Oregon Immunization Bulletin Oregon Immunization Program Public Health Division Winter Fall 09/10 2009 View the Oregon Immunization Bulletin online! http://www.oregon.gov/dhs/ph/imm/immnews.shtml H1N1 vaccine reaches state employees Our fearless immunization staff face off with the H1N1 vaccine. Public Health employees practice what they preach on H1N1 vaccination! On December 14th, the priority groups for H1N1 were expanded beyond the highest-risk clients and vaccination was made available to everyone else that wanted to reduce their risk of getting infected with or spreading H1N1 flu. On December 23rd, the Public Health Division had their first chance to be vaccinated. Over 200 Public Health staff and their families lined up at the Portland State Office Building to be vaccinated against seasonal and H1N1 influenza. In addition to giving them a chance to be good role models, this was a good opportunity to demonstrate the bestpractice of getting multiple vaccinations at the same time.
Oregon Immunization Bulletin EOC officially launched The Enhanced Ordering Cycle (EOC) project is underway in Oregon, one of four states currently piloting this initiative from the Centers for Disease Control and Prevention (CDC). EOC provides tools and guidance to balance and optimize vaccine order sizes, order frequencies, and storage and handling capacities. This will improve work flow and reduce costs on the clinic level while streamlining vaccine flow on a national level. On December 15, 2009, staff members from nine Portland-area clinics participated in the first EOC provider training at the State Office Building in Portland. Participants were introduced to the new EOC tools that will assist them in ordering the right amount of vaccine at the right time. The six-hour pilot training also included updates on other topics such as Oregon AFIX, Storage and Handling, Oregon Immunization ALERT and H1N1. As pilot clinics, participants provided valuable feedback throughout the day regarding training content and delivery. As a result, this feedback has helped Oregon s EOC Team tailor the training to effectively meet the needs of future participants. The clinics involved in this pilot training are the first in Oregon to implement the new EOC process, including the ordering guide. Each clinic in attendance received $150 for their participation. The EOC Team will contact more clinics throughout Oregon to participate in the training and subsequently utilize the EOC process in their clinics. We look forward to seeing some of you at a training session soon.
Oregon Immunization Bulletin Oregon VFC University is now accepting new students! The Oregon Immunization Program is committed to providing quality training to vaccine providers across the state. To reach providers more often we now offer quarterly educational sessions via webinar. For those new to immunization, or who just want to brush up on a subject, we strongly encourage your participation. The first round of webinars concluded on January 26 and included sessions on General VFC Requirements, Vaccine Funding and Eligibility for Public Providers, Vaccine Storage and Handling, and Immunization Updates from 2009. We will offer similar sessions in April and continue to encourage submissions for additional topic ideas. April 2010 class schedule Topic Date Time General VFC Requirements April 21, 2010 12:00 to 1:00pm Vaccine Funding and Eligibility April 22, 2010 12:00 to 1:15 pm (Public Providers) Vaccine Funding and Eligibility April 23, 2010 12:00 to 1:00 pm (Private VFC Providers) Vaccine Storage and Handling April 28, 2010 12:00 to 1:00 pm Adult Immunizations April 29, 2010 12:00 to 1:00 pm Clinic Requested Topic (TBD) April 30, 2010 12:00 to 1:00 pm VFC University continued on page 5
Oregon Immunization Bulletin Spotlights Samaritan Health System develops best pratice solutions In 2009, during a routine VFC site visit at a Samaritan clinic location, some storage and handling problems were found. Samaritan partnered with the Oregon Immunization Program to resolve the storage and handling problems at the site; yet, the organization went far beyond. On their own, Samaritan undertook a thorough audit of all its clinics that store vaccine (both clinics that stock State supplied and those that stock private supplied vaccine) in order to make sure all sites were in compliance with the State Immunization VFC storage and handling standards. Samaritan created a team to review all aspects of storage and handling throughout the Samaritan Health System. They developed a number of standards and operational processes to ensure that all temperature-sensitive biologicals will be stored appropriately. Samaritan has developed a process of internal audits and quality checks to assure all their clinics are storing and delivering vaccine according to best practices. Once a month, each clinic sends their twice daily logs to a central system monitor who reviews the logs for proper temperatures and documentation. Each clinic s refrigerator and freezer have been added to the system s safety tours to ensure that the sites are reviewed for compliance between VFC site visits. Samaritan has worked hard to create a standardized system for all refrigerated/frozen biologicals. They purchased a new system-wide temperature monitoring system that went live on February 8, 2010. The new system allows for temperature checks electronically 24-7 and will alarm when thoes temperatures go out
Oregon Immunization Bulletin of range. It can be monitored off-site and by multiple users, ensuring that no temperature excursions go unnoticed. Samaritan Health Systems shows exemplary patient service and attention to the public health of Oregonians! We thank them for their hard work and partnership with the Oregon Immunization Program. VFC University continued from page 3 Registration information will be sent out in March or you can register via our website here: www.oregon.gov/dhs/ph/imm/provider/ calendar.shtml If you have any questions (or ideas) about the webinars please contact: Anona Gund 971.673.0305 anona.e.gund@state.or.us We will still offer many of these trainings in person, and we are happy to come to your clinic to address the training needs of your staff. Contact your health educator at 971.673.0300 to schedule training. Mini grants The Oregon Adult Immunization Coalition (OAIC) proudly announces our third cycle of Adult Immunization Mini Grants! The past two cycles supported twelve excellent projects that increased or enhanced adult immunization in Oregon. In this cycle, we anticipate even larger funding for the grant awards. Watch for the announcement on our new OAIC website in the coming month; www.oregonimmunization.org. Grant opportunity details and an application form can be found on our new site. Grant application will be availible on February 22 and funds awarded in early May. Funds must be spent by December 31, 2010. The maximum award available to any one agency is $2,000. An independent committee will be review proposals by and will fund agencies with innovative projects and partnerships that improve adult immunization rates, reach underserved populations or support and advance the use of evidence-based practices in adult immunization.
Oregon Immunization Bulletin Vaccine transfer between clinics If you are unable to use VFC vaccine before its expiration date, you may transfer it to another VFC provider. Contact your VFC Health Educator for more information on this process. If your clinic has already been approved to make transfers, always remember to document these transfers via email to your Health Educator with the following information: Receiving Site s Name Vaccine Name Number of Doses Expiration Date Lot Number Fridge and freezer tips: defrost cycles Keep defrost cycles in mind: Suppose you check your frost-free freezer temperature and find that it reads 12ºF (or -11ºC): out of range! Don t make any adjustments yet especially if you have a household style combined refrigerator-freezer unit, or a unit with only one temperature control for both the fridge and freezer. Before making any adjustments, come back to the freezer 45 minutes later, check your continuous temperature recorder, and see if the temperature has begun to lower. What s going on: Frost-free freezers go through defrost cycles as part of their normal functioning. You can rest easy if you find that your freezer s temperature has returned to its proper range within an hour. As long as the defrost cycle is kept to an hour s time, your vaccines will remain viable. Additionally, check to see how many defrost cycles per day your freezer goes through. As many as four per day are fine; if your freezer goes through more than four in a day, it might be time to replace it. Give us a call and we can help you assess your freezer. Lastly, the defrost cycles should all continuously maintain freezing temperatures, and not spike above 32ºF or 0ºC at any time.
Oregon Immunization Bulletin Ask Maria Maria Grumm RN, MPH is the Oregon Immunization Program Public Health Nurse and our in-house expert on vaccine administration. Commonly asked questions about administering HIN1 vaccine. Q: Should the 2009 H1N1 influenza vaccine be given to someone who had an influenza-like illness between April and now? A: If an influenza-like illness (ILI) was laboratory-confirmed as H1N1 (with reverse transcriptase polymerase chain reaction [RT-PCR]), then vaccination with H1N1 monovalent vaccine is not necessary for the 2009-2010 season. If the ILI was not confirmed by RT-PCR, then the person should be vaccinated if indicated. There is no harm in vaccinating a person who had 2009 H1N1 influenza in the past. Q: If seasonal live attenuated influenza vaccine (LAIV) and 2009 H1N1 LAIV are mistakenly given during the same visit, do either or both doses need to be repeated? A: There is no data on the administration of seasonal LAIV and 2009 H1N1 LAIV (in the same nostril) during the same visit. ACIP recommends that seasonal LAIV and 2009 H1N1 LAIV not be administered during the same visit. However, if both types are inadvertently administered during the same visit, neither vaccine needs to be repeated. Q: If a child receives his first dose of H1N1 vaccine at age 9 years, but is 10 years old when he comes back for the second dose, should the second dose be given? A: According to CDC recommendations, if a child turns 10 years old between the first and second doses of H1N1 vaccine, the second dose is not necessary. References for above answers: IAC Express Ask the Experts for November 2009 and Needle TIPS Ask the Experts for January 2010. Available at: www.immunize.org/askexperts.
Oregon Immunization Bulletin Bits and Pieces MMR/V - Proquad Despite earlier notices to the contrary, the re-release of MMR/V has been postponed indefinately. PCV7 and PCV13 - Prevnar Wyeth is replacing the existing formulation of Prevnar (PCV7) with a new 13-valent product. If PCV13 receives FDA licensure prior to the February 2010 ACIP meeting as expected, we anticipate an ACIP vote to add PCV13 to the VFC program. If the resolution passes, providers may be able to place orders for PCV13 as soon as late March or early April. In order to avoid wasting PCV7 vaccine during the transition to PCV13, we ask that every Oregon provider do the following: 1. Conduct a physical inventory of your PCV7 supply each time you place an order. 2. Use available data sources to determine how much vaccine you expect to use between the time of your vaccine order and late March or early April. 3. Only order enough PCV7 to last through late March or early April. If you run out of PCV7 before PCV13 becomes available, we will be happy to fill an additional PCV7 order for you.
Oregon Immunization Bulletin Hib vaccine Merck returned to the market in late January with Pedvax Hib. We anticipate that by the end of March, Oregon providers will be able to again choose their preferred brands of single-antigen Hib vaccines (Pedvax, ActHib, and Hiberix ). Until you receive notice from us about your ability to order the brands you need in full quantities, we will continue to allocate based on your history. It is not known at this time whether or when Comvax will return to the market. Hepatitis vaccines Adult Hepatitis B: There is currently supply of GSK adult Hepatitis B vaccine. It is not expected that there will be any Merck adult Hepatitis B supply before July, 2010. Pediatric Hepatitis B: Pediatric supply is available for both GSK and Merck products. Allocation limits have been lifted. Adult Hepatitis A: GSK adult Hepatitis A vaccine is available in the vial presentation only. No Merck product will be available in 2010. Pediatric Hepatitis A: Both GSK and Merck products are currently available. Updated VFC and 317 eligibility charts Updated VFC and 317 (public clinics only) Eligibility charts are available and have been mailed to all VFC providers. These charts can also be accessed at: http://www.oregon.gov/dhs/ph/imm/docs/vfcchart.pdf http://www.oregon.gov/dhs/ph/imm/docs/317chart.pdf Among other clarifications, these updated charts include eligibility information coverage for males with HPV vaccine. Make sure the eligibility charts you re using now are dated January 15, 2010!
10 Oregon Immunization Bulletin ALERT update New ALERT Immunization Information System electronic transfer specifications The new ALERT Immunization Information System (IIS) is in the final stages of construction; roll-out for public and private clinics is scheduled for the summer of 2010, with schools and childcare centers to follow late fall. A detailed letter of the changes to expect will be sent to clinics soon. The new IIS will have improved functionality, timeliness, and ease of use for clinics submitting doses electronically. The new system will have an improved interface for data submission and a new format for data files, though current submitters will be allowed to transition to this new interface gradually. In the next month, ALERT staff will begin reaching out to clinics and health systems to share the data specifications of the new system, so that clinics can prepare to adjust the format of the data that is sent to the IIS. In an effort to ensure high data accuracy, ALERT staff will work with our clinic sites to improve data quality in some specific ways: Organizations will be asked to use standardized vaccine codesets for reporting vaccinations; typically CPT/CVX codes are the most common. This will eliminate errors created through translating from unique codesets or free-text fields. ALERT and VFC staff will work with sites to report eligibility codes by dose for the Vaccines for Children program, rather than inferring this information from insurance sources. ALERT staff will gladly work with both clinical and technical staff to ensure that data submitted is both accurate and complete; we also welcome the opportunity to consult on how a clinic s EMR is developed or modified, so that these key fields can be captured as part of the electronic system. Watch for more information throughout February and March!
Oregon Immunization Bulletin 11 H1N1 and ALERT Thanks to all providers who continue to submit H1N1 doses to ALERT. The list of providers approved to administer H1N1 in the state of Oregon includes over 1200 new ALERT reporters. ALERT has received an estimated 750,000 H1N1 dose reports as of mid-february, 2010, and these numbers continue to grow daily. To date, the vast majority of these data have been processed and are available on the secure ALERT website. Authorized users can now find all-ages information on reported doses of both H1N1 and seasonal flu at www.immalert.org. Approximately 40% of H1N1 doses have been reported to date using the scannable Vaccine Administration Record. One of the significant challenges of the H1N1 season has been in centrally processing this large number of scannable forms. Computerized character recognition of hand-written information yielded lower accuracy than expected, and the verification of essential fields (name, address, phone) has been resource-intensive. As a result, ALERT is backlogged in processing some of 2010 reported doses. Boxes and boxes of H1N1 submissions. In response to the broad uptake of the scannable form and subsequent backlog, the State Immunization Program has partnered with the Emergency Preparedness Program to hire and supervise 18 temporary staff to assist with the data entry backlog. These temporary employees are entering about 30,000 records a week and are expected to be current with all H1N1 data received by mid-march. Like many providers and public health entities across the state, ALERT will be evaluating our response to H1N1, and documenting lessons learned throughout the pandemic. A large part of this evaluation will focus on the benefits and challenges of scanning technology as we plan for next flu season.
Free pediatric and adult immunization educational event on March 9th The Oregon Medical Association, along with the American Medical Association and the Oregon Pediatric Society, will host Pediatric and Adult Immunization: Benefits, Safety and Perceived Risks from 8:30 am to 12:15 pm on Tuesday, March 9 at OMA Headquarters. This free program, featuring nationally-recognized experts, will educate physicians, nurses and other providers on the benefits of vaccination as well as vaccine safety and perceived risks so they can better address patients questions and concerns about this currently controversial issue. Participants of this free educational program are eligible for up to 2.5 AMA PRA Category 1 Credits and 3.0 contact hours under American Nurses Credentialing Center s Commission on Accreditation criteria. For learning objectives, CME and CNE details and registration, visit: www.ama-assn.org/ama/pub/physicianresources/public-health/vaccinationresources/immunization-benefits-andsafety.shtml. If you have questions, call or e-mail Courtni Dresser at the OMA: courtni@theoma.org phone:503.619.8110 Oregon Department of Human Services Oregon Immunization Program 800 NE Oregon Street, Suite 370 Portland, OR 97232-2162