Massachusetts Immunization Program Update Pejman Talebian, MA, MPH Director, Immunization Program Massachusetts Department of Public Health MIAP Conference 2017 1
Disclosures I, Pejman Talebian, have been asked to disclose any significant relationships with commercial entities that are either providing financial support for this program or whose products or services are mentioned during my presentations. I have no relationships to disclose. I may discuss the use of vaccines in a manner not approved by the U.S. Food and Drug Administration. But in accordance with ACIP recommendations. MA Immunization Update, MIAP Oct. 2017 2 MIAP Conference 2017 2
Outline Regulatory Updates Public Provider Billing Vaccine Availability Updates Vaccine Storage and Handling School Immunization Data New School Immunization Requirements Status of the Massachusetts Immunization Information System (MIIS) MA Immunization Update, MIAP Oct. 2017 3 MIAP Conference 2017 3
Regulatory Updates In December of 2016, 105 CMR 220 (Immunization of Students Before Admission to School) was updated In November of 2016, Chapter 234 of the Acts of 2016 created a new law, MGL Chapter 112, Section 265 that allows primary care providers to delegate the administration of immunizations to CMAs Circular letter distributed by BORIM and BHPL provided additional guidance detail regulations forthcoming In May of 2017, 105 CMR 700 updated expanding scope of pharmacists ability to vaccinate down to 9 years of age Joint Policy Statement was distributed in August by the BORIP to all pharmacists providing additional guidance. MA Immunization Update, MIAP Oct. 2017 4 MIAP Conference 2017 4
Public Providers Reimbursement Reimbursement of pediatric vaccine administration fee: through Commonwealth Medicine, the administration fee for routinely recommended pediatric vaccines can now be reimbursed! Prior to this, only the administration of flu vaccine to pediatric patients was reimbursed. Why is this important? Public providers treated like other providers This gives public providers a more sustainable model to offer pediatric vaccines for things like back to school immunizations and getting new families up to date with vaccines. MA Immunization Update, MIAP Oct. 2017 5 MIAP Conference 2017 5
Vaccine Availability Massachusetts is fully universal for all routinely recommended ACIP vaccines Men B vaccines for healthy 16-18 year olds only available for VFC-eligible Vaccine brand choice is available for most vaccines Quadracel (DTaP-IPV) manufactured by Sanofi Pasteur is the most recent formulation made available earlier this year MA Immunization Update, MIAP Oct. 2017 6 MIAP Conference 2017 6
New Storage and Handling Requirements for 2017-2018 Continuous temperature monitoring data loggers (Fridgetag 2L or comparable) are now required for all vaccine storage units (primary and secondary) at all sites administering pediatric vaccines Pharmaceutical grade refrigerators are currently required for all primary vaccine storage refrigerators and strongly recommended for all secondary units. Beginning on January 1, 2018, pharmaceutical grade refrigerators will be required for storage of all state-supplied pediatric vaccines Stand alone household freezers will still be acceptable for frozen vaccines. MA Immunization Update, MIAP Oct. 2017 7 MIAP Conference 2017 7
Pharmaceutical Grade Refrigerator Although there is no clear description of a pharmaceutical refrigerator, we have identified the following characteristics: Internal fans to disperse cold air throughout the unit, eliminating cold pockets of air Wire racks to allow better air flow No storage bins, or shelves on door Electronic digital thermostat and microprocessor Typically, have a narrow operating range (less than 2 Celsius degrees or 3 Fahrenheit degrees) MA Immunization Update, MIAP Oct. 2017 8 MIAP Conference 2017 8
% Exemptions Religious and Medical Exemptions Among Massachusetts Kindergarten Students 1986-2016 1.6 1.4 1.2 1 0.8 Total Exemptions Medical Religious N=893 N=702 0.6 0.4 0.2 N=191 0 Year Source: Massachusetts Annual Kindergarten Immunization Survey MA Immunization Update, MIAP Oct. 2017 9 MIAP Conference 2017 9
Suffolk Middlesex Essex Norfolk Plymouth Bristol Worcester Hampden % Exemption Rate Berkshire Barnstable Hampshire Franklin Nantucket Dukes 10 9 8 7 6 5 4 3 2 1 0 Kindergarten Total Exemption Rates by County 2016-17 MA State Average: 1.3% Source: Massachusetts Annual Kindergarten Immunization Survey 2016 MA Immunization Update, MIAP Oct. 2017 10 MIAP Conference 2017 10
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Suffolk Norfolk Plymouth Middlesex Bristol Worcester Essex % Unimmunized Rate Hampden Berkshire Hampshire Barnstable Franklin Nantucket Dukes 4 3.5 Kindergarten Unimmunized* Rates by County 2016-17 *Students with an exemption with no documented vaccines 3 2.5 MA State Average: 0.5% 2 1.5 1 0.5 0 Source: Massachusetts Annual Kindergarten Immunization Survey 2016 MA Immunization Update, MIAP Oct. 2017 12 MIAP Conference 2017 12
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Dukes Norfolk Bristol Plymouth Middlesex Hampden Hampshire Barnstable Worcester Essex % Gap Rate Franklin Berkshire Nantucket Suffolk Kindergarten Gap * Rates by County 2016-17 20 18 16 14 MA State Average: 4.6% 12 10 8 6 4 2 0 2016 *Students that are missing one or more vaccines and do not have an exemption Source: Massachusetts Annual Kindergarten Immunization Survey MA Immunization Update, MIAP Oct. 2017 14 MIAP Conference 2017 14
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New School Immunizations webpage Updated webpage including maps, with explanations, on school immunization rates School immunization rates also available for download in pdf and excel formats New page with resources specifically for school nurses MA Immunization Update, MIAP Oct. 2017 16 MIAP Conference 2017 16
School Immunization Scroll down for link to School Nurse Information at the bottom of the page MA Immunization Update, MIAP Oct. 2017 17 MIAP Conference 2017 17
Updated Immunization Regulation In December of 2016, 105 CMR 220 (Immunization of Students Before Admission to School) was updated Specifics about each vaccine and wording around the 2010 phase-in schedule removed Refers to Department schedules MA Immunization Update, MIAP Oct. 2017 18 MIAP Conference 2017 18
New MDPH School Immunization Requirements Document MA Immunization Update, MIAP Oct. 2017 19 MIAP Conference 2017 19
New MDPH School Immunization Requirements Document Updates: Medical exemptions (dated statement signed by a physician stating that a vaccine(s) are medically contraindicated for a student) and religious exemptions (dated statement signed by a student or parent/guardian, if the student is <18 years of age, stating that a vaccine(s) are against sincerely held religious beliefs) must be renewed annually, at the start of the school year. MA Immunization Update, MIAP Oct. 2017 20 MIAP Conference 2017 20
New MDPH School Immunization Requirements Document Updates: Polio for K-12 minimum age and interval for the final dose in the series. 4 th dose must be given on or after the 4 th birthday and 6 months after the previous dose, or a 5 th dose is required. 3 doses are acceptable if the 3 rd dose is given on or after the 4 th birthday and 6 months after the previous dose. MA Immunization Update, MIAP Oct. 2017 21 MIAP Conference 2017 21
Future Meningococcal Requirement Fall 2018 College Students: 1 dose MenACWY received on or after the 16 th birthday for all newly enrolled full time college students under 22 years of age Receipt of meningococcal B vaccine would not fulfill school requirements MA Immunization Update, MIAP Oct. 2017 22 MIAP Conference 2017 22
MIIS Status Update MIIS Onboarding Status Recent System Upgrades Looking Ahead Coming Enhancements What you can do now MA Immunization Update, MIAP Oct. 2017 23 MIAP Conference 2017 23
MIIS Progress Report - Data over time 2017 2012 Sites: 55 Patients: 815,928 2011 Shots: Sites: 9 3,371,434 Patients: 3,902 Shots: 69,505 2013 Sites: 341 Patients: 1,539,629 Shots: 7,303,293 2014 Sites: 532 Patients: 2,370,194 Shots: 13,597,285 2015 Sites: 1,121 Patients: 4,427,623 Shots: 33,334,571 2016 Sites: 1,970 Patients: 5,770,424 Shots: 40,464,697 Sites: 2,192 Patients: 6,249,629 Shots: 43,846,531 MIAP Conference 2017 24
NUMBER OF SITES BY PRACTICE TYPE MA Immunization Update, MIAP Oct. 2017 25 MIAP Conference 2017 25
Recent System Upgrades Immunization Registry Coverage Reports includes patient listing New Delivered Reports functionality Reminder recall for a single patient Vaccine Management Temperature log upload more intuitive Flu order redesign Updates to various vaccine reports MA Immunization Update, MIAP Oct. 2017 26 MIAP Conference 2017 26
Looking Ahead Enhancements to patient dedup queue Additional delivered reports Updates to the inventory decrementing tool Storage & Handling Workflow streamlined 2017 MA Immunization Update, MIAP Oct. 2017 27 MIAP Conference 2017 27
MIIS What You Can Do TODAY! Attend a MIIS Breakout Session: AM Session: An Overview of the Massachusetts Immunization Information System (MIIS) PM Session: How Well Do You Know Your Data? Using the Massachusetts Immunization Information System to Improve Your Data Quality Visit the MIIS Table to learn more about: Legal responsibilities for reporting immunizations Coming on board with the MIIS Registering to gain access to the MIIS Training Opportunities Visit the ContactMIIS Resource Center at www.contactmiis.info MA Immunization Update, MIAP Oct. 2017 28 MIAP Conference 2017 28
MDPH Immunization Program Contact Information General Information Phone: 617-983-6800 Fax: 617-983-6840 Website: www.mass.gov/dph/imm MIIS Help Desk Phone: 617-983-4335 Fax: 617-983-4301 Email: miishelpdesk@state.ma.us Websites: www.contactmiis.info www.mass.gov/dph/miis MDPH Vaccine Unit Phone: 617-983-6828 Fax: 617-983-6924 Email: dph-vaccine-management@state.ma.us Website: www.mass.gov/dph/imm (click on Vaccine Management) MA Immunization Update, MIAP Oct. 2017 29 MIAP Conference 2017 29