HPV2 can only be administered to girls Three dose series Any series started with HPV4 can be finished with HPV9

Human Papillomavirus (HPV) Protects against HPV Cancers HPV types 16 and 18 causes Cervical, oropharyngeal, anal and other genital cancers Vaccine is safe and effective 85% effective against types 16 and 18 90% effective against types 6 and 11 Immune response is best at 11 to 12 years of age Protect before exposure

ACIP Adult Schedule

Adult Vaccination Factors for adult vaccination Age Work Medical conditions Travel

Tetanus, Diphtheria, acellular Pertussis (Tdap) All adults need at least one dose of Tdap Pregnant women need a dose with each pregnancy 27th through the 36th week of gestation Tdap can be administered to anyone 11 years and older Tdap vaccination recommended for all health care workers

Human Papillomavirus (HPV) Females For all females 19 through 26 years of age Males For healthy males 19 through 22 years of age For males 19 through 26 years of age: Men who have sex with men Immunocompromised men

Pneumococcal 23 (PPSV23) Adults 65 years and older One dose needed Adults 19 through 64 years of age Chronic heart or lung diseases Smokers, alcoholics Diabetes mellitus, chronic liver disease

Pneumococcal 23 Adults recommended for second doses before 65 years of age Persons with congenital or functional asplenia Immunocompromised persons Separate doses by at least five years Repeat vaccination after 65 years of age

Pneumococcal Conjugate 13 (PCV13) Adults 65 years of age and older Adults 19-64 years of age Immunocompromised Congenital or acquired asplenia Cerebral spinal fluid leaks Cochlear implants If administering both pneumococcal vaccines administer PCV13 first then 12 months later administer PPSV23

Measles, Mumps and Rubella (MMR) Adults born before 1957 need one dose of MMR Adults vaccinated between 1963 – 1967 who received inactivated measles vaccine need one dose of MMR Adults traveling overseas, healthcare workers and college students should receive two doses of MMR

Varicella Zoster (Shingles) Adults 60 years and older Disease rates are lower in younger adults Risk of shingles disease increases with age Younger adults do not have the severity and postherpetic neuralgia Vaccinate regardless of disease history of Chickenpox Shingles

Influenza Individuals six months and older October through May Types of Influenza vaccine available Inactivated Influenza vaccine IIV3 IIV4 Live Attenuated Influenza vaccine

Influenza Specific presentations of flu vaccine Recombinant influenza vaccine egg free product Cell Cultured Influenza vaccine (CCIV) High Dose influenza vaccine

Best Practices to Raise Vaccination Rates Increase access to vaccines Utilize the Missouri Immunization Registry Educate Review Incorporate the Standards of Immunization

Increase Access to Vaccines Participate in the Vaccines for Children program Incorporate vaccine only appointments Know where to refer

What is Vaccines for Children? (VFC) VFC is a federal entitlement program Created in 1994 Provides free vaccine to both public and private providers Automatically covers all ACIP recommended vaccines Eliminates cost as a barrier Keeps children in their medical home

Vaccine only Appointments Flexible hours Lunch time After 5pm Nontraditional days Weekends Increases access during busy times Vaccine only clinics Temporary staff for vaccine only clinics

Where to refer clients Health Map Vaccine finder Pharmacies Local public health agencies

SHOWMEVAX Free web based system Contains over 4.2 million clients Birth to death registry Contains over 38 million doses Birth dose of Hepatitis B Utilized by 2000+ organizations Health systems, pharmacies and public and private providers 4800 individual users

SHOWMEVAX SHOWMEVAX Capabilities: Run reports Doses administered Immunization rates for practice Reminder / recall Patient Access an immunization scheduler By age client Last dose given Dose validity

SHOWMEVAX Health care providers / organizations Data Entry and Inventory Users Electronic Messaging Users Read only Users For more information on SHOWMEVAX visit health.mo.gov/showmevax

Educate All staff Nurse Medical assistants Front desk staff Patient / Parent / Caregiver Update staff with new requirements Webinars In-services In-person trainings VFC411 trainings

Educate Current Immunization Schedule Vaccination Algorithms Educational tools Current Immunization Schedule 2015 Immunization Schedule Catch up Immunization Schedule Vaccination Algorithms Pneumococcal Influenza Informational Fact Sheets HPV Meningococcal Pertussis

Review Review charts routinely Vaccinations Missed opportunities Documentation Dose Lot number Manufacturer Vaccine Information Statement (VIS)

Standards of Immunizations: Assess Assess the patient’s immunization record at every opportunity Assess at sick visits Assess at well visits Increase immunization access to patients Immunization only visits Participate in VFC program

Standards of Immunization: Recommend All appropriate vaccinations due that day Educate on the benefits of immunization Prevent Protect Share personal stories on why immunizations are important Reasons you choose to vaccinate

Standards of Immunization: Administer Administer all vaccinations that are due Vaccines recommended and offered Increase number of adults receiving vaccines Decrease missed opportunity Refer for vaccines not available at office Pharmacy Able to give all ACIP approved vaccines to adults Children under 12 years of age will need a prescription for vaccination Local Public Health Agency Some offer vaccinations for underinsured and uninsured adults

Standards of Immunizations: Document Document all vaccines given during visit in patient’s chart Document all vaccines caregiver / patient refused Give a copy of vaccination record to patient Make sure to document any vaccination history of patient Use SHOWMEVAX

Questions Contact information: Lana Hudanick 314.982.8260 lana.hudanick@health.mo.gov