Immunize Georgia, Vol. 3 (Oct. 2004)

A PUBLICATION OF CHILDREN'S HEALTHCARE OF ATLANTA AND THE GEORGIA IMMUNIZATION PROGRAM I 2004 VOL. 3

Vaccines on the Horizon: What's SPOTlight

New in Immunization?

New vaccines to protect children, adolescents vaccine that includes acellular pertussis, tetanus and adults from illnesses are on the horizon. and diphtheria vaccines.

Of the many new vaccines in production, the few A new conjugate meningococcal vaccine against

that are anticipated to be available in the next

four strains of this organism is expected to be

couple of years include vaccines for pertussis,

licensed for persons 11-55 years of age in the

meningococcal disease and human

near future. The Advisory

papillomavirus (HPV). In

New vaccines to be Committee on Immunization

addition, new combination

available in the Practices (ACIP) is considering

vaccines for existing vaccines such as measles, mumps, rubella and varicella are being developed.
Pertussis cases and infant deaths due to pertussis have increased over the past couple of years. Often infants, who were too young to

next couple of years include vaccines for pertussis, meningococcal disease and human
papillomavirus (HPV).

recommendations for targeting adolescents with the initial supply of this vaccine. Anticipated benefits of the new conjugate vaccine compared to the current licensed polysaccharide may include improved duration and type of immunity and reduced

have completed their initial vaccine

nasopharyngeal carriage of vaccine

series, contracted the infection from an older child strains. The polysaccharide meningococcal vaccine

or adult in their household. Currently there is not (Menomune) will still be available for use, when

a pertussis vaccine licensed for children over seven indicated, for persons over 2 years of age.

years of age in the United States. A vaccine for

Another vaccine being researched is one for

pertussis would not only protect older children HPV. Like the hepatitis B vaccine, the vaccine for

and adults but also prevent young infants in their HPV may prevent initial infection as well as long

household from contracting the disease. The new term complications, including cancer.

vaccine, pending licensure, will be a combination

WHAT'Sinside
GRITS Update ............................................................3 Varicella Surveillance..................................................4 Vaccine Safety ............................................................4 Immunization Conferences ......................................5 Flu News ................................................................6 Parent Pages ....................................................Insert

VFC Providers Respond to Survey
Four hundred Georgia Vaccines for Children (VFC) providers, representing both public and private healthcare offices, completed Provider Satisfaction Surveys of the program this year. These surveys covered user responses to VFC program requirements, customer service, enrollment, quality assurance site visits, shipments and education. Michelle Conner, VFC coordinator/ vaccine manager, reported, "The survey indicates that providers are appreciative of the VFC program and the ability to immunize children without vaccine insurance coverage in their medical home. There also appears to be a great deal of excitement about the Georgia Registry of Immunization Transactions and Services (GRITS). We've learned of educational needs through the survey, and Immunization Program Consultants have received this information so that in-service programs can be set up with individual practices by the representative that serves them."
Of those completing surveys, overall satisfaction with the VFC program was 97 percent. Ninetyeight percent responded that they

CONTINUED ON PAGE 2

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VFC Providers Respond to Survey CONTINUED FROM PAGE 1

Survey Question
Easy to comply with record-keeping requirements Easy to understand Vaccine Loss policy Easy to document eligibility Annual recertification process straightforward Easy to reach Program Associate on the phone Program Associate was knowledgeable Problem solved or question answered Participating 3 yrs or longer
1-2 yrs <1 yr Information and supplies I received to launch program were adequate. Ease of procuring vaccines Condition of vaccines received Time to receive vaccines Prefer to receive single-dose vials Prefer to receive pre-filled syringes Had Quality Assurance Site visit in last 12 months Visit was beneficial Received helpful materials Visit did not interfere with practice operation VFC rep knowledgeable Visit changed some of our practices

Agree
90% 90% 92% 86% 93% 91% 90% 74% 16% 10% 98%
95% satisfied 99% satisfied 93% satisfied
51 % 49% 72% 98% 98% 97% 99% 55%

Disagree
6% 3% 3% 3% 2% 1% 2%

would recommend the program to colleagues. Ninety-seven percent said the program keeps them up-to-date on changes and availability of vaccines. Eighty-eight percent agreed that the program has increased the number of children immunized in their practice. Eighty-five percent said the program has decreased the number of families being referred to public clinics for immunizations.
Survey respondents also added comments to their surveys: "Thank you for enabling us to serve our community, to reassure moms and to care for children. A job well-done."
"This program is a great asset to our practice, and we are able to pass it on to our patients."
"I would like to see a bar code on the individual vaccine and use the code to scan the inventory and the computer documentation in GRITS, etc. This would be ideal in the future!"
"It would be nice if we could transmit usage reports via the Internet."
"Please make GRITS easier to use."

"Excellent customer service team, always helpful and polite."
"VFC packets help keep us aware of what's going on."
"I like the idea that kids of low income or single parents are able to get their vaccinations and not worry about high prices."
"It helps us reach out to families who are otherwise not fully informed."
"Very easy to implement; helpful staff; good for patients."
"Everything works like it's supposed to! In today's world that is unusual."
"Wonderful program. Keeps me up-to-date on an area of medicine that has constantly changing requirements. Having constant availability of vaccine allows me to provide good continuity of care to every patient in my practice."
"Our clinic LOVES GRITS. Greatest thing that has happened. Such ease in producing 3231 forms, such a timesaver and easy to use."

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Resources

On October 5, 2004, CDC, in coordination with the Advisory Committee on Immunization Practices (ACIP), issued interim recommendations for influenza vaccination during the 200405 season because of an urgent vaccine supply situation. These interim recommendations take precedence over earlier recommendations. For access to the interim recommendations please visit: http://www.cdc.gov/flu/protect/whoshouldget.htm
The National Partnership for Immunization (NPI) works to improve the effectiveness of efforts focused on reducing vaccine preventable diseases among infants, children, adolescents and adults. NPI focuses on four areas: communication and awareness, education, partnership and outreach, and assessment and information exchange. For more information and resources visit http://www.partnersforimmunization.org.
Educating Physicians In their Communities (EPIC) is spreading the good word about immunizations. The peer-topeer, in-office program, managed by the Georgia Chapter of the American Academy of Pediatrics (AAP) has begun its 5th year providing education and resources to immunization

providers across the state. With the assistance of public and private program partners, EPIC team members have been able to present the most current immunization information to better explain reasons for immunization, missed opportunities for immunization and what individual providers can do to improve immunization rates. EPIC has delivered quality education to thousands of immunization providers at more than 500 locations. Originally designed to present childhood immunizations, this year, EPIC is able to offer an additional curriculum targeting adult immunizations. The program is free for offices and continuing education credits are offered for physicians and nurses. For more information call Cynthia (404) 881-5054 or Melonie (404) 881-5081 at the Georgia Chapter of the AAP.
Georgia Immunization Program Resource Line: 404-657-3158 or http://health.state.ga.us/programs/immunization/
The 2004 IGLG poster "Recommended Childhood and Adolescent Immunization Schedule" is still available. For copies call or email Rachana Naran at 404.785.7216 or rachana.naran@choa.org.

GRITS Update

The Georgia Registry of Immunization Transactions and Accessibility by schools to print out completed Form 3231

Services (GRITS) is busy training providers all over the state of Certificates: schools will be able to print off Form 3231.

Georgia, since its initial rollout in March of 2003. Currently the Certificates for students who have 100 percent completion and

registry is managing over 3.9 million clients of all ages and 26.5 an Immunizations Needed form for students who are not

million immunization transactions. Staff from the Immunization completely immunized.

Program at the Georgia Department of Human Resources has

surveyed providers utilizing GRITS to determine the registry's The March 30, 2005 release will update the GRITS algorithm,

benefits and to enhance any areas of concern. Many adjustments which is based on the Advisory Committee on Immunization

and improvements have been made to better serve the providers Practices's (ACIP) recommendations to include the following:

utilizing the registry.

A complete Adult schedule will be added with high-risk adult

With the December 31, 2004 release of GRITS, the

contraindications

following services will be offered:

An expansion of existing comments section to include

Modification of expiration date on Form 3231 Certificate:

additional contraindications

providers will be able to override the recommended expiration An addition of Synagis and Respigam

date with a date in between the print off date and the

An improvement on the handling of historical immunization

recommended date.

transactions that are provided with only Current Procedural

Ability to print out a vaccine transactions report: the report

Terminology (CPT) codes.

will include the name of the patient, the date of

administration, the vaccine trade name, the lot number, the In March 2005, the program plans to have its first GRITS User

name of the administering individual and a few other fields. Group gathering. This meeting will give users the opportunity to

Opportunity to utilize GRITS to report Vaccines for Children provide direction for the future of the registry.

(VFC) usage and accountability: upon approval from the VFC

Program, providers will be able to use GRITS to report usage

and accountability instead of current paper forms.

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Vaccine Safety: Everyone Can Help

The Vaccine Adverse Event Reporting System (VAERS) is information is kept confidential as required by law. Data

the national public health surveillance system that represents the collection includes information about the patient, vaccinations

"front line" of vaccine safety activities. Historically reporting of given, reported adverse event and the person reporting the event.

adverse events by clinicians has been the most reliable source of Reports defined as serious include those involving hospitalization,

drug safety alerts. Since VAERS receives large numbers of

life-threatening illness, permanent disability or death. To download

reports and covers a diverse population, it is useful for detecting reporting forms visit www.vaers.org, or call 1.800.822.7967.

new, unusual or rare events, and assessing newly licensed vaccines. The online reporting Web site is

The role of the health professional in supporting the national http://secure.vaers.org/VaersDataEntryintro.htm. Reports also

passive surveillance system is essential and has been incorporated can be faxed to 1.877.721.0366 or mailed to: VAERS, PO Box

into the Standards for Pediatric Vaccine Practices. The

1100, Rockville, MD. 20849-1100. Public Health providers should

observations of the astute clinician are key in this process.

submit their reports through the Georgia Immunization Program.

The primary purpose of VAERS is to identify new or rare

There are also three newer vaccine safety initiatives. The

side effects, increases or decreases in rates of known side effects, Clinical Immunization Safety Assessment Centers were

and patient risk factors for particular types of adverse events. established as a national network to improve the scientific

Examples include intussusception after rotavirus vaccine, the understanding of immunization safety issues at the individual

enhanced safety profile of DTaP, as compared to DTP, and

patient level. The goals of the centers are to enhance the

anaphylactic reactions to MMR vaccine caused by gelatin allergy. understanding of pathophysiology and risk factors of known

A secondary goal of VAERS is to identify vaccine lots with

serious or unusual vaccine reactions and to evaluate newly

increased numbers of reported events. Between 1991 and 2001, hypothesized syndromes or events identified by VAERS reports.

the overall reporting rate was 11.4 reports per 100,000 doses The Institute of Medicine's Immunization Safety Review

distributed; and 53 percent of side effects were related to

Committee is made up of experts in all fields of medicine and

pediatric and adolescent age groups. A total of 14.2 percent of all public health and reviews hypotheses about existing and

reports described serious adverse events.

emerging immunization safety concerns. The Brighton

VAERS accepts spontaneous reports from health professionals, Collaboration is an international group whose primary purpose is

manufacturers, patients or parents submitted via mail, fax or to develop globally accepted standardized case definitions of

secure electronic reporting on its Web site. Personal identifying adverse events following immunizations.

Varicella Surveillance in Georgia

Varicella-zoster virus(VZV) causes chickenpox. The virus is surveillance program for providers, schools and day care centers

spread through the respiratory secretions or through direct contact to report chickenpox and herpes zoster (shingles) cases.

with fluid from the vesicular lesions. Cases of VZV infection most Participation in the program is voluntary and offers providers

often occur in the late winter and early spring. Children under the the opportunity to report any cases of chickenpox that they may

age of 15 are more commonly infected. However, fatality rates for observe. Information provided to GDPH includes the child's

chickenpox are higher among individuals greater than 15 years of age, immunization history, number of lesions and source if

age. A varicella vaccine was licensed in 1995 and has an efficacy known. Providers can report cases by the State Electronic

rate of 80-90 percent against infection and 95 percent against

Notifiable Disease Surveillance System (SENDSS), by phone,

severe disease. The vaccine has contributed to lowering the number by fax or by email. The objectives of GDPH's surveillance

of cases of chickenpox nationwide.

program are to monitor the epidemiology of varicella by age,

In the past four years chickenpox cases also have declined in the place and over time; to monitor the impact of widespread and

state of Georgia. This is particularly due to the state of Georgia's increasing rates of varicella immunization; to provide data to

requirement for documentation of varicella immunity for child care guide future immunization policies; and to ensure the prompt

and school entry. Varicella surveillance assists with tracking disease implementation of disease control measures.

incidence and identifying outbreaks. Surveillance is also helpful in For more information about the surveillance program or

identifying breakthrough cases. Breakthrough cases are those

how to participate, please contact Dr. Julie Gabel (404.657.2629)

chickenpox infections occuring in vaccinated individuals.

or Beth Ward (404.463.8924) at the State of Georgia

In August of 2004, the Epidemiology Branch of the Georgia Epidemiology Program.

Division of Public Health (GDPH) began a sentinel

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2004 Immunization Conferences

Two immunization conferences this year offered a variety of educational information to Georgia providers. The 2004 Immunization Conference Closing the Gap on Immunizations, hosted by The Children's Hospital at the Medical Center of Central Georgia, was held on August 25, 2004. The 11th Annual Immunize Georgia's Little Guys Conference Seeking the Gold Standard: Strategies for Improving Immunization Practices was held on September 28, 2004.
About 90 people attended the 2004 Immunization Conference held in Macon, Georgia. Speakers included representatives from the Centers for Disease Control and Prevention (CDC), the Immunization Program at the Georgia Department of Human Resources (DHR), Children's Hospital at the Medical Center of Central Georgia and the other departments of the Georgia Division of Public Health. The conference touched on a variety of topics including the 2004 general vaccine schedule, vaccine accountability, storage and handling, reluctant parents, an overview of varicella outbreaks and surveillance, an update on the Georgia Registry of Immunization Transactions and Services (GRITS), college immunization policies, flu vaccines and vaccine administration techniques. The session ended with a questionand-answer panel for attendees.
The 11th Annual Immunize Georgia's Little Guys Conference was held at the Georgia International Convention Center in College Park, Georgia. Over 300 people attended the one-day event. The conference offered networking opportunities and a variety of exhibitors with helpful resources regarding immunizations. Jeff Poltawsky, director of Community Health Development and Advocacy at Children's Healthcare of Atlanta (Children's), introduced the welcome speaker, Mike Chaney,

program manager for the Georgia Immunization Program. Topics discussed throughout the day included new information on vaccines, vaccine accountability, GRITS, varicella surveillance and immunization policies for colleges and universities. Dr. Walter Orenstein presented the first ever Walter Orenstein Champions for Immunization Awards. Congratulations to the five award recipients:
Ms. Mary House, school clinic assistant for Toney Elementary in Fulton County, for her"Get on Board" program encouraging students, staff and parents to turn in their immunization forms
Dr. Neil Goodman, pediatrician in Brunswick, Ga., for his utilization of GRITS
Dr. Joel Goldstein, partner in a medical practice in metro Atlanta, and Dr. Harry Keyserling, professor of pediatrics at Emory University's School of Medicine, for serving as co-chairs on the Infectious Disease Committee for the Georgia Chapter of the American Academy of Pediatrics
Dr. Alan Sievert, retired pediatrician and district health director, for his commitment to educating physicians in the Georgia community regarding immunizations
Ms. Freda Shepperd, immunization coordinator for Clayton County, and Ms. Marty Huntsinger, coordinator for the Clayton County Board of Education for their varicella surveillance program
The conference adjourned following a family's touching story about varicella outbreak and complications.

fluNEWS
Flu News
On October 5, 2004, CDC was notified by Chiron Corporation that none of its influenza vaccine (Fluvirin) would be available for distribution in the United States for the 200405 influenza season, significantly reducing the United States supply of available flu shots by one half. Currently available for the 2004-2005 flu season are approximately 58 million doses of Fluzone (inactivated flu shot) and 3 million doses of live attenuated influenza vaccine (LAIV/FluMist). Providers are encouraged to provide vaccines to the following high priority groups: children between the ages of 6 and 23 months, adults 65 years and older, persons 2 years of age and older with underlying chronic medical conditions, household contacts and caregivers of children less than 6 months of age, and women who will be pregnant during the influenza season. Georgia Vaccines for Children (VFC) providers needing additional flu vaccine should contact the VFC Program Office at 1-800-848-3868. In addition, providers who have flu vaccine that they anticipate will not be administered should contact the VFC Program Office so that the vaccine can be redistributed.

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Published quarterly by Children's Healthcare of Atlanta 1655 Tullie Circle NE, Atlanta, Georgia 30329-2321
Children's Healthcare of Atlanta 404.250.kids, www.choa.org
Immunize Georgia's Little Guys Rachana Naran, M.P.H. 404.785.7216, rachana.naran@choa.org
Alison Ellison, R.N., N.C.S.N. 404.785.7201, alison.ellison@choa.org
Georgia Immunization Program 404.657.3158, fax 404.657.1463 www.health.state.ga.us/programs/immunization/
Vaccines For Children Program 404.657.5013, fax 404.657.5736 800.848.3868, fax 800.372.3627
American Academy of Family Physicians Georgia Chapter 404.321.7445, www.gafp.org
American Academy of Pediatrics Georgia Chapter 404.876.7535, www.gaaap.org
CDC National Immunization Program and Hotline 800.232.2522, www.cdc.gov/nip
CDC Spanish-Language Hotline 800.232.0233, www.cdc.gov/spanish/

2004 Children's Healthcare of Atlanta, Inc. All rights reserved. DPH04/318HW/CHDA909408:jt10/04.
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PARENT PAGES -- DO YOU KNOW WHAT YOUR CHILD NEEDS BY TWO? I 2004 VOL. 3

? Do You Know...
What Your Child Needs By Two

Immunizations protect children from many diseases that can easily be prevented. Most of these diseases are spread from

Making sure your child gets all needed shots by the age of two years will protect him or her from these harmful diseases:

person to person, and children are at special

hepatitis B

risk because their bodies lack all the protection

diphtheria

that adults have. For many available vaccines

tetanus (lockjaw)

or immunizations, your child will require

pertussis (whooping cough)

several shots in a series to get all the

H. influenzae, type b disease

protection he needs. Several doses are

polio

required because the medicine causes your

measles

child's body to build its own protection

mumps

against the disease gradually rather than

rubella (German measles)

all-at-once. Infants are at the highest risk of

varicella (chicken pox)

these diseases, so many of these vaccines are

influenza (flu)

given at the same time at well-baby visits,

pneumococcal disease

starting at six to eight weeks of age and

continuing through 18 months of age. This

Preschools, day care centers and all schools

practice has proven to be one of the safest

require children to be up-to-date with their

and best things you can do for your child.

immunizations. You should talk to your doctor

Because infants see their doctor or health

or local health care clinic to find out when

clinic provider on a frequent basis for checkups, most receive all and where your child can get these. Many healthcare insurance

the recommended vaccines until 12 months of age. However, plans, including Medicaid and PeachCare, cover the cost of

after 12 months of age, many children do not receive their 4th immunizations. If you do not have insurance or your plan does

dose of diphtheria, tetanus, and pertussis (DTaP) vaccine.

not pay for these shots, ask if your healthcare provider offers the

Many times, this is not discovered until it is time for the children Vaccines for Children (VFC) program. This program provides

to receive their 5th booster dose at age free vaccines to doctors and clinics for children who meet

4 or 5 before entering kindergarten

certain guidelines.

or school.

A minor illness should not prevent your child from getting

Young children who have not had all his shots. Common side effects may include a slight fever or

of these shots are at the highest risk of

redness, tenderness and swelling at the site of the vaccination for

contracting a severe illness that can affect a day or two. If you feel your child has an unusual or severe side

their breathing, vision and hearing, organs, effect, you should call your doctor or nurse right away.

such as their heart and liver, and can even

cause death.

2004 Children's Healthcare of Atlanta, Inc. All rights reserved. DPH04/318HW/CHDA909408:jt10/04.

Parent Pages are intended to be copied and distributed to parents.

PARENT PAGES -- WHEN TO IMMUNIZE I 2004 VOL. 3

When To Immunize

How to stay on track:

How to comfort your child after shots:

1 Begin your child's shots on time. Hepatitis B can be given at birth, and others start at six to eight weeks of age.
2 Talk with your doctor or nurse about each vaccine--don't be afraid to ask questions.
3 Read the vaccine fact sheets you receive before your child gets each shot.
4 Mark your calendar with the date that your child's next shot is due and stay on schedule.
5 Ask for a copy of your child's immunization record and always take it with you to all your child's well-baby checkups. Ask your doctor or nurse to review and update it each time you go.

1Stay calm. Your child can tell if you are nervous or upset.
2 Hold your child--being close to you will comfort your child.
3 Talk to your child in a soothing, quiet voice. 4 Try to distract your child by singing or playing
a game like peek-a-boo.
5 Bring a special toy from home to help calm your child after the shots.
6 Allow your child to cry--it's normal.

6 Ask your healthcare provider to enter your child's immunizations into the Georgia Registry of Immunization Transactions and Services (GRITS).

7 Be truthful--don't tell your child it won't hurt.

Here is a checklist that will help you keep your child healthy and on track for the important FIRST TWO YEARS.

Immunization/Age Hepatitis B

Birth-1mo. 2 mo.


4 mo.

6 mo.


12 mo.

15-18 mo.

24 mo.

Comments
Can start birth-2 mos. 3rd dose 6-18 mos.

DTaP (diphtheria, tetanus, pertussis)
Hib (H. influenzae, type b)
Polio




4th dose 12-15 mos. 3rd dose 6-18 mos.

MMR (measles, mumps, rubella) Varicella (chicken pox) Flu (influenza)
PCV (pneumococcal disease)




12-15 mos.
12-18 mos.
Recommended for children 6-23 mos. each Oct-Mar. First year needs 2 doses, 1 month apart
4th dose 12-15 mos.

For more information about Children's Healthcare of Atlanta, call 404.250.kids or visit www.choa.org.

2004 Children's Healthcare of Atlanta, Inc. All rights reserved. DPH04/318HW/CHDA909408:jt10/04.

Parent Pages are intended to be copied and distributed to parents.