1. 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

2. 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

3. 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

4. ACIP Infant and Child Schedule

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. ACIP Adolescent Schedule

17. 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

18. 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 school year
8th grade entry
12th grade entry

19. 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

20. 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

21. 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

22. ACIP Adult Schedule

23. Adult Vaccination Factors for adult vaccination Age Work
Medical conditions
Travel

24. 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

25. 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

26. 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

27. 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

28. Pneumococcal Conjugate 13 (PCV13)
Adults 65 years of age and older
Adults 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

29. 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

30. 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

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

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

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

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

35. 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

36. 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

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

38. 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 organizations
Health systems, pharmacies and public and private providers
4800 individual users

39. 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

40. 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

41. 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

42. 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

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

44. 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

45. 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

46. 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

47. 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

48. Questions
Contact information: Lana Hudanick