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K-12 REQUIREMENTS: SNAPSHOT

Already Required

DTaP/DT and/or Td (Tdap)

Polio

Hepatitis B

MMR

Varicella

New Requirements

Meningococcal grades 7-12

Tdap instead of Td grades 7-12

Changes to previous requirements

DTaP for K: last dose on/after 4 years

Polio for K: last dose on/after 4 years

Hepatitis B: expanded K-12

MMR: expanded K-12

Varicella: expanded K-12

GIVE ADOLESCENTS ALL RECOMMENDED VACCINES

• Tdap

• HPV

• Meningococcal

• Influenza

PERTUSSIS IN MINNESOTA, 2013

PERTUSSIS PREVENTION

Early diagnosis and treatment: think, test, treat

Reduce morbidity and mortality to most vulnerable – children under 1 year of age

TDAP RECOMMENDATIONS

Tdap at 11-12 y, then Td every 10 years (2006)

One Tdap for person 13 years or older not previously vaccinated, then Td every 10 years

Give Tdap regardless of interval since last Td

Tdap in incompletely or unvaccinated persons 7-9 y

ACIP off-label recommendation: use Tdap as one of the doses in the series

Update: Adacel now licensed to age 10 years, (Boostrix has been since first licensed)

TDAP RECOMMENDATIONS

Pregnant womenTdap during every pregnancy regardless of the number of doses previously received, Give between 27-36 weeks gestation

KEY TDAP LAW IMPLEMENTATION ISSUES

Tdap not necessary if dose given between ages 7-10

Don’t need to consider waiting between last Td and Tdap

Can assume Td/Tdap documentation of older ages is likely Tdap

Serogroups C and Y account for the majority of meningococcal cases in adolescents

RECOMMENDATIONS FOR ROUTINE MENINGOCOCCAL VACCINATIONVaccines:

Menactra (MCV4-D) or Menveo (MCV4-CRM)

Schedule:Routine adolescent

Give MCV4 at age 11-12 (2005) MCV4 booster at age 16 (2011)

If first dose given at 13-15 years, give booster between 16-18 years Minimum interval between doses is 8 weeks

If first dose given on of after age 16, a booster dose is not necessary

Catch-up through age 21 years if person is a first year college student living in residential housing

UPDATE: Two vaccine candidates for serogroup B under FDA review

KEY MENINGOCOCCAL LAW IMPLEMENTATION ISSUES

Phased AISR reporting

No booster dose reporting

Doses given before age 10 years not considered compliant (won’t protect through risk years)

Rates for upcoming 7th graders are sobering

2012 MN NIS13-17

2012 MIIC13-17

2014 MIIC11-13

010203040506070

32

Comparison of 1+ MCV4 in Adoles-cents

13-17 years versus 11-13 years, MN

Phased AISR Reporting for Meningococcal Vaccine

Grade

2014-15School Year

2015-16School Year

2016-17 School Year

2017-18 School Year

2018-19 School Year

2019-2020

School Year

7th 1 MCV4 dose

1 MCV4 dose

1 MCV4 dose

1 MCV4 dose

1 MCV4 dose

1 MCV4 dose

8th 1 MCV4 dose

1 MCV4 dose

1 MCV4 dose

1 MCV4 dose

1 MCV4 dose

9th 1 MCV4 dose

1 MCV4 dose

1 MCV4 dose

1 MCV4 dose

10th 1 MCV4 dose

1 MCV4 dose

1 MCV4 dose

11th 1 MCV4 dose

1 MCV4 dose

12th 1 MCV4 dose

INFLUENZA

Return of H1N1 since 2009 pandemic

Incidence declining but still seeing B strains circulating

Less hospitalizations than last year but higher than recent years

Severe disease seen mostly in young and middle age adults

INFLUENZA LABORATORY SURVEILLANCE

MN Lab System (MLS) Laboratory Influenza Surveillance Program

Influenza week 17, 2014

NEW INFLUENZA VACCINE PRODUCTS

1. Flumist Quadrivalent (LAIV4), MedImmune

2. Fluarix Quadrivalent (IIV4), GSK

3. Fluzone Quadrivalent(IIV4), Sanofi Pasteur

4. Flulaval Quadrivalent (IIV4), ID Biomedical /GSK

5. Flulaval (IIV3) age expansion to 3 years, ID Biomedical/GSK

6. Flucelvax, a cell culture-based trivalent inactivated influenza vaccine (ccIIV3) ), Novartis

7. Flublok, a trivalent recombinant HA influenza vaccine (RIV3), Protein Sciences

OTHER KEY FLU MESSAGES

Efficacy 50% give or take - mostly in healthy adults and children Current flu vaccines are the most specific tool we have

to reduce morbidity and mortality of influenza

Timing of vaccination Ideal: 2 weeks before onset of flu season Real: impossible to predict the start of

flu season! Real: millions to vaccinate every season Don’t miss the opportunity to vaccinate,

there may not be another chance to do it

PNEUMOCOCCAL VACCINATION – GOOD TO KNOW

Pneumococcal conjugate vaccine, 13 valent

Routinely recommended in infancy 2m, 4m, 6, 12-15m

Two vaccines, many older at-risk children need both

Pneumococcal conjugate vaccine (PCV13)Conjugated technology allows for longer protection and more responsive boosting effect

Pneumococcal polysaccharide vaccine (PCV23)Covers strains not included in 13-valent product

Preferable to give after conjugated product

Risk Group Underlying Medical Condition PCV13 PPSV23

Immunocompetent      

Chronic heart or lung disease   X

Diabetes mellitus   X

CSF fluid leak X X

Cochlear implants X X

Chronic liver disease   X

Alcoholism   X

Has asthma X

Smokes cigarettes   X

Functional or anatomic asplenia

Sickle cell disease/other hemaglobinopathies

X X

Congenital or acquired asplenia X X

Immunocompromised      

Congenital or acquired immunodeficiencies

X X

HIV infection X X

Chronic renal failure/nephrotic syndrome X X

Leukemia/lymphoma/Hodgkin disease/generalized malignancy

X X

Iatrogenic immunosuppression X X

Solid organ transplant X X

Multiple myeloma X X

CHILD CARE & EARLY CHILDHOOD PROGRAM REQUIREMENTS: A SNAPSHOT

Already Required

DTaP/DT

Polio

Hib (through age 4 years)

Pneumococcal (to age 24 months)

MMR

Varicella

New Requirements

Hepatitis B

Hepatitis A

School-based early childhood programs added

Changes to previous requirements

Varicella required starting at 15 months (instead of 18 m)

HEPATITIS A

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012*2013*

0

50

100

150

200

250

Number of Hepatitis A Cases per Year, MN 1998 - 2013

Included an outbreak that involved school-aged children

HEPATITIS A RECOMMENDATIONS

Products: Havrix (GlaxoSmithKline) and Vaqta (Merck)

Age recommended: 12 Months

Schedule: 2 doses, at least 6 months apart

Immunization Rule: required for children in child care and early childhood education programs through Pre-kindergarten

• Extended-day programs (K and up) are not included

in this requirement

SCHOOL-BASED EARLY CHILDHOOD PROGRAMS

Early childhood special education (ECSE) - has been included in the law for a couple decades

School-based early childhood programs Children from birth through pre-kindergartenMeet at least once a week for 6 or more weeks during the year

Vaccine requirements are the same as for child care

EARLY CHILDHOOD LAW IMPLEMENTATION Q/AQ: Do the new requirements only apply to newly enrolling

kids?

A: No. Any child enrolled in child care or early childhood programs needs to meet the new requirements effective Sept 1, 2014.

Q: Are early childhood programs required to complete the Annual Immunization Status Report?

A: No, the Annual Immunization Status Report (AISR) is for K-12.

Q: How often should we check immunization records of children enrolled in Early Childhood programs?

A: Once during the school year is adequate.

CHANGES TO IMMUNIZATION LAW

Implementation: September 1, 2014

Immunization Law Communications

Target audiences/ mechanism

Resources Other promotional projects

Schools/school nurses/daycare/early education:• SNOM conference• Email listservs• Formed advisory team• WebEx sessions• School nurse meetings

Updated:• Student Immunization

Form • Child Care Immunization

Form• Early Childhood

Immunization Form • Schedules that include law• Are Your Kids Ready?

HPV Grant: focuses on all recommended adolescent vaccines• Public information campaign• Postcard reminder mailing

to 123,000 families of 11-12 y o

• Clinician outreach and education

Local public health:• Monthly calls• Workspace updates

New resources:• Factsheet on the Law

changes• School software vendor

guidance sheet• Frequently Asked

Questions

Mass vaccination exercises – certain LPHA in collaboration with emergency planning staff• Vaccines include

meningococcal, and Tdap; some include HPV

Providers/clinics:• Broadcast faxes• Got Your Shots newsletter• MIPAC partner

communication• Professional organization

messages/venues• Mailings• Health systems contacts

•MIIC Adolescent Assessment tool

•MIIC Reminder/recall feature

ResourcesForms: www.health.state.mn.us/divs/idepc/immunize/tracking.html

Updates: Sign up for GovDelivery updates - click on the little red envelope on each of these pages:

School Health Personnel: www.health.state.mn.us/divs/idepc/immunize/school/

Minnesota Immunization Rule Revisions: www.health.state.mn.us/divs/idepc/immunize/immrule/

Webex: https://health-state-mn-ustraining.webex.com/ Select Recorded Sessions in the left navigation

Questions? Call MDH: 651-201-5503 or 800-657-3970 or Email: health.immrule@state.mn.us

QUESTIONS?