1. THE LAW AND OTHER IMMUNIZATION BRIEFS LYNN BAHTA, RN, PHN MINNESOTA DEPARTMENT OF HEALTH MAY 2014

2. K-12 REQUIREMENTS: SNAPSHOT Already Required DTaP/DT and/or Td (Tdap) Polio Hepatitis B MMR Varicella New Requirements Meningococcal grades 7-12 Tdap instead of Td grades 7-12 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

3. GIVE ADOLESCENTS ALL RECOMMENDED VACCINES Tdap HPV Meningococcal Influenza

4. PERTUSSIS IN MINNESOTA, 2013

5. PERTUSSIS PREVENTION Early diagnosis and treatment: think, test, treat Reduce morbidity and mortality to most vulnerable – children under 1 year of age

6. 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)

7. TDAP RECOMMENDATIONS Pregnant women Tdap during every pregnancy regardless of the number of doses previously received, Give between 27-36 weeks gestation

8. KEY TDAP LAW IMPLEMENTATION ISSUES Tdap not necessary if dose given between ages 7-10 Dont need to consider waiting between last Td and Tdap Can assume Td/Tdap documentation of older ages is likely Tdap

10. Serogroups C and Y account for the majority of meningococcal cases in adolescents

11. 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

12. KEY MENINGOCOCCAL LAW IMPLEMENTATION ISSUES Phased AISR reporting No booster dose reporting Doses given before age 10 years not considered compliant (wont protect through risk years) Rates for upcoming 7 th graders are sobering

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 2019- 2020 School Year 7 th 1 MCV4 dose 8 th 1 MCV4 dose 9 th 1 MCV4 dose 10 th 1 MCV4 dose 11 th 1 MCV4 dose 12 th 1 MCV4 dose

14. 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

15. INFLUENZA LABORATORY SURVEILLANCE MN Lab System (MLS) Laboratory Influenza Surveillance Program Influenza week 17, 2014

16. 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

17. 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 Dont miss the opportunity to vaccinate, there may not be another chance to do it

18. 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

19. Risk GroupUnderlying Medical Condition PCV13PPSV23 Immuno competent Chronic heart or lung disease X Diabetes mellitus X CSF fluid leak XX Cochlear implants XX Chronic liver disease X Alcoholism X Has asthma X Smokes cigarettes X Functional or anatomic asplenia Sickle cell disease/other hemaglobinopathies XX Congenital or acquired asplenia XX Immuno compromised Congenital or acquired immunodeficiencies XX HIV infection XX Chronic renal failure/nephrotic syndrome XX Leukemia/lymphoma/Hodgkin disease/generalized malignancy XX Iatrogenic immunosuppression XX Solid organ transplant XX Multiple myeloma XX

20. 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)

21. HEPATITIS A Included an outbreak that involved school- aged children

22. 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

23. 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

24. 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.

25. CHANGES TO IMMUNIZATION LAW Implementation: September 1, 2014

26. Immunization Law Communications Target audiences/ mechanismResourcesOther 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

27. Resources Forms: www.health.state.mn.us/divs/idepc/immunize/tracking.htmlwww.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/ www.health.state.mn.us/divs/idepc/immunize/school/ Minnesota Immunization Rule Revisions: www.health.state.mn.us/divs/idepc/immunize/immrule/ www.health.state.mn.us/divs/idepc/immunize/immrule/ Webex: https://health-state-mn-ustraining.webex.com/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: health.immrule@state.mn.us health.immrule@state.mn.us

28. QUESTIONS?