Immunize Georgia, Vol. 1 (Mar. 2008)

What's Inside

2 Plan and Prepare Now for the 2008-2009 Flu Season 3 Spot Light Vaccines for Adults 5 Parent Page

Immunize 2008vol.1
Georgia
A PUBLICATION OF CHILDREN'S HEALTHCARE OF ATLANTA AND DHR'S GEORGIA IMMUNIZATION Section

Preventing Hepatitis B in High-Risk Babies
The infants at the highest risk of hepatitis B virus (HBV) infection are those born to Hepatitis B surface antigen (HBsAg)-positive mothers. If hepatitis B immune globulin (HBIG) and/or hepatitis B (HB) vaccine are not administered within hours of birth, these babies have a 70 to 90 percent risk of acquiring perinatal HBV infection.

Consequently, 85 to 90 percent of infected infants will become chronic HBV carriers, and 25 percent of these carriers will die prematurely from liver cancer or cirrhosis. These deaths usually occur in adulthood but have happened as early as childhood and infancy. Babies disproportionately affected are those born to mothers who are new to the United States from highly endemic regions such as Asia, Africa and Eastern Europe. However, some infected mothers in Georgia were born in the U.S.

Because targeted prenatal screening prior to 1988 was unsuccessful in identifying the majority of at-risk infants, recommendations for universal prenatal HBsAg screening of all pregnant women were published in 1988. In 1991, the Centers for Disease Control and Prevention (CDC) established a public health program to identify infected pregnant women and prevent perinatal hepatitis B infection. Georgia also has a statewide program that
identifies and tracks these high-risk women and infants.

Treating newborns with HBIG and HB vaccine is 85 to 95 percent effective in

preventing HBV transmission and subsequent chronic infection. In addition, a universal birth

dose of HB vaccine provides a "safety net" by protecting newborns whose mothers are admitted

in labor with no history of prenatal testing or care, or when errors in maternal HBsAg reporting

occur. Even in the absence of HBIG, giving only HB vaccine at birth is reported to be 70 to 90

percent effective in protecting high-risk infants.

continued on page 4

Plan and Prepare Now for the 2008-2009 Flu Season

Though it was slow to start, once it got started, flu activity for the 2007-2008 flu season in Georgia was significant compared to 2006-2007. As of mid-March 2008, flu activity was still widespread in Georgia with a significant number of flu cases in over half the state. Surveillance summaries also suggested that influenza primarily affected children and young adults.
In order to protect Georgia's children from the life-threatening effects of the flu, it is critical to adhere to the current Advisory Committee on Immunization Practices (ACIP) recommendations for vaccinating against the flu.* Take into consideration that six children died from the flu in Georgia during the 2006-2007 flu season. What if one of those children was yours or belonged to someone in your family?
Three of the six deaths in 2006-2007 were in previously healthy children. Four of the six deaths involved staph infections, and three of those four staph infections involved MRSA, a drugresistant staph infection. According to Ariane Reeves, Influenza Surveillance Coordinator, with the Georgia Division of Public Health Epidemiology Branch, "Influenza damages the respiratory tract which paves the way for bacterial super-infections. One of the infections that we are seeing more of now is pneumonia due to MRSA." So far in 2008, Georgia has reported one pediatric influenza death associated with MRSA pneumonia.As we see more of these co-infections with the flu, we must be aware of the potential complications and become more vigilant in vaccinating our staff and patients.
Ordering vaccine for the 2008-2009 flu season should be well under way.** When planning for your flu vaccine supply, keep the ACIP provisional recommendations in mind.** In February 2008, the Advisory Committe on Immunization Practices (ACIP) voted to recommend routine influenza vaccination for all children ages six months through 18 years of age. Be sure to order enough for your staff and all the patients in your practice. Some vendors will allow you to return unused flu vaccine, which is an important consideration in your planning process. When accounting for your numbers, plan to vaccinate throughout the flu season (up through May), not just in the fall. A 2006 study showed that missed opportunities can increase as the flu season progresses.1 In this study, the persons with missed opportunities for a flu shot reported

not knowing flu vaccination was necessary or that they did not receive a recommendation from their provider.
In addition to the recommendations for children to receive flu vaccine each season, pregnant women are also recommended to be vaccinated.* Tragically, one of the six pediatric deaths in Georgia during the 2006-2007 flu season involved a pregnant teen who, as a result of flu complications, had to emergently deliver a very premature baby. The pregnant teen subsequently died from her flu complications. The resources are out there to help your practice plan accordingly.*** Each child matters, each life matters help wipe out the flu in Georgia by planning now for the 2008-2009 flu season.
Take Action Accurately assess supply needs based on vaccinating everyone
involved with your practice. Place your order now for the 2008-2009 flu season. Identify a "flu champion" in your practice/agency to research,
initiate and motivate. Develop a plan that involves vaccinating the healthcare workers
in your office or agency strive to have 100 percent staff vaccination rates in your practice.**** Ensure this plan eliminates missed opportunities by vaccinating throughout the flu season (up to the end of May).
* Prevention and Control of Influenza Recommendations: http://www.cdc.gov/mmwr/PDF/rr/rr5606.pdf
** Resources for the 2008-2009 flu season: http://www.cdc.gov/vaccines/recs/provisional/default.htm http://www.flusupplynews.com/news.cfm?article_id=64
*** Other Resources: http://www.preventinfluenza.org/ http://www.preventchildhoodinfluenza.org/ http://www.facesofinfluenza.org/home.php http://www.familiesfightingflu.org/
**** Health Care Workers and Influenza Vaccination: http://www.nfid.org/HCWtoolkit/index.html http://www.publichealth.va.gov/flu/flu_hcw.htm
1. Fishbein et al. "Why do not patients receive influenza vaccine in December and January?" Vaccine, Vol. 24 (2006), pgs. 798-802. n

Immunize Georgia / 2008 / VOL. 1 2

Spot Light

Vaccines for Adults Educate and Encourage

Vaccines are available and recommended to protect adults in the United States from chickenpox, diphtheria, hepatitis A, hepatitis B, human papillomavirus/cervical cancer (HPV), influenza, measles, meningococcal disease, mumps, pertussis (whooping cough), pneumococcal disease, rubella, shingles and tetanus. "Combined, these infectious diseases kill more Americans annually than breast cancer, HIV/AIDS or traffic accidents," said William Schaffner, MD, Vice President of the National Foundation on Infectious Diseases (NFID)1.
Yet a national survey conducted by NFID reveals that most adults can only name one or two vaccine-preventable diseases for which they might be at risk. The report also found that "half of those surveyed say they are not concerned about whether they or another adult family member gets a vaccine preventable disease"1. In addition, the CDC's National Immunization Survey reports the following data on adult immunization rates1: 2 .1 percent of adults 18 to 64 years of age are immunized
against tetanus-diphtheria-whooping cough. 1 0 percent of women age 18 to 26 are vaccinated for HPV
(human papillomavirus). Influenza and pneumococcal vaccination rates for the elderly
are well below the 90 percent national target rates. L ess than two percent of adults are vaccinated with the herpes
zoster/shingles vaccine.
Why is it important to know the perceptions of adults and data on vaccination rates in adults, especially if you are a pediatric healthcare provider? Vaccinating healthcare workers is critical in protecting not only yourself, but also in setting the example for the children and families you are there to protect. Studies continue to show that one of the strongest, if not the strongest, motivators for getting a vaccination is when a healthcare provider recommends it.
The February 2008 issue of Parents Pack Newsletter from Children's Hospital of Philadelphia featured an article entitled, "Not the Usual Adult Coming for an Immunization." In it, the author, who works in the field of immunizations, describes an experience trying to get vaccinated for hepatitis A. The author concludes the story with the following concerns related to his experience2:
" If I had not requested the vaccine, I would not have been offered it.
If I had not known when I needed to get a second dose, I would have been given incorrect information.
If I had not attempted to schedule a follow-up appointment, I would not have completed the necessary doses.
If I had not confirmed that I needed hepatitis A and not hepatitis B, I could have received the wrong vaccine.
If I would not have known who to contact in the county health department, I would not have a way of getting the second dose of vaccine."

The author's words speak for themselves. We all have a role and responsibility to become educated about adult vaccines and to assure our patients AND families are receiving the appropriate care. The general population does not see the importance of protecting our children by protecting adults from vaccine preventable diseases. That education and motivation starts with a healthcare provider taking a stand to ensure all are protected from vaccine preventable diseases.
In summary, Dr. Sandra Fryhofer, a member of the American College of Physicians Adult Immunization Advisory Board, states that "recent data from the CDC's National Immunization Survey of adult vaccination rates are disappointing and disturbing and show that we still have much work to do. We must continue to get the word out about the importance, value, and lifesaving potential of vaccines and strive to make every patient encounter a vaccination opportunity. All providers should invest in overcoming financial barriers and access, remove the barriers of misinformation, and stress the value of vaccines for preventing disease... Vaccines are not just for kids. Adults need them too and we as health care professionals need to make that happen."
Take Action Now: Print and review the MMWR on the 2007-2008
Adult Immunization Schedule at http:// www.cdc.gov/vaccines/recs/schedules every year (the schedule changes annually). E ducate the staff in your practice or agency about which vaccines are recommended for them and encourage them to be immunized--to protect themselves, their patients and their own families. Encourage the parents/families of pediatric patients to protect their health and their family's health by getting vaccinated, too.
1. National Foundation for Infectious Diseases Press Conference January 23, 2008. "New Data Show Unacceptably Low Adult Immunization Rates and that Adults Unaware of Infectious Disease Threat. Experts Urge Integration of Adult Vaccine into Routine Care to Save Lives, Reduce Needless Illness."
2. V accineEducation Center. Parents Pack Newsletter. February 2008. http://vaccine.chop.edu/parents. n

Immunize Georgia / 2008 / VOL. 1 3

Preventing Hepatitis B in High-Risk Babies continued from page 1

However, hospital provision of HBIG and the birth dose of HB vaccine to infants born to infected mothers is only the first step in protecting them. Providers of pediatric care play the next important role. These high-risk infants must complete their HB immunization series and have documented post-vaccination serology completed between 9 and 18 months of age. The use of monovalent HB vaccine is recommended. The second dose of HB vaccine should be given at 1 to 2 months of age, and the third dose should be given between 6 and 8 months of age.
Timely administration of the vaccine series is often complicated for two reasons. One, the medical provider is unaware that the infant was born to an HBsAg-positive mother and so delays administering HB vaccine. Also, the provider does not know to encourage the mother to get the infant's next dose on time. Two, when infants are given combination vaccines, they often receive a dose (e.g., ComvaxTM or Pediatrix) at 4 months of age. This dose, however, is not considered a valid third dose of HB vaccine because the infant has not yet reached 24 weeks of age--the minimum age for completing the series.
Infants receiving ComvaxTM complete their HB vaccine series after age 12 months. Post-vaccination serologic testing (HBsAg and anti-HBs)1 should be drawn a minimum of one month after the last dose of HB vaccine. The goal is a positive anti-HBs1 test. When both results are negative, a second series of HB vaccine (three doses) is recommended. If the HBsAg test is positive after the first series, the infant is infected and needs no additional HB vaccine. Infants diagnosed with perinatal HBV infection are reportable to the Georgia Division of Public Health, Epidemiology Section (404-657-2588), within seven days of diagnosis.

Providers can take certain key actions to help protect high-risk infants from HBV infection: Ensure that high-risk newborns receive HBIG and the birth dose of
HB vaccine. When seeing a new infant patient, request mother's prenatal HBsAg
status and proof of the infant's immunization from hospital records. Ensure that all doses of HB vaccine are given on time. Explain to the infant's parent(s) the need for the baby to complete
the HB vaccine series and post-vaccination testing to document immunity or infection. Some mothers may not be aware of their HBV status or understand its implications. Inform public health authorities of the HB post-vaccination test results on infants born to infected mothers.
You can play an additional important role in interrupting this transmission cycle by vaccinating susceptible women of childbearing age. Be sure also to give HB vaccine to susceptible pregnant women with negative prenatal HBsAg tests when they are at risk of becoming infected through sexual exposure to an infected partner or blood exposure to an infected household contact.
1. Anti-HBs - Antibody to the Hepatitis B surface antigen
References:
http://www.cdc.gov/mmwr/preview/mmwrhtml/00000036.htm
http://www.cdc.gov/mmwr/PDF/rr/rr5416.pdf
This article was written by Lynne Mercedes, Hepatitis Program Director, Georgia Division of Public Health. n

Save The Date 15th Annual Immunize

Georgia Conference 15th Annual Immunize Georgia Conference
Georgia International Convention Center October 1, 2008 We are expecting up to 500 attendees this year and looking forward Last year, we had 159 attendees get vaccinated with the Tdap shot. to some dynamic speakers on timely topics. Dr. William Atkinson will This year, we are hoping to provide both the Tdap and the flu shot.

provide his annual immunization update, and Dr. Larry Pickering will be detailing issues of vaccine safety. Pickering will provide attendees with practical steps for talking with parents about vaccines from a foundation of trust and respect. Drs. Atkinson and Pickering also will take part in a Q&A panel. Dr. Deborah Wexler with the Immunization Action Coalition will discuss utilizing available resources to improve immunization rates. Kari Sapsis with the Pre-Teen Campaign at the

Be sure to use the included form to nominate an agency or individual for a Walt Orenstein Champions for Immunization Award. The awards will be presented this year as a part of the main program, instead of at lunch. This change will allow for more focus on the award recipients and their achievements while attendees will have more time to network during lunch.

CDC will provide the latest information about vaccinating our teens. A survivor of meningitis will share his story highlighting the importance of preventing this disease in Georgia's children and young adults.

The conference brochure will be available in mid-May at www.choa.org/immunizegeorgia. You can also go to this site to review the Ten Tips for a Successful Conference. n

Immunize Georgia / 2008 / VOL. 1 4

Hib Vaccine Recall & Disease Monitoring

Haemophilus influenzae type b (Hib) is a vaccine preventable disease, which was previously a common cause of meningitis, sepsis and death in young children. Since Hib conjugate vaccines became available in 1988, this dreaded pathogen has moved from the most common cause of bacterial meningitis in children less than 5 years old to a very rare cause of severe disease.
Other strains of Haemophilus influenzae still cause disease in persons with weakened immune systems and those at the extremes of age, but none of the other serotypes is as dangerous as serotype b.
Public health routinely requests all invasive Haemophilus influenzae isolates so that serotyping can be performed and verified. This allows the effectiveness of Hib vaccinations to be monitored.
In late 2007, one of the two Hib conjugate vaccine manufacturers (Merck) announced a voluntary recall of certain lot numbers of PedvaxHib and Comvax, the Hib/Hepatitis B combination vaccine. Production of the vaccine was subsequently suspended.

Because of this, a shortage is anticipated during the coming months. For the present, another vaccine manufacturer, Sanofi Pasteur, will be able to provide doses of their Hib product ActHIB. Until the shortage is over, the Centers for Disease Control and Prevention (CDC) has recommended providers defer administration of the booster dose of any Hib vaccine series (normally given to children aged 12 to 15 months), unless they are at particularly high risk of Hib disease.1 Serotyping of Haemophilus influenzae isolates is essential to measure any potential impact of the vaccine shortage. Now more than ever, please remember to submit all invasive (sterile site) isolates of Haemophilus influenzae to the Georgia Public Health Laboratory. For additional questions, please contact the Georgia Immunization Section at 404-657-3158.
1. Interim Recommendations for the Use of Haemophilus influenzae Type b (Hib) Conjugate Vaccines Related to the Recall of Certain Lots of Hib-Containing Vaccines (PedvaxHIB and Comvax. Morbidity and Mortality Weekly Report. December 21, 2007/ 56(5); 1318-1320. http://www.cdc.gov/mmwr/preview/mmwrhtml/ mm5650a4.htm n

Welcome Lisa Roberts, New GRITS Manager

Lisa Roberts has been working at the Georgia Immunization Section since 2003. In the time that she has been there, Roberts has become the expert on the Georgia Registry of Immunization Transactions and Services (GRITS). As a result of her hard work and dedication, Lisa Roberts was announced as the new Manager for GRITS at the beginning of 2008.

has a quiet and peaceful demeanor that draws people to her. She is flexible and takes on difficult tasks with grace. Her style of problem-solving motivates a provider to use GRITS and encourages them to update their records frequently. Lisa is dedicated and very passionate about GRITS. She is patient and extremely knowledgeable. People in the district constantly compliment Lisa on her patience and knowledge about GRITS. If you need a simple explanation to a complex issue with GRITS, she is the one to explain it even for those who are unfamiliar with information technology (IT) language.

In that role, Roberts is responsible for the planning, analysis, design and implementation of system enhancements for the GRITS application. She provides leadership in the day-to-day operations of GRITS and directs the planning, program development and ongoing progress made towards established goals and objectives related to GRITS.

A native New Yorker who moved to Atlanta to escape the winter weather, Roberts has a daughter, Janine, who also resides in Atlanta. Thank you, Lisa Roberts, for being Georgia's GRITS expert and helping our population to stay up to date on their immunizations. n

Her peers report she is a wonderful asset to the Georgia Immunization Section. In addition, they emphasize Roberts

Immunize Georgia / 2008 / VOL. 1 5

Best Wishes Diana Gaskins

Immunize Georgia wishes the best to Diana Gaskins who retired from the Georgia Immunization Section at the end of March. Diana worked with the Immunization Section as a nurse consultant for six years. For most of the 30 years prior to that, she worked as a public health nurse in county health departments in Georgia and Nebraska.
"Diana is a gem," says Michelle Conner, Senior Director, Essential Preventive Clinical Services at the Georgia Division of Public Health. "The quality of Diana's contributions to public health in Georgia is immeasurable, as is her commitment to that work. I've always been able to depend on her to provide her expertise at a moment's notice, regardless of the audience. She is ever the professional and someone whom all employees within Immunization should strive to emulate. Her personal care and concern for her coworkers is indescribable, and we will miss her tremendously!" Her coworkers have also appreciated Diana always bringing in yummy baked goodies.
In her spare time Diana enjoys reading, painting and many kinds of needlework and sewing. Diana - we wish you lots of fun with your crafts as well as time well spent with family. Thank you for all that you did to promote the health of Georgia's families!!

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 Section Laura Moore, Ed. D., R.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

Visit www.choa.org/immunizegeorgia to access previous volumes of the Immunize Georgia newsletter and the Vaccines for Teens brochure. Please also visit this site to sign up for the Immunize Georgia News and Resource Update, which is sent monthly to your email.
2008 Children's Healthcare of Atlanta/CHDA928872 jt03.08 DPH 08.176 H

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

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Parent Pages / Immunize Georgia / 2008 / VOL. 1
ParentPages ShotSmarts From Immunize Georgia

Hepatitis B Protection from Birth to Adulthood
Why are immunizations to protect against hepatitis B so important? Hepatitis B infection is caused by a virus that attacks the liver. This virus is spread person to person and is found in the blood and body fluids of those infected. Hepatitis B affects people of all ages--from babies to older adults--all over the world.

Some people get infected with hepatitis B and recover within six months. Others develop a chronic infection that can last a lifetime and destroy their liver. Of those who develop chronic hepatitis B--also known as "chronic carriers"--25 percent will develop cirrhosis (scarring of the liver) or liver cancer. Some will die at an early age. Most people who die of liver disease from hepatitis B are adults; however, some are children and even infants.
There is good news. A three-dose series of hepatitis B vaccine is available to protect against the disease. Hepatitis B is still spreading in Georgia. By learning about this serious disease and getting the vaccine to prevent it, you can protect yourself and your loved ones.

at daycare or school if a bleeding accident occurs. If your child is exposed to someone who has hepatitis B at home or school, he/she is protected if he/she has received the hepatitis B vaccine series.
Teenagers Hepatitis B spreads through infected blood or sexual contact. Again, the hepatitis B vaccine series will protect teens from the virus. Since 1997, hepatitis B shots have been required for school attendance in Georgia for students born after January 1, 1992. Many colleges also require the vaccine series for freshman under age 19. If you are not sure if your teenager received hepatitis B vaccinations, check with the doctor's office.

Newborn babies When a mother is infected with hepatitis B, her baby is exposed to the virus through blood at the time of birth. If the baby does not receive the first dose of hepatitis B vaccine after birth (preferably within 12 hours), the baby has a 70 to 90 percent risk of getting infected and becoming a chronic carrier. Because this baby is at risk of hepatitis B infection, the rest of the vaccine series needs to be taken by age 6 to 7 months. Babies born to hepatitis B-infected mothers should also get the immune globulin (called HBIG) that protects against hepatitis B right after birth.

Adults at risk In Georgia, most reported cases of hepatitis B occur in adults 19 to 40 years of age who were not vaccinated against the disease. Some adults are at higher risk than others due to exposure at work, certain health conditions or lifestyles. If you are concerned about the risk of hepatitis B infection, talk to your doctor about getting the vaccine series. There is even a combination vaccine for adults that protects against both hepatitis A and hepatitis B in a three-shot series (rather than five shots, if given separately). This may be handy for people who travel outside the country or have lifestyles that put them at risk of getting infected.

Sometimes the hospital does not know a pregnant woman has hepatitis Some older adults also may be at risk of hepatitis B exposure and

B, when she is admitted for delivery. Sometimes the woman does not should receive the three-dose series of vaccine. If you have been

even know. This is one reason why it is important for all babies to

diagnosed with another type of hepatitis (like hepatitis C), but are

receive hepatitis B vaccine in the hospital soon after birth.

negative for hepatitis B, it's a good idea to be vaccinated against

Young children If they have not completed the hepatitis B vaccine series, children can

hepatitis B. Anyone who may need to begin kidney dialysis should also get vaccinated.

get infected when they are exposed to the blood of someone who

Please remember hepatitis B immunization is important

has hepatitis B. This could happen at home when personal items are at all ages.

shared (toothbrushes, nail clippers, etc.) or handled (bloody bandages, instruments for testing blood sugar, etc.). Exposure could also happen

This article was written by Lynne Mercedes, Hepatitis Program Director, Georgia Division of Public Health. n

2008 Children's Healthcare of Atlanta/CHDA928872 jt03.08 DPH 08.176 H

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

www.choa.org/immunizegeorgia www.health.state.ga.us/programs/immunization/

Parent Pages / Immunize Georgia / 2008 / Vol. 1

Take Charge of Your Health with Adult Shots

Vaccines are available and recommended to protect adults in the United States from chickenpox, diphtheria, hepatitis A, hepatitis B, human papillomavirus/cervical cancer (HPV), influenza, measles, meningococcal disease, mumps, pertussis (whooping cough), pneumococcal disease, rubella, shingles and tetanus.

"Combined, these infectious diseases kill more Americans annually than breast cancer, HIV/AIDS or traffic accidents," said William Schaffner, MD, Vice President of the National Foundation on Infectious Diseases (NFID)1.
A national survey showed that most adults can only name one or two vaccine-preventable diseases that they may be at risk of getting. In addition, the CDC's National Immunization Survey reports the following data1: 2.1 percent of adults 18 to 64 years of age are immunized
against tetanus-diphtheria-whooping cough. Infants too young to have begun or completed the vaccine series can die from whooping cough. Studies show that whooping cough in these little ones can come from a family member. Less than two percent of adults are vaccinated with the herpes zoster/shingles vaccine. Every year, there are more than 1 million new cases of shingles anyone who has had chickenpox is at risk of getting shingles2.
One of the most important reasons for adults to receive their vaccines (shots) is to protect our children and the elderly. Many people may not realize that a disease they get can be deadly for a child or elder who is not protected. These unprotected are either too young to have received all of their shots or could have another health condition that prevents them from getting all the shots they need. In addition, adults who get their shots will prevent lost days at work and lost income.

As adults, sometimes our medical history can be complicated and involve a lot of detailed information. A good way to manage your own healthcare is to start a personal health record (PHR). A PHR can help you receive fast care and avoid repeating tests or care you may have already received. A PHR should include a one-page sheet or wallet size card stating any current medical needs, medications, immunizations you have received (shots, etc.) and emergency contact information. Keep this part of your PHR in your car or purse/briefcase in case of emergency. A second part of your PHR should include a history of medical care you have received in the past and a list of preventive tests you will need in the future. Keep this document in a place at home where you can easily find it, take it to healthcare visits and consult it at least once every few months. Taking control of your health is also a good example for the children in your family. Take the time to explain to them what and why it is important to have a PHR. To learn more about how to create a PHR, go to http://www.myphr.com/.
Take Action Now: Ask your healthcare provider which vaccines are needed
and/or go to http://www.cdc.gov/vaccines/recs/ schedules/adult-schedule.htm or www.immunize.org/catg.d/p4036.pdf. Get the vaccines you need to protect your family. Ask your healthcare providers if they have received all of their vaccines. Ask those who are caring for your children and parents if they have received their vaccines. Start a Personal Health Record (PHR) for yourself and ensure all family members have one as well.

1.National Foundation for Infectious Diseases Press Conference January 23, 2008. "New Data Show Unacceptably Low Adult Immunization Rates and that Adults Unaware of Infectious Disease Threat. Experts Urge Integration of Adult Vaccine into Routine Care to Save Lives, Reduce Needless Illness."
2." Increasing Adult Vaccination Rates What Works." Centers for Disease Control and Prevention. http://www2.cdc.gov/vaccines/ed/whatworks/ index.html. Accessed March 7, 2008. n

2008 Children's Healthcare of Atlanta/CHDA928872 jt03.08 DPH 08.176 H Parent Pages are intended to be copied and distributed to parents.
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