June 20, RE: Revisions to 2006 CHAM-June Dear CHAM User:

Transcription

1 ALASKA NATIVE TRIBAL HEALTH CONSORTIUM Community Health Aide Program 4000 Ambassador Drive Anchorage, Alaska Telephone: /3642 Facsimile: June 20, 2011 RE: Revisions to 2006 CHAM-June 2011 Dear CHAM User: There are changes in the immunization schedule and some new vaccine recommendations. This packet updates the Medicine Handbook of the 2006 Alaska Community Health Aide/Practitioner Manual (CHAM). These changes are related to the Immunizations Chapter (Revision 12/07 booklet), p. M-47 through M-64, and the Tdap/Td Section, p. M-428 and p. M-430. There are changes throughout the Immunizations Chapter and the Tdap/Td Description and Uses and Warnings Before You Give this Vaccine sections on p. M-428 and Storage and Preparation and Patient Education sections on p. M-430. Please read the new packet to get familiar with all the changes. A summary of the important changes: New Recommendation: A single Tdap dose may be given regardless of previous Td interval. Adults 65 years of age and older may receive a single dose of Tdap. Children 7-10 years of age may receive a single dose of Tdap, if they have an incomplete DTaP series and are not contraindicated to receive pertussis vaccine. New Recommendation: A booster Menactra dose for all teens years who receive their first dose between years of age; no booster for teens who receive their first dose on or after 16 years of age. In addition, for children 2 years through 10 years old who are at increased risk for meningococcal disease (includes children with terminal complement disorders, asplenia or HIV), give two doses of Menactra. The minimum interval for all ages is 8 weeks. New Recommendation: Prevnar13 replaces Prevnar7 using the same vaccination schedule as Prevnar7. In addition, a single supplemental dose of Prevnar13 is given to children 14 months through 59 months who have not received any Prevnar13. New Recommendation: Gardasil may be given to boys 9 to 18 years old, 3 dose series. New Recommendation: The last dose of polio (IPV) vaccine must be given on or after the 4 th birthday and at least 6 months after the previous dose. New Recommendation: Pneumovax23 is given to all Alaska Native adults age 50 years or older who have not received previous Pneumovax23, with a single booster for all at age 65 years or older, if at least 5 years have passed since the previous dose. New Vaccine: Live Attenuated Influenza Vaccine (LAIV) FluMist for healthy non-pregnant people 2 years though 49 years of age, administered by intranasal route. If you are not familiar with intranasal administration, contact your CHAP Instructor or go to the Immunization Update page on the CHAP Program website at and view the Nasal Spray Administration Illustration. Expanded Age: Influenza vaccine is recommended for all 6 month olds and older. Removed Procedure: What do you use for birth control? was removed on p. M-49.

2 Revised Procedure: Keep patient in clinic for 20 minutes to watch for severe allergic reaction, p. M- 49, M-50, and M-430. Remember to have teens sit or lay down to prevent fainting after vaccination. Updated Table 3A and 3B: Divided into two age groups, p. M-55 and M Table 3A: Standard Childhood Vaccine Schedule Birth through 6 Years Old. - Table 3B: Standard Childhood Vaccine Schedule 7 Years through 18 Years Old. - Footnotes updated (M-56): Superscripts refer to information in Tables 3A and 3B. Updated Table 7: Standard Influenza Vaccine Schedule Age 6 Months & Older, p. M-59. Additional Information: Program Support and Internet Resources, p. M-64. Please find enclosed: 1. Pages M-47 to M-64, Immunizations Chapter (Revision 6/11 as a booklet) 2. Pages M-428 to M-430, Tdap/Td Section as single pages, pre-cut to tape-in. There are no changes on p. M-429 but now the entire section will have a Revision 6/11 date in the header. If you have any questions about any of the new recommendations, contact your CHAP Director, local Public Health Nurse, Dr. Ros Singleton or Tania Smallenberg of the ANTHC Immunization Program: Rosalyn Singleton MD ris2@cdc.gov Tania Smallenberg BSN tlsmallenberg@anthc.org Please review these instructions and make these changes as soon as possible: Updated Immunizations Chapter, p. M-47 to M-64. To add this chapter, open your CHAM Medicine Handbook to p. M-47 and remove the Immunizations Chapter (Revision 12/07) and discard. Use the metal rings to attach your new Immunizations Chapter (Revision 6/11). Revised Tdap/Td Section p. M-428 to M-430. Place these pages directly on the corresponding page of your 2006 CHAM Medicine Handbook. These updated pages have been cut so they can be taped directly onto the page while avoiding the spiral binding. We recommend you use regular tape to put the new pages in place. If you have any questions about how to add these revisions to your CHAM Medicine Handbook or need additional metal rings, please contact Shae Aliu ( , saliu@anthc.org) for assistance. This update is referred to as Revisions to 2006 CHAM-June 2011 packet and is available at the CHAP website, Thank you for taking the time to make these revisions in your CHAM to bring it up to date. If you have any other questions or concerns that have not been identified, you may contact this office or go to and find the 2006 CHAM User Comment Sheet to provide feedback. Thank you very much to Tania Smallenberg, BSN; Dr. Rosalyn Singleton; Jean Rounds-Riley, PA-C, CHAP Instructor/Provider; Ella Gonzalez, Program Administrator (all from ANTHC); Gina Carpenter, RN, former BBAHC Regional Immunization Coordinator; and Kathleen Stanton, BSN, YKHC Regional Immunization Coordinator. Your hard work is appreciated. Sincerely, Victorie Heart, MS, RN, Director, CHAP/Rural Health Community Health Aide Program Alaska Native Tribal Health Consortium Enclosure: Revisions to 2006 CHAM-June 2011 Packet

3 REVISION 6/11 Introduction to Vaccines IMMUNIZATIONS Immunizations Chapter Contents: page Introduction to Vaccines M-47 Vaccine Storage and Handling M-48 Giving Immunizations M-49 History and Exam M-49 Vaccine Tables Definition of Important Terms M-50 Vaccine Information M-50 Recommended and Minimum Ages and Intervals M-54 Standard Childhood Vaccine Schedule Birth through 6 Years Old M-55 Standard Childhood Vaccine Schedule 7 Years through 18 Years Old.... M-56 Vaccines for Older Children and Adults.... M-57 Catch-Up Schedule for Children Age 4 Months Through 6 Years M-58 Catch-Up Schedule for Children Age 7 Years Through 18 Years M-59 Standard Influenza Vaccine Schedule Age 6 Months and Older M-59 Alaska School and Child Care Center Vaccine Requirements M-60 Vaccine Abbreviations, Brand Names and RPMS Codes M-60 Refrigerator Log Sample M-61 Program Support and Internet Resources..... M-64 Introduction to Vaccines Why We Need Vaccines Vaccines are responsible for the control of many infectious diseases that were once common in this country. Vaccines have reduced and, in some cases, eliminated many diseases that once routinely killed or hed tens of thousands of infants, children and adults. In the United States before vaccines: Polio permanently paralyzed 10,000 children. Hib meningitis struck 15,000 children, leaving many dead or with permanent brain damage. Measles infected 400,000 children every year before vaccine, killing 1 of every 3,000 children infected. Pertussis (whooping cough) killed 8,000 children. Rubella (German measles) caused birth defects in 20,000 newborns. Vaccines have dramatically reduced the number of childhood infections. Today there are no cases of polio; only about 5 cases of birth defects from rubella; and less than 100 cases of Hib meningitis in the United States per year. Because vaccines have nearly eliminated many diseases, some parents wonder whether vaccines are still necessary. The answer is YES. Vaccines are needed because: Some diseases (such as polio) no longer seen in the USA, are still common in other parts of the world. Some diseases (such as whooping cough and measles) still cause outbreaks. If immunization rates drop, these diseases could cause epidemics. In 2010, 10 infants, died during a whooping cough epidemic in California. How Vaccines Work Vaccines contain part of a killed or a weakened germ which cause an immune system to make antibodies against the real germ. After getting a vaccine, a person is immunized or protected from the disease. Then, if we are ever exposed to the real germ, our immune system is better prepared to produce more antibodies to fight against the real germ. Vaccines contain weakened or killed versions of viruses or bacteria that stimulate our immune system to fight off the disease. An example of immunization: James and Robert are both 4 years old. James got measles vaccine when he was one year old, but Robert never got the measles vaccine. Another child from their village came down with measles, which is very contagious. One week later, Robert got symptoms of measles (a runny nose, fever, rash) and developed pneumonia requiring hospitalization. James never caught measles, because the measles vaccine helped his immune system produce antibodies to protect him against this disease. Vaccine Safety Are vaccines safe? Yes. The most common side effects are swelling and tenderness at the injection site and fever. Serious allergic reactions occur in about 1 or 2 people per million. Are there too many vaccines, too soon? A baby s immune system can handle multiple vaccines with weakened or killed germs. Delaying immunization means leaving a child at risk for serious disease. Does the benefit of vaccines outweigh the risk? If you choose not to vaccinate, you risk infection with diseases that vaccines can prevent. M-47 IMMUNIZATIONS

4 M-48 IMMUNIZATIONS Vaccine Storage and Handling REVISION 6/11 Risk of Disease Hib Disease before vaccine: 1 in 200 children developed Hib meningitis or other Hib infections. 1/3 of these children suffered permanent brain damage. 1 in 20 of these children died. Measles before vaccine: 400,000 cases a year. 1 in 20 children had pneumonia. 1 in 2,000 suffered brain encephalitis. 1 in 3,000 died. Compare the Risks The Health Aide s Role Risk of Vaccine Hib vaccine: Very well tolerated. 1 in 20 children will have a low fever. 1 in a million children have a severe allergic reaction. MMR vaccine: 1 in 100,000 have low platelets which can cause a bleeding tendency. 1 in a million children have a severe allergic reaction. Vaccines can only work if they are given before a person is exposed to the disease. The Health Aide can make sure children and adults get vaccines on time by: Helping the Public Health Nurse (PHN) and/ or Immunization Program keep track of every child in the village. Vaccinating children routinely in between PHN visits to keep children on time. Explaining the importance of vaccines to parents. Vaccine Supply The State of Alaska: The State uses the Vaccines For Children (VFC) Program to fund vaccines given to children from birth through 18 years of age. Some vaccines are limited to children who meet 1 of the following VFC criteria: American Indian/Alaska Native (AI/AN) Medicaid eligible Uninsured Underinsured Ask your local immunization coordinator to learn more about VFC vaccine. As of January 2011, the State no longer provides any vaccine for people 19 years and older. Adult vaccines may be provided by your Tribal Health Organization or private clinic. Vaccine Storage and Handling Vaccine Storage Recommendations NEVER store vaccines or medicines in the door of the refrigerator. NEVER store food or drinks in the refrigerator with vaccines. Check expiration dates every week. Move vaccines with closest expiration date to the front, so they will be used first. NEVER use vaccines that have expired. Remove expired vaccine from the refrigerator. Send expired vaccine back to your Immunization Program or phacy. Keep refrigerator temperature within normal range, between 35 F and 46 F (2 C and 8 C). Keep freezer temperature at 5 F (-15 C) or colder. Varicella is the only vaccine stored in the freezer. Check and record refrigerator temperature 2 times a day even if a continuous recorder is used. If temperature is outside of normal range: Call your Immunization Program or phacist immediately. Use State of Alaska Temperature Log Sheet (p. M-61) or similar locally approved form. Dealing with Vaccine Storage Problems If vaccine thaws or the refrigerator temperature goes outside normal temperature range: Call your Immunization Program or phacist. Explain what happened. Follow the instructions given to you. If power goes out in clinic: Call your Immunization Program or phacist for instructions. Find another refrigerator that is still working, like at the school. Prepare to move vaccine to that refrigerator. If power goes out for the whole village: Do not move vaccine. Keep the refrigerator doors closed. Call your Immunization Program or phacist for instructions. Have the following information: How long power has been out. Highest temperature in refrigerator. Shipping and Receiving Vaccines Vaccines should be shipped in: The original package. Insulated containers with a freeze monitor. On arrival, vaccines should immediately be put in refrigerator or freezer as appropriate. Check temperature monitoring device in the shipping container. If out of range temperature, notify your Immunization Program or phacy.

5 REVISION 6/11 Giving Immunizations IMMUNIZATIONS M-49 Giving Immunizations Decide Which Immunizations to Give Check which immunizations are due. Look at: Table 1: Vaccine Information, p. M-50. Table 2: Recommended and Minimum Ages and Intervals Between Vaccine Doses, p. M-54. Tables 3A and 3B: Standard Childhood Vaccine Schedules, p. M-55 to M-56. Table 4: Vaccines for Older Children and Adults, p. M-57. If you have questions, talk to your referral doctor, PHN or Immunization Program. There are also tables for: Children and Adolescents Who Start Late. Catch-Up Schedule for Children Age 4 Months Through 6 Years (Table 5, p. M-58). Catch-Up Schedule for Children Age 7 Years Through 18 Years (Table 6, p. M-59). Standard Infl uenza Vaccine (Table 7, p. M-59). Alaska School and Child Care Center Vaccine Requirements (Table 8, p. M-60). Have patient/parent read Vaccine Information Statement (VIS) for EACH vaccine to be given. Tell patient/parent about: Common side effects. Reasons to come back to the clinic. Document on Patient Encounter Form (PEF) the publication date of the VIS (found on the bottom of the VIS) and that it was reviewed with patient/parent. Do History and Exam Below Record History, Exam and Immunizations on Patient Encounter Form (PEF). 1. History: Ask these screening questions. [If a child, ask parent:] If any YES answers, talk to referral doctor, PHN, or Immunization Program BEFORE giving vaccines. Are you sick today? Do you have allergies to medicine, food, or any vaccine? [If yes, what?] Have you had a serious reaction to a vaccine in the past? [If yes, what?] Have you received any vaccinations in the past 4 weeks? [If yes, what?] Have you ever had a seizure? [If yes:] When was last seizure? Do you have cancer, leukemia, HIV, AIDS, or any other immune system problem? Do you take: Cortisone, Prednisone, other steroids? Medicine for rheumatoid arthritis? Anti-cancer drugs? Have you had x-ray treatment for cancer in the past 3 months? During the past year, have you: Received a transfusion of blood or blood products? [If yes, when?] Been given a medicine called immune (gamma) globulin? [If yes, when?] [If a woman:] Are you pregnant? [If no:] Is there a chance you could become pregnant during the next month? 2. Exam: Record on PEF. Temperature. If more than 101 F, talk with referral doctor before giving any immunization. If an infant younger than 3 months with fever F rectal or higher, NOW Go to p. 145, Young Child Who May Be Sick. This may be a Very Sick Child. Weight. 3. Review Vaccine Information Table, p. M-50, for possible contraindications. If any contraindications, do NOT give vaccines. Report to your referral doctor, PHN or Immunization Program. 4. Review Recommended and Minimum Ages and Intervals Between Vaccine Doses table (p. M-54) to ensure immunizations can be given. Give the Immunizations 1. Check vaccine name and expiration date. 2. Drawing up and injecting vaccine: Draw up the correct amount. Draw up entire volume of single dose vial. Use correct syringe: 1ml or 3ml. Use correct needle length and size: IM: 1 inch, 23 or 25 gauge. SQ: 5 /8 inch, 25 gauge. Inject in correct location with correct technique (see p. M-29, M-30 and M-33). NEVER give an immunization in the buttocks (hip). 3. Document vaccines you give on: PEF. Patient s State of Alaska Immunization Card. In RPMS or send in PEF for data entry. 4. For each vaccine you give, document: Patient s name. Patient s date of birth or age. Date vaccine given. Name of vaccine and manufacturer. Lot number of vaccine. Route of vaccine and amount. Injection site of vaccine Vaccine Information Statement (VIS) date. Your signature as vaccine provider. 5. Keep patient in clinic for 20 minutes to watch for severe allergic reaction. If severe allergic reaction (shortness of breath, wheezing, severe swelling, shock, hives): Go to p. 77, Emergency 21: Severe Allergic Reaction. continues IMMUNIZATIONS

6 M-50 IMMUNIZATIONS Vaccine Information REVISION 6/11 6. For all vaccines given, tell patient/parent to call Any reactions occur that are listed under the or come back to clinic if: What if there is a severe reaction on the Vaccine Any reactions occur that are listed under Information Statements (VIS). Patients should take Side Effects Call clinic if on Table 1: Vaccine the VIS home as a guide in case of a serious side effect. Information (p. M-50 to M-53). Moderate or severe illness Definition of Important Terms Term Signs and Symptoms Time Frame What Needs to be Done? Fever (after vaccination) Normal Ranges: Oral: 96.4 to 99.4 F Rectal: 97.4 to F Local Adverse Reaction (occurs at injection site) Systemic Adverse Reaction (whole body reaction) Severe Allergic Reaction (anaphylaxis) More than a mild illness (ie: low fever, colds, mild ear infections are mild illnesses). Low fever is a temperature that is less than 3 above normal range. High fever is a temperature that is 3 or more above normal range. Pain, ache, soreness, redness, swelling located at site of injection. Rash after vaccination with live vaccines, Varicella or MMR. Sudden hives, weak, severe swelling of face or tongue, wheezing, shortness of breath, chest tightness. Assess for moderate or severe illness BEFORE vaccination. Fever can occur hours after vaccines, lasting 1-2 days. Live vaccines cause fevers 1-3 weeks after vaccination. Occur within hours of vaccination, lasting 1 to 2 days. Rashes typically occur 1 to 3 weeks after vaccination. Within minutes or few hours of vaccination. Monitor all patients for 20 minutes after shots. Do not give vaccines today, have the patient return when feeling better. Low fevers after vaccination are common. Instruct on care of fever. High fevers need to be monitored; instruct patient to call clinic if high fever. Local reactions after vaccination are common, ensure there are no signs of infection. Rash from MMR is not contagious. Rash after Varicella vaccine is rarely contagious; instruct patient to stay away from persons who are at risk for chickenpox until rash disappears. NOW Go to p. 77, Emergency 21: Severe Allergic Reaction. Immunizations Table 1: Vaccine Information (goes from p. M-50 to M-53) Vaccine What it Prevents DTaP (diphtheria, tetanus, pertussis) Infanrix Pediarix = DTaP + IPV + Hepatitis B (formerly used DTP) DT (pediatric tetanus, diphtheria) Diphtheria throat infection which can cause suffocation and death. Tetanus lockjaw Muscle spasm from a bacteria in the soil and can cause death. Pertussis whooping cough Can cause breathing trouble, pneumonia, seizures and death. Diphtheria Tetanus See DTaP for the description of these diseases. Who Needs this Vaccine? All children younger than 7 years. Children younger than 7 years who can not receive DTaP. Do NOT give IF: (Contraindications) (anaphylaxis) in past with DTP, DTaP or DT. Moderate/severe illness. Reaction to prior DTP or DTaP: Fever 105 F or higher. Crying longer than 3 hours. Collapse, shock. Seizure. Encephalopathy (brain disorder) within 7 days after DTP or DTaP. Guillain-Barre (nerve disorder) within 6 weeks after DTaP, DTP or DT. or Guillian-Barre (nerve disorder) after DTaP, DTP or DT. Moderate/severe illness. Side Effects Patient Information Fever. Fussiness. Local Soreness* Local Redness* Local Swelling* Seizure. High fever. Crying longer than 3 hours. Pale or limp. Allergic reaction (hives, short of breath). *Common after 4th or 5th DTaP dose. See list for DTaP. continues

7 REVISION 6/11 Vaccine Information IMMUNIZATIONS Immunizations Table 1: Vaccine Information (continued) Vaccine Td (adult tetanus, diphtheria) NOTE:Tdap replaces one dose of Td, unless Tdap is contraindicated. Tdap (adult tetanus and diphtheria with pertussis) Boostrix Adacel NOTE:Tdap replaces one dose of Td, unless Tdap is contraindicated. NOTE:You may give Tdap regardless of interval of last Td. IPV (killed inactivated polio) Pediarix = DTaP + IPV + Hepatitis B Hib (Haemophilus influenza type b) PedvaxHIB Comvax = PedvaxHIB + Hepatitis B HibTITER Hepatitis A HAVRI Vaqta What it Prevents Diphtheria Tetanus See DTaP for the description of these two diseases. See DTaP. Polio A virus that causes paralysis, trouble breathing and death. Hib A bacteria that causes meningitis, blood infection, pneumonia, any of which may cause death. Hepatitis A A very contagious virus spread by contaminated food and water, that causes acute liver infection, rarely liver failure. Who Needs this Vaccine? Persons 7 years and older who are contraindicated to receive Tdap. (see Do NOT give IF contraindications list for Tdap below) All persons 11 years through 64 years old due for a Td booster with no history of previous Tdap. Postpartum women who have not had Tdap vaccine, regardless of when they last had Td vaccine. Persons 65 years old and older in contact wtih infants. Any persons 7-10 years old with incomplete childhood DTaP. All children 18 years and younger. All children younger than 5 years. All children 12 months through 18 years. High risk adults: Hepatitis B or C carrier. Liver disease. Homosexual male. IV drug user. Do NOT give IF: (Contraindications) to DTaP, DTP, DT or Td. Moderate/severe illness. Guillain-Barre (nerve disorder) within 6 weeks after DTP, DT, DTaP, Tdap or Td. to DTaP, DTP, DT or Td. Moderate/severe illness. Pregnant. Encephalopathy (brain disorder) within 7 days after DTP or DTaP. Guillain-Barre (nerve disorder) within 6 weeks after DTP, DT, DTaP, Tdap or Td. to IPV, neomycin, streptomycin or polymixin B. Moderate/severe illness. (If using Pediarix, do NOT give if DTaP or Hep B is contraindicated.) to Hib vaccine. Moderate/severe illness. to Hepatitis A vaccine or alum. Moderate/severe illness. Previous Hepatitis A infection or blood test that indicates previous Hepatitis A infection. Side Effects Patient Information Fever. Local Soreness/Ache. Local Redness. Local Swelling. Fever. Local Soreness/Ache. Local Redness. Local Swelling. Headache. Nausea. Local Soreness. Fever. Local Soreness/Ache. Local Redness. Local Swelling. Local Soreness. Local Swelling. Headache. Nausea. continues M-51 IMMUNIZATIONS

8 M-52 IMMUNIZATIONS Vaccine Information REVISION 6/11 Immunizations Table 1: Vaccine Information (continued) Vaccine Hepatitis B RecombivaxHB Engerix B Pediarix = DTaP + IPV + Hepatitis B Comvax = PedvaxHIB + Hepatitis B MMR (measles, mumps and rubella) What it Prevents Hepatitis B A virus spread by blood, sex, or body fluids, that causes chronic liver infection. It can lead to liver cancer and death. Measles A very contagious virus that causes rash, pneumonia, rarely brain infections. Mumps A virus that causes swollen glands and meningitis. Rubella German measles A virus that causes mild rash; birth defects. Who Needs this Vaccine? All children at birth through 18 years of age. All persons who have not had Hepatitis B infection. All children 12 months through 18 years. Non-immune women of childbearing age. Health care workers with blood test indicating no previous measles, mumps or rubella immunity. Do NOT give IF: (Contraindications) to Hepatitis B vaccine or yeast. Moderate/severe illness. Previous Hepatitis B infection or blood test that indicates previous Hepatitis B infection. to MMR, MR, measles vaccines, neomycin or gelatin. Moderate/severe illness. Recent blood product or Immune Globulin (IG, HBIG, etc.). Immune deficiency. Pregnant. History of low platlets (thrombocytopenia). Side Effects Patient Information Fever. Local Soreness/Ache. Local Redness. Local Swelling. Fever or mild rash 1 to 2 weeks after vaccination. Joint pain or stiffness (rare). Swelling of glands in cheeks or neck (rare). Pneumococcal conjugate (PCV13) Prevnar Pneumococcus A bacteria that causes blood infections, pneumonia, and meningitis, any of which may cause death. All children younger than 5 years. Children 2 years old and older with high risk conditions may also need Pneumovax, consult with referral doctor. to Pneumococcal vaccine: Prevnar Pneumovax Moderate/severe illness. Fever. Local Soreness/Ache. Local Redness. Local Swelling. Fussiness. Varicella (chickenpox) Varivax Chickenpox A virus that causes fever and rash, sometimes pneumonia, rarely brain infections. All children 12 months through 18 years old who have not had a documented case of chickenpox. Health care workers with blood test indicating no previous chickenpox infection. to Varicella vaccine, neomycin or gelatin. Immune deficiency. Moderate/severe illness. Pregnant. Recent blood products or Immune Globulin. Fever or mild rash 1 to 4 weeks after vaccination. Meningococcal Conjugate Menactra Meningococcus A bacteria that causes severe blood infection or meningitis, any of which may cause death. All children 11 years through 18 years old. High risk children 2 years through 10 years old who have terminal complement disorder, asplenia or HIV (consult doctor). to Meningococcal vaccines or diphtheria containing (DTaP, DT, Tdap or Td) vaccines. Moderate or severe illness. History of Guillain- Barre (nerve disorder). Fever. Local Soreness/Ache. Local Redness. continues

9 REVISION 6/11 Vaccine Information IMMUNIZATIONS M-53 Immunizations Table 1: Vaccine Information (continued) Vaccine Influenza (flu) TIV = Trivalent Inactivated Influenza Vaccine (injectable) LAIV= Live Attenuated Influenza Vaccine (intranasal) See Table 7 on p. M-59 for more details. Pneumococcal polysaccharide (Pneumo-PS) Pneumovax Rotavirus RotaTeq Human Papillomavirus (HPV) Gardasil What it Prevents Influenza A virus that causes winter outbreaks of sore throat, fever, cough, and pneumonia. Influenza can lead to death in the very young, the frail and the elderly. Pneumococcus A bacteria that causes blood infections, pneumonia and meningitis, any of which may cause death. Rotavirus A virus that is the most common cause of mild to severe diarrhea and vomiting. Human Papillomavirus A virus that causes warts, genital warts and cervical cancer. NOTE: Women need PAP Smears even if vaccinated. Who Needs this Vaccine? All people 6 months of age and older. Refer to Table 7 (p. M-59) for list of priority groups in event of a fl u vaccine shortage and other recommendations of Influenza vaccine. All AI/AN persons 50 years and older without previous dose. Single booster for all persons 65 years and older. Persons 2 years and older with: chronic heart, lung, kidney, liver disease; diabetes; alcoholism; spinal fluid leak; immune deficient; asplenia; cochlear implant; smokers; adult asthma. All children 6 weeks through 8 months (and 0 days) old. First dose is given between 6 weeks through 14 weeks old. DO NOT start series if 15 weeks or older. DO NOT give if 8 months or older. Females and males age 9 years through 18 years old (licensed for 9 years through 26 years). Given routinely at 11 years to12 years with a catch up through 18 years of age. Do NOT give IF: (Contraindications) to Influenza vaccine or eggs. Moderate or severe illness. Guillain-Barre (nerve disorder) within 6 weeks after previous Influenza vaccine. Do NOT give FluMist (LAIV) IF: Less than 2 years old. Older than 49 years. Pregnant. Any chronic disease. Immune deficiency. Asthma. Wheezing in past year. to Pneumococcal vaccine. Moderate or severe illness. to Rotavirus vaccine. Moderate or severe illness. Immune deficiency. Chronic intestinal disease. Hx. of intussusception. Moderate to severe stomach or intestinal illness (gastroenteritis). to HPV vaccine or yeast. Pregnant. DO NOT give Statesupplied Gardasil to women 19 yrs through 26 yrs old. Side Effects Patient Information Fever. Local Soreness. Local Redness. Local Swelling. Muscle aches. Malaise. (You can NOT get the flu from Influenza vaccine.) Fever. Local Soreness/Ache. Local Swelling. Mild diarrhea. Vomiting. Fever. Local Soreness/Ache. Local Swelling. Local Redness. Fever. IMMUNIZATIONS

10 M-54 IMMUNIZATIONS Age and Intervals for Vaccine Doses REVISION 6/11 Table 2: Recommended and Minimum Ages and Intervals Between Vaccine Doses Vaccine And Dose Number Recommended Age For Dose Minimum Age For Dose Recommended Interval to Next Dose Minimum Interval to Next Dose Hepatitis B #1 (RecombivaxHB ) Birth Birth 6 weeks 4 weeks Hepatitis B #2 (Pediarix ) 6 weeks to 2 months 6 weeks 2 months (AND min. 16 weeks from dose 1) 4 weeks Hepatitis B #3 (Pediarix ) 4 months 10 weeks 2 months to 17 months -- Hepatitis B #4 (Pediarix ) 6 months to 18 months 24 weeks DTaP #1 (Pediarix ) 2 months 6 weeks 2 months 4 weeks DTaP #2 (Pediarix ) 4 months 10 weeks 2 months 4 weeks DTaP #3 (Pediarix ) 6 months 14 weeks 6 months to 12 months 6 months DTaP #4 (Infanrix ) 15 months to 18 months 12 months 3 years 6 months DTaP #5 (Infanrix ) 4 years to 6 years 4 years Hib #1 (PedvaxHIB ) 2 months 6 weeks 2 months 4 weeks Hib #2 (PedvaxHIB ) 4 months 10 weeks 8 months 8weeks Hib #3 (PedvaxHIB ) 12 months to 15 months 12 months IPV #1 (Pediarix ) 2 months 6 weeks 2 months 4 weeks IPV #2 (Pediarix ) 4 months 10 weeks 2 months to 14 months 4 weeks IPV #3 (Pediarix ) 6 months to 18 months 14 weeks 3 years to 5 years 6 months IPV #4 (NOT Pediarix ) 4 years to 6 years 4 years PCV13 #1 (Prevnar ) 2 months 6 weeks 2 months 4 weeks PCV13 #2 (Prevnar ) 4 months 10 weeks 2 months 4 weeks PCV13 #3 (Prevnar ) 6 months 14 weeks 6 months 8 weeks PCV13 #4 (Prevnar ) 12 months to 15 months 12 months MMR #1 12 months to 15 months 12 months 3 years to 5 years 4 weeks MMR #2 4 years to 6 years 13 months Varicella #1 12 months to 15 months 12 months 3 years to 5 years 3 months Varicella #2 4 years to 6 years 15 months Hepatitis A #1 15 months or older 12 months 6 months to 18 months 6 months Hepatitis A #2 2 years or older 18 months Influenza, Inactivated Injectable (TIV) Influenza, Live Attentuated Intranasal (LAIV) TIV: 6 months LAIV: 2 years 4 weeks 4 weeks 2nd dose is only needed if younger than 9 years. Two doses at least 1 month apart is recommended for children age 6 months through 8 years receiving flu vaccine for the first time. Two doses the second year if only one dose was given the first year of flu vaccination. Pneumo PS #1 (Pneumovax ) 50 years for AI/AN 2 years 5 years 5 years Pneumo PS #2 (Pneumovax ) years Rotavirus #1 (RotaTeq ) 2 months 6 weeks 2 months 4 weeks (between 6 wks-14 wks old) (max. age: 14 wks) Rotavirus #2 (RotaTeq ) 4 months 10 weeks 2 months 4 weeks Rotavirus #3 (RotaTeq ) 6 months 14 weeks (max age: 8 months, 0 days) HPV #1 (Gardasil ) years 9 years 2 months 4 weeks HPV #2 (Gardasil ) years (+2 mos) 109 months 4 months 12 weeks HPV #3 (Gardasil ) years (+6 mos) 114 months -- --

11 REVISION 6/11 Childhood Vaccine Schedule Birth through 6 Years Old IMMUNIZATIONS M-55 Immunizations Table 3A: Standard Childhood Vaccine Schedule Birth through 6 Years Old Use this schedule for Well Child Visit or Routine Care (for information about each vaccine, Go to p. M-50, Table 1, Vaccine Information) NOTE: Superscript numbers (ex: 4 ) indicate important footnotes on p. M-56, please read. If you have questions, report to your referral doctor, PHN or Immunization Program. Vaccine Hepatitis B (RecombivaxHB at birth) DTaP (for ages 6 wks through 6 yrs) (diphtheria, tetanus, pertussis) Use DT if DTaP should not be given (contraindicated). IPV (killed inactivated polio) Hib (Haemophilus influenza B) Pneumococcal conjugate (PCV13) Rotavirus 2 ml Oral MMR (measles, mumps and rubella) Varicella (chickenpox) Dose, Route, Site, Needle thigh thigh, 0.5ml IM/SQ thigh, 1"needle (IM) 5/8" needle (SQ) thigh thigh 0.5 ml SQ thigh, 5/8" needle 0.5 ml SQ thigh, 5/8" needle Hepatitis A thigh, Meningococcal conjugate thigh, Influenza (injectable TIV or intranasal LAIV) See Table 7 (p. M-59) Birth 1 Hep B 6 weeks to 2 months 1 4 months 6 months 12 months 15 months 2 Pediarix (DTaP/HepB/IPV) 0.5ml IM Pediarix (DTaP/HepB/IPV) 0.5ml IM 3 Pediarix (DTaP/HepB/IPV) 0.5ml IM PedvaxHib PedvaxHib PedvaxHib Prevnar Prevnar 8 RotaTeq RotaTeq RotaTeq DTaP 2 years 4 to 6 years Infanrix 4 DTaP Infanrix 6 IPV Prevnar Prevnar (one supplemental PCV13 dose for 14 to month olds with no previous PCV13) 9 MMR 9 MMR 9 Varivax Varivax 10 Hepatitis A Hep A 12 Menactra High risk group only TIV MINIMUM AGE 6 months: Given yearly, 6 months and older 11 LAIV MINIMUM AGE 2 years: FluMist is given to non-pregnant healthy people 2 years to 49 years old; see footnote for more details. 11 IMMUNIZATIONS

12 M-56 IMMUNIZATIONS Childhood Vaccine Schedule 7 Years through 18 Years Old REVISION 6/11 Immunizations Table 3B: Standard Childhood Vaccine Schedule 7 Years through 18 Years Old Use this schedule for Well Child Visit or Routine Care (for information about each vaccine, Go to p. M-50, Table 1, Vaccine Information) NOTE: Superscript numbers (ex: 4 ) indicate important footnotes below, please read. If you have questions, report to your referral doctor, PHN or Immunization Program. Vaccine Tdap (for ages 10 yrs to 64 yrs) (diphtheria, tetanus, pertussis) Use Td (for ages 7 yrs & older) if Tdap is contraindicated. Dose, Route, Needle Series Description 7 to 8 years 9 to 10 years 11 to 18 years One dose. Given routinely between 11 years to 12 years old. Use Tdap only if incomplete DTaP series in childhood. (see Table 6, p. M-59) Use Td if Tdap is contraindicated 5 Tdap Boostrix or Adacel Use Td if Tdap is contraindicated. Meningococcal conjugate HPV (human papillomavirus) Two doses. 12 First dose given routinely at 11 years to 12 years old. Three doses. Females (may give to males). First dose given routinely between 11 yrs to 12 yrs old, second dose 8 wks later, then third dose in 16 wks. High risk group only Menactra Influenza (injectable or intranasal) see Table 7 (p. M-59) Give yearly Gardasil May begin series at 9 years old but routinely started between 11 years and 12 years old. IMPORTANT NOTE: Ensure all older children have a complete immunization history: 3 Hepatitis B, 5 DTaP, 4 IPV, 2 MMR, 2 Varicella, and 2 Hepatitis A vaccines. If they are missing some of these vaccines, refer to the Catch-Up Schedule for Children Age 7 Years Through 18 Years (p. M-59). FOOTNOTES: 1 All newborns should be given single antigen Hepatitis B shortly after birth. The first DTaP/IPV/Hib/Pneum-conj series must be given at or after 42 days (6 weeks) of age. 2 Pediarix (DTaP, IPV, Hep B) is used for the first 3 doses of DTaP and IPV as well as doses 2, 3, and 4 of Hep B. Do not use Pediarix in children 7 yrs or older. See footnote 4. 3 Final dose of Hep B must be at or after 24 weeks of age, at least 8 weeks from dose 2, and at least 16 wks between dose 1 and dose 3. If Pediarix is given, infants will receive 4 Hep B doses. 4 Do not use Pediarix for DTaP doses 4 or 5. DTaP dose 4 can be given at 12 months of age if at least 6 months since dose 3. Need at least 6 months between DTaP dose 4 and 5. Do not need DTaP dose 5 if dose 4 was given after age 4 yrs. 5 Give Tdap (Td with Pertussis) to 11 yr to 18 yr olds as booster instead of Td, regardless of interval since last Td. Use Td instead of Tdap if Tdap is contraindicated (contraindicated in persons who are pregnant, or history of severe allergy to DTaP or DTP). 6 Single antigen IPV, not Pediarix, must be used for IPV dose 4. IPV dose 4 is given on or after the 4th birthday. Do not need IPV4 if IPV3 was given after age 4 yrs. 7 Pneumo-conj (Prevnar ) dose 4 recommended at or after 12 months of age; must be at least 2 months interval from previous dose. Give single supplemental dose of Prevnar13 to children 14 months to 59 month olds who completed the Prevnar7 series. 8 Rotovirus (RotaTeq ) 3 dose series, routine at 2 mos, 4 mos and 6 mos of age. Minimum interval between all doses is 4 weeks. Dose 1 must be given between 6 wks to 14 wks of age. Don t start series if 15 weeks of age or older. All doses of RotaTeq must be given before 8 months (and 0 days ) of age, don t give any more doses if 8 months old or older. 9 2nd MMR given routinely at 4 yrs to 6 yrs old, but can be given minimum 4 wks interval after dose 1. 2nd Varicella dose given routinely at 4 yrs to 6 yrs old, minimum interval is 3 months but don t repeat dose if given only 4 weeks apart. If live vaccines (MMR, Varicella, FluMist ) and PPD are not given on the same day, these must be separated by a minimum interval of 4 weeks. 10 Hepatitis A vaccine can be given as early as 12 months of age, but is usually given at 15 months. Two doses of Hepatitis A vaccine are needed at least 6 months apart. 11 Influenza (injectable) for all people 6 months old and older. FluMist (live intranasal) should not be given if under 2 years old, older than 49 years, received a live vaccine in the past 4 weeks, pregnant, has chronic disease, has weak immune system, asthma or (in children under 5 years old) wheezing in past 12 months. Two doses at least 1 month apart is recommended for children aged 6 months through 8 years receiving flu vaccine for the first time (2 doses the second year if child failed to receive 2 doses the previous year.) Otherwise, one dose yearly through adulthood. 12 Meningococcal conjugate (Menactra ): 2 doses. All children 11 yrs through 18 yrs old. If first dose given between 11 yrs through 15 yrs of age, give second dose between16 yrs though 18 yrs of age (minimum 8 weeks between doses). If first dose given at 16 years of age or older, do not give second dose. To high risk children 2 yrs through 10 yrs of age with terminal complement disorder, asplenia or HIV, give 2 doses, 8 weeks apart, with a booster dose every 5 years. 13 HPV (Gardasil ) State-supplied vaccine for 9 yrs to18 yrs old girls and boys. Routine age 11 yrs to 12 yrs with catch-up through 18 yrs old. Second dose given 2 months after dose 1, then third dose is given 4 months after dose 2 (and minimum 6 months between dose 1 and dose 3).

13 REVISION 6/11 Patients 7 years and Older Vaccine Schedule IMMUNIZATIONS M-57 Immunizations Table 4: Vaccines for Older Children and Adults (for Patients 7 years and Older) State vaccine is only for children through 18 years old. Vaccine Hepatitis A HAVRI Vaqta Hepatitis B Engerix B RecombivaxHB Influenza MMR Pneumococcal polysaccharide Pneumovax Tdap Boostrix Adacel or Td NOTE:Tdap replaces one dose of Td, unless Tdap is contraindicated Varicella Varivax Meningococcal Menactra Age 12 months to 18 years 19 years and older Birth to 19 years 20 years and older Dose, Route, Needle 1 ml IM 1"needle 1 ml IM 1"needle see Table 7 (p. M-59) 12 months and older 2 years and older Tdap (10 yrs to 64 yr olds) Td (7 yrs & older) 12 months and older 2 years to 18 years 0.5 ml SQ 5/8" needle 0.5 ml SQ 5/8" needle Schedule (how often) In persons 19 years and older, must do a blood test BEFORE giving vaccine to ensure previous infection has not already occurred. For all ages, the second dose is given 6 months after the first dose. In persons 20 years and older, must do a blood test (see Hep A above). For all ages, give today, then in 1 month, and then 6 mos after dose 1. See Table 6 (p. M-59). 2 doses, at least one month apart. In persons 19 years and older, do a blood test BEFORE giving MMR to ensure no previous immunity. AI/AN persons 50 years or older. One booster for all at 65 years of age & older. High risk persons 2 years and older. Minimum 5 years interval between doses. One dose, Give Tdap regardless of interval from last Td, if no history of previous Tdap. If treating a dirty wound, give Tdap or Td (see p. M-428). Two doses given at minimum 3 months apart (if at least 4 weeks apart, do not repeat dose.) If first dose is given at 11 years to 15 years of age, give a second dose between 16 years and 18 years. If first dose is given after 16 years of age, do not give second dose. Indications (who should get) Hep A vaccine for persons 19 yrs and older is provided by the ANTHC Hepatitis program for adults who have these risk factors: Hepatitis B carrier; Hepatitis C; chronic liver disease; males who have sex with males; IV drug users; receiving clotting factors. Hepatitis B vaccine for adults is provided by the ANTHC Hepatitis program for adults who are unvaccinated or nonimmune against Hepatitis B. Non-immune women of childbearing age. Health care workers with blood test indicating no immunity. High risk persons 2 yrs and older with chronic heart, lung, kidney, or liver disease; diabetes; alcoholism, cirrhosis; spinal fluid leaks; immune deficiency; cochlear implant, smoker, adult asthma. Use Tdap to replace one dose of Td for persons 11 years through 64 years old. UseTdap in persons 65 years and older who are in contact with infants. If contraindicated for Tdap, use Td (see Table 1, p. M-51). Health care workers with no history of previous Tdap. Children who do not have a documented history of chickenpox. Give to all children 11 years through 18 years old (give to high risk children 2 years through 10 years of age with terminal complement disorder, asplenia [no spleen] or HIV). IMMUNIZATIONS Minimum 8 weeks interval between doses.

14 M-58 IMMUNIZATIONS Catch-up Schedule for Childhood Vaccine REVISION 6/11 Children and Adolescents Who Start Late or are More Than One Month Behind Tables 5 and 6 have schedules and minimum intervals between doses for children who have delayed immunizations. There is no need to restart a vaccine series regardless of the time that has elapsed between doses. Use the chart appropriate for the child s age. Immunizations Table 5: Catch-Up Schedule For Children Age 4 Months Through 6 Years NOTE: If you have questions, report to your referral doctor, PHN or Immunization Program. Vaccine and Dose One (Minimum age at which vaccine can be given) Minimum Time (Interval) Between Doses Dose One to Dose Two Dose Two to Dose Three Dose Three to Dose Four Dose Four to Dose Five Hepatitis B (birth) 4 weeks 8 weeks AND need 16 weeks between dose 1 and 3 DTaP (6 weeks) 4 weeks 4 weeks 6 months 6 months IPV (6 weeks) 4 weeks 4 weeks 6 months Final dose at 4 years and older. Rotavirus (6 weeks) Must give first dose between 6 weeks through 14 weeks old. MMR (12 months) Varicella (12 mos) 4 weeks Do not start series if child is 15 weeks of age or older. 4 weeks Routine at 4 yrs to 6 yrs 3 months (if second dose was given at least 4 weeks apart, do not repeat) 4 weeks Do not give any further doses if child is 8 months of age or older. Routine at 4 yrs to 6 yrs Hepatitis A (12 mos) Hib (6 weeks) PedvaxHIB Vaccine is recommended for all children younger than 5 years old. PCV13 (6 weeks) Prevnar Vaccine is recommended for all children younger than 5 years old. 6 months 4 weeks: If 1 st dose given at age younger than 12 months. 8 weeks: Final dose if 1 st dose given at age 12 months to 14 months. No more doses: If first dose given at age 15 months or older. 4 weeks: If 1st dose given at age younger than 12 months and current age is younger than 24 months. 8 weeks: Final dose if 1 st dose given at age 12 months or older or current age 24 months to 59 months. No more doses: If first dose given at age 24 months of age or older. 8 weeks: Final dose if current age 12 months or older and 2 nd dose given at age younger than 15 months. No more doses: If previous dose given at age 15 months or older. 4 weeks: If current age younger than 12 months. 8 weeks: Final dose if current age 12 months or older. No more doses: For healthy children if previous dose given at age 24 months of age or older. 8 weeks: Final dose. This dose is only necessary for children age 12 months to 5 years old who received 3 doses before age 12 months. NOTE: One supplemental PCV13 dose for children 14 months through 59 months old with no previous PCV13.

15 REVISION 6/11 Catch-up Schedule for Childhood Vaccine IMMUNIZATIONS M-59 Immunizations Table 6: Catch-Up Schedule for Children Age 7 Years Through 18 Years NOTE: If you have questions, report to your referral doctor, PHN or Immunization Program. Tdap/Td Vaccine NOTE: These doses are only needed if a child did not receive a complete DTaP childhood series. Minimum Time (Interval) Between Doses Dose One to Dose Two Dose Two to Dose Three 4 weeks 8 weeks: If first dose given at age younger than 12 months. 6 months: If first dose given at 12 months of age or older. Dose Three to Booster Dose 6 months: If 1 st dose given at age younger than 12 months. Use Tdap for one dose only, unless Tdap is contraindicated (see Table 1, p. M-51). IPV 4 weeks 4 weeks 6 months Final dose at 4 years & older. Hepatitis B 4 weeks 8 weeks AND need 16 weeks between dose 1 and 3. Hepatitis A MMR Varicella Meningococcal (see Table 3B, p. M-56 ). HPV (minimum age: 9 yrs) Give Gardasil to females routinely (may give to males) 6 months 4 weeks 3 months (if 2nd dose was given at least 4 wks apart, do not need to repeat). 8 weeks 4 weeks 12 weeks AND need 24 weeks after dose 1. IMMUNIZATIONS Immunizations Table 7: Standard Influenza Vaccine Schedule Age 6 Months and Older Age 6 months through 35 months 36 months through 8 years 9 years or older Adults Dose, Route, Needle 0.25 ml IM thigh How Often 2 doses, 4 weeks apart in the first year to receive flu vaccine (2 doses the second year if only one dose the first year). Then one dose every year. One dose every year. Priority Groups to Receive Flu Vaccine if Vaccine Shortage American Indian and Alaska Native (AI/AN). Children ages 6 months through 18 years. Persons with high risk medical conditions: chronic heart, lung, kidney, and metabolic conditions; asthma; diabetes; hemoglobin disorders; weakened immune system; spleen dysfunction; HIV infection; chronic aspirin therapy; seizure disorder; neuromuscular disease; or spinal cord injury. Persons age 50 years and older. Women who will be pregnant during the flu season. Residents of long-term care facilities. Health care personnel who provide direct patient care. Household contacts and caregivers of children, elderly and anyone with a high risk condition. NOTE: Anyone 6 months and older can receive the flu vaccine; the priority groups are used in the event of a flu vaccine shortage. NOTE: FluMist (Live Attenuated Influenza Vaccine, LAIV) should NOT be given to anyone under 2 years of age, older than 49 years of age, anyone who received a live vaccine within past 4 weeks, is pregnant, has chronic conditions, weak immune system, asthma, or a child under 5 years of age with history of wheezing within the past 12 months.

16 M-60 IMMUNIZATIONS School Vaccine Requirements REVISION 6/11 Immunizations Table 8: Alaska School and Child Care Center Vaccine Requirements Vaccine for These Diseases School Child Care Diphtheria Tetanus Pertussis Polio Measles Mumps Rubella Hepatitis A Hepatitis B Hib Varicella (kindergarden through Grade 6 only) Exemptions may be granted for medical or religious reasons. Immunizations Table 9: Vaccine Abbreviations, Brand Names and RPMS Codes Abbreviations Description Brand Names RPMS Codes DTaP Diphtheria, tetanus, acellular pertussis Infanrix DTaP Tdap Tetanus, diphtheria, acellular pertussis Boostrix, Adacel Tdap Td Tetanus and diphtheria Decavac Td-ADULT Flu; TIV (injectable) LAIV (intranasal) Influenza changes every year FLU-TIV (injectable flu) FLU-TIVpf (preservative free injectable flu) FLU-NASAL (intranasal flu) Hep A Hepatitis A Havrix, Vaqta HEP A 2PED (for peds), HEP A ADLT (for adults) Hep B Hepatitis B RecombivaxHB, Engerix HEP B PED (for peds), HEP B ADLT (for adults) Hib Haemophilus influenza type B PedvaxHib PEDVAHIB IPV Inactivated polio IPV IPV Mening-conj; MCV4 Meningococcal conjugate Menactra MENING-CV4 MMR Measles, mumps and rubella MMR MMR PCV13 Pneumococcal conjugate Prevnar PCV-13 Pneumo PS; PPV23 Pneumococcal polysaccaride Pneumovax23 PNEUMO-PS HPV Human papillomavirus Gardasil HPV-4 Rotavirus Rotavirus RotaTeq ROTA-5 Pediarix DTaP + IPV + Hep B Pediarix PEDIARI Varicella Chickenpox Varivax VARICELLA

17 REVISION 6/11 Refrigerator Log IMMUNIZATIONS M-61 IMMUNIZATIONS

18 M-62 IMMUNIZATIONS Refrigerator Log REVISION 6/11

19 REVISION 6/11 Refrigerator Log-Action Sheet IMMUNIZATIONS M-63 IMMUNIZATIONS

20 M-64 REVISION 6/11 Program Support and Internet Resources Program Support State of Alaska Immunization Program: ANTHC Immunization Program: CHAP Program Immunization Updates: Centers for Disease Control Vaccine Program: Immunization Action Coalition: Internet Resources for CHAP Centers for Disease Control for Providers: Vaccinate Alaska Coalition: You Call the Shots (online education): Shot of Prevention (blog): Children s Hospital of Philadelphia Vaccines: Internet Resources for Parents Vaccinate Your Baby: Parents of Kids with Infectious Diseases: Shot by Shot (Stories of Vaccine Preventable Disease): History of Vaccines: Centers for Disease Control for Parents: American Academy of Pediatrics for Parents: families.html Get The Picture: What to Expect Foundation: Recommended Books Baby 411 by Ari Brown Do Vaccines Cause That by Martin Myers and Diago Pineda Vaccine and Your Child: Separating Fact from Fiction by Paul Offit Autism s False Prophets by Paul Offit Deadly Choices: How the Anti-Vaccine Movement Threatens Us All by Paul Offit