3/10/2017. Overview N.J.A.C. 8:57-6. Purpose of N.J.A.C. 8:57-6. New Jersey Higher Education Immunization Requirements

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1 N.J.A.C. 8:57-6 New Jersey Higher Education Immunization Requirements Jenish Sudhakaran, MPH Population Assessment Coordinator Vaccine Preventable Disease Program New Jersey Department of Health NJCHA Meeting March 17, 2017 Overview N.J.A.C. 8:57-6 Disease Overview ACIP Recommendations Immunization Requirements Annual College Immunization Status Report Rulemaking Resource Links Purpose of N.J.A.C. 8:57-6 Implement provisions of N.J.S.A. 18A:61D-1 To establish a set of uniform immunization requirements for students entering or attending institutions of higher education Reduce incidence of vaccine preventable diseases in the greater community 1

2 Applicability of 8:57-6 All new or continuing full- and part-time undergraduate and graduate students enrolled in a program of study leading to an academic degree Two-year institutions: New students registered for 12 or more credit hours of course study per semester/term. Two-year institutions and Thomas Edison State Collegeshallnotberequiredtoapplythe meningococcal rule at N.J.A.C. 8: and 6.7. Exemptions Medical Religious Philosophical or moral objections are not accepted in New Jersey Religious Exemption Must explain how immunizing agent(s) conflicts with the student s religious beliefs Meningococcal and Hep B statutes require explanation on how the administration of vaccines conflicts with the student s bona fide religious tenets or practices 2

3 Medical Exemption Indicate specific period of time Reason(s) for medical contraindication must be enumerated by the ACIP Precautions are not contraindications Precaution and Contraindication Precaution Increase the chance or severity of an adverse reaction, or Compromise the ability of the vaccine to produce immunity Contraindication A condition in a recipient that increases the chance of a serious adverse reaction Guide to Vaccine Contraindications and Precautions: Exemptions Institutions may make exemptions for the following students: Born prior to 1957 are not subject to MMR vaccine requirement Do not congregate on campus 31 years of age and older Attended elementary or secondary school in NJ 3

4 Provisional Admission Granted ONLY one time Students may register on a provisional basis for the first term if immunization documents are not available Students must submit immunization documentation before the second term or be reimmunized Hepatitis B allows for a total of 9 months to complete the series. Four-Day Grace Period All doses administered less than or equal to four days before either the specified minimum ageordosespacingintervalshallbecounted as valid Foreign Immunization Record Accept with proper written documentation -SealorStampOR - Signed and dated by physician or healthcare official Match up with U.S. requirements Revaccinate (may be simpler) or do serology (when possible) 4

5 Evidence of Immunizations Official records are acceptable from the following: Schools Public health departments College New Jersey Immunization Information System (NJIIS) Record Military or Armed forces Laboratory Evidence of Immunity Accepted for measles, mumps, rubella, hepatitis B, diphtheria, tetanus, polio and varicella Serology should not be done in lieu of aborting series No reliable serologic test exists for pertussis, Haemophilus influenzae type b, pneumococccus and meningococcus Copy of laboratory test must be in the record Source: General Recommendations on Immunization: Recommendations of the Advisory Committee of Immunization Practices Source: New Jersey Department of Health Vaccine Preventable Disease Program Immunization Requirements Frequently Asked Questions Section on Serology Titers: Disease Overview, ACIP Vaccine Recommendations and Immunization Requirements MEASLES MUMPS RUBELLA MENINGOCOCCAL HEPATITIS B 5

6 Measles, Mumps, Rubella (MMR) Overview Measles virus causes rash, cough, runny nose, eye irritation, and fever Children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications Can cause life-threatening pneumonia and brain inflammation, middle-ear infection, severe diarrhea, and sometimes death Mumps virus causes fever, headache, muscle pain, loss of appetite, and swollen glands Can cause meningitis, deafness, and in rare cases, death Approximately two-fifths of infected people do not have symptoms of mumps Rubella virus causes rash, arthritis (mostly in women), and mild fever 85 out of 100 babies born to mothers who had rubella in the first 3 months of her pregnancy will have a birth defect ACIP Recommendations: MMR Vaccine MMR vaccine is a live virus vaccine licensed for 12 months of age and older Anyone 18 years of age or older and born in 1957 or later: 1 or more doses unless previously vaccinated or had all 3 diseases Routine 2 doses recommended: Students in postsecondary educational institutions Work in a healthcare facility Plan to travel internationally MMR Vaccine Requirement New students in 2 or 4 year institutions: 2 doses of measles 1doseofmumps 1doseofrubella 6

7 Meningococcal Overview At least 13 serogroups Serogroups most often implicated in invasive disease: A,B,C,Y, and W-135 Can produce severe disease or permanent disability, or death if antibiotic therapy is not initiated immediately Case Fatality: ~10% even with appropriate antibiotic therapy ACIP recommends meningococcal vaccine for select individuals to reduce incidence and disease transmission ACIP Recommendations: Meningococcal Vaccines Meningococcal Conjugate Vaccine (MenACWY): licensed for persons aged 9 months 55 years Recommended for adults withcertainriskfactors based on health condition, occupation, or in a high-risk setting First-year college students aged 21 years or younger living in campus dormitory: 1 dose at age 16 years of age and older Meningococcal Polysaccharide Vaccine (MPSV4): approved for adults aged 56 and older who need only 1 dose to provide protection against serogroups A,C, Y, W-135 ACIP Recommendations: Meningococcal Vaccines (2) Serogroup B meningococcal vaccines: Bexsero and Trumenba : approved for anyone 16 through 23 years old to provide short term protection Healthy adolescents and young adults who are not at an increased risk: 2 doses During outbreak: 3 doses (Trumenba ) 7

8 Meningococcal Disease and Meningococcal Vaccine: Required Information Institutions must provide disease and vaccine information Collect students responses No response = No provisional admission VPDP Meningococcal brochure: Meningococcal Vaccine Requirement New students entering a four-year institution and residing in a campus dormitory: 1 dose Hepatitis B Overview Hepatitis B virus can cause liver damage, liver cancer, and death Loss of appetite, tiredness, pain in muscles, joints, and stomach, and jaundice People with lifelong hepatitis B usually show no symptoms Babies can get hepatitis B at birth from their infected mother Infants and young children: 90% chance of developing a life-long, chronic infection Source: Centers for Disease Control and Prevention 8

9 ACIP Recommendation: Hepatitis B Vaccine Recommended for series to begin at birth Series may consist of 3 or 4 doses Alternate 2-dose Hepatitis B formulation approved for children 11 through 15 years of age Recommended for adults with certain risk factors based on health condition, occupation, or lifestyle Hepatitis B Vaccine Requirement Students enrolled in 12 or more hours of course study per semester or term: 3 doses or approved 2 dose formulation Students with no documentation have up to nine months to comply ** Note: 9 months for completion apply only to those who have never been vaccinated and are starting their vaccination series for the first time. All others should follow the minimum interval schedule Other ACIP Recommended Adult Vaccines Influenza Tdap Human Papillomavirus (HPV) Varicella Herpes Zoster (HZV) Pneumococcal Polysaccharide Hepatitis A Haemophilus influenza type b (Hib) 9

10 Figures 1 and 2 should be read with the footnotes that contain important general information and considerations for special populations. Figure 1.Recommended Immunization schedule for adults aged 19years or older by age group, United States, 2017 Vaccine years I years years years 65 years lnfluenza 1 1dose annually Td/Tdap2 MMR 1 Substitute Tdap for Tdonce,then Tdbooster every 1oyrs 1or 2 doses dependingon lndkatlon VAR 4 2doses HZV 5 I 1dose HPV-Female 6 3 doses HPV-Male 6 3doses PCV13 7 1dose PPSV237 1or 2 dosesdepending onlnc:llcnlon 1dose HepA 8 2or3dosesdepending onvkclne Hep8 9 3doses MenACWY or MPSV4 10 1or moreclosesdepandlng onindication MenB 10 2or3closesdepending onvkclne Hib 11 1or 3dosesdepending onlnc:llcnlon age requirement, lack documenta tion of vaccination, or lack evidence of past infection D Recommended for adults with additiona l medical conditions or other indications D No recommendation 2017 ACIP Recommendations 2017 Recommended Immunization Schedules for Childhood, Adolescents and Adults: Updates on the use of influenza, human papillomavirus (HPV), hepatitis B (HBV), and meningococcal vaccines Technical changes to schedule and footnotes Reporting Requirements ANNUAL COLLEGE IMMUNIZATION STATUS REPORT (IMM-3) 10

11 Annual College Immunization Status Report (IMM-3) IMM-3 notifications are sent in November of the respective academic year Accessible under the VPDP forms page at: Reporting time frame is from August through December 31 st (Fall Semester) Due February 1 st of respective academic year N.J.A.C. 8:57-6 Rulemaking BACKGROUND BASIS FOR CHANGE Background N.J.A.C. 8:57 rules were set to expire March 10, 2016 The Vaccine Preventable Disease Program (VPDP) is looking to revise N.J.A.C. 8:57-6 rules Last amended to primarily add Hepatitis B vaccine requirement and other technical changes on April 6, 2009 Readopted without change 11

12 Basis for Change NJ immunizations requirements do not mirror current Advisory Committee on Immunization Practices (ACIP) recommendations Rules reflect the ACIP recommendations during the time the rules were written and are not updated as frequently as ACIP revises or updates their recommendations Resource Links State VPDP : N.J.A.C. 8:57-6: Instructions for viewing regulations: ons.pdf NJ Vaccine Requirements and Guidance Materials: Antibody Titer Law: Immunization Action Coalition (IAC): Resource Links (2) 2017 ACIP Recommended Childhood & Adolescent Immunization Schedule: ACIP Recommended Adult Immunization Schedule: ACIP recommendations: ACIP Guide to Contraindications and Precautions to Commonly Used Vaccines: 12

13 Questions? Contact Jenish Sudhakaran, MPH Population Assessment Coordinator Vaccine Preventable Disease Program Ph:(609) Fax:(609)