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The “LAW” and other Immunization Briefs

The “LAW” and other Immunization Briefs. Lynn Bahta, RN, PHN Minnesota Department of Health May 2014. K-12 Requirements: Snapshot. Give Adolescents All Recommended Vaccines. Tdap HPV Meningococcal Influenza. Pertussis in Minnesota, 2013. Pertussis Prevention.

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The “LAW” and other Immunization Briefs

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  1. The “LAW” and other Immunization Briefs Lynn Bahta, RN, PHN Minnesota Department of Health May 2014

  2. K-12 Requirements: Snapshot

  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 • Don’t need to consider waiting between last Td and Tdap • Can assume Td/Tdap documentation of older ages is likely Tdap

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

  10. 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

  11. Key Meningococcal Law Implementation Issues • Phased AISR reporting • No booster dose reporting • Doses given before age 10 years not considered compliant (won’t protect through risk years) • Rates for upcoming 7th graders are sobering

  12. Phased AISR Reporting for Meningococcal Vaccine

  13. 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

  14. Influenza Laboratory Surveillance MN Lab System (MLS) Laboratory Influenza Surveillance Program Influenza week 17, 2014

  15. New Influenza Vaccine Products • Flumist Quadrivalent (LAIV4), MedImmune • Fluarix Quadrivalent (IIV4), GSK • Fluzone Quadrivalent(IIV4), Sanofi Pasteur • Flulaval Quadrivalent (IIV4), ID Biomedical /GSK • Flulaval (IIV3) age expansion to 3 years, ID Biomedical/GSK • Flucelvax, a cell culture-based trivalent inactivated influenza vaccine (ccIIV3) ), Novartis • Flublok, a trivalent recombinant HA influenza vaccine (RIV3), Protein Sciences

  16. 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 • Don’t miss the opportunity to vaccinate, there may not be another chance to do it

  17. 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

  18. Child Care & Early Childhood Program Requirements: a snapshot

  19. Hepatitis A Included an outbreak that involved school-aged children

  20. 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

  21. 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

  22. 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.

  23. Changes to Immunization Law • Implementation: September 1, 2014

  24. Immunization Law Communications

  25. Resources • Forms: www.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/ • Minnesota Immunization Rule Revisions: www.health.state.mn.us/divs/idepc/immunize/immrule/ Webex: 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

  26. Questions?

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