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1 2012 CIC Education Hour: January 24, 2012 Navigating Adolescent Vaccinations through Private and Safety Net Providers Contact Information Claudia Aguiluz, VFC Program Coordinator Maria Volk, Chief, Field Services and Program Coordination Objectives Understand adolescent required and recommended immunizations. Identify which adolescent vaccines are covered by VFC and where to get them. Learn about a successful county partnership that helped meet the 2011 Tdap school mandate.

2 Adolescent Immunization Schedule Updated HPV ACIP Recommendations: ACIP recommends routine vaccination of males aged 11 or 12 years with a 3 dose series of HPV4. The vaccination series can be started beginning at age 9 years. MMWR. December 23, 2011; 60 (50): Updated ACIP Recommendations: Meningococcal Conjugate Vaccine Booster Routine immunization age at years Booster dose recommended at age 16 years for those who received a dose at age 11 through 12 years If vaccinated at age 13 through 15 years, they should receive a one time booster at age 16 through 18 years Note: Recommended for high risk persons 9 months through 55 years.

3 PCV13 Supplemental Dose Don t Forget! A supplemental dose of PCV13 is recommended for all children through the age of 59 months who completed a PCV7 series For high risk children, a supplemental dose of PCV13 is recommended through age 71 months and may be given through age 18 years for those high risk children that completed the PCV7 series. Vaccines for Pre Teens Recommended vs. Required Immunizations Recommended immunizations, as included in ACIP s Adolescent Immunization Schedule, are vaccines that a group of experts (CDC & ACIP) have been reviewed and deemed safe and useful for a particular age group or population; they recommend it for use. Required vaccines are a requirement usually enforced by state laws, such as for child care entry or for school entry, in order to protect the pupil s health.

4 Recommended vs. Required Immunizations Immunization requirements vary from state to state. Recommended immunizations are a set of recommendations, published annually by the Advisory Committee on Immunization Practices (ACIP), for the US. Recommended vs. Required Immunizations Recommended vaccines are no less important than required vaccines. Example: HPV and MCV vaccinations are NOT required for school entry but critical in protecting adolescent s health VFC Program Overview The Vaccines for Children (VFC) Program was created by Congress in 1993 as an entitlement Program designed to help raise childhood immunization levels by providing free vaccines for eligible children. Children who are eligible for VFC vaccines are entitled to receive all pediatric vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP) The program began to operate in October 1, 1994, and it represents an unprecedented approach to improving vaccine availability nationwide by providing vaccine at no cost to VFC eligible children through enrolled public and private providers. The Program is administered at the national level by the Centers for Disease Control and Prevention (CDC) through the National Centers of Immunizations and Respiratory Diseases (NCIRD). In California, the VFC Program is operated by the, Immunization Branch. CDC contracts with vaccine manufacturers to buy vaccines at reduced prices.

5 CA s VFC Program Highlights CA s VFC Program represents approximately 10% of the nation s enrolled providers, distributing over 10M doses of vaccines annually. Eligible population: 48% of California s children 0 18 years of age are eligible to receive VFC vaccines (4.8M) 3.3M are in the 7 18 years of age category Over 4,000 public and private sites are currently enrolled. Types of providers include: Pediatric practices Family practitioners Community and rural health centers Colleges and universities Correctional Youth Facilities Hospitals Women s Health Clinics and Planned Parenthoods VFC Eligibility Children, birth through 18 years of age, who meet at least one of the following criteria are eligible to receive VFC supplied vaccines: Medi Cal eligible: a child who is eligible for the Medi Cal program Uninsured: a child who has no health insurance coverage American Indian or Alaska Native: As defined by the Indian Health Care Improvement Act (25U.S.C. 1603) Underinsured: a child who has commercial (private) health insurance but the coverage does not include vaccines, a child whose insurance covers only selected vaccines (VFC eligible for non covered vaccines only), or a child whose insurance caps vaccine coverage at a certain amount. Once that coverage amount is reached, the child is categorized as underinsured. Underinsured children are eligible to receive VFC vaccines only through a Federally Qualified Health Centers (FQHC) or Rural Health Clinics (RHC)]. Note: Healthy Families Program participants and commercially insured children (private insurance coverage) are NOT eligible to receive VFC vaccines Vaccines Available Through VFC The VFC Program includes all ACIP recommended vaccines New vaccines are quickly incorporated into the program After the negotiation of a federal vaccine price contract An official vote from ACIP and A VFC Resolution CA makes all product, brands and presentations available to enrolled providers.

6 Adolescent Vaccines Covered by VFC All ACIP routinely recommended vaccines, catch up vaccines and vaccines required by special adolescent populations are covered by VFC as long as the patient meets VFCeligibility criteria. VFC Provider Locator Section 317 Immunization Program Vaccine Funding: National 317: Discretionary funding through Section 317 grant funds. This funding allows the State to expand eligibility for vaccines. 317 vaccine funds are made available to states to use according to local needs. The use of 317 varies from state to state, but is generally used for non VFC eligible children in public clinics and limited vaccines for adults.

7 Section 317 Immunization Program Vaccine Funding: National Vaccine targets varied over years: polio, measles, rubella, back to measles Section 317 changed dramatically when VFC started in 1994 with the program emphasis squarely on children Primary use for Section 317 vaccine since 1994 has been to fill structural gap in VFC program: underinsured children outside of FQHC/RHCs and also insured children who need shots for school entry and can t get into their provider. 10-Year Vaccine Purchase Contrast: VFC and Section 317 Programs Changes between 2001 and 2010 Section 317 VFC Vaccine purchase budget $48 M $2,594 M Percent increase in vaccine purchase budget Average annual growth in vaccine purchase budget 24% 423% $5 M $288 M % Change in cost to fully vaccinate a child from 0 through 19 years old during same time: 362% CA Budget Figures: FY 2012 VFC Budget: $500 million 317 Budget: $20 million

8 Vaccine Supplies at LHDs Because the vaccine received from the State comes from a variety of funding sources, the LHD should provide immunizations to anyone who meets the eligibility criteria and presents requesting them at a LHD clinic and then refer them back their provider. (Insured at LHD Policy) The California State Eligibility Table clearly outlines the use of this combined source of vaccine supply among patients seeking services at their clinics. Vaccines ordered by LHDs are paid with a combination of funds: VFC and Section 317 funds. It all happens at the Federal Level. However funding source is invisible upon ordering and upon receiving vaccines. Therefore, LHDs do not need to keep supplies separate, but VFC screening is required. LHDs Vaccine Eligibility Guidelines Vaccine Eligibility Criteria DTaP/DT Children under age 7 years. Hepatitis A Children ages 1 through 18 years. Children through age 18 years. Hepatitis B Adults only if household or sexual contact of HbsAg+ pregnant woman. Children through age 4 years. Hib Older children with high risk conditions as recommended by ACIP. HPV Adolescents 9-18 years. Influenza Refer to current year CDPH Influenza Guidelines Adolescents ages 11 through 18 years. Meningococcal Conjugate Vaccine Ages 2-10 with high risk conditions as recommended by ACIP. 1 st dose Children aged 1 year and older, and adults 1. 2 nd dose Children ages 1 through 18 years. MMR 2 nd dose/additional Dose Adults 19 years and older and born in 1957 or later ONLY if they are: College/university students, or Health care workers. Children under 5 years of age and children 5 years through 18 years Pneumococcal Conjugate Vaccine with high-risk conditions as recommended by ACIP. Children through 18 years of age. Polio (IPV) Adults 19 years and older in high-risk situations as recommended by ACIP. Rotavirus Infants 6 weeks through 8 months of age. Td Clients over 7 years of age only when Tdap is not indicated. Tdap Clients over 7 years of age. Varicella Susceptible children ages 1 year through 18 years. LHDs and AB 354 The Ideal: Adolescents should go to their provider for Tdap, all other recommended vaccines, and other preventive care. Reality 1: Not everyone will go and LHDs will end up immunizing many people at the last minute.

9 LHDs and AB 354 Question: Why shouldn t LHDs do mass vaccination clinics early in the spring to avoid the rush and get everyone immunized. Reality 2: We simply can t afford to immunize a huge number of insured children. Besides we would prefer they go get everything they need, i.e. the Ideal LHDs and AB354 Therefore, LHD Role: Promote the requirement to their providers, encourage adolescents and parents to go to their providers early and get their shots and documentation. And then LHDs should be available as the safety net, for those adolescents who don t have a provider, or can t get into the office to get their Tdap at the last minute. Our Goal The majority of adolescents with providers will go to them and CDPH will be able to support LHDs to immunize those who, for whatever reason, don t go and need to get into school.

10 Our Goal Continue to promote among VFC, and non VFC, providers the importance of vaccinations in the medical home. Assess immunization status of adolescent patients among VFC enrolled providers Develop materials for parents and providers on adolescent immunizations. Market VFC among adolescent providers

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