Oregon Immunization Bulletin

Transcription

1 Oregon Immunization Bulletin Oregon Immunization Program Public Health Division Fall Fall View the Oregon Immunization Bulletin online! Advisory Committee on Immunization Practices (ACIP) update The Advisory Committee on Immunization Practices (ACIP) met June This article provides a brief summary of some of the recommendations from the meeting. To see the meeting s minutes and full recommendations, please go to: Poliovirus Vaccine: ACIP s recommendation emphasizes the importance of the booster dose at age 4 years, extends the minimum interval from dose three to dose four from 4 weeks to 6 months, adds a precaution for the use of minimum intervals in the first 6 months of life, and clarifies the poliovirus vaccination schedule when specific combination vaccines are used. The four-dose IPV series should continue to be administered at ages 2 months, 4 months, 6 18 months, and 4 6 years of age. The final dose in the IPV series should be administered at age 4 years regardless of the number of previous doses. The minimum interval from dose three to dose four is extended from 4 weeks to 6 months. The minimum interval from dose one to dose two, and from dose two to dose three, remains 4 weeks. The minimum age for dose one remains age 6 weeks. ACIP update continued on page 2

2 Oregon Immunization Bulletin ACIP update continued from page 1 Meningococcal Vaccine: Because of the high risk for meningococcal disease among certain groups and limited data on duration of protection, the ACIP recommends that persons previously vaccinated with either MCV4 or MPSV4 who are at prolonged increased risk for meningococcal disease should be revaccinated with MCV4. Persons who previously were vaccinated at age 7 years and are at prolonged increased risk should be revaccinated 5 years after their previous meningococcal vaccine, Persons who previously were vaccinated at ages 2 6 years and are at prolonged increased risk should be revaccinated 3 years after their previous meningococcal vaccine. Persons who remain in one of the increased risk groups indefinitely should continue to be revaccinated at 5-year intervals. Persons at prolonged increased risk for meningococcal disease include: 1. Persons with increased susceptibility such as persistent complement component deficiencies 2. Persons with anatomic or functional asplenia 3. Persons who have pro longed exposure (e.g., microbiologists routinely working with Neisseria meningitidis, or travelers to or residents of countries where meningococcal disease is hyperendemic or epidemic). Reference: School law update: School and children s facility immunization exclusion day is coming! Please note these important dates: January 13, 2010 schools and children s facilities complete their initial review of children s immunization records

3 Oregon Immunization Bulletin February 3, 2010 Exclusion letters are mailed to parents by this date February 17, 2010 Exclusion Day Children must have records showing that they are up-to-date on vaccines required for attending school, child care, preschool, or Head Start (medical and religious exemptions are also acceptable). If the school/children s facility record shows that a child is missing required immunizations, the child will be excluded on Exclusion Day and will not be allowed to return until documentation is provided showing the needed immunizations or an exemption. Please remind parents to update their child s immunization record with the school, child care, or preschool program every time their child receives a vaccine! School Vaccine Notes: Hib Due to the previous shortage of Hib vaccine, Hib will not be required for children s facility attendance again this year. This will give providers one more year to get children caught up with the booster dose of Hib. Hepatitis A This year, hepatitis A vaccine is required for children 18 months and older in child care, preschool, Head Start, kindergarten, and 1st grade. Hepatitis A vaccine will be required for all children through 12th grade in school year , so students currently in 2nd through 7th grade will need to have Hepatitis A vaccine before graduation from high school. Tdap One dose of Tdap vaccine is required for students in 7th and 8th grades this year, if it has been at least 5 years since their last dose of tetanus-containing vaccine. When adolescents receive their Tdap, it s a great time to screen for other recommended vaccines, including meningococcal conjugate, HPV, and influenza. The CDC has produced materials about adolescent immunizations and preteen check-ups specific to a variety of audiences. Please see the following websites for posters, flyers, and more information for general, Korean, Vietnamese, and Native American audiences: (General Audiences; English and Spanish) (Korean) (Vietnamese) (Native American)

4 Oregon Immunization Bulletin Spotlights Effective & innovative approach to improving back-to-school immunizations Who says business and pleasure don t mix? For Klamath Tribal kids, this statement might not be so true. In August 2009, Klamath Tribal Health & Wellness Center, in Chiloquin, OR, held a Well Child Health Fair. The fair offered backto-school and other routine immunizations, backpacks, books, school supplies, and plenty of fun activities. Meanwhile, parents received the latest information about childhood health and safety. Planning for the event began in spring 2009 and included the health educator, youth intervention counselor and community services department for Klamath Tribal Health & Wellness Center. The Health Educator coordinated the event, the Youth Intervention Counselor purchased Nike backpacks, and the community services department purchased back-to-school supplies, books, and provided transportation. During the event, the medical clinic provided nursing staff, immunizations, and important information regarding child health. The pharmacy, dental clinic, contract health, patient registration, diabetes program, youth and family intervention counselors, and education and employment program staff provided additional assistance. Vaccines and some educational materials were provided by the Vaccines for Children (VFC) Program. Advertising for the event was done through the tribal newsletter, flyers and mailings. About 160 children and their families/caregivers attended the event. At the immunization booth, nursing staff reviewed immunization records, updated them as needed, and then gave all shots that were due. According to Lt. Nikowa Kates, RN and VFC Coordinator at the Klamath Tribal Health & Wellness Center, the event exceeded our expectations regarding attendance. She attributes the event s success to early planning, participant collaboration, and a strong commitment by all involved. Following the huge success of the event, Klamath Tribal Health & Wellness Center plans to make this an annual event. If you would like additional information on how to hold a similar Well Child Health Fair at your clinic, please contact Nikowa Kates at nnkates@klm. portland.ihs.gov or call her at

5 Oregon Immunization Bulletin Dallas Family Medicine hits 100% We would like to congratulate Dallas Family Medicine in Dallas, OR for an outstanding VFC site visit! The site visit resulted in an almost unheard of 100% compliance finding. Site visits are conducted throughout the state by VFC Health Educators every two to four years. A full VFC site visit includes a review of administrative practices, temperature log documentation, and an in-depth inspection of the vaccine supply and vaccine storage equipment. If anything is out of compliance, clinics are required to submit corrective action plans and demonstrate that they have implemented all required changes. Faith Shinn, RN and her staff have done a magnificent job following VFC policy and state recommendations to perfect her clinical operations. In addition to complying with VFC requirements, Dallas Family Medicine annually participates in the immunization program s continuous quality improvement initiative (AFIX) and works extremely hard to keep its patients up to date with all ACIP recommended vaccines. Great job Dallas Family Medicine! VFC Policy Check! Is it a drag meeting the requirement to write in the patient s record both the date of administration and the date that the VIS was given to the patient? Is it especially a drag because most often, those dates are one and the same? Save yourself the aggravation and extra time by drafting a VIS policy for your site. Make sure to explicitly state in your policy, among other things, that unless otherwise noted, the date of administration is the date that the VIS was given to the patient. You will want to store this policy in the same notebook or file as all of your VFC policies and/or SOPs. Note that drafting a policy about VIS use is not a VFC requirement. You may continue to document, for every immunization given, both the date of administration and the date that the VIS was given to the patient. Please make sure to do this, or the policy option, as it is not only a VFC requirement, but it is also federal law.

6 Oregon Immunization Bulletin Vaccine borrowing guidance Have you ever needed to borrow a dose from your private stock to give to a VFC-eligible patient, or a dose from your VFC stock to give to a privately insured patient? Did you wonder if this was okay and, if so, what kind of documentation was necessary? CDC has recently updated their guidance on borrowing between VFC and private stock vaccine. According to CDC, borrowing between stocks is an acceptable practice in certain limited circumstances. Examples of when borrowing is okay include if you re out of one stock because of a delayed shipment or because vaccine was nonviable when it arrived in your office. Beginning immediately, providers must document all instances of borrowing on the Vaccine Borrowing Report, or in an alternate Hot tips for keeping your vaccine cold 1. Shut the door: Sounds elementary, doesn t it? You might be surprised at how often people leave the fridge door ajar. It might look closed, but you need to know it really is. How to address this: Instruct your staff that every time they walk format that has been approved by your VFC Health Educator. These reports must be maintained for a minimum of three years. Borrowing reports will be reviewed during VFC site visits and must be made available upon request by VFC staff. Questions about borrowing vaccine between stocks, or need to access the borrowing report? You can access the VFC Vaccine Borrowing Policy and the VFC Vaccine Borrowing Report on our website: VFCvacborrowguide.pdf VFCvacborrowrep.pdf Or contact your health educator! past the refrigerator where vaccines are stored, they get into the habit of checking that the door is closed. Put a small block or wedge under the front feet of the fridge, to slightly tip the fridge backwards. This encourages the door to swing shut on its own. From a hardware store, buy an inexpensive magnetic window/door alarm that will chime every time the door is left open. Alternatively,

7 Oregon Immunization Bulletin you might purchase a child-proof lock for fridges or adhesive Velcro strap to remind you to close the door. 2. Check temperatures an hour earlier: Instead of checking your fridge and freezer temperatures at the end of the day, check the temps an hour before you leave. Why this is important: When you check the temperature an hour before you leave, an out-of-range temperature reading can be dealt with immediately. You can Dorm-style deadline! CDC requires that all VFC clinics discontinue use of dorm-style refrigerators for vaccine storage by 12/31/2009. Hot tips continued on page 12 What is a dorm-style fridge? There has been some confusion around what constitutes a dormstyle fridge. For our purposes, the distinguishing characteristic of a dorm style unit is the built-in freezer section. If your refrigerator has this feature, you must stop using it for vaccine storage on or before 12/31/2009!

8 Oregon Immunization Bulletin The co t of vaccine loss Many of our VFC clinics are surprised to discover the true cost of vaccine loss due to poor storage and handling. Using high-grade equipment and following proper storage and handling practices are not just good clinical decisions, they re also sound financial ones. Example 1: Clinic A is a small rural provider in Klamath Falls, Oregon and carries only the minimum of ACIP recommended vaccine. This equates to 10 doses of the following vaccines: DTaP, DTaP/IPV, DTaP/IPV/Hib, Influenza, Hep A, Hep B, Hib, HPV, MCV4, MMR, PCV7, Rotavirus, Tdap, Varicella At current vaccine pricing, this small clinic is housing well over $5,000 worth of VFC stock. Example 2: Clinic B is a busy urban provider in Portland, Oregon. On an average day they carry the following VFC inventory: 100 DTaP, 40 IPV, 150 Hep A, 50 Hep B, 40 Hib, 20 HPV, 20 MCV4, 20 MMR, 50 PCV7, 150 Tdap, 50 Varicella At current vaccine pricing, this large clinic is housing well over $20,000 worth of VFC stock. When you consider that most clinics also carry private vaccine, you begin to understand the amount of money that s at stake. It is important to consider the value of your inventory when making the decision to upgrade your storage equipment. While more expensive, lab-grade equipment is always the best option. The cost

9 Oregon Immunization Bulletin of lab grade equipment pales in comparison to the cost of the vaccines that are stored in it, and it will pay for itself by preventing even one major vaccine loss due to a temperature excursion. The co t of revaccination As Oregon providers are aware, the proper storage and handling of vaccines is crucial to prevent disease. When proper vaccine storage temperatures are not maintained, vaccine can become subpotent, and clinics may need to revaccinate patients and replace wasted stock. Revaccination results in financial, political, social, and emotional costs to clinics, patients, and communities. It is difficult to quantify the social costs; however, we can measure the financial cost of a revaccination campaign. Susan Weiner, MSW, Immunization Health Educator, and Scott Jeffries, Immunization Research Analyst, recently completed a cost analysis of a typical vaccine excursion and revaccination campaign, using data from one Oregon pediatric clinic s recent revaccination campaign. In the study, they assessed monetary costs for replacing nonviable vaccine, contacting patients and media, and replacing old vaccine storage equipment. They also looked at costs associated with additional staff time required during the revaccination campaign and costs associated with lost administration fees and office visit fees. At this pediatric clinic, 155 patients were vaccinated with sub-potent doses (898 individual doses of vaccine) and the cost of the revaccination campaign was estimated at $63,684. This translates to $411 per patient! While the financial costs of revaccination can be tremendous, these costs are just the tip of the iceberg of what a revaccination campaign truly costs a clinic and its patients. In order to avoid unnecessary revaccinations, clinics must commit to improving vaccine storage and handling practices, and instituting policies and procedures for closer monitoring. Please contact your health educator if you need guidance on how to improve your storage and handling processes! The study, Immunizations and Vaccine Excursion Costs, was presented at this year s Oregon Public Health Association s (OPHA) annual conference.

10 10 Oregon Immunization Bulletin ALERT update FAQ- Submitting H1N1 doses to ALERT Q. Our clinic currently submits data to ALERT. Can we submit the H1N1 doses using our regular submission format? A. Yes, in fact we prefer that you add H1N1 doses to your regular submission format. Barcode Clinics use an other sticker and write in H1N1 pfree, H1N1 nasal, or H1N1 injectable. Electronic Transfer Clinics please verify that the H1N1 codes are in your system and that you are sending these codes to ALERT weekly or biweekly. Other Clinics if you submit doses using a purple or yellow form, please enter the H1N1 information under the other immunization section. Q: Is there a way to enter H1N1 doses online? A: Yes, ALERT has an easy to use online entry form that is available to all H1N1 providers. Please call our Customer Service line at to get access. Q: Do we have to use the Scannable VAR to submit H1N1 doses to ALERT? A: No, if you are submitting via another route, there is no need to use this form. Q: Can we submit H1N1 doses using multiple reporting methods? A: Yes, a good example is a clinic that regularly submits to ALERT but would like to administer H1N1 vaccine to their staff or others who are not patients in their clinic, or who are not entered into their electronic system. For patients, they can use their regular submission format; for non-patients, they can use either online entry or the Scannable VAR to submit doses. Q: What fields are essential on the scannable VAR? A: ALERT needs as much information as possible to accurately enter and merge records, but the registry does not require the consent signature on the front side of the form, or the lot number on the back of the form. The absolutely essential fields are: Side 1: Key patient information (Name, DOB, address, phone, gender) Side 2: Bubble(s) on left side that mark what was given, administration date at bottom of form, and AL number (if you have questions about your clinic s AL# please call our customer service line)

11 Oregon Immunization Bulletin 11 Q: Can we photocopy the Scannable VAR if we run out of copies? A: No, our software will not read the form accurately if you do not use the original forms. You can order more Scannable VAR forms and postage paid envelopes from our website at Please remember to click on submit to finalize the order. Complete ALERT Reporting Guidelines can be found at: DHS/ph/imm/docs/H1N1ReprtGdlines. pdf. Providers can also call ALERT Customer Service with any questions: Thank you for your hard work! A new look at vaccine ordering In an effort to improve vaccine-ordering practices among providers in Oregon, the Oregon Immunization Program is in the process of implementing a new Economic Order Quantity (EOQ) initiative. The EOQ initiative focuses on helping providers balance order size, order frequency, storage and handling capacity, and costs of vaccine shipment, and are tailored to the specific vaccine needs of individual practices. Oregon is one of four states currently piloting this effort, through funding and guidance from the Centers for Disease Control and Prevention (CDC). Providers will be gradually rolled into the EOQ process after participating in comprehensive trainings in vaccine management. The trainings, beginning in 2010, will give providers tools to help forecast vaccine needs (based on ordering history and seasonality considerations), and determine the amount of safety stock to keep on hand. The EOQ tools will help take the guesswork out of deciding the number of doses to order at each ordering cycle. Another anticipated benefit of the EOQ initiative is that providers will spend less time placing orders, and the Immunization Program will spend less time processing orders. These changes will result in quicker vaccine shipments and improved overall inventory management. Given the large scope of this project, two staff members have been hired to work exclusively on the design, implementation, and evaluation of EOQ; Rafe Hewett, a Training Development Specialist, and Anne VanCuren, the Provider Services Vaccine Grant Specialist. However, in order for EOQ to be fully adopted by providers, the team will rely heavily on the staff from the Provider Services Team, who are involved in day-to-day communication with the provider community. While the implementation of EOQ will require a lot of coordinated effort on the part of the Oregon Immunization Program together with the willing participation of the provider community, there will be a lot to gain from its success.

12 Hot tips continued from page 7 make a minor adjustment to the control, wait 20 minutes, and see the effect your change made. If you are still unable to get your temps in range, you will have time before leaving to put your emergency plan into action. 3. Avoid the vent! Refrigerated vaccines stored near the vent where cold air enters the refrigerator can very easily freeze. Freezing vaccines is the quickest way to destroy them. How to address this: Look in your refrigerator and locate the cold-air vent. In household-type fridges, it is most often found above the top shelf, in the center or on either side. However, not all fridges are alike: make sure to locate this vent for each fridge where vaccine is stored. Move vaccines away from this vent. Using the second and/or third shelves for vaccine storage is your best option. Also make certain to keep your temperature monitor/logger near the center of your unit. Before choosing to store any vaccines on the top shelf, test the temperture with a continuoustracking thermomoter over several days. Only use the area of the shelp that is out of the direct path of the cold air and has displayed proper temperatures. If your top shelf is not appropriate for storage, remove it or put up a sign that warns against vaccine storage. Better yet, use that shelf to store less sensitive biologicals or water bottles. Oregon Department of Human Services Oregon Immunization Program 800 NE Oregon Street, Suite 370 Portland, OR