2018 VACCINE UPDATE Mick Bolduc Epidemiologist/Vaccine Coordinator Connecticut Immunization Program March 22, 2018 1 OVERVIEW - Immunization Schedule - New ACIP Recommendations - Religious & Medical Exemptions - Connecticut Immunization Rates - Flu Requirements for Daycare & Pre-K - Flu Vaccine Effectiveness for 2017 - Vaccine Outbreaks - New Immunization Registry 2 1970 VACCINE SCHEDULE 3 1
2018 VACCINE SCHEDULE 4 2018 CATCH UP SCHEDULE u Vaccine is provided universally for all children 6 months through 59 months old Flu vaccine is provided for VFC-eligible children 5-18 years old VFC eligible children: -uninsured -Medicaid enrolled -underinsured -Alaskan Native/American Indian 5 2018 SCHEDULE-HIGH RISK 6 2
MINIMUM SPACING INTERVALS - 7 MAJOR CHANGES FOR 2018-3 rd dose of Mumps can be administered during outbreaks -LAIV licensed for use for 2018-19 flu season -New Shingles vaccine (Shingrix) licensed for use for adults 50 years of age and older 8 SCHOOL IMMUNIZATION REQUIREMENTS 10-204a General Statutes requires all students to be adequately immunized before being permitted to enroll in a public or non-public school or submit a medical or religious exemption. 9 3
MEDICAL EXEMPTIONS -Student must present a document from a physician, physician assistant or APRN that a vaccine(s) is medically contraindicated and consistent with national standards -Child had a reaction to a previous dose -Child is allergic to a vaccine component -Child is immunocompromised 10 RELIGIOUS EXEMPTIONS Parent/guardian must submit a statement upon initial entry into the school and again at 7 th grade entry that immunization is contrary to the religious beliefs of the child or the parent/guardian. The statement must be acknowledged by one of the following: 11 RELIGIOUS EXEMPTION -Judge -Court clerk or deputy clerk -Town clerk -Notary public -Justice of the peace -Attorney -School nurse 12 4
CONNECTICUT IMMUNIZATION RATES: 2016-17 K POLIO 96.8 DTAP 96.7 MMR 96.7 HEP B 97.1 HEP A 96.7 VARICELLA 96.5 7 TH POLIO 98.6 DTAP 98.6 MMR 98.6 HEP B 98.5 VARICELLA 98.3 MCV 95.9 TDAP 96.2 13 CONNECTICUT IMMUNIZATION RATES: 2016-17 K Exemptions Religious 1.8 % Medical 0.3 % Total 2.1 % 7 th Exemptions Religious 0.9 % Medical 0.3 % Total 1.2 % 14 INFLUENZA REQUIREMENT -In 2010, Connecticut implemented an influenza vaccine requirement for all children 6 59 months attending child day care centers, group day care homes, or family day care homes. -The influenza requirement expanded in 2011 to include all children aged 24-59 months enrolled in a preschool program. After implementation of the influenza requirements, vaccination rates among Connecticut children up through 59 months of age increased from 67.8% in 2009-10 to 87 % by 2016-17. 15 5
CONNECTICUT IMMUNIZATION RATES: 2016-17 Pre-K Influenza: Vaccinated 87.0 Exemptions Religious-Flu only 3.6 Religious-All 1.7 Medical 0.7 16 INFLUENZA EFFECTIVENESS 17 INFLUENZA EFFECTIVENESS 18 6
INFLUENZA EFFECTIVENESS 19 VACCINE OUTBREAKS 2015 Disneyland Measles -147 Cases in 6 states plus Mexico & Canada 2017 Minnesota Measles -79 cases mostly affecting children under 10 years of age and largely in the unvaccinated Somali community -Cost to contain the outbreak was estimated to be $1.3 million 20 VACCINE OUTBREAKS Hepatitis A -San Diego 2017 577 cases 396 hospitalizations 20 deaths -Michigan 2017-18 750 + cases 25 deaths -Kentucky 2017-18 150 cases 1 death 21 7
VACCINE OUTBREAKS -Measles in Europe 2016: 5,273 cases 2017: 21,315 cases -Romania & Italy > 5000 cases -Ukraine > 4700 cases -Belgium, France, Germany, Greece, Russia, Tajikistan all >1000 cases 22 VACCINE OUTBREAKS 2017-18 Influenza Connecticut 2014-15: 48 deaths-all ages 2015-16: 37 deaths-all ages 2016-17: 65 deaths-all ages 2017-18: 112 deaths-all ages United States 2014-15: 148 deaths-pediatric 2015-16: 93 deaths-pediatric 2016-17: 110 deaths-pediatric 2017-18: 119 deaths-pediatric 23 CT CASE OCCURENCES OF SELECTED DISEASES YEAR MEASLES RUBELLA MUMPS PERTUSSIS* TETANUS HIB VARICELLA* 1969 649 1695 4086 22 1 1970 117 620 3704 71 2 1971 1190 477 1612 21 3 1972 1540 304 1168 24 1 1973 1789 915 1632 10 2 1974 183 422 1698 32 0 1975 129 423 812 12 2 1976 295 132 757 16 1 1977 806 318 379 8 1 1978 327 206 140 11 1 1979 4 258 231 5 1 1980 25 23 103 6 1 1981 10 13 53 2 2 1982 6 6 29 5 0 1983 9 3 23 7 0 1984 14 1 10 6 1 1985 7 4 8 13 0 1986 9 1 23 27 0 1987 22 0 16 31 0 29 1988 15 0 10 22 1 56 1989 229 1 11 24 0 38 1990 196 3 17 31 1 44 1991 29 1 14 25 0 18 1992 6 1 8 50 1 13 1993 9 0 8 102 1 10 1994 4 3 12 44 1 8 1995 2 40 4 34 0 7 1996 2 4 1 49 0 1 1997 1 5 1 36 0 3 1998 0 29 3 56 0 2 1999 2 0 0 35 0 2 24 8
CT CASE OCCURENCES OF SELECTED DISEASES YEAR MEASLES RUBELLA MUMPS PERTUSSIS TETANUS HIB VARICELLA 2000 0 1 3 54 0 0 2001 1 0 0 25 0 0 1704 2002 1 0 1 30 0 0 1816 2003 0 0 1 77 0 0 1583 2004 0 0 0 67 0 0 1902 2005 0 0 1 86 1 1 1709 2006 0 1 0 126 0 0 1725 2007 0 0 2 89 0 0 1438 2008 0 1 0 55 0 0 857 2009 0 0 1 56 0 1 486 2010 1 0 11 109 0 2 323 2011 1 0 0 68 0 0 304 2012 1 0 0 183 0 0 266 2013 0 0 4 60 0 0 223 2014 5 0 3 100 0 0 182 2015 0 0 4 74 0 1 165 2016 1 0 36 96 0 2 116 Diphtheria last case 1962 Polio last case 1972 25 OUTBREAKS Pediatrics February 2018 -Influenza associated pediatric deaths 2010-16 -675 reported deaths in children <18 years old -only 31 % of those children 6 months of age and older had received a flu vaccine -almost half of these children had no pre-existing medical condition http://pediatrics.aappublications.org/content/early/2018/02/09/peds.2017-2918 26 WHAT CAN BE DONE? -Italy: Summer 2017 law authorizing a fine of $600 to parents of non-compliant students up to age 16 -Germany: kindergartens obliged to report parents who refuse counseling from doctors about vaccinations. Parents subject to $3000 fine -France: now making 11 vaccines mandatory up from the current number of 3 -New South Wales Australia: no jab, no play bans unvaccinated children from pre-school and day care and fines directors who admit such children $4400 27 9
NEW IMMUNIZATION REGISTRY -New Web based registry rollout summer 2018 -New registry will provide one stop shopping : vaccine ordering, doses administered, transfers, returns, bi-directional data exchange between IIS and Electronic Health Records (EHRs) 28 FUTURE LEGISLATION?? -Influenza for 5-18 year olds -HPV for 7 th grade entry -Group B Meningococcal for college 29 Contact Information Mick Bolduc PHONE: (860) 509-7940 FAX: (860) 509-7945 E-Mail: michael.bolduc@ct.gov 30 10