Review of Recommended Schedule Presentation to: Presented by: Date:

Disclosure Statements Neither the planners of this session nor I have any financial relationship with pharmaceutical companies, biomedical device manufacturers, or corporations whose products and services are related to the vaccines we discuss. There is no commercial support being received for this event. The mention of specific brands of vaccines in this presentation is for the purpose of providing education and does not constitute endorsement. The GA Immunization Program utilizes ACIP recommendations as the basis for this presentation and for our guidelines, policies, and recommendations. For certain vaccines this may represent a slight departure from or off- label use of the vaccine package insert guidelines.

Disclosure Statement To obtain nursing contact hours for this training, you must be present for the entire training and complete an evaluation Contact hours are available for this training from 02/17/2015 until 08/31/2015

Objectives At the end of this presentation, you will be able to: Explain the difference between a vaccine indication, recommendation and requirement Discuss the ACIP General Recommendations for the use and administration of vaccines Define herd immunity Identify the vaccine antigens used for infants, children, adolescents and adults to prevent Vaccine Preventable Diseases Discuss the role of a vaccine champion List at least 2 reliable sources for immunization information

The Impact of Vaccines N/A = Data not available * MMWR 48(12); April 2, 1999 ** MMWR 63(32); August 15, 2014

Herd Immunity Immunized individuals block infection from reaching those who are unimmunized INFECTED UNIMMUNIZED INFECTED = immunized

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

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

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

IT’s The Law!

Observe the Guidelines Route of administration Number of doses required 4-day grace period Minimal age for immunization Minimal interval between doses

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

Diphtheria Pertussis Tetanus Required for school and child care attendance

Cocooning Strategy Siblings Child Care Provider Healthcare Worker Grandparents Parents

Hepatitis B

Hepatitis A Required for school or child care attendance for children born on or after

Haemophilus influenzae Type b (Hib) Required only for child care and pre-K attendance

Polio Ref. MMWR 2009; 58 (30); (August 7, 2009) Source: World Health Organization Required for school and childcare attendance

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

Varicella (Chickenpox) © Copyright American Academy of Pediatrics

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)

Pneumococcal Disease Required for child care and pre-K attendance

Influenza Vaccine Not required for school or child care attendance

Flucelvax (Novartis) – Approved for persons 18 years 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 years 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

Influenza Vaccine and Egg Allergy Recommendations regarding influenza vaccination of persons who report allergy to eggs — ACIP 2014–15 influenza season

Meningococcal Disease New 7 th Grade School Requirement

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 Red Book – AAP 2012 Report of the Committee on Infectious Diseases

Herpes Zoster “Shingles”

Frequently Asked Shingles Questions? Shingles cannot be passed from one person to another. However, a person with shingles can spread the virus to a person who has never had chickenpox. If the person who has never had chickenpox becomes infected with the virus, he or she will develop chickenpox, not shingles.

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 !!!

Critical Elements for Immunization Services

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.

Standards for Child, Adolescent, and Adult Immunization Practices Availability of vaccines Assessment of client’s 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

VAERS

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”

IT STARTS WITH YOU!

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?

Resources for Factual & Responsible Vaccine Information

Stay Current! Sign up for listserv sites which provide timely information pertinent to your practice – AAP Newsletter – CDC immunization websites (32 in all) – CHOP Parents Pack Newsletter – IAC Express – Websites specific to particular vaccines

Internet Resources Georgia Department of Public Health CDC Immunization information CDC Flu information Immunization Action Coalition

Resources Local health department District Immunization Coordinator GA Immunization Program Office – On call Help line: – GRITS Help Line: – VFC Help Line: – Website – Your local Immunization Program Consultant (IPC) – Epidemiology: GA Chapter of the AAP GA Academy of Family Physicians

It’s a Team Effort! High Immunization rates begin with a team designed plan! What can your team do to improve rates?