Immunize Georgia, Vol. 1 (Mar. 2007)

What's Inside

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Spot Light - New Certificate Of Immunization

3
5 Insert

S tay Up to Date Changes in the 2007 Childhood and Adolescent Schedule GRITS Champion Sulton Pediatric Group Parent Pages

Immunize 2007vol.1
Georgia

A PUBLICATION OF CHILDREN'S HEALTHCARE OF ATLANTA AND DHR'S GEORGIA IMMUNIZATION PROGRAM

Changes in the Georgia Immunization Requirements for Attending Child Care and School
This summer, when Georgia's children enter school, child care, Head Start and Pre-K, they will have a new set of immunization requirements. The changes were made to align the list of required vaccines more closely with the current recommendations of the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics and the American Academy of Family Physicians. The Georgia Department of Human Resources (DHR) approved the new requirements on February 21, 2007, and they take effect on July 1, 2007.
"Georgia currently ranks third in the nation for immunization coverage levels for 2-year-old children, and our goal, at a minimum, is for 90 percent of Georgia's children to be protected against vaccine-preventable diseases," said Dr. Stuart Brown, Director, Division of Public Health. "Amending the new requirements goes a long way to helping us maintain our high
vaccination levels and achieve that goal."
The new rules add two vaccines--hepatitis A and pneumococcal conjugate--to the list of previously required immunizations, which still include diphtheria, pertussis, tetanus, poliomyelitis, measles, rubella, mumps, Haemophilus influenzae type B (not required on or after a child's fifth birthday), hepatitis B and varicella (chickenpox).
Children entering child care, Pre-K or Head Start must meet these new prerequisites: All children born on or after January 1, 2006 and enrolled in school, child care, Head
Start and Pre-K on or after July 1, 2007 must receive the hepatitis A vaccine series or show serological proof of immunity. Children under age 5 must be age-appropriately immunized against pneumococcal disease. The number of doses depends on the child's age when started on the vaccine series.
continued on page 2

Changes in the Georgia Immunization Requirements for Attending Child Care and School
continued from page 1

Children aged 4 years who met the 2006 school year recommendations and were issued a Certificate of Immunization (Form 3231/Rev. 10/2003) must have their immunization status reevaluated for entry into kindergarten in Fall 2007. If they have received the required two doses of mumps and varicella vaccines, or have documented immunity on this version of the 3231, they will not be required to return to their provider for the new certificate (Form 3231/Rev. 3/2007).*
Finally, a few more new requirements apply to children entering kindergarten and sixth grade, as well as "new entrants"** into a Georgia school at any grade level. Now, they also must have documented: T wo doses of a varicella-containing vaccine or
healthcare provider documentation of immunity from disease history or serological proof of immunity T wo doses of a mumps-containing vaccine or serological proof of immunity

For children who are eligible for the Vaccines for Children (VFC) program, doses of the vaccines needed to meet the new requirements will be covered by that program.
DHR sent letters and information packets to physicians, schools, child care organizations, Head Start programs, Pre-K programs and other organizations throughout the state. Copies of these letters, order forms and other information may also be viewed on the Georgia Immunization Program's Website: http://health.state.ga.us/programs/immunization. If you have questions, please call your local health department or the Georgia Immunization Program at (404) 657-3158.
* S ee article below for description of the new certificate and additional rules pertaining to its use.
** U nder the new requirements, "new entrant" has been added. It means "any child entering any school or facility in Georgia for the first time or entering after having been absent from a Georgia school or facility for more than 12 months or one school year." n

Spot Light

New Georgia Certificate of Immunization

In addition to the changes in vaccine requirements for children to attend Georgia schools and child care facilities, a new Certificate of Immunization (Form 3231) will make its debut for the start of the 2007-08 school year. The new form may be used any time on or after March 1, 2007, but will be required for all children entering school, child care, Head Start and Pre-K for the first time in Georgia on or after July 1, 2007.
Like prior forms, the revised certificate will feature a section listing all the required vaccinations and columns to note the dates when they were administered, as well as spaces to document serological immunity, disease histories or medical exemption. This part is required for child care attendance and school entry and must be completed fully (including dates) for all children.
However, the revised Form 3231 will include a new section at the bottom for noting if a child has received vaccines that are recommended but not required for school and child care attendance. Vaccines listed here include: meningococcal vaccine (MCV/MPSV), rotavirus (Rota) human papillomavirus (HPV), influenza Td or Tdap booster doses.
Completion of the recommended section will be optional, but was added with the hope of increasing vaccination rates for these shots as well. "This encourages parents to have their children receive all the routinely recommended vaccines, not just what is required," said Michelle Conner, Director, Georgia Immunization Program.
To make filling out the form easier, the revised certificate can be generated and printed from the Georgia Registry of Immunization

Transactions and Services (GRITS) system. Providers who want to utilize their own medical software system for printing the Form 3231 will need to contact the Georgia Immunization Program for approval and for assistance with incorporating the state form into their current software system.
For children under 4 years of age, a "Date of Expiration" should be noted on the certificate. This date shows when the next immunization or evaluation of a medical exemption is due. The parent or caregiver should receive a new certificate, with a new "Date of Expiration," at each visit during which a child receives an immunization until all vaccinations are up to date and the form can be marked "Complete for School."
Children who are currently attending child care facilities and whose certificate has an expiration date after July 1, 2007, will need to have the new form issued to them at that expiration date and any needed vaccines administered. Whenever a certificate expires, a new certificate must be obtained and submitted to the school or facility within 30 days after the expiration date or the child will not be allowed to continue in attendance.
Finally, the new Form 3231 means that Form 3189, the Supplemental Vaccine Certification Form, will no longer be needed or used to verify the required doses for students entering the sixth grade. From now on, all required immunizations should be documented on Form 3231, regardless of age or grade level.
A copy of the new certificate and other related resources can be viewed at http://health.state.ga.us/programs/immunization. If you have any questions or would like to request training on the new form, call your local health department or the Georgia Immunization Program at 404-657-3158. n
Immunize Georgia / 2007 / VOL. 1 2

Stay Up to Date Changes in the 2007 Childhood and Adolescent Immunization Schedule

The Advisory Committee on Immunization Practices (ACIP) annually reviews the Recommended Childhood and Adolescent Immunization Schedule and updates it based on the latest scientific findings and FDA approvals.
One major change for 2007 is an effort to make the format simpler to read and follow by providers. The main recommendations are now separated into three schedules--one for children aged 0 through 6 years, another for those aged 7 through 18 years and a catch-up schedule which is also divided by age for persons aged 4 months through 18 years who start late or who are more than one month behind. Recommendations for special high-risk populations are highlighted with purple bars. The section for persons aged 11 to 12 years features bold, capitalized fonts in the title of that column
to add special emphasis to vaccines recommended for that key age group.
In terms of content changes, highlights include additions of the rotavirus vaccine (Rota) and the vaccine against human papillomavirus (HPV). Both vaccines were approved by the FDA in 2006. A second dose of varicella (chickenpox) vaccine also has been added after findings that 15 to 20 percent of children who have received just one dose are not fully protected from contracting the disease. Rotavirus, HPV and varicella vaccines are now also included in the catch-up immunization schedule.
The following is a summary of the major revisions to the 2007 schedule and the new or revised ACIP recommendation statements. For the most comprehensive information on the 2007 schedule, please go to http:// www.cdc.gov/nip/recs/child-schedule. htm. Providers will be notified when new vaccines become available for distribution through the Georgia Vaccines for Children program.

Rotavirus (Rota) Vaccine T he new rotavirus vaccine (Rota) is recommended to be given in a
three-dose schedule, at ages 2, 4 and 6 months. G ive the first dose at age 6 through 12 weeks with subsequent
doses at 4 to 10 week intervals. D o not initiate rotavirus vaccination for infants aged greater than
12 weeks. D o not administer rotavirus vaccination to infants older than age
32 weeks.
Influenza Vaccine T he influenza vaccine is now recommended for all children 6
through 59 months.
Varicella (chickenpox) Vaccine A dminister first dose at age 12 through 15 months. A dditionally, a newly recommended second dose should be given at
age 4 through 6 years.
Human Papillomavirus (HPV) Vaccine The new HPV vaccine is recommended in a three-dose schedule
with the second and third doses given two and six months after the first dose. Routine vaccination is recommended for females aged 11 through 12 years. Vaccination, however, can be started in girls as young as age 9. A catch-up vaccination is recommended for girls aged 13 through 26 years who have not been vaccinated previously or who have not completed the full vaccine series.
Providers should be sure to also review the footnotes for all three schedules because they may contain important additional information for the different age groups such as dosage instructions and safety precautions for individual vaccines. Table I, published in the December, 2006 General Recommendations on Immunization ACIP statement, also is a valuable tool that can be used in conjunction with the new schedules to assist providers in quickly determining the recommended and minimal ages and time intervals between doses for each vaccine. It can be found at http://www.cdc.gov/mmwr/PDF/rr/rr5515.pdf.
The complete 2007 Childhood & Adolescent Immunization Schedule is available for download at http://www.cdc.gov/nip/recs/child-schedule.htm#printable.
Source: Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years--United States, 2007. MMWR 2006;55(51&52):Q1-Q4. n

Immunize Georgia / 2007 / VOL. 1 3

Immunize Georgia Welcomes Monica Trigg New Vaccine Manager, Vaccines for Children Program

In February 2007, Monica Trigg took the position of Vaccine Manager, vacated by Michelle Conner, who is now Director of the Georgia Immunization Program. Immunize Georgia spoke to Trigg recently about her new position and her thoughts on the Vaccines for Children (VFC) Program.
Q: How did you start working with immunizations? I understand you served in the Peace Corps.
A: I lived and worked for three years in Chuuk (a.k.a. Truk), Micronesia, a string of islands in the Pacific Ocean. I worked with the Office of Public Health, helping improve programs to immunize the children there. We realized a significant increase in coverage levels for this group of children who had little or no access to anything but the most basic of primary health care services. I also spent the last two years in Augusta as an Immunization Program Consultant, which gave me valuable insight that will help me in my role as Vaccine Manager.
Q: What are some of your top priorities this year?
A: I am looking forward to offering human papillomavirus vaccine (HPV) through the VFC program. We expect to begin shipping HPV to providers by July. Many initiatives are underway to help the program run even more smoothly. We're also working on updating our Operations Guide and Enrollment Packet.

Q: What are some of the biggest vaccine management issues currently in Georgia's provider community and how can they be addressed?
A: One of the messages we reiterate to VFC providers is that there is definitely enough vaccine to meet demands. Sometimes providers call us concerned about being sent either too much or too little of one or more vaccines. Our message to providers is if you feel you are being over-shipped or under-shipped, simply write your requests to increase or decrease the amount of any particular vaccine, by amount, on the bottom of your monthly comprehensive report (be sure to make a follow-up call to confirm receipt).
Q: What changes do you foresee in the near future for the VFC program?
A: Two major changes are upcoming: One is the addition of HPV vaccine to the VFC menu, and the other is the recently-approved changes to school entry requirements. As a result, vaccine management will become a little more involved. But as I mentioned, our vaccine supply is stable. There are no concerns about running short. n

Kaiser Permanente Shares Award Dollars to Increase Adolescent Immunization Rates

The Healthy People 2010 initiative has set a goal of 90 percent immunization rates for all Americans. However, the national HEDIS average for adolescent immunizations in 2004 was only 59 percent compared to 74 percent for childhood immunizations. America's Health Insurance Plans (AHIP) initiated an annual Grant for Innovation in Immunization Practices which supports one insurer in its commitment to meet the Healthy People 2010 goal for increasing vaccination rates for these groups.
The 2005 winner was Kaiser Foundation Health Plan of Georgia, Inc., for a plan to increase statewide adolescent immunization rates. Kaiser designated $25,000 of their award money to establish grant funds to promote adolescent vaccinations. Grant proposals were received from county health departments and non-profit organizations throughout the state.
Eight organizations received grants for their initiatives which included programs that are working with community partners and coalitions to utilize awareness campaigns for promoting adolescent vaccination.

The winners, in alphabetical order, are: Bulloch County Health Department Coastal Health District Adolescent Health & Youth
Development Program Coastal Empire Polio Survivors Association, Inc.
(CEPSA) Cobb & Douglas Family Health Charlton County Health Department Clayton County Board of Health Madison County Health Department Upson County Health Department
If you would like to know more about the work being done in these communities or if you have additional questions, please contact Angie Matthiessen at angie.matthiessen@choa.org. n
Immunize Georgia / 2007 / VOL. 1 4

GRITS Champion

Sulton Pediatric Group Finds Success in Utilizing GRITS

Dr. Jacqueline R. Sulton of the Sulton Pediatrics Group began her practice 18 years ago. Throughout the years, she and her staff learned just how crucial it is to know the exact immunization history of children and adolescents on any given office visit. For this reason, when the Georgia Registry of Immunization Transactions and Services (GRITS) was founded to serve as a database for Georgia to maintain accurate immunization records, the Sulton Pediatric Group examined its services with great interest. At first, Dr. Sulton said she was concerned that she would not have the
manpower to handle a huge GRITS project. But after realizing the potential benefits of GRITS to her practice, she decided to allocate staff training time.

Pediatricians at The Sulton Pediatric Group find it more than beneficial to use GRITS during back-to-school season. Unfortunately, many parents do not keep up with immunization records for their children or all of the vaccine doses administered. This can present a problem when they later need an immunization certificate to enter their child in school or child care. As long as previous providers have entered their information into GRITS, Sulton can complete the child's checkup and issue the certificate without having to call all previous providers for the immunization history.
"With the new immunization requirements for child care and school facilities, it is very important for pediatricians all over Georgia to have accurate shot records," said Michelle Conner. "GRITS helps pediatricians to know what a child needs, and it allows them to print the new immunization certificate for school or child care, and also a personal record of the shots for parents to keep on file."

The Sulton Pediatric Group has now been using GRITS for about four years. The data are entered at the time of service for those patients seen for health check services as well as when random charts are pulled. According to Office Manager Audria Riley, if a patient's information is currently in GRITS, it takes less than a minute to enter new vaccine data. Entering a patient's full record for the first time may take three to four minutes. Sulton Pediatric Group has approximately 16,000 active patient charts. Currently, 35 to 40 percent have been entered in the GRITS system. Dr. Sulton and staff are consistently checking GRITS for patient information and have used GRITS to document almost 3,000 clients and over 25,000 immunizations.

Georgia Immunization program staff and their partners visit and train doctors and nurses all year long on how to utilize GRITS, said Thomas Moss, GRITS Manager. "At first, it can seem overwhelming to a practice or clinic, but once they enter their first batch of immunization records and are consistently able to track a child's immunization history, the staff immediately see the value of GRITS," he added.
Public healthcare facilities and private practices are using GRITS today more than ever. In addition to providing the patient's immunization history, GRITS also alerts the provider when a patient has received an invalid vaccine dose, as well as when the patient is due for immunizations. "There have been numerous parents that benefit from and appreciate our practice's use of GRITS," Dr. Sulton said. "Not only are parents relieved that the service of receiving the immunizations was not interrupted, but they also feel that Sulton went the extra mile for their child." The Sulton Pediatric Group, P.C. is a true GRITS success story!
For questions on how to train your staff on GRITS, call the Georgia Immunization Program/GRITS at (404) 463-0810 or visit http://health.state.ga.us/programs/immunization/grits/.
This article was contributed by Connie F. Smith, Program Information/ Marketing Coordinator with the Georgia Immunization Program, Division of Public Health. n
Immunize Georgia / 2007 / VOL. 1 5

Save The Date

14th Annual Immunize Georgia Conference to be held on September 20, 2007
The 14th Annual Immunize Georgia Conference will be held at the Georgia International Convention Center in College Park. We have expanded capacity for up to 450 attendees and are looking forward to a great turnout. Dr. Paul Offit, powerful author and speaker from Children's Hospital of Philadelphia will be speaking on talking with parents about vaccine safety. Dr. Sandra Fryhofer will be addressing HPV and the new cervical cancer vaccine. As always, we will have Dr. Atkinson providing the latest information on the immunization schedule.
The nomination form for the Walt Orenstein Champions for Immunization Award is provided in this newsletter. Please consider nominating an individual or agency/ coalition for excellent care in decreasing vaccine preventable diseases in their community. In addition, we are accepting nominations for the Clay Coleman Excellence in Customer Service Award (see insert), which was established as a way to honor Georgia Immunization Program staff members. The recipient of this award should personify the ideals set forth in Governor Sonny Perdue's Team Georgia campaign for "faster, friendlier, easier" service as well as exemplary customer service that goes above and beyond the call of duty with the ultimate goal of immunizing Georgia. Conference brochures will be mailed out in late June and be available at www.choa.org/immunization.
The articles in this Volume 1 of Immunize Georgia were written by Anya Martin.
Visit www.choa.org/immunization to access previous volumes of the Immunize Georgia newsletter and the Take 5 for Teens brochure.
2007 Children's Healthcare of Atlanta/CHDA924635 jt03.07 DPH07/043HW

ImmunGizeeorgia
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 Angie Matthiessen, M.S.W. 404-785-7225, fax 404-785-7258 angie.matthiessen@choa.org
Georgia Immunization Program Ruth Gilmore, B.S.N. 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 800-232-4636, www.cdc.gov/spanish/

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Parent Pages / Immunize Georgia / 2007 / VOL. 1
ParentPages ShotSmarts From Immunize Georgia

Shots Aren't Just for Attending School and Child Care

Each year experts put together a "schedule" of shots your child should receive in order to be fully protected against serious diseases. They also make recommendations about the age your child should be to receive these shots. Three key groups that come together to make these decisions are the American Academy of Pediatrics, the American Academy of Family Physicians and the Advisory Committee on Immunization Practices (ACIP).
For many reasons, not all the shots on the recommended schedule may be required for children to enter school or attend child care, Head Start and Pre-K programs. However, even if a shot is not required, your child should still receive that recommended shot.
Currently four shots are recommended but not required for child care or school attendance in Georgia: Influenza Meningococcal Rotavirus Human Papillomavirus females 9 through 26 years of age
Both rotavirus vaccine (Rota) and human papillomavirus vaccine (HPV) were recently approved by the Food and Drug Administration (FDA) and are new to the 2007 Childhood and Adolescent Immunization Schedule.

Human Papillomavirus is the name of a group of more than 100 different types of viruses that are sexually transmitted and which are estimated to cause 70 percent of all cervical cancer cases. HPV is thus the second shot, after hepatitis B vaccine, that protects people against a form of cancer. For this reason, it is now recommended for all girls aged 11 through 12 years, although it can be given to girls as young as age 9. It requires three shots to be fully protected. Catchup shots are recommended for girls aged 13 through 26 years who have not had the vaccine previously or who have not completed the full three-shot series.
Influenza (flu) is a disease that affects the lungs and can be very serious for young children. They are even more likely to have severe illness or be hospitalized due to this disease than are the elderly. Since 2006, children 6 through 59 months have been recommended to get this shot every year.
Meningococcal Meningitis is a serious, potentially life-threatening infection of the fluid around a person's spinal cord and the fluid that surrounds the brain. It is especially serious for children and can spread quickly in close living conditions. Meningococcal conjugate vaccine (MCV4) is recommended for children at age 11 through 12 years, children entering high school and college freshman who are living in a dorm.

Rotavirus is the most common cause of severe diarrhea among children, resulting each year in the hospitalization of approximately 55,000 children in the United States and the death of over 600,000 children worldwide. The new rotavirus shot (Rota) is recommended to be given in three doses at ages 2, 4 and 6 months. It should not be given to infants aged less than 6 weeks or older than 8 months (32 weeks).

Shots Are For All Ages MCV4 and HPV are good examples of shots recommended for adolescents, rather than babies and small children. Many childhood vaccines also have booster shots that need to be taken throughout the teenage years and adult life. These include tetanus-diphtheria (Td) or tetanus-diphtheria-pertussis (Tdap) booster doses (for adolescents).

Leah Marie Matthiessen, born December 23, 2006, is keeping up with her shots.

To see if your child, or even you, is due for a recommended shot, visit http://www.cdc.gov/nip/recs/child-schedule. htm#printable. Be sure to check the schedule and/or ask your child's doctor at least once a year whether any new shots have been added to the recommended schedule for his age group. n

2007 Children's Healthcare of Atlanta/CHDA924635 jt03.07 DPH07/043HW Parent Pages are intended to be copied and distributed to parents.
www.choa.org 404-250-kids www.health.state.ga.us/programs/immunization/

Parent Pages / Immunize Georgia / 2007 / Vol.1

New Vaccine Requirements for Entering School or Attending Child Care, Head Start and Pre-K Programs

Georgia has added two new vaccines (shots) to the list required for entering school or attending child care, Head Start and Pre-K programs.

The state also has a new Certificate of Immunization (Form 3231). The Georgia Department of Human Resources approved the new requirements on February 21, 2007, and they take effect on July 1, 2007.
The changes were made to align the list of required shots more closely with the current recommendations of several key organizations that keep track of the latest research on all available shots. These include the American Academy of Pediatrics, the American Academy of Family Physicians and the Advisory Committee on Immunization Practices (ACIP), all of which are made up of experts from all over the country.
Required new shots Now all children born on or after January 1, 2006 must
receive the Hepatitis A series of two shots. All children under age 5 must have received one or more
shots against pneumococcal disease. Be sure and check with your doctor for the correct schedule for your child as the number of doses depends on your child's age when started on the series of shots.
Required second doses New second doses have also been added to two previously
required shots--varicella (chickenpox) and mumps--for all children entering kindergarten and sixth grade, as well as "new entrants"* into a Georgia school at any grade level.

Introducing a New, Improved Certificate of Immunization (Form 3231) This year Georgia also revised the Certificate of Immunization (Form 3231) that your school or child care program needs to keep on file to show that your child has all the required shots. If your child is enrolled in school or child care and has a current certificate on file already, then you do not need to replace it until the expiration date arrives or the child reaches 6th grade. However, if your child is entering school, child care, Head Start or Pre-K for the first time in Georgia on or after July 1, 2007, you will need to make sure that your child has the new form.
The new Form 3231 looks a lot like the old one with a section listing all the required shots and columns to note the dates when they were given. It also includes spaces to indicate serologic immunity (i.e., if your child has had a blood test showing he cannot get the disease), disease histories (i.e., whether your child has had the disease already) or medical exemption (for a variety of reasons).
Finally, a new section has been added at the bottom to make it easy for you to note if your child has received shots that are recommended but not required for school attendance. Shots listed here include meningococcal vaccine (MCV/MPSV), rotavirus (RotaTeq), human papillomavirus (HPV), influenza and tetanus-diphtheria (Td) or tetanus-diphtheria-pertussis (Tdap) booster doses (for teenagers).

The complete list of shots which children are required to have for school enrollment or child care attendance now includes: Diphtheria Hepatitis A - if born on or after 1-1-06 Hepatitis B Measles Mumps (two doses) Pertussis Polio Rubella Tetanus Varicella (chicken pox) - two doses Pneumococcal - children under age 5 H aemophilus Influenzae type B (HIB) - children under age 5

Resources: More information about Georgia's new requirements for entering school and attending child care, as well as an example of Georgia's new Certificate of Immunization (Form 3231), can be found at the Georgia Immunization Program's Website: http://health.state.ga.us/programs/immunization.
If you have questions, please call your local health department or the Georgia Immunization Program at (404) 657-3158.
*A "new entrant" is "any child entering any school or facility in Georgia for the first time or entering after having been absent from a Georgia school or facility for more than 12 months or one school year." n

2007 Children's Healthcare of Atlanta/CHDA924635 jt03.07 DPH07/043HW Parent Pages are intended to be copied and distributed to parents. www.choa.org 404-250-kids www.health.state.ga.us/programs/immunization/