Missouri Newborn Blood Spot Screening. Missouri Department of Health and Senior Services Bureau of Genetics and Healthy Childhood September 21, 2017

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1 Missouri Newborn Blood Spot Screening Missouri Department of Health and Senior Services Bureau of Genetics and Healthy Childhood September 21, 2017

2 Senate Bill 50 Newborn Screening Statute By January 1, 2019, the Department of Health and Senior Services shall, subject to appropriations, expand the newborn screening requirements in section to include spinal muscular atrophy (SMA) and Hunter syndrome (MPS II). To access newborn blood spot screening statutes and rules go to: o Newborn Blood Spot Screening Laws, Regulations, and Policies

3 What does Transit Time mean??? Transit Time = the time from sample collection to the start of testing by the Missouri State Public Health Laboratory (MSPHL) Transit time can be impacted by many factors. It is important for newborn nurseries, hospital laboratories, the MSPHL, and the follow-up program to continuously communicate and collaborate. Each and every screen should be treated as though it will make the difference between life and death for a newborn.

4 Missouri s Principal Timeliness Issues No weekend or holiday courier pickup (the state contracted courier had the same days off as the MSPHL). Smaller birthing hospitals were not provided courier (did not have enough births) so they routinely utilized regular U.S. mail. MSPHL did not work weekends. MSPHL had several observed Monday holidays resulting in three-day weekends. Some hospitals experienced logistical issues provoking delays internally. Lack of traceability for hospitals to promptly verify their samples were received by the MSPHL. Lack of funding to remedy the above issues.

5 Initial Improvements at MSPHL (with no additional funding) Worked with hospitals who were not on the courier system to self-transport their newborn screening (NBS) samples to their nearest county health department (included midwives). Worked one-on-one with any hospitals displaying timeliness issues. Began providing customized monthly timeliness reports to Laboratory and OB managers in those institutions. Increased timeliness education overall. During routine phone conversations with nurseries, laboratories and PCP s. Newborn Screening Regulations reminder on website samples must be sent to the MSPHL (not received) within 24 hours of collection. Top 10 Reminders Notice.

6 Hospital formerly utilizing regular U.S. mail service (most samples took 5 to 9 days) Same hospital now utilizing a local county health department s courier stop (most samples took 1 to 4 days)

7 Education Sent with all NBS Laboratory reports for one full month Sent with all NBS collection card orders on a permanent basis Posted on NBS Laboratory website Posted on NBS Laboratory Report Access Portal Reminder # 8

8 Improvements Requiring Funding Implemented holiday courier pickup January 1, 2014 ($6,000 per year). MSPHL received legislative funding to enhance the courier system and implement Saturday and holiday testing (supported by a Kansas City, MO legislator). Implemented Sunday courier pickups starting July 5, 2015 ($36,000 per year). Added 8 more birthing hospitals to the current 46 routine hospital sites for the courier starting July 5, 2015 ($44,000 per year). Implemented Saturday and holiday testing beginning October 3, 2015 ($200,000 per year).

9 A notice was sent out each day for one month with NBS Laboratory reports: NBS courier expansion announcement A reminder about getting the sample to the pickup site immediately after drying A reminder about the lifesaving importance of timeliness State NBS Laboratory will be converting to a six-day work week A reminder to get connected to the NBS Laboratory report access portal to provide verification of sample receipt

10 Missouri s Saturday/Holiday Work Model 100% voluntary staffing process. A skeleton crew of seven scientists work each Saturday/holiday (excludes Thanksgiving, Christmas, and New Year s Day) and all screening tests are performed. Hired one full-time employee, a manager to run the Saturday/holiday expansion and supervise the adjunct staff. Two newborn screening laboratory employees were hired agreeing they would work Tuesday through Saturday until attrition allows them to move to Monday through Friday. Four other adjunct employees work each Saturday/holiday making straight-time pay (classified as secondary assignment staff).

11 Holiday Courier Pickup Started January, 2014 Sunday Courier Pickup Started July, 2015 Saturday/Holiday Testing Began October, 2015

12 What Can Hospitals Do? Aim to collect NBS specimens at 24 hours of age for all babies. Fill out the collection card completely, accurately, and legibly. Check the specimen. If there is any doubt about quality, recollect immediately. Dry specimen horizontally for three to four hours making sure it does not touch anything. Package specimens for transport daily and know your courier s pickup time. Routinely check the laboratory report access portal to ensure specimens were received and determine if any action is necessary.

13 The Missouri Newborn Screening Laboratory Report Access Portal

14 The Laboratory Report Access Portal provides a secure website where submitters can track their NBS samples along with printing and/or saving their laboratory reports in real time.

15 NBS announcements are displayed on this page.

16 Three ways to search for results.

17 What are the benefits of the portal? A secure website for hospitals to verify daily that the MSPHL has received their samples. Sample receipt verification is a College of American Pathologists (CAP) Laboratory Accreditation requirement for laboratories for all send-out samples. Hospitals can notify the MSPHL if they determine that samples may not have been received and investigations on both sides can commence quickly. Hospitals can print and/or save their own NBS reports from this site and not have to wait for them to come through the mail. Reduces the number of calls into the MSPHL requesting NBS lab reports. Both submitting hospital and MSPHL can become paperless.

18 Saturday and Holiday Work Team

19 Contact Information Jami Kiesling, RN, BSN Bureau of Genetics and Healthy Childhood Newborn Screening Website:

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21 Objectives Identify newborn vaccines Identify vaccines for healthcare workers Identify vaccines for pregnant women

22 Who makes vaccine recommendations? Advisory Committee on Immunization Practices (ACIP) Medical personnel Vaccinology Immunology Pediatrics Internal and Family medicine Nursing Infectious disease Public health

23 Why is the ACIP schedule recommended? Best immune response Protects at the earliest possible age Provides appropriate spacing for best outcomes Research has shown this schedule to be the safest and most effective

24 Why are vaccinations recommended for newborns? Protect as soon as possible Passive immunity wanes Vaccine-preventable diseases still exist The body responds best to some vaccinations early in life

25 At what age should vaccines be started? Within 24 hours of birth Hepatitis B 6 weeks 8 weeks of age Diphtheria, Tetanus and acellular Pertussis (DtaP) Haemophilus Influenza B (Hib) Polio (IPV) Hepatitis B (HepB) Pneumococcal Conjugate Vaccine 13 (PCV13) Rotavirus (Rota)

26 Hepatitis B Vaccine Protects against the virus Hepatitis B Hepatitis B is contracted through blood and bodily fluids Why do we vaccinate against Hepatitis B at birth? Children who contract the disease at a young age have a 90% chance of developing chronic infection Children who have chronic infection tend to have a shortened life expectancy

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28 Hepatitis B Vaccine (cont.) Recommendations: Dose one at birth (within 24 hours of birth) Dose two at two or four months of age Dose three at six months of age Spacing guidelines for vaccination At least four weeks between dose one and two At least eight weeks between dose two and three At least 16 weeks between dose one and three Infant must be at least 24 weeks of age for 3 rd dose

29 Other infant immunizations DTaP, IPV, Hib,PCV13 Start between 6-8 weeks of age Are repeated at four, six and between months of age Infants are not fully protected until completing each vaccine series Rotavirus is started between 6-16 weeks of age and finished by eight months of age Hep B Dose 2 administered at 2 months or 4 months Dose 3 administered at 6 months or 24 weeks of age

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31 Tetanus, Diphtheria and acellular Pertussis (Tdap) Why does this affect adults? Protects against tetanus, diphtheria and pertussis Half of infants under twelve months of age who contract pertussis will require hospitalization 1 in 100 of those will die due to pertussis Infants are not protected until all four doses of DTaP have been administered

32 Tetanus, Diphtheria and acellular Pertussis (Tdap) Recommendations One dose for all adults One dose for all healthcare workers One dose recommended during each pregnancy for women beginning at 27 weeks gestation Efficacy 73% effective at reducing disease for up to two years after vaccination 91% protection rate following pregnancy for infants through the first two months

33 Tetanus, Diphtheria acellular Efficacy Pertussis (Tdap) Infants who contracted pertussis after mother was vaccinated during pregnancy were shown to have: Decreased need for hospitalization Decreased need for intubation Quicker recovery Pertussis was not life-threatening Safety Research has shown that the vaccine is safe and has shown no adverse effects for mom or baby

34 Influenza Flu season is October-May each year Peaks January-March Influenza A occurs early with Influenza B later Missouri had 71,000+ individuals test positive for the 2016 flu season 2,093 Missourians died due to influenza/pneumococcal complications in 2016 alone 1 pediatric death

35 Spread Influenza Individuals are contagious one day before start of symptoms Recommendations Flu vaccination for everyone six months of age and older Flu vaccination for every pregnant woman any time during pregnancy Flu vaccination for all healthcare providers/staff

36 Influenza Why should pregnant women and healthcare workers receive the flu vaccine? Pregnant women who contract the flu tend to have more serious complications from influenza Infants tend to have lower birth weights Healthcare workers Spread influenza to vulnerable patients Unimmunized healthcare workers are often the source of influenza outbreaks in hospitals and long-term care facilities Immunized healthcare workers are associated with fewer patient deaths in nursing homes and long-term care facilities.

37 Talking points for providers Why are vaccines important? Vaccines stimulate your baby s immune system to create antibodies so they can fight off these serious diseases I don t know anyone with these diseases, so why do I need to vaccinate my baby? Even though we do not see some of these diseases here in the United States, they do still occur overseas and we do see outbreaks of whooping cough, measles and mumps Isn t it better for my baby to get these diseases naturally? While natural infection is best for some of these diseases, unfortunately, the price paid could be paralysis, brain damage, cancer, blindness or even death

38 Talking Points to staff Inactivated Influenza Vaccine does not give you the flu Influenza is not treated with antibiotics Influenza season is October-May Hospital patients, both the very young and the very old, are vulnerable to complications from influenza

39 Vaccine safety Are there side effects? Pain/redness at injection site Are there risks to vaccinations? Limited risk - greater benefit Screening questions limit the risk Vaccine Adverse Events Reporting System (VAERS) Does not show causality System is routinely checked

40 Vaccine safety never stops They are continuously monitored for safety

41 Thank You Lana Hudanick, Public Health Consultant Nurse Bureau of Immunizations Jeanine Pagan, Public Health Senior Nurse Bureau of Immunizations