Immunize Georgia, 2018 Fall

ImmunGiezoergia
A publication of the Georgia Department of Public Health

dph.georgia.gov
FALL 2018
Vaccine News Adult Vaccine Program Attention Providers Attention Parents Awards

W H AT ' S I N S I D E

VACCINE NEWS
FluMist Quadrivalent (Influenza Vaccine Live, Intranasal)

For the 2018-2019 U.S. influenza season, CDC and its vaccines advisory committee (ACIP) recommend that providers use any licensed, age-appropriate influenza vaccine (Inactivated influenza vaccines (IIV), Recombinant influenza vaccine (RIV), or live attenuated influenza vaccine (LAIV4) with no preference expressed for one vaccine over another. LAIV4 is again a recommended option for people for whom it is otherwise appropriate.
INDICATIONS AND USAGE FluMist Quadrivalent is a vaccine indicated for active immunization for the prevention of influenza disease caused by influenza A subtype viruses and type B viruses contained in the vaccine.

FluMist Quadrivalent is approved for use in persons 2 through 49 years of age.
DOSAGE AND ADMINISTRATION 1 or 2 doses depends on vaccination history as per Advisory Committee on Immunization Practices annual recommendations on prevention and control of influenza with vaccines. Administer as 0.1 mL per nostril. Each 0.2 mL dose is a suspension supplied in a single-dose pre-filled intranasal sprayer
What flu viruses does the nasal spray vaccine protect against? All nasal spray flu vaccines for the 2018-2019 season will contain four flu viruses: an influenza A (H1N1) virus, an influenza A (H3N2) virus and two influenza B viruses.
Are any of the available flu vaccines recommended over the others? For the 2018-2019 flu season,ACIP recommends annual influenza vaccination for everyone 6 months and older with any licensed, age-appropriate flu vaccine (IIV, RIV4, or LAIV4) with no preference expressed for any one vaccine over another.There are many vaccine options to choose from; the most important thing is for all people 6 months and older to get a flu vaccine every year. If you have questions about which vaccine is best for you, talk to your doctor or other health care professional.
Please refer to the full Prescribing Information for FluMist Quadrivalent for full details.

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Heplisav-B Vaccination
HEPLISAV-B is indicated for prevention of infection caused by all known subtypes of hepatitis B virus. On February 21, 2018, the Advisory Committee on Immunization Practices (ACIP) recommended Heplisav-B (HepB-CpG), a yeast-derived vaccine prepared with a novel adjuvant for use in adults 18 years of age and older.
Dosage and Administration Administer 2-dose series (0.5 mL each) of HEPLISAV-B intramuscularly one month apart (0, 1 month). The 2-dose HepB vaccine series only applies when both doses in the series consist of Heplisav-B Series consisting of a combination of 1 dose of Heplisav-B and a vaccine from a different manufacturer should consist of 3 total vaccine doses and should adhere to the 3-dose schedule minimum intervals of 4 weeks between dose 1 and 2, 8 weeks between dose 2 and 3, and 16 weeks between dose 1 and 3. Doses administered at less than the minimum interval should be repeated. However, a series containing 2 doses of Heplisav-B administered at least 4 weeks apart is valid, even if the patient received a single earlier dose from another manufacturer.
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Key Facts About Heplisav-B Do not administer HEPLISAV-B to individuals with a history of severe allergic reaction (eg, anaphylaxis) after a previous dose of any hepatitis B vaccine or to any component of HEPLISAV-B, including yeast. Immunocompromised persons, including individuals receiving immunosuppressant therapy, may have a diminished immune response to HEPLISAV-B. Hepatitis B has a long incubation period. HEPLISAV-B may not prevent hepatitis B infection in individuals who have an unrecognized hepatitis B infection at the time of vaccine administration. The most common patient-reported adverse reactions reported within 7 days of vaccination were injection site pain (23%-39%), fatigue (11%17%), and headache (8%-17%).
Storage, Reconstitution, and administration of Heplisav-B
Administer HEPLISAV-B by intramuscular injection in the deltoid region
Store in a refrigerator at 2C to 8C (35F to 46F) Do not freeze
Please refer to the full Prescribing Information for Heplisav-B for full details.

Adult Vaccine Program (AVP)
What is the Adult Vaccine Program? The Adult Vaccine Program is a publicly funded program that provides Tdap, influenza, hepatitis A vaccine, hepatitis B vaccine, and combination hepatitis A/hepatitis B vaccine (Twinrix) free of charge to adults 19 years of age and older who are:
Uninsured (Adult has no health insurance coverage)
Underinsured (Adult has health insurance but immunizations are not a covered benefit)
Who qualifies for vaccines provided through AVP? Adults 19 years and older who are uninsured or underinsured in the state of Georgia.
How can a provider enroll in AVP? All interested providers should start with completing the AVP Pre-enrollment survey (https://www.surveymonkey. com/r/NDKKNC8).
If your site qualifies for the program an enrollment packet will be sent to you 2 - 3 weeks after completion of the pre-enrollment survey.
For questions about enrollment or the Adult Vaccine Program please contact Saron Ephraim at 404-651-5666 (email: saron.ephraim@dph.ga.gov).

Adults undinsured and underinsured qualify for the Adult Vaccine Program
(AVP)
Interested providers should keep the following in mind: Having appropriate vaccine storage units and temperature monitoring devices are a requirement for AVP enrollment. For more information about best practices for vaccine storage please review the CDC storage and handling toolkit (https://www.cdc.gov/vaccines/hcp/admin/storage/ toolkit/storage-handling-toolkit.pdf)

ATTENTION PROVIDERS

VFC Annual Re-certification
Annual VFC re-certification for 2018 will be done online through GRITS. Information in GRITS will be used to pre-populate the information on the VFC Provider Agreement and the VFC Provider profile.
The primary and back-up VFC vaccine coordinator should complete two webinar trainings annually provided by the CDC at the following website https://www.cdc.gov/ vaccines/ed/youcalltheshots.html
"You Call the Shots" module on Vaccines for Children
"You Call the Shots" module on Vaccine Storage and Handling
When Immunization Regional Consultants conduct VFC Compliance site visits they will ask to see the following documents as part VFC re-certification process:
Completed You Call the Shot Training certificates, Current Vaccine Emergency Plans, Thermometer Calibration certificates.
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Serving up GRITS
GRITS Coverage Assessment Reports The Georgia Registry of Immunization Transactions and Services (GRITS) has recently developed easy-touse immunization assessment reports to help monitor immunization rates for vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). Development of the assessment reports are part of the Center for Disease Control's efforts to transitions from Comprehensive Clinical Assessment Software Application (CoCASA) to Registry based assessment reporting. Implementation is also a part of the Immunization Program's on-going effort to provide user friendly tools to improve immunization rates throughout the state of Georgia. It is our hope that the new registry-based coverage reporting will be easier to access, easier to read and encourages more providers to conduct routine coverage assessments in their practice.
The assessment reports offer clinic-based and countybased immunization rates to assist in monitoring immunization coverage and quality improvement activities.

The assessment reports can: Generate baseline immunization rates Identify areas for improvement Provide data to assist with implementing practice change and/or outreach activities Provides access to regular follow-ups to evaluate whether practices change and/or outreach is improving immunization rates
Access to the new report function will be available late September 2018. Please looked for further details on your GRITS homepage.

ATTENTION PARENTS
Is your child's asthma under control? As your child heads back to school, take proactive steps to be sure they're safe and healthy. Develop an asthma action plan. Be sure your child's medications are filled and get your child a flu shot. Learn more: www.dph.georgia.gov/asthma

Is Your Child's Asthma Under Control?

ASTHMA ACTION PLAN

MEDICATIONS FILLED

FOR MORE INFORMATION VISIT: dph.georgia.gov/Asthma

FLU SHOT

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AWARDS
Georgia Immunization Program Received Two National Awards for Adolescent Immunization Coverage

The Centers for Disease Control and Prevention (CDC) honored the Georgia Immunization Program at the 48th annual National Immunization Conference, held this past spring in Atlanta, with the following two awards for outstanding performance:
Healthy People 2020 Immunization Coverage Award Adolescents Aged 13-17 Years (for four vaccinations), 2016
Most Improved Coverage among Adolescents 13 17 years Award (for four vaccinations), 2016
Healthy People 2020 (HP2020) provides science-based, 10-year national goals and objectives for improving the health of all Americans. Both awards were granted based on results from the National Immunization Survey, which is a random telephone survey conducted by the CDC every year.
These awards indicate the State is doing an excellent job of immunizing its children and adolescents.
According to Sheila Lovett, Immunization Program Director at the Georgia Department of Public Health,"Such success can be attributed to Georgia's healthcare providers who are committed to making sure their patients receive the appropriate immunizations." Advisory Committee on Immunization Practices (ACIP) recommendations and state-mandated vaccination requirements for school entry have contributed as well. Georgia should be acknowledged and congratulated on the improvements made in the adolescent coverage rates in 2016. (Chart provided below). Georgia is above national averages for HPV,Tdap and MCV4; however, the state is still below Healthy People 2020 goals for some vaccines.

National Immunization SurveyTeen (13 to 17 years), United States, 2016

Names

% Coverage

1 HPV Vaccination, both males and females Age 13 to 17 years

Georgia

67.3

United States

60.4

HPV Vaccination Up-To-Date, Males and Females Age 13 to 17 years

Georgia

45.6

United States

43.4

1 dose Tdap Vaccination Age 13 to 17 years

Georgia

92.8

United States

88.0

1 dose MenACWY Vaccination Age 13 to 17 years

Georgia

91.4

United States

82.2

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In Georgia, two studies are conducted annually to further assess infant and adolescent coverage rates.The first is the Georgia Immunization Study (2016) which employs a retrospective cohort research design to determine the up-to-date (UTD) immunization rate for 2-year old children born in the State of Georgia.
The study looks at immunization rates based on ACIP recommendations of 4 DtaP, 3 Polio, 1 MMR, 3 Hib, 3 Hepatitis B, 1 Varicella, and 4 PCV (4:3:1:3:3:1:4).The 2016 statewide UTD immunization rate by 24 months was 82.1 percent, down from 82.7 in 2015.

Vaccine or Series 4 DTaP 3 Hib 1 MMR 3 Hep B 3 Polio 1 Varicella 4 PCV4 4313314 Series

Coverage or Goal 90% 90% 90% 90% 90% 90% 90% 80%

Georgia Coverage 84% 91% 91% 95% 95% 93% 91% 82%

Although Georgia is above goal for total series completion, DTaP coverage is lagging below the goal by 6%, which perhaps explains the slight drop in total series completion from 2015 to 2016.Thus, ensuring the DTaP series has been covered should be an area of focus for improvement in infants and toddlers.
The second study is the Georgia Adolescent Immunization Study (GAIS2017) which ascertains vaccine coverage rates for 7th grade children.The percentage of 7th graders UTD, which included having at least 3 doses of Hepatitis B, 2 doses of MMR, 2 doses of Varicella, 1 dose of Tdap, and 1 dose of MCV4 vaccines was 94%.

Vaccine or Series
1 Tdap 1 MCV4 3 HPV (female only) 2 Varicella

Coverage or Goal (13 to 18 Years) 80% 80% 80% 90%

Georgia Coverage*
97% 96% 23%** 97%

* This is not a direct comparison. HP2020 Goals are based on females aged 13 to 18, while the GIAS17 looks at 7th grader males and females.
**HPV coverage was assessed using the 2016 ACIP recommendations of a 2 or 3-dose schedule based on the age of the recipient.

As shown by the table above, though mandated immunization rates for adolescents are in the mid- to high-nineties, the recommended HPV vaccine series completion rate is a dismal 23%.Therefore, provision of the first dose and completion of the HPV series should be another area of focus for improvement.

The State as well as the American Cancer Society have responded to these findings by initiating campaigns to assist healthcare providers with strategies to increase HPV immunization rates.The strategies include bundling HPV with the mandated immunizations required of 7th graders and using a strong healthcare provider recommendation followed by practice reminder/recalls.
According to Harry Keyserling, MD, Infectious Disease Chair for the Georgia Chapter, American Academy of Pediatrics, "We are doing an excellent job of immunizing our patients.All, practices should review office protocols to optimize identification and recall of children that are behind in their schedules. We must remain vigilant in maintaining high immunization coverage rates."Immunization has proven to be the most efficient and effective means of maintaining overall health, reducing disease-associated healthcare expenses, and protecting children and communities against vaccine preventable diseases. For these reasons, immunization should remain at the forefront of our efforts to meet the mission of the Chapter to improve the health and welfare of all the infants, children, and adolescents in the state.
References:
Walker TY, Elam-Evans LD, Singleton JA, et al. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 1317 Years -- United States, 2016. MMWR Morb Mortal Wkly Rep 2017;66:874 882. DOI: http://dx.doi.org/10.15585/mmwr.mm6633a2
Machado, F. (2016). Georgia immunization study 2016. Atlanta, GA: Georgia Department of Public Health.
Machado, F. (2017). Georgia adolescent immunization study 2017. Atlanta, GA: Georgia Department of Public Health.
Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination -- Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:14051408. DOI: http://dx.doi.org/10.15585/ mmwr. mm6549a5
Noreen Dahill, BS, Immunization Coordinator, Ga-Chapter American Academy of Pediatrics
Cordia Starling, EdD, MS, BSN, RN, EPIC Immunization Program Director, Ga-Chapter American Academy of Pediatrics

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2018 Immunize Georgia Award Recipients

2018 Clay Coleman Excellence in Customer Service Award winner, Lisa Jenkins
The Georgia Department of Public Health hosted the 25th annual Immunize Georgia conference at the Columbus Convention and Trade Center on September 14, 2018 to focus on raising immunization rates in Georgia. Public health immunization champions were recognized this year for their leadership in getting Georgians immunized.
The 2018 Clay Coleman Excellence in Customer Service Award honors a staff member who demonstrates passion, enthusiasm and innovation in the provision of services, expertise or technical assistance to any immunization stakeholder, including the public. This year's recipient, Lisa Jenkins, has shown exemplary customer service. She "knows her stuff" and is always willing to answer or find out the answer to any question our office may have. Lisa "is by the book" but also kind and caring in the way she carries out her duties. Her willingness to help us be the best VFC provider we can be is truly genuine.
The 2018 Walt Orenstein Champions for Immunization Award honors individuals, agencies or coalitions who demonstrate excellence in providing immunization care.

Here are this year's recipients. Albany Area Primary Healthcare In the past five years,Albany Area Primary HealthCare (AAPHC) has opened seven school-based health clinics to provide healthcare to students and school staff on-site, which allows students to receive the care they need during the regular school day. Because of the rural location and poverty levels in the area, these schoolbased health clinics have given access to healthcare to many children who would not otherwise have this opportunity. In addition to making sure all students are up to date on all required and recommended vaccines, AAPHC administered nearly 5600 flu vaccines through the VFC Program, and nearly 6,000 flu vaccines to their insured population. Dekalb County Board of Health, Clifton Springs Health Center The staff at the Dekalb County Board of Health, Clifton Springs Health Center show care and humanity in the service they provide to their clients.They make efforts
Albany Area Primary Healthcare
Dekalb County fBoard of Health, Clifton Springs Health Center
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Awards continued...
Kay Davis
to spend time with clients (both children and adults) to explain why it is important for them to leave protected against vaccine preventable diseases.They work on weekends and extended immunization services during the week to meet the demands of back to school rush to accommodate clients who could not otherwise come in during regular clinic hours.They often travel to health fairs, community centers, malls, schools and other nontraditional settings to reach vulnerable populations. Kay Davis Kay Davis is continually looking for ways that we can increase immunization awareness and administration rates. For example she coordinated a contest within the health district to increase HPV administration to 7th graders, where she provided each clinic with educational materials and made sure there was adequate stock of the vaccine. Some counties showed as much as a 54% increase in 12 months. Kay is also proactive in ensuring

that all nurses in the 16 counties of the Southeast Health District are adequately trained. She provides education during new nurse orientation, at yearly protocol training, and distributes additional learning opportunities to all nurses throughout the year.The success of our Immunization program in the Southeast Health District would not be possible without Kay Davis.
North Georgia Health District 1-2 The North Georgia Health District is committed to reducing barriers to care and providing quality service at every visit.The North Georgia Health District addresses barriers to care such as no cost vaccinations, community outreach and events, and maintains flexible hours to meet the needs of the community. The North Georgia Health District is composed of seven health departments and one Ryan White Clinic.All our clinics work in conjunction with others in the public and private settings to ensure that all applicable vaccines are given to every person in their community.
CONGRATULATIONS
Congratulations to all the recipients from this year's conference. We thank you for
your continued efforts to protect and immunize Georgia.

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North Georgia Health District 1-2