Immunize Georgia, 2019 Fall

W H AT ' S I N S I D E

ImmunGiezoergia
A publication of the Georgia Department of Public Health

dph.georgia.gov
FALL 2019
Hepatitis A Update MCV4 Update Out with the Old and In
with the New Flu Update GRITS Update Awards

Hepatitis A Update

Hepatitis A (HAV) is spread through fecal-oral contact, typically through close contact with someone who is infected with HAV and contaminated food or water. HAV is an acute infection and most people will resolve the infection within 6 months of exposure. Once resolved, the person will develop lifelong immunity against HAV.

Symptoms of viral hepatitis can include fever, fatigue, nausea, vomiting, diarrhea, abdominal pain, dark urine, clay-colored bowels, joint or muscle pain and/or jaundice (yellowing of the skin and eyes). Not everyone will experience symptoms (or all of these symptoms) when first infected with viral hepatitis.

29 states have experienced HAV outbreaks since 2016, being spread through close person-to-person contact. These outbreaks have been occurring primarily among those who use injection and non-injection drugs, homeless individuals and their close contacts. Increases in HAV infection are also being seen among homosexual and bisexual men.

Figure 1:

Confirmed HAV Infections, Georgia, June 1, 2018 to September 14, 2019* (n=656)

Count of Cases

100

83 91 87

81

80

74

66

60

47

40

39

20 6

6

10

12 14 16 3

21

0

JUNE

2018

JULY

2A0U18GUSSTEP2T01E8MBERO2C01T8OBENRO2V01E8MBERDE2C01E8MBER

J2A0N18UARYF2E0B1R9UARY

2019 MARCH

2019APRIL

2019

MAY

2019JUNE

2019JULY

2A0U1G9 USTS2E0P1T9EMBER

2019

Month of Infection

*2019 data is preliminary and subject to change.

Source: GA DPH State Electronic Notifiable Disease Surveillance System (SendSS)

29 states have experienced HAV outbreaks
since 2016.
Georgia has been experiencing a HAV outbreak since June 2018, with 656 cases having been reported as of September 14, 2019.* (see Figure I) Geographically, the areas of Northwest Georgia,Augusta and Fulton County account for 80 percent of the HAV infections being seen statewide. (see Figure 2) In response to this outbreak, Georgia DPH has been working closely with district public health staff to increase hepatitis A vaccination rates in those populations
Continued on page 2...
ImmunGiezoergia 1

Hepatitis A continued from page 1 ...

Figure 2:

Geographic Distribution of Confirmed HAV Infections, Georgia, June 1, 2018 to September

14, 2019* (n = 656)

COUNT HEPATITIS A CASES 1-20 21-40 41-60 81-102

*2019 data is preliminary and subject to change. Source: GA DPH State Electronic Notifiable Disease Surveillance System (SendSS)

at highest risk, primarily among illicit drug users, those with a recent or current incarceration history, gay and bisexual men, and homeless individuals. District public health staff have been targeting vaccination efforts in Public Health clinics, county jails, drug rehabilitation services, homeless shelters and establishments frequented by gay and bisexual men.
The hepatitis A vaccine can provide pre- and postexposure protection. If someone has been exposed to HAV and has not been vaccinated against HAV, then it is recommended that anyone over 12 months of age receive the hepatitis A vaccine as post-exposure prophylaxis (PEP). Immune Globulin (IG) can be provided for contacts who are under 12 months of age or anyone who is immunocompromised or has chronic liver disease. PEP must be provided within 14 days of the last exposure. (www.cdc.gov/mmwr/volumes/67/wr/mm6743a5.htm)
More information from the Georgia Department of Public Health about Hepatitis A can be found here: dph.georgia.gov/hepatitis

MCV4 UPDATE
It's Booster Time!
New 11th Grade Immunization Requirements Georgia's immunization requirements for students entering or transferring into the eleventh grade have been revised to align with the current recommendations of the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). Effective July 1, 2020, all students sixteen years of age or older entering or transferring into eleventh grade will need proof of a meningococcal booster shot (MCV4), unless their first dose was received on or after their sixteenth birthday.
For information on the new school entry requirement and other vaccine news, please visit the immunization section website at dph.georgia.gov/immunization-section.

2 ImmunGiezoergia

Out with the Old and In with the New

On July 1, 2019, the Centers for Disease Control and Prevention (CDC) implemented a new quality improvement program Immunization Quality Improvement for Providers (IQIP). IQIP replaces Assessment, Feedback, Incentive eXchange (AFIX).
IQIP promotes and supports implementation of provider-level strategies designed to help increase on-time vaccination of children and adolescents.

IQIP Provides technical assistance to three core QI strategies:
Scheduling a next visit before the patient leaves;
Leveraging the IIS (GRITS) function to improve immunization practices; and
Providing vaccine recommendations, specifically for HPV.
Your assigned Immunization Regional Consultant will provide you with further details on IQIP during the annual VFC Compliance visit. We welcome in IQIP and the strategies it provides to improve immunization practices and coverage.

FLU UPDATE
Do you have expired flu vaccines from last season? Make sure you pull them out of your storage units, label them "DO NOT USE" and set them aside until you receive the return label for shipping public vaccines back to the distribution center. If you have not received your label within three weeks of the expiration date, please contact the VFC program at dph-gavfc@dph.ga.gov.
The Georgia Immunization Program (GIP) started shipping flu vaccines in mid-August. Providers who completed a pre-book or waitlist survey order for flu vaccines should have received shipments during August and September. The Advisory Committee on Immunization Practices (ACIP) has advised that some of the manufacturers will have delays in vaccine distribution this year.

If providers did not submit a pre-book or waitlist survey for public flu vaccine orders, they can complete a waitlist survey at the following link: www.surveymonkey.com/r/ FLUWL2020
The FluMist order for the GIP was reduced by 2/3 and providers can anticipate a reduction in their FluMist orders this season. The School Based Flu Program (SBF) will not have FluMist as an option for this season of flu vaccine supply.
SBF has entered its ninth year. Last year 57,339 doses were administered in SBF clinics throughout Georgia. The table below shows the doses administered for the past few years through SBF and each year we have seen an increase in influenza vaccines given to both privately insured and VFC eligible patients.There were a total of 101 counties out of the 159 that participated in SBF last year.Thank you to all the public health nurses, clerical staff, school nurses, school administrators and school staff that work so hard to make SBF a success. Let us work to continue to increase participation in SBF this season.

School Year
2016 2017 2017 2018 2018 2019

Total SBF Doses Administered 45,000 50,633 57,339

ImmunGiezoergia 3

GRITS UPDATE
What's new with GRITS?
GRITS was originally installed in May 2003. Since that time, we have strived to ensure the functionality within the application was intuitive and user-friendly. Recently, we decided that it was time to improve the user experience by upgrading the look and feel of the application.We have made comprehensive changes to the layout of the GRITS User Interface.This provides a more noticeable login function and easier accessibility for healthcare providers, school users and the public. You will notice the difference immediately!
GRITS got a facelift.
So, what does that mean to you? Here's what you need to know ...
Functionality has not changed The look and feel may be different, but the functions and operations of GRITS remain the same.
"Clients" are now known as "Patients" To align our verbiage with the nurse staff that typically uses GRITS, we have changed the term client to patient all throughout the system.
Release Notes section Choose this hyperlink Announcements and Release Notes
located below the image of the State Capital picture to access any GRITS/VFC related announcements and release notes.
Homepage made easier The Home screen has been revamped to allow easy access to the functions most important to you (i.e. manage patient, inventory alerts, etc.)
The options to the left are now true headers Click on a header to see a drop down with further options.
This is only the beginning Look for more enhancements and updates to come for our system. The best has yet to come!
4 ImmunGiezoergia

For any questions or concerns regarding the system please contact:
GRITS Help Desk (866) 483-2958
GRITS Help Desk email: dhp-gaimmreg@dph.ga.gov

CONFERENCE AWARD UPDATE

2019 Immunize Georgia Award Recipients

The Georgia Department of Public Health hosted the 26th annual Immunize Georgia conference at the Sonesta Gwinnett Place Atlanta, September 12, 2019, to focus on raising immunization rates in Georgia. Public health immunization champions were recognized for their leadership in getting Georgians immunized.
The 2019 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, Saron Ephraim, has put forth vigorous creative efforts to educate providers on seasonal influenza activities, the School Based Flu program, and adult and adolescent immunization practices. Saron identifies problems and resolves them. She has a gentle and professional manner of answering providers' questions that allow us to feel "heard" and that our questions are important. She gives providers the opportunity to share lessons learned and best practices based on our experience, and she never fails to express gratitude and offer positive feedback.

Nikki Adams Bryant
The 2019 Walt Orenstein Champions for Immunization
Nikki Adams Bryant Nikki Adams Bryant was instrumental in improving adult immunization rates in Webster and Stewart counties. In a three-month improvement pilot, Nikki and her staff increased the immunization rates for seniors in her pharmacy by 8 to 33 percent depending on the vaccine. She demonstrated for others how she increased doses given by 300 percent in one quarter over the entire previous year. Nikki works to identify alternatives to patients coming into the office, including sending a pharmacist out to immunize patients while delivering their medications, and providing immunizations at health fairs.
Nikki was a part of an Immunization Best Practices panel presentation, where she shared the community immunization coalition efforts at the Georgia Pharmacy Association in 2018. Nikki co-presented in 2019 on a project to improve her pharmacy's immunization rates, providing other pharmacists with a step-by-step guide on how to identify patients needing immunizations and recalling patients who needed immunizations.

2019 Clay Coleman Excellence in Customer Service Award winner, Saron Ephraim

Awards continues on page 6
ImmunGiezoergia 5

Awards continued ...

Elizabeth (Libby) Massiah

Whitfield County Health Department Children's Access Clinic

North Georgia Health District 1-2

Elizabeth Massiah Four years ago, Elizabeth (Libby) Massiah joined Alliant Quality to lead Georgia's Medicare Quality Improvement Organization Immunization program. Her experience and creativity play equal parts in our success to exceed goal improvements in rural and statewide rates for influenza and pneumococcal vaccines. Libby developed an immunization education and improvement series targeted at key stakeholder groups; primary care, pharmacies, health departments and home health agencies. She created unique patient conversation aids with real-world language prompts, among other resources targeted at challenges gathered from the field. Libby has led the Georgia Immunization Coalition and championed immunization best-practice implementation with the Georgia Association of Family Practitioners, the Georgia Pharmacy Association, the Georgia Home Health Association and the DPH Health Symposium. Of particular note is a highly successful pilot project that Libby led to identify Georgia's most under-immunized and under-served counties to improve pneumococcal vaccination rates for adults 65 and over.The result was an improvement in pneumococcal immunization rate of over 33 percent. Libby's enthusiasm is welcomed and drives the conversation no matter if presented in person, on webinars, small group meetings or newsletter messages.
Whitfield County Health Department Children's Access Clinic Children's Access Clinic not only plays a vital role in preserving the health of local children but also provides immunizations across all ages.The Children's Access Clinic works to reduce barriers in immunizations and addresses community needs, attending many health fairs throughout the year to educate and improve awareness of adult vaccination recommendations. Many times, the staff of the Children's Access Clinic work outside normal
6 ImmunGiezoergia

office hours to accommodate outreach events. Whether they are providing school-based flu clinics, off-site flu vaccinations for businesses, and more recently, hepatitis A outreach; the team is always willing to act.
North Georgia Health District 1-2 The North Georgia Health District developed a plan to address rising hepatitis A cases and increase adult vaccinations after noticing a concerning increase in hepatitis A cases that coincided with a marked increase in the surrounding geographic area in October 2018. In December 2018, the North Georgia Health District began working with local jails and substance abuse facilities to vaccinate those who are at high risk for hepatitis A.The North Georgia Health District also made educational presentations to local stakeholders including key hospital staff and county board of health members to promote hepatitis A and other adult vaccinations. In efforts to reduce barriers to vaccination, the North Georgia Health District began a no cost hepatitis A vaccine campaign targeting high-risk populations as well as any client desiring to be vaccinated against hepatitis A. From December 1, 2018 to July 1, 2019, a total of 4,257 adult hepatitis A containing vaccines were administered with over 1,400 of those vaccinations occurring off-site. By comparison, only 578 adult hepatitis A containing vaccines were administered in the same time period the previous year.
CONGRATULATIONS TO ALL THE RECIPIENTS FROM THIS YEAR'S
CONFERENCE. WE THANK YOU FOR YOUR CONTINUED EFFORTS TO PROTECT AND
IMMUNIZE GEORGIA.