Immunize Georgia, Vol. 3 (Oct. 2007)

What's Inside

2 ImmunizeGeorgia Conference Attendees Receive Tdap Vaccinations and Much More
3 Spot Light HPV 5 Parent Page
Immunize 2007vol.3
Georgia
A PUBLICATION OF CHILDREN'S HEALTHCARE OF ATLANTA AND DHR'S GEORGIA IMMUNIZATION PROGRAM
Georgia Ranks in Top Five Again
The National Immunization Survey (NIS)*, which is performed by the Centers for Disease Control and Prevention (CDC), assesses immunization coverage levels for children between the ages of 19 and 35 months of age.
For the 2006 NIS, Georgia ranks fourth in the nation for children between the ages of 19 and 35 months of age who received the 4:3:1:3:3:1series.** According to the survey, 81.4 percent of Georgia's children received these vaccines on time. Georgia is separated from third place (North Carolina), by only 0.10 percent! Congratulations to each provider for such hard work protecting our youngest Georgians.
Nationally, the largest increase in coverage was for the pneumococcal conjugate vaccine (PCV). For three or more doses of PCV, national coverage increased from 82.8 percent in 2005 to 87 percent in 2006. Even though the rates for PCV are increasing on a national level, the pneumococcal coverage levels for the state of Georgia are still in need of improvement. Georgia had an 81.6 percent coverage level in 2006 for three or more doses of PCV compared to the 87 percent nationally.
For the first time, the NIS also studied the immunization coverage of adolescents aged 13 to 17 years of age referred to as NIS-Teen.*** Highlights from NIS-Teen include coverage with one dose of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) at 10.8 percent and vaccination with mengingococcal conjugate vaccine (MCV4) at 11.7 percent. While this first report provided national data, future reports will provide state-level estimates and information relative to vaccine financing and state mandates.
continued on page 4

Immunize Georgia Conference Attendees Receive Tdap Vaccinations and Much More

The 14th Annual Immunize

Georgia Conference once

again attracted a record

attendance of 428 healthcare

providers on September

20, 2007 at the Georgia

Left to right: Natalia Ortiz, Jimmy Ventura and Shae Daniels

International Convention Center. To jumpstart the morning, the PowerZone Kidz woke everyone

up through a medium kids understand--the universal language of

music! The PowerZone Kidz use a fun and informative way to partner

with local law enforcement, public health agencies and school

districts to address critical health and safety issues such as Internet

and personal safety and the importance of immunizations. Attendees

clapped along with Shae, Jimmy and Natalia as they sang "Bee

Wise Immunize." For more information about PowerZone Kidz

and for the words to "Bee Wise Immunize," please go to

www.choa.org/immunizegeorgia.

With the focus on the importance of healthcare worker vaccination, the Fulton County Department of Health & Wellness vaccinated 159 conference attendees with tetanus, diphtheria and acellular pertussis (Tdap) vaccine. More attendees deserve kudos for emphasizing in their conference evaluations that they had already received their Tdap. If you missed the opportunity at the conference, be sure to get your Tdap shot when you receive your annual flu shot (hint, hint --you need this one too!).

Another highlight was the presentation of the Walt Orenstein Champions for Immunizations Awards, which celebrate people and organizations that promote and provide immunizations. Dr. Orenstein was unable to be at the conference this year to present the awards named in his honor, but he did send his congratulations to each of the five recipients.

Clois W. Witt, from McDuffie County, worked as a nurse and, after

retiring, continued to work in the field she loves--immunizations.

For the past four years, Witt has assisted with the Population Based

Immunization Study. She is known for finding noncompliant children

and won't stop until

that child is up to

date on all of his or

her vaccinations.

Witt then bakes

cookies and delivers

them to everyone

who aided her in

this important task.

Left to right: Clois Witt, Barbara Turner, BSN, RN, Gail Cloer, LPN

Barbara Turner, RN, BSN has been

educating and immunizing the patients of North Fulton Pediatrics for 16 years. Through the Educating Physicians in the Community (EPIC) program, Turner taught more than 500 people about the importance of immunizations in 2006. In just one example of her dedication, Turner has been known to wake up at 3 a.m. and drive to South Georgia pediatric offices to educate physicians about immunizations. Gail Cloer, LPN from the Murray County Health Department has had a huge impact on the administration of the Tdap vaccine. As a result of her tenacity, the clinic has seen an increase in patients seeking the Tdap vaccination, including both siblings and grandparents.

The Longstreet Clinic is

one of the largest providers of

Vaccines for Children (VFC) in

the state of Georgia. In the past

12 months alone, they have

administered 45,887 doses of

VFC vaccines. Even with this

volume, for the past several years, the Longstreet Clinic has

Left to right: Tara Arp, Charlene Hall

been able to adequately immunize 95 percent or more of their two-

year-olds. The Longstreet Clinic also has an asset in Charlene Hall.

Hall handles all vaccine management issues, as well as ensuring all

vaccine updates and information are communicated to staff.

The fifth award goes

to the Network of

Trust School Health

Program at Phoebe

Putney Memorial

Hospital, a school

Left to right: Sue Dale, RN, Tom Seegmueller, Angie Barber, RN, Ri Lamb, RN

health program that serves five counties around Southwest

Georgia over 16,000 students and faculty. In 2005, the Network

of Trust audited the schools in the Dougherty County School System

and discovered that the average immunization rate was 52 percent.

By the following year they had raised this rate to 88.6 percent. They

also have begun hosting an annual immunization update for public

and private healthcare professionals in District 8.2.

In 2008, the conference will hold a special awards program to focus on the recipients, instead of having them receive their awards during lunch. Start planning now for the programs you will initiate in 2008. Take notice of those around you who excel at promoting immunizations and protecting our families. Working together to increase immunization rates will ensure many nominations for the 2008 Walt Orenstein Champions for Immunization Awards.
continued on page 3
Immunize Georgia / 2007 / VOL. 3 2

Spot Light

What You May Not Know About HPV

This year, in the United States, 3,700 women will die from cervical cancer--10 women per day.1 However, there is good news and bad news. The good news is that healthcare providers can prevent a great deal of those deaths! The bad news is that some people still do not know this. Cervical cancer is almost always caused by the human papillomavirus (HPV).2 In the United States, HPV is the most common sexually transmitted disease (STD).1 By the age of 50, an estimated 80 percent of all sexually active women will acquire genital HPV.1 But even with all of the information available, a lot of confusion and misconceptions still exist about HPV.
Approximately 100 strains of HPV have been identified.1 Some strains are categorized as having a low risk of developing cervical cancer, such as types 6 and 11, which cause genital warts.1 Some other types are categorized as having a high risk, such as types 16 and 18.1 High risk types act as carcinogens and have been found in 99 percent of all cases of cervical cancer.1 The Centers for Disease Control and Prevention (CDC) estimates that types 16 and 18 are responsible for over 70 percent of cervical cancer cases.1
GARDASILTM is the quadrivalent vaccine that protects girls and women from HPV, types 6, 11, 16 and 18.1 Currently this vaccine is recommended for girls starting at the ages of 11 to 12.*1 Vaccinating girls at this age is ideal, since the vaccine will be the most effective when administered before any sexual activity or exposure to HPV.2 The vaccine is also recommended for females ages 13 through 26 who were not vaccinated earlier.1
Dr. Yolanda Wimberly, Assistant Professor of Pediatrics at Morehouse School of Medicine, states that one of the greatest barriers in communication about this vaccine is misinformation and miseducation. "There has been a lot of publicity and not enough dialogue," she says. "I encourage everyone to speak with their physician about this vaccine and the need for their daughter to be vaccinated."

Patients may want to know if they can get HPV from the vaccine; the answer is no. The HPV vaccine does not contain any active form of the virus. Actually, the vaccine is genetically engineered to look like HPV but contains only noninfectious virus-like particles (VLP) that then trigger the body's immune system to develop antibodies.1
Patients with an abnormal Pap smear or infected with one or more types of HPV may still be vaccinated.2
The vaccine does not cure HPV or have any therapeutic effects on current conditions. It is highly unlikely for an individual to be infected with all four types of HPV the vaccine protects against.2
If a patient is overdue for the next shot in the series, it is not necessary for the patient to restart the series.2
A Pap smear or pregnancy test is not required prior to vaccination. It is important to impress upon patients the need for continued
annual screenings because the vaccine does not protect against all strains of HPV. In addition, the patient may have already been infected with one of the strains of HPV prior to vaccination.
In summary, cervical cancer is now a largely preventable disease. Therefore healthcare providers have the responsibility to inform patients and protect them from this life-threatening disease. Dr. Sandra Fryhofer, a general internist in metro Atlanta, emphasizes the importance of having materials in the patient's native language in order to communicate effectively. Dr. Fryhofer encourages all of us to "Talk about it and spread the word. We know it works. Now the challenge is getting it out there and getting young women vaccinated."
* This vaccine is approved by the Food and Drug Administration (FDA) for girls and women age 9 through 26 years of age.
1 Centers for Disease Control and Prevention: Morbidity Mortality Weekly Report (MMWR) [Electronic Version]. Quadrivalent Human Papillomavirus Vaccine 56, 1-24. March 23, 2007. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5602a1.htm
2 Centers for Disease Control and Prevention. HPV and HPV Vaccine: Information for Healthcare Providers. August, 2006. Retrieved from http://www.cdc.gov/std/hpv/hpv-vacc-hcp-3-pages.pdf n

Immunize Georgia Conference Attendees Receive Tdap Vaccinations and Much More
continued from page 2
Created last year with the retirement of Clay Coleman, the Clay Coleman Excellence in Customer Service Award was also presented this year. Coleman himself bestowed Jan Slaughter with the award, given to a Georgia Immunization Program staff person who exemplifies exceptional customer service, passion and enthusiasm for work with providers in Georgia. Slaughter was commended for going above and beyond her duties and giving 110 percent to the providers she works with. Congratulations Jan! n

Left to right: Michelle Conner, Jan Slaughter, Clay Coleman

Immunize Georgia / 2007 / VOL. 3 3

During this Holiday Season... Don't Forget

It's not too late to vaccinate With the rush of activity during the holiday season, many people plan to get their flu shot, but then forget. By the time the holidays are over and the New Year begins, some may have the perception that it is too late. However, data from the last 30 years show peak influenza activity occurring in January or later (80 percent) and February or later (60 percent).1 Experts stress people can and should be vaccinated against the flu throughout the winter months.
The resources below can be used to promote flu vaccination with your staff and patients this flu season:
Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/flu/
Immunization Action Coalition Flu Page http://www.immunize.org/influenza/
Prevent Influenza http://www.preventinfluenza.org/ http://www.preventchildhoodinfluenza.org/
Influenza Medscape Resource Center http://www.medscape.com/resource/influenza
Why should we remain vigilant in vaccinating for the flu? In the 2006-2007 flu season, based on data from six immunization sentinel sites, less than one third of children aged 6 to 23 months

and less than one fifth of children aged 24 to 59 months were fully vaccinated against influenza.2 During the 2006-2007 flu season, 68 children died from influenza-related complications. Out of the 53 deaths of children older than six months for whom vaccination status was known, 50 (94 percent) had not been vaccinated against influenza.3
For personal stories on what this kind of tragedy can do to a family, visit Families Fighting Flu at http://www.familiesfightingflu. org/about/families/. Don't let one of the children who dies this year be someone in your family or from your practice.
1 Centers for Disease Control and Prevention: Morbidity Mortality Weekly Report (MMWR). Influenza Vaccination Coverage Among Children Aged 6-23 Months United States, 200506 Influenza Season. September 21, 2007 / 56(37); 959-963. http://www.cdc.gov/mmwR/preview/ mmwrhtml/mm5637a2.htm.
2 C enters for Disease Control and Prevention: Morbidity Mortality Weekly Report (MMWR). Influenza Vaccination Coverage Among Children Aged 6-59 Months Six Immunization Information System Sentinel Sites, United States, 2006-07 Influenza Season. September 21, 2007 / 56(37); 963-965. http://www.cdc.gov/mmwR/preview/mmwrhtml/mm5637a3. htm.
3 Centers for Disease Control and Prevention: Morbidity Mortality Weekly Report (MMWR). Update: Influenza Activity -- United States and Worldwide, 200607 Season, and Composition of the 200708 Influenza Vaccine. August 10, 2007 / 56(31); 789-794. http://w.cdc.gov/mmwr/preview/mmwrhtml/mm5631a2.htm n

Georgia Ranks in Top Five Again continued from page 1

Being in the top five nationally is not all about numbers it is about doing all we can as providers to protect Georgia's children and families. The following tips can be used to improve your immunization rates and ultimately protect your patients from vaccine preventable diseases.
Tips to improve your immunization rates:
Incorporate Georgia Registry of Immunization Transactions and Services (GRITS) into your daily clinical practice to ensure your patients are appropriately immunized. Make sure all immunizations administered are properly documented in the patient's records or GRITS. For GRITS training, call 1-888-223-8644.
Assess the patient immunization history and administer all needed vaccines at any visit, unless the vaccine is contraindicated.
Implement a reminder/recall system. Follow up with your patients by calling, sending a letter, postcard or email to ensure that they remain on schedule for their immunizations.
P rovide parents with educational materials.
P articipate in community activities to raise immunization awareness.

C onduct annual assessments of your practice's coverage rates. Software is available to assist you in conducting an assessment of your immunization coverage rates. You may contact the Georgia Immunization Program for more details at (404) 463-0812.
Take advantage of the educational opportunities offered by organizations such as the Georgia Immunization Program and the Georgia Chapter of the American Academy of Pediatrics: http://health.state.ga.us/programs/immunization/ http://www.gaepic.org/
* To review the National Immunization Survey report, go to http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5634a2. htm?s_cid=mm5634a2_e
** The 4:3:1:3:3:1 vaccine series includes: 4 doses of diphtheria, tetanus toxoid, and acellular pertussis (DTaP), 3 doses of poliovirus vaccine, 1 dose of measles, mumps, rubella vaccine (MMR), 3 doses of Haemophilus influenzae type b (Hib) vaccine, 3 doses of hepatitis B vaccine, and 1 dose of varicella vaccine.
*** To review the 2006 national vaccination coverage for adolescents, go to http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5634a3. htm?s_cid=mm5634a3_e n
Immunize Georgia / 2007 / VOL. 3 4

Parent Pages / Immunize Georgia / 2007 / VOL. 3
ParentPages ShotSmarts From Immunize Georgia

Take Action this Winter to Protect Your Family

It's Not Too Late to Vaccinate
With the rush of activity during the holiday season, many plan to get their flu shot, but then forget. By the time the holidays are over and the New Year begins, some may think it is too late to get a flu shot. In fact, your family can and should be vaccinated against the flu throughout the winter months.
During the 2006-2007 flu season, 68 children died from influenzarelated complications. According to the CDC, 50 out of 53 children (greater than age 6 months) had not been vaccinated against influenza.* Remember that babies under the age of six months cannot receive a flu shot, so it is especially important that family members get their flu shot in order to protect them.
Visit the Families Fighting Flu site at http://www.familiesfighting flu.org/about/families/ for personal stories on what this kind of tragedy can do to a family. Don't let this happen to your family.

There are other reasons to make sure your family gets their flu shot. Flu shots for the whole family: Protect everyone from getting sick
w W hile the flu can be less severe for healthy people, it can be deadly for family members who are very young, grandparents or those who have certain medical conditions.
Reduce absences at work, school and social events Reduce possible loss of income
Flu Information for Parents http://www.cdc.gov/flu/parents/index.htm
Prevent Childhood Influenza http://www.preventchildhoodinfluenza.org/ Be sure to use the "Influenza Risk Calculator"
* Centers for Disease Control and Prevention: Morbidity Mortality Weekly Report (MMWR) [Electronic Version]. Update: Influenza Activity -- United States and Worldwide, 200607 Season, and Composition of the 200708 Influenza Vaccine. August 10, 2007 / 56(31); 789-794. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/ mm5631a2.htm n

Shots Are Not Just for Children
Making sure your children have received their shots is only part of the picture. Many teenagers are behind on booster shots, and the protection provided by some shots wears off over time. Teens and even adults will need additional shots from time to time to stay protected from diseases throughout their entire life. Children who are too young to have received all of their shots can still catch diseases from other members of their family including parents, teenage siblings and grandparents.
Any doctor visit is a perfect time to catch up on needed vaccines for you and your children. If you or your child visits the doctor for being sick, use this chance to ask your doctor about what vaccines you may need.

Not familiar with what shots are needed for teenagers and adults and how often booster shots are needed?
Childhood Immunization Scheduler http://www2a.cdc.gov/nip/kidstuff/newscheduler_le/
"What Parents, Preteens and Adolescents Should Know" www.cdc.gov/vaccines/preteen/
"Do I Need Any Vaccinations Today?"
http://www.immunize.org/catg.d/p4036.pdf
American Academy of Pediatrics Information for Families http://www.cispimmunize.org/fam/fam_main.html n

www.choa.org www.health.state.ga.us/programs/immunizaItmiomnu/nize Georgia / 2007 / VOL. 3 5

Best Wishes to Ruth Gilmore

Ruth Gilmore retired from

the Georgia Immunization

Program on November 1 after

working tirelessly for years--

all because she has a passion

for Georgia's children and

families. For the past decade,

Gilmore served as a Nurse

Consultant for the Georgia

Immunization Program.

Left to right: Michelle Conner, Ruth Gilmore,

According to Michelle Conner, Mike Chaney

Director of the Georgia Immunization Program, "Ruth's quest for excellence in

immunization can be rivaled by none. She demonstrates her passion for what

she does every single day that she comes to work. Her attention to detail and

reliability as a resource for her peers and coworkers is something that will be

sorely missed. So much of what I've learned in immunization, I learned from Ruth."

If we could all emulate her commitment and energy -- think of the impact we could make. In 2007, Ruth Gilmore received the Dedication and Commitment Award from the Georgia Immunization Program and a Lifetime Achievement Award from Immunize Georgia (see photo). We will miss you Ruth and wish you many happy times playing with those beautiful grandchildren!

Visit www.choa.org/immunizegeorgia to access previous volumes of the Immunize Georgia newsletter and the Vaccines for Teens brochure.
2007 Children's Healthcare of Atlanta/CHDA924637 jt10.07 DPH138H

ImmunGizeeorgia
Published by Children's Healthcare of Atlanta 1655 Tullie Circle NE, Atlanta, Georgia 30329-2321
Children's Healthcare of Atlanta www.choa.org
Immunize Georgia Angie Matthiessen, M.S.W. 404-785-7225, fax 404-785-7258 angie.matthiessen@choa.org
Georgia Immunization Program Diana Gaskins, B.S.N., M.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/

Children's Healthcare of Atlanta Child Health Promotion 1655 Tullie Circle Atlanta, Georgia 30329-2321

Please route to:
o Physician(s) o Nurse Practitioner(s) o Registered Nurse(s) o Nurse Tech(s) o Office Manager

Parent Pages / Immunize Georgia / 2007 / VOL. 3
ParentPages ShotSmarts From Immunize Georgia

Take Action this Winter to Protect Your Family

It's Not Too Late to Vaccinate
With the rush of activity during the holiday season, many plan to get their flu shot, but then forget. By the time the holidays are over and the New Year begins, some may think it is too late to get a flu shot. In fact, your family can and should be vaccinated against the flu throughout the winter months.
During the 2006-2007 flu season, 68 children died from influenzarelated complications. According to the CDC, 50 out of 53 children (greater than age 6 months) had not been vaccinated against influenza.* Remember that babies under the age of six months cannot receive a flu shot, so it is especially important that family members get their flu shot in order to protect them.
Visit the Families Fighting Flu site at http://www.familiesfighting flu.org/about/families/ for personal stories on what this kind of tragedy can do to a family. Don't let this happen to your family.

There are other reasons to make sure your family gets their flu shot. Flu shots for the whole family: Protect everyone from getting sick
w W hile the flu can be less severe for healthy people, it can be deadly for family members who are very young, grandparents or those who have certain medical conditions.
Reduce absences at work, school and social events Reduce possible loss of income
Flu Information for Parents http://www.cdc.gov/flu/parents/index.htm
Prevent Childhood Influenza http://www.preventchildhoodinfluenza.org/ Be sure to use the "Influenza Risk Calculator"
* Centers for Disease Control and Prevention: Morbidity Mortality Weekly Report (MMWR) [Electronic Version]. Update: Influenza Activity -- United States and Worldwide, 200607 Season, and Composition of the 200708 Influenza Vaccine. August 10, 2007 / 56(31); 789-794. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/ mm5631a2.htm n

Shots Are Not Just for Children
Making sure your children have received their shots is only part of the picture. Many teenagers are behind on booster shots, and the protection provided by some shots wears off over time. Teens and even adults will need additional shots from time to time to stay protected from diseases throughout their entire life. Children who are too young to have received all of their shots can still catch diseases from other members of their family including parents, teenage siblings and grandparents.
Any doctor visit is a perfect time to catch up on needed vaccines for you and your children. If you or your child visits the doctor for being sick, use this chance to ask your doctor about what vaccines you may need.

Not familiar with what shots are needed for teenagers and adults and how often booster shots are needed?
Childhood Immunization Scheduler http://www2a.cdc.gov/nip/kidstuff/newscheduler_le/
"What Parents, Preteens and Adolescents Should Know" www.cdc.gov/vaccines/preteen/
"Do I Need Any Vaccinations Today?"
http://www.immunize.org/catg.d/p4036.pdf
American Academy of Pediatrics Information for Families http://www.cispimmunize.org/fam/fam_main.html n

www.choa.org www.health.state.ga.us/programs/immunizaItmiomnu/nize Georgia / 2007 / VOL. 3 5