Adult Immunization New York State Updates Diana Joyce, RN MPA BSN Adult & Adolescent Immunization Coordinator NYSDOH Bureau of Immunization October 27, 2016 2 Let s talk about: NYS Adult Influenza and Pneumococcal Vaccine Coverage NYSIIS; Adult Consent and Reporting Vaccine For Adults Program Pharmacists as Immunizers Maternal Immunization Vaccine Preventable Disease Update and Meningococcal B Vaccines 1
3 How are we doing with Flu and Pneumococcal Vaccine coverage In New York State? US vs NYS Flu Vaccine Coverage, 2009-16 100% 4 80% 60% 40% 20% 0% HP 2020 Target US children NY children US adults NY adults Source: www.cdc.gov/flu/fluvaxview 2
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Flu Vaccine Coverage by Age, 2015-16 6 m+ 6 m - 4 y 5-12 y 13-17 y 18-49 y 50-64 y Source: www.cdc.gov/flu/fluvaxview 65 y+ U.S. N.Y. 5 HP 2020 Target NYS Flu Vaccine Coverage by Race and Ethnicity, 2010-15 60% 6 50% 40% 30% 20% White Black Hispanic 10% 0% 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 Source: www.cdc.gov/flu/fluvaxview 3
7 Healthcare Provider Influenza Vaccine Coverage 8 100% Median HCP Influenza Vaccination Rates, by Year and Facility/Agency Type, 2013/14-2015/16 90% 80% 70% 60% Healthcare Provider 50% 40% Influenza Vaccine 30% 20% Coverage 10% 0% Hospitals Nursing Homes ADHCPs D&TCs Hospices Home Health Agencies LHCSAs 2013 14 2014 15 2015 16 HP 2020 Target Median 2015 16 4
9 100% Median NYS HCP Flu Vaccination Rates by Year and Facility Type, Hospitals and Nursing Homes, 2008-2015 90% 88% 89% 89% 80% 70% Healthcare 60% Provider 54% 60% 47% 47% 47% Influenza 50% Vaccine 40% Coverage 30% 20% Hospitals Nursing Homes Overall HP 2020 Target 10% 0% 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 10 Pneumococcal Vaccine Coverage In NYS 5
Adults aged 65 and Over Pneumococcal Vaccination Rates in NYS 11 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Adults 65+ years who have ever had a pneumococcal vaccination, BRFSS, 2011-2014 2011 2012 2013 2014 U.S. New York HP 2020 Target 12 NYS AdultVaxView Pneumococcal Vaccination Rates Coverage for adults >18 years who completed BRFSS interviews 2008-2014 6
BRFSS NYS Data 2014 Pneumococcal Vaccine Coverage Age 65 or Older 13 http://www.cdc.gov/vaccines/imz managers/coverage/adultvaxview 65.4% NYS 14 NYSIIS Adult Consent and Reporting Created by Dina Hoefer 7
15 Consent for Adult Immunization Reporting to NYSIIS Amendments to PHL 2168 passed by the Legislature and effective July 12, 2013 Revised consent requirements for persons 19 years of age or older Individuals who are 19 years or older can consent to have their immunizations registered in NYSIIS and CIR verbally, eliminating the express written consent requirement Consent for Adult Immunization Reporting to NYSIIS 16 Expressed need for written consent was eliminated All health care providers and pharmacists that administer immunizations to persons 19 years of age or older are still required to obtain consent to submit immunization information Now it may be acquired verbally or included in your organization s existing consent form 8
17 Consent for Adult Immunization Reporting to NYSIIS Adult consent must still be documented; either by Manually switching the consent indicator to yes in NYSIIS Insuring consent is documented in electronic medical record (EMR) and electronically submitted to NYSIIS The option to withdraw consent is still in effect The NYSIIS Withdrawal Consent form is available from the NYSIIS home page under Forms or the NYSIIS website 18 Consent for Adult Immunization Reporting to NYSIIS Amendments to PHL 2168 passed by the Legislature and effective Oct 24, 2014 Bill S7253A-2013; A9561A-2013 Expanded authorized users Changed reporting requirements for adult immunizations 9
Amendments to PHL 2168 Passed by the Legislature and effective Oct 24, 2014 Impact Consent still required Burden of consent on the provider (not DOH) RN s and Pharmacists are REQUIRED to report consented adult immunizations Messaging and education on changes to law Notification letter published and emailed on March 18, 2015 More information on PHL 2168 http://www.health.ny.gov/prevention/immunization/information_system/la ws_and_regulations/ 19 Adult Immunizations in NYSIIS 20 Doses by Year Reported Age at Immunization 19 years+ 900000 800000 700000 600000 500000 400000 300000 200000 100000 0 2008 2009 2010 2011 2012 2013 2014 2015 2016* Doses 10
Lifetime Registry 21 Patient Entered into NYSIIS <19 Patient Entered into NYSIIS 19+ Immunization given at <19 Immunization given at 19+ 82,919,113 1,537,286 164,069 2,640,226 Total 83,093,182 4,177,512 Vaccines for Adults Leveraging Changing Vaccine Use to Expand Adult Vaccine Access in New York State Elizabeth Rausch-Phung, M.D., M.P.H. Immunization Program Manager New York State Department of Health 11
NYS VFA Vaccines 23 Hepatitis A Hepatitis B Hepatitis A/B HPV** MMR* MenACWY** MenB** PCV13** PPSV23* Tdap* Td* Influenza (in season)* *Previously offered through MSFWIP but not AHVP **Newly added to both programs Eligible sites in NYS outside of NYC 24 LHDs FQHCs, rural health centers, and community health centers Tribal health centers Migrant health clinics College health clinics STD clinics Methadone and addiction treatment centers County jails 12
25 Eligible Patients Uninsured and underinsured adults seeking care at any enrolled site Eliminated previous requirements for participating sites to screen patients for o Hepatitis A/B risk status o MSFW status 26 NYS VFA 227 active sites 10,580 doses ordered through the VFA between 8/1/2015 and 4/6/2016 48 LHDs (84%) had more than 1 active adult PIN prior to launch of the VFA (median: 3 adult PINs) LHD FQHC Tribal Migrant College STD Addiction Jail 13
27 Pharmacists as Immunizers Partners in Protection New York State Education laws 6527, 6801, and 6909 permit pharmacists who obtain additional certification to administer to adults aged 18 years and older: Influenza vaccines Pneumococcal vaccines Meningococcal vaccines Tetanus, Diphtheria, and Pertussis containing vaccines Herpes Zoster vaccine May administer vaccines under patient specific or non-patient specific orders Per NYS Public Health law 2168, pharmacists must: report all immunizations to persons aged 18 in NYSIIS or the City Immunization Registry (CIR) report immunizations for persons aged 19 or older to NYSIIS or the CIR upon consent of the patient Vaccines not entered in either registry must be reported annually to the Certified Pharmacist Immunization Survey 28 14
Pharmacies and Reporting to NYSIIS 29 Pharmacies are increasingly obtaining consent to report immunizations to NYSIIS Overall, Pharmacies have reported 17% of adult vaccinations found in NYSIIS Trend showing increasing contribution from year to year All events recorded in NYSIIS are available for providers Pharmacies and Reporting to NYSIIS 30 15
Number of Pharmacies Reporting to NYSIIS Jan 2014 July 2016 31 GRP_NAME Number of Stores Rite Aid 423 CVS Store 378 Walgreens Pharmacy 165 Walmart 112 Kinny Drugs 76 Target Pharmacy 61 Price Chopper 54 Tops Pharmacy 52 Wegmans Pharmacy 47 Stop and Shop Pharmacy 46 Hannaford Pharmacy 45 Medicine Shoppe 4 Kmart Pharmacy 3 Shoprite Pharmacy 3 SaluMed Pharmacy 2 Single Stores 73 Total 1544 32 120000 Vaccinations Administered by Pharmacies Reported to NYSIIS Monthly for 2014 2016 100000 80000 60000 40000 20000 0 Jan Feb Mar April May Jun July Aug Sept Oct Nov Dec 2014 2015 2016 16
33 Pharmacy Vaccine Administration; 7/1/2105-6/30/2016 NYSIIS Data Vaccines Administered by Pharmacies 2015 2016 Season By Age Group 79,194 34 76,644 123,921 18 49 50 64 17
35 800,000 Total Vaccine Doses Reported by NYS Pharmacies, by Data Source and Year 700,000 600,000 500,000 400,000 300,000 200,000 100,000 0 2013 14 2014 15 2015 16 NYSIIS CIR CPIS All Sources 35 36 Flu Vaccine, Tdap Vaccine and Pregnancy 18
Influenza Vaccine 37 Advisory Committee on Immunization Practices (ACIP) recommends Inactivated Influenza Vaccine (IIV) for pregnant women The live flu vaccine has never been advised for pregnant women Historically LAIV or IIV could be given to a breast feeding mother During pregnancy maternal antibodies cross the placenta and provide protection to the newborn Influenza vaccine allows the pregnant woman to develop antibodies against the flu that provides protection to the newborn baby for up to 6 months of age NYS Flu Vaccine Coverage Among New Mothers, NYS, 2012-13 38 60% 46.8% 54.4% Source: NYS Pregnancy Risk Assessment Monitoring System (PRAMS) 40% 33.6% 42.5% 20% 0% 2012 2013 Before Pregnancy During Pregnancy 19
Tdap Vaccine 39 Recommended vaccination is between 27-36 weeks which allows for maternal antibody response including passive anti-body transfer to infant Substantial transport of maternal Immunoglobulin G (IgG) occurs after 30 weeks gestation This timeframe maximizes anti-pertussis antibodies crossing from mother to baby Studies have determined higher levels of IgG to pertussis in newborn umbilical cord blood when immunized between 27-36 weeks gestation MMWR/ February 22, 2013 / Vol. 62/ No. 7 40 Tdap vaccine coverage among mothers with a recent live birth, PRAMS, NYS excluding NYC, 2011-2013 70% 60% Tdap Vaccine 50% Recommendations 40% 30% During Pregnancy 20% 7.4% 11.3% 23.2% 10% 0% 2011 2012 2013 Before Pregnancy During Pregnancy After Pregnancy 20
Cocooning 41 Cocooning Surround infants with a vaccinated family (including extended) Vaccinate family & friends 2 weeks before meeting the baby NYS PHL 2805-h Hospitals with NICUS must offer influenza vaccine annually, September 1 to April 1, to all persons who are parents, or who are reasonably anticipated to be caregivers in the households of newborns being treated in NICUs. Hospitals with newborn nurseries or obstetric services must offer Tdap vaccine to parents and anticipated caregivers of all newborns treated in the hospital following birth NYSDOH Bureau of Immunization Initiatives 42 Collaborative project with the School of Public Health, SUNY Albany Focus on maternal Influenza and Tdap immunization Kicked off with a live webcast on July 21 st 4 additional webinars are planned with a variety of subject matter experts and providers of obstetrical care. Some topics include: o Business practices including billing and implementing an immunization program in an office o Using electronic medical records to improve maternal Tdap and Flu vaccine rates o Overview of maternal immunization recommendations and applicable NYS requirements o Communicating with patients Link to website: http://www.albany.edu/sph/cphce/phl_0716.shtml 21
43 Vaccine Preventable Disease Updates Created by Kathy Sen, RN BSN VPD Surveillance Officer Mumps Mumps-Viral vaccine preventable disease No longer very common in the US Year to year variation in the numbers of cases As of September 10, 2016, 44 states have reported infections in 1,897** people to the CDC Past/Present outbreaks have been reported from university campuses and high school aged students 44 **case count is preliminary and subject to change 22
Mumps 45 People with 2 doses of the MMR vaccine are about 9 times less likely to get mumps than unvaccinated people with the same exposure Vaccine is still the best protection against mumps Some people who receive 2 doses of MMR can still get mumps, especially if they have prolonged, close contact with someone who has the disease If a vaccinated person does get the mumps, they will likely have less severe illness than an unvaccinated person 46 http://www.immunize.org/photos/mumps-photos.asp 23
47 VPD Case Reports, 2015 New York State (excludes NYC) Disease Cases Incidence/100,000 Haemophilus Influenzae, Type B (< 5 years old) 3 0.0 Hepatitis A 49 0.4 Hepatitis B, Acute 31 0.3 Measles 1 0.0 Mumps 24 0.2 Rubella 0 0.0 Pertussis 616 5.5 S. Pneumo Invasive Resistant 20 0.2 S. Pneumo Invasive Intermediate 23 0.2 S. Pneumo Invasive Sensitive 630 5.6 S. Pneumo Invasive Unknown 131 1.2 Tetanus 1 0.0 48 NYS Tdap, MenACWY, and HPV Coverage Rates 100% 90% 80% 70% 60% 50% 40% 30% 20% 1 Tdap 1 MenACWY 1 HPV girls 3 HPV girls 1 HPV boys 3 HPV boys HP 2020 10% 0% 2008 2009 2010 2011 2012 2013 2014 2015 NIS Teen 2008-2015 24
49 Meningococcal B Vaccines 50 What Do You Need to Know about MenB Vaccines? The Centers for Disease Control and Prevention(CDC) and NYSDOH do not have a preference for which meningococcal B vaccine is used The same vaccine product must be used for all doses Bexsero (0, 1 month after first dose) Trumenba (0, 1 through 2 months after first dose, 6 months after first dose) ACIP recommends patients age 16 through 23 years may be administered a MenB vaccine at the discretion of the provider This is based on available antibody data Goal is to provide maximum protection during the highest risk timeframe 25
Vaccine Recommendation ACIP recommends MenB vaccines may be administered to those aged 16 to 23 Clinical decision to vaccinate Assessment/discussion of risks and benefits with each individual patient/parent Preferred age is 16 to 18 years This provides short-term protection against most strains of serogroup B meningococcal disease Category B recommendation Vaccines may be administered at the same time as other vaccines, preferably at a different anatomical site http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6441a3.htm 51 NYSIIS MenB Coverage Estimates 52 26
To Sum it All Up Adults need vaccines too Even with high childhood vaccination rates, many diseases still persist Vaccination per recommended ACIP guidelines provides protection across the lifespan Effective strategies include: Communicating with patients Utilization of vaccine information databases NYS-NYSIIS NYC-CIR Reminder recall notices Adhering to national and professional standards of care Know community resources to refer patients to Local pharmacies, health departments, travel clinics etc. Know federal, state and your professional licensure laws 53 Reminder/Recall Notice 54 27
55 56 Questions? Contact NYSDOH at: Immunize@health.ny.gov 28
Resources Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/vaccines/index.html New York State Department of Health o Bureau of Immunization http://www.health.ny.gov/prevention/immunization/ Immunization Action Coalition http://www.immunize.org/ ACOG http://immunizationforwomen.org/ 57 29