Immunize Georgia, Vol. 1 (Apr. 2005)

What's Inside

2 GRITS School Users Rollout
3 Saturn Pediatrics/GRITS Champion

5 IGLG Conference Update
Insert Parent Pages

Spot Light

Immunize 2005vol.1 Georgia's Little Guys
A PUBLICATION OF CHILDREN'S HEALTHCARE OF ATLANTA AND THE GEORGIA IMMUNIZATION PROGRAM

EPIC Update
In 2004, Educating Physicians in their Communities

MenactraTM

(EPIC) completed five years of program delivery.
EPIC is a peer-to-peer, office, team approach to immunization education. The program began as a result of the existing collaboration between the Georgia Immunization Program and the American Academy of Pediatrics. The two organizations shared a vision to ensure comprehensive access
to immunization education for private providers, no matter where they were located in Georgia. At the program's onset, surveys confirmed that only 39 percent of the practices responding had attended immunization offerings in the prior two years. Providers said that
their top three reasons for requesting an EPIC program were: the program topic of immunizations, the convenience of not having to leave their office and the fact the program was free.
The continued success of EPIC has been supported by both public and private community partnerships including the Georgia Immunization Program, the Georgia Academy of Family Physicians, the National Immunization Program, Georgia Medical Care Foundation (Georgia's Medicare peer review organization), the Georgia Adult Immunization Coalition (GAIC) and Immunize Georgia's Little Guys. An Advisory Board assists in programming and planning for future needs.

Disease prevention in adolescents is continuing to advance by the recent introduction of the Meningococcal Conjugate Vaccine for Adolescents and College Freshman (MCV-4). Manufactured by Sanofi Pasteur and marketed as MenactraTM, this new vaccine was licensed by the U.S. Food and Drug Administration
continued on page 4

Successful Outcomes Since the EPIC program began in 2000, 495 childhood education programs have been presented to 4,765 participating providers. While it began with a focus on childhood vaccines, EPIC's partners and Advisory Board encouraged the EPIC staff to expand the program's efforts to offer education
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GRITS

School Users' Rollout

In October 2004, the Georgia Registry of Immunization Transactions and Services (GRITS) completed its pilot programs for providing access to the schools. The pilot programs took place in Chatham and Houston Counties, and even before the official rollout in the Fall 2005, many schools and county school systems are requesting to come on board.
Michelle Martin, a health educator in Houston County, attributes much of the pilot's success to the great relationship between public health staff and the schools. She says at the beginning of each year she spends time providing Houston County schools with the latest immunization updates and assisting with problem-solving on immunization issues. Additionally, the smooth immunization record reviews at the schools each year have resulted in successful pilot projects with GRITS.
When Houston County Schools agreed to take part in the pilot school rollout, Ms. Martin attended the school training, providing ongoing support and assistance in how the GRITS system could benefit each school. Even after completing the pilot, during kindergarten audits Ms. Martin found that many of the schools were still using GRITS to print their Form 3231 certificates. As they finished with the kindergarten process, the schools are utilizing GRITS to facilitate the process of ensuring that 5th graders meet the 6th grade immunization requirements.
Provider Update

Schools in Chatham County also took part in the pilot this past year. Both Lynn Wood, BSN, RN, at Charles Ellis School and Betty Warnock, RN, at Coastal Middle School use GRITS for gathering information on which shots are needed and for notifing parents. Nurse Wood states the GRITS records offer more leverage with parents who are noncompliant or who insist their child is up-todate. Nurse Warnock states when a child receives a minor injury, she also has used GRITS to determine if that child is up-to-date with his tetanus shot.
Both nurses agree the system is simple and user-friendly, as easy as logging into a computer. School users are assigned a login name and a secure password and can search students' immunization records by the child's name, guardian's name and date of birth. As new students are enrolled, if their immunization records are complete in GRITS, school users can easily print out Form 3231. If a student's records are incomplete, another form will print indicating missing shots and the date the immunizations were due. The parent then can take this form to the student's health care provider to obtain needed immunizations.
Debbie Beall, RN, at Heard Elementary School reports that GRITS has saved her literally "hours" of time making copies, writing letters, mailing letters and waiting for parents to follow-up. Now all she has to do is look up the record and print the 3231 without having to notify the parents. If shots are needed, she prints the information, highlights the missing shots and sends to parents.

One of the challenges for the GRITS program is entering historical data on Georgia children into the system. While this process can seem time-consuming, the effort is well worth it. When this process is completed, the full benefits of GRITS can be felt.
Top 5 Benefits of Entering Historical Data
1 The system can automatically print the immunizations a child needs based on the Advisory Committee on Immunization Practices (ACIP) childhood immunization schedule and a patient's immunization history.
2 Physician practices and schools can experience relief during the school rush. Physician practices can print the Form 3231 certificate for day care. Schools can access the child's immunization record and produce the Form 3231 rather than relying on the parents and the physician's office staff to provide it. Once a child's name is entered and information

displayed, just four simple steps make this process efficient and stress-free.
3 The child's family and physician will benefit when transferring care to another medical home in Georgia. The time spent placing calls to the original physicians and requesting/sending faxes no longer will be necessary.
4 There will be reduced requests related to CASA or HEDIS for office staff to pull records.
5 The reminder / recall system will identify individuals due or late for immunizations. This reminder system can benefit the practice by managing the monthly recall system. With the recent Prevnar shortage, when vaccine was again available, GRITS was able to print recall postcards and send them directly to parents, rather than relying on the physician practices to do this task.

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continued on page 3

Top 5 Methods for Entering Historical Data
1 Contact the GRITS Team at 404-657-3158 and discuss with a GRITS Business Analyst how to upload your historical data. If your Medical Records or Practice Management System Vendor has created a means for you to extract historical data in the existing GRITS format, the GRITS team can also assist you.
2 If your Medical Records or Practice Management System Vendor has a method of extracting historical immunization data, but it is not in the existing GRITS format, also contact the GRITS team at 404-657-3158. They will be happy to discuss ways to extract your data and what information they will need to import your data into GRITS, if possible.
3 Identify someone who can enter data into GRITS.
Some high schools have an Occupational Therapy and Certified Nurse Assistant (CNA) program, and by working with the school official, an agreement may be worked out

where the CNA program student will be given extra credit for entering the data.
Hire someone in the community who will charge based on the number of records to be entered.
4 Photo-copy patient records, then mail them (up to 100 records per week) to the GRITS office. The records then will be placed in line, and the data entry person will enter the data as their schedule permits. While the office cannot guarantee how long it will take to enter the data, all records are shredded once they are entered. Place the records in a sealed yellow envelope and address it to GRITS Data Entry, Georgia Immunization Program, Two Peachtree Street, Mail Stop 13.476, Atlanta, GA 30303-3186.
5 Enter historical data as a child returns to the practice. However, if the child does not return for a vaccine, then the child's immunization history will not be entered into GRITS.

Saturn Pediatrics/GRITS Champion

On the 25th anniversary of her pediatric practice, Rose Badaruddin, M.D., renamed her practice to Saturn Pediatrics, reflecting her continuous mission to keep the children in her practice healthy.
In 2003, Dr. Badaruddin began hearing about GRITS being piloted in Gwinnett County. She inquired into how she could be among the first to get on board. Angie Webster, Immunization Program Consultant for the Georgia Immunization Program, contacted Dr. Badaruddin to initiate the process and set up the "Train the Trainer" session with Felicia Davis, RN., who streamlined the training packet and customized it to fit the office staff.

Georgia's children now have their immunization history maintained in one common data base, which reduces duplication of shots and, as well, assures that children receive all their necessary immunizations."
Saturn Pediatrics is to be commended for having entered over 22,000 immunizations in GRITS!! They make GRITS a part of their daily practice ensuring immunizations are entered within the same workday. Nurse Davis feels free to use the GRITS Help Desk, and she has taken the time to provide feedback and suggestions for enhancements to GRITS.

Dr. Badaruddin was pleased with how her office transitioned to GRITS. They devised a systematic method to add the historical data by first entering the children age three years old and under. They then added children of all ages. Many of their children were already in GRITS as Vital Records had deposited historical data from 1998, along with the ongoing Vital Records interface.
When children come to the office, the staff looks in GRITS to compare the demographics and immunization data with their medical records. Dr. Badaruddin always has been diligent about checking with other providers to get a complete picture of the immunization history. She states, "With GRITS in place, we do not have to call around, checking to see if shots have been given elsewhere.

Saturn Pediatrics especially appreciates the GRITS feature which allows the user to determine which shots are due via the ACIP schedule, ensuring shots are not missed. These combined efforts assure that all their children are adequately immunized, helping to maintain standards of excellence, with no lost opportunities. Dr. Badaruddin enjoys telling parents their children are in GRITS. Now the immunization records are easily accessible making it easier to assure Georgia's children are protected.
Congratulations to Saturn Pediatrics, a true GRITS Champion.
This article was written by Marianne Pappas, Coalition Coordinator, Chatham County Health Department.
IGLG / 2005 / VOL. 1 3

EPIC Update continued from page 1
to colleges in 2002 and to include adult immunization education in 2004. Between August 2004 and December 2004, 23 adult programs were provided to 146 healthcare providers.
In 2004, the ability to identify ongoing follow-up needs led to 617 referrals to the Georgia Immunization Program for additional education on vaccine storage and handling, vaccine administration techniques, the childhood immunization schedule, Georgia School and Day Care Requirements, Vaccines for Children and GRITS.
EPIC staff learned that physicians preferred to be taught by physicians or persons who are considered authorities on immunizations, vaccinations or infectious disease. A nurse or office manager accompanies the physician to address issues and topics requiring their clinical or office practice expertise, thereby emphasizing the importance of a team approach to providing excellent immunization care. EPIC currently has 118 committed team members who support the standards of immunization practice by educating their peers. In 2004 alone, EPIC staff recruited and trained 52 presenters, which especially helps as the program grows.
In 2004, participants who completed six-month post-program evaluations said they felt they provided better patient and parent education and knew the contraindications. Nearly all expressed that they would like to see other topics presented in this style. Of the participants who completed a post-program survey, 10 percent had started a reminder/recall system.
Dr. Peeler states, "We have been very fortunate to have a great professional staff, led by Melonie JacksonKronemeyer, to drive this program. It's been very gratifying to participate with many others in promoting good immunization practices in Georgia". The successes of EPIC have culminated in Ms. Jackson presenting "All Grown Up- Georgia's EPIC Program" at the 2005 National Immunization Conference in Washington, D.C. in March. Her presentation afforded a great opportunity to show other states how Georgia has championed the standards of immunization education and served the needs of Georgia's growing population. Sadly though, Ms. Jackson left her position at EPIC in April and will be working in a new position as Health Science Advisor for Merck's childhood vaccines in Georgia. IGLG wishes Ms. Jackson all the best in her new endeavor. EPIC is excited to announce that Karen Townsend, who previously worked with EPIC and the Georgia Chapter of the American Academy of Pediatrics, will be taking Jackson's position as Director of EPIC starting June 1, 2005. Welcome back Ms. Townsend!

(FDA) on January 14, 2005, for use in people 11 to 55 years of age. MenactraTM will help protect against four serogroups (A,C,Y and W-135). It will not protect against Serogroup B. The vaccine is licensed to be administered as a single 0.5 ml intramuscular injection and will be available in single dose vials with no mixing required.
On February 11, 2005, the Advisory Committee on Immunization Practices (ACIP) introduced a recommendation for routine vaccination of young adolescents with MCV-4 at the pre-adolescent visit for 11 to 12 year olds. The ACIP recommends young adolescents see a healthcare provider at age 11 to 12 for a preventive visit, at which time appropriate immunizations and other preventive services should be provided.
Ninety two percent of adolescent visits to a healthcare provider are for acute care, while only 8 percent of adolescent visits are for preventive care, according to data from physicians' offices through Surveillance Data Inc. (March 2004). However, an acute care visit can be used as an opportunity either to administer needed vaccinations or, at minimum, to schedule a preventive visit for this purpose. As more vaccines become available for this age group (such as Human Papilloma Virus (HPV), Pertussis, Herpes, Chlamydia), it will become even more important to utilize every face-to-face encounter with parents and adolescents to educate them about the availability of these vaccines, as well as to teach them about the risks posed by vaccine-preventable diseases.
For those who previously have not received the MCV-4 vaccine, the ACIP recommends the vaccination before high school entry (around 15 years of age) as the most effective strategy towards reducing meningococcal disease in adolescence and young adulthood. While vaccine supply and demand will continue to be monitored to ensure adequate supplies, the ACIP set the goal of routine vaccination of MCV-4 for all adolescents beginning at 11 years of age. Initial vaccine supplies are limited but are expected to increase gradually. The Georgia Vaccines for Children (VFC) program expects to begin supplying the vaccine later in June. Because college freshman living in dormitories are at higher risk for contracting meningococcal disease compared to other people the same age, providers and colleges should educate and offer this vaccine to incoming freshman.
According to data from the Centers for Disease Control and Prevention (CDC), ten to 14 percent of people with meningococcal disease die, and 11 to 19 percent of survivors have permanent disabilities (such as mental retardation, hearing loss and loss of limbs). A 1990's study* reportedly found that after early childhood (up to five years of age), the rates for meningococcal disease began to rise during adolescence and were elevated between the ages of 15 to 24. For this age group, the fatality rate was over 22 percent, more than five times the rate found in younger age groups.
For the latest information on meningococcal disease and recommendations for vaccine usage, please visit the following Websites: www.cdc.gov/nip/ www.cdc.gov/ncidod www.immunize.org www.menactra.com
* "FDA approves quadrivalent conjugate meningococcal vaccine". Infectious Diseases in Children. February 2005; 18: No.2.
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Spot Light continued from page 1

IGLG Conference Update

The 12th Annual IGLG Conference is scheduled for Tuesday, September 20, 2005 at the Georgia International Convention Center. We are anticipating great speakers and subjects this year, including Dr. Steve Cochi, Acting Director of the National Immunization Program, Dr. Walt Orenstein, Dr. Bill Atkinson, Dr. Harry Keyserling and Dr. Dennis Murray. Programming will include a celebration of the 50th Anniversary of the introduction of the first polio vaccine. There will be an update on the GRITS program and access for schools. Additionally, we will have a special presentation from a family affected by pertussis, as well as an overview of pertussis outbreaks and surveillance in Georgia.
Display your Agencies Successful Strategies In the past several years, we have offered an opportunity for community agencies to showcase their immunization initiatives to attendees during the exhibit time. This free opportunity for you to share resources and ideas with other providers in Georgia has been well received. Each year we try to include more time for this networking. Examples of projects and initiatives that can be shared include developing a mass flu clinic in your community,

creative recall techniques or collaborations between agencies. Please feel free to call Angie Matthiessen with questions or for brainstorming ideas to display your strategies. Please see the insert for the form to complete if you are interested in displaying at the conference.
Accepting Nominations for the Walt Orenstein Champions for Immunization Awards IGLG is looking forward to receiving nominations for this year's awards, to be given out at a conference luncheon with Dr. Orenstein. Consider nominating individuals or communities who have made significant strides towards improving the health and well-being of Georgia's children and adolescents through immunizations. Please see insert for nomination form, and contact Angie Matthiessen at 404.785.7225 or angie. matthiessen@choa.org with questions. We look forward to seeing everyone at the conference. Conference registration information will be mailed out in July.

The Centers for Disease Control and Prevention (CDC) and the Association of Teachers of Preventive Medicine have introduced a new Web-based training course entitled "Immunization: You Call the Shots." The first module to be introduced is Understanding the Basics: General Recommendations on Immunization. The course offers a simple review of antigens and antibiotics; passive and active immunity; types of vaccines; seven general rules; contraindications and precautions and resources. The navigation is user-friendly, and the course provides CEU credits. Many other modules are under development including details on individual diseases, vaccine administration practices and an overview of Bioterrorism. You can find the course at: http://www.cdc.gov/nip/ed/youcalltheshots.htm.
By visiting the Georgia Immunization program Web site at http://health.state.ga.us/programs/immunization/, you can access the latest information on GRITS and VFC, educational presentations, school resources, travel immunization information and parental resources.

The Immunization Action Coalition (IAC) recently made significant changes to its online Directory of Immunization Resources. Information was completely reorganized, and material was added and updated. To access the refurbished directory, go to: http://www.immunize.org/resources
One resource available for on IAC is the "Suggestions to Improve Your Immunization Services" offers 35 suggestions that typically support the Standards for Child and Adolescent Immunization Practices. This form can be found at http://www.immunize.org/catg.d/p2045tip.pdf.
The CDC National Immunization Program has posted a new professional-education resource on its Web site. The Vaccine Storage and Handling Toolkit features 11 chapters of information, numerous online resources,and two videos. This comprehensive and user friendly toolkit can be accessed at: http://www2a.cdc.gov/nip/isd/shtoolkit/splash.html.

Resources

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Upcoming Events

Summer Georgia Chapter American Academy of Pediatrics Meeting Pediatrics by the Sea at the Cloister, Sea Island, Georgia June 15 18, 2005, www.gaaap.org

Advisory Committee on Immunization Practices, Quarterly Meeting Location to be determined June 29-30, 2005, www.cdc.gov/nip/acip

14th Annual Georgia Association of School Nurses Conference Savannah Marriott Riverfront Hotel, Savannah, Georgia July 12 July 14, 2005, www.gasn.org

Regional Immunization Updates Sponsored by district health offices and community partners The LaGrange Health District, recently held their regional updates with tremendous success. According to Immunization Program Consultant, Carol Tompkins, six full day programs were held throughout the district, with a total of 345 attendees the average attendance at each location was 58. As the GRITS program is preparing for school access this fall, Tompkins was excited to have 11 school districts represented to hear the program on GRITS. Visiting private provider offices to distribute flyers and marketing to the school nurses made for a great turnout. Congratulations to Ms. Tompkins and all the partners who helped make these updates possible.

For information on the areas where updates will be held for the remainder of

2005, please call the following Immunization Program Consultants at

404-657-3158.

Albany (August) - Tom Seegmueller

Macon (October) - Kelly Bruce

Richmond, McDuffie, Screven Counties (June) - Monica Trigg

2005 Children's Healthcare of Atlanta/CHDA913349 jt04.05 DPH05/033HW

Immunize Georgia's Little Guys
Published 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 Angie Matthiessen, M.S.W. 404-785-7225, fax 941-505-8267 angie.matthiessen@choa.org
Georgia Immunization Program 404-657-3158, fax 404-657-1463 http://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-INFO Contact Center 800-232-4636, www.cdc.gov/nip
CDC Spanish-Language Hotline 800-232-0233, www.cdc.gov/spanish/

Children's Healthcare of Atlanta Community Health Development and Advocacy 1655 Tullie Circle Atlanta, Georgia 30329-2321

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Parent Pages / IGLG / 2005 / VOL. 1
ParentPages
SHOTSMARTS FROM IMMUNIZE GEORGIA'S LITTLE GUYS

New Vaccine Available to Protect your Teenager

In February 2005, the Advisory Committee on Immunization Practices (ACIP) recommended that young teenagers receive a new vaccine to prevent meningococcal disease. This vaccine, MenactraTM, was licensed by the U.S. Food and Drug Administration (FDA) on January 14, 2005, for use in people 11 to 55 years of age.

Listed below are details about meningococcal disease and the new vaccine:
Meningococcal Disease1 The meningococcus bacteria live on the lining of the nose and
throat and are spread by close personal contact. These bacteria can enter the bloodstream and cause serious life-threatening illness. Meningococcus infects the bloodstream, the lining of the brain and spinal cord (causing meningitis).
Who can get the disease? The highest rate of meningococcal disease occurs in infants less
than one year of age.*1 The rates for meningococcal disease begin to rise again during
adolescence and are elevated between the ages of 15 to 24.2 College freshman living in dormitories are five times more likely
to be infected with meningococcal disease compared to other people the same age.1

How does the MenactraTM vaccine protect my child? Five types of meningococcal bacteria cause the disease, and
the MenactraTM vaccine will help protect against the four most common types of the bacteria - A,C,Y and W-135. The MenactraTM vaccine will not protect against type B, which accounts for one-third of the cases in teenagers and young adults.
Who should get the vaccine? If your child is 11 to 12 years of age, call your doctor's office
to schedule a pre-adolescent appointment to get this and other needed vaccines. If your child enters high school (age 15) and has not already received this vaccine, call your doctor's office to schedule an appointment to get this and other needed vaccines. College freshmen living in dormitories. Even if your child goes to the doctor for a sick visit, he may still be able to get the vaccine that day. Check with your physician.

What can happen if my child gets meningococcal disease? Ten to 14 percent of people with meningococcal disease die.2 Eleven to 19 percent of survivors have permanent disabilities
- mental retardation, hearing loss and loss of limbs.2 A 1990's study reportedly found that for the 15 to 24 age group,
22 percent of those infected died, over five times more than for younger age groups.3
What are the symptoms? Meningococcal disease can be mistaken for a common illness, such as the flu and can progress quickly, killing some of those infected within 48 hours or less. Symptoms of meningococcal disease include4: Drowsiness, confusion, extreme tiredness Rash small purplish black blotches or red dots Stiff neck, sensitivity to bright lights Fever/vomiting, severe headache

For the latest information on meningococcal disease, please visit the following websites: www.cdc.gov/nip/ www.immunize.org/resources/ www.menactra.com
* No vaccine is available for this age group, but Menommune vaccine is available for persons (age 2 to 10 years of age and adults age 55 and older) who will be traveling abroad or who have medical conditions that put them at risk for meningococcal disease. 1 "Meningococcus: What you Should Know". www.vaccine.chop.edu. Vol. 1, Winter 2005. Accessed March 22, 2005. 2 "Meningococcal Conjugate Vaccine ACIP Recommends Meningococcal Vaccine for Adolescents and College Freshman". www.cdc.gov/nip. Accessed March 14,2005. 3 "FDA approves quadrivalent conjugate meningococcal vaccine". Infectious Diseases in Children. February 2005; 18: No.2. 4 VaccinePlace.com. Accessed March 22, 2005.

2005 Children's Healthcare of Atlanta/CHDA913349 jt04.05 DPH05/033HW Parent Pages are intended to be copied and distrubuted to parents.

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Parent Pages / IGLG / 2005 / Vol.1

Research and Resources on Vaccines and the Diseases they Prevent

As medicine advances and more vaccines are introduced to protect your child, you may have questions about the safety of vaccines (shots).
The Basics of Vaccine Preventable Diseases The first step in making smart decisions about your child's health is to learn the facts about the diseases and the vaccines that can protect your child. The following Websites include information to help you understand: http://www.hhs.gov/nvpo/concepts.htm http://www.cispimmunize.org/
(Click on Families section)
The Benefits of Vaccines Vaccines have prevented many children from getting serious diseases. As recently as 1990, Haemophilus influenza type b (Hib) was a common devastating illness and the leading cause of bacterial meningitis in children. Now, thanks to the Hib vaccines, most doctors who have just finished their training have never seen a case. For answers to common questions about vaccine effectiveness, see: http://www.immunizationinfo.org/assets/files/ pdfs/4_VAC_E.pdf
The Safety of Vaccines Since some vaccines may have side effects in some children, you need to know how to respond if you have concerns. Most reactions to vaccines are mild, ranging from warmth, redness

and tenderness at the site of the shot to a fever. However, if you are concerned about any symptom, you should report it to your doctor right away. You know your child and what is not a normal response. Be sure to let the doctor know if you feel the situation is an emergency. Write everything down and ask your doctor to file a Vaccine Adverse Event Report form, or you can call 800-338-2382 to make a report. See the article by Dr. Paul Offit entitled, "Vaccine Concerns" at http://www.vaccineinformation.org/safety.asp
For more info on vaccine safety, visit: http://www.hhs.gov/nvpo/vacsafe.htm http://www.cdc.gov/nip/vacsafe/
The Recommended Vaccination Schedule The most important thing to always do is keep a record of your child's shots. This record is often needed in emergency rooms, for school registrations, camp applications, college applications and in adulthood. When your child is at the doctor and he gets additional vaccines, remember to ask for an updated vaccine record. The Centers for Disease Control and Prevention have an interactive immunization scheduler where you can enter your child's date of birth and it will display the recommended schedule your child should follow. Just log onto http://www2a.cdc.gov/nip/scheduler_le/default.asp.
Where to Go for More Information on Vaccines Because the Internet includes so many Websites with information about vaccines, trying to get answers to your questions can be overwhelming. Finding accurate information is critical, and knowing which Website to trust can be hard. The following site provides "Ten Tips on Evaluating Immunization Information on the Internet": http://www.hhs.gov/nvpo/tips.htm

The Standards for Pediatric Immunization Practice The Standards for Child and Adolescent Immunization Practices provide guidelines for what your pediatrician or family health care provider should know and practice concerning vaccines. For a review, please visit http://www.cdc.gov/nip/recs/rev-immz-stds.htm.

2005 Children's Healthcare of Atlanta/CHDA913349 jt04.05 DPH05/033HW Parent Pages are intended to be copied and distrubuted to parents. www.choa.org 404-250-kids www.health.state.ga.us/programs/immunization/