Oregon Immunization Bulletin Oregon Immunization Bulletin

Oregon Immunization Bulletin Oregon Immunization Program • Public Health Division Winter 2009 Spring Advisory Committee on Immunization Practices (ACIP) Update The ACIP met February 25-26 in Atlanta. Among the discussions was hepatitis A disease among contacts of internationally adopted children. A CDC study revealed an unusually high number of hepatitis A cases among non-traveling contacts of international adoptees. The children in many of the cases were asymptomatic but tested positive for hepatitis A. Infection among contacts varied from one or two family members to an entire family group. After considering the data, ACIP recommended hepatitis A vaccine for previously unvaccinated non-traveling persons who anticipate close personal contact with an international adoptee from a country of high or intermediate endemicity. The ACIP also considered information on reduced anthrax vaccine dosage and changing the administration route. Studies showed that vaccine given intramuscularly instead of subcutaneously produced similar levels of anti-PA titer. Research also showed that bringing the number of doses down from six to five mounted an appropriate immune response. ACIP approved label changes for dosing and route. 2008 provider survey results offer interesting insights Thanks to everyone who took the time to respond to the 2008 Provider Survey! We received 235 responses, more than half the number of invitations we sent out, which is an excellent participation rate. Your thoughtful responses will be invaluable to shaping our program and resources. We were thrilled to see high levels of satisfaction - over 90% in most cases. We learned a great deal about your use of our immunization information systems, the types of communication you receive and prefer, the frequency and kinds of problems you have experienced with vaccine delivery, and many other issues. You can view the full PowerPoint report at: www.oregon.gov/DHS/ph/Imm/docs/ 08ProvSurvey.ppt . If you have any questions about the survey, please contact Scott Jeffries, Research Analyst, at scott.r.jeffries@state.or.us or (971) 673-0316.  Oregon Immunization Bulletin School law update: Thank you providers! Online VAERS data now available A huge thanks goes out to Oregon to the public providers for stepping up services during Since 1990, CDC has tracked vaccine safety through a national passive surveillance system, the Vaccine Adverse Event Reporting System (VAERS). VAERS collects reports from vaccine providers and the public on post-vaccination adverse events ranging from injection site pain to hospitalization, which may or may not be related to a vaccine. These reports are monitored to detect new or unusual vaccine side effects. In 2008, VAERS vaccine safety data was released to the public for the first time. Please visit the Oregon Immunization Program website for a review of Oregon VAERS reports: www.oregon.gov/DHS/ph/imm/ research/index.shtml To report an event to Oregon VAERS please visit: www.flu.oregon.gov/DHS/ph/imm/docs/ vaersformImmiaddress.pdf For more information, please contact Samantha Kurosky, Immunization Research Analyst, at 971-673-0304 or samantha. k.kurosky@state.or.us. this year’s school exclusion. More than 36,000 exclusion letters were sent for children whose school/childcare records showed missing immunizations. With your help, over 85% of these children received needed immunizations and updated their records before exclusion day. Look for final data from Exclusion 2009 in the next issue of the Bulletin. Recalibrating your continuoustracking thermometers Your clinic refrigerator/freezer’s continuous tracking thermometer must be calibrated on a regular basis (as determined by the calibrating service or manufacturer). Prices will depend on the style of unit you have and whether it’s a one or two point calibration. Reclabration continued on page 3 Oregon Immunization Bulletin Reclabration continued from page 2  One thing you might not know is that, although new continuous tracking thermometers are shipped with a calibration certificate, these are not National Institute of Standards and Technology (NIST) - traceable calibration certificates. They are merely a basic- usually room temperature- test to ensure that the thermometer is within factory tolerances. To comply with VFC requirements you will need to purchase an additional NIST-traceable calibration certificate. Most vendors offer these certificates as an additional service with prices starting at $40 (price will depend on the vendor, the unit and the level of calibration you choose). This NIST-traceable calibration will need to be repeated on a regular basis. If you are interested in getting your thermometer re-calibrated, contact your vendor or one of the many local private calibration businesses using NIST approved equipment. Two local options are: • • Advanced Technical Services: Federal Way, Washington, 1-800-287-8046 Control Solutions: Warren, Oregon, 503-543-5416 Many of these business offer a range of supplies (i.e. Dickson paper, charting pens, batteries, etc.) and services at very reasonable rates. *Ordering Dickson thermometer paper: Remember, if you have a Fahrenheit recorder, order Fahrenheit paper, and a Celsius recorder needs Celsius paper! The chart paper you order must also match the model of your unit, so be sure to double check the model number before placing your order! If you use a digital continuous tracking thermometer, the general recommendation is to have it recalibrated annually (although this can vary by manufacturer). Contact your vendor for more information on this service and associated prices. Need to order new temperature tracking recorders that meet VFC program requirements? Contact your health educator- they’ll be able to provide you with a list of options that meet requirements.  Oregon Immunization Bulletin Spotlights Mosaic Medical (Bend): Leading the way in storage and handling been stored properly and will be effective in preventing disease. In addition, staff from all three Mosaic Medical locations recently participated in a training provided by the Oregon Immunization Program that covered: vaccine forecasting, vaccine administration, and vaccine storage and handling, among other topics. Mosaic Medical of Bend Oregon has shown outstanding dedication to running a strong and successful immunization program. One way they have done this is by focusing on proper vaccine storage and handling. Proper storage and handling practices are critical because they minimize Congratulations to the staff at Mosaic costs to the provider and the community, Medical of Bend! reduce liability, and ensure community health. Lisa Fortin is the Clinic Manager at Mosaic Medical of Bend and is proficient in implementing vaccine storage and handling procedures. Mosaic Medical of Bend has purchased new refrigeration/freezer equipment, dedicated individual circuit breakers to refrigeration/freezer equipment, recertified and calibrated their continuous tracking thermometers, established procedures for emergencies, and trained all staff in proper vaccine storage and handling practices. By doing this, they are ensuring that their patients receive vaccine that has Community Health in Motion (CHIM): A partnership that works Community Health In Motion (CHIM) provides no-cost immunizations for children, sports physicals for grades 6 – 12 and adult health screenings. This alliance, made up of many Clackamas County organizations began in 2003. Collaborators donate materials, medical and administrative services, and volunteer staff at events. They also provide access to medical facilities, schools and other Oregon Immunization Bulletin  public spaces to set up clinics three to four times a year. Partners include Providence Milwaukie Hospital and local Providence clinics, Clackamas County Community Health, Oregon Immunization Program, North Clackamas School District, Clackamas Lions and Rotary Clubs, and local fire districts. The most recent immunization clinic was held in February just prior to school exclusion. In five hours, two dozen volunteers screened, forecast and immunized 203 children with over 500 doses of vaccine. At the same time, the local Lions van provided health screenings. Spanish and Russian-speaking interpreters assisted families, and every child received treats after completing their vaccinations. CHIM’s success shows that developing partnerships with stakeholders who have a common mission and vision is vital. The group has been very successful because members have committed resources to offer easily accessible health care services to those most in need, especially children. Volunteers have a great time helping out and guarantee sustainability, as most return over and over. Special thanks to Providence Health and Services which funds a small grant to assist with operational costs. Pap-A-Thon: Taking steps to a healthier Siletz An ounce of prevention is worth a pound of cure. Believing in this adage, the Siletz Community Health Center in Siletz, Lincoln County, holds a “Women’s Health Night” twice a year. The primary goal is to reach area uninsured or underinsured women who would not otherwise have access to healthcare. The event focuses on providing preventive tests and services such as pap-testing, blood glucose and cholesterol checks, selfbreast exam, scheduling mammograms, and skin cancer screenings. Massages, manicures, food, prizes and educational materials are also a part of the event. Women’s Health Night started nine years ago. Each year since then, the staff works extremely hard to bring in local and state sponsors and volunteers to make this event a great success. In May 2009, Siletz Community Health Center plans to hold a “Mother-Daughter Tea” to talk about human papillomavirus (HPV) and the HPV vaccine. HPV vaccine will be offered at this event. Siletz Community Health Center hosts Pap-A-Thon continued on page 7  Oregon Immunization Bulletin Odds and Ends New materials available from the Oregon Immunization Program! The Oregon Immunization Program is pleased to offer these new materials and resources to providers: • HPV/Cervical Cancer Resource Guide: For details about this exciting new resource for providers, please refer to the article on page 11. • Updated Contraindications and Precautions posters: This poster now contains all routinely recommended vaccines and the most current information on contraindications and precautions. This wonderful resource for clinic staff and parents describes common symptoms and conditions that do and do not contraindicate immunization. A copy of the poster has been mailed to each VFC-enrolled clinic. To request additional copies, contact your health educator. • Vaccine Administration Record (VAR) for private providers: This comprehensive VAR is easy to use and captures all the information required under federal statute 42 US Code 300aa-25 and 300aa-26. To view and print copies of this VAR, please visit our website at: http://www.oregon.gov/DHS/ph/imm/provider/forms.shtml Public clinics: The Oregon Immunization Program requires your continued use of the Oregon public provider VAR. The public provider VAR has been customized to meet the additional documentation requirements of public clinics. If a public clinic would like to use a custom VAR, please contact your health educator for approval. Get ready for re-enrollment! It is a federal requirement that all VFC providers re-enroll annually in the VFC program. This gives you a chance to update important information about your clinic, like your vaccine delivery hours, the contact information for your VFC Coordinator, and the number of patients you see based on age and vaccine eligibility. It also gives you the Oregon Immunization Bulletin the opportunity to review the VFC program requirements listed on the provider agreement. Re-enrollment paperwork will be arriving at your clinic in the next few months through through certified mail. Keep your eyes open for these important, timesensitive documents!  Local Health Department AFIX Assessments In March, each local health department in Oregon received their annual AFIX assessment of immunization rates and practices. AFIX is a quality improvement tool for providers who are interested in improving their immunization practices and coverage rates. The staff at local health departments in Oregon are doing terrific work to make sure their patients are fully protected from vaccine-preventable diseases. In just two years, the local health department average up-to-date rate for two year olds increased a remarkable five percentage points, from 67% in 2006 to 72% in 2008! Staff at the local health departments have accomplished this by ensuring that all forecasted shots are given at every visit, by working closely with parents who are hesitant about vaccinating their child, and by focusing on the completion of certain vaccine series, like DTaP. Congratulations to all of the local health departments. We appreciate all you do to keep your communities healthy! Pap-A-Thon continued from page 5 a similar event for men once a year. Preventive testing at this event includes screening for skin, bladder and prostate cancer; and blood glucose and cholesterol checks. Educational materials and on-site education is also provided. When asked about the secret of the event’s success, Siletz’s Cherity Bloom, RN, said that encouraging women to get involved in their health, in a relaxed and comfortable atmosphere is a great way to bring them back for other health care issues. If you are interested in finding out how to hold a similar event in your clinic, contact: Cherity Bloom at 541-444-9602  Oregon Immunization Bulletin ALERT update Looking ahead: New tools for ALERT and IRIS users Oregon’s immunization tracking systems are getting even better! In the upcoming year, the Oregon Immunization Program will implement a new immunization information system (IIS) with many new features. Currently we have two different immunization systems in use across Oregon. Most private clinics submit immunization data directly to ALERT, while most local public health departments enter their data into a system called FamilyNet-IRIS, which then feeds into ALERT. Both systems have been exchanging data since 2006, but soon ALERT and IRIS will be combined into one system, making consolidated immunization records available to authorized users anytime, anywhere via a secure web interface. All of the functions sites currently use will be available in the new system. In addition, even more helpful new functions will also be built in. You can search for immunization records on individuals of any age; add historical shots (then rerun the forecast); update demographic or vaccine information; run reports on uptake or up-todate rates; manage your vaccine inventory; even run your own reminder or recall letters. Clinics will also have more options for submitting their data. Currently, clinics submit data to ALERT via electronic transfer or barcodes/hard copy. IRIS users submit through an online user interface. With the new system, all users will have the option to submit via electronic transfer, barcodes/hard copy, or to add doses administered directly to a patient’s record in real time through the user interface. The new ALERT IIS will also offer more options for bidirectional data exchange using HL7 messaging. At this time, the new ALERT IIS project plans to pilot with select clinics in spring 2010 and begin statewide implementation by the end of 2010. We’re committed to supporting you. The new ALERT IIS will have a new look with new features and functions. We’ll share information with all users about how each site will transition to the new system once plans are finalized. As we approach implementation, training options will be available for users, in many different formats – online, webinars, and in-person. Plus, ALERT help desk support and technical assistance will be just a phone call Oregon Immunization Bulletin away at 800-980-9431. For more information about the new ALERT IIS, please call Jenne McKibben, ALERT Training Lead, at 971-673-0280.  A 2007 Centers for Disease control and Prevention survey showed that only 1.9 percent of those who should get immunized for shingles do so. More than one-third of people 65 and older — and almost half of noninstitutionalized 65-plus Americans — report that they haven’t received their needed PPV dose. Keep in mind that Tdap, measles/mumps/ rubella (MMR) as well as hepatitis A & B may need to be offered to those meeting the age and physical health requirements. So the next time you see an older person in your waiting room or bringing in a child for immunization, keep in mind that older folks need vaccinations, too. Silvered Heads Need Golden Needles Some of us with silvering hair may notice our expanding waist lines and receding hair lines, but what we may not know is that our vaccine immunity can fade as well. The 2009 Adult Immunization Schedule recommends ten vaccines for adults 19 and older. People 60 and over should have the following three vaccines: zoster (shingles), influenza, and tetanus/diphtheria/pertussis (Tdap). Those up to 65 with high-risk health conditions should have the pneumococcal polysaccharide vaccine (PPV). At 65 and over, all adult should have it. Zoster is the newest vaccine routinely recommended for older adults, and some providers may not be aware that this vaccine is indicated for their patients 60 and older. Patients not yet eligible for Medicare may have to pay out-of-pocket for the vaccine if they are not privately insured. Visit http://www.cdc.gov/vaccines for a printable version of the 2009 Adult Immunization Schedules. 10 Oregon Immunization Bulletin Ask Maria Frequently asked questions about administering newly licensed vaccines Rotarix® and Pentacel® children 5 years or as the booster dose for children ages 4–6 years. The DTaP-IPV component is supplied as a sterile liquid, which is used to reconstitute lyophilized (freeze-dried) ActHIB vaccine. The two components of the vaccine should be stored together in their original packaging to reduce vaccine administration errors. The DTaP-IPV component should never be administered alone. Rotavirus vaccines: Q: If we don’t know which rotavirus vaccine - Rotarix® (GSK) or RotaTeq® (Merck) -an infant previously received, how shall we complete the schedule? A: If you have any doubt about which vaccine the infant previously received and the infant is at an age when the vaccine can still be given, you must assume that the child needs three doses – not two doses – to Q: Can I use Pentacel® to give the 12– complete the series. Give a total of three 15 month booster dose of Hib vaccine doses of rotavirus vaccine. to children not at high risk of Hib complications, even though there is a Hib Pentacel® vaccine: vaccine shortage? Q: Please describe the combination vaccine Pentacel® and how it should be A: No. During the Hib vaccine shortage, used. you should not give Pentacel® as the fourth dose of the series to children at low risk. A: On 6/20/08, FDA licensed Pentacel® Administer a single dose of DTaP for the (s pasteur), a DTaP-IPV/Hib combination fourth dose. vaccine. It is approved for use as a fourdose series in infants and children at ages 2, 4, 6, and 15-18 months. It should not be *Source: CDC’s “Ask the Experts” available at: http:// used for any dose in the primary series for www.immunize.org/askexperts. Oregon Immunization Bulletin Human Papillomavirus (HPV)/ Cervical Cancer Resource Guide In February 2009 The Oregon Immunization Program mailed the HPV/Cervical Cancer Resource Guide to public and private providers. The HPV Resource guide was created by the Oregon Immunization Program to provide resources to providers, patients, schools and communities regarding HPV and cervical cancer. The purpose is to increase understanding of the link between HPV and cervical cancer and strengthen communications about HPV infection and prevention. We also hope to 11 increase understanding of the HPV vaccine and of the health disparities and cultural differences associated with HPV and cervical cancer. Materials provided in the guide can be found on our website: www.oregon.gov/ dhs/ph/imm/docs/hpvguide.pdf . For questions, or to request an additional copy of the HPV/Cervical Cancer Resource Guide, please contact: Lindsay Weaver Immunization Health Educator 971-673-0319 Lindsay.weaver@state.or.us Oregon Tdap Special Project a huge success! After providing over 50,000 doses of no-cost Tdap vaccine, the Oregon Tdap Special Project is now closed. The vaccine, valued at $2,010,000 was distributed between May 2008 and March 2009. We have exhausted our current supply of Tdap vaccine and will no longer fill Tdap Special Project Orders. As a result of participating Tdap continued on page 12 Tdap continued from page 11 in this project, providers across the state have ensured that their communities are better protected from pertussis disease. Over 175 separate agencies participated in the Tdap Special Project. Efforts ranged from small clinics vaccinating their staff to huge health systems vaccinating everyone that asked. Many innovative partnerships have developed as a result of the Tdap Special Project and will continue beyond the scope of this project. Up next we will compile survey responses and analyze the final reports from project participants, as part of our thorough evaluation of the Project. All participants will be sent a final report and findings will Oregon Department of Human Services Oregon Immunization Program 800 NE Oregon Street, Suite 370 Portland, OR 97232-2162 be presented at a variety of conferences and trainings in 2010. Several innovations have already surfaced through your work on this project. It is our hope to further streamline the Special Project model for use in future outreach. Please join us in congratulating the many diverse partners that participated in the Tdap Special Project. We greatly appreciate the important work done to protect our communities against pertussis. Please address any questions about this project to Bryan Goodin, Adult Immunization Coordinator (bryan.goodin@ state.or.us).