Georgia immunization program manual [Mar. 2010]

Georgia Immunization Program Manual
Georgia Department of Community Health Division of Public Health

VOL. 10-1
DPH -

March 2010

Division of Public Health Policy and Procedure Approval
This publication, in combination with the Advisory Committee on Immunization Practices Recommendations Manual, represents the official Policies and Procedures for the Administration of Vaccines and Provision of Immunization Services of the Georgia Division of Public Health. In addition, these manuals serve as an Annex to the Standard Operating Procedures (SOP) of the Department of Community Health (DCH) Division of Public Health (DPH) Emergency Operations Plan (EOP). The purpose of this manual is two-fold. First, to serve either as the official Policies and Procedures for the Administration of Vaccines and Provision of Immunization Services by a health district, or to be utilized as a guide for writing a district's Immunization Policies and Procedures. District Health Directors who choose to utilize these two publications as their district Policies and Procedures should review and sign both manuals annually. We encourage District Health Directors, Clinical Coordinators and Immunization Coordinators, as well as other providers, to review this manual and ensure that their district's policies are in conformance with those outlined in this document. Secondly, the purpose is to delineate the responsibilities and working relationships of state, district and county personnel in matters that concern the Immunization Program.
Any discrepancies or errors found in the manual should be brought to the attention of the Immunization Program at (404) 657-3158 or email immunization@dhr.state.ga.us. Thank you for your support of the Immunization Program in Georgia.

Signed by, _Miriam Bell

_

Division of Public Health Georgia Department of Community Health

Date _ 04/07/2010

9

Equal Opportunity Employer

Georgia Immunization Program Manual
TABLE OF CONTENTS

Division Of Public Health

1. INTRODUCTION Introduction to the Manual Georgia Immunization Program Staff Central Office (REPLACE) Immunization Program Consultants (REPLACE) District Immunization Coordinators (REPLACE) Request for Immunization Forms---Form 3184 (REPLACE) U.S. Vaccines (REPLACE)
2. RECOMMENDED SCHEDULE & GUIDELINES* DCH GA Immunizations Program Vaccine Guidelines Approval Sheet (ADD) (Do Not Remove Previous Sheets) Immunization Guidelines for DHR Clinics Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults (REPLACE) Georgia Department of Community Health, Immunization Program Vaccine Guidelines Vaccines to Prevent Hepatitis B (REPLACE) Vaccines to Prevent Diphtheria, Tetanus, and Pertussis (REPLACE) Vaccines to Prevent Haemophilus influenzae Type B (REPLACE) Vaccines to Prevent Polio (REPLACE) Vaccines to Prevent Pneumococcal Disease (REPLACE) Vaccines to Prevent Measles, Mumps, and Rubella (REPLACE) Vaccines to Prevent Varicella (REPLACE) Combination Vaccines (REPLACE) Vaccines to Prevent Influenza (REPLACE) Vaccines to Prevent Hepatitis A (includes use of Immune Globulin [IG]) (REPLACE) Vaccines to Prevent Meningococcal Disease (REPLACE) Vaccines to Prevent Rotavirus Gastroenteritis (REPLACE) Vaccines to Prevent Human Papillomavirus Infection (REPLACE) Vaccines to Prevent Herpes Zoster (Shingles) (REPLACE) Vaccines to Prevent H1N1 (ADD) Recommended Childhood/Adolescent Immunization Schedule 2010 and Catch Up for Children with Lapsed Immunization Schedule (REPLACE) Recommended and Minimum Ages and Intervals Between Vaccine Doses (Table1) (REPLACE) Suggested Intervals between Administration of Antibody-containing Products and Measles-containing and Varicella Vaccines (Table 4) Recommended Adult Immunization Schedule United States, 2010 (REPLACE) Summary of ACIP General Recommendations Screening Questionnaires for Child and Teen Immunization (English/Spanish)(REPLACE BOTH) Screening Questionnaires for Adult Immunization (English/Spanish) (REPLACE BOTH) Standards For Child & Adolescent Immunization Practices Standards For Adult Immunization Practices
* See the Hepatitis Section for specific information regarding guidelines for clients being seen in Family Planning, STD and HIV clinics; for contacts to persons with HIV; and for Perinatal Hepatitis B Program guidelines.

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3. INFORMED REQUEST POLICY

Informed Request Policy (REPLACE)

Vaccine Information Statements (VIS)

Version Form#

Date Issused

DTP/DTaP/DT

English 3177

(05/17/07)

Vacunas Difteria,Tetano y Tos Ferina (DTaP)

Spanish 3162

(05/17/07)

Td

English 3070

(06/10/94) (REMOVE)

Vacuna Contra Tetanos y Difteria (Td)

Spanish 3069

(06/10/94)

Tdap

English 25-IMM-003E (07/12/06)(Interim

REMOVE)

Vacuna Contra Tetanos, Difteria Y Tos Ferina (Tdap)

Spanish 25-IMM-003S (07/12/06) (Interim)

Polio

English 3173

(01/01/00)

Vacuna Antipoliomielitca (Polio)

Spanish 3163

(01/01/00)

MMR

English 3198

(03/13/08)

Vacuna Contra Sarampion, y Paperas y Rubola(MMR) Spanish 3160

(01/15/03)

HIB

English 3180

(12/16/98)

Vacuna Contra Influenzae Haemophilus Tipo B (HIB)

Spanish 3172

(12/16/98)

Hepatitis B

English 3039

(07/18/07)

Vacuna Contra la Hepatitis B (Hepatitis B)

Spanish 3170

(07/18/07)

Varicella

English 3157

(03/13/08)

Vacuna Contra Varicela (Varicella)

Spanish 3174

(01/10/07)

Hepatitis A

English 25-IMM-004E (03/21/06)

La Vacuna Hepatitis A (Hepatitis A)

Spanish 25-IMM-004S (03/21/06)

*Pneumococcal Polysaccharide (PPSV)

English

(10/06/09)(REPLACE)

* Vacuna Antineumoccica Polisacrida (Pneumococcal Polysaccharide Spanish) (04/16/09)(REPLACE)

Pneumococcal Conjugate (PCV)

English 3178

(04/16/10) (REPLACE)

Vacuna Antineumoccica Conjugada(Pneumococcal Conjugate Spanish) 3179

(04/16/10) (REPLACE)

+ Influenza Inactivated

English 25-IMM-008E (08/11/09)(REPLACE)

+Vacuna Desactivada Contra (Influenza)

Spanish 25-IMM-008S (08/11/09)(REPLACE)

+ Influenza Live Intranasal

English 25-IMM-009E (08/11/09)(REPLACE)

+ Vacuna Intranasal Viva Contra (Influenza)

Spanish 25-IMM-009S (08/11/09)(REPLACE)

Meningococcal Vaccine

English 25-IMM-001E (01/28/08)

Vacuna Meningoccica

Spanish 25-IMM-001S (10/07/05) (Interim)

Rotavirus Vaccine

English 25-IMM-006E (05/14/10)(REPLACE)

Vacuna Contra El Rotavirus

Spanish 25-IMM-006S (05/14/10) (REPLACE)

HPV Gardasil Human Papillomavirus) Vaccine

English 25-IMM-007E (03/30/10)(REPLACE)

Vacuna Contra EL HPV (Human Papillomavirus) Vaccine Gardasil Spanish 25-IMM-007S (03/30/10)(REPLACE)

HPV Cervarix (Human Papillomavirus) Vaccine

English 25-IMM-013E (03/30/10) (ADD)

Vacuna Contra EL HPV (Human Papillomavirus) Vaccine Cervarix Spanish 25-IMM-013S (03/30/10) (ADD)

*Shingles Vaccine

English

(10/06/09)(REPLACE)

*Vacuna Contra La Culebrilla

Spanish

(09/11/06)

Multi VIS

English 25-IMM-010E (09/18/08)(REPLACE)

LAS PRIMERAS VACUNAS DE SU BEB

Spanish 25-IMM-010S (01/30/08)

Td/ Tdap Combination (Replaces Td and Tdap English)

English 25-IMM-011E (11/18/08)(Interim ADD)

*Not stocked in Central Supply. Single copy is available from Immunization Program + Changes annually

After The Shots Despus de las vacunas (After The Shots -Spanish) Georgia Vaccine Administration Record Refusal to Vaccinate Form

English Spanish
English

3199 3196 25-IMM-002E 25-IMM-012E

(05/09) (REPLACE) (04/05)(REPLACE) (07/09)(REPLACE)
(ADD)

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4. ADVERSE EVENTS FOLLOWING IMMUNIZATIONS Policy for Reporting Vaccine Adverse Events Following Immunizations (REPLACE) Handling of Emergencies Following the Administration of Vaccines Vaccine Adverse Event Reporting System- Form VAERS (FDA) Frequently Asked Questions About VAERS VAERS Brochure Commonly Asked Questions About the National Vaccine Injury Compensation Program (REMOVE) (See National Vaccine Injury Compensation Program (VICP) Web Page below for link) National Vaccine Injury Compensation Program (VICP) Web Page (ADD) (Link to Frequently Asked Questions http://www.hrsa.gov/vaccinecompensation/) National Vaccine Injury Compensation Program Vaccine Injury Table (REPLACE)

5. REQUIREMENTS OF SCHOOL/DAY CARE LAW Summary of Immunization Policies Relative to Georgia Law Official Code of Georgia, Annotated Section 20-2-771 Section 49-4-182 Section 49-4-183 Section 31-12-3.1 DHR Rules, Chapter 290-5-4 Historical Statement Listing Dates of Immunization Requirements (REPLACE) School Certificate of Immunization Form 3231 (Rev. 3/07) Policy Guide 3231INS: Standards for Issuing and Filing Certificates of Immunization Policy Guide 3231REQ: Vaccine Requirements for Attending Day Care Facilities and Schools in Georgia Relative to the Certificate of Immunization Summary Of Georgia Immunization Requirements For Child Care and School Attendance Immunization Requirements and Recommendations for University System of Georgia Students

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TABLE OF CONTENTS
6. SURVEILLANCE AND REPORTING Procedure for the Investigation and Reporting of Vaccine Preventable Diseases Contact Persons for VPD Surveillance at the District Health Office (REPLACE) Vaccine Preventable Disease Fact Sheets Diphtheria Fact Sheet Hepatitis A Fact Sheet and Q & A (REPLACE) Hepatitis B Fact Sheet and Q & A (REPLACE) Haemophilus influenzae Invasive Disease Fact Sheet and Q & A (REPLACE) Measles Fact Sheet and Q & A Mumps Fact Sheet Pertussis Fact Sheet and Q & A Polio Fact Sheet and Q & A Rubella Fact Sheet and Q & A Streptococcus pneumoniae Fact Sheet and Q & A Tetanus Fact Sheet Resources for Influenza Prevention and Control Influenza Outbreak Control in a Long Term Care Facility Georgia Notifiable Disease Report, Form 3095 (Rev. 8/04) CDC Diphtheria Worksheet Measles Surveillance Worksheet Mumps Surveillance Worksheet Pertussis Surveillance Worksheet Rubella Surveillance Worksheet Tetanus Surveillance Worksheet Viral Culture Submission Form (Rev. 9/02) GPHL Microbial Immunology Submission Form GPHL Molecular Biology Submission Form
7. HEPATITIS Perinatal Hepatitis B Prevention Program Guidelines (REPLACE) Appendix Table (REPLACE) A---Flow Chart for Following Babies Born to HBsAg Positive Females (REPLACE) B---Perinatal Hepatitis B Prevention Case Management Referral Form C-- Patient Notification Letters C-1---Sample Letter for Pregnant Women Testing Positive for HBsAg C-2---Sample Letter for Foster Parents of Infants Born to HBsAg (+) Women C-3---Sample Letter For Adoptive Parents Of Infants Born To HBsAg (+) Women (REMOVE) D---Immunization Action Coalition Patient Notification Letter E---Hepatitis B Alert (Infant) F---HIPAA Form for Perinatal Hepatitis B Prevention Program G---Hepatitis B Alert (HBsAg Positive Woman) H---Georgia Public Health Laboratory Service Manual Excerpt I---Questions Frequently Asked About Hepatitis B J---Guidelines for Standing Orders in Labor & Delivery and Nursery Units to Prevent Hepatitis B Virus Transmission to Newborns (REPLACE) K---What the Physician Can Do to Help the Child with Chronic Hepatitis B Virus Infection (REPLACE) L---If You Have Chronic Hepatitis B Virus (HBV) Infection M---Example Hepatitis B Interviewing/Counseling Format M1, M2, M3 and M4(REPLACE) N---Hepatitis B Facts: Testing and Vaccination (REPLACE)

State Hepatitis Program Memorandum of 5/13/2005---Vaccine Preventable Hepatitis in HIV, Family Planning, and STD Clinics Hepatitis B Vaccination in STD, HIV and Family Planning Clinics, Guidelines for Public Health

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8. RECALL OF PATIENTS Recall of Immunization Patients Policy Statement (REPLACE) Immunization Documentation, "Moved or Gone Elsewhere" (MOGE) Categories (REPLACE)
9. VACCINE DISTRIBUTION AND STORAGE Distribution of Vaccines (REPLACE) Temperature Log Sheet Provider Agreement For Public Health Providers Provider Agreement Policy For Public Health Providers Fraud and Abuse Policy Vaccine Loss Policy For Public Health Providers Handling Of Vaccine During Inclement Weather Conditions (REPLACE) Temperature Conversion Chart Vaccine Management (Recommendations for Handling & Storage of Selected Biologicals, April 2009) (REPLACE) Chart of Refrigerated /Frozen Pack Needs Maintaining the Cold Chain during Transport Guidelines for Returning Vaccine Products to the Manufacturer for Disposal (Replace with Guidelines for Returning State or Public Health District Purchased Outdated, Deteriorated, Returned and Recalled Drugs) (and can be located in the Public Health Nurse Protocol Manual Drug Dispensing Procedure, Section D under Outdated, Deteriorated, Returned and Recalled Drugs at http://health.state.ga.us/pdfs/nursing/Protocol%20Manual/04.0%20Drug%20Dispensing%20Procedure.pdf) Form for Return of Outdated, Unused or Overstocked Drugs (REPLACE with McKesson Return of Federal Vaccine Form) Vaccine Storage and Handling Toolkit, Chapter 9 --- Vaccine Shipments (REMOVE) Title X Unaccompanied Minor without Insurance Information VFC Vaccine Log (REPLACE) Centralized Distribution Information and Instruction for VFC Providers (ADD)
10. DISTRICT/COUNTY INSERTS Empty section for the District/County to use for items considered necessary to complement or supplement the material provided by the State Program
11. TRANSMITTAL MEMOS Section for filing memos which accompany revised pages, forms or documents
12. TRAVEL INFORMATION* Foreign Travel Information Travel and Yellow Fever Vaccination Clinics in Georgia (REPLACE) Vaccines and Biologics Used in U.S. and Foreign Markets Translation of Foreign Vaccine-Related Terms into English
*For travel information specific to travel vaccines or destinations, consult the ACIP Recommendations manual and/or the Center for Disease Control and Prevention's current edition of Health Information for International Travel.

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13. QUALITY ASSURANCE Quality Assurance/Quality Improvement for Immunization Practice for Public Health Nurses and Immunization Support Staff Appendices Attachment A - Immunization Reference Video Information and Resources, Training Sessions (REPLACE) Attachment B - Post Test Attachment C - Post Test Answers Attachment D IM/SC (Intramuscular) & (Subcutaneous) Injections (REPLACE) Attachment E - Vaccine Administration Techniques Post Test Attachment F - Vaccine Administration Techniques Post Test Answer Key Attachment G - Clinical Skills Checklist (REPLACE) Attachment H - QA/QI Review Assessment Tool
14. STANDARD OPERATING GUIDELINES FOR MASS VACCINATION CLINICS Standard Operating Guidelines for Conducting Mass Vaccination Clinics (REPLACE) Appendix A: Sample Vaccination/Administration Site Flowchart Appendices B1, B2, B3, B4: Sample Vaccination Site Command Charts Appendices C1, C2, C3: Sample Clinic, District and State Vaccination Reports

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1. INTRODUCTION Introduction to the Manual Georgia Immunization Program Staff Central Office (REPLACE) Immunization Program Consultants (REPLACE) District Immunization Coordinators (REPLACE) Request for Immunization Forms---Form 3184 (REPLACE) U.S. Vaccines (REPLACE)

Division Of Public Health

Table of Contents 11/2009

Georgia Immunization Program Manual

Division of Public Health

INTRODUCTION TO THE MANUAL

The Georgia Immunization Manual is intended to provide District and County personnel with up-to-date information and guidance. The Georgia Immunization Manual is based primarily on the Recommendations of the Advisory Committee on Immunization Practices (ACIP). The ACIP Recommendations are provided as a separate manual. These two manuals should be utilized together as the basis for formulating policies and procedures for administering vaccines and providing immunization services. The Division of Public Health also recognizes the Red Book (Report of the Committee on Infectious Diseases) of the American Academy of Pediatrics.
Another important reference is the package insert supplied by the manufacturer of the vaccine.
This manual and the ACIP Recommendations Manual represent official state policies and standards, and the recommended policies and procedures for administering vaccines, providing immunization services, and documenting and evaluating quality assurance. In addition these manuals serve as an annex to the Standard Operations Procedures (SOP) of the Department of Community Health (DCH), Division of Public Health (DPH) Emergency Operations Plan EOP). Districts may utilize these two manuals as the district's written Policies and Procedures for Administering Vaccines by Registered and Licensed Practical Nurses or use this manual as a guide to write their own. In addition, districts may utilize the Quality Assurance (QA) document included in this manual as a tool to document and evaluate the credentialing, policies, training, administration of vaccine and provision of immunization services. If a district chooses to utilize their own QA instrument, it should include all elements in the QA document in this manual. Constructive criticism, questions and notification of apparent error will be welcome, but deviation from state policy should not be undertaken lightly. Statements made in this manual take precedence over contradictory policy statements or memos that predate the manual pages.
Occasionally, due to ongoing research and evaluation, ACIP recommendations may differ from the manufacturer's package insert or the information in the Red Book, which is published every three years. When this occurs, the State Immunization Program utilizes the most current ACIP Recommendations.
Frequently, the ACIP publishes provisional guidelines prior to receiving final approval from the Director of the CDC and the Secretary of the Department of Health and Human Services (HHS). To facilitate the administration of newly licensed vaccines, the Georgia Immunization Program will utilize these provisional recommendations when necessary in developing guidelines.
From time to time, children present at DCH clinics with requests or orders from private physicians to administer vaccines under unusual circumstances. When the request clearly falls outside the ACIP Recommendations, such as using reduced dosage schedules, it simply should not be honored. When a child has a history or condition which calls for careful judgment as to whether it might be a contraindication and the physician assures that vaccine may be given safely, the District Health Director must make a decision whether to immunize or refer the child back to the physician.
Each subject in the manual is dated. When changes are made, appropriately indexed pages will be made available on the program website to replace outdated material. Transmittal letters should be logged and filed in the Memo section in the manual.
When recommendation changes occur between the annual manual updates, health districts will be notified by memos from the State Immunization Program. The Immunization Program Manual will be updated at least annually to include the recommended changes. Health districts are responsible for developing and implementing a plan to ensure that all memos and manual revisions are distributed, discussed, and implemented within a month of receipt with all appropriate clinics and staff and that the Immunization Program Manuals and ACIP manuals are kept current.
When questions arise that are not covered adequately anywhere in the manual, the Immunization Program personnel are eager to field them and provide or obtain clarification. A staff person is available for on-call questions Monday through Friday, from 8:00 A.M. until 5:00 P.M. The Immunization Program telephone numbers may be found in Section 1 of this manual.

Introduction To Manual

1

11/2009

Georgia Immunization Program Manual
Anil T. Mangla., MS., Ph.D., MPH., FRIPH Director
Infectious Disease & Immunization Program Elizabeth Sullivan, Acting Director - Immunization Office
Atlanta Central Office 2 Peachtree Street, NW Suite 13.276
Atlanta, GA 30303-3142 Phone: (404) 657-3158 or 3159, Fax: (404) 657-1463

Jeffrey Dixon (jwdixon) (404) 657-3164
Deanna Gabriel (ddgabriel) (404) 657-6071
Deborah Jelks (ddjelks) (404) 657-4589 Mobile Ph: (404) 277-9760
Gwendolyn McCray (gsmccray) (404) 657-3173
Elizabeth Sullivan (exsullivan) (404) 657-6338 Mobile Ph: (404) 277-6864 Acting Director, Imm. Office
Vacant (404) 657-3157 Director, Immunization Office
Vacant (404) 651-7371 Program Evaluator
Vacant Operations Analyst II
Data Team Jeanette Ivey (jxivey) (404) 657-3172
Ben Sloat (wbsloat) (404) 651-5666 Mobile Ph: (404) 277-6065
LaTonya Thomas (lmthomas) (404) 657-2155 Mobile Ph: (404) 277-7028 Acting Vaccine Manager

Education Penny Conner (phconner) (404) 657-2137 Mobile Ph: (404) 277-6183
Gwendolyn Dozier (gjdozier) (404) 657-3158 & 3159 Receptionist Desk
Chuntiel James (ccjames) (404) 463-6639 Mobile Ph: (678) 644-5464
Linda Simmons (lxsimmons) (404) 463-0384
EPI Staff Liaison Ebony Thomas (esthomas) (404) 463-0781 Mobile Ph: 404-803-8385
Rebecca Willis (rmwillis) (404) 463-3750 Mobile Ph: (404) 803-8236
GRITS HELP DESK 1-866-483-2958
Immunization Information Systems (IIS) GRITS: 1-888-223-8644 immreg@dhr.state.ga.us Fax: (404) 657-7496
Tracy Culbreath (tculbreath) (404) 463-0806 Mobile Ph: (404) 277-6484
Adrienne Johnson (aljohnson5) (404) 463-0810 & 0811 GRITS Main Desk

Diane Martin diane.martin2@hp.com (404) 463-0588 HP Contractor
Andre Wilson andre.wilson@hp.com (404) 657-4590 HP Contractor
Sharon Wilson (spwilson2) (404) 463-0807 Acting GRITS Training Coordinator
Vacant (404) 463-0808 GRITS Business Analyst
Vacant (404) 657-3166 GRITS Business Analyst
Vacant (404) 657-4607 GRITS Training Coordinator
Perinatal Hepatitis B Janice Sloan (jlsloan) 404-657-3142
Kathryn [Kate] Spruit (kespruit) (404) 657-3151 Mobile Ph: (404) 824-3153
Vaccines for Children (404) 657-5013 Or 1-800-848-3868 Fax: (404) 657-5736 Or 1-800-372-3627
Edna Chambers (ecchambers) (404)-657-5015 & 5016
Pamela Lindo (palindo) (404) 657-3174 VFC (Temp)

1. Introduction 5/2010

Division of Public Health
Sherrionda [Sherri] Grady (slgrady) (404) 657-5018 & 1266
Shelena King (shking) (404) 657-5013 & 5014
Crystal Robinson (crrobinson) (404) 651-7305
Dorlisa Tillman (ditillman) (404) 657-6395
Vacant (404) 657-9635 Vaccine Manager
Vacant VFC Property Supply Supervisor
Infectious Disease & Immunization Program Anil T. Mangla (anmangla) (404) 463-0772 Mobile Ph: (404) 824-5511
Amy Orr (arorr) (404) 463-3474 I DI Executive Asst. (Temp)
Jamillia Richmond (jlrichmond) (404) 463-0096
Annette Wells (apwells) (404) 656-3546 Mobile Ph: (404) 277-9295
IDI Program Fax: (770) 357-9466
Conference Room 13-390 (404) 463-0813
Team Room 13-240 (404) 463-0814

GroupWise e-mail via Internet: immunization@dhr.state.ga.us Program website: http://health.state.ga.us/programs/immunization/index.asp
Revised June 3, 2010

Georgia Immunization Program Manual
Anil T. Mangla., MS., Ph.D., MPH., FRIPH Director
Infectious Disease & Immunization Program Elizabeth Sullivan, Acting Director - Immunization Office
Atlanta Central Office 2 Peachtree Street, NW Suite 13.276
Atlanta, GA 30303-3142 Phone: (404) 657-3158 or 3159, Fax: (404) 657-1463

Rome District. 1-1
Rick [William] Naus
(wfnaus)
Phone: (404) 657-3158 Fax: (404) 657-1463 Mobile Ph.: (404) 277-5637

East Metro Dist.rict 3-4
Angela Corbin (ambumphus)
2 Peachtree Street, Atlanta Phone: (404) 657-3158 Fax: (404) 657-1463 Mobile Ph.: (404) 277-5636

Dalton District. 1-2
Rick [William] Naus
(wfnaus)
Phone: (404) 657-3158 Fax: (404) 657-1463 Mobile Ph.: (404) 277-5637

Dekalb District. 3-5
Jotonna Tulloch
(jvhorton)
Phone: (404) 657-3158 Fax: (404) 657-1463 Mobile Ph.: (404) 277-0302

Gainesville District. 2
Jan Slaughter
(jsslaughter)
Phone: (404) 657-3158 Fax: (404) 657-1463 Mobile Ph.: (404) 277-9800

LaGrange District. 4
Tina Dempsey
(twdempsey)
Phone: (404) 657-3158 Fax: (404) 657-1463 Mobile Ph.: (404) 277-6442

Cobb, Douglas District. 3-1 Tasia Sheppard (trsheppard)
Phone: (404) 657-3158 Fax: (404) 657-1463 Mobile Ph: (404) 277-7555
Fulton District. 3-2
Janet Kelly (jckelly1)
Phone: (404) 657-3158 Fax: (404) 657-1463 Mobile Ph.: (404) 277-2461
Fulton District. 3-2 Valerie Pritchett (vgjones)
Phone: (404) 657-3158 Fax: (404) 657-1463 Mobile Ph: (404) 277-3331
Clayton District. 3-3 Conrad Harrow (cgharrow)
Phone: (404) 657-3158 Fax: (404) 657-1463 Mobile Ph.: (404) 277-9478

Dublin District. 5-1 DeAnna Brown (ddbrown)
Phone: (404) 657-3158 Fax: (404) 657-146 Mobile Ph: (404) 277-0340
Macon District. 5-2 Kelly Duke (kkduke)
Phone: (404) 657-3158 Fax: (404) 657-1463 Mobile Ph.: (404) 277-9414
Augusta District. 6 Natasha Poleate (Nlpoleate)
1916 North Leg Road Building D, Office D1 Augusta, GA 30909 Phone: (706) 729-2253 Fax: (404) 657-1463 Mobile Ph.: (404) 277-6958
Columbus Dist.rict 7 Libby [Elizabeth] Massiah (lrmassiah)
Phone: (404) 657-3158 Fax: (404) 657-1463 Mobile Ph.: (404) 277-0646

Division of Public Health
Valdosta District. 8-1 Jenny C. Howell (jchowell)
319 N. Main Street Moultrie, GA 31768-3809 Phone: (229) 891-7112 Fax: (229) 891-7114 Mobile Ph.: (404) 245-9620
Albany District 8-2 Kelly Seegmueller (kgbruce)
P.O. Box 1314 (Zip 31702-1314) 623-B. West Oglethorpe Blvd. Albany, GA 31701-2703 Phone: (229) 430-5139 Fax: (229) 430-5250
Mobile Ph.: (404) 277-3179
Savannah & Brunswick District 9-1 Georgia Dittmar (gds1)
Phone: (404) 657-3158 Fax: (404) 657-1463 Mobile Ph.: (404) 277-9358
Waycross District 9-2 Lorie M. Banks, RN, BSN (labanks)
Southeast Health Unit 1724-A Reynolds Street Waycross, GA 31501-1036 Phone: (912) 287-6667 Fax: (912) 287-6669 Mobile Ph.: (404) 725-5004
Athens District. 10 Angie Webster (amwebster)
Phone: (404) 657- 3158 Fax: (404) 657-1463 Mobile Ph.: (404) 277-8923

Revised June 3, 2010

1. Introduction 5/2010
GroupWise e-mail via Internet: immunization@dhr.state.ga.us Program website: http://health.state.ga.us/programs/immunization/index.asp

DISTRICT COORDINATOR AND ADDITIONAL CONTACT LIST
REVISED 07/26/10

DISTRICT

COORD/CONTACT INFO

PHONE/FAX

1-1 Bulk Mail

Marie Smith Immunization Coordinator Northwest GA. Public Health 1309 Redmond Rd, NW Rome, GA 30165-1391 lmsmith@dhr.state.ga.us
1309 Redmond Rd Rome, GA 30165-1391

(706) 215-2118(w) (706) 859-7984(f)

*Additional Contact 1-2

Margaret Bean District Program Manager 1309 Redmond Rd, NW Rome, GA 30165-1391 mrbean@dhr.state.ga.us
Gayle Brannon Assistant Director of Nursing North Georgia Health District 100 West Walnut Ave, Ste. 92 Dalton, GA 30720-8427 cgbrannon@dhr.state.ga.us

(706) 295-6647(w) (706) 802-5681(f)
(706) 272-2342, x339(w) (706) 272-2221(f)

Bulk Mail

North Georgia Health District 100 West Walnut Ave, Ste. 92 Dalton, GA 30720-8427

*Additional Contact 2
Bulk Mail *Additional Contact

Debbie Robbins Director of PH Nursing and Clinical Services North Georgia Public Health District 100 West Walnut Ave, Ste. 92 Dalton, GA 30720-8427 dlrobbins@dhr.state.ga.us
Janie Dalton Immunization Coordinator District 2 Public Health 1280 Athens St. Gainesville, GA 30507-7000 jldalton@dhr.state.ga.us
1280 Athens St. Gainesville, GA 30507-7000
Angie Hanes District 2 Public Health 1280 Athens St. Gainesville, GA 30507-7000 ahhanes1@dhr.state.ga.us

(706) 272-2125(w) (706) 272-2221(f)
(770) 535-5864(w) (770) 535-5958(f)
(770) 535-5743(w) (770) 535-5958(f)

* Additional Contact

COUNTIES/IPC
Bartow, Catoosa, Chattooga, Dade, Floyd, Gordon, Haralson, Paulding, Polk, Walker
IPC(s) VACANT Cherokee, Fannin, Gilmer, Murray, Pickens, Whitfield
IPC(s) Rick Naus Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Stephens, Towns, Union, White
IPC(s) Jan Slaughter

1

DISTRICT COORDINATOR AND ADDITIONAL CONTACT LIST
REVISED 07/26/10

DISTRICT

COORD/CONTACT INFO

PHONE/FAX

3-1 Bulk Mail *Additional Contact
3-2
Bulk Mail *Additional Contact
3-3 Bulk Mail *Additional Contact
* Additional Contact

Karen Thomas Immunization Coordinator Cobb and Douglas Public Health 1650 County Services Pkwy. Marietta, GA 30008-4009 kdibling@dhr.state.ga.us
1650 County Services Pkwy. Marietta, GA 30008-4009
Lisa Shadrix Office Manager, Immunization Cobb and Douglas Public Health 1650 County Services Pkwy Marietta, GA 30008-4009 lshadri@dhr.state.ga.us
Georgia Goseer Immunization Coordinator Fulton County Dept. Of Health & Wellness TCHR 265 Boulevard, NE, Rm. #328 Atlanta, GA 30312-1208 georgia.goseer@fultoncountyga.gov
99 Jesse Hill Jr. Dr. Atlanta, GA 30303-3045
Valencia Beckley Assistant Director Of Nursing Fulton County Dept. of Health and Wellness TCHR 265 Boulevard, NE 4th FL Atlanta, GA 30312-1208 valencia.beckley@fultoncountyga.gov
Freda Sheppard Immunization Coordinator Clayton County Board Of Health 1117 Battle Creek Rd Jonesboro, GA 30236-2407 flsheppard@dhr.state.ga.us
1117 Battle Creek Rd Jonesboro, GA 30236-2407
Java White Drug Coordinator/Building Operations Manager Clayton Board Of Health 1117 Battle Creek Rd Jonesboro, GA 30236-2407 jwhite@dhr.state.ga.us

(770) 514-2349(w) (770) 428-3855(f) (404) 429-8212(alt)
(770) 514-2307(w) (770) 428-3855(f)
(404) 730-1677(w) (404) 335-5066(f)
(404) 730-1647(w) (404) 730-1629(f)
(678) 610-7565(w) (770) 603-4872(f) (678) 610-7199(alt)
(678) 610-7358(w) (770) 603-4886(f)

COUNTIES/IPC
Cobb, Douglas
IPC(s) Tasia Sheppard
Fulton
IPC(s) Janet Kelly
& Valerie Pritchett
Clayton
IPC(s) Conrad Harrow

2

DISTRICT COORDINATOR AND ADDITIONAL CONTACT LIST
REVISED 07/26/10

DISTRICT
3-4
Bulk Mail *Additional Contact

COORD/CONTACT INFO
Gloria Melvin Immunization Coordinator East Metro Health District 455 Grayson Highway, Ste. 500 Lawrenceville, GA 30046-6387 gcmelvin@dhr.state.ga.us
455 Grayson Highway, Ste. 500 Lawrenceville, GA 30046-6387
Connie Russell District Program Director Louise Radloff Administration Bldg, GBOH PO Box 897 Lawrenceville, GA 30046-0897 CLRussell@dhr.state.ga.us

PHONE/FAX
(770) 277-1235(w) (770) 339-4280(f) (770) 237-5306(alt)
(678) 442-6865(w) (770) 339-2334(f)

3-5
Bulk Mail *Additional Contact
4
Bulk Mail *Additional Contact
* Additional Contact

Mia Young District Immunization Program Supervisor Dekalb County Board Of Health 30 Warren St, SE, Ste. 1168 Atlanta, GA 30317-2267 mjyoung@dhr.state.ga.us
30 Warren St, SE, Ste. 1168 Atlanta, GA 30317-2267
Katrina Green DeKalb County Board of Health Health Care Programs Manager PO Box 987 Decatur, GA 30030 kagreen@dhr.state.ga.us
Amy Fenn Child Health/Immunization Coordinator District Four Health Services 122-A Gordon Commerical Dr. LaGrange, GA 30240-5754 asfenn@dhr.state.ga.us
120-C Gordon Commerical Dr. LaGrange, GA 30240-5754
Darlene Sheets Child Health/Immunization Program Assistant District Four Health Services 122-A Gordon Commerical Dr LaGrange, GA 30240-5754 mdsheets@dhr.state.ga.us

(404) 371-0524(w) (404) 270-2400(f) (404) 217-7272(alt)
(404) 294-3722 (404) 508-7783
(706) 845-4035, x223(w) (706) 845-4350(f)
(706) 845-4035, x216(w) (706) 845-4350(f)

COUNTIES/IPC
Gwinnett, Newton, Rockdale
IPC(s) Angela Bumphus-Corbin Dekalb
IPC(s) Jotonna (Horton) Tulloch Butts, Carroll, Coweta, Fayette, Heard, Henry, Lamar, Meriwether, Pike, Spalding, Troup, Upson
IPC(s) Tina Dempsey

3

DISTRICT COORDINATOR AND ADDITIONAL CONTACT LIST
REVISED 07/26/10

DISTRICT

COORD/CONTACT INFO

PHONE/FAX

COUNTIES/IPC

5-1
Bulk Mail *Additional Contact
5-2
Bulk Mail *Additional Contact
6
Bulk Mail *Additional Contact
7
Bulk Mail *Additional Contact
* Additional Contact

Kelly Knight Immunization Coordinator South Central Health District 2121-B Bellevue Rd Dublin, GA 31021-2952 kyknight@dhr.state.ga.us
2121-B Bellevue Rd Dublin, GA 31021-2952
Donna Forth Clinical Nursing Director South Central Health District 2121-B Bellevue Rd Dublin, GA 31021-2952 dgforth@dhr.state.ga.us
Sherry Cook Immunization Coordinator North Central Health District 811 Hemlock St. Macon, GA 31201-2144 slcook@dhr.state.ga.us
811 Hemlock St. Macon, GA 31201-2144
David Harvey, M.D. District Health Director North Central Health District 811 Hemlock St. Macon, GA 31201-2144 dnharvey@dhr.state.ga.us
Susan Edmunds Child Health/Imunization Coordinator East Central Health District 1916 North Leg Rd Augusta, GA 30909-4402 sjedmunds@dhr.state.ga.us
1916 North Leg Rd Augusta, GA 30909-4402
Runae Watson Operations Analyst II East Central Health District 1916 North Leg Rd Augusta, GA 30909-4402 rkpowell@dhr.state.ga.us
Beverly Roberson Immunization Coordinator West Central Health District 2100 Comer Ave Columbus, GA 31902-2299 bmroberson@dhr.state.ga.us
2100 Comer Ave Columbus, GA 31902-2299
No Additional Contact Available

(478) 275-6545(w) (478) 275-6575(f)
(478) 275-6545(w) (478) 275-6575(f)
(478) 751- 4175(w) (478) 751-6099(f) (478) 951-9740(alt)
(478) 751-6247(w) (478)751-6099(f)
(706) 667-4409(w) (706) 667-4555(f) (706) 339-4072(alt)
(706) 667-4757(w) (706) 667-4555(f)
(706) 321-6121(w) (706) 321-6126(f) (888) 289-4067(alt)

Bleckley, Dodge, Johnson, Laurens, Montgomery, Pulaski, Telfair, Tretutlen, Wheeler, Wilcox
IPC(s) DeAnna Brown Baldwin, Bibb, Crawford, Hancock, Houston, Jasper, Jones, Monroe, Peach, Putnam, Twiggs, Washingon, Wilkson
IPC(s) Kelly Duke Burke, Columbia, Emanuel, Glascock, Jefferson, Jenkins, Lincoln, McDuffie, Richmond, Screven, Taliaferro, Warren, Wilkes
IPC(s) Natasha Poleate Chattahoochee, Clay, Crisp, Dooly, Harris, Macon, Marion, Muscogee, Quitman, Randolph, Schley, Stewart, Sumter, Talbot, Taylor, Webster
IPC(s) Libby Massiah
4

DISTRICT COORDINATOR AND ADDITIONAL CONTACT LIST
REVISED 07/26/10

DISTRICT

COORD/CONTACT INFO

8-1
Bulk Mail *Additional Contact

Debra Adams District Nursing & Clinical Director South Health District PO Box 5147 Valdosta, GA 31603-5147 daadams@dhr.state.ga.us
312 N. Patterson St Valdosta, GA 31601-5526
Shirley Davis Secretary II South Health District PO Box 5147 Valdosta, GA 31603-5147 sedavis@dhr.state.ga.us

PHONE/FAX
(229) 245-6433(w) (229) 333-7822(f) (229) 333-5290(alt)
(229) 333-5290(w) (229) 333-7822

8-2
Bulk Mail *Additional Contact
9-1
Bulk Mail *Additional Contact
* Additional Contact

Sue Dale District Immunization Coordinator Colquitt County Health Department PO Box 639 Moultrie, GA 31776-0639 skdale@dhr.state.ga.us
214 West Central Ave Moultrie, GA 31768-3834
Kelly Tillery Environmental Health/Immunization Program Associate Colquitt County Health Department PO Box 639 Moultrie, GA 31776-0639 ketillery@dhr.state.ga.us
Marianne Pappas Immunization Coordiantor Coastal Health District 24 Oglethorpe Professional Blvd, 4th Floor Savannah, GA 31406-3613 mkpappas1@dhr.state.ga.us
24 Oglethorpe Professional Blvd, 4th Floor Savannah, GA 31406-3613
Ruthie Smoak Administrative Assistant Coastal Health District 24 Oglethorpe Professional Blvd, 4th Floor Savannah, GA 31406-3613 rmsmoak@dhr.state.ga.us

(229) 891-7100, x123(w) (229) 891-7106(f) (229) 317-3197(alt)
(229) 891-7100, x133(w) (229) 891-7106(f)
(912) 644-5204(w) (912) 644-5220(f) (912) 224-9392 (alt)
(912) 644-5205(w) (912) 644-5220(f)

COUNTIES/IPC
Ben Hill, Berrien, Brooks, Cook, Echols, Irwin, Lanier, Lowndes, Tift, Turner
IPC(s) Jenny Howell Baker, Calhoun, Colquitt, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas, Worth
IPC(s) Kelly Seegmueller Bryan, Camden, Chatham, Effingham, Glynn, Liberty, Long, McIntosh
IPC(s) Georgia Dittmar

5

DISTRICT COORDINATOR AND ADDITIONAL CONTACT LIST
REVISED 07/26/10

DISTRICT

COORD/CONTACT INFO

9-2
Bulk Mail *Additional Contact

Kay Davis Immunization Coordinator Southeast Health District P.O. Box 430 Reidsville, GA 30453-0430 ksdavis@dhr.state.ga.us
200 B South Main St. Reidsville, GA 30453-0426
Cindi Hart Nursing & Clinical Coordinator Southeast Health District 200-B S. Main St Reidsville, GA 30453-0426 crhart@dhr.state.ga.us

10

Paula Young

Child Health & Immunization Coordinator

Northeast Health District

220 Research Drive

Athens, GA 30605-2738

plyoung@dhr.state.ga.us

Bulk Mail

345 North Harris St Athens, GA 30601-2470

*Additional Contact

Dionne Hansey Administrative Assistant Northeast Health District 345 North Harris St. Athens, GA 30601-2470 dchansey@dhr.state.ga.us

PHONE/FAX
(912) 557-7172(w) (912) 557-7954(f) (912) 237-2166(alt)
(912) 557-7193(w) (912) 557-7954(f)
(706) 583-2775(w) (706) 227-7120(f) (706) 201-5174(alt)
(706) 227-5332(w) (706) 389-6891(f)

* Additional Contact

COUNTIES/IPC
Appling, Atkinson, Bacon, Brantley, Bulloch, Cander, Charlton, Clinch, Coffee, Evans, Jeff Davis, Pierce, Tattnall, Toombs, Ware, Wayne
IPC(s) Lorie Banks Barrow, Clarke, Ebert, Greene, Jackson, Madison, Morgan, Oconee, Oglethorpe, Walton
IPC(s) Angie Webster

6

(DATE OF REQUEST)

Department of Community Health REQUEST FOR IMMUNIZATION FORMS
Please Stamp Or Type Below Your Information:

SEND TO:

Georgia Immunization Program 2 Peachtree Street, NW, 13-276 Atlanta, GA 30303 (404) 657-3158 Or Fax To: (404) 657-1463

Person Ordering Name
Office Name

NOTE: 1. All forms are to be ordered individually, not by package. 2. Form 3300, Hearing/Vision Dental Form, Office of Birth
Outcomes -(404) 657-3150 or http://health.state.ga.us/programs/family/index.asp

QTY

FORM NO. DESCRIPTION Vaccine Information Statements(or print from (http://www.immunize.org/vis/)

3039-E Hepatitis B (English)

Address City, State, ZipCode

Telephone # County Name

QTY

FORM NO. DESCRIPTION

Vaccine Information Statements (Cont.)

25-IMM-010-E Your Baby's First Vaccines Multiple VIS (English)

3170-S Hepatitis B (Spanish)

25-IMM-010-S Your Baby's First Vaccines Multiple VIS (Spanish)

3069-S Td (Spanish)

3177-E 3162-S 3157-E 3174-S 3198-E

DTP/DTaP (English) DTP/DTaP (Spanish) Varicella (English) Varicella (Spanish) MMR (English)

Tetanus, Diphtheria (Td) or Tetanus, Diphtheria, 25-IMM-011-E Pertussis (Tdap) (Replaces Td and Tdap) 25-IMM-013-E HPV Cervarix (English)

Certificates For School/Child Care Attendance

3231

Certificate of Immunization

3231REQ Outlines Vaccine Requirements For Form 3231

3160-S 3180-E 3172-S 3173-E 3163-S

MMR (Spanish) Hib (English) Hib (Spanish) Polio (English) Polio (Spanish)

3178-E Pneumococcal Conjugate (English)

3231 INS Instructions On How To Complete Form 3231

Parent & Client Education

3193-E 3194-S 3227-E&S

Give `Em Your Best Shot (GA. Requirement For School/Child Care) (Infant & Child) (English)
Hay que Vacunarlos (GA. Requirement For School/Child Care) (Infant & Child) (Spanish)
Be There For Your Child During Shots (English & Spanish)

3266-S

Proteja la salud de su hijo (a) -icon vacunas! (Guard Your Childs Health With Shots) (Spanish)

3179-S Pneumococcal Conjugate (Spanish)

3116-E Hop to It! (Infant, Child and Adolescent)

25-IMM-001-E Meningococcal (Conjugate & Polysaccharide) (English)

3110-E Word to the Wise: Immunize (Adult) (English)

25-IMM-001-S Meningococcal (Conjugate & Polysaccharide) (Spanish)

3110S Word to the Wise: Immunize (Adult) (Spanish)

25-IMM-003-S Tdap (Spanish) 25-IMM-004-E Hepatitis A (English) 25-IMM-004-S Hepatitis A (Spanish) 25-IMM-006-E Rotavirus (English) 25-IMM-006-S Rotavirus (Spanish) 25-IMM-007-E HPV Gardasil (English) 25-IMM-007-S HPV (Spanish) Temp 25-IMM-008-E Inactivated Influenza (English) 25-IMM-008-S Desactivada Contra LA Influenza (Spanish)

3199-E After the Shots (Infant & Child) (English)

3199-S After the Shots (Infant & Child) (Spanish)

25-IMM-005-E GRITS (Keeping Georgians Healthy) (English)

25-IMM-005-S

GRITS (Manteniendo A Los Residentes De Georgia Saludables) (Spanish)

Records, Reports & Request Forms

3184-E 3185-E 3034-E

Request for Immunization Forms Temperature Log Vaccine Adverse Event Reporting System

3187-E&S Personal Immunization Record (English & Spanish)

25-IMM-009-E Live, Intranasal Influenza (English)
25-IMM-009-S Intranasal Viva Contra La Influenza (Spanish) Form 3184 (Rev. 04/05/10)

25-IMM-002-E Georgia Vaccine Administration Record (for charts) 25-IMM-012-E Refusal to Vaccinate Form

Vaccine
Anthrax
DTaP
DT DTaP/Hib DTaPIPV DTaP-HepB-IPV DTaP-IPV/Hib
Haemophilus influenzae type b (Hib)
Haemophilus influenzae type b hepatitis B

Trade Name
BioThrax
Daptacel

Abbreviation
AVA
DTaP

U.S. Vaccines

Manufacturer

Type

Emergent BioSolutions

Inactivated Bacterial

sanofi

Inactivated Bacterial

Infanrix

DTaP

GlaxoSmithKline Inactivated Bacterial

Tripedia Generic

DTaP DT

sanofi sanofi

Inactivated Bacterial
Inactivated Bacterial Toxoids

TriHIBit

DTaP/Hib

sanofi

Inactivated Bacterial

Kinrix Pediarix Pentacel

DTaP-IPV DTaP-HepB-IPV
DTaP-IPV/Hib

GlaxoSmithKline GlaxoSmithKline
sanofi

Inactivated Bacterial & Viral
Inactivated Bacterial & Viral
Inactivated Bacterial & Viral

PedvaxHIB

Hib

Merck

Inactivated Bacterial

ActHIB Hiberix Comvax

Hib Hib Hib-HepB

sanofi

Inactivated Bacterial

GlaxoSmithKline Inactivated Bacterial

Merck

Inactivated Bacterial & Viral

Hepatitis A

Havrix

HepA

GlaxoSmithKline

Inactivated Viral

Vaqta

HepA

Merck

Inactivated Viral

Route
IM IM IM IM IM IM IM IM IM IM IM IM IM
IM
IM

Comments
Tetanus & diphtheria toxoids and acellular pertussis vaccine.
Tetanus & diphtheria toxoids and acellular pertussis vaccine.
Tetanus & diphtheria toxoids and acellular pertussis vaccine.
Pediatric formulation (through age 6).
ActHIB reconstituted with Tripedia. Licensed for 4th dose of DTaP & Hib
series. Licensed for 5th (DTaP) and 4th (IPV)
booster at 4-6 years.
Licensed for doses at 2, 4, & 6 months (through 6 years of age). Not
licensed for boosters.
Licensed for 4 doses at 2, 4, 6, and 15-18 months.
PRP-OMP. Polysaccharide conjugate (mening. protein carrier).
2-dose primary schedule. PRP-T. Polysaccharide conjugate
(tetanus toxoid carrier). 3-dose primary schedule. Pollysaccharide conjugate (tetanus toxoid carrier). Booster only.
Should not be used for hepB birth dose.
Pediatric (<18) and adult formulations.
Pediatric = 720 EL.U., 0.5mL Adult = 1,440 EL.U., 1.0mL
Minimum age = 1 year
Pediatric (<18) and adult formulations.
Pediatric = 25 U. 0.5mL Adult = 50 U. 1.0mL
Minimum age = 1 year

Vaccine
Hepatitis B
Hepatitis A Hepatitis B
Herpes Zoster (Shingles) Human Papillomavirus (HPV)

Trade Name Abbreviation Manufacturer

Engerix-B

HepB

GlaxoSmithKline

Recombivax HB

HepB

Merck

Type
Inactivated Viral
Inactivated Viral

Twinrix

HepA-HepB

GlaxoSmithKline

Inactivated Viral

Zostavax Gardasil Cervarix Fluarix Fluvirin

ZOS HPV4 HPV2
TIV TIV

Merck

Live Attenuated Viral

Merck

Inactivated Viral

GlaxoSmithKline GlaxoSmithKline

Inactivated Viral Inactivated Viral

Chiron

Inactivated Viral

Influenza (seasonal)
Japanese encephalitis Measles, Mumps, Rubella

Fluzone
FluLaval Afluria Agriflu FluMist JE-VAX Ixiaro M-M-R II

TIV

sanofi

Inactivated Viral

TIV TIV TIV LAIV JE JE MMR

GlaxoSmithKline CSL
Novartis Medimmune
sanofi Novartis Merck

Inactivated Viral Inactivated Viral Inactivated Viral Live Attenuated Viral Inactivated Viral Inactivated Viral Live Attenuated Viral

Route
IM IM
IM
SC IM IM IM IM
IM
IM IM IM Intranasal SC IM SC

Comments
Pediatric (<19) and adult formulations. Pediatric formulation
not licensed for adults.
Pediatric (<19), adult, and dialysis formulations. Two pediatric doses may be substituted for an adult dose.
Pediatric dose of HepA + adult dose of HepB.
Minimum age = 18 years. 3-dose routine series (4-dose alternate schedule for rapid
protection).
Licensed for age 60 and older.
Quadrivalent (types 6, 11, 16, 18). Licensed for males and females
9 through 26 years.
Bivalent (types 16, 18). Licensed for females 10 through 26 years.
Trivalent types A & B. Minimum age = 3 years.
Trivalent types A & B, purified surface antigen.
Minimum age = 4 years.
Trivalent types A & B, subvirion. Minimum age (multidose vial) = 6
mo. Age range (0.25mL prefilled syringe)
= 6 through 35 mo. Minimum age (0.5mL prefilled
syringe) = 3 years.
Trivalent types A & B. Minimum age = 18 years.
Trivalent types A & B. Minimum age = 6 months.
Trivalent types A & B. Minimum age 18 years.
Trivalent types A & B. Age range = 2 through 49 years.
3-dose series.
Licensed for age 17 and older. 2-dose series.

Vaccine
Measles, Mumps, Rubella, Varicella

Trade Name
ProQuad

Abbreviation
MMRV

Manufacturer
Merck

Menomune

MPSV4

sanofi

Type
Live Attenuated Viral Inactivated Bacterial

Meningococcal

Menactra

MCV4

sanofi

Inactivated Bacterial

Menveo

Novartis

Inactivated Bacterial

Pneumovax 23

PPSV23

Merck

Inactivated Bacterial

Pneumococcal

Prevnar

PCV7

Wyeth

Inactivated Bacterial

Polio Rabies
Rotavirus

PCV13 Ipol
Imovax Rabies RabAvert Rota Teq
Rotarix

Tetanus (reduced) Diphtheria

Decavac (Generic)

PCV13 IPV
RV5 RV1 Td Td

Pfizer (Wyeth)
sanofi sanofi Chiron

Inactivated Bacterial
Inactivated Viral Inactivated Viral Inactivated Viral

Merck

Live Viral

GlaxoSmithKline

Live Viral

sanofi
Massachusetts Biological Labs

Inactivated Bacterial Toxoids
Inactivated Bacterial Toxoids

Route
SC SC IM
IM SC or IM
IM
IM SC or IM
IM IM Oral
Oral IM IM

Comments
Age range = 1 through 12 years.
Polysaccharide (serogroups A, C, Y, W135). Minimum age = 2 years.
Polysaccharide conjugate (diphtheria toxoid carrier, serogroups A, C, Y, W135). Age range = 2 through 55 years.
Polysaccharide conjugate (diphtheria toxoid carrier, serogroups A, C, Y, W135). Age range = 11 through 55 years.
Polysaccharide (contains 23 strains). Minimum age = 2 years.
Polysaccharide conjugate (diphtheria protein carrier, contains 7 strains). Routine age range = 2 through 59 months.
Polysaccharide conjugate (diphtheria protein carrier, contains 13 strains).
Trivalent, Types 1, 2, 3
Pentavalent. First dose between 6 weeks and 14 weeks 6 days;
complete 3-dose series by 8 months 0 days.
Monovalent. First dose between 6 weeks and 14 weeks 6 days;
complete 2-dose series by 8 months 0 days.
Adult formulation (age 7 and older).
Adult formulation (age 7 and older).

Tetanus (reduced) Diphtheria (reduced) Pertussis

Boostrix Adacel

Tetanus toxoid
Typhoid
Varicella Vaccinia (Smallpox) Yellow Fever Zoster

(Generic) Typhim Vi Vivotif Berna
Varivax ACAM2000
YF-Vax

Tdap Tdap
TT
VAR YF

GlaxoSmithKline
sanofi
sanofi sanofi Berna Merck Acambis sanofi

Inactivated Bacterial
Inactivated Bacterial
Inactivated Bacterial Toxoid
Inactivated Bacterial Live Attenuated Bacterial
Live Attenuated Viral Live Attenuated Viral Live Attenuated Viral (See Herpes Zoster)

IM
IM
IM IM Oral SC Percutaneous SC

Tetanus and diphtheria toxoids & pertussis vaccine.
Age range 10 through 64 years. Tetanus and diphtheria toxoids &
acellular pertussis vaccine. Age range 11 through 64 years. May be used for adults or children.
Polysaccharide Ty21a strain.
Minimum age = 9 months.
February 2010

Georgia Immunization Program Manual
TABLE OF CONTENTS

Division Of Public Health

2. RECOMMENDED SCHEDULE & GUIDELINES* DCH GA Immunizations Program Vaccine Guidelines Approval Sheet (ADD) (Do Not Remove Previous Sheets) Immunization Guidelines for DHR Clinics Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults (REPLACE) Georgia Department of Community Health, Immunization Program Vaccine Guidelines Vaccines to Prevent Hepatitis B (REPLACE) Vaccines to Prevent Diphtheria, Tetanus, and Pertussis (REPLACE) Vaccines to Prevent Haemophilus influenzae Type B (REPLACE) Vaccines to Prevent Polio (REPLACE) Vaccines to Prevent Pneumococcal Disease (REPLACE) Vaccines to Prevent Measles, Mumps, and Rubella (REPLACE) Vaccines to Prevent Varicella (REPLACE) Combination Vaccines (REPLACE) Vaccines to Prevent Influenza (REPLACE) Vaccines to Prevent Hepatitis A (includes use of Immune Globulin [IG]) (REPLACE) Vaccines to Prevent Meningococcal Disease (REPLACE) Vaccines to Prevent Rotavirus Gastroenteritis (REPLACE) Vaccines to Prevent Human Papillomavirus Infection (REPLACE) Vaccines to Prevent Herpes Zoster (Shingles) (REPLACE) Vaccines to Prevent H1N1 (ADD) Recommended Childhood/Adolescent Immunization Schedule 2010 and Catch Up for Children with Lapsed Immunization Schedule (REPLACE) Recommended and Minimum Ages and Intervals Between Vaccine Doses (Table1) (REPLACE) Suggested Intervals between Administration of Antibody-containing Products and Measles-containing and Varicella Vaccines (Table 4) Recommended Adult Immunization Schedule United States, 2010 (REPLACE) Summary of ACIP General Recommendations Screening Questionnaires for Child and Teen Immunization (English/Spanish)(REPLACE BOTH) Screening Questionnaires for Adult Immunization (English/Spanish) (REPLACE BOTH) Standards For Child & Adolescent Immunization Practices Standards For Adult Immunization Practices
* See the Hepatitis Section for specific information regarding guidelines for clients being seen in Family Planning, STD and HIV clinics; for contacts to persons with HIV; and for Perinatal Hepatitis B Program guidelines.

Table of Contents 11/2009

Division of Public Health Policy and Procedure Approval
This publication, in combination with the Advisory Committee on Immunization Practices Recommendations Manual, represents the official Policies and Procedures for the Administration of Vaccines and Provision of Immunization Services of the Georgia Division of Public Health. In addition, these manuals serve as an Annex to the Standard Operating Procedures (SOP) of the Department of Community Health (DCH) Division of Public Health (DPH) Emergency Operations Plan (EOP). The purpose of this manual is two-fold. First, to serve either as the official Policies and Procedures for the Administration of Vaccines and Provision of Immunization Services by a health district, or to be utilized as a guide for writing a district's Immunization Policies and Procedures. District Health Directors who choose to utilize these two publications as their district Policies and Procedures should review and sign both manuals annually. We encourage District Health Directors, Clinical Coordinators and Immunization Coordinators, as well as other providers, to review this manual and ensure that their district's policies are in conformance with those outlined in this document. Secondly, the purpose is to delineate the responsibilities and working relationships of state, district and county personnel in matters that concern the Immunization Program.
Any discrepancies or errors found in the manual should be brought to the attention of the Immunization Program at (404) 657-3158 or email immunization@dhr.state.ga.us. Thank you for your support of the Immunization Program in Georgia.

Signed by, _Miriam Bell

_

Division of Public Health Georgia Department of Community Health

Date _ 04/07/2010

9

Equal Opportunity Employer

Georgia Immunization Program Manual

Division Of Public Health

Georgia Department of Human Resources Immunization Program Vaccine Guidelines
These vaccine guidelines represent a summary of the pertinent information on each vaccine found in the most current ACIP Recommendations statements, Epidemiology and Prevention of Vaccine-Preventable Diseases, 11th edition (The Pink Book), the 2006 Red Book: Report of the Committee on Infectious Diseases, and in the most recent Vaccines for Children Program resolutions.
These guidelines have been developed for use by RNs and LPNs and are intended to be used as a quick but accurate source of guidance for practitioners giving immunizations or providing information about vaccines. For more specific details about any portion of these guidelines, the above-named references should be consulted.
These vaccine guidelines will be updated at least on a yearly basis, and more often as circumstances dictate. In addition to staff members of the Georgia Immunization Program, the following physicians have reviewed and approved the information provided therein:

Signed by Dr. Lynne Feldman Lynne Feldman, M.D., M.P.H. District Health Director, South Health District, 8-1

____11/12/09________ Date

2. Recommended Schedule and Guidelines 11/09

1

Georgia Immunization Program Manual

Division Of Public Health

Georgia Department of Human Resources Immunization Program Vaccine Guidelines

These vaccine guidelines represent a summary of the pertinent information on each vaccine found in the most current ACIP Recommendations statements, Epidemiology and Prevention of Vaccine-Preventable Diseases, 10th edition (The Pink Book), the 2006 Red Book: Report of the Committee on Infectious Diseases, and in the most recent Vaccines for Children Program resolutions.
These guidelines have been developed for use by RNs and LPNs and are intended to be used as a quick but accurate source of guidance for practitioners giving immunizations or providing information about vaccines. For more specific details about any portion of these guidelines, the above-named references should be consulted.
These vaccine guidelines will be updated at least on a yearly basis, and more often as circumstances dictate. In addition to staff members of the Georgia Immunization Program, the following physicians have reviewed and approved the information provided therein:

Signed by Dr. Feldman Lynne Feldman, M.D., M.P.H. District Health Director, South Health District, 8-1

Date Signed 6/19/08 Date

2. Recommended Schedule and Guidelines 6/2008

1

Georgia Immunization Program Manual

Division Of Public Health

Georgia Department of Human Resources Immunization Program Vaccine Guidelines

These vaccine guidelines represent a summary of the pertinent information on
each vaccine found in the most current ACIP Recommendations statements, Epidemiology and Prevention of Vaccine-Preventable Diseases, 10th edition (The
Pink Book), the 2006 Red Book: Report of the Committee on Infectious
Diseases, and in the most recent Vaccines for Children Program resolutions.

These guidelines have been developed for use by RNs and LPNs and are intended to be used as a quick but accurate source of guidance for practitioners giving immunizations or providing information about vaccines. For more specific details about any portion of these guidelines, the above-named references should be consulted.

These vaccine guidelines will be updated at least on a yearly basis, and more often as circumstances dictate. In addition to staff members of the Georgia Immunization Program, the following physicians have reviewed and approved the information provided therein:

Signed by Dr. Lynne Feldman
Lynne Feldman, M.D., M.P.H. District Health Director, South Health District, 8-1

6-19-07

________

___

Date

_______________________________ District Health Director

____________________ Date

2. Recommended Schedule and Guidelines 7/2007

1

Georgia Immunization Program Manual

Division Of Public Health

Georgia Department of Human Resources Immunization Program Vaccine Guidelines

These vaccine guidelines represent a summary of the pertinent information on
each vaccine found in the most current ACIP Recommendations statements, Epidemiology and Prevention of Vaccine-Preventable Diseases, 9th edition (The
Pink Book), the 2006 Red Book: Report of the Committee on Infectious
Diseases, and in the most recent Vaccines for Children Program resolutions.

These guidelines have been developed for use by RNs and LPNs and are intended to be used as a quick but accurate source of guidance for practitioners giving immunizations or providing information about vaccines. For more specific details about any portion of these guidelines, the above-named references should be consulted.

These vaccine guidelines will be updated at least on a yearly basis, and more often as circumstances dictate. In addition to staff members of the Georgia Immunization Program, the following physicians have reviewed and approved the information provided therein:

Lynne Feldman, M.D., M.P.H. Signature on file
Lynne Feldman, M.D., M.P.H. District Health Director, South Health District, 8-1

_10/16/06__

___

Date

_______________________________ District Health Director

________________ Date

2. Recommended Schedule and Guidelines - 10/2006

1

Georgia Immunization Program Manual

Division Of Public Health

Georgia Department of Human Resources Immunization Program Vaccine Guidelines

These vaccine guidelines represent a summary of the pertinent information on
each vaccine found in the most current ACIP Recommendations statements, Epidemiology and Prevention of Vaccine-Preventable Diseases, 9th edition (The
Pink Book), the 2003 Red Book: Report of the Committee on Infectious
Diseases, and in the most recent Vaccines for Children Program resolutions.

These guidelines have been developed for use by RNs and LPNs and are intended to be used as a quick but accurate source of guidance for practitioners giving immunizations or providing information about vaccines. For more specific details about any portion of these guidelines, the above-named references should be consulted.

These vaccine guidelines will be updated at least on a yearly basis, and more often as circumstances dictate. In addition to staff members of the Georgia Immunization Program, the following physicians have reviewed and approved the information provided therein:

Lynne Feldman, M.D.
Lynne Feldman, M.D., M.P.H. District Health Director, South Health District, 8-1

Signed by Dr. Feldman 3/6/2006

___

___

Date

_______________________________ District Health Director

________________ Date

2 Recommended Schedule and Guidelines 3/2006

1

Georgia Immunization Program Manual

Division Of Public Health

Georgia Department of Human Resources Immunization Program Vaccine Guidelines

These vaccine guidelines represent a summary of the pertinent information on each vaccine found in the most current ACIP Recommendations statements, Epidemiology and Prevention of Vaccine-Preventable Diseases, 8th edition (The Pink Book), the 2003 Red Book: Report of the Committee on Infectious Diseases, and in the most recent Vaccines for Children Program resolutions.
These guidelines have been developed for use by RNs and LPNs and are intended to be used as a quick but accurate source of guidance for practitioners giving immunizations or providing information about vaccines. For more specific details about any portion of these guidelines, the above-named references should be consulted.
These vaccine guidelines will be updated at least on a yearly basis, and more often as circumstances dictate. In addition to staff members of the Georgia Immunization Program, the following physician(s) have reviewed and approved the information provided therein:

Signed by Dr. Feldman Lynne Feldman, M.D., M.P.H. District Health Director, South Health District, 8-1

___9/27/2005 ___ Date

_______________________________ District Health Director

________________ Date

2 Recommended Schedule and Guidelines---10/2005

1

Immunization Program Manual

Division Of Public Health

Georgia Department of Human Resources Immunization Program Vaccine Guidelines

These vaccine guidelines represent a summary of the pertinent information on
each vaccine found in the most current ACIP Recommendations statements, Epidemiology and Prevention of Vaccine-Preventable Diseases, 8th edition (The
Pink Book), the 2003 Red Book: Report of the Committee on Infectious
Diseases, and in the most recent Vaccines for Children Program resolutions.

These guidelines have been developed for use by RNs and LPNs and are intended to be used as a quick but accurate source of guidance for practitioners giving immunizations or providing information about vaccines. For more specific details about any portion of these guidelines, the above-named references should be consulted.

These vaccine guidelines will be updated at least on a yearly basis, and more often as circumstances dictate. In addition to staff members of the Georgia Immunization Program, the following physicians have reviewed and approved the information provided therein:

Signed by Lynne Feldman, M.D., M.P.H.
Lynne Feldman, M.D., M.P.H. District Health Director, South Health District, 8-1

1-11-05

___

___

Date

_______________________________ District Health Director

________________ Date

2 Recommended Schedule and Guidelines 2/2005

1

Immunization Program Manual

GA Immunization Program

Georgia Department of Human Resources Immunization Program Vaccine Guidelines

These vaccine guidelines represent a summary of the pertinent information on each vaccine found in the most current ACIP Recommendations statements, Epidemiology and Prevention of Vaccine-Preventable Diseases, 8th edition (The Pink Book), the 2003 Red Book: Report of the Committee on Infectious Diseases, and in the most recent Vaccines for Children Program resolutions.
These guidelines have been developed for use by RNs and LPNs and are intended to be used as a quick but accurate source of guidance for practitioners giving immunizations or providing information about vaccines. For more specific details about any portion of these guidelines, the above-named references should be consulted.
These vaccine guidelines will be updated at least on a yearly basis, and more often as circumstances dictate. In addition to staff members of the Georgia Immunization Program, the following physicians have reviewed and approved the information provided therein:

Signed by Dr. Feldman
Lynne Feldman, M.D., M.P.H. District Health Director, South Health District, 8-1

___5-28-2004 ___ Date

_______________________________ District Health Director

________________ Date

Recommended Schedule and Guidelines--Immunization Program Vaccine 1
Guidelines
6/2004

Georgia Immunization Program Manual

Division of Public Health

Immunization Guidelines For DCH Clinics
A. Guidelines for Administration
The Georgia Immunization Program recommends that all DCH clinics follow the current Recommended Childhood Immunization Schedule that is developed and published annually by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP). A copy of the most current schedule, including the footnotes, is inserted in this section of the manual. Additional charts and tables are included to provide assistance in further defining and clarifying the recommended schedule. Also included is a recommended infant/child screening questionnaire to assist providers in identifying possible contraindications and precautions for administering vaccines.
The Recommended Adult Immunization Schedule and a Screening Questionnaire for Adults are also included in this section.
The charts and tables are meant to serve as guidelines and provide quick references for individuals assessing immunization records and administering vaccines. Detailed information regarding vaccines and vaccine administration policies should be obtained from the most current ACIP Recommendations. These recommendations may be accessed from CDC's web site (see Immunization Resources in Section 13, Attachment A of this manual).
It is imperative that all those who administer vaccines follow the guidelines put forth in the General Recommendations on Immunization ACIP statement1, the Epidemiology and Prevention of Vaccine-Preventable Diseases (the "Pink Book"),2 as well as those found in this manual in Chapter 13, Quality Assurance. The following principles are merely a summary of these recommendations and are not meant to be all-inclusive:
1. Ascertain the client's need for the recommended immunizations to avoid drawing up vaccine that will not be used.
2. Select correct needle size for vaccine, route, and size of client. 3. Double-check the vial label and expiration date before AND after drawing up vaccine. 4. If preparing multiple vaccinations, label each syringe or use labeled tray in order to
correctly identify vaccines before administration. 5. Use aseptic technique throughout vaccine preparation, administration, and disposal of
syringes and other materials. 6. Avoid prefilling syringes because of the risk for administration errors. Other problems
that could be associated with this practice are vaccine wastage and possible bacterial growth in vaccines that do not contain a preservative. In addition, syringes other than those that are prefilled by the manufacturer are designed for immediate administration, not for vaccine storage. 7. If it is necessary to reconstitute more than one vaccine dose, as for a large influenza clinic, only prefill a FEW syringes at a time, which you can administer while someone else is prefilling a few syringes they will administer. Any syringes left at the end of the clinic day should be discarded. 8. Under NO CIRCUMSTANCES should MMR, MMRV, Zoster or varicella vaccine ever be reconstituted and drawn prior to the immediate need for the vaccines. These live virus vaccines are unstable and begin to deteriorate as soon as they are reconstituted with diluent.

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Immunization Guidelines For DCH Clinics

Georgia Immunization Program Manual

Division of Public Health

9. All providers who administer vaccinations should be aware of the potential for syncope
(fainting) after vaccination and take appropriate measures to prevent it. Thus, clinicians should
(1) make sure that people who are being vaccinated are always seated; (2) be aware of
symptoms that precede fainting (weakness, dizziness, pallor, etc.); and (3) take appropriate measures to prevent injuries if such symptoms occur.3 Vaccine providers should strongly consider observing vaccinated people for 15 minutes after vaccination.4 This is particularly
important when vaccinating adolescents and young adults.

B. Guidelines for Eligibility for VFC and State-Supplied Vaccines
Eligibility criteria are outlined in each of the Immunization Program Vaccine Guidelines in this section. In addition, the table following this document outlines the eligibility criteria for vaccines provided by the Vaccines for Children Program (VFC) and by the Georgia Immunization Program. All clinics are responsible for screening and documenting a person's eligibility for receiving state supplied vaccines. For the purposes of these documents, a child is defined as a person from 0 through 18 years of age. An adult is anyone 19 years of age or older. The following mandates should be utilized when conducting eligibility screening for either group:

I.

Eligibility Criteria for Children

A. All children 0 through18 years of age should be screened to determine VFC eligibility

using the following terms and definitions:

1. Medicaid---is eligible for Medicaid services.

2. American Indian/Alaska Native---self-reported by the patient.

3. Uninsured children---have no health insurance. 4. Underinsured children---have insurance but vaccines are not a covered benefit.5

Example: An insurance company may not cover certain vaccines, such as

the pneumococcal conjugate vaccine. The child will qualify for VFC for that

particular vaccine only.

Example: An insurance company may cover immunizations up to a certain

age. Up to that age, the child is fully insured. After that age, the child is

considered underinsured (has insurance but vaccines are not a covered

benefit).

Example: An insurance company may only provide $100.00 per year to

cover the costs of immunizations. The child is fully insured up to $100.00.

Once this amount is exhausted, the child is then eligible to receive VFC

vaccine.

5. PeachCare for Kids---has a current PeachCare for Kids card at the time of service.5

B. Any child who has insurance coverage for immunizations is not eligible to receive

state-supplied vaccines. This is the case even when the insured has a high

deductible --- the child is considered fully insured. These children should be:

1. referred to their private provider; or

2. administered vaccine purchased by the district.

II. Eligibility Criteria for Vaccines Supplied by VFC for minors presenting for services without proof of insurance. Please use the following guidance: A. Unaccompanied minors through the age of 18 who are being seen in a public health STD or Family Planning clinic, and who present without proof of insurance, may be immunized using VFC vaccine. 1. Hep A, Hep B, and HPV are the only vaccines that may be administered to someone under the age of 18 based on their own consent.

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Immunization Guidelines For DCH Clinics

Georgia Immunization Program Manual

Division of Public Health

2. Be aware that you may come across an 18 year old patient who is still covered by their parent's insurance, but is unable to access it. Because the patient is 18 she or he may legally consent for additional vaccines, all of which should be included on the Title X form.
B. To document eligibility screening, records should reflect `Uninsured' for this population.
C. Complete Title X log sheet for any minor receiving vaccine in this category.

III. Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults (Refer to table on following pages.)
C. Guidelines for Documentation
All public health clinics should be utilizing the Georgia Registry of Immunization Transactions and Services (GRITS) for reviewing and documenting the immunization status of all clients. Public health clinics should have the technological capability and staff trained to ensure that, regardless of the individual software system used, immunizations administered will be entered into the GRITS system within 2 business days.
1 General Recommendations on Immunization, MMWR, December 1, 2006, Vol. 55, RR-15, pg. 20. 2 Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Hamborsky J, McIntyre J, Wolfe S, eds. 10th ed. Washington DC: Public Health Foundation, 2007, Appendix D. 3 "Medical Management of Vaccine Reactions in Children and Teens" at www.immunize.org/catg.d/p3082a.pdf and "Medical Management of Vaccine Reactions in Adult Patients" at www.immunize.org/catg.d/p3082.pdf] 4 General Recommendations on Immunization, MMWR, December 1, 2006, Vol. 55, RR-15, pg. 19. 5 Vaccines provided for these groups come from state or federal funding sources other than VFC.

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Immunization Guidelines For DCH Clinics

Eligibility Criteria for Vaccines Supplied by the GA Immunization Program for Children, Adolescents, and Adults

The Georgia Immunization Program (GIP) manages vaccines funded by: the federal Vaccines for Children (VFC) program state and other federal sources. The following tables indicate which vaccines: are available from the GIP should be given to VFC eligible children are state supplied and should be given to clients of
all ages seen in Georgia public health clinics.

Children, adolescents, and adults with private insurance may receive state supplied vaccine if they meet the eligibility guidelines.
The intent of these tables: IS NOT to determine which children, adolescents
and/or adults should be immunized, but IS to define which groups can be immunized with
VFC or state supplied vaccine.

For specific vaccine guidelines refer to Section 2, Recommended Schedules and Guidelines, of the Georgia Immunization Program Manual (GIP). The vaccine must be provided at no cost to the patient, and administration fees are capped at $14.81 per injection for both VFC and state-supplied vaccine. No client should be refused vaccination with state supplied or VFC vaccine due to inability to pay the administration fee. If a client meets at least one eligibility criterion for each component of a combination vaccine (e.g., Pediarix, Comvax, MMRV, Twinrix), they are eligible to receive that combination vaccine if the state supplies it.

Eligibility

Diphtheria, Tetanus, Pertussis vaccines

Hib vaccine

Supplied for VFC eligible children: VFC eligibility criteria1
Age 0 through
18 years and
No insurance or Underinsured or Eligible for
Medicaid or PeachCare or
American Indian
or Alaska native

Yes: VFC eligible children: DTaP---for children less than 7 years of age
Td--- for children 7 years through 18 years of age
Tdap---One dose of Boostrix for children 10 years through 18 years of age
OR

Yes: VFC eligible children: 6 weeks through 4 years of age

One dose of Adacel for children 11years through 18 years of age

Pediatric DT---(VFC does not supply)

Supplied by GIP for Yes

No

other groups seen in public health clinics?1



one dose of Tdap for Medicare-covered,

Medicaid-covered, or

uninsured individuals 11-

64 years of age

Td for Medicare-covered,

Medicaid-covered, or

uninsured individuals 7

years of age and older

Refugees1 19 years of

age

Tdap for WIC Postpartum

mothers presenting with

flyer Available through

ARRA funding (reporting

via reimbursement form

required for WIC)

Influenza vaccine

Meningococcal vaccines

Yes: VFC eligible children:
6 through 59 months of
age
High risk children 5
through 18 years of age (See Influenza Guidelines in the GIP Manual)
Healthy children and
adolescents 5 through 18 years of age who are household members of persons in high-risk groups
Healthy children and
adolescents 5 through 18 years of age whose parents wish them to be immunized against influenza

Menactra
Yes: VFC eligible children 2 through 18 years of age
Menomune-- VFC does not supply

No

No

3/1/2010 Eligibility Criteria for State Supplied Vaccines

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To access most current version, go to http://www.health.state.ga.us/programs/immunization/publications.asp

Eligibility Criteria for Vaccines Supplied by the GA Immunization Program for Children, Adolescents, and Adults

Eligibility
Supplied for VFC eligible children:1 VFC eligibility criteria
Age 0 through
18 years and
No insurance or Underinsured or Eligible for
Medicaid or PeachCare for Kids or
American Indian
or Alaska native

Hepatitis B vaccine4
Yes: VFC eligible children birth through 18 years of age

Hepatitis A vaccine4
Yes: VFC eligible children 12 months through 18 years of age

Measles, Mumps, and Rubella vaccine

Inactivated Polio vaccine

Yes: VFC eligible children 12 months through 18 years of age

Yes: VFC eligible children 6 weeks through 18 years of age

Supplied by GIP for Yes, for individuals regardless of

Yes, for individuals regardless of Yes, for Medicare-

No

other groups seen in insurance status meeting one of the public health clinics?1 high risk criteria below:

insurance status meeting one of the high risk criteria below:

covered, Medicaidcovered, or uninsured

Men having sex with men

Men having sex with men

individuals meeting one

Illegal drug users
Persons seeking STD/HIV clinic
services, including HIV testing and counseling and HIV care

(MSM)
HIV-infected persons
seeking HIV care services
American Indians and

of the following criteria:
Persons born in or
after 1957 and who specifically request it

services

Alaska natives

Individuals with multiple partners Persons who began the

College students of
any age

(more than 1 partner in 6 months)

series using state-supplied vaccine and still need to

HIV-infected



Persons recently diagnosed with an STD
Homeless adults



complete the series
Persons 12 mos. through 40 years of age (and persons over aged 40 years, if IG



persons seeking HIV care services 3
Persons seeking Family Planning

Persons seeking Family

cannot be obtained)

clinic services

Planning clinic services

designated by district or

Women of

Sexual partners of persons with

state epidemiology

childbearing age

acute or chronic hepatitis B virus

personnel as eligible

who could become

infection
Household contacts of persons
with acute and chronic HBV

contacts to a documented

pregnant6

case of hepatitis A disease5 Persons 19 years

Refugees1 19 years of age

of age and older

infection

with negative

Hemodialysis/transplant patients Persons who began the series

serology results for measles, mumps, or rubella immunity

using state-supplied vaccine and still need to complete the series
Refugees1 19 years of age

Refugees1 19
years of age

Available through ARRA funding (reporting via reimbursement form required)

Available through ARRA funding (reporting via reimbursement form required)

Groups NOT covered by VFC or GIP2

International travelers Public safety workers Health care workers Inmates Staff of institutions for
developmentally disabled

International travelers Public safety workers Health care workers Inmates Food handlers

International
travelers
Health care
workers
Inmates

International
travelers

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To access most current version, go to http://www.health.state.ga.us/programs/immunization/publications.asp

Eligibility Criteria for Vaccines Supplied by the GA Immunization Program for Children, Adolescents, and Adults

Eligibility

Pneumococcal vaccines

Varicella vaccine

Rotavirus Vaccine

IG

Supplied for VFC

Yes: VFC eligible children

Yes: VFC eligible children Yes: VFC eligible children 6

No

eligible children:1 VFC eligibility criteria:
Age 0 through 18

PCV (Prevnar7) for children 12 months through 18

weeks through 32 weeks of age

6 weeks through 23

years of age are eligible for

months of age

2 doses of vaccine.

years and
No insurance or

For ages 24-59 months,
1 dose of PCV for healthy

Underinsured or Eligible for
Medicaid or PeachCare or
American Indian
or Alaska native

children with any incomplete schedule.
For incompletely
vaccinated children ages 24-59 months who have underlying medical conditions, 2 doses of PCV

at least 2 months apart.

One dose of PPSV

(Pneumovax) for high-risk

children 2 years through 18

years

Supplied by GIP for other groups seen in public health clinics?1

Yes, for Medicaid, Medicare,

Refugees1 19 years No

underinsured, or uninsured

of age (Refugee

clients meeting one of the

Health Program

criteria below:

reimburses the

Individuals 19 years of age

Immunization

and older with high-risk

Program for these

criteria. (See

doses).

"Pneumococcal Vaccine

Guidelines" in the GIP

Manual)

1 dose of PPSV for

unvaccinated adults 65

years of age and older

State will only supply 2 doses of PPSV during a person's lifetime.

Yes for:
Hepatitis A
contacts who fall within specific guidelines. See "Vaccines to Prevent Hepatitis A" guidelines in the GIP Manual
To obtain IG, contact the Hepatitis Program Director at (404) 6573171.

Groups NOT covered by VFC or GIP2

Individuals wanting more
than 2 documented doses
of PPSV

International
travelers
Pre-exposure
vaccination for persons with occupational exposure

3/1/2010 Eligibility Criteria for State Supplied Vaccines

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To access most current version, go to http://www.health.state.ga.us/programs/immunization/publications.asp

Eligibility Criteria for Vaccines Supplied by the GA Immunization Program for Children, Adolescents, and Adults

Eligibility

HBIG

HPV4

Zoster vaccine

Supplied for VFC

No

eligible children:1

VFC eligibility criteria:

Age 0 through 18

years and

No insurance or

Underinsured or

Eligible for

Medicaid or

PeachCare or

American Indian

or Alaska native

Yes; VFC eligible females 9

No

years through 18 years of age

Permissive for VFC eligible males 9 years through 18 years of age

Supplied by GIP for other groups seen in public health ?1

Yes for:
Infants of HBsAg positive
mothers, if HBIG was not received at birth in the hospital, and if it can be administered within 7 days of birth
Unvaccinated infants
whose primary caregiver has acute hepatitis B
Persons not previously
immunized with hepatitis B vaccine who have had recent sexual exposure (in the past 14 days) to a person who is acutely infected with the hepatitis B virus
Household contacts of any
age in direct contact with the blood of an acutely infected person within 7 days of exposure To obtain HBIG, contact the Hepatitis Program Director at (404) 657-3171.

Yes for:
Females only aged 19
through 26 years of age regardless of insurance status meeting high risk criteria below : -Persons who began the series with state-supplied vaccine - Persons recently diagnosed with an STD - Persons seeking STD clinic services - Persons seeking Family Planning clinic services Available through ARRA funding (reporting via reimbursement form)
Females aged 19 through
26 years of age who have Medicaid or Medicare, or are underinsured or uninsured.
-Immunization (walk in)

Yes for:
Individuals aged 60
years and older with Medicaid or Medicare, or are underinsured or uninsured.

Groups NOT covered by VFC or GIP2

International travelers Persons exposed to needle
sticks
Persons with occupational
exposure

1 Children aged 0 through 18 years of age who are in "refugee" status and meet VFC eligibility criteria are considered VFC eligible. Vaccine for adult refugee populations may be administered out of 317/State supplied stock using above guidelines. Medicaid should be billed for the administration fee only for vaccines given to refugees in the 19-20 year old age group. Reimbursement for vaccine administration for refugees aged 21 years of age will continue to be billed to and paid by the Refugee Health Program. (Note: US citizenship is not required to receive any federal or state-supplied vaccine.) 2Persons in these groups are not eligible to receive VFC or state-supplied vaccine as described above. 3 For guidance re: specific conditions, refer to "General Recommendations on Immunization," MMWR, December 1, 2006, Vol. 55, RR-15, pg. 27. 4 A person under 19 years of age who may have insurance but because of the circumstances for seeking services does not have access to that insurance coverage is uninsured for the purposes of the VFC program. 5 Such persons would be eligible for both doses of the hepatitis A vaccine series. 6Women of childbearing age including premenopausal adult women. Because rubella can occur in some persons born before 1957 and because congenital rubella and congenital rubella syndrome can occur in the offspring of women infected with rubella virus during pregnancy, birth before 1957 is not acceptable evidence of rubella immunity for women who could become pregnant. 7PCV refers to Prevnar 7 and Prevnar 13.

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HPV VACCINE DECISION GUIDE
Georgia Immunization Program Eligibility Table Annex

Is client at least 19 years old?

No (client is under 19 years old)
Is the client VFCeligible?

No

Yes

Administer privatelypurchased vaccine. Do not record on
ARRA report.

Administer HPV vaccine from your 'Pediatric' VFC supply. Do not record on
ARRA Report.

Yes (but less than 27 years old)
Does the client meet eligibility guidelines for state-supplied
vaccine?

No

Yes

Eligibility includes clients with Medicaid
or Medicare or are
underinsured or uninsured.

Administer privatelypurchased vaccine. Do not record on
ARRA report.

Has the client previously received a dose of VFC- or State-supplied HPV vaccine?

No

Yes

Administer HPV vaccine from your 'Adult' State supply. Do not record on
ARRA report.

Administer HPV vaccine from your 'Adult' State supply. Record on
ARRA report.

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Georgia Department of Human Resources Immunization Program Vaccine Guidelines

VACCINES TO PREVENT HEPATITIS B
The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for each of the vaccines supplied by the Georgia Immunization Program. These guidelines should serve as a quick reference for clinics administering hepatitis B vaccine. The guidelines are not all inclusive and when more information is needed, the complete ACIP Recommendations statements should be referenced:
"A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States---Part II: Immunization of Adults," MMWR, December 8, 2006, Vol. 55, RR-16
"A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States - Part 1: Immunization of Infants, Children, and Adolescents," MMWR, December 23, 2005, Vol. 54, No. RR-16
ACIP Hepatitis B Vaccine Resolution for the Vaccines for Children Program (VFC), (Resolution No.10/03-2)
2006 Red Book: Report of the Committee on Infectious Diseases published by the American Academy of Pediatrics
Epidemiology and Prevention of Vaccine Preventable Diseases, 11th ed.
Vaccine Description
Two types of hepatitis B vaccine (Hep B) have been licensed in the U.S. 1. The first was plasma-derived and is no longer produced in the U.S. 2. The currently available vaccines are produced by recombinant DNA technology using yeast cells. Since they contain no potentially infectious viral DNA or complete viral particles, they are incapable of causing hepatitis B infection.
Hepatitis B vaccine is manufactured by two different companies. Although the antigen content differs, the vaccines are interchangeable.

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Georgia Immunization Program Manual

Division of Public Health

Brand Name & Manufacturer

VACCINES Engerix B

Pediatric/Adolescent Formulation (10g/0.5mL)

MANUFACTURERS Glaxo SmithKline

Adult Formulation (20 g/1 mL) (Administered to dialysis/compromised persons 20 years of age and older as 2 doses [2 mL total] on the same visit)

Recombivax HB Pediatric/Adolescent Formulation (5g/0.5mL)1

Merck

Adult Formulation (10g/1 mL)

Formulation for dialysis/compromised 2, 3 (40 g/2 mL)

Hepatitis B Immune Globulin (HBIG)4

Bayer Corp. Biological

Products

Hepatitis B Combination Vaccines

a. COMVAX

Hib (PedvaxHIB) and HepB (Recombivax HB) Merck

b. TwinRix 5

Hepatitis B (Engerix B) and Hepatitis A (Havrix) Glaxo SmithKline c. Pediarix (Infanrix, EngerixB, and inactivated poliovirus vaccine)6

Glaxo SmithKline

(See "Combination Guidelines" for more information on these 3 vaccines.)

1 Recombivax HB Pediatric/Adolescent formulation is also licensed for administration to
persons 20 years of age and older. However, the dose should be increased to1 mL (10g). 2 Not supplied by the GA VFC or Georgia Immunization Program. 3 In this case, use the Engerix B product as directed in the package insert for these at risk
populations. 4 State-supplied HBIG is available by calling the Hepatitis Program Director at the GA
Immunization Program at 404-657-3171. See "Eligibility Criteria for Vaccines Supplied by the
Georgia Immunization Program for Children, Adolescents, and Adults" for further information. 5 Licensed only for persons 18 years and older. 6 Licensed only for the primary series of DTaP and polio and cannot be administered before the
child is 6 weeks of age or to anyone 7 years of age or older.

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Recommended Doses of Currently Licensed Formulations of Hepatitis B Vaccine, by Age Group and Vaccine Type

Single-Antigen Vaccine

Combination Vaccine

Recombivax HB

Engerix-B

Comvax

Pediarix

Twinrix

Age Group Infants (<1 yr) Children (1-10 yrs) Adolescents
11-15 yrs

Dose (g)1
5 5

Volume (mL) 0.5 0.5

Dose (g)1
10 10

Volume (mL) 0.5 0.5

Dose (g)1
5 5

Volume (mL) 0.5 0.5

Dose (g)1
0 10

Volume (mL) 0.5 0.5

Dose (g)1 N/A6
N/A

Volume (mL) N/A N/A

102

1

N/A N/A N/A N/A N/A N/A N/A N/A

11-19 yrs

5

0.5

10

0.5 N/A N/A N/A N/A N/A N/A

Adults ( 20 yrs)

10

1

20

1

N/A N/A N/A N/A 20

1

Hemodialysis

patients and other

immunocompromised

persons < 20 yrs3

5

0.5

10

0.5 N/A N/A N/A N/A N/A N/A

20 yrs

404

1

405

2

N/A N/A N/A N/A N/A N/A

1 Recombinant hepatitis B surface antigen protein dose.

2 Adult formulation administered on a 2-dose schedule.

3 Higher doses might be more immunogenic, but no specific recommendations have been made.

4 Dialysis formulation administered on a 3-dose schedule at age 0,1, and 6 months.

5 Two 1 mL doses administered at one site, on a 4-dose schedule at age 0, 1, 2, and 6 months.

6 Not applicable.

Epidemiology and Prevention of Vaccine-Preventable Diseases, 10th edition, January 2007, pg. 221

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Eligible1,2 Groups for State Supplied Vaccine

Hepatitis B Vaccine
1. All children birth through 18 years of age who qualify for the GA Vaccines for Children Program. See eligibility criteria listed in "Immunization Guidelines for DHR Clinics" located in the front of this section.
2. Eligible patients screened in public health clinics include: a. Men having sex with men b. Illegal drug users c. Persons seeking STD/HIV screening services including HIV testing and counseling d. HIV infected persons e. Individuals with multiple partners (more than 1 partner in 6 months) f. Persons recently diagnosed with a sexually transmitted disease g. Homeless adults h. Persons seeking Family Planning clinic services i. Sexual partners of persons with acute or chronic hepatitis B virus infection j. Household contacts of persons with acute and chronic HBV infection k. Hemodialysis/transplant patients l. Persons who began the series using state-supplied vaccine and still need to complete the series. m. Refugees 19 years of age
Hepatitis B Vaccine & HBIG 2, 3 The following persons are eligible for post-exposure immunoprophylaxis with HBIG and hepatitis B vaccine. See Recommended Schedule Section for specific administration details.
Infants of HBsAg positive mothers, if HBIG was not received at birth in the hospital, and if it can be administered within 7 days of birth
Unvaccinated infants whose primary caregiver has acute hepatitis B Unvaccinated persons whose sexual partners have acute hepatitis B and whose
last sexual exposure to this acutely infected person was within 14 days Household contacts with direct blood contact from an acutely infected person
within 7 days of exposure
1Although Hep B vaccine is also recommended for health care providers, public safety workers, refugees, clients and staff of institutions for the developmentally disabled, inmates of long-term correctional facilities, and certain travelers; the GA Immunization Program does not supply vaccine for administration to these persons. 2Hep B vaccine and HBIG are not provided by the Georgia Immunization Program for persons with percutaneous or mucosal exposure to blood due to occupational exposure. It is only provided for household or sexual contacts. 3 To obtain HBIG, contact the state Hepatitis Program Director at 404-657-3171.

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Recommended Hepatitis B Vaccine Schedule

Recommended Infant and Child Schedules
The hepatitis B vaccine series is routinely recommended for all infants. The first dose should be given at birth, but the recommended schedule for an infant depends upon the mother's hepatitis B surface antigen (HBsAg) status and infant's birth weight. See Minimal Age and Time Interval Section for requirements for minimum spacing of doses. Persons <19 years of age should receive the pediatric/adolescent vaccine formulation.

A. Infant born to mother known to be HBsAg-negative

(Option 1)

Dose Hep B-1

Age of Infant Birth1

Hep B-2 Hep B-3

1-2 months 6-18 months2

(Option 2)
Age of Infant 1-2 months1
4 months 6-18 months2

B. Infant born to mother known to be HBsAg-positive

Dose

Age of Infant

Hep B-1

Birth (within 12 hours)1

HBIG

Birth (within 12 hours)3

Hep B-2

1-2 months

Hep B-3

6 months2, 4

C. Infant born to mother whose HBsAg status is unknown

Dose

Age of Infant

Hep B-1

Birth (within 12 hours)1

HBIG

Mother should be tested and if HBsAg-positive, HBIG should be

given to the infant no later than 7 days after birth3

Hep B-2

1-2 months

Hep B-3

6 months2

D. Infants born weighing less than 2 kg. (4.4 lbs.)

If mother's status is HBsAg negative by laboratory testing

Dose

Age of Infant

Hep B-1

Chronological age of 1 month or at hospital discharge

Complete the vaccine series using recommended intervals

If mother's status is unknown or HBsAg positive by laboratory testing

Dose Hep B-1

Age of Infant Birth (within 12 hours)1

HBIG

Birth (within 12 hours)3

Continue vaccine series beginning at age 1-2 months according to recommended schedule based on mother's HBsAg status. Do not count birth dose as part of vaccine series.4

1 COMVAX, the combination HIB/Hepatitis B vaccine is licensed for use at 2, 4, and 1215 months of age. Pediarix is a combination of DTaP, hepatitis B, and IPV and is licensed
only for the primary series of 3 doses of DTaP and polio. Neither of these combination
vaccines should be used for doses given before the child is 6 weeks of age. See the
"Combination Vaccines" section in this section of the manual for more information on both of
these vaccines. 2 This dose is recommended at 6 calendar months of age, but should not be administered
before 24 weeks of age.

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3 Hepatitis B Immune Globulin: 0.5ml administered IM at a site different from that used for
the vaccine. 4 When the mother is HBsAg positive, the infant should receive the final dose of hepatitis
B vaccine at 6 months of age and have a follow up serology for anti-HBs and HBsAg 3-9 months after the final dose in the vaccine series.

Recommended Schedules for Infants 4 Months of Age, Children, Adolescents and Adults

Previously unvaccinated infants older than 4 months of age, children, adolescents and adults should begin the vaccination series at the earliest opportunity. There are 2 optional schedules for vaccinating these age groups; however, minimum time intervals between doses apply.

Option 1: The pediatric/adolescent formulation should be used for persons <19 years of age, and those 20 years of age should receive the adult formulation.

. Dose
Hep B-1 Hep B-2 Hep B-3

Usual Time Interval
----1-2 months 4-6 months

Minimum Time Interval Between Doses
----4 weeks 8 weeks from dose #2 and 16 weeks from dose #1

Option 2: Alternative 2 Dose Schedule for Adolescents (age 11 through 15 years only) and using Adult Formulation (RecombivaxTM only). This vaccine is not available from the GA VFC Program.

Dose
Hep B-1 Hep B-2

Usual Time Interval
-----4-6 months

MinimumTime Interval Between Doses
16 weeks

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In view of the fact that there are 2 combination vaccines containing hepatitis B vaccine, Comvax and Pediarix, the following table may be helpful in determining how to administer these combination vaccines in a schedule where the first dose of hepatitis B vaccine is given at birth.

Recommended schedule for hepatitis B vaccination for infants born to hepatitis B surface antigen (HBsAg) negative mothers:

Vaccination Schedule Options

Dose
1 2 3 4

Single antigen1
Birth 1-2 months 6 months
NA

Single antigen1 and PEDIARIX
Birth (single antigen)2
2 months 4 months3
6 months

Single antigen1 and COMVAX
Birth (single antigen)2
2 months 4 months3
12-15 months

1 Single antigen vaccine: ENGERIX-B or RECOMBIVAX HB 2 Only a single antigen hepatitis B vaccine can be given at birth 3 If a hepatitis B-containing combination vaccination is given at age 4 months, that dose of hepatitis B will be
declared invalid in GRITS, since it would be the 3rd dose of the series and given before 24 weeks of age.

Recommended Hepatitis B Post-Exposure Prophylaxis

All contacts should be pre-tested and vaccinated at the same visit.

1. Infants of HBsAg Positive Mom

HBIG: 0.5mL IM plus Hepatitis B Vaccine: at birth but administered in different sites. Give subsequent doses of Hepatitis B vaccine according to the recommended vaccine schedule.

2. Preterm infants weighing < 2000 gms. (4.4 lbs.)

If the mother's HBsAg status cannot be determined 12 hrs. of birth, infants should receive both single antigen hepatitis B vaccine and HBIG (0.5 mL). The infants should receive 3 additional doses of hepatitis B vaccine according to the routine schedule------the birth dose should not be counted.

3. Unvaccinated Infants (0-12 months) whose primary caregiver is acutely infected

HBIG: 0.5mL IM plus Hepatitis B Vaccine: age-specific dose at the time of HBIG but administered in different sites. Give subsequent doses according to the vaccine schedule.

4. Unvaccinated Household contacts (>12 mos. of age) with identifiable blood exposure to acutely
infected person within 7 days of exposure.

HBIG: single dose (0.06mL/kg IM) plus Hepatitis B Vaccine: age-specific dose at the time of HBIG but administered in different sites.
Give subsequent doses according to the vaccine
schedule.

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5. Unvaccinated sexual contact to acutely infected person within 14 days of last sexual exposure
6. Percutaneous or permucosal exposure

HBIG: single dose (0.06mL/kg IM) plus Hepatitis B Vaccine: age-specific dose at the time of HBIG but administered in different sites Give subsequent doses according to the vaccine schedule.
See "Recommended Hepatitis B Post-Exposure Prophylaxis" Tables, for exposure in occupational and nonoccupational settings

Recommendations for postexposure prophylaxis after percutaneous or mucosal exposure to HBV in an OCCUPATIONAL setting

Vaccination and
antibody
response status
of exposed persons1

HBsAg positive

Unvaccinated

HBIG2 (1 dose) and begin Hep B vaccine series

Treatment when source is:

HBsAg negative

Source not tested or unknown

High Risk

Low Risk

Begin Hep B vaccine series

Begin the Hep B vaccine series

Begin the Hep B vaccine
series

Known responder3

No treatment

No treatment

No treatment No treatment

Nonresponder3
Not revaccinated4 After revaccination4

HBIG (1 dose) and begin a
revaccination series
HBIG (2 doses)5

Begin a revaccination
series
No treatment

Antibody response unknown

Test for anti-HBs6
If adequate3: no treatment

No treatment

If inadequate: HBIG x 1 dose and vaccine booster

HBIG (1 dose) and begin a revaccination series
HBIG (2 doses)5

Begin a revaccination
series
No treatment

Test for anti-HBs6

If adequate3: no treatment

If inadequate: give vaccine booster and check anti-HBs in 1-2 months

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Recommendations for postexposure prophylaxis after percutaneous or mucosal exposure to HBV in an OCCUPATIONAL setting (cont'd)

1Persons known to have had HBV infection in the past or who are chronically infected do not require HBIG or vaccine. 2 Hepatitis B immune globulin (0.06 mL/kg) administered IM 3 Adequate response is anti-HBs of at least 10 mIU/mL after vaccination. 4 Revaccination means an additional 3-dose series of hepatitis B vaccine administered after the primary series. 5 First dose as soon as possible after exposure and the 2nd dose 1 month later 6 Testing should be done as soon as possible after exposure.
Reference: Immunization Action Coalition, "Hepatitis B and the Healthcare Worker," Item #P2109 (8/06) found at www.immunize.org

Postexposure Prophylaxis1 of Persons with Nonoccupational2 Exposure

Exposure

Unvaccinated person3

Treatment Previously vaccinated person4

HBsAg-positive source
Percutaneous (e.g. bite or needlestick) or mucosal exposure to HBsAg-positive blood or body fluids
Sex or needle-sharing contact of an HBsAg-positive person
Victim of sexual assault/abuse by a perpetrator who is HBsAgpositive

Administer hep B vaccine series and HBIG
Administer hep B vaccine series and HBIG Administer hep B vaccine series and HBIG

Administer hep B vaccine booster dose
Administer hep B vaccine booster dose Administer hep B vaccine booster dose

Source with unknown HBsAg status

Victim of sexual assault/abuse by a perpetrator with unknown HBsAg status

Administer hep B vaccine series

No treatment

Percutaneous or mucosal exposure to potentially infectious blood or body fluids from a source with unknown HBsAg status

Administer hep B vaccine series

No treatment

Sex or needle-sharing contact

of person with unknown HBsAg Administer hep B vaccine

status

series

No treatment

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Postexposure Prophylaxis1 of Persons with Nonoccupational2 Exposure (cont'd)

1 When indicated, immunoprophylaxis should be initiated as soon as possible, preferably within 24 hours. The interval during which postexposure prophylaxis is effective is unlikely to exceed 7 days for percutaneous exposures or 14 days for sexual exposures. The hep B vaccine series should be completed. 2 These guidelines apply to nonoccupational exposures. See previous table for management of occupational exposures. 3 A person who is in the process of being vaccinated but who has not completed the vaccine series should complete the series and receive treatment as indicated. 4 A person who has written documentation of a complete hep B vaccine series and who did not receive postvaccination testing.
Reference: "A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States," MMWR, December 8, 2006, Vol. 55, No. RR-16

Minimum Age & Dose Intervals

Vaccine

Age Dose 1

Interval Dose 1 to 2

Interval Dose 2 to 3

Interval Dose 1 to 3

Hep B (3-dose schedule with pediatric or adolescent formulation)

Birth

4 weeks

8 weeks

16 weeks1

Hep B

11 years 16 weeks

-----

-----

(2-dose schedule

adult formulation

for children

11-15 years of age)2,3

1The 3rd dose is recommended to be given to infants at 6 calendar months of age. It should
not be administered before 24 weeks of age. 2Adult vaccine for this specific use is not available through VFC. 3This schedule can be used only with RecombivaxTM brand vaccine and if started
11 years of age, must be completed before 16 years of age. If not completed within these minimal age and time intervals, the series should be completed
following the 3 dose schedule.

NOTE: Post-vaccine serologic testing is not routinely recommended. However, testing is recommended 1-2 months after the 3rd vaccine dose for the following:
1. Hemodialysis patients 2. Persons with HIV infection 3. Those at occupational risk of exposure from sharps injuries 4. Immunocompromised patients at risk of exposure to HBV. Infants born to HBsAg
positive mothers should be tested 3-9 months after the final dose of Hep B vaccine is administered. 5. Sex partners of HBsAg positive persons

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Recommended Dosage and Route

Hepatitis B Vaccines1 Pediatric/adolescent formulations: Adult formulations:

0.5mL administered intramuscularly 1 mL administered intramuscularly

NOTE: Hepatitis B vaccine should be administered in the deltoid or anterolateral aspect (vastus lateralis) of the thigh. It should not be administered in the buttocks.

Hepatitis B Immune Globulin (HBIG)

Infant (birth-12 months):

0.5 mL intramuscularly in vastus lateralis

Children and adults:

0.06 mL/kg intramuscularly

1 Refer to chart on pg. 3 of these guidelines for more dosing information.

Contraindications and Precautions
I. Hepatitis B Vaccine A. Contraindications and Precautions 1. Anaphylactic reaction to a previous dose of hepatitis B vaccine, whether given as a single antigen or in a combination product. 2. Known allergy to yeast or yeast products. 3. COMVAX , PediarixTM, or other combination vaccines containing hepatitis B vaccine, should not be given to infants younger than 6 weeks of age. Pediarix should not be given to anyone 7 years of age or older. Combinations containing Hib vaccine are particularly contraindicated because of the potential for the suppression of the immune response to future Hib vaccinations. 4. Moderate or severe illnesses with or without fever. 5. Administration of TwinRix vaccine to persons younger than 18 years of age. See the "Combination Vaccine Guidelines" in this section of the manual.
Note: 1. Pregnancy is not a contraindication to receiving HepB vaccine. 2. Since hepatitis B vaccine does not contain live virus, it may be used in persons with immunodeficiencies, although their response may be suboptimal.
II. Hepatitis B Immune Globulin A. Contraindications 1. Anaphylactic reaction to a previous dose of any immune globulin preparation. 2. Serum immunoglobulin A deficiency.
Note: HBIG is not contraindicated for a pregnant woman and should be administered if clearly indicated.

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Simultaneous Vaccine Administration
Hepatitis B Vaccine May be administered simultaneously with any of the following routinely recommended vaccines:
DTaP, Tdap, Td, DT, RV, MMR, Hib, Varicella, IPV, Hepatitis A, MCV, PCV or PPSV, HPV, Zoster and Influenza
Hepatitis B Immune Globulin (HBIG)1 May be administered simultaneously with any of the following routinely recommended vaccines:
DTaP, Tdap, Td, DT, hepatitis B, Hib, IPV, Hepatitis A, MCV, PCV or PPSV, HPV, RV, Zoster, MMR, Varicella and Influenza
1 For guidelines on spacing of HBIG and MMR or varicella vaccines, see "General Recommendations on Immunization," MMWR, December 1, 2006, Vol. 55, No. RR-15.

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Georgia Department of Human Resources Immunization Program Vaccine Guidelines

VACCINES TO PREVENT DIPHTHERIA, TETANUS, AND PERTUSSIS
The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for these vaccines or vaccine components supplied by the Georgia Immunization Program: diphtheria toxoid; tetanus toxoid; or acellular pertussis vaccine; (A) DTaP; (B) DT; (C) Tdap; and (D) Td. These guidelines were developed from the pertinent Vaccine Resolution from the Vaccines for Children Program and the references below and will be updated as needed. The guidelines are not all inclusive and when more information is needed, the following publications should be referenced: the provisional guidelines for the prevention of diphtheria, tetanus, and pertussis among pregnant
women at http://www.cdc.gov/nip/recs/provisional_recs/tdap-preg.pdf "Preventing Tetanus, Diphtheria, and Pertussis Among Adults: Use of Tetanus Toxoid, Reduced
Diphtheria Toxoid and Acellular Pertussis Vaccine " MMWR, December 15, 2006, Vol. 55, RR-17 "Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid,
Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines," MMWR, March 24, 2006, Vol. 55, No. RR-3 "Use of Diphtheria Toxoid-Tetanus Toxoid-Acellular Pertussis Vaccine as a Five-Dose Series," MMWR, November 17, 2000, Vol. 49, No. RR-13 "Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children," MMWR, March 28,1997, Vol. 46, No. RR-7 "Diphtheria, Tetanus, and Pertussis: Recommendations for Vaccine Use and Other Preventive Measures," MMWR, August 8, 1991, Vol. 40, No. RR-10 ACIP Diphtheria, Tetanus, and Pertussis Resolution for the Vaccines for Children Program (VFC), (Resolution No. 6/08-3) 2006 Red Book: Report of the Committee on Infectious Diseases published by the American Academy of Pediatrics Epidemiology and Prevention of Vaccine Preventable Diseases, 11th ed. "License of a Diphtheria and Tetanus Toxoids and acellular Pertussis Absorbed and Inactivated Poliovirus vaccine and Guidance for Use as a Booster Dose," MMWR Weekly, October 3, 2008, Vol. 57(39); 1078-1079.
Vaccine Description

A. DTaP Diphtheria and Tetanus and Acellular Pertussis Vaccine is an inactivated vaccine containing diphtheria and tetanus toxoids and purified inactivated components of Bordetella pertussis cells. DTaP is the recommended substitute for whole-cell DTP but should not be used if DTP has been contraindicated. Combination diphtheria and tetanus toxoid and whole-cell pertussis (DTP) vaccine is no longer available.

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B. DT DT is an inactivated vaccine containing diphtheria and tetanus toxoids. This is the vaccine of choice for children < 7 years of age when there is any contraindication to pertussis vaccine.
C. Tdap Tdap is an inactivated vaccine containing tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis components. This is the vaccine of choice for adolescents at the 11-12 year old healthcare visit, or for older adolescents who have not already received a Td, or who received a Td 5 years or more previously.
D. Td Td is an inactivated vaccine and contains a full dose of tetanus toxoid and a reduced dose of diphtheria toxoid. This vaccine should be used to initiate or complete a tetanus/diphtheria series if the child is 7 years of age and for most booster doses administered after that age.
E. TT Tetanus toxoid is an inactivated bacterial toxoid that may be prescribed for active immunization of persons over age 7 years. It is NOT to be used for the treatment of tetanus infection. However, TT should be administered with diphtheria toxoid (as Td or Tdap, depending on age) when a primary series or decennial booster is indicated.
F. Other information Single antigen diphtheria toxoid is not available. Diphtheria toxoid is available combined with tetanus as pediatric DT or adult Td, and with tetanus toxoid and acellular pertussis vaccine as DTaP or Tdap. Use of single antigen tetanus toxoid is not recommended. DTaP and DT vaccines contain similar amounts of tetanus toxoid as adult Td vaccine, but 3-4 times as much diphtheria toxoid as adult Td vaccine. Pertussis vaccine in the form of DTaP is not recommended for persons 7 years of age. (See Tdap recommendations on subsequent pages of these guidelines.) For additional information about the inadvertent administration of Tdap or pediatric DTaP and how to handle these errors, please refer to page 10 at the end of this guidelines section. It is excerpted from page 27 of the current ACIP statement on the use of Tdap in adolescents.

Brand Name & Manufacturer

VACCINES

MANUFACTURERS

Current brands of diphtheria and

tetanus toxoids and acellular

pertussis vaccine adsorbed (DTaP):

Infanrix

GlaxoSmithKline

Tripedia

sanofi pasteur

(See "Combination Guidelines" for further information on Pediarix)

Daptacel

sanofi pasteur

(This vaccine is licensed for the first 4 doses only)

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Brand Name & Manufacturer (cont'd)

Current brand of diphtheria and tetanus toxoids, pediatric (DT):
Diphtheria/Tetanus, Pediatric

sanofi pasteur

Current brands of tetanus toxoid, reduced
diphtheria toxoid, and acellular pertussis
vaccine, adsorbed (Tdap): Boostrix AdacelTM

GlaxoSmithKline sanofi pasteur

Current brand of tetanus
and diphtheria toxoids, adult (Td): Tetanus/Diphtheria, Adult DecavacTM

Massachusetts Biological Labs sanofi pasteur

Current brand of tetanus toxoid (TT): Tetanus Toxoid, Adsorbed USP

sanofi pasteur

Vaccines previously available
that have been discontinued: Acel-ImuneTM (DTaP) CertivaTM (DTaP) Tetramune (DTP/HIB)

Lederle Laboratories North American Vaccine, Inc. Lederle, and Pasteur Merieux
Connaught

DTaP Combination Vaccines (See "Combination Vaccines" for more information.)

TriHIBit (ActHIB reconstituted with Tripedia DTaP) sanofi pasteur (This vaccine is licensed for 4th dose of DTaP only and is currently not available through the Vaccines for

Children Program.) Pediarix (DTap-IPV/Hib)

GlaxoSmithKline

(This vaccine is licensed for primary series only [Doses 1-3].)

PentacelTM (DTap-Hepb/IPV)

sanofi pasteur

(This vaccine is licensed for primary series, and 1st booster dose [Doses 1-4].)

KinrixTM (DTap-IPV)

GlaxoSmithKline

(This vaccine is licensed for booster dose at age 4-6.)

Eligible Groups for State Supplied Vaccine
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.

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Recommended Diphtheria, Tetanus and Pertussis Vaccine Schedule

A. DTaP 1, 2, 3 Diphtheria, tetanus, and pertussis vaccine is recommended as part of the routine childhood immunization schedule at 2, 4, 6, and 15-18 months of age, and 4-6 years of age. Regardless of age and timing of doses, no more than a total of 6 DTaP vaccines should be given before 7 years of age.

Dose Primary 1 Primary 2 Primary 3 First Booster Second Booster Tdap or Td Booster

Age
2 months
4 months
6 months 15-18 months5,6,11 4-6 years9, 10
11-12 years

Interval4
----------8 weeks after 1st dose 8 weeks after 2nd dose 6-12 months after 3rd dose7,8

B. DT If the child begins the series at <1 year of age, follow the schedule outlined above. If the child is 12 months of age at the time the 1st dose of DT is administered, a 2nd dose should be administered 4-8 wks. later, followed by a 3rd dose given 6-12 months after the 2nd dose. This completes primary vaccination with DT. A booster dose should be given at 4-6 years of age.
C. Tdap use in adolescents and adults- based on ACIP guidelines for use of Tdap in adolescents and the guidelines for use of Tdap in adults. A (one-time dose) is recommended for persons 11 years of age through adulthood, providing they have previously completed the recommended DTP/DTaP/Td series and have not already received a dose of Td: Give in place of Td at the 11-12 year old healthcare visit. For those older adolescents or adults who have not already received a dose of Td. For those who have already received a dose of Td 5 years, intervals as short as 2 years may be considered if the benefits of protection from pertussis outweigh the risk of local or systemic reactions. Can be given one time for tetanus prophylaxis in wound management, if a dose of Tdap has not previously been given. Can be used as any one of the 3 doses when administering a primary Td series to a person in the licensed age groups. Adults who have or anticipate having close contact with an infant <12 months of age should receive a single dose. Persons with a history of pertussis generally should receive Tdap according to routine recommendations.
D. Tdap use in pregnancy Pregnancy is not considered a contraindication of the use of Tdap. However, safety and immunogenicity are not available for pregnant women who receive Tdap. Women should receive a one-time dose in the immediate post-partum period if they have not previously received Tdap and if it has been more than 2 years since the last Td. Shorter intervals may be considered, depending on the need for protection against pertussis.

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Recommended Diphtheria, Tetanus and Pertussis Vaccine Schedule (cont'd)
Special situations o Td should be administered during the pregnancy if 10 or more years have elapsed since a dose of Td. o Pregnant women who might be at high risk for contracting or transmitting pertussis to vulnerable persons include adolescents, healthcare workers, and child care providers. Physicians may choose to administer Tdap to these persons during pregnancy. If so, the 2nd or 3rd trimester is preferred.
E. Td (refer to Tdap guidelines above for situations when that vaccine would be recommended instead of a dose of Td.) If administering as a primary series at 7 years of age, give at 0, 1, and 6 months. A Td booster is recommended at any age 11 through 18 years of age, if 5 years have elapsed since the previous dose of any tetanus-containing vaccine. Subsequent boosters are recommended at 10 year intervals. For wound management, give booster if >5 years have elapsed since last dose.
F. Use of DTaP, DT, Td, Tdap, and Tetanus Immune Globulin (TIG)12 for Wound Management Refer to wound management guidelines in ACIP Manual: "Diphtheria, Tetanus, and Pertussis: Recommendations for Vaccine Use and Other Preventive Measures, " MMWR, August 8, 1991, pg. 16; "Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines," MMWR, March 24, 2004, pg. 25; "Preventing Tetanus, Diphtheria, and Pertussis Among Adults: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine " MMWR, December 15, 2006, Vol. 55, RR-17; the provisional statement for use of Tdap in pregnant women; and the 2006 Red Book, pg. 649.
1 Use diphtheria and tetanus toxoids, adsorbed (DT), if encephalopathy has occurred after administration of a previous dose of pertussis-containing vaccine.
2 ACIP recommends using the same brand of DTaP vaccine for all doses of the series. However, if the brand used for previous doses is not known or not available, use any brand of DTaP to complete the series.
3 Pertussis vaccine given as DTaP is not recommended for children 7 years of age. 4 Prolonging the interval does not require restarting the series. 5 If using DaptacelTM, this dose is recommended to be given at 17-20 months of age. (MMWR, July 5,
2002, Vol. 51, No. 26, pp.574.) 6 PediarixTM is licensed only for the primary series of 3 doses, not for the booster doses (#4and #5) 7The 4th dose of DTaP may be given as early as 12 months of age, provided 6 months have elapsed
since the 3rd dose and if the child is unlikely to return at 15-18 months of age. TriHIBit TM can be administered as the 4th dose following a primary series with either DTaP or whole-cell DTP and following a primary series with any Haemophilus influenzae type b conjugate vaccine. 8 DTaP #4 does not need to be repeated if administered 4 months after DTaP #3. 9 A 5th dose is not necessary if the 4th dose was given on or after the 4th birthday. 10 KinrixTM is licensed for the booster dose at age 4-6. PentacelTM is licensed for the primary series and 1st booster dose (Doses 1-4.) The state does not supply TIG. There are 2 brands of TIG; hyperlet and baylet. Providers can order TIG from their wholesaler, or FFS Enterprise (1-800-843-7477) or from the manufacturer, Talecris (1-800243-4153) .

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Minimum Age and Dose Intervals8

Vaccine
DTAP DTaP-HepB-IPV2
DTaP-Hib-IPV3 DT
DTaP-Hib4
DTaP-IPV5 Tdap6
Td (catch-up schedule)7

Minimum age
6 weeks 6 weeks 6 weeks 6 weeks
15-18 months 4 years 10 or 11 years 7 years

Dose 1-2 4 weeks 4 weeks 4 weeks 4 weeks

Minimum interval between doses

Dose 2-3

Dose 3-4

4 weeks

6 months

8 weeks

4 weeks

6 months

4 weeks

6 months

6 months

Dose 4-5 6 months1
6 months1

6 months1

4 weeks

6 months

5 years7

Note: DT containing vaccines are not indicated for children >6 years of age. 1 The fifth dose is not necessary if the fourth dose was given after the fourth birthday. 2 The recommended DTaP-HepB-IPV vaccine may be used when any component of the combination is indicated, and if the other components are not contraindicated. The combined DTaP-HepB-IPV vaccine is approved for the primary series only (Doses 1-3). For adequate immune response, the last dose of hepatitis B vaccine should be given at 24 weeks of age and therefore this combination vaccine should not be administered as a complete primary series on an accelerated schedule at 4 week intervals for prevention of pertussis. 3 The combined DTaP-Hib-IPV vaccine may be used when any component of the combination is indicated, and if the other components are not contraindicated. The combined DTaP-Hib-IPV vaccine is approved for the primary series and first booster dose (Doses 1-4). The combined DTaP-Hib-IPV vaccine is not indicated for children 5 years. 4 The combined DTaP/Haemophilus influenzae type b (Hib) vaccine is indicated for the fourth dose at age 15-18 months. 5 The combined DTaP-IPV vaccine may be used when any component of the combination is indicated, and if the other components are not contraindicated. The combined DTaP-IPV vaccine is approved for the booster dose at age 4-6 years. 6 Recommended at age 11 years or older as booster dose. Tdap is preferred over Td as adolescents are susceptible to pertussis due to waning immunity. Tdap is indicated for a single booster dose if the childhood DTP/DTaP vaccination series has been completed. A five year interval is encouraged if Tdap is administered after Td. Please see ACIP recommendations for further information. 7 Recommendation at age 11 or older as a booster rather that Tdap may be indicated in some special situations (please see ACIP recommendations). May be used as early as age 7 years if needed for catchup including for a primary series if indicated The interval from the 3rd to 4th dose may vary for catch-up schedules depending on the previous doses- please see the ACIP recommendations for further information. 8 the ACIP Diphtheria, Tetanus, and Pertussis Resolution for the Vaccines for Children Program (VFC), (Resolution No. 6/08-3)

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Recommended Dosage and Route
A. DTaP: 0.5 mL administered intramuscularly
B. DT: 0.5 mL administered intramuscularly
C. Tdap: 0.5 mL administered intramuscularly
D. Td: 0.5 mL administered intramuscularly
Contraindications and Precautions for DTaP, DT, Tdap, and Td1 2
I. DTaP A. CONTRAINDICATIONS 1. An immediate anaphylactic reaction following a previous dose. Defer further use of this vaccine because of the uncertainty as to which component of the vaccine might be responsible. However, because of the importance of tetanus vaccination, persons who experience anaphylactic reactions may be referred to an allergist for evaluation and, if specific allergy can be demonstrated, desensitized to tetanus toxoid. 2. Encephalopathy following a previous dose not attributable to another identifiable cause. An acute, severe central nervous system disorder occurring within 7 days after vaccination and generally consisting of major alterations in consciousness, unresponsiveness, or generalized or focal seizures that persist more than a few hours, without recovery within 24 hours, is a contraindication to further administration of any DTaP-containing vaccine. B. PRECAUTIONS If any of the following events occurs within the specified period after administration of DTaP vaccine, providers and parents should evaluate the risks and benefits of administering subsequent doses of a pertussis-containing vaccine: 1. Temperature of 105F. (40.5C.) within 48 hours, not attributable to another identifiable cause. 2. Collapse or shock-like state (hypotonic hyporesponsive episode) within 48 hours. 3. Persistent crying lasting 3 hours, occurring within 48 hours. 4. Convulsions with or without fever, occurring within 3 days. 5. Acute, moderate or severe illnesses with or without fever. 6. Latex Allergy
II. DT A. CONTRAINDICATIONS B. 1. An immediate anaphylactic reaction. Defer further use of this vaccine because of the uncertainty as to which component of the vaccine might be responsible. However, because of the importance of tetanus vaccination, persons who experience anaphylactic reactions may be referred to an allergist for evaluation and, if specific allergy can be demonstrated, desensitized to tetanus toxoid.

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B. PRECAUTIONS 1. Arthus-type hypersensitivity reactions. These are exaggerated local reactions that present as extensive, painful swelling, often from the shoulder to the elbow. Persons who experience arthus-type hypersensitivity reactions or a temperature of 103F (39.4C.) following a prior dose of tetanus toxoid usually have high serum tetanus antitoxin levels and should not be given DT or even emergency doses of Td more frequently than every 10 years, even if they have a wound that is neither clean nor minor. 2. Acute, moderate or severe illnesses with or without fever. 3. Latex Allergy.
III. Tdap A. CONTRAINDICATIONS 1. An immediate anaphylactic reaction to any vaccine containing any of the 3 Tdap components: tetanus, diphtheria, or pertussis. 4. Encephalopathy not attributed to another identifiable cause, within 7 days of administration of a pertussis-containing vaccine (this is a contraindication for the pertussis components; Td can be used). C. PRECAUTIONS 1. Arthus-type hypersensitivity reactions following a prior dose of a tetanus toxoid 2. Progressive neurological disorder, uncontrolled epilepsy, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized. If decision is made to withhold pertussis vaccination, then Td may be used instead of Tdap. 5. Latex allergy. The tip cap and rubber plunger of the BOOSTRIX needleless prefilled syringe presentation contain dry natural latex rubber. The vial stoppers of both BOOSTRIX and AdacelTM are latex-free. 6. Guillain-Barr syndrome (GBS) within 6 weeks after a previous dose of tetanus toxoid-containing vaccines. 7. Acute, moderate or severe illnesses with or without fever.

Contraindications and Precautions for DTaP, DT, Tdap, and Td (cont'd)

IV. Td A. CONTRAINDICATIONS 1. An immediate anaphylactic reaction. Defer further use of this vaccine because of the uncertainty as to which component of the vaccine might be responsible. However, Because of the importance of tetanus vaccination, persons who experience anaphylactic reactions may be referred to an allergist for evaluation and, if specific allergy can be demonstrated, desensitized to tetanus toxoid. 2. Moderate or severe illnesses with or without fever. B. PRECAUTIONS 1. Arthus-type hypersensitivity reactions. Persons who experience Arthus-type hypersensitivity reactions following a prior dose of tetanus toxoid usually have high serum tetanus antitoxin levels and should not be given even emergency doses of Td more frequently than every 10 years, even if they have a wound that is neither clean nor minor. 2. Guillain-Barre syndrome (GBS) within 6 weeks after a previous dose of tetanus toxoid containing vaccines. 3. Acute, moderate or severe illness with or without fever. 4. Latex Allergy.

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1 For other contraindications and precautions, refer to Table 5, Contraindications and Precautions to Commonly Used Vaccines, in the ACIP statement, "General Recommendations on Immunization," MMWR, December 1, 2006, Vol. 55, RR-15 2 the ACIP Diphtheria, Tetanus, and Pertussis Resolution for the Vaccines for Children Program (VFC), (Resolution No. 6/08-3)

Simultaneous Vaccine Administration
DTaP, DT, Tdap, and Td may be administered simultaneously with any of the following routinely recommended vaccines:
MMR, Hib, Hepatitis A, Hepatitis B, RV, IPV, Varicella, PCV or PPSV, HPV, Zoster and Influenza
Tdap or Td may also be administered simultaneously with MCV, or at any time before or after.
If administering DTaP and either PCV or PPSV, it is recommended to administer the vaccines in separate limbs.

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Appendix E
Guide to catch-up vaccination with Td for children aged 7--10 years*

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.
This appendix taken from the ACIP statement "Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines," MMWR, March 24, 2006, Vol. 55, No. RR-3.

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3-J. Inadvertent Administration of Tdap or Pediatric DTaP To help prevent inadvertent administration of Tdap when pediatric DTaP is indicated or pediatric DTaP when Tdap is indicated, vaccine providers should review product labels before administering these vaccines; the packaging might appear similar. Tdap is not indicated for children aged <10 years. Tdap contains lower amounts of diphtheria toxoid and lower amounts of some pertussis antigens compared with pediatric DTaP. Studies of the immune responses to Tdap among infants have not been conducted. Pediatric DTaP is not indicated for persons aged >7 years; the increased diphtheria toxoid content is associated with higher rates of adverse reactions in older persons (2428).
Guidance on the best approach to vaccination following inadvertent administration of Tdap or pediatric DTaP is based primarily on expert opinion. The family should be informed of any inadvertent vaccine administration. Adverse events associated with inadvertent vaccine administration can be reported to VAERS (see Reporting of Adverse Events after Vaccination). If Tdap is inadvertently administered instead of pediatric DTaP to a child aged <7 years as any one of the first three doses of the tetanus-diphtheria-pertussis vaccination series, the Tdap dose should not be counted as valid, and a replacement dose of pediatric DTaP should be administered. If the inadvertent administration is discovered while the child is in the office, the pediatric DTaP can be administered during the same visit. If the child has left the office, some experts suggest administering the replacement dose of pediatric DTaP within approximately 72 hours, or administering it 4 weeks later to optimize the child's immune response to the antigens in pediatric DTaP. This practice helps ensure that the child stays on the primary series schedule and has adequate protection against diphtheria and pertussis. However, the replacement dose of pediatric DTaP can be administered as soon as feasible at any interval after the inadvertent Tdap dose. The remaining doses of the pediatric DTaP series should be administered on the routine schedule, with at least a 4 week interval between the replacement dose of pediatric DTaP and the next dose of pediatric DTaP. For example, if an 8-week week old infant inadvertently received a dose of Tdap instead of the first dose of pediatric DTaP and does not receive a replacement dose of pediatric DTaP within about 72 hours, a replacement dose

of pediatric DTaP can be administered 4 weeks after the inadvertent Tdap dose (age 12 weeks). The routine schedule of pediatric DTaP can then be resumed 4 weeks after the pediatric DTaP replacement dose (age 16 weeks) with the other recommended vaccines (1,23).
If Tdap is inadvertently administered as the fourth or the fifth dose in the tetanus-diphtheria-pertussis vaccination series to a child aged <7 years, the Tdap dose should be counted as valid and does not need to be repeated; the child who received Tdap as a fourth dose should complete the pediatric DTaP schedule (23). The routine adolescent Tdap vaccination recommendations would apply when this child becomes an adolescent. For example, a child who inadvertently receives Tdap at age 5 years instead of the fifth dose of pediatric DTaP should receive a second dose of Tdap at age 1112 years.
If Tdap or pediatric DTaP is inadvertently administered to a child aged 7-9 years instead of Td as part of catch-up vaccination or for wound management, this dose can be counted as the adolescent Tdap dose, or the child can later receive an adolescent booster dose of Tdap according to the interval guidance used for Td to Tdap (see Routine Tdap Vaccination [section 1-A] and Pertussis Outbreaks and Other Settings with Increased Risk for Pertussis or its Complications [section 3-C]). In either case, the child should receive a dose of vaccine containing tetanus and diphtheria toxoids no longer than 10 years after the inadvertent Tdap or pediatric DTaP dose or according to the guidance for catch-up vaccination (Appendix E).
If pediatric DTaP is inadvertently administered to an adolescent aged 1118 years, the dose should be counted as the adolescent Tdap booster. The adolescent should receive the next dose of a vaccine containing tetanus and diphtheria toxoids 10 years after the inadvertent pediatric DTaP dose or according to the guidance for catch-up vaccination (Appendix D).*
* This page excerpted from "Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines," MMWR, March 24, 2006, Vol. 55, No. RR-3, pg. 27.

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Georgia Department of Human Resources Immunization Program Vaccine Guidelines

VACCINES TO PREVENT HAEMOPHILUS INFLUENZAE TYPE B
The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for each of the vaccines supplied by the Georgia Immunization Program. These guidelines should serve as a quick reference for clinics administering Haemophilus influenzae type b vaccine. The guidelines are not all inclusive and when more information is needed, the complete ACIP Recommendations statement should be referenced:
"Haemophilus b Conjugate Vaccines for Prevention of Haemophilus influenzae type b Disease Among Infants and Children Two Months of Age and Older," MMWR, January 11, 1991, Vol. 40, No. RR-1.
ACIP Haemophilus influenzae type b Resolution for the Vaccines for Children Program (VFC), (Resolution No. 6/08-5)
2006 Red Book: Report of the Committee on Infectious Diseases published by the American Academy of Pediatrics
Epidemiology & Prevention of Vaccine Preventable Diseases, 11th ed.
Vaccine Description
Haemophilus influenzae type b polysaccharide-protein conjugate vaccines are produced by chemically bonding a polysaccharide (a poor antigen) to a protein "carrier," which is a more effective antigen.
There are four types of Hib conjugate vaccines: 1. HbOC (HibTITER) 2. PRP-OMP (PedvaxHIB) 3. PRP-T (ActHIBand OmniHIB) 4. PRP-D (ProHIBiT).
HbOC, PRP-T, and PRP-OMP containing vaccines are highly immunogenic and are licensed for use in infants. These vaccines are interchangeable for use in the primary series and booster doses. However, the number of doses recommended depends upon the type of vaccine administered and the age at the time of the first dose. See "Recommended Schedule" Section.

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Brand Name & Manufacturer

HIB VACCINES PRP-T (ActHIB) PRP-OMP (PedvaxHIB)
Hib Combination Vaccines:
Whole cell DTP-Hib TETRAMUNE 1 (no longer manufactured) DTP-ActHIBTM 1 (no longer manufactured)
DTaP/Hib (for booster only) TriHIBit 1
Hib/Hepatitis B Comvax (PedvaxHIB and RecombivaxB)
DTap/IPV/Hib
Vaccines previously available: PRP-T (OmniHIB) PRP-D (ProHIBiT) HbOC (HibTITER)
1Not available from GA VFC Program

MANUFACTURERS sanofi pasteur Merck
Wyeth-Lederle Connaught
sanofi pasteur
Merck
sanofi pasteur Connaught Wyeth-Lederle

Eligible Groups for State Supplied Vaccine
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.

ACIP-Recommended Haemophilus influenzae type b (Hib) Routine Vaccination Schedule

Vaccine PRP-T (ActHIB) PRP-OMP (PedvaxHIB)

2 Months Dose 1
Dose 1

4 Months Dose 2
Dose 2

6 Months Dose 3

12-15 Months Booster
Booster

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Recommended Haemophilus influenzae type b (Hib) Vaccine Schedule

Vaccine PRP-T (ActHIB)
PRP-OMP (PedvaxHIB)

Age at 1st dose (months) 2-6 1 7-11 12-14 15-59
2-6 7-11 12-14 15-59 2

Primary series 3 doses, 2 months apart 2 doses, 2 months apart
1 dose 1dose
2 doses, 2 months apart 2 doses, 2 months apart
1 dose 1 dose

Booster 12-15 months* 12-15 months* 2 months later
--
12-15 months* 12-15 months* 2 months later

TriHIBit DTap/Hib

(See Section on "Combination Vaccines")

Comvax Hib-Hep B

(See Section on "Combination Vaccines")

PentacelTM DTap-IPV/Hib (See Section on "Combination Vaccines")

1 Limited data suggest that Hib conjugate vaccines given before 6 weeks of age may induce immunologic

tolerance to subsequent doses of Hib vaccine. 2Generally not recommended for persons older than 59 months of age
* At least 2 months after a previous dose

Minimum Age and Dose Intervals

Vaccine

Age

Interval

Interval

Dose 1 Dose 1 to 2 Dose 2 to 3

ActHIB

6 weeks 4 weeks

PedvaxHIB 6 weeks 4 weeks

4 weeks not needed

TriHIBit Comvax PentacelTM

(See Section on "Combination Vaccines") (See Section on "Combination Vaccines") (See Section on "Combination Vaccines")

Interval

Age

Booster Dose Booster Dose

8 weeks 8 weeks

12 months 12 months

Recommended Dosage and Route
0.5mL administered intramuscularly

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Contraindications and Precautions
A. Contraindications and Precautions 1. Anaphylactic reaction to a prior dose or to any component of the vaccine 2. Acute, moderate, or severe illness with or without fever. Immunize as soon as illness subsides. 3. Do not administer to infants < 6 weeks of age because of the potential for development of immunologic tolerance.
Simultaneous Vaccine Administration
May be administered simultaneously with any of the following routinely recommended vaccines: DTaP, RV, MMR, Varicella, Hepatitis A, Hepatitis B, IPV, PCV or PPV, Zoster and Influenza

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Georgia Department of Human Resources Immunization Program Vaccine Guidelines

VACCINES TO PREVENT POLIO

The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for each of the vaccines supplied by the Georgia Immunization Program. These guidelines should serve as a quick reference for clinics administering polio vaccine. The guidelines are not all inclusive. When more information is needed, the complete ACIP Recommendation statement should be referenced.
"Poliomyelitis Prevention in the United States," MMWR, May 19, 2000, Vol. 49, No. RR-5.
ACIP Polio Vaccine Resolution for the Vaccines for Children Program (VFC), (Resolution No. 6/08-4)
Epidemiology and Prevention of Vaccine Preventable Diseases, 11th ed. 2006 Red Book: Report of the Committee on Infectious Diseases published by the
American Academy of Pediatrics "Updated Recommendations of the Advisory Committee on Immunization Practices
(ACIP) Regarding Routine Poliovirus Vaccination, "MMWR, Vol. 58/August 7, 2009.
Vaccine Description
Trivalent oral polio vaccine was the vaccine of choice in the U.S. from the time it was licensed in 1963. Since wild virus-induced paralytic polio was essentially eliminated in the western hemisphere by 1979, vaccine-induced paralytic polio (VAPP) became the greater risk. Therefore, in order to further the goal of eliminating any paralytic polio in the U.S., the ACIP recommended that inactivated polio vaccine be used exclusively, beginning in 2000. Oral polio vaccine is no longer available in the U.S.
Inactivated polio vaccine (IPV) was introduced in the U.S. in 1955 but was largely replaced by OPV in the 1960's. Enhanced-potency IPV (e-IPV) was licensed in 1987 and is now the preferred polio vaccine.

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Brand Name & Manufacturer

VACCINES IPOLTM (e-IPV) PoliovaxTM (IPV)

MANUFACTURERS sanofi pasteur sanofi pasteur

(licensed but not distributed in the U.S.)

OrimuneTM (OPV)

Wyeth-Lederle

(not available for use in U.S.)

PediarixTM (combination of InfanrixTM, EngerixBTM, and inactivated polio vaccine)

GlaxoSmithKline

KinrixTM (combination DTap-IPV)

GlaxoSmithKline

PentacelTM (combination DTap-IPV/Hib) sanofi pasteur

(See Section on "Combination Vaccines" for more information on KinrixTM, PediarixTM, And PentacelTM)

Eligible Groups for State Supplied Vaccine
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.

Infants
Vaccine IPV

Recommended Polio Vaccine Schedule1

Dose 1 age 2 mos.

Dose 2 age 4 mos.

Dose 3 age 6-18 mos.

Dose 41, 2, 3, 4, 5,6 age 4-6 yrs.

Children and Persons < 18 years of age 7

Vaccine IPV

Dose 1 ------

Dose 2 4 8 wks. after Dose 1

Dose 3 6-12 mos. after Dose 2

Dose 42, 3, 4, 5, 6 3.5 years after Dose 3

1 Prior to 2001 individuals may have received a combination of OPV and IPV. For
assessment purposes the recommended schedule for this would be the same as the one
outlined here for IPV. 2 The 4-dose IPV series is administered at ages 2 months, 4 months, 6-18 months, and 4-6
years.

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3 The final dose in the IPV series should be administered at age 4 years regardless of the
number of previous doses. 4 Pediarix is licensed only for the primary series of 3 doses of IPV and should not be used
for the booster dose. Not indicated for children > 6 years of age. 5 PentacelTM is approved for the primary series and first booster dose (doses 1-4). It is not
indicated for children 5 years. 6 KinrixTM is approved for the booster dose at age 4-6. Not to be administered to children aged
< 4 years or 7 years. 7 Polio vaccination is not routinely recommended for healthy persons 18 years of age even if
living in the U.S. and even if they have never received or completed a primary polio series.
Some immunocompromised persons may need to be vaccinated. For more information, see
"General Recommendations on Immunization," MMWR, December 1, 2006, Vol. 55, No. RR-
15.Polio vaccine may be recommended for certain travelers. For special adult vaccination
recommendations, refer to pg. 13 of the ACIP statement listed in the introduction of this
statement.

Minimum Age & Dose Intervals for IPV1

DOSE 1 2 3 4

MINIMUM AGE 6 weeks 10 weeks 14 weeks 4 years

MINIMUM DOSE INTERVAL
-------4 weeks after 1st dose 4 weeks after 2nd dose 6 months after 3rd dose.

1Use of the minimum age and minimum intervals for vaccine administration in the first 6 months of life are recommended only if the vaccine recipient is at risk for imminent exposure to circulating poliovirus (e.g., during outbreak or because of travel to a polio-endemic region). ACIP is making this precaution because shorter intervals and earlier start dates lead to lower seroconversion rates.

Recommended Dosage and Route
0.5 mL administered subcutaneously or intramuscularly

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Contraindications and Precautions
A. Contraindications 1. Allergy to any vaccine component. Persons who have had anaphylactic reactions to topically or systemically administered streptomycin, neomycin, or Polymyxin B should not receive IPV. Persons with only skin contact sensitivity may be vaccinated. 2. Moderate or severe illness with or without fever.
B. Precautions Pregnancy. In general, polio vaccine should not be administered to pregnant women unless immediate protection against poliomyelitis is needed. If determined necessary, IPV is recommended.

Simultaneous Vaccine Administration
May be administered simultaneously with any of the following routinely recommended vaccines:
DTaP, RV, Td, Tdap, MMR, Hib, Hepatitis A, Hepatitis B, Varicella, MCV, PCV or PPSV, HPV, and Influenza

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Georgia Department of Human Resources D
Immunization PrograRm Vaccine Guidelines

VACCINES TO PREVENT PNEUMOCOCCAL DISEASE
The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for each of the vaccines supplied by the Georgia Immunization Program. These guidelines should serve as a quick reference for clinics administering A) pneumococcal conjugate (PCV) and B) pneumococcal polysaccharide (PPSV) vaccines. The guidelines are not all inclusive and when more information is needed, the complete ACIP Recommendations statements should be referenced:
"Preventing Pneumococcal Disease Among Infants and Young Children", MMWR, October 6, 2000, Vol.49, No. RR-9
"Prevention of Pneumococcal Disease", MMWR, April 4, 1997, Vol. 46, No.RR-8. ACIP Pneumococcal Vaccine Resolution for the Vaccines for Children Program
(VFC), (Resolution No. 6/00-1) ACIP Pneumococcal Vaccine Resolution for the Vaccines for Children Program
(VFC), (Resolution No. 2/09-1) Epidemiology and Prevention of Vaccine Preventable Diseases, 11th ed. 2006 Red Book: Report of the Committee on Infectious Diseases published by the
American Academy of Pediatrics
A. Pneumococcal Conjugate Vaccine (PCV)
Vaccine Description

Pneumococcal Conjugate Vaccine (PCV7) is a seven-valent pneumococcal polysaccharideprotein conjugate vaccine. It protects against the 7 serotypes of Streptococcus pneumoniae that account for 86% of the bacteremias, 83% of meningitis, and 65% of acute bacterial otitis media among children under 6 years of age in the US.

Brand Name & Manufacturer

VACCINE Prevnar

MANUFACTURER Wyeth

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Eligible Groups for State Supplied Vaccine
Pneumococcal Conjugate Vaccine (PCV7) is supplied for:
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.
This vaccine is supplied for all VFC eligible children ages 6 weeks through 59 months.
ACIP Recommendations for the use of PCV7
Children for Whom PCV7 is Recommended : 1. All children 6 weeks through 59 months of age 2. At ages 24-59 months, administer one dose of PCV7 to healthy children with any incomplete schedule 3. At ages 24-59 months, administer two doses of PCV7 at least 2 months apart to incompletely vaccinated children with underlying medical conditions. Those who have previously received three PCV7 doses need only one dose.
Note: Conjugate vaccine has not been studied sufficiently among older children or adults to make recommendations for its use among persons 5 years of age. Persons aged 5 years who are at increased risk for serious pneumococcal disease should continue to receive the 23valent polysaccharide vaccine (PPSV23) according to ACIP recommendations. See Section B: Pneumococcal Polysaccharide Vaccine (PPSV).

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Recommended PCV7 Vaccine Schedule

The routinely recommended schedule is a primary series at 2, 4, and 6 months of age with a booster at 12-15 months of age. However, the recommended schedule for pneumococcal conjugate vaccine varies with the age of the child and the presence of underlying conditions.

Recommended Schedule for Previously Unvaccinated Infants and Children

Age at first dose 2-6 months 7-11 months

Primary Series 3 doses, 2 months apart1 2 doses, 2 months apart1

Additional dose 1 dose at 12-15 months2 1 dose at 12-15 months2

12-23 months 24-59 months (healthy children) 5

2 doses, 2 months apart None

1 dose

None

24-59 months (children with SCD,
asplenia, HIV infection, chronic
illness, immunocompromising conditions 3, or cochlear implant recipients4) 5

< 3 doses

2 doses at least 8 weeks apart

24-59 months (children with SCD,
asplenia, HIV infection, chronic
illness, immunocompromising conditions 3, or cochlear implant recipients)4 5

3 doses

1 dose

1For children vaccinated at age <1 year, minimum interval between doses is 4 weeks. 2The booster (additional) dose should be administered at least 2 months (8 weeks) after the
primary series is completed. 3Recommendations do not include children who have undergone bone marrow transplant. Consult with child's primary care provider if the child is < 59 months of age and a 2nd dose is
needed due to one of the listed high risk conditions. See ACIP recommendations, October 6,
2000, Vol. 49, No. RR-9, Pg. 26. Some children may require Pneumococcal Polysaccharide
Vaccine (PPV). See Section B, PPV Recommendations. 4 "Pneumococcal Vaccination of Cochlear Implant Recipients," MMWR, October 18,
2002/51(41); 931. 5 "Updated Recommendation from the Advisory Committee on Immunization Practices (ACIP)
for use of 7-Valent Pneumococcal Conjugate Vaccine (PCV7) in children Aged 24-59 months
who are not Completely Vaccinated," MMRV, Vol. 57/ April 4, 2008.

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PCV7 Schedule for Children with Lapse in Immunization

Age at Presentation 7-11 Months

Previous PCV7 Immunization History 1 dose

Recommended Regimen
1 dose PCV7 at 7-11 months, with a booster dose at least 2 months later, at 12-15 months

12-23 months

2 doses

Same regimen as above

1 dose before age 12 2 doses of PCV7, at least 2 months apart

months

2 doses before age 1 dose PCV7, at least 2 months following the most

12 months

recent dose

24-59 months Any incomplete schedule

1 dose of PCV71

1Children with certain chronic diseases or immunosuppressing conditions should receive 2 doses at least 2 months apart.

Minimum Age and Dose Intervals For PCV7 Vaccine

Minimum age and dose intervals: Vaccination should not begin earlier than 6 weeks of age. The minimum age for the booster dose is 12 months of age. The minimum time interval between the last dose of the primary series and the booster dose is 2 months. Where pneumococcal polysaccharide vaccine (PPSV) is recommended following conjugate vaccination (PCV7), the recommended and minimum interval between the conjugate and the polysaccharide vaccine is 2 months.
If a child has received the polysaccharide vaccine (PPSV), and is recommended to receive the conjugate vaccine (PCV7) vaccine, the minimum time interval between the polysaccharide and conjugate vaccine is 2 months.

Recommended Dosage and Route
0.5 mL administered intramuscularly

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Contraindications and Precautions
A. Contraindications and Precautions 1. Allergy to vaccine components. Anaphylactic reaction to the vaccine or a constituent of the vaccine.
2. Moderate or severe illnesses with or without fever. Pneumococcal conjugate vaccine can be administered to persons with minor illness, such as diarrhea; mild upper respiratory tract infection, with or without low grade fever; or other illnesses with low grade fever. Persons with an illness associated with a moderate or severe fever should be vaccinated as soon as they have recovered from the acute phase of the illness.
Simultaneous Vaccine Administration
PCV may be administered simultaneously with any of the following routinely recommended vaccines:
DTaP, DT, RV, MMR, Hib, Hepatitis A, Hepatitis B, Polio, Varicella and Influenza
Concurrent administration of PCV and PPSV is not recommended because safety and efficacy of concurrent vaccination has not been established. See "Minimum Age and Dose Interval" section.

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B. Pneumococcal Polysaccharide Vaccine (PPSV)
Vaccine Description
Pneumococcal Polysaccharide Vaccine (PPSV23) is a purified capsular polysaccharide vaccine that protects against 23 serotypes of pneumococcal bacteria that cause 88% of bacteremic pneumococcal disease. It is not effective in children under 2 years of age.

Brand Name & Manufacturer

PNEUMOCOCCAL POLYSACCHARIDE VACCINE (PPSV) Pneumovax 23

MANUFACTURER Merck

Eligible Groups for State Supplied Vaccine
Pneumococcal Polysaccharide Vaccine (PPSV):
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.

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Recommended PPSV Vaccine Schedule

One dose of Pneumococcal Polysaccharide Vaccine (PPSV) is recommended for all persons > 65 years of age.
One to two doses of Pneumococcal Polysaccharide Vaccine (PPSV) are recommended for all persons aged 2-64 years who have one of the following high-risk conditions. (The number of doses is dependent upon the person's age and high-risk condition. Refer to the ACIP statement on Prevention of Pneumococcal Disease for specific guidelines.) If earlier vaccination status is unknown, these persons should be administered PPSV vaccine. (See the "Recommended Doses and Intervals" section for dosage recommendations for children receiving both pneumococcal conjugate (PCV) and pneumococcal polysaccharide (PPV) vaccines.)
High-risk Conditions:
1. A chronic illness a. Chronic cardiovascular disease (e.g., congestive heart failure or cardiomyopathies) b. Chronic pulmonary disease (e.g., COPD, emphysema, or asthma) 4 c. Diabetes mellitus d. Alcoholism e. Chronic liver disease (cirrhosis) f. Cerebrospinal fluid (CSF) leaks
2. Functional or anatomic asplenia a. Sickle cell disease b. Splenectomy1
3. Living in special environments or social settings a. Alaska Natives or American Indians where risk of invasive pneumococcal disease is increased 4 b. Residents of nursing homes or long-term care facilities
4. Immunocompromised 2 persons with a. HIV infection b. Leukemia c. Lymphoma, Hodgkins disease, multiple myeloma, generalized malignancy d. Chronic renal failure, nephrotic syndrome e. Organ or bone marrow transplants f. Immunosuppressive chemotherapy and long term corticosteroids
5. Cochlear implant recipients 3 6. Adults who smoke cigarettes4
1When an elective splenectomy is planned, PPV should be administered at least 2 weeks before surgery (Prevention of Pneumococcal Disease, MMWR, April 4, 1997, Vol. 46, RR-8, p.11). 2See "Contraindications and Precautions" section. 3 "Pneumococcal Vaccination of Cochlear Implant Recipients," MMWR, October 18, 2002/51(41); 931. 4 "ACIP Provisional Recommendation for use of Pneumococcal vaccines" October 22, 2008, linked @ http://www.cdc.gov/vaccines/recs/provisional/downloads/pneumo-oct-2008-508.pdf

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Recommended Doses and Intervals for PPSV Vaccine1

Population Persons >65 years

Schedule for follow-up with PPSV for children >2 years of age
Not Applicable

Revaccinate with PPV
Give 2nd dose of vaccine if: 1. Person was < 65 years
of age at the time of first dose And 2. It has been > 5 years since first dose

Persons ages 2-64 years with:
Sickle cell disease or anatomic or functional asplenia
Immunocompromised2
HIV-Infected
Persons ages 2-64 years with: Cardiovascular disease2 Chronic pulmonary disease2
Diabetes mellitus
Alcoholism
Chronic liver disease
Cerebrospinal Fluid (CSF) leaks
Cochlear implant recipients Adults who smoke cigarettes4 Adults with asthma4

1 dose PPSV given at age > 2 years and at least 2 months after last dose of PCV3
1 dose PPSV given at >2 years and at least 2 months after last dose of PCV3

Give 2nd dose of vaccine 5 years after the first dose
Not recommended

Persons ages 2-64 years who live in special environments or social settings: Alaska Natives or American
Indians aged 50 through 64 years who are living in areas with increased risk of invasive pneumococcal disease Residents of nursing homes or long-term facilities

Health care providers of Alaska Natives and American Indians may recommend PPSV for children aged 24-59 months who are living in areas in which risk of invasive pneumococcal disease is increased

Healthy Children

None

Not recommended No

1See 1997 ACIP Recommendations, Vol. 46, RR-8, p. 12 and 2000 ACIP Recommendations, Vol. 49, RR-9, p. 25, for more detailed information. 2See detailed listing in "Recommended PPSV Vaccine Schedule" section. 3Regardless of when administered, a second dose of PPV should not be given earlier than 3 years following the previous PPV dose. Revaccination is recommended only once. (1997 ACIP, Vol. 46, RR-8, p.15; 2006 Red Book, pp. 534-535). If a child has received the polysaccharide vaccine (PPV), and is recommended to receive the conjugate vaccine (PCV), the minimal time interval between the polysaccharide and conjugate vaccine, is 2 months. 4 "ACIP Provisional Recommendation for use of Pneumococcal vaccines" October 22, 2008, linked @ http://www.cdc.gov/vaccines/recs/provisional/downloads/pneumo-oct-2008508.pdf

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Recommended Dosage and Route
0.5 mL administered intramuscularly or subcutaneously

Contraindications and Precautions
A. CONTRAINDICATIONS 1. Allergy to vaccine components. Anaphylactic reaction to the vaccine or a constituent of the vaccine. 2. Moderate or severe illnesses with or without fever. Pneumococcal polysaccharide vaccine (PPSV) can be administered to persons with a minor illness, such as: diarrhea; mild upper respiratory tract infection, with or without low grade fever; or other illnesses with low grade fever. Persons with an illness associated with a moderate or severe fever should be vaccinated as soon as they have recovered from the acute phase of the illness. 3. Anaphylactic reaction or localized arthus-type reaction (extensive painful swelling from shoulder to elbow) to the initial dose. (1997 ACIP, Vol. 46, RR-8, p.15).
B. PRECAUTIONS 1. Pregnancy. It is prudent on theoretical grounds to avoid vaccinating pregnant women. 2. When cancer or immunosuppressive therapy is being considered (e.g., for patients with Hodgkins Disease or those who undergo organ or bone marrow transplantation) the interval between vaccination and initiation of immunosuppressive therapy should be at least 2 weeks. Vaccination during chemotherapy or radiation should be avoided (1997 ACIP, Vol. 46, RR-8, p.13).
Simultaneous Vaccine Administration
PPSV may be administered simultaneously with any of the following routinely recommended vaccines:
DTaP, DT, Td, Tdap, MMR, Hib, Hepatitis A, Hepatitis B, Polio, MCV4, Varicella, HPV, Zoster and Influenza
Concurrent administration of PCV and PPSV is not recommended because safety and efficacy of concurrent vaccination has not been established. See "PCV Minimum Age and Dose Interval" section.

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Georgia Departmen*t of Community Health Immunization Program Vaccine Guidelines

VACCINES TO PREVENT MEASLES, MUMPS, AND RUBELLA
The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for this vaccine which is supplied by the Georgia Immunization Program. These guidelines were developed from the pertinent Vaccine Resolution from the Vaccines for Children Program and the references below and will be updated as needed. The guidelines are not all inclusive and when more information is needed, the following publications should be referenced: "Updated Recommendations of the Advisory Committee on Immunization Practices
(ACIP) for the Control and Elimination of Mumps," MMWR, Vol. 55/June 1, 2006. "Measles, Mumps, and Rubella---Vaccine Use and Strategies for Elimination of Measles,
Rubella, and Congenital Rubella Syndrome and Control of Mumps," MMWR, May 22, 1998, Vol. 47, No. RR-8 the ACIP Measles, Mumps, Rubella, and Varicella Vaccine Resolution for the Vaccines for Children Program (VFC), (Resolution No. 6/06-3) 2006 Red Book: Report of the Committee on Infectious Diseases published by the American Academy of Pediatrics Epidemiology and Prevention of Vaccine Preventable Diseases, 11th ed. "ACIP Provisional Recommendations for Measles-Mumps-Rubella (MMR) `Evidence of Immunity' Requirements for Healthcare Personnel", August 28, 2009, linked at http://www.cdc.gov/vaccines/recs/provisional/downloads/mmr-evidence-immunityAug2009-508.pdf

Vaccine Description
Measles, mumps, and rubella vaccines are live virus vaccines and are available in monovalent form (Attenuvax, Mumpsvax, and Meruvax, respectively) and in combinations as measlesmumps-rubella or MMR (M-M-R II), and measles-mumps-rubella-varicella or MMRV (ProQuad). The ACIP recommends that the combined vaccine MMR be used when any of the individual
components is indicated, unless one component is contraindicated. Single antigen measles, mumps or rubella vaccines should be used only if:
1. there is a specific contraindication to one component of the MMR vaccine; or
2. the child is known to be immune or adequately vaccinated for one or more of the diseases; or
3. measles vaccine is indicated for a child <1 year of age in an outbreak situation. (Routine vaccination should be completed with MMR, i.e. two doses given at appropriate intervals, on or after the first birthday.)

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Brand Name & Manufacturer

VACCINES
Measles (Attenuvax)1 Mumps (Mumpsvax)1 Rubella (Meruvax)1 MMR (M-M-R II) Measles-rubella (M-R-Vax)2 Rubella-mumps (Biavax)2 Measles-mumps-rubella-varicella (ProQuad)
(See section on "Combination Vaccines")

MANUFACTURERS
Merck Merck Merck Merck Merck Merck Merck

1 Not available from the GA Immunization Program. Manufacturer provides these only in
packages containing 10 single doses. 2 No longer available from the manufacturer

Eligible Groups for State Supplied Vaccine
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.

Recommended MMR Vaccine Schedule1

Vaccine

Dose 12

Dose 2

MMR

12-15 months2,3

4-6 years2

1 Acceptable presumptive evidence of immunity to mumps is now the documentation of:
1 dose of mumps vaccine for preschool-aged children and adults not at high risk; and
2 doses of mumps vaccine for school-aged children grades K-12, and for adults at high
risk (i.e., persons who work in healthcare facilities, international travelers, and students
at post-high school educational institutions.) 2 May be given as MMR or MMRV, if both MMR and varicella are indicated. See
"Combination Vaccines" in this section for more information. Children whose vaccination
history indicates they have received single antigen measles and/or mumps vaccine, should receive MMR to complete the 2nd dose requirement for each. 3 Previously unvaccinated children beyond the recommended 12-15 months of age should receive the 1st dose of MMR as soon as possible. The 2nd dose can be provided at any age
from 13 months on, as long as there has been an interval of at least 28 days between doses.

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Minimum Age & Dose Intervals1

Vaccine Dose 1

Minimum age 12 months2

Minimum interval from dose 1 to 2 -------

Dose 2

13 months

28 days

1 MMR vaccine may offer some protection to persons exposed to measles if it is administered within 72 hours of exposure.
2 Infants as young as 6 months of age may be given measles vaccine in an outbreak situation, or if it is recommended before travel to a foreign country where the child might be at risk for contracting measles. However, doses of MMR administered before 1 year of age should not be counted. Any child receiving vaccine before 1 year of age should be re-vaccinated at 12-15 months of age, with an additional dose at the time of school entry. Doses of any measles-containing vaccine should be separated by at least 28 days.

Recommended Dosage and Route
0.5 mL administered subcutaneously
`Evidence of Immunity' Requirements for Healthcare Personnel
Adequate presumptive evidence of immunity to measles, rubella, and mumps for persons who work in health care facilities: Measles:
Documented administration of two doses of live measles virus vaccine1 or Laboratory evidence of immunity or laboratory confirmation of disease or Born before 1957123
Rubella Documented administration of one dose of live rubella virus vaccine1 or Laboratory evidence of immunity or laboratory confirmation of disease or Born before 1957 (except women of childbearing age who could become pregnant)123
Mumps Documented administration of two doses of live mumps virus vaccine1 or Laboratory evidence of immunity or laboratory confirmation of disease or Born before 1957123
1 May vary depending on current state or local requirements. 2 For unvaccinated personnel born before 1957 who lack laboratory evidence of measles, mumps and/or rubella immunity or laboratory confirmation of disease, healthcare facilities should consider vaccinating personnel with two doses of MMR vaccine at the appropriate interval (for measles and mumps) and one dose of MMR vaccine (for rubella), respectively. 3 For unvaccinated personnel born before 1957 who lack laboratory evidence of measles, mumps and/or rubella immunity or laboratory confirmation of disease, healthcare facilities should recommend two doses of MMR vaccine during an outbreak of measles or mumps and one dose during an outbreak of rubella. http://www.cdc.gov/mmwr/preview/mmwrhtml/00050577.htm

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Contraindications and Precautions
A. Contraindications 1. Previous anaphylactic reactions to any vaccine component (i.e. gelatin or gelatincontaining products, or to topically or systemically administered neomycin), or following a previous dose of MMR vaccine 2. Moderate or severe illness with or without fever 3. Pregnancy - Because of the theoretical risk to the fetus, women of childbearing age should receive MMR or its component vaccines only if they state they are not pregnant and are counseled not to become pregnant for 4 weeks after vaccination. However, MMR or measles, mumps, or rubella vaccination inadvertently given during pregnancy should not ordinarily be a reason to consider interruption of pregnancy. 4. Known altered immunocompetence - Replication of vaccine viruses can be enhanced in persons with immune deficiency diseases and in persons with immunosuppression. Severe immunosuppression may be caused by many disease conditions (e.g., congenital immunodeficiency, HIV infection, hematologic or generalized malignancy) and by therapy with immunosuppressive agents, including large doses of corticosteroids. The degree to which affected persons are immunocompromised can depend on the disease, its severity, and the treatment stage. Ultimately, the patient's physician must assume responsibility for determining whether the patient is severely immuno-compromised based on clinical and laboratory assessment.

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B. Precautions 1. Thrombocytopenia---Persons who have an episode of thrombocytopenic purpura within 6 weeks of vaccination with MMR should weigh the risk versus the benefit of receiving a 2nd dose. Serologic testing of immunity should be considered in lieu of MMR vaccination. 2. Recent receipt of blood, plasma, or immune globulin (in past 3-11 months) --- Blood and other antibody containing blood products, including immune globulin (IG) preparations, can diminish the immune response to MMR or its individual component vaccines. MMR or its component vaccines should be given at least 2 weeks before administration of an immune globulin or blood or blood-containing product or deferred until 3 or more months after administration of such preparations. (See Table 4 in this chapter for more specific guidelines regarding the time to wait before administering vaccine.) 3. Tuberculin skin tests --- MMR vaccine may interfere with the response to a tuberculin test. If such testing is otherwise indicated, it can be done either on the same day as MMR vaccine is administered or 4-6 weeks later. 4. Corticosteroid therapy --- Such therapy usually does not contraindicate the administration of live virus vaccines such as MMR when therapy is: a) short term (i.e. <14 days) low-to-moderate dose; b) low-to-moderate dose administered daily or on alternate days; c) long term alternate day treatment with short-acting preparations; d) physiologic maintenance doses (replacement therapy); or e) administered topically (skin or eyes), by aerosol, or by intra-articular, bursal, or tendon injection. Doses that are considered to be immunosuppressive are those equivalent to or greater than a prednisone dose of 2 mg/kg of body weight per day or a total of 20 mg per day. (For further information on this precaution, see the ACIP Recommendations Statement listed in the introductory paragraph.)

Simultaneous Vaccine Administration
May be administered simultaneously with any of the following routinely recommended vaccines: DTaP, Tdap, Td, Hib, Hepatitis A, Hepatitis B, Polio, Varicella, PCV or PPV, MCV4, HPV, and Influenza

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Georgia Department of Human Resources Immunization Program Vaccine Guidelines

VACCINES TO PREVENT VARICELLA

The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for each of the vaccines supplied by the Georgia Immunization Program. These guidelines were developed from the pertinent Vaccine Resolution from the Vaccines for Children Program and the references below and will be updated as needed. The guidelines are not all inclusive and when more information is needed, the following publications should be referenced:
"Prevention of Varicella," MMWR, June 22, 2007, Vol. 56, No. RR-4 ACIP Measles, Mumps, Rubella, and Varicella Vaccine Resolution for the Vaccines
for Children Program (VFC), (Resolution No.6/06-3) 2006 Red Book: Report of the Committee on Infectious Diseases published by the
American Academy of Pediatrics Epidemiology and Prevention of Vaccine Preventable Diseases, 11th ed.

Vaccine Description

Varicella zoster vaccine is a live attenuated viral vaccine, derived from the Oka strain of varicella zoster virus.

Brand Name & Manufacturer

VACCINE Varicella (Varivax ) Measles-mumps-rubella-varicella (ProQuad)
(See "Combination Vaccines" in this section)

MANUFACTURER Merck
Merck

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Eligible Groups for State Supplied Vaccine

For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.
The varicella immune globulin (VZIG) product currently used in the U.S. is VariZIG. TM It is available under an Investigational New Drug Application Expanded Access protocol. This product can be obtained 24 hours a day from the sole authorized U.S. distributor (FFF Enterprises, Temecula, California) at 1-800-843-7477 or online at hppt://www.fffenterprises.com

Recommended Varicella Vaccine Schedule

Two doses of varicella vaccine are recommended for all susceptible1 persons beginning at 1215 months of age. If a child is 15 months or older and has not had the disease, the child should be immunized at the earliest opportunity.

Vaccine

Dose2

Age (for routine vaccination)3

Varicella

1

2

12-15 months 4-6 years

In addition, varicella vaccination is recommended in the following situations: A 2nd dose catch-up for all children, adolescents, and adults who previously had received one dose.
Vaccination should be considered for HIV-infected children with age-specific CD4+ T-
lymphocyte percentage 15% and may be considered for adolescents and adults in with
CD4+ T-lymphocyte count 200 cells/L. DO NOT use MMRV vaccine for these
persons.
For postpartum women whose prenatal assessment indicated susceptibility to varicella disease, the 1st dose of vaccine should be administered before discharge from the healthcare facility and the 2nd dose scheduled at an appropriate interval.
During a varicella outbreak, a 2nd dose of vaccine should be given to those who had previously only received 1 dose, provided the appropriate minimum interval has elapsed since the first dose.3

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Other adults who should receive special consideration for varicella vaccine if determined not to be immune: o Healthcare providers o Household contacts of immunocompromised persons o Persons in environments where transmission of VZV is likely, such as teachers, childcare employees, persons in institutional settings, college students, staff and inmates of correctional institutions, and military personnel. o Nonpregnant women of childbearing age o Adolescents and adults living in households with children o International travelers
1 See Guidelines for Documentation of Immunity below. 2 Doses of varicella may be given as MMRV if the child is 12 months through 12 years of age, and a dose
of MMR is also indicated. See "Combination Vaccine" guidelines in this section for more information. 3 Minimum interval from dose 1 to 2:
3 months if 1st dose is given at <13 years of age 4 weeks if 1st dose is given at 13 years of age NOTE: Varicella vaccine is effective in preventing illness or modifying varicella severity if it is administered within 3 days and possibly up to 5 days after exposure.

Guidelines for Public Health Clinics Documentation of Varicella Immunity
These guidelines are to be used by nurses in public health clinics to document varicella immunity. This documentation will be for issuing a "Certificate of Immunization" for childcare and school attendance.
1. Documentation of age-appropriate vaccination: Ages 12 months through preschool----1 dose Ages kindergarten through adulthood---2 doses
2. Laboratory evidence of immunity or confirmation of disease 3. Born in the US before 1980 4. Healthcare provider diagnosis of disease or documentation of history of disease
Typical case history o Recollection of an itchy, blister-like rash that lasted about a week with o History of known exposure to shingles or a typical case of chickenpox (fever and maculopapular rash with successive crops of vesicular lesions in different stages) o Documentation should be made by licensed medical personnel (e.g., physician, public health nurse, physician's assistant, or nurse practitioner); however, the Immunization Certificate must be signed by a physician licensed in Georgia or by a Public Health Official.

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Guidelines for Public Health Clinics Documentation of Varicella Immunity (cont'd)

Mild or atypical case history o Assessment should be made by licensed medical personnel (e.g., physician, public health nurse, physician's assistant, or nurse practitioner) and one of the following should be sought: An epidemiologic link to a typical varicella case, or a laboratory confirmed case Evidence of laboratory confirmation (if the testing was performed at the time of acute disease)
If none of the above can be ascertained, vaccination with appropriate doses of varicella vaccine should be considered.
5. History of herpes zoster (shingles) based on healthcare provider diagnosis

Recommended Doses & Intervals

Vaccine

Minimum age

Minimum interval from dose 1 to 21

Dose 1

12 months

3 months

Dose 2

13 months

-----

1 If 2 doses of varicella vaccine are given during the time the child is 12 months through 12
years of age, the minimum interval between doses is 3 months. Once the child turns 13 years
of age, the minimum interval between the 2 doses is 1 month. However, regardless of the child's age, if the 2nd dose was administered after at least 28 days following the 1st dose, the 2nd
dose does not need to be repeated.

Recommended Dosage and Route
0.5 mL administered subcutaneously

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Contraindications and Precautions

A. Contraindications and Precautions 1. Allergy to vaccine components Anaphylactic reaction to the vaccine or a constituent of the vaccine (e.g., gelatin or neomycin) 2. Moderate or severe illnesses with or without fever Varicella vaccine can be administered to persons with minor illness, such as diarrhea; mild upper respiratory tract infection, with or without low grade fever; or other illnesses with low grade fever. Persons with an illness associated with a moderate or severe fever should be vaccinated as soon as they have recovered from the acute phase of the illness. Although no data exist as to whether varicella or live varicella virus vaccine exacerbates tuberculosis, vaccination is not recommended for persons who have untreated, active tuberculosis. Tuberculin skin testing is not a prerequisite for varicella vaccination. 3. Altered immune status Altered immune status due to: a malignant condition (blood dyscrasia, leukemia,1 lymphoma, or other neoplasms affecting the bone marrow or lymphatic system); primary or acquired immune deficiency, including acquired immunodeficiency syndrome (AIDS) or other clinical manifestations of HIV infection, cellular immunodeficiencies, hypogammaglobulinemia, and dysgammaglobulinemia; family history of congenital or hereditary immunodeficiency, unless immune competence of possible vaccine recipient is demonstrated; and individuals receiving immunosuppressive therapy. See ACIP statement cited in the opening paragraph of "Vaccines to Prevent Varicella." 4. Receipt of blood products Varicella virus vaccine should not be given for at least 5 months after receipt of blood (except washed red blood cells) or plasma transfusions, Immune Globulin (IG), or Varicella Zoster Immune Globulin (VZIG). In addition, IG and VZIG should not be administered for 3 weeks after vaccination unless the benefits of receiving the IG or VZIG exceed the benefits of vaccination. 5. Steroid therapy Receiving doses of systemic prednisone or its equivalent at a dose of 2 mg/kg of body weight per day or 20 mg/day. 6. Exposure of immunocompromised persons to vaccinees In persons who develop a rash post-vaccination, there is a minimal risk of transmission of vaccine virus to close contacts. Thus, vaccinees in whom vaccine-related rash develops, particularly health care workers and household contacts of immunocompromised persons, should avoid contact with susceptible persons who are at high risk of serious complications. 7. Salicylates Due to the association between wild varicella zoster infection, salicylates, and Reye syndrome, if feasible, vaccine recipients should avoid using salicylates for 6 weeks after receiving varicella virus vaccine. Vaccination with subsequent close monitoring should be considered for children who have conditions requiring therapeutic aspirin because the risk for serious complications associated with aspirin is likely to be greater in children in whom natural varicella disease develops than in children who receive the vaccine containing attenuated varicella zoster virus.

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Georgia Immunization Program Manual Contraindications and Precautions (cont'd)

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8. Pregnancy Theoretically, it is best not to administer varicella vaccine to pregnant women. Woman who are not pregnant but are of childbearing age who receive the vaccine should be advised not to become pregnant for at least 1 month after each injection. Merck and the CDC have established a hotline to monitor the maternal/fetal outcomes of women who are vaccinated with varicella 3 months before or at any time during the pregnancy. The phone number is (800) 986-8999.
9. Nursing mothers Whether attenuated varicella (VZV) vaccine is excreted in human milk and, if so, whether the infant could be infected, are not known. Most live vaccines have not been demonstrated to be secreted in human milk. Therefore, varicella vaccine may be considered for a nursing mother.
1 Except under research protocol
Note: A prior history of chicken pox is not a contraindication to varicella vaccination.

Simultaneous Vaccine Administration
Varicella vaccine may be administered simultaneously with any of the following routinely recommended vaccines:
DTaP, Tdap, Td, MMR, Hib, Hepatitis A, Hepatitis B, Polio, PCV and PPSV, Influenza, HPV, and MCV
Tuberculin Skin Testing: While no data are available regarding the effect of varicella vaccination on tuberculin reactivity, it is prudent to apply the same precautions as with MMR when using the varicella vaccine. See guidelines for simultaneous tuberculin skin testing (TST) and the administration of live virus vaccines in the ACIP statement, "General Recommendations on Immunization," MMWR, December 1, 2006, Vol. 55, RR-15, page 30.

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Georgia Department of Human Resources Immunization Program Vaccine Guidelines

COMBINATION VACCINES
The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for each of the vaccines supplied by the Georgia Immunization Program. These guidelines were developed from the pertinent Vaccine Resolutions from the Vaccines for Children Program and the references below and will be updated as needed. These guidelines should serve as a quick reference for clinics administering currently available combination vaccines which include: (A) TriHIBit (ActHIB reconstituted with Tripedia DTaP; (B) Comvax (PRP-OMPC as PedvaxHIB and Hepatitis B vaccine as Recombivax; (C) TwinRix (Hepatitis A Inactivated [Havrix] & Hepatitis B (Recombinant) Vaccine [Engerix B ]); (D) Pediarix (Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed, Hepatitis B Recombinant] and Inactivated Poliovirus Vaccine Combined); and (E) KinrixTM (Diphtheria, Tetanus, acellular pertussis [DTap] and inactivated poliovirus vaccine [IPV]); (F) Pentacel (DTap-IPV and ActHIB); (G) ProQuad (Measles, Mumps, Rubella and Varicella vaccines combined). The guidelines are not all inclusive and when more information is needed, the following publications should be referenced: "Notice to readers: Licensure of a Combined Live Attenuated Measles, Mumps, Rubella
and Varicella Vaccine", MMWR, December 2, 2005, Vol. 4, No. RR-46 "Notice to Readers: FDA Licensure of Diphtheria and Tetanus Toxoids and Acellular
Pertussis Adsorbed, Hepatitis B (Recombinant), and Poliovirus Vaccine Combined, (PEDIARIXTM) for Use in Infants," MMWR, March 14, 2003/52(10); 203-204 "Notice to Readers: FDA Approval for a Combined Hepatitis A and B Vaccine," MMWR, September 21, 2001, Vol. 50, No. 37 "Combination Vaccines for Childhood Immunization," MMWR, May 14, 1999, Vol. 48, No. RR-5 "Recommendations for the Use of Haemophilus b Conjugate Vaccines and a Combined Diphtheria, Tetanus, Pertussis, and Haemophilus b Vaccine," MMWR, September 17, 1993, Vol. 42, No. RR-13 the VFC Resolution "Vaccines to Prevent Measles, Mumps, Rubella, and Varicella," Resolution No. 6/06-3 the VFC Resolution "Vaccines to Prevent Diphtheria, Tetanus and Pertussis," Resolution No. 6/08-3 "License of a Diphtheria and Tetanus Toxoids and acellular Pertussis Adsorbed Inactivated Poliovirus vaccine and Guidance for use as a Booster Dose," MMWR, October 3, 2008, Vol. 57 No. 39 the 2006 Red Book: Report of the Committee on Infectious Diseases published by the American Academy of Pediatrics Epidemiology and Prevention of Vaccine Preventable Diseases, 11th ed. "ACIP Provisional Recommendations for Use of Measles, Mumps, Rubella and Varicella (MMRV)," October 20, 2009, linked at http://www.cdc.gov/vaccines/recs/provisional/default.htm

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General Guidelines for the Use of Combination Vaccines1
To minimize the number of injections children receive, parenteral combination vaccines should be used, if licensed and indicated for the patient's age, instead of their equivalent component vaccines.
Recommended intervals and ages for single antigen vaccines, when used in combination series, should be observed.
Hepatitis A, hepatitis B, and Haemophilus influenzae type b vaccines, in either monovalent or combination formulations from the same or different manufacturers, are interchangeable for sequential doses in the vaccination series.
Using the same acellular pertussis vaccine product from the same manufacturer is preferable for at least the first three doses. However, if the brand is not known, ACIP recommends to vaccinate the child using the DTaP vaccine that is available.
When patients have already received the recommended vaccinations for some of the components in a combination vaccine, administering the extra antigen(s) in the combination is often permissible if doing so will reduce the number of injections required and if the other components are not contraindicated.
To avoid recording errors and ambiguities in the names of vaccine combinations, extra care should be taken to record exactly what was given.
1 General Recommendations on Immunization, MMWR, December 1, 2006, Vol. 55, RR-15

A. TRIHIBIT (ActHIB reconstituted with Tripedia DTaP)
Vaccine Description
This vaccine combines diphtheria and tetanus toxoids and acellular pertussis (Tripedia) and Haemophilus influenzae type b conjugate vaccine (ActHIB). This product is licensed only for the 4th dose of the DTaP series. ActHIB cannot be mixed with Infanrix.

Brand Name & Manufacturer

VACCINES TriHIBit (DTaP/HIB) TetramuneTM(DPT/HIB)

MANUFACTURERS sanofi pasteur No longer manufactured

Eligible Groups for State Supplied Vaccine

This vaccine is not supplied by the Vaccines for Children Program and the information included in this document is intended for use in evaluating and assessing immunization records of children who may have received this vaccine.

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Recommended TriHIBit Vaccine Schedule

This combination vaccine should not be administered to infants less than 12 months of age. However, it can be used as the booster dose following any Hib vaccine if:
at least 6 or more months have elapsed since a 3rd dose of DTaP, and 2 or more months have elapsed since a previous dose of Hib, and the child is 12 months of age or older but less than 60 months of age, and this child has received at least one prior dose of Hib vaccine, and TriHIBit will be the last dose in the Hib series.1
TriHIBit should not be used if child has received no prior Hib doses 2
1 General Recommendations on Immunization, MMWR, December 1, 2006, Vol. 55, RR-15, pg.6; and Pink Book, January 2007, 10th edition, pg. 125 2 Epidemiology and Prevention of Vaccine Preventable Diseases, 11th ed.

Recommended Dosage and Route

0.5 mL administered intramuscularly

Contraindications and Precautions
Assess client according to any contraindications or precautions to the components of the vaccine. See guidelines for DTaP and Hib vaccines.

Simultaneous Vaccine Administration
TriHIBit may be administered simultaneously with any of the following routinely recommended vaccines:
MMR, Hepatitis A, Hepatitis B, IPV, Varicella, PCV or PPSV, and Influenza

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B. COMVAX

Division of Public Health

Vaccine Description

COMVAX is a combination of Haemophilus b Conjugate (PRP-OMPC or PedvaxHIB) and hepatitis B vaccine (Recombinant pediatric formula or Recombivax HBTM). This vaccine is
recommended when the needed vaccinations include both hepatitis B and Hib.

VACCINE COMVAX

Brand Name & Manufacturer
MANUFACTURER Merck

Eligible Groups for State Supplied Vaccine
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.
Indications for Use
Administer if: Both PedvaxHIB and Recombivax HB are needed, and The child is 6 weeks of age and 59 months of age or younger
Comvax is not approved for hepatitis B doses given at birth or at 1 month of age. Consequently, for those infants born to mothers whose HBsAg status is positive or unknown and who should therefore receive the first 2 doses of hepatitis B vaccine at birth and age 1 month, this vaccine would be inappropriate. It may be used for the 3rd dose of hepatitis B if given at the recommended 6 months of age, but not before 24 weeks of age.

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Recommended COMVAX Vaccine Schedule

For infants and children of HBsAg negative mothers. The COMVAX series schedule depends upon the age at which the first dose was given.

AGE Dose 1 2-11 months
12-14 months

NO. OF COMVAX DOSES REQUIRED
3 doses (2nd dose 2 months after 1st 3rd dose 8-11 months after 2nd)
2 doses (2nd dose 2 months after 1st)

ADDITIONAL DOSES OF HEPATITIS B REQUIRED None
1 dose (at appropriate intervals)

15-60 months

1 dose

2 doses (at appropriate intervals)

Minimum Age and Dose Intervals

DOSE 1 2 3

AGE 6 weeks ----12 months

INTERVAL BETWEEN DOSES
------4 weeks after 1st dose 8 weeks after 2nd dose and child
must be 12 months of age or older

Recommended Dosage and Route
0.5 mL administered intramuscularly

Contraindications and Precautions
A. Contraindications and Precautions 1. Anaphylactic reaction to a prior dose or any component of the vaccine. 2. Hypersensitivity to any component of the vaccine. 3. Moderate or severe acute illness. 4. Allergies to yeast, aluminum hydroxide, or formaldehyde. 5. This vaccine is not approved for hepatitis B vaccine doses given at birth or at one month of age, and can only be given to infants 6 weeks of age or older. As long as this guideline is followed, it can be used for infants of mothers whose HBsAg status is positive or unknown, when administering the remaining dose(s) of the hepatitis B vaccine series.

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Simultaneous Vaccine Administration
May be administered simultaneously with any of the following routinely recommended vaccines:
DTaP, RV, Hepatitis A, MMR, IPV, Varicella, PCV or PPSV, and Influenza

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C. TWINRIX

Division of Public Health

Vaccine Description
TwinRix is a bivalent inactive vaccine containing the antigenic components used in producing Havrix (Hepatitis A Vaccine, Inactivated) and Engerix-B [Hepatitis B Vaccine (Recombinant)].
A 1 mL dose contains 720 ELISA Units (ELU) of inactivated hepatitis A virus (pediatric dose of Havrix) and 20 mcg. of recombinant HBsAg protein (adult dose of Engerix-B).
The advantage of using this vaccine over single antigen vaccines is that it reduces the number of shots. The time to complete the series is the same.
TwinRix Junior is licensed in other countries but not in the United States and consists of 360 ELU hepatitis A antigen and 10 mcg. of hepatitis B antigen usually given in a 3 dose series at 0,1, and 6 months for children <18 years of age.

Brand Name & Manufacturer

VACCINE TwinRix (Hepatitis A/Hepatitis B) TwinRix Junior (Pediatric Hepatitis A/Hepatitis B)

MANUFACTURER GlaxoSmithKline GlaxoSmithKline

Eligible Groups for State Supplied Vaccine
TwinRix is provided by the Georgia Immunization Program for use by certain populations age 18 years and older. Refer to "Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" for those persons eligible for hepatitis A and hepatitis B vaccines.

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Recommended Schedule

The recommended schedules for TwinRix and TwinRix Junior are the same as for single antigen hepatitis B vaccine.

Dose 1

Dose 2

Dose 3

--------

1 month

6 months

Single antigen Hepatitis A and Hepatitis B vaccine may be used to complete a series begun with Twinrix and vice versa. Follow one of the schedules below using recommended dose intervals:1

Dose 1

Dose 2

Dose 32

Twinrix

Adult hepatitis A vaccine and Adult hepatitis B vaccine

Twinrix
OR Adult hepatitis A vaccine and Adult hepatitis B vaccine

Twinrix

Twinrix

Adult hepatitis A vaccine and Adult hepatitis B vaccine

Adult Hepatitis A and Adult Hepatitis B

Twinrix

Twinrix
OR Adult hepatitis A vaccine and Adult hepatitis B vaccine

1 Pink Book, January, 2007, pg. 205 2 The minimum time interval between doses 2 and 3 should be 5 months or longer.

Minimum Age & Dose Intervals

TwinRix may only be administered to persons 18 years of age.

DOSE

MINIMUM AGE

MINIMUM INTERVAL BETWEEN DOSES

Dose 1

18 years of age and older

--------

Dose 2 Dose 3

-----------------------

4 wks. after 1st dose 5 months after 2nd dose

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Accelerated Schedule for Administration of Twinrix 1,2

Dose 1

Dose 2

Now

7 days after Dose 1

Dose 3 21-30 days after Dose 1

Dose 4 12 months after Dose 1

1 This schedule may be preferable for individuals at imminent risk for hepatitis A and hepatitis B. These include travelers to countries endemic for hepatitis A and hepatitis B, prison inmates, military personnel, emergency care first responders to disaster areas, persons with high-risk sexual behavior, and intravenous drug users. 2 Refer to "Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" for those persons eligible for hepatitis A and hepatitis B vaccines.

Recommended Dosage and Route
1 mL administered intramuscularly NOTE: Do not give in gluteal area. Use only deltoid or vastus lateralis (antero-lateral
aspect of thigh.)
Contraindications and Precautions
A. Contraindications 1. Known hypersensitivity to any component of the vaccine or to a previous dose of TwinRix or its component vaccines. 2. Persons < 18 years of age.
B. Precautions 1. Moderate or severe acute illness with or without fever. 2. If administered to immunosuppressed persons, the expected immune response may not be obtained.

Simultaneous Vaccine Administration
May be administered simultaneously with any of the following routinely recommended vaccines: Tdap, Td, MMR, IPV, Varicella, PPSV, MCV, MPSV, HPV, Zoster and Influenza

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D. PEDIARIX

Division of Public Health

Vaccine Description

Pediarix is a combined diphtheria and tetanus toxoids and acellular pertussis adsorbed
(DTaP), hepatitis B (HepB) (recombinant), and inactivated poliovirus vaccine (IPV). It contains Infanrix, Engerix-B, and the same strains and quantity of inactivated
poliovirus Types 1, 2, and 3 as IPV from a different manufacturer (IPOL, sanofi pasteur).

Vaccine
Pediarix

Brand Names & Manufacturer
Manufacturer
GlaxoSmithKline

Eligible Groups for State Supplied Vaccine
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.

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Recommended Vaccine Schedule1

Pediarix is recommended for the primary series of DTaP, hepatitis B, and IPV
vaccination (Doses 1-3).
It should not be given before 6 weeks of age or after the child turns 7 years old. This vaccine is not approved for booster doses. To complete the DTaP and IPV series,
use those individual vaccines.
Pediarix is not approved for hepatitis B vaccine doses given at birth or at 1 month of
age. Consequently, for those infants born to mothers whose HBsAg status is positive or unknown and who should therefore receive the first 2 doses of hepatitis B vaccine at birth and age 1 month, this vaccine would be inappropriate. It may be used for the 3rd dose of hepatitis B if given at the recommended 6 months of age.

Dose 1
2 months of age

Dose 22
4 months of age

Dose 3

Booster

6 months of age Not approved

for booster doses

1 This reflects the routinely recommended schedule. However, the vaccine may be
administered as a primary series (Doses 1, 2, and 3) at any time between 6 weeks and 7
years of age. 2 If the child has received 2 doses of hepatitis B vaccine by 4 months of age, giving Pediarix at 4 months of age would be too soon for the 3rd dose of vaccine (minimum age is 24 weeks.) A 3rd dose given at 4 months would be declared "invalid" in GRITS. Therefore, It is
suggested that single antigen DTaP and IPV be given at this visit instead of the combination
vaccine in order to avoid this.

Minimum Age and Dose Intervals1

Dose 1

Minimum Age 6 weeks

Time Interval to Dose 2 Time Interval to Dose 32

4 weeks3

8-12 weeks3

1 If the Pediarix series is not completed until after age 4, the IPV series would be considered
to be complete. However, an additional dose of DTaP would still be needed. 2Though Pediarix cannot be used for a 4th or 5th booster dose, the intervals to the 4th or
booster doses of any of the component vaccines (DTaP, hepatitis B, and IPV) should reflect
the minimum interval for each of those vaccines. (Refer to individual Vaccine Guidelines for
DTaP, hepatitis B, and IPV found in this section.) 3 Though the vaccine manufacturer has recommended a minimum interval of 6-8 weeks between doses, the ACIP has approved a minimum interval of 4 weeks between the 1st and 2nd doses when used in an accelerated vaccination schedule; 8 weeks between doses 2 and 3; and 16 weeks between doses 1 and 3. The 3rd dose should not be given before 6 months
(or 24 weeks) of age.

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Recommended Dosage and Route

0.5 mL administered intramuscularly

Contraindications and Precautions
A. Contraindications
1. Anaphylactic reaction to a previous dose of vaccine or to a dose of any of the component vaccines, or to a vaccine component including yeast, neomycin, and polymyxin B. (See "Contraindications and Precautions" section for each component vaccine under that Vaccine Guideline found in this section.)
2. Administration at age less than 6 weeks or greater than 6 years 3. Encephalopathy within 7 days of administration of a previous dose of DTP or
DTaP 4. Progressive neurologic disorder. Defer DTaP until neurologic status is clarified
and stabilized. 5. Do not give for birth dose or at age 1 month for any infant. Infants born to
mothers who are HBsAg positive or whose status is unknown should receive single antigen hepatitis B vaccine for the birth dose and for Dose 1 when it is given at 1 month of age.
B. Precautions:
1. Fever of 105F ( 40.5 C.) 48 hours after vaccination with a previous dose of DTP or DTaP, or a combination vaccine that contains DTP or DTaP
2. Collapse or shock like state in same circumstances as #1 3. Seizure occurring 3 days after receiving a previous dose of DTP or DTaP or
combination vaccine that contains DTP or DTaP 4. Persistent, inconsolable crying lasting 3 hours and occurring 48 hours after
vaccine containing DTP or DTaP 5. Moderate or severe acute illness with or without fever
Simultaneous Vaccine Administration
May be administered simultaneously with any of the following routinely recommended vaccines:
RV, Hepatitis A, MMR, Hib, Varicella, Influenza, and PCV
NOTE: When administered simultaneously with Hib and PCV vaccines, use separate injection sites.

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E. KINRIXTM
Vaccine Description
Kinrix TM is a combined diphtheria and tetanus toxoids and acellular pertussis adsorbed (DTap) and inactivated poliovirus vaccine (IPV).
It contains Infanrix and the same strains and quantity of inactivated poliovirus types 1, 2, and 3 as IPV from a different manufacturer (IPOL, sanofi pasteur).
KinrixTM is the first combination vaccine to offer protection against diphtheria, tetanus, pertussis and polio diseases in one shot.

Vaccine
KinrixTM

Brand Names & Manufacturer
Manufacturer
GlaxoSmithKline

Eligible Groups for State Supplied Vaccine
For Adults, children, and adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.
Indications and Usage
Kinrix TM is approved for: 5th dose in the DTap series, and 4th dose in the IPV series children 4 through 6 years of age previous DTaP vaccine doses were Infanrix and/or Pediarix for the first three doses and Infanrix for the fourth dose. Use of KinrixTM for any dose except the 5th dose of DTap and 4th dose of IPV should be considered a vaccine administration error.

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Minimum Age and Dose Intervals

Minimum age for first dose 4 years of age
4 years of age

Minimum interval between doses 3 to 4 (IPV) 6 months
Minimum interval between doses 4 to 5 (DTap) 6 months

KinrixTM is not approved for use in persons < 4 years of age or 7 years of age. If KinrixTM is inadvertently administered as an earlier dose in the series, the dose may be counted as valid and does not need to be repeated if the minimum age and minimum interval since the prior dose are met. The fourth dose is not necessary if the third dose was given on or after the fourth birthday. The fifth dose is not necessary if the fourth dose was given on or after the fourth birthday.

Contraindications and Precautions
A. Contraindications 6. Anaphylactic reaction to a previous dose of vaccine or to a dose of any of the component vaccines, or to a vaccine component including neomycin, and polymyxin B. (See "Contraindications and Precautions" section for each component vaccine under that Vaccine Guideline found in this section.) 7. Administration at age less than 6 weeks or greater than 6 years 8. If Guillain-Barre syndrome occurs within 6 weeks of receipt of a prior vaccine containing tetanus toxoid, the decision to give KinrixTM should be based on potential benefits and risks. 9. Encephalopathy within 7 days of administration of a previous dose of DTP or DTaP 10. Progressive neurologic disorder. Defer DTaP until neurologic status is clarified and stabilized.
C. Precautions: 6. Fever of 105 F, 48 hours after vaccination with a previous dose of DTP or DTaP, or a combination vaccine that contains DTP or DTaP 7. Collapse or shock like state in same circumstances as #1 8. Seizure occurring 3 days after receiving a previous dose of DTP or DTaP or combination vaccine that contains DTP or DTaP 9. Persistent, inconsolable crying lasting 3 hours and occurring 48 hours after vaccine containing DTP or DTaP 10. Moderate or severe acute illness with or without fever 11. Latex sensitivity (needleless prefilled syringes contain dry natural latex rubber)

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Simultaneous Vaccine Administration
May be administered simultaneously with any of the following routinely recommended vaccines:
MMR, Hib, Varicella, Hepatitis B, Influenza, and PCV

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Georgia Department of Human Resources Immunization Program Vaccine Guidelines

F. PENTACEL

Vaccine Description
Pentacel consists of Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed and Inactivated Poliovirus (DTaP-IPV) component and an ActHIB vaccine component. ActHIB vaccine (Haemophilus b Conjugate Vaccine [Tetanus Toxoid Conjugate]), consists of Haemophilus influenzae type b capsular polysaccharide (polyribosyl-ribitol-phosphate [PRP]) covalently bound to tetanus toxoid (PRP-T). The DTaP-IPV component is supplied as a sterile liquid used to reconstitute the lyophilized ActHIB vaccine component to form Pentacel vaccine.

Vaccine Pentacel

Brand Names & Manufacturer
Manufacturer sanofi pasteur

Eligible Groups for State Supplied Vaccine
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section

Recommended Vaccine Schedule

The recommended schedule for Pentacel is similar to those for DTap and ActHib.

Dose 1 2 months

Dose 2 4 months

Dose 3 6 months

Dose 4 15-18 months

Pentacel is approved for the primary series and first booster dose (Doses 1-4) of DTaP, Hib, and IPV vaccination. Four doses of Pentacel vaccine constitute a primary immunization course against pertussis. Three doses of Pentacel vaccine constitute a primary immunization course
against diphtheria, tetanus, H influenzae type b invasive disease, and poliomyelitis; the fourth
dose constitutes a booster vaccination against diphtheria, tetanus, H influenzae type b invasive
disease, and poliomyelitis.
Licensed combination vaccines can be used whenever any components of the combination
are indicated and its other components are not contraindicated and if licensed by the Food and
Drug Administration (FDA) for that dose in the series.

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Recommended Doses & Intervals1

Parameter

Age/ Interval

Minimum age for any dose

6 weeks

Minimum interval for doses 1 and 2

4 weeks

Minimum age for dose 2

10 weeks

Minimum interval for doses 2 and 3

4 weeks

Minimum age for dose 3

14 weeks

Minimum interval for dose 3 and 4

6 months (determined by DTaP component;

minimum interval for dose 3-4 is two months for

Hib and four weeks for IPV)

Minimum age for dose 4

12 months (determined by DTaP and Hib

components). Note that both the minimum

interval AND age must be met for the fourth dose of DTaP or Hib (as Pentacel or any other

formulation) to be counted as valid

Maximum age for any dose

4 years, 364 days (do not administer at age 5

or older)

The schedule, minimum intervals, and minimum ages are determined by the individual

components.

Recommended Dosage and Route
0.5 ml administered intramuscularly

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Contraindications and Precautions
A. Contraindications Anaphylactic reaction to a previous dose of vaccine or to a dose of any of the component vaccines, or to a vaccine component including neomycin, and polymyxin B. (See "Contraindications and Precautions" section for each component vaccine under that Vaccine Guideline found in this section.) Administration at < 6 months of age or >5 years of age or older Encephalopathy within 7 days of administration of a previous dose of DTP or DTaP Progressive neurologic disorder. Defer DTaP until neurologic status is clarified and stabilized.
B. Precautions: Fever of 105F ( 40.5 C.) 48 hours after vaccination with a previous dose of DTP or DTaP, or a combination vaccine that contains DTP or DTaP Collapse or shock like state in same circumstances as #1 Seizure occurring 3 days after receiving a previous dose of DTP or DTaP or combination vaccine that contains DTP or DTaP Persistent, inconsolable crying lasting 3 hours and occurring 48 hours after vaccine containing DTP or DTaP Moderate or severe acute illness with or without fever Latex Allergy
Simultaneous Vaccine Administration
May be administered simultaneously with any of the following routinely recommended vaccines:
MMR, Varicella, Hepatitis B, Hepatitis A, RV, Influenza, PPSV, and PCV

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G. ProQuad

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Vaccine Description

ProQuad (MMRV) is a live virus vaccine containing measles, mumps, rubella, and varicella viruses. In September, 2005 it was licensed by the FDA for use in children ages 12 months through 12 years.
It is a lyophilized preparation of the components of M-M-R II (measles, mumps and rubella combination vaccine); and Varicella (Oka/Merck) Virus Vaccine Live.
This vaccine contains no preservative and comes packaged as single dose vials with separate vials of sterile water diluent.
Special storage and handling guidelines include: o MMRV must be transported and stored at temperatures of 50 F. or colder. o It cannot be stored at refrigerator temperatures and must be used within 30 minutes of being reconstituted and cannot be refrozen.
Guidance is provided in the December 2, 2005 MMWR article, "Notice to Readers: Licensure of Combined Live Attenuated Measles, Mumps, Rubella, Varicella Vaccine," and in the VFC Resolution "Vaccines to Prevent Measles, Mumps, Rubella, and Varicella," Resolution No. 6/06-3.
"ACIP Provisional Recommendations for Use of Measles, Mumps, Rubella and Varicella (MMRV)," October 20, 2009, linked at http://www.cdc.gov/vaccines/recs/provisional/default.htm

Vaccine
ProQuad

Brand Name & Manufacturer
Manufacturer
Merck

Eligible Groups for State Supplied Vaccine
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.

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Recommended Vaccine Schedule1

Dose 1 12-15months

Dose 2 4-6 years

12-47 months 2

15-12 years 3

48 months and older 3

1 MMRV should only be used when both of the component vaccines (MMR and varicella) are indicated and the child is 12 months through 12 years of age. Routinely recommended ages for measles, mumps, rubella and varicella vaccination are 12 through 15 months of age for dose 1 and 4 through 6 years of age for dose 2. 2 Dose 1 at Ages 12 through 47 Months * For the first dose of measles, mumps, rubella, and varicella vaccines at ages 12 through 47 months, either MMR and varicella vaccines or MMRV vaccine can be used. Providers who are considering administering MMRV vaccine should discuss the benefits and risks of both vaccination options with the parents or caregivers. Compared with use of MMR and varicella vaccines at the same visit, use of MMRV vaccine results in one fewer injection but is associated with a higher risk for fever and febrile seizures 5 through 12 days after the first dose among children aged 12 through 23 months* (about one extra febrile seizure for every 2,3002,600 MMRV vaccine doses). Use of MMR and varicella vaccines avoids this increased risk for fever and febrile seizures following MMRV vaccine. Providers who face barriers to clearly communicating these benefits and risks for any reason (e.g., language barriers) should administer MMR and varicella vaccines. 3 Dose 1 at Ages 48 Months and Older and Dose 2 at any Age For the first dose of measles, mumps, rubella, and varicella vaccines at ages 48 months and older and for dose 2 at any age (15 months through 12 years), use of MMRV vaccine generally is preferred over separate injections of its equivalent component vaccines (i.e., MMR and varicella vaccines). Considerations should include provider assessment, patient preference, and the potential for adverse events.

* The 47 month cut-off was chosen on the basis of the epidemiology of febrile seizures: first febrile seizures are uncommon after age 4 years, approximately 94% of febrile seizures occur in children aged less than 4 years.

Minimum Age and Dose Intervals

Dose 1

Minimum Age 12 months

Time Interval to Dose 2 3 months

Spacing and timing of MMRV from individual component vaccines (MMR and varicella):
At least 1 month should elapse between a dose of a measles-containing vaccine and a dose of MMRV.
At least 3 months should elapse between a dose of varicella vaccine and a dose of MMRV. However, if a 2nd dose was administered after at least 28 days following the

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Recommended Dosage and Route

0.5 mL administered subcutaneously

Contraindications

A. Contraindications
Anaphylactic reaction to a prior dose of any of the vaccines (measles, mumps, rubella, or varicella) or to the vaccine components
Moderate or severe illness, with or without fever Altered immune status due to such things as malignancy, immunodeficiency, or
immunosuppressive therapy Receipt of blood products---consult Appendix A of the listed reference for a table
denoting the spacing of live virus vaccines and blood products. Steroid therapy---doses of systemic prednisone or equivalent at a dose of
>2 mg/kg of body weight per day or 20 mg/day Persons receiving ongoing salicylate therapy In persons who develop a rash post-vaccination, there is a minimal risk of
transmission of vaccine virus to close contacts. Thus, vaccinees in which vaccinerelated rash develops, particularly healthcare workers and household contacts of immunocompromised persons, should avoid contact with susceptible persons who are at high risk of serious complications. Pregnancy Untreated, active TB MMRV should not be administered to HIV-positive children. Consult Appendix A of the "Pink Book," 11th edition, for directions on administration of single antigen live virus vaccines to immunocompromised persons.
Precaution
A personal or family (i.e., sibling, parent) history of seizures is a precaution for MMRV vaccination. Studies suggest that children who have a personal or family history of febrile seizures or family history of epilepsy are at increased risk for febrile seizures compared with children who do not have such histories. Children with a personal or family history of seizures generally should be vaccinated with MMR and varicella vaccines because the risks of using MMRV vaccine in this group of children generally outweigh the benefit of MMRV vaccine.

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Simultaneous Vaccine Administration
May be administered simultaneously with any of the following routinely recommended vaccines: Hepatitis A, Hepatitis B, DTaP, Tdap, Td, IPV, Hib, Influenza, MCV, MPSV, HPV, PCV, and PPSV

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Georgia Department of Human Resources Immunization Program Guidelines

VACCINES TO PREVENT INFLUENZA
The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for each of the vaccines supplied by the Georgia Immunization Program. These guidelines were developed from the pertinent Vaccine Resolution from the Vaccines for Children Program and the references below and will be updated as needed. The guidelines are not all inclusive and when more information is needed, the following publications should be referenced: ACIP Vaccine Resolution for the Vaccines for Children Programs (VFC), (Resolution No.
2/08-1) 2006 Red Book: Report of the Committee on Infectious Diseases published by the
American Academy of Pediatrics Epidemiology and Prevention of Vaccine Preventable Diseases, 11th ed. "Prevention & Control of Influenza," MMWR, August 8, 2008, Vol. 57, No. RR-07 "Prevention & Control of Seasonal Influenza with Vaccines," MMWR, July 31, 2009,
Vol.58, No. RR-08
Vaccine Description
Trivalent influenza vaccine (TIV) contains hemaglutinins of 3 strains of virus (typically two (2) type A and one (1) type B), representing the influenza viruses likely to circulate in the U.S. in the upcoming winter. This injectable vaccine is inactivated, but because the viruses were initially grown on embryonated hens' eggs, the vaccine might contain limited amounts of residual egg protein. Manufacturers may use different compounds to inactivate the viruses and add antibiotics to prevent bacterial contamination during production. Therefore, package inserts should be consulted for additional information regarding potential allergenic components.
Live attenuated influenza vaccine (LAIV) is a live, trivalent nasally- administered vaccine. It contains the same strains of influenza virus as the inactivated vaccine. It is manufactured in a manner similar to the TIV so the same precautions should be taken with regard to potential allergenic components.

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Brand Name & Manufacturer

Fluzone
Preservative free, pre-filled syringes
Preservative free, single dose vials
Multi-dose vials containing preservative Fluvirin FluMist Fluarix 1 Flulaval 1

sanofi pasteur
Novartis MedImmune GlaxoSmithKline GlaxoSmithKline

1 Fluarix, and FlulavalTM are currently not supplied by the Georgia Vaccines for Children Program. Providers administering these vaccines should consult the current year's ACIP recommendations and /or the individual vaccine package inserts and develop their own protocols/guidelines. The recommendations of the Advisory Committee on Immunization Practices (ACIP) may differ in some respects from the information found in the package insert for these particular vaccines.

NOTE: Only split-virus vaccines are available in the United States due to the increased potential for febrile reactions with whole-virus preparations.

Eligible Groups for State Supplied Vaccine
The information included in this section is intended for use in administering Fluzone and Fluvirin available from VFC. All single dose units are preservative-free; the multidose vials contain preservative. Administer the specific vaccine formulations as indicated below:
Fluzone (sanofi pasteur) 0.25mL prefilled syringes (no preservative)---for children ages 6 months through 35 months
Fluzone (sanofi pasteur) 0.5 ml prefilled syringes (no preservative)---for children 36 months of age
Fluzone (sanofi pasteur) 10-dose vial (with preservative)---use product in appropriate dosage for children 6 months of age
Fluvirin (Novartis)---10 dose vial (with preservative) for children 4 years of age FluMist (MedImmune)---0.2 mL intranasal spray applicator for healthy children
2 years of age
For additional guidelines for Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.

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Recommended Influenza Vaccine Schedule1, 2
Influenza vaccine is recommended for any person aged 6 months who is at increased risk for complications from influenza. These include:
persons 50 years of age; residents of nursing homes and other chronic-care facilities; persons with chronic pulmonary or cardiovascular disease, including asthma; persons with chronic metabolic diseases such as diabetes mellitus; renal
dysfunction; hemoglobinopathies; or immunosuppression (whether caused by medications or by HIV); children or adolescents receiving long-term aspirin therapy; women who will be pregnant during the influenza season; persons with any condition (e.g. cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration.
Other persons for whom annual vaccination is recommended include: all persons who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others healthcare personnel healthy children aged 6 months through 18 years; healthy household contacts and caregivers of children from birth through 18 years of age and adults aged 50 years, with particular emphasis on vaccinating contacts of children aged <6 months healthy household contacts (including children) and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza
1 To avoid missed opportunities for vaccination of persons at high risk for serious complications, such persons should be offered vaccine beginning in September during routine health-care visits or during hospitalizations, if vaccine is available. (Centers for Disease Control and Prevention. Prevention and Control of Influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, August 8, 2008/Vol. 57 No. RR-07)
2 For guidance on conducting mass influenza clinics, and for prioritizing groups in the event of an influenza vaccine shortfall, go to http://www.cdc.gov/flu/professionals/vaccination/pdf/vax_clinic.htm

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Recommended Doses & Intervals 6

Vaccine Age Group

Fluzone Fluvirin 2

6-35 months 3-8 years 9 years
4-8 years 9 years

Dosage & Route
0.25 mL IM 0.5 mL IM 0.5 mL IM
0.5 mL IM 0.5 mL IM

Number of Doses
1 or 21 1 or 21
1
1 or 21 1

Minimum Interval from dose 1 to 2
28 days 28 days ---------
28 days ---------

FluMist 3

24 months through 35 months

0.2 mL 4 Intranasally

1 or 21

28 days

FluMist 3 9 years

0.2 mL 4 7

1

through 49

intranasally

years of age

Fluarix 5

18 years of age and older

0.5 mL

1

----------------

Flulaval 5

18 years of age and older

0.5 mL

1

---------

1 Two doses at least 4 weeks apart are recommended for children less that 9 years of age
who are receiving influenza vaccine of any type, live or inactivated, for the first time. In
subsequent years, only 1 dose would be necessary, regardless of age or type of vaccine.
Children in this age group who receive only 1 dose in the first year of vaccination should
receive 2 doses in their second year of vaccination. Children recommended for
vaccination who are in their third or more year of being vaccinated and who received
only 1 dose in each of their first 2 years of being vaccinated, should continue receiving a
single annual dose. For further guidance regarding influenza vaccination for children, see
the "algorithm for determining recommended influenza immunization actions for children"
in the current Influenza ACIP statement. 2 Not licensed to be used in children less than 4 years of age. 3 Licensed for use only in healthy persons 2 through 49 years of age. 4 Administer as 0.l mL in each nostril. 5 Not licensed to be used in persons < 18 years of age. 6 All children ages 6 months to< 9 years receiving the influenza vaccine for the first time and
requiring 2 doses do not have to use the same type of vaccine for both doses. The first and
second doses do not have to match; live or inactivated vaccine can be used for either dose.
The doses should be separated by at least one month.

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7 Minimum Interval between Different LAIV Formulations: There are no data on sequential administration of the two types of LAIV (seasonal and 2009 H1N1). The ACIP General Recommendations on live attenuated vaccines indicates that 28 days (4 weeks) is the recommended minimum interval, and can be applied to use of a seasonal LAIV and a 2009 H1N1 LAIV, because these are considered 2 different vaccines. The ACIP recommendations were developed based on data from studies using attenuated live virus vaccines such as measles, mumps and rubella vaccine that are injected. However, based on previous studies of LAIV replication and immune response, as little as 14 days (2 weeks) might be sufficient to allow for an appropriate immune response to both vaccines. Therefore, an interval between the two types of LAIV of 2 weeks or more may be acceptable, although an interval of 28 days is preferred.
CDC, (2009) Frequently asked questions on use of influenza A (H1N1) 2009 monovalent vaccines (2009 H1N1 vaccines): Practical considerations for immunization programs and providers retrieved from http://www.cdc.gov/H1N1flu/vaccination/top10_faq.htm on November 3, 2009.

Recommended Dosage and Route

0.25 mL or 0.5 mL administered intramuscularly for TIV
0.2 mL administered intranasally for LAIV * (Please refer to the package insert for specific and detailed instructions on administering this vaccine. Storage and handling issues should also be addressed with the manufacturer.)
* NOTE: If the vaccine recipient sneezes after administration, the dose should not be repeated. However, if nasal congestion is present that might impede delivery of the vaccine to the nasopharyngeal mucosa, deferral of administration should be considered until resolution of the illness, or TIV should be administered instead.
Contraindications and Precautions

Contraindications (TIV or LAIV) Allergy to vaccine components. Anaphylactic reaction to the vaccine or a constituent of the vaccine (e.g. eggs, thimerosal, or any antibiotic used as a preservative). See package inserts for detailed list of components for each specific vaccine. Moderate or severe illnesses with or without fever. Persons with moderate or severe illness should be immunized as soon as they have recovered from the acute phase of the illness. Minor illnesses (e.g., upper respiratory tract infection, allergic rhinitis) with or without fever should not contraindicate the use of influenza vaccine.
Contraindications specific to LAIV :
Persons with a history of hypersensitivity, including anaphylaxis, to any of the components of LAIV or to eggs.
Persons aged <2 years or those aged >50 years Persons with any of the underlying medical conditions that serve as an indication for
routine influenza vaccination, including asthma, reactive airways disease, or other

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chronic disorders of the pulmonary or cardiovascular systems; other underlying medical conditions, including such metabolic diseases as diabetes, renal dysfunction, and hemoglobinopathies; or known or suspected immunodeficiency diseases or immunosuppressed states Children aged 2-4 years whose parents or caregivers report that a health-care provider has told them during the preceding 12 months that their child had wheezing or asthma, or whose medical record indicates a wheezing episode has occurred during the preceding 12 months Children or adolescents receiving aspirin or other salicylates (because of the association of Reye syndrome with wild-type influenza virus infection) Persons with a history of GBS after influenza vaccination y Pregnant women

Precautions (TIV or LAIV)
History of GBS following influenza vaccination is a precaution for administering Trivalent Influenza Vaccine. Avoiding vaccinating persons who are known to have experienced GBS within 6 weeks after a previous influenza vaccination is prudent. Although data are limited, the established benefits of influenza vaccination might outweigh the risks for many persons who have a history of GBS and who are also at high risk for severe complications from influenza.1
The tip cap and rubber plunger of Fluarix pre-filled syringes contain dry natural latex rubber and may cause allergic reactions in latex sensitive individuals.
Immunization should be delayed in a patient with an active neurologic disorder, but should be considered when the disease process has been stabilized.
1 Centers for Disease Control and Prevention. Prevention and Control of Influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, August 8, 2008/Vol. 57, RR-07

Simultaneous Vaccine Administration
May be administered simultaneously with any of the following routinely recommended vaccines:
DTaP, Tdap, Td, RV, MMR, Varicella, Hib, Hepatitis A, Hepatitis B, IPV, PPSV, PCV, HPV, Zoster, MCV, and MPSV
NOTE: See current ACIP statement regarding FluMist and simultaneous administration with other vaccines. The package insert for this vaccine reports that the safety and immunogenicity of this practice has not been determined.

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Georgia Department of Human Resources Immunization Program Guidelines
VACCINES TO PREVENT HEPATITIS A

The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for each of the vaccines supplied by the Georgia Immunization Program. These guidelines were developed from the pertinent Vaccine Resolution from the Vaccines for Children Program and the references below and will be updated as needed. The guidelines are not all inclusive and when more information is needed, the following publications should be referenced: "Update: Prevention of Hepatitis A After Exposure to Hepatitis A Virus and in
International Travelers," MMWR, October 19, 2007, Vol. 56, No. 41 "Prevention of Hepatitis A Through Active or Passive Immunization." MMWR, May 19,
2006, Vol. 55, No. RR-7 "Notice to Readers: FDA Approval of Havrix (Hepatitis A Vaccine, Inactivated) for
Persons Aged 1--18 Years," MMWR, December 9, 2005, Vol. 54, No. 49 "Notice To Readers: FDA Approval of VAQTA (Hepatitis A Vaccine, Inactivated) for
Children Aged >1 Year," MMWR, October 14, 2005, Vol. 54, No. 40 "Protection Against Viral Hepatitis," MMWR, February 9,1990, Vol.39, No.RR-2; CDC STD Prevention website at http://www.cdc.gov/STD/treatment/7-
2002TG.htm#VaccinePreventableSTDs Hepatitis A Vaccine Resolution for the Vaccines for Children Programs (VFC),
(Resolution No.06-07-1) 2006 Red Book, Report of the Committee on Infectious Diseases by the American
Academy of Pediatrics Epidemiology and Prevention of Vaccine-Preventable Diseases, 11th ed. "Updated Recommendation from the Advisory Committee on Immunization (ACIP) for
use of Hepatitis A Vaccine in Close Contacts of Newly Arriving International Adoptees," MMWR, September 18, 2009, Vol. 58. No. 36

Vaccine Description
Hepatitis A vaccine is an inactivated vaccine grown in cell culture. There are 2 hepatitis A vaccine products licensed for use in the U.S. Both are available
in 2 formulations: adult and pediatric. Both products are currently licensed for persons aged 12 months and older. An additional vaccine product available in the U.S. combines hepatitis A and hepatitis B
vaccine (Twinrix) in an adult formulation for administration to persons ages 18 and older.

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Brand Names & Manufacturer

VACCINES

MANUFACTURER

Havrix

GlaxoSmithKline Biologicals

Pediatric Formulation

720 EL.U./0.5 mL

Adult Formulation

1440 EL.U./1 mL

Vaqta

Merck & Co., Inc.

Pediatric/Adolescent Formulation

25U/0.5 mL

Adult Formulation

50U/1 mL Twinrix (combination hepatitis A and hepatitis B)

GlaxoSmithKline Biologicals

(see "Combination Vaccines Guidelines" in this section for more information)

Eligible Groups for State Supplied Vaccine
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.

Groups Recommended to Receive Hepatitis A Vaccine

Routine childhood/adolescent recommendations for vaccination: Children at 1 year of age. Children who are not vaccinated by age 2 years can be vaccinated at subsequent visits. States, counties, and communities with existing hepatitis A vaccination programs for children aged 2-18 years are encouraged to maintain these programs.
Recommendations for persons who are at increased risk of infection: Persons traveling to developing countries which have high or intermediate endemicity of hepatitis A Men who have sex with men (MSM) Users of injecting and non-injecting illegal drugs Persons who have clotting factor disorders Persons working with HAV infected primates or with HAV in a research laboratory setting Persons with chronic liver disease Close personal contacts of children adopted from countries with high rates of hepatitis A

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Groups Recommended to Receive Hepatitis A Vaccine (cont'd)

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Although hepatitis A may occur in other groups or settings, serologic surveys have not found that they are at increased risk for hepatitis A because of their occupation or setting, and are therefore not routinely recommended to receive vaccine. These would include:
Food service establishments or food handlers Child care centers, employees or attendees Health-care institutions including specific hospital units Institutions for persons who have developmental disabilities Schools Sewage plants or sanitation workers
"Updated Recommendations from the Advisory Committee on Immunization (ACIP) for use of Hepatitis A Vaccine in Close Contacts of Newly Arriving International Adoptees," MMWR, September 18, 2009, Vol. 58. No. 36

Recommended Hepatitis A Vaccine Schedule

Vaccine Havrix
Pediatric
Adult Vaqta
Pediatric
Adult

Age Group
12 months through18 yrs.
19 years
12 months through 18 yrs.
19 years

Number of Doses 2 2 2
2

Volume 0.5 mL 1 mL 0.5 mL 1 mL

Schedule 0, 6-12 mos. 0, 6-12 mos. 0, 6-18 mos. 0, 6-12 mos.

For Twinrix schedule, see "Combination Vaccine Guidelines" in this section.

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Recommended Minimum Age & Time Intervals & Interchangeability of Vaccine Brands

Vaccine1

Minimum age for first dose

Minimum interval from dose 1 to dose 22

Havrix Vaqta Twinrix

12 months

6 months

12 months

6 months

See "Combination Vaccine Guidelines" in this section

1 The 2 brands of vaccine can be considered interchangeable. 2The minimum interval between the first and booster doses of hepatitis A vaccine is six calendar months. If the interval between the first and booster doses of hepatitis A vaccine is longer than the recommended interval of 6-18 months, it is not necessary to repeat the first dose. For both vaccines, the booster dose given should be based on the person's age at the time of the booster dose, not the age when the first dose was given. For example, if a child received the first dose of the pediatric formulation of VAQTA at 18 years of age, and returns for the booster dose at age 19 years, the booster dose should be the adult formulation, not the pediatric formulation.

Recommended Vaccine Dosage and Route
0.5 mL (pediatric formulations) administered intramuscularly 1 mL (adult formulations) administered intramuscularly

Contraindications and Precautions to Vaccine1
Contraindications: 1. Allergy to any vaccine component. (For a complete listing of components, see package insert.) 2. Acute, moderate or severe illnesses with or without fever
Precautions: 1. Pregnancy. The safety of hepatitis A vaccination given during pregnancy has not been determined; however, because hepatitis A vaccine is produced from inactivated HAV, the theoretical risk to the developing fetus is expected to be low. The risk associated with vaccination should be weighed against the risk for hepatitis A in women who may be at high risk for exposure to HAV.
1For Twinrix Contraindications and Precautions see "Combination Vaccine Guidelines" in this section.

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Simultaneous Vaccine Administration

Hepatitis A vaccine may be administered simultaneously with any of the following routinely recommended vaccines:
DTaP, Tdap, Td, Hib, hepatitis B, IPV, Influenza, PCV, PPSV, MMR, Varicella, Zoster, HPV, MCV, and MPSV.

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Recommendations for Hepatitis A Immunoprophylaxis
(see January 2, 2008 Memorandum, "New Policy for Hepatitis A Postexposure Prophylaxis" located at the end of these guidelines)
A. Immune Globulin (IG)
Hepatitis A Immunoprophylaxis with Immune Globulin (IG) is routinely recommended in 2 situations: 1. Pre-exposure prophylaxis for international travel; and 2. Post-exposure prophylaxis for persons <12 months of age or >40 years of age who are contacts to acute cases of hepatitis A
The provision of IG is available from the Epidemiology Branch for hepatitis A postexposure prophylaxis. The State Office of Pharmacy no longer stocks an IG supply. To obtain IG for this purpose, contact: 1. The appropriate designated district epidemiology personnel; and 2. Hepatitis epidemiology staff in the state office at (404) 657-3158 or (404) 657-2588. (When calling to request IG, please have on hand the necessary information regarding name of hepatitis A case and number of contacts, with some descriptive information [i.e., ages].)
Supplies of IG given for pre-exposure prophylaxis, i.e. international travel, should be purchased by districts.
The guidelines below are only a minimum reference and any decision to use IG should be prefaced by further research using available resources, including medical providers. For more specific information, please see Chapter 6, "Surveillance and Reporting" in this manual, the ACIP Hepatitis A statement and the 2006 Red Book references cited in the opening paragraph of "Vaccines to Prevent Hepatitis A."
Pre-exposure Prophylaxis
For persons traveling to certain parts of the world where hepatitis A has high or
intermediate endemicity, immunoprophylaxis is indicated. For persons 1 years of
age, vaccine is preferable over IG. However, for children under 1 year of age, and for those whose travel plans are imminent and therefore do not allow enough time for vaccine to provide adequate protection, IG may be the better choice. (Not supplied by the State)
Post-exposure Prophylaxis for persons <12 months of age or >40 years of age Household and sexual contacts of persons with acute hepatitis A. Administration of
IG should take place within 2 weeks of most recent exposure, and is not indicated if that period of time has already elapsed.
IG should be administered as age appropriate to all previously unvaccinated staff
and attendees of child care centers or homes if 1) one or more cases of hepatitis A are recognized in children or employees, or 2) cases are recognized in two or more households of center attendees.
If a food handler is diagnosed with hepatitis A, IG should be administered to other
food handlers at the same establishment. In the event of a common-source outbreak, IG should NOT be administered to exposed patrons after cases have begun to occur because the 2-week period during which IG is effective will have been exceeded.

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Recommendations for Hepatitis A Immunoprophylaxis (cont'd)

For children aged <12 months, immunocompromised persons, persons who have had chronic liver disease diagnosed, and persons for whom vaccine is contraindicated, IG should be used.
NOTE: IG would not routinely be recommended for: School settings, unless transmission within the school is documented. Hospital personnel caring for patients with hepatitis A disease, unless an outbreak among patients or between patients and staff is documented
B. Hepatitis A Vaccine1,2
For healthy persons ages 12 months through 40 years, single-antigen hepatitis A vaccine at the age-appropriate dose is preferred to IG for post-exposure prophylaxis to hepatitis A infection because of vaccine advantages that include long-term protection and ease of administration.
For person over 40 years of age, IG is preferred; vaccine can be used if IG cannot be obtained.
1 "Update: Prevention of Hepatitis A After Exposure to Hepatitis A Virus and in International Travelers," MMWR, October 19. 2007, Vol. 56, No. 41 2 See pages 1-5 of the Hepatitis A guidelines for the recommended schedule, minimum intervals, and contraindications and precautions for hepatitis A vaccine.
Recommended IG1 Dosage and Route

Time Since Exposure2 Age of Patient Recommended Prophylaxis

2 weeks

<12 months of
age or >40 years of age3

IG, 0.02 mL/kg4

> 2 weeks

All ages

No prophylaxis

1 This product does NOT contain thimerosal. 2 Because hepatitis A cannot be reliably diagnosed on clinical presentation alone, serologic
confirmation of HAV infection in index patients by IgM anti-HAV testing is recommended
before postexposure treatment of contacts. 3 Hepatitis A vaccine is recommended for post-exposure prophylaxis for persons ages 12
months of age through 40 years of age. 4Immune Globulin should be administered deep into a large muscle mass (deltoid, gluteus, or in
children under 24 months of age, the anterolateral thigh muscle.) Ordinarily, no more than
5 mL should be administered in 1 site in an adult or large child; lesser amounts (maximum
3 mL) should be given to small children and infants.

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Contraindications and Precautions to IG

Contraindications: 1. Persons with IgA deficiency. Anaphylaxis has been reported after repeated administration of IG to these persons. 2. Pregnancy or lactation is NOT a contraindication to IG use.
Precautions: 1. IG can interfere with the response to live injected vaccines, such as MMR, varicella, and LAIV. Administration of live vaccines should be delayed for at least 3 months after administration of IG (See Table 4 of ACIP "General Recommendations on Immunization" for more specific guidelines.) 2. Unless the benefits of IG prophylaxis exceed the benefits of vaccination, IG should not be administered for 2 weeks after measles-, mumps-, and rubella-containing vaccines, and for 3 weeks after vaccination with varicella vaccine. If IG is given during this period, the person should be revaccinated with the live vaccine, but not sooner than 3 months after administration of IG.

Simultaneous Administration of IG with Vaccines
Immune Globulin does not interfere in general with inactivated vaccines or to yellow fever vaccine. It may be administered simultaneously with any of the following routinely recommended vaccines:
DTaP, Tdap, Td, Hib, hepatitis A, hepatitis B, IPV, Inactivated Influenza, PCV, PPSV, HPV, MCV.
Seroconversion rates are not impaired by simultaneous administration of IG with the first dose of Hepatitis A vaccine, but lower serum antibody concentrations may be achieved. This decreased immunogenicity is not likely to be clinically important.
See "Contraindications and Precautions" section regarding administration of IG with or near live virus vaccines such as MMR, varicella., and LAIV

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Georgia Department of Human Resources Immunization Program Vaccine Guidelines

VACCINES TO PREVENT MENINGOCOCCAL DISEASE
The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for each of the vaccines supplied by the Georgia Immunization Program. These guidelines should serve as a quick reference for clinics administering A) meningococcal conjugate (MCV) and B) meningococcal polysaccharide (MPSV) vaccines. These guidelines were developed from the pertinent Vaccine Resolution from the Vaccines for Children Program and the references below and will be updated as needed. The guidelines are not all inclusive and when more information is needed, the following publications should be referenced: Notice to Readers: Recommendation from the Advisory Committee on Immunization
Practices (ACIP) for Use of Quadrivalent Meningococcal Conjugate Vaccine (MCV4) in Children Aged 2-10 Years at Increased Risk for Invasive Meningococcal Disease, MMWR, December 7, 2007, Vol. 56, No. 48 Notice to Readers: Revised Recommendations of the Advisory Committee on Immunization Practices to Vaccinate All Persons Aged 11-18 Years with Meningococcal Conjugate Vaccine, MMWR, August 10, 2007, Vol. 56, No. 31 "Prevention and Control of Meningococcal Disease," MMWR, May 27, 2005, Vol. 54, No. RR-7 "Control and Prevention of Meningococcal Disease and Control and Prevention of Serogroup C Meningococcal Disease: Evaluation and Management of Suspected Outbreaks," MMWR, February 14, 1997, Vol. 46, Mo. RR-5 ACIP Vaccines to Prevent Meningococcal Disease, Vaccine Resolution for the Vaccines for Children Programs (VFC), (Resolution No. 10/07-2) 2006 Red Book: Report of the Committee on Infectious Diseases published by the American Academy of Pediatrics Epidemiology and Prevention of Vaccine Preventable Diseases, 11th ed. CDC. Updated Recommendation from the Advisory Committee on Immunization Practices (ACIP) for revaccination of persons at prolonged increased risk for meningococcal disease. MMWR 2009; 58:10423.
A. Meningococcal Conjugate Vaccine (MCV)

Vaccine Description
Meningococcal (Groups A, C, Y, and W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine (MCV4) contains Neisseria meningitidis serogroup A, C, Y, and W-135 capsular polysaccharide antigens individually conjugated to diphtheria toxoid protein. MCV4 is available only in single dose vials. No preservative or adjuvant is added during manufacture. This vaccine was licensed in January, 2005 for use in persons 11-55 years of age, and relicensed to include persons 2-10 years of age in October, 2007.
Protective antibody levels are usually achieved within 7-10 days of vaccination.

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VACCINE
Menactra

Brand Names and Manufacturer
MANUFACTURER
sanofi pasteur

Eligible Groups for State Supplied MCV
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.

ACIP Recommendations for Administration of MCV
In addition to the priority categories listed above, ACIP recommends routine vaccination for certain other persons who are at increased risk for meningococcal disease. Due to limited funds, the state does not supply vaccine for these additional categories. These guidelines are meant to provide information for those districts and clinics that administer this vaccine from privately purchased stock. The following populations are at increased risk for meningococcal disease and are recommended to be vaccinated:
College freshman who live in dormitories Military recruits Persons who will be traveling to or reside in areas in which meningococcal disease is
hyperendemic or epidemic Research, industrial, and clinical laboratory personnel who are routinely exposed to N.
meningitidis in solutions that may be aerosolized Patients with anatomic or functional asplenia and patients with terminal complement
deficiency Other populations that may consider vaccination with MCV:
HIVinfected persons, although the efficacy of MCV among HIV-infected patients is unknown
Persons 2-55 years of age who do not have high risk factors, but wish to decrease their risk for meningococcal disease

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ACIP Recommendations for Administration of MCV (cont'd)
Use of Meningococcal Conjugate Vaccine (MCV) vs. Meningococcal Polysaccharide Vaccine (MPSV):
MCV is the preferred vaccine for people 2-55 years of age in these risk groups, but MPSV can be used if MCV is not available. MPSV should be used for adults over 55 who are at risk. (See Section B, MPSV, of this document.)
MCV is not indicated for:
The prevention of meningitis caused by other microorganisms or for the prevention of invasive meningococcal disease caused by N. meningitidis serogroup B
The treatment of meningococcal infections Immunization against diphtheria
Revaccination
MCV is recommended for persons previously vaccinated with either MCV4 or MPSV4 who are at prolonged increased risk for meningococcal disease should be revaccinated with MCV4. Persons who previously were vaccinated at age 7 years and are at prolonged increased risk should be revaccinated 5 years after their previous meningococcal vaccine, and persons who previously were vaccinated at ages 2--6 years and are at prolonged increased risk should be revaccinated 3 years after their previous meningococcal vaccine. Persons at prolonged increased risk for meningococcal disease include 1) persons with increased susceptibility such as persistent complement component deficiencies (e.g., C3, properdin, Factor D, and late complement component deficiencies), 2) persons with anatomic or functional asplenia, and 3) persons who have prolonged exposure (e.g., microbiologists routinely working with Neisseria meningitidis, or travelers to or residents of countries where meningococcal disease is hyperendemic or epidemic). Persons who remain in one of these increased risk groups indefinitely should continue to be revaccinated at 5-year intervals with MCV4.
Although the duration of protection from MCV4 is unknown, most entering college students will have received MCV4 within the preceding 4 years. Because of the limited period of increased risk, ACIP currently does not recommend that college freshmen living in dormitories who were previously vaccinated with MCV4 be revaccinated.
"Updated Recommendation from the Advisory Committee on Immunization Practices (ACIP) for Revaccination of Persons at Prolonged Increased Risk for Meningococcal Disease", MMWR, September 25, 2009/ 58(37)

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Recommended Doses and Intervals

MCV4

Recommended age for first dose

Booster Doses

Dose 1

11 years1

Revaccination doses for persons at

prolonged risk 2

1 This vaccine is licensed for persons 2-55 years of age if indicated. 2 Persons who previously were vaccinated at age 7 years and are at prolonged increased risk should be

revaccinated 5 years after their previous meningococcal vaccine, and persons who previously were

vaccinated at ages 2--6 years and are at prolonged increased risk should be revaccinated 3 years after

their previous meningococcal vaccine. Persons at prolonged increased risk for meningococcal disease

include 1) persons with increased susceptibility such as persistent complement component deficiencies

(e.g., C3, properdin, Factor D, and late complement component deficiencies), 2) persons with anatomic

or functional asplenia, and 3) persons who have prolonged exposure (e.g., microbiologists routinely

working with Neisseria meningitidis, or travelers to or residents of countries where meningococcal

disease is hyperendemic or epidemic). Persons who remain in one of these increased risk groups

indefinitely should continue to be revaccinated at 5-year intervals with MCV4.

Recommended Dosage and Route
0.5 mL administered intramuscularly1, preferably in the deltoid 1 For guidance on the follow-up of vaccine doses inadvertently administered subcutaneously, rather than intramuscularly, please reference "Inadvertent Misadministration of Meningococcal Conjugate Vaccine---United State, June---August, 2005," MMWR, September 22, 2006, Vol. 55 No. 37.

Contraindications
The following conditions are contraindications to the administration of MCV:
1. Allergy to vaccine components Anaphylactic reaction to either MCV or MPSV or a constituent of either of these vaccines, including diphtheria toxoid (for MCV) or dry natural rubber latex.
2. Acute, moderate or severe illnesses with or without fever Persons with moderate or severe illness should be immunized as soon as they have recovered from the acute phase of the illness. Minor illnesses (e.g. upper respiratory tract infection, allergic rhinitis) with or without fever should not contraindicate the use of meningococcal conjugate vaccine.
3. Previous history of Guillain-Barr syndrome (GBS)1,2
NOTE: MCV is a new vaccine and has not been studied as much as MPSV with regard to
pregnant women. Women of childbearing age who become aware that they were pregnant at the time of MCV vaccination should contact their healthcare provider or the vaccine manufacturer.
1 "Guillain-Barr Syndrome Among Recipients of Menactra Meningococcal Conjugate Vaccine --- United States, June--July 2005," MMWR, October 14, 2005, Vol. 54, No. 40
2 "Update: Guillain-Barr Syndrome Among Recipients of Menactra Meningococcal Conjugate Vaccine-United States, October 2005---February 2006," MMWR, April 7, 2006, Vol. 55, No. 13
3 "Update: Guillain-Barr Syndrome Among Recipients of Menactra Meningococcal Conjugate Vaccine -United States, June 2005--September 2006," MMWR, October 20, 2006, Vol. 55. No. 41

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Simultaneous Vaccine Administration
MCV may be administered simultaneously with any of the following routinely recommended vaccines:
DTap,Tdap, Td, MMR, Varicella, Hepatitis A, Hepatitis B, IPV, Influenza, HPV, Hib, PCV and PPSV
B. Meningococcal Polysaccharide Vaccine (MPSV)
Vaccine Description
Meningococcal Polysaccharide Vaccine, Groups A, C, Y, and W-135 Combined (MPSV) is a freeze-dried preparation of the group-specific polysaccharide antigens from Neisseria meningitidis, Group A, Group C, Group Y, and Group W-135. It is available in single dose (0.5mL) and 10 dose (5 mL) vials. The vials of diluent used to reconstitute single doses of vaccine are preservative-free. However, the 6 mL vial of diluent intended for reconstitution of the10 mL vial of freeze-dried vaccine contains thimerosal that has been added as a preservative. This vaccine was licensed for use in the United States in 1981.
Protective antibody levels may be achieved within 7-10 days after vaccination.

Brand Names and Manufacturer

VACCINE
Menomune

MANUFACTURER
sanofi pasteur

Eligible Groups for State Supplied Vaccine (MPSV4)
The Georgia Immunization Program and the Georgia Vaccines for Children Program do not currently supply meningococcal polysaccharide vaccine (Menomune) for any populations. These guidelines are meant to provide information for those districts and clinics that administer this vaccine using privately purchased stock.

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ACIP Recommendations for Administration of MPSV4
ACIP recommends that MPSV should be used for adults age 56 and older who are at risk for meningococcal disease. The following high risk populations in that age group are recommended to be vaccinated with MPSV:
Persons who are traveling to countries in which N. meningitidis is hyperendemic or epidemic, particularly if contact with the local population will be prolonged
Persons with terminal complement deficiencies and those with anatomic or functional
asplenia Persons who are infected with HIV Research, industrial, and clinical laboratory personnel who routinely are exposed to N.
meningitidis in solutions that may be aerosolized Persons who might have been exposed to meningococcal disease during an outbreak
Revaccination: Persons who previously were vaccinated with MPSV4 at age 7 years and are at prolonged increased risk should be revaccinated 5 years after their previous meningococcal vaccine with MCV4. Persons who previously were vaccinated at ages 2--6 years and are at prolonged increased risk should be revaccinated 3 years after their previous meningococcal vaccine with MCV4. Persons at prolonged increased risk for meningococcal disease include 1) persons with increased susceptibility such as persistent complement component deficiencies (e.g., C3, properdin, Factor D, and late complement component deficiencies), 2) persons with anatomic or functional asplenia, and 3) persons who have prolonged exposure (e.g., microbiologists routinely working with Neisseria meningitidis, or travelers to or residents of countries where meningococcal disease is hyperendemic or epidemic. Persons who remain in one of these increased risk groups indefinitely should continue to be revaccinated at 5-year intervals with MCV4. College freshmen living in dormitories who were vaccinated with MPSV4 5 years previously are recommended to be vaccinated with MCV4.1 "Updated Recommendation from the Advisory Committee on Immunization Practices (ACIP) for Revaccination of Persons at Prolonged Increased Risk for Meningococcal Disease", MMWR, September 25, 2009/ 58(37)

MPSV
Dose 1

Recommended Doses and Intervals1

Minimum age for first dose2,3

Minimum interval from

dose 1 to 2 (when indicated)

2 years

(1) 2-3 years for children first vaccinated when they were <4 years of age
(2) 3-5 years for persons aged 4 years and older

1 Multidose vials of MPSV must be used within 35 days of reconstitution. Any doses remaining after that date should not be administered. 2 MCV is the recommended vaccine for children 2 years of age and older 3In general, use of MPSV should be restricted to persons 2 years of age and older; however, children as young as 3 months of age may be vaccinated to elicit short-term protection against serogroup A meningococcal disease (two doses administered 3 months apart should be considered for children 3-18 months of age).

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Recommended Dosage and Route
0.5 mL administered subcutaneously
Contraindications and Precautions
The following conditions are contraindications to the administration of MPSV:
1. Allergy to vaccine components Anaphylactic reaction to either MPSV or MCV or a constituent of either of these vaccines, including diphtheria toxoid (for MCV) or dry natural rubber latex.
2. Acute, moderate, or severe illnesses with or without fever Persons with moderate or severe illness should be immunized as soon as they have recovered from the acute phase of the illness. Minor illnesses (e.g. upper respiratory tract infection, allergic rhinitis) with or without fever should not contraindicate the use of meningococcal polysaccharide vaccine.
Based on data from studies involving use of meningococcal vaccines and other polysaccharide vaccines administered during pregnancy, altering meningococcal vaccination recommendations for MPSV during pregnancy is unnecessary.
Simultaneous Vaccine Administration
MPSV may be administered simultaneously with any of the following routinely recommended vaccines:
DTaP, Tdap, Td, MMR, Varicella, Hib, Hepatitis A, Hepatitis B, IPV, Influenza, PCV, PPSV, ZOS and HPV

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Georgia Department of Human Resources Immunization Program Vaccine Guidelines

VACCINES TO PREVENT ROTAVIRUS GASTROENTERITIS
The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for each of the vaccines supplied by the Georgia Immunization Program. These guidelines were developed from the pertinent Vaccine Resolution from the Vaccines for Children Program and the references below and will be updated as needed. The guidelines are not all inclusive and when more information is needed, the following publications should be referenced: "Prevention of Rotavirus Gastroenteritis among Infants and Children," MMWR, August
11, 2006, Vol. 55 ACIP Rotavirus Gastroenteritis Vaccine Resolution for the Vaccines for Children
Programs (VFC), (Resolution No. 6/08-1) "Prevention of Rotavirus Gastroenteritis among Infants and Children," MMWR, Feb 6,
2009, Vol. 58, RR-02
A. Rotateq (RV5) Vaccine Description
Pentavalent rotavirus vaccine is an oral vaccine that contains 5 live, reassortant rotaviruses isolated from human and bovine hosts. There are no preservatives or thimerosal present. The vaccine is a pale yellow clear liquid that may have a pink tint. It is supplied in a squeezable plastic, latex-free dosing tube with a twist-off cap, allowing for direct oral administration.

RotaTeq

Brand Names & Manufacturer
Merck & Co.

Eligible Groups for State Supplied Vaccine
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.

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Recommended RV5 Rotavirus Vaccine Schedule

Dose

Age

Primary 1 Primary 2 Primary 3

2 months 4 months 6 months

Recommended Doses & Intervals 2

Number of doses in series Recommended ages for doses
Minimum age for first dose Maximum age for first dose
Interval between doses Maximum age for last dose

Rotateq

3 2 , 4 and 6 months
6 weeks 14 weeks 6 days1 4 weeks or more 8 months 0 days

1 Vaccination should not be initiated for infants >15 weeks of age. However, for infants in whom the first dose is inadvertently administered off label at age 15 weeks and 0 days or later, the rest of the vaccine series should be completed as per the schedule.
2 ACIP recommends that the rotavirus vaccine series be completed with the same product whenever possible. However, vaccination should not be deferred because the product used for a previous dose(s) is not available or unknown. Continue or complete the series with product available.
NOTE: Infants who have had rotavirus gastroenteritis before receiving the full course of rotavirus vaccinations should still initiate or complete the 3-dose schedule because the initial infection frequently provides only partial immunity.

Special Situations: 1. Premature infants (< 37 weeks gestation)----immunize if they are: a. At least 6 weeks of age b. Clinically stable c. Being or have been discharged from the nursery 2. Infants living in households with immunocompromised persons can be vaccinated. The benefit to the household members of vaccinating young children outweighs the small risk for transmitting vaccine virus to immunocompromised persons. To minimize even this risk, all household members should employ good hygiene practices, especially after changing the infant's diapers. 3. Regurgitation of the vaccine dose---if for any reason an incomplete dose is administered (e.g., infant spits or regurgitates the vaccine), a replacement dose is not recommended. The infant should continue to receive any remaining doses in the recommended series at appropriate intervals. 4. Infants living in households with pregnant women can be vaccinated. 5. Hospitalization after recent rotavirus vaccination---no precautions other than routine standard precautions need be taken. 6. Rotavirus may be administered at any time before, concurrent with, or after administration of any blood product, including antibody-containing products.

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Recommended Dosage and Route
2 mL (in individual single dose tube) administered orally
Contraindications and Precautions
Contraindications:
1. Serious allergic reaction to vaccine components or after receiving a previous dose of rotavirus vaccine
Precautions:
1. Acute gastroenteritis--- rotavirus vaccine should not be administered to infants with acute, moderate to severe gastroenteritis until the condition improves.
2. Moderate to severe illness---vaccinate infants as soon as they have recovered from the acute phase of the illness.
3. Preexisting chronic gastrointestinal disease---providers should consider the potential risks and benefits of administering this vaccine to infants with this preexisting condition. Infants with preexisting chronic gastrointestinal conditions (i.e. congenital malabsorption syndromes, Hirschsprung's disease, short-gut syndrome, or persistent vomiting of unknown cause) and not undergoing immunosuppressive therapy should benefit from rotavirus vaccination and the benefits outweigh the theoretical risks.
4. Intussusception---the current rotavirus vaccine has shown no evidence of an association with intussusception. However, additional post-licensure surveillance data are required to confirm that the vaccine is not associated with intussusception. Until post-licensure data on safety of rotavirus vaccine are available, the risks and benefits of vaccination should be considered when vaccinating infants with a previous episode of intussusception. Until further safety data is available, vaccination of these infants with rotavirus vaccine should be delayed.
5. Altered immunocompetence---providers should consider the potential risks and benefits of administering rotavirus vaccine in this situation. Shedding of the vaccine virus may be possible, particularly after administration of the first dose. Caution is advised when considering whether to administer rotavirus vaccine to individuals with immunodeficient close contacts. No safety or efficacy data are available for the administration of this vaccine to infants who are potentially immunocompromised including: a. Infants with blood dyscrasias, leukemia, lymphomas of any type or other malignant neoplasms b. Infants on immunosuppressive therapy (including high-dose systemic corticosteroids) c. Infants with primary and acquired immunodeficiency states d. Infants who are HIV-exposed or infected. However, two considerations support vaccination of HIV-exposed or infected infants: first, the HIV diagnosis might not be established in infants born to HIV-infected mothers before the age of the first rotavirus vaccine and second, vaccine strains of rotavirus are considerably attenuated.

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Simultaneous Vaccine Administration

May be administered simultaneously with any of the following routinely recommended vaccines:
DTaP, Hib, Hepatitis B, IPV, inactivated influenza and Pneumococcal Conjugate (PCV)

B. Rotarix (RV1) Vaccine Description
Rotarix (RV1) is a live, oral, attenuated rotavirus vaccine derived from the human 89-12 strain which belongs to G1P[8] type. The liquid diluent contains calcium carbonate, sterile water, and xanthan. The diluent includes an antacid component (calcium carbonate) to protect the vaccine during passage through the stomach and prevent its inactivation due to the acidic environment of the stomach. ROTARIX contains no preservatives. The tip cap and the rubber plunger of the oral applicator contain dry natural latex rubber. The vial stopper and transfer adapter are latex-free.

Brand Names & Manufacturer

Rotarix

GlaxoSmithKline

Eligible Groups for State Supplied Vaccine
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.

Recommended RV1 Rotavirus Vaccine Schedule

Dose

Age

Primary 1

2 months

Primary 2

4 months

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Recommended Doses & Intervals 3

Number of doses in series Recommended ages for doses
Minimum age for first dose Maximum age for first dose
Interval between doses Maximum age for last dose

Rotarix

2
2 and 4 months
6 weeks 14 weeks 6 days1 4 weeks or more2
8 months 0 days

1 Vaccination should not be initiated for infants aged 15 weeks 0 days or older because of insufficient data on safety of dose 1 of rotavirus vaccine in older infants. For infants to whom dose 1 is administered inadvertently at age 15 weeks and 0 days or older, the rest of the rotavirus vaccination series should be completed according to the schedule and by 8 months and 0 days. 2 The minimum interval between doses of rotavirus vaccine is 4 weeks; no maximum interval is set. 3 ACIP recommends that the rotavirus vaccine series be completed with the same product
whenever possible. However, vaccination should not be deferred because the product used for a previous dose(s) is not available or unknown. Continue or complete the series with product available. If any dose in the series is RV5 or the vaccine product is unknown for any dose in the series, a total of 3 doses of rotavirus should be administered.

NOTE: Infants who have had rotavirus gastroenteritis before receiving the full course of rotavirus vaccinations should still initiate or complete the 2-dose schedule because the initial infection frequently provides only partial immunity.
Special Situations: 1. Premature infants (< 37 weeks gestation)----immunize if they are: a. At least 6 weeks of age b. Clinically stable c. Are being or have been discharged from the nursery 2. Infants living in households with immunocompromised persons can be vaccinated. The benefit to the household members of vaccinating young children outweighs the small risk for transmitting vaccine virus to immunocompromised persons. To minimize even this risk, all household members should employ good hygiene practices, especially after changing the infant's diapers. 3. Regurgitation of the vaccine dose---if for any reason an incomplete dose is administered (e.g., infant spits or regurgitates the vaccine), a replacement dose is not recommended. The infant should continue to receive any remaining doses in the recommended series at appropriate intervals. 4. Infants living in households with pregnant women can be vaccinated. 5. Hospitalization after recent rotavirus vaccination---no precautions other than routine standard precautions need be taken. 6. Rotavirus may be administered at any time before, concurrent with, or after administration of any blood product, including antibody-containing products.

Recommended Dosage and Route
1 mL (in individual single dose tube) administered orally

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Contraindications and Precautions
Contraindications:
1. Serious allergic reaction to vaccine components or after receiving a previous dose of rotavirus vaccine
2. Allergy to latex (latex rubber is contained in the RV1 oral applicator)
Precautions:
1. Acute gastroenteritis--- rotavirus vaccine should not be administered to infants with acute, moderate to severe gastroenteritis until the condition improves.
2. Moderate to severe illness---vaccinate infants as soon as they have recovered from the acute phase of the illness.
3. Preexisting chronic gastrointestinal disease---providers should consider the potential risks and benefits of administering this vaccine to infants with this preexisting condition. Infants with preexisting chronic gastrointestinal conditions (i.e. congenital malabsorption syndromes, Hirschsprung's disease, short-gut syndrome, or persistent vomiting of unknown cause) and not undergoing immunosuppressive therapy should benefit from rotavirus vaccination and the benefits outweigh the theoretical risks.
4. Intussusception---the current rotavirus vaccine has shown no evidence of an association with intussusception. However, additional post-licensure surveillance data are required to confirm that the vaccine is not associated with intussusception. Until post-licensure data on safety of rotavirus vaccine are available, the risks and benefits of vaccination should be considered when vaccinating infants with a previous episode of intussusception. Until further safety data is available, vaccination of these infants with rotavirus vaccine should be delayed.
5. Altered immunocompetence---providers should consider the potential risks and benefits of administering rotavirus vaccine in this situation. Shedding of the vaccine virus may be possible, particularly after administration of the first dose. Caution is advised when considering whether to administer rotavirus vaccine to individuals with immunodeficient close contacts. No safety or efficacy data are available for the administration of this vaccine to infants who are potentially immunocompromised including: a. Infants with blood dyscrasias, leukemia, lymphomas of any type or other malignant neoplasms b. Infants on immunosuppressive therapy (including high-dose systemic corticosteroids) c. Infants with primary and acquired immunodeficiency states d. Infants who are HIV-exposed or infected. However, two considerations support vaccination of HIV-exposed or infected infants: first, the HIV diagnosis might not be established in infants born to HIV-infected mothers before the age of the first rotavirus vaccine and second, vaccine strains of rotavirus are considerably attenuated
6. Infants with Spina Bifida or Bladder Exstrophy experts prefer that infants at high risk for acquiring latex allergy, receive RV5 instead of RV1 to minimize latex exposure in these children.

Simultaneous Vaccine Administration

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May be administered simultaneously with any of the following routinely recommended vaccines:

DTaP, Hib, Hepatitis B, IPV, inactivated Influenza, and PCV

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Georgia Department of Human Resources Immunization Program Vaccine Guidelines

VACCINES TO PREVENT HUMAN PAPILLOMAVIRUS INFECTION
The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for this vaccine. These guidelines were developed from the references below and will be updated as needed. The guidelines are not all inclusive and when more information is needed, the following publications should be referenced: "Quadrivalent Human Papillomavirus Vaccine," MMWR, March 23, 2007, Vol. 56, No.
RR-2 ACIP Human Papillomavirus Resolution for the Vaccines for Children Program (VFC),
(Resolution No. 6/08-2) HPV vaccine package insert for HPV4 & HPV2 Epidemiology and Prevention of Vaccine-Preventable Diseases, 11th ed. Provisional guidelines for HPV Vaccine at
http://www.cdc.gov/vaccines/recs/provisional/downloads/hpv-vac-dec2009-508.pdf

Vaccine Description
Gardasil is a non-infectious recombinant, quadrivalent vaccine prepared from virus-like particles of HPV Types 6, 11, 16, and 18. HPV types 16 and 18 cause approximately 70% of cervical cancer. Types 6 and 11 cause approximately 90% of genital wart cases. This product does not contain a preservative or antibiotics. After thorough agitation, it is a white, cloudy liquid.
Cervarix is a Human papillomavirus bivalent (types 16 and 18) vaccine, recombinant] for the prevention of cervical pre-cancers and cervical cancer associated with oncogenic human papillomavirus (HPV) types 16 and 18 for use in girls and young women (aged 1025).
It is important to emphasize these points: Females should continue to have routine cervical cancer screening as recommended by their healthcare provider. Females do not need to get an HPV test or Pap test before receiving vaccine. If the person is already infected, the tests cannot tell which type of HPV she has. There are many types of HPV and vaccination would provide protection against infection with those types not already acquired.

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Brand Names & Manufacturer

Gardasil Cervarix

(HPV4) (HPV2)

Merck & Co., Inc. GlaxoSmithKline

Eligible Groups for State Supplied Vaccine
For Adults, Children, and Adolescents, see "Eligibility for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults" located in the front of this section.

Provisional Recommended HPV Vaccine Schedule 1, 2

Vaccine

Dose 1

Dose 2

Dose 3

Gardasil 3,4,5,6 11-12 years of age 1- 2 months after Dose

6 months after Dose 1

Cervarix 4,6

11-12 years of age 1-2 months after Dose 6 months after Dose 1

1 Catch-up vaccination is recommended for females 13-26 years of age who have not been

previously vaccinated or who have not completed the full series.

Note: Interrupted vaccine schedules

If the HPV vaccine schedule is interrupted, the vaccine series does not need to be restarted. 2 HPV vaccines are most effective for both males and females when given before exposure to HPV

through sexual contact. 3 The ACIP provisional recommendation is for this vaccine series to be administered to females

aged 11-12 years at their pre-adolescent visit to their healthcare provider. HPV4 may be

administered in a 3-dose series to males aged 9 through 18 years to reduce their likelihood of

acquiring genital warts. 4 HPV4 or HPV2 is recommended for the prevention of cervical precancers and cancers in females.

5 HPV4 is recommended for prevention of cervical cancers and precancers and genital warts. 6Whenever possible, the same HPV vaccine product should be use for all doses in the series

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Recommended Age & Dose Intervals

Vaccine Gardasil Cervarix

Recommended

Minimum interval

age for first dose

Dose 1 to Dose 2

11-12 years (minimum age 4 weeks

is 9 years) 2

11-12 years (minimum age 4 weeks

is 9 years)

1 The minimum interval between the first and third dose is 24 weeks. 2 This vaccine is licensed for use in females and males 9-26 years of age.

Minimum Interval 1 Dose 2 to Dose 3
12 weeks
12 weeks

Recommended Dosage and Route
0.5mL administered intramuscularly In the deltoid region of the upper arm or in the higher anterolateral area of the thigh

Contraindications and Precautions
Contraindications: 1. Previous anaphylactic or allergic reaction to yeast, to any other vaccine component, or to a previous dose of HPV vaccine.
Precautions: 1. Persons with moderate or severe acute illness 2. Persons with impaired immune responsiveness either from disease or medication can receive the vaccine, but may have reduced antibody response to active immunization. 3. Not recommended for use in pregnant women. However, pregnancy testing is not needed before vaccination. Any exposure to vaccine during pregnancy should be reported to the appropriate vaccine pregnancy registry: 1-800-986-8999 (Merck and Co. Inc. for quadrivalent HPV vaccine) 1-888-452-9622 (GlaxoSmithKline for bivalent HPV vaccine) 4. Bivalent HPV vaccine in prefilled syringes is contraindicated for persons with anaphylactic latex allergy.
Special Situations: 1. Lactating women can receive HPV vaccine. 2. Syncope can occur after vaccination, most commonly among adolescents and
young adults. To avoid serious injury related to syncopal episode, observation for 15 minutes after administration is recommended.

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Simultaneous Vaccine Administration
May be administered simultaneously with any of the following routinely recommended vaccines: Tdap, Td, MMR, Varicella, Hepatitis A, Hepatitis B, IPV, MCV, MPSV, Influenza, and PPSV NOTE: Can be administered to lactating women.

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Georgia Department of Human Resources Immunization Program Vaccine Guidelines

VACCINES TO PREVENT HERPES ZOSTER (SHINGLES) DISEASE

The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for this vaccine, though it is not supplied by the Georgia Immunization Program. These guidelines were developed from the vaccine package insert and the references below and will be updated as needed. The guidelines are not all inclusive and when more information is needed, the following publications should be referenced:
"ACIP Recommendations for the Use of the Prevention of Herpes Zoster," MMWR, June 6, 2008, Vol. 57, No. RR-5.
Vaccine package insert; available at http://www.fda.gov/cber/label/zosmer052506LB.pdf

Vaccine Description
Licensed zoster vaccine is a lyophilized preparation of a live, attenuated strain of VZV, the same strain used in the varicella vaccines. However, its minimum potency is at least 14times the potency of single-antigen varicella vaccine. To maintain potency, lyophilized zoster vaccine must be stored frozen at an average temperature of 5 F (-15C) until it is reconstituted for injection.

Zostavax

Brand Names & Manufacturer
Merck

Eligible Groups for State Supplied Vaccine
This vaccine is not supplied by the Georgia Immunization Program. These guidelines are for informational purposes only.

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ACIP Recommendations for Administration of ZosterVax1
Zoster vaccine is recommended for all persons aged >60 years who have no contraindications, including persons who report a previous episode of zoster or who have chronic medical conditions. Zoster vaccination is not indicated to treat acute zoster, to prevent persons with acute zoster from developing postherpetic neuralgia (PHN), or to treat ongoing PHN.
Vaccination of Persons who have received Varicella Vaccine
Zoster vaccination is not recommended for persons of any age who have received varicella vaccine. However, health-care providers do not need to inquire about varicella vaccination history before administrating zoster vaccine because virtually all persons currently or soon to be in the recommended age group have not received varicella vaccine. In the United States, varicella vaccination began in 1995. Since that time, few adults aged 40 years would have been susceptible to varicella and thus eligible to receive varicella vaccine. The number of persons eligible for zoster vaccine who have received varicella vaccine is extremely small and will remain so for at least a decade.

Recommended Herpes Zoster Vaccine Schedule

Vaccine Zostavax

Dose 1

Minimum Age 60 years

Recommended Dosage and Route
0.65 mL administered subcutaneously in the deltoid region

1"ACIP Recommendations for the Use of the Prevention of Herpes Zoster," MMWR, June 6, 2008, Vol. 57, No. RR-5.

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Contraindications and Precautions

Contraindications: 1. History of anaphylactic reaction to gelatin, neomycin, or any other vaccine component 2. History or primary or acquired immunodeficiency states including leukemia, lymphomas of any type, or other malignant neoplasms affecting the bone marrow or lymphatic system; AIDS or other clinical manifestations of infection with HIV 3. Individuals on immunosuppressive therapy, including high-dose corticosteroids 4. Individuals with active untreated tuberculosis 5. Women who are or may become pregnant 6. Persons undergoing hematopoietic stem cell transplantation (HSCT)
Precautions: 1. Moderate to severe illness

Special Groups and Circumstances
1. Persons with a reported history of zoster can be vaccinated 2. Persons anticipating immunosuppression- The risk for zoster and its severe
morbidity and mortality is much greater among persons who are immunosuppressed. Such patients without a history of zoster vaccination should receive 1 dose of zoster vaccine at the first possible clinical encounter while their immunity is intact. Zoster vaccine should be administered at least 14 days before initiation of immunosuppressive therapy, although some experts advise waiting 1 month after zoster vaccination to begin immunosuppressive therapy if delay is possible 3. Persons receiving antiviral medication- These agents might interfere with replication of the live, VZV-based zoster vaccine 4. Persons receiving blood products-Zoster vaccine can be administered to persons at any time before, concurrent with, or after receiving blood or other anti-bodycontaining blood products.

Simultaneous Vaccine Administration

May be administered simultaneously with any of the following routinely recommended vaccines:
Tdap, Td, MMR, Hepatitis A, Hepatitis B, Polio, Influenza,
If simultaneous administration is not possible, zoster vaccine can be administered at any time before or after an inactivated vaccine, but at least 4 weeks before or after another live, attenuated vaccine

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Georgia Department of Community Health Immunization Program Vaccine Guidelines

VACCINES to Prevent H1N1 Influenza (2009)

The purpose of these guidelines is to provide public health clinics with a summary of the current Recommendations of the Advisory Committee on Immunization Practices (ACIP) for each of the vaccines supplied by the Georgia Immunization Program. These guidelines should serve as a quick reference for clinics administering vaccine. The guidelines are not all inclusive and when more information is needed, the following publications should be referenced:
"Use of Influenza A (H1N1) 2009 Monovalent Vaccine," MMWR, August 21, 2009, Vol.58, (Early Releases); 1-8
Vaccine Description
Influenza A (H1N1) 2009 Monovalent Live, Intranasal is a live monovalent nasally-administered influenza virus vaccine. The single influenza strain contained in Influenza A (H1N1) 2009 Monovalent Live, Intranasal is cold-adapted in that it replicates efficiently at low temperatures such as 25, is temperature-sensitive in that its replication is reduced at higher temperatures of 37 (for influenza B) and 39 (for influenza A), and is attenuated in that it does not produce classical influenza-like illness in the ferret model of human influenza infection. Influenza A (H1N1) 2009 Monovalent Live, Intranasal is indicated for the active immunization of health children and adults, 249 years of age against influenza caused by pandemic (H1N1) 2009 virus.
Influenza A (H1N1) 2009 Monovalent Vaccine, an inactivated influenza virus vaccine, for intramuscular use, is prepared from influenza viruses propagated in embryonated chicken eggs. Manufacturers may use different compounds to inactivate the viruses and add antibiotics to prevent bacterial contamination during production. Therefore, package inserts should be consulted for additional information regarding potential allergenic components.

Brand Names & Manufacturer
sanofi pasteur (three presentations of injectable vaccine) 0.25mL prefilled syringe (no preservative) distinguished by a pink syringe plunger rod 0.5 mL prefilled syringe (no preservative) 5 mL multi-dose with preservative
CSL (two presentations of injectable vaccine) 0.5 mL prefilled syringe (no preservative) 5 mL multi-dose with preservative

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Novartis (two presentations) 0.5 mL prefilled syringe (no preservative) 5 mL multi-dose with preservative
MedImmune (one presentation) 0.2 mL prefilled intranasal sprayer
GlaxoSmithKline (pending FDA approval)

Division of Public Health

Initial Target Groups
Pregnant women, Persons who live with or provide care for infants aged < 6 months (e.g., parents, siblings, and
daycare providers), Health-care and emergency medical services personnel Children and young adults aged 6 months-24 years and Persons aged 25-64 years with any condition (e.g. cognitive dysfunction, spinal cord injuries,
seizure disorders, or other neuromuscular disorders) that can compromise respiratory function
As more vaccine becomes available, these groups should also be vaccinated: Healthy 25 through 64 year olds Adults 65 years and older
The Federal government is providing this vaccine for receipt on a voluntary basis.
Recommended Influenza Vaccine Schedule1, 2

Recommended Doses, Intervals & Route

Manufacturer sanofi pasteur

Age Group

Dosage & Route

6-35 months 36 months through 9 yrs 10 years of age & older

0.25mL IM 0.5 mL IM 0.5 mL IM

# of Doses
2 2 1

Minimum Interval From dose 1-2 4 weeks 4 weeks

CSL

Adults (18 years or older)

0.5 mL IM

1

Novartis

4 through 9 years

0.5mL IM

2

4 weeks

10 years of age & older

0.5mL IM

1

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MedImmune

2 years through 9 years Children, adolescents & Adults (10-49)

GlaxoSmithKline Pending

0.2 mL intranasal 2 0.2 mL intranasal 1

4 weeks**

FDA has approved two doses for children 6 months through 9 years of age. Each 0.2 mL dose is administered as 0.1 mL per nostril. Should not be administered to children under the age of 2 years, or to any person with asthma or child < 5 years of age with a history of asthma or wheezing. Refer to package insert. Intranasal vaccine is contraindicated in children and adolescents (2-17 years of age) receiving aspirin therapy or aspirin-containing therapy, because of the association of Reye's syndrome with aspirin and wild-type influenza infection. ** There are no data on sequential administration of the two types of LAIV (seasonal and 2009 H1N1). The ACIP General Recommendations on live attenuated vaccines indicates that 28 days (4 weeks) is the recommended minimum interval, and can be applied to use of a seasonal LAIV and a 2009 H1N1 LAIV, because these are considered 2 different vaccines. The ACIP recommendations were developed based on data from studies using attenuated live virus vaccines such as measles, mumps and rubella vaccine that are injected. However, based on previous studies of LAIV replication and immune response, as little as 14 days (2 weeks) might be sufficient to allow for an appropriate immune response to both vaccines. Therefore, an interval between the two types of LAIV of 2 weeks or more may be acceptable, although an interval of 28 days is preferred.

Contraindications and Precautions

The following conditions are contraindications and precautions to the administration of vaccine: Contraindications:

1. Hypersensitivity to egg proteins or any other vaccine components, or life-threatening reactions after previous administration of any influenza vaccine. Consult package insert. 2. Moderate or severe illness with or without fever.

Precautions: 1. If Guillain-Barr Syndrome (GBS) has occurred within 6 weeks of previous influenza vaccination, the decision to give Influenza A (H1N1) 2009 Monovalent Vaccine should be based on careful consideration of the potential benefits and risks. 2. Immunocompromised persons may have a diminished immune response to Influenza A (H1N1) 2009 Monovalent Vaccine.

Contraindications (TIV or LAIV) Allergy to vaccine components. Anaphylactic reaction to the vaccine or a constituent of the vaccine (e.g. eggs, thimerosal, or any antibiotic used as a preservative). See package inserts for detailed list of components for each specific vaccine. Moderate or severe illnesses with or without fever. Persons with moderate or severe illness should be immunized as soon as they have recovered from the acute phase of the illness. Minor illnesses (e.g., upper respiratory tract infection, allergic rhinitis) with or without fever should not contraindicate the use of H1N1 influenza vaccine.

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Contraindications specific to LAIV :
Persons with a history of hypersensitivity, including anaphylaxis, to any of the components of LAIV or to eggs.
Persons aged <2 years or those aged >50 years Persons with any of the underlying medical conditions that serve as an indication for routine
influenza vaccination, including asthma, reactive airways disease, or other chronic disorders of the pulmonary or cardiovascular systems; other underlying medical conditions, including such metabolic diseases as diabetes, renal dysfunction, and hemoglobinopathies; or known or suspected immunodeficiency diseases or immunosuppressed states Children aged 2-4 years whose parents or caregivers report that a health-care provider has told them during the preceding 12 months that their child had wheezing or asthma, or whose medical record indicates a wheezing episode has occurred during the preceding 12 months Children or adolescents receiving aspirin or other salicylates (because of the association of Reye's syndrome with wild-type influenza virus infection) Persons with a history of GBS after influenza vaccination y Pregnant women 1 Centers for Disease Control and Prevention. Prevention and Control of Influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, August 8, 2008/Vol. 57, RR-07

Simultaneous Vaccine Administration

Seasonal Influenza and H1N1 influenza Vaccine Spacing

Vaccine Types
Inactivated + Inactivated Inactivated + Live*
Live + Live

No Interval No Interval 4 week Interval**

Intervals

* Providers can administer seasonal and 2009 H1N1 inactivated vaccines, seasonal inactivated vaccine and 2009 H1N1 LAIV, or seasonal LAIV and inactivated 2009 H1N1 at the same visit, or at any time before or after each other but in different places on the body. Live attenuated seasonal and live 2009 H1N1 vaccines should NOT be administered at the same visit until further studies are done. If a person is eligible for the live vaccine, these vaccines should be separated by a minimum of four weeks. ** There are no data on sequential administration of the two types of LAIV (seasonal and 2009 H1N1). The ACIP General Recommendations on live attenuated vaccines indicates that 28 days (4 weeks) is the recommended minimum interval, and can be applied to use of a seasonal LAIV and a 2009 H1N1 LAIV, because these are considered 2 different vaccines. The ACIP recommendations were developed based on data from studies using attenuated live virus vaccines such as measles, mumps and rubella vaccine that are injected. However, based on previous studies of LAIV replication and immune response, as little as 14 days (2 weeks) might be sufficient to allow for an appropriate immune response to both vaccines. Therefore, an interval between the two types of LAIV of 2 weeks or more may be acceptable, although an interval of 28 days is preferred.

The safety and immunogenicity of Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal when administered concurrently with inactivated vaccines have not been determined. Studies of FluMist excluded subjects who received any inactivated or subunit vaccine within two weeks of enrollment. Therefore, healthcare providers should consider the risks and benefits of concurrent administration of Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal with inactivated vaccines.

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Inactivated H1N1vaccines may be administered simultaneously with any of the following routinely recommended vaccines: DTaP, MMR, Hib, Varicella, Hepatitis B, Polio, Influenza, Pneumococcal Polysaccharide, and Pneumococcal Conjugate

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Recommended Immunization Schedule for Persons Aged 0 Through 6 Years--United States 2010 For those who fall behind or start late, see the catch-up schedule

Vaccine Age
Hepatitis B1 Rotavirus2 Diphtheria, Tetanus, Pertussis3 Haemophilus influenzae type b4 Pneumococcal5 Inactivated Poliovirus6 Influenza7 Measles, Mumps, Rubella8 Varicella9 Hepatitis A10 Meningococcal11

Birth HepB

1

2

4

6

12

15

18 1923 23

46

month months months months months months months months years years

HepB

HepB

RV DTaP Hib PCV

RV DTaP Hib PCV

RV 2 DTaP Hib4 PCV

see footnote 3
Hib PCV

DTaP

DTaP PPSV

Range of recommended ages for all children except certain high-risk groups

IPV

IPV

IPV

Influenza (Yearly)

MMR

see footnote 8

Varicella

see footnote 9

IPV
MMR Varicella

Range of recommended ages for certain high-risk groups

HepA (2 doses)

HepA Series

MCV

This schedule includes recommendations in effect as of December 15, 2009. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines. Considerations should include provider assessment, patient preference, and the potential for adverse events. Providers should consult the relevant Advisory

Committee on Immunization Practices statement for detailed recommendations: http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at http://www.vaers.hhs.gov or by telephone, 800-822-7967.

1. Hepatitis B vaccine (HepB). (Minimum age: birth) At birth: Administer monovalent HepB to all newborns before hospital discharge. If mother is hepatitis B surface antigen (HBsAg)-positive, administer HepB and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth. If mother's HBsAg status is unknown, administer HepB within 12 hours of birth. Determine mother's HBsAg status as soon as possible and, if HBsAgpositive, administer HBIG (no later than age 1 week). After the birth dose: The HepB series should be completed with either monovalent HepB or a combination vaccine containing HepB. The second dose should be administered at age 1 or 2 months. Monovalent HepB vaccine should be used for doses administered before age 6 weeks. The final dose should be administered no earlier than age 24 weeks. Infants born to HBsAg-positive mothers should be tested for HBsAg and antibody to HBsAg 1 to 2 months after completion of at least 3 doses of the HepB series, at age 9 through 18 months (generally at the next well-child visit). Administration of 4 doses of HepB to infants is permissible when a combination vaccine containing HepB is administered after the birth dose. The fourth dose should be administered no earlier than age 24 weeks.
2. Rotavirus vaccine (RV). (Minimum age: 6 weeks) Administer the first dose at age 6 through 14 weeks (maximum age: 14 weeks 6 days). Vaccination should not be initiated for infants aged 15 weeks 0 days or older. The maximum age for the final dose in the series is 8 months 0 days If Rotarix is administered at ages 2 and 4 months, a dose at 6 months is not indicated.
3. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). (Minimum age: 6 weeks) The fourth dose may be administered as early as age 12 months, provided at least 6 months have elapsed since the third dose. Administer the final dose in the series at age 4 through 6 years.
4. Haemophilus influenzae type b conjugate vaccine (Hib). (Minimum age: 6 weeks) If PRP-OMP (PedvaxHIB or Comvax [HepB-Hib]) is administered at ages 2 and 4 months, a dose at age 6 months is not indicated. TriHiBit (DTaP/Hib) and Hiberix (PRP-T) should not be used for doses at ages 2, 4, or 6 months for the primary series but can be used as the final dose in children aged 12 months through 4 years.
5. Pneumococcal vaccine. (Minimum age: 6 weeks for pneumococcal conjugate vaccine [PCV]; 2 years for pneumococcal polysaccharide vaccine [PPSV]) PCV is recommended for all children aged younger than 5 years. Administer 1 dose of PCV to all healthy children aged 24 through 59 months who are not completely vaccinated for their age. Administer PPSV 2 or more months after last dose of PCV to children aged 2 years or older with certain underlying medical conditions, including a cochlear implant. See MMWR 1997;46(No. RR-8).

6. Inactivated poliovirus vaccine (IPV) (Minimum age: 6 weeks) The final dose in the series should be administered on or after the fourth birthday and at least 6 months following the previous dose. If 4 doses are administered prior to age 4 years a fifth dose should be administered at age 4 through 6 years. See MMWR 2009;58(30):82930.
7. Influenza vaccine (seasonal). (Minimum age: 6 months for trivalent inactivated influenza vaccine [TIV]; 2 years for live, attenuated influenza vaccine [LAIV]) Administer annually to children aged 6 months through 18 years. For healthy children aged 2 through 6 years (i.e., those who do not have underlying medical conditions that predispose them to influenza complications), either LAIV or TIV may be used, except LAIV should not be given to children aged 2 through 4 years who have had wheezing in the past 12 months. Children receiving TIV should receive 0.25 mL if aged 6 through 35 months or 0.5 mL if aged 3 years or older. Administer 2 doses (separated by at least 4 weeks) to children aged younger than 9 years who are receiving influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but only received 1 dose. For recommendations for use of influenza A (H1N1) 2009 monovalent vaccine see MMWR 2009;58(No. RR-10).
8. Measles, mumps, and rubella vaccine (MMR). (Minimum age: 12 months) Administer the second dose routinely at age 4 through 6 years. However, the second dose may be administered before age 4, provided at least 28 days have elapsed since the first dose.
9. Varicella vaccine. (Minimum age: 12 months) Administer the second dose routinely at age 4 through 6 years. However, the second dose may be administered before age 4, provided at least 3 months have elapsed since the first dose. For children aged 12 months through 12 years the minimum interval between doses is 3 months. However, if the second dose was administered at least 28 days after the first dose, it can be accepted as valid.
10. Hepatitis A vaccine (HepA). (Minimum age: 12 months) Administer to all children aged 1 year (i.e., aged 12 through 23 months). Administer 2 doses at least 6 months apart. Children not fully vaccinated by age 2 years can be vaccinated at subsequent visits HepA also is recommended for older children who live in areas where vaccination programs target older children, who are at increased risk for infection, or for whom immunity against hepatitis A is desired.
11.Meningococcal vaccine. (Minimum age: 2 years for meningococcal conjugate vaccine [MCV4] and for meningococcal polysaccharide vaccine [MPSV4]) Administer MCV4 to children aged 2 through 10 years with persistent complement component deficiency, anatomic or functional asplenia, and certain other conditions placing tham at high risk. Administer MCV4 to children previously vaccinated with MCV4 or MPSV4 after 3 years if first dose administered at age 2 through 6 years. See MMWR 2009;58:10423.

CS207330-A

The Recommended Immunization Schedules for Persons Aged 0 through 18 Years are approved by the Advisory Committee on Immunization Practices (http://www.cdc.gov/vaccines/recs/acip), the American Academy of Pediatrics (http://www.aap.org), and the American Academy of Family Physicians (http://www.aafp.org).
Department of Health and Human Services Centers for Disease Control and Prevention

Recommended Immunization Schedule for Persons Aged 7 Through 18 Years--United States 2010 For those who fall behind or start late, see the schedule below and the catch-up schedule

Vaccine Age
Tetanus, Diphtheria, Pertussis1 Human Papillomavirus2 Meningococcal3 Influenza4 Pneumococcal5 Hepatitis A6 Hepatitis B7 Inactivated Poliovirus8 Measles, Mumps, Rubella9 Varicella10

710 years
see footnote 2 MCV

1112 years
Tdap HPV (3 doses)
MCV Influenza (Yearly)
PPSV HepA Series Hep B Series IPV Series MMR Series Varicella Series

1318 years
Tdap HPV series
MCV

Range of recommended ages for all children except certain high-risk groups
Range of recommended ages for catch-up immunization
Range of recommended ages for certain high-risk groups

This schedule includes recommendations in effect as of December 15, 2009. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines. Considerations should include provider assessment, patient preference, and the potential for adverse events. Providers should consult the relevant Advisory

Committee on Immunization Practices statement for detailed recommendations: http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at http://www.vaers.hhs.gov or by telephone, 800-822-7967.

1. Tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap). (Minimum age: 10 years for Boostrix and 11 years for Adacel) Administer at age 11 or 12 years for those who have completed the recommended childhood DTP/DTaP vaccination series and have not received a tetanus and diphtheria toxoid (Td) booster dose. Persons aged 13 through 18 years who have not received Tdap should receive a dose. A 5-year interval from the last Td dose is encouraged when Tdap is used as a booster dose; however, a shorter interval may be used if pertussis immunity is needed.
2. Human papillomavirus vaccine (HPV). (Minimum age: 9 years) Two HPV vaccines are licensed: a quadrivalent vaccine (HPV4) for the prevention of cervical, vaginal and vulvar cancers (in females) and genital warts (in females and males), and a bivalent vaccine (HPV2) for the prevention of cervical cancers in females. HPV vaccines are most effective for both males and females when given before exposure to HPV through sexual contact. HPV4 or HPV2 is recommended for the prevention of cervical precancers and cancers in females. HPV4 is recommended for the prevention of cervical, vaginal and vulvar precancers and cancers and genital warts in females. Administer the first dose to females at age 11 or 12 years. Administer the second dose 1 to 2 months after the first dose and the third dose 6 months after the first dose (at least 24 weeks after the first dose). Administer the series to females at age 13 through 18 years if not previously vaccinated. HPV4 may be administered in a 3-dose series to males aged 9 through 18 years to reduce their likelihood of acquiring genital warts.
3. Meningococcal conjugate vaccine (MCV4). Administer at age 11 or 12 years, or at age 13 through 18 years if not previously vaccinated. Administer to previously unvaccinated college freshmen living in a dormitory. Administer MCV4 to children aged 2 through 10 years with persistent complement component deficiency, anatomic or functional asplenia, or certain other conditions placing them at high risk. Administer to children previously vaccinated with MCV4 or MPSV4 who remain at increased risk after 3 years (if first dose administered at age 2 through 6 years) or after 5 years (if first dose administered at age 7 years or older). Persons whose only risk factor is living in on-campus housing are not recommended to receive an additional dose. See MMWR 2009;58:10423.

4. Influenza vaccine (seasonal). Administer annually to children aged 6 months through 18 years. For healthy nonpregnant persons aged 7 through 18 years (i.e., those who do not have underlying medical conditions that predispose them to influenza complications), either LAIV or TIV may be used. Administer 2 doses (separated by at least 4 weeks) to children aged younger than 9 years who are receiving influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but only received 1 dose. For recommendations for use of influenza A (H1N1) 2009 monovalent vaccine. See MMWR 2009;58(No. RR-10).
5. Pneumococcal polysaccharide vaccine (PPSV). Administer to children with certain underlying medical conditions, including a cochlear implant. A single revaccination should be administered after 5 years to children with functional or anatomic asplenia or an immunocompromising condition. See MMWR 1997;46(No. RR-8).
6. Hepatitis A vaccine (HepA). Administer 2 doses at least 6 months apart. HepA is recommended for children aged older than 23 months who live in areas where vaccination programs target older children, who are at increased risk for
infection, or for whom immunity against hepatitis A is desired. 7. Hepatitis B vaccine (HepB).
Administer the 3-dose series to those not previously vaccinated. A 2-dose series (separated by at least 4 months) of adult formulation
Recombivax HB is licensed for children aged 11 through 15 years. 8. Inactivated poliovirus vaccine (IPV).
The final dose in the series should be administered on or after the fourth birthday and at least 6 months following the previous dose.
If both OPV and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child's current age.
9. Measles, mumps, and rubella vaccine (MMR). If not previously vaccinated, administer 2 doses or the second dose for those who have received only 1 dose, with at least 28 days between doses.
10. Varicella vaccine. For persons aged 7 through 18 years without evidence of immunity (see MMWR 2007;56[No. RR-4]), administer 2 doses if not previously vaccinated or the second dose if only 1 dose has been administered. For persons aged 7 through 12 years, the minimum interval between doses is 3 months. However, if the second dose was administered at least 28 days after the first dose, it can be accepted as valid. For persons aged 13 years and older, the minimum interval between doses is 28 days.

CS207330-A

The Recommended Immunization Schedules for Persons Aged 0 through 18 Years are approved by the Advisory Committee on Immunization Practices (http://www.cdc.gov/vaccines/recs/acip), the American Academy of Pediatrics (http://www.aap.org), and the American Academy of Family Physicians (http://www.aafp.org).
Department of Health and Human Services Centers for Disease Control and Prevention

Catch-up Immunization Schedule for Persons Aged 4 Months Through 18 Years Who Start Late or Who Are More Than 1 Month Behind--United States 2010
The table below provides catch-up schedules and minimum intervals between doses for children whose vaccinations have been delayed. A vaccine series does not need to be restarted, regardless of the time that has elapsed between doses. Use the section appropriate for the child's age.

Vaccine

Minimum Age for Dose 1

Hepatitis B1

Birth

Rotavirus2 Diphtheria, Tetanus, Pertussis3

6 wks 6 wks

Haemophilus influenzae type b4

6 wks

Pneumococcal5

6 wks

Inactivated Poliovirus6 Measles,Mumps, Rubella7 Varicella8 Hepatitis A9

6 wks 12 mos 12 mos 12 mos

Tetanus,Diphtheria/ Tetanus,Diphtheria,Pertussis10
Human Papillomavirus11 Hepatitis A9 Hepatitis B1 Inactivated Poliovirus6 Measles,Mumps, Rubella7

7 yrs10
9 yrs 12 mos
Birth 6 wks 12 mos

Varicella8

12 mos

PERSONS AGED 4 MONTHSTHROUGH 6 YEARS

Dose 1 to Dose 2

Minimum Interval Between Doses Dose 2 to Dose 3

4 weeks

8 weeks (and at least 16 weeks after first dose)

4 weeks

4 weeks2

4 weeks

4 weeks

4 weeks if first dose administered at younger than age 12 months

4 weeks4 if current age is younger than 12 months

8 weeks (as final dose) if first dose administered at age 1214 months
No further doses needed if first dose administered at age 15 months or older

8 weeks (as final dose)4 if current age is 12 months or older and first dose administered at younger than age 12 months and second dose administered at younger than 15 months
No further doses needed if previous dose administered at age 15 months or older

4 weeks if first dose administered at younger than age 12 months

4 weeks if current age is younger than 12 months

8 weeks (as final dose for healthy children) if first dose administered at age 12 months or older
or current age 24 through 59 months

8 weeks
(as final dose for healthy children) if current age is 12 months or older

No further doses needed for healthy children if first dose administered at age 24 months or older

No further doses needed for healthy children if previous dose administered at age
24 months or older

4 weeks

4 weeks

4 weeks

3 months

6 months

PERSONS AGED 7 THROUGH 18 YEARS

4 weeks

4 weeks if first dose administered at younger than age 12 months
6 months if first dose administered at 12 months or older

Routine dosing intervals are recommended11

6 months

4 weeks

8 weeks (and at least 16 weeks after first dose)

4 weeks

4 weeks

4 weeks

3 months if person is younger than age 13 years

4 weeks if person is aged 13 years or older

Dose 3 to Dose 4
6 months
8 weeks (as final dose) This dose only necessary for children aged 12 months through 59 months who received 3 doses before
age 12 months
8 weeks (as final dose) This dose only necessary for children aged 12 months through 59 months who received 3 doses before age 12 months or for highrisk children who received
3 doses at any age 6 months
6 months if first dose administered at younger than age 12 months
6 months

Dose 4 to Dose 5 6 months3

1. Hepatitis B vaccine (HepB). Administer the 3-dose series to those not previously vaccinated. A 2-dose series (separated by at least 4 months) of adult formulation Recombivax HB is licensed for children aged 11 through 15 years.
2. Rotavirus vaccine (RV). The maximum age for the first dose is 14 weeks 6 days. Vaccination should not be initiated for infants aged 15 weeks 0 days or older. The maximum age for the final dose in the series is 8 months 0 days. If Rotarix was administered for the first and second doses, a third dose is not indicated.
3. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). The fifth dose is not necessary if the fourth dose was administered at age 4 years or older.
4. Haemophilus influenzae type b conjugate vaccine (Hib). Hib vaccine is not generally recommended for persons aged 5 years or older. No efficacy data are available on which to base a recommendation concerning use of Hib vaccine for older children and adults. However, studies suggest good immunogenicity in persons who have sickle cell disease, leukemia, or HIV infection, or who have had a splenectomy; administering 1 dose of Hib vaccine to these persons who have not previously received Hib vaccine is not contraindicated. If the first 2 doses were PRP-OMP (PedvaxHIB or Comvax), and administered at age 11 months or younger, the third (and final) dose should be administered at age 12 through 15 months and at least 8 weeks after the second dose. If the first dose was administered at age 7 through 11 months, administer the second dose at least 4 weeks later and a final dose at age 12 through 15 months.
5. Pneumococcal vaccine. Administer 1 dose of pneumococcal conjugate vaccine (PCV) to all healthy children aged 24 through 59 months who have not received at least 1 dose of PCV on or after age 12 months. For children aged 24 through 59 months with underlying medical conditions, administer 1 dose of PCV if 3 doses were received previously or administer 2 doses of PCV at least 8 weeks apart if fewer than 3 doses were received previously. Administer pneumococcal polysaccharide vaccine (PPSV) to children aged 2 years or older with certain underlying medical conditions, including a cochlear implant, at least 8 weeks after the last dose of PCV. See MMWR 1997;46(No. RR-8).
6. Inactivated poliovirus vaccine (IPV). The final dose in the series should be administered on or after the fourth birthday and at least 6 months following the previous dose.

A fourth dose is not necessary if the third dose was administered at age 4 years or older and at least 6 months following the previous dose.
In the first 6 months of life, minimum age and minimum intervals are only recommended if the person is at risk for imminent exposure to circulating poliovirus (i.e., travel to a polio-endemic region or during an outbreak).
7. Measles, mumps, and rubella vaccine (MMR). Administer the second dose routinely at age 4 through 6 years. However, the second dose may be administered before age 4, provided at least 28 days have elapsed since the first dose. If not previously vaccinated, administer 2 doses with at least 28 days between doses.
8. Varicella vaccine. Administer the second dose routinely at age 4 through 6 years. However, the second dose may be administered before age 4, provided at least 3 months have elapsed since the first dose. For persons aged 12 months through 12 years, the minimum interval between doses is 3 months. However, if the second dose was administered at least 28 days after the first dose, it can be accepted as valid. For persons aged 13 years and older, the minimum interval between doses is 28 days.
9. Hepatitis A vaccine (HepA). HepA is recommended for children aged older than 23 months who live in areas where vaccination programs target older children, who are at increased risk for infection, or for whom immunity against hepatitis A is desired.
10.Tetanus and diphtheria toxoids vaccine (Td) and tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap). Doses of DTaP are counted as part of the Td/Tdap series Tdap should be substituted for a single dose of Td in the catch-up series or as a booster for children aged 10 through 18 years; use Td for other doses.
11. Human papillomavirus vaccine (HPV). Administer the series to females at age 13 through 18 years if not previously vaccinated. Use recommended routine dosing intervals for series catch-up (i.e., the second and third doses should be administered at 1 to 2 and 6 months after the first dose). The minimum interval between the first and second doses is 4 weeks. The minimum interval between the second and third doses is 12 weeks, and the third dose should be administered at least 24 weeks after the first dose.

Information about reporting reactions after immunization is available online at http://www.vaers.hhs.gov or by telephone, 800-822-7967. Suspected cases of vaccine-preventable diseases should be reported to the state or local health department. Additional information, including precautions and contraindications for immunization, is available from the National Center for Immunization and Respiratory Diseases at http://www.cdc.gov/ vaccines or telephone, 800-CDC-INFO (800-232-4636).
Department of Health and Human Services Centers for Disease Control and Prevention

CS207330-A

Recommended and Minimum Ages and Intervals Between Doses of Routinely Recommended Vaccines1,2

Vaccine and dose number Hepatitis B (HepB)-13

Recommended age for this dose
Birth

Minimum age for this dose
Birth

Recommended Minimum

interval to next interval to next

dose

dose

1-4 months

4 weeks

HepB-2 HepB-34 Diphtheria-tetanus-acellular pertussis (DTaP)-13

1-2 months 6-18 months
2 months

4 weeks 24 weeks 6 weeks

2-17 months --
2 months

8 weeks --
4 weeks

DTaP-2 DTaP-3 DTaP-4

4 months 6 months 15-18 months

10 weeks 14 weeks 12 months

2 months 6-12 months
3 years

4 weeks 6 months5,6 6 months5

DTaP-5 Haemophilus influenzae type b (Hib)-13,7

4-6 years 2 months

4 years 6 weeks

-- 2 months

-- 4 weeks

Hib-2 Hib-38

4 months 6 months

10 weeks 14 weeks

2 months 6-9 months

4 weeks 8 weeks

Hib-4 Inactivated poliovirus (IPV)-13

12-15 months 2 months

12 months 6 weeks

-- 2 months

-- 4 weeks

IPV-2

4 months

10 weeks

2-14 months

4 weeks

IPV-3 IPV-49 Pneumococcal conjugate (PCV)-17

6-18 months 4-6 years 2 months

14 weeks 4 years 6 weeks

3-5 years --
8 weeks

6 months --
4 weeks

PCV-2

4 months

10 weeks

8 weeks

4 weeks

PCV-3

6 months

14 weeks

6 months

8 weeks

PCV-4 Measles-mumps-rubella (MMR)-110 MMR-210 Varicella (Var)-110 Var-210 Hepatitis A (HepA)-13

12-15 months 12-15 months
4-6 years 12-15 months
4-6 years 12-23 months

12 months 12 months 13 months 12 months 15 months 12 months

-- 3-5 years
-- 3-5 years
-- 6-18 months5

--
4 weeks --
12 weeks11 --
6 months5

HepA-2

18-41 months

18 months

--

--

Influenza, inactivated (TIV)12

6 months and older

6 months13

1 month

4 weeks

Influenza, live attenuated (LAIV)12

24 months 49 years

24 months

1 month

4 weeks

Meningococcal conjugate (MCV) Meningococcal polysaccharide (MPSV)-114

11-12 years --

2 years 2 years

-- 5 years

-- 5 years

MPSV-2

--

7 years

--

--

Tetanus-diphtheria (Td) Tetanus-diphtheria-acellular pertussis (Tdap)15

11-12 years >11 years

7 years 10 years

10 years --

5 years --

Pneumococcal polysaccharide (PPSV)-1 PPSV-216 Human papillomavirus (HPV)-117

-- -- 11-12 years

2 years 7 years 9 years

5 years --
2 months

5 years --
4 weeks

HPV-2

11-12 years (+ 2 months)

109 months

4 months

12 weeks

HPV-318 Rotavirus (RV)-119

11-12 years (+ 6 months)
2 months

114 months 6 weeks

-- 2 months

-- 4 weeks

RV-2 RV-320 Herpes zoster21

4 months 6 months 60 years

10 weeks 14 weeks 60 years

2 months -- --

4 weeks -- --

1 Combination vaccines are available. Use of licensed combination vaccines is generally preferred over separate injections of their equivalent component vaccines. When administering combination vaccines, the minimum age for administration is the oldest age for any of the individual components; the minimum interval between doses is equal to the greatest interval of any of the individual components.
2 For travel vaccines including typhoid, Japanese encephalitis, yellow fever, see www.cdc.gov/travel. Other vaccines that are licensed in the US but not distributed include anthrax, rhesus rotavirus and smallpox, see www.bt.cdc.gov/.
3 Combination vaccines containing the Hepatitis B component are available (HepB-Hib, DTaP-HepB-IPV, and HepA-HepB). These vaccines should not be administered to infants younger than 6 weeks because of the other components (i.e., Hib, DTaP, HepA, and IPV).
4 Hepatitis B-3 should be administered at least 8 weeks after Hepatitis B-2 and at least 16 weeks after Hepatitis B-1, and should not be administered before age 24 weeks.
5 Calendar months.
6 The minimum recommended interval between DTaP-3 and DTaP-4 is 6 months. However, DTaP-4 need not be repeated if administered at least 4 months after DTaP-3.
7 For Hib and PCV, children receiving the first dose of vaccine at age 7 months or older require fewer doses to complete the series.
8 If PRP-OMP (Pedvax-Hib, Merck Vaccine Division) was administered at age 2 and 4 months, a dose at age 6 months is not required.
9 If the 3rd dose is given after the fourth birthday, a fourth dose is not needed.
10 Combination measles-mumps-rubella-varicella (MMRV) vaccine can be used for children aged 12 months through 12 years.
11 The minimum interval from VAR-1 to VAR-2 for persons beginning the series at age 13 years and older is 4 weeks.
12 One dose of influenza vaccine per season is recommended for most people. Children younger than 9 years of age who are receiving influenza for the first time, or received only 1 dose the previous season (if it was their first vaccination season) should receive 2 doses this season.
13 The minimum age for inactivated influenza vaccine varies by vaccine manufacturer. Fluzone (manufactured by sanofi Pasteur) and Afluria (manufactured by Commonwealth Serum Laboratories) are approved for children 6-35 months of age. The minimum age for Fluarix (manufactured by GlaxoSmithKline) is 3 years. The minimum age for Fluvirin (manufactured by Novartis) is 4 years. For FluLaval (manufactured by GlaxoSmithKline) and Agriflu (manufactured by Novartis), the minimum age is 18 years. For Fluzone High Dose (manufactured by sanofi Pasteur) the minimum age is 65 years.
14 Revaccination with meningococcal vaccine is recommended for people previously vaccinated who remain at high risk of meningococcal disease. (ref CDC. Updated Recommendations from the Advisory Committee on Immunization Practices (ACIP) for revaccination of persons at Prolonged Increased Risk for Meningococcal Disease. MMWR 2009;58:[1042-1043].
15 Only one dose of Tdap is recommended. Subsequent doses should be given as Td. If vaccination to prevent tetanus and/or diphtheria disease is required for children aged 7 through 9 years, Td should be administered (minimum age for Td is 7 years). For one brand of Tdap, the minimum age is 11 years. The preferred interval between Tdap and a previous dose of Td is 5 years. In persons who have received a primary series of tetanus-toxoid containing vaccine, for management of a tetanus-prone wound, the minimum interval after a previous dose of any tetanus-containing vaccine is 5 years.
16 A second dose of PPSV is recommended 5 years after the first dose for persons at highest risk for serious pneumococcal infection and those who are likely to have a rapid decline in pneumococcal antibody concentration. (See CDC. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1997;46[No. RR-8]:1-24.)
17 HPV2 (Cervarix, manufactured by GlaxoSmithKline) is approved for females aged 9 through 26 years. HPV4 (Gardasil, manufactured by Merck) is approved for males and females 9 through 26 years.
18 The minimum age for HPV-3 is based on the baseline minimum age for dose 1 (i.e. 108 months) and the minimum interval of 24 weeks between the first and third dose.
19 The first dose of RV must be administered at age 6 weeks through 14 weeks 6 days. The vaccine series should not be started at age 15 weeks 0 days or older. RV should not be administered to children older than 8 calendar months regardless of the number of doses received between 6 weeks and 8 months 0 days of age.
20 If two doses of Rotarix are administered as age appropriate, a third dose is not necessary.
21 Herpes zoster vaccine is recommended as a single dose for persons 60 years and older.

Adapted from Table 1, ACIP General Recommendations on Immunization: MMWR 2006;55 (No. RR-15)

March 2010

8

MMWR

December 1, 2006

TABLE 4. Suggested intervals between administration of antibody-containing products for different indications and measles-

containing vaccine and varicella-containing vaccine*

Dose, including mg immunoglobulin G (IgG)/

Recommended interval before measles or varicella-containing vaccine

Product/indication

kg body weight*

administration (months)

Respiratory syncytial virus immune
globulin (IG) monoclonal antibody (SynagisTM)

15 mg/kg intramuscularly (IM)

None

Tetanus IG

250 units (10 mg IgG/kg) IM

3

Hepatitis A IG

Contact prophylaxis

0.02 mL/kg (3.3 mg IgG/kg) IM

3

International travel

0.06 mL/kg (10 mg IgG/kg) IM

3

Hepatitis B IG

0.06 mL/kg (10 mg IgG/kg) IM

3

Rabies IG

20 IU/kg (22 mg IgG/kg) IM

4

Measles prophylaxis IG

Standard (i.e., nonimmunocompromised) contact

0.25 mL/kg (40 mg IgG/kg) IM

5

Immunocompromised contact

0.50 mL/kg (80 mg IgG/kg) IM

6

Blood transfusion

Red blood cells (RBCs), washed

10 mL/kg negligible IgG/kg intravenously (IV)

None

RBCs, adenine-saline added

10 mL/kg (10 mg IgG/kg) IV

3

Packed RBCs (hematocrit 65%)

10 mL/kg (60 mg IgG/kg) IV

6

Whole blood (hematocrit 35%50%)

10 mL/kg (80100 mg IgG/kg) IV

6

Plasma/platelet products

10 mL/kg (160 mg IgG/kg) IV

7

Cytomegalovirus intravenous immune globulin (IGIV)

150 mg/kg maximum

6

IGIV

Replacement therapy for immune deficiencies

300400 mg/kg IV

8

Immune thrombocytopenic purpura

400 mg/kg IV

8

Postexposure varicella prophylaxis**

400 mg/kg IV

8

Immune thrombocytopenic purpura

1000 mg/kg IV

10

Kawasaki disease

2 g/kg IV

11

* This table is not intended for determining the correct indications and dosages for using antibody-containing products. Unvaccinated persons might not be fully protected against measles during the entire recommended interval, and additional doses of immune globulin or measles vaccine might be indicated after measles exposure. Concentrations of measles antibody in an immune globulin preparation can vary by manufacturer's lot. Rates of antibody clearance after receipt of an immune globulin preparation also might vary. Recommended intervals are extrapolated from an estimated halflife of 30 days for passively acquired antibody and an observed interference with the immune response to measles vaccine for 5 months after a dose of 80 mg IgG/kg.
Contains antibody only to respiratory syncytial virus Assumes a serum IgG concentration of 16 mg/mL. Measles and varicella vaccinations are recommended for children with asymptomatic or mildly symptomatic human immunodeficiency virus (HIV)
infection but are contraindicated for persons with severe immunosuppression from HIV or any other immunosuppressive disorder. ** The investigational product VariZIG, similar to licensed VZIG, is a purified human immune globulin preparation made from plasma containing high
levels of anti-varicella antibodies (immunoglobulin class G [IgG]). When indicated, health-care providers should make every effort to obtain and administer VariZIG. In situations in which administration of VariZIG does not appear possible within 96 hours of exposure, administration of immune globulin intravenous (IGIV) should be considered as an alternative. IGIV also should be administered within 96 hours of exposure. Although licensed IGIV preparations are known to contain anti-varicella antibody titers, the titer of any specific lot of IGIV that might be available is uncertain because IGIV is not routinely tested for antivaricella antibodies. The recommended IGIV dose for postexposure prophylaxis of varicella is 400 mg/kg, administered once. For pregnant women who cannot receive VariZIG within 96 hours of exposure, clinicians can choose either to administer IGIV or closely monitor the women for signs and symptoms of varicella and institute treatment with acyclovir if illness occurs. (Source: CDC. A new product for postexposure prophylaxis available under an investigational new drug application expanded access protocol. MMWR 2006;55:20910).

Recommended Adult Immunization Schedule
UNITED STATES 2010
Note: These recommendations must be read with the footnotes that follow containing number of doses, intervals between doses, and other important information.
Figure 1. Recommended adult immunization schedule, by vaccine and age group

VACCINE

AGE GROUP

1926 years

2749 years

5059 years

6064 years

>65 years

Tetanus, diphtheria, pertussis (Td/Tdap)1,*

Substitute 1-time dose of Tdap for Td booster; then boost with Td every 10 yrs

Td booster every 10 yrs

Human papillomavirus (HPV)2,*

3 doses (females)

Varicella3,*

2 doses

Zoster4

1 dose

Measles, mumps, rubella (MMR)5,*

1 or 2 doses

1 dose

Influenza6,*

1 dose annually

Pneumococcal (polysaccharide)7,8

1 or 2 doses

1 dose

Hepatitis A9,*

2 doses

Hepatitis B10,*

3 doses

Meningococcal11,*

1 or more doses

*Covered by the Vaccine Injury Compensation Program.

For all persons in this category who meet the age requirements and who lack evidence of immunity (e.g., lack documentation of vaccination or have no evidence of prior infection)

Recommended if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications)

No recommendation

Report all clinically significant postvaccination reactions to the Vaccine Adverse Event Reporting System (VAERS). Reporting forms and instructions on filing a VAERS report are available at www.vaers.hhs.gov or by telephone, 800-822-7967.
Information on how to file a Vaccine Injury Compensation Program claim is available at www.hrsa.gov/vaccinecompensation or by telephone, 800-338-2382. To file a claim for vaccine injury, contact the U.S. Court of Federal Claims, 717 Madison Place, N.W., Washington, D.C. 20005; telephone, 202-357-6400.
Additional information about the vaccines in this schedule, extent of available data, and contraindications for vaccination is also available at www.cdc.gov/vaccines or from the CDC-INFO Contact Center at 800-CDC-INFO (800-232-4636) in English and Spanish, 24 hours a day, 7 days a week.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

Figure 2. Vaccines that might be indicated for adults based on medical and other indications

INDICATION
VACCINE Tetanus, diphtheria, pertussis (Td/Tdap)1,*

Pregnancy

Immuno-

HIV

compromising

infection35,12,13

conditions (excluding human CD4+ T lymphoimmunodeficiency cyte count

virus [HIV])35,13 <200

>200

cells/L cells/L

Diabetes, heart disease,
chronic lung disease,
chronic alcoholism

Asplenia12 (including elective splenectomy and persistent complement component deficiencies)

Chronic liver disease

Kidney failure, end-stage renal
disease, receipt of hemodialysis

Health-care personnel

Td

Substitute 1-time dose of Tdap for Td booster; then boost with Td every 10 yrs

Human papillomavirus (HPV)2,*

3 doses for females through age 26 yrs

Varicella3,*

Contraindicated

2 doses

Zoster4

Contraindicated

1 dose

Measles, mumps, rubella (MMR)5,* Influenza6,* Pneumococcal (polysaccharide)7,8

Contraindicated

1 or 2 doses 1 dose TIV annually
1 or 2 doses

1 dose TIV or LAIV annually

Hepatitis A9,*

2 doses

Hepatitis B10,*

3 doses

Meningococcal11,*

1 or more doses

*Covered by the Vaccine Injury Compensation Program.

For all persons in this category who meet the age requirements and who lack evidence of immunity (e.g., lack documentation of vaccination or have no evidence of prior infection)

Recommended if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications)

No recommendation

These schedules indicate the recommended age groups and medical indications for which administration of currently licensed vaccines is commonly indicated for adults ages 19 years and older, as of January 1, 2010. Licensed combination vaccines may be used whenever any components of the combination are indicated and when the vaccine's other components are not contraindicated. For detailed recommendations on all vaccines, including those used primarily for travelers or that are issued during the year, consult the manufacturers' package inserts and the complete statements from the Advisory Committee on Immunization Practices (www.cdc.gov/vaccines/pubs/acip-list.htm).

The recommendations in this schedule were approved by the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), the American College of
Obstetricians and Gynecologists (ACOG), and the American College of Physicians (ACP).

Department of Health and Human Services Centers for Disease Control and Prevention

CS209938-A

Footnotes
Recommended Adult Immunization Schedule--UNITED STATES 2010
For complete statements by the Advisory Committee on Immunization Practices (ACIP), visit www.cdc.gov/vaccines/pubs/ACIP-list.htm.
1. Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination Tdap should replace a single dose of Td for adults aged 19 through 64 years who have not received a dose of Tdap previously. Adults with uncertain or incomplete history of primary vaccination series with tetanus and diphtheria toxoid-containing vaccines should begin or complete a primary vaccination series. A primary series for adults is 3 doses of tetanus and
diphtheria toxoid-containing vaccines; administer the first 2 doses at least 4 weeks apart and the third dose 612 months after the second; Tdap can substitute for any one of the doses of Td in the 3-dose primary series. The booster dose of tetanus and diphtheria toxoid-containing vaccine should be administered to adults who have completed a primary series and if the last vaccination was received 10 years previously. Tdap or Td vaccine may be used, as indicated.
If a woman is pregnant and received the last Td vaccination 10 years previously, administer Td during the second or third trimester. If the woman received the last Td vaccination <10 years previously, administer Tdap during the immediate postpartum period. A dose of Tdap is recommended for postpartum women, close contacts of infants aged <12 months, and all health-care personnel with direct patient contact if they have not previously received Tdap. An interval as short as 2 years from the last Td is suggested; shorter intervals can be used. Td may be deferred during pregnancy and Tdap substituted in the immediate postpartum period, or Tdap can be administered instead of Td to a pregnant woman.
Consult the ACIP statement for recommendations for giving Td as prophylaxis in wound management.
2. Human papillomavirus (HPV) vaccination HPV vaccination is recommended at age 11 or 12 years with catch-up vaccination at ages 13 through 26 years. Ideally, vaccine should be administered before potential exposure to HPV through sexual activity; however, females who are sexually active should still be vaccinated consistent with age-based recommendations. Sexually active females
who have not been infected with any of the four HPV vaccine types (types 6, 11, 16, 18 all of which HPV4 prevents) or any of the two HPV vaccine types (types 16 and 18 both of which HPV2 prevents) receive the full benefit of the vaccination. Vaccination is less beneficial for females who have already been infected with one or more of the HPV vaccine types. HPV4 or HPV2 can be administered to persons with a history of genital warts, abnormal Papanicolaou test, or positive HPV DNA test, because these conditions are not evidence of prior infection with all vaccine HPV types.
HPV4 may be administered to males aged 9 through 26 years to reduce their likelihood of acquiring genital warts. HPV4 would be most effective when administered before exposure to HPV through sexual contact. A complete series for either HPV4 or HPV2 consists of 3 doses. The second dose should be administered 12 months after the first dose; the third dose should be administered 6 months after the first dose. Although HPV vaccination is not specifically recommended for persons with the medical indications described in Figure 2, "Vaccines that might be indicated for adults based on medical and other indications," it may be administered to these persons because the HPV vaccine is not a live-virus vaccine. However, the immune response and vaccine efficacy might be less for persons with the medical indications described in Figure 2 than in persons who do not have the medical indications described or who are immunocompetent. Health-care personnel are not at increased risk because of occupational exposure, and should be vaccinated consistent with age-based recommendations.
3. Varicella vaccination All adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine if not previously vaccinated or the second dose if they have received only 1 dose, unless they have a medical contraindication.
Special consideration should be given to those who 1) have close contact with persons at high risk for severe disease (e.g., health-care personnel and family contacts of persons with immunocompromising conditions) or 2) are at high risk for exposure or transmission (e.g., teachers; child-care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers).
Evidence of immunity to varicella in adults includes any of the following: 1) documentation of 2 doses of varicella vaccine at least 4 weeks apart; 2) U.S.-born before 1980 (although for health-care personnel and pregnant women, birth before 1980 should not be considered evidence of immunity); 3) history of varicella based on diagnosis or verification of varicella by a health-care provider (for a patient reporting a history of or presenting with an atypical case, a mild case, or both, health-care providers should seek either an epidemiologic link with a typical varicella case or to a laboratory-confirmed case or evidence of laboratory confirmation, if it was performed at the time of acute disease); 4) history of herpes zoster based on diagnosis or verification of herpes zoster by a health-care provider; or 5) laboratory evidence of immunity or laboratory confirmation of disease.
Pregnant women should be assessed for evidence of varicella immunity. Women who do not have evidence of immunity should receive the first dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the health-care facility. The second dose should be administered 48 weeks after the first dose.
4. Herpes zoster vaccination A single dose of zoster vaccine is recommended for adults aged 60 years regardless of whether they report a prior episode of herpes zoster. Persons with chronic medical conditions may be vaccinated unless their condition constitutes a
contraindication.
5. Measles, mumps, rubella (MMR) vaccination Adults born before 1957 generally are considered immune to measles and mumps. Measles component: Adults born during or after 1957 should receive 1 or more doses of MMR vaccine unless they have 1) a medical contraindication; 2) documentation of vaccination with 1 or more doses of MMR vaccine; 3) laboratory
evidence of immunity; or 4) documentation of physician-diagnosed measles. A second dose of MMR vaccine, administered 4 weeks after the first dose, is recommended for adults who 1) have been recently exposed to measles or are in an outbreak setting; 2) have been vaccinated previously with killed measles
vaccine; 3) have been vaccinated with an unknown type of measles vaccine during 19631967; 4) are students in postsecondary educational institutions; 5) work in a health-care facility; or 6) plan to travel internationally. Mumps component: Adults born during or after 1957 should receive 1 dose of MMR vaccine unless they have 1) a medical contraindication; 2) documentation of vaccination with 1 or more doses of MMR vaccine;
3) laboratory evidence of immunity; or 4) documentation of physician-diagnosed mumps. A second dose of MMR vaccine, administered 4 weeks after the first dose, is recommended for adults who 1) live in a community experiencing a mumps outbreak and are in an affected age group; 2) are students in postsecondary
educational institutions; 3) work in a health-care facility; or 4) plan to travel internationally. Rubella component: 1 dose of MMR vaccine is recommended for women who do not have documentation of rubella vaccination, or who lack laboratory evidence of immunity. For women of childbearing age, regardless of birth year, rubella
immunity should be determined and women should be counseled regarding congenital rubella syndrome. Women who do not have evidence of immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge from the health-care facility.
Health-care personnel born before 1957: For unvaccinated health-care personnel born before 1957 who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease, health-care facilities should consider vaccinating personnel with 2 doses of MMR vaccine at the appropriate interval (for measles and mumps) and 1 dose of MMR vaccine (for rubella), respectively.

During outbreaks, health-care facilities should recommend that unvaccinated health-care personnel born before 1957, who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease, receive 2 doses of MMR vaccine during an outbreak of measles or mumps, and 1 dose during an outbreak of rubella.
Complete information about evidence of immunity is available at www.cdc.gov/vaccines/recs/provisional/default.htm.
6. Seasonal Influenza vaccination Vaccinate all persons aged 50 years and any younger persons who would like to decrease their risk of getting influenza. Vaccinate persons aged 19 through 49 years with any of the following indications. Medical: Chronic disorders of the cardiovascular or pulmonary systems, including asthma; chronic metabolic diseases, including diabetes mellitus; renal or hepatic dysfunction, hemoglobinopathies, or immunocompromising conditions
(including immunocompromising conditions caused by medications or HIV); cognitive, neurologic or neuromuscular disorders; and pregnancy during the influenza season. No data exist on the risk for severe or complicated influenza disease among persons with asplenia; however, influenza is a risk factor for secondary bacterial infections that can cause severe disease among persons with asplenia.
Occupational: All health-care personnel, including those employed by long-term care and assisted-living facilities, and caregivers of children aged <5 years. Other: Residents of nursing homes and other long-term care and assisted-living facilities; persons likely to transmit influenza to persons at high risk (e.g., in-home household contacts and caregivers of children aged <5 years, persons aged 50 years, and persons of all ages with high-risk conditions). Healthy, nonpregnant adults aged <50 years without high-risk medical conditions who are not contacts of severely immunocompromised persons in special-care units may receive either intranasally administered live, attenuated influenza vaccine (FluMist) or inactivated vaccine. Other persons should receive the inactivated vaccine.
7. Pneumococcal polysaccharide (PPSV) vaccination Vaccinate all persons with the following indications. Medical: Chronic lung disease (including asthma); chronic cardiovascular diseases; diabetes mellitus; chronic liver diseases, cirrhosis; chronic alcoholism; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy [if elective
splenectomy is planned, vaccinate at least 2 weeks before surgery]); immunocompromising conditions including chronic renal failure or nephrotic syndrome; and cochlear implants and cerebrospinal fluid leaks. Vaccinate as close to HIV diagnosis as possible.
Other: Residents of nursing homes or long-term care facilities and persons who smoke cigarettes. Routine use of PPSV is not recommended for American Indians/Alaska Natives or persons aged <65 years unless they have underlying medical conditions that are PPSV indications. However, public health authorities may consider recommending PPSV for American Indians/Alaska Natives and persons aged 50 through 64 years who are living in areas where the risk for invasive pneumococcal disease is increased.
8. Revaccination with PPSV One-time revaccination after 5 years is recommended for persons with chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy); and for persons with immunocompromising
conditions. For persons aged 65 years, one-time revaccination is recommended if they were vaccinated 5 years previously and were younger than aged <65 years at the time of primary vaccination.
9. Hepatitis A vaccination Vaccinate persons with any of the following indications and any person seeking protection from hepatitis A virus (HAV) infection. Behavioral: Men who have sex with men and persons who use injection drugs. Occupational: Persons working with HAVinfected primates or with HAV in a research laboratory setting. Medical: Persons with chronic liver disease and persons who receive clotting factor concentrates. Other: Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A (a list of countries is available at wwwn.cdc.gov/travel/contentdiseases.aspx). Unvaccinated persons who anticipate close personal contact (e.g., household contact or regular babysitting) with an international adoptee from a country of high or intermediate endemicity during the first 60 days after arrival of the
adoptee in the United States should consider vaccination. The first dose of the 2-dose hepatitis A vaccine series should be administered as soon as adoption is planned, ideally 2 weeks before the arrival of the adoptee. Single-antigen vaccine formulations should be administered in a 2-dose schedule at either 0 and 612 months (Havrix), or 0 and 618 months (Vaqta). If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3
doses at 0, 1, and 6 months; alternatively, a 4-dose schedule, administered on days 0, 7, and 2130 followed by a booster dose at month 12 may be used.
10. Hepatitis B vaccination Vaccinate persons with any of the following indications and any person seeking protection from hepatitis B virus (HBV) infection. Behavioral: Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than one sex partner during the previous 6 months); persons seeking evaluation or treatment for a sexually
transmitted disease (STD); current or recent injection-drug users; and men who have sex with men. Occupational: Health-care personnel and public-safety workers who are exposed to blood or other potentially infectious body fluids. Medical: Persons with end-stage renal disease, including patients receiving hemodialysis; persons with HIV infection; and persons with chronic liver disease. Other: Household contacts and sex partners of persons with chronic HBV infection; clients and staff members of institutions for persons with developmental disabilities; and international travelers to countries with high or intermediate
prevalence of chronic HBV infection (a list of countries is available at wwwn.cdc.gov/travel/contentdiseases.aspx). Hepatitis B vaccination is recommended for all adults in the following settings: STD treatment facilities; HIV testing and treatment facilities; facilities providing drug-abuse treatment and prevention services; health-care settings targeting
services to injection-drug users or men who have sex with men; correctional facilities; end-stage renal disease programs and facilities for chronic hemodialysis patients; and institutions and nonresidential daycare facilities for persons with developmental disabilities.
Administer or complete a 3-dose series of HepB to those persons not previously vaccinated. The second dose should be administered 1 month after the first dose; the third dose should be administered at least 2 months after the second dose (and at least 4 months after the first dose). If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6 months; alternatively, a 4-dose schedule, administered on days 0, 7, and 2130 followed by a booster dose at month 12 may be used.
Adult patients receiving hemodialysis or with other immunocompromising conditions should receive 1 dose of 40 g/mL (Recombivax HB) administered on a 3-dose schedule or 2 doses of 20 g/mL (Engerix-B) administered simultaneously on a 4-dose schedule at 0, 1, 2 and 6 months.

11. Meningococcal vaccination Meningococcal vaccine should be administered to persons with the following indications. Medical: Adults with anatomic or functional asplenia, or persistent complement component deficiencies. Other: First-year college students living in dormitories; microbiologists routinely exposed to isolates of Neisseria meningitidis; military recruits; and persons who travel to or live in countries in which meningococcal disease is
hyperendemic or epidemic (e.g., the "meningitis belt" of sub-Saharan Africa during the dry season [December through June]), particularly if their contact with local populations will be prolonged. Vaccination is required by the government of Saudi Arabia for all travelers to Mecca during the annual Hajj.
Meningococcal conjugate vaccine (MCV4) is preferred for adults with any of the preceding indications who are aged 55 years; meningococcal polysaccharide vaccine (MPSV4) is preferred for adults aged 56 years. Revaccination with MCV4 after 5 years is recommended for adults previously vaccinated with MCV4 or MPSV4 who remain at increased risk for infection (e.g., adults with anatomic or functional asplenia). Persons whose only risk factor is living in on-campus housing are not recommended to receive an additional dose.
12. Selected conditions for which Haemophilus influenzae type b (Hib) vaccine may be used Hib vaccine generally is not recommended for persons aged 5 years. No efficacy data are available on which to base a recommendation concerning use of Hib vaccine for older children and adults. However, studies suggest good
immunogenicity in patients who have sickle cell disease, leukemia, or HIV infection or who have had a splenectomy. Administering 1 dose of Hib vaccine to these high-risk persons who have not previously received Hib vaccine is not contraindicated.
13. Immunocompromising conditions Inactivated vaccines generally are acceptable (e.g., pneumococcal, meningococcal, influenza [inactivated influenza vaccine]) and live vaccines generally are avoided in persons with immune deficiencies or immunocompromising
conditions. Information on specific conditions is available at www.cdc.gov/vaccines/pubs/acip-list.htm.

GENERAL RECOMMENDTIONS APPLYING TO SPACING AND ADMINISTRATION OF ROUTINELY RECOMMENDED CHILDHOOD VACCINES
1) Simultaneous administration. This recommendation states that there are no contraindications to the simultaneous administration of any of the routinely recommended vaccines included on the current ACIP schedule. The only exception to this rule is that PCV and PPV should be separated by 8 weeks.
2) No minimum time intervals between the administration of 2 different inactivated vaccines. For example, you could give a DTaP one day and a HIB the next, or 2 weeks later. Again, the one exception is for doses of PCV and PPV.
3) If 2 different live virus vaccines are not administered on the same day, they must be separated by at least 4 weeks. This would apply specifically to doses of MMR and varicella, if not administered on the same day.
4) If 2 different live injectable vaccines are given <28 days apart, the one given second should be repeated 28 days after the second or invalid dose.
5) This recommendation states that vaccine doses should not be given at intervals less than the minimum intervals or earlier than the minimum age. Table 1 of the General Recommendations gives all the minimum intervals and ages for each dose of the recommended childhood vaccines.
6) The 4 day grace period In 2002 the ACIP instituted what is referred to as the grace period, for use in evaluating immunization records. Basically, it states that doses given 4 days before the minimum age or interval may be counted as valid doses. The exception to this is in regard to the spacing of doses of MMR and varicella. This rule should be used primarily for evaluating records, NOT for scheduling visits. In Georgia, this rule does not conflict with the requirements for school and day care. This is not true in some states.
7) If vaccines are administered later than the recommended schedule: Do not start over Do not repeat doses Continue with the rest of the series according to recommended intervals and ages.
8) The importance of administering vaccines by the recommended routes and sites. It does, however, state that in evaluating records, all doses given by nonstandard routes and sites may be accepted except: Rabies and hepatitis B given in the gluteus Hepatitis B not given IM Continue to discard and repeat vaccines given in "divided doses" Do not mix vaccines unless they are licensed to be mixed.
9) Combination vaccines may be used whenever any components of the combination are indicated AND its other components are not contraindicated. The manufacturers' package insert should be consulted for further information.
10 Contraindications and precautions are circumstances that dictate when vaccines should not be administered. A contraindication is a condition in the recipient that increases the risk for a serious adverse reaction. A precaution is a condition in the recipient that might increase the risk for a serious adverse reaction. In some circumstances it may be necessary to weigh benefits vs. risks, as in an outbreak. The majority of both are temporary and vaccines can be administered later.

Patient name:

Date of birth:
(mo.) (day) (yr.)

Screening Questionnaire

for Child and Teen Immunization

For parents/guardians: The following questions will help us determine which vaccines your child may

be given today. If you answer "yes" to any question, it does not necessarily mean your child should not

be vaccinated. It just means additional questions must be asked. If a question is not clear, please ask your

healthcare provider to explain it.

Don't

Yes No Know

1. Is the child sick today?



2. Does the child have allergies to latex, medications, food, or any vaccine?



3. Has the child had a serious reaction to a vaccine in the past?



4. Has the child had a health problem with lung, heart, kidney or metabolic disease



(e.g., diabetes), asthma, or a blood disorder? Is he/she on long-term aspirin therapy?

5. If the child to be vaccinated is between the ages of 2 and 4 years, has a healthcare provider told you that the child had wheezing or asthma in the past 12 months?



6. Has the child, a sibling, or a parent had a seizure; has the child had brain or other nervous system problems?



7. Does the child have cancer, leukemia, AIDS, or any other immune system problem?

8. In the past 3 months, has the child taken cortisone, prednisone, other steroids, or anticancer drugs, or had radiation treatments?



9. In the past year, has the child received a transfusion of blood or blood products, or been given immune (gamma) globulin or an antiviral drug?



10. Is the child/teen pregnant or is there a chance she could become pregnant during the next month?



11. Has the child received vaccinations in the past 4 weeks?



Form completed by:_ ___________________________________________ Date:_________________

Form reviewed by: _ ___________________________________________ Date:_________________

Did you bring your child's immunization record card with you?

yes no

It is important to have a personal record of your child's vaccinations. If you don't have a personal record, ask the child's

healthcare provider to give you one with all your child's vaccinations on it. Keep this record in a safe place and bring it with

you every time you seek medical care for your child. Your child will need this important document for the rest of his or her

life to enter day care or school, for employment, or for international travel.

Technical content reviewed by the Centers for Disease Control and Prevention, June 2010

www.immunize.org/catg.d/p4060.pdf Item #P4060 (6/10)

Immunization Action Coalition 1573 Selby Ave. St. Paul, MN 55104 (651) 647-9009 www.immunize.org www.vaccineinformation.org

Information for Health Professionals about the Screening Questionnaire for Child & Teen Immunization
Are you interested in knowing why we included a certain question on the Screening Questionnaire? If so, read the information below. If you want to find out even more, consult the references listed at the bottom of this page.

1. Is the child sick today? [all vaccines]
There is no evidence that acute illness reduces vaccine efficacy or increases vaccine adverse events (1, 2). However, as a precaution with moderate or severe acute illness, all vaccines should be delayed until the illness has improved. Mild illnesses (such as otitis media, upper respiratory infections, and diarrhea) are NOT contraindications to vaccination. Do not withhold vaccination if a person is taking antibiotics.
2. Does the child have allergies to latex, medications, food, or any vaccine? [all vaccines]
History of anaphylactic reaction such as hives (urticaria), wheezing or difficulty breathing, or circulatory collapse or shock (not fainting) to latex or from a previous dose of vaccine or vaccine component is a contraindication for further doses. For example, if a person experiences anaphylaxis after eating eggs, do not administer influenza vaccine, or if a person has anaphylaxis after eating gelatin, do not administer MMR, MMRV, or varicella vaccine. A local reaction is not a contraindication. For a table of vaccines supplied in vials or syringes that contain latex, go to www.cdc.gov/ vaccines/pubs/pinkbook/downloads/appendices/B/latex-table.pdf. For an extensive table of vaccine components, see reference 3.
3. Has the child had a serious reaction to a vaccine in the past?
[all vaccines] History of anaphylactic reaction (see question 2) to a previous dose of vaccine or vaccine component is a contraindication for subsequent doses (1). History of encephalopathy within 7 days following DTP/DTaP is a contraindication for further doses of pertussis-containing vaccine. Precautions to DTaP (not Tdap) include the following: (a) seizure within 3 days of a dose, (b) pale or limp episode or collapse within 48 hours of a dose, (c) continuous crying for 3 or more hours within 48 hours of a dose, and (d) fever of 105F (40C) within 48 hours of a previous dose. There are other adverse events that might have occurred following vaccination that constitute contraindications or precautions to future doses. Under normal circumstances, vaccines are deferred when a precaution is present. However, situations may arise when the benefit outweighs the risk (e.g., during a community pertussis outbreak).
4. Has the child had a health problem with lung, heart, kidney, or metabolic disease (e.g., diabetes), asthma, or a blood disorder? Is he/she on long-term aspirin therapy? [LAIV]
Children with any of the health conditions listed above should not be given the intranasal, live attenuated influenza vaccine (LAIV). These children should be vaccinated with the injectable influenza vaccine.
5. If the child to be vaccinated is between the ages of 2 and 4 years, has a healthcare provider told you that the child had wheezing or asthma in the past 12 months? [LAIV]
Children who have had a wheezing episode within the past 12 months should not be given the live attenuated influenza vaccine. Instead, these children should be given the inactivated influenza vaccine.
6. Has the child, a sibling, or a parent had a seizure; has the child had brain or other nervous system problem? [DTaP, Td, Tdap,
TIV, LAIV, MCV4, MMRV] DTaP and Tdap are contraindicated in children who have a history of encephalopathy within 7 days following DTP/DTaP. An unstable progressive neurologic problem is a precaution to the use of DTaP and Tdap and a progressive neurologic disorder in a teen is a precaution to the use of Td. For children with stable neurologic disorders (including seizures) unrelated to vaccination, or for children with a family history of seizures, vaccinate as usual (exception: children with a personal or family [i.e., parent or sibling] history of seizures generally should not be vaccinated with MMRV; they should receive separate MMR and varicella vaccines). A history of Guillain-Barr syndrome (GBS) is a consideration with the following: 1) Td/Tdap: if GBS has occurred within 6 weeks of a tetanus-containing vaccine and decision is made to continue vaccination, give age-appropriate Tdap instead of Td if no history of prior Tdap; 2) Influenza vaccine (TIV or LAIV): if GBS has occurred within 6 weeks of a prior influenza vaccination, vaccinate with TIV if at high risk for severe influenza complications; 3) MCV4: avoid vaccinating persons unless in recommended risk groups.

7. Does the child have cancer, leukemia, AIDS, or any other immune system problem? [LAIV, MMR, MMRV, RV, Var]
Live virus vaccines (e.g., MMR, MMRV, varicella, rotavirus, and the intranasal live, attenuated influenza vaccine [LAIV]) are usually contraindicated in immunocompromised children. However, there are exceptions. For example, MMR is recommended for asymptomatic HIV-infected children who do not have evidence of severe immunosuppression. Likewise, varicella vaccine should be considered for HIV-infected children with age-specific CD4+ T-lymphocyte percentage at 15% or greater and may be considered for children age 8 years and older with CD4+ T-lymphocyte counts of greater than or equal to 200 cells/L. Immunosuppressed children should not receive LAIV. Infants who have been diagnosed with severe combined immunodeficiency (SCID) should not be given a live virus vaccine, including rotavirus (RV) vaccine. For details, consult the ACIP recommendations (4, 5, 6).
8. In the past 3 months, has the child taken cortisone, prednisone, other steroids, or anticancer drugs, or had radiation treatments? [LAIV, MMR, MMRV, Var]
Live virus vaccines (e.g., MMR, MMRV, varicella, LAIV) should be postponed until after chemotherapy or long-term high-dose steroid therapy has ended. For details and length of time to postpone, consult the ACIP statement (1). To find specific vaccination schedules for stem cell transplant (bone marrow transplant) patients, see reference 7. LAIV can only be given to healthy non-pregnant individuals age 249 years.
9. In the past year, has the child received a transfusion of blood or blood products, or been given immune (gamma) globulin or an antiviral drug? [LAIV, MMR, MMRV, Var]
Certain live virus vaccines (e.g., LAIV, MMR, MMRV, varicella) may need to be deferred, depending on several variables. Consult the most current ACIP recommendations or the current Red Book for the most current information on intervals between antiviral drugs, immune globulin or blood product administration and live virus vaccines (1, 2).
10. Is the child/teen pregnant or is there a chance she could become pregnant during the next month? [LAIV, MMR, MMRV, Var]
Live virus vaccines (e.g., MMR, MMRV, varicella, LAIV) are contraindicated one month before and during pregnancy because of the theoretical risk of virus transmission to the fetus (1, 6). Sexually active young women who receive a live virus vaccine should be instructed to practice careful contraception for one month following receipt of the vaccine (5, 8). On theoretical grounds, inactivated poliovirus vaccine should not be given during pregnancy; however, it may be given if risk of disease is imminent (e.g., travel to endemic areas) and immediate protection is needed. Use of Td or Tdap is not contraindicated in pregnancy. At the provider's discretion, either vaccine may be administered during the 2nd or 3rd trimester (9).
11. Has the child received vaccinations in the past 4 weeks?
[LAIV, MMR, MMRV, Var, yellow fever]
If the child was given either live, attenuated influenza vaccine (LAIV) or an injectable live virus vaccine (e.g., MMR, MMRV, varicella, yellow fever) in the past 4 weeks, they should wait 28 days before receiving another vaccination of this type. Inactivated vaccines may be given at the same time or at any spacing interval.
References: 1. CDC. General recommendations on immunization, at www.cdc.gov/vaccines/pubs/acip-list.htm. 2. AAP. Red Book: Report of the Committee on Infectious Diseases at www.aapredbook.org. 3. Table of Vaccine Components: www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/
excipient-table-2.pdf. 4. CDC. Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and
congenital rubella syndrome and control of mumps. MMWR 1998; 47 (RR-8). 5. CDC. Prevention of varicella: Recommendations of the Advisory Committee on Immunization Prac-
tices. MMWR 2007; 56 (RR-4). 6. CDC. Prevention and Control of Influenza--Recommendations of ACIP at www.cdc.gov/flu/profes-
sionals/vaccination/. 7. CDC. Excerpt from Guidelines for preventing opportunistic infections among hematopoietic stem cell
transplant recipients, MMWR 2000; 49 (RR-10), www.cdc.gov/vaccines/pubs/down-loads/b_hsct-recs.pdf. 8. CDC. Notice to readers: Revised ACIP recommendation for avoiding pregnancy after receiving a
rubella-containing vaccine. MMWR 2001; 50 (49). 9. CDC. Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and
their infants: Recommendations of the ACIP. MMWR 2008; 57 (RR-4).

Immunization Action Coalition Item #P4060 p. 2

Nombre del paciente:

Fecha de nacimiento: / /
(mes) (da) (ao)

Cuestionario de seleccin

para vacunacin de nios y adolescentes

A los padres/tutores: Las siguientes preguntas nos ayudarn a determinar cules vacunas le podremos

dar hoy a su hijo. Si contesta "s" a alguna pregunta, eso no siempre quiere decir que no deben vacunar

a su hijo. Simplemente quiere decir que hay que hacerle ms preguntas. Si alguna pregunta no est clara,

pida a su profesional de la salud que se la explique.

S

No No Sabe

1. Est enfermo hoy el nio?



2. Es alrgico el nio al ltex, a algn medicamento, alimento o vacuna?



3. Tuvo alguna vez el nio alguna reaccin seria a una vacuna en el pasado?



4. Ha tenido el nio algn problema de salud como enfermedad de los pulmones, del corazn, de los riones o metablica (como diabetes), asma o un trastorno de la sangre? Est en terapia de aspirina a largo plazo?



5. Si el nio que va a ser vacunado tiene entre 2 y 4 aos de edad, le dijo algn profesional de la salud en los ltimos 12 meses que el nio tuvo sibilancias o asma?



6. El nio, uno de sus hermanos o padres, ha tenido convulsiones; ha tenido el nio otros problemas del cerebro o del sistema nervioso?



7. Tiene el nio cncer, leucemia, SIDA o algn otro problema del sistema inmunolgico?

8. En los ltimos 3 meses, ha tomado el nio cortisona, prednisona, otros esteroides o medicamentos contra el cncer, o le han hecho tratamientos de radiacin?







9. Durante el ao pasado, le hicieron al nio una transfusin de sangre o de productos de la sangre, o le dieron inmunoglobulina o gamaglobulina o algn medicamento antiviral?







10. Est la nia/adolescente embarazada o hay alguna posibilidad de que quede embarazada durante el prximo mes?
11. Le aplicaron alguna vacuna al nio en las ltimas 4 semanas?



Formulario llenado por:

Fecha:

Formulario revisado por:

Fecha:

Trajo el comprobante de vacunacin de su hijo?

s no

Es importante que tenga un comprobante de vacunacin personal de las vacunas de su hijo. Si no lo tiene, pdale al profesional

de la salud de su hijo que le d uno con todas las vacunas que le aplicaron a su hijo. Gurdelo en un lugar seguro y llvelo

todas las veces que su hijo reciba atencin mdica. Su hijo necesitar este documento importante por el resto de su vida para

ingresar a la guardera o a la escuela, para empleos o para viajar al extranjero.

Translation by Transcend, Davis, CA

www.immunize.org/catg.d/p4060-01.pdf Item #P4060-01 Spanish (6/10)

Immunization Action Coalition 1573 Selby Ave. St. Paul, MN 55104 (651) 647-9009 www.immunize.org www.vaccineinformation.org

Information for Health Professionals about the Screening Questionnaire for Child & Teen Immunization
Are you interested in knowing why we included a certain question on the Screening Questionnaire? If so, read the information below. If you want to find out even more, consult the references listed at the bottom of this page.

1. Is the child sick today? [all vaccines]
There is no evidence that acute illness reduces vaccine efficacy or increases vaccine adverse events (1, 2). However, as a precaution with moderate or severe acute illness, all vaccines should be delayed until the illness has improved. Mild illnesses (such as otitis media, upper respiratory infections, and diarrhea) are NOT contraindications to vaccination. Do not withhold vaccination if a person is taking antibiotics.
2. Does the child have allergies to latex, medications, food, or any vaccine? [all vaccines]
History of anaphylactic reaction such as hives (urticaria), wheezing or difficulty breathing, or circulatory collapse or shock (not fainting) to latex or from a previous dose of vaccine or vaccine component is a contraindication for further doses. For example, if a person experiences anaphylaxis after eating eggs, do not administer influenza vaccine, or if a person has anaphylaxis after eating gelatin, do not administer MMR, MMRV, or varicella vaccine. A local reaction is not a contraindication. For a table of vaccines supplied in vials or syringes that contain latex, go to www.cdc.gov/ vaccines/pubs/pinkbook/downloads/appendices/B/latex-table.pdf. For an extensive table of vaccine components, see reference 3.
3. Has the child had a serious reaction to a vaccine in the past?
[all vaccines] History of anaphylactic reaction (see question 2) to a previous dose of vaccine or vaccine component is a contraindication for subsequent doses (1). History of encephalopathy within 7 days following DTP/DTaP is a contraindication for further doses of pertussis-containing vaccine. Precautions to DTaP (not Tdap) include the following: (a) seizure within 3 days of a dose, (b) pale or limp episode or collapse within 48 hours of a dose, (c) continuous crying for 3 or more hours within 48 hours of a dose, and (d) fever of 105F (40C) within 48 hours of a previous dose. There are other adverse events that might have occurred following vaccination that constitute contraindications or precautions to future doses. Under normal circumstances, vaccines are deferred when a precaution is present. However, situations may arise when the benefit outweighs the risk (e.g., during a community pertussis outbreak).
4. Has the child had a health problem with lung, heart, kidney, or metabolic disease (e.g., diabetes), asthma, or a blood disorder? Is he/she on long-term aspirin therapy? [LAIV]
Children with any of the health conditions listed above should not be given the intranasal, live attenuated influenza vaccine (LAIV). These children should be vaccinated with the injectable influenza vaccine.
5. If the child to be vaccinated is between the ages of 2 and 4 years, has a healthcare provider told you that the child had wheezing or asthma in the past 12 months? [LAIV]
Children who have had a wheezing episode within the past 12 months should not be given the live attenuated influenza vaccine. Instead, these children should be given the inactivated influenza vaccine.
6. Has the child, a sibling, or a parent had a seizure; has the child had brain or other nervous system problem? [DTaP, Td, Tdap,
TIV, LAIV, MCV4, MMRV] DTaP and Tdap are contraindicated in children who have a history of encephalopathy within 7 days following DTP/DTaP. An unstable progressive neurologic problem is a precaution to the use of DTaP and Tdap and a progressive neurologic disorder in a teen is a precaution to the use of Td. For children with stable neurologic disorders (including seizures) unrelated to vaccination, or for children with a family history of seizures, vaccinate as usual (exception: children with a personal or family [i.e., parent or sibling] history of seizures generally should not be vaccinated with MMRV; they should receive separate MMR and varicella vaccines). A history of Guillain-Barr syndrome (GBS) is a consideration with the following: 1) Td/Tdap: if GBS has occurred within 6 weeks of a tetanus-containing vaccine and decision is made to continue vaccination, give age-appropriate Tdap instead of Td if no history of prior Tdap; 2) Influenza vaccine (TIV or LAIV): if GBS has occurred within 6 weeks of a prior influenza vaccination, vaccinate with TIV if at high risk for severe influenza complications; 3) MCV4: avoid vaccinating persons unless in recommended risk groups.

7. Does the child have cancer, leukemia, AIDS, or any other immune system problem? [LAIV, MMR, MMRV, RV, Var]
Live virus vaccines (e.g., MMR, MMRV, varicella, rotavirus, and the intranasal live, attenuated influenza vaccine [LAIV]) are usually contraindicated in immunocompromised children. However, there are exceptions. For example, MMR is recommended for asymptomatic HIV-infected children who do not have evidence of severe immunosuppression. Likewise, varicella vaccine should be considered for HIV-infected children with age-specific CD4+ T-lymphocyte percentage at 15% or greater and may be considered for children age 8 years and older with CD4+ T-lymphocyte counts of greater than or equal to 200 cells/L. Immunosuppressed children should not receive LAIV. Infants who have been diagnosed with severe combined immunodeficiency (SCID) should not be given a live virus vaccine, including rotavirus (RV) vaccine. For details, consult the ACIP recommendations (4, 5, 6).
8. In the past 3 months, has the child taken cortisone, prednisone, other steroids, or anticancer drugs, or had radiation treatments? [LAIV, MMR, MMRV, Var]
Live virus vaccines (e.g., MMR, MMRV, varicella, LAIV) should be postponed until after chemotherapy or long-term high-dose steroid therapy has ended. For details and length of time to postpone, consult the ACIP statement (1). To find specific vaccination schedules for stem cell transplant (bone marrow transplant) patients, see reference 7. LAIV can only be given to healthy non-pregnant individuals age 249 years.
9. In the past year, has the child received a transfusion of blood or blood products, or been given immune (gamma) globulin or an antiviral drug? [LAIV, MMR, MMRV, Var]
Certain live virus vaccines (e.g., LAIV, MMR, MMRV, varicella) may need to be deferred, depending on several variables. Consult the most current ACIP recommendations or the current Red Book for the most current information on intervals between antiviral drugs, immune globulin or blood product administration and live virus vaccines (1, 2).
10. Is the child/teen pregnant or is there a chance she could become pregnant during the next month? [LAIV, MMR, MMRV, Var]
Live virus vaccines (e.g., MMR, MMRV, varicella, LAIV) are contraindicated one month before and during pregnancy because of the theoretical risk of virus transmission to the fetus (1, 6). Sexually active young women who receive a live virus vaccine should be instructed to practice careful contraception for one month following receipt of the vaccine (5, 8). On theoretical grounds, inactivated poliovirus vaccine should not be given during pregnancy; however, it may be given if risk of disease is imminent (e.g., travel to endemic areas) and immediate protection is needed. Use of Td or Tdap is not contraindicated in pregnancy. At the provider's discretion, either vaccine may be administered during the 2nd or 3rd trimester (9).
11. Has the child received vaccinations in the past 4 weeks?
[LAIV, MMR, MMRV, Var, yellow fever]
If the child was given either live, attenuated influenza vaccine (LAIV) or an injectable live virus vaccine (e.g., MMR, MMRV, varicella, yellow fever) in the past 4 weeks, they should wait 28 days before receiving another vaccination of this type. Inactivated vaccines may be given at the same time or at any spacing interval.
References: 1. CDC. General recommendations on immunization, at www.cdc.gov/vaccines/pubs/acip-list.htm. 2. AAP. Red Book: Report of the Committee on Infectious Diseases at www.aapredbook.org. 3. Table of Vaccine Components: www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/
excipient-table-2.pdf. 4. CDC. Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and
congenital rubella syndrome and control of mumps. MMWR 1998; 47 (RR-8). 5. CDC. Prevention of varicella: Recommendations of the Advisory Committee on Immunization Prac-
tices. MMWR 2007; 56 (RR-4). 6. CDC. Prevention and Control of Influenza--Recommendations of ACIP at www.cdc.gov/flu/profes-
sionals/vaccination/. 7. CDC. Excerpt from Guidelines for preventing opportunistic infections among hematopoietic stem cell
transplant recipients, MMWR 2000; 49 (RR-10), www.cdc.gov/vaccines/pubs/down-loads/b_hsct-recs.pdf. 8. CDC. Notice to readers: Revised ACIP recommendation for avoiding pregnancy after receiving a
rubella-containing vaccine. MMWR 2001; 50 (49). 9. CDC. Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and
their infants: Recommendations of the ACIP. MMWR 2008; 57 (RR-4).

Immunization Action Coalition Item #P4060-01 p. 2

Patient name:

Date of birth:
(mo.) (day) (yr.)

Screening Questionnaire for Adult Immunization

For patients: The following questions will help us determine which vaccines you may be given today.

If you answer "yes" to any question, it does not necessarily mean you should not be vaccinated. It just

means additional questions must be asked. If a question is not clear, please ask your healthcare provider

to explain it.

Don't

Yes No Know

1. Are you sick today?



2. Do you have allergies to medications, food, or any vaccine?



3. Have you ever had a serious reaction after receiving a vaccination?



4. Do you have a long-term health problem with heart disease, lung disease, asthma,



kidney disease, metabolic disease (e.g., diabetes), anemia, or other blood disorder?

5. Do you have cancer, leukemia, AIDS, or any other immune system problem?



6. Do you take cortisone, prednisone, other steroids, or anticancer drugs, or have you had radiation treatments?
7. Have you had a seizure, brain, or other nervous system problem?



8. During the past year, have you received a transfusion of blood or blood products, or been given immune (gamma) globulin or an antiviral drug?
9. For women: Are you pregnant or is there a chance you could become pregnant during the next month?
10. Have you received any vaccinations in the past 4 weeks?



Form completed by:_ ___________________________________________ Date:_________________

Form reviewed by: _ ___________________________________________ Date:_________________

Did you bring your immunization record card with you?

yes no

It is important for you to have a personal record of your vaccinations. If you don't have a personal record, ask your healthcare provider to give you one. Keep this record in a safe place and bring it with you every time you seek medical care. Make sure your healthcare provider records all your vaccinations on it.

Item #R4065 (4/09) Printed by Immunization Action Coalition Saint Paul, MN (651) 647-9009 www.immunize.org/shop

Healthcare Professionals: Retain this card for your reference. It explains why the 10 questions on the padded "Screening Questionnaire for Adult Immunization" are important to ask your patients.

1. Are you sick today? There is no evidence that acute illness reduces vaccine efficacy or increases vaccine adverse events (1). However, as a precaution with moderate or severe acute illness, all vaccines should be delayed until the illness has improved. Mild illnesses (such as upper respiratory infections or diarrhea) are NOT contraindications to vaccination. Do not withhold vaccination if a person is taking antibiotics.
2. Do you have allergies to medications, food, or any vaccine? History of anaphylactic reaction such as hives (urticaria), wheezing or difficulty breathing, or circulatory collapse or shock (not fainting) from a previous dose of vaccine or vaccine component is a contraindication for further doses. For example, if a person experiences anaphylaxis after eating eggs, do not administer influenza vaccine, or if a person has anaphylaxis after eating gelatin, do not administer MMR or varicella vaccine. Local reactions (e.g., a red eye following instillation of ophthalmic solution) are not contraindications. For an extensive list of vaccine components, see reference 2.
3. Have you ever had a serious reaction after receiving a vaccination? History of anaphylactic reaction (see question 2) to a previous dose of vaccine or vaccine component is a contraindication for subsequent doses (1). Under normal circumstances, vaccines are deferred when a precaution is present. However, situations may arise when the benefit outweighs the risk (e.g., during a community measles outbreak).
4. Do you have a long-term health problem with heart disease, lung disease, asthma, kidney disease, metabolic disease (e.g., diabetes), anemia, or other blood disorder? Persons with any of these health conditions should not be given the intranasal live attenuated influenza vaccine (LAIV). Instead, they should be vaccinated with the injectable influenza vaccine.
5. Do you have cancer, leukemia, AIDS, or any other immune system problem? Live virus vaccines (e.g., MMR, varicella, zoster [shingles], and LAIV) are usually contraindicated in immunocompromised people. However, there are exceptions. For example, MMR vaccine is recommended and varicella vaccine should be considered for adults with CD4+ T-lymphocyte counts of greater than or equal to 200 cells/L. Immunosuppressed persons should not receive LAIV. For details, consult the ACIP recommendations (3, 4, 5).
6. Do you take cortisone, prednisone, other steroids, or anticancer drugs, or have you had radiation treatments? Live virus vaccines (e.g., MMR, varicella, zoster, LAIV) should be postponed until after chemotherapy or long-term high-dose steroid therapy has ended. For details and length of time to postpone, consult the ACIP statement (1, 5). To find specific vaccination schedules for stem cell transplant (bone marrow transplant) patients, see reference 6. LAIV can be given only to healthy non-pregnant persons younger than age 50 years.
7. Do you have a seizure, brain, or other nervous system problem? Tdap is contraindicated in persons who have a history of encephalopathy within 7 days following DTP/DTaP given before age 7 years. An unstable progressive neurologic problem is a precaution to the use of Tdap. For persons with stable neurologic disorders (including seizures) unrelated to

vaccination, or for persons with a family history of seizure, vaccinate as usual. A history of Guillain-Barr syndrome (GBS) is a consideration with the following: 1) Td/Tdap: if GBS has occurred within 6 weeks of a tetanuscontaining vaccine and decision is made to continue vaccination, give Tdap instead of Td if no history of prior Tdap; 2) Influenza vaccine (TIV/LAIV): if GBS has occurred within 6 weeks of a prior influenza vaccine, vaccinate with TIV if at high risk for severe influenza complications; 3) MCV4: avoid vaccinating persons unless in recommended risk groups.
8. During the past year, have you received a transfusion of blood or blood products, or been given immune (gamma) globulin or an antiviral drug?
Certain live virus vaccines (e.g., LAIV, MMR, varicella) may need to be deferred, depending on several variables. Consult the most current ACIP recommendations for current information on intervals between antiviral drugs, immune globulin or blood product administration and live virus vaccines. (1)
9. For women: Are you pregnant or is there a chance you could become pregnant during the next month? Live virus vaccines (e.g., MMR, varicella, zoster, LAIV) are contraindicated one month before and during pregnancy because of the theoretical risk of virus transmission to the fetus. Sexually active women in their childbearing years who receive live virus vaccines should be instructed to practice careful contraception for one month following receipt of the vaccine. On theoretical grounds, inactivated poliovirus vaccine should not be given during pregnancy; however, it may be given if risk of disease is imminent and immediate protection is needed (e.g., travel to endemic areas). Use of Td or Tdap is not contraindicated in pregnancy. At the provider's discretion, either vaccine may be administered during the 2nd or 3rd trimester. (1, 3, 4, 5, 7, 8)
10. Have you received any vaccinations in the past 4 weeks? If the person to be vaccinated was given either LAIV or an injectable live virus vaccine (e.g., MMR, varicella, zoster, yellow fever) in the past 4 weeks, they should wait 28 days before receiving another vaccination of this type. Inactivated vaccines may be given at any spacing interval if they are not administered simultaneously.
References:
1. CDC. General recommendations on immunization, at www.cdc.gov/vaccines/pubs/acip-list.htm.
2. Table of Vaccine Components: www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/ B/excipient-table-2.pdf.
3. CDC. Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps. MMWR 1998; 47 (RR-8).
4. CDC. Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices. MMWR 2007; 56 (RR-4).
5. CDC. Prevention and control of influenza--recommendations of ACIP, at www.cdc.gov/flu/professionals/vaccination.
6. CDC. Excerpt from Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients, MMWR 2000; 49 (RR-10), www.cdc.gov/vaccines/pubs/ downloads/b_hsct-recs.pdf.
7. CDC. Notice to readers: Revised ACIP recommendation for avoiding pregnancy after receiving a rubella-containing vaccine. MMWR 2001; 50 (49).
8. CDC. Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants: Recommendations of the ACIP. MMWR 2008; 57 (RR-4).

Item #R4065 (4/09) Printed by Immunization Action Coalition Saint Paul, MN (651) 647-9009 www.immunize.org/shop

Nombre del paciente:

Fecha de nacimiento:
(mes) (da) (ao)

Cuestionario de seleccin para vacunacin de adultos

A los pacientes: Las siguientes preguntas nos ayudarn a determinar cules vacunas le podemos

dar hoy. Si contesta "s" a alguna pregunta, eso no siempre quiere decir que no lo deben vacunar.

Simplemente quiere decir que hay que hacerle ms preguntas. Si alguna pregunta no est clara,

pida a su profesional de la salud que se la explique.

No

S

No sabe

1. Est enfermo hoy?



2. Es alrgico a algn medicamento, alimento o vacuna?



3. Tuvo alguna vez una reaccin seria despus de vacunarse?
4. Tiene algn problema de salud a largo plazo, como enfermedad del corazn, enfermedad de los pulmones, asma, enfermedad de los riones, enfermedad metablica (como la diabetes), anemia o algn otro trastorno de la sangre?
5. Tiene cncer, leucemia, SIDA o algn otro problema del sistema inmunolgico?




6. Toma cortisona, prednisona, otros esteroides o medicamentos contra el cncer, o le han hecho tratamientos de radiacin?



7. Tuvo alguna vez un ataque (convulsin) o algn problema del cerebro o de los nervios?

8. Durante el ao pasado, le hicieron una transfusin de sangre o de productos



de la sangre, o le dieron inmunoglobulina o gamaglobulina o un medicamento antiviral?

9. Para las mujeres: Est embarazada o hay alguna posibilidad de que quede embarazada en el prximo mes?



10. Le aplicaron alguna vacuna en las ltimas 4 semanas?



Formulario llenado por:

Fecha:

Formulario revisado por:

_ Fecha:

Trajo su comprobante de vacunacin?

s no

Es importante que tenga un comprobante de vacunacin personal. Si no lo tiene, pdale a su profesional de la salud que le d uno. Gurdelo en un lugar seguro y llvelo todas las veces que reciba atencin mdica. Asegrese de que su profesional de la salud escriba all todas las vacunas que reciba.

Item #R4065 (4/09) Printed by Immunization Action Coalition Saint Paul, MN (651) 647-9009 www.immunize.org/shop

Healthcare Professionals: Retain this card for your reference. It explains why the 10 questions on the padded "Screening Questionnaire for Adult Immunization" are important to ask your patients.

1. Are you sick today? There is no evidence that acute illness reduces vaccine efficacy or increases vaccine adverse events (1). However, as a precaution with moderate or severe acute illness, all vaccines should be delayed until the illness has improved. Mild illnesses (such as upper respiratory infections or diarrhea) are NOT contraindications to vaccination. Do not withhold vaccination if a person is taking antibiotics.
2. Do you have allergies to medications, food, or any vaccine? History of anaphylactic reaction such as hives (urticaria), wheezing or difficulty breathing, or circulatory collapse or shock (not fainting) from a previous dose of vaccine or vaccine component is a contraindication for further doses. For example, if a person experiences anaphylaxis after eating eggs, do not administer influenza vaccine, or if a person has anaphylaxis after eating gelatin, do not administer MMR or varicella vaccine. Local reactions (e.g., a red eye following instillation of ophthalmic solution) are not contraindications. For an extensive list of vaccine components, see reference 2.
3. Have you ever had a serious reaction after receiving a vaccination? History of anaphylactic reaction (see question 2) to a previous dose of vaccine or vaccine component is a contraindication for subsequent doses (1). Under normal circumstances, vaccines are deferred when a precaution is present. However, situations may arise when the benefit outweighs the risk (e.g., during a community measles outbreak).
4. Do you have a long-term health problem with heart disease, lung disease, asthma, kidney disease, metabolic disease (e.g., diabetes), anemia, or other blood disorder? Persons with any of these health conditions should not be given the intranasal live attenuated influenza vaccine (LAIV). Instead, they should be vaccinated with the injectable influenza vaccine.
5. Do you have cancer, leukemia, AIDS, or any other immune system problem? Live virus vaccines (e.g., MMR, varicella, zoster [shingles], and LAIV) are usually contraindicated in immunocompromised people. However, there are exceptions. For example, MMR vaccine is recommended and varicella vaccine should be considered for adults with CD4+ T-lymphocyte counts of greater than or equal to 200 cells/L. Immunosuppressed persons should not receive LAIV. For details, consult the ACIP recommendations (3, 4, 5).
6. Do you take cortisone, prednisone, other steroids, or anticancer drugs, or have you had radiation treatments? Live virus vaccines (e.g., MMR, varicella, zoster, LAIV) should be postponed until after chemotherapy or long-term high-dose steroid therapy has ended. For details and length of time to postpone, consult the ACIP statement (1, 5). To find specific vaccination schedules for stem cell transplant (bone marrow transplant) patients, see reference 6. LAIV can be given only to healthy non-pregnant persons younger than age 50 years.
7. Do you have a seizure, brain, or other nervous system problem? Tdap is contraindicated in persons who have a history of encephalopathy within 7 days following DTP/DTaP given before age 7 years. An unstable progressive neurologic problem is a precaution to the use of Tdap. For persons with stable neurologic disorders (including seizures) unrelated to

vaccination, or for persons with a family history of seizure, vaccinate as usual. A history of Guillain-Barr syndrome (GBS) is a consideration with the following: 1) Td/Tdap: if GBS has occurred within 6 weeks of a tetanuscontaining vaccine and decision is made to continue vaccination, give Tdap instead of Td if no history of prior Tdap; 2) Influenza vaccine (TIV/LAIV): if GBS has occurred within 6 weeks of a prior influenza vaccine, vaccinate with TIV if at high risk for severe influenza complications; 3) MCV4: avoid vaccinating persons unless in recommended risk groups.
8. During the past year, have you received a transfusion of blood or blood products, or been given immune (gamma) globulin or an antiviral drug?
Certain live virus vaccines (e.g., LAIV, MMR, varicella) may need to be deferred, depending on several variables. Consult the most current ACIP recommendations for current information on intervals between antiviral drugs, immune globulin or blood product administration and live virus vaccines. (1)
9. For women: Are you pregnant or is there a chance you could become pregnant during the next month? Live virus vaccines (e.g., MMR, varicella, zoster, LAIV) are contraindicated one month before and during pregnancy because of the theoretical risk of virus transmission to the fetus. Sexually active women in their childbearing years who receive live virus vaccines should be instructed to practice careful contraception for one month following receipt of the vaccine. On theoretical grounds, inactivated poliovirus vaccine should not be given during pregnancy; however, it may be given if risk of disease is imminent and immediate protection is needed (e.g., travel to endemic areas). Use of Td or Tdap is not contraindicated in pregnancy. At the provider's discretion, either vaccine may be administered during the 2nd or 3rd trimester. (1, 3, 4, 5, 7, 8)
10. Have you received any vaccinations in the past 4 weeks? If the person to be vaccinated was given either LAIV or an injectable live virus vaccine (e.g., MMR, varicella, zoster, yellow fever) in the past 4 weeks, they should wait 28 days before receiving another vaccination of this type. Inactivated vaccines may be given at any spacing interval if they are not administered simultaneously.
References:
1. CDC. General recommendations on immunization, at www.cdc.gov/vaccines/pubs/acip-list.htm.
2. Table of Vaccine Components: www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/ B/excipient-table-2.pdf.
3. CDC. Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps. MMWR 1998; 47 (RR-8).
4. CDC. Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices. MMWR 2007; 56 (RR-4).
5. CDC. Prevention and control of influenza--recommendations of ACIP, at www.cdc.gov/flu/professionals/vaccination.
6. CDC. Excerpt from Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients, MMWR 2000; 49 (RR-10), www.cdc.gov/vaccines/pubs/ downloads/b_hsct-recs.pdf.
7. CDC. Notice to readers: Revised ACIP recommendation for avoiding pregnancy after receiving a rubella-containing vaccine. MMWR 2001; 50 (49).
8. CDC. Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants: Recommendations of the ACIP. MMWR 2008; 57 (RR-4).

Item #R4065 (4/09) Printed by Immunization Action Coalition Saint Paul, MN (651) 647-9009 www.immunize.org/shop

Standards for Child and Adolescent Immunization Practices National Vaccine Advisory Committee Pediatrics 2003;112;958-963
This information is current as of February 1, 2006 The online version of this article, along with updated information and services, is
located on the World Wide Web at: http://www.pediatrics.org/cgi/content/full/112/4/958
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2003 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Downloaded from www.pediatrics.org at Georgia Dept Of Med Asst on February 1, 2006

SPECIAL ARTICLE

Standards for Child and Adolescent Immunization Practices

National Vaccine Advisory Committee

ABBREVIATIONS. NVAC, National Vaccine Advisory Committee; ACIP, Advisory Committee on Immunization Practices; AAP, American Academy of Pediatrics; AAFP, American Academy of Family Physicians; VFC, Vaccines for Children Program; CDC, Centers for Disease Control and Prevention; VIS, Vaccine Information Statement; VAERS, Vaccine Adverse Events Reporting System; VICP, Vaccine Injury Compensation Program.
In 1992, the National Vaccine Advisory Committee (NVAC), in collaboration with the Ad Hoc Working Group for the Development of Standards for Pediatric Immunization Practices, a working group representing public and private agencies with input from state and local health departments, physician and nursing organizations, and public and private providers, developed a set of standards as to what constitutes the most essential and desirable immunization policies and practices. These standards were endorsed by a variety of medical and public health organizations and represented an important element in our national strategy to protect America's children against vaccine-preventable diseases.
Since that time, vaccine delivery in the United States has changed in several important ways. First, vaccination coverage rates among preschool children have increased substantially and are now monitored by the National Immunization Survey.1,2 Second, vaccination of children has shifted markedly from the public to the private sector,35 with an emphasis on vaccination in the context of primary care and the medical home.6 The Vaccines for Children Program has provided critical support to this shift by covering the cost of vaccines for the most economically disadvantaged children and adolescents. Third, the development and introduction of performance measures, such as the National Committee for Quality Assurance's Health Plan Employer Data and Information Set,7 have focused national attention on the quality of preventive care, including vaccination. Finally, highquality research in health services has helped to refine strategies for raising and sustaining vaccination coverage levels among children, adolescents, and adults.8
Health care professionals who vaccinate children and adolescents continue to face important chal-
From the National Vaccine Advisory Committee, Providence, Rhode Island. Received for publication Feb 26, 2003; accepted Apr 10, 2003. Reprint requests to the Centers for Disease Control and Prevention, National Immunization Program Resource Center, 1600 Clifton Rd, MS E-34, Atlanta, GA 30333. PEDIATRICS (ISSN 0031 4005). Copyright 2003 by the American Academy of Pediatrics.

lenges. These challenges include a diminishing level of experience--among patients, parents, and physicians--with the diseases that vaccines prevent, the ready availability of vaccine-related information that may be inaccurate or misleading, the increasing complexity of the vaccination schedule, and the failure of many health plans to pay for the costs associated with vaccination. In addition, recommendations from the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Medical Association in 1996 underscored the need to focus on adolescent vaccination.9
In this context, NVAC, along with partners representing the federal agencies, state and local health departments, and professional organizations, revised and updated the standards during 20012002 to reflect these changes and challenges in vaccine delivery. The revision was approved by NVAC on February 8, 2002 (Table 1), and distributed widely among a variety of medical and public health organizations for review and endorsement. Table 2 lists those organizations that have formally endorsed the Standards for Child and Adolescent Immunization Practices.
The standards are directed toward "health care professionals," an inclusive term for the many people in clinical settings who share in the responsibility for vaccination of children and adolescents: physicians, nurses, midlevel practitioners (eg, nurse practitioners, physician assistants), medical assistants, and clerical staff. In addition to this primary audience, the standards are intended to be useful to public health professionals, policy makers, health plan administrators, employers who purchase health care coverage, and others whose efforts shape and support the delivery of vaccination services.
Of note, the use of the term "standards" should not be confused with a minimum standard of care. Rather, these standards represent the most desirable immunization practices, which health care professionals should strive to achieve. Given current resource limitations, some health care professionals may find it difficult to implement all of the standards, because of circumstances over which they have little control. The expectation is that, by summarizing best immunization practices in a clear and concise format, the standards will assist these providers in securing the resources necessary to implement this set of recommendations.

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TABLE 1. Standards for Child and Adolescent Immunization Practices
Availability of vaccines 1. Vaccination services are readily available. 2. Vaccinations are coordinated with other health care services and provided in a medical home6 when possible. 3. Barriers to vaccination are identified and minimized. 4. Patient costs are minimized.
Assessment of vaccination status 5. Health care professionals review the vaccination and health status of patients at every encounter to determine which vaccines are indicated. 6. Health care professionals assess for and follow only medically accepted contraindications.
Effective communication about vaccine benefits and risks 7. Parents/guardians and patients are educated about the benefits and risks of vaccination in a culturally appropriate manner and in easy-to-understand language.
Proper storage and administration of vaccines and documentation of vaccinations 8. Health care professionals follow appropriate procedures for vaccine storage and handling. 9. Up-to-date, written vaccination protocols are accessible at all locations where vaccines are administered. 10. People who administer vaccines and staff who manage or support vaccine administration are knowledgeable and receive ongoing education. 11. Health care professionals simultaneously administer as many indicated vaccine doses as possible. 12. Vaccination records for patients are accurate, complete, and easily accessible. 13. Health care professionals report adverse events after vaccination promptly and accurately to the Vaccine Adverse Events Reporting System (VAERS) and are aware of a separate program, the Vaccine Injury Compensation Program (VICP). 14. All personnel who have contact with patients are appropriately vaccinated.
Implementation of strategies to improve vaccination coverage 15. Systems are used to remind parents/guardians, patients, and health care professionals when vaccinations are due and to recall those who are overdue. 16. Office- or clinic-based patient record reviews and vaccination coverage assessments are performed annually. 17. Health care professionals practice community-based approaches.

By adopting these standards, health care professionals can enhance their own policies and practices, making achievement of vaccination objectives for children and adolescents as outlined in Healthy People 2010, a nationwide health promotion and disease prevention agenda from the US Department of Health and Human Services,10 both feasible and likely. Achieving these objectives will improve the health and welfare of all children and adolescents as well as the communities in which they live.
THE STANDARDS
Availability of Vaccines
1. Vaccination Services Are Readily Available
All health care professionals who provide primary care to children and adolescents should always include routinely recommended vaccines as a part of the care that they deliver in the medical home.6 For some children and adolescents, the main contact with the health care system is not in a primary care provider's office; therefore, opportunities for vaccination may be missed. Thus, specialists and health care professionals in settings such as schools and school health clinics, sports physical clinics, family planning clinics, sexually transmitted disease clinics, and substance abuse treatment centers should assess each patient's vaccination status and either offer indicated vaccines or refer for vaccination if necessary. Information on vaccines administered outside the primary care setting should be communicated to the primary care provider.

2. Vaccinations Are Coordinated With Other Health Care Services and Provided in a Medical Home When Possible
Ideally, vaccines should be given as part of comprehensive health care. In primary care settings, vaccination services should be coordinated with routine well-care visits and other visits.6 Patients who are vaccinated in other settings should be encouraged to receive subsequent vaccines in their primary care setting. Patients without a primary care provider should be assisted with identifying one.
3. Barriers to Vaccination Are Identified and Minimized
Barriers to receiving vaccines include delays in scheduling appointments, requiring a well-care visit, long waiting periods in the office, and lack of culturally and age-appropriate educational materials. A physical examination, although an important part of well care, should not be required before administering vaccines: simply observing the patient and questioning about the patient's health status, immunization history, and vaccine contraindications are sufficient. In addition, vaccination-only visits should be available. Health care professionals should seek advice from parents/guardians and patients to identify ways to make vaccination services easier to use.
4. Patient Costs Are Minimized
Out-of-pocket costs--including vaccine, administration, and office visit fees--should be as low as possible for all patients, and no child or adolescent should be denied vaccination because of inability to pay. Resources should be identified to keep patient vaccination costs as low as possible. Free vaccine is

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TABLE 2. Organizations That Provide Endorsement for the Revised Standards for Child and Adolescent Immunization Practices
Advisory Committee on Immunization Practices Albert B. Sabin Vaccine Institute Ambulatory Pediatric Association American Academy of Family Physicians American Academy of Pediatrics American Academy of Physician Assistants American College of Emergency Physicians American College of Osteopathic Pediatricians American College of Preventive Medicine American Medical Association American Nurses Association American Osteopathic Association American Public Health Association Association of Immunization Program Managers Association of Maternal and Child Health Programs Association of State and Territorial Health Officials Center for Pediatric Research Centers for Medicare and Medicaid Services Council of State and Territorial Epidemiologists Every Child by Two Health Resources and Services Administration Immunization Action Coalition Infectious Diseases Society of America National Alliance for Hispanic Health National Asian Women's Health Organization National Assembly on School-Based Health Care National Association for City and County Health Officials National Association for Pediatric Nurse Practitioners National Association of School Nurses National Coalition for Adult Immunization National Foundation for Infectious Diseases National Institute of Allergy and Infectious Diseases National Medical Association National Network of Immunization Nurses and Associates National Partnership for Immunization National Perinatal Association Partnership for Prevention Pediatric Infectious Disease Society Project Immunize Virginia Rotary International Society for Adolescent Medicine Society for Teachers of Family Medicine Vaccine Education Center at the Children's Hospital of
Philadelphia
available through some public programs, although health care professionals who offer these vaccines may charge a reasonable administration fee. Sources of publicly funded vaccines include the Vaccines for Children Program (VFC), Public Health Service Section 317 grants to states, and state or local programs. Children and adolescents should be screened for their eligibility to receive vaccines through these programs. Vaccinations provided through VFC or Section 317 grants may not be denied because of an inability to pay the administration fee, and health care professionals should ensure that parents/ guardians and patients are aware of this requirement (applies to all vaccines purchased using Centers for Disease Control and Prevention [CDC] contracts, regardless of the setting--private or public--in which the vaccines are administered).
To minimize costs for patients, health plans and insurance plans should include the provision and administration of all routinely recommended vaccines as a covered benefit for all children and adolescents. Furthermore, to minimize costs for health care professionals, purchasers and health plans

should reimburse health care professionals adequately for delivering vaccines, including the time required for vaccine administration and for communication about vaccine benefits and risks. The CDC maintains a web page about VFC at http://www. cdc.gov/nip/vfc.
Assessment of Vaccination Status
5. Health Care Professionals Review the Vaccination and Health Status of Patients at Every Encounter to Determine Which Vaccines Are Indicated
Health care professionals should review the vaccination status of all patients at all health care visits to minimize the number of missed opportunities to vaccinate. This review should determine whether the patient has received any vaccinations elsewhere or is at high risk for disease or undervaccination. This information should be documented in the patient's chart and preventive health summary. Health care professionals who do not offer vaccinations should refer patients to a primary care provider for needed vaccinations.
6. Health Care Professionals Assess for and Follow Only Medically Accepted Contraindications
Withholding vaccinations because of medical concerns that are not contraindications results in missed opportunities for prevention. Health care professionals should ask about any condition or circumstance that might indicate that a vaccination should be withheld or delayed and about previous adverse events temporally associated with any vaccination. Health care professionals should support their decisions about what constitutes a contraindication or deferral for each vaccine by consulting the Guide to Contraindications to Vaccinations published by the CDC (available at: http://www.cdc.gov/nip/ recs/contraindications.pdf); the harmonized recommendations of the ACIP, the AAP, and the AAFP (available at: http://www.cdc.gov/nip/recs/childschedule.htm#Printable); the AAP's Red Book and other relevant recommendations; Vaccine Information Statements; and manufacturers' package inserts. Contraindications and deferrals should be documented in the medical record.
Effective Communication About Vaccine Benefits and Risks
7. Parents/Guardians and Patients Are Educated About the Benefits and Risks of Vaccination in a Culturally Appropriate Manner and in Easy-to-Understand Language
Health care professionals should allow sufficient time with parents/guardians and adolescent patients to discuss the benefits of vaccines, the diseases that they prevent, any known risks from vaccines, the immunization schedule and the need to receive vaccines at the recommended ages, and the importance of bringing the patient's hand-held vaccination record to each health care visit. Health care professionals should encourage parents/guardians and adolescent patients to take responsibility for ensuring that the patient is fully vaccinated.
For all commonly used childhood vaccines, all

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health care professionals are required by federal law to give a Vaccine Information Statement (VIS) to vaccine recipients or their parents/guardians at each visit. A VIS is a vaccine-specific, 2-page information sheet, produced by the CDC, that describes the benefits and risks of a vaccine. If necessary, health care professionals should supplement the VIS with oral explanations or other written materials that are culturally and linguistically appropriate. Health care professionals should review written materials with patients and their parents/guardians and address questions and concerns.
Health care professionals should encourage parents/guardians and adolescent patients to inform the health care professional of adverse events after the vaccine to be administered and explain how to obtain medical care, if necessary. (See Standard 13 for a description of the Vaccine Adverse Events Reporting System [VAERS]).
General vaccination information for health care professionals, parents, and members of the public may be obtained by calling the CDC National Immunization Information Hotline at 1-800-232-2522 (English) or 1-800-232-0233 (Spanish). Information about vaccine risk communication for health care professionals can be found at http://www.cdc.gov/nip/ vacsafe/research/peds.htm and in the latest edition of the Red Book. VISs are available in English and numerous other languages from state health departments and at http://www.cdc.gov/nip/publications/ VIS/default.htm and http://www.immunize.org. Recommendations for national standards for culturally and linguistically appropriate services in health care may be found at http://www.omhrc.gov/omh/ programs/2pgprograms/finalreport.pdf.
Proper Storage and Administration of Vaccines and
Documentation of Vaccinations
8. Health Care Professionals Follow Appropriate Procedures for Vaccine Storage and Handling
Vaccines should be handled and stored as recommended in the manufacturers' package inserts; the expiration date for each vaccine should be noted. Temperatures at which vaccines are stored and transported should be monitored and recorded twice daily. Summary information about vaccine storage and handling procedures are also available from state and local health departments and the CDC. Health care professionals should monitor vaccine inventory and undertake efforts to reduce wastage and loss. CDC-recommended storage and handling procedures are available from the CDC by calling 404-639-8222.
9. Up-to-Date, Written Vaccination Protocols Are Accessible at All Locations Where Vaccines Are Administered
To promote the safe and effective use of vaccines, health care professionals should maintain written protocols that detail the following: vaccine storage and handling; the recommended vaccination schedule, vaccine contraindications, and administration techniques; treatment and reporting of adverse events; vaccine benefit and risk communication; and

vaccination record maintenance and accessibility. These protocols should be consistent with established guidelines, reviewed frequently, and revised as needed to ensure that they remain up-to-date.
10. People Who Administer Vaccines and Staff Who Manage or Support Vaccine Administration Are Knowledgeable and Receive Ongoing Education
Health care professionals or others who administer vaccinations should be knowledgeable and receive continuing education in vaccine storage and handling; the recommended vaccine schedule, contraindications, and administration techniques; treatment and reporting of adverse events; vaccine benefit and risk communication; and vaccination record maintenance and accessibility. With appropriate training and in accordance with state law/regulation/policy, people other than physicians and nurses may administer vaccines. In addition, other staff should receive training and continuing education related to their specific roles and responsibilities that affect vaccination services.
The CDC sponsors distance-based training opportunities (eg, satellite broadcasts, web-based training, videotapes, self-administered print materials) for health care professionals. Information about training is available at http://www.cdc.gov/nip/ed.
11. Health Care Professionals Simultaneously Administer as Many Indicated Vaccine Doses as Possible
Administering vaccines simultaneously (at the same visit), in accordance with recommendations from the ACIP, the AAP, and the AAFP, is safe, effective and indicated. Although the immunization schedule provides age flexibility for administering certain vaccine doses, simultaneous administration decreases the number of visits needed and the potential for missed doses and enables earlier protection. When indicated vaccines are not simultaneously administered, arrangements should be made for the patient's earliest return to receive the needed vaccination(s). Additional information on the safety of simultaneous vaccination may be found at http://www.cdc.gov/nip/ vacsafe/research/simultaneous.htm.
12. Vaccination Records for Patients Are Accurate, Complete, and Easily Accessible
Vaccination records for patients should be recorded on a standard form in an easily accessible location in the medical record to facilitate rapid review of vaccination status. Accurate record keeping helps to ensure that only needed vaccinations are given. As required by federal law (42 US Code 300aa25), health care professionals should ensure that records contain the following information for each vaccination: the date of administration, the vaccine manufacturer and lot number, the signature and title of the person administering the vaccine, and the address where the vaccine was given. Vaccine refusal should also be documented.
The medical record maintained by the primary care provider should document all vaccines received, including those received at a specialist's office or in another health care setting. When a health care pro-

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fessional who does not routinely care for a patient vaccinates that patient, the patient's primary care provider should be informed.
All vaccinations administered should be reported to state or local immunization registries, where available, to ensure that each patient's vaccination history remains accurate and complete. Registries also may be useful for verifying the vaccination status of new patients, determining which vaccines are needed at a visit, printing official records, and providing reminders and recalls to parents, guardians, and patients.
Health care professionals should ensure that each patient has a hand-held vaccination record that documents each vaccine received, including the date and the name of the health care professional who administered the vaccine. Health care professionals should encourage parents/guardians and adolescent patients to bring the patient's hand-held record to each health care visit so that it can be updated.
The CDC maintains an Immunization Registry Clearinghouse. Information about this clearinghouse is available at http://www.cdc.gov/nip/registry/.
13. Health Care Professionals Report Adverse Events After
Vaccination Promptly and Accurately to the Vaccine Adverse
Events Reporting System (VAERS) and Are Aware of a
Separate Program, the National Vaccine Injury Compensation
Program (VICP)
Health care professionals should promptly report all clinically significant adverse events after vaccination to the VAERS even if the health care professional is not certain that the vaccine caused the event. Health care professionals should document in detail the adverse event in the patient's medical record as soon as possible. Providers should be aware that parents/guardians and patients may report to VAERS and that if they choose to do so, they are encouraged to seek the help of their health care provider.
The National Vaccine Injury Compensation Program (VICP) is a no-fault system that compensates people of any age for injuries or conditions that may have been caused by a vaccine recommended by the CDC for routine use in children. Health care professionals should be aware of the VICP to address questions raised by parents/guardians and patients.
Because VAERS and VICP are separate programs, a report of an event to VAERS does not result in the submission of a compensation claim to VICP. A brief description and contact information for both programs is provided on each VIS for those vaccines covered by the National Childhood Vaccine Injury Act.
Information about VAERS, as well as guidance about how to obtain and complete a VAERS form, can be found at http://www.vaers.org or by calling 1-800-822-7967. Information about the VICP is available at http://www.hrsa.gov/osp/vicp or by calling 1-800-338-2382.
14. All Personnel Who Have Contact With Patients Are
Appropriately Vaccinated
Health care professionals and other personnel who have contact with patients should be appropriately

vaccinated. Offices and clinics should have policies to review and maintain the vaccination status of staff and trainees. ACIP recommendations for vaccinating health care workers are available at ftp://ftp.cdc. gov/pub/publications/mmwr/rr/rr4618.pdf.
Implementation of Strategies to Improve Vaccination Coverage
15. Systems Are Used to Remind Parents/Guardians, Patients, and Health Care Professionals When Vaccinations Are Due and to Recall Those Who Are Overdue
Evidence demonstrates that reminder/recall systems improve vaccination coverage.11 Patient reminder/recall interventions inform individuals that they are due (reminder) or overdue (recall) for specific vaccinations. Patient reminders/recalls can be mailed or communicated by telephone; an autodialer system can be used to expedite telephone reminders. Patients who might be at high risk for not complying with medical recommendations, for example, those who have missed previous appointments, should receive more intensive follow-up. Similarly, provider reminder/recall systems alert health care professionals when vaccines are due or overdue. Notices should be placed in patient charts or communicated to health care professionals by computer or other means. Immunization registries can facilitate automatic generation of reminder/recall notices.
16. Office- or Clinic-Based Patient Record Reviews and Vaccination Coverage Assessments Are Performed Annually
Evidence shows that assessments are most effective in improving vaccination coverage in a practice when they combine chart reviews to determine coverage with the provision of results to health care professionals and staff.11 Effective interventions also may incorporate incentives or compare performance with a goal or a standard. Coverage should be assessed regularly so that reasons for low coverage in the practice or in a subgroup of patients are identified and addressed. For assistance in conducting vaccination coverage assessments, health care professionals should contact their state or local immunization program.
17. Health Care Professionals Practice Community-Based Approaches
All health care professionals share in the responsibility to achieve the highest possible degree of community protection against vaccine-preventable diseases. Immunization protects the entire community as well as the individual. No community is optimally protected against vaccine-preventable diseases without high vaccination coverage. Therefore, health care professionals should consider the needs of the community (especially underserved populations) as well as those of their patients. Community-based approaches may involve working with partners in the community, including public health departments, managed care organizations, other service providers such as the US Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), advocacy groups, schools,

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and service organizations to determine community needs and develop vaccination services that address these needs.
NATIONAL VACCINE ADVISORY COMMITTEE
(NVAC)
The NVAC was chartered in 1988 to advise and make recommendations to the director of the National Vaccine Program and the assistant secretary for health, Department of Health and Human Services, on matters related to the prevention of infectious diseases through immunization and the prevention of adverse reactions to vaccines. The NVAC is composed of 15 members from public and private organizations representing vaccine manufacturers, physicians, parents, and state and local health agencies. In addition, representatives from governmental agencies involved in health care or allied services serve as ex-officio members of the NVAC.
Committee members: Georges Peter, MD (Chair), Brown Medical School, Providence, RI; Ann Margaret Arvin, MD, Stanford University School of Medicine, Stanford, CA; Jeffrey P. Davis, MD, Wisconsin Division of Health, Madison, WI; Michael D. Decker, MD, MPH; Aventis Pasteur, Swiftwater, PA; Patricia Fast, MD, PhD, International AIDS Vaccine Initiative, New York, NY; Fernando A. Guerra, MD, MPH, San Antonio Metropolitan Health District, San Antonio, TX; Charles M. Helms, MD, PhD, University of Iowa Hospital and Clinics, Iowa City, IA; Alan Richard Hinman, MD, The Task Force for Child Survival and Development, Decatur, GA; Ruth Katz, JD, MPH, Yale University School of Medicine, New Haven, CT; Jerome O. Klein, MD, Boston Medical Center, Boston, MA; Mary Beth Koslap-Petraco, MS, CPNP, Suffolk County Department of Health Services, Lindenhurst, NY; Peter R. Paradiso, PhD, Wyeth-Lederle Vaccines and Pediatric American Home Products, West Henrietta, NY; William Schaffner, MD, Vanderbilt University School of Medicine, Nashville, TN; Patricia N. Whitley-Williams, MD, Robert Wood Johnson Medical School, New Brunswick, NJ; Donald E. Williamson, MD, Alabama Department of Public Health, Montgomery, AL.
ACKNOWLEDGMENTS
The NVAC acknowledges the following liaison representatives and ex officio members for their valuable contributions to this report: Steven Black, MD, Kaiser Permanente Study Center, Oakland, CA (representing the American Association of Health Plans); Jackie Noyes, American Academy of Pediatrics, Washington, DC (representing the Advisory Commission on Childhood Vaccines); David S. Stevens, MD, Emory University School of Medicine, Atlanta, GA (representing the Vaccines and Related Biological Products Advisory Committee); Robert S. Daum, MD, University of Chicago Children's Hospital, Chicago, IL (representing the Vaccines and Related Biological Products Advisory Committee; former liaison representative to NVAC); John F. Modlin, MD,

Dartmouth Medical School, Lebanon, NH (representing the Advisory Committee on Immunization Practices); Karen Midthun, MD, Food and Drug Administration, Rockville, MD; Col Renata J.M. Engler, Walter Reed Medical Center, Washington, DC; Carole Heilman, PhD, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Geoffrey Evans, MD, Health Resources and Services Administration, Rockville, MD; Ruth Frischer, PhD, US Agency for International Development, Washington, DC; T. Randolph Graydon, Centers for Medicare and Medicaid Services, Baltimore, MD; Walter A. Orenstein, MD, Centers for Disease Control and Prevention, Atlanta, GA; William A. Robinson, MD, Health Resources and Services Administration, Rockville, MD; Emily Marcus Levine, Office of the General Counsel (Department of Health and Human Services), Rockville, MD.
REFERENCES
1. Simpson DM, Ezzati-Rice TM, Zell E. Forty years and four surveys: how does our measuring measure up? Am J Prev Med. 2001;20(4 suppl):6 14
2. Barker LE, Luman BT. Changes in vaccination coverage estimates among children aged 19 35 months in the United States, 1996 1999. Am J Prev Med. 2001;20:28 31
3. Szilagyi PG, Humiston SG, Shone LP, Barth R, Kolasa MS, Rodewald LE. Impact of vaccine financing on vaccinations delivered by health department clinics. Am J Public Health. 2000;90:739 745
4. Zimmerman RK, Nowalk MP, Mieczkowski TA, Mainzer HM, Jewell KI, Raymund M. The Vaccine for Children Program. Policies, satisfaction, and vaccine delivery. Am J Prev Med. 2001;21:243249
5. Zimmerman RK, Medsger AR, Ricci EM, Raymund M, Mieczkowski TA, Grufferman S. Impact of free vaccine and insurance status on physician referral of children to public vaccine clinics. JAMA. 1997;278: 996 1000
6. American Academy of Pediatrics, Medical Home Initiative for Children With Special Needs Project Advisory Committee. The medical home. Pediatrics. 2002;110;184 186
7. Background and descriptive information. Available at: http:// www.ncqa.org/Programs/HEDIS/. Accessed December 10, 2002
8. Briss PA, Rodewald LE, Hinman AR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med. 2000;18(1 suppl):97140
9. Centers for Disease Control and Prevention. Immunization of adolescents: recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association. MMWR Recomm Rep. 1996;45(RR-13):116
10. US Department of Health and Human Services. Healthy People 2010 (Conference Edition in Two Volumes). Washington, DC: January 2000. Available at: http://www.health.gov/healthypeople/document/ tableofcontents.htm. Accessed December 10, 2002
11. Task Force on Community Preventive Services. Recommendations regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med. 2000;18(1 suppl):9296

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Standards for Child and Adolescent Immunization Practices National Vaccine Advisory Committee Pediatrics 2003;112;958-963
This information is current as of February 1, 2006

Updated Information & Services References Citations Subspecialty Collections
Errata Permissions & Licensing Reprints

including high-resolution figures, can be found at: http://www.pediatrics.org/cgi/content/full/112/4/958
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ERRATA
Numerical errors occurred in the article by Holt et al, titled "Response to Intravenous Immunoglobulin Predicts Splenectomy Response in Children With Immune Thrombocytopenic Purpura," that was published in the January 2003 issue of Pediatrics (2003;111:8790). On page 88, right column (fourth paragraph of the "Response to IVIG" section), the second sentence currently reads: "Response to IVIG was a sensitive predictor of response to splenectomy in 91% of patients, with a specificity of 66%, a positive predictive value of 87%, and a negative predictive value of 75%." It should read: "Response to IVIG was a sensitive predictor of response to splenectomy in 88% of patients, with a specificity of 75%, a positive predictive value of 91%, and a negative predictive value of 67%."
Two errors occurred in the article by the National Vaccine Advisory Committee, titled "Standards for Child and Adolescent Immunization Practices," that was published in the October 2003 issue of Pediatrics (2003;112:958 963). On page 958, left column (first footnote), the National Vaccine Advisory Committee is based in Washington, DC. On page 963, left column (second paragraph of the "National Vaccine Advisory Committee (NVAC)" section), the correct affiliation for Peter R. Paradiso, PhD, is Wyeth Vaccines.
Decimal errors occurred in the article by Verstraeten et al, titled "Safety of Thimerosal-Containing Vaccines: A Two-Phased Study of Computerized Health Maintenance Organization Databases," that was published in the November 2003 issue of Pediatrics (2003;112:1039 1048). On page 1039, right column (first paragraph), the fifth sentence currently reads: ". . . may have exceeded the 1995 EPA guidelines for exposure to organic Hg (1 g/kg/d vs 3 g/kg/d). . . ." It should read: ". . . may have exceeded the 1995 EPA guidelines for exposure to organic Hg (0.1 g/kg/d vs 0.3 g/kg/d). . . ."
Also in this article, as indicated, Thomas Verstraeten, MD, was an employee of the Centers for Disease Control and Prevention when he worked on the study. He is currently employed by GlaxoSmithKline.
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Review and Special Articles
Standards for Adult Immunization Practices
Gregory A. Poland, MD, Abigail M. Shefer, MD, Mary McCauley, MTSC, Peggy S. Webster, MD, Patricia N. Whitley-Williams, MD, Georges Peter, MD, and the National Vaccine Advisory Committee, Ad Hoc Working Group for the Development of Standards for Adult Immunization Practices

Abstract:

Since the Standards for Adult Immunization Practices were first published in 1990, healthcare researchers and providers have learned important lessons on how to better achieve and maintain high vaccination rates in adults. The success rate of childhood immunization far exceeds the success rate of adult immunization. Thus, information and practices that will produce higher success rates for adult vaccination are crucial, resulting in overall societal cost savings and substantial reductions in hospitalizations and deaths. The Standards, which were developed to encourage the best immunization practices, represent the collective efforts of more than 100 people from more than 60 organizations. The revised Standards are more comprehensive than the 1990 Standards and focus on the accessibility and availability of vaccines, proper assessment of patient vaccination status, opportunities for patient education, correct procedures for administering vaccines, implementation of strategies to improve vaccination rates, and partnerships with the community to reach target patient populations. The revised Standards are recommended for use by all healthcare professionals and all public and private sector organizations that provide immunizations for adults. All who are involved in adult immunization should strive to follow the Standards in order to create the same level of success achieved by childhood vaccination programs and to meet the Healthy People 2010 goals.
(Am J Prev Med 2003;25(2):144 150)

Introduction
In the United States, years of clinical and programmatic experience have been translated into successful childhood immunization practices. As a result, vaccination rates among infants and children are near or at all-time highs. Today, most childhood vaccinepreventable diseases rarely occur or are non-existent. However, similar success in vaccinating adults has not been achieved.
Goals for adult immunization feature prominently in Healthy People 2010,1 a comprehensive, nationwide health promotion and disease prevention agenda from the U.S. Department of Health and Human Services. The target is 90% coverage for annual influenza immunization among adults aged 65 years and 90% for one dose of pneumococcal vaccine. Success will require a dramatic increase from rates in 2000, which were only
From the Mayo Vaccine Research Group, Mayo Clinic (Poland), Rochester, Minnesota; National Immunization Program, Centers for Disease Control and Prevention (Shefer, McCauley), Atlanta, Georgia; Abott Laboratories (Webster), Abbott Park, Illinois; University of Medicine and Dentistry of New JerseyRobert Wood Johnson Medical School (Whitney-Williams), New Brunswick, New Jersey; Brown Medical School (Peter), Providence, Rhode Island.
Address correspondence and reprint requests to: National Vaccine Program Office, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K-77, Chamblee GA 30341.
The full text of this article is available via AJPM Online at www.ajpm-online.net.

66% for influenza vaccine and 50% for pneumococcal vaccine.2
Increasing the use of these two vaccines among older
adults could have tremendous health impacts. Influ-
enza and its complications kill approximately 40,000 individuals every year in the United States.3 Another
100,000 individuals suffer so severely from influenza that hospitalization is required.4 The overwhelming
majority of these deaths and hospitalizations occur in
the elderly. When vaccine viruses are well matched to
circulating viruses, vaccination lowers the risk of infection among healthy adults by up to 90%.4,5 Although
influenza vaccination is somewhat less effective among
the elderly, vaccination has been estimated to reduce
their risk of influenza-related hospitalization and death by up to 70%.4,68 The Centers for Disease Control and Prevention (CDC)9 estimate that for each additional 1
million elderly people vaccinated each year, 900 deaths
and 1300 hospitalizations would be averted. Further-
more, economic studies find overall societal cost sav-
ings and substantial reductions in hospitalizations and deaths if people aged 65 years receive the influenza vaccine.4,6,7
In recent years, pneumococcal infections have accounted for 100,000 hospitalizations for pneumonia, 60,000 cases of bacteremia and other forms of inva-
sive disease, and about 7000 deaths from invasive pneumococcal disease.1012 In 1998, 50% of these deaths occurred among people aged 65 years. Over-

144 Am J Prev Med 2003;25(2) Published by Elsevier Inc.

0749-3797/03/$see front matter doi:10.1016/S0749-3797(03)00120-X

all, vaccine effectiveness against invasive pneumococcal disease among immunocompetent people aged 65 years is 75%,13 and the vaccine has been shown to be cost effective for people in this age group as well.14 Based on 1998 projections, annually 76% of invasive pneumococcal disease cases and 87% of resulting deaths occurred in people who were eligible for pneumococcal vaccine in the United States.12
Additional health benefits could also be gained by reaching immunization targets for younger high-risk adults. Healthy People 20101 targets are 60% coverage with influenza and pneumococcal vaccines among high-risk adults aged 18 to 64 years. In 1999, only 31% of these adults reported receiving influenza vaccine, and only 17% received pneumococcal vaccine (Centers for Disease Control and Prevention, unpublished data, 1999). In 1998, 41% of deaths attributed to invasive pneumococcal disease occurred among individuals aged 18 to 64 years who had a medical indication for the pneumococcal vaccine.12
Despite the availability of a vaccine that is 95% effective in preventing hepatitis B, approximately 80,000 individuals, mostly adolescents and adults, are infected annually in the United States.15,16 About 6% of newly infected people become chronically infected and face a 15% to 25% lifetime risk of death from chronic liver disease. Annually, an estimated 4000 to 5000 chronically infected people die prematurely from chronic liver disease.17 Without an improvement in vaccinating adults at increased risk of hepatitis B infection, transmission of hepatitis B will continue for decades.
Vaccines also remain underutilized among other groups of adults, especially among certain racial/ethnic populations. For example, the rates of influenza and pneumococcal vaccination in African-American and Hispanic populations are significantly lower than those among whites.18 In addition, adult immunization is not limited to pneumococcal, influenza, and hepatitis B vaccines. All adults should be immune to measles, mumps, rubella, tetanus, diphtheria, and varicella, and adults who are susceptible to hepatitis A and polio should be vaccinated if they are at risk for exposure. Further, certain vaccines, such as travel vaccines or vaccines occupationally required, should be reviewed and provided if appropriate. The CDC's Advisory Committee on Immunization Practices (ACIP) has recently published an Adult Immunization Schedule (http:// cdc.gov/nip/recs/adult-schedule.htm).
Revising the Standards
The Standards for Adult Immunization Practices, developed to encourage best practices, were first published in 1990.19 Since then, the healthcare system has changed dramatically. For example, there has been a shift toward managed care, resulting in a change in

Table 1. Standards for adult immunization practices
Make vaccinations available. 1. Adult vaccination services are readily available. 2. Barriers to receiving vaccines are identified and minimized. 3. Patient "out-of-pocket" vaccination costs are minimized.
Assess patients' vaccination status. 4. Healthcare professionals routinely review the vaccination status of patients. 5. Healthcare professionals assess for valid contraindications.
Communicate effectively with patients. 6. Patients are educated about risks and benefits of vaccination in easy-to-understand language.
Administer and document vaccinations properly. 7. Written vaccination protocols are available at all locations where vaccines are administered. 8. Persons who administer vaccines are properly trained. 9. Healthcare professionals recommend simultaneous administration of indicated vaccine doses.
10. Vaccination records for patients are accurate and easily accessible.
11. All personnel who have contact with patients are appropriately vaccinated.
Implement strategies to improve vaccination rates. 12. Systems are developed and used to remind patients and
healthcare professionals when vaccinations are due and to recall patients who are overdue. 13. Standing orders for vaccinations are employed. 14. Regular assessments of vaccination coverage levels are conducted in a provider's practice. Partner with the community. 15. Patient-oriented and community-based approaches are used to reach target populations.
provider incentives and reimbursement for preventive services. Also in the past decade, healthcare researchers and providers have learned many valuable lessons about what is needed to achieve and maintain high vaccination rates among adults.
This revision of the Standards for Adult Immunization Practices (Table 1) reflects the experience of the past 10 years. The Standards represent the collective efforts of more than 100 people from more than 60 organizations, including professional societies, state and local health departments, immunization programs, and immunization providers. The National Vaccine Advisory Committee (NVAC) led this effort. As the Federal Advisory Committee is charged by the Secretary of Health and Human Services to ensure the adequate delivery of safe and effective vaccination products in the United States, the NVAC itself is composed of people who represent the spectrum of those with an interest in immunization, including physicians, researchers, developers, manufacturers, state and public health agencies, and more than 20 federal agencies. The revised Standards also incorporate information from two important reports published by NVAC in the last decade on the status of adult immunization20 and on adult immunization programs in nontraditional settings.21

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Information published from the Guide to Community Preventive Services reviews strategies to improve immunization service delivery and provides a broader base of evidence to support the Standards.22,23 Based on research published in the 1990s concerning techniques proven to improve immunization rates among adults, three new standards were constructed and require the following: (1) systems that remind patients and providers when an immunization is due, (2) standing orders from physicians that enable other personnel to prescribe and deliver vaccinations, (3) regular assessments of coverage rates at clinics, and (4) pertinent information provided to clinic staff to ensure current patient immunizations.
The Standards supplement research with expert consensus in areas where research does not offer guidance but experience does. The revised Standards are more comprehensive than the previous version and organized to focus on the provider's ongoing process of minimizing barriers that prevent patients from receiving vaccines, assessing for valid indications and contraindications, keeping patients' immunizations current, and communicating effectively with patients about vaccines.
Today, more tools are available to support immunization providers. The revised Standards include links to websites that contain information on model standingorder policies, instructions for setting up reminder/ recall systems, and templates for personal vaccination records. The tools are currently available free on CDROM, but will soon be available online. In addition, information about federal requirements and programs, including Vaccine Information Statements, the Vaccine Adverse Event Reporting System (VAERS), and the National Vaccine Injury Compensation Program (VICP) is current and has been made easily accessible in the Standards.
Applying the Standards
Once the revised Standards are implemented on a practice-by-practice or program-by-program basis, immediate results can be expected for improved adult immunization. Long-term sustainable improvement in adult immunization necessitates an infrastructure to organize immunization efforts by providers and federal agencies, as well as state and local health departments. Such an infrastructure is lacking.24 Partnerships among healthcare professionals, state and local health departments, medical and nursing organizations, and insurance companies will need to be strengthened. Factors that cause low vaccination coverage among adults must be addressed. These factors include provider behaviors and practices that may affect accurate identification of patients in need of vaccination, attitudes toward the healthcare system that may impact adults seeking and accepting vaccines, and financial issues that may im-

pede appropriate vaccination of certain populations. For example, although Medicare ensures coverage benefits for vaccines for those aged 65 years, in 2001 an estimated 17% and 13% of adults aged 35 to 44 years and 45 to 64 years, respectively, did not have health insurance.2 In addition, even though many adults may have insurance coverage, the medical insurance may not cover vaccination.
Overall improvement in our healthcare system will take time. However, we can do much now to improve the delivery of vaccination services for adults. The following Standards for Adult Immunization Practices and the accompanying discussion are intended to address these issues.
The Standards Make Vaccinations Available
Standard 1: Adult vaccination services are readily available. Primary care healthcare professionals who serve adults should always include routinely recommended vaccinations as part of their care. Specialists, whose patients may be at increased risk of vaccine-preventable diseases, should also include routinely recommended vaccinations as part of their care. For selected vaccines (e.g., meningococcal vaccine for college entrants and vaccines for international travelers), patients may be referred to another provider.
Standard 2: Barriers to receiving vaccines are identified and minimized. Barriers to receiving vaccines may include requiring a physical examination before vaccination, requiring an additional visit for vaccination, long waiting periods, and lack of educational materials that are culturally appropriate. Prior to vaccine administration, simply observing the patient, asking if the patient is well and questioning the patient/guardian about vaccine contraindications is sufficient.
Standard 3: Patient "out-of-pocket" vaccination costs are minimized. Resources should be identified to keep patient vaccination costs as low as possible, specifically for those patients aged 65 years and for vaccines not covered by Medicare Part B. In the public sector, patient fees should include only the cost of vaccine and administration that cannot be funded through another source. In the private sector, routinely recommended vaccination services should be included in basic benefits packages. System and policy changes should be addressed to provide adequate reimbursement to providers for delivering vaccinations to their adult population.
Assess Patients' Vaccination Status
Standard 4: Healthcare professionals routinely review the vaccination status of patients. Healthcare professionals should review and document the vaccination

146 American Journal of Preventive Medicine, Volume 25, Number 2

status of all new patients during initial office visits and also review vaccination status on an annual basis thereafter. Healthcare professionals should ascertain if the patient has medical risk factors, lifestyle risk factors, or an occupation for which certain vaccines may be indicated. Healthcare professionals should record this information in the patient's chart and preventive health summary. Healthcare professionals should also routinely review pneumococcal vaccination status at the time of influenza vaccination.
Standard 5: Healthcare professionals assess for valid contraindications. Failure to differentiate between valid and invalid contraindications often results in the needless deferral of indicated vaccinations. Healthcare professionals should ask about prior adverse events in connection with a vaccination and about any conditions or circumstances that might indicate vaccination should be withheld or delayed. Healthcare professionals should refer to current ACIP recommendations on valid and invalid contraindications as well as on valid indications for vaccine use (www.cdc.gov/nip).
Communicate Effectively with Patients
Standard 6: Patients are educated about risks and benefits of vaccination in easy-to-understand language. Healthcare professionals should discuss with the patient the benefits of vaccines, the diseases that the vaccines prevent, and any known risks from vaccines. These issues should be discussed in the patient's native language, whenever possible. Printed materials, accurately translated into the patient's language, should be provided. For most commonly used vaccines, the U.S. federal government has developed Vaccine Information Statements for use by both public and private healthcare professionals to give to potential vaccine recipients. For vaccines covered by the National Childhood Vaccine Injury Act, including those vaccines used in children, these forms are required. These statements are available in English and other languages. Healthcare professionals should allot ample time with patients to review written materials and address questions and concerns. Information and assistance can be obtained by calling the Immunization Hotline (1-800-232-2522) or accessing the website (www.cdc.gov/nip).
Healthcare professionals should respect each patient's right to make an informed decision to accept or reject a vaccine or to defer vaccination until more information is collected.
Administer and Document Vaccinations Properly
Standard 7: Written vaccination protocols are available at all locations where vaccines are administered. The medical protocol should detail procedures for vaccine storage and handling, vaccine schedules, contraindications, administration techniques, management and re-

porting of adverse events, and record maintenance and accessibility. These protocols should be consistent with established guidelines. CDC-recommended storage and handling procedures are available on the Internet at http://gravity.lmi.org/lmi_cdc/geninfo.htm.
Healthcare professionals should promptly report all clinically significant adverse events following vaccination to VAERS, even if the healthcare professional does not believe that the vaccine caused the event. Reporting is required for those vaccines given to adults and medical conditions covered by the National Childhood Vaccine Injury Act of 1986, as amended. Healthcare professionals should be aware that patients may report to VAERS; if they choose to do so, they are encouraged to seek the help of their healthcare professional. Report forms and assistance are available by calling 1-800822-7967 or on the Internet at www.fda.gov/cber/ vaers/vaers.htm.
The VICP is a no-fault system that compensates people of any age for injuries or conditions that may have been caused by a vaccine recommended by CDC for routine administration to children. Healthcare professionals should be aware of the VICP in order to address questions raised by patients. Information about the VICP is available on the Internet at www.hrsa.gov/ bhpr/vicp.htm or by calling 1-800-338-2382.
Since VAERS and VICP are separate programs, a report of an event to VAERS does not result in the submission of a compensation claim to VICP. Such a claim must be filed independently in the U.S. Court of Federal Claims. A brief description and contact information for both programs are provided on each Vaccine Information Statement for vaccines covered by the VICP.
Standard 8: People who administer vaccines are properly trained. All people who administer vaccinations should be fully trained in vaccine storage and handling, vaccine schedules, contraindications, administration techniques, management and reporting of adverse events, and record maintenance and accessibility. Office staff should receive continuing education on these issues annually. With appropriate training, people other than physicians and nurses can administer vaccines. Healthcare professionals should contact public health authorities or other medical authorities in their state for more information concerning which individuals are permitted to administer vaccines.
Standard 9: Healthcare professionals recommend simultaneous administration of all indicated vaccine doses. Administering indicated vaccines simultaneously is safe and effective. Simultaneous administration decreases the number of required visits and the potential for missed doses. Measles, mumps, and rubella (MMR) vaccine and tetanus and diphtheria (Td) toxoids should always be administered in their combined product. Giving influenza and pneumococcal vaccine at the

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same time (but in separate arms) is also safe and effective. Healthcare professionals should respect the choices of patients and their caregivers.
Standard 10: Vaccination records for patients are accurate and easily accessible. Patient vaccination histories should be recorded on a standard form in an easily accessible location in the medical record to facilitate rapid review of vaccination status. Accurate record keeping helps ensure that needed vaccinations are administered and unnecessary vaccinations are not administered. Records should indicate the vaccine, the date of administration, the vaccine manufacturer and lot number, the signature and title of the person administering the vaccine, and the address where the vaccine was administered. The medical record at the primary care provider's office, clinic, or worksite should include all vaccinations received (such as those received at a specialist's office, influenza vaccination clinic, or pharmacy).
Record keeping may be paper-based or computerized. Computer systems make record maintenance, retrieval, and review easier.
Healthcare professionals should give patients a personal record of vaccinations they have received, including the dates and places of administration. Patients should be encouraged to bring their vaccination records to all medical visits.
Information and a modifiable template of these forms and records are available at www.ahcpr.gov/ ppip/adultflow.pdf and are also available on CD-ROM and can be ordered on the Internet at www.atpm.org/ Immunization/whatworks.html.
Standard 11: All personnel who have contact with patients are appropriately immunized. Healthcare professionals and other personnel (including first responders) who have contact with patients should be appropriately immunized (e.g., annual influenza vaccination, hepatitis B vaccination). Institutions should have policies to review and maintain the appropriate vaccination of staff and trainees.
ACIP recommendations for vaccinating healthcare workers are available on the Internet at www.cdc.gov/ nip/publications/ACIP-list.htm.
Implement Strategies to Improve Vaccination Rates
Standard 12: Systems are developed and used to remind patients and healthcare professionals when vaccinations are due and to recall patients who are overdue. Evidence shows that reminder/recall systems improve adult vaccination rates. Systems may be designed to alert patients who are due (reminder) or overdue (recall) for specific vaccine doses or they may alert patients to contact their provider to determine if vaccinations are needed. Reminders or recalls can be

mailed or communicated by telephone; an autodialer can be used to expedite telephone reminders. Patients who might be at high risk for not complying with medical recommendations may require more intensive follow-up.
Provider reminder/recall interventions inform those who administer vaccinations that individual patients are due or overdue for specific vaccinations. Reminders can be delivered in patient charts, by computer, and/or by mail or other means, and content of the reminders can be specific or general. Information about these strategies and resources to assist in their implementation are available on CD-ROM and can be ordered on the Internet at www.atpm.org/Immunization/whatworks.html. Model reminder recall templates are also available at www.ahcpr.gov/ppip/postcard.pdf.
Standard 13: Standing orders for vaccinations are employed. Evidence shows that standing orders improve vaccination coverage among adults in a variety of healthcare settings, including nursing homes, hospitals, clinics, doctor's offices, and other institutional settings. Standing orders enable nonphysician personnel such as nurses and pharmacists to prescribe or deliver vaccinations by approved protocol without direct physician involvement at the time of the interaction. Standing orders overcome administrative barriers such as lack of physician personnel to order vaccines. Further, the Centers for Medicare and Medicaid allow standing order exemption from Medicare rules (www.cms. hhs.gov/medicaid/ltcsp/sc0302.pdf).
Information about this strategy and its implementation is available on CD-ROM and can be ordered on the Internet at www.atpm.org/Immunization/whatworks. html.
Standard 14: Regular assessments of vaccination coverage rates are conducted in a provider's practice. Evidence shows that assessment of vaccination coverage and provision of the results to the staff in a practice improves vaccination coverage among adults. Optimally, such assessments are performed annually. Provider assessment can be performed by the staff in the practice or by other organizations, including state and local health departments. Effective interventions that include assessment and provision of results may also incorporate incentives or compare performance to a goal or standard. This process is commonly referred to as AFIX (assessment, feedback, incentives, and exchange of information). Coverage should be assessed regularly so that reasons for low coverage in the practice, or in a subgroup of the patients served, can be identified and interventions implemented to address them.
Information about this strategy and its implementation is available on CD-ROM and can be ordered on the Internet at www.atpm.org/Immunization/whatworks. html. Software to assist in conducting coverage rate

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assessments and feedback is available at www.cdc. gov/nip.
Partner with the Community
Standard 15: Patient-oriented and community-based approaches are used to reach target populations. Vaccination services should be designed to meet the needs of the population served. For example, interventions that include community education, along with other components such as extended hours, have been demonstrated to improve vaccination coverage among adults. Vaccination providers can work with partners in the community, including other health professionals (e.g., pharmacists), vaccination advocacy groups, managed care organizations, service organizations, manufacturers, and state and local health departments to determine community needs and develop vaccination services to address them.
Conclusion
The revised Standards for Adult Immunization Practices provide a concise, convenient summary of the most desirable immunization practices. The Standards have been widely endorsed by major professional organizations. This revised version of the Standards for Adult Immunization Practices is recommended for use by all healthcare professionals and payers in the public and private sectors who provide immunizations for adults. Everyone involved in adult immunization should strive to follow these Standards. Not all practices and programs have the resources necessary to fully implement the Standards; nevertheless, those lacking the resources should find the Standards useful to guide current practice and to guide the process of defining immunization needs and obtaining additional resources in the future.
These Standards are approved by the National Vaccine Advisory Committee (NVAC), the National Coalition for Adult Immunization (NCAI), the Advisory Committee on Immunization Practices (ACIP), and the U.S. Public Health Service, and endorsed, as of December 1, 2001, by the American Medical Association, Infectious Diseases Society of America, American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, Society of Adolescent Medicine, Health Resources and Services Administration, National Medical Association, National Association of County and City Health Officials, Association of State and Territorial Health Officers, Council of State and Territorial Epidemiologists, Association of Professionals in Infection Control and Epidemiology, Inc., Chiron, State of Washington Department of Health, Society of Teachers of Preventive Medicine, Immunization Action Coalition, Partnership for Prevention, National Coalition for Adult Immunization, American Academy of Otolaryngology Head and Neck Surgery, American Health Care Association, Hepatitis B Foundation, American College of Preventive

Medicine, American Pharmaceutical Association, American Society for Health System Pharmacists, State of Maine Department of Health, National Alliance for Hispanic Health, American Academy of Physician Assistants, National Association of School Nurses, Memphis County Health Department, Maine Ambulatory Care Association, Institute for Advanced Studies in Aging and Geriatric Medicine, The Arizona Partnership for Adult Immunization, National Foundation for Infectious Diseases, and the National Partnership for Immunization.
The NVAC was charted in 1988 to advise and make recommendations to the director of the National Vaccine Program and the assistant secretary for health, Department of Health and Human Services, on matters related to the prevention of infectious diseases through immunization and the prevention of adverse reactions to vaccines. The NVAC is composed of 15 members from public and private organizations representing vaccine manufacturers, physicians, parents, and state and local health agencies, and public health organizations. In addition, representatives from government agencies involved in health care of allied services serve as ex-officio members of the NVAC.
Members of the National Vaccine Advisory Committee in 2001 are listed below.
Regular members: Georges Peter, MD (chair), Brown Medical School, Providence RI; Bruce Gellin, MD, MPH, Executive Secretary (Martin G. Myers, MD, former Executive Secretary), National Vaccine Program Office, Atlanta GA; Jeffrey P. Davis, MD, State Epidemiologist, Wisconsin Division of Health, Madison WI; Michael D. Decker, MD, MPH, Vice President, Scientific and Medical Affairs, Aventis Pasteur, Swiftwater PA; Patricia Fast, MD, PhD, Director, Medical Affairs, International AIDS Vaccine Initiative, New York City NY; Mary desVignes-Kendrick, MD, Director, City of Houston Department of Health and Human Services, Houston TX; Amy Fine, Health Policy/Program Consultant, Washington DC; Jerome O. Klein, MD, Professor of Pediatrics and Vice Chairman for Academic Affairs, Boston University School of Medicine, Boston MA; Yvonne A. Maldonado, MD, Associate Professor, Department of Pediatrics, Stanford University School of Medicine, Stanford CA; Stanley Plotkin, MD, Aventis Pasteur, Doylestown PA; Peter R. Paradiso, PhD, Vice President, Scientific Affairs, Wyeth-Lederle Vaccines and Pediatric American Home Products, West Henrietta NY; Gregory A. Poland, MD, Chief, Mayo Vaccine Research Group, Mayo Clinic and Foundation, Rochester MN; Marian Sokol, PhD, Founding Executive Director, Any Baby Can, Inc., San Antonio TX; Donald E. Williamson, MD, State Health Officer, Alabama Department of Public Health, Montgomery AL; and Patricia N. Whitley-Williams, MD, Associate Professor of Pediatrics, University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School, New Brunswick NJ.
Liaison representatives: Steven Black, MD, American Association of Health Plans, Director, Vaccine Study Center, Kaiser Permanente Study Center, Oakland CA; Jackie Noyes, Advisory Commission on Childhood Vaccines, Associate Director, American Academy of Pediatrics, Washington DC; Robert Daum, MD, The Food and Drug Administration's Vaccines and Related Biologic Products Advisory Committee, Professor of Pediatrics, University of Chicago, Chicago IL; and John F. Modlin, MD, Advisory Committee on Immunization Practices,

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Chairman, Department of Pediatrics and Professor of Pediatrics and Medicine, Dartmouth Medical School, Lebanon NH.
Ex-officio members: Karen Midthun, MD, Food and Drug Administration, Director, Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Rockville MD; Renata J.M. Engler, MD, Department of Defense, Chief, Allergy/Immunology Department, Walter Reed Medical Center, Washington DC; Geoffrey Evans, MD, Health Resources and Services Administration, Medical Director, Division of Vaccine Injury Compensation, Rockville MD; Ruth Frischer, PhD, Agency for International Development, Health Science Specialist, Washington DC; Randolph T. Graydon, MD, Centers for Medicaid and Medicare Services, Director, Division of Advocacy and Special Issues, Center for Medicaid and State Operations, Baltimore MD; Carole Heilman, PhD, National Institutes of Health, Director, Division of Microbiology and Infectious Diseases, Bethesda MD; Walter A. Orenstein, MD, Centers for Disease Control and Prevention, Director, National Immunization Program, Atlanta GA; William A. Robinson, MD, Health Resources and Services Administration, Chief Medical Officer, Rockville MD.
Members of the Ad Hoc Working Group for the Development of the Standards for Adult Immunization Practices, who have authorship responsibility for this article, are listed below.
Executive and writing committee: Gregory A. Poland, MD; Abigail M. Shefer, MD; Peggy S. Webster, MD; Mary McCauley, MTSC; Edward W. Brink, MD; Marc LaForce, MD; Dennis J. O'Mara; James A. Singleton, MS; Raymond A. Strikas, MD; Patricia N. Whitley-Williams, MD; Georges Peter, MD (EB, MM, DM, AS, JS, and RS are from the National Immunization Program, Centers for Disease Control and Prevention, Atlanta GA; ML is from Bill and Melinda Gates Foundation, Seattle WA [formerly of BASICS II, Arlington VA]; GP is from Mayo Clinic and Foundation, Rochester MN; PW is from Abbott Laboratories, Abbott Park IL; PWW is from Robert Wood Johnson Medical School, New Brunswick NJ; and GP is from Brown Medical School, Providence RI.
Review committee: William J. Hall, MD, FACP, and William Schaffner, MD, American College of PhysiciansAmerican Society for Internal Medicine; Carol Baker, MD, and Mark Leasure, MD, Infectious Diseases Society of America; Dennis Smith, Jeffrey Kang, MD, MPH, Jacquie Harley, and Rachel Block, Centers for Medicaid and Medicare Services; Geoffrey Evans, MD, and Rita Goodman, MS, RNC, Health Resources and Services Administration; Litjen Tan, PhD, American Medical Association; Viking Hedberg, MD, and Trina M. Anglin, MD, PhD, Society for Adolescent Medicine; Herbert Young, MD, and Belinda K. Schoof, MD, American Academy of Family Physicians; and Ralph Hale, MD, Stanley Gall, MD, and W. Benson Harer, MD, American College of Obstetricians and Gynecologists.
References
1. U.S. Department of Health and Human Services. Healthy People 2010. Conference edition in 2 vols. Washington DC: U.S. Department of Health and Human Services, 2000. Available at: www.health.gov/healthypeople/ document/tableofcontents.htm. Accessed December 1, 2001.
2. National Center for Health Statistics. Early release of selected estimates from the 2000 and early 2001 National Health Interview Surveys, 2001.

Available at: www.cdc.gov/nchs/releases/01facts/keyhealth.htm. Accessed December 1, 2001. 3. Thompson WW, Shay DK, Weintraub E, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA 2003;289:179 86. 4. Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2001;50:128. 5. Palache AM. Influenza vaccines: a reappraisal of their use. Drugs 1997;54: 84156. 6. Mullooly JP, Bennett MD, Hornbrook MC, et al. Influenza vaccination programs for elderly persons: cost effectiveness in a health maintenance organization. Ann Intern Med 1994;121:94752. 7. Nichol KL, Wuorenma J, Von Sternberg T. Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens. Arch Intern Med 1998;158:1769 76. 8. Nordin J, Mullooly J, Poblete S, et al. Influenza vaccine effectiveness in preventing hospitalizations and deaths in persons 65 years or older in Minnesota, New York, and Oregon: data from 3 health plans. J Infect Dis 2001;184:66570. 9. Centers for Disease Control and Prevention. Notice to readers: updated recommendations from the Advisory Committee on Immunization Practices in response to delays in the supply of influenza vaccine for the 2000 01 season. MMWR Morb Mortal Wkly Rep 2000;49:888 92. 10. Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs) Report, Emerging Infections Program Network (EIP), 2000. Available at: www.cdc.gov/ncidod/dbmd/abcs/survreports/spneu00prelim. pdf. Accessed September 15, 2001. 11. Feikin DR, Schuchat A, Kolczak M, et al. Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 19951997. Am J Public Health 2000;90:2239. 12. Robinson KA, Baughman W, Rothrock G, et al. Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 19951998. JAMA 2001;285:1729 35. 13. Butler JC, Breiman RF, Campbell JF, Lipman HB, Broome CV, Facklam RR. Pneumococcal polysaccharide vaccine efficacy: an evaluation of current recommendations. JAMA 1993;270:1826 31. 14. Sisk JE, Moskowitz AJ, Whang W, et al. Cost-effectiveness of vaccination against pneumococcal bacteremia among elderly people. JAMA 1997;278: 13339. 15. Centers for Disease Control and Prevention. Notice to readers: National Hepatitis Awareness Month--May 2001. MMWR Morb Mortal Wkly Rep 2001;50:399. 16. Centers for Disease Control and Prevention. Viral hepatitis B fact sheet, 2001. Available at: www.cdc.gov/ncidod/diseases/hepatitis/b/fact.htm. Accessed December 1, 2001. 17. Centers for Disease Control and Prevention. Vaccine fact sheet, 2001. Available at: www.cdc.gov/ncidod/diseases/hepatitis/b/factvax.htm. Accessed December 1, 2001. 18. Centers for Disease Control and Prevention. Influenza and pneumococcal vaccination levels among adults aged 65 years--United States, 1999. MMWR Morb Mortal Wkly Rep 2001;50:5327. 19. Centers for Disease Control and Prevention. Health objectives for the national public health burden of vaccine-preventable diseases among adults: standards for adult immunization practice. MMWR Morb Mortal Wkly Rep 1990;39:7259. 20. Fedson DS. Adult immunization. Summary of the National Vaccine Advisory Committee report. JAMA 1994;272:11337. 21. Centers for Disease Control and Prevention. Adult immunization programs in nontraditional settings: quality standards and guidance for program evaluation. A report of the National Vaccine Advisory Committee. MMWR Morb Mortal Wkly Rep 2000;49:113. 22. Centers for Disease Control and Prevention. Vaccine-preventable diseases: improving vaccination coverage in children, adolescents, and adults. A report on recommendations of the Task Force on Community Preventive Services. MMWR Morb Mortal Wkly Rep 1999;48:115. 23. Briss PA, Rodewald LE, Hinman AR, et al. Review of evidence: interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000;18(suppl 1):97140. 24. Institute of Medicine. Calling the shots: immunization finance policies and practices, 2001. Available at: www.iom.edu. Accessed December 1, 2001.

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Georgia Immunization Program Manual
TABLE OF CONTENTS

Division Of Public Health

3. INFORMED REQUEST POLICY

Informed Request Policy (REPLACE)

Vaccine Information Statements (VIS)

Version Form#

Date Issused

DTP/DTaP/DT

English 3177

(05/17/07)

Vacunas Difteria,Tetano y Tos Ferina (DTaP)

Spanish 3162

(05/17/07)

Td

English 3070

(06/10/94) (REMOVE)

Vacuna Contra Tetanos y Difteria (Td)

Spanish 3069

(06/10/94)

Tdap

English 25-IMM-003E (07/12/06)(Interim

REMOVE)

Vacuna Contra Tetanos, Difteria Y Tos Ferina (Tdap)

Spanish 25-IMM-003S (07/12/06) (Interim)

Polio

English 3173

(01/01/00)

Vacuna Antipoliomielitca (Polio)

Spanish 3163

(01/01/00)

MMR

English 3198

(03/13/08)

Vacuna Contra Sarampion, y Paperas y Rubola(MMR) Spanish 3160

(01/15/03)

HIB

English 3180

(12/16/98)

Vacuna Contra Influenzae Haemophilus Tipo B (HIB)

Spanish 3172

(12/16/98)

Hepatitis B

English 3039

(07/18/07)

Vacuna Contra la Hepatitis B (Hepatitis B)

Spanish 3170

(07/18/07)

Varicella

English 3157

(03/13/08)

Vacuna Contra Varicela (Varicella)

Spanish 3174

(01/10/07)

Hepatitis A

English 25-IMM-004E (03/21/06)

La Vacuna Hepatitis A (Hepatitis A)

Spanish 25-IMM-004S (03/21/06)

*Pneumococcal Polysaccharide (PPSV)

English

(10/06/09)(REPLACE)

* Vacuna Antineumoccica Polisacrida (Pneumococcal Polysaccharide Spanish)

(04/16/09)(REPLACE)

Pneumococcal Conjugate (PCV)

English 3178

(04/16/10) (REPLACE)

Vacuna Antineumoccica Conjugada(Pneumococcal Conjugate Spanish) 3179

(04/16/10) (REPLACE)

+ Influenza Inactivated

English 25-IMM-008E (08/11/09)(REPLACE)

+Vacuna Desactivada Contra (Influenza)

Spanish 25-IMM-008S (08/11/09)(REPLACE)

+ Influenza Live Intranasal

English 25-IMM-009E (08/11/09)(REPLACE)

+ Vacuna Intranasal Viva Contra (Influenza)

Spanish 25-IMM-009S (08/11/09)(REPLACE)

Meningococcal Vaccine

English 25-IMM-001E (01/28/08)

Vacuna Meningoccica

Spanish 25-IMM-001S (10/07/05) (Interim)

Rotavirus Vaccine

English 25-IMM-006E (05/14/10)(REPLACE)

Vacuna Contra El Rotavirus

Spanish 25-IMM-006S (05/14/10) (REPLACE)

HPV Gardasil Human Papillomavirus) Vaccine

English 25-IMM-007E (03/30/10)(REPLACE)

Vacuna Contra EL HPV (Human Papillomavirus) Vaccine Gardasil Spanish 25-IMM-007S (03/30/10)(REPLACE)

HPV Cervarix (Human Papillomavirus) Vaccine

English 25-IMM-013E (03/30/10) (ADD)

Vacuna Contra EL HPV (Human Papillomavirus) Vaccine Cervarix Spanish 25-IMM-013S (03/30/10) (ADD)

*Shingles Vaccine

English

(10/06/09)(REPLACE)

*Vacuna Contra La Culebrilla

Spanish

(09/11/06)

Multi VIS

English 25-IMM-010E (09/18/08)(REPLACE)

LAS PRIMERAS VACUNAS DE SU BEB

Spanish 25-IMM-010S (01/30/08)

Td/ Tdap Combination (Replaces Td and Tdap English)

English 25-IMM-011E (11/18/08)(Interim ADD)

*Not stocked in Central Supply. Single copy is available from Immunization Program + Changes annually

After The Shots Despus de las vacunas (After The Shots -Spanish) Georgia Vaccine Administration Record Refusal to Vaccinate Form

English Spanish
English

3199 3196 25-IMM-002E 25-IMM-012E

(05/09) (REPLACE) (04/05)(REPLACE) (07/09)(REPLACE)
(ADD)

Table of Contents 03/2010

GA Immunization Program Manual

Division Of Public Health

INFORMED REQUEST POLICY

As providers of immunizations, it is important to furnish the vaccinee (or the parents/legal guardians of minors) with objective information on vaccine safety and the disease that the vaccine protects against, thereby making them active participants in decisions affecting their health or the health of their children. Vaccine Information Statements (VISs) are standardized to provide objective information about vaccine benefits and adverse events.
What are VISs? VISs are developed by the staff of the Centers for Disease Control and Prevention (CDC) and undergo intense scrutiny by panels of experts for accuracy. Each VIS provides information to properly inform the adult vaccinee or, in the case of a minor, the child's parent or legal representative about the risks and benefits of each vaccine. VISs are not meant to replace interactions with health care providers who should attempt to answer questions and address concerns that the vaccinee or the parent/guardian may have.
VIS use is mandatory! Before a health care provider (public or private) vaccinates a child or adult with a dose of any recommended childhood vaccine (DTaP, Td, Tdap, MMR, Varicella, Polio, Hib, hepatitis B, RV, human papillomavirus (HPV), pneumococcal conjugate, meningococcal (conjugate and polysaccharide), hepatitis A, and influenza), the provider is required by the National Childhood Vaccine Injury Act of 1986 to provide the most current copy of the VIS to either the adult vaccinee or the child's parent/legal guardian. The dates reflecting the most current copy of each VIS are listed beside each vaccine in the Table of Contents for this section of the manual. If there is not a single VIS for a combination vaccine (e.g., Hib/hepatitis B), use the VISs for all the component vaccines.
A VIS is also available for the pneumococcal polysaccharide vaccine. Its use is not required by the National Childhood Injury Act, but is strongly encouraged-------and it must be used when giving vaccines purchased through a CDC contract (i.e. VFC vaccines.) The Georgia Immunization Program recommends the utilization of all the VISs listed above and has included a master copy of each statement in this manual to duplicate and distribute.
State or local health departments or individual providers may place identifiers (such as form numbers) on the VISs but any other changes must be approved by CDC's National Immunization Program.
What to do with the VISs:
Some of the legal requirements concerning the use of VISs are as follows:
1) Before a routine vaccine is administered to anyone (including adults), you must give the patient or the parent/guardian a copy of the most current VIS available for that vaccine. Make sure you give your patient time to read the VIS prior to the administration of the vaccine and review the VIS with them.
2) Record on your patient's chart which VIS was given and the date that it was given. 3) Record on the patient's chart the publication date of the VIS (a date which
appears on the lower right hand corner of the VIS). In Georgia, there may also be a form number and date displayed. This information is utilized for ordering copies of the statements and does not need to be recorded in the patient's chart.

3. Informed Request Policy 11/2009

1

Informed Request Policy

GA Immunization Program Manual

Division Of Public Health

INFORMED REQUEST POLICY

How to get VISs: VISs are available upon request from the Georgia Immunization Program. (See order form 3184, included in Section 1 of this manual). English and translated statements may also be downloaded from the following websites:

Georgia Immunization Program Centers for Disease Control (CDC) Immunization Action Coalition (IAC)

http://health.state.ga.us/programs/immunization/index.asp
www.cdc.gov/nip/publications/vis www.immunize.org/vis

Physician offices will be provided with a single copy for duplication. Please contact the Georgia Immunization Program at 404-657-3158 for more information on ordering copies of VISs in English and other foreign languages.

Required Documentation: Georgia law requires that vaccines administered to individuals of all ages must be documented in the Georgia Registry of Immunization Transactions and Services (GRITS). This legal requirement is referenced in the "Requirements of Law" section of the Immunization Program Manual under the Official Code of Georgia. Written documentation is required in the vaccine recipient's medical record (or in a permanent office file or log) of each immunization and the receipt by vaccine recipients (or their parents or legal representatives) of the appropriate VIS. The documentation shall consist of the following:

vaccine administration date vaccine manufacturer and lot number name, title, and address of the person administering the vaccine (i.e.,
address where the medical record will be maintained) which VIS is given date printed on the appropriate VIS date the VIS was given to the vaccine recipient (or the parent/legal
guardian) date vaccine was given, appropriate notation of the preparation given
and date of administration should be provided on either an existing or newly issued Personal Immunization Record

It is recommended that DHR Form 3199/3196, "After the Shots", or an equivalent description of common side effects be given to the patient or parent/guardian, along with a telephone number that may be called in the case of adverse events. A copy of form 3199/3196 is included in this section of the manual.

It is also recommended that each vaccine be recorded on a client's personal immunization record. Personal Immunization Records (Form 3187 [English and Spanish]) may be ordered from the GA Immunization Program Office utilizing form 3184, the Request For Immunization Forms (see section 1). In addition, GRITS may be utilized to document an immunization record and can print out the clients' immunization history.

In Georgia, (in public health clinics) a parent or legal representative must sign an informed consent for vaccinations. VISs are not consent forms. In Georgia, the legal definition of a person authorized to make a request for immunization is very broad. Pertinent excerpts from the Official Code of Georgia, Annotated, Title 31, Chapter 9, 12/2001 cited as the Georgia Medical Consent Law are reproduced below:

3. Informed Request Policy 11/2009

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Informed Request Policy

GA Immunization Program Manual

Division Of Public Health

INFORMED REQUEST POLICY

Official Code of Georgia, Annotated 2002
31-9-2
(a) In addition to such other persons as may be authorized and empowered, any one of the following persons is authorized and empowered to consent, either orally or otherwise, to any surgical or medical treatment or procedures not prohibited by law which may be suggested, recommended, prescribed, or directed by a duly licensed physician:
(1) Any adult, for himself, whether by living will or otherwise (1.1) Any person authorized to give such consent for the adult under a health care agency complying with Chapter 36 of Title 31, the "Durable Power of Attorney for Health Care Act"
(2) In the absence or unavailability of a living spouse, any parent, whether an adult or a minor, for his minor child;
(3) Any married person, whether an adult or a minor, for himself and for his spouse; (4) Any person temporarily standing in loco parentis, whether formally serving or not,
for the minor under his care; and any guardian, for his ward; (5) Any female, regardless of age or marital status, for herself when given in connection
with pregnancy, or the prevention thereof, or childbirth; (6) Upon the inability of any adult to consent for himself and in the absence of any
person to consent under paragraphs (2) through (5) of this subsection, the following persons in the following order of priority: (A) Any adult child for his parents; (B) Any parent for his adult child; (C) Any adult for his brother or sister; or (D) Any grandparent for his grandchild.
(b) Any person authorized and empowered to consent under subsection (a) of this Code section shall, after being informed of the provisions of this Code section, act in good faith to consent to surgical or medical treatment or procedures which the patient would have wanted had the patient understood the circumstances under which such treatment or procedures are provided.
(c) For purposes of this Code section, "inability of any adult to consent for himself" shall mean a determination in the medical record by a licensed physician after the physician has personally examined the adult that the adult "lacks sufficient understanding or capacity to make significant responsible decisions" regarding his medical treatment or the ability to communicate by any means such decisions.
Cross References
Authority of court in juvenile proceeding to order that a child undergo medical examination or treatment, 15-11-12.
Right of minor to obtain medical services for treatment of venereal disease on his consent alone. 31-17-7 (a).

3. Informed Request Policy 11/2009

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Informed Request Policy

GA Immunization Program Manual

Division Of Public Health

INFORMED REQUEST POLICY
Official Code of Georgia, Annotated 2002
31-9-6.
(a) This chapter shall be liberally construed, and all relationships set forth in this chapter shall include the adoptive, foster, and step relations as well as blood relations and the relationship by common-law marriage as well as ceremonial marriage.
(b) A consent by one person authorized and empowered to consent to surgical or medical treatment shall be sufficient.
(c) Any person acting in good faith shall be justified in relying on the representations of any person purporting to give consent, including, but not limited to, his identity, his age, his marital status, his emancipation, and his relationship to any other person for whom the consent is purportedly given.
(d) A consent to surgical or medical treatment which discloses in general terms the treatment or course of treatment in connection with which it is given and which is duly evidenced in writing and signed by the patient or other person or persons authorized to consent pursuant to the terms of this chapter shall be conclusively presumed to be a valid consent in the absence of fraudulent misrepresentations of material facts in obtaining the same.

3. Informed Request Policy 11/2009

4

Informed Request Policy

VACCINES DIPHTHERIA
TETANUS & PERTUSSIS
W H A T Y O U N E E D T O K N OW

1 Why get vaccinated?
Diphtheria, tetanus, and pertussis are serious diseases caused by bacteria. Diphtheria and pertussis are spread from person to person. Tetanus enters the body through cuts or wounds.
DIPHTHERIA causes a thick covering in the back of the throat. It can lead to breathing problems, paralysis, heart
failure, and even death.
TETANUS (Lockjaw) causes painful tightening of the muscles, usually all over the body. It can lead to "locking" of the jaw so the victim
cannot open his mouth or swallow. Tetanus leads to death in up to 2 out of 10 cases.
PERTUSSIS (Whooping Cough) causes coughing spells so bad that it is hard for infants to eat, drink, or breathe. These spells can last for weeks. It can lead to pneumonia, seizures (jerking and
staring spells), brain damage, and death.
Diphtheria, tetanus, and pertussis vaccine (DTaP) can help prevent these diseases. Most children who are vaccinated with DTaP will be protected throughout childhood. Many more children would get these diseases if we stopped vaccinating.
DTaP is a safer version of an older vaccine called DTP. DTP is no longer used in the United States.

2 Who should get DTaP vaccine and when?

Children should get 5 doses of DTaP vaccine, one dose

at each of the following ages:

2 months

4 months

6 months

15-18 months

4-6 years

DTaP may be given at the same time as other vaccines.

Some children should not
3 get DTaP vaccine or should wait
Children with minor illnesses, such as a cold, may be vaccinated. But children who are moderately or severely ill should usually wait until they recover before getting DTaP vaccine.
Any child who had a life-threatening allergic reaction after a dose of DTaP should not get another dose.
Any child who suffered a brain or nervous system disease within 7 days after a dose of DTaP should not get another dose.
Talk with your doctor if your child: - had a seizure or collapsed after a dose of DTaP, - cried non-stop for 3 hours or more after a dose of DTaP, - had a fever over 105oF after a dose of DTaP.
Ask your health care provider for more information. Some of these children should not get another dose of pertussis vaccine, but may get a vaccine without pertussis, called DT.

4 Older children and adults

DTaP is not licensed for adolescents, adults, or children 7 years of age and older.

But older people still need protection. A vaccine called Tdap is similar to DTaP. A single dose of Tdap is recommended for people 11 through 64 years of age. Another vaccine, called Td, protects against tetanus and diphtheria, but not pertussis. It is recommended every 10 years. There are separate Vaccine Information Statements for these vaccines.

Diphtheria/Tetanus/Pertussis

5/17/2007

5 What are the risks from DTaP vaccine?
Getting diphtheria, tetanus, or pertussis disease is much riskier than getting DTaP vaccine.
However, a vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of DTaP vaccine causing serious harm, or death, is extremely small.
Mild Problems (Common) Fever (up to about 1 child in 4) Redness or swelling where the shot was given (up to
about 1 child in 4) Soreness or tenderness where the shot was given (up
to about 1 child in 4) These problems occur more often after the 4th and 5th doses of the DTaP series than after earlier doses. Sometimes the 4th or 5th dose of DTaP vaccine is followed by swelling of the entire arm or leg in which the shot was given, lasting 1-7 days (up to about 1 child in 30). Other mild problems include: Fussiness (up to about 1 child in 3) Tiredness or poor appetite (up to about 1 child in 10) Vomiting (up to about 1 child in 50)
These problems generally occur 1-3 days after the shot.
Moderate Problems (Uncommon) Seizure (jerking or staring) (about 1 child out of
14,000) Non-stop crying, for 3 hours or more (up to about
1 child out of 1,000) High fever, over 105oF (about 1 child out of
16,000)
Severe Problems (Very Rare) Serious allergic reaction (less than 1 out of a million
doses) Several other severe problems have been reported
after DTaP vaccine. These include: - Long-term seizures, coma, or lowered consciousness - Permanent brain damage. These are so rare it is hard to tell if they are caused by the vaccine.
Controlling fever is especially important for children who have had seizures, for any reason. It is also important if another family member has had seizures. You can reduce fever and pain by giving your child an aspirin-free pain reliever when the shot is given, and for the next 24 hours, following the package instructions.

6 What if there is a moderate or severe reaction?
What should I look for?
Any unusual conditions, such as a serious allergic reaction, high fever or unusual behavior. Serious allergic reactions are extremely rare with any vaccine. If one were to occur, it would most likely be within a few minutes to a few hours after the shot. Signs can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness. If a high fever or seizure were to occur, it would usually be within a week after the shot.
What should I do?
Call a doctor, or get the person to a doctor right away. Tell your doctor what happened, the date and time it
happened, and when the vaccination was given. Ask your doctor, nurse, or health department to report the
reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form.
Or you can file this report through the VAERS web site at www.vaers.hhs.gov, or by calling 1-800-822-7967. VAERS does not provide medical advice
7 The National Vaccine Injury Compensation Program
In the rare event that you or your child has a serious reaction to a vaccine, a federal program has been created to help pay for the care of those who have been harmed.
For details about the National Vaccine Injury Compensation Program, call 1-800-338-2382 or visit the program's website at www.hrsa.gov/vaccinecompensation.
8 How can I learn more?
Ask your health care provider. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department's immunization program.
Contact the Centers for Disease Control and Prevention (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) - Visit the National Immunization Program's website at www.cdc.gov/nip

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease Control and Prevention

Vaccine Information Statement

DTaP (5/17/07)

42 U.S.C. 300aa-26

VACUNA CONTRA TETANOS Y DIFTERIA
(Td)
Lo que usted necesita saber acerca de la vacuna

INFORMACION SOBRE LAS ENFERMEDADES

El ttanos (trismo) y la difteria son enfermedades graves. El ttanos es causado por un germen que entra al cuerpo a travs de una cortadura o

herida. La difteria se disemina cuando los grmenes pasan de una persona infectada a la nariz o garganta de otras.

El ttanos causa: espasmos graves y dolorosos de todos los msculos
Puede ocasionar:
- `trabazn' de las mandbulas de
manera que el paciente no puede abrir su boca o tragar
- muerte

La dlfterla causa: un recubrimrento espeso en la nariz, garganta o conducto respiratorio.
Puede ocasionar:
- problemas respiratorios
- insuficiencia cardaca - parlisis - muerte

INFORMACION SOBRE LAS VACUNAS
Beneficios de la vacuna
La vacunacin es la mejor manera de protegerse en contra del ttanos y la difteria. Gracias a la vacunacin, hay mucho menos casos de estas enfermedades. Los casos son raros en nios porque la mayora de ellos reciben las vacunas DTP (Difteria, ttanos y tos ferina), DTaP (Difteria, ttanos y tos ferina acelular) 0 DT (Difteria y ttanos). Habran mucho ms casos si dejaramos de vacunar a la gente.
iCundo debe recibir la vacuna Td?
La vacuna Td es para las personas de 7 aos de edad o mayor.
Las personas que no han recibido por lo menos 3 dosis de cualquier vacuna contra ttanos y difteria (DTP DTaP o DT) en su vida, deben de hacerlo al recibir la Td. Despus de que una persona reciba la tercera dosis, se necesita una d&is de Td cada 10 aos por el resto de su vida.
Se pueden dar otras vacunas al mismo tiempo que la Td.

Digaa su mdico0
enfermera si usted:
l alguna vez ha tenido una reaccin grave u otro problema-con la vacuna Td
' 0 con cualquier otra vacuna contra ttanos y difteria (DTf? DTaP o DT)
l tiene ahora una enfermedad moderada o grave
l est embarazada
Si no est seguro, pregunte a su doctor o enfermera.
CUALES SON LOS RIESGOS DE LA VACUNA TD?
Como con cualquier otra medicina, existe el riesgo muy reducido que, despus de recibir la vacuna, pudieran ocurrir problemas serios incluyendo la muerte.
Los riesgos que presenta la vacuna son mucho menores que los riesgos de las enfermedades que resultaran si la gente dejara de vacunarse.
La gran mayori de gente que recibe Td no tiene problemas relacionados a esta vacuna.

Problemas leves
Si ocurren estos problemas, usualmente comienzan dentro de unas horas y un da o dos despus de la vacunacin. Pueden durar hasta 1 2 das:
l inflamacin, enrojecimiento o tumefaccin del rea en donde se coloc la inyeccin
Estos problemas pueden ser peores en adultos que reciben la vacuna Td frecuentemente.
Se puede usar acetaminofen o ibuprofen (sin aspirina) para disminuir el dolor.
Problemas graves
Estos problemas suceden muy raramente:
l reaccin alrgica seria
l dolor intenso y debilitamiento muscular en la parte superior del (los) brazo(s). Esto comienza de los 2 das a las 4 semanas despus de la inyeccin y puede durar varios meses.

QUE HACER SI SE PRESENTA UNA REACCION SERIA
Llame al mdico o lleve a la persona al mdico inmediatamente.
Apunte lo que sucedi y la fecha y hora en
que sucedi.
Pida a su mdico, enfermera o al departamento de salud que entablen un formulario de Reporte de Efectos Adversos de la Vacuna, 0 que llame al
(800) 822-7967 (sin costo)
El Programa Nacional de Compensacin por Lesiones causadas por Vacunas da una compensacin (pago) para algunas personas que se cree resultaron lesionadas por vacunas. Para obtener ms informacin, llame al
(800) 338-2382 (sin costo)

Si quiere saber ms acerca de las vacunas, pregunte a su mdico o enfermera. El o ella le pueden dar la informacin ms detallada que se incluye en el paquete de la vacuna o le pueden sugerir otras fuentes de informacin.

Td 6/10/94 42 U.S.C. 5 300aa-26

POLIO VACCINE

WHAT YOU NEED TO KNOW

1 What is polio?
Polio is a disease caused by a virus. It enters a child's (or adult's) body through the mouth. Sometimes it does not cause serious illness. But sometimes it causes paralysis (can't move arm or leg). It can kill people who get it, usually by paralyzing the muscles that help them breathe.
Polio used to be very common in the United States. It paralyzed and killed thousands of people a year before we had a vaccine for it.

3 Who should get polio vaccine and when?
IPV is a shot, given in the leg or arm, depending on age. Polio vaccine may be given at the same time as other vaccines.
Children Most people should get polio vaccine when they are children. Children get 4 doses of IPV, at these ages:
A dose at 2 months A dose at 6-18 months A dose at 4 months A booster dose at 4-6 years

2 Why get vaccinated?
Inactivated Polio Vaccine (IPV) can prevent polio.
History: A 1916 polio epidemic in the United States killed 6,000 people and paralyzed 27,000 more. In the early 1950's there were more than 20,000 cases of polio each year. Polio vaccination was begun in 1955. By 1960 the number of cases had dropped to about 3,000, and by 1979 there were only about 10. The success of polio vaccination in the U.S. and other countries sparked a world-wide effort to eliminate polio.
Today: No wild polio has been reported in the United States for over 20 years. But the disease is still common in some parts of the world. It would only take one case of polio from another country to bring the disease back if we were not protected by vaccine. If the effort to eliminate the disease from the world is successful, some day we won't need polio vaccine. Until then, we need to keep getting our children vaccinated.

Adults Most adults do not need polio vaccine because they were already vaccinated as children. But three groups of adults are at higher risk and should consider polio vaccination: (1) people traveling to areas of the world where polio is
common, (2) laboratory workers who might handle polio virus, and (3) health care workers treating patients who could have polio.
Adults in these three groups who have never been vaccinated against polio should get 3 doses of IPV:
The first dose at any time, The second dose 1 to 2 months later, The third dose 6 to 12 months after the second.
Adults in these three groups who have had 1 or 2 doses of polio vaccine in the past should get the remaining 1 or 2 doses. It doesn't matter how long it has been since the earlier dose(s).

Oral Polio Vaccine: No longer recommended There are two kinds of polio vaccine: IPV, which is the shot recommended in the United States today, and a live, oral polio vaccine (OPV), which is drops that are swallowed.
Until recently OPV was recommended for most children in the United States. OPV helped us rid the country of polio, and it is still used in many parts of the world.
Both vaccines give immunity to polio, but OPV is better at keeping the disease from spreading to other people. However, for a few people (about one in 2.4 million), OPV actually causes polio. Since the risk of getting polio in the United States is now extremely low, experts believe that using oral polio vaccine is no longer worth the slight risk, except in limited circumstances which your doctor can describe. The polio shot (IPV) does not cause polio. If you or your child will be getting OPV, ask for a copy of the OPV supplemental Vaccine Information Statement.

Adults in these three groups who have had 3 or more doses of polio vaccine (either IPV or OPV) in the past may get a booster dose of IPV.
Ask your health care provider for more information.

Polio - 1/1/2000

4 Some people should not get IPV or should wait.
These people should not get IPV:
Anyone who has ever had a life-threatening allergic reaction to the antibiotics neomycin, streptomycin or polymyxin B should not get the polio shot.
Anyone who has a severe allergic reaction to a polio shot should not get another one.
These people should wait: Anyone who is moderately or severely ill at the time the
shot is scheduled should usually wait until they recover before getting polio vaccine. People with minor illnesses, such as a cold, may be vaccinated.
Ask your health care provider for more information.
5 What are the risks from IPV?
Some people who get IPV get a sore spot where the shot was given. The vaccine used today has never been known to cause any serious problems, and most people don't have any problems at all with it.
However, a vaccine, like any medicine, could cause serious problems, such as a severe allergic reaction. The risk of a polio shot causing serious harm, or death, is extremely small.
6 What if there is a serious reaction?
What should I look for? Look for any unusual condition, such as a serious allergic reaction, high fever, or unusual behavior.
If a serious allergic reaction occurred, it would happen within a few minutes to a few hours after the shot. Signs of a serious allergic reaction can include difficulty breathing, weakness, hoarseness or wheezing, a fast heart beat, hives, dizziness, paleness, or swelling of the throat
What should I do? Call a doctor, or get the person to a doctor right away.

Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
Ask your doctor, nurse, or health department to file a Vaccine Adverse Event Reporting System (VAERS) form. Or call the VAERS toll-free number yourself at 1-800-822-7967 or visit their website at http://www.vaers.org.
Reporting reactions helps experts learn about possible problems with vaccines.
7 The National Vaccine Injury Compensation Program
In the rare event that you or your child has a serious reaction to a vaccine, there is a federal program that can help pay for the care of those who have been harmed.
For details about the National Vaccine Injury Compensation Program, call 1-800-338-2382 or visit the program's website at http://www.hrsa.gov/osp/vicp
8 How can I learn more?
Ask your doctor or nurse. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department's immunization program.
Contact the Centers for Disease Control and Prevention (CDC): -Call 1-800-232-2522 (English) -Call 1-800-232-0233 (Espaol) -Visit the National Immunization Program's website at http://www.cdc.gov/nip

U.S. DEPARTMENT OF HEUALTH & HUMAN SERVICES
Centers for Disease Control and Prevention National Immunization Program

Vaccine Information Statement

Polio (1/1/2000)

42 U.S.C. 300aa-26

VACCINES MEASLES, MUMPS
& RUBELLA (MMR)

WHAT YOU NEED TO KNOW

1 Why get vaccinated?
Measles, mumps, and rubella are serious diseases.
Measles Measles virus causes rash, cough, runny nose, eye
irritation, and fever. It can lead to ear infection, pneumonia, seizures
(jerking and staring), brain damage, and death.
Mumps Mumps virus causes fever, headache, and swollen
glands. It can lead to deafness, meningitis (infection of the
brain and spinal cord covering), painful swelling of the testicles or ovaries, and, rarely, death.
Rubella (German Measles) Rubella virus causes rash, mild fever, and arthritis
(mostly in women). If a woman gets rubella while she is pregnant, she
could have a miscarriage or her baby could be born with serious birth defects.
You or your child could catch these diseases by being around someone who has them. They spread from person to person through the air.
Measles, mumps, and rubella (MMR) vaccine can prevent these diseases.
Most children who get their MMR shots will not get these diseases. Many more children would get them if we stopped vaccinating.

2

Who should get MMR vaccine and when?

Children should get 2 doses of MMR vaccine:
The first at 12-15 months of age and the second at 4-6 years of age.
These are the recommended ages. But children can get the second dose at any age, as long as it is at least 28 days after the first dose.
Some adults should also get MMR vaccine:
Generally, anyone 18 years of age or older who was born after 1956 should get at least one dose of MMR vaccine,

unless they can show that they have had either the vaccines or the diseases.
Ask your provider for more information.
MMR vaccine may be given at the same time as other vaccines.
Note: A "combination" vaccine called MMRV, which contains both MMR and varicella (chickenpox) vaccines, may be given instead of the two individual vaccines to people 12 years of age and younger.

3

Some people should not get MMR vaccine or should wait

People should not get MMR vaccine who have ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or to a previous dose of MMR vaccine.

People who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting MMR vaccine.

Pregnant women should wait to get MMR vaccine until after they have given birth. Women should avoid getting pregnant for 4 weeks after getting MMR vaccine.

Some people should check with their doctor about whether they should get MMR vaccine, including anyone who:
- Has HIV/AIDS, or another disease that affects the immune system
- Is being treated with drugs that affect the immune system, such as steroids, for 2 weeks or longer.
- Has any kind of cancer
- Is taking cancer treatment with x-rays or drugs
- Has ever had a low platelet count (a blood disorder)

People who recently had a transfusion or were given other blood products should ask their doctor when they may get MMR vaccine

Ask your provider for more information.

4

What are the risks from MMR vaccine?

A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of MMR vaccine causing serious harm, or death, is extremely small.

Getting MMR vaccine is much safer than getting any of these three diseases.

Most people who get MMR vaccine do not have any problems with it.

Mild Problems Fever (up to 1 person out of 6) Mild rash (about 1 person out of 20) Swelling of glands in the cheeks or neck (rare) If these problems occur, it is usually within 7-12 days after the shot. They occur less often after the second dose.

Moderate Problems Seizure (jerking or staring) caused by fever (about
1 out of 3,000 doses) Temporary pain and stiffness in the joints, mostly
in teenage or adult women (up to 1 out of 4) Temporary low platelet count, which can cause a
bleeding disorder (about 1 out of 30,000 doses)

Severe Problems (Very Rare) Serious allergic reaction (less than 1 out of a million
doses) Several other severe problems have been known to
occur after a child gets MMR vaccine. But this happens so rarely, experts cannot be sure whether they are caused by the vaccine or not. These include: - Deafness - Long-term seizures, coma, or lowered
consciousness - Permanent brain damage
Note: The first dose of MMRV vaccine has been associated with rash and higher rates of fever than MMR and varicella vaccines given separately. Rash has been reported in about 1 person in 20 and fever in about 1 person in 5. Seizures caused by a fever are also reported more often after MMRV. These usually occur 5-12 days after the first dose.

allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.
What should I do?
Call a doctor, or get the person to a doctor right away.
Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at www.vaers.hhs.gov, or by calling 1-800-822-7967.
VAERS does not provide medical advice.

6

The National Vaccine Injury Compensation Program

A federal program has been created to help people who may have been harmed by a vaccine.

For details about the National Vaccine Injury Compensation Program, call 1-800-338-2382 or visit their website at www.hrsa.gov/vaccinecompensation.

7 How can I learn more?
Ask your provider. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) - Visit CDC website at: www.cdc.gov/vaccines

5

What if there is a moderate or severe reaction?

What should I look for?

Any unusual condition, such as a high fever, weakness, or behavior changes. Signs of a serious

department of health and human services Centers for Disease Control and Prevention

Vaccine Information Statement (Interim)

MMR Vaccine (3/13/08)

42 U.S.C. 300aa-26

Haemophilus Influenzae Type b (Hib) Vaccine
WHAT YOU NEED TO KNOW

1 What is Hib disease?
Haemophilus influenzae type b (Hib) disease is a serious disease caused by a bacteria. It usually strikes children under 5 years old.
Your child can get Hib disease by being around other children or adults who may have the bacteria and not know it. The germs spread from person to person. If the germs stay in the child's nose and throat, the child probably will not get sick. But sometimes the germs spread into the lungs or the bloodstream, and then Hib can cause serious problems.
Before Hib vaccine, Hib disease was the leading cause of bacterial meningitis among children under 5 years old in the United States. Meningitis is an infection of the brain and spinal cord coverings, which can lead to lasting brain damage and deafness. Hib disease can also cause: pneumonia severe swelling in
the throat, making it hard to breathe infections of the blood, joints, bones, and covering of the heart death Before Hib vaccine, about 20,000 children in the United States under 5 years old got severe Hib disease each year and nearly 1,000 people died.
Hib vaccine can prevent Hib disease. Many more children would get Hib disease if we stopped vaccinating.

2 Who should get Hib vaccine and when?

Children should get Hib vaccine at:

2 months of age

6 months of age*

4 months of age

12-15 months of age

* Depending on what brand of Hib vaccine is used, your child might not need the dose at 6 months of age. Your doctor or nurse will tell you if this dose is needed.

If you miss a dose or get behind schedule, get the next dose as soon as you can. There is no need to start over.
Hib vaccine may be given at the same time as other vaccines.

Older Children and Adults Children over 5 years old usually do not need Hib vaccine. But some older children or adults with special health conditions should get it. These conditions include sickle cell disease, HIV/AIDS, removal of the spleen, bone marrow transplant, or cancer treatment with drugs. Ask your doctor or nurse for details.

3 Some people should not get Hib vaccine or should wait
People who have ever had a life-threatening allergic reaction to a previous dose of Hib vaccine should not get another dose.
Children less than 6 weeks of age should not get Hib vaccine.
People who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting Hib vaccine.
Ask your doctor or nurse for more information.

4 What are the risks from Hib vaccine?
A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of Hib vaccine causing serious harm or death is extremely small.
Most people who get Hib vaccine do not have any problems with it.
Mild Problems Redness, warmth, or swelling
where the shot was given (up to 1/4 of children) Fever over 101oF (up to 1 out of 20 children)
If these problems happen, they usually start within a day of vaccination. They may last 2-3 days.
5 What if there is a moderate or severe reaction?
What should I look for?
Any unusual condition, such as a serious allergic reaction, high fever or behavior changes. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat, or dizziness within a few minutes to a few hours after the shot.
What should I do?
Call a doctor, or get the person to a doctor right away.
Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
Ask your doctor, nurse, or health department to file a Vaccine Adverse Event Reporting System (VAERS) form. Or call VAERS yourself at 1-800-822-7967 or visit their website at http://www.vaers.org.

6 The National Vaccine Injury Compensation Program
In the rare event that you or your child has a serious reaction to a vaccine, a federal program has been created to help you pay for the care of those who have been harmed.
For details about the National Vaccine Injury Compensation Program, call 1-800-338-2382 or visit the program's website at http://www.hrsa.gov/osp/vicp
7 How can I learn more?
Ask your doctor or nurse. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department's immunization program.
Contact the Centers for Disease Control and Prevention (CDC): - Call 1-800-232-2522 (English) - Call 1-800-232-0233 (Espaol) - Visit the National Immunization Program's website at http://www.cdc.gov/nip

U.S. DECPeAntRerTsMfoErNDTisOeFasHeECUAoLnTtrHol&anHdUPMrAevNenStEioRnVICES
National Immunization Program

Vaccine Information Statement

Hib (12/16/98)

42 U.S.C. 300aa-26

Vacuna contra Influenzae Haemophilus tipo B (Hib)
LO QUE USTED NECESITA SABER

1 Qu es la enfermedad Hib?
La enfermedad Haemophilus influenzae tipo b (Hib) es una enfermedad grave causada por una bacteria. En general ataca a los nios menores de 5 aos.
Su hijo se puede contagiar la enfermedad Hib al estar cerca de otros nios y adultos que tengan la bacteria sin saberlo. Los grmenes pasan de una persona a otra. Si los grmenes permanecen en la nariz y en la garganta del nio, lo ms probable es que el nio no se enferme. Pero a veces los grmenes pasan a los pulmones o al torrente sanguneo, y en ese caso el Hib puede causar problemas serios.
Antes de la vacuna Hib, la enfermedad Hib era la principal causa de meningitis bacteriana entre los nios menores de cinco aos de edad en Estados Unidos. La meningitis es una enfermedad de las membranas del cerebro y de la columna que puede causar daos cerebrales permanentes y sordera. La enfermedad Hib tambin puede causar: neumona mucha hinchazn de la
garganta, lo cual dificulta la respiracin infecciones de la sangre, de las articulaciones, de los huesos y del recubrimiento del corazn la muerte Antes de la vacuna Hib, todos los aos unos 20,000 nios en EE. UU. menores de 5 aos de edad contraan una forma grave de la enfermedad Hib y unos 1,000 de ellos moran.
La vacuna Hib puede prevenir la enfermedad Hib. Si dejramos de vacunarlos, muchos ms nios contraeran la enfermedad Hib.

2

Quines deben vacunarse contra Hib y cundo?

Los nios deben vacunarse contra Hib a las siguientes

edades:

2 meses

6 meses *

4 meses

12 a 15 meses

* Dependiendo de la marca de vacuna Hib que se utilice, su hijo puede o no necesitar la dosis a los seis meses de edad. Su mdico o su enfermera le indicarn si esa dosis es necesaria.

Si pierde una dosis o se atrasa, obtenga la prxima dosis lo antes posible. No hay necesidad de volver a empezar.

La vacuna Hib se puede dar junto con otras vacunas.

Nios de mayor edad y adultos En general, los nios mayores de 5 aos de edad no necesitan la vacuna Hib. Pero algunos nios de mayor edad, y algunos adultos con ciertos problemas de salud, la deben recibir. Estos problemas especiales incluyen la anemia de clulas falciformes, el VIH y el sida, la extraccin del bazo, el transplante de mdula o el tratamiento del cncer con frmacos. Pida mayores detalles a su mdico o a su enfermera.

Algunas personas no deben
3 vacunarse contra Hib o deben
esperar

Las personas que han tenido una reaccin alrgica a una dosis anterior de la vacuna Hib que puso su vida en peligro no deben recibir otra dosis.
Los nios menores de 6 semanas de edad no deben vacunarse contra Hib.
Las personas que en el da en que se vayan a vacunar estn moderadamente o muy enfermas, en general no deben recibir la vacuna Hib hasta que se recuperen.
Para ms informacin, hable con su mdico o enfermera.

4

Cules son los riesgos de la vacuna contra Hib?

Como todos los medicamentos, las vacunas pueden causar problemas serios como reacciones alrgicas graves. El riesgo de que la vacuna Hib cause daos graves o la muerte es extremadamente pequeo.
La mayora de las personas que reciben la vacuna Hib no tienen ningn problema relacionado con la vacuna.
Problemas leves Enrojecimiento, calor o
hinchazn en el sitio de la inyeccin (hasta la cuarta parte de los nios) Fiebre de ms de 101 F (hasta 1 de cada 20 nios)
Si estos problemas ocurren, en general comienzan dentro de un da despus de recibir la vacuna. Pueden durar 2 a 3 das.

5

Qu pasa si hay una reaccin moderada o grave?

A qu debo prestar atencin?
A cualquier cosa fuera de lo comn, como una reaccin alrgica seria, fiebre elevada o cambios en el comportamiento. Los signos de una reaccin alrgica seria pueden incluir dificultad para respirar, ronquera o ruidos al respirar, ronchas, palidez, debilidad, latidos rpidos del corazn o mareos dentro de los pocos minutos hasta varias horas despus de la inyeccin.
Qu debo hacer?
Llame inmedia tamente al mdico o lle ve inmediatamente al mdico a la persona afectada.
Dg ale al mdico lo que ocurri, la fecha y la hora en que ocur ri y cundo fue v acunado.
Pida a su mdico, enfermera o departamento de salud que llenen un formulario del Sistema de Informacin Sobre Ev entos Adve rsos de Vacunas (V AERS), o llame usted mismo a VAERS, 1a-l800-822-7967.

El Programa Nacional de
6 Compensacin por Lesiones
Causadas por Vacunas

En el raro caso en que usted o su hijo tenga una reaccin grave a una vacuna, se ha creado un programa federal para ayudarlo a pagar la atencin de los lesionados.
Para mayores detalles sobre el Programa Nacional de Compensacin por Lesiones Causadas por Vacunas, llame al 1-800-338-2382 o visite el website del programa, en http://www.hrsa.gov/bhpr/vicp/

7

En dnde puedo obtener ms informacin?

Pre gunte a su mdico o enfermera. Le pueden dar el instructi vo que viene con la v acuna o sugerirle otr as fuentes de informacin.
Llame al prog rama de v acunacin del departamento de salud local o estatal.
Pngase en contacto con los Centros para el Control y la Pre vencin de las Enfer medades (CDC): - Llame al 1-800-232-0233 (espaol) - Llame al 1-800-232-2522 (ingls) - Visite el we bsite del Programa Nacional de Vacunacin, en http://www.cdc.gov/nip

U.S. DECPeAntReTrsMfoErNDTisOeFasHeECUAoLnTtrHol&anHdUPMrAevNenStEioRnVICES
National Immunization Program

Vaccine Information Statement

Hib IMM-664S-Spanish (12/16/98)

42 U.S.C. 300aa-26

HEPATITIS B VACCINE
WHAT YOU NEED TO KNOW

1 What is hepatitis B?

Hepatitis B is a serious disease that affects the liver. It is caused by the hepatitis B virus (HBV). HBV can cause:

Acute (short-term) illness. This can lead to:

loss of appetite diarrhea and vomiting

tiredness

jaundice (yellow skin or eyes)

pain in muscles, joints, and stomach

Acute illness is more common among adults. Children who become infected usually do not have acute illness.

Chronic (long-term) infection. Some people go on to develop chronic HBV infection. This can be very serious, and often leads to: liver damage (cirrhosis) liver cancer death

Chronic infection is more common among infants and children than among adults. People who are infected can spread HBV to others, even if they don't appear sick.

In 2005, about 51,000 people became infected with hepatitis B.
About 1.25 million people in the United States have chronic HBV infection.
Each year about 3,000 to 5,000 people die from cirrhosis or liver cancer caused by HBV.

Hepatitis B virus is spread through contact with the blood or other body fluids of an infected person. A person can become infected by:
- contact with a mother's blood and body fluids at the time of birth;
- contact with blood and body fluids through breaks in the skin such as bites, cuts, or sores;
- contact with objects that could have blood or body fluids on them such as toothbrushes or razors;
- having unprotected sex with an infected person;
- sharing needles when injecting drugs;
- being stuck with a used needle on the job.

2

Hepatitis B vaccine: Why get vaccinated?

Hepatitis B vaccine can prevent hepatitis B, and the serious consequences of HBV infection, including liver cancer and cirrhosis.

Routine hepatitis B vaccination of U.S. children began in 1991. Since then, the reported incidence of acute hepatitis B among children and adolescents has dropped by more than 95% and by 75% in all age groups.

Hepatitis B vaccine is made from a part of the hepatitis B virus. It cannot cause HBV infection.

Hepatitis B vaccine is usually given as a series of 3 or 4 shots. This vaccine series gives long-term protection from HBV infection, possibly lifelong.

3

Who should get hepatitis B vaccine and when?

Children and Adolescents

All children should get their first dose of hepatitis B vaccine at birth and should have completed the vaccine series by 6-18 months of age.
Children and adolescents through 18 years of age who did not get the vaccine when they were younger should also be vaccinated.

Adults
All unvaccinated adults at risk for HBV infection should be vaccinated. This includes: - sex partners of people infected with HBV, - men who have sex with men, - people who inject street drugs, - people with more than one sex partner, - people with chronic liver or kidney disease, - people with jobs that expose them to human blood, - household contacts of people infected with HBV, - residents and staff in institutions for the developmentally disabled, - kidney dialysis patients,

- people who travel to countries where hepatitis B is common,
- people with HIV infection.

reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.

Anyone else who wants to be protected from HBV infection may be vaccinated.

4

Who should NOT get hepatitis B vaccine?

Anyone with a life-threatening allergy to baker's yeast, or to any other component of the vaccine, should not get hepatitis B vaccine. Tell your provider if you have any severe allergies.

Anyone who has had a life-threatening allergic reaction to a previous dose of hepatitis B vaccine should not get another dose.

Anyone who is moderately or severely ill when a dose of vaccine is scheduled should probably wait until they recover before getting the vaccine.

Your provider can give you more information about these precautions.

Pregnant women who need protection from HBV infection may be vaccinated.

5 Hepatitis B vaccine risks

Hepatitis B is a very safe vaccine. Most people do not have any problems with it.
The following mild problems have been reported:
Soreness where the shot was given (up to about 1 person in 4).
Temperature of 99.9F or higher (up to about 1 person in 15).
Severe problems are extremely rare. Severe allergic reactions are believed to occur about once in 1.1 million doses.
A vaccine, like any medicine, could cause a serious reaction. But the risk of a vaccine causing serious harm, or death, is extremely small. More than 100 million people have gotten hepatitis B vaccine in the United States.

What should I do? Call a doctor, or get the person to a doctor right
away.
Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
Ask your doctor, nurse, or health department to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form.
Or you can file this report through the VAERS web site at www.vaers.hhs.gov, or by calling 1-800-822-7967.
VAERS does not provide medical advice.

7

The National Vaccine Injury Compensation Program

In the event that you or your child has a serious reaction to a vaccine, a federal program has been created to help pay for the care of those who have been harmed.

For details about the National Vaccine Injury Compensation Program, call 1-800-338-2382 or visit their website at www.hrsa.gov/vaccinecompensation.

8 How can I learn more?
Ask your doctor or nurse. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) - Visit CDC websites at: www.cdc.gov/ncidod/diseases/hepatitis www.cdc.gov/vaccines www.cdc.gov/travel

6

What if there is a moderate or severe reaction?

What should I look for? Any unusual condition, such as a high fever or
behavior changes. Signs of a serious allergic

department of health and human services Centers for Disease Control and Prevention

Vaccine Information Statement (Interim)

Hepatitis B (7/18/07)

42 U.S.C. 300aa-26

CHICKENPOX VACCINE

WHAT YOU NEED TO KNOW

Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis.

1 Why get vaccinated?

Catch-Up Anyone who is not fully vaccinated, and never had

Chickenpox (also called varicella) is a common

chickenpox, should receive one or two doses of

childhood disease. It is usually mild, but it can be

chickenpox vaccine. The timing of these doses

serious, especially in young infants and adults.

depends on the person's age. Ask your provider.

It causes a rash, itching, fever, and tiredness.
It can lead to severe skin infection, scars, pneumonia, brain damage, or death.
The chickenpox virus can be spread from person to person through the air, or by contact with fluid from chickenpox blisters.
A person who has had chickenpox can get a painful rash called shingles years later.
Before the vaccine, about 11,000 people were hospitalized for chickenpox each year in the United States.
Before the vaccine, about 100 people died each year as a result of chickenpox in the United States.
Chickenpox vaccine can prevent chickenpox.
Most people who get chickenpox vaccine will not get chickenpox. But if someone who has been vaccinated does get chickenpox, it is usually very mild. They will have fewer blisters, are less likely to have a fever, and will recover faster.

Chickenpox vaccine may be given at the same time as other vaccines.
Note: A "combination" vaccine called MMRV, which contains both chickenpox and MMR vaccines, may be given instead of the two individual vaccines to people 12 years of age and younger.

3

Some people should not get chickenpox vaccine or should wait

People should not get chickenpox vaccine if they have ever had a life-threatening allergic reaction to a previous dose of chickenpox vaccine or to gelatin or the antibiotic neomycin.

People who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting chickenpox vaccine.

Pregnant women should wait to get chickenpox vaccine until after they have given birth. Women should not get pregnant for 1 month after getting chickenpox vaccine.

2

Who should get chickenpox vaccine and when?

Some people should check with their doctor about whether they should get chickenpox vaccine, including anyone who:

Routine Children who have never had chickenpox should get 2 doses of chickenpox vaccine at these ages:
1st Dose: 12-15 months of age

- Has HIV/AIDS or another disease that affects the immune system
- Is being treated with drugs that affect the immune system, such as steroids, for 2 weeks or longer

2nd Dose: 4-6 years of age (may be given earlier, if at least 3 months after the 1st dose)

People 13 years of age and older (who have never had chickenpox or received chickenpox vaccine) should get two doses at least 28 days apart.

Chickenpox

3/13/08

- Has any kind of cancer - Is getting cancer treatment with radiation or
drugs
People who recently had a transfusion or were given other blood products should ask their doctor when they may get chickenpox vaccine.
Ask your provider for more information.

4

What are the risks from chickenpox vaccine?

A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of chickenpox vaccine causing serious harm, or death, is extremely small.

Getting chickenpox vaccine is much safer than getting chickenpox disease. Most people who get chickenpox vaccine do not have any problems with it. Reactions are usually more likely after the first dose than after the second.

Mild Problems

Soreness or swelling where the shot was given (about 1 out of 5 children and up to 1 out of 3 adolescents and adults)

Fever (1 person out of 10, or less)
Mild rash, up to a month after vaccination (1 person out of 25). It is possible for these people to infect other members of their household, but this is extremely rare.

Moderate Problems
Seizure (jerking or staring) caused by fever (very rare).

Severe Problems Pneumonia (very rare)

Other serious problems, including severe brain reactions and low blood count, have been reported after chickenpox vaccination. These happen so rarely experts cannot tell whether they are caused by the vaccine or not. If they are, it is extremely rare.

Note: The first dose of MMRV vaccine has been associated with rash and higher rates of fever than MMR and varicella vaccines given separately. Rash has been reported in about 1 person in 20 and fever in about 1 person in 5. Seizures caused by a fever are also reported more often after MMRV. These usually occur 5-12 days after the first dose.

allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.
What should I do?
Call a doctor, or get the person to a doctor right away.
Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at www.vaers.hhs.gov, or by calling 1-800-822-7967.
VAERS does not provide medical advice.

6

The National Vaccine Injury Compensation Program

A federal program has been created to help people who may have been harmed by a vaccine.

For details about the National Vaccine Injury Compensation Program, call 1-800-338-2382 or visit their website at www.hrsa.gov/vaccinecompensation.

7 How can I learn more?
Ask your provider. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) - Visit CDC website at: www.cdc.gov/vaccines

5

What if there is a moderate or severe reaction?

What should I look for?

Any unusual condition, such as a high fever, weakness, or behavior changes. Signs of a serious

department of health and human services Centers for Disease Control and Prevention

Vaccine Information Statement (Interim)

Varicella Vaccine (3/13/08)

42 U.S.C. 300aa-26

HEPATITIS A VACCINE
W H AT YO U N E E D T O K N OW

1 What is hepatitis A?

Hepatitis A is a serious liver disease caused by the hepatitis A virus (HAV). HAV is found in the stool of persons with hepatitis A. It is usually spread by close personal contact and sometimes by eating food or drinking water containing HAV.
Hepatitis A can cause: mild "flu-like" illness jaundice (yellow skin or eyes) severe stomach pains and diarrhea
People with hepatitis A often have to be hospitalized (up to about 1 person in 5).
Sometimes, people die as a result of hepatitis A (about 3-5 deaths per 1,000 cases).
A person who has hepatitis A can easily pass the disease to others within the same household.
Hepatitis A vaccine can prevent hepatitis A.

2

Who should get hepatitis A vaccine and when?

WHO?

Some people should be routinely vaccinated with hepatitis A vaccine:

All children 1 year (12 through 23 months) of age.

Persons 1 year of age and older traveling to or working in countries with high or intermediate prevalence of hepatitis A, such as those located in Central or South America, Mexico, Asia (except Japan), Africa, and eastern Europe. For more information see www.cdc.gov/travel.
Children and adolescents through 18 years of age who live in states or communities where

routine vaccination has been implemented because of high disease incidence.
Men who have sex with men.
Persons who use street drugs.
Persons with chronic liver disease.
Persons who are treated with clotting factor concentrates.
Persons who work with HAV-infected primates or who work with HAV in research laboratories.
Other people might get hepatitis A vaccine in special situations:
Hepatitis A vaccine might be recommended for children or adolescents in communities where outbreaks of hepatitis A are occurring.
Hepatitis A vaccine is not licensed for children younger than 1 year of age.
WHEN?
For children, the first dose should be given at 12-23 months of age. Children who are not vaccinated by 2 years of age can be vaccinated at later visits.
For travelers, the vaccine series should be started at least one month before traveling to provide the best protection.
Persons who get the vaccine less than one month before traveling can also get a shot called immune globulin (IG). IG gives immediate, temporary protection.
For others, the hepatitis A vaccine series may be started whenever a person is at risk of infection.
Two doses of the vaccine are needed for lasting protection. These doses should be given at least 6 months apart.
Hepatitis A vaccine may be given at the same time as other vaccines.

Hepatitis A

3/21/06

Some people should not get
3 hepatitis A vaccine or should
wait
Anyone who has ever had a severe (lifethreatening) allergic reaction to a previous dose of hepatitis A vaccine should not get another dose.
Anyone who has a severe (life threatening) allergy to any vaccine component should not get the vaccine. Tell your doctor if you have any severe allergies. All hepatitis A vaccines contain alum and some hepatitis A vaccines contain 2-phenoxyethanol.
Anyone who is moderately or severely ill at the time the shot is scheduled should probably wait until they recover. Ask your doctor or nurse. People with a mild illness can usually get the vaccine.
Tell your doctor if you are pregnant. The safety of hepatitis A vaccine for pregnant women has not been determined. But there is no evidence that it is harmful to either pregnant women or their unborn babies. The risk, if any, is thought to be very low.

4

What are the risks from hepatitis A vaccine?

A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. The risk of hepatitis A vaccine causing serious harm, or death, is extremely small.

Getting hepatitis A vaccine is much safer than getting the disease.

Mild problems
soreness where the shot was given (about 1 out of 2 adults, and up to 1 out of 6 children)
headache (about 1 out of 6 adults and 1 out of 25 children)
loss of appetite (about 1 out of 12 children) tiredness (about 1 out of 14 adults)
If these problems occur, they usually last 1 or 2 days.

Severe problems

serious allergic reaction, within a few minutes to a few hours of the shot (very rare)

Vaccine Information Statement

Hepatitis A (3/21/06)

42 U.S.C. 300aa-26

5

What if there is a moderate or severe reaction?

What should I look for? Any unusual condition, such as a high fever or
behavior changes. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.

What should I do? Call a doctor, or get the person to a doctor right
away.
Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
Ask your doctor, nurse, or health department to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form.

Or you can file this report through the VAERS web site at www.vaers.hhs.gov, or by calling 1-800-822-7967.

VAERS does not provide medical advice.

6

The National Vaccine Injury Compensation Program

In the event that you or your child has a serious reaction to a vaccine, a federal program has been created to help pay for the care of those who have been harmed.

For details about the National Vaccine Injury Compensation Program, call 1-800-338-2382 or visit their website at www.hrsa.gov/vaccinecompensation.

7 How can I learn more?
Ask your doctor or nurse. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) - Visit CDC websites at: www.cdc.gov/hepatitis or www.cdc.gov/nip

department of health and human services Centers for Disease Control and Prevention
National Immunization Program

VACUNA CONTRA LA HEPATITIS A

LO QUE USTED NECESITA SABER

1 Qu es la hepatitis A?

La hepatitis A es una enfermedad seria del hgado, causada por el virus de la hepatitis A (HAV). El HAV se encuentra en el excremento de las personas que tienen hepatitis A. Por lo general se pasa por el contacto personal cercano, y algunas veces por comer alimentos o tomar agua que contiene HAV.
La hepatitis A puede producir:
Una enfermedad leve similar a la gripe (tambin conocida como la influenza)
Ictericia (piel u ojos amarillentos)
Dolores graves en el estmago y diarrea
A menudo, las personas con hepatitis A tienen que ser hospitalizadas (hasta casi 1 de cada 5 personas).
En algunos casos, las personas mueren a causa de la hepatitis A (cerca de 3 a 5 muertes por cada 1,000 casos).
Una persona con hepatitis A fcilmente puede pasar la enfermedad a otras personas en la misma casa.
La vacuna contra la hepatitis A puede prevenir la hepatitis A.

2

Quines deben vacunarse contra la hepatitis A y cundo?

QUINES?
Algunas personas deben vacunarse contra la hepatitis A de manera rutinaria:
Todos los nios de 1 ao de edad (de 12 a 23 meses).
Las personas de 1 ao de edad y mayores que viajen a, o que trabajen en, pases con una incidencia alta o intermedia de hepatitis A, como los situados en Centro o Sudamrica, Mxico, Asia (excepto Japn), frica y Europa oriental. Si desea ms informacin, visite: www.cdc.gov/travel.

Los nios y los adolescentes hasta de 18 aos de edad que vivan en estados o comunidades donde se ha establecido la vacunacin de rutina a causa de la alta incidencia de la enfermedad.
Los hombres que tengan relaciones sexuales con otros hombres.
Las personas que usan drogas callejeras.
Las personas con enfermedades crnicas del hgado.
Las personas que reciban tratamiento con concentrados de factor de coagulacin.
Las personas que trabajen con primates infectados con HAV o que trabajen con el HAV en laboratorios de investigacin.
Otras personas podran vacunarse contra la hepatitis A en situaciones especiales:
La vacuna contra la hepatitis A se podra recomendar para nios o adolescentes en comunidades donde estn ocurriendo epidemias de la hepatitis A.
La vacuna contra la hepatitis A no est autorizada para nios menores de 1 ao.
CUNDO?
Para los nios, se debe dar la primera dosis entre los 12 y los 23 meses de edad. Los nios que no estn vacunados al cumplir los 2 aos de edad se pueden vacunar despus.
Para los viajeros, la serie de vacunas debe empezar por lo menos un mes antes de viajar, para obtener la mejor proteccin.
Las personas que se vacunen menos de un mes antes de viajar tambin pueden recibir una vacuna de inmunoglobulina (IG), que ofrece una proteccin inmediata y temporal.
Para otros, la serie de vacunas contra la hepatitis A puede empezar cuando la persona tenga riesgo de infectarse.
Se necesitan dos dosis de la vacuna para que la proteccin sea duradera. Estas dosis deben darse por lo menos con 6 meses de diferencia.
La vacuna contra la hepatitis A se puede dar al mismo tiempo que otras vacunas.

Hepatitis A - Spanish

3/21/06

Algunas personas no deben
3 vacunarse contra la hepatitis A
o deben esperar

Las personas que alguna vez hayan tenido una reaccin alrgica grave (que ponga en peligro la vida) a una dosis anterior de la vacuna contra la hepatitis A no deben recibir otra dosis.
Las personas que tengan alguna alergia grave (que ponga en peligro la vida) a algn componente de la vacuna no deben vacunarse. Dgale a su mdico si tiene alguna alergia grave. Todas las vacunas contra la hepatitis A contienen alumbre y algunas contienen 2-fenoxietanol.
Las personas que estn moderada o gravemente enfermas cuando tienen programado recibir la vacuna probablemente deben esperar hasta que se recuperen. Hable con su mdico o enfermera. Las personas con una enfermedad leve usualmente pueden vacunarse.
Dgale a su mdico si est embarazada. No se ha determinado la seguridad de la vacuna contra la hepatitis A para mujeres embarazadas, pero no hay pruebas de que sea daina para las mujeres embarazadas ni para sus bebs por nacer. El riesgo, si lo hubiera, se considera muy bajo.

4

Cules son los riesgos de la vacuna contra la hepatitis A?

Una vacuna, como todo medicamento, tiene la posibilidad de causar problemas serios, como reacciones alrgicas graves. El riesgo de que la vacuna contra la hepatitis A cause daos graves o la muerte es sumamente pequeo.
Vacunarse contra la hepatitis A es mucho ms seguro que adquirir la enfermedad.
Problemas leves
Dolor en el lugar de la vacuna (cerca de 1 de cada 2 adultos, y hasta 1 de cada 6 nios)
Dolor de cabeza (cerca de 1 de cada 6 adultos y 1 de cada 25 nios)
Prdida del apetito (cerca de 1 de cada 12 nios) Cansancio (cerca de 1 de cada 14 adultos)
Si ocurriera alguno de estos problemas, por lo general duran de 1 a 2 das.
Problemas graves
Reaccin alrgica grave, a partir de unos minutos a algunas horas de haber sido vacunado (ocurre muy rara vez)

5

Qu pasa si hay una reaccin moderada o grave?

A qu debo prestar atencin? Cualquier cosa fuera de lo comn, como fiebre alta o
cambios en el comportamiento. Los signos de una reaccin alrgica grave pueden incluir dificultad para respirar, ronquera o sibilancias, urticaria, palidez, debilidad, latidos rpidos del corazn o mareos.
Qu debo hacer? Llame a un mdico o lleve a la persona inmediatamente
a un mdico. Diga al mdico lo que ocurri, la fecha y la hora en que
ocurri y cundo recibi la vacuna. Pida a su mdico, enfermera o departamento de salud
que informe la reaccin llenando un formulario del Sistema de Informacin sobre Eventos Adversos a una Vacuna (VAERS).
O puede presentar este informe mediante el sitio web de VAERS, en www.vaers.hhs.gov o puede llamar al 1-800-822-7967.
VAERS no proporciona asesoramiento mdico.
Programa Nacional de
6 Compensacin por Lesiones
Causadas por las Vacunas

En caso de que usted o su hijo tenga una reaccin grave ante una vacuna, se ha creado un programa federal para ayudar a pagar la atencin de quienes resulten lastimados.
Si desea conocer los detalles del Programa Nacional de Compensacin por Lesiones Causadas por las Vacunas (National Vaccine Injury Compensation Program), llame al 1-800-338-2382 visite su sitio web en www.hrsa.gov/vaccinecompensation.

7

Cmo puedo obtener ms informacin?

Pregunte a su mdico o enfermera. Le pueden dar el instructivo que viene con la vacuna o sugerirle otras fuentes de informacin.
Llame al departamento de salud local o estatal.
Pngase en contacto con los Centros para el Control y la Prevencin de Enfermedades (CDC): - Llame al 1-800-232-4636 (1-800-CDC-INFO) - Visite los sitios web del CDC en www.cdc.gov/hepatitis o www.cdc.gov/nip

Vaccine Information Statement

Hepatitis A IMM-502 - Spanish (3/21/06)

42 U.S.C. 300aa-26

Translated by Transcend Translations, Davis, CA

www.transcend.net

department of health and human services Centers for Disease Control and Prevention
National Immunization Program

VACCINE PNEUMOCOCCAL
POLYSACCHARIDE

WHAT YOU NEED TO KNOW

Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis.

1 Pneumococcal disease

Another type of pneumococcal vaccine (pneumococcal conjugate vaccine, or PCV) is routinely recommended

Pneumococcal disease is caused by Streptococcus pneumoniae bacteria. It is a leading cause of vaccine-

for children younger than 5 years of age. PCV is described in a separate Vaccine Information Statement.

preventable illness and death in the United States. Anyone can get pneumococcal disease, but some

3 Who should get PPSV?

people are at greater risk than others: People 65 years and older The very young People with certain health problems People with a weakened immune system Smokers
Pneumococcal disease can lead to serious infections of the:
Lungs (pneumonia), Blood (bacteremia), and Covering of the brain (meningitis).

All adults 65 years of age and older.
Anyone 2 through 64 years of age who has a longterm health problem such as: - heart disease - lung disease - sickle cell disease - diabetes - alcoholism - cirrhosis -leaks of cerebrospinal fluid or cochlear implant

Pneumococcal pneumonia kills about 1 out of 20 people who get it. Bacteremia kills about 1 person in 5, and meningitis about 3 people in 10.

People with the health problems described in Section 3 of this statement may be more likely to die from the disease.

2

Pneumococcal polysaccharide vaccine (PPSV)

Treatment of pneumococcal infections with penicillin and other drugs used to be more effective. But some strains of the disease have become resistant to these drugs. This makes prevention of the disease, through vaccination, even more important.

Pneumococcal polysaccharide vaccine (PPSV) protects against 23 types of pneumococcal bacteria, including those most likely to cause serious disease.

Most healthy adults who get the vaccine develop protection to most or all of these types within 2 to 3 weeks of getting the shot. Very old people, children under 2 years of age, and people with some long-term illnesses might not respond as well, or at all.

Anyone 2 through 64 years of age who has a disease or condition that lowers the body's resistance to infection, such as: - Hodgkin's disease - lymphoma or leukemia - kidney failure - multiple myeloma - nephrotic syndrome - HIV infection or AIDS - damaged spleen, or no spleen - organ transplant
Anyone 2 through 64 years of age who is taking a drug or treatment that lowers the body's resistance to infection, such as: - long-term steroids - certain cancer drugs - radiation therapy
Any adult 19 through 64 years of age who: - is a smoker - has asthma
PPSV may be less effective for some people, especially those with lower resistance to infection.

But these people should still be vaccinated, because they are more likely to have serious complications if they get pneumococcal disease.
Children who often get ear infections, sinus infections, or other upper respiratory diseases, but who are otherwise healthy, do not need to get PPSV because it is not effective against those conditions.

4

How many doses of PPSV are needed, and when?

Usually only one dose of PPSV is needed, but under some circumstances a second dose may be given.

A second dose is recommended for people 65 years and older who got their first dose when they were younger than 65 and it has been 5 or more years since the first dose.

A second dose is recommended for people 2 through 64 years of age who: - have a damaged spleen or no spleen - have sickle-cell disease - have HIV infection or AIDS - have cancer, leukemia, lymphoma, multiple myeloma - have nephrotic syndrome - have had an organ or bone marrow transplant - are taking medication that lowers immunity (such as chemotherapy or long-term steroids)

When a second dose is given, it should be given 5 years after the first dose.

5

Some people should not get PPSV or should wait

Anyone who has had a life-threatening allergic reaction to PPSV should not get another dose.

Anyone who has a severe allergy to any component of a vaccine should not get that vaccine. Tell your provider if you have any severe allergies.

Anyone who is moderately or severely ill when the shot is scheduled may be asked to wait until they recover before getting the vaccine. Someone with a mild illness can usually be vaccinated.
While there is no evidence that PPSV is harmful to either a pregnant woman or to her fetus, as a precaution, women with conditions that put them at risk for pneumococcal disease should be vaccinated before becoming pregnant, if possible.

6 What are the risks from PPSV?
About half of people who get PPSV have mild side effects, such as redness or pain where the shot is given.
Less than 1% develop a fever, muscle aches, or more severe local reactions.
A vaccine, like any medicine, could cause a serious reaction. But the risk of a vaccine causing serious harm, or death, is extremely small.

7

What if there is a severe reaction?

What should I look for? Any unusual condition, such as a high fever or behavior changes. Signs of a severe allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.

What should I do? Call a doctor, or get the person to a doctor right away. Tell the doctor what happened, the date and time it happened, and when the vaccination was given. Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at www.vaers.hhs.gov, or by calling 1-800-822-7967.

VAERS does not provide medical advice.

8 How can I learn more?

Ask your provider. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) or - Visit CDC's website at www.cdc.gov/vaccines.

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention
PPSV (10/6/09) Vaccine Information Statement

VACCINE PNEUMOCOCCAL CONJUGATE

WHAT YOU NEED TO KNOW

Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis.

1 Pneumococcal disease
Infection with Streptococcus pneumoniae bacteria can make children very sick.

PCV13 may also prevent some cases of pneumonia and some ear infections. But pneumonia and ear infections have many causes, and PCV13 only works against the types of pneumococcal bacteria targeted by the vaccine.

It causes blood infections, pneumonia, and meningitis, mostly in young children. (Meningitis is an infection of the covering of the brain.) Although pneumococal meningitis is relatively rare (less than 1 case per 100,000 people each year), it is fatal in about 1 of 10 cases in children.
Pneumococcal meningitis can also lead to other health problems, including deafness and brain damage.
Before routine use of pneumococcal conjugate vaccine, pneumococcal infections caused:
over 700 cases of meningitis, 13,000 blood infections, about 5 million ear infections, and about 200 deaths annually in the United States in children under five.
Children younger than 2 years of age are at higher risk for serious disease than older children.
Pneumococcal bacteria are spread from person to person through close contact.
Pneumococcal infections may be hard to treat because some strains of the bacteria have become resistant to the drugs that are used to treat them. This makes prevention of pneumococcal infections through vaccination even more important.

PCV13 is given to infants and toddlers, to protect them when they are at greatest risk for serious diseases caused by pneumococcal bacteria.
In addition to receiving PCV13, older children with certain chronic illnesses may get a different vaccine called PPSV23. There is a separate Vaccine Information Statement for that vaccine.

3

Who should get PCV13, and when?

Infants and Children Under 2 Years of Age PCV13 is recommended as a series of 4 doses, one dose at each of these ages: 2 months, 4 months, 6 months, and 12 through 15 months

Children who miss their shots at these ages should still get the vaccine. The number of doses and the intervals between doses will depend on the child's age. Ask your health care provider for details.

Children who have began their immunization series with PCV7 should complete the series with PCV13.

Older Children and Adolescents Healthy children between their 2nd and 5th birth-
days who have not completed the PCV7 or PCV13 series before age 2 years should get 1 dose.

2

Pneumococcal conjugate vaccine (PCV13)

There are more than 90 types of pneumococcal bacteria. The new pneumococcal conjugate vaccine (PCV13) protects against 13 of them. These bacteria types are responsible for most severe pneumococcal infections among children. PCV13 replaces a previous conjugate vaccine (PCV7), which protected against 7 pneumococcal types and has been in use since 2000. During that time severe pneumococcal disease dropped by nearly 80% among children under 5.

Children between the 2nd and 6th birthdays with medical conditions such as: - sickle cell disease, - a damaged spleen or no spleen, - cochlear implants, - diabetes, - HIV/AIDS or other diseases that affect the immune system (such as cancer, or liver disease), or - chronic heart or lung disease, or who take medications that affect the immune system, such as immunosuppressive drugs or steroids, should get 1 dose of PCV 13 (if they received 3

doses of PCV7 or PCV13 before age 2 years), or 2 doses of PCV13 (if they have received 2 or fewer doses of PCV7 or PCV13).

A dose of PCV13 may be administered to children and adolescents 6 through 18 years of age who have certain medical conditions, even if they have previously received PCV7 or PPSV23.

Children who have completed the 4-dose series with PCV7: Healthy children who have not yet turned 5, and children with medical conditions who have not yet turned 6, should get one additional dose of PCV13.

Ask your health care provider if you have questions about any of these recommendations.

PCV13 may be given at the same time as other vaccines.

4

Some children should not get PCV13 or should wait

Children should not get PCV13 if they had a serious (life-threatening) allergic reaction to a previous dose of this vaccine, to PCV7, or to any vaccine containing diphtheria toxoid (for example, DTaP).

Children who are known to have a severe allergy to any component of PCV7 or PCV13 should not get PCV13. Tell your health care provider if your child has any severe allergies.

Children with minor illnesses, such as a cold, may be vaccinated. But children who are moderately or severely ill should usually wait until they recover before getting the vaccine.

5 What are the risks from PCV13?

Any medicine, including a vaccine, could possibly cause a serious problem, such as a severe allergic reaction. However, the risk of any vaccine causing serious harm, or death, is extremely small.
In studies, most reactions after PCV13 were mild. They were similar to reactions reported after PCV7, which has been in use since 2000. Reported reactions varied by dose and age, but on average:
About half of children were drowsy after the shot, had a temporary loss of appetite, or had redness or tenderness where the shot was given.
About 1 out of 3 had swelling where the shot was given.
About 1 out of 3 had a mild fever, and about 1 in 20 had a higher fever (over 102.2F).

Up to about 8 out of 10 became fussy or irritable.

Life-threatening allergic reactions from vaccines are very rare. If they do occur, it would be within a few minutes to a few hours after the vaccination.

6

What if there is a severe reaction?

What should I look for? Any unusual condition, such as a high fever or behavior changes. Signs of a severe allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.

What should I do? Call a doctor, or get the person to a doctor right away. Tell the doctor what happened, the date and time it happened, and when the vaccination was given. Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at www.vaers.hhs.gov, or by calling 1-800-822-7967.

VAERS does not provide medical advice.

7

The National Vaccine Injury Compensation Program

The National Vaccine Injury Compensation Program (VICP) was created in 1986.

Persons who believe they may have been injured by a vaccine may file a claim with VICP by calling 1-800-338-2382 or visiting their website at www.hrsa.gov/vaccinecompensation.

8 How can I learn more?
Ask your provider. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) or - Visit CDC's website at www.cdc.gov/vaccines.

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention

Vaccine Information Statement (Interim)

PCV13 4/16/2010

42 U.S.C. 300aa-26

VACUNA ANTINEUMOCCICA CONJUGADA

LO QUE USTED NECESITA SABER

Muchas Hojas de Informacin sobre Vacunas estn disponibles en espaol y en otros idiomas. Vea www.immunize.org/vis.

1 La enfermedad neumoccica

Es posible que la PCV13 tambin prevenga algunos casos de neumona y algunas infecciones de los odos. Pero la

La infeccin por la bacteria Streptococcus pneumoniae puede enfermar mucho a los nios.
Causa infecciones de la sangre, neumona y meningitis, principalmente en nios pequeos. (La meningitis es una infeccin del recubrimiento del cerebro). Aunque la meningitis neumoccica es relativamente poco comn (menos de 1 caso de cada 100,000 personas por ao), es mortal en ms o menos 1 de cada 10 casos en nios.
La meningitis neumoccica tambin puede conducir a otros problemas de salud, incluyendo sordera y dao cerebral.

neumona y las infecciones de los odos tienen muchas causas y la PCV13 slo es eficaz contra los tipos de bacterias neumoccicas a las que se dirige la vacuna.
La PCV13 se da a bebs y a nios pequeos para protegerlos cuando estn en mayor riesgo de contraer enfermedades serias causadas por las bacterias neumoccicas.
Adems de darles la PCV13, los nios mayores que tienen ciertas enfermedades crnicas pueden recibir una vacuna diferente llamada PPSV23. Hay una hoja de informacin diferente sobre esa vacuna.

Antes del uso rutinario de la vacuna antineumoccica conjugada las infecciones neumoccicas causaban:
ms de 700 casos de meningitis, 13,000 infecciones de la sangre, unos 5 millones de infecciones de los odos y unas 200 muertes cada ao en nios menores de cinco aos de edad en Estados Unidos.
Los nios menores de 2 aos de edad tienen un riesgo ms alto de contraer una enfermedad seria que los nios de ms edad.

3

Quines deben vacunarse con la PCV13 y cundo?

Bebs y nios menores de 2 aos de edad La PCV13 se recomienda como una serie de 4 dosis, una dosis a cada una de estas edades: 2 meses, 4 meses, 6 meses, y entre los 12 y 15 meses.
Los nios que no fueron vacunados a estas edades de todos modos se deben vacunar. El nmero de dosis y los intervalos entre ellas dependern de la edad del nio. Pida ms detalles a su profesional de la salud.

Las bacterias neumoccicas se pasan de una persona a otra mediante el contacto cercano.

Los nios que empezaron la serie de vacunas con la PCV7 deben completarla con la PCV13.

Las infecciones neumoccicas podran ser difciles de tratar porque algunos tipos de la bacteria han pasado a ser resistentes a los medicamentos que se usan para tratarlas. Esto hace la prevencin de las infecciones neumoccicas por medio de la vacunacin an ms importante.

2

La vacuna antineumoccica conjugada (PCV13)

Hay ms de 90 tipos de bacterias neumoccicas. La nueva vacuna antineumoccica conjugada (PCV13) protege contra 13 de ellos. Estos tipos de bacterias son los causantes de la mayora de las infecciones neumoccicas graves en nios. La PCV13 reemplaza una vacuna conjugada anterior (PCV7), que protega contra 7 tipos de bacterias neumoccicas y que ha estado en uso desde 2000. Durante ese tiempo la enfermedad neumoccica grave se reduj cerca de 80% en nios menores de 5 aos de edad.

Nios mayores y adolescentes Los nios sanos, entre su 2 y 5 cumpleaos, que no
completaron la serie de la PCV7 de la PCV13 antes de los 2 aos de edad, deben recibir 1 dosis.
Los nios entre su 2 y 6 cumpleaos con problemas mdicos como: - enfermedad de clulas falciformes, - el bazo daado o no tener bazo, - implantes cocleares, - diabetes, - VIH/SIDA o algunas otras enfermedades que afecten el sistema inmunolgico (como cncer o una enfermedad del hgado) o - enfermedad crnica del corazn o de los pulmones, o que toman medicamentos que afectan el sistema inmunolgico, como medicamentos inmunosupresores o esteroides, deben recibir 1 dosis de la PCV 13 (si les dieron 3 dosis de la PCV7 la PCV13 antes de los 2

PCV13 - Spanish (4/16/10)

aos de edad) 2 dosis de la PCV13 (si les dieron 2 dosis o menos de la PCV7 la PCV13).
Se puede dar una dosis de la PCV13 a nios y adolescentes de 6 a 18 aos de edad con ciertos problemas mdicos, incluso si les dieron anteriormente la PCV7 la PPSV23.
Nios que completaron la serie de 4 dosis de la PCV7: Los nios sanos que todava no han cumplido los 5 aos de edad y los nios con problemas mdicos que todava no han cumplido los 6 aos de edad deben recibir una dosis adicional de la PCV13.
Consulte a su profesional de la salud si tiene preguntas sobre alguna de estas recomendaciones.
La PCV13 se puede dar al mismo tiempo que otras vacunas.

4

Algunos nios no deben vacunarse con la PCV13 deben esperar

Los nios que tuvieron una reaccin alrgica seria (que puso sus vidas en peligro) a una dosis anterior de esta vacuna, a la PCV7 a cualquier otra vacuna que contenga toxoide de difteria (como la DTaP, por ejemplo) no se deben vacunar con la PCV13.
Los nios que se sabe que tienen una reaccin alrgica grave a cualquier componente de la PCV7 la PCV13 no se deben vacunar con la PCV13. Diga a su profesional de la salud si su hijo tiene alergias graves.
Los nios con enfermedades menores, como un resfriado, se pueden vacunar. Pero los nios que estn moderadamente o muy enfermos por lo general deben esperar hasta recuperarse antes de vacunarse.

5

Cules son los riesgos de la PCV13?

Todos los medicamentos, incluyendo una vacuna, podran causar un problema serio, como una reaccin alrgica grave. Sin embargo, el riesgo de que una vacuna cause un dao serio, o la muerte, es sumamente pequeo.
En estudios, la mayora de las reacciones despus de la PCV13 fueron leves. Fueron similares a las reacciones que se informaron despus de la PCV7, que ha estado en uso desde 2000. Las reacciones que se informaron variaron por dosis y edad, pero en promedio:
Cerca de la mitad de los nios estuvieron adormilados despus de vacunarse, tuvieron una prdida temporal del apetito o tuvieron enrojecimiento o molestia en el lugar donde se aplic la inyeccin.
Cerca de 1 de cada 3 tuvo hinchazn en el lugar donde se aplic la inyeccin.
Cerca de 1 de cada 3 tuvo fiebre leve y cerca de 1 de cada 20 tuvo fiebre ms alta (de ms de 102.2F).
Hasta 8 de cada 10 estuvieron molestos o irritables.

Las reacciones alrgicas a las vacunas que ponen la vida en peligro son muy poco comunes. Si ocurren, es a los pocos minutos o a las pocas horas de haberse vacunado.

6

Qu pasa si hay una reaccin grave?

A qu debo prestar atencin? Cualquier cosa fuera de lo comn, como fiebre alta o cambios en el comportamiento. Los signos de una reaccin alrgica grave pueden incluir dificultad para respirar, ronquera o sibilancias, ronchas, palidez, debilidad, latidos rpidos del corazn o mareos.
Qu debo hacer? Llame a un doctor o lleve a la persona inmediatamente a
un doctor. Diga a su doctor lo que ocurri, la fecha y la hora en que
ocurri y cundo recibi la vacuna. Pida a su profesional de la salud que informe la reaccin
presentando un formulario del Sistema de Informacin sobre Eventos Adversos a una Vacuna (VAERS). O puede presentar este informe mediante el sitio web de VAERS, en: www.vaers.hhs.gov o puede llamar al: 1-800-822-7967.

VAERS no proporciona consejos mdicos.

Programa Nacional de
7 Compensacin por Lesiones
Causadas por las Vacunas
El Programa Nacional de Compensacin por Lesiones Causadas por las Vacunas (VICP) fue creado en 1986.
Las personas que creen que pudieron haber sido lesionadas por una vacuna pueden presentar un reclamo ante el VICP llamando al 1-800-338-2382 visitando su sitio Web en www.hrsa.gov/vaccinecompensation.

8

Cmo puedo obtener ms informacin?

Consulte con su profesional de la salud. Le puede dar el folleto de informacin que viene con la vacuna o sugerirle otras fuentes de informacin.
Llame al departamento de salud local o estatal.
Comunquese con los Centros para el Control y la Prevencin de Enfermedades (CDC): - Llame al: 1-800-232-4636 (1-800-CDC-INFO) o - Visite el sitio Web de los CDC en: www.cdc.gov/vaccines

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention

Vaccine Information Statement (Interim)

PCV13 IMM-577S Spanish (4/16/2010)

42 U.S.C. 300aa-26

Translated by Transcend Translations, Davis, CA

www.transcend.net

VACCINE
INACTIVATED
INFLUENZA

2009-10
W H A T Y O U N E E D T O K N O W

Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis.

1 Why get vaccinated?
Influenza ("flu") is a contagious disease.
It is caused by the influenza virus, which can be spread by coughing, sneezing, or nasal secretions.

3

Who should get inactivated influenza vaccine?

Anyone who wants to reduce the likelihood of becoming ill with influenza or spreading influenza to others.

Other illnesses can have the same symptoms and are often mistaken for influenza. But only an illness caused by the influenza virus is really influenza.

All children 6 months and older and all older adults: All children from 6 months through 18 years of age. Anyone 50 years of age or older.

Anyone can get influenza, but rates of infection are highest among

children. For most people, it lasts only a few days. It can cause:

fever

sore throat chills

fatigue

cough

headache muscle aches

Some people, such as infants, elderly, and those with certain health conditions, can get much sicker. Flu can cause high fever and pneumonia, and make existing medical conditions worse. It can cause diarrhea and seizures in children. On average, 226,000 people are hospitalized every year because of influenza and 36,000 die mostly elderly. Influenza vaccine can prevent influenza.

2 Inactivated influenza vaccine

There are two types of seasonal influenza vaccine:

1. Inactivated (killed) vaccine, or the These "seasonal" influenza "flu shot" is given by injection into vaccines are formulated to

the muscle. 2. Live, attenuated

prevent annual flu. They do

(weakened) influenza vaccine is

not protect against pandemic

sprayed into the nostrils. This vaccine
H1N1 influenza.

is described in a separate Vaccine Information Statement.


Influenza viruses are always changing. Because of this, influenza vaccines are updated every year, and an annual vaccination is recommended.

Each year scientists try to match the viruses in the vaccine to those most likely to cause flu that year. When there is a close match the vaccine protects most people from serious influenza related illness. But even when there is not a close match, the vaccine provides some protection. Influenza vaccine will not prevent "influenza-like" illnesses caused by other viruses.

It takes up to 2 weeks for protection to develop after the shot. Protection lasts up to a year.

Some inactivated influenza vaccine contains a preservative called thimerosal. Some people have suggested that thimerosal may be related to developmental problems in children. In 2004 the Institute of Medicine reviewed many studies looking into this theory and concluded that there is no evidence of such a relationship. Thimerosal-free influenza vaccine is available.

Anyone who is at risk of complications from influenza, or more likely to require medical care:

Women who will be pregnant during influenza season.

Anyone with long-term health problems with:

- heart disease - kidney disease

- liver disease

- lung disease - metabolic disease, such as diabetes

- asthma

- anemia, and other blood disorders

Anyone with a weakened immune system due to: - HIV/AIDS or other diseases affecting the immune system - long-term treatment with drugs such as steroids - cancer treatment with x-rays or drugs

Anyone with certain muscle or nerve disorders (such as seizure disorders or cerebral palsy) that can lead to breathing or swallowing problems.

Anyone 6 months through 18 years of age on long-term aspirin treatment (they could develop Reye Syndrome if they got influenza).

Residents of nursing homes and other chronic-care
facilities.


Anyone who lives with or cares for people at high risk for influenza-related complications:
Health care providers.
Household contacts and caregivers of children from
birth up to 5 years of age.

Household contacts and caregivers of - people 50 years and older, or - anyone with medical conditions that put them at higher risk for severe complications from influenza.

Health care providers may also recommend a yearly influenza vaccination for:
People who provide essential community services.
People living in dormitories, correctional facilities, or
under other crowded conditions, to prevent outbreaks.

People at high risk of influenza complications who travel to the Southern hemisphere between April and September, or to the tropics or in organized tourist groups at any time.

4

When should I get influenza vaccine?

You can get the vaccine as soon as it is available, usually in the fall, and for as long as illness is occurring in your community. Influenza can occur any time from November through May, but it most often peaks in January or February. Getting vaccinated in December, or even later, will still be beneficial in most years.

Most people need one dose of influenza vaccine each year. Children younger than 9 years of age getting influenza vaccine for the first time or who got influenza vaccine for the first time last season but got only one dose should get 2 doses, at least 4 weeks apart, to be protected.

Influenza vaccine may be given at the same time as other vaccines, including pneumococcal vaccine.

Some people should talk with a
5 doctor before getting influenza
vaccine
Some people should not get inactivated influenza vaccine or should wait before getting it.
Tell your doctor if you have any severe (life-threatening) allergies. Allergic reactions to influenza vaccine are rare. - Influenza vaccine virus is grown in eggs. People with a severe egg allergy should not get the vaccine. - A severe allergy to any vaccine component is also a reason to not get the vaccine. - If you have had a severe reaction after a previous dose of influenza vaccine, tell your doctor.
Tell your doctor if you ever had Guillain-Barr Syndrome (a severe paralytic illness, also called GBS). You may be able to get the vaccine, but your doctor should help you make the decision.
People who are moderately or severely ill should usually wait until they recover before getting flu vaccine. If you are ill, talk to your doctor or nurse about whether to reschedule the vaccination. People with a mild illness can usually get the vaccine.

6

What are the risks from inactivated influenza vaccine?

A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. The risk of a vaccine causing serious harm, or death, is extremely small.

Serious problems from influenza vaccine are very rare. The viruses in inactivated influenza vaccine have been killed, so you cannot get influenza from the vaccine.
Mild problems: soreness, redness, or swelling where the shot was given hoarseness, sore or red eyes, cough, itchiness fever aches If these problems occur, they usually begin soon after the shot and last 1-2 days.

Severe problems: Life-threatening allergic reactions from vaccines are very
rare. If they do occur, it is usually within a few minutes to a few hours after the shot.
In 1976, a type of influenza (swine flu) vaccine was associated with Guillain-Barr Syndrome (GBS). Since then, flu vaccines have not been clearly linked to GBS. However, if there is a risk of GBS from current flu vaccines, it would be no more than 1 or 2 cases per million people vaccinated. This is much lower than the risk of severe influenza, which can be prevented by vaccination.

7

What if there is a severe reaction?

What should I look for? Any unusual condition, such as a high fever or behavior changes. Signs of a severe allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.
What should I do? Call a doctor, or get the person to a doctor right away. Tell the doctor what happened, the date and time it
happened, and when the vaccination was given.
Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at www.vaers.hhs.gov, or by calling 1-800-822-7967.

VAERS does not provide medical advice.

8

The National Vaccine Injury Compensation Program

A federal program exists to help pay for the care of anyone who has a serious reaction to a vaccine.

For more information about the National Vaccine Injury Compensation Program, call 1-800-338-2382, or visit their website at www.hrsa.gov/vaccinecompensation.

9 How can I learn more?

Ask your provider. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) or - Visit CDC's website at www.cdc.gov/flu

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention

Vaccine Information Statement (Interim)
Inactivated Influenza Vaccine (8/11/09) 42 U.S.C. 300aa-26


VACCINE
LIVE, INTRANASAL
INFLUENZA

2009-10 W H A T Y O U N E E D T O K N O W

Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis.

1 Why get vaccinated?

3 Who can get LAIV?

Influenza ("flu") is a contagious disease.

It is caused by the influenza virus, which can be spread by coughing, sneezing, or nasal secretions.

Other illnesses can have the same symptoms and are often mistaken for influenza. But only an illness caused by the influenza virus is really influenza.

Anyone can get influenza, but rates of infection are highest among children. For most people, it lasts only a few days. It can cause: fever sore throat chills muscle aches cough headache fatigue
Some people, such as infants, elderly, and those with certain health conditions, can get much sicker. Flu can cause high fever and pneumonia, and make existing medical conditions worse. It can cause diarrhea and seizures in children. On average, 226,000 people are hospitalized every year because of influenza and 36,000 die mostly elderly. Influenza vaccine can prevent influenza.

2

Live, attenuated influenza vaccine - LAIV (nasal spray)

There are two types of seasonal influenza vaccine:

1. Live, attenuated influenza vaccine (LAIV) contains live but attenuated (weakened) influenza virus. It is sprayed into the nostrils. 2. Inactivated influenza vaccine,

These "seasonal" influenza vaccines are formulated to prevent annual flu. They do not protect against pandemic H1N1 influenza.


sometimes called the "flu shot," is


given by injection. Inactivated influenza vaccine is described in


a separate Vaccine Information Statement.


Influenza viruses are always changing. Because of this, influenza vaccines are updated every year, and an annual vaccination is recommended.
Each year scientists try to match the viruses in the vaccine to those most likely to cause flu that year. When there is a close match the vaccine protects most people from serious influenza related illness. But even when there is not a close match, the vaccine provides some protection. Influenza vaccine will not prevent "influenza-like" illnesses caused by other viruses.
It takes up to 2 weeks for protection to develop after the vaccination. Protection lasts up to a year.

LAIV does not contain thimerosal or other preservatives.

LAIV is approved for people from 2 through 49 years of age, who are not pregnant and do not have certain health conditions (see #4, below). Influenza vaccination is recommended for people who can spread influenza to others at high risk, such as:
Household contacts and out-of-home caregivers of children up to 5 years of age, and people 50 and older.
Physicians and nurses, and family members or anyone else in close contact with people at risk of serious influenza.
Health care providers may also recommend a yearly influenza vaccination for:
People who provide essential community services.
People living in dormitories, correctional facilities, or under other crowded conditions, to prevent outbreaks.
Influenza vaccine is also recommended for anyone who wants to reduce the likelihood of becoming ill with influenza or spreading influenza to others.

4 Some people should not get LAIV

LAIV is not licensed for everyone. The following people should get the inactivated vaccine (flu shot) instead:

Adults 50 years of age and older or children between 6 months and 2 years of age. (Children younger than 6 months should not get either influenza vaccine.)

Children younger than 5 with asthma or one or more episodes of wheezing within the past year.

People who have long-term health problems with:

- heart disease

- kidney or liver disease

- lung disease

- metabolic disease, such as diabetes

- asthma

- anemia, and other blood disorders

Anyone with certain muscle or nerve disorders (such as seizure disorders or cerebral palsy) that can lead to breathing or swallowing problems.

Anyone with a weakened immune system.

Children or adolescents on long-term aspirin treatment.

Pregnant women.

Tell your doctor if you ever had Guillain-Barr syndrome (a severe paralytic illness also called GBS). You may be able to get the vaccine, but your doctor should help you make the decision.

The flu shot is preferred for people (including health-care workers, and family members) in close contact with anyone who has a severely weakened immune system (requiring care in a protected environment, such as a bone marrow transplant unit). People in close contact with those whose immune systems are less severely weakened (including those with HIV) may get LAIV.

Anyone with a nasal condition serious enough to make breathing difficult, such as a very stuffy nose, should get the flu shot instead.

Some people should talk with a doctor before getting either influenza vaccine:
Anyone who has ever had a serious allergic reaction to eggs or another vaccine component, or to a previous dose of influenza vaccine. Tell your doctor if you have any severe allergies.
People who are moderately or severely ill should usually wait until they recover before getting flu vaccine. If you are ill, talk to your doctor or nurse about whether to reschedule the vaccination. People with a mild illness can usually get the vaccine.

5

When should I get influenza vaccine?

You can get the vaccine as soon as it is available, usually in the fall, and for as long as illness is occurring in your community. Influenza can occur any time from November through May, but it most often peaks in January or February. Getting vaccinated in December, or even later, will still be beneficial in most years

Most people need one dose of influenza vaccine each year. Children younger than 9 years of age getting influenza vaccine for the first time or who got influenza vaccine for the first time last season but got only one dose should get 2 doses, at least 4 weeks apart, to be protected.

Influenza vaccine may be given at the same time as other vaccines.

6 What are the risks from LAIV?

A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. The risk of a vaccine causing serious harm, or death, is extremely small.

Live influenza vaccine viruses rarely spread from person to person. Even if they do, they are not likely to cause illness.
LAIV is made from weakened virus and does not cause influenza. The vaccine can cause mild symptoms in people who get it (see below).

Mild problems:

Some children and adolescents 2-17 years of age have

reported mild reactions, including:

runny nose, nasal congestion or cough fever

headache and muscle aches

wheezing

abdominal pain or occasional vomiting or diarrhea

Some adults 18-49 years of age have reported:

runny nose or nasal congestion

sore throat

cough, chills, tiredness/weakness

headache

Severe problems:
Life-threatening allergic reactions from vaccines are very rare. If they do occur, it is usually within a few minutes to a few hours after the vaccination.
If rare reactions occur with any product, they may not be identified until thousands, or millions, of people have used it. Millions of doses of LAIV have been distributed since it was licensed, and no serious problems have been identified. Like all vaccines, LAIV will continue to be monitored for unusual or severe problems.

7

What if there is a severe reaction?

What should I look for? Any unusual condition, such as a high fever or behavior changes. Signs of a severe allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.
What should I do? Call a doctor, or get the person to a doctor right away.
Tell the doctor what happened, the date and time it
happened, and when the vaccination was given.

Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at www.vaers.hhs.gov, or by calling 1-800-822-7967.
VAERS does not provide medical advice.

8

The National Vaccine Injury Compensation Program

A federal program exists to help pay for the care of anyone who has a serious reaction to a vaccine.

For more information about the National Vaccine Injury Compensation Program, call 1-800-338-2382, or visit their website at www.hrsa.gov/vaccinecompensation.

9 How can I learn more?

Ask your provider. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) or - Visit CDC's website at www.cdc.gov/flu

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention

Vaccine Information Statement Live, Attenuated Influenza Vaccine (8/11/09) U.S.C. 300aa-26

MENINGOCOCCAL VACCINES

WHAT YOU NEED TO KNOW

Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis.

1 What is meningococcal disease?

Both vaccines work well, and protect about 90% of people who get them. MCV4 is expected to give better,

Meningococcal disease is a serious bacterial illness. It is longer-lasting protection.

a leading cause of bacterial meningitis in children 2 through 18 years old in the United States. Meningitis is an infection of the fluid surrounding the brain and spinal cord.
Meningococcal disease also causes blood infections.

MCV4 should also be better at preventing the disease from spreading from person to person.

3

Who should get meningococcal vaccine and when?

About 1,000 - 2,600 people get meningococcal disease each year in the U.S. Even when they are treated with

A dose of MCV4 is recommended for children and adolescents 11 through 18 years of age.

antibiotics, 10-15% of these people die. Of those who

This dose is normally given during the routine pre-

survive, another 11-19% lose their arms or legs, become adolescent immunization visit (at 11-12 years). But

deaf, have problems with their nervous systems, become those who did not get the vaccine during this visit

mentally retarded, or suffer seizures or strokes.

should get it at the earliest opportunity.

Anyone can get meningococcal disease. But it is most common in infants less than one year of age and people with certain medical conditions, such as lack of a spleen. College freshmen who live in dormitories, and teenagers 15-19 have an increased risk of getting meningococcal disease.

Meningococcal vaccine is also recommended for other people at increased risk for meningococcal disease:
College freshmen living in dormitories.
Microbiologists who are routinely exposed to meningococcal bacteria.

Meningococcal infections can be treated with drugs such as penicillin. Still, about 1 out of every ten people who get the disease dies from it, and many others are affected for life. This is why preventing the disease through use of meningococcal vaccine is important for people at highest risk.
2 Meningococcal vaccine
There are two kinds of meningococcal vaccine in the U.S.:
- Meningococcal conjugate vaccine (MCV4) was licensed in 2005. It is the preferred vaccine for people 2 through 55 years of age.
- Meningococcal polysaccharide vaccine (MPSV4) has been available since the 1970s. It may be used if MCV4 is not available, and is the only meningococcal vaccine licensed for people older than 55.
Both vaccines can prevent 4 types of meningococcal disease, including 2 of the 3 types most common in the United States and a type that causes epidemics in Africa. Meningococcal vaccines cannot prevent all types of the disease. But they do protect many people who might become sick if they didn't get the vaccine.

U.S. military recruits.
Anyone traveling to, or living in, a part of the world where meningococcal disease is common, such as parts of Africa.
Anyone who has a damaged spleen, or whose spleen has been removed.
Anyone who has terminal complement component deficiency (an immune system disorder).
People who might have been exposed to meningitis during an outbreak.
MCV4 is the preferred vaccine for people 2 through 55 years of age in these risk groups. MPSV4 can be used if MCV4 is not available and for adults over 55.
How Many Doses?
People 2 years of age and older should get 1 dose. Sometimes a second dose is recommended for people who remain at high risk. Ask your provider.
MPSV4 may be recommended for children 3 months to 2 years of age under special circumstances. These children should get 2 doses, 3 months apart.

Some people should not get
4 meningococcal vaccine or
should wait
Anyone who has ever had a severe (life-threatening) allergic reaction to a previous dose of either meningococcal vaccine should not get another dose.
Anyone who has a severe (life threatening) allergy to any vaccine component should not get the vaccine. Tell your provider if you have any severe allergies.
Anyone who is moderately or severely ill at the time the shot is scheduled should probably wait until they recover. Ask your provider. People with a mild illness can usually get the vaccine.
Anyone who has ever had Guillain-Barr Syndrome should talk with their provider before getting MCV4.
Meningococcal vaccines may be given to pregnant women. However, MCV4 is a new vaccine and has not been studied in pregnant women as much as MPSV4 has. It should be used only if clearly needed.
Meningococcal vaccines may be given at the same time as other vaccines.

5

What are the risks from meningococcal vaccines?

A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. The risk of meningococcal vaccine causing serious harm, or death, is extremely small.

6

What if there is a moderate or severe reaction?

What should I look for?
Any unusual condition, such as a high fever, weakness, or behavior changes. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.
What should I do?
Call a doctor, or get the person to a doctor right away.
Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
Ask your doctor, nurse, or health department to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS web site at www.vaers.hhs.gov, or by calling 1-800-822-7967.
VAERS does not provide medical advice.

7

The National Vaccine Injury Compensation Program

A federal program exists to help pay for the care of anyone who has had a rare serious reaction to a vaccine.

For information about the National Vaccine Injury Compensation Program, call 1-800-338-2382 or visit their website at www.hrsa.gov/vaccinecompensation.

Mild problems
As many as half the people who get meningococcal vaccines have mild side effects, such as redness or pain where the shot was given.
If these problems occur, they usually last for 1 or 2 days. They are more common after MCV4 than after MPSV4.
A small percentage of people who receive the vaccine develop a fever.
Severe problems
Serious allergic reactions, within a few minutes to a few hours of the shot, are very rare.
A serious nervous system disorder called GuillainBarr Syndrome (or GBS) has been reported among some people who received MCV4. This happens so rarely that it is currently not possible to tell if the vaccine might be a factor. Even if it is, the risk is very small.

8 How can I learn more?
Ask your doctor or nurse. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC):
- Call 1-800-232-4636 (1-800-CDC-INFO)
- Visit CDC's National Immunization Program website at www.cdc.gov/vaccines
- Visit CDC's meningococcal disease website at
www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_g.htm
- Visit CDC's Travelers' Health website at wwwn.cdc.gov/travel

Meningococcal

1/28/08 Vaccine Information Statement (Interim)

department of health and human services Centers for Disease Control and Prevention

ROTAVIRUS VACCINE


W H A T Y O U N E E D T O K N O W


Many Vaccine Information Statements are available in Spanish and other languages. See http://www.immunize.org/vis.

1 What is rotavirus?
Rotavirus is a virus that causes severe diarrhea, mostly in babies and young children. It is often accompanied by vomiting and fever.
Rotavirus is not the only cause of severe diarrhea, but it is one of the most serious. Before rotavirus vaccine was used, rotavirus was responsible for: more than 400,000 doctor visits,
more than 200,000 emergency room visits,
55,000 to 70,000 hospitalizations, and
20-60 deaths
in the United States each year.

Almost all children in the U.S. are infected with rotavirus before their 5th birthday.
Children are most likely to get rotavirus diarrhea between November and May, depending on the part of the country.
Your baby can become infected by being around other children who have rotavirus diarrhea.
2 Rotavirus vaccine

A virus (or parts of the virus) called porcine circovirus is in both rotavirus vaccines. This virus is not known to infect people and there is no known safety risk. For more information, see http://www.fda.gov.
3 Who should get rotavirus vaccine and when?
There are two brands of rotavirus vaccine. A baby should get either 2 or 3 doses, depending on which brand is used.
The doses are recommended at these ages: First Dose: 2 months of age Second Dose: 4 months of age Third Dose: 6 months of age (if needed)
The first dose may be given as early as 6 weeks of age,
and should be given by age 14 weeks 6 days. The last
dose should be given by 8 months of age.

Rotavirus vaccine may be given at the same time as
other childhood vaccines.

Babies who get the vaccine may be fed normally
afterward.


Better hygiene and sanitation have not reduced rotavirus diarrhea very much in the United States. The best way to protect your baby is with rotavirus vaccine.
Rotavirus vaccine is an oral (swallowed) vaccine, not a shot.
Rotavirus vaccine will not prevent diarrhea or vomiting caused by other germs, but it is very good at preventing diarrhea and vomiting caused by rotavirus. Most babies who get the vaccine will not get rotavirus diarrhea at all, and almost all of them will be protected from severe rotavirus diarrhea.
Babies who get the vaccine are also much less likely to be hospitalized or to see a doctor because of rotavirus diarrhea.

4 Some people should not get rotavirus vaccine or should wait.
A baby who has had a severe (life-threatening) allergic reaction to a dose of rotavirus vaccine should not get another dose. A baby who has a severe (lifethreatening) allergy to any component of rotavirus vaccine should not get the vaccine. Tell your doctor if your baby has any severe allergies that you know of, including a severe allergy to latex.
Babies who are moderately or severely ill at the time the vaccination is scheduled should probably wait until they recover. This includes babies who have moderate or severe diarrhea or vomiting. Ask your doctor or nurse. Babies with mild illnesses should usually get the vaccine.

Check with your doctor if your baby's immune system is weakened because of: -HIV/AIDS, or any other disease that affects the immune system -treatment with drugs such as long-term steroids -cancer, or cancer treatment with x-rays or drugs
In the late 1990s a different type of rotavirus vaccine was used. This vaccine was found to be associated with a common type of bowel obstruction called "intussusception," and it was taken off the market. The new rotavirus vaccines have not been associated with intussusception. However, babies who have had intussusception, from any cause, are at higher risk for getting it again. If your baby has ever had intussusception, discuss this with your doctor.
5 What are the risks from rotavirus vaccine?

to an hour after the vaccination. Signs of a serious allergic reaction can include difficulty breathing, weakness, hoarseness or wheezing, a fast heart beat, hives, dizziness, paleness, or swelling of the throat.
What should I do?
Call a doctor, or get the person to a doctor right away.
Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at http://www.vaers.hhs.gov, or by calling 1-800-822-7967.
VAERS does not provide medical advice.
7 The National Vaccine Injury Compensation Program

A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. The risk of any vaccine causing serious harm, or death, is extremely small.
Most babies who get rotavirus vaccine do not have any problems with it.

The National Vaccine Injury Compensation Program (VICP) was created in 1986.
Persons who believe they may have been injured by a vaccine may file a claim with VICP by calling 1-800-338-2382 or by visiting their website at http://www.hrsa.gov/vaccinecompensation.

Mild problems
Babies may be slightly more likely to be irritable, or to have mild, temporary diarrhea or vomiting after getting a dose of rotavirus vaccine than babies who did not get the vaccine.
Rotavirus vaccine does not appear to cause any serious side effects.
If rare reactions occur with any new product, they may not be identified until thousands, or millions, of people have used it. Like all vaccines, rotavirus vaccine will continue to be monitored for unusual or severe problems.

8 How can I learn more?
Ask your health care provider. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC):
- Call 1-800-232-4636 (1-800-CDC-INFO)
- Visit CDC's National Immunization Program website at: http://www.cdc.gov/vaccines

6 What if there is a moderate or severe reaction?

What should I look for?
Any unusual condition, such as a severe allergic reaction or a high fever. If a severe allergic reaction occurred, it would be within a few minutes

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention

Vaccine Information Statement (Interim)

Rotavirus 42 U.S.C. 300aa-26

5/14/2010

VACUNA CONTRA EL ROTAVIRUS

LO QUE USTED NECESITA SABER

Muchas Hojas de Informacin sobre Vacunas estn disponibles en espaol y en otros idiomas. Vea www.immunize.org/vis.

1 Qu es el rotavirus?
El rotavirus es un virus que causa diarrea grave, ms que todo en bebs y nios pequeos. A menudo est acompaado por fiebre y vmitos.
El rotavirus no es la nica causa de la diarrea grave, pero es una de las ms serias. Antes de que se usara la vacuna contra el rotavirus, el rotavirus era responsable por:
ms de 400,000 visitas al doctor,
ms de 200,000 visitas a la sala de emergencias,
55,000 a 70,000 hospitalizaciones y
20 a 60 muertes
todos los aos en los Estados Unidos.
Casi todos los nios en Estados Unidos son infectados por el rotavirus antes de cumplir los 5 aos de edad.
Los nios tienen ms probabilidad de que les d la diarrea causada por el rotavirus de noviembre a mayo, dependiendo de la parte del pas.
Su beb se puede infectar al estar cerca de otros nios con diarrea causada por el rotavirus.
2 Vacuna contra el rotavirus
La mejor higiene y las mejores condiciones de saneamiento no han reducido mucho la diarrea causada por el rotavirus en Estados Unidos. La mejor manera de proteger a su beb es con la vacuna contra el rotavirus.
La vacuna contra el rotavirus es una vacuna oral (que se traga), no una inyeccin.
La vacuna contra el rotavirus no previene la diarrea ni los vmitos causados por otros grmenes, pero es muy buena para prevenir la diarrea y los vmitos causados por el rotavirus. A la mayora de los bebs vacunados no se les dar la diarrea causada por el rotavirus y casi todos ellos estarn protegidos contra la diarrea grave causada por el rotavirus.
Adems, los bebs vacunados son mucho menos propensos a ser hospitalizados, o a tener que ir al doctor, debido a la diarrea causada por el rotavirus.

Las dos vacunas contra el rotavirus contienen un virus (o partes del virus) llamado circovirus porcino. Segn se sabe, este virus no infecta a la gente y no se conoce ningn riesgo de seguridad. Para obtener ms informacin visite www.fda.gov.

3

Quines deben vacunarse contra el rotavirus y cundo?

Hay dos marcas de vacunas contra el rotavirus. Los bebs deben recibir 2 3 dosis, dependiendo de la marca que se use.
Las dosis se recomiendan a estas edades:
Primera dosis: a los 2 meses de edad
Segunda dosis: a los 4 meses de edad
Tercera dosis: a los 6 meses de edad (si es necesaria)
La primera dosis se puede dar a partir de las 6 semanas de edad y a ms tardar a las 14 semanas y 6 das de edad. La ltima dosis se debe dar a ms tardar a los 8 meses de edad.
La vacuna contra el rotavirus se puede dar al mismo tiempo que otras vacunas de la niez.
Se puede alimentar normalmente a los bebs despus de que se vacunen.

4

Algunas personas no deben vacunarse contra el rotavirus o deben esperar.

No se debe dar otra dosis a un beb que haya tenido una reaccin alrgica grave (que puso en peligro su vida) a una dosis de la vacuna contra el rotavirus. No se debe dar la vacuna a un beb que haya tenido una alergia grave (que pone en peligro su vida) a algn componente de la vacuna contra el rotavirus. Diga a su doctor si sabe que su beb tiene alergias graves a algo, incluyendo alergia grave al ltex.
Los bebs que estn moderadamente o muy enfermos en la fecha programada para recibir la vacuna, probablemente deben esperar hasta que se recuperen. Esto incluye a los bebs con diarrea o vmitos moderados o graves. Consulte con su doctor o enfermera. Los nios con enfermedades leves por lo general se deben vacunar.

Rotavirus - Spanish (5/14/10)

Consulte a su doctor si el sistema inmunolgico de su beb est debilitado a causa de:
- el VIH/SIDA o cualquier otra enfermedad que afecte el sistema inmunolgico
- tratamiento con medicamentos, como esteroides a largo plazo
- cncer o tratamiento del cncer con rayos x o medicamentos
A fines de la dcada de los 90 se usaba otro tipo de vacuna contra el rotavirus. Se hall que esta vacuna estaba asociada a un tipo comn de obstruccin del intestino llamado "intususcepcin" y fue retirado del mercado. No se ha encontrado ninguna relacin entre las nuevas vacunas contra el rotavirus y la intususcepcin. Sin embargo, los bebs que tuvieron intususcepcin, por cualquier causa, tienen un riesgo ms alto de tenerla de nuevo. Hable con su doctor si su beb alguna vez tuvo intususcepcin.

5

Cules son los riesgos de la vacuna contra el rotavirus?

Una vacuna, como cualquier medicamento, podra causar problemas serios, como reacciones alrgicas graves. El riesgo de que una vacuna cause daos serios, o la muerte, es sumamente pequeo.
La vacuna contra el rotavirus no causa ningn problema a la mayora de los bebs que la reciben.
Problemas leves Los bebs pueden ser ligeramente ms propensos a estar irritables o a tener diarrea temporal leve o vmitos despus de recibir una dosis de la vacuna contra el rotavirus que los bebs que no fueron vacunados.
La vacuna contra el rotavirus no parece causar ningn efecto secundario serio.
Si ocurren reacciones poco comunes con algn producto nuevo, es posible que no se identifiquen hasta que lo hayan usado miles, o millones, de personas. Como en el caso de todas las vacunas, se seguir prestando atencin por si la vacuna contra el rotavirus causa problemas inusuales o graves.

pueden incluir dificultad para respirar, debilidad, ronquera o sibilancias, latidos rpidos del corazn, urticaria, mareos, palidez o hinchazn de la garganta.
Qu debo hacer? Llame a un doctor o lleve a la persona inmediatamente a un
doctor.
Diga al doctor lo que ocurri, la fecha y la hora en que ocurri y cundo recibi la vacuna.
Pida a su profesional de la salud que informe la reaccin presentando un formulario del Sistema de Informacin sobre Eventos Adversos a una Vacuna (Vaccine Adverse Event Reporting System, VAERS). O puede presentar este informe mediante el sitio web de VAERS, en: www.vaers.hhs.gov o puede llamar al: 1-800-822-7967.
VAERS no proporciona consejos mdicos.

7

El Programa Nacional de Compensacin por Lesiones Causadas por las Vacunas

El Programa Nacional de Compensacin por Lesiones Causadas por las Vacunas (VICP) fue creado en 1986.
Las personas que creen que pudieron haber sido lesionadas por una vacuna pueden presentar un reclamo ante el VICP llamando al: 1-800-338-2382 visitando su sitio Web en: www.hrsa.gov/vaccinecompensation.

8 Cmo puedo obtener ms informacin?
Consulte con su profesional de la salud. Le puede dar el folleto con la informacin que viene con la vacuna o sugerirle otras fuentes de informacin.
Llame al departamento de salud local o estatal.
Comunquese con los Centros para el Control y la Prevencin de Enfermedades (CDC):
- Llame al: 1-800-232-4636 (1-800-CDC-INFO)
- Visite el sitio web del Programa Nacional de Vacunacin de los CDC, en: www.cdc.gov/vaccines

6

Qu pasa si hay una reaccin moderada o grave?

A qu debo prestar atencin? Preste atencin a cualquier cosa fuera de lo comn, como una reaccin alrgica grave o fiebre alta. Si ocurre una reaccin alrgica grave es a los pocos minutos o a una hora despus de haberse vacunado. Los signos de una reaccin alrgica seria

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention

Vaccine Information Statement (Interim)

Rotavirus IMM-661S Spanish (5/14/2010)

42 U.S.C. 300aa-26

Translated by Transcend Translations, Davis, CA

www.transcend.net

VACCINE
H P V(HUMAN
PAPILLOMAVIRUS)

Gardasil W H A T Y O U N E E D T O K N O W

Many Vaccine Information Statements are available in Spanish and other languages. See http://www.immunize.org/vis.

1 What is HPV?
Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. More than half of sexually active men and women are infected with HPV at some time in their lives.
About 20 million Americans are currently infected, and about 6 million more get infected each year. HPV is usually spread through sexual contact.
Most HPV infections don't cause any symptoms, and go away on their own. But HPV can cause cervical cancer in women. Cervical cancer is the 2nd leading cause of cancer deaths among women around the world. In the United States, about 10,000 women get cervical cancer every year and about 4,000 are expected to die from it.
HPV is also associated with several less common cancers, such as vaginal and vulvar cancers in women and other types of cancer in both men and women. It can also cause genital warts and warts in the throat.
There is no cure for HPV infection, but some of the problems it causes can be treated.

3

Who should get this HPV vaccine and when?

Females: Routine Vaccination HPV vaccine is recommended for girls 11 or 12
years of age. It may be given to girls starting at age 9.

Why is HPV vaccine given to girls at this age? It is important for girls to get HPV vaccine before their first sexual contact because they won't have been exposed to human papillomavirus.

Once a girl or woman has been infected with the virus, the vaccine might not work as well or might not work at all.

Females: Catch-Up Vaccination The vaccine is also recommended for girls and
women 13 through 26 years of age who did not get all 3 doses when they were younger.

Males Males 9 through 26 years of age may get HPV vaccine to prevent genital warts. As with females, it is best to be vaccinated before the first sexual contact.

2

HPV vaccine - Why get vaccinated?

HPV vaccine is important because it can prevent most cases of cervical cancer in females, if it is given before a person is exposed to the virus.

Protection from HPV vaccine is expected to be long-lasting. But vaccination is not a substitute for cervical cancer screening. Women should still get regular Pap tests.

HPV vaccine is given as a 3-dose series 1st Dose Now 2nd Dose 1 to 2 months after Dose 1 3rd Dose 6 months after Dose 1
Additional (booster) doses are not recommended.
HPV vaccine may be given at the same time as other vaccines.

The vaccine you are getting is one of two vaccines that can be given to prevent HPV. It may be given to both males and females. In addition to preventing cervical cancer, it can also prevent vaginal and vulvar cancer in females, and genital warts in both males and females.
The other vaccine is given to females only, and only for prevention of cervical cancer.

4

Some people should not get HPV vaccine or should wait

Anyone who has ever had a life-threatening allergic reaction to any component of HPV vaccine, or to a previous dose of HPV vaccine, should not get the vaccine. Tell your doctor if the person getting vaccinated has any severe allergies, including an allergy to yeast.

HPV vaccine is not recommended for pregnant women. However, receiving HPV vaccine when pregnant is not a reason to consider terminating the pregnancy. Women who are breast feeding may get the vaccine.

Any woman who learns she was pregnant when she got this HPV vaccine is encouraged to contact the manufacturer's HPV in pregnancy registry at 800-986-8999. This will help us learn how pregnant women respond to the vaccine.

People who are mildly ill when a dose of HPV vaccine is planned can still be vaccinated. People with a moderate or severe illness should wait until they are better.

5

What are the risks from this vaccine?

This HPV vaccine has been used in the U.S. and around the world for several years and has been very safe.
However, any medicine could possibly cause a serious problem, such as a severe allergic reaction. The risk of any vaccine causing a serious injury, or death, is extremely small.
Life-threatening allergic reactions from vaccines are very rare. If they do occur, it would be within a few minutes to a few hours after the vaccination.
Several mild to moderate problems are known to occur with HPV vaccine. These do not last long and go away on their own.
Reactions in the arm where the shot was given:
- Pain (about 8 people in 10)
- Redness or swelling (about 1 person in 4)
Fever:
- Mild (100 F) (about 1 person in 10)
- Moderate (102 F) (about 1 person in 65)
Other problems:
- Headache (about 1 person in 3)
- Fainting. Brief fainting spells and related symptoms (such as jerking movements) can happen after any medical procedure, including vaccination. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries caused by falls. Tell your provider if the patient feels dizzy or light-headed, or has vision changes or ringing in the ears.

Like all vaccines, HPV vaccines will continue to be monitored for unusual or severe problems.

6

What if there is a severe reaction?

What should I look for? Serious allergic reactions including rash; swelling of the hands and feet, face, or lips; and breathing difficulty.
What should I do? Call a doctor, or get the person to a doctor right
away.
Tell the doctor what happened, the date and time
it happened, and when the vaccination was given.
Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at http://www.vaers.hhs.gov, or by calling 1-800-822-7967.

VAERS does not provide medical advice.

7

The National Vaccine Injury Compensation Program

The National Vaccine Injury Compensation Program (VICP) was created in 1986.
Persons who believe they may have been injured by a vaccine may file a claim with VICP by calling 1-800-338-2382 or visiting their website at http://www.hrsa.gov/vaccinecompensation.

8 How can I learn more?
Ask your provider. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) or - Visit CDC's website at http://www.cdc.gov/hpv and http://www.cdc.gov/vaccines

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention
Vaccine Information Statement (Interim)
Human Papillomavirus (HPV) Gardasil 3/30/2010


VACUNA CONTRA EL HPV (VIRUS DEL PAPILOMA HUMANO)

Gardasil LO QUE USTED NECESITA SABER
Muchas Hojas de Informacin sobre Vacunas estn disponibles en espaol y en otros idiomas. Visite www.immunize.org/vis.

1 Qu es el HPV?
El virus del papiloma humano (HPV, por sus siglas en ingls) genital es el virus de transmisin sexual ms comn en los Estados Unidos. Ms de la mitad de los hombres y las mujeres sexualmente activos son infectados por el HPV en algn momento de sus vidas.
En la actualidad, unos 20 millones de estadounidenses estn infectados y todos los aos se infectan cerca de 6 millones ms. Por lo general, el HPV se transmite por medio del contacto sexual.
La mayora de las infecciones por el HPV no causan ningn sntoma y desaparecen solas. Pero el HPV puede causar cncer del cuello del tero en las mujeres. El cncer del cuello del tero es la segunda causa principal de muertes por cncer entre las mujeres del mundo. En Estados Unidos, cerca de 10,000 mujeres contraen cncer del cuello del tero todos los aos y se espera que unas 4,000 mueran a causa de l.
El HPV tambin est asociado a varios cnceres menos comunes, como el cncer de la vagina y de la vulva en las mujeres y a otros tipos de cnceres en hombres y mujeres. Tambin puede causar verrugas genitales y verrugas en la garganta.
La infeccin por el HPV no tiene cura, pero algunos de los problemas que causa se pueden tratar.

2

La vacuna contra el HPV, por qu vacunarse?

La vacuna contra el HPV es importante porque puede prevenir la mayora de los casos de cncer del cuello del tero en mujeres, si se aplica antes de que la persona est expuesta al virus.

Se espera que la proteccin de la vacuna contra el HPV dure mucho tiempo. Pero la vacuna no es un sustituto de una prueba de deteccin del cncer del cuello del tero. Las mujeres se deben seguir haciendo regularmente la prueba de Papanicolaou.

La vacuna que le van a dar es una de dos vacunas que se pueden aplicar para prevenir el HPV. Se puede dar a hombres y mujeres. Adems de prevenir el cncer del cuello del tero, tambin puede prevenir el cncer de la vagina y de la vulva en las mujeres y las verrugas genitales en los hombres y mujeres.

La otra vacuna se da nicamente a mujeres y slo para la prevencin del cncer del cuello del tero.

3

Quines deben vacunarse contra el HPV y cundo?

Mujeres: Vacunacin de rutina
La vacuna contra el HPV se recomienda para las nias de 11 12 aos de edad. Se puede dar a nias a partir de los 9 aos de edad.

Por qu se aplica la vacuna contra el HPV a nias a estas edades? Es importante que las nias se vacunen contra el HPV antes de su primer contacto sexual, porque no habrn estado expuestas al virus del papiloma humano.

Una vez que una nia o una mujer ha sido infectada por el virus es posible que la vacuna no funcione tan bien o que no funcione en absoluto.

Mujeres: Vacunacin para ponerse al da
La vacuna tambin se recomienda para nias y mujeres de 13 a 26 aos de edad que no recibieron las 3 dosis completas cuando eran ms jvenes.

Varones y Hombres
Los varones y hombres de 9 a 26 aos de edad pueden vacunarse contra el HPV para prevenir verrugas genitales. Al igual que en las mujeres, es mejor vacunarse antes del primer contacto sexual.

La vacuna contra el HPV se da en una serie de 3 dosis

1 dosis 2 dosis 3 dosis

Ahora 1 a 2 meses despus de la 1 dosis 6 meses despus de la 1 dosis

No se recomiendan dosis adicionales (de refuerzo).

La vacuna contra el HPV se puede dar al mismo tiempo que otras vacunas.

4

Algunas personas no deben vacunarse contra el HPV o deben esperar

Las personas que alguna vez tuvieron una reaccin alrgica a algn componente de la vacuna contra el HPV, o a una dosis anterior de la vacuna contra el HPV, que puso en peligro su vida no se deben vacunar. Diga a su doctor si la persona que va a ser vacunada tiene alergias graves, incluyendo alergia a la levadura.

HPV (Gardasil) - Spanish (3/30/10)

La vacuna contra el HPV no se recomienda para mujeres embarazadas. Sin embargo, vacunarse contra el HPV estando embarazada no es un motivo para considerar terminar el embarazo. Las mujeres que estn dando pecho pueden vacunarse.
Animamos a todas las mujeres que se enteren que estaban embarazadas cuando recibieron esta vacuna contra el HPV a comunicarse con el Registro de vacunacin contra el HPV durante el embarazo del fabricante de la vacuna, llamando al 800-986-8999. Esto nos ayudar a aprender cmo responden las mujeres embarazadas a la vacuna.
Las personas levemente enfermas el da de la aplicacin de una dosis de la vacuna contra el HPV se pueden vacunar. Las personas con una enfermedad moderada o grave deben esperar hasta mejorarse.

5

Cules son los riesgos de esta vacuna?

Esta vacuna contra el HPV ha sido usada en Estados Unidos y en el mundo entero por varios aos y ha demostrado ser muy segura.

Sin embargo, todos los medicamentos podran causar un problema serio, como una reaccin alrgica grave. El riesgo de que una vacuna cause un dao serio, o la muerte, es sumamente pequeo.

Las reacciones alrgicas a las vacunas que ponen en peligro la vida son muy poco comunes. Si ocurren, es a los pocos minutos o a las pocas horas de haberse vacunado.

Se sabe que ocurren problemas leves a moderados con la vacuna contra el HPV. stos no duran mucho tiempo y desaparecen solos.

Reacciones en el brazo donde se aplic la vacuna:

- Malestar (cerca de 8 personas de cada 10)

- Enrojecimiento o hinchazn (cerca de 1 persona de cada 4)

Fiebre:

- Leve (100 F) (cerca de 1 persona de cada 10)

- Moderada (102 F) (cerca de 1 persona de cada 65)

Otras problemas:

- Dolor de cabeza (cerca de 1 persona de cada 3)

- Desmayos. Desmayos que duran poco tiempo y sntomas asociados (como sacudidas) pueden ocurrir despus de cualquier intervencin mdica, incluyendo la vacunacin. Sentarse o acostarse por unos 15 minutos despus de vacunarse puede ayudar a prevenir desmayos y lesiones causadas por cadas. Diga a su profesional de la salud si el paciente se siente mareado o dbil, tiene cambios en la visin o le zumban los odos.

Como en el caso de todas vacunas, se seguir prestando atencin a las vacunas contra el HPV para determinar si surgen problemas inusuales o graves.

6 Qu pasa si hay una reaccin grave?
A qu debo prestar atencin?
Preste atencin a las reacciones alrgicas graves, incluyendo ronchas, hinchazn de las manos y de los pies, de la cara o de los labios y dificultad para respirar.
Qu debo hacer?
Llame a un doctor o lleve a la persona inmediatamente a un doctor.
Diga a su doctor lo que ocurri, la fecha y la hora en que ocurri y cundo recibi la vacuna.
Pida a su profesional de la salud que informe la reaccin presentando un formulario del Sistema de Informacin sobre Eventos Adversos a una Vacuna (Vaccine Adverse Event Reporting System, VAERS). O puede presentar este informe mediante el sitio web de VAERS, en: www.vaers.hhs.gov o puede llamar al: 1-800-822-7967.
VAERS no proporciona consejos mdicos.

7

El Programa Nacional de Compensacin por Lesiones Causadas por las Vacunas

El Programa Nacional de Compensacin por Lesiones Causadas por las Vacunas (National Vaccine Injury Compensation Program, VICP) fue creado en 1986.

Las personas que creen que pudieron haber sido lesionadas por una vacuna pueden presentar un reclamo ante el VICP, llamando al 1-800-338-2382 visitando su sitio Web (en ingls) en www.hrsa.gov/vaccinecompensation.

8 Cmo puedo obtener ms informacin?
Consulte con su profesional de la salud. Le puede dar el folleto de informacin que viene con la vacuna o sugerirle otras fuentes de informacin.
Llame al departamento de salud local o estatal.
Comunquese con los Centros para el Control y la Prevencin de Enfermedades (CDC): - Llame al: 1-800-232-4636 (1-800-CDC-INFO) o - Visite el sitio Web de los CDC (en ingls) en: www.cdc. gov/std/hpv o www.cdc.gov/vaccines

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention

Vaccine Information Statement (Interim)

Human Papillomavirus (HPV) Gardasil IMM-866S Spanish (3/30/2010) 42 U.S.C. 300aa-26

Translated by Transcend Translations, Davis, CA

www.transcend.net

VACCINE
H P V(HUMAN
PAPILLOMAVIRUS)

Cervarix W H A T Y O U N E E D T O K N O W

Many Vaccine Information Statements are available in Spanish and other languages. See http://www.immunize.org/vis.

1 What is HPV?
Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. More than half of sexually active men and women are infected with HPV at some time in their lives.

3

Who should get this HPV vaccine and when?

Routine Vaccination HPV vaccine is recommended for girls 11 or 12
years of age. It may be given to girls starting at age 9.

About 20 million Americans are currently infected, and about 6 million more get infected each year. HPV is usually spread through sexual contact.
Most HPV infections don't cause any symptoms, and go away on their own. But HPV can cause cervical cancer in women. Cervical cancer is the 2nd leading cause of cancer deaths among women around the world. In the United States, about 10,000 women get cervical cancer every year and about 4,000 are expected to die from it.
HPV is also associated with several less common cancers, such as vaginal and vulvar cancers in women and other types of cancer in both men and women. It can also cause genital warts and warts in the throat.
There is no cure for HPV infection, but some of the problems it causes can be treated.

2

HPV vaccine - Why get vaccinated?

HPV vaccine is important because it can prevent most cases of cervical cancer in females, if it is given before a person is exposed to the virus.

Protection from HPV vaccine is expected to be longlasting. But vaccination is not a substitute for cervical cancer screening. Women should still get regular Pap tests.

The vaccine you are getting is one of two vaccines that can be given to prevent HPV. It is given to females only.

The other vaccine may be given to both males and females, and can also prevent some vaginal and vulvar cancers, and genital warts.

Why is HPV vaccine given to girls at this age? It is important for girls to get HPV vaccine before their first sexual contact because they won't have been exposed to human papillomavirus.

Once a girl or woman has been infected with the virus, the vaccine might not work as well or might not work at all.
Catch-Up Vaccination The vaccine is also recommended for girls and
women 13 through 26 years of age who did not get all 3 doses when they were younger.

HPV vaccine is given as a 3-dose series 1st Dose Now 2nd Dose 1 to 2 months after Dose 1 3rd Dose 6 months after Dose 1

Additional (booster) doses are not recommended.

HPV vaccine may be given at the same time as other vaccines.

4

Some people should not get HPV vaccine or should wait

Anyone who has ever had a life-threatening allergic reaction to any component of HPV vaccine, or to a previous dose of HPV vaccine, should not get the vaccine. Tell your doctor if the person getting vaccinated has any severe allergies, including an allergy to latex.

HPV vaccine is not recommended for pregnant women. However, receiving HPV vaccine when pregnant is not a reason to consider terminating the pregnancy. Women who are breast feeding may get the vaccine.

Any woman who learns she was pregnant when she got this HPV vaccine is encouraged to contact the manufacturer's HPV in pregnancy registry at 888-452-9622. This will help us learn how pregnant women respond to the vaccine.
People who are mildly ill when a dose of HPV vaccine is planned can still be vaccinated. People with a moderate or severe illness should wait until they are better.

5

What are the risks from this vaccine?

This HPV vaccine has been in use around the world for several years and has been very safe.
However, any medicine could possibly cause a serious problem, such as a severe allergic reaction. The risk of any vaccine causing a serious injury, or death, is extremely small.
Life-threatening allergic reactions from vaccines are very rare. If they do occur, it would be within a few minutes to a few hours after the vaccination.
Several mild to moderate problems are known to occur with HPV vaccine. These do not last long and go away on their own.
Reactions where the shot was given:
- Pain (about 9 people in 10)
- Redness or swelling (about 1 person in 2)
Other mild reactions:
- Fever of 99.5F or higher (about 1 person in 8)
- Headache or fatigue (about 1 person in 2)
- Nausea, vomiting, diarrhea, or abdominal pain (about 1 person in 4)
- Muscle or joint pain (up to 1 person in 2)
Fainting:
Brief fainting spells and related symptoms (such as jerking movements) can happen after any medical procedure, including vaccination. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries caused by falls. Tell your provider if the patient feels dizzy or light-headed, or has vision changes or ringing in the ears.

Like all vaccines, HPV vaccines will continue to be monitored for unusual or severe problems.

6

What if there is a severe reaction?

What should I look for? Serious allergic reactions including rash; swelling of the hands and feet, face, or lips; and breathing difficulty.

What should I do? Call a doctor, or get the person to a doctor right
away.
Tell the doctor what happened, the date and time
it happened, and when the vaccination was given.
Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at http://www.vaers.hhs.gov, or by calling 1-800-822-7967.

VAERS does not provide medical advice.

7

The National Vaccine Injury Compensation Program

The National Vaccine Injury Compensation Program (VICP) was created in 1986.

Persons who believe they may have been injured by a vaccine may file a claim with VICP by calling 1-800-338-2382 or visiting their website at http://www.hrsa.gov/vaccinecompensation.

8 How can I learn more?
Ask your provider. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) or - Visit CDC's website at http://www.cdc.gov/hpv and http://www.cdc.gov/vaccines

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention
Vaccine Information Statement (Interim)
Human Papillomavirus (HPV) Cervarix 3/30/2010


VACUNA CONTRA EL HPV (VIRUS DEL PAPILOMA HUMANO)

Cervarix LO QUE USTED NECESITA SABER
Muchas Hojas de Informacin sobre Vacunas estn disponibles en espaol y en otros idiomas. Visite www.immunize.org/vis.

1 Qu es el HPV?
El virus del papiloma humano (HPV, por sus siglas en ingls) genital es el virus de transmisin sexual ms comn en los Estados Unidos. Ms de la mitad de los hombres y las mujeres sexualmente activos son infectados por el HPV en algn momento de sus vidas.
En la actualidad, unos 20 millones de estadounidenses estn infectados y todos los aos se infectan cerca de 6 millones ms. Por lo general, el HPV se transmite por medio del contacto sexual.
La mayora de las infecciones por el HPV no causan ningn sntoma y desaparecen solas. Pero el HPV puede causar cncer del cuello del tero en las mujeres. El cncer del cuello del tero es la segunda causa principal de muertes por cncer entre las mujeres del mundo. En Estados Unidos, cerca de 10,000 mujeres contraen cncer del cuello del tero todos los aos y se espera que unas 4,000 mueran a causa de l.
El HPV tambin est asociado a varios cnceres menos comunes, como el cncer de la vagina y de la vulva en las mujeres y a otros tipos de cnceres en hombres y mujeres. Tambin puede causar verrugas genitales y verrugas en la garganta.
La infeccin por el HPV no tiene cura, pero algunos de los problemas que causa se pueden tratar.

2

La vacuna contra el HPV, por qu vacunarse?

La vacuna contra el HPV es importante porque puede prevenir la mayora de los casos de cncer del cuello del tero en mujeres, si se aplica antes de que la persona est expuesta al virus.
Se espera que la proteccin de la vacuna contra el HPV dure mucho tiempo. Pero la vacuna no es un sustituto de una prueba de deteccin del cncer del cuello del tero. Las mujeres se deben seguir haciendo regularmente la prueba de Papanicolaou.
La vacuna que le van a dar es una de dos vacunas que se pueden dar para prevenir el HPV. Se da nicamente a mujeres.
La otra vacuna se puede dar a hombres y mujeres, y tambin puede prevenir algunos cnceres de vagina y de vulva, as como verrugas genitales.

3

Quines deben vacunarse contra el HPV y cundo?

Vacunacin de rutina
La vacuna contra el HPV se recomienda para las nias de 11 12 aos de edad. Se puede dar a nias a partir de los 9 aos de edad.

Por qu se aplica la vacuna contra el HPV a nias a estas edades? Es importante que las nias se vacunen contra el HPV antes de su primer contacto sexual, porque no habrn estado expuestas al virus del papiloma humano.

Una vez que una nia o una mujer ha sido infectada por el virus es posible que la vacuna no funcione tan bien o que no funcione en absoluto.
Vacunacin para ponerse al da La vacuna tambin se recomienda para nias y mujeres
de 13 a 26 aos de edad que no recibieron las 3 dosis completas cuando eran ms jvenes.
La vacuna contra el HPV se da en una serie de 3 dosis

1 dosis 2 dosis 3 dosis

Ahora 1 a 2 meses despus de la 1 dosis 6 meses despus de la 1 dosis

No se recomiendan dosis adicionales (de refuerzo).

La vacuna contra el HPV se puede dar al mismo tiempo que otras vacunas.

4

Algunas personas no deben vacunarse contra el HPV o deben esperar

Las personas que alguna vez tuvieron una reaccin alrgica a algn componente de la vacuna contra el HPV, o a una dosis anterior de la vacuna contra el HPV, que puso en peligro su vida no se deben vacunar. Diga a su doctor si la persona que va a ser vacunada tiene alergias graves, incluyendo alergia al ltex.
La vacuna contra el HPV no se recomienda para mujeres embarazadas. Sin embargo, vacunarse contra el HPV estando embarazada no es un motivo para considerar terminar el embarazo. Las mujeres que estn dando pecho pueden vacunarse.
HPV (Cervarix) - Spanish (3/30/10)

Animamos a todas las mujeres que se enteren que estaban embarazadas cuando recibieron esta vacuna contra el HPV a comunicarse con el Registro de vacunacin contra el HPV durante el embarazo del fabricante de la vacuna, llamando al 888-452-9622. Esto nos ayudar a aprender cmo responden las mujeres embarazadas a la vacuna.
Las personas levemente enfermas el da de la aplicacin de una dosis de la vacuna contra el HPV se pueden vacunar. Las personas con una enfermedad moderada o grave deben esperar hasta mejorarse.

5

Cules son los riesgos de esta vacuna?

Esta vacuna contra el HPV ha estado en uso en el mundo entero por varios aos y ha demostrado ser muy segura.

Sin embargo, todos los medicamentos podran causar un problema serio, como una reaccin alrgica grave. El riesgo de que una vacuna cause un dao serio, o la muerte, es sumamente pequeo.

Las reacciones alrgicas a las vacunas que ponen en peligro la vida son muy poco comunes. Si ocurren, es a los pocos minutos o a las pocas horas de haberse vacunado.

Se sabe que ocurren problemas leves a moderados con la vacuna contra el HPV. stos no duran mucho tiempo y desaparecen solos.

Reacciones en el lugar donde se aplic la vacuna:

- Malestar (cerca de 9 personas de cada 10)

- Enrojecimiento o hinchazn (cerca de 1 persona de cada 2)

Otras reacciones leves:

- Fiebre de 99.5F o ms (cerca de 1 persona de cada 8)

- Dolor de cabeza o cansancio (cerca de 1 persona de cada 2)

- Nuseas, vmitos, diarrea o dolor abdominal (cerca de 1 persona de cada 4)

- Dolores musculares o en las articulaciones (hasta 1 persona de cada 2)

Desmayos:

Desmayos que duran poco tiempo y sntomas asociados (como sacudidas) pueden ocurrir despus de cualquier intervencin mdica, incluyendo la vacunacin. Sentarse o acostarse por unos 15 minutos despus de vacunarse puede ayudar a prevenir desmayos y lesiones causadas por cadas. Diga a su profesional de la salud si el paciente se siente mareado o dbil, tiene cambios en la visin o le zumban los odos.

Como en el caso de todas vacunas, se seguir prestando atencin a las vacunas contra el HPV para determinar si surgen problemas inusuales o graves.

6 Qu pasa si hay una reaccin grave?
A qu debo prestar atencin?
Preste atencin a las reacciones alrgicas graves, incluyendo ronchas, hinchazn de las manos y de los pies, de la cara o de los labios y dificultad para respirar.
Qu debo hacer?
Llame a un doctor o lleve a la persona inmediatamente a un doctor.
Diga a su doctor lo que ocurri, la fecha y la hora en que ocurri y cundo recibi la vacuna.
Pida a su profesional de la salud que informe la reaccin presentando un formulario del Sistema de Informacin sobre Eventos Adversos a una Vacuna (Vaccine Adverse Event Reporting System, VAERS). O puede presentar este informe mediante el sitio web de VAERS, en: www.vaers.hhs.gov o puede llamar al: 1-800-822-7967.
VAERS no proporciona consejos mdicos.

7

El Programa Nacional de Compensacin por Lesiones Causadas por las Vacunas

El Programa Nacional de Compensacin por Lesiones Causadas por las Vacunas (National Vaccine Injury Compensation Program, VICP) fue creado en 1986.

Las personas que creen que pudieron haber sido lesionadas por una vacuna pueden presentar un reclamo ante el VICP, llamando al 1-800-338-2382 visitando su sitio Web (en ingls) en www.hrsa.gov/vaccinecompensation.

8 Cmo puedo obtener ms informacin?
Consulte con su profesional de la salud. Le puede dar el folleto de informacin que viene con la vacuna o sugerirle otras fuentes de informacin.
Llame al departamento de salud local o estatal.
Comunquese con los Centros para el Control y la Prevencin de Enfermedades (CDC): - Llame al: 1-800-232-4636 (1-800-CDC-INFO) o - Visite el sitio Web de los CDC (en ingls) en: www.cdc.gov/std/hpv o www.cdc.gov/vaccines

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention

Vaccine Information Statement (Interim)

Human Papillomavirus (HPV) Cervarix IMM-1001S Spanish (3/30/2010) 42 U.S.C. 300aa-26

Translated by Transcend Translations, Davis, CA

www.transcend.net

SHINGLES VACCINE

WHAT YOU NEED TO KNOW

Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis.

1 What is shingles?
Shingles is a painful skin rash, often with blisters. It is also called Herpes Zoster, or just Zoster.
A shingles rash usually appears on one side of the face or body and lasts from 2 to 4 weeks. Its main symptom is pain, which can be quite severe. Other symptoms of shingles can include fever, headache, chills and upset stomach. Very rarely, a shingles
infection can lead to pneumonia, hearing problems, blindness,
brain inflammation (encephalitis) or death.

Shingles is far more common in people 50 years of age and older than in younger people. It is also more common in people whose immune systems are weakened because of a disease such as cancer, or drugs such as steroids or chemotherapy.
At least 1 million people a year in the United States get shingles.
2 Shingles vaccine
A vaccine for shingles was licensed in 2006. In clinical trials, the vaccine reduced the risk of shingles by 50%. It can also reduce pain in people who still get shingles after being vaccinated.
A single dose of shingles vaccine is recommended for adults 60 years of age and older.

For about 1 person in 5, severe pain can continue even long after the rash clears up. This is called post-herpetic neuralgia.

3 Some people should not get shingles vaccine or should wait A person should not get shingles vaccine who:
has ever had a life-threatening allergic

Shingles is caused by the Varicella Zoster

reaction to gelatin, the antibiotic

virus, the same virus that causes chickenpox. neomycin, or any other component of

shingles vaccine. Tell your doctor if you

Only someone who has had chickenpox or, have any severe allergies.

rarely, has gotten chickenpox vaccine can

get shingles. The virus stays in your body, has a weakened immune system because

and can cause shingles many years later.

of current:

- AIDS or another disease that affects

You can't catch shingles from another

the immune system,

person with shingles. However, a person

- treatment with drugs that affect the

who has never had chickenpox (or chickenpox vaccine) could get chickenpox from

immune system, such as prolonged use of high-dose steroids,

someone with shingles. This is not very

- cancer treatment such as radiation or

common.

chemotherapy,

- cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.
is pregnant, or might be pregnant. Women should not become pregnant until at least 4 weeks after getting shingles vaccine.
Someone with a minor acute illness, such as a cold, may be vaccinated. But anyone with a moderate or severe acute illness should usually wait until they recover before getting the vaccine. This includes anyone with a temperature of 101.3 F or higher.

4

What are the risks from shingles vaccine?

A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. However, the risk of a vaccine causing serious harm, or death, is extremely small.

include difficulty breathing, weakness, hoarseness or wheezing, a fast heart beat, hives, dizziness, paleness, or swelling of the throat.
What should I do?
Call a doctor, or get the person to a doctor right away.
Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at www.vaers.hhs.gov, or by calling 1-800-822-7967.
VAERS does not provide medical advice.
6 How can I learn more?

No serious problems have been identified with shingles vaccine.
Mild Problems

Ask your doctor or other health care provider. They can give you the vaccine package insert or suggest other sources of information.

Redness, soreness, swelling, or itching at the site of the injection (about 1 person in 3).
Headache (about 1 person in 70).
Like all vaccines, shingles vaccine is being closely monitored for unusual or severe problems.

Contact the Centers for Disease Control and Prevention (CDC):
- Call 1-800-232-4636 (1-800-CDC-INFO)
- Visit the CDC's website at www.cdc.gov/vaccines

5

What if there is a moderate or severe reaction?

What should I look for?

Any unusual condition, such as a severe allergic reaction or a high fever. If a severe allergic reaction occurred, it would be within a few minutes to an hour after the shot. Signs of a serious allergic reaction can

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention

Vaccine Information Statement

Shingles

10/6/2009

YOUR BABY'S FIRST VACCINES
WHAT YOU NEED TO KNOW

Babies get six vaccines between birth and 6 months of age.
These vaccines protect your baby from 8 serious diseases (see the next page).

Your baby will get vaccines today that prevent these diseases:
Hepatitis B Polio Pneumococcal Disease Diphtheria, Tetanus & Pertussis Rotavirus Hib
(Provider: Check appropriate boxes)

These vaccines may be given separately, or some might be given together in the same shot (for example, Hepatitis B and Hib can be
given together, and so can DTaP, Polio and Hepatitis B). These "combination vaccines" are as safe and effective as the individual vaccines, and mean fewer shots for your baby.

These vaccines may all be given at the same visit. Getting several vaccines at the same time will not harm your baby.

This Vaccine Information Statement (VIS) tells you about the benefits and risks of these vaccines. It also contains information about reporting an adverse reaction, the National Vaccine Injury Compensation Program, and how to get more information about childhood diseases and vaccines.

Please read this VIS before your child gets his or her immunizations, and take it home
with you afterward. Ask your doctor, nurse, or other healthcare provider if you have
questions.
Individual Vaccine Information Statements are also available for these vaccines. Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis

department of health and human services Centers for Disease Control and Prevention

Vaccine Information Statement (Interim)
42 U.S.C. 300aa-26
9/18/2008

Vaccine Benefits: Why get vaccinated?
Your children's first vaccines protect them from 8 serious diseases, caused by viruses and bacteria. These diseases have injured and killed many children (and adults) over the years. Polio paralyzed about 37,000 people and killed about 1,700 each year in the 1950s before there was a vaccine. In the 1980s, Hib disease was the leading cause of bacterial meningitis in children under 5 years of age. About 15,000 people a year died from diphtheria before there was a vaccine. Most children have had at least one rotavirus infection by their 5th birthday.
None of these diseases has completely disappeared. Without vaccination, they will come back. This has happened in other parts of the world.

8 Diseases
Prevented by Childhood Vaccines

DIPHTHERIA

Bacteria

You can get it from contact with an infected person.

Signs and symptoms include a thick covering in the back of the throat that can make it hard to breathe.

It can lead to breathing problems, heart failure, and death.

HEPATITIS B

Virus

You can get it from contact with blood or body fluids of an

infected person. Babies can get it at birth if the mother is

infected, or through a cut or wound. Adults can get it from

unprotected sex, sharing needles, or other exposures to blood.

Signs and symptoms include tiredness, diarrhea and vomiting, jaundice (yellow skin or eyes), and pain in muscles, joints and stomach.

It can lead to liver damage, liver cancer, and death.

TETANUS (Lockjaw)

Bacteria

You can get it from a cut or wound. It does not spread from person to person.

Signs and symptoms include painful tightening of the muscles, usually all over the body.

It can lead to stiffness of the jaw, so the victim can't open his mouth or swallow. It leads to death in about 1 case out of 5.

P0LIO

Virus

You can get it from close contact with an infected person. It enters the body through the mouth.

Signs and symptoms can include a cold-like illness, or there may be no signs or symptoms at all.

It can lead to paralysis (can't move arm or leg), or death (by paralyzing breathing muscles).

PERTUSSIS (Whooping Cough) Bacteria
You can get it from contact with an infected person.
Signs and symptoms include violent coughing spells that can make it hard for an infant to eat, drink, or breathe. These spells can last for weeks.
It can lead to pneumonia, seizures (jerking and staring spells), brain damage, and death.

HIB (Haemophilus influenzae type b)

Bacteria

You can get it from contact with an infected person.

Signs and symptoms. There may be no signs or symptoms in mild cases.

It can lead to meningitis (infection of the brain and spinal cord coverings); pneumonia; infections of the blood, joints, bones, and covering of the heart; brain damage; deafness; and death.

PNEUMOCOCCAL

Bacteria

You can get it from contact with an infected person.

Signs and symptoms include fever, chills, cough, and chest pain.

It can lead to meningitis (infection of the brain and spinal cord coverings), blood infections, ear infections, pneumonia, deafness, brain damage, and death.

ROTAVIRUS

Virus

You can get it from contact with other children who are infected.

Signs and symptoms include severe diarrhea, vomiting and fever.

It can lead to dehydration, hospitalization (up to about 70,000 a year), and death.

How Vaccines Work
Immunity from Disease: When a child gets sick with one of these diseases, her immune system produces immunity, which keeps her from getting the same disease again. But getting sick is unpleasant, and can be dangerous.
Immunity from Vaccines: Vaccines are made with the same bacteria or viruses that cause a disease, but they have been weakened or killed to make them safe. A child's immune system responds to a vaccine the same way it would if the child had the disease. This means he will develop immunity without having to get sick first.

Routine Childhood Vaccines
Six vaccines are recommended for children between birth and 6 months of age. They can prevent the 8 diseases described on the previous page. Children will also get at least one "booster" dose of most of these vaccines when they are older.
DTaP (Diphtheria, Tetanus & Pertussis) Vaccine: 5 doses 2 months, 4 months, 6 months, 15-18 months, 4-6 years.
Some children should not get pertussis vaccine. These children can get a vaccine called DT, which does not contain pertussis.
Hepatitis B Vaccine: 3 doses Birth, 1-2 months, 6-18 months.
Polio Vaccine: 4 doses 2 months, 4 months, 6-18 months, 4-6 years.
Hib (Haemophilus influenzae type b) Vaccine: 3 or 4 doses 2 months, 4 months, 6 months, 12-15 months. Several
Hib vaccines are available. With one type, the 6-month dose is not needed.
Pneumococcal Vaccine: 4 doses 2 months, 4 months, 6 months, 12-15 months. Older children with certain
diseases may also need this vaccine.
Rotavirus Vaccine: 2 or 3 doses 2 months, 4 months, 6 months. Rotavirus is an oral (swallowed) vaccine, not a
shot. Two rotavirus vaccines are available. With one type, the 6 month dose is not needed.
Vaccine Risks
Vaccines can cause side effects, like any other medicine. Mostly these are mild "local" reactions such as tenderness, redness or swelling where the shot is given, or a mild fever. They happen in up to 1 child out of 4 with most childhood vaccines. They appear soon after the shot is given and go away within a day or two.
More severe reactions can also occur, but this happens much less often. Some of these reactions are so uncommon that experts can't tell whether they are caused by vaccines or not.
Among the most serious reactions to vaccines are severe allergic reactions to a substance in a vaccine. These reactions happen very rarely less than once in a million shots. They usually happen very soon after the shot is given. Doctor's office or clinic staff are trained to deal with them.
The risk of any vaccine causing serious harm, or death, is extremely small. Getting a disease is much more likely to harm a child than getting a vaccine.
Other Reactions The following conditions have been associated with routine childhood vaccines. By "associated" we mean that they appear more often in children who have been recently vaccinated than in those who have not. An association doesn't prove that a vaccine caused a reaction, but does mean it is probable.
DTaP Vaccine Mild Problems: Fussiness (up to 1 child in 3); tiredness or poor appetite (up to 1 child in 10); vomiting (up to 1 child in 50); swelling of the entire arm or leg for 1-7 days (up to 1 child in 30) usually after the 4th or 5th dose. Moderate Problems: Seizure (jerking or staring)(1 child in 14,000); non-stop crying for 3 hours or more (up to 1 child in 1,000); fever over 105F (1 child in 16,000). Serious Problems: Long-term seizures, coma, lowered consciousness, and permanent brain damage have been reported very rarely after DTaP vaccine. They are so rare we can't be sure they are caused by the vaccine.
Polio Vaccine / Hepatitis B Vaccine / Hib Vaccine These vaccines have not been associated with mild problems other than local reactions, or with moderate or serious problems.
Pneumococcal Vaccine Mild Problems: During studies of the vaccine, some children became fussy or drowsy or lost their appetite.
Rotavirus Vaccine Mild Problems: Children who get rotavirus vaccine are slightly more likely than other children to be irritable or to have mild, temporary diarrhea or vomiting. This happens within the first week after getting a dose of vaccine. Rotavirus vaccine does not appear to cause any serious side effects.

Precautions
If your child is sick on the date vaccinations are scheduled, your provider may want to put them off until she recovers. A child with a mild cold or a low fever can usually be vaccinated that day. But for a more serious illness, it may be better to wait.
Some children should not get certain vaccines. Talk with your provider if your child had a serious reaction after a previous dose of a vaccine, or has any life-threatening allergies. (These reactions and allergies are rare.)
If your child had any of these reactions to a previous dose of DTaP: - A brain or nervous system disease within 7 days - Non-stop crying for 3 or more hours - A seizure or collapse - A fever over 105F
Talk to your provider before getting DTaP Vaccine.
If your child has: - A life-threatening allergy to the antibiotics neomycin, streptomycin, or polymyxin B
Talk to your provider before getting Polio Vaccine.
If your child has: - A life-threatening allergy to yeast
Talk to your provider before getting Hepatitis B Vaccine.
If your child has: - A weakened immune system - Ongoing digestive problems - Recently gotten a blood transfusion or other blood product -Ever had intussusception (an uncommon type of intestinal obstruction)
Talk to your provider before getting Rotavirus Vaccine.

What if my child has a moderate or severe reaction?

What should I look for?
Look for any unusual condition, such as a serious allergic reaction, high fever, weakness, or unusual behavior.

Serious allergic reactions are extremely rare with any vaccine. If one were to happen, it would most likely come within a few minutes to a few hours after the shot.

Signs of a serious allergic reaction can include:

- difficulty breathing

- weakness - hives

- hoarseness or wheezing - dizziness - paleness

- swelling of the throat - fast heart beat

What should I do?
Call a doctor, or get the child to a doctor right away.
Tell your doctor what happened, the date and time it happened, and when the shot was given.
Ask your healthcare provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report yourself through the VAERS website at www.vaers.hhs.gov, or by calling 1-800-822-7967.
VAERS does not provide medical advice.

The National Vaccine Injury Compensation Program
A federal program exists to help pay for the care of anyone who has a serious reaction to a vaccine.
For information about the National Vaccine Injury Compensation Program, call 1-800-338-2382 or visit their website at www.hrsa.gov/vaccinecompensation.

For More Information
Ask your healthcare provider. They can show you the vaccine package insert or suggest other sources of information.
Call your local or state health department.
Contact the Centers for Disease Control and Prevention (CDC) at 1-800-232-4636 (1-800-CDC-INFO).
Visit CDC websites at www.cdc.gov/vaccines and www.cdc.gov/ncidod/diseases/hepatitis.

VACCINE TETANUS, DIPHTHERIA (Td) or TETANUS, DIPHTHERIA, PERTUSSIS (Tdap)

WHAT YOU NEED TO KNOW

Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis.

1 Why get vaccinated?

3 Which vaccine, and when?

Children 6 years of age and younger are routinely vaccinated against tetanus, diphtheria and pertussis. But older children, adolescents, and adults need protection from these diseases too. Td (Tetanus, Diphtheria) and Tdap (Tetanus, Diphtheria, Pertussis) vaccines provide that protection.
TETANUS (Lockjaw) causes painful muscle spasms, usually all over the body. It can lead to tightening of the jaw muscles so the victim
cannot open his mouth or swallow. Tetanus kills about 1 out of 5 people who are infected.
DIPHTHERIA causes a thick covering in the back of the throat. It can lead to breathing problems, paralysis, heart
failure, and even death.
PERTUSSIS (Whooping Cough) causes severe coughing spells, vomiting, and disturbed sleep. It can lead to weight loss, incontinence, rib fractures and
passing out from violent coughing. Up to 2 in 100 adolescents and 5 in 100 adults with pertussis are hospitalized or have complications, including pneumonia.
These three diseases are all caused by bacteria. Diphtheria and pertussis are spread from person to person. Tetanus enters the body through cuts, scratches, or wounds.
The United States averaged more than 1,300 cases of tetanus and 175,000 cases of diphtheria each year before vaccines. Since vaccines have been available, tetanus cases have fallen by over 96% and diphtheria cases by over 99.9%.
Before 2005, only children younger than than 7 years of age could get pertussis vaccine. In 2004 there were more than 8,000 cases of pertussis in the U.S. among adolescents and more than 7,000 cases among adults.
2 Td and Tdap vaccines
Td vaccine has been used for many years. It protects against tetanus and diphtheria.
Tdap was licensed in 2005. It is the first vaccine for adolescents and adults that protects against all three diseases.
Note: At this time, Tdap is licensed for only one lifetime dose per person. Td is given every 10 years, and more often if needed.
These vaccines can be used in three ways: 1) as catch-up for people who did not get all their doses of DTaP or DTP when they were children, 2) as a booster dose every 10 years, and 3) for protection against tetanus infection after a wound.

Routine: Adolescents 11 through 18 A dose of Tdap is recommended for adolescents who got
DTaP or DTP as children and have not yet gotten a booster dose of Td. The preferred age is 11-12.
Adolescents who have already gotten a booster dose of Td are encouraged to get a dose of Tdap as well, for protection against pertussis. Waiting at least 5 years between Td and Tdap is encouraged, but not required.
Adolescents who did not get all their scheduled doses of DTaP or DTP as children should complete the series using a combination of Td and Tdap.

Routine: Adults 19 and Older All adults should get a booster dose of Td every 10 years.
Adults under 65 who have never gotten Tdap should substitute it for the next booster dose.
Adults under 65 who expect to have close contact with an infant younger than 12 months of age (including women who may become pregnant) should get a dose of Tdap. Waiting at least 2 years since the last dose of Td is suggested, but not required.
Healthcare workers under 65 who have direct patient contact in hospitals or clinics should get a dose of Tdap. A 2-year interval since the last Td is suggested, but not required.
New mothers who have never gotten Tdap should get a dose as soon as possible after delivery. If vaccination is needed during pregnancy, Td is usually preferred over Tdap.

Protection After a Wound A person who gets a severe cut or burn might need a dose of Td or Tdap to prevent tetanus infection. Tdap may be used for people who have never had a dose. But Td should be used if Tdap is not available, or for:
- anybody who has already had a dose of Tdap, - children 7 through 9 years of age, or - adults 65 and older.

Tdap and Td may be given at the same time as other vaccines.

4

Some people should not be vaccinated or should wait

Anyone who has had a life-threatening allergic reaction after a dose of DTP, DTaP, DT, or Td should not get Td or Tdap.

Anyone who has a severe allergy to any component of a vaccine should not get that vaccine. Tell your provider if the person getting the vaccine has any severe allergies.

Anyone who had a coma, or long or multiple seizures within 7 days after a dose of DTP or DTaP should not get Tdap, unless a cause other than the vaccine was found (these people can get Td).
Talk to your provider if the person getting either vaccine: - has epilepsy or another nervous system problem, - had severe swelling or severe pain after a previous dose of DTP, DTaP, DT, Td, or Tdap vaccine, or - has had Guillain Barr Syndrome (GBS).
Anyone who has a moderate or severe illness on the day the shot is scheduled should usually wait until they recover before getting Tdap or Td vaccine. A person with a mild\ illness or low fever can usually be vaccinated.

5

What are the risks from Tdap and Td vaccines?

With a vaccine (as with any medicine) there is always a small risk of a life-threatening allergic reaction or other serious problem.
Getting tetanus, diphtheria or pertussis would be much more likely to lead to severe problems than getting either vaccine.
Problems reported after Td and Tdap vaccines are listed below.

Mild Problems (Noticeable, but did not interfere with activities)
Tdap Pain (about 3 in 4 adolescents and 2 in 3 adults) Redness or swelling (about 1 in 5) Mild fever of at least 100.4F (up to about 1 in 25
adolescents and 1 in 100 adults) Headache (about 4 in 10 adolescents and 3 in 10 adults) Tiredness (about 1 in 3 adolescents and 1 in 4 adults) Nausea, vomiting, diarrhea, stomach ache (up to 1 in 4
adolescents and 1 in 10 adults) Chills, body aches, sore joints, rash, swollen glands (uncommon)
Td Pain (up to about 8 in 10) Redness or swelling (up to about 1 in 3) Mild fever (up to about 1 in 15) Headache or tiredness (uncommon)

Moderate Problems (Interfered with activities, but did not require medical attention)

Tdap Pain at the injection site (about 1 in 20 adolescents and 1
in 100 adults) Redness or swelling (up to about 1 in 16 adolescents and 1
in 25 adults) Fever over 102F (about 1 in 100 adolescents and 1 in 250
adults) Headache (1 in 300) Nausea, vomiting, diarrhea, stomach ache (up to 3 in 100
adolescents and 1 in 100 adults)
Td Fever over 102F (rare)

Vaccine Information Statement (Interim)

Td & Tdap Vaccines (11/18/08)

U.S.C. 42 300aa-26

Tdap or Td Extensive swelling of the arm where the shot was given
(up to about 3 in 100).

Severe Problems (Unable to perform usual activities; required medical attention)

Tdap Two adults had nervous system problems after getting the
vaccine during clinical trials. These may or may not have been caused by the vaccine. These problems went away on their own and did not cause any permanent harm.

Tdap or Td Swelling, severe pain, and redness in the arm where the
shot was given (rare).

A severe allergic reaction could occur after any vaccine. They are estimated to occur less than once in a million doses.

6

What if there is a severe reaction?

What should I look for? Any unusual condition, such as a high fever or behavior changes. Signs of a severe allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.
What should I do? Call a doctor, or get the person to a doctor right away. Tell the doctor what happened, the date and time it happened, and when the vaccination was given. Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at www.vaers.hhs.gov, or by calling 1-800-822-7967.

VAERS does not provide medical advice.

7

The National Vaccine Injury Compensation Program

A federal program exists to help pay for the care of anyone who has a serious reaction to a vaccine.
For details about the National Vaccine Injury Compensation Program, call 1-800-338-2382 or visit their website at www.hrsa.gov/vaccinecompensation.

8 How can I learn more?

Ask your provider. They can give you the vaccine package insert or suggest other sources of information.
Call your local or state health department.

Contact the Centers for Disease Control and Prevention (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) or - Visit CDC's website at www.cdc.gov/vaccines.

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention

After the Shots . . .
Your child may need extra love and care after getting vaccinated. Some vaccinations that protect children from serious diseases also can cause discomfort for a while. Here are answers to questions many parents have after their children have been vaccinated. If this sheet doesn't answer your questions, call your healthcare provider.
Vaccinations may hurt a little . . . but disease can hurt a lot!
Call your healthcare provider right away if you answer "yes" to any of the following questions:
I Does your child have a temperature that your healthcare provider has told you to be concerned about?
I Is your child pale or limp? I Has your child been crying
for more than 3 hours and just won't quit? I Is your child's body shaking, twitching, or jerking? I Is your child very noticeably less active or responsive?

What to do if your child has discomfort
I think my child has a fever. What should I do?
Check your child's temperature to find out if there is a fever. An easy way to do this is by taking a temperature in the armpit using an electronic thermometer (or by using the method of temperature-taking your healthcare provider recommends). If your child has a temperature that your healthcare provider has told you to be concerned about or if you have questions, call your healthcare provider.
Here are some things you can do to help reduce fever:
Give your child plenty to drink. Dress your child lightly. Do not cover or wrap your child tightly. Give your child a fever- or pain-reducing medicine such as acetamino-
phen (e.g., Tylenol) or ibuprofen (e.g., Advil, Motrin). The dose you give your child should be based on your child's weight and your heathcare provider's instructions. See the dose chart on page 2. Do not give aspirin. Recheck your child's temperature after 1 hour. Call your healthcare provider if you have questions.
My child has been fussy since getting vaccinated. What should I do?
After vaccination, children may be fussy because of pain or fever. To reduce discomfort, you may want to give your child a medicine such as acetaminophen or ibuprofen. See the dose chart on page 2. Do not give aspirin. If your child is fussy for more than 24 hours, call your healthcare provider.
My child's leg or arm is swollen, hot, and red. What should I do?
Apply a clean, cool, wet washcloth over the sore area for comfort. For pain, give a medicine such as acetaminophen or ibuprofen. See the
dose chart on page 2. Do not give aspirin. If the redness or tenderness increases after 24 hours, call your healthcare
provider.
My child seems really sick. Should I call my healthcare provider?
If you are worried at all about how your child looks or feels, call your healthcare provider!

Please see the back of this page for information on the proper amount of medicine to give your child to reduce pain or fever.

healthcare provider: please fill in the information below.

[ If your child's temperature is

F or

or if you have questions, call your healthcare provider.

Healthcare provider phone number:

] C or higher,

L

Technical content reviewed by the Centers for Disease Control and Prevention, May 2009.
Immunization Action Coalition 1573 Selby Avenue St. Paul, Minnesota 55104 www.vaccineinformation.org www.immunize.org
www.immunize.org/catg.d/p4015.pdf Item #P4015 (5/09)

after the shots: what to do if your child has discomfort page 2
Medicines and Dosages to Reduce Pain and Fever
Choose the proper medicine, and measure the dose accurately.
1. Ask your healthcare provider or pharmacist which medicine is best for your child. 2. Give the dose based on your child's weight. If you don't know your child's weight, give the dose based on
your child's age. Do not give more medicine than is recommended. 3. If you have questions about dosage amounts or any other concerns, call your healthcare provider. 4. Always use a proper measuring device. For example:
When giving infant drops, use the dropper enclosed in the package. Never use a spoon or a cup! When giving children's liquid, use the cup enclosed in the package. If you misplace the cup, consult
your healthcare provider or pharmacist for advice. Kitchen spoons are not accurate measures.

Take these two steps to avoid causing a serious medication overdose in your child.
1. Don't give your child a larger amount of acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Motrin, Advil) than is shown in the table below. Too much of any of these medicines can cause an overdose.
2. When you give your child acetaminophen or ibuprofen, don't also give them over-the-counter (OTC) cough or cold medicines. This can also cause a medication overdose because cough and cold medicines often contain acetaminophen or ibuprofen. In fact, to be safe, don't give OTC cough and cold medicines to your child unless you talk to your child's healthcare provider first.

Acetaminophen (Tylenol or another brand): How much to give?
Give every 4 to 6 hours, as needed, no more than 5 times in 24 hours (unless directed to do otherwise by your healthcare provider).

child's weight
611 lbs (2.75 kg) 1217 lbs (5.57.7 kg) 1823 lbs (8.210.5 kg) 2435 lbs (10.915.9 kg) 3647 lbs (16.421.4 kg) 4859 lbs (21.826.8 kg) 6071 lbs (27.332.3 kg) 7295 lbs (32.743.2 kg)

child's age
03 mos 411 mos 1223 mos 23 yrs 45 yrs 68 yrs 910 yrs 11 yrs

infant's drops
80 mg in each o.8 mL
Advised dose* Advised dose* Advised dose* 1.6 mL (0.8 mL+ 0.8 mL)

children's liquid

children's

160 mg in 5 mL (1 tsp)

tablets

Kitchen spoons are not accurate measures. 80 mg in each tab

Advised dose*

Advised dose*

Advised dose*

1 teaspoon or 5 mL 11/2 teaspoon or 7.5 mL

2 tablets 3 tablets

2 teaspoons or 10 mL 2 1/2 teaspoons or 12.5 mL

4 tablets 5 tablets

3 teaspoons or 15 mL

6 tablets

junior strength
160 mg in each tab
2 tablets 21/2 tablets 3 tablets

Ibuprofen (Advil, Motrin, or another brand): How much to give?
Give every 6 to 8 hours, as needed, no more than 4 times in 24 hours (unless directed to do otherwise by your healthcare provider).

child's weight

child's age

infant's drops
50 mg in each 1.25 mL

less than 11 lbs (5 kg)

05 mos

1217 lbs (5.57.7 kg)

611 mos 1.25 mL

1823 lbs (8.210.5 kg)

1223 mos 1.875 mL

2435 lbs (10.915.9 kg)

23 yrs

3647 lbs (16.421.4 kg)

45 yrs

4859 lbs (21.826.8 kg)

68 yrs

6071 lbs (27.332.3 kg)

910 yrs

7295 lbs (32.743.2 kg)

11 yrs

* healthcare provider: please fill in the advised dose.

children's liquid

children's

100 mg in 5 mL (1 tsp)

tablets

Kitchen spoons are not accurate measures. 50 mg in each tab

junior strength
100 mg in each tab

Advised dose* Advised dose* 1 teaspoon or 5 mL 11/2 teaspoon or 7.5 mL 2 teaspoons or 10 mL 21/2 teaspoons or 12.5 mL 3 teaspoons or 15 mL

2 tablets 3 tablets 4 tablets 5 tablets 6 tablets

2 tablets 21/2 tablets 3 tablets

Immunization Action Coalition www.immunize.org/catg.d/p4015.pdf

The English-language version of this document has been updated. It can be found at www.immunize.org/catg.d/p4015.pdf. Because this translation has not been updated, healthcare professionals should refer to pages 3 and 4 of this document for changes (strike out = deleted text; underlined = new text).

Despus de las vacunas

Qu hacer si su hijo tiene molestias

Es posible que su hijo necesite ms cario y atencin despus de que lo vacunen. Algunas vacunas que protegen a los nios contra enfermedades graves tambin pueden causar molestias por un tiempo. Estas son respuestas a preguntas que muchos padres tienen despus de vacunar a sus hijos. Si esta hoja no contesta sus preguntas, llame a su clnica o profesional de la salud.
Telfono de la clnica o del profesional de la salud:

Las vacunas pueden doler un poco... Creo que mi hijo tiene fiebre. Qu puedo hacer?

pero una enfermedad puede

Tome la temperatura al nio para ver si tiene fiebre. No use un termmetro de

doler mucho!

mercurio. Si su hijo tiene menos de 3 aos, tmele la temperatura con un termmetro digital rectal para el mejor resultado. Cuando su hijo tenga 4 5 aos,

tal vez prefiera tomarle la temperatura en la boca con un termmetro digital oral.

LseliascmtSoaidnuesniqEjthappuoHfeisooirjlsqtsaerTaaoertuutmg,gsiameaceEepuapsunmalnT"rscdttnrtneaitneslsudeoaiooeiadet,rdidefd)nsa"ccncoees?sioueecscaaeussealia:idnoh3uglnsodhloaadinumnondhijerloanjo?egraaeoohasminnlbufrlnureiiotajdlid?nanseemoolsoeuilbmqa?tluye(arullsabduaenadduecnnlnaeoitsaoalhti?aenrolvtilheldojiauordadonadyuatr?ocdoocoinLomontErsoeassDteVtoeeDaserspdjsml,DstceeSMatttlsimiaDaeniaoefaQilelmmilnrnpsnoeeupemjasehLpeelusnebburpduocaptimieatirpejaorun,rmlshuceogmorripncTnpi.ipneabdeussjilyshLpgoiroraaedoulnleltoeeuoad,e.ie.eiema2rpcrmnosVTelnpanpsd4aeatuyodutbupvaudmaoscuhcllloeeesaeeeiorthode,lbvnlcodanh)aosveonreliiueaolrdaaoasacdtsbantlsolpsnodeycoomaaird,oqasaqb)emprasell,tn.uermusualuaorozqajaeNimpa?reamadofmru,ohairioosbpsoeleielaleruodjuasuenfbulropemsoepleasrehdteace1neeernditdirlucsomds.mjoaliaau(uceonafeNpddibetpii2nodhrcuotocenoreeyhslaanmelraplrm_aa(lnicaplsueoenj_pmaoetifuopjltdiruc_oeisgerdpe.eeear_erlmmaerdrdnobap_oadeoesiiprqpaaftcbjeaentuleeepFrsuansaoo,msrrparmejvse,caadi(oosi.ohu_ApoatreeftdulSnee_almeiyinodoenarnlalris_utavvsgo,lioacb_smvdpoaiAuadu.r_hlaacunaaadoaeSdcoahacrzpelCeitvolmeslidouinraatjisb)sdeaodtloMnou(tsirtmobeoeeao,aaatahoansoi.ldlmic1recaduitnjapojrnlMaeaedoohamisotenrlns.faoaliroae,eeae.lmmrltxsuenoa)narnto.ildio.itlsnftnerNsd.aiiee(.ome)odpoju),fbalyeooesoap,lrtnlreur3eeraseonoo:drsoatqn(jolopuaoe.pror

Qu puedo hacer?

Meaqsipdrfuteiaeaeerclbhaauproreaupje.daeaddarputeedacrdeidaraemevralleeetdrdraoliaclssoadudrmoeohesiniljsaoto

Ponga un pao limpio, hmedo y fresco en la parte dolorida, para calmar el malestar.
Para el dolor dle un medicamento como acetaminofeno (por ejemplo, Tylenol) o ibuprofen (por ejemplo, Advil o Motrin). No le d aspirina.
Si el enrojecimiento o el dolor aumentan despus de 24 horas, llame a su clnica o profesional de la salud.
Mi hijo se ve muy enfermo. Debo llamar al profesional de la salud? Si tiene la menor preocupacin sobre el aspecto de su hijo o cmo se siente, llame a su clnica o profesional de la salud!







The English-language version of this document has been updated. It can be found at www.immunize.org/catg.d/p4015.pdf. Because this translation has not been updated, healthcare professionals should refer to pages 3 and 4 of this document for changes (strike out = deleted text; underlined = new text).

Medicamentos y dosis para reducir el dolor y la fiebre

Notas importantes: 1. Pregunte a su profesional de la salud o farmacutico qu medicamento es mejor para su hijo.
2. Dle la dosis segn el peso del nio. Si no sabe cunto pesa, dle la dosis segn la edad. No le d ms medicamento que lo recomendado.
3. Si tiene alguna pregunta sobre las dosis o alguna otra inquietud, llame a su clnica o profesional de la salud.
4. Use siempre un dispositivo apropiado para medir. Por ejemplo:
Al darle gotas para bebs, use slo el dispositivo de dosis (gotero o jeringa) que viene en el paquete.
Al darle lquido para nios, use el vasito de dosis que viene en el paquete. Si pierde el vasito de dosis, pida asesoramiento a su profesional de la salud o farmacutico. (Las cucharas de cocina no sirven para medir con exactitud).
5. ADVERTENCIA: Si tambin le est dando medicamentos de venta libre, tales como preparaciones para el resfriado, tenga en cuenta que estos medicamentos pueden contener reductores de dolor o de fiebre, como acetaminofeno o ibuprofen. Asegrese de leer con atencin las etiquetas de todos los medicamentos de venta libre, para estar seguro de que su hijo no est recibiendo ms acetaminofeno o ibuprofen que lo recomendado.
Informacin sobre la dosis de acetaminofeno (Tylenol u otra marca)






0.8 mL = 80 mg









1 cucharadita (5 mL) = 160 mg 1 tableta = 80 mg 1 tableta = 160 mg

6 a 11 lbs (2.7 a 5 kg)

0 a 3 meses Dosis recomendada*: _______

12 a 17 lbs (5.5 a 7.7 kg) 18 a 23 lbs (8.2 a 10.5 kg) 24 a 35 lbs (10.9 a 15.9 kg)

4 a 11 meses Dosis recomendada*: _______

12 a 23 meses

Dosis recomendada*: _______

2 a 3 aos

1.6 mL

Dosis recomendada*: _______ Dosis recomendada*: _______
1 cucharadita (160 mg)

2 tabletas

36 a 47 lbs (16.4 a 21.4 kg) 4 a 5 aos

11/2 cucharaditas (240 mg)

3 tabletas

48 a 59 lbs (21.8 a 26.8 kg) 6 a 8 aos

2 cucharaditas (320 mg)

4 tabletas

2 tabletas

60 a 71 lbs (27.3 a 32.3 kg) 9 a 10 aos

21/2 cucharaditas (400 mg)

5 tabletas

21/2 tabletas

72 a 95 lbs (32.7 a 43.2 kg)

11 aos

3 cucharaditas (480 mg)

6 tabletas

3 tabletas

*Pregunte a su profesional de la salud

Informacin sobre la dosis de ibuprofen (Advil, Motrin u otra marca)



menos de 11 lbs (5 kg) 12 a 17 lbs (5.5 a 7.7 kg) 18 a 23 lbs (8.2 a 10.5 kg) 24 a 35 lbs (10.9 a 15.9 kg)



1.25 mL = 50 mg









1 cucharadita (5 mL) = 100 mg 1 tableta = 50 mg 1 tableta = 100 mg

menor de 6 meses

Dosis recomendada*: _______

6 a 11 meses

1.25 mL

12 a 23 meses

1.875 mL

2 a 3 aos

1 cucharadita (100 mg)

2 tabletas

36 a 47 lbs (16.4 a 21.4 kg) 4 a 5 aos

11/2 cucharaditas (150 mg)

3 tabletas

48 a 59 lbs (21.8 a 26.8 kg) 6 a 8 aos

2 cucharaditas (200 mg)

4 tabletas

2 tabletas

60 a 71 lbs (27.3 a 32.3 kg) 9 a 10 aos

21/2 cucharaditas (250 mg)

5 tabletas

21/2 tabletas

72 a 95 lbs (32.7 a 43.2 kg)

11 aos

3 cucharaditas (300 mg)

6 tabletas

3 tabletas

*Pregunte a su profesional de la salud

An updated English-language version of this document, dated 5/09, can be found at www.immunize.org/catg.d/p4015.pdf. Because some translations have not been updated, healthcare providers should refer to this out-of-date version for changes (strike-out = deleted text; underlined = new text) made in the 5/09 version.

After the Shots

What to do if your child has discomfort

Your child may need extra love and care after getting vaccinated. Some vaccinations that protect children from serious diseases also can cause discomfort for a while. Here are answers to questions many parents have after their children have been vaccinated. If this sheet doesn't answer your questions, call your clinic or health care provider.

Vaccinations may hurt a little . . . but disease can hurt a lot!

Clinic or health care provider phone number:

An easy way to do this is by taking a

temp in the armpit using an electronic

I think my child has a fever. What should I do?

thermometer (or by using the method your healthcare provider recommends.)

Check your child's temperature to find out if there is a fever. Do not use a

mercury thermometer. If your child is younger than 3 years of age, taking

a temperature with a rectal digital thermometer provides the best reading.

CyfaoolullDlpoyhayoewoeInroeHsauaifssuwnloytrawDtuygcrhtosopcorreooIumnlieqyytcsuiretwrDb'naocudoastr"ytdecrhuiihoeberyqocecyteheercacecoseuhcuoidprtorshcutltrsiirueiidhrntliihetgcyo"a?drnsocaacirwohpnsnvghltncysehdeuoa'tsii,ehhr)tadll3rn?a:ioibidevainnelcecwnre'hdenrohosdheaojayrrhrha?einbcymeuylaraltdoosotrkicisveaipsmvdufrifhemltonyiyratoapt(nghainy-vals?ns?dedehsgoihtvajrmriuekgansianhnterg-gkses,eO?dbmcnyuhcHenmiealdeGsdoCyeruGruioer(lrveRaetoiueSnehavr.ItehMrgp.mfthrWeycwaAe.ocIeemy,yhovmy(fhni(hafoeTseueyotaatiygncpho.acuelyrouyxgoqeddehmkrrtlurcia.uuerwl,yivifchrnsaylcrenelsTeoaahdiathcohsocvlourytc4uinthdiulyhhloerircllhrtdioraeode)iriiplu).lcat'nnlnndrscdtoliahlDosaesogednhd5tli,rtmignlsfiesiiolisbgglecydiitomiIdypv)dybvihoaneentd'oieeeupelsotlaaone,tlldurorpeorrlyytttacn-yes1rher?t.riothcgdaorohmbeueoDaufitirfuedut2rluuvfinerehpderorunprensaamaie,rcekcrdcnrgennrshaoai(,.locaonieonieliysfsa3htmntl,etpg.uthdmrgei_ynsocemirecosm._roaaoei,tu(ahnooei_yuovAeemagnnrenr_cfe.d.fhbmogdl.tr_ehteilpThet.evcIudiea,hoysfrtiagkFrifayAerlmctuyi1oeeleriswa(tdpwsdo,ofph_tohtsvrnuMnurtiaaa_yepooaiciorgncrnlf_stupnaotmdeeieciu_rgroct,aru,h.yserc_fnsMuwieyiettohvnlpahcvoadfuCtaakoraeohoecurto)c)sirtirerc.nrsmvcapccor:uiaoDghsi.naafricrodluinniaoadealmehns)tdcateraiesnta.eeotgrtely.tmootsteirhmbaegotfderifamrohpneegrsbt.rtedova,iioilnvrkueeympwraoe.srec,ht.hopeuieaaYarifhnrncsnepoeeyphdauntoiihnruainn. 24 hours, call your clinic or health care provider.

Cfdochporaeasnicinankgfgootievhrrmeeofefaybvmtoaieoucernrk.dcioochfnaitlttdhihoitsenoppyraroeogudpeuecre

My child's leg or arm is swollen, hot, and red. What should I do? Apply a clean, cool, wet washcloth over the sore area for comfort.
For pain, give a medication such as acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Advil, Motrin). Do not give aspirin.
If the redness or tenderness increases after 24 hours, call your clinic or health care provider.

My child seems really sick. Should I call my health care provider?

If you are worried at all about how your child looks or feels, call your clinic or

health care provider!

Item #P4015 (9/04)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

An updated English-language version of this document, dated 5/09, can be found at www.immunize.org/catg.d/p4015.pdf. Because some translations have not been updated, healthcare providers should refer to this out-of-date version for changes (strike-out = deleted text; underlined = new text) made in the 5/09 version.

Medications and Dosages to Reduce Pain and Fever
Important notes: 1. Ask your health care provider or pharmacist which formulation is best for your child.
2. Give dose based on your child's weight. If you don't know the weight, give dose based on your child's age. Do not give more medication than recommended.
3. If you have questions about dosing or any other concern, call your clinic or health care provider.
4. Always use a proper measuring device. For example:
When giving infant drops, use only the dosing device (dropper or syringe) enclosed in the package. Never use a
spoon or a cup!
When giving children's suspension or liquid, use the dosage cup enclosed in the package. If you misplace the dosage cup, consult your health care provider or pharmacist for advice. (Kitchen spoons are not accurate measures.)
5. WARNING: If you're also giving your child over-the-counter (OTC) medications such as cold preparations, be aware that these may contain pain or fever reducers such as acetaminophen or ibuprofen. Be sure to read all OTC medication labels carefully to ensure your child is not receiving more acetaminophen or ibuprofen than recommended.
In fact, to be safe, don't give OTC cough and cold medicines to your child unless you talk to your child's healthcare provider first.
Acetaminophen Dosing Information (Tylenol or another brand)
Give every 46 hours, as needed, no more than 5 times in 24 hours (unless directed to do otherwise by your health care provider).

Weight of child

Age of child

Infant drops 0.8 mL = 80 mg

Children's liquid or suspension
1 tsp (5 mL) = 160 mg

Children's tablets

Junior strength

1 tablet = 80 mg 1 tablet = 160 mg

611 lbs (2.75 kg)

03 mos Advised dose*: _________

1217 lbs (5.57.7 kg)

411 mos Advised dose*: _________ Advised dose*: _________

1823 lbs (8.210.5 kg) 1223 mos Advised dose*: _________ Advised dose*: _________

2435 lbs (10.915.9 kg)

23 yrs

1.6 mL

1 teaspoon (160 mg) or 5 mL

2 tablets

3647 lbs (16.421.4 kg)

45 yrs

1 teaspoons (240 mg) or 7.5 mL 3 tablets

4859 lbs (21.826.8 kg)

68 yrs

2 teaspoons (320 mg) or 10 mL

4 tablets

2 tablets

6071 lbs (27.332.3 kg)

910 yrs

2 teaspoons (400 mg) or 12.5 mL 5 tablets

2 tablets

7295 lbs (32.743.2 kg)

11 yrs

3 teaspoons (480 mg) or 15 mL

6 tablets

3 tablets

*Ask your health care provider

Don't give your child a larger amount of acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Motrin, Advil) than is shown in these tables. Too much of any of these medicines can cause an overdose.

Ibuprofen Dosing Information (Advil, Motrin or another brand)

Give every 68 hours, as needed, no more than 4 times in 24 hours (unless directed to do otherwise by your health care provider).

Weight of child

Age of child

Infant drops 1.25 mL = 50 mg

Children's liquid or suspension
1 tsp (5 mL) = 100 mg

Children's tablets

Junior strength

1 tablet = 50 mg 1 tablet = 100 mg

under 11 lbs (5 kg) 1217 lbs (5.57.7 kg)

under 6 mos Advised dose*: _________

611 mos

1.25 mL

Advised dose*: _________

1823 lbs (8.210.5 kg)

1223 mos

1.875 mL

Advised dose*: _________

2435 lbs (10.915.9 kg)

23 yrs

1 teaspoon (100 mg) or 5 mL

2 tablets

3647 lbs (16.421.4 kg)

45 yrs

1 teaspoons (150 mg) or 7.5 mL 3 tablets

4859 lbs (21.826.8 kg)

68 yrs

2 teaspoons (200 mg) or 10 mL

4 tablets

2 tablets

6071 lbs (27.332.3 kg)

910 yrs

2 teaspoons (250 mg) or 12.5 mL 5 tablets

2 tablets

7295 lbs (32.743.2 kg)

11 yrs

3 teaspoons (300 mg) or 15 mL

6 tablets

3 tablets

*Ask your health care provider

GEORGIA VACCINE ADMINISTRATION RECORD

Patient Name: ________________________________ Date of Birth: _____________Record #: ___________
Clinic Name/Address:

*** VFC Eligibility: This patient is under 19 years
of age and is eligible to receive VFC vaccine because: M=Child has Medicaid, PC=Child has PeachCare for Kids, N=Child is Not Insured, U=Child is Underinsured, A=Child is American Indian or Alaska Native, or PI=Private insurance patient (not eligible for VFC).

Vaccine
(Circle)

VACCINE ADMINISTERED

**Place in box C if

Route

combination vaccine given (e.g. Comvax)

Date mm/dd/yy

Patient Dosage Age

IM or subQ

Site*

C**

DTaP or DT 1

VFC Eligibility
*** Manufacturer

VACCINE
Lot Number

Expiration Date

DTaP or DT 2

DTaP or DT 3

DTaP or DT 4

DTaP or DT 5 Tdap-1 Rotavirus-1

Rotavirus-2

Rotavirus-3

Td 1

Td 2

Hib 1

Hib 2

Hib 3

Hib 4

Hep B 1

Hep B 2

Hep B 3

Polio 1

Polio 2

Polio 3

Polio 4

MMR 1

MMR 2

Varicella 1

Varicella 2

MCV4

MPSV4

Hep A - 1

Hep A - 2

PCV7 1

PCV7 2

PCV7 3

PCV7 4

FLU 1

FLU 2

Zoster - 1

PPV23 1

PPV23 2

HPV 1

HPV 2 HPV - 3

DRPevH.0R75-T/200204R9Hight

Had chickenpox disease: Year _______ Age at time of disease: ______

* Site: RA Right Arm LA Left Arm RT - Right Thigh LT Left Thigh

VACCINE INFORMATION STATEMENTS

Date

Date

Published Provided

Vaccine Administrator Initials

Parent/ Guardian
Initials (Optional)

Form 25-IMM-002E

ADVERSE REACTION (AR) Date Immunization Reaction
You must file a Vaccine Adverse Event by calling 1-877-721-0366 or logging on to www.vaers.org

DPH05/024H

Form 25-IMM-002E

GEORGIA VACCINE ADMINISTRATION RECORD Addendum

Vaccine
(Circle)

VACCINE ADMINISTERED

**Place in box C if

combination vaccine given (e.g. Comvax)

Date Patient Dosage Route

mm/dd/yy Age

IM or

Site*

C**

subQ

VFC Eligibility ***

Manufacturer

VACCINE
Lot Number

Expiration Date

VACCINE INFORMATION STATEMENTS

Date

Date

Published Provided

Vaccine Administrator Initials

Parent/ Guardian
Initials (Optional)

* Site: RA Right Arm LA Left Arm RT Right Thigh LT Left Thigh
*** VFC Eligibility: This patient is under 19 years of age and is eligible to receive VFC vaccine because: M=Child has Medicaid, PC=Child
has PeachCare for Kids, N=Child is Not Insured, U=Child is Underinsured, A=Child is American Indian or Alaska Native, or PI=Private insurance patient (not eligible for VFC).

DPH05/024H

Form 25-IMM-002E

REFUSAL TO VACCINATE

Client Name

Client DOB

Parent/Guardian Name

Healthcare Provider's Name

Healthcare Provider's Address & Phone

My healthcare provider has advised that I / my child (circle one) should receive the following vaccines:

Recommended

Vaccinations Diphtheria, Tetanus, acellular Pertussis (DTaP or Tdap) Vaccine Diphtheria Tetanus (DT) or Tetanus diphtheria (Td) Vaccine Haemophilus influenzae type b (Hib) Vaccine Hepatitis A Vaccine (HAV) Hepatitis B Vaccine (HBV) Human Papillomavirus Vaccine (HPV) Inactivated Polio Virus Vaccine (IPV) Influenza (flu) Vaccine Measles-Mumps-Rubella (MMR) Vaccine Meningococcal Vaccine (MCV or MPV) Pneumococcal Vaccine (PCV or PPSV) Rotavirus Vaccine Varicella (Chickenpox) Vaccine Zoster Vaccine Other

Declined

I have read the Vaccine Information Statement(s) from the Centers for Disease Control and Prevention, which explain the vaccine(s) and the disease(s) they prevent. I have had the opportunity to discuss these with my healthcare provider, who has answered all of my questions regarding the recommended vaccine(s). I understand the following:
The purpose of and the need for the recommended vaccine(s) The risks and benefits of the recommended vaccine(s) If (I) my child (do) does not receive the vaccine(s), the consequences may include:
- Contracting the illness the vaccine should prevent (The outcomes of these illnesses may include but are not limited to one or
more of the following: hospitalization, pneumonia, brain damage, meningitis, seizures, deafness, and death.)
- transmitting the disease to others (If an outbreak of vaccine-preventable disease occurs at my child's school or child care and
my child is not protected, he/she may not be permitted to return until risk of catching the disease has passed.) My healthcare provider, the Georgia Immunization Program, the American Academy of Pediatrics, the American Academy of
Family Physicians, and the Centers for Disease Control and Prevention all strongly recommend that these vaccines be given according to the published Advisory Committee on Immunization Practices (ACIP) schedule. Nevertheless, I have decided at this time to decline the vaccine(s) recommended for me / my child, as indicated above, by checking the appropriate box under the column titled "declined."

I understand that failure to follow the recommendations about vaccination may endanger the health or life of me or my child and others with whom I or my child might come into contact.

I understand that I may discuss this issue with my (my child's) healthcare provider and that I may change my mind and accept vaccination for myself (my child) anytime in the future.

I understand that my refusal to have my child vaccinated does not exempt my child from Georgia school or child care facility immunization requirements and that he/she will be unable to attend school or child care without the required vaccinations.

Client/Parent/Guardian

Signature

Date

Witness

Date

Form #25-IMM-012E

Georgia Immunization Program Manual
TABLE OF CONTENTS

Division Of Public Health

4. ADVERSE EVENTS FOLLOWING IMMUNIZATIONS Policy for Reporting Vaccine Adverse Events Following Immunizations (REPLACE) Handling of Emergencies Following the Administration of Vaccines Vaccine Adverse Event Reporting System- Form VAERS (FDA) Frequently Asked Questions About VAERS VAERS Brochure Commonly Asked Questions About the National Vaccine Injury Compensation Program (REMOVE) (See National Vaccine Injury Compensation Program (VICP) Web Page below for link) National Vaccine Injury Compensation Program (VICP) Web Page (ADD) (Link to Frequently Asked Questions http://www.hrsa.gov/vaccinecompensation/) National Vaccine Injury Compensation Program Vaccine Injury Table (REPLACE)

Table of Contents 11/2009

Georgia Immunization Program Manual

Division Of Public Health

POLICY FOR REPORTING VACCINE ADVERSE EVENTS FOLLOWING IMMUNIZATION

The Vaccine Adverse Event Reporting System (VAERS) is a national vaccine safety surveillance program. The National Vaccine Injury Compensation Program is a separate program designed to compensate individuals or families of individuals, who have been injured by childhood vaccines. Reporting an event to VAERS does NOT file a claim for compensation.

PUBLIC HEALTH CLINICS

When the recipient of an immunizing agent is known to have experienced a problem that was serious enough to involve a visit to a physician, hospital or health care facility within 30 days after the immunization, that event is to be reported to the Immunization Program as soon as possible on Form 3034 (Rev.11-90). A reproduction of Form 3034 is included in this section.

The original Form 3034 should be mailed immediately to the Georgia Immunization Program. Copies may be sent to the District Health Unit as established by the district health authority. It is no longer necessary to send VAERS Reports to the Immunization Program Field Staff.

Georgia Immunization Program 2 Peachtree Street, NW, Room 13-276 Atlanta, GA 30303

Phone 404-657-3158 FAX 404-657-1463

VAERS Reports alleging a death temporally associated with immunization should be FAXED immediately to the Immunization Program. An autopsy report should be sent to the Immunization Program as soon as it is available.

After evaluation of the VAERS Report(s) by the Immunization Program staff, it may be necessary to communicate with the person who completed the form to request additional information.

PRIVATE CLINICS and COMMUNITY HEALTH CENTERS

Private physicians should report adverse events on Form VAERS - 1 directly to:

VAERS P. O. Box 1100 Rockville, MD 20849-1100

Phone 1-800-822-7967 ext. 214 FAX 301-217-9660

Private physicians may also submit vaccine adverse event data securely via the internet at www.vaers.org
ATTENTION ALL PUBLIC CLINICS Do not send reports directly to the Centers for Disease Control and
Prevention (CDC).

4. Adverse Events Following Immunizations 11/2009 Policy For Reporting Vaccine Adverse Events

Immunization Program Manual

GA Immunization Program

HANDLING OF EMERGENCIES FOLLOWING THE ADMINISTRATION OF VACCINES

For the handling of emergencies following the administration of vaccines, the GA Immunization Program recommends the following:
1. Each district should follow the "Medical Emergency Procedures" included in the current State Nurse Protocol Manual or develop and utilize emergency protocols and procedures consistent with those outlined in the State Nurse Protocol.
2. Each district should utilize the Quality Assurance Standards for the "Management of Drug Reactions" that are outlined in Section IV of the "Quality Assurance/Quality Improvement for Immunization Practice for Public Health Nurses and Immunization Support Staff" document that is included in Chapter 13 of this manual.

Adverse Events Following Immunizations

1

6/2004

WEBSITE: www.vaers.hhs.gov E-MAIL: info@vaers.org

VACCINE ADVERSE EVENT REPORTING SYSTEM
24 Hour Toll-Free Information 1-800-822-7967 P.O. Box 1100, Rockville, MD 20849-1100
PATIENT IDENTITY KEPT CONFIDENTIAL

Patient Name:

Vaccine administered by (Name):

Last Address

First

M.I. Responsible Physician Facility Name/Address

FAX: 1-877-721-0366
For CDC/FDA Use Only VAERS Number Date Received Form completed by (Name):

Relation

Vaccine Provider Patient/Parent

to Patient Manufacturer

Other

Address (if different from patient or provider)

City

State

Zip

City

State

Zip

City

State

Zip

Telephone no. (____) ______________________ Telephone no. (____) ______________________ Telephone no. (____) ______________________

1. State

2. County where administered

3. Date of birth

4. Patient age

mm dd yy 7. Describe adverse events(s) (symptoms, signs, time course) and treatment, if any

9. Patient recovered

YES NO UNKNOWN

5. Sex MF

6. Date form completed mm dd yy

8. Check all appropriate:

Patient died (date Life threatening illness mm dd

yy )

Required emergency room/doctor visit

Required hospitalization (________days)

Resulted in prolongation of hospitalization

Resulted in permanent disability None of the above

10. Date of vaccination 11. Adverse event onset

12. Relevant diagnostic tests/laboratory data

13. Enter all vaccines given on date listed in no. 10

Vaccine (type) a.

Manufacturer

b.

c.

d.

14. Any other vaccinations within 4 weeks prior to the date listed in no. 10

Vaccine (type) a. b.

Manufacturer

Lot number

Lot number Route/Site

mm dd

yy AM

mm dd yy AM

Time ____________ PM Time ____________ PM

Route/Site

No. Previous Doses

No. Previous doses

Date given

15. Vaccinated at: Private doctor's office/hospital Public health clinic/hospital
18. Illness at time of vaccination (specify)

Military clinic/hospital Other/unknown

16. Vaccine purchased with:

Private funds

Military funds

Public funds

Other/unknown

17. Other medications

19. Pre-existing physician-diagnosed allergies, birth defects, medical conditions (specify)

20. Have you reported this adverse event previously?

No To doctor

To health department To manufacturer

21. Adverse event following prior vaccination (check all applicable, specify)

Adverse

Onset

Type

Dose no.

Event

Age

Vaccine

in series

In patient
In brother or sister

Only for children 5 and under

22. Birth weight

23. No. of brothers and sisters

__________ lb. _________ oz.

Only for reports submitted by manufacturer/immunization project

24. Mfr./imm. proj. report no.

25. Date received by mfr./imm.proj.

26. 15 day report?

Yes

No

27. Report type Initial

Follow-Up

Health care providers and manufacturers are required by law (42 USC 300aa-25) to report reactions to vaccines listed in the Table of Reportable Events Following Immunization. Reports for reactions to other vaccines are voluntary except when required as a condition of immunization grant awards.
Form VAERS-1(FDA)

GENERAL

DIRECTIONS FOR COMPLETING FORM (Additional pages may be attached if more space is needed.)

Use a separate form for each patient. Complete the form to the best of your abilities. Items 3, 4, 7, 8, 10, 11, and 13 are considered essential and should be completed whenever possible. Parents/Guardians may need to consult the facility where the vaccine was administered for some of the information (such as manufacturer, lot number or laboratory data.)
Refer to the Reportable Events Table (RET) for events mandated for reporting by law. Reporting for other serious events felt to be related but not on the RET is encouraged.
Health care providers other than the vaccine administrator (VA) treating a patient for a suspected adverse event should notify the VA and provide the information about the adverse event to allow the VA to complete the form to meet the VA's legal responsibility.
These data will be used to increase understanding of adverse events following vaccination and will become part of CDC Privacy Act System 09-20-0136, "Epidemiologic Studies and Surveillance of Disease Problems". Information identifying the person who received the vaccine or that person's legal representative will not be made available to the public, but may be available to the vaccinee or legal representative.
Postage will be paid by addressee. Forms may be photocopied (must be front & back on same sheet).

SPECIFIC INSTRUCTIONS Form Completed By: To be used by parents/guardians, vaccine manufacturers/distributors, vaccine administrators, and/or the person
completing the form on behalf of the patient or the health professional who administered the vaccine. Item 7: Describe the suspected adverse event. Such things as temperature, local and general signs and symptoms, time course,
duration of symptoms, diagnosis, treatment and recovery should be noted. Item 9: Check "YES" if the patient's health condition is the same as it was prior to the vaccine, "NO" if the patient has not returned
to the pre-vaccination state of health, or "UNKNOWN" if the patient's condition is not known. Item 10: Give dates and times as specifically as you can remember. If you do not know the exact time, please and 11: indicate "AM" or "PM" when possible if this information is known. If more than one adverse event, give the onset date and
time for the most serious event. Item 12: Include "negative" or "normal" results of any relevant tests performed as well as abnormal findings. Item 13: List ONLY those vaccines given on the day listed in Item 10. Item 14: List any other vaccines that the patient received within 4 weeks prior to the date listed in Item 10. Item 16: This section refers to how the person who gave the vaccine purchased it, not to the patient's insurance. Item 17: List any prescription or non-prescription medications the patient was taking when the vaccine(s) was given. Item 18: List any short term illnesses the patient had on the date the vaccine(s) was given (i.e., cold, flu, ear infection). Item 19: List any pre-existing physician-diagnosed allergies, birth defects, medical conditions (including developmental and/or
neurologic disorders) for the patient. Item 21: List any suspected adverse events the patient, or the patient's brothers or sisters, may have had to previous vaccinations.
If more than one brother or sister, or if the patient has reacted to more than one prior vaccine, use additional pages to explain completely. For the onset age of a patient, provide the age in months if less than two years old. Item 26: This space is for manufacturers' use only.

Immunization Program Manual

GA Immunization Program

Frequently Asked Questions About VAERS

What is VAERS? Who can report to VAERS? Why should I report to VAERS? How do I report to VAERS? What events should I report to VAERS? How are VAERS reports analyzed? Are all events reported to VAERS caused by vaccinations? What if I can't tell if a reaction was caused by a vaccine or another medication? How do I find out if a vaccine adverse event has been reported to VAERS? How can I get information on VAERS? Is VAERS involved in the Vaccine Injury Compensation Program? Does VAERS provide general vaccine information?
1. What is VAERS? The Vaccine Adverse Event Reporting System (VAERS) is a national vaccine safety surveillance program co-sponsored by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). VAERS collects and analyzes information from reports of adverse events following immunization. Since 1990, VAERS has received over 123,000 reports, most of which describe mild side effects such as fever. Very rarely, people experience serious adverse events following immunization. By monitoring such events, VAERS helps to identify any important new safety concerns and thereby assists in ensuring that the benefits of vaccines continue to be far greater than the risks.
2. Who can report to VAERS? Anyone can report to VAERS. The majority of VAERS reports are sent in by vaccine manufacturers (42%) and health care providers (30%). The remaining reports are obtained from state immunization programs (12%), vaccine recipients (or their parent/guardians, 7%) and other sources (9%). Vaccine recipients or their parents or guardians are encouraged to seek the help of their health care professional in filling out the VAERS form.
3. Why should I report to VAERS? Each report provides valuable information that is added to the VAERS database. Accurate and complete reporting of post-vaccination events supplies the information needed for evaluation of vaccine safety. The CDC and FDA use VAERS information to ensure the safest strategies of vaccine use and to further reduce the rare risks associated with vaccines.

Adverse Events Frequently Asked Questions About VAERS

1

6/2008

Immunization Program Manual

GA Immunization Program

Frequently Asked Questions About VAERS
4. How do I report to VAERS? You should use a VAERS report form to report any adverse event. You can obtain pre-addressed postage paid report forms by calling VAERS at 1-800-822-7967. You may use photocopies of the form to submit reports. You may also download printable copies of the VAERS form as well as other information about the VAERS Program from the following Internet sites:
The VAERS Web site at http://www.vaers.hhs.gov/ The Food and Drug Administration's Web site at
http://www.fda.gov/cber/vaers/vaers.htm The Centers for Disease Control and Prevention Web site at
http://www.cdc.gov/nip/
5. What events should I report to VAERS? VAERS encourages the reporting of any clinically significant adverse event that occurs after the administration of any vaccine licensed in the United States. You should report clinically significant adverse events even if you are unsure whether a vaccine caused the event. The National Childhood Vaccine Injury Act (NCVIA) requires health care providers to report:
Any event listed by the vaccine manufacturer as a contraindication to subsequent doses of the vaccine.
Any event listed in the Reportable Events Table that occurs within the specified time period after vaccination.
A copy of the Reportable Events Table can be obtained by calling VAERS at 1-800822-7967 or by downloading it from http://www.vaers.hhs.gov/pubs.htm.
6. How are VAERS reports analyzed? Both the CDC and the FDA review data reported to VAERS. The FDA reviews reports to assess whether a reported event is adequately reflected in product labeling, and closely monitors reporting trends for individual vaccine lots. Copies of published reviews are available from VAERS. Many different types of events occur after vaccination. Approximately 85% of the reports describe mild events such as fever, local reactions, episodes of crying or mild irritability, and other less serious experiences. The remaining 15% of the reports reflect serious adverse events involving life-threatening conditions, hospitalization, permanent disability, or death, which may or may not have been truly caused by an immunization.

Adverse Events Frequently Asked Questions About VAERS

2

6/2008

Immunization Program Manual

GA Immunization Program

Frequently Asked Questions About VAERS
7. Are all events reported to VAERS caused by vaccinations? No. VAERS receives reports of many events that occur after immunization. Some of these events may occur coincidentally following vaccination, while others may truly be caused by vaccination. Studies help determine if there is more than a temporal (time) association between immunization and adverse events. The fact that an adverse event occurred following immunization is not conclusive evidence that the event was caused by a vaccine. Factors such as medical history and other medications given near the time of the vaccination must be examined to determine if they could have caused the adverse event. It is important to remember that many adverse events reported to VAERS may not be caused by vaccines.
8. What if I can't tell if a reaction was caused by a vaccine or another medication? We encourage you to report any reaction following vaccination to VAERS, regardless of whether or not you can tell if the vaccine or another product caused it. Reports sent to the VAERS program that also make reference to non-vaccine pharmaceutical products are shared with MedWatch, the FDA's drug safety surveillance system.
9. How do I find out if a vaccine adverse event has been reported to VAERS? You can request information about adverse events reported to VAERS by faxing requests to (301) 443-1726, or by sending requests to:
Food and Drug Administration Freedom of Information Staff (HFI-35)
5600 Fishers Lane Rockville, MD 20857
(301) 827-6500
10. How can I get information on VAERS? There are four ways to obtain information about the VAERS program:
Send e-mail inquiries to info@vaers.org Visit the VAERS Web site at: http://www.vaers.hhs.gov Call the toll-free VAERS information line at (800) 822-7967 Fax inquiries to the toll-free information fax line at (877) 721-0366
11. Is VAERS involved in the Vaccine Injury Compensation Program? No. The National Childhood Vaccine Injury Act created the Vaccine Injury Compensation Program (VICP) to compensate individuals whose injuries may have been caused by vaccines recommended by the CDC for routine use. VICP is separate from the VAERS program. Reporting an event to VAERS does not file a claim for compensation to the VICP.

Adverse Events Frequently Asked Questions About VAERS

3

6/2008

Immunization Program Manual

GA Immunization Program

Frequently Asked Questions About VAERS
A petition must be filed with VICP to start a claim for compensation. For more information call (800) 338-2382, or go to http://www.hrsa.gov/vaccinecompensation/default.htm
12. Does VAERS provide general vaccine information? No. VAERS concentrates on collecting and analyzing the report data. For general information about vaccines and vaccine safety, immunization schedules for children and adults, publications on vaccine-preventable diseases, and more:
Call the CDC National Immunization Hotline at: o (800) 232-2522 (English) o (800) 232-0233 (Spanish)
Visit CDC's National Immunization Program Web site at http://www.cdc.gov/nip/.
VAERS Mailing Address: VAERS P.O. Box 1100 Rockville, MD 20849-1100

Reference: http://vaers.hhs.gov/vaers.htm

Adverse Events Frequently Asked Questions About VAERS

4

6/2008

What Types of Events Should I Report?
You should report any adverse event that happens after getting a vaccine, even if you are not sure that the vaccine caused the adverse event. It is especially important to report any adverse event that resulted in hospitalization, disability, or death. If you are not sure that a certain type of adverse event should be reported to VAERS, talk with your healthcare provider.
Healthcare providers are required by law to report certain adverse events. To get a list of these, please call 1-800-822-7967 or go to www.vaers.hhs.gov/reportable.htm.
How Do I Report?
It's very easy to report to VAERS. You can report by:
Internet: Report on-line at https://secure.vaers.org
Fax: Fax the completed report form to 1-877-721-0366 (toll-free)
Mail: Mail the completed report form to VAERS, P.O. Box 1100 Rockville, MD, 20849-1100
Report forms are available for printing at www.vaers.hhs.gov or by calling the VAERS Information Line at 1-800-822-7967. Operators are on duty from 9:00 a.m. to 5:00 p.m., Eastern Time, Monday through Friday. After you submit a report, VAERS staff may contact you for additional information.

National Vaccine Injury Compensation Program
e National Vaccine Injury Compensation Program (VICP) is a separate federal program that provides compensation to individuals whose injuries may have been caused by certain vaccines. Please be aware that reporting an event to VAERS does not constitute filing a claim with the VICP. Information on the VICP can be obtained by calling 800-338-2382 or visiting their website at http://www.hrsa.gov/vaccinecompensation/
For More Information
Food and Drug Administration For safety and effectiveness information on FDA-licensed vaccines you can call 800-835-4709 or 301-827-2000 and visit www.fda.gov/cber/vaers/vaers.htm. Centers for Disease Control and Prevention For general information on vaccines and immunization schedules you can call 1-800- CDC-INFO (1-800-232-4636) or visit www.cdc.gov/vaccines
VAERS
www.vaers.hhs.gov
P.O. Box 1100 Rockville, MD 20849-1100
Tel: 800-822-7967 Fax: 877-721-0366
info@vaers.org
U.S. Department of Health and Human Services Centers for Disease Control and Prevention Food and Drug Administration
CS115232

VAERS
Vaccine Adverse Event Reporting S ystem A National Program for Monitoring Vaccine Safety
Everyone has a part to play!

Limitation and Usefulness of VAERS
VAERS is unable to determine that a vaccine caused or did not cause an adverse event. Sometimes people who are vaccinated get sick from another cause unrelated to the vaccine.
Even though VAERS cannot determine that a vaccine caused an adverse event, it can give FDA and CDC important information that might signal a problem. If it looks as though a vaccine might be causing an adverse event, FDA and CDC will investigate further.

What is VAERS?
The Vaccine Adverse Event Reporting System (VAERS) is a national program that monitors the safety of vaccines after they are licensed. VAERS is managed by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA).
Vaccines prevent serious illnesses and even death in persons who receive them. Before a vaccine is licensed, FDA takes steps to make sure the vaccine is safe. FDA requires that a vaccine goes through extensive safety testing. After a vaccine is licensed, VAERS is one of the mechanisms used to monitor for any problems, or "adverse events," that happen after vaccination.
Not all events reported to VAERS are caused by the vaccine. Even though careful studies are done before a vaccine is licensed, rare adverse effects may not be found until a vaccine is given to millions of people with different backgrounds and medical histories. By continued monitoring, VAERS helps to make sure that the benefits of vaccines are far greater than the risks.
Anyone who receives a vaccine should be informed about both the benefits and risks of vaccination. Any questions or concerns should be discussed with a healthcare provider.

Does VAERS
Provide Medical Advice?

No, VAERS does not provide medical advice.
For medical advice, please contact your healthcare
provider or state health department.


Who Can Report to VAERS?
Parents Patients Healthcare Providers Others
FDA and CDC encourage anybody who experiences any problems after vaccination to report to VAERS. Healthcare providers are required by law to report certain problems.
Why Should I Report to VAERS?
Reporting gives valuable information that helps CDC and FDA make sure that vaccines are safe
Reporting strengthens VAERS so it can be used to assess public health response to vaccines
Reporting allows for evaluating public health prevention and control measures
Remember, no vaccine (or any medicine) is completely free of risk and adverse events are possible. If you have an adverse event after a vaccine, please report to VAERS. Each report is important!

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National Vaccine Injury Compensation Program (VICP)

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Omnibus Autism

Autism Decisions and Background Information (U.S. Court of Federal Claims)

Proceeding

Statement Regarding the Decisions of the U.S. Court of Federal Claims in the

Covered Vaccines

Omnibus Autism Proceeding (U.S. Department of Health and Human Services)

Persons Eligible to File a Claim

About the Omnibus Autism Proceeding

(02/12/09)

Filing a Claim with the VICP
Filing Deadlines
Vaccine Injury Table list of vaccines and associated injuries covered under the program
Frequently Asked Questions
Statistics Reports
Strategic Plan

About VICP
On October 1, 1988, the National Childhood Vaccine Injury Act of 1986 (Public Law 99660) created the National Vaccine Injury Compensation Program (VICP). The VICP was established to ensure an adequate supply of vaccines, stabilize vaccine costs, and establish and maintain an accessible and efficient forum for individuals found to be injured by certain vaccines. The VICP is a no-fault alternative to the traditional tort system for resolving vaccine injury claims that provides compensation to people found to be injured by certain vaccines. The U. S. Court of Federal Claims decides who will be paid. Three Federal government offices have a role in the VICP:
the U.S. Department of Health and Human Services (HHS); the U.S. Department of Justice (DOJ); and the U.S. Court of Federal Claims (the Court). The VICP is located in the HHS, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Vaccine Injury Compensation.

Advisory Commission on Childhood Vaccines (ACCV)
Contact Information
Vaccine Injury Compensation Trust Fund
Review of Adverse Effects of Vaccines
Media Inquiries

Additional HHS Vaccine Information Smallpox Vaccine Injury Compensation Program Preparedness Countermeasures Injury Compensation Childhood Immunization Information for Consumers (National Library of Medicine
MEDLINEPlus) National Center for Immunization and Respiratory Diseases (Centers for Disease
Control and Prevention) 2008 Draft Strategic National Vaccine Plan (National Vaccine Program Office)
This information reflects the current thinking of the United States Department of Health and Human Services on the topics addressed. This information is not legal advice and does not create or confer any rights for or on any person and does not operate to bind the Department or the public. The ultimate decision about the scope of the statutes authorizing the VICP is within the authority of the United States Court of Federal Claims, which is responsible for resolving claims for compensation under the VICP.

HRSA | HHS | Privacy Policy | Disclaimers | Accessibility | Clinician Recruitment & Service | Health Professions | Healthcare Systems | HIV/AIDS | Maternal and Child Health | Primary
Health Care | Rural Health | Download Adobe Reader | Freedom of Information Act
http://www.hrsa.gov/vaccinecompensation/

National Childhood Vaccine Injury Act
Vaccine Injury Tablea

Vaccine

Adverse Event

Time Interval

I. Tetanus toxoid-containing vaccines (e.g., DTaP, Tdap, DTP-Hib, DT, Td, TT)

A. Anaphylaxis or anaphylactic shock B. Brachial neuritis

0-4 hours 2-28 days

II. Pertussis antigen-containing vaccines (e.g., DTaP, Tdap, DTP, P, DTP-Hib)

C. Any acute complication or sequela (including death) of above events
A. Anaphylaxis or anaphylactic shock
B. Encephalopathy (or encephalitis)

Not applicable 0-4 hours 0-72 hours

III. Measles, mumps and rubella viruscontaining vaccines in any combination (e.g., MMR, MR, M, R)
IV. Rubella virus-containing vaccines (e.g., MMR, MR, R)
V. Measles virus-containing vaccines (e.g., MMR, MR, M)

C. Any acute complication or sequela (including death) of above events
A. Anaphylaxis or anaphylactic shock
B. Encephalopathy (or encephalitis)
C. Any acute complication or sequela (including death) of above events
A. Chronic arthritis
B Any acute complication or sequela (including death) of above event
A Thrombocytopenic purpura
B. Vaccine-Strain Measles Viral Infection in an immunodeficient recipient

VI. Polio live virus-containing vaccines (OPV)

C Any acute complication or sequela (including death) of above events
A. Paralytic polio --- in a non-immunodeficient recipient --- in an immunodeficient recipient --- in a vaccine assoc. community case

B. Vaccine-strain polio viral infection --- in a non-immunodeficient recipient --- in an immunodeficient recipient --- in a vaccine assoc. community case

Not applicable 0-4 hours 5-15 days
Not applicable 7-42 days Not applicable
7-30 days 0-6 months
Not applicable
0-30 days 0-6 months Not applicable 0-30 days 0-6 months Not applicable

VII. Polio inactivated-virus containing vaccines (e.g., IPV)
VIII. Hepatitis B antigen- containing vaccines
IX. Hemophilus influenzae type b polysaccharide conjugate vaccines)
X. Varicella vaccine

C. Any acute complication or sequela (including death) of above events
A Anaphylaxis or anaphylactic shock B. Any acute complication or sequela
(including death) of above event A. Anaphylaxis or anaphylactic shock
B. Any acute complication or sequela (including death) of above event
A. No condition specified for compensation
A. No condition specified for compensation

Not applicable 0-4 hours Not applicable 0-4 hours Not applicable
Not applicable
Not applicable

XI. Rotavirus vaccine

A. No condition specified for compensation Not applicable

XII. Pneumococcal conjugate vaccines

A. No condition specified for compensation Not applicable

XIII. Any new vaccine recommended by the A. No condition specified for compensation

Not applicable

Centers for Disease Control and

Prevention for routine administration to

children, after publication by Secretary, HHS of a notice of coveragebc

aEffective date: November 10, 2008 bAs of December 1, 2004, hepatitis A vaccines have been added to the Vaccine Injury

Table (Table) under this Category. As of July 1, 2005, trivalent influenza vaccines have been added to the Table under this

Category. Trivalent influenza vaccines are given annually during the flu season either by needle and syringe or in a nasal spray. All influenza vaccines routinely administered in the U.S. are trivalent vaccines covered under this Category. cAs of

February 1, 2007, meningococcal (conjugate and polysaccharide) and human papillomavirus (HPV) vaccines have been

added to the Table under this Category. See News on the VICP website (www.hrsa.gov/vaccinecompensation).

Qualifications and Aids to Interpretation
(1) Anaphylaxis and anaphylactic shock mean an acute, severe, and potentially lethal systemic allergic reaction. Most cases resolve without sequelae. Signs and symptoms begin minutes to a few hours after exposure. Death, if it occurs, usually results from airway obstruction caused by laryngeal edema or bronchospasm and may be associated with cardiovascular collapse. Other significant clinical signs and symptoms may include the following: Cyanosis, hypotension, bradycardia, tachycardia, arrhythmia, edema of the pharynx and/or trachea and/or larynx with stridor and dyspnea. Autopsy findings may include acute emphysema which results from lower respiratory tract obstruction, edema of the hypopharynx, epiglottis, larynx, or trachea and minimal findings of eosinophilia in the liver, spleen and lungs. When death occurs within minutes of exposure and without signs ofrespiratory distress, there may not be significant pathologic findings.
(2) Encephalopathy. For purposes of the Vaccine Injury Table, a vaccine recipient shall be considered to have suffered an encephalopathy only if such recipient manifests, within the applicable period, an injury meeting the description below of an acute encephalopathy, and then a chronic encephalopathy persists in such person for more than 6 months beyond the date of vaccination.
(i) An acute encephalopathy is one that is sufficiently severe so as to require hospitalization (whether or not hospitalization occurred).
(A) For children less than 18 months of age who present without an associated seizure event, an acute encephalopathy is indicated by a "significantly decreased level of consciousness" (see "D" below) lasting for at least 24 hours. Those children less than 18 months of age who present following a seizure shall be viewed as having an acute encephalopathy if their significantly decreased level of consciousness persists beyond 24 hours and cannot be attributed to a postictal state (seizure) or medication.
(B) For adults and children 18 months of age or older, an acute encephalopathy is one that persists for at least 24 hours and characterized by at least two of the following:
(1) A significant change in mental status that is not medication related; specifically a confusional state, or a delirium, or a psychosis; (2) A significantly decreased level of consciousness, which is independent of a seizure and cannot be attributed to the effects of medication; and (3) A seizure associated with loss of consciousness.
(C) Increased intracranial pressure may be a clinical feature of acute encephalopathy in any age group.
(D) A "significantly decreased level of consciousness" is indicated by the presence of at least one of the following clinical signs for at least 24 hours or greater (see paragraphs (2)(I)(A) and (2)(I)(B) of this section for applicable timeframes):
(1) Decreased or absent response to environment (responds, if at all, only to loud voice or painful stimuli); (2) Decreased or absent eye contact (does not fix gaze upon family members or other individuals); or (3) Inconsistent or absent responses to external stimuli (does not recognize familiar people or things).
(E) The following clinical features alone, or in combination, do not demonstrate an acute encephalopathy or a significant change in either mental status or level of consciousness as described above: Sleepiness, irritability (fussiness), high-pitched and unusual screaming, persistent inconsolable crying, and bulging fontanelle. Seizures in themselves are not sufficient to constitute a diagnosis of encephalopathy. In the absence of other evidence of an acute encephalopathy, seizures shall not be viewed as the first symptom or manifestation of the onset of an acute encephalopathy.
(ii) Chronic encephalopathy occurs when a change in mental or neurologic status, first manifested during the applicable time period, persists for a period of at least 6 months from the date of vaccination. Individuals who return to a normal neurologic state after the acute encephalopathy shall not be presumed to have suffered residual neurologic damage from that event; any subsequent chronic encephalopathy shall not be presumed to be a sequela of the acute encephalopathy. If a preponderance of the evidence indicates that a child's chronic encephalopathy is secondary to genetic, prenatal or perinatal factors, that chronic encephalopathy shall not be considered to be a condition set forth in the Table.
(iii) An encephalopathy shall not be considered to be a condition set forth in the Table if in a proceeding on a petition, it is shown by a preponderance of the evidence that the encephalopathy was caused by an infection, a toxin, a metabolic disturbance, a structural lesion, a genetic disorder or trauma (without regard to whether the cause of the infection, toxin, trauma, metabolic disturbance, structural lesion or genetic disorder is known). If at the time a decision is made on a petition filed under section 2111(b) of the Act for a vaccine-related injury or death, it is not possible to determine the cause by a preponderance of the evidence of an encephalopathy, the encephalopathy shall be considered to be a condition set forth in the Table.
(iv) In determining whether or not an encephalopathy is a condition set forth in the Table, the Court shall consider the entire medical record.
(3) Seizure and convulsion. For purposes of paragraphs (b)(2) of this section, the terms, "seizure" and "convulsion" include myoclonic, generalized tonic-clonic (grand mal), and simple and complex partial seizures. Absence (petit mal) seizures shall not be considered to be a condition set forth in the Table. Jerking movements or staring episodes alone are not necessarily an indication of seizure activity.

(4) Sequela. The term "sequela" means a condition or event which was actually caused by a condition listed in the Vaccine Injury Table.
(5) Chronic Arthritis. For purposes of the Vaccine Injury Table, chronic arthritis may be found in a person with no history in the 3 years prior to vaccination of arthropathy (joint disease) on the basis of:
A) Medical documentation, recorded within 30 days after the onset, of objective signs of acute arthritis (joint swelling) that occurred between 7 and 42 days after a rubella vaccination;
(B) Medical documentation (recorded within 3 years after the onset of acute arthritis) of the persistence of objective signs of intermittent or continuous arthritis for more than 6 months following vaccination:
(C) Medical documentation of an antibody response to the rubella virus.
For purposes of the Vaccine Injury Table, the following shall not be considered as chronic arthritis: Musculoskeletal disorders such as diffuse connective tissue diseases (including but not limited to rheumatoid arthritis, juvenile rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, mixed connective tissue disease, polymyositis/dermatomyositis, fibromyalgia, necrotizing vasculitis and vasculopathies and Sjogren's Syndrome), degenerative joint disease, infectious agents other than rubella (whether by direct invasion or as an immune reaction), metabolic and endocrine diseases, trauma, neoplasms, neuropathic disorders, bone and cartilage disorders and arthritis associated with ankylosing spondylitis, psoriasis, inflammatory bowel disease, Reiter's syndrome, or blood disorders.
Arthralgia (joint pain) or stiffness without joint swelling shall not be viewed as chronic arthritis for purposes of the Vaccine Injury Table.
(6) Brachial neuritis is defined as dysfunction limited to the upper extremity nerve plexus (i.e., its trunks, divisions, or cords) without involvement of other peripheral (e.g., nerve roots or a single peripheral nerve) or central (e.g., spinal cord) nervous system structures. A deep, steady, often severe aching pain in the shoulder and upper arm usually heralds onset of the condition. The pain is followed in days or weeks by weakness and atrophy in upper extremity muscle groups. Sensory loss may accompany the motor deficits, but is generally a less notable clinical feature. The neuritis, or plexopathy, may be present on the same side as or the opposite side of the injection; it is sometimes bilateral, affecting both upper extremities. Weakness is required before the diagnosis can be made. Motor, sensory, and reflex findings on physical examination and the results of nerve conduction and electromyographic studies must be consistent in confirming that dysfunction is attributable to the brachial plexus. The condition should thereby be distinguishable from conditions that may give rise to dysfunction of nerve roots (i.e., radiculopathies) and peripheral nerves (i.e., including multiple mononeuropathies), as well as other peripheral and central nervous system structures (e.g., cranial neuropathies and myelopathies).
(7) Thrombocytopenic purpura is defined by a serum platelet count less than 50,000/mm3. Thrombocytopenic purpura does not include cases of thrombocytopenia associated with other causes such as hypersplenism, autoimmune disorders (including alloantibodies from previous transfusions) myelodysplasias, lymphoproliferative disorders, congenital thrombocytopenia or hemolytic uremic syndrome. This does not include cases of immune (formerly called idiopathic) thrombocytopenic purpura (ITP) that are mediated, for example, by viral or fungal infections, toxins or drugs. Thrombocytopenic purpura does not include cases of thrombocytopenia associated with disseminated intravascular coagulation, as observed with bacterial and viral infections. Viral infections include, for example, those infections secondary to Epstein Barr virus, cytomegalovirus, hepatitis A and B, rhinovirus, human immunodeficiency virus (HIV), adenovirus, and dengue virus. An antecedent viral infection may be demonstrated by clinical signs and symptoms and need not be confirmed by culture or serologic testing. Bone marrow examination, if performed, must reveal a normal or an increased number of megakaryocytes in an otherwise normal marrow.
(8) Vaccine-strain measles viral infection is defined as a disease caused by the vaccine-strain that should be determined by vaccine-specific monoclonal antibody or polymerase chain reaction tests.
(9)Vaccine-strain polio viral infection is defined as a disease caused by poliovirus that is isolated from the affected tissue and should be determined to be the vaccine-strain by oligonucleotide or polymerase chain reaction. Isolation of poliovirus from the stool is not sufficient to establish a tissue specific infection or disease caused by vaccine-strain poliovirus.

Georgia Immunization Program Manual
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5. REQUIREMENTS OF SCHOOL/DAY CARE LAW Summary of Immunization Policies Relative to Georgia Law Official Code of Georgia, Annotated Section 20-2-771 Section 49-4-182 Section 49-4-183 Section 31-12-3.1 DHR Rules, Chapter 290-5-4 Historical Statement Listing Dates of Immunization Requirements (REPLACE) School Certificate of Immunization Form 3231 (Rev. 3/07) Policy Guide 3231INS: Standards for Issuing and Filing Certificates of Immunization Policy Guide 3231REQ: Vaccine Requirements for Attending Day Care Facilities and Schools in Georgia Relative to the Certificate of Immunization Summary Of Georgia Immunization Requirements For Child Care and School Attendance Immunization Requirements and Recommendations for University System of Georgia Students

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SUMMARY OF IMMUNIZATION POLICIES RELATIVE TO GEORGIA LAW
Copies of the pertinent immunization sections of the Georgia law and Rules of the Department of Human Resources, Division of Public Health are included in this section along with copies of the Immunization Certificate and accompanying Policy Guides. Copies are also posted on the Immunization Program web site under the resource section. The following is a summary of policies that relate to the law and rules. For more detailed information, please refer to the copies of the law and rules.
I. Georgia Law and DHR Rules
A. Georgia Law (Official Code of Georgia, Annotated, Section 20-2-771, Section 49-4-182 and Section 49-4-183) defines the target population for which immunity to specified diseases is required and sets standards for the use of immunization certificates.
B. The law also charges the Department of Human Resources (DHR) with responsibility for specifying which immunizations are required and the standards for the same. These are defined in the immunization section (Chapter 290-5-4) of the Rules of the Department of Human Resources, Division of Public Health.
C. The DHR Rules define terms such as "Immunization," "Physician," and "Health Authority," list the diseases for which immunity is required, and state the standards for issuing certificates of immunization based on the current ACIP Recommended Childhood Immunization Schedule.
D. Standards for the Georgia Department of Human Resources (DHR) Certificates of Immunization are also defined on the GA DHR Certificate of Immunization (Form 3231) and the accompanying Policy Guide 3231REQ and Policy Guide 3231INS.
E. Georgia law requires immunization of a preschool age child as a condition of receipt of Temporary Assistance for Needy Families (TANF) benefits. The implementation of the law is the responsibility of the Department of Family and Children Services. Proof of compliance will be provided on the GA DHR Certificate of Immunization (Form 3231).
F. Any school/facility official who does not enforce the requirements or any parent/guardian who does not comply with the requirements is subject to penalties as outlined in Subsection (h) of the Official Code of Georgia, Annotated, Section 20-2-771.
G. When persons in charge of child care facilities fail to improve unacceptable levels of compliance with the law, despite repeated requests by public health officials, Bright from the Start, Georgia Department of Early Care and Learning (DECAL) should be notified.
H. Any infant/child who is under the age of four and is attending child care must be age appropriately immunized with the required vaccines during the time of attendance. This means that the certificate for every child under four years of age must be marked with an expiration date that indicates the date the next immunization is due. Once a child is four years of age or older and has met the entry requirements for school, [kindergarten (5 year)], a copy of the Immunization Certificate which has been marked as "Complete for School" and includes the vaccine administration dates, or dates of immunity through disease history or serology, may be utilized as documentation for both school and child care facilities.

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SUMMARY OF IMMUNIZATION POLICIES RELATIVE TO GEORGIA LAW
I. Children attending school (5 year old kindergarten-12th grade) must be age appropriately immunized with all the required vaccines at the time of first entry into a school in Georgia. "New entrant" is defined as any child entering a Georgia school or facility for the first time, or entering after having been absent for 12 months or 1 school year. This means that if a child is not "up-to-date" at the time of entry, he/she may attend school provided the certificate is marked with a current expiration date indicating that the child is in the process of receiving the required vaccines and doses. Once the entry requirements have been met, the certificate must be replaced with a certificate marked "Complete for School Entry."
J. Children who are entering a school or child care facility, may be granted a 30 day waiver period by the facility to accommodate the obtaining of immunization records. If necessary, this waiver may be extended from the date of first admittance or first attendance for up to 90 calendar days for children transferring into the school system from out-of-state or entering kindergarten or the school system from out-of-state, providing the parent/guardian can show documentation from their provider or public health clinic that the child is in the process of receiving the required immunizations. A school or child care facility should maintain a file of those children who have been granted a 30 day waiver and should keep the file current. Children who have not submitted an Immunization Certificate by the end of the 30 day grace period should be excluded from further attendance until the appropriate Immunization Certificate is submitted.
II. Immunization Certificates
A. Physicians licensed in Georgia and qualified employees of a local health department or the State Immunization Program are responsible for certifying that a child has met all the immunization requirements for attendance to school/day care as stipulated by the DHR rules. This certification is documented by the physician's or health official's signature.
B. Schools and child care facilities are responsible for filing and maintaining current certificates.
C. A Certificate of Immunization must be on file for each child attending any child care facility or school in Georgia, whether public or private. The certificates must be on site and available for inspection by health officials.
D. If a child attends more than one school/facility, a photocopy of the form must be submitted to the second school/facility.
E. When a provider utilizes computerized versions of the Immunization Certificate (Form 3231), it is the responsibility of that provider to have these versions approved by the Georgia Immunization Program. The certificates must include all of the information that is illustrated on the hard copy of these forms. In addition, when the Georgia Immunization Program makes updates to these certificates, it is the responsibility of the provider to update their computerized versions to reflect these changes and have them approved by the state office.
F. Certificates should be marked with either a "Date of Expiration" or as "Complete for School Attendance," not both.

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SUMMARY OF IMMUNIZATION POLICIES RELATIVE TO GEORGIA LAW
G. A certificate marked as "Complete for School Attendance" does not expire.
H. A certificate marked with a "Date of Expiration" expires on the date indicated. A current certificate must be submitted within 30 days after the expiration date or the child must be excluded from attendance until a current certificate is submitted.
III. Immunization Reports
By law, an annual report is required for each facility. This report indicates the percentage of adequately immunized children attending that facility.
A. For child care facilities, district or local health personnel must conduct inventories (audits) at least once per year. Licensed child care facilities should maintain at least a 90% compliance level. Health Districts are responsible for working with facilities to obtain and maintain this compliance level. The State Immunization Program will provide district health personnel with a listing of all child care facilities known to Bright from the Start, Georgia Department of Early Care and Learning (DECAL). Completed Child Care Facilities Status Review forms should be submitted to the State Immunization Program according to the time frame assigned to each district. State Immunization Program Consultants will annually validate the results of the audits.
B. For schools, inventories (audits) of immunization records of all kindergarten and sixth grade students must be conducted at least once per year by health departments. Schools should maintain at least a 90% compliance level. Health Districts are responsible for working with schools to obtain and maintain this compliance level. Health Districts may establish their own methodologies for collection of information, utilizing school or other designated personnel, but they are ultimately responsible for the accuracy and completeness of the reports. If a health district collaborates with schools or other agencies to conduct the inventory, they are responsible for the training of the individuals who perform and complete the forms. The information must be summarized on the Immunization Inventory for Georgia Schools form and must be submitted to the State Immunization Program. Inventories must be completed so that reports will be received at the State Program office by November 30 of each year. State Immunization Program Consultants will annually validate the results of the audits.

IV. Exemptions
Exemptions: Georgia Law (Section 20-2-771) provides for two (2) types of exemptions from immunization requirements.
A. Medical: A medical exemption for a vaccine should be completed on the GA DHR Certificate of Immunization (Form 3231) only when there is a physical disability or condition that contraindicates immunization for that particular vaccine. There must be an annual review of the medical exemption and certificates must be reissued with or without indication of the medical exemption. O.C.G.A. 20-2-771 (d).

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B. Religious: For a child to be exempt from immunizations on religious grounds, the parent or guardian must furnish the school/facility with a notarized statement stating that immunization conflicts with his or her religious beliefs. There is not a standard form for religious exemption. The notarized statement must be kept on file in lieu of an immunization certificate. O.C.G.A. 20-2-771 (e).
The notarized statement must meet the following criteria: (1) State that their religious beliefs conflict with immunization requirements. (2) The statement must be signed and dated by the parent/guardian. (3) The statement must be notarized, dated, and signed by a Notary Public. (4) The statement should be submitted to the school or childcare facility in lieu of an immunization certificate. (5) The statement does not expire.
Reference: The Official Code of Georgia, Annotated, Section 20-2-771(e):

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OFFICIAL CODE OF GEORGIA
ANNOTATED
SECTION 20-2-771 SECTION 49-4-182 SECTION 49-4-183 SECTION 31-12-3.1

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O.C.G.A. 20-2-771 (2004)
20-2-771. Immunization of students
(a) As used in this Code section, the term:
(1) "Certificate of immunization" means certification by a physician licensed under the laws of this state or by an appropriate official of a local board of health, on a form provided by the Department of Human Resources, that a named person has been immunized in accordance with the applicable rules and regulations of the Department of Human Resources.
(2) "Facility" means any public or private day-care center or nursery intended for the care, supervision, or instruction of children.
(3) "Responsible official" means a county school superintendent, a school principal, or a chief operating officer of a school or facility.
(4) "School" means any public or private educational program or institution instructing children at any level or levels, kindergarten through twelfth grade, or children of ages five through 19 if grade divisions are not used.
(b) No child shall be admitted to or attend any school or facility in this state unless the child shall first have submitted a certificate of immunization to the responsible official of the school or facility. The responsible official of any school or facility may grant a 30 calendar day waiver of the certification requirement for a justified reason. The waiver may be extended from the date of first admittance or of first attendance, whichever is earlier, for up to 90 calendar days provided documentation is on file at the school or facility from the local health department or a physician specifying that an immunization sequence has been started and that this immunization time schedule can be completed within the 90 day waiver period, provided confirmation is received during the waiver period from the health department or physician that immunizations are being received as scheduled, and provided the student under waiver is a transfer student, who is defined as a student who moves from an out-ofstate school system to a Georgia school system, or a student entering kindergarten or first grade from out of state. The waiver may not be extended beyond 90 calendar days; and upon expiration of the waiver, the child shall not be admitted to or be permitted to attend the school or facility unless the child submits a certificate of immunization.
(c) The Department of Human Resources shall promulgate rules and regulations specifying those diseases against which immunization is required and the standards for such immunizations. The school or facility shall maintain on file the certificates of immunization for all children attending the school or facility. All facilities shall file a report annually with the Department of Human Resources. The report shall be filed on forms prepared by the Department of Human Resources and shall state the number of children attending the school or facility, the number of children who did not submit certificates of immunization within the waiver period, and the number of children who are exempted from the certification requirement for medical or religious reasons.

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(d) If, after examination by the local board of health or any physician licensed under the laws of this state or of any other state having comparable laws governing the licensure of physicians, any child to whom this Code section applies is found to have any physical disability which may make vaccination undesirable, a certificate to that effect issued by the local board of health or such physician licensed under the laws of this or such other state may be accepted in lieu of a certificate of immunization and shall exempt the child from the requirement of obtaining a certificate of immunization until the disability is relieved.
(e) This Code section shall not apply to a child whose parent or legal guardian objects to immunization of the child on the grounds that the immunization conflicts with the religious beliefs of the parent or guardian; however, the immunization may be required in cases when such disease is in epidemic stages. For a child to be exempt from immunization on religious grounds, the parent or guardian must first furnish the responsible official of the school or facility an affidavit in which the parent or guardian swears or affirms that the immunization required conflicts with the religious beliefs of the parent or guardian.
(f) During an epidemic or a threatened epidemic of any disease preventable by an immunization required by the Department of Human Resources, children who have not been immunized may be excluded from the school or facility until (1) they are immunized against the disease, unless they present valid evidence of prior disease, or (2) the epidemic or threat no longer constitutes a significant public health danger.
(g) The requirement of a certificate of immunization shall become effective for all children entering or attending facilities on or after April 7, 1981. The certification requirement shall apply to all children entering or attending schools:
(1) On September 1, 1981, for all such children entering or attending kindergarten or the first, ninth, tenth, eleventh, or twelfth grades, or of the equivalent ages if grade divisions are not used;
(2) On September 1, 1982, for all such children entering or attending all grades, or of all ages if grade divisions are not used.
(h) Any responsible official permitting any child to remain in a school or facility in violation of this Code section, and any parent or guardian who intentionally does not comply with this Code section, shall be guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not more than $100.00 or by imprisonment for not more than 12 months. The Department of Human Resources may adopt rules and regulations for the enforcement of this Code section. The Department of Human Resources and the local board of health, or either of them, may institute a civil action in the superior court of the county in which the defendant resides for injunctive relief to prevent a threatened or continuing violation of any provision of this Code section.

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O.C.G.A. 49-4-182 (2004)
49-4-182. Temporary Assistance for Needy Families Program created
(a) There is created the Georgia Temporary Assistance for Needy Families Program, which shall be known as the "Georgia TANF Program." The purpose of such program is to provide necessary assistance to needy families with children on a temporary basis and to provide parents, legal guardians, or other caretaker relatives of children with the necessary support services to enable such parents, legal guardians, or caretaker relatives to become self-sufficient and leave the program as soon as possible. After an initial assessment and once the state determines an applicant is ready for work, applicants for assistance shall be required to engage in a work activity in accordance with Part A of Title IV of the federal Social Security Act, as amended, and the state plan as soon as possible after making application for assistance, but in any event no later than 24 months after first receiving cash assistance.
(b) Assistance shall be provided in accordance with the state plan and any future amendments thereto. Cash assistance to a recipient who is not a minor child and who is a head of a household or married to the head of a household shall be limited to a lifetime maximum of 48 months, whether or not consecutive, beginning January 1, 1997.
(c) Nothing in this article, the state plan, or any rules or regulations adopted pursuant to this article shall be interpreted to entitle any individual or any family to assistance under the Georgia TANF Program.

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O.C.G.A. 49-4-183 (2004)
49-4-183. Administration of article by department; promulgation of rules and regulations by board; duties of department
(a) This article shall be administered by the Department of Human Resources. The Board of Human Resources shall issue such rules and regulations as may be necessary to administer this article properly and to comply with the requirements of Part A of Title IV of the federal Social Security Act, as amended, the state plan, and any future amendments to such Act or plan. The initial rules and regulations for the Georgia TANF Program shall be promulgated by the board pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," and specifically Code Section 50-13-4 no later than July 1, 1997.
(b) The board shall ensure that such rules and regulations provide for:
(1) Methods of administration necessary for the proper and efficient operation of the state plan for implementation of this article;
(2) Reasonable standards for determining eligibility and the extent of assistance available for recipients;
(3) Consideration of the income and resources of an applicant for assistance in determining eligibility;
(4) Personal responsibility obligations and work activity requirements consistent with Part A of Title IV of the federal Social Security Act, as amended, and the state plan, provided that programs included in the personal responsibility obligations established by the board shall include counseling on abstinence until marriage;
(5) Criteria which make an applicant ineligible to receive benefits under the Georgia TANF Program, including but not limited to those specified in Code Section 49-4-184;
(6) Specific conduct which would authorize the reduction or termination of assistance to a recipient, including but not limited to that specified in Code Section 49-4-185;
(7) Standards whereby certain obligations, requirements, and criteria will be waived for specific applicants or recipients based on hardship;
(8) An administrative hearing process with hearings to be conducted by the Office of State Administrative Hearings in accordance with Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," and subsection (b) of Code Section 49-4-13;
(9) Safeguards which restrict the use and disclosure of information concerning applicants for and recipients of assistance under this article and in accordance with Code Section 49-4-14 and Part A of Title IV of the federal Social Security Act, as amended;
(10) Immunizations for specified diseases for preschool age children as a condition of assistance being provided for such children, and the schedule of and standards for administering such immunizations, including the presentation of a certificate of immunization, unless:
(A) There is appropriate evidence from the local health department or a physician that an immunization sequence has been started and can be completed within a period of up to 180 days, in which case a waiver of the immunization requirement for up to 180 days shall be granted;

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(B) After examination by the local board of health or a physician, any preschool age child is found to have a physical disability which may make vaccination undesirable, in which case a certificate to that effect issued by the local board of health or the physician may be accepted in lieu of a certificate of immunization and shall exempt the child from obtaining a certificate of immunization until the disability is relieved;
(C) The parent or legal guardian furnishes an affidavit swearing or affirming that the immunization conflicts with the religious beliefs of the parent or legal guardian; or
(D) The implementation of such an immunization requirement violates any federal law or regulations or would result in the loss of any federal funds to this state; and
(11) The establishment and maintenance of individual development accounts. The funds in such accounts may be used for postsecondary educational expenses, the purchase of a first home, or business capitalization. The funds in such accounts shall not be considered in determining eligibility for cash assistance pursuant to 42 U.S.C. Section 604(h).
(c) The department shall:
(1) Supervise the administration of assistance pursuant to the Georgia TANF Program by the division of family and children services;
(2) Prescribe necessary forms and procedures to carry out the Georgia TANF Program, subject to the rules and regulations prescribed by the board pursuant to this article;
(3) Publish an annual report and such interim reports as may be necessary. The annual report and such interim reports shall be provided to the Governor and members of the General Assembly and contain the following:
(A) The total TANF caseload count;
(B) Quarterly and annual TANF reports, in full, prepared for submission to the federal government;
(C) The percentage of the TANF caseload and the number of individuals given a hardship exemption from the lifetime limit on cash assistance and a categorization of the reasons for such exemptions;
(D) The number of individuals who received transportation assistance and the cost of such assistance;
(E) The number of individuals who received diversionary assistance in order to prevent their requiring TANF assistance and the categories and cost of such diversionary assistance, and job acceptance and retention statistics;
(F) The number of individuals denied assistance due to a serious violent felony conviction;
(G) The number of mothers under 19 years of age who received assistance and their percentage of the total TANF caseload;
(H) The number of children receiving subsidized child care and the total and average per recipient cost of child care provided to TANF recipients;
(I) Data on teen pregnancy prevention;
(J) The number of families sanctioned;

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(K) The number of legal immigrants receiving TANF benefits by category of immigration status;
(L) The number of families no longer eligible because of time limits;
(M) Follow-up information on job retention and earnings; and
(N) An evaluation of the effect of Code Section 49-4-186 on the number of births to TANF recipient families.
The information required under this paragraph shall be provided on a county-by-county basis where feasible; and
(4) Develop a plan, on or before January 1, 1998, to provide incentives for employers to hire those TANF recipients who have difficulty in finding employment.

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O.C.G.A. 31-12-3.1 (2004)

31-12-3.1. Vaccination registry; reporting requirements, maintenance, and use

(a) The department, for purposes of establishing and maintaining a single repository of accurate, complete, and current vaccination records to be used in aiding, coordinating, and promoting effective and cost-efficient disease prevention and control efforts, shall establish and maintain a vaccination registry.
(b) Any person who administers a vaccine or vaccines licensed for use by the United States Food and Drug Administration to a person shall for each such vaccination provide to the department such data as are deemed by the department to be necessary and appropriate for purposes of the vaccination registry established pursuant to subsection (a) of this Code section, including, without limitation:
(1) The name of the person;
(2) The person's date and place of birth, including the name of the hospital where delivered, if applicable;
(3) The names and addresses of the person's parents or guardians if the person is 18 years of age or younger;
(4) The date of the vaccination and the specific type or types of vaccine or vaccines administered to the person on that date; and
(5) Complications or side effects resulting from a vaccination, if any.

Vaccination data reporting requirements, including without limitation the types of data required to be reported and the time and manner of reporting such data, shall begin after the registry has established linkages to vaccine providers and shall be established by the department in consultation with the United States Centers for Disease Control and Prevention, the Georgia chapter of the American Academy of Pediatrics, and the Georgia Academy of Family Physicians.
(c) The department shall utilize the registry to provide notices, whether by mail, telephone, personal contact, or other means, to persons and to parents or guardians regarding their children or wards who are due or overdue for a particular type of vaccination according to recommended vaccination schedules. The department shall consult with medical services providers to determine the most effective and efficient manner of using the registry to provide such notices.
(d) Vaccination records for any person included within the vaccination registry shall be maintained as part of the registry until the person's death.
(e) Individually identifiable vaccination information regarding a person may be provided to the department by, or released by the department to, a local health department, hospital, physician, or other provider of medical services to the person or to a school or child care facility in which the person is enrolled if the person is 18 years of age or younger without the consent of the person or the person's parents or guardians. All persons shall be enrolled unless a specific exemption is requested by the person or the person's parent or guardian if the person is 18 years of age or younger. A parent or guardian may obtain and upon request to the department shall be provided with all individually identifiable vaccination registry information regarding his or her child or ward. Except as provided otherwise by this Code section, individually identifiable vaccination registry information shall be treated as confidential and shall not be released to a third party without consent of the person or the person's parent or guardian if the person is 18 years of age or younger.

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(f) Nothing in this Code section shall:
(1) Prohibit the department from providing or publishing registry information in aggregate form for scientific, educational, or public health purposes, provided that such information is published without releasing or identifying individual names contained in the registry;
(2) Prohibit the department or any medical services provider from notifying a person or the person's parent or guardian if the person is 18 years of age or younger of the person's vaccination status or of a vaccination that is due or overdue according to recommended vaccination schedules; or
(3) Diminish a parent's or guardian's responsibility for having a child vaccinated properly.
(g) Any person, including but not limited to practitioners of the healing arts, submitting or obtaining in good faith vaccination reports or data to or from the department in compliance with the provisions of this Code section and any rules or regulations promulgated pursuant to this Code section shall not be liable for any civil damages therefor.
(h) The department is authorized to accept any grants, gifts, awards, and funds from government, public, and private sources to supplement any appropriation made for the purpose of funding the provisions of this Code section.
(i) The department is authorized and directed to promulgate such rules and regulations as are necessary and appropriate to implement the provisions of this Code section.

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5. Requirements of School/Childcare Law-----7/2007 DHR Rules, Chapter 290-5-4

290-5-4-.01 Definitions.
Unless a different meaning is required by the context, the following terms as used in these rules shall have the meaning hereinafter respectively ascribed to same:
(a) "Immunization" means the presumptive presence in the body of an immunized person of sufficient protective antibodies or of cellular immunity, as a result of previous infection or introduction of specific antigenic agents, or a presumptive state of being so conditioned by previous experience with a particular disease so as to provide an immediate and protective response upon exposure to specific infectious agents of that disease;
(b) "Local Board of Health" means any county, city or District Board of Health supported entirely or in part by the Department through the allocation of public funds or other support;
(c) "Physician" means a practitioner of the healing arts licensed in accord with O.C.G.A. or the equivalent laws of the practitioner's jurisdiction if outside Georgia;
(d) "Physical Disability" means any physical condition or physiological idiosyncrasy which might in the opinion of a physician cause a specific immunization to endanger the life or health of the recipient;
(e) "Health Authority" means the Department of Human Resources or a local Board of Health in Georgia or the corresponding agencies in other states or nations;
(f) "Epidemic" means an outbreak, or rise in incidence rate, or spread of incidence of a contagious or infectious disease so as to constitute a clear and present risk of infection to the public at large or to congregated groups thereof;
(g) "Facility" means any public or private day center or nursery intended for the care, supervision, or instruction of children;
(h) "School" means any public or private educational program or institution instructing children at any level or levels, kindergarten through twelfth grade, or children of ages five through nineteen if grade divisions are not used;
(i) "Affidavit" means a written statement made under oath before an authorized magistrate or officer which certifies that the required immunization conflicts with religious beliefs of the parent or guardian.
(j) "New Entrant" 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 twelve (12) months or one (1) school year.
Authority O.C.G.A. Secs. 20-2-771, 31-12-3, 49-5-12. History. Original Rule entitled "Definitions" adopted. F. Jan. 28, 1977; eff. Feb. 17, 1977. Repealed: New Rule of same title adopted. F. Nov. 29, 1979; eff. Dec. 19, 1979. Repealed: New Rule of same title adopted. F. Apr. 22, 1982; eff. May 12, 1982. Amended: F. July 19, 1989; eff. Aug. 8, 1989. Amended: F. Jan. 20, 2000; eff. Feb. 9, 2000. Repealed: New Rule of same title adopted. F. Feb. 22, 2007; eff. Mar. 14, 2007.

290-5-4-.02 Immunization Required.
(1) Except as otherwise provided by law or herein specified, immunization as specified by section 290-5-4-.03 of this chapter against the following named diseases, shall be required for entrance into any school or facility operating in the state:
(a) Diphtheria;
(b) Pertussis;
(c) Tetanus;
(d) Poliomyelitis;
(e) Measles;
(f) Rubella;
(g) Mumps;
(h) Haemophilus influenzae type B (Not required on or after 5th birthday);
(i) Hepatitis B;
(j) Varicella;
(k) Pneumococcal (Not required on or after 5th birthday);
(l) Hepatitis A.
(2) For any child attending any school or facility in the state of Georgia for the first time, a parent or guardian must submit a valid certificate of immunization. School or facility officials, for justified reasons, may allow a child to attend for up to 30 calendar days after first admittance without a valid certificate of immunization. Certificates of Immunization are to be issued in accord with the current Official Immunization Schedules. A certificate may be issued for a child who has not received all required immunizations with the conditions that the child is in the process of completing required immunizations and that immunizations are being scheduled with the shortest intervals recommended in the current Official Immunization Schedules. The certificate must be retained and monitored for currency by the school or facility while the child continues in attendance and must be made available for inspection during normal business hours by authorized health authority officials. When a child transfers to another school or facility, the certificate of immunization must be transferred. When a child ceases to attend without transfer, the certificate should be returned to the parent or guardian.
(3) A certificate for a child who is in the process of receiving all required vaccines must have a date of expiration that relates to the date the next required immunization is due or the date on which a medical exemption must be reviewed. A new certificate must then be obtained and submitted to the school or facility within 30 days after the expiration date. Children whose parents fail to renew said certificates within the time allotted shall not be permitted to continue in attendance.

(4) Effective July 1, 2007 for entrance into kindergarten and for new entrants into a Georgia School, students must have a total of two (2) doses of measles vaccine, two (2) doses of mumps vaccine, one (1) dose of rubella vaccine and a total of two (2) doses of varicella (chickenpox) vaccine.
(5) Effective July 1, 2007 for entrance into grade six (6), students must have a total of two (2) doses of measles vaccine, two (2) doses of mumps vaccine, one (1) dose of rubella vaccine and two (2) doses of varicella (chickenpox) vaccine.
(6) Effective July 1, 2007 children attending any childcare facility (including prekindergarten programs) must show evidence of protection against pneumococcal disease.
(7) Effective July 1, 2007 children born on or after January 1, 2006 who are attending childcare facilities (including pre-kindergarten programs) and schools must have proof of protection against hepatitis A disease (vaccination or serology).
(8) Requirements for hepatitis A, hepatitis B, measles, mumps, rubella and varicella vaccines may be waived with serologic proof of immunity. Requirements for varicella vaccine may be waived also with a healthcare provider diagnosis of varicella disease or healthcare provider verification of history of varicella disease.
Authority O.C.G.A. Secs. 20-2-771, 31-2-4, 31-12-3, 49-5-12. History. Original Rule entitled "Provisions; Certificate of Immunization" adopted. F. Jan. 28, 1977; eff. Feb. 17, 1977. Repealed: New Rule entitled "Immunization Required" adopted. F. Nov. 29, 1979; eff. Dec. 19, 1979. Repealed: New Rule of same title adopted. F. Apr. 22, 1982; eff. May 12, 1982. Amended: F. July 19, 1989; eff. Aug. 8, 1989. Amended: F. Aug. 19, 1993; eff. Sept. 8, 1993. Amended: F. Nov. 21, 1996; eff. Dec. 11, 1996. Amended: F. Jan. 20, 2000; eff. Feb. 9, 2000. Repealed: New Rule of same title adopted. F. Feb. 22, 2007; eff. Mar. 14, 2007

290-5-4-.03 Official Immunization Schedules. Amended.
(1) An immunization regimen equivalent to the current immunization schedule developed by the Advisory Committee on Immunization Practices (ACIP), adopted by the Department of Human Resources, and promulgated in the official state immunization program manual shall be deemed the minimum regimen of immunization which satisfies the requirements of and creates the condition of immunization. Immunization certified by local Boards of Health shall be accomplished in accord with the departmental immunization schedule. (2) Any other immunization schedule which includes the immunizations itemized in Rule 290-5-4-.02, Immunizations Required, and equals or exceeds the minimum requirements of the Departmental Immunization Schedule shall be deemed to satisfy the requirement for issuance of a Certificate of Immunization. (3) Copies of the Departmental Immunization Schedule may be obtained from the Department or local Board of Health.
Authority Ga. L. 1964, pp. 499, 564, 644; Ga. L. 1968, pp. 1436-1438; Ga. L. 1973, pp. 910, 911; Ga. L. 1977, pp. 787-789; Ga. L. 1979, p. 1284; Ga. L. 1981, pp. 756, 757; O.C.G.A. Secs. 20-2-771, 31-12-3, 49-5-12. History. Original Rule entitled "Immunizations Required" was filed on Jan. 28, 1977; eff. Feb. 17, 1977. Amended: F. Apr. 25, 1978; eff. May 15, 1978. Amended: Rule repealed and a new Rule entitled "Official Immunization Schedules" adopted. F. Nov. 29, 1979; eff. Dec. 19, 1979. Amended: Rule repealed and a new Rule of the same title adopted. F. Apr. 22, 1982; eff. May 12, 1982. Amended: F. Jul. 19, 1989; eff. Aug. 8, 1989. Amended: F. Jan. 20, 2000; eff. Feb. 9, 2000.

290-5-4-.04 Certificate of Immunization. Amended.
Immunization shall be deemed to exist when certification is made by a physician or a qualified employee of a local Board of Health or the State Immunization Program, on a form provided by or approved by the Department of Human Resources, that a named person has been vaccinated against a specific disease in compliance with Section 290-5-4-.03 of this Chapter. Such Certificates may only be issued to persons immunized in accordance with Section 290-5-4-.02, .03 and .04 of this Chapter.
Authority Ga. L. 1964, pp. 499, 564, 644; Ga. L. 1968, pp. 1436-1438; Ga. L. 1973, pp. 910, 911; Ga. L. 1977, pp. 787-789; Ga. L. 1979, p. 1284; Ga. L. 1981, pp. 756, 757; O.C.G.A. Secs. 20-2-771, 31-12-3, 49-5-12. History. Original Rule entitled "Certificate of Adequate Immunization" was filed on Jan. 28, 1977; eff. Feb. 17, 1977. Amended: Rule repealed and a new Rule entitled "Certificate of Immunization" adopted. F. Nov. 29, 1979; eff. Dec. 19, 1979. Amended: Rule repealed and a new Rule of the same title adopted. F. Apr. 22, 1982; eff. May 12, 1982. Amended: F. Jan. 20, 2000; eff. Feb. 9, 2000.

290-5-4-.05 Certificate of Immunization Issued for Child with Physical Disability. Amended.
A physical disability having been found to exist, and in the opinion of a physician there being no clear prospect of when said disability or disabilities can be removed, said physician may at his discretion issue a Certificate of Immunization indicating medical exemption. A Certificate of Immunization indicating medical exemption shall be subject to review as provided by the certifying or another physician who may reissue it from year to year until and unless there is cause to believe that immunization or a specific immunization may finally be accomplished without danger to the child's health.
Authority Ga. L. 1964, pp. 499, 564, 644; Ga. L. 1968, pp. 1436-1438; Ga. L. 1973, pp. 910, 911; Ga. L. 1977, pp. 787-789; Ga. L. 1979, p. 1284; Ga. L. 1981, pp. 756, 757; O.C.G.A. Secs. 20-2-771, 31-12-3, 49-5-12. History. Original Rule entitled "Official Immunization Schedules" was filed on Jan. 28, 1977; eff. Feb. 17, 1977. Amended: Rule repealed and a new Rule entitled "Certificate of Immunization Issued for Child with Physical Disability" adopted. F. Nov. 29, 1979; eff. Dec. 19, 1979. Amended: Rule repealed and a new Rule of the same title adopted. F. Apr. 22, 1982; eff. May 12, 1982. Amended: F. Jan. 20, 2000; eff. Feb. 9, 2000. .

290-5-4-.06 Certificate of Immunization for a Child Immunized Outside of Georgia. Amended.
Upon presentation of written proof (by vaccine type with the date of each dose) attested to by a physician licensed by the State of Georgia, or another state, or attested to by an authorized representative of the Health Authority of another country, state or nation, that all required immunizations have been accomplished for a child for whom entrance into a school or facility in Georgia is sought, or that a physical disability exists in such child, regardless of the grade of school or facility to be entered, said local Board of Health or physician shall place the presented proof on file and may issue a Certificate of Immunization as provided by Rule 290-5-4-.04, or a Certificate of Immunization indicating medical exemption as provided by Rule 290-5-4-.05.
Authority Ga. L. 1964, pp. 499, 564, 644; Ga. L. 1968, pp. 1436-1438; Ga. L. 1973, pp. 910, 911; Ga. L. 1977, pp. 787-789; Ga. L. 1979, p. 1284; Ga. L. 1981, pp. 756, 757; O.C.G.A. Secs. 20-2-771, 31-2-4, 31-12-3, 49-5-12. History. Original Rule entitled "Certificate of Immunization Issued for Child with Physical Disability" was filed on Jan. 28, 1977; eff. Feb. 17, 1977. Amended: Rule repealed and a new Rule entitled "Certificate of Immunization for a Child Immunized Outside of Georgia" adopted. F. Nov. 29, 1979; eff. Dec. 19, 1979. Amended: Rule repealed and a new Rule of the same title adopted. F. Apr. 22, 1982; eff. May 12, 1982. Amended: F. Jul. 19, 1989; eff. Aug. 8, 1989. Amended: F. Aug. 19, 1993; eff. Sept. 8, 1993. Amended: F. Nov. 21, 1996; eff. Dec. 11, 1996. Amended: F. Jan. 20, 2000; eff. Feb. 9, 2000.

290-5-4-.07 Epidemics. Amended.
When in the opinion of the Department of Human Resources or local Board of Health an epidemic or the threat of an epidemic exists, said Department or Board shall immediately, by the most expedient means notify the governing authorities of all schools and facilities within the affected area. When the threat of epidemic exists, the health authority may require immunization for those who object on the grounds of religious beliefs, or may alternatively prohibit attendance at schools or facilities within the area by unimmunized children.
Authority Ga. L. 1964, pp. 499, 564, 644; Ga. L. 1968, pp. 1436-1438; Ga. L. 1973, pp. 910, 911; Ga. L. 1977, pp. 787-789; Ga. L. 1979, p. 1284; Ga. L. 1981, pp. 756, 757; O.C.G.A. Secs. 20-2-771, 31-12-3, 49-5-12. History. Original Rule entitled "Certificate of Immunization Issued for Child Exempt from Immunization Because of a Conflict with Religious Tenets and Practices" was filed on Jan. 28, 1977; eff. Feb. 17, 1977. Amended: Rule repealed and a new Rule entitled "Epidemics" adopted. Filed November 29, 1979; effective December 19, 1979. Amended: Rule repealed and a new Rule of the same title adopted. F. Apr. 22, 1982; eff. May 12, 1982. Amended: F. Jan. 20, 2000; eff. Feb. 9, 2000.

290-5-4-.08 Repealed.
Authority Ga. L. 1964, pp. 499, 564, 644; Ga. L. 1968, pp. 1436-1438; Ga. L. 1973, pp. 910, 911; Ga. L. 1977, pp. 787-789; and Ga. L. 1979, p. 1284. History. Original Rule entitled "Certificate of Immunization Issued for a Child Immunized Outside of Georgia" was filed on January 28, 1977; effective February 17, 1977. Amended: Rule repealed. Filed November 29, 1979; effective December 19, 1979.

290-5-4-.09 Repealed.
Authority Ga. L. 1964, pp. 499, 564, 644; Ga. L. 1968, pp. 1436-1438; Ga. L. 1973, pp. 910, 911; Ga. L. 1977, pp. 787-789; and Ga. L. 1979, p. 1284. History. Original Rule entitled "Enforcement" was filed on January 28, 1977; effective February 17, 1977. Amended: Rule repealed. Filed November 29, 1979; effective December 19, 1979.

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HISTORICAL STATEMENT LISTING

HISTORICAL STATEMENT LISTING DATES FOR SCHOOL AND CHILDCARE IMMUNIZATION
REQUIREMENTS AND OTHER VACCINE ISSUES

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HISTORICAL STATEMENT LISTING

2/1977 1994

Regulation requiring Immunization of Children as a Prerequisite to Admission to School becomes effective
Second MMR required for entrance into 6th grade (Form 3189 introduced) "Effective with the 1994-95 school year, for entrance into the sixth grade of schools in this state or at its equivalent age, the child must have at least one (1) additional dose of MMR vaccine, for a total of two (2) MMR vaccines administered on or after the child's first birthday and at least thirty (30) days apart." [See DHR Rules 290-5-4-.02 (4) (b).]

4/1996 Legislation providing for the establishment of a statewide childhood immunization registry

1997-98

Hepatitis B vaccination requirement for all children born after 1-1-92 who are entering kindergarten (5 year old) or day care
"Effective date: 1997-98 school year for kindergarten entrants and September 1, 1997 for children entering child centers." "Affected children: all children born after January 1, 1992 entering kindergarten or child care facility."
[See DHR Rules 290-5-4-.02 (4) (a) (3).] [See Memorandum of January 17, 1997]

1997

Change to an IPV/OPV sequential schedule recommended "...begin to implement the new schedule on February 1, 1997, or as soon as possible." [See Memorandum of January 29, 1997]

2000

All IPV schedule routinely recommended. (No OPV available in the US as of 11/2000.)
"IPV is now the only polio vaccine recommended for routine use. A child should now receive IPV for all four scheduled doses."
[See Memorandum of January 14, 2000]

2000-01

Requirement for 2nd measles/MMR for children entering a Georgia school for the first time
"Two doses of a measles-containing vaccine, one dose of mumps vaccine, and one dose of rubella vaccine is now required at the time of entry to school."
[See DHR Rules 290-5-4-.02 (4).]

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HISTORICAL STATEMENT LISTING

2000-01 (cont'd)

Varicella immunity required for entrance to school or attendance in Daycare "A child entering any child care facility or school in Georgia for the first time (at any age up to 19 years) must be age-appropriately immunized with all of the required vaccines (DTP, DTaP, DT, or Td; Hepatitis B; Hib; OPV or IPV; Measles, Mumps and Rubella or MMR; and Varicella)." [See DHR Rules 290-5-4-.02 (1).]

Began use of Immunization Certificate (Form 3231) for admission to school and day care "Children attending child care or Pre-K programs on or after August 1, 2000 whose immunization certificate expires will need to have their immunization status evaluated, the recommended immunizations administered, and a new certificate (Form 3231) issued within thirty days after the certificate (Form 3227) expires."

"A new Certificate of Immunization (Form 3231) will serve as a means of documenting the immunization status for children who will be admitted to any facility or school in Georgia for the first time on or after August 1, 2000. The new Certificate of Immunization (Form 3231) will replace the current certificates for school (Form 3032) and day care (Form 3227) and may be used any time on or after February 1, 2000."
[See Memorandum of January 20, 2000, the Ga. Code, and current DHR Rules and Regulations posted on the GA Immunization Program website at http://health.state.ga.us/programs/immunization.asp

2001-02

Requirement for 6th graders to show proof of immunity to varicella "The requirement for children to show proof of immunity against varicella prior to school entry and for attendance to day care was extended to include all students entering sixth grade (6th) or the age equivalent grade beginning 2001." [See Memorandum of October 4, 2000]

5/2001

Began Td prioritization "Two populations should be given priority for the administration of Td. The first are those who need treatment for acute wounds. The second priority is children between the ages of 7-18 who are traveling to a country where the risk for diphtheria is high." [See Memorandum of May 1, 2001]

1/2002

Began PCV prioritization "Interim Recommendations for Pneumococcal Conjugate Vaccine Prevnar)" [See Memorandum of January 4, 2002]

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2/2002

Changes to ACIP General Recommendations. Most significant for audit purposes were the institution of the 4-day grace period and the publication of a minimum age and interval chart. A copy of the 2002 Recommended Schedule accompanied this mailout.
[See Memorandum of February 20, 2002 and the General Recommendations on Immunization, MMWR, February 8, 2002]

3/2002 Interim recommendations for prioritization of DTaP, varicella, MMR, and continued prioritization of Td and PCV. Recommendations were also made for the completion of immunization certificates (Forms 3231 and 3189) for school and day care attendance reflecting the deferred status of certain vaccines. Providers were strongly encouraged to institute or implement recall systems in order to immunize children as soon as vaccine supplies became available. [See Memorandum of March 8, 2002]

6/2002

MMR and Td deferrals withdrawn. Recommendations were made for providers to start recalling children as soon as possible and to resume issuing regular certificates when deferred vaccines were administered.
[See Memorandum of June 6, 2002]

7/2002

DTaP and varicella deferrals withdrawn Revision of 3231REQ and 3231INS. (NOTE: Form 3231 did not change.) Development of Standardized Statement for Form 3231 for public health providers to use in dealing with students whose original certificate (Form 3032) is lost
[See Memorandums of July 8, 2002; July 30, 2002; July 18, 2002; and July 18, 2002]

4/2003

PediarixTM (DTaP-Hep B-IPV) made available through the Georgia Immunization Program.
[See memorandum of April 21, 2003]

5/2003 PCV deferral withdrawn. [See memorandum of May 16, 2003]

10/2003 Revision of 3231, 3231 INS, 3231 REQ [See memorandum of October 1, 2003]

2/2004 and 3/2004 Suspension of 4th dose of PCV, followed 3 weeks later by suspension of
doses 3 and 4.
[E-mails on February 12, 2004 and March 2, 2004]

7/1/2004 Legislation passed expanding statewide childhood registry to birth to death lifetime registry

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HISTORICAL STATEMENT LISTING

7/2004 Influenza vaccine ROUTINELY recommended for 6-23 month old children

[Recommended Childhood & Adolescent Immunization Schedule, July-December 2004]

9/2004 PCV deferrals withdrawn. [E-mails on September 22, 2004]

7/2006 Rotavirus, MMRV, and Hepatitis A Vaccine Guidelines sent by memorandum [E-mailed on July 24, 2006]

8/2006 Began shipments of rotavirus vaccine and MMRV vaccine to VFC providers

8/2006

Letter dated August 8, 2006 sent to all VFC Providers with information on MMRV
and also documenting the categories of VFC-eligible children who could receive 2nd doses of varicella vaccine for the present time.

5/07

Memo signed by Dr. Stuart Brown, Director of the Division of Public Health,

authorizing public health clinics to administer hepatitis A, hepatitis B, and HPV

vaccines without parental consent to teens being seen in STD and Family

Planning clinics.

[Memorandum dated May 4 2007]

5/07

Human papillomavirus vaccine (HPV) was shipped to public health clinics

7/2007

New vaccine requirements for school and childcare attendance, effective 7-1-07
Children entering childcare, pre-K, and Head Start facilities will be required to show age appropriate vaccination against pneumococcal disease; and show proof of immunity to or vaccination against hepatitis A, if born on or after 1-1-06.
Children entering a Georgia school for the first time, or those classified as "new entrants," and those students entering the 6th grade, will have to show evidence of 2 doses of mumps vaccine (or immunity) and 2 doses of varicella vaccine (or immunity).

12/2007

National limited supply of Hib vaccine. ACIP defers booster dose

4/2008

Hib shortage and 3231 In GRITS, if all other age-appropriate vaccines other than Hib are up-to-date,
the 3231 will reflect an expiration date of 30 days prior to the child's 5th birthday. Once the child turns 5, a completed 3231 can be printed from GRITS as Hib is no longer recommended

5/2008

School and Daycare user given access and the ability to print up-to-date Form 3231 in GRITS

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6/2008

Pentacel (DTap/IPV/Hib) made available through Georgia Immunization Program

2/2009

Statement from the Department of Health and Human Services regarding the decisions of the U.S. Court of Federal Claims in the Omnibus Autism Proceedings find no association between vaccines and autism

2/2009

ACIP HepA Overdue Changes and BOOSTRIX Max Age Change The HepA dose 1 is now overdue at 2 years of age. HepA dose 2 is now
overdue 7 months after dose 1, but no earlier than 2 years of age

2/2009

VFC sends communication letter addressing vaccine choice and switch from Rotateq to Rotarix vaccine

2/2009 2/2009

Boostrix (manufactured by GlaxoSmithKline) is now licensed for adolescents and adults ages 10 through 64.
Hib alert letter sent to Georgia Pediatricians by Dr. Elizabeth Ford regarding Hib Vaccine

2/2009

Hepatitis B vaccine supply limited

5/2009 6/2009

Georgia Medical Practice Act adds language to allow medical assistants to give Injections
Georgia Health Departments are approved for 3rd party billing

7/2009

CDC reinstated the Hib booster dose for children from 12-15 months. [Updated Recommendations for Use of Haemophilus influenzae Type b (Hib) Vaccine: Reinstatement of the Booster Dose at Ages 12--15 Months, June 26, 2009]

8/2009

GRITS algorithm for Pediarix vaccine changed. The spacing of Pediarix vaccine doses for the hepatitis B antigen did not
meet the minimum intervals between doses

2009

Flu Vaccine law (HB 217) O.C.G.A. 43-34-26.1 enacted

10/2009

ARRA (American Recovery and Reinvestment Act of 2009) grants funds used for purchase and / or administration fees for HPV, Hep A & B and Tdap (for post partum WIC mothers) for adult vaccines.

10/2009

Interim recommendations for prioritization of novel H1N1 vaccine established by CDC

10/2009

Novel H1N1 vaccine shipped to private and public approved H1N1 vaccine providers

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Form 3231 (Rev. 03/2007)
Use required on or after July 1, 2007.

Georgia Department of Human Resources CERTIFICATE OF IMMUNIZATION

Form 3231

Total Doses Diagnosed Serology + History Med. Exemption

Child's Name (Last name first) (Optional) Parent/Guardian Name (Last name first)

10 01 2001
Birthdate

OR Date of Expiration
(Next required immunization or review of medical exemption due.)

(Fill in X) Complete For School Attendance
Child must be 4 years and have met all requirements for school attendance. The vaccine history section must be filled in.

Unless specifically exempted by law, Georgia law (O.C.G.A. 20-2-771) requires a certificate on file for each child in attendance in any school or child care facility in Georgia with penalties for failure to comply. Detailed instructions for this form and immunization requirements by age are spelled out in policy guides 3231INS and 3231REQ distributed by the Georgia Immunization Program.

VACCINE

DATE

DATE

DATE

DATE

DATE

DATE

MM DD YY MM DD YY MM DD YY MM DD YY MM DD YY MM DD YY
Required Vaccines for School or Child Care Attendance

DTP, DTaP, DT
Td or Tdap
Hepatitis B
OPV
IPV HIB
(Under Age 5)
PCV
(Under Age 5)
Measles
Mumps
Rubella Hepatitis A
(Born on/after 1/1/06)
Varicella

Recommended Vaccines (For Information Only)

MCV/MPSV

Rotavirus

HPV

Influenza
Td or Tdap
(Booster Dose)
Notes: A licensed physician or qualified employee of a local Board of Health or the State Immunization Program is responsible for the content of this certificate. All dates must include month, day and year. In cases of natural immunity or Medical Exemption, the 4 digit year of infection, test or exemption must be filled in in the appropriate box(es). The certificate is NOT valid without name and birthdate of the child, date of expiration OR "X" in Complete for School Attendance box, legible name and address of the physician or health department, certified by signature and a date of issue. A school or facility official is responsible for keeping a current valid certificate on file for each child in attendance. A certificate must be replaced within 30 days after expiration. When a child leaves or transfers to another facility, the Certificate of Immunization should be given to a parent/guardian or sent to the new facility.

Printed, Typed or Stamped Name, Address and Telephone # of Licensed Physician or Health Dept.
Certified by (Signature)

12 01 2006 Date of Issue

Policy Guide 3231INS Standards for Issuing and Filing Certificates of Immunization
[Form 3231 (Rev. March-2007)] For Georgia Facilities and Schools

Who is required to have the Certificate of Immunization (Form 3231)? Children attending any childcare facility, pre-kindergarten, Head Start program, nursery, or school are required to have this form on file. This includes public and private operations and all enterprises, educational programs and institutions involved in the care, supervision or instruction of children. Certificates are required for all children through grade 12. There is no lower age limit. It will not be necessary to replace Form 3032 or prior versions of Form 3231 for children already attending schools. Who may issue certificates? Only a physician licensed in Georgia or qualified employee of a local Health Department or the State Immunization Program may issue this certificate. The physician or health department is responsible for interpretation of and compliance with the requirements set forth in Chapter 290-5-4 of the Rules of the Department of Human Resources Division of Public Health. How to file and maintain the certificates: 1. A valid certificate for all children must have the following information legibly completed:
Child's Name Birth date Name, address, and phone number of a Physician or Health Department Certified by Signature Date of Issue Dates (month, date and year) in the vaccine history (dates vaccines administered) section and/or 4 digit year
in the "Disease Dx", "Serology +", "Disease Hx" or "Medical Exemption" boxes. 2. A valid certificate for children under 4 years of age must have:
All of the information in item #1 and a "Date of Expiration" noted in the appropriate space. 3. A valid certificate for a child age 4 years or older must have:
All of the information in item #1 and either an X in the "Complete For School Attendance" box or a marked "Date of Expiration"
4. Valid certificates marked "Complete For School Attendance" do not expire. 5. The certificate becomes invalid on the expiration date indicated. If a current certificate has not been
submitted within 30 days after the expiration date, the child must be excluded from attendance until a current certificate is obtained. 6. A school/facility official is responsible for keeping track of certificates with expiration dates and for notifying a parent/guardian of an upcoming expiration date and requesting that an up-to-date certificate be submitted. 7. A valid certificate of immunization must be kept on file by the school/facility and be available for inspection by health officials. The school/facility is not responsible for the accuracy of immunization information filled in by the certifying authority. 8. If a child attends more than one school/facility, a photocopy of this form must be on file at the second school/facility. 9. If a child leaves or transfers to another school/facility, this certificate should be given to a parent/guardian or sent to the new school/facility. 10. Any school/facility official who does not enforce the requirements and any parent/guardian who intentionally does not comply with the requirements shall be guilty of a misdemeanor. See Official Code of Georgia Annotated, 20-2-771(h). Instructions for completing certificates: 1. ALL dates must include month, day and year. 2. The "Child's Name" and "Birthdate" must be filled in. 3. The "Date of Expiration" is the date the child's next immunization is due or the date a review of the medical exemption is due. This date must be filled in when a child is in the process of receiving the required number of vaccine doses
appropriate for age as set forth in Policy Guide 3231REQ, Vaccine Requirements for Attending Facilities and Schools in Georgia. The date filled in may be the date a review of a medical exemption for a vaccine is due. The "Date of Expiration" must be filled in if "Complete for School Attendance" is not marked.

Rev. March/2007

(Use Required On Or After July1, 2007.)

Page 1 of 2

4. Put an X in the "Complete For School Attendance" box if a child who is four years of age or older has
completed all the immunization requirements for first time attendance in a school in Georgia as set forth in Policy Guide 3231REQ, Vaccine Requirements for Attending Facilities and Schools in Georgia. Note that requirements for kindergarten (age 5 years) include doses indicated by the ACIP for 4-6 years. The "Complete For School Attendance" box must be filled in if the "Date of Expiration" is not. 5. The Georgia Department of Human Resources establishes the requirements for immunization for school/facility attendance in accord with the Recommended Childhood Immunization Schedule, United States, developed and approved annually by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP). See Policy Guide 3231REQ Vaccine Requirements for Attending Facilities and Schools in Georgia for requirements for doses for age, minimum ages, and minimum intervals between doses for children who are behind schedule. 6. Hib and PCV vaccine are not required on or after the 5th birthday. The number of doses for both vaccines is dependent on age at first dose and/or the brand(s) of vaccine administered. If the "Complete For School Attendance" box is marked for a child who is 4 years of age, dates for Hib and PCV vaccine must be filled in. 7. The Hepatitis A, Hepatitis B, Measles, Mumps, Rubella and Varicella vaccine requirements may be waived with serologic proof of immunity. Filling in a 4-digit year is required for each requirement waived. 8. For varicella vaccine, the dates for each dose given must be entered or the 4 digit year in one of the columns indicating "Diagnosed" disease, "Serology +" (serologic evidence of immunity), "History" of disease or "Medical Exemption" must be filled in. The Varicella vaccine requirement may be waived with: (a) a physician's diagnosis of disease; or (b) a health care provider's interpretation that a parent/guardian description of chickenpox disease history is indicative of past infection. Filling in a 4-digit year for the year of infection is required. 9. In the interest of having a more complete record, providers are requested to fill in dates of Recommended Vaccines the child has received, but are not required to do so. 10. The certificate is not valid without a printed, typed or stamped name, address, and phone number of the certifying authority in the certification section in the lower right corner. There must be a written or stamped licensed physician's signature or a signature of a qualified employee of a local Board of Health or State Immunization Program on the "Certified by" signature line. 11. The "Date of Issue" is the date a child's immunization status was reviewed and the certificate was issued. It must be filled in. 12. During times when vaccine shortages may necessitate deferral of doses of specific vaccines, the GA Immunization Program will follow the recommendations made by the ACIP and will send providers the interim plans for issuing certificates based on these temporary recommendations. Exemptions: The Official Code of Georgia provides for only two types of exemptions from immunization requirements: 1. Medical: Medical exemption for a vaccine should be filled in only when there is a physical disability or condition that contraindicates immunization for that particular vaccine. There must be an annual review of medical exemptions, and certificates must be reissued with or without indication of exemption. O.C.G.A. 20-2-771(d) 2. Religious: For a child to be exempt from immunizations on religious grounds, the parent or guardian must furnish the school/facility with a notarized affidavit stating that immunization conflicts with his or her religious beliefs. There is no standard form for Religious Exemption. The school/facility must keep the affidavit on file and available for inspection by health officials in lieu of an Immunization Certificate. Affidavits denoting religious exemption do not expire. O.C.G.A. 20-2-771(e) Certificate ordering and computer generated facsimiles: 1. Certificates of Immunization (Form 3231) may be ordered in bulk from: Georgia Immunization Program 2 Peachtree Street N.W, Suite 13-476 Atlanta, GA 30303-3186 The order form can be printed from: http://health.state.ga.us/programs/immunization/ 2. Computerized versions of the Certificate of Immunization (Form 3231) must contain all the information included in the current form provided by the Georgia Department of Human Resources and must be approved by the Georgia Immunization Program prior to use. References: Official Code of Georgia Annotated, 20-2771 and Rules of the Department of Human Resources, Division of Public Health, Chapter 290-5-4.

Rev. March/2007

(Use Required On Or After July1, 2007.)

Page 2 of 2

Policy Guide 3231REQ
Vaccine Requirements for Attending Facilities and Schools in Georgia*
Relative to the Certificate of Immunization (Form 3231)

Side 1

Required Doses for Attendance in Facilities and Schools For Children Who Started Immunizations Before Age 7 Years*

Required Vaccines** with footnote numbers in [ ] [1] DTP, DTaP, DT [2]Hepatitis B [3]Hib HbOC or [3]Hib PRP-T or [3]Hib PRP-OMP [4]Polio [5]MMR [6] Varicella [7] PCV [8] Td/Tdap [9] Hepatitis A

2 Months 4 Months 6 Months of Age of Age of Age

1

2

3

1

2

1

2

3

1

2

3

1

2

1

2

1

2

3

12-15 Months of Age
4 3 4 4 3 3 1 1 4

1

18-24 Months of Age

4-6 Yrs.* (School Entry)
5

4 2 2
2

Total Doses Required*** For Checking Complete For School Attendance Box on Immunization Certificate 5 or 4 (See Footnote [1]) 3 (See Footnote [2]) N/A for school (See Footnote [3]) N/A for school (See Footnote [3]) N/A for school (See Footnote [3]) 4 or 3 (See Footnote [4]) 2 (See Footnote [5]) 2 (See Footnote [6]) N/A for school (See Footnote [7]) (See Footnote [8]) (See Footnote [9])

*These requirements were established in accordance with the current Recommended Childhood and Catch-Up Immunization Schedules, United States. (See references on reverse side.) Georgia requirements for Kindergarten (5 years) include doses indicated for 4-6 years
**There are other vaccines included in the Childhood Immunization Schedule that are recommended routinely but are not required in Georgia for child care or school attendance.
***Children who are behind schedule may attend while in the process of completing the requirements with minimum intervals as indicated below.

Vaccine

Minimum Age For

For First Dose

[1] DTP/DTaP (DT)

6 weeks

[2] Hepatitis B

birth

[3] Hib (Primary Series)

HbOC & PRP-T

6 weeks

PRP-OMP (Pedvax)

6 weeks

[4] Polio

6 weeks

[5] MMR

12 months

[6] Varicella

12 months

[7] PCV

6 weeks

[8] Td/Tdap

See Side 2, Footnote [5]

[9] Hepatitis A

12 months

Minimum interval from dose 1 to 2
1 month 1 month
1 month 1 month 1 month 1 month 3 months 1 month
6 months

Minimum Ages For Initial Immunization

And Minimum Intervals Between Doses

Minimum interval Minimum interval

from dose 2 to 3

from dose 3 to 4

1 month

6 months

See Footnote [2]

N/A

1 month See Footnote [3]
1 month N/A N/A
1 month

See Footnote [3] N/A
See Footnote [4] N/A N/A
See Footnote [7]

Minimum interval from dose 4 to 5 See Footnote [1]
N/A
N/A N/A N/A N/A N/A N/A

With respect to these intervals, 1 month is a minimum of 4 weeks or 28 days.
Don't restart any series, no matter how long since the previous dose. Doses given 4 days before the minimum age or the minimum interval may be counted as valid. Two different live vaccines must be given on the same day or spaced at least 28 days apart.

[1] One dose of DTP/DTaP/DT must be on or after the 4th birthday. If the 4th dose was on or after the 4th birthday, the 5th dose is not needed. The 4th dose should be administered a minimum of 6 months after the 3rd dose. However, the 4th dose does not need to be repeated if administered 4 months after dose 3. Total doses of diphtheria and tetanus toxoids should not exceed 6 before the 7th birthday.
[2] The 3rd dose of Hepatitis B vaccine should be given a minimum of 4 months after the 1st dose and 2 months after the 2nd dose and not before 24 weeks of age. [3] The number of doses of Hib depends on age at 1st dose and brand of vaccine given. The last dose in the series, whether 3rd or 4th, should be given at least 2 months after the
previous dose and not before 12 months of age. Hib is required for children younger than 5 years attending facilities. Hib is not required for admission to kindergarten (5 years) through grade 12 and is not indicated for children who have reached the 5th birthday. One dose is sufficient if it is given at age 15 months or later. The brand name for HbOC is HibTITER. Brand names for PRP-T are ActHIB and OmniHIB. The brand name for PRP-OMP is Pedvax Hib and the Hib component of Comvax is Pedvax Hib [4] If minimum ages and intervals have been maintained,a child who has received 4 doses of all OPV, all IPV or a combination of IPV and OPV is considered to be adequately immunized. A booster dose does not have to be given on or after the 4th birthday. If the 3rd dose of an all IPV or all OPV series is given on or after the 4th birthday, a 4th dose is not needed. [5] The MMR requirement is 2 doses of measles vaccine, 2 doses of mumps vaccine and 1 dose of rubella vaccine . The vaccines may be given as MMR or MMRV (combined antigens) or as single antigens. [6] The varicella requirement is for 2 doses of varicella-containing vaccine for entry into any level, K-12. (See Side 2, Footnote [4]).These may be administered as single dose varicella or in
combination as MMRV.
[7] The number of doses in the PCV series depends on age at 1st dose. The last dose in the series should be given at least 2 months after the previous dose and not before 12 months of age. [8] The number of doses required depends on age at first dose and number of previous doses. See current ACIP Immunization Catch-Up Schedule. [9] Hepatitis A vaccine should be administered to all children born on or after 1-1-06.

Rev. March 2007

Use Required on or After July 1, 2007

Policy Guide 3231REQ
Vaccine Requirements for Attending Facilities and Schools in Georgia*
Relative to the Certificate of Immunization (Form 3231)

Side 2

Required Doses for Attendance in Schools For Children Who Started Immunizations At Age 7 Years or Older*

Required Vaccines** First

with footnote

Visit

numbers in [ ]

[1]Hepatitis B

Engerix 10 mcg or

Recombivax 5 mcg 1

Recombivax 10 mcg

(11-15 years only)

1

[2]Polio

1

[3]MMR

1

[4]Varicella

1

[5]Td/Tdap

1

1 Month After First

1 Month After
Second

2

2

3

2

2

1 Month After Third

4 Months 6 Months

After

After

First Previous

Total Doses Required*** For Checking Complete For School Attendance Box on Immunization Certificate

3
2 4 or 3
2 3

3 (See Footnote [1])
2 (See Footnote [1]) 4 or 3 (See Footnote [2])
2 (See Footnote [3]) 2 (See Footnote [4]) 3 (See Footnote [5])

*These requirements were established in accordance with the current Recommended Childhood Immunization Schedule, United States. See References. **There are other vaccines included in the Childhood Immunization Schedule that are recommended routinely but are not required in GA for child care or school attendance. ***Children who are behind schedule may attend while in the process of completing requirements with minimum intervals indicated above. With respect to these intervals,
1 month is a minimum of 4 weeks or 28 days.
Footnotes:

[1]

The 3rd dose of Hepatitis B Engerix-B 10 mcg or Recombivax-HB 5 mcg should be given a minimum of 4 months after the 1st dose and 2 months after the 2nd dose.

A 3rd dose is not needed when 2 doses of Adult Recombivax-HB 10 mcg are given when a child is 11-15 years old and the 2 doses are at least 4 months apart.

Documentation of this alternate schedule is very important, especially when issuing the 3231 certificate.

[2]

If polio vaccine is all OPV or all IPV, dose 4 is not needed. If polio is a mix of IPV and OPV, 4 doses are required.

[3]

The MMR requirement is 2 doses of measles vaccine, 2 doses of mumps vaccine and 1 dose of rubella vaccine . The vaccines may be given as

MMR or MMRV (combined antigens) or as single antigens.

[4]

Two doses of varicella vaccine are required for children entering school at any level, K-12, for the first time. For children already enrolled, the second dose is required

at 6th grade. If given before age 12, the doses should be separated by 3 months, however, the 2nd dose does not need to be repeated if administered 1 month

after 1st dose. If given on or after the 13th birthday, the doses should be separated by 4 or more weeks.

[5]

One dose of Tdap is recommended in lieu of a dose of Td. If a primary series is indicated, one dose, preferably the first, should be Tdap. If Td has already been

administered, 5 years is the preferred interval to a dose of Tdap, but shorter intervals may be used if risk warrants it.

References: Official Code of Georgia Annotated, Section 20-2-771 Rules of the Department of Human Resources Division of Public Health, Chapter 290-5-4 Georgia Immunization Program Manual Georgia VFC Program Manual Recommendations of the Advisory Committee on Immunization Practices (ACIP) The Red Book - Report of the Committee on Infectious Diseases

Recommended Childhood & Catch-Up Immunization Schedules, U.S.: Centers for Disease Control and Prevention American Academy of Pediatrics (AAP) Approved by ACIP, AAP and American Academy of Family Physicians (AAFP)

Rev. March 2007

Use Required on or After July 1, 2007

Summary of Georgia Immunization Requirements for Child Care & School Attendance
These charts are based on the ACIP Recommendations and Georgia Requirements; for
more detailed information including dose schedules and minimum time intervals, please refer to Georgia Form 3231REQ and Table 1 of the ACIP General Recommendations, MMWR, December 1, 2006.
Required Number of Doses For Children Who Started Immunizations Before Age 7 Years

Required Vaccines
DTP, DT, DTaP
Hep B Hib or Hib as (Pedvax)

2 mo of age
1
1 1 1

4 mo 6 mo 12-15 mo 18-24 of age of age of age mo of
age

2

3

4

2

3

2

3

4

2

3

4-6 yrs of age
5

5-6 yrs of age (Total Doses Required
for School Entry)
5 or 4 (if #4 dose given on or after 4th birthday,
#5 not needed )
3
Required for Child Care and Pre-K only

Polio

1

2

3

4*

4* or 3

MMR

1

2**

2**

Varicella

1

2

2

PCV

1

2

3

4

Required for Child Care & Pre-K only

Td/Tdap

***

Hep A

1

2

Required for Child Care & Pre-K only****

* Provided that minimum ages and intervals have been maintained, a child who has received 4 doses of

all OPV, all IPV, or a combination polio series before the age of 4, is considered to be adequately Immunized. If the 3rd dose of all IPV or all OPV series is given on or after the 4th birthday, a 4th dose

is not needed.

** Actual requirement is for 2 doses each of measles and mumps, and 1 dose of rubella vaccine. *** The number of doses required depends on age at 1st dose and number of previous doses. See current ACIP

Catch-up Schedule.

**** Only for children born on or after 1-1-06

Required Number of Doses For Children Who Started Immunizations After Age 7 Years

Required Vaccines

First Visit

1 Mo

1 Mo

1 Mo

4 Mo

After 1st After 2nd After 3rd After 1st

6 Mo After

Total Doses Required

Dose

Dose

Dose

Dose Previous

Dose

Hep B

1

2

3*

3*

Polio

1

2

3

4** or 3

3 or 4**

MMR

1

2***

2***

Varicella

1

2****

2 ****

Td/Tdap

1

2

3

3*****

* If child received 2 doses of adult Recombivax-HB 10 mcg between the ages of 11-15 yrs and the doses

are separated by at least 4 months, dose 3 is not needed.

** Four doses of polio vaccine are recommended; at least 3 doses are required.

*** Actual requirement is for 2 doses each of measles and mumps, and 1 dose of rubella vaccine.

**** Doses administered between ages 12 months and 12 years should be spaced by 3 months. If given on

or after age 13, the doses should be spaced by 1 month. ***** If primary series is administered at age 11 yrs. or later, 1 dose of the 3 dose series should be Tdap.

(Rev. 03/2007)

GA Immunization Program Manual

Division Of Public Health

IMMUNIZATION REQUIREMENTS AND RECOMMENDATIONS FOR UNIVERSITY SYSTEM OF GEORGIA STUDENTS

The following table contains the University System of Georgia's (USG) required and recommended vaccines for students attending a public college or university. The Board of Regents' approved immunization policy only applies to PUBLIC colleges and universities in Georgia. The University System of Georgia's (USG) student services website at http://www.usg.edu/student_affairs/faq/immun contains additional immunization information.
Private colleges in Georgia develop and implement immunization policy for their campuses. In order to obtain a private college's immunization policy you will need to contact the individual institution. In addition, there is no standardized state immunization form for colleges; the specific institution should be contacted to obtain their version of this record.

5. Requirements of School/Childcare Law 7/2007 Immunization Requirements and Recommendations
for University of Georgia System Students

Immunization Requirements and Recommendations for University System of Georgia Students

Proof of Immunization or Naturally-Acquired Immunity Required for Some or All Students

Vaccine

Requirement

Required for:

Notes

Measles (Rubeola) Mumps

- 2 doses of live measles containing vaccine (combined measles-mumps-rubella or "MMR" meets this requirement), with first dose at 12 months of age or later and second dose at least 28 days after the first dose,
or - Laboratory/serologic evidence of
immunity

Students born in 1957 or later

- 2 doses of live mumps containing vaccine (combined measlesmumps-rubella or "MMR" meets this requirement), with first dose at 12 months of age or later and second dose at least 28 days after the first dose,
or - Laboratory/serologic evidence of
immunity

Students born in 1957 or later

1) Vaccinations received between 1963 1967 must be confirmed to have been with live (not inactivated) vaccine.
2) Due to a theoretical risk of fetal infection, women who are pregnant or considering becoming pregnant within 1 month should not receive this vaccine.
3) Guidelines exist for vaccination of persons with altered immunocompetence2,4.
4) For students born before 1957, proof of immunity may be required if enrolled in health care curriculum.
1) Due to a theoretical risk of fetal infection, women who are pregnant or considering becoming pregnant within 1 month should not receive this vaccine.
2) Guidelines exist for vaccination of persons with altered immunocompetence2,4.
3) For students born before 1957, proof of immunity may be required if enrolled in health care curriculum.

Rubella (German Measles)

- 1 dose at 12 months of age or later (MMR meets this requirement),
or - Laboratory/serologic evidence of
immunity

Students born in 1957 or later
(Because rubella can occur in some persons born before 1957 and because congenital rubella syndrome can occur in the offspring of women infected with rubella during pregnancy, women born prior

1) Due to a theoretical risk of fetal infection, women who are pregnant or considering becoming pregnant within 1 month should not receive this vaccine.
2) Guidelines exist for vaccination of persons with altered immunocompetence2,4.

Rev 1-2007

1

Proof of Immunization or Naturally-Acquired Immunity Required for Some or All Students

Vaccine

Requirement

Required for:

Notes

to 1957 who may

Varicella (Chicken Pox)

- 2 doses spaced at least 3 months apart if both doses are given before the student's 13th birthday,
or - 2 doses at least 4 weeks apart, If
first dose given after the student's 13th birthday: or - Reliable history of varicella disease ("chicken pox"), or - Laboratory/serologic evidence of immunity or - History of herpes zoster (shingles)

become pregnant are strongly encouraged to ensure that they are immune to rubella) All U.S born students born in 1980 or later
All foreign born students regardless of year born

1) Due to a theoretical risk of fetal infection, women who are pregnant or considering becoming pregnant within 1 month should not receive this vaccine.
2) Guidelines exist for vaccination of persons with altered immunocompetence2,4.
3) For students born before 1966, proof of immunity may be required if enrolled in health care curriculum.

Tetanus, Diphtheria

- One tetanus/diphtheria containing All students booster dose within 10 years prior to matriculation. Combined tetanus, diphtheria, and acellular pertussis (whooping cough) booster (Tdap) is preferred but Td is acceptable (Students who are unable to document a primary series of 3 doses of tetanus/diphtheria-containing vaccine (DTaP, DTP, or Td) are strongly advised to complete a 3-dose primary series).

1) Tetanus/diphtheria containing boosters are recommended every 10 years throughout adulthood. Adults should receive a single dose of Tdap to replace a single dose of Td. Tdap should also be given to adults who will have close contact with an infant less than 12 months of age, ideally at least one month before beginning close contact with infants.

Rev 1-2007

2

Proof of Immunization or Naturally-Acquired Immunity Required for Some or All Students

Vaccine

Requirement

Required for:

Notes

Hepatitis B

- 3 dose hepatitis B series (0, 1-2,

Required for all students who May be required (along with

and 4-6 months),

will be 18 years of age or less recommended post-vaccine

or

at matriculation.

serologic testing) for students in

- 3 dose combined hepatitis A and

the health sciences, regardless

hepatitis B series (0, 1-2, and 6-12 It is strongly recommended of age at matriculation.

months),

that all students, regardless of

or

their age at matriculation,

- 2 dose hepatitis B series of

discuss hepatitis B

RecombivaxTM (0 and 4-6 months, given at 11-15 years of age),

immunization with their health care provider.

or

- Laboratory / serologic evidence of

immunity or prior infection

Signed Documentation Stating that Student Has Received the Vaccine OR Reviewed Information Provided as

Required by House Bill 521 Required for Some Students

Vaccine

Requirement

Required for:

Notes

Meningococcal

- 1 dose meningococcal conjugate Newly admitted freshmen or

1) Effective January 2004,

vaccine (preferred)

matriculated students planning

University System of

-+or

to reside in university

Georgia institutions are

- 1 dose of meningococcal

managed campus housing

required by O.C.G.A.

polysaccharide within 5 years

31-12-3.2 to obtain

prior to matriculation,

signed documentation

or

from newly admitted

Signed documentation that

freshman or

student (or parent or guardian if

matriculated students

student <18 years old) has

indicating that they have

received and reviewed

received the vaccine or

information about the disease as

have reviewed

required by

information about the

O.C.G.A. 31-12-3.2

disease. If a student is a

minor, only a parent or

guardian may sign such

document.

Rev 1-2007

3

Vaccine Influenza
Vaccine Human Papillomavirus Hepatitis A
Other Vaccines

Immunization Recommended for All Students
Recommended Schedule - Annual vaccination at the start of influenza season (October
March)

Notes
Strongly recommended for students with medical conditions such as diabetes, asthma, or immunodeficiencies, as well as for students residing in dormitories or other group living situations or who are members of athletic teams.

Immunization Recommended for Some Students Recommended Schedule
- 3 dose HPV series. Dose #2 given 4-8 wks after dose #1, and dose #3 is given 6 mos after dose #1 (at least 10 wks after dose #2).
- 2 dose hepatitis A series (0 and 6-12 months), or - 3 dose combined hepatitis A and hepatitis B series (0, 1-2, and
6-12 months)
- Other vaccines may be recommended for students with underlying medical conditions and students planning international travel. Students meeting these criteria should consult with their physicians or health clinic regarding additional vaccine recommendations.

Recommended for:
Strongly recommended for all unvaccinated women through age 26 yrs.
Strongly recommended for: persons traveling to countries where hepatitis A is moderately or highly endemic, men who have sex with men, users of injectable and noninjectable drugs, persons with clotting-factor disorders, persons working with nonhuman primates, and persons with chronic liver disease

Rev 1-2007

4

References:
1. American College Health Association (ACHA). Recommendations for Institutional Prematriculation Immunizations. August 2006. http://www.acha.org/info_resources/RIPIstatement.pdf
2. CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP). MMWR 2002;51(RR-2):1-35.
3. CDC. Immunization of Adolescents: recommendations of the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Medical Association (AMA). MMWR 1996;45(RR-13):1-17.
4. CDC. Recommendations of the Advisory Committee on Immunization Practices (ACIP): use of vaccines and immune globulins in persons with altered immunocompetence. MMWR 1993;42(RR-4)1-18.
5. CDC. Recommended Adult Immunization Schedule United States, October 2006 September 2007. MMWR 2006:55(40):Q1-Q4. 6. Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003.
Related Links:
Georgia Department of Human Resources, Division of Public Health, Immunization Program: http://www.health.state.ga.us/programs/immunization
Centers for Disease Control and Prevention (CDC), National Immunization Program homepage: http://www.cdc.gov/nip/
CDC Vaccine Information Statements (VIS): http://www.cdc.gov/nip/publications/vis/default.htm
CDC Vaccines for teenagers and college students: http://www.cdc.gov/nip/recs/teen-schedule.htm#chart
American College Health Association: http://www.acha.org/info_resources/guidelines.cfm

Rev 1-2007

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6. SURVEILLANCE AND REPORTING Procedure for the Investigation and Reporting of Vaccine Preventable Diseases Contact Persons for VPD Surveillance at the District Health Office (REPLACE) Vaccine Preventable Disease Fact Sheets Diphtheria Fact Sheet Hepatitis A Fact Sheet and Q & A (REPLACE) Hepatitis B Fact Sheet and Q & A (REPLACE) Haemophilus influenzae Invasive Disease Fact Sheet and Q & A (REPLACE) Measles Fact Sheet and Q & A Mumps Fact Sheet Pertussis Fact Sheet and Q & A Polio Fact Sheet and Q & A Rubella Fact Sheet and Q & A Streptococcus pneumoniae Fact Sheet and Q & A Tetanus Fact Sheet Resources for Influenza Prevention and Control Influenza Outbreak Control in a Long Term Care Facility Georgia Notifiable Disease Report, Form 3095 (Rev. 8/04) CDC Diphtheria Worksheet Measles Surveillance Worksheet Mumps Surveillance Worksheet Pertussis Surveillance Worksheet Rubella Surveillance Worksheet Tetanus Surveillance Worksheet Viral Culture Submission Form (Rev. 9/02) GPHL Microbial Immunology Submission Form GPHL Molecular Biology Submission Form

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Procedure for the Investigation and Reporting of Vaccine Preventable Diseases

Surveillance Each District (or local) Health office must maintain a surveillance system to monitor the incidence of vaccine-preventable diseases (VPD) in their community, especially as immunization rates increase. In most areas of the state, a passive disease surveillance system is used to collect information on vaccine preventable disease. This type of surveillance system is simpler and less burdensome than active surveillance, but is limited by incompleteness of data and a lack of timeliness. Even after efforts are made to publicize the importance of reporting, passive surveillance systems may still not be representative of the disease burden in the community and may fail to identify outbreaks. The quality of surveillance data can be improved through active surveillance, in which public health officials contact providers and/or laboratories regularly to identify cases of reportable disease. This type of surveillance system yields more complete data, and validates the representativeness of the data for vaccine preventable diseases and other notifiable conditions. Active systems require more resources and therefore are generally used for brief periods or discrete purposes (e.g., CDC projects such as the Emerging Infections Program, disease elimination projects, etc.)
Procedure for Reporting Each and every case of vaccine-preventable disease (confirmed or suspect) must be investigated promptly and thoroughly. All positive and "suspect" cases of vaccine preventable disease should be reported immediately to the Notifiable Disease Section, Epidemiology Branch, Division of Public Health. District Epidemiologists and Communicable Disease Coordinators will have primary responsibility for VPD case investigations in partnership with the Notifiable Disease Epidemiologists at GDPH. The District Immunization Coordinators and Immunization Field staff will initiate case follow up if the epidemiologist is unavailable. Detailed instructions for case investigation and reporting for each vaccine preventable disease are included in the Disease Fact Sheets in this section. Also included in this section are copies of the Notifiable Disease Report Form (Form 3095), disease worksheets, and the Virology Request Form (Form 3595), all of which are referenced in the Disease Fact Sheets.
Enclosed is a line listing for the contact persons for VPD surveillance and case investigation at the District Health offices, Immunization Program and the Notifiable Disease Epidemiology Section. For questions regarding a specific vaccine preventable disease, please contact the Notifiable Disease Epidemiology Section epidemiologist listed for the specific disease. If that person is unavailable, please speak with any NDES epidemiologist for assistance. The Notifiable Disease Epidemiology Section's main phone number is (404) 657-2588. Please remember that contact names and numbers may change frequently, therefore call the NDES main number if you are having difficulty reaching a specific individual, or if you have any questions regarding the investigation or reporting of a vaccine preventable disease or any other reportable disease.

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Contact Persons For VPD Surveillance at

The District Health Office

Personnel may change frequently. In the event that a specific person listed below, at either the State or District level cannot be reached, please call the

main Epidemiology number, (404) 657-2588.

DISTRICT HEALTH UNIT CONTACT PERSON:

1-1 Epi. Melissa Atkins
Imm. Marie Smith

(706) 295-6658 3-5 Epi. Heidi Davidson

(706) 215-2118

Epi. Tina John

(404) 508-7851 8-2 Epi. Dan Staib

(404) 294-3892

Epi. Jackie Jenkins

(229) 430-2918 (229) 430-1858

Imm. VACANT

(404) 657-3158

Imm. Joyce Hess

(404) 370-7360

Imm. Sue Dale

(229) 891-7100

Imm.Jotonna Horton (404) 657-3158

Imm. Kelly

(404) 657-3158

Seegmueller

1-2 Epi. Trish Foster
Epi. Larry Staton

(706) 272-2342 (706) 272-2342

4 Epi. David Lankford
Imm. Amy Fenn

(706) 845-4035 9-1 Epi. Robert Thornton (912) 644-5232

(706) 845-4035

Imm. Marianne Pappas (912) 644-5204

Imm. Ann Vossen Imm. Rick Naus

(770) 345-7371 (706) 657-3158

Imm. Tina Dempsey (770) 657-3158

Imm. Georgia Dittmar (404) 657-3158

2-0 Epi. VACANT
Imm. Janie Dalton Imm. Jan Slaughter
3-1 Epi. Gail Mills
Epi. Jennifer Munoz Epi. Jessica Grippo Imm. Karen Thomas Imm. Tasia Sheppard
3-2 Epi. Shamim Khan
Epi. Priti Kohle Imm. Georgia Goseer Imm. Janet Kelly
Conrad Harrow
3-3 Epi. Heartley Egwuogu
Imm. Freda Sheppard Imm. VACANT

() (770) 535-5743 (404) 657-3158
(770) 514-2747 (678) 354-5489 (770) 514-2384 (770) 514-2349 (404) 657-3158 (404) 730-1336 (404) 730-1330 (404) 730-1677 (404) 657-3158 (404) 657-3158
(678) 610-7193 (678) 610-7565 (404) 463-0808

5-1 Epi. Jodi Bazemore

(478) 275-6545 9-2 Epi. Hollard Phillips

Imm. Kelly Knight

(478) 275-6545

Epi. Tiffany James

Imm. VACANT

()

Imm. Diane Watson

Imm. Lorie Banks

5-2 Epi. German Gonzalez (478) 751-6034 10 Epi. Lynn Beckmann

Epi. Ronnie Boone (478) 751-6125

Epi. Robert Hamilton

Imm. Sherry Cook

(478) 751-4175

Imm Paula Young

Imm. Kelly Duke

(404) 657-3158

Imm. Angie Webster

6 Epi. Joy Miller

(706) 667-4263

Epi. Ann Kenny

(706) 667-4264

Imm. Melba McNorrill (706) 667-4286

Imm. Natasha Daniels (404) 657-3158

7 Epi. Eileen Usman

(706) 321-6238

Imm. Beverly Roberson (706) 321-6121

Imm. Libby Massiah (404) 657-3158

(912) 285-6002 (912) 285-6022 (912) 287-4890 (912) 287-6667
(706) 583-2772 (706) 583-2761 (706) 583-2775 (404) 657-3158

3-4 Epi. Farrah Machida
Epi. Helen Ellis

(770) 339-4260 (404) 597-8453

Imm. Gloria Melvin

(770) 277-1235

Imm. Angela

(404) 657-3158

Bumphus- Corbin

IPC Immunization Program Consultant

8-1 Epi. Rachael Jones
Imm. Deborah Adams
Imm. Jenny Howell

(229) 249-2796 (229) 245-6433 (229) 891-7112

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Contact Persons For VPD Surveillance at The District Health Office
Contact Persons for VPD Surveillance at the GDPH Epidemiology Branch
****Personnel may change frequently. If an epidemiologist listed below cannot be reached, please call the main Epidemiology number, (404) 657-2588.

DISEASE Diphtheria
DISEASE Haemophilus
Influenzae
DISEASE Hepatitis A
DISEASE Hepatitis B
DISEASE Influenza
DISEASE Measles
DISEASE Meningococcal
Meningitis
DISEASE Mumps

Epidemiology Contact Julie Gabel / Epi vacant
Epidemiology Contact Epi vacant / Katie Arnold

Phone (404) 657-2588
Phone (404) 657-2588

Epidemiology Contact

Phone

Tina Benoit / Lynne Mercedes (404) 657-2588

Epidemiology Contact Lynne Mercedes

Phone (404) 657-3171

Epidemiology Contact Ariane Reeves

Phone (404) 463-4625

Epidemiology Contact Epi vacant / Julie Gabel

Phone (404) 657-2588

Epidemiology Contact

Phone

Epi vacant / Katie Arnold (404) 657-2588

Epidemiology Contact Epi vacant / Julie Gabel

Phone (404) 657-2588

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Contact Persons For VPD Surveillance at The District Health Office
Contact Persons for VPD Surveillance at the GDPH Epidemiology Branch
****Personnel may change frequently. If an epidemiologist listed below cannot be reached, please call the main Epidemiology number, (404) 657-2588.

DISEASE Pertussis

Epidemiology Contact Epi vacant / Julie Gabel

DISEASE Pneumococcal
Disease

Epidemiology Contact Epi vacant / Katie Arnold

DISEASE Poliomyelitis

Epidemiology Contact Epi vacant / Julie Gabel

DISEASE Rubella

Epidemiology Contact Epi vacant / Julie Gabel

DISEASE

Epidemiology Contact

Congenital Rubella Epi vacant / Julie Gabel

Syndrome

DISEASE Tetanus

Epidemiology Contact Epi vacant / Julie Gabel

DISEASE Varicella

Epidemiology Contact Epi vacant / Julie Gabel

Phone (404) 657-2588
Phone (404) 657-2588
Phone (404) 657-2588
Phone (404) 657-2588
Phone (404) 657-2588
Phone (404) 657-2588
Phone (404) 657-2588

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DIPHTHERIA FACT SHEET

Agent: Caused by the bacterium, Corynebacterium diphtheriae.

Brief Description: In the United States, diphtheria is an uncommon infection of the upper respiratory tract. Initial symptoms of illness include a sore throat and low-grade fever. Nasopharyngitis due to diphtheria commonly presents with patches of adherent, grayish membrane with a surrounding dull red inflammatory zone on the tonsils, soft palate, uvula, and/or back of the pharynx. In severe disease, obstruction of the respiratory tract develops due to extensive membrane formation and there may be marked tenderness and swelling of the neck (Bull Neck). Late effects of diphtheria may include myocarditis and motor and sensory nerve palsy. Most clinical characteristics are caused by the release of a cytotoxin by the bacteria. Asymptomatic nasopharyngeal infection (carriage) occurs in the general population despite vaccination. In the United States, severe diphtheria infection has been documented to occur more frequently in American Indian and homeless populations.

Reservoir: Humans.

Mode of Transmission: Transmission is most often person-to-person spread from the respiratory tract of a patient or carrier. Rarely, transmission may occur from skin lesions or articles soiled with discharges from lesions of infected persons.

Incubation Period: Usually 2 to 5 days, occasionally longer.

Clinical Case Definition: An upper-respiratory tract illness characterized by sore throat, lowgrade fever, and an adherent membrane of the tonsil(s), pharynx, and/or nose.

Lab Criteria for Diagnosis: Isolation of toxin producing Corynebacterium diphtheriae from a nasopharyngeal specimen
(preferably a culture of membrane tissue or a swab of tissue underlying the membrane), or PCR positive for Corynebacterium diphtheriae toxin by the CDC Diphtheria Laboratory.

Diagnostic Testing: A. Culture (THE LABORATORY MUST BE INFORMED THAT YOU SUSPECT DIPHTHERIA. A SPECIAL MEDIUM IS REQUIRED FOR ISOLATION OF THIS ORGANISM.) 1. Specimen: Throat or nasopharyngeal swab. 2. Outfits: Culture referral outfit, order #0505, and Loeffler's slant outfit, order #0560. 3. Lab Form: Culture referral form 3410 and Loeffler's slant form 3415. 4. Lab Test Performed: Isolation and identification of organism, toxigenicity testing. 5. Lab: State Bacteriology Laboratory (A REFERENCE LABORATORY IS NEEDED). 6. Transport requirements: If the duration of transport is < 24hrs, use Amies medium; if duration 24 hrs, use silica gel sachets. Isolates will be subcultured on Loeffler, Pai egg, or cystine blood agar slants. Toxigenicity testing will be performed at CDC. Send suspected isolates in culture referral outfit (#0505).
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B. Polymerase Chain Reaction (PCR) 1. Specimen: Throat or nasopharyngeal swab. 2. Outfits: Culture referral outfit, order #0505, and Loeffler's slant outfit, order #0560. 3. Lab Form: Culture referral form 3410 and Loeffler's slant form 3415. 4. Lab Test Performed: PCR. 5. Lab: CDC Diphtheria Lab alert lab when Diphtheria is suspected, so that a specific PCR assay will be used. 6. Transport requirements: silica gel sachet, or a sterile dry container at 4 degrees Celsius.

Case Classification: Suspect: Sore throat, low-grade fever, and an adherent membrane on the tonsils or pharynx. Probable: A clinically compatible case that is not laboratory confirmed and is epidemiologically linked to a laboratory-confirmed case. Confirmed: A clinically compatible case that is laboratory confirmed. Carrier: An asymptomatic person with laboratory confirmed C. diphtheria isolated from the nasopharynx.

Comment: C. diphtheria from non-respiratory sources (e.g. cutaneous, vaginal, otic) should not be reported. All toxin-producing C. diphtheria respiratory isolates, regardless of association with disease, should be sent to the Diphtheria Laboratory, National Center for Infectious Diseases, CDC.

Period of Communicability: Variable, until virulent bacilli have disappeared from discharges and lesions; shedding is usually 2 weeks or less, and seldom more than 4 weeks. Effective antibiotic therapy promptly terminates shedding within 4 days. Chronic carriers are rare but may shed organisms for 6 months or more.
Vaccination: Primary diphtheria immunization with diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) is recommended for all persons at least 6 weeks old but < 7 years of age and without a history of contraindications. DTaP is the preferred vaccine for all doses in the vaccination series (including completion of the series in children who have received one or more doses of whole-cell DTP). The primary vaccination with DTaP series consists of a threedose series, administered at ages 2, 4, and 6 months, with a minimum interval of 4 weeks between the first three doses. The fourth dose (first booster) is recommended at 15-18 months of age to maintain adequate immunity during preschool years. The fifth dose (second booster) is recommended for children aged 4-6 years to confer continued protection against disease during the early years of schooling. Routine tetanus booster immunization with Td, the adult formulation of tetanus and diphtheria toxoids, is recommended for all persons > 7 years of age every 10 years.
Treatment: Diphtheria antitoxin (of equine origin) should be given when diphtheria is suspected, without waiting for laboratory confirmation. Detailed recommendations can be
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DIPHTHERIA FACT SHEET
obtained from the Georgia Division of Public Health and CDC. Antitoxin is only available for treatment of clinical cases through CDC. The responsible health-care provider should contact the State Epidemiologist at (404) 657-2588, 24 hours a day, to request antitoxin, obtain authorization for its release and make arrangements for transport.

Antimicrobial therapy is also required to eradicate the organism and prevent spread, but it is not a substitute for antitoxin in clinical cases of diphtheria. Either erythromycin or penicillin is recommended to be administered for a 14-day treatment course.

Post-Exposure Prophylaxis: A single dose of benzathine penicillin or a 7-10 day course of erythromycin is recommended for all persons with household exposure to diphtheria, regardless of their immunization status.

Investigation: Guidelines for investigating a suspected case and for managing contacts are published and are referenced below.2 Management of close contacts of suspected cases should include screening for possible respiratory or cutaneous diphtheria, obtaining nasopharyngeal cultures for C. diphtheriae, administering prophylactic antibiotics, treatment and follow-up of carriers, assessing diphtheria vaccination status, and administering any necessary vaccinations. The CDC Diphtheria Worksheet may be used for guidelines in conducting a case investigation.

Reporting: Report all suspect, probable, and confirmed cases IMMEDIATELY by phone to the local health department, District Health Office, or the Epidemiology Branch at 404-657-2588. If calling after regular business hours, it is very important to report cases to the Epidemiology Branch answering service. After a verbal report has been made, please transmit the case information electronically through the State Electronic Notifiable Disease Surveillance System (SENDSS) at http://sendss.state.ga.us, or complete and mail a GA Notifiable Disease Report Form (#3095).

Reported Cases of Diphtheria in Georgia, 2001-2007

Year 2001 2002 2003 2004 2005 2006 2007

Number of Cases 0 0 0 0 0 0 0

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DIPHTHERIA FACT SHEET
References: 1. American Academy of Pediatrics. Measles. In: Pickering L, Eds. Diphtheria. In: 2006 Red Book: Report of the Committee on Infectious Diseases. 27th Ed. Elk Grove Village, IL: American Academy of Pediatrics, 2006: pp. 277-281. 2. Centers for Disease Control and Prevention. Manual for the Surveillance of VaccinePreventable Diseases. Centers for Disease Control and Prevention: Atlanta, GA, 2002. 3. Heymann, ed. Diphtheria. In: Control of Communicable Diseases Manual. 18th Ed. Washington, DC: American Public Health Association, 2004: pp. 171-176. 4. Farizo KM, Strebel PM, Chen RT, et al. Fatal respiratory disease due to Corynebacterium diphtheriae: Case report and review of guidelines for management, investigation, and control. Clin Infect Dis 1993; 16:59-68.

Links: CDC Diphtheria Fact Sheet http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/dip.pdf CDC National Immunization Program http://www.cdc.gov/vaccines/

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HEPATITIS A FACT SHEET

Agent: Hepatitis A virus (HAV)
Brief Description: An acute infectious disease with fever, fatigue, malaise, loss of appetite, nausea, abdominal pain, dark urine and yellowing of the skin and eyeballs. The disease varies widely in severity ranging from asymptomatic to a mild illness without jaundice lasting one to two weeks in children, to severe debilitating illness and lasting several weeks with prolonged convalescence in adults. Fortunately, recovery is generally complete and without complication.
Reservoir: Humans, rarely chimpanzees and other nonhuman primates.
Mode of Transmission: The primary mode of transmission is by the fecal-oral route. This includes ingestion of fecally contaminated water or ice; raw or undercooked shellfish; fruits, vegetables, and other foods eaten uncooked that may have become contaminated during handling. Contact with stool from infected infants and toddlers during diaper changes that is not immediately followed by thorough hand washing is a common means of spread to day care and household contacts. Waterborne transmission of hepatitis A is more common in places with inadequate sewage disposal and water treatment, such as can be found in developing nations. Sexual contact can spread the virus. In rare cases bloodborne transmission occurs.
Incubation Period: Average 28-30 days; Range 15-50 days.
Laboratory criteria for diagnosis: Immunoglobulin M (IgM) antibody to hepatitis A virus (anti-HAV) positive. Note that a person may remain IgM positive for six months or longer after infection, which makes it difficult to determine the timing of infection in a person who has been asymptomatic.
Diagnostic Testing: Serology
1. Specimen: Serum/blood, >6 ml 2. Outfits: Outfit 0500 3. Lab Form: Form 3432 4. Lab Tests Performed: Anti-HAV (total) and Anti-HAV IgM 5. Lab: State Immunology Laboratory (GPHL) 6. Transport requirements: All specimens should be transported as soon as possible.
Refrigerate if specimen must be held overnight. Specimens >14 days old or hemolyzed will be rejected.
Case Classification: Suspected: Meets the clinical case definition of having an acute illness with (a) discrete onset of symptoms and (b) jaundice or elevated serum aminotransferase levels >2.5 times normal. Probable: Meets the clinical case definition and occurs in a person who has an epidemiologic link with a person who has laboratory-confirmed hepatitis A (i.e., household or sexual contact with an infected person during the 15-50 days before the onset of symptoms). Confirmed: Laboratory confirmed (HAV IgM positive).

Period of Communicability: Hepatitis A virus is highly infective, requiring only a few virus particles to cause infection. The virus is present in the highest quantity in stool during the latter half of the incubation period (7-14 days prior to onset of illness). Most cases are not infectious after the first week of jaundice.

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HEPATITIS A FACT SHEET

Vaccine: Three inactivated vaccines are currently available to protect against infection with hepatitis A virus. Protection begins two to four weeks after the first dose of hepatitis A vaccine. A second dose is considered necessary for long-term protection. Two vaccines, HAVRIX and VAQTA, are currently licensed for persons 12 months of age and older and are available in two formulations based on the recipient's age. The third vaccine, TWINRIX, is a hepatitis A and hepatitis B combination vaccine licensed for persons 18 years of age or older. Pre-exposure hepatitis A vaccine is recommended for all children at 12 months of age, persons traveling to or working in countries that have high or intermediate rates of hepatitis A, persons with chronic liver disease or clotting factor disorders, men who have sex with men, injecting drug users, and persons who work with HAV infected primates or with HAV in laboratory settings. Postexposure vaccine use is listed below. For more detailed vaccination information, see Hepatitis A Vaccine Guidelines in Chapter 2 of this manual.

Treatment: Symptomatic only. Hepatitis A is usually self-limiting.

Post-exposure Prophylaxis of Contacts: Depending on age of contact, immune globulin (IG) or hepatitis A vaccine should be offered after exposure to hepatitis A if it can be given within 14 days of last exposure to the case as indicated below:
Persons who live in the same household, or who are intimate and/or sex partners of a diagnosed case
Day care center associated cases as follows: - Children who attend the same room as a diagnosed case - Workers who change diapers in a day care center with a diagnosed case
Inmates in the same cell in a detention center Foodhandlers who work with the acute case

When a food worker has acute infection, consideration may be given to prophylaxis of patrons if prophylaxis can be given within 14 days of last exposure and the case worked while having diarrhea and/or having questionable hygienic practices, combined with having contact with ready to eat foods. Consult the Epidemiology Section at (404) 657-2588 promptly in these instances. For contacts younger than 12 months of age or older than 40 years of age, give IG as a single dose of 0.02 ml per kilogram of body weight within 14 days after exposure to hepatitis A. Immune globulin is NOT recommended for hepatitis A exposure for business, office or school contacts, or household visitors (e.g., neighbors and relatives) who do not meet the above criteria. When IG is not readily available, hepatitis A vaccine can be given to contacts older than 40 years of age.

Investigation: Complete the hepatitis case report in SENDSS (State Electronic Notifiable Disease Surveillance System) at https://sendss.state.ga.us to aid in the investigation. Conduct an assessment of the patient for high-risk activities (food handler, day care attendee/provider, health care provider) and hygienic practices such as hand washing. Determine whether the case worked while experiencing diarrhea. Assess the need for immune globulin (IG) or vaccine as indicated above for contacts of the case patient, and educate case contacts regarding the risk of hepatitis A virus transmission. Investigate the source of the infection. Attention should be paid to sanitation and potential fecal contamination via food or water. Advise international travelers, men who have sex with men, and others who will be at increased risk of exposure to hepatitis A in the future, to obtain the hepatitis A vaccine. Special evaluation is indicated for outbreaks in institutional settings and hepatitis in food handlers. Consult the Epidemiology Section at (404) 657-2588 promptly in these instances.

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Reporting: Report acute, laboratory-confirmed cases IMMEDIATELY by phone to the local health department, District Health Office, or the Epidemiology Section at 404-657-2588. If calling after regular business hours, reports can be made to 1-866-PUB-HLTH (782-4584). After a verbal report has been made, please transmit the case information electronically through the State Electronic Notifiable Disease Surveillance System (SENDSS) at https://sendss.state.ga.us. Please complete all data fields in SENDSS, including the case report form.

Reported Cases of Acute Hepatitis A in Georgia, 2001-2008

Year 2001 2002 2003 2004 2005 2006 2007 2008

Number of Cases 927* 509 776* 318 216 56 67 61

*Note: Large outbreaks were documented in 2001 and 2003.

References: 1. Centers for Disease Control. Prevention of Hepatitis A Through Active or Passive Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006; 55(RR7): 1-23. 2. Heymann, ed. Hepatitis, Viral. In: Control of Communicable Diseases Manual. 18th ed. Washington, DC: American Public Health Association, 2004: 247-253. 3. Centers for Disease Control and Prevention. Case Definitions for Infectious Conditions Under Public Health Surveillance. MMWR Vol. 46(RR10): 1-55. 4. Centers for Disease Control. Update: Prevention of Hepatitis A After Exposure to Hepatitis A Virus and in International Travelers. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007; 56(41): 1080-1084.

Links: CDC Hepatitis A Fact Sheet http://www.cdc.gov/hepatitis

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HEPATITIS A Q&A
What is hepatitis A? Hepatitis A is a liver disease caused by a specific virus. The hepatitis A virus (HAV) is one of several viruses known to cause hepatitis (liver inflammation) in humans. Prior to 2006, several hundred cases were reported in Georgia each year.
Who gets hepatitis A? Anyone who has not previously been infected with or vaccinated against hepatitis A can become infected. Certain persons at increased risk of exposure to hepatitis A include:
Children and employees of child care centers where a child or employee has hepatitis A
Persons who share a household or have sexual contact with someone with hepatitis A Travelers to developing countries where hepatitis A is common and where clean
water and proper sewage disposal are not readily available; and Residents and staff of institutions for disabled children where a resident or an
employee has hepatitis A.
How is the hepatitis A virus spread? The hepatitis A virus enters through the mouth, multiplies in the body and is passed in the feces. The virus is fairly hardy and can be carried on an infected person's hands and can be spread by direct contact, or by consuming food or drink that has been handled by the individual. In some cases, consuming untreated or inadequately treated water contaminated with improperly treated sewage can spread it. Eating raw or undercooked shellfish is another way one can become infected.
What are the symptoms of hepatitis A? In outbreak settings, three of every four persons infected with hepatitis A virus have symptoms. When the symptoms are present, they usually develop suddenly and may include fatigue, poor appetite, fever and vomiting. Urine may become darker in color, and then jaundice (a yellowing of the skin and whites of the eyes) may appear. The disease is rarely fatal and most people recover in a few weeks without any complications. Infants and young children tend to be asymptomatic or have very mild symptoms and are less likely to develop jaundice than are older children and adults. Not everyone who is infected will have all of the symptoms, but adults are more likely to have symptoms.
How soon do symptoms appear? The symptoms usually begin to appear three to four weeks after exposure, but the onset of symptoms may range two to seven weeks after exposure.
When and for how long is an infected person able to spread the virus? The contagious period begins about a week before the symptoms appear and may extend up to a week after jaundice (a yellow color of the skin and whites of the eyes) begins.
Does past infection with hepatitis A make a person immune? Yes. Once an individual recovers from hepatitis A, he or she is immune for life and does not continue to carry the virus. Additionally, vaccination against hepatitis A is thought to provide lifelong protection against infection.

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HEPATITIS A FACT SHEET
What is the treatment for hepatitis A? There are no special medicines to treat a person once the symptoms appear. Generally, bed rest is all that is needed.

How can hepatitis A be prevented? An important way to prevent spread of hepatitis A is careful handwashing after using the toilet. Infected people should not handle foods served to others during the contagious period. Household members or others who have not been immunized, but are in close contact with an infected person, should promptly call a doctor or the health department to determine whether a shot of immune globulin or hepatitis A vaccine can decrease their chance of becoming ill. The FDA has approved two vaccines that very effectively protect against infection with hepatitis A virus. Persons in higher risk groups (e.g. travelers to developing countries) may wish to consider being vaccinated. All children should be vaccinated at 12 months of age. Please contact the Georgia Immunization Program at (404) 657-3158 for current vaccine recommendations.

Where can I get additional information on hepatitis A? Contact the Georgia Division of Public Health, Epidemiology Section, by email at gaepinfo@dhr.state.ga.us. The following web sites may be useful: GDPH hepatitis web page http://health.state.ga.us/epi/disease/hepatitis/index.asp CDC hepatitis web page http://www.cdc.gov/hepatitis

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HEPATITIS B FACT SHEET

Agent: Hepatitis B Virus (HBV)

Brief Description: Exposure to HBV may result in transient or chronic infections, either of which can be asymptomatic. Hepatitis B can present as an acute infectious disease with fever, malaise, loss of appetite, vague abdominal discomfort, nausea and vomiting, sometimes arthralgias and rash, often progressing to jaundice. Liver enzyme levels are markedly elevated. Fever may be absent or mild. Severity ranges from inapparent cases detectable only by liver function tests, to fatal cases of acute hepatic necrosis.

The likelihood of becoming a chronic carrier is affected by age at infection. Fewer than 5% of acutely infected adults in the U.S. become chronic carriers, compared with some 25% (with HBeAg-negative mothers) to 90% (HBeAg-positive mothers) of perinatally infected infants. Chronically infected persons are at increased risk for developing cirrhosis and/or primary hepatocellular carcinoma, leading to end-stage liver disease later in life.

Reservoir: Humans

Mode of Transmission: HBV is usually transmitted by contact with the blood, semen, or vaginal secretions of an infected person. HBV may also be found in saliva and other body fluids. The virus must be introduced through broken skin or come into contact with mucous membranes for infection to occur. In addition, percutaneous transmission of HBV can occur through blood or blood product transfusion, needle sharing, hemodialysis, acupuncture, tattooing, and needlesticks. Indirect inoculation of HBV can also occur via inanimate objects, as the virus can remain viable outside the body for at least 7 days.

Incubation Period: Varies from 45-180 days usually between 60 and 90 days.

Clinical Case Definition: An acute illness with: Discrete onset of symptoms, and Jaundice or elevated serum aminotransferase levels.

Lab Criteria for Diagnosis: 1. IgM antibody to hepatitis B core antigen (anti-HBc) positive and/or hepatitis B surface antigen (HBsAg) positive 2. IgM anti-HAV negative (if done)

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HEPATITIS B FACT SHEET

Interpretation of the Hepatitis B Serology Panel

Tests

Results

Interpretation

HBsAg

negative

Susceptible to hepatitis B

Anti-HBc (IgG + IgM)

negative

infection

Anti-HBs

negative

HBsAg

negative

Immune to hepatitis B infection

Anti-HBc (IgG + IgM)

negative or positive

Anti-HBs

positive

HBsAg

positive

Acutely infected with hepatitis B

Anti-HBc (IgG)

positive

Anti-HBc (IgM)

positive

Anti-HBs

negative

HBsAg

positive

Chronically infected with hepatitis

Anti-HBc (IgG)

positive

B

Anti-HBc (IgM)

negative

Anti-HBs

negative

HBsAg

negative

Four interpretations possible*

Anti-HBc (IgG + IgM)

positive

Anti-HBs

negative

* Interpretations possible for isolated positive Anti-HBc (IgG + IgM)

1. Person may be recovering from acute HBV infection (in the "core window" before

anti-HBs appears);

2. Person may be distantly immune, and the test is not sensitive enough to detect very

low levels of anti-HBs in serum;

3. Person may have a false positive anti-HBc; or

4. Person may be chronically infected with HBV, with an undetectable level of HBsAg

in the serum.

HBeAg is tested in the presence of HBsAg and if present, is a marker of intense viral production.

Diagnostic Testing: 1. Specimen: Serum/blood, >6 ml. 2. Outfits: Outfit 0500 3. Lab Form: Form 3432 4. Lab Tests Performed: HBsAg, anti-HBs, and total anti-HBc (IgG). Georgia Public Health Lab (GPHL) in Decatur, does not currently offer anti-HBc (IgM), but this is available through commercial laboratories. 5. Lab: GPHL Immunology Laboratory, hospital laboratories, and private clinic laboratories. 6. Transport requirements: All specimens should be transported as soon as possible. Refrigerate if specimen must be held overnight. Specimens >14 days old or hemolyzed will be rejected.

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HEPATITIS B FACT SHEET

Case Classification Confirmed: A case that meets the clinical case definition and is laboratory confirmed. Persons who have chronic hepatitis or persons identified as HBsAg positive should not be reported as having acute viral hepatitis unless they have evidence of an acute illness compatible with viral hepatitis or documented seroconversion.
Comment: Also reportable (in addition to acute hepatitis B) (1) all newly identified HBsAgpositive carriers, (2) all HBsAg positive pregnant women.
Period of Communicability: All persons who are HBsAg positive are potentially infectious. Blood can be infective many weeks before the first onset of symptoms and remain infective through the acute clinical course of the disease. For chronically infected people, the infectivity varies from highly infectious (HBeAg positive) to potentially infectious (anti-HBe positive).
Vaccination: Vaccination is recommended for all infants as part of the routine childhood immunization schedule. Three doses comprise the series:
Dose one: at birth Dose two: between 1 month and 4 months (but at least 1 month after 1st dose) Dose three: between 6 months and 18 months (but at least 4 months after 1st dose, and 2 months after 2nd dose, but no earlier than 24 weeks of age). For more detailed vaccination information, see Hepatitis B Vaccine Guidelines in Chapter 2 of this manual.
All children should be vaccinated by 11-12 years of age. Risk of hepatitis B infection increases in the adolescent years, so catch-up vaccination is recommended for children, adolescents and young adults, especially in certain sub-populations, such as Alaska Natives, Asian and Pacific Islanders, and immigrants from countries with high HBV endemicity. In addition, the following categories of high-risk adults should be immunized:
1. Heterosexuals with >1 sex partner in the last 6 months, or who have a sexually transmitted disease.
2. Men who have sex with men (MSM). 3. Household contacts and sex partners of HBsAg-positive people. 4. Injection drug users. 5. Health care personnel, and others with occupational risk of infection through exposure to
blood (including but not limited to public safety workers, trainees in medicine, dentistry, nursing, and laboratory technology.) 6. Residents and staff of institutions for developmentally disabled persons. 7. Staff of non-residential child care and school programs for developmentally disabled persons if attended by an HBsAg-positive person. 8. Hemodialysis patients. 9. Patients with bleeding disorders. 10. Household members of adoptees who are HBsAg positive. 11. International travelers to areas with high or intermediate rates of HBV infection. 12. Inmates of juvenile detention centers or long-term correctional facilities.

Note: See Chapter 2 of this Manual for list of persons eligible for state-supplied vaccine in Public Health clinics.

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HEPATITIS B FACT SHEET

Although recommended in infancy, the vaccine series can be given at any time. A lapse in immunization does not require restarting the series. Studies have demonstrated vaccine efficacy with one-year intervals between doses. Vaccine is most effective if given intramuscularly. Thus the deltoid (arm) is recommended in persons >18 months old, and antero-lateral thigh for infants and children 18 months or younger.

Treatment: No specific therapy for acute HBV infection is available, other than supportive care. Several drugs are now licensed for treatment of chronic hepatitis B in the USA.

Post-exposure Prophylaxis: Passive immunization with hepatitis B immune globulin (HBIG) and active immunization with hepatitis B vaccine are both used to prevent infection. To be effective, HBIG must be given as soon as possible after exposure (within 7 days after blood exposure and 14 days after sexual exposure). HBIG is available commercially and may be provided by the Georgia Immunization Program under certain specific conditions. (See Chapter 2 for table entitled, "Eligibility Criteria for Vaccines Supplied by the GA Immunization Program for Children, Adolescents, and Adults.")

Post-exposure prophylaxis should be considered in the following situations: 1. Perinatal exposure to HBsAg-positive mother; 2. Percutaneous or permucosal exposure to blood; 3. Sexual exposure to a HBsAg-positive individual; 4. Household contact with a chronic carrier, or known exposure to an acute hepatitis B case.

Investigation: Collect information about possible exposures, including high-risk behavior during the period 45-180 days before the onset of illness. Particular emphasis should be placed on 60-90 days before onset. Investigators should identify contacts that could benefit from hepatitis B vaccination or HBIG. Special attention should be paid to the presence of hepatitis B among women of childbearing age, since post-exposure prophylaxis with hepatitis B vaccine and HBIG soon after birth is 90-95% effective in preventing infection in the infant with attendant likelihood of chronic disease (see Perinatal Hepatitis B Prevention Guidelines section for complete details).

Follow-up: All new cases of hepatitis B should be re-tested for HBsAg after six months to determine whether infection has cleared or a chronic infection is present. Those people still HBsAg-positive are considered confirmed chronic carriers, and should be counseled accordingly and referred for maintenance care. Refer to the Perinatal Hepatitis B Prevention Guidelines for detailed follow-up recommendations of HBsAg-positive women, their infants, and sexual and household contacts.

Reporting: Report all cases of acute hepatitis B, newly identified HBsAg-positive carriers, and HBsAg-positive pregnant women WITHIN SEVEN DAYS electronically through the State Electronic Notifiable Disease Surveillance System (SENDSS) at https://sendss.state.ga.us. Please be sure to complete all data fields in SENDSS, including the case report form. For all cases of acute hepatitis B, complete the hepatitis case report in SENDSS (State Electronic Notifiable Disease Surveillance System) at https://sendss.state.ga.us to aid in the investigation. Chronic hepatitis B infections are also reportable in SENDSS.

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HEPATITIS B FACT SHEET

Report perinatal hepatitis B cases on the Perinatal Hepatitis B Prevention Case Management Form to the state Perinatal Hepatitis B Prevention Program.

Reported Cases of Acute Hepatitis B in Georgia, 2001-2007

Year 2001 2002 2003 2004 2005 2006 2007 2008

Number of Cases 389 442 512 444 203 198 157 187

In 1990 the Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial Epidemiologists (CSTE) published a new case definition that was not uniformly adopted by all counties and local health departments in Georgia until 1993. The drop in cases in 1995 is due, at least in part, to more careful adherence to the surveillance case definition, requiring evidence for an acute case. Case data improved after 2003.

References: 1. Pickering L, et al, eds. Hepatitis B. In: 2006 Red Book: Report of the Committee on Infectious Diseases. 27th Ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006: pp. 335-355. 2. Heymann D, ed. Viral Hepatitis B. In: Control of Communicable Diseases Manual. 18th ed. Washington, DC: American Public Health Association, 2004: pp. 253-261. 3. Centers for Disease Control and Prevention. Case Definitions for Infectious Conditions Under Public Health Surveillance. MMWR 1997; 46(RR10): 1-55. 4. CDC. Hepatitis B. National Center for Infectious Diseases, Division of Viral and Rickettsial Diseases. 01/01/1996. 5. CDC. Recommendations of the Immunization Practices Advisory Committee. Prevention of Perinatal Transmission of Hepatitis B Virus: Prenatal Screening of all Pregnant Women for Hepatitis B Surface Antigen. MMWR 1988; 37(22): 341-6,351. 6. CDC. Notice to Readers: Availability of Hepatitis B Vaccine That Does Not Contain Thimerosal as a Preservative. MMWR 1999; 48(35): 780-782. 7. CDC. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP); Part 1: Immunization of Infants, Children, and Adolescents. MMWR 2005;54 (No.RR-16) Part 2. Immunization of Adults. MMWR 2006:55(No. RR-16)
Links: Georgia Immunization Program http://health.state.ga.us/programs/immunization/index.asp CDC National Immunization Program http://www.cdc.gov/vaccines/vac-gen/safety/default.htm CDC Hepatitis Branch http://www.cdc.gov/hepatitis GDPH Acute Disease Epidemiology Section, Hepatitis Program http://health.state.ga.us/epi/disease/hepatitis/index.asp

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HEPATITIS B FACT SHEET

HEPATITIS B Q&A
What is hepatitis B? Hepatitis B is a liver disease caused by a specific virus. The hepatitis B virus (HBV) is one of several viruses known to cause hepatitis (liver inflammation) in humans. HBV is completely unrelated to the viruses that cause hepatitis A, C, or other non-A, B, C hepatitis. The HBV may cause no symptoms or mild illness, but can also cause lifelong infection, cirrhosis of the liver, liver cancer, liver failure, and death.
Who gets hepatitis B? All people, no matter how old they are or where they live, may be at risk for hepatitis B. Those at greatest risk include:
Certain health care workers who have contact with infected blood; Injecting drug users who share needles and drug equipment; Men who have sex with men (MSM), particularly those with multiple partners; Other persons with multiple sex partners; Sex partners of people infected with HBV; Patients or workers in a residence for the developmentally disabled; Hemodialysis patients; Certain household contacts of an infected person; Infants born to mothers who are carriers of HBV; Children of individuals born in Southeast Asia, Africa, the Amazon Basin in South
America, the Pacific Islands, and the Middle East; and Persons who have spent time in correctional facilities.
If you are at risk for HBV infection, ask your health care provider about hepatitis B vaccine.
How is hepatitis B virus spread? Hepatitis B virus can be found in the blood, semen and, to a lesser extent, saliva and other body fluids of an infected person. It is spread by direct contact with infected body fluids, usually by needle stick injury or sexual contact. The virus can also be transmitted from mother to baby at birth. HBV is not spread by casual contact.
What are the symptoms of hepatitis B? The symptoms of hepatitis B include fatigue, poor appetite, fever, vomiting, and occasionally joint pain, hives or rash. Urine may become darker in color, and jaundice (yellowing of the skin and whites of the eyes) may appear. Some individuals may experience few or no symptoms.
How soon do symptoms appear? The symptoms may appear two to six months after exposure, but usually within three months.
When and for how long is a person able to spread the virus? The virus can be found in blood and other body fluids several weeks before symptoms appear, and it generally persists for several months afterwards. Some people with hepatitis B virus infection may become long-term carriers of the virus, and may be able to spread the virus over many years.

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Hepatitis B Fact Sheet

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HEPATITIS B FACT SHEET

What is the hepatitis B carrier state? Some persons infected with hepatitis B virus never fully recover and carry the virus for the rest of their lives. These persons have chronic infection and are known as carriers. They can infect other household and sexual contacts throughout their lives. Among adults who get hepatitis B, 5-10% develop a lifelong infection. When children are infected, the risk for lifelong infection is much higher. An estimated one million people have lifelong hepatitis B virus infections in the United States today.
Why is hepatitis B a problem for pregnant women and their babies? Pregnant women may have hepatitis B virus (HBV) in their blood without knowing it and can pass it on to their babies at birth, if their infants are not vaccinated at birth. Many of these babies develop lifelong HBV infections and can pass the virus on to others throughout their lives. At first, babies may not look or feel sick, but as they grow up, they may have liver damage. About 25% of babies who develop lifelong HBV infections die prematurely of liver disease or liver cancer.
What is the treatment for hepatitis B? There are no special medicines that can be used to treat a person once the symptoms appear. Generally, bed rest as needed is recommended for acute hepatitis B infection.
What precautions should hepatitis B carriers take? Hepatitis B carriers should follow standard hygienic practices to ensure that their blood or other body fluids do not directly contaminate close contacts. Carriers must not share razors, toothbrushes, or any other object that may become contaminated with blood. Susceptible household members, particularly sex partners, should be immunized with hepatitis B vaccine. It is important for carriers to inform their dentist and health care providers. Medications are available to treat persons with chronic hepatitis B, but they don't work for everyone.
How can hepatitis B be prevented? Preventing hepatitis B is important because of the risk of lifelong infection leading to serious liver problems. A vaccine has been used since 1982 to prevent hepatitis B. The vaccine is given in a series of three shots. Hepatitis B vaccine is safe, effective and is recommended for
All babies, beginning at birth; Everyone 18 years of age and younger; Adults over 18 years of age who are at risk for HBV infection; and Persons whose jobs expose them to human blood.

Where can I get additional information on hepatitis B? Contact the Georgia Division of Public Health, Epidemiology Branch, by email at gaepinfo@dhr.state.ga.us. The following websites may be useful:
Georgia Immunization Program http://health.state.ga.us/programs/immunization/index.asp
CDC National Immunization Program http://www.cdc.gov/vaccines/vac-gen/safety/default.htm
CDC Hepatitis Branch http://www.cdc.gov/hepatitis

For needlestick accidents and blood exposures, medical providers can call the National Clinicians' Post-Exposure Prophylaxis Hotline (PEPline) 24 hours a day, 7 days a week at: 1-888-448-4911

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Haemophilus Influenzae Invasive Disease Fact Sheet

Agent: Haemophilus influenzae is a bacterium often found in the upper respiratory tract of humans. H. influenzae is divided into several strains based on the presence of a polysaccharide capsule virulence factor. Encapsulated strains are considered "typable" (types A, B, C, D, E, and F), while non-encapsulated strains are non-typable.

Brief Description: H. influenzae causes a variety of illnesses. Typable strains, especially type B ("Hib") and type F, have been commonly associated with invasive disease, including meningitis, epiglottitis, pneumonia, septic arthritis, cellulitis, osteomyelitis, pericarditis, and bacteremia. Historically, type B was a common, devastating pathogen, especially in children; however, since the widespread use in the U.S. of conjugate vaccines against Hib, cases caused by Hib have decreased drastically. Non-typable H. influenzae is occasionally associated with otitis media, pneumonia, sinusitis, conjunctivitis, aggravation of chronic obstructive pulmonary disease, neonatal and maternal sepsis, and bacteremia.

Reservoir: Humans.

Mode of Transmission: Spread occurs through airborne droplets or by direct contact with infectious secretions. Between 30% and 80% of people are carriers of non-typable H. influenzae, while approximately 2% are carriers of types A, C, D, E, and F and less than 1% carry type B (in a vaccinated population). Illness may occur in carriers when host immunity is compromised for some reason.

Incubation Period: Unknown, possibly 2-4 days.

Laboratory Criteria for Diagnosis: Isolation of H. influenzae from a normally sterile site (e.g., blood or cerebrospinal fluid or, less commonly, joint, pleural, or pericardial fluid).

Diagnostic Testing: 1. Specimen: Blood, CSF, or other sterile site for culture; pure specimen for serotyping. 2. Outfits: Sterile vial for isolation and identification; culture referral order #0505 for serotyping. 3. Lab Form: Form 3410. 4. Lab Test Performed: Bacterial isolation and identification; H. influenzae serotyping. 5. Lab Performing Test: Isolation and identification is usually performed at hospital or private labs; serotyping is performed at the GPHL Bacteriology Section in Decatur.

Case Classification: Probable: a clinically compatible case with detection of H. influenzae antigen in CSF or other sterile site. Confirmed: a clinically compatible case that is laboratory confirmed by culture.

Period of Communicability: As long as organisms are present, which may be for a prolonged period even without nasal discharge. Cases are considered non-infectious 24-48 hours after starting effective antibiotic therapy.

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Haemophilus Influenzae Invasive Disease Fact Sheet

Vaccination: A conjugate vaccine for Hib has been licensed for use in the U.S. since the mid1980s. Children should get Hib vaccine at 2, 4, 6, and 12-15 months of age (if PRP-OMP vaccine is used, the dose at 6 months is not required). Children over 5 years of age usually do not need Hib vaccine. Older children or adults with sickle cell disease, HIV/AIDS, removal of the spleen, bone marrow transplant, or undergoing chemotherapy should also receive Hib vaccine. For more detailed vaccination information, see Haemophilus Influenzae Vaccine Guidelines in Chapter 2 of this manual.
Treatment: The 2003 Red Book recommends, ceftriaxone, cefotaxime, OR chloramphenicol plus ampicillin for the treatment of H. influenzae until sensitivities are known (many strains are resistant to ampicillin). The patient should be given rifampin before discharge from the hospital to ensure elimination of the organism IF chloramphenicol or ampicillin were used to treat illness.
Investigation: The Active Bacterial Core Surveillance (ABCs) Case Report form (CDC form 52.15A) should be used as a guide for collecting demographic and epidemiologic information in a case investigation. Identification of young children who are household or day care classroom contacts of cases and assessment of their vaccination status may help identify persons who should receive antimicrobial prophylaxis and who need to be immunized.
Prophylaxis and Follow-Up of Contacts [disease caused by type B (Hib) only]: Observe contacts under 6 years old (especially infants) for indications of illness and provide prompt medical attention should signs and symptoms appear. When two or more cases of invasive disease have occurred within 60 days at a day care facility or school which un-immunized or under-immunized children attend, administration of rifampin to all attendees and supervisory personnel is indicated. When a single case has occurred, use of rifampin is controversial. Efforts should be made to ensure that all day care attendees under 5 years of age are fully vaccinated. Rifampin prophylaxis is warranted for all household contacts, including adults, in households with: a. One or more infants <12 months of age; b. A child 1-3 years of age who is inadequately vaccinated; or c. An immunocompromised child. Dosage of rifampin for prophylaxis: a. Age <1 month: 10 mg/kg once daily for 4 days; b. Age 1 month: 20 mg/kg once daily for 4 days, maximum daily dose 600 mg. Rifampin can be administered to infants and children suspended in simple syrup or as a dry powder mixed with applesauce.
Reporting: Report all confirmed cases of invasive H. influenzae IMMEDIATELY electronically though the State Electronic Notifiable Disease Surveillance System (SENDSS) at http://sendss.state.ga.us. For invasive cases of H. influenzae under the age of 15 years, Districts should complete CDC Form 52.15A, "Active Bacterial Core Surveillance (ABCs) Case Report", and forward it to the Epidemiology Branch (FAX # 404-657-7517). Isolates from patients less than 15 years of age should be serotyped by the Georgia Public Health Laboratory (GPHL) to determine whether or not the case is Hib.

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Haemophilus Influenzae Invasive Disease Fact Sheet

Reported Cases of Invasive Haemophilus influenzae in Georgia, 2004-2008 (Source: SENDSS)

Year 2004 2005 2006 2007 2008

Number of Cases 116 113 123 128 149

References: 1. American Academy of Pediatrics. Haemophilus influenzae Infections. In: Peter, G, and Pickering, L, eds. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th Ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006: 310-318. 2. Case definitions for infectious conditions under public health surveillance. MMWR Vol 46(RR-10); 1997: 1-55. 3. Epidemiology and Prevention of Vaccine-Preventable Diseases, 11th edition. Centers for Disease Control and Prevention: Atlanta, GA, 2009. 4. Notice to readers: recommended childhood immunization schedule United States, 2000. MMWR Vol 49(02); 2000: 35-38,47. 5. Manual for the Surveillance of Vaccine-Preventable Diseases. Centers for Disease Control and Prevention: Atlanta, GA, 2002. 6. Heymann, ed. Haemophilus Meningitis. In: Control of Communicable Diseases Manual. 18th ed. Washington, DC: American Public Health Association, 2004: 366368. 7. Mandell, Bennett, and Dolin. The Principles and Practice of Infectious Diseases. 5th Ed., Philadelphia, PA, 2000:pp. 2369-2376. 8. Urwin G, et al. Invasive disease due to Haemophilus influenzae serotype f: clinical and epidemiologic characteristics in the H. influenzae serotype b vaccine era. Clin Infect Dis 1996; 22:1069-1076.

Links:


CDC Haemophilus influenzae type b http://www.cdc.gov/ncidod/dbmd/diseaseinfo/haeminfluserob_t.htm CDC National Immunization Program http://www.cdc.gov/vaccines/ Haemophilus influenzae type B Vaccine http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/hib.pdf

What is invasive Haemophilus influenzae disease? Invasive Haemophilus influenzae disease is a serious disease caused by bacteria. Before Haemophilus influenzae type B (Hib) vaccine, Hib disease was the leading cause of bacterial meningitis among children under 5 years old in the United States. Today invasive disease is less common, and is more often caused by serotypes that are not prevented by the Hib vaccine (types A, C, D, E, F, and non-typable).

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Haemophilus Influenzae Invasive Disease Fact Sheet
Who gets invasive Haemophilus influenzae disease? Before the introduction of the Hib vaccine, almost all invasive infections were among children under 5 years of age and were caused by serotype B. Two-thirds of cases were among children less than 18 months of age. Due to high vaccination rates, Hib invasive disease is now less common among children, although invasive disease due to all serotypes continues to occur at low levels in children and adults, especially those with underlying medical conditions.
How is Haemophilus influenzae spread? The bacteria spread from person to person via airborne droplets or direct contact with secretions. If the bacteria stay in the person's nose and throat, the person probably will not get sick. Sometimes the bacteria spread into the lungs or the bloodstream, and then Haemophilus influenzae can cause serious problems.
What are the symptoms of invasive Haemophilus influenzae disease? Invasive Haemophilus influenzae disease can affect different organ systems of the body. The most common types of disease include meningitis (infection of the brain and spinal cord coverings, which can lead to lasting brain damage and deafness); pneumonia; severe swelling in the throat, which makes it difficult to breathe; infections of the blood, joints, bones, and covering of the heart; and death.
How soon after contact could illness develop? This is uncertain. The period is probably short, from 2-4 days.

When and for how long is a person able to spread Haemophilus influenzae? As long as the bacteria are present, which could be for a prolonged period of time. Within 24-48 hours after beginning treatment with appropriate antibiotics, a person should no longer be able to spread the infection.
How can a person find out if he or she has invasive Haemophilus influenzae disease? A doctor may take a sample of blood or spinal fluid from an ill person to conduct laboratory tests.
What is the treatment for invasive Haemophilus influenzae disease? Hospitalization is generally necessary. A doctor will prescribe antibiotics for treatment.
How can invasive Haemophilus influenzae disease be prevented? For type B Haemophilus influenzae, the Hib vaccine can prevent disease. Children should get Hib vaccine at 2, 4, 6, and 12-15 months of age (if the PRP-OMP vaccine is used, the dose at 6 months is not required). If a dose is missed, the next dose should be given as soon as possible; there is no need to start over. Hib vaccine may be given at the same time as other vaccines. Children over 5 years old usually do not need Hib vaccine. Older children or adults with sickle cell disease, HIV/AIDS, removal of the spleen, bone marrow transplant, or undergoing chemotherapy should get the Hib vaccine. Vaccines have not yet been developed to prevent disease caused by other serotypes of H. influenzae.
Other ways to prevent invasive Haemophilus influenzae disease include regular handwashing, good hygiene, and disposal of soiled tissues after use.

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Haemophilus Influenzae Invasive Disease Fact Sheet

Where can I get additional information on invasive Haemophilus influenzae disease? Contact the Georgia Division of Public Health, Epidemiology Branch, by email at gaepinfo@dhr.state.ga.us. If you have internet access, the following sites may be useful:
CDC Haemophilus influenzae type b http://www.cdc.gov/ncidod/dbmd/diseaseinfo/haeminfluserob_t.htm
CDC National Immunization Program http://www.cdc.gov/vaccines/ Haemophilus influenzae type B Vaccine -
http://www.cdc.gov/vaccines/pubs/vis/default.htm#hib

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MEASLES FACT SHEET (RUBEOLA)

Agent: Measles virus.

Brief Description: An acute, highly communicable, systemic, viral infection characterized by a prodromal period of 2 to 4 days, in which fever and malaise, cough, coryza (profuse amount of clear nasal discharge), and conjunctivitis are observed. Approximately 3 to 4 days later, a characteristic maculopapular (dusky-red blotchy) rash appears on the face and neck. The rash usually starts at the hairline, then spreads downward and outward to the trunk, hands and feet. The rash generally lasts 5 to 6 days. Koplik's spots, characteristic blue-white spots against the bright red background of the buccal (cheek) mucosa, can be observed 1 to 2 days before or 1 to 2 days after the appearance of the maculopapular rash. Complications include diarrhea, otitis media, pneumonia and encephalitis. One or more complications occur in approximately 30% of reported measles cases. In recent years, mortality from measles occurred in roughly 1 to 2 per 1000 reported cases in the United States.

Reservoir: Humans.

Mode of Transmission: Airborne by small droplet spread, direct contact with nasal or throat secretions of an infected person, and less commonly by articles freshly soiled with secretions of nose and throat. Measles can be transmitted from 4 days before to 4 days after the onset of rash.

Incubation Period: Usually 10 to 12 days from exposure to prodrome (range, 7 to 18 days). The rash usually appears about 14 days after exposure.

Clinical Case Definition: An illness characterized by all of the following:
A generalized maculopapular rash lasting 3 or more days. A temperature of at least 101.0o F (38.3o C). Cough, coryza, and/or conjunctivitis.

Laboratory Criteria for Diagnosis: Positive serologic test for measles immunoglobulin M (IgM) antibody, or Significant rise in measles IgG antibody level by any standard serologic assay, or Isolation of measles virus from a clinical specimen

Diagnostic Testing: A. Serology
1. Specimen Needed: Blood - 5cc collected during acute phase of illness and 5 cc collected 14-30 days later, or two capillary tubes collected during acute phase and convalescent phase.
2. Outfit: Other serology outfit, order #500 3. Form: 3432 4. Lab Test Performed: Measles IgG (acute and convalescent) and IgM titers (note: be
sure to request the IgM titer with the acute phase draw so that case confirmation can be accomplished in a timely manner). 5. Lab Performing Test: Immunology Laboratory, Georgia Public Health Laboratory (GPHL) in Decatur. 6. Transport requirements: blood must be non-hemolyzed.

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B. Culture or Polymerase Chain Reaction (PCR) 1. Specimen Needed: Urine, heparinized blood, nasopharyngeal aspirates, or throat swabs collect at same time as samples for serology (best within 3 days after rash onset). 2. Outfit: Viral transport media culture: order #0575 PCR: order #0565 3. Form: 3595R. 4. Lab Test Performed: Culture, PCR. 5. Lab Performing Test: Virology Laboratory, GPHL in Decatur -culture, specimen forwarded to CDC for PCR. 6. Transport: Transport at 4o C if tests are to be performed within 72 hours; otherwise freeze at 70o C.
Case Classification: Suspected: Febrile illness accompanied by generalized maculopapular rash. Probable: a case that meets the clinical case definition, has noncontributory or no serologic or virology testing, and is not epidemiologically linked to a confirmed case. Confirmed: a case that is laboratory confirmed or that meets the clinical case definition and is epidemiologically linked to a confirmed case. A laboratoryconfirmed case does not need to meet the clinical case definition. Comment: Two probable cases that are epidemiologically linked would be considered confirmed cases, even in the absence of laboratory confirmation.
Confirmed cases should be classified as: International importation: An international imported case has its source outside the country, rash onset occurs within 21 days after entering the country, and illness cannot be linked to a local transmission. Indigenous case: Any case for which importation cannot be proven. Out-of-state importation: A case imported from another state in the United States. The patient must have either been out of state continuously for the entire period of possible exposure (at least 7-18 days before onset of rash) or have one of the following types of exposure while out of state: a) face-to-face contact with a person who had either a probable or confirmed case, or b) attendance in the same institution as a person who had a case of measles (e.g., in a school, classroom or day care center).
Vaccination: The current recommendation is a two-dose schedule. The first dose should be given at 12 to 15 months of age, the second at school entry (4 to 6 years of age.) Both doses can be given as MMR or MMRV vaccine. For any child older than six who has not received one or both doses, any opportunity to immunize should be utilized.

Period of Communicability: Measles is highly communicable, with greater than 90% secondary attack rates among susceptible persons. The virus may be transmitted from 4 days prior to 4 days after rash onset. Maximum communicability occurs from the onset of the prodromal period through the first 3-4 days of rash.

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Treatment: Supportive care only.

Protection of Contacts: Transmission is likely in households, schools, and other institutions. All contacts of a case-patient during the infectious period (4 days before appearance of rash to 4 days after appearance) should be identified. If they have not received two doses of vaccine on or after their first birthday, they should be considered susceptible and vaccinated.

Investigation: Measles and rubella must be ruled out whenever illness involving fever and rash are reported. The investigation must be started immediately when a potential case is identified. Essential components of the case investigation include the following:
a. Establish a diagnosis, obtain laboratory specimens for serology if not already done. b. Obtain accurate and complete immunization histories. c. Identify the source of infection. d. Assess potential transmission and identify contacts. e. Obtain specimens for virus isolation.

Initial response to the report of suspected measles: 1. Call the Notifiable Disease Epidemiology Section (404) 657-2588 IMMEDIATELY. 2. Contact the parent(s) or guardian and reporting physician immediately to obtain a detailed clinical and exposure history of the patient. Ask parent(s) about any out-of-town travel or visitations during the 7-21 days period prior to rash onset. Identify any person(s) or group(s) exposed by the patient during the period 4 days before to 4 days after rash onset. 3. Complete the Measles Surveillance Worksheet (from the Centers for Disease Control and Prevention's Manual for the Surveillance of Vaccine Preventable Diseases, Appendix 10). Read the instructions carefully and complete as much of the form as possible. Do not leave any item blank. If information is not available, enter "none" or "NA". The following should be collected during case investigations: Demographic data Clinical details, including a. date of onset of all symptoms, b. date of rash onset, c. rash duration and presentation, d. complications and/or hospitalization Laboratory information, including a. serologic test results, b. date of collection of specimen for virus isolation Case classification Vaccination status, including a. number of doses of measles vaccine, b. date(s) of measles vaccine

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Risk factors for disease, including a. Travel history to determine import status (indigenous, international import, or out-of-state import), b. contact with a probable or confirmed case, c. contact with immigrants or travelers, d. setting (i.e., is case part of an outbreak or is it a sporadic case).
Dates, including a. date reported to health department, b. date of case investigation

Fax the completed worksheet and any pertinent lab results to the Notifiable Disease Epidemiology Section (404) 657-7517. Do not wait for laboratory confirmation to fax the report.

Outbreak Control Strategy: All reports of suspected measles cases should be investigated rapidly. Control activities should not be delayed until laboratory results on suspected cases are received. A measles outbreak exists in a community whenever there is one confirmed case of measles. Once this occurs, preventing dissemination of measles depends on promptly vaccinating susceptible persons and limiting the number of exposures to infectious cases. All persons who cannot readily provide documentation of measles immunity (see ACIP Statement on Measles Prevention, dated 5/22/98) should be vaccinated or excluded from the setting (e.g. school). Documentation of vaccination is adequate only if the date of vaccination is provided. Persons who have been exempted from measles vaccination for medical or religious reasons should be excluded from the outbreak area for at least 2 weeks after the onset of rash in the last case of measles.

Institution-based outbreaks During outbreaks in day care centers, elementary, middle, junior and senior high schools, and colleges and other institutions of higher education, a program of mandatory revaccination with MMR vaccine should be conducted in the affected schools. Revaccination should include all students and their siblings and all school personnel born in or after 1957 who cannot provide documentation of receipt of two doses of measles-containing vaccine on or after their first birthdays or other evidence of measles immunity. Students and personnel receiving their first dose as part of an outbreak control program may be immediately readmitted to school. A second dose should be given in 28 days. If there is an unconfirmed but clinically compatible case in a school, the response should be phased in. Reimmunization should be recommended but not mandatory until the case is confirmed. Proceed with the epidemiologic work on the case. Search for a source, immunize siblings and close contacts when appropriate, ensure an adequate supply of vaccine and begin to prepare for a school-based clinic. At this point it is very important to implement daily active surveillance of absenteeism of two or more days and any rashes should be followed up immediately. New cases signal the immediate need for schoolbased clinics and the exclusion of children and staff who do not have two documented doses of measles vaccine.

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Outbreaks among preschool-age children The risk of complications from measles is high among infants less than one (1) year of age. Therefore, considering the benefits and risks, vaccination with monovalent measles vaccine is recommended for infants as young as six (6) months of age when exposure to measles is considered likely. Children less than six months of age do not require measles vaccination because they still have passive antibody passed to them from their mother during gestation. MMR may be used in children before the first birthday if monovalent measles vaccine is not readily available. Infants vaccinated before the first birthday should be revaccinated when they are 12 months old and at school entry to ensure adequate protection.

Medical Settings If an outbreak occurs in the areas served by a hospital or within a hospital, all employees with direct patient contact who were born in or after 1957 who cannot provide documentation of receipt of two doses of measles vaccine on or after their first birthday or other evidence of immunity to measles (see ACIP Statement on Measles Prevention dated 5/22/98) should receive a dose of measles vaccine. Since some medical personnel who have acquired measles in medical facilities were born before 1957, vaccination of older employees who may have occupational exposure to measles should also be considered during outbreaks. Susceptible personnel who have been exposed should be relieved from direct patient contact from the 5th to the 21st day after the exposure, regardless of whether they received vaccine or immunoglobulin after the exposure. Those who become ill should be relieved from patient contact for seven days after they develop a rash.

Reporting: Report all suspected, probable, or confirmed cases IMMEDIATELY by phone to the local health department, District Health Office, or the Epidemiology Branch at 404-657-2588. If calling after regular business hours, it is very important to report cases to 1-866-PUB-HLTH. After verbal report has been made, please transmit the case information electronically through the State Electronic Notifiable Disease Surveillance System (SENDSS) at http://sendss.state.ga.us. Note: Please be sure to complete all data fields in SENDSS, including the case report form.

Reported Cases of Measles in Georgia, 2001-2007

Year 2001 2002 2003 2004 2005 2006 2007

Number of Cases 1 3 1 1 0 0 0

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References: 1. American Academy of Pediatrics. Measles. In: Pickering, L, Eds. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th Ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006: 441-452. 2. Measles --- United States, 1999. MMWR Vol. 49(25), 2000: 557-560. 3. Case Definitions for Infectious Conditions Under Public Health Surveillance. MMWR Vol. 46(RR10), 1997: 1-55. 4. Epidemiology of measles United States, 1998. MMWR Vol. 48, 1999: 749-53. 5. Epidemiology and Prevention of Vaccine-Preventable Diseases, 10th edition, January 2007: 129-148. 6. Centers for Disease Control and Prevention. Measles Outbreak ---- Netherlands, April 1999--January 2000. MMWR Vol. 49(14), 2000: 299-303. 7. Centers for Disease Control and Prevention. Manual for the Surveillance of VaccinePreventable Disease. Centers for Disease Control and Prevention: Atlanta, GA, 2002. 8. Heymann, ed. Measles. In: Control of Communicable Diseases Manual. 18th ed. Washington, DC: American Public Health Association, 2004: 347-354.

Links:

CDC Measles Fact Sheet http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf
CDC National Immunization Program http://www.cdc.gov/vaccines/

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MEASLES Q&A (rubeola, hard measles, red measles)

What is measles? Measles is an acute, highly contagious viral disease capable of producing epidemics. Pneumonia occurs in up to 6 percent of reported cases and accounts for 60 percent of deaths attributed to measles. Encephalitis (inflammation of the brain) may also occur. Other complications include middle ear infection and convulsions. Measles is more common in winter and spring. Very few, if any, cases of measles occur in Georgia each year.

Who gets measles? Although measles is usually considered to be a childhood disease, it can be contracted at any age. Generally, inadequately immunized preschool children, adolescents, and young adults comprise the majority of measles cases in the United States.

How is measles spread? Measles is spread by direct contact with nasal or throat secretions of infected people or, less frequently, by airborne transmission. Measles is one of the most highly communicable infectious diseases.

What are the symptoms of measles? Measles symptoms generally appear in two stages. In the first stage, the individual may have a runny nose, cough and a slight fever. The eyes may become reddened and sensitive to light while the fever consistently rises each day. The second stage begins on the third to seventh day and consists of a temperature at or above 101F, and a red blotchy rash lasting four to seven days. The rash usually begins on the face and then spreads over the entire body. Koplik spots (little white spots) may also appear on the gums and inside of the cheeks.

How soon do symptoms appear? Symptoms usually appear in 10 to 12 days, although they may occur as early as 7 or as late as 18 days after exposure.

When and for how long is a person able to spread measles? An individual is able to transmit measles from five days prior to and five days after rash onset.

Does past infection make a person immune? Yes. Permanent immunity is acquired after contracting the disease.

What is the treatment for measles? There is no specific treatment for measles.

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How can measles be prevented? Anyone born on or after January 1, 1957, who does not have a history of physician-diagnosed measles or serologic confirmation of measles immunity, should receive two doses of MMR vaccine for maximum protection. The first dose should be given at 12 months of age. The second dose should be given at four to six years of age (school entry) at the same time as the DTaP and polio booster doses. The MMR vaccine is recommended for all routine measles vaccine doses to provide increased protection against all three vaccine-preventable diseases: measles, mumps and rubella. Two doses of measles-containing vaccine are required of all children enrolled in schools, grades K-12. College students also are required to demonstrate immunity against measles. For more detailed vaccination information, see Measles, Mumps, and Rubella Vaccine Guidelines in Chapter 2 of this manual.
Where can I get additional information on measles? Contact the Georgia Division of Public Health, Epidemiology Branch, by email at gaepinfo@dhr.state.ga.us. If you have Internet access, the following sites may be useful:
CDC Measles Fact Sheet http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf
CDC National Immunization Program http://www.cdc.gov/vaccines/

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MUMPS FACT SHEET (INFECTIOUS PAROTITIS)

Agent: Mumps virus.
Brief Description: An illness with acute onset of unilateral or bilateral swelling of the parotid gland or other salivary glands (parotitis), and without other apparent cause. Symptoms such as myalgia, anorexia, malaise, headache, and low-grade fever may precede parotitis by several days. Asymptomatic infections also occur; parotitis is present in only 30-40% of infected persons. Not all cases of parotitis especially sporadic ones are due to mumps infection; however, mumps is the only known cause of epidemic parotitis. Complications can include meningitis, arthritis, inflammation of the testicles or ovaries, inflammation of the pancreas and deafness.
Reservoir: Humans.
Mode of Transmission: Airborne, by droplet spread, or by direct contact with saliva of an infected person.
Incubation Period: Commonly 15 to 18 days, range 14 to 25 days.
Clinical Case Definition: An illness with acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting greater than or equal to 2 days, and without other apparent cause.
Lab Criteria for Diagnosis: Positive serologic test for mumps immunoglobulin M (IgM) antibody, or Significant rise between acute- and convalescent-phase titers in serum mumps immunoglobulin G antibody level by any standard serologic assay, or Isolation of mumps virus from clinical specimen.
Diagnostic Testing:

A. Serology 1. Specimen needed: Serum/blood - acute and convalescent. 2. Outfit: Other serology, order # 0504. 3. Form: 3432. 4. Lab Test Performed: Mumps serology (IgG and IgM; must write in IgM on this form). 5. Lab Performing Test: State Immunology Laboratory, Georgia Public Health Laboratory, (GPHL) in Decatur. 6. Transport Requirements: Acute sera (for IgG and IgM) should be collected as soon as possible after onset of parotitis for examining seroconversion. The convalescent specimen for IgG detection should be drawn about 2 weeks later. IgM antibodies are detectable within a few days after illness onset, peak about a week after onset and remain elevated for several weeks to months.

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B. Culture 1. Specimen Needed: throat swab, urine, or cerebrospinal fluid (CSF). 2. Outfit: Viral culture, order #0575. 3. Form: 3595. 4. Lab Test Performed: Mumps culture. 5. Lab Performing Test: State Virology Laboratory, GPHL in Decatur. 6. Transport Requirements: Virus may be isolated from the buccal mucosa from 7 days before, until 9 days after salivary enlargement. Ideally, the specimen should be collected within 72 hours of the onset of illness. If tests are to be performed within 72 hours after collection, transport specimens at 4o Celsius. Otherwise, freeze the specimen at 70o Celsius.
Case Classification: Probable: a case that meets the clinical case definition, has noncontributory or no serologic or virologic testing, and is not epidemiologically linked to a confirmed or probable case. Confirmed: a case that is laboratory confirmed or that meets the clinical case definition and is epidemiologically linked to a confirmed or probable case. A laboratory-confirmed case does not need to meet the clinical case definition.

Comment: False-positive IgM results by immunofluorescent antibody assays have been reported. Other serologic tests include Enzyme-Linked Immunosorbent Assay (ELISA or EIA) and Hemagglutination Inhibition (HI).
Period of Communicability: Persons with mumps are usually considered infectious from 2 days before until 4 days after onset of parotitis. Virus has been isolated from saliva from 7 days before parotitis and 9 days after onset of illness.
Vaccination: Live attenuated mumps virus vaccine is recommended for persons > 12 months of age unless medically contraindicated or unless a person is immune as defined by documentation of 1) immunization with at least one dose of mumps vaccine on or after the first birthday, 2) serological evidence of mumps immunity, or 3) birth in or before 1957. With use of MMR for measles vaccination under the currently recommended 2-dose schedule, most children and adolescents now receive two doses of mumps vaccine. Mumps vaccine, as MMR, is recommended at 12-15 months of age and 4-6 years of age. For more detailed vaccination information, see Measles, Mumps, and Rubella Vaccine Guidelines in Chapter 2 of this manual.
Post-exposure Prophylaxis: There is no evidence that giving mumps vaccine provides protection to those already exposed. However, in those susceptible persons who were exposed but not infected, the vaccine will provide future immunity, and its use in these situations is not contraindicated.
Treatment: Supportive only.

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Investigation: 1. Call the Notifiable Diseases Epidemiology Section (404) 657-2588. Complete the Mumps Surveillance Worksheet (from the Centers for Disease Control and Prevention's Manual for the Surveillance of Vaccine Preventable Diseases, Appendix 8). Identification of suspected or confirmed cases of mumps is important in the initiation of control measures to prevent the spread of disease among susceptible persons. Essential components of the case investigation include the following: a. Establish a diagnosis of mumps (submit specimens for serology). b. Obtain accurate and complete immunization histories. c. Identify the source of infection. d. Assess potential transmission and identify contacts. e. Obtain specimens for virus isolation.
2. Fax the completed sheet and the completed Notifiable Disease Report Form (#3095) and any pertinent lab results to the Notifiable Disease Epidemiology Section (404) 657-7517.
Outbreak Control: The main strategy for controlling a mumps outbreak is to define the at-risk population and a transmission setting, and to rapidly identify and vaccinate susceptible persons or, if a contraindication exists, to exclude susceptible persons from the setting to prevent exposure and transmission.
Reporting: Report all probable or confirmed cases IMMEDIATELY by phone to the local health department, District Health Office, or the Epidemiology Branch at 404-657-2588. If calling after regular business hours, it is very important to report cases to the Epidemiology Branch answering service. After verbal report has been made, please transmit the case information electronically through the State Electronic Notifiable Disease Surveillance System (SENDSS). Please be sure to complete all data fields in SENDSS including the case report form. **(Georgia code requires notification of both lab-confirmed and clinical mumps diagnosis within 7 days; however, immediate notification enables a prompt case investigation and public health response.)
Reported Cases of Mumps in Georgia, 2001-2007

Year 2001 2002 2003 2004 2005 2006 2007

Number of Cases 9 2 3 2 2 4 0

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References: 1. American Academy of Pediatrics. Mumps. In: Pickering, L, eds. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th Ed. Elk Grove Village, IL:
American Academy of Pediatrics; 2006: 464-468. 2. Heymann, ed. Mumps. In: Control of Communicable Diseases Manual. 18th ed.
Washington, DC: American Public Health Association, 2004: 376-379.
3. Centers for Disease Control and Prevention. Manual for the Surveillance of VaccinePreventable Diseases. Centers for Disease Control and Prevention: Atlanta, GA, 3rd
edition, 2002. 4. CDC. Case Definitions for Infectious Conditions under Public Health Surveillance.
MMWR Vol. 46(RR10), 1997: 1-55.
5. CDC. Measles, mumps, and rubella--vaccine use and strategies for elimination of
measles, rubella, and congenital rubella syndrome and control of mumps:
Recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR Vol. 47(RR-8), 1998: 1-57.
6. Wharton, Melinda. Mumps. In: Maxcy-Rosenau-Last: Public Health and Preventive Medicine. Wallace, R, ed. 14th Ed. Appleton & Lange, Stamford, CT, 1998: 93-95.

Links: CDC Mumps Fact Sheet http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/mumps.pdf CDC National Immunization Program http://www.cdc.gov/vaccines/

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PERTUSSIS FACT SHEET (WHOOPING COUGH)

Agent: The bacterium Bordetella pertussis.
Brief Description: An acute bacterial infection involving the respiratory tract. The initial (catarrhal) stage has insidious onset with irritating cough that can progress to severe paroxysms of cough (paroxysmal stage). Paroxysms are characterized by a series of many coughs without intervening inhalation, often followed by a high-pitched inspiratory "whoop" and vomiting.
Disease in infants younger than 6 months of age may be atypical; apnea is a common manifestation and whoop is often absent. Similarly, older children and adults can have atypical manifestations, with persistent cough and no whoop. In recent years in the United States, pertussis has been recognized with increasing frequency in adolescents and young adults. Many of these cases occur in previously immunized persons and indicate waning immunity following immunization.
Complications of pertussis include seizures, pneumonia, encephalopathy, and death. Disease rates and risk of serious complications, including death, are highest among young children, particularly those younger than 1 year of age.
Reservoir: Humans are believed to be the only host.
Mode of Transmission: By direct contact with discharges from respiratory mucous membranes of infected persons by the airborne route, probably by droplets. Frequently brought home by an older sibling and sometimes by a parent.
Incubation Period: Commonly 7-20 days.
Period of Communicability: Highly communicable in the early catarrhal stage before paroxysmal cough. Thereafter communicability gradually decreases and becomes negligible in about 3 weeks for non-household contacts, despite persisting spasmodic cough with whoop. When treated with erythromycin, the period of infectiousness is usually 5 days or less after onset of therapy.
Clinical Case Definition: A cough illness lasting greater than or equal to 2 weeks with one of the following: paroxysms of coughing, inspiratory "whoop," or post-tussive vomiting, and without other apparent cause (as reported by a health professional).
Case Classification: Probable: meets the clinical case definition, is not laboratory confirmed, and is not epidemiologically linked to a laboratory-confirmed case Confirmed: a case that is culture positive and in which an acute cough illness of any duration is present; or a case that meets the clinical case definition and is confirmed by positive PCR; or a case that meets the clinical case definition and is epidemiologically linked directly to a case confirmed by either culture or PCR

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Lab Criteria for Diagnosis: 1. Isolation of Bordetella pertussis from a clinical specimen 2. Positive polymerase chain reaction (PCR) for B. pertussis

Diagnostic Testing: 1. Culture, DFA and PCR are recommended for pertussis diagnosis. 2. Specimen needed: Nasopharyngeal (NP) swabs are the specimens of choice and should be collected as soon as possible after illness onset, preferably before antibiotic treatment. 3. See Appendix 1 for specimen collection and submission details.
*Comment: Although serologic and PCR tests are widely available, they are not standardized and should not be used for case confirmation until an approved test has been licensed. Direct fluorescent antibody (DFA) testing is available from the Georgia Public Health Laboratory (GPHL) and from many hospital and commercial laboratories. The DFA test is more sensitive than culture, but it is less specific; cases with a positive DFA test only are considered presumptive. DFA tests should always be accompanied with a culture for diagnosis of B. pertussis.
Vaccination: Beginning in 1996 acellular pertussis vaccines were recommended for all doses in the pertussis vaccine series, replacing the whole-cell vaccines which previously had been used. All acellular vaccines are combined with diphtheria and tetanus toxoid (DTaP vaccine). Children should receive four doses of vaccine, with the first three doses administered at 4- to 8-week intervals, beginning at 6 to 8 weeks of age. The fourth dose should be given 6-12 months after the third dose. In children younger than seven years old, DTaP vaccines efficacy ranges from 71% to 84%. Tdap vaccine is a formulation licensed for use in persons ages 10-64, and should be given as a one-time dose in lieu of a booster dose of Td. For more detailed vaccination information for either Tdap or DTaP, see Diphtheria, Tetanus, and Pertussis Vaccine Guidelines in Chapter 2 of this manual.
Investigation: I. Obtain the following information immediately in order to perform a risk assessment to gauge index of suspicion.
1. Immunization history 2. Exposure history (any possibility the suspect case was around a confirmed or
suspect case in the 20 days before becoming ill) 3. Obtain detailed description of the clinical presentation:
History of cough including onset date Onset of coryza, cyanosis, whoop, post-tussive vomiting or presence of apnea.
II. Confirm the diagnosis. See "Diagnostic Testing" section.
III. Conduct epidemiology investigation 1. Ensure isolation of case and counsel immediate contacts to avoid exposure to highrisk groups until 5 days of antibiotic treatment is completed. 2. Determine period of communicability (one week before to two weeks after cough onset) 3. Interview case to identify possible contacts (i.e. household, school, childcare, work, healthcare facility). Specific definitions of contact will vary according to the situation.
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Transmission can be expected with:
Direct face-to-face contact for a period (not defined) with a case who is symptomatic
(e.g., in the catarrhal or paroxysmal period of illness)
Shared confined space in close proximity for a prolonged period of time, such as 1
hour, with a symptomatic case.
Direct contact with respiratory, oral, or nasal secretions from a symptomatic case
(e.g., an explosive cough or sneeze in the face, sharing food, sharing eating utensils during a meal, kissing, unprotected mouth-to-mouth resuscitation, or performing a full medical exam including examination of the nose and throat).
4. Refer contacts for prophylaxis to health department, pharmacy or primary care physician.
5. If period of prophylaxis has passed (three weeks except in high risk cases), counsel contacts to call their health provider if they develop respiratory symptoms and/or cough.
6. Work with Georgia Division of Public Health and State Pharmacy (District pharmacies in certain Districts) to ensure availability of adequate antibiotics for contacts.
IV. Conduct surveillance for secondary cases and contacts.
* Note that the steps are not ordered by priority since several of these steps are conducted simultaneously. * Prepared by the Metro Atlanta Surveillance Task Force (MASTF) Standardization Subcommittee, last update 1/28/05. Reference for Investigation Protocol: Red Book, 26th Edition by American Academy of Pediatrics.

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Treatment and Prophylaxis: The following treatment/prophylaxis recommendations are from "Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis, 2005 CDC Guidelines" (see citation). The choice of antimicrobial for treatment or prophylaxis should take into account effectiveness, safety (including the potential for adverse events and drug interactions), tolerability, ease of adherence to the regimen prescribed, and cost. All close contacts of cases should receive chemoprophylaxis regardless of their immunization status. Please refer to the article for additional details regarding treatment and prophylaxis (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm or see citation). Table 4 lists the recommended antimicrobial treatment and postexposure prophylaxis by age group:

Reporting: Report cases IMMEDIATELY by phone to the local health department, District Health Office, or the Epidemiology Branch at 404-657-2588. If calling after regular business hours, cases can be reported to 1-866-PUB-HLTH. After a verbal report has been made, please transmit the case information electronically through the State Electronic Notifiable Disease Surveillance System (SENDSS) at http://sendss.state.ga.us. Please be sure to complete all data fields in SENDSS, including the case report form.
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Reported Pertussis Cases (Probable and Confirmed) in Georgia, 2001-2007

Year 2001 2002 2003 2004 2005 2006 2007

Number of Cases 23 29 36 71 78 102 37

References: 1. American Academy of Pediatrics. Pertussis. In: Pickering, L, Eds. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th Ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006: 498-520. 2. CDC. Pertussis United States, January 1992-June 1995. MMWR Vol. 44; 1995: 525-529. 3. CDC. Pertussis vaccination: use of acellular pertussis vaccines among infants and young children Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Vol. 46(RR-7), 1997: 1-25. 4. Use of diphtheria toxoid-tetanus toxoid-acellular pertussis vaccine as a five-dose series: supplemental recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Vol. 49(RR-13); 2000: 1-8. 5. Manual for the Surveillance of Vaccine-Preventable Diseases. Centers for Disease Control and Prevention: Atlanta, GA, 2002. 6. Heymann, ed. Pertussis. In: Control of Communicable Diseases Manual. 18th Ed. Washington, DC: American Public Health Association, 2004: 399-404. 7. De Moissac YR, Ronald SL, Peppler MS. Use of pulsed-field gel electrophoresis for epidemiological study of Bordetella pertussis in a whooping cough outbreak. J Clin Microbiol Vol. 32, 1994: 398-402. 8. Epidemiology and Prevention of Vaccine-Preventable Diseases. 10th ed. Public Health Foundation; 2007: 81-99. 9. CDC. Recommended Antimicrobial Agents for Treatment and Postexposure Prophylaxis of Pertussis, 2005 Guidelines. MMWR Vol. 54(RR-14), 2005:1-16.
Links: CDC Pertussis http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf National Immunization Program http://www.cdc.gov/vaccines/ Diphtheria, Tetanus, and Pertussis Vaccine Information Statement http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-dtap.pdf Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis - http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm

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APPENDIX 1: PERTUSSIS SPECIMEN COLLECTION AND SUBMISSION
Specimen Collection A swab of nasopharyngeal secretions is the optimal specimen for confirming a pertussis diagnosis. Specimens should be collected as soon as possible after onset of illness, preferably before antibiotic treatment. Dacron (not cotton) swabs are superior to other types of swabs and are recommended. A culture is the preferred test to confirm pertussis and requires a special transport medium (Regan-Lowe). The State Epidemiology Branch (through the District Epidemiologists) currently provides Regan-Lowe media. Alternative diagnostics, such as Direct Fluorescent Antibody (DFA) and Polymerase Chain Reaction (PCR) are useful as an adjunct and should not replace culture. Please consult with the Notifiable Disease Epidemiology Section, Epidemiology Branch at 404-657-2588 for questions about diagnostics for pertussis.
Regan-Lowe Media Regan-Lowe medium is used to transport specimens to the laboratory for culture and is available in each District. The medium should be stored in a refrigerator at 2-8 C. ReganLowe medium should be removed from the refrigerator and warmed to room temperature before use. Consult the District Epidemiologist and/or the Notifiable Disease Epidemiology Section to obtain Regan-Lowe media.
Nasopharyngeal Swab Procedure and Specimen Preparation 1. Immobilize the patient's head. 2. Pass nasopharyngeal swab very gently into a nostril until the posterior nares is reached. 3. Leave the swab in place for up to 10 seconds (this may induce a cough and in practice only a few seconds may be possible.) If resistance is encountered during insertion of the swab, remove it and attempt insertion on the opposite nostril. 4. Remove the swab slowly. This swab can be used for both the DFA and culture. 5. Streak slides (frosted side up) for DFA testing then insert and immerse swab into the Regan-Lowe transport medium. 6. Cut the handle end of the swab extending above the transport tube if necessary and cap the container tightly. 7. Label slide holder with the patient's name and date of specimen collection (avoid using wax pencil or gummed labels on slides). 8. Label the Regan-Lowe tube with the patient's name and date of specimen collection. 9. A second swab (Dacron, polyester or rayon) must be used for a PCR test. Follow steps 1 4 for specimen collection.

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Requisition Forms Use Form #3410 to request DFA and culture. Use Form #3409 for PCR testing. It is extremely important that the forms are completed entirely. Please include the following information:
1. Patient name 2. Date of specimen collection 3. Test requested (culture for B. pertussis and B. parapertussis, DFA and PCR for B.
pertussis) 4. Submitter's name and address 5. Name and telephone number of clinician to contact 6. Source of specimen, such as nasopharyngeal 7. Patient's race, sex, age, and address, if available 8. Brief clinical history, if available

Specimen Transport Culture and DFA: Place slides for DFA testing securely in the plastic slide holders provided (Outfit #0525, available from Laboratory Services and Supply, 404-327-7920). Place slides in plastic holder and Regan-Lowe media tube in a plastic biohazard bag. Insert requisition form in the front pouch of the bag. Place the bag with form affixed in the orange-labeled cardboard mailing container (Decatur address). Seal the lid of the outside container with tape. The specimens should be transported (room temperature) to the Bacteriology Unit immediately by courier or via Federal Express or UPS. If the shipment is delayed, the specimens should be refrigerated at 2-8 degrees Celsius and then sent the next day on ice packs by first class mail, common carrier, or courier.

PCR: The specimen can be submitted dry, preferably in a sterile centrifuge tube. Please notify the Epidemiology Branch at 404-657-2588 before sending the specimen, as PCR testing is available by request only from the State office. Specimens should be sent to the Molecular Biology Lab.

Shipping Addresses: Bacteriology Unit Georgia Public Health Laboratory 1749 Clairmont Rd. Decatur, Ga. 30033-4050 Attn: Barbara Wallace

Molecular Biology Lab Georgia Public Health Laboratory 1749 Clairmont Rd. Decatur, Ga. 30033-4050 Attn: Tonia Parrott

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PERTUSSIS Q&A (Whooping cough)
What is pertussis? Pertussis, or whooping cough, is a highly contagious disease involving the respiratory tract. It is caused by a bacterium that is found in the mouth, nose and throat of an infected person.
Who gets pertussis? Pertussis can occur at any age. Seventy-five percent of reported cases occur in children under five years of age and 50 percent of these are in children under one year of age.
How is pertussis spread? Pertussis is primarily spread by direct contact with discharges from the nose and throat of infected individuals. Frequently, older siblings who may be harboring the bacteria in their nose and throat can bring the disease home and infect an infant in the household.
What are the symptoms of pertussis? Pertussis begins as a mild upper respiratory infection. Initially, symptoms resemble those of a common cold, including sneezing, runny nose, low-grade fever and a mild cough. Within two weeks, the cough becomes more severe and is characterized by episodes of numerous rapid coughs followed by a crowing or high-pitched whoop. A thick, clear mucous may be discharged. These episodes may recur for one to two months, and are more frequent at night. Older people or partially immunized children generally have milder symptoms.
How soon after infection do symptoms appear? The incubation period is usually 7 to 20 days.
When and for how long is a person able to spread pertussis? A person can transmit pertussis from seven days following exposure to three weeks after the onset of coughing episodes. The period of communicability is reduced to between five and seven days when antibiotic therapy is begun.
Does past infection with pertussis make a person immune? One attack usually confers prolonged immunity but persons are not immune for life after infection.
What are the complications associated with pertussis? Complications of pertussis may include pneumonia, middle ear infection, dehydration, loss of appetite, seizures, encephalopathy (disorders of the brain), apneic episodes (brief cessation of breathing) and death.
What is the treatment for pertussis? Antibiotics may be given to shorten the period of time that an infected person can transmit the infection to others, but antibiotics do not reduce symptoms except when given before or shortly after symptoms develop.

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How can pertussis be prevented? The single most effective control measure is maintaining the highest possible level of immunization in the community. The vaccine for pertussis is usually given in combination with diphtheria and tetanus. For more detailed vaccination information for either Tdap or DTaP, see Diphtheria, Tetanus, and Pertussis Vaccine Guidelines in Chapter 2 of this manual.
Treatment of cases with certain antibiotics such as erythromycin can shorten the contagious period. People who have or may have pertussis should stay away from young children and infants until properly treated.
Where can I get additional information on pertussis? Contact the Georgia Division of Public Health, Epidemiology Branch, by email at gaepinfo@dhr.state.ga.us. The following web sites may be useful:
CDC Pertussis http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf National Immunization Program http://www.cdc.gov/vaccines/ Diphtheria, Tetanus, and Pertussis Vaccine Information Statement -
http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-dtap.pdf Georgia Division of Public Health, Epidemiology Branch http://health.state.ga.us/epi

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POLIOMYELITIS FACT SHEET
(INFANTILE PARALYSIS, POLIO)

Agent: Poliovirus serotypes 1, 2, and 3.
Brief Description: A highly contagious viral infection with manifestations ranging from inapparent infection to non-specific febrile illness, aseptic meningitis, paralytic disease and death. Symptoms include fever, headache, sore throat, gastrointestinal upset, malaise, and stiffness of neck and back. In approximately 0.1% to 2% of cases, symptoms include a flaccid paralysis typified by absent deep tendon reflexes; in approximately 1 out of 250 cases, residual neurologic symptoms occur, including paralysis.
Reservoir: Humans.
Mode of Transmission: Primarily person-to-person spread, principally through the fecal-oral route but also by the respiratory route; fecal-oral transmission occurs in situations where sanitation is poor. However, where sanitation is good, pharyngeal spread may be more apparent. In rare instances, milk, foodstuffs and other materials contaminated with feces have been incriminated as vehicles. There is no reliable evidence of spread by insects; sewage and water are rarely implicated.
Incubation Period: Usually 6 to 20 days, with a range of 3 to 35 days.
Clinical Case Definition: Acute onset of a flaccid paralysis of one or more limbs with decreased or absent tendon reflexes in the affected limbs, without other apparent cause, and without sensory or cognitive loss.
Laboratory Criteria for Diagnosis: Case confirmation is based on a clinical definition. However, a probable case can be supported by laboratory information. Diagnosis is made by isolation of the organism from throat, stool, rectum, cerebrospinal fluid (CSF), or blood. The highest probability of isolation is achieved when two stool and throat specimens are obtained twenty-four hours apart. These should be sent to the Georgia Public Health Laboratory for primary isolation. The state laboratory will forward isolates to the Centers for Disease Control and Prevention (CDC) for Polymerase Chain Reaction (PCR) and antibody blocking testing to determine intratypic variation. This will determine whether a paralytic polio case is derived from wild-type or vaccine related virus.
Diagnostic Testing: A. Culture 1. Specimen Needed: Stool, throat swab, rectal swab, CSF, or blood. 2. Outfit: Viral culture outfit, order #0575. 3. Form: 3595. 4. Lab Test Performed: Isolation and identification of poliovirus. 5. Lab Performing Test: State Virology Laboratory, Georgia Public Health Laboratory (GPHL) in Decatur, followed by intratypic differentiation performed at the CDC. 6. Transport Requirements: Collect within 72 hours of onset of symptoms; specimens should be frozen immediately and shipped on dry ice.

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Comment: Isolation of wild-type virus constitutes a public health emergency and appropriate control measures must be initiated immediately (in consultation between health care providers, state and local health departments, and CDC).
B. Serology 1. Specimen Needed: Acute and convalescent sera, or whole blood. a. Acute sera: 2-3 cc collected as soon as possible after onset of illness. b. Convalescent sera: 2-3 cc whole blood collected 14-21 days after acute phase of illness. 2. Outfit: Serology, order #0504. 3. Form: 3432. 4. Lab Test Performed: Neutralizing antibody titers to poliovirus serotype 1, 2, and 3. 5. Lab Performing Test: CDC with prior arrangement by the Georgia Public Health Laboratory. Do not submit specimens directly to CDC. All specimens must be submitted to the Georgia Public Health Laboratory.
Case Classification: Probable: A case that meets the clinical case definition. Confirmed: A case that meets the clinical case definition and in which the patient has a neurologic deficit 60 days after onset of initial symptoms, has died, or has unknown follow-up status.
Vaccination: There are two types of polio vaccine: the Inactivated Polio Vaccine (IPV) and the Oral Polio Vaccine (OPV). The IPV is given intramuscularly or subcutaneously, and OPV, a live attenuated virus, is given orally. The Advisory Committee for Immunization Practices (ACIP) recommends a four-dose schedule of IPV for routine immunization of infants and children. The first three are given at two-month intervals beginning at 2 months of age (the third dose can be given between 6 and 18 months.) The fourth dose is given at age 4 to 6 years, before entering school. For more detailed vaccination information see Polio Vaccine Guidelines in Chapter 2 of this manual.
Oral polio vaccine (OPV) is no longer routinely recommended in the United States because of the continued risk for vaccine-associated paralytic poliomyelitis (VAPP), the absence of indigenous disease, and the low risk for wild poliovirus importation into the United States. OPV is no longer available for routine vaccination in the U.S.
Most adults in the United States are at low risk for polio due to immunizations received in childhood. Certain adults are at high risk however, and should be vaccinated. These adults are:
1. Travelers to areas or countries where polio may be epidemic or endemic. 2. Members of communities with disease caused by wild-type polio. 3. Laboratory workers handling specimens that may contain wild-type polio. 4. Health-care personnel in close contact with patients who may be excreting wild-type
polio. 5. Unvaccinated adults whose children will be receiving oral poliovirus vaccine.

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Period of Communicability: Not accurately known, but transmission is possible as long as virus is excreted. Virus is demonstrable in the throat as early as 36 hours after exposure and in the feces 72 hours after exposure to infection in both clinical and inapparent cases. Virus persists in the throat for approximately 1 week and in the feces for 3 to 6 weeks or longer. Cases are most infectious during the first few days before and after onset of symptoms.
Treatment: None except attention during the acute illness to the complications of paralysis.
Investigation: The Epidemiology Branch will give instructions regarding investigation when a case is reported by phone. The following information should be collected as part of the investigation:
1. Demographic Information: The name, age, sex, race, occupation, and address (county, city and zip code) of the patient.
2. Immunization History: The number, dates and lot numbers of previous doses of inactivated polio vaccine (IPV) and the number, dates, type (monovalent versus trivalent) and lot numbers of previous doses of oral polio vaccine (OPV). Information on the number, site and types of injections given at either the time of vaccination or within 30 days after vaccination should also be collected.
3. Clinical Information: A brief description of the patient's illness including the date of onset of paralysis. Information should include the course of the illness and the sites of paralysis or other complications.
4. Immunologic Status: Since persons with some immune deficiency diseases are at increased risk of paralytic poliomyelitis, known immune deficiency either in the patient or patient's family should be documented. If any doubt exists, an immunologic evaluation (quantitative immunoglobulins, T and B cell quantitation, lymphocyte transformation, etc.) should be considered.
5. Exposure History: a. History of recent travel of the patient or a close contact outside of the United States to an endemic or epidemic area for poliomyelitis. b. History of contact with any known cases of poliomyelitis and the date of contact, if applicable. c. History of receipt of OPV by the patient within 30 days prior to onset, including the date of receipt and the lot number of the vaccine. d. History of contact within 30 days prior to onset of symptoms with any person who received OPV within the last 60 days prior to onset, including the date of contact, the nature of the contact, the date the contact received OPV, the lot number of the vaccine, the age of the contact, and the relationship to the patient. Information regarding the contact's prior history of immunization with IPV should also be collected.

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6. Laboratory Data: For the diagnosis of suspected cases, original specimens are most desirable because special methods are used to determine if viruses other than polioviruses are present. Types of laboratory tests are described above in "Diagnostic Testing."

Reporting: Report cases IMMEDIATELY by phone to the local health department, District Health Office, or the Epidemiology Branch at 404-657-2588. If calling after regular business hours, it is very important to report cases to the Epidemiology Branch answering service. After a verbal report has been made, please transmit the case information electronically through the State Electronic Notifiable Disease Surveillance System (SENDSS) at http://sendss.state.ga.us. Please be sure to complete all data fields in SENDSS including the case report form.

Reported Cases of Poliomyelitis in Georgia, 2001-2007

Year 2001 2002 2003 2004 2005 2006 2007

Number of Cases 0 0 0 0 0 0 0

References: 1. American Academy of Pediatrics. Poliovirus Infections. In: Pickering L, Ed. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th Ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006: 542-547. 2. CDC. Case Definitions for Infectious Conditions Under Public Health Surveillance. MMWR Vol. 46(RR10); 1997: 1-55. 3. Centers for Disease Control and Prevention. Manual for the Surveillance of VaccinePreventable Diseases. Centers for Disease Control and Prevention: Atlanta, GA, 3rd edition, 2002. 4. Centers for Disease Control and Prevention. Developing and Expanding Contributions of the Global Laboratory Network for Poliomyelitis Eradication, 19971999. MMWR Vol. 49(08); 2000: 156-160. 5. Centers for Disease Control and Prevention. Poliomyelitis Prevention in the United States. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Vol. 49(RR-5); 2000: 1-22. 6. Heymann, ed. Poliomyelitis, Acute. In: Control of Communicable Diseases Manual. 18th ed. Washington, DC: American Public Health Association, 2004: 399-404. 7. Edwards E, Grant C, Huang Q, Powell K, Croxson M. A case of vaccine-associated paralytic poliomyelitis. J Paediatr Child Health Vol. 36(4); 2000: 408-11.

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Links: CDC National Immunization Program http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/polio.pdf
POLIOMYELITIS Q&A
(Infantile paralysis, Polio)
What is polio? Polio is a viral disease that may affect the central nervous system. Complications include paralysis (most commonly of the legs). Paralysis of the muscles of respiration and swallowing can be fatal. Since polio immunization has become widespread, cases of polio are very rare.
Who gets polio? Polio is more common in infants and young children and occurs under conditions of poor hygiene. However, paralysis is more common and more severe when infection occurs in older individuals. In exceedingly rare cases, oral polio vaccine can cause paralytic polio in a person who receives the vaccine (one in every 2.4 million doses).
How is polio spread? Polio is predominately spread from person to person through the fecal-oral route when community or personal hygiene is imperfect.
What are the symptoms of polio? Infection with poliovirus can range from inapparent to a severe paralytic disease that may result in death. Symptoms include fever, malaise, headache, nausea and vomiting, excruciating muscle pain and stiffness in the neck and back.
How soon after infection do symptoms appear? The incubation period is usually 6 to 20 days, with a range of 3 to 35 days.
When and for how long is a person able to spread the poliovirus? Patients are most infectious from 7 to 10 days before and after the onset of symptoms. However, patients are potentially contagious as long as the virus is present in the throat and feces. The virus persists in the throat for approximately one week after onset of illness and is excreted in feces for several weeks or, occasionally, months.
Does past infection with polio make a person immune? There are three types of poliovirus. Lifelong immunity usually depends on which type of virus one is infected with. Second attacks are rare and result from infection with a poliovirus of a different type than the first attack.
What is the treatment for polio? There is presently no cure for polio. Treatment involves supportive care.

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How can polio be prevented? Maintaining high levels of polio immunization in the community is the single most effective preventive measure. Two types of polio vaccine are available: trivalent oral polio vaccine (OPV) and inactivated polio vaccine (IPV). However, in the United States IPV is the vaccine of choice and OPV is not readily available. Contact the Georgia Immunization Program at 404-657-3158 for current vaccine recommendations.
Where can I get additional information on polio? Contact the Georgia Division of Public Health, Epidemiology Branch, by email at gaepinfo@dhr.state.ga.us. If you have Internet access, the following web site may be useful: CDC National Immunization Program http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/polio.pdf

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Agent: Rubella virus.
Brief Description: A mild febrile viral disease with a diffuse punctate (pinpoint) and maculopapular rash sometimes resembling that of measles or scarlet fever. Children usually present few or no constitutional symptoms, but adults may experience a 1 to 5 day prodrome of low grade fever, headache, malaise, mild coryza, and conjunctivitis. Rubella is important because of its ability to produce anomalies in the developing fetus. These abnormalities are termed Congenital Rubella Syndrome (CRS). Congenital rubella syndrome occurs when a pregnant mother becomes infected and passes the virus to her fetus. The primary congenital defects are ophthalmologic (cataracts, glaucoma, retinopathy), cardiac (patent ductus arteriosus, peripheral pulmonary artery stenosis), auditory (sensorineural deafness) and neurologic (behavioral disorders, meningoencephalitis, mental retardation). Other congenital defects include radiolucent bone disease and growth retardation. The occurrence of these defects is 50% if the mother is infected in the first month of pregnancy, 20% to 30% if infected in the second month and 5% if infected in the third to fourth month. Defects are rare when maternal infection occurs after the 20th week.
Reservoir: Humans.
Mode of Transmission: Contact with nasopharyngeal secretions of infected persons. Infection is transmitted by droplet spread or direct contact with patients. Infants with congenital rubella syndrome shed large quantities of virus from body secretions for up to one year, and can therefore serve as a source of infection for susceptible persons caring for them. Rubella may also be transmitted by sub-clinical cases (approximately 30% to 50% of all rubella infections).
Incubation Period: Sixteen to 18 days, with a range of 12 to 23 days.
Clinical Case Definition: An illness with ALL of the following characteristics: Acute onset of generalized maculopapular rash, and Temperature > 37.2 C ( 99 F), if measured, and Arthralgia, arthritis, lymphadenopathy, or conjunctivitis.
Cases meeting the measles case definition are excluded. Also excluded are cases with serology that is compatible with recent measles virus infection. All rubella cases should be confirmed by a laboratory test (serology).
Lab Criteria for Diagnosis: Positive serologic test for rubella IgM antibody, or Significant rise in rubella antibody level by any standard serologic assay, or Isolation of rubella virus

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Diagnostic Testing: A. Serology 1. Specimen: Blood - acute sera (at least 5cc whole blood) for IgM and IgG titers collected at the onset of illness and convalescent sera (IgG) collected 14-21 days later. Please note that a single IgM test will confirm the diagnosis. False-positive rubella IgM tests have been found in persons with parvovirus infections, a positive heterophile test for infectious mononucleosis, or a positive rheumatoid factor. 2. Outfits: Other serology outfit, order #0504. 3. Form: 3432. 4. Lab Test Performed: Titers for Rubella - IgG and IgM (must write IgM request on the form). 5. Lab Performing Test: Immunology Laboratory, Georgia Public Health Laboratory (GPHL) in Decatur. 6. Transport Requirements: Sera can be kept at ambient temperature, refrigerated, or frozen. Specimen should be non-hemolyzed.

B. Culture / Polymerase Chain Reaction (PCR) 1. Specimen: Nasopharyngeal swab/aspirate, throat, urine, or cerebrospinal fluid (CSF). 2. Outfit: Viral transport media. 3. Form: Form 3595. 4. Lab Test Performed: Culture or PCR. 5. Lab Performing Test: Virology Laboratory, GPHL in Decatur. 6. Transport Requirements: Specimen should be kept in viral transport medium.
Case Classification: Suspect: any generalized rash illness of acute onset. Probable: a case that fits the clinical description, has no or noncontributory serologic or virologic testing, and is not epidemiologically linked to a laboratory-confirmed case. Confirmed: a case that is laboratory confirmed or that meets the clinical case definition and is epidemiologically linked to a laboratory-confirmed case.
Period of Communicability: Rubella is moderately contagious. The disease is most contagious as the rash is erupting, but can be transmitted about 1 week before to 5-7 days after onset of rash. Infected children should be excluded from school until 7 days after rash onset.
Vaccination: Children should receive rubella vaccine at 12-15 months of age, and 4-6 years of age. It is usually given combined with measles and mumps vaccine as MMR or MMRV. Adults born in 1957 or later should receive at least one dose of MMR vaccine unless they have documentation of vaccination with at least one MMR, or other acceptable evidence (laboratory results) of immunity to measles, mumps, and rubella. Efforts should be made to identify and vaccinate susceptible adolescents and adults, particularly women of childbearing age who are not pregnant. Women who are pregnant or who plan to become pregnant within one month should not receive the vaccine, due to the theoretical risk for causing birth defects in the developing fetus. Emphasize vaccinating susceptible males and females in colleges, employment and health care settings. For more detailed vaccination information, see Measles, Mumps, and Rubella Vaccine Guidelines in Chapter 2 of this manual.

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Post-exposure Prophylaxis: Live attenuated vaccine given after exposure has not been demonstrated to prevent illness. However, non-pregnant people exposed to rubella may still theoretically benefit from the vaccine if given up to three days after exposure. Immunization of a person who is incubating natural rubella or who already is immune is not associated with increased risk of adverse effects. The risk of congenital rubella when a pregnant woman is exposed is significant. Exposed pregnant women should not be given live virus vaccine. An intramuscular dose of 20 ml of immune globulin (IG) may decrease clinically apparent infection, but no studies show that such a dose protects the fetus. It should only be used in cases where therapeutic abortion is not an option.
Treatment: None.
Investigation: Case Investigation:
1. Establish a diagnosis: Because the clinical diagnosis of rubella is unreliable, cases must be confirmed by a laboratory test (serology).
2. For adult women, obtain accurate pregnancy status: All women of childbearing age should be evaluated for pregnancy status. If a pregnant woman is infected, immediate referral to her medical care provider is necessary.
3. Obtain accurate and complete immunization histories. 4. Identify the source of infection: Case-patients and their caregivers should be asked
about contact with other known cases. Since 20%-50% of cases are asymptomatic, identification of a source will not always be possible. 5. Assess potential for transmission and identify contacts: Contacts of case-patients during the infectious period (7 days before to 7 days after rash onset) should be identified. Transmission can occur in households, communities, workplaces, and prisons. 6. Obtain specimens for virus isolation: Nasopharyngeal swabs and urine should be collected within 4 days after rash onset and submitted for virus isolation. Isolates are essential to identify virus types and track the epidemiology of rubella in the United States, especially as we progress towards elimination of the virus in geographical regions. 7. Laboratory evaluation of exposed pregnant women: Pregnant women who have been exposed should have serologic testing (an IgG and IgM test) at the time of exposure, an IgG titer 2 to 3 weeks later, and another IgG titer 6 weeks after exposure. If the first IgG test is positive, the woman is immune. If the first test is negative, the second and third test will determine whether infection has occurred in the absence of an IgM test. A positive IgM indicates a recent or acute infection. 8. Pregnancy Outcome Registry for women diagnosed with rubella during pregnancy: All pregnant women infected with rubella during pregnancy should be monitored to document the pregnancy outcome (e.g., termination, CRS, or normal infant) on Centers for Disease Control and Prevention (CDC) Form 71.17, "Congenital Rubella Case Report Form," and forward to the Epidemiology Branch.

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Outbreak Investigation: Strategies to control rubella outbreaks include defining at-risk populations, ensuring susceptibles are rapidly vaccinated, and maintaining active surveillance for new cases. Outbreak control measures should be implemented immediately when one case of rubella is confirmed in a community.

Reporting: Report all suspect, probable or confirmed cases IMMEDIATELY by phone to the local health department, District Health Office, or the Epidemiology Branch at 404-657-2588. If calling after regular business hours, it is very important to report cases to the Epidemiology Branch answering service. After a verbal report has been made, please transmit the case information electronically through the State Electronic Notifiable Disease Surveillance System (SENDSS) at http://sendss.state.ga.us. Please complete all data fields in SENDSS including the case report form. Additionally, Districts should report all congenital rubella cases on CDC Form 71.17, "Congenital Rubella Case Report Form," and forward to the Epidemiology Branch. **(Georgia code requires notification of rubella diagnosis within 7 days; however, immediate notification enables a prompt case investigation and public health response.)

Reported Cases of Rubella in Georgia, 2001-2007

Year 2001 2002 2003 2004 2005 2006 2007

Number of Cases 1 0 0 1 0 0 0

References: 1. American Academy of Pediatrics. Rubella. In: Pickering L, Eds. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th Ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006: 474-479. 2. CDC. Case Definitions for Infectious Conditions Under Public Health Surveillance. MMWR Vol. 46(RR10), 1997: 1-55. 3. Manual for the Surveillance of Vaccine-Preventable Diseases. Centers for Disease Control and Prevention: Atlanta, GA, 2002. 4. Heymann, ed. Rubella. In: Control of Communicable Diseases Manual. 18th ed. Washington, DC: American Public Health Association, 2004: 464-469.
Links: CDC National Center for Infectious Diseases Rubella Information http://www.cdc.gov/ncidod/diseases/submenus/sub_rubella.htm CDC National Immunization program http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/rubella.pdf

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RUBELLA FACT SHEET (German Measles)

RUBELLA Q&A (German measles)
What is rubella? Rubella is a viral disease characterized by slight fever, rash and swollen glands. Very few to no cases are reported in Georgia each year.
Who gets rubella? In unvaccinated populations, rubella is primarily a childhood disease. Where children are well immunized, adolescent and adult infections become more evident. Rubella occurs more frequently in winter and spring.
How is rubella spread? Rubella is spread by direct contact with nasal or throat secretions of infected individuals.
What are the symptoms of rubella? Rubella is a mild illness that may present with few or no symptoms. Symptoms may include a rash, slight fever, joint aches, headache, discomfort, runny nose and reddened eyes. The lymph nodes just behind the ears and at the back of the neck may swell causing some soreness and/or pain. The rash, which may be itchy, first appears on the face and progresses from head to foot, lasting about three days. As many as half of all rubella cases occur without a rash.
How soon do symptoms appear? The incubation period for rubella ranges from 14 to 23 days. However, in most cases symptoms appear within 16 to 18 days.
When and for how long is a person able to spread rubella? Rubella may be transmitted from seven days before to four days after the onset of rash.
Does past infection with rubella make a person immune? Yes. Immunity acquired after contracting the disease is usually permanent.
When is the vaccine for rubella needed? Rubella vaccine is given on or after a child's first birthday, but is recommended at 12 months of age when given in combination with measles vaccine. The vaccine can be given alone or in a one-shot combination vaccine that protects against measles, mumps and rubella (MMR) or measles, mumps, rubella, and varicella (MMRV). A second dose of MMR is recommended at age 4 to 6 years, to produce immunity in those who failed to respond to the first dose.
What can be the effect of not being immunized against rubella? Rubella infection is serious due to its potential to cause birth defects. Infection in a pregnant woman may result in miscarriage, stillbirth, or the birth of an infant with abnormalities that may include deafness, cataracts, heart defects, liver and spleen damage, and mental retardation. These abnormalities are defined as "congenital rubella syndrome" (CRS) and occur in at least 25 percent of infants born to women who have had rubella during the first trimester of pregnancy.

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RUBELLA FACT SHEET (German Measles)

What can be done to prevent the spread of rubella? Maintaining high levels of rubella immunization in the community is critical to controlling transmission of the virus when sporadic cases or outbreaks occur. Prevention of rubella is especially important in susceptible pregnant women to prevent the birth defects caused by CRS. Therefore, women of childbearing age who have not been vaccinated should receive one rubella vaccine. Women known to be pregnant or attempting to become pregnant should not receive rubella vaccine. Although there is no evidence that rubella vaccine causes birth defects, pregnancy should be avoided for 1 month after rubella or MMR vaccine. Infected children should not attend school when they are infectious; infected children may return to school 7 days after rash onset.

Where can I get additional information on rubella? Contact the Georgia Division of Public Health, Epidemiology Branch, by email at gaepinfo@dhr.state.ga.us. The following web sites may be useful:
CDC National Center for Infectious Diseases Rubella Information http://www.cdc.gov/rubella/index.html
CDC National Immunization Program http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/rubella.pdf
Georgia Division of Public Health, Epidemiology Branch- http://health.state.ga.us/epi

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STREPTOCOCCUS PNEUMONIAE FACT SHEET
(Invasive Disease, Reported Syndrome and Susceptiblility Information)

Agent: Streptococcus pneumoniae (Pneumococcus)
Brief Description: Streptococcus pneumoniae causes many clinical syndromes, depending on the site of infection (e.g., acute otitis media, pneumonia, bacteremia, or meningitis). Pneumococci are increasingly likely to be resistant to one or several antibiotics, including penicillin, doxycycline, erythromycin, azithromycin, trimethoprim-sulfamethoxazole, and cephalosporins. Invasive disease caused S. pneumoniae is notifiable with microbial susceptibility information.
Reservoir: Humans. The pneumococcus asymptomatically colonizes the nasopharynx of 5-40% of healthy people.
Mode of Transmission: By droplet spread, direct oral contact, or indirectly through articles freshly soiled with respiratory discharges. Person-to-person transmission of the organism is common, but illness among casual contacts and attendants is infrequent. Disease results when the organism multiplies locally (e.g., otitis media), multiplies after aspiration (pneumonia) or invades a sterile site (e.g., central nervous system or bloodstream).
Incubation Period: Variable. For pneumococcal pneumonia, approximately 1 to 3 days.
Laboratory Criteria for Diagnosis: For invasive disease:
Isolation of S. pneumoniae from a normally sterile site (e.g., blood, cerebrospinal fluid, or, less commonly, joint, pleural, or pericardial fluid)
Drug resistant S. pneumoniae: "Nonsusceptible" isolate (i.e., intermediate- or high-level resistance of pneumococcal isolate to at least one antimicrobial agent currently approved for use in treating pneumococcal infection)
Diagnostic testing: 1. Specimen: Pure culture 2. Outfit: Culture referral 3. Lab Form: CDC form 50.34 4. Lab Test Performed: Streptococcus pneumoniae typing 5. Lab Performing Test: CDC bacteriology lab
Case Classification:
Probable: a clinically compatible case without laboratory confirmation or with
isolation of S. pneumoniae from a non-sterile site.
Confirmed: a clinically compatible case with a laboratory confirmed isolation of S.
pneumoniae from a normally sterile site.
Period of Communicability: Presumably until discharges of mouth and nose no longer contain virulent pneumococci in significant numbers. This can be a prolonged period among immunocompromised persons.

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STREPTOCOCCUS PNEUMONIAE FACT SHEET
(Invasive Disease, Reported Syndrome and Susceptiblility Information)

Treatment: Sensitivities of strains isolated from normally sterile sites should be determined because of increasing prevalence of drug-resistant pneumococci. Where diagnostic facilities are limited and delay in treatment could prove fatal, antibiotic treatment should be started presumptively based on clinical signs.
Vaccine: The polyvalent pneumococcal polysaccharide vaccine (PPV-23) is recommended for all adults over age 65 and any individuals 2 years of age or older with chronic medical conditions that place them at high risk for pneumococcal disease. PPV-23 is not effective in children under age 2. The heptavalent pneumococcal conjugate vaccine (PCV-7) is recommended for infants and young children up to five years of age. Both PPV-23 and PCV-7 provide protection against commonly resistant pneumococcal strains. For more detailed vaccination information, see Pneumococcal Vaccine Guidelines in Chapter 2 of this manual.
Reporting: Report all confirmed cases of invasive Streptococcus pneumoniae WITHIN 7 DAYS electronically though the State Electronic Notifiable Disease Surveillance System (SENDSS) at http://sendss.state.ga.us. Please be sure to complete all data fields. Antibiotic susceptibilities are also reportable though SendSS for S. pneumoniae.
References and Further Reading: 1. Preventing Pneumococcal Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000; 49 (No. RR-9): 1-38. 2. Prevention of Pneumococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997; 46 (No. RR-8): 124. 3. Geographic Variation in Penicillin Resistance in Streptococcus pneumoniae -Selected Sites, United States, 1997. MMWR 1999; 48(30): 656-661. 4. Outbreaks of Pneumococcal Pneumonia Among Unvaccinated Residents in Chronic-Care Facilities--Massachusetts, October 1995, Oklahoma, February 1996, and Maryland, May-June 1996. MMWR 1997; 46(03): 60-62. 5. Defining the Public Health Impact of Drug-resistant Streptococcus pneumoniae: Report of a Working Group. MMWR 1996; 45 (No. RR-1): 1-14. 6. Case Definitions for Infectious Conditions under Public Health Surveillance. MMWR 1997; 46(RR10): 1-55. 7. Heymann, ed. Pneumonia. In: Control of Communicable Diseases Manual. 18th ed. Washington, DC: American Public Health Association, 2004: pp. 413-424. 8. National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing. Villanova, PA: National Committee for Clinical Laboratory Standards, 1994; 14(16). 9. Mandell, Bennett, and Dolin. The Principles and Practice of Infectious Diseases. 5th Ed., Philadelphia, PA, 2000:pp. 2128-2147.

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STREPTOCOCCUS PNEUMONIAE FACT SHEET
(Invasive Disease, Reported Syndrome and Susceptiblility Information)

Links: CDC Streptococcus pneumoniae Fact Sheet http://www.cdc.gov/ncidod/dbmd/diseaseinfo/streppneum_t.htm National Foundation for Infectious Diseases Drug-resistant Streptococcus pneumoniae Fact Sheet http://www.nfid.org/factsheets/drsp.html CDC Antimicrobial Resistance Web Site http://www.cdc.gov/drugresistance/ Alliance for the Prudent Use of Antibiotics --- http://www.healthsci.tufts.edu/apua
INVASIVE DISEASE, Streptococcus pneumoniae Q&A
What are drug-resistant Streptococcus pneumoniae? Drug-resistant Streptococcus pneumoniae (DRSP) are strains of the common bacterium S. pneumoniae (also called pneumococcus) that have become resistant to a variety of antibiotics. Some strains are resistant to only one antibiotic, while other strains are resistant to many antibiotics, making infection with these strains more difficult to treat.
How common is DRSP? Surveillance studies by the Centers for Disease Control and Prevention have shown that in the U.S., DRSP strains have been increasing in frequency since 1987. In some communities, 30% of S. pneumoniae isolates are resistant to at least one drug, and strains causing infections may be resistant to several antibiotics. DRSP strains in Georgia are more common than in many other parts of the U.S.
What caused these strains of bacteria to become resistant to antibiotics? Many experts believe that overuse of antibiotics contributes to the development of DRSP strains. Antibiotics are sometimes used to treat infections caused by viruses (such as colds and bronchitis), which are not killed by antibiotics. Once DRSP is in the community, use of antibiotics may "select" the resistant strains for survival.
What kinds of infection does DRSP cause? S. pneumoniae is the most common cause of ear infections in children and pneumonia in the general population. S. pneumoniae bacteria also cause infections of the bloodstream and the meninges (the thin membrane covering of the brain); these types of infections are called "invasive" because these parts of the body normally do not contain bacteria of any type. These invasive infections are particularly dangerous when they are caused by drug-resistant strains, which cannot be as easily killed.
Who gets DRSP infections? Anyone can get an infection with DRSP, but pneumococcal infections are more common and severe in people with weakened immune systems, such as the very young, the elderly, persons with chronic diseases such as diabetes or HIV infection, and persons undergoing chemotherapy.

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STREPTOCOCCUS PNEUMONIAE FACT SHEET
(Invasive Disease, Reported Syndrome and Susceptiblility Information)

How is DRSP spread? DRSP is spread from person to person through respiratory droplets containing pneumococcus. These bacteria can also be passed by direct contact with secretions from the mouth or nose. Clothing or other articles that are freshly soiled with infectious respiratory secretions can also be a source of infection. While person-to-person spread is common, illness among casual contacts of an ill person is rare; most persons simply "carry" the germ in the nasopharynx.
What are the symptoms of a S. pneumococcal (SP) infection? Symptoms of SP pneumonia include abrupt onset of fever, shaking chills, chest pain, productive cough, shortness of breath, and weakness. Signs of pneumococcal meningitis include headache, drowsiness, vomiting, irritability, fever, stiff neck, and seizures. Ear infection can cause fever and ear pain or discharge.
How soon do symptoms appear? Symptoms of infections caused by SP take a minimum of 1 to 3 days to develop after exposure.
When and for how long is a person able to spread SP? A person can spread SP as long as the pneumococci are present in the discharges from the nose and mouth. Illness among casual contacts of a person with SP is infrequent.
How can SP be prevented? Two pneumococcal vaccines are available. PPV-23 protects against infections caused by common susceptible and drug-resistant strains of S. pneumoniae. It is recommended for everyone age 65 and older, and for younger people age 2 years and older with underlying health conditions making them more susceptible to S. pneumoniae infections. Another pneumococcal vaccine, PCV-7, prevents disease in infants and young children. PCV-7 is recommended for use in children under 5 years old.
Where can I get additional information on SP? Contact the Georgia Division of Public Health, Epidemiology Branch, by email at gaepinfo@dhr.state.ga.us. The following web sites may be useful:
CDC Streptococcus pneumoniae Fact Sheet http://www.cdc.gov/ncidod/dbmd/diseaseinfo/streppneum_t.htm
National Foundation for Infectious Diseases Drug-resistant Streptococcus pneumoniae Fact Sheet http://www.nfid.org/factsheets/drsp.html
CDC Antimicrobial Resistance Web Site http://www.cdc.gov/drugresistance/

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TETANUS FACT SHEET
(LockJaw)

Agent: Caused by the bacterium, Clostridium tetani.
Brief Description: Tetanus is an acute, often fatal disease caused by an exotoxin produced by the anaerobic organism C. tetani in a contaminated wound. Increased muscle rigidity and severe muscle spasms characterize tetanus. The muscle stiffness usually first involves the jaw (lockjaw) and neck, and later becomes generalized. Muscle spasms may continue for 3-4 weeks or more. Other symptoms include fever, sweating, elevated blood pressure, and rapid heart rate.
Reservoir: Intestines of humans, as well as the intestines of horses and other animals, in which the organism is a normal inhabitant. Tetanus spores are ubiquitous in the environment and can contaminate wounds of all types. Soil or fomites contaminated with animal and human feces can also be important reservoirs.
Mode of Transmission: Tetanus spores are introduced into the body through: (1) puncture wounds; (2) lacerations, burns, trivial or unnoticed wounds in which fecally-contaminated soil containing C. tetani spores penetrates body tissues; or (3) by injected contaminated street drugs.
Incubation Period: Usually 3-21 days, although it may range from 1 day to several months, depending on the wound. The average is 10 days, and most cases occur within 14 days. Shorter incubation periods have been associated with more heavily contaminated wounds, more severe disease, and a worse prognosis.
Clinical Case Definition: Acute onset of hypertonia and/or painful muscular contractions (usually of the muscles of the jaw and neck) and generalized muscle spasms without other apparent medical cause.
Laboratory Criteria for Diagnosis: Attempts at laboratory confirmation are of little help. The organism is rarely recovered from the site of infection, and there is usually no detectable antibody response. The diagnosis is entirely clinical and does not depend upon bacteriologic confirmation.
Diagnostic Testing: Not indicated.
Case Classification: Confirmed: A clinically compatible case, as reported by a health-care professional.
Period of Communicability: Not directly transmitted from person-to-person.

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TETANUS FACT SHEET
(LockJaw)

Vaccination: Primary tetanus immunization with diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) is recommended for all persons at least 6 weeks old, but < 7 years of age, for whom the vaccine is not contraindicated. For those with allergies to pertussis vaccine, a diphtheria and tetanus toxoid vaccine is available (DT). The primary vaccination consists of a three-dose series, administered at ages 2, 4, and 6 months. The fourth dose (first booster) is recommended at 15-18 months of age to maintain adequate immunity during preschool years. The fifth dose (second booster) is recommended for children aged 4-6 years to confer continued protection against disease during the early years of schooling. Routine tetanus booster immunization, with tetanus toxoid usually combined with adult-diphtheria toxoid (Td), is recommended for all persons > 7 years of age every 10 years. Persons aged 10-64 years may get a one-time dose of Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) in lieu of one booster dose of Td. For more detailed vaccination information, see Diphtheria, Tetanus, and Pertussis Vaccine Guidelines in Chapter 2 of this manual.
Treatment: Tetanus Immune Globulin (TIG) IM, in doses of 3,000-6,000 IU. The wound should be properly cleaned, debrided, and excised if necessary. Metronidazole (30 mg/kg per day, given at 6-hour intervals) is the antibiotic of choice and should be given for 7-14 days. Active immunization should be initiated concurrently with therapy. Tetanus clinical disease does not confer immunity because of the small amount of toxin required to produce illness.
Post-exposure Prophylaxis: For routine wound management, wounds that are "dirty" should be treated with TIG IM unless the patient has had three or more doses of the tetanus vaccine. "Dirty" wounds include those contaminated with dirt, feces, soil, or saliva, puncture wounds, avulsions, and wounds resulting from missiles, crushing, burns, or frostbite. For all wounds, clean or dirty, a dose of Td should be given if the patient has had less than three doses of the vaccine. If patients have had three or more doses, the decision to give Td should be based on the amount of time since the last vaccine was given. If the wound is clean, the patient should receive Td unless he or she has had the vaccine within the last ten years. If the wound is dirty, give Td unless he or she has had the vaccine within the last five years. The wound should be cleaned and debrided as described under "Treatment."
Investigation: The Tetanus Surveillance Worksheet and the Tetanus Surveillance Case Report Form may be used as guidelines. The investigation should include identification of age at onset, the circumstances of any previous injury, tetanus toxoid vaccination history, and determination of the patient's status (alive, dead) at one-month after onset of disease.
Reporting: Report all cases WITHIN 7 DAYS electronically through the State Electronic Notifiable Disease Surveillance System (SENDSS) at http://sendss.state.ga.us. Please complete all data fields in SENDSS including the case report form.

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TETANUS FACT SHEET
(LockJaw)

Reported Cases of Tetanus in Georgia, 2001-2007

Year 2001 2002 2003 2004 2005 2006 2007

Number of Cases 0 0 0 2 0 0 2

References: 1. American Academy of Pediatrics. Tetanus (Lockjaw). In: Pickering L, ed. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th Ed. Blk Grove Village, IL: American Academy of Pediatrics; 2006: 648-653. 2. Case Definitions for Infectious Conditions under Public Health Surveillance. MMWR 1997; 46(No. RR-10): 39-40. 3. Tetanus among injecting drug users California, 1997. MMWR 1998; 47(08): 149151. 4. Centers for Disease Control and Prevention. Manual for the Surveillance of VaccinePreventable Diseases. Centers for Disease Control and Prevention: Atlanta, GA, 2002. 5. Heymann, ed. Tetanus. In: Control of Communicable Diseases Manual. 18th ed. Washington, DC: American Public Health Association, 2004: 528-534.
Links: 1. CDC Tetanus Fact Sheet http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf 2. CDC National Immunization Program http://www.cdc.gov/vaccines/

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Influenza Resources
RESOURCES FOR INFLUENZA PREVENTION AND CONTROL
PREVENTING INFLUENZA
Vaccination remains the primary method of preventing influenza infection or lessening the severity of influenza. Because circulating influenza strains change from year to year, a new vaccine is manufactured each year. For complete protection individuals must receive a new influenza vaccine annually. October to November is the ideal time for influenza vaccination, especially for persons at higher risk of developing complications from influenza, such as residents of long-term care facilities (LTCF). Persons who did not receive an influenza vaccine during the ideal time should still be immunized throughout the influenza season to achieve some protection. Employees of LTCF are also strongly urged to be vaccinated to reduce the chance of their spreading influenza to residents. LTCF visitors should be encouraged to receive influenza vaccine. In fact, given that influenza vaccine is more effective at preventing disease among young, healthy adults than among the elderly, vaccination of workers and visitors may be more effective in preventing disease among LTCF residents than vaccination of the residents themselves.
Listed below are the three manufacturers of influenza vaccine with contact information for ordering. The ideal time to order influenza vaccine for the upcoming flu season is in the spring, as most manufacturers' stocks are pre-booked by May. sanofi pasteur (www.sanofipasteur.com) 1-800-822-2463 Novartis (www.chiron.com) 1-800-244-7668 Medimmune (www.medimmune.com) 1-877-633-4411 GlaxoSmithKline (www.gskvaccines.com) 1-866-475-8222
DIAGNOSING INFLUENZA
Numerous infectious agents cause flu-like symptoms, making influenza diagnosis difficult on clinical grounds. A verified diagnosis of influenza requires a positive viral culture, which may take up to ten days. Several rapid tests for influenza have been developed with variable sensitivities and specificities. Rapid tests may be useful in a LTCF setting to attempt to quickly document the cause of an outbreak of influenza-like illness. While negative rapid test results do not rule out influenza virus as the causative agent, a single positive test result in a LTCF setting strongly indicates an outbreak is due to influenza. If rapid tests are being used, viral cultures should still be done for confirmation and to identify the strain and antigenic characteristics of the virus. Public health officials can provide viral culture kits to an LTCF during an outbreak and arrange for viral testing at the Georgia Public Health Laboratory. Call your local health department immediately if an influenza outbreak is suspected in a LTCF. Public health does not supply rapid tests for influenza.

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Table 1 describes the various laboratory tests available for documenting influenza infection1. Long-term care facilities might consider stocking some of the rapid tests

available for point-of-care use.

Table 1. Laboratory Diagnostic Procedures for Influenza

Procedure Influenza Acceptable specimens Time for Point-of-

types

results care market

detected

Viral Culture

A and B Nasopharyngeal Swab

5-10

No

Throat Swab

days

Nasal Wash

Bronchial Wash

Nasal Aspirate

Sputum

Immuno-

A and B Nasopharyngeal Swab

2-4 hours

No

fluorescence

Nasal Wash

Bronchial Wash

Nasal Aspirate

Sputum

Influenza A

A and B Nasopharyngeal Swab

2 hours

No

Enzyme

Throat Swab

Immuno-Assay

Nasal Wash

(EIA)

Bronchial Wash

Directigen A

A

Nasopharyngeal Swab

<30

Yes

(Becton-

Throat Swab

minutes

Dickinson)

Nasal Wash

Nasal Aspirate

Directigen Flu A A and B Nasopharyngeal Swab

<30

Yes

and B (Becton-

Throat Swab

minutes

Dickinson)

Nasal Wash

Nasal Aspirate

Bronchial Wash

FLU OIA

A and B Nasopharyngeal Swab

<30

Yes

(Biostar)

Throat Swab

minutes

Nasal Aspirate

Sputum

Quick Vue

A and B Nasopharyngeal Swab

<30

Yes

(Quidel)

Nasal Wash

minutes

Nasal Aspirate

Zstat Flu

A and B Throat Swab

<30

Yes

(ZymeTx)

minutes

RT-PCR

A and B Nasopharyngeal Swab

1-2 days

No

Throat Swab

Nasal Wash

Bronchial Wash

Nasal Aspirate

Sputum

Serology

A and B Paired Acute and

>2 weeks

No

Convalescent Serum

Samples

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TREATING INFLUENZA

Two antiviral drugs are currently approved for influenza treatment: oseltamivir and zanamivir. Oseltamivir and zanamivir have also been approved for prophylaxis against influenza. Oseltamivir and zanamivir may be used for influenza A or B. Influenza A virus resistance to amantadine and rimantadine can emerge rapidly during treatment. On the basis of antiviral testing results conducted at CDC and in Canada indicating high levels of resistance, CDC and ACIP recommend that neither amantadine nor rimantadine be used for the treatment or chemoprophylaxis of influenza A in the United States until susceptibility to these antiviral medications has been re-established among circulating influenza A viruses.

Zanamivir and oseltamivir are chemically related antiviral drugs known as neuraminidase inhibitors that have activity against both influenza A and B viruses. Both zanamivir and oseltamivir were approved in 1999 for treatment of uncomplicated influenza virus infections.

Zanamivir, an inhaled drug, may aggravate existing chronic respiratory illnesses. Table
2 describes medication dosage and duration for persons age 65 years and older with normal renal function2. Each medication should be administered within 48 hours of
symptom onset.

Table 2. Antiviral Medications for Treatment of Influenza

Agent

Influenza Dosage in nursing

Duration of therapy

type

home residents

Zanamivir

A and B

10 mg inhaled

5 days

("Relenza"

twice per day

GlaxoSmithKline) Oseltamivir

A and B

75 mg twice per

5 days

("Tamiflu"

day

Roche)

Cost* $48.00
$60.00

Cost based on a five-day course of therapy at regular dosage level, rounded to the nearest dollar. Estimated cost to the pharmacist based on average wholesale prices in Red book. Montvale, N.J.: Medical Economics Data, 2001. Cost to the patient will be higher, depending on prescription filling fee.
A reduction in the dose of oseltamivir is recommended for persons with creatinine clearance <30 mL/min.

INFLUENZA PROPHYLAXIS
In 2000, oseltamivir was approved for chemoprophylaxis of influenza among persons aged >13 years and was approved for chemoprophylaxis of children aged >1 year in 2005. In 2006, zanamivir was approved for chemoprophylaxis of children aged >5 years. Once a cluster of influenza-like illness has been identified in a long-term care facility, chemoprophylaxis of all residents should begin immediately, regardless of whether they received vaccine. Chemoprophylaxis of staff should also be considered.

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Table 3 describes dosage and duration for persons 65 years and older with normal renal function3.

Table 3. Antiviral Medications for Influenza Prophylaxis

Agent

Influenza Dosage for nursing home Duration of therapy

type

residents

Zanamivir ("Relenza"

A and B

10 mg (two inhalations) >2 weeks or until 1 week

GlaxoSmithKline)

once daily

after end of outbreak

Oseltamivir

A and B

75 mg once per day

>2 weeks or until 1 week

("Tamiflu" Roche)

after end of outbreak

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REIMBURSEMENT FOR INFLUENZA AND PNEUMOCOCCAL VACCINATION

Influenza and pneumococcal vaccines are a Medicare benefit, so long-term care facilities can bill Medicare for these immunizations. Frequently, nursing homes in Georgia are not billing Medicare and are losing this revenue. One of the most effective strategies for increasing influenza and pneumococcal
immunizations involves the health care provider. Medicare beneficiaries are more likely to get immunized when their physician specifically recommends vaccination. Medicare Part B began paying for influenza vaccine on May 1, 1993. Medicare Part B began paying for pneumococcal polysaccharide vaccine (PPV) on July 1, 1981. Coverage of the vaccines and their administration is available under Medicare Part B regardless of the setting in which they are administered. If a beneficiary at high risk of pneumococcal disease (i.e., aged 65 or older) is unsure about his or her PPV vaccination status, Medicare will cover re-vaccination.

Roster bills can be submitted so that only one bill is needed per facility (although influenza and pneumococcal vaccines must be on separate roster claim forms).

Billing Code 90658
90732 G0008 G0009 V04.81 V03.82

Description Influenza split-virus vaccine (Only split virus vaccines are available in the U.S.) Pneumococcal polysaccharide vaccine Administration of influenza vaccine Administration of pneumococcal vaccine Diagnosis code for influenza vaccine Diagnosis code for pneumococcal polysaccharide vaccine

References: 1. Centers for Disease Control and Prevention. Detection and Control of Influenza
Outbreaks in Acute Care Facilities. Available at http://www.cdc.gov/ncidod/hip/INFECT/ FluBook2001.pdf; September 2001. 2. Kingston BJ and Wright CV. Influenza in the Nursing Home. Am Fam Physician 2002;65:75-78. 3. Centers for Disease Control and Prevention. Prevention and Control of Influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2002;51 (No. RR-3):1-31.

Other Resources: Georgia Division of Public Health Influenza Web Site http://health.state.ga.us/epi/flu Centers for Disease Control and Prevention, National Center for Infectious Diseases
Influenza Web Site - http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm Centers for Disease Control and Prevention, National Immunization Program Influenza
Web Site - http://www.cdc.gov/nip/Flu/default.htm Georgia Adult Immunization Coalition - http://www.immunizeadultga.org/ Medicare Preventive Services, Adult Immunization Overview
http://www.cms.hhs.gov/AdultImmunizations/

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Influenza Outbreak Control In A Long-Term Care Facility
Influenza vaccination remains the primary method of preventing illness and death associated with influenza. Among elderly persons residing in nursing homes, influenza vaccine can be 50-60% effective in preventing hospitalization or pneumonia and 80% effective in preventing death. However, the vaccine may be less effective in preventing milder illness. If an outbreak of influenza-like illness (defined as fever > 100F oral (> 101F rectal) AND cough and/or sore throat) occurs in a long-term care facility, please immediately contact the local county health department or the Georgia Division of Public Health Epidemiology Branch at 404-657-2588 for assistance in outbreak investigation and control. Public health can help you confirm the diagnosis and prevent spread.
A. Confirmation of Influenza and Determination of the Outbreak Strain
Early in the outbreak, obtain viral throat swab specimens from up to 10 patients with symptoms suggestive of influenza for viral culture and antigen detection. Viral specimen kits can be obtained through the health department, which can also arrange testing at the Georgia Public Health Laboratory.
Because viral culture results may not be available for up to 10 days, facilities may also consider using rapid flu tests. While a negative rapid test result does not rule out influenza, a single positive result strongly indicates that influenza is causing the outbreak. Please see RESOURCES FOR INFLUENZA PREVENTION AND CONTROL for more information about rapid flu tests. Rapid flu tests are not available through public health.
B. Vaccination of Patients and Personnel
Even during an outbreak, administer current influenza vaccine to unvaccinated patients and staff, especially if the outbreak occurs early in the influenza season.
The local county health department may have vaccine available during flu season. See RESOURCES FOR INFLUENZA PREVENTION AND CONTROL for information on how to order influenza vaccine prior to flu season.
For more detailed vaccination information, see Influenza Vaccine Guidelines in Chapter 2 of this manual.

C. Treatment and Prophylaxis
Certain rapid tests are able to differentiate between influenza A and B which can help guide which antiviral medication can be used. Even in the absence of viral strain confirmation, the Georgia Division of Public Health advises long-term care facilities to begin treatment and prophylaxis of residents and staff with antiviral medications. If influenza is suspected, treatment and prophylaxis should not be delayed until viral culture results are available.
Two antiviral drugs are currently approved for influenza treatment: oseltamivir and zanamivir. Oseltamivir and zanamivir have also been approved for prophylaxis against influenza. Oseltamivir and zanamivir may

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GA Immunization Program Manual

Division of Public Health

Influenza Outbreak Control In A Long-Term Care Facility

be used for influenza A or B. Influenza A virus resistance to amantadine and rimantadine can emerge rapidly during treatment. On the basis of antiviral testing results conducted at CDC and in Canada indicating high levels of resistance, CDC and ACIP recommend that neither amantadine nor rimantadine be used for the treatment or chemoprophylaxis of influenza A in the United States until susceptibility to these antiviral medications has been re-established among circulating influenza A viruses.
Zanamivir and oseltamivir are chemically related antiviral drugs known as neuraminidase inhibitors that have activity against both influenza A and B viruses. Both zanamivir and oseltamivir were approved in 1999 for treatment of uncomplicated influenza virus infections. In 2000, oseltamivir was approved for chemoprophylaxis of influenza among persons aged >13 years and was approved for chemoprophylaxis of children aged >1 year in 2005. In 2006, zanamivir was approved for chemoprophylaxis of children aged >5 years.
Please see RESOURCES FOR INFLUENZA PREVENTION AND CONTROL for information regarding medication dosage and therapy duration.

D. Interruption of Person-to-Person Transmission
Keep residents known or suspected to have influenza in a private room or in a room with other residents with documented influenza unless there are medical contraindications.
If feasible, place persons with influenza-like illness together in an area with an independent air supply and exhaust system.
Implement respiratory droplet precautions, including requiring all staff who have contact with ill residents to wear masks and gloves, and to wash hands frequently and thoroughly. Consider using hand sanitizers in areas where hand washing is difficult.
Restrict visitors who have a febrile respiratory illness.
Do not allow staff to work while ill.
Consider temporarily closing the facility to new admissions while the outbreak continues.

Preventing Influenza Outbreaks in Long-Term Care Facilities

Morbidity and mortality from influenza can be greatly reduced if long-term care facilities follow these guidelines for influenza prevention:

Develop an influenza control plan incorporating vaccination, surveillance, diagnosis, treatment, and prophylaxis activities. Ensure all staff are familiar with the plan's components.

Plan an annual vaccination campaign targeting all residents, staff, volunteers, and visitors for flu vaccination. Ideally, vaccination should occur in October or early November, but the facility should also have methods in place to ensure that all staff

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Influenza Outbreak Control In A Long-Term Care Facility

and residents who enter the facility after the mass vaccination campaign are also vaccinated. Standing orders by the facility medical director may make this process more convenient.
Review residents' immunization histories and administer pneumococcal vaccine to those who are eligible. This should be done on a regular basis, and especially during the annual flu vaccine campaign. If a pneumococcal vaccination history is unknown, it is safe and preferable to give another dose.
During flu season, post signs asking visitors with flu-like symptoms, such as fever, cough, sore throat, or muscle aches, to refrain from visiting.
Train staff at the beginning of each flu season on the proper respiratory secretion precautions, handwashing procedures, and surveillance activities. Have a mechanism to ensure all new employees who are hired during flu season receive the training as well.
Establish and post a definition of flu-like illness. The Centers for Disease Control and Prevention (CDC) defines flu-like illness as fever >100F oral or >101F rectal and at least one of the following: cough, runny nose, nasal congestion, or sore throat. Be aware that influenza symptoms are sometimes different in elderly persons or persons with chronic medical conditions. Staff should be alert for residents who have fever with lethargy or delirium, or changes in their functional status.
Monitor influenza activity in the community. The Georgia Division of Public Health posts influenza information at http://health.state.ga.us/epi/flu. You may also receive periodic influenza activities during flu season by subscribing to the public health flu email list (sign up by sending an email to flu@dhr.state.ga.us with the word "subscribe" in the subject line). Knowledge of influenza activity in the community can assist in making a clinical diagnosis.
Consider stocking rapid flu tests and antiviral medications for immediate detection and response to outbreaks. If you do not stock rapid tests, have a plan in place for quickly obtaining laboratory confirmation of influenza. There should also be a method to quickly obtain physician orders for antiviral medication.
Post the county, district, or state health department phone number for reporting a cluster of influenza-like illness. A cluster is defined as 3 or more cases of illness among residents and/or staff within a 72-hour period. By law, any cluster of illness must be reported to Georgia public health authorities immediately.
(DHR Rule 290-5-3-.02(2))

6. Surveillance and Reporting LTCF Influenza Outbreak Control

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NOTIFIABLE DISEASE/ CONDITION REPORT FORM
All Georgia physicians, laboratories, and other health care providers are required by law to report patients with conditions of public health concern listed on the reverse of the enclosed form 3095. Both lab-confirmed and clinical diagnoses are reportable within the time intervals specified.
Reporting enables appropriate public health follow-up for your patients, helps identify outbreaks, and provides a better understanding of disease trends in Georgia. For the latest information from the DHR, Division of Public Health, visit their web site at: www.health.state.ga.us

District Health Office Contact Information

Northwest Health District

Clayton County Health District

Epidemiology Section

Administrative Office

1305 Redmond Circle

1117 Battlecreek Road

Bldg. 614

Jonesboro, GA 30236

Rome, GA 30165-1391

Phone (678) 610-7246

Phone (706) 295-6656

FAX (770) 603-4875

FAX (706) 802-5342

East Metro Health District

North Georgia Health District Office of Infectious Diseases

Infectious Disease Department 2570 Riverside Parkway

100 West Walnut Ave., Suite 92 Lawrenceville, GA 30045-3339

Dalton, GA 30720-8417

Phone (770) 339-4260

Phone (706) 272-2342

FAX (770) 339-5971

FAX (706) 272-2929

DeKalb Health District

North Health District

Office of Infectious Diseases

1280 Athens Street

445 Winn Way

Gainesville, GA 30507-7000

P.O. Box 987

Phone (770) 535-5743

Decatur, GA 30031-1701

FAX (770) 535-5958

Phone (404) 508-7851

FAX (404) 508-7813

Cobb and Douglas Public Health

Center for Health Assessment

LaGrange Health District

1650 County Services Pkwy., SW 122 Gordon Commercial Dr.

Marietta, GA 30008-4010

Suite A

Phone (770) 514-2432

LaGrange, GA 30240-5740

FAX (770) 514-2313

Phone (706) 845-4035

FAX (706) 845-4038

Fulton Health District

Fulton County Department of

South Central Health District

Health and Wellness

2121-B Bellevue Road

Office of Epidemiology

Dublin, GA 31021-2998

99 Jessie Jr. Dr., SE

Phone (478) 275-6545

Atlanta, GA 30303-3045

FAX (478) 275-6575

Phone (404) 730-1391

FAX (404) 730-1326

North Central Health District Infectious Disease Unit Supervisor 811 Hemlock Street Macon, GA 31201-2198 Phone (478) 751-6214 FAX (478) 752-1710
East Central Health District 1916 North Leg Rd. Augusta, GA 30909-4437 Phone (706) 667-4342 FAX (706) 667-4728
West Central Health District Epidemiology Unit 2100 Comer Ave. P.O. Box 2299 Columbus, GA 31902-2299 Phone (706) 321-6300 FAX (706) 321-6155
South Health District Epidemiology 312 North Patterson Street P.O. Box 5147 Valdosta, GA 31603-5147 Phone (229) 333-5290 FAX (229) 259-5003 Toll Free 866-801-5360
Southwest Health District 1306 S. Slappey Blvd., Suite L Albany, GA 31701 Phone (229) 430-7870 FAX (229) 430-2920

Coastal Health District Notifiable Disease Division Brunswick Office: 777 Gloucester Brunswick, GA 31520 Phone (912) 262-3092 FAX (912) 261-1964 Savannah Office: 2011 Eisenhower Drive P.O. Box 14257 Savannah 31416-1257 Phone (912) 644-5232 FAX (912) 644-5230
Southeast Health District Office of Infectious Disease 1115 Church Street, Suite A Waycross, GA 31501-3525 Phone (912) 285-6022 (24 hr) FAX (912) 284-2522
Northeast Health District Epidemiology Section 220 Research Drive Athens, GA 30605-2738 Phone (706) 583-2868 FAX (706) 369-5640
State Contact Information Notifiable Diseases Epidemiology Section Division of Public Health 2 Peachtree Street, N.W. 14th Floor Atlanta, GA 30303-3142 Phone (404) 657-2588 FAX (404) 657-2608

Legal Authority: O.C.G.A. 31-12-2, 31-22-7;DHR Rules and Regulations, Notification of Disease, Chapter 290-5-3 and Chapter 290-9-8.
Form 3095 (8-04)

NOTIFIABLE DISEASE/CONDITION REPORT FORM
All Georgia physicians, laboratories, and other health care providers are required by law to report patients with conditions of public health concern listed on the reverse of the enclosed form 3095. Both lab-confirmed and clinical diagnoses are reportable within the time interval specified.
Reporting enables appropriate public health follow-up for your patients, helps identify outbreaks, and provides a better understanding of disease trends in Georgia. For the latest information from the DHR, Division of Public Health, visit their web site at: www.health.state.ga.us.
Instructions:
1. Report cases for all diseases, except those noted below, electronically through the State Electronic Notifiable Disease Surveillance System at: http://sendss.state.ga.us OR Complete reverse of this Notifiable Disease/Condition Report Form and mail, in an envelope marked CONFIDENTIAL, to: District Health Office (see cover for contact information) OR Fax to: District Health Office (see cover for contact information).
2. Fill out the form as completely and as timely as possible, including laboratory submissions.
3. Include treatment information for sexually transmitted diseases.
4. Report symptoms and tests needed to establish the diagnosis for viral hepatitis and Lyme disease and other tick-borne diseases.
5. If you mail the form, photocopy the form as your record of reported disease/condition.
6. Report a suspect case of hearing impairment (under age 5) by completing the Children 1st Screening and Referral Form. Report a confirmed case of hearing impairment (under age 5) by completing the Surveillance of Hearing Impairment in Infants and Young Children Form (both forms available at: http://health.state.ga.us/programs/unhs/reporting.asp)
7. For Birth Defects, DO NOT USE THIS FORM, Refer to the Georgia Birth Defects Reporting and Information System (GBDRIS) Reporting Guidelines (available at: http://health.state.ga.us/epi/mch/birthdefects/gbdris/publications.asp).
8. For Cancer and Benign Brain Tumor, DO NOT USE THIS FORM, Refer to the GCCR Policy and Procedure Manual (available at: http://health.state.ga.us/programs/gccr/reporting.asp) AND Call the Georgia Comprehensive Cancer Registry at 404-463-8919 for how and what to report.
9. For HIV infections and AIDS, DO NOT USE THIS FORM, Complete the CDC form 50.42A (available at: http://health.state.ga.us/epi/aidsunit.shtml or by calling 1-800-827-9769) and mail in an envelope marked CONFIDENTIAL to:
Attention: Roger Davis Georgia Division of Public Health, Epidemiology Branch 2 Peachtree St. NW, 14th floor Office 460 Atlanta, GA 30303-3189

Disease/Condition

GEORGIA NOTIFIABLE DISEASE/CONDITION REPORT FORM
REPORT CASES BY MAIL, FAX OR PHONE TO DISTRICT HEALTH OFFICE OR TO SENDSS (http://sendss.state.ga.us)
Medical Record Number

PATIENT DEMOGRAPHICS Patient's Name
Last Name
Patient's Address

First Name

Date of Birth

Age

Age Type

_______/______/_______ Yrs

Ethnicity

Sex

Mos

Hispanic

Male

Weeks

MI

Non-Hispanic

Female

Days

Unknown

Unknown

Unk

Race

Street

Asian Black/African-American

Native Hawaiian or Pacific Islander

Native American or

Other

City

State

Zip+4

County

Alaska Native

Unknown

(

)

(

)

Multiracial

(

)

White

(

)

(

)

(

)

Patient's Home Phone Illness Onset Date
L _______/______/_______ IA If hospitalized, complete:

Patient's Work Phone

Patient's Other Phone

CLINICAL INFORMATION

Y | N | UNK

Y | N | UNK

Hospitalized

Outpatient

Emergency Rm

Died?

N

Y

UNK

Date of Death:

_______/______/_________

Hospital Name

Admit Date

Discharge Date

T Specimen N Collection Date

Test Name (ex. Culture, IFA,
IGM, EIA)

LABORATORY INFORMATION *Report Hepatitis information in Viral Hepatitis box below

Specimen Type (ex. Stool, Blood,

Result (ex. +/-, titer, Presumptive)

Species / Serotype

Lab Name

IDE ADDITIONAL INFORMATION Pregnant Nursing Home or other F Chronic Care Facility Child In Daycare N Daycare Worker Prisoner/Detainee Food Handler Health Care Worker O Outbreak Related C Travel in Last 4 Weeks

Yes | No | UNK

*VIRAL HEPATITIS Test Results

Total anti-HAV Hepatitis A IgM anti-HAV

Hepati-

HBsAg Total anti-HBc

IgM anti-HBc

anti-HCV (EIA)

Date of test(s) _________ Pos | Neg | UNK

Hepatitis C

anti-HCV signal to cut-off ratio RIBA HCV RNA (PCR, bDNA)

All

ALT(SGPT)

AST (SGOT)

REPORTER INFORMATION
Report Date _______/______/____

Comments/Symptoms/Treatment:

Reporter Name

Reporter Phone ( Reporter Institution

) _____ - _________

Local Use Only

State Use Only

Physician Name

Physician Phone (

) _____ - _________

Need More 3095 Forms Entered into SENDSS

Additional form completed Name:

Form 3095 (5-04)

NOTIFIABLE DISEASE/ CONDITION REPORTING

All Georgia physicians, laboratories, and other health care providers are required by law to report patients with the following conditions. Both lab-confirmed and clinical diagnoses are reportable within the time interval specified below.
Reporting enables appropriate public health follow-up for your patients, helps identify outbreaks, and provides a better understanding of disease trends in Georgia. For the latest information from the DHR, Division of Public Health, visit their web site at:www.health.state.ga.us

REPORT IMMEDIATELY
any cluster of illnesses animal bites anthrax all acute arboviral infections:
-Eastern Equine Encephalitis (EEE) -LaCrosse Encephalitis (LAC) -St. Louis Encephalitis (SLE) -West Nile Virus (WNV) botulism brucellosis cholera diphtheria E. coli O157:H7 Haemophilus influenzae (invasive)* hantavirus pulmonary syndrome hemolytic uremic syndrome (HUS) hepatitis A (acute) measles (rubeola) meningitis (specify agent) meningococcal disease pertussis plague poliomyelitis Q fever rabies (human & animal) severe acute respiratory syndrome (SARS) shiga toxin positive tests S. aureus with vancomycin MIC > 4g/ml smallpox syphilis (congenital & adult) tuberculosis latent TB infection, under age 5 tularemia

REPORT WITHIN 7 DAYS

AIDS (see below, to report) aseptic meningitis campylobacteriosis chancroid Chlamydia trachomatis (genital
infection) Creutzfeldt-Jakob Disease
(CJD), suspected cases, under age 55 cryptosporidiosis cyclosporiasis ehrlichiosis giardiasis gonorrhea HIV (see below, to report) hearing impairment (permanent, under age 5) hepatitis B -acute hepatitis B -newly identified HBsAg+ carriers** -HBsAg+ pregnant women hepatitis C virus infection (past or present) influenza-associated death (under age 18) lead blood level > 10g/dL

legionellosis leptospirosis listeriosis*** Lyme disease lymphogranuloma venereum malaria methicillin-resistant S. aureus
(community-associated)# mumps psittacosis Rocky Mountain spotted fever rubella (including congenital) salmonellosis shigellosis streptococcal disease, Group A
or B (invasive)* Streptococcus pneumoniae
(invasive)* -report with antibiotic-resistance information tetanus toxic shock syndrome toxoplasmosis typhoid Vibrio infections yersiniosis

REPORT WITHIN 1 MONTH

birth defects maternal death##
(Report electronically or call Maternal & Child Health Epidemiology Section, 404-657-6448)
REPORT WITHIN 4-6 MONTHS

benign brain and central nervous system tumors
cancer (Refer to the web site http://health.state.ga.us/programs/gccr/reporting.asp)
Poster Key
Potential agent of bioterrorism. * Invasive = isolated from blood, bone, CSF, joint, pericardial fluid, peritoneal fluid, or
pleural fluid. Hearing impairment is reportable to the Children 1st Program
(http://health.state.ga.us/epi/disease/hearing.asp). ** HBsAg+ = hepatitis B surface antigen positive. *** L. monocytogenes isolated from any site. Infant mortality is reportable to Vital Re-
cords. # Resulting in severe illness or death ## Maternal deaths during pregnancy or within one year of birth are reportable to Maternal
and Child Epidemiology (http://health.state.ga.us/epi/mch/publications.asp). Birth defects are reportable to the Georgia Birth Defects Reporting and Information
System (http://health.state.ga.us/epi/disease/birthdefects.asp).

To Report Immediately
Call: District Health Office (See cover for contact information) or 1-866-PUB-HLTH (1-866-782-4584)

To Report Within 7 Days
Report cases electronically through the State Electronic Notifiable Disease Surveillance System at http://sendss.state.ga.us or Complete reverse of this Notifiable Disease Report Form and mail in an envelope marked CONFIDENTIAL or fax to: District Health Office
(See cover for contact information)

To Report HIV & AIDS
Complete the CDC form 50.42A (available at http://health.state.ga.us/epi/aidsunit.shtml or by calling 1-800-827-9769) and mail in an envelope marked CONFIDENTIAL to: Georgia Division of Public Health, Epidemiology Branch 2 Peachtree St. NW, 14th floor - Office 460 Atlanta, GA 30303-3189

CDC Diphtheria Worksheet

Date of Request

Name (Last, First)

Month Day Year
Birth Date
Month Day Year

Age
Unk = 999

Address (Street and No.)

Age Type
0 = 0-120 years 1 = 0-11 months 2 = 0-52 weeks 3 = 0-28 days
9 = Age unknown

Sex
M = Male F = Female U = Unknown
County

Pregnant?
Y = Yes N = No
U = Unknown

Race N=NativeAmer./AlaskanNative
A = Asian/Pacific Islander B = African American W = White O = Other U = Unknown

Ethnicity
H = Hispanic N = Not Hispanic U = Unknown

State

Zip

Phone

PATIENT INFORMATION

CLINICAL INFORMATION

Date Symptom Onset Date First Diagnosis Date Hospitalized

Month Day Year

Month Day Year

Month Day Year

Description of Clinical Picture

History of Immunization Against Diphtheria

Childhood Primary Boosters as

Series?

Adult?

Date of Last Dose

Y = Yes

Y = Yes

N = No U = Unknown

N = No U = Unknown

OR

Month Day Year

U = Unknown

Outcome
N = Recovered, No Residua R = Recovered, Residua D = Died U = Unknown

Symptoms
Fever? Sore Throat? Difficulty Swallowing? Change in Voice? Shortness of Breath? Weakness?
Fatigue?
Other?

Enter Y = Yes, N = No, or U = Unknown in the Boxes Below Unless Otherwise Indicated

Signs

Complications

Fever? If Yes, Temp

Soft Tissue

.

o Swelling? C (Around Membrane)

Complications? Airway Obstruction?

Membrane? If Yes, Site(s) Tonsils

Neck Edema? If Yes

B = Bilateral L = Left Side Only R = Right Side Only

Date of Onset Intubation Required?

Month Day Year

Soft Palate Hard Palate

If Yes, Extent

S = Submandibular Only M = Midway to Clavicle C = To Clavicle B = Below Clavicle

Myocarditis? Date of Onset

Month Day Year

Larynx

Stridor?

(Poly)neuritis?

Nares Nasopharynx Conjunctiva Skin

Wheezing? Palatal Weakness?
Tachycardia?
EKG Abnormalities?

Date of Onset
Other? Describe:

Month Day Year

Specimen for Diphtheria Culture Obtained?
Y = Yes N = No U = Unknown

If Yes, Obtained on

OR

Month Day Year

U = Unknown

Culture Result
P = Positive
N = Negative
U = Unknown

Specify Lab Performing Culture:

If Culture Positive, Biotype
M = Mitis G = Gravis I = Intermedious B = Belfanti

If Culture Positive, Results of Toxigenicity Testing
X = Not Done P = Positive N = Negative U = Unknown

Specimen Sent to CDC Diphtheria Lab for Confirmation/Molecular Typing?
Y = Yes N = No W = Will be Sent

Type of Specimen (Check All That Apply)
Clinical Swab
Piece of Membrane
C. diphtheria Isolate

Serum Specimen for Diphtheria Antitoxin
Antibodies Obtained?
Y = Yes N = No W = Will be Obtained Prior to DAT

PCR Result
P = Positive N = Negative U = Unknown X = Not Done

Treated with Antibiotics?
Y = Yes
N = No

As an Outpatient If Yes, Date Initiated
Month Day Year

Were Antibiotics Given in the 24
Hours Before Culture?
Y = Yes N = No U = Unknown

Antibiotic

Duration of Therapy

See Codes

Below

Days

Antibiotic Therapy in Hospital?
Y = Yes
N = No

As an Inpatient If Yes, Date Initiated
Month Day Year

Antibiotic

Duration of Therapy

See Codes

Below

Days

Antibiotic Codes

1 = Erythromycin (incl. Pediazole, ilosone)

5 = Cotrimoxazole (bactrim/septra)

2= Penicillin (Bicillin, Pfizerpen-AS, Wycillin)

6 = Tetracycline/Doxycycline

3 = Amoxicillin/Ampicillin/Augmentin/Ceclor/Cefixime 7=Other

4 = Clarithromycin/azithromycin

9 = Unknown

LABORATORY

ANTIBIOTICS

Note: This Form Has 2 Sides

EXPOSURE

REPORTING INFORMATION

Country of Residence
U = US O = Other
History of International Travel? (2 Weeks Prior to Onset)
Y = Yes N = No U = Unknown
History of Interstate Travel? (2 Weeks Prior to Onset)
Y = Yes N = No U = Unknown

If Other, Country Name:

Country(s) Visited

From
Month Day

Date of US Arrival

Month Year

Day Year
To
Month Day

OR
U = Unknown
Year

State(s) Visited

From
Month Day Year

To
Month Day Year

Known Exposure to Diphtheria
Case or Carrier?
Y = Yes N = No U = Unknown

Known Exposure to International Travelers?
Y = Yes N = No U = Unknown

Known Exposure to Immigrants?
Y = Yes N = No U = Unknown

Has This Suspected Case Been Reported to The State or Local Health Department?
Y = Yes N = No U = Unknown
Person Informed:
Reporting Physician:

Phone
-
Phone
-

Date Reported to State or Local Health Department

Month Day Year

Fax

-

-

-

Fax

-

-

-

Name

Institution

Street

City

Phone

-

-

Name of Investigator Under the IND (If Different From
Requesting Physician)

Phone
-

State

Zip

Fax

-

-

Fax

-

-

-

Name

Attn. Institution

Street

City

Phone

-

-

State

Zip

Fax

-

-

Amount of DAT Administered: Final Diagnosis:

,

IU DAT

How Was the Final Diagnosis Confirmed?

Final Case Disposition
C = Confirmed P = Probable N = Not a Case

REQUESTING PHYSICIAN

SEND DRUG TO

DISPOSITION DOSE

(h:\esd\cvpd\surveil\forms\dip.pre 1/98)

NAME (Last, First)

Measles Surveillance Worksheet

Hospital Record No.

Address (Street and No.)

City

County

Zip

Phone

Reporting Physician/Nurse/Hospital/Clinic

Address

Phone

----------------------------------------------------- DETACH HERE and transmit only lower portion if sent to CDC -----------------------------------------------
Measles Surveillance Worksheet

Birth Date

Month Day

Year

County

Age
Unk = 999

Age Type
0 = 0-120 years
1 = 0-11 months 2 = 0-52 weeks
3 = 0-28 days 9 = Age unknown

Sex
M = Male
F = Female U = Unknown

State

Race
N = Native Amer./Alaskan Native
A = Asian/Pacific Islander B = African American

W = White O = Other
U = Unknown

Zip

Ethnicity
H = Hispanic N = Not Hispanic U = Unknown

Any Rash? Rash Onset

Y = Yes

N = No

U = Unknown Month Day

Year

Rash Duration
0 - 30 Days 99 = Unknown

Rash Generalized?
Y = Yes N = No U = Unknown

Fever? If Recorded, Highest

Y = Yes N = No

Measured Temp.

U = Unknown

.

36.0 - 110.0 Degrees 999.9 = Unknown

Cough?
Y = Yes N = No U = Unknown

Coryza?
Y = Yes N = No U = Unknown

Conjunctivitis?
Y = Yes N = No U = Unknown

Otitis?
Y = Yes N = No U = Unknown

Diarrhea?
Y = Yes
N = No U = Unknown

Pneumonia?
Y = Yes N = No U = Unknown

Encephalitis?
Y = Yes N = No U = Unknown

Thrombocytopenia?
Y = Yes N = No U = Unknown

Died?
Y = Yes N = No U = Unknown

Hospitalized?
Y = Yes N = No U = Unknown

Days Hospitalized
0 - 998 999 - Unknown

Other Complications?
Y = Yes N = No U = Unknown
If Yes, Please Specify:
(Max 15 spaces)

Was Laboratory Testing For Measles Done?
Y = Yes N = No U = Unknown

Date IGM Specimen Taken

Month Day

Year

Result
P = Positive N = Negative I = Indeterminate

E = Pending X = Not Done U = Unknown

Vaccinated? (Received measles-

containing vaccine?)

Y = Yes N = No

U = Unknown

If Not Vaccinated, What Was

The Reason?

(See Reason Codes Below)

Vaccination Date Vaccine Vaccine Month Day Year Type Manuf.

(See Type and Manuf. Codes Below)
Lot Number

Date IGG Acute Specimen Taken

Month Day

Year

Result
P = Significant Rise in IGG N = No Significant Rise in IGG I = Indeterminate E = Pending X = Not Done U = Unknown

Date IGG Convalescent Specimen Taken

Month Day

Year

Other Lab Result
P = Positive N = Negative I = Indeterminate

E = Pending X = Not Done U = Unknown

Specify Other Lab Method:
(max 8 spaces)

Number of doses received BEFORE 1st birthday
Number of doses received ON or AFTER 1st birthday
If vaccinated BEFORE 1st birthday, but no doses given ON or AFTER 1st birthday, what was the reason?
If received one dose after 1st birthday, but never received 2nd dose after 1st birthday, what was the reason?

Reason Codes 1 = Religious Exemption 2 = Medical Contraindication 3 = Philosophical Objection 4 = Lab. Evidence of Previous Disease 5 = MD Diagnosis of Previous Disease 6 = Under Age For Vaccination 7 = Parental Refusal 8 = Other 9 = Unknown

Vaccine Type Codes A = MMR B = Measles O = Other U = Unknown

Vaccine Manuf. Codes M = Merck O = Other U = Unknown

Date First Reported to a Health Department

Date Case Investigation Started

Month Day

Year

Transmission Setting (Where did this case acquire measles?)

1 = Day Care

6 = Hospital Outpatient Clinic 11 = Military

2 = School 7 = Home

12 = Correctional Facility

3 = Doctor's Office 8 = Work

13 = Church

4 = Hospital Ward

9 = Unknown

14 = International Travel

5 = Hospital ER

10 = College

15 = Other

Were Age and Setting
Verified? (Is age appropriate for setting, i.e. under 16 and in school, etc.)
Y = Yes N = No U = Unknown

If Transmission Setting Not Among Those Listed And Known, What Was The
Transmission Setting?
(Max 15 Spaces)

Note: This form has 2 sides

Month Day

Year

Outbreak Related?
Y = Yes N = No
U = Unknown

If Yes, Outbreak Name (Max 15 Spaces)

Source of Exposure For Current Case
Enter State ID if source was an in-state case Enter Country if source was out of USA Enter State if source was out-of-state

(Max 15 Spaces)

Epi-Linked to Another

Confirmed or Probable

Case?

Y = Yes N = No

U = Unknown

Is Case Traceable Within 2

Generations to an International

Import?

Y = Yes N = No

U = Unknown

Indicates epidemiologically important items not yet on NETSS screen

Contact Information: (for state/local health department use) Mother's Name Phone

Father's Name

--------------------------------------------------------------- DETACH HERE and transmit only lower portion if sent to CDC ------------------------------------------------------The information below is epidemiologically important, but not included on NETSS screens
Activity History For 18 Days Before Rash Onset And 7 Days After Rash Onset Day -18 Day -17 Day -16 Day -15 Day -14 Day -13 Day -12 Day -11 Day -10 Day -9 Day -8 Day -7 Day -6 Day -5 Day -4 Day -3 Day -2 Day -1 Day 0 (Rash Onset) Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Clinical Case Definition*: A generalized rash lasting >3 days, a temperature > 101.0 F (>38.3 C), and cough, coryza, or conjunctivitis.
Case Classification*: Suspected: Any febrile illness accompanied by rash. Probable: A case that meets the clinical case definition, has noncontributory or no serologic or virologic testing, and is not epidemiologically
linked to a confirmed case. Confirmed: A case that is laboratory confirmed or that meets the clinical case definition and is epidemiologically linked to a confirmed case.
A laboratory-confirmed case does not need to meet the clinical case definition.

*CDC. Case Definitions for Infectious Conditions Under Public Health Surveillance. MMWR 1997;46(No.RR-10):39. (h:\esd\cvpd\surveil\forms\meas.pre 1/98)

NAME (Last, First)

Mumps Surveillance Worksheet

Hospital Record No.

Address (Street and No.)

City

County

Zip

Phone

Reporting Physician/Nurse/Hospital/Clinic

Address

Phone

----------------------------------------------------- DETACH HERE and transmit only lower portion if sent to CDC -----------------------------------------------
Mumps Surveillance Worksheet

Birth Date
Month Day Year
County

Age
Unk = 999

Age Type
0 = 0-120 years 1 = 0-11 months 2 = 0-52 weeks 3 = 0-28 days 9 = Age unknown

Sex
M = Male
F = Female
U = Unknown

State

Race
N = Native Amer./Alaskan Native A = Asian/Pacific Islander B = African American

W = White O = Other
U = Unknown

Zip

Ethnicity
H = Hispanic N = Not Hispanic U = Unknown

Parotitis?
Y = Yes N = No U = Unknown
Notes:

Was Laboratory Testing For Mumps Done?
Y = Yes N = No U = Unknown

Date IGM Specimen Taken

Month Day

Year

Result
P = Positive N = Negative I = Indeterminate

E = Pending X = Not Done U = Unknown

Meningitis?
Y = Yes N = No U = Unknown
Encephalitis?
Y = Yes N = No U = Unknown

Deafness?
Y = Yes N = No U = Unknown
Died?
Y = Yes N = No U = Unknown

Hospitalized?
Y = Yes N = No U = Unknown

Days Hospitalized
0 - 998 999 - Unknown

Orchitis?
Y = Yes N = No U = Unknown
Other Complications?
Y = Yes N = No U = Unknown
If Yes, Please Specify:
(Max 15 spaces)

Vaccinated? (Received mumps-containing vaccine?)

Y = Yes N = No U = Unknown

Vaccination Date Vaccine Vaccine Month Day Year Type Manuf.

Lot Number

Date IGG Acute Specimen Taken

Month Day

Year

Result
P = Significant Rise in IGG N = No Significant Rise in IGG I = Indeterminate E = Pending X = Not Done U = Unknown

Date IGG Convalescent Specimen Taken

Month Day

Year

Other Lab Result
P = Positive N = Negative I = Indeterminate

E = Pending X = Not Done U = Unknown

Specify Other Lab Method:
(max 8 spaces)

Vaccine Type Codes A = MMR B = Mumps O = Other U = Unknown

Vaccine Manuf. Codes M = Merck O = Other U = Unknown

Number of doses received ON or AFTER 1st birthday

If Not Vaccinated, What Was The Reason?

1 = Religious Exemption 2 = Medical Contraindication 3 = Philosophical Objection 4 = Lab. Evidence of Previous Disease 5 = MD Diagnosis of Previous Disease

6 = Under Age For Vaccination 7 = Parental Refusal 8 = Other 9 = Unknown

Date First Reported to a Health Department

Date Case Investigation Started

Month Day Year

Transmission Setting (Where did this case acquire mumps?)

1 = Day Care

6 = Hospital Outpatient Clinic 11 = Military

2 = School 7 = Home

12 = Correctional Facility

3 = Doctor's Office 8 = Work

13 = Church

4 = Hospital Ward

9 = Unknown

14 = International Travel

5 = Hospital ER

10 = College

15 = Other

Were Age and Setting
Verified? (Is age appropriate for setting, i.e. under 16 and in school, etc.)
Y = Yes N = No U = Unknown

If Transmission Setting Not Among Those
Listed And Known, What Was The
Transmission Setting?
(Max 15 Spaces)

Note: This form has 2 sides

Month Day

Year

Outbreak Related?
Y = Yes N = No U = Unknown

If Yes, Outbreak Name (Max 15 Spaces)

Source of Exposure For Current Case
Enter State ID if source was an in-state case Enter Country if source was out of USA Enter State if source was out-of-state

(Max 15 Spaces)

Epi-Linked to Another Confirmed or Probable Case?
Y = Yes N = No U = Unknown
Indicates epidemiologically important items not yet on NETSS screen

--------------------------------------------------------------- DETACH HERE and transmit only lower portion if sent to CDC -------------------------------------------------------
Clinical Case Definition*: An illness with acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting > 2 days, and without other apparent cause. Case Classification*: Probable: A case that meets the clinical case definition, has noncontributory orno serologic or virologic testing, and is not epidemiologically
linked to a confirmed or probable case. Confirmed: A case that is laboratory confirmed or that meets the clinical case definition and is epidemiologically linked to a confirmed or
probable case. A laboratory-confirmed case does not need to meet the clinical case definition. *CDC. Case Definitions for Infectious Conditions Under Public Health Surveillance. MMWR 1997;46(No.RR-10):39.
(h:\esd\cvpd\surveil\forms\mumps.pre 1/98)

NAME (Last, First) Address (Street and No.)

Active Laboratory-Based Surveillance Pertussis Form
Hospital Chart #

City

County

Zip

Phone

-----------------------------------------------------DETACH HERE and transmit only lower portion if sent to CDC---------------------------------------------------
Active Laboratory-Based Surveillance Pertussis Form

Hospital Lab/ID County

Status: Is the form complete?

Y = Yes Update Date

N = No

Month Day

Year

State

Zip

State ID

Birth Date

Month Day

Year

Age

Age Type
0 = 0-120 years 1 = 0-11 months 3 = 0-28 days 2 = 0-52 weeks 9 = Age unknown

Race

1 = Native Amer./Alaskan Native 5 = White

2 = Asian/Pacific Islander

8 = Other

3 = African American 9 = Unknown

Ethnicity
1 = Hispanic 2 = Not Hispanic 9 = Unknown

Sex
1 = Male
2 = Female
9 = Unknown

Any Cough? Cough Onset

Y = Yes

N = No U = Unknown Month Day

Year

Paroxysmal Cough?
Y = Yes N = No U = Unknown

Whoop?
Y = Yes
N = No
U = Unknown

Posttussive Vomiting?
Y = Yes N = No U = Unknown

Apnea?
Y = Yes N = No U = Unknown

Final Interview Date

Cough at Final

Month Day

Year

Duration of Cough at

Interview?

Final Interview

Days

Chest X-ray for Pneumonia Seizures Due to Pertussis

P = Positive N = Negative X = Not Done U = Unknown

Y = Yes N = No U = Unknown

Acute Encephalopathy Due to Pertussis
Y = Yes N = No U = Unknown

Hospitalized?
Y = Yes N = No U = Unknown

Days Hospitalized
0 - 998 999 - Unknown

Died?
Y = Yes N = No U = Unknown

Were Antibiotics Given? First Antibiotic Received

Y = Yes N = No U = Unknown

1 = Erythromycin (incl. pediazole, ilosone) 2 = Cotrimoxazole (bactrim/septra) 3 = Clarithromycin/azithromycin 4 = Tetracycline/Doxycycline

6 = Other 9 = Unknown

Date Started First Antibiotic

5 = Amoxicillin/Penicillin/Ampicillin/Augmentin/Ceclor/Cefixime
Days First Antibiotic Actually Taken

0 - 98

Month Day

Year

99 - Unknown

Was Laboratory Testing for Pertussis Done?

Y = Yes

N = No

Result Date Specimen Taken

U = Unknown

Month Day

Year

Culture

DFA

Serology

Second Antibiotic Received

See Choices for First Antibiotic Given

Date Started Second Antibiotic

Month Day

Year

Days Second Antibiotic Actually Taken
0 - 98 99 = Unknown

Vaccinated? (Received any doses of diphtheria, tetanus, and/or pertussis-containing vaccines)

Vaccination Date
Month Day Year

Vaccine Vaccine Type* Manuf.*

Y = Yes N = No U = Unknown
Lot Number*+

PCR

P = Positive N = Negative I = Indeterminate

RESULT CODES E = Pending
X = Not Done S = Parapertussis

U = Unknown

Date First Reported to a Date Case Investigation

Health Department

Started

Month Day

Year

Month Day

Year

Outbreak Related?
Y = Yes N = No U = Unknown

Epi-Linked?
Y = Yes N = No U = Unknown

Outbreak Name (Name of outbreak this case is associated with)

Vaccine Type Codes W = DTP Whole Cell A = DTaP
H = DTaP-Hib D = DT or Td T = DTP-Hib

Vaccine Manufacturer Codes C = Connaught
L = Lederle S = SmithKline Beecham M = Mass. Health Department N = North American

*Record for each dose (unlikely to be available if patient born before 1989)

Transmission Setting (Where did this case acquire pertussis)?

01 = Day Care 02 = School
03 = Doctor's Office
04 = Hospital Ward 05 = Hospital ER

06 = Hosp. Outpatient Clinic 11 = Military

07 = Home

12 = Correctional Facility

08 = Work

13 = Church

99 = Unknown 10 = College

14 = International Travel 15 = Other

P = Pertussis Only O = Other

I = Mich. Health Department O = Other

+unknown = 9999999999

U = Unknown

U = Unknown

Setting (Outside Household) of Further Documented

Date of Last Pertussis-Containing Number of Doses of Pertussis-Containing Vaccine Prior to Illness Onset Vaccine Prior to Illness Onset

Spread From This Case
Use same codes as for Transmission Settings, except: 7 = >1 Setting Outside Household

0 - 6

16 = No Documented Spread Outside Household

9 = Unknown

Month Day Year

Site PFGE type: Erythromycin susceptibility

Reason Not Vaccinated With > 3 Doses of Pertussis Vaccine

1 = Religious Exemption

5 = Parental Refusal

test results:

S = (susceptible I = Intermediate

2 = Medical Contraindication

6 = Age Less Than 7 Months

R = Resistant

3 = Philosophical Exemption

7 = Other

4 = Previous Pertussis Confirmed by Culture or MD

9 = Unknown

Suspected source of infection: For cases <1 yr, is another person with suspected pertussis* known?:

Source's Age

Y = Yes

N = No

U = Unknown

Unk = 999

Source's Age Type

0 = 0-120 years 1 = 0-11 months 2 = 0-52 weeks 3 = 0-28 days 9 = Age unk

Source's Sex
1 = Male 2 = Female 9 = Unk

Relation to 1 = Mother

case:

2 = Father 3 = sister

4 = brother

5 = neighbor

6 = day care

7 = grandparent
8 = friend 11 = other 99 = unknown

* Another person with a cough who was in contact with the case 7-20 days before the case's cough Note: This form has 2 sides onset

------------------------------------------------------------------------------------------DETACH HERE -----------------------------------------------------------------------------------------------------

Comments:

The information below is epidemiologically important, but not needed for reporting

Setting

Day Care School

Doctor's Office
Hospital (Ward/ER/Outpatient/Clinic)

Home

Work Travel (International/Domestic)

Other

Unknown

Name of Contact

Birthdate

In which setting was pertussis acquired (Please Specify)

In which setting was there secondary spread (Please Specify)

Relation to the Case

Is it a Case
?

If it's a Case, Case ID #

Cough Onset Date (If Present)

# of PCVs*

Date of Last PCV

Parent's Name and Phone # (If Applicable)

*PCV = Pertussis-Containing Vaccine

Clinical Case Definition*: A cough illness lasting > 2 weeks with one of the following: paroxysms of coughing, inspiratory "whoop", or post-tussive vomiting, without other apparent cause.

Case Classification*:

Probable:

A case that meets the clinical case definition, is not laboratory confirmed, and is not epidemiologically linked to a laboratory-confirmed case.

Confirmed: 1) A person with an acute cough illness of any duration who is culture positive, or 2) a case that meets the clinical case definition and is confirmed by PCR, or

3) a case that meets the clinical case definition and is epidemiologically linked directly to a case confirmed by either culture or PCR.

*CDC. Case Definitions for Infectious Conditions Under Public Health Surveillance. MMWR 1997;46(No.RR-10):39. Manual for the Surveillance of Vaccine-Preventable Diseases. 1997.

(h:\esd\cvpd\surveil\forms\pert.pre 5/19/98)

NAME (Last, First)

Rubella Surveillance Worksheet

Address (Street and No.)

City

County

Reporting Physician/Nurse/Hospital/Clinic

Address

Hospital Record No.

Zip

Phone

Phone

----------------------------------------------------- DETACH HERE and transmit only lower portion if sent to CDC -----------------------------------------------
Rubella Surveillance Worksheet

Birth Date

Month Day

Year

County

Age
Unk = 999

Age Type
0 = 0-120 years 1 = 0-11 months 2 = 0-52 weeks 3 = 0-28 days 9 = Age unknown

Sex
M = Male F = Female U = Unknown

State

Race
N = Native Amer./Alaskan Native A = Asian/Pacific Islander B = African American

W = White O = Other U = Unknown

Zip

Ethnicity
H = Hispanic N = Not Hispanic U = Unknown

Any Rash? Rash Onset

Y = Yes N = No

U = Unknown Month Day

Year

Rash Duration
0 - 30 Days 99 = Unknown

Fever?
Y = Yes N = No U = Unknown

If Recorded, Highest Measured Temp.

36.0 - 110.0 Degrees

.

999.9 = Unknown

Arthralgia/ Arthritis?
Y = Yes N = No U = Unknown

Lymphadenopathy?
Y = Yes N = No U = Unknown

Conjunctivitis?
Y = Yes N = No U = Unknown

Was Laboratory Testing For Rubella Done?
Y = Yes N = No U = Unknown

Date IGM Specimen Taken

Month Day

Year

Result
P = Positive N = Negative I = Indeterminate

E = Pending X = Not Done U = Unknown

Encephalitis?
Y = Yes N = No U = Unknown

Arthralgia/Arthritis?
Y = Yes N = No U = Unknown

Thrombocytopenia?
Y = Yes N = No U = Unknown

Died?
Y = Yes N = No U = Unknown

Hospitalized?
Y = Yes N = No U = Unknown

Days Hospitalized
0 - 998 999 - Unknown

Other Complications?
Y = Yes N = No U = Unknown
If Yes, Please Specify:
(Max 15 spaces)

Vaccinated? (Received rubella-containing vaccine?)

Y = Yes N = No U = Unknown

Vaccination Date Vaccine Vaccine

Month Day

Year

Type Manuf.

Lot Number

Date IGG Acute Specimen Taken

Month Day

Year

Result
P = Significant Rise in IGG N = No Significant Rise in IGG I = Indeterminate E = Pending X = Not Done U = Unknown

Date IGG Convalescent Specimen Taken

Month Day

Year

Other Lab Result
P = Positive N = Negative I = Indeterminate

E = Pending X = Not Done U = Unknown

Specify Other Lab Method:
(max 8 spaces)

Vaccine Type Codes A = MMR B = Rubella O = Other
U = Unknown

Vaccine Manuf. Codes M = Merck O = Other U = Unknown

Number of doses received ON or AFTER 1st birthday

If Not Vaccinated, What Was The Reason?

1 = Religious Exemption 2 = Medical Contraindication 3 = Philosophical Objection 4 = Lab. Evidence of Previous Disease 5 = MD Diagnosis of Previous Disease

6 = Under Age For Vaccination 7 = Parental Refusal 8 = Other 9 = Unknown

Date First Reported to a Health Department

Date Case Investigation Started

Month Day

Year

Transmission Setting (Where did this case acquire rubella?)

1 = Day Care

6 = Hospital Outpatient Clinic

11 = Military

2 = School

7 = Home

12 = Correctional Facility

3 = Doctor's Office

8 = Work

13 = Church

4 = Hospital Ward

9 = Unknown

14 = International Travel

5 = Hospital ER

10 = College

15 = Other

Were Age and Setting Verified? (Is age appropriate for setting, i.e. under 16 and in school, etc.)

If Transmission Setting Not Among Those
Listed And Known, What Was The
Transmission Setting?
(Max 15 Spaces)

Y = Yes N = No U = Unknown

Note: This form has 2 sides

Month Day

Year

Outbreak Related?
Y = Yes N = No
U = Unknown

If Yes, Outbreak Name (Max 15 Spaces)

Source of Exposure For Current Case
Enter State ID if source was an in-state case Enter Country if source was out of USA Enter State if source was out-of-state

(Max 15 Spaces)

Epi-Linked to Another Confirmed or Probable Case?
Y = Yes N = No U = Unknown
Indicates epidemiologically important items not yet on NETSS screen

--------------------------------------------------------------- DETACH HERE and transmit only lower portion if sent to CDC -------------------------------------------------------

PREGNANT WOMEN

Was The Case Pregnant?
Y = Yes N = No U = Unknown

Number of Weeks Gestation (or Trimester) at Onset of Illness

1st = First Trimester 2nd = Second Trimester 3rd = Third Trimester

Prior Evidence of Serological Immunity?
Y = Yes N = No U = Unknown

Year of Test OR
1940 - 2010

Age of Patient at Time of Test
0 - 50 99 = Unknown

1 = 1 Week 2 = 2 Weeks 3 = 3 Weeks ' '' ' ' '' ' (etc. -- continue up to 45 weeks)

Was Previous Rubella Serologically Confirmed?
Y = Yes N = No
U = Unknown

Year of Disease OR
1940 - 2010

Age of Patient at Time of Disease
0 - 50 99 = Unknown

The information below is epidemiologically important, but not included on NETSS screens

Country of Birth

Contact(s) to Case in Case's Infectious Period (7 Days Before to 7 Days After Rash Onset) Who Are in 1st 5 Months of Pregnancy

Name

Address/Phone

Documented Prior
Rubella Immunization?
If Yes, Date Y = Yes N = No U = Unknown Month Day

Documented Rubella

Seropositivity Before

If No or Unknown,

or Within 7 Days

Action Taken --

After First Exposed?

Rubella Serology, etc.

Y = Yes

N = No

Year

U = Unknown

If Yes, Date Y = Yes
N = No U = Unknown Month Day Year

Y = Yes N = No U = Unknown

Y = Yes

If Yes, Date

N = No U = Unknown Month Day Year

Y = Yes N = No U = Unknown

Group Contact(s) to Case in Case's Infectious Period (7 Days Before to 7 Days After Rash Onset), i.e. Households, Child Care Center, School, College, Workplace, Jail/Prison, Physician's Office/Clinic/Hospital/Emergency Room, etc..

Name of Group/Site

Address/Phone/Contact Person

Notes

Clinical Case Definition*: An illness that has all of the following characteristics: acute onset of generalized maculopapular rash, temperature > 99.0 F (>37.2 C), if measured, and arthralgia/arthritis, lymphadenopathy, or conjunctivitis.
Case Classification*: Suspected: Any generalized rash illness of acute onset. Probable: A case that meets the clinical case definition, has no or noncontributory serologic or virologic testing, and is not epidemiologically
linked to a laboratory-confirmed case. Confirmed: A case that is laboratory confirmed or that meets the clinical case definition and is epidemiologically linked to a laboratory-
confirmed case.
*CDC. Case Definitions for Infectious Conditions Under Public Health Surveillance. MMWR 1997;46(No.RR-10):39. (h:\esd\cvpd\surveil\forms\rubella.pre1/98)

NAME (Last, First)

Tetanus Surveillance Worksheet

Hospital Record No.

Address (Street and No.)

City

County

Zip

Phone

Reporting Physician/Nurse/Hospital/Clinic

Address

Phone

----------------------------------------------------- DETACH HERE and transmit only lower portion if sent to CDC -----------------------------------------------
Tetanus Surveillance Worksheet

Birth Date
Month Day Year
County

Age
Unk = 999

Age Type
0 = 0-120 years 1 = 0-11 months 2 = 0-52 weeks
3 = 0-28 days 9 = Age unknown

Sex
M = Male F = Female
U = Unknown

State

Race
N = Native Amer./Alaskan Native A = Asian/Pacific Islander
B = African American

W = White O = Other
U = Unknown

Zip

Ethnicity
H = Hispanic
N = Not Hispanic U = Unknown

HISTORY

Date Year of Onset

Month Day

Year

Occupation (Max 15 Spaces)

History of Military/ National Guard Service?
Y = Yes N = No U = Unknown

Year of Entry Into Military or National Guard

Tetanus Toxoid (TT) History Prior to

Tetanus Disease
(Exclude Doses Received Since Acute Injury)

0 = Never 1 = 1 dose 2 = 2 doses

3 = 3 doses 4 = 4 + doses 9 = Unknown

Years Since Last Dose
0 - 98 99 = Unknown

CLINICAL DATA

Acute Wound
Identified?
Y = Yes N = No
U = Unknown

Date Wound Occurred

Month Day

Year

Principal Anatomic Site

1 = Head

9 = Unspecified

2 = Trunk

3 = Upper Extremity

4 = Lower extremity

Work Related?
Y = Yes N = No U = Unknown

Environment
1 = Home 2 = Other Indoors
3 = Farm/Yard 4 = Automobile
5 = Other Outdoors 9 = Unknown

Circumstances
(Describe in Detail. Max 20 Spaces)

Principal Wound Type
1 = Puncture 2 = Stellate Laceration 3 = Linear Laceration
4 = Crush 5 = Abrasion

6 = Avulsion
7 = Burn 8 = Frostbite
9 = Compound Fracture
10 = Other 99 = Unknown

Wound Contaminated?
Y = Yes N = No U = Unknown

Depth of Wound
1 = 1cm. or less 2 = More than 1cm. 9 = Unknown

Signs of Infection?
Y = Yes N = No U = Unknown

Devitalized, Ischemic, or
Denervated Tissue Present?
Y = Yes N = No
U = Unknown

Was Medical Care Obtained For This Acute Injury?
Y = Yes N = No U = Unknown

Tetanus Toxoid (TT) Administered Before Tetanus Onset?
Y = Yes N = No U = Unknown

If Yes, TT Given How Soon After Injury?

1 = < 6 Hours

6 = 15+ Days

2 = 7-23 Hours

9 = Unknown

3 = 1-4 Days

4 = 5-9 Days

5 = 10-14 Days

Wound Debrided Before
Tetanus Onset?
Y = Yes N = No U = Unknown

If Yes, Debrided How Soon

After Injury?
1 = < 6 Hours 2 = 7-23 Hours 3 = 1-4 Days 4 = 5-9 Days 5 = 10-14 Days

6 = 15+ Days 9 = Unknown

Tetanus Immune Globulin (TIG) Prophylaxis Received Before Tetanus Onset?
Y = Yes N = No U = Unknown

If Yes, TIG Given How Soon

After Injury?
1 = < 6 Hours 2 = 7-23 Hours 3 = 1-4 Days 4 = 5-9 Days 5 = 10-14 Days

6 = 15+ Days 9 = Unknown

Dosage
(Units)
0-998 999 = Unknown

Associated Condition

(If no Acute Injury)

1 = Abscess 2 = Ulcer
3 = Blister 4 = Gangrene

5 = Cellulitis 6 = Other Infection 9 = None

Describe Condition
(Max 20 Spaces)

Diabetes?
Y = Yes N = No U = Unknown

If Yes, InsulinDependent?
Y = Yes N = No U = Unknown

Parenteral
Drug Abuse?
Y = Yes N = No U = Unknown

Describe Condition
(Max 20 Spaces)

Type of Tetanus Disease
1 = Generalized 2 = Locoalized 3 = Cephalic 4 = Unknown

TIG Therapy Given?
Y = Yes N = No U = Unknown

If Yes, How Soon After

Illness Onset?
1 = < 6 Hours
2 = 7-23 Hours 3 = 1-4 Days

4 = 5-9 Days 5 = 10-14 Days
6 = 15+ Days 9 = Unknown

Dosage
(Units)

0-998 999 = Unknown

Days Hospitalized
0-998 999 = Unknown

Days in ICU
0-998 999 = Unknown

Days Received Mechanical Ventilation
0-998 999 = Unknown

COURSE OF TETANUS DISEASE MEDICAL CARE PRIOR TO ILLNESS ONSET

Outcome One Month After Onset?
R = Recovered C = Convalescing D = Died
Note: This form has 2 sides

If Died, Date Expired

Month Day

Year

Indicates epidemiologically important information not yet on NETSS screen

NEONATAL (< 28 DAYS OLD)

--------------------------------------------------------------- DETACH HERE and transmit only lower portion if sent to CDC -------------------------------------------------------

Mother's Age in Years
12-60
99 = Unknown

Mother's Birthdate
Month Day Year

Date Mother's Arrival in U.S.
Month Day Year

Mother's Tetanus Toxoid (TT)

History PRIOR to Child's Disease
(Known Doses Only)

0 = Never 1 = 1 dose 2 = 2 doses

3 = 3 doses 4 = 4 + doses 9 = Unknown

Child's Birthplace
1 = Hospital 2 = Home
3 = Other 9 = Unknown

Birth Attendant(s)
1 = Physician 2 = Nurse 3 = Licensed Midwife

4 = Unlicensed Midwife 5 = Other 9 = Unknown

Other Birth Attendant(s)
(If Not Previously Listed. Max 10 Spaces)

Years Since Mother's
Last Dose
0 - 98 99 = Unknown

OtherComments? Reporter'sName
Y = Yes N = No U = Unknown
Institution

Title

Phone

-

-

Date Reported
Month Day Year

Clinical Case Definition*:
Acute onset of hypertonia and/or painful muscular contractions (usually of the muscles of the jaw and neck) and generalized muscle spasms without other apparent medical cause.
Case Classification*:
Confirmed: A clinically compatible case, as reported by a health-care professional.

*CDC. Case Definitions for Infectious Conditions Under Public Health Surveillance. MMWR1997;46(No. RR-10):39.

(h:\esd\cvpd\surveil\forms\tet.pre 1/98)

Georgia Department of Human Resources

Public Health Laboratory

Viral Culture Submission Form

SUBMITTER INFORMATION

PATIENT INFORMATION

SUBMITTER CODE:

-

NAME AND ADDRESS:

NAME:
LAST

PATIENT #
FIRST

MIDDLE INITIAL

PHONE NUMBER: ( ) CONTACT PERSON:

STREET:

ZIP Code:

+

DATE OF BIRTH:

/

ZIP CODE + 4

RACE:
Black White Am. Indian/Alaska Native Asian/Pacific Islander Multi-racial Unknown

CITY: COUNTY: /
ETHNICITY:
Hispanic Non-Hispanic Unknown
DATE OF ONSET: TRAVEL:

STATE:
GENDER:
Male Female Unknown
//

SYMPTOMS:( Check all that apply)
fever______ chills cough meningitis conjunctivitis rash
Other____________________________

SPECIMEN INFORMATION

DATE COLLECTED:

/ /

SOURCE/TYPE: Lesion/Genital Swab Lesion/General Swab Throat Swab Nasopharyngeal Swab

Nasopharyngeal Aspirate Urine

Stool Rectal Swab

CSF Whole Blood

Other

Serum

TEST REQUESTED: Herpes Culture Influenza Culture Enterovirus Culture Respiratory Panel

Norwalk identification on EM

Viral Culture / identification (misc.)

REASON FOR TESTING: Diagnosis Routine Screening Other

Rotavirus identification

LABORATORY COPY

Form 3595 (Rev. 9-02)

1

Georgia Department of Human Resources Public Health Laboratory
Microbial Immunology Submission Form

SUBMITTER INFORMATION

PATIENT INFORMATION

SUBMITTER CODE:-

PLEASE PRINT INFORMATION LEGIBLY PATIENT #: _________________________________________________

NAME AND ADDRESS: __________________________________________
__________________________________________

NAME: _____________________________________________________

Last

First

Middle Initial

STREET: ___________________________________________________

__________________________________________ CITY: ____________________ STATE: ___ ZIP Code: _______+_____

__________________________________________ COUNTY: _______________________ Date of BIRTH: ____/____/____

ZIP Code + 4

RACE

ETHNICITY

SEX

PHONE NUMBER: _____________________

Black/African American

Hispanic

Male

CONTACT PERSON:

White

Non-Hispanic Female

Am. Indian/Alaska Native Undetermined Undetermined

Asian/Pacific Islander

Multi-Racial

Undetermined

SPECIMEN INFORMATION

DATE COLLECTED: _____/_____/_______
Type of specimen: Acute serum Convalescent serum

Spinal fluid

Serum/Blood

Reason for testing: Diagnosis

Contact to STD

Medical/Legal Repeat testing

Please complete: Pregnant: Yes No Unknown Prenatal (Hepatitis B) EDC Date: _____/_____/_______

Date of onset of illness: _____/_____/_______

Please check the appropriate box(es) for test(s) requested

*(Not available @ Albany or Waycross Regional Labs)

*Arbovirus/WNV panel
Arbo IgG & IgM panel WNV IgG&IgM WNV IgM (CSF)
Routine Syphilis
Routine RPR VDRL(spinal fluid)

* Hepatitis Testing
Hep B (Prenatal) Hep B (Routine Screen) Anti-HAV-total antibody Anti-HAV-IgM
SARS
SARSCoV Serology

CMV- IgG CMV-IgM EBNA (IgG) EBV-VCA(IgG EBV-VCA(IgM) HSV1/HSV-2 Mumps-IgG

* Miscellaneous Serology

Murine Typhus Rubella-IgM

Mycoplasma-IgG Rubeola-IgG

Parvovirus-IgG Rubeola-IgM

Parvovirus-IgM TORCH panel **

Rocky Mountain Toxoplasmosis-IgG

Spotted Fever

Toxoplasmosis-IgM

Rubella-IgG

Varicella Zoster-IgG

Special RPR testing request: Quantitative(Titer) and Confirmatory even if screening test (RPR) negative No Confirmatory Test needed even if screening test (RPR) is positive Quantitative (Titer) RPR

**TORCH panel includes Toxoplasmosis, Rubella, CMV, HSV 1/2

Note: Please submit a separate specimen for each Group

Special test requests ________________________________________________________________________________________ List test for CDC referrals___________________________________________________________________________________
Form 3432 (Rev. 3-2004)

Georgia Department of Human Resources Public Health Laboratory
Molecular Biology Submission Form

SUBMITTER INFORMATION

- SUBMITTER CODE:
NAME _____________________________________________

STREET____________________________________________

CITY______________________________________________

ZIP CODE__________________________________________

COUNTY___________________________________________

PHONE NUMBER: (

)

CONTACT PERSON:

ENVIRONMENTAL SPECIMENS
Specimen Type: _____________________________ Suspicious Organism: _________________________ Source: _____________________________________

CLINICAL SPECIMENS

PATIENT INFORMATION

PLEASE PRINT ALL INFORMATION LEGIBLY

PATIENT #

NAME:

_

Last

First

Middle Initial

STREET:

CITY:

ZIP Code:

+

COUNTY:

STATE:

DATE OF BIRTH:

/

/

OCCUPATION:__________________________

RACE:_____ SEX: Male Female Unknown

CLINICAL SYMPTOMS: Headache; Fever; Chills; Nausea; Vomiting; Backache; Myalgia; Difficulty in swallowing; Blurred vision; Disordered speech; Swollen lymph nodes; Hemorrhage; Necrosis; Chest pain; Sore throat; Fatigue; Cough; Weight loss; Constipation; Joint pain; Rash
BRIEF HISTORY:___________________________________________________
____________________________________________________________________________ __________________________________________________________________________

SPECIMEN INFORMATION

DATE COLLECTED:

/

/

TIME COLLECTED: ___________________ DATE RECEIVED: _____________________

TEST REQUESTED: ____________________

Type of Specimen Clinical Culture for identification Other (Specify)_____________________________
RESULTS

Agent Identified:

Genetic Pattern Analysis:

Date Reported: __________________

Form 3409 (Rev.6-03)

Georgia Immunization Program Manual
TABLE OF CONTENTS

Division Of Public Health

7. HEPATITIS Perinatal Hepatitis B Prevention Program Guidelines (REPLACE) Appendix Table (REPLACE) A---Flow Chart for Following Babies Born to HBsAg Positive Females (REPLACE) B---Perinatal Hepatitis B Prevention Case Management Referral Form C-- Patient Notification Letters C-1---Sample Letter for Pregnant Women Testing Positive for HBsAg C-2---Sample Letter for Foster Parents of Infants Born to HBsAg (+) Women C-3---Sample Letter For Adoptive Parents Of Infants Born To HBsAg (+) Women (REMOVE) D---Immunization Action Coalition Patient Notification Letter E---Hepatitis B Alert (Infant) F---HIPAA Form for Perinatal Hepatitis B Prevention Program G---Hepatitis B Alert (HBsAg Positive Woman) H---Georgia Public Health Laboratory Service Manual Excerpt I---Questions Frequently Asked About Hepatitis B J---Guidelines for Standing Orders in Labor & Delivery and Nursery Units to Prevent Hepatitis B Virus Transmission to Newborns (REPLACE) K---What the Physician Can Do to Help the Child with Chronic Hepatitis B Virus Infection (REPLACE) L---If You Have Chronic Hepatitis B Virus (HBV) Infection M---Example Hepatitis B Interviewing/Counseling Format M1, M2, M3 and M4(REPLACE) N---Hepatitis B Facts: Testing and Vaccination (REPLACE)
State Hepatitis Program Memorandum of 5/13/2005---Vaccine Preventable Hepatitis in HIV, Family Planning, and STD Clinics Hepatitis B Vaccination in STD, HIV and Family Planning Clinics, Guidelines for Public Health

Table of Contents 11/2009

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Perinatal Hepatitis B Prevention Program
Guidelines

Georgia Perinatal Hepatitis B Prevention Program
2 Peachtree Street, NW, 11-476 Atlanta, Georgia 30303 404/657-3151 Fax: 678-7176104
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Table of Contents

Sections A. B. C. D. E. F. G. H.
I. J.
K.

Background Program Goals Georgia Perinatal Hepatitis B Program Eligibility Requirements Universal Perinatal Screening for Hepatitis B General Management of HBsAg Positive Pregnant Women General Management of Infants Born to HBsAg Positive Women Management of Infants Born to Women with Unknown HBsAg Status Management of Sexual and Household Contacts to HBsAg Positive Pregnant Women Finding Clients that are lost to follow-up Required Reports and Case Updates for Perinatal Hepatitis B Prevention in Georgia Glossary of Terms

Appendix

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A. Background In the United States, over 24,000 pregnant women test positive for hepatitis B virus (HVB) each year. In Georgia, the Centers for Disease Control and Prevention (CDC) estimates between 514-782 births to Hepatitis B Surface Antibody (HBsAg) positive women should be reported annually. There is currently no cure for Hepatitis B; however, there are methods to prevent perinatal exposure. Administering the hepatitis B vaccine to the infant within 12 hours of birth has have shown to be 85-95 percent effective in preventing acute and chronic HBV in infants born to women who are positive for both HBsAg and HBeAg.
The purpose of Georgia's Perinatal Hepatitis B Prevention Program is to ensure that babies born to hepatitis B surface antigen (HBsAg) positive women are given the opportunity to live their lives free of hepatitis B disease. Infants born to HBsAg positive women are exposed to the virus through contact with their mother's blood during delivery. Infants and children who become infected with the hepatitis B virus have a 90 percent chance of becoming chronic carriers. These children are more likely to die from end-stage liver disease (hepatocellular carcinoma or cirrhosis) as adults. Immunizing babies born to HBsAg-positive women with hepatitis B immune globulin (HBIG) and the hepatitis B vaccine series prevents this tragic outcome.
Identification of the hepatitis B virus (HBV) in pregnant women occurs through prenatal screening and reporting of positive HBsAg results from the laboratory and/or physician to the state or local health department. To prevent perinatal transmission of hepatitis B, health district case managers and staff follow HBsAg-positive pregnant women during gestation and track their infants through the post-vaccination serologic testing. Infants born to HBsA-positive women should be administered HBIG and hepatitis B vaccine at birth, followed by hepatitis B vaccine at 1-2 months and 6 months of age. Vaccination of sexual and household contacts of HBsAg positive pregnant women also prevents transmission to susceptible individuals who are at high risk for the disease.
The Perinatal Hepatitis B Prevention Program is funded through the CDC's National Center for Immunization and Respiratory Disease, Immunization Services Division, with technical support from CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Since 1991, every state has received federal funding to support the Perinatal Hepatitis B Prevention Program. Separate funding from the state has been allocated to each district to assist with case management.
These guidelines are to be used as a reference for the case management of HBsAgpositive pregnant women, their infants, and sexual/household contacts. Emphasis is placed upon infant prophylaxis and post-vaccination testing. The appendix contains several forms and tools that can be used during the case management process. Please adapt these materials to suit the needs of your Health District's perinatal hepatitis B prevention program.

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B. Program Goals The goals of the Georgia Perinatal Hepatitis B Prevention Program are to: Ensure that all pregnant women are screened for HBsAg at their initial prenatal screening panel. Assure that all local health departments perform case investigations on all positive HBsAg pregnant women reported to their jurisdiction. Confirm that infants born to HBsAg-positive women receive HBIG and the first dose of hepatitis B vaccine within twelve (12) hours of birth. Ensure that infants born to HBsAg positive women receive the second dose of vaccine at 1-2 months of age, and the third dose of vaccine at six (6) months of age. Ensure that infants born in Georgia to HBsAg-positive women are tested at nine (9) months to eighteen (18) months of age for HBsAg and hepatitis B surface antibody (Anti-HBs) after completing the hepatitis B vaccination series.

C. Georgia Perinatal Hepatitis B Program Eligibility Requirements Eligibility requirements for enrollment into Georgia's Perinatal Hepatitis B Prevention Program include: All pregnant women who test positive for HBsAg All infants born to HBsAg positive women All sexual and household contacts of HBsAg positive pregnant women
D. Universal Prenatal Screening for Hepatitis B The Advisory Committee on Immunization Practices (ACIP), The American College of Obstetrics and Gynecologists (ACOG), and The American Academy of Pediatrics (AAP) recommend that all pregnant women be routinely tested for HBsAg at an early prenatal visit in each pregnancy. The Georgia Perinatal Hepatitis B Prevention Program encourages all prenatal health providers to follow this recommendation. An additional test for HBsAg can be ordered later in the pregnancy (approximately 34 weeks gestation) if the mother is at high risk for acquiring HBV infection (e.g., more than one sex partner during the past six (6) months, intravenous drug use, household contact of a chronically HBV infected person). Pregnant women susceptible to hepatitis B virus can and should be vaccinated against the disease during pregnancy, especially if they are at high risk for infection (see CDC "Guidelines for Vaccinating Pregnant Women" at http://www.cdc.gov/nip/publications/preg_guide.htm). Chapter 2 in this manual also addresses the hepatitis B vaccine schedule and age appropriate dosage information. Appendix N, "Hepatitis B Facts: Testing and Vaccination," will provide a concise interpretation of the hepatitis B serology profile.

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E. General Management of HBsAg-Positive Pregnant Women The following guidelines are recommended by the Georgia Perinatal Hepatitis B Program and follow the recommendations of the Centers for Disease Control and Prevention (CDC) and the ACIP for managing an HBsAg positive pregnant woman.
1. The client's physician should draw a prenatal serology panel at the time pregnancy is confirmed. While there is no law in Georgia mandating prenatal HBsAg testing, it is considered a standard of care for prenatal screening panels to include HBsAg serology. One of the following two scenarios may occur after the laboratory performs the test:
a. If the HBsAg test is NEGATIVE, the laboratory will report the results to the physician. The physician files the results in the client's records and sends the information with the rest of her prenatal records to the hospital before delivery.
b. If the HBsAg test is POSITIVE, the laboratory notifies the physician AND the Epidemiology Section at the State Health Department of the results. The physician should inform the pregnant woman of her HBsAg positive status, file the results in the client's record, and send the information with the rest of her prenatal records to the hospital prior to delivery.
NOTE: All HBsAg positive test results for pregnant women must be reported to either the Local Health Department or the state, Division of Public Health, Acute Disease Epidemiology Section by the laboratory and health care provider within seven (7) days of receiving positive results. Reporting is required by authority of the Official Code of Georgia Section 31-12-2, Official Code of Georgia Section 31-22-7, Rules of the Department of Human Resources, chapter 290-5-3-02.
2. The Epidemiology section sends laboratory reports on all women between the ages of 10-50 that test positive for HBsAg to the Perinatal Hepatitis B Prevention Program.
3. The Perinatal Hepatitis B Prevention Program reviews the laboratory reports for females aged 10 to 50 years that are positive for HBsAg. The program then contacts the physician and inquires of pregnancy status, estimated date of confinement (EDC), and delivery hospital of each reported case.
4. All pregnant HBsAg women are then entered in state database and sent to the district perinatal hepatitis B prevention case manager for case management.
5. All PREGNANT clients are contacted by the Health District for counseling about their infection and interviewed for sexual and household contacts. The message is then reinforced that the client must also alert medical personnel attending her baby's birth that she is positive for HBsAg.

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NOTE: Communicating the woman's HBsAg status to the birthing hospital's department of labor and delivery should be the responsibility of her healthcare provider. It is strongly recommended that the Health District make efforts to remind the healthcare provider and the hospital of the woman's impending delivery at least four weeks before her EDC. An alert letter should be sent to the hospital's labor & delivery unit and/or provider. See Appendix G for a sample fax to use when notifying the hospital for this purpose.
6. The hepatitis B counseling interview should be performed in the client's own language. Each district has a Limited English Proficient/Sensory Impaired (LEP/SI) Program Coordinator. This coordinator can assist the district with the utilization of the language line. It is critical that she is aware of self-care and disease transmission in order to protect her own health and that of others. See the Example Interviewing/Counseling Format for assistance (Appendix M).
7. Any client who is chronically infected with hepatitis B should be encouraged to seek care with her physician so that her condition can be monitored routinely. Advise the client to discuss possible treatment options with her physician that may improve her health outcome and overall quality of life.
F. General Management of Infants Born to HBsAg Positive Women 1. Babies born to women who are HBsAg positive must receive HBIG and the appropriate dose of hepatitis B vaccine (see Section 2, "Recommended Schedule and Guidelines, Hepatitis B") within twelve (12) hours of birth.
NOTE: There is a window of seven (7) days to administer HBIG if an infant born to an HBsAg positive woman did not receive HBIG within twelve (12) hours of delivery. Every effort should be made to locate the infant and administer HBIG within seven (7) days, if the baby was released from the hospital before receiving this important prophylactic component.
2. The Health District should contact either the client or the delivery hospital close to the date of delivery to learn:
a. Infant's name, birth date and sex, and b. If the infant received HBIG and hepatitis B vaccine within twelve (12)
hours of birth. After obtaining this information, the Health District should update the Perinatal Case Management Form and send the information to the Perinatal Hepatitis B Prevention Program.
3. The Georgia Perinatal Hepatitis B Prevention Program will enter the infant's information the district obtained into the state database and remind the Health District when the second dose of hepatitis B vaccine is overdue.
4. The Health District will notify the mother that the baby should receive the second dose of vaccine, consult GRITS for verification that the vaccine was administered, update the Perinatal Case Management Form and send the information to the Perinatal Hepatitis B Prevention Program for tracking system entry.

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5. The Health District will notify the mother to take the baby for the third dose of vaccine, verify that vaccine was given, update the Perinatal Case Management Form and send the information to the Perinatal Hepatitis B Prevention Program for tracking system entry. The Perinatal Hepatitis B Prevention Program will notify the Health District when third dose of hepatitis B vaccine is overdue.
6. This serology should be obtained when the child is 9-18 months old. If the third dose is given late, the child must have received the third hepatitis vaccination a minimum of one month before obtaining the post vaccination test (PVT). When the tests results are known, the Health District will update the Perinatal Case Management Form, and send the information to the Perinatal Hepatitis B Prevention Program. The Perinatal Hepatitis B Prevention Program will notify the Health District when the PVT is due.
Note: The health district has the discretion to send the parent/guardian and baby to a local public health clinic for the (HBsAg and Anti-HBs) PVT, if testing is not affordable to the family. The local health department, Health District or private physician can send the blood sample to the Georgia Public Health Laboratory where specimen processing will be performed at no charge to the baby's parents or guardians.
7. If the test is NEGATIVE for HBsAg and POSITIVE for Anti-HBs, the baby is considered IMMUNE to hepatitis B and the perinatal case is closed.
8. If the test is NEGATIVE for BOTH HBsAg and Anti-HBS, the baby is considered SUSCEPTIBLE to hepatitis B infection, and must be immunized again with the complete 3-dose series of hepatitis B vaccine. The baby should be retested 1 month after the sixth dose of hepatitis B vaccine. In the rare instance the child tests negative for HBsAg and AntiHBs after completion of the second series, no additional hepatitis B vaccine is to be given. The mother should be counseled regarding her child's negative results and susceptible status. The perinatal hepatitis B case is closed for the infant after the initial PVT is completed.
9. If the test is POSITIVE for HBsAg and NEGATIVE for Anti-HBs, the baby is INFECTED and should be referred to the pediatrician for subsequent follow-up and specialist referrals. This infection is a notifiable disease that should be submitted to the State through State Electronic Notifiable Disease Surveillance System (SendSS), and will be reported to the CDC by the Epidemiology Section. The perinatal hepatitis B case is then considered closed.

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G. Management of Infants Born to Women with Unknown HBsAg Status 1. Infants born to women whose HBsAg status is unknown at the time of delivery should receive hepatitis B vaccine at the appropriate dosage per manufacturer (see Section 2, "Recommended Schedule and Guidelines, Hepatitis B") within twelve (12) hours of delivery. The woman should be tested in the hospital at the time of delivery and an expedited HBsAg test should be run to determine her status. If the mother's test is positive, the baby should receive HBIG as soon as possible, preferably before hospital discharge.
REMINDER: There is a window of seven (7) days to administer HBIG if an infant born to an HBsAg positive woman did not receive HBIG within twelve (12) hours of delivery. Every effort should be made to locate the infant and administer HBIG within this seven (7) days if the baby was released from the hospital without it.
2. The hospital laboratory and physician are required by law (see Note under Section E, 1-b) to report the positive HBsAg test within seven (7) days to the Georgia Division of Public Health, Acute Disease Epidemiology, Notifiable Diseases Section.
3. Upon receipt of the HBsAg positive serology report from the hospital, the Perinatal Hepatitis B Prevention Program will notify the Health District to obtain the baby's vaccination history. The Perinatal Hepatitis B Prevention Program will enter the infant into the tracking system and the baby will be followed as indicated in Section F, General Management of Infants Born to HBsAg Positive Women. If the mother is determined to be HBsAg negative, the baby should receive the hepatitis B vaccine according to the schedule recommended by the ACIP for infants born to HBsAg negative women, that is, first dose at birth, second dose at 1 to 2 months and third dose at 6 to18 months of age.
NOTE: When the mother is HBsAg-negative but is at high risk for hepatitis B infection, she should be vaccinated as soon as possible. Hepatitis B vaccine is not contraindicated during pregnancy.
H. Management of Sexual/Household Contacts to HBsAg Positive Pregnant Women 1. When Health Districts receive Perinatal Hepatitis B Prevention Program referrals of HBsAg-positive pregnant women, appropriate District personnel should make every effort to interview these women for household and sexual contacts. The contact interview should take place during the initial counseling session with the woman. It is imperative to identify younger contacts of the HBsAg-positive client due to the high risk for chronic infection in children aged five (5) years and younger. (See Section III, "Example Interviewing/Counseling Format", Appendix M, for further information.)

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2. Household and sexual contacts to HBsAg-positive women are at increased risk of infection; therefore, it is important to test contacts for HBsAg and Anti-HBs (See Appendix N, "Hepatitis B Facts: Testing and Vaccination"). Order these tests at the same visit when the contact receives the first dose of hepatitis B vaccine, but draw the blood for serology before administering vaccine. The test can be sent to the Georgia Public Health Laboratory using the Hepatitis B Request Form. (See Appendix H2 for specific form numbers.)
NOTE: Post-vaccination testing is NOT recommended for sexual or household contacts to HBsAg positive pregnant women.
3. Sexual and household contacts should be vaccinated during their first visit to a medical provider with the age-appropriate dose of hepatitis B vaccine. Vaccine must be given according to the ACIP recommended schedule. See Section 2, "Recommended Schedule and Guidelines, Hepatitis B" of this manual for information on the hepatitis B vaccine dosage and scheduling for infants, children and adults.
4. HBIG can be given to sexual contacts of HBsAg-positive pregnant women who are determined to be acutely infected (e.g., HBsAg infection under six (6) months duration with or without symptoms of hepatitis and /or positive Anti-HBc IgM) as long as the last sexual exposure occurred within fourteen (14) days of administration. Administer HBIG and vaccine during the same visit, in two different body sites. HBIG can also be given to those household contacts that have not had sexual exposure, but have had known blood exposure with an acute case of hepatitis B within the past seven (7) days.
5. To calculate HBIG dosage for children one (1) year of age through adulthood use 0.06 mL per kilogram of body weight or 0.06 mL per 2.2 pounds of body weight. For example, for an adult weighing 140 pounds, the weight would be divided by 2.2 to obtain the equivalent in kilograms, then multiplied by 0.06 to obtain the HBIG dosage. Example: 140 lbs. 2.2 = 63.636 kg, rounded up to 64 kg 64 kg x 0.06 mL = 3.84 mL of HBIG
6. If it is determined that the contact is infected (HBsAg positive) or has immunity (HBsAg negative and Anti-HBs positive) to infection, no further doses of vaccine are to be given. If the contact is susceptible to infection, that is, HBsAg negative, Anti-HBs and Anti-HBc negative, then complete the vaccine series. (See Appendix N for hepatitis B serology interpretations.)
7. Each susceptible contact must be followed and reminded to complete the hepatitis B vaccine series at the appropriate intervals (See Section 2, "Recommended Schedule and Guidelines, Hepatitis B"). The Health District is responsible for tracking perinatal hepatitis B sexual and household contacts. The back of the Perinatal Case Management Form can be used for documenting contact serology and vaccine history. (See Appendix B)

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8. Contacts that are infected with hepatitis B should be counseled about the disease and its transmission. The "Example Interviewing/Counseling Format" is a useful guide for this situation. (See Appendix M)

9. Update the Perinatal Case Management Form with sexual and household contact information after each contact receives testing or vaccination. Send copies of the updated forms to the Perinatal Hepatitis B Prevention Program once the hepatitis B series is completed for each contact. Post-vaccination testing of contacts is not recommended.

I. Finding Clients that are lost to follow-up
Call telephone information 411 to see if you can locate the lost contact. Use Internet search engines (Google), white pages, and United States Postal
Service online (USPS.com) to search for contact information.
Try old telephone numbers. Relatives/friends with information on the patient
might still be reached at those numbers.
Look in directories that list occupants of each household in the city. Most
sexually transmitted disease (STD) programs have such directories.
Transpose digits in telephone numbers and addresses. Try "street" instead of "Avenue" and vise versa. Ask neighbors. Ask mail carriers; they cannot give you addresses, by law, but might confirm
whether or not the patient lives at the address.
Ask the post office for the forwarding address. You may have to complete a
justification form provided by the postal service and show your health department identification. The STD case manager may have local procedures.
Search health department records. Ask other state and local agencies and programs (e.g. Medicaid, WIC
programs, Department of Family and Child Services, parole and probation offices) for contact information.

J. Required Reports and Case Updates for Perinatal Hepatitis B Prevention in Georgia Each month, the Perinatal Hepatitis B Prevention Program will request information about any cases that are due for activity during that month, such as vaccination, blood tests, or deliveries. The Health District will be requested to update the Perinatal Hepatitis B Prevention Program with any new information by the requested due date.

Prompt return of the requested information allows for efficient maintenance of the tracking system and thus timely disease prevention. The updates will be used to complete state and federal annual reports including the Perinatal Hepatitis B Prevention Report requested biannually from the CDC. If the requested information is not received by the due date, a copy of the form will be sent to the District Clinical Coordinator and District Health Director for assistance in returning the requested information to the Perinatal Hepatitis B Prevention Program.

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K. Glossary of Terms

EDC Viral Hepatitis HBV HBsAg
HBeAg
Anti-HBs
Anti-HBc IgM Anti-HBc HBsAg Chronic Carriage
HBIG

Estimated date of confinement or the approximate day that a woman's baby is expected to be born (aka: due date).
Inflammation of the liver as a result of viral infection.
Hepatitis B virus, the agent that causes hepatitis B virus infection.
Hepatitis B surface antigen found on the surface of the hepatitis B virus. HBsAg is detected in serum thirty (30) to sixty (60) days after HBV exposure and persists for variable periods.
The core of the virus contains hepatitis B e antigen, which is associated with HBV replication, high concentrations of HBV serum, and high infectivity of serum.
Antibody to HBsAg is associated with long-term protection against reinfection and, in most persons, persists for many years after natural infection. Anti-HBs is also produced as an immune response to hepatitis B vaccine or is passively transferred when HBIG is administered. Anti-HBs is currently measured by radioimmunoassay (RIA) or enzyme-linked immunosorbent assay (ELISA).
Antibody to HBcAg is produced in all HBV infections; it indicates infection as some undefined time and persists indefinitely.
IgM class antibody to HBcAg indicates recent infection with HBV and is positive for approximately six (6) months after infection.
Through serologic testing, a person is confirmed as an HBsAg carrier when: 1) HBsAg is detected on at least two tests, spaced a minimum of six (6) months apart; or 2) the results of a single serum specimen are HBsAg positive and IgM anti-HBc negative. Carriers may be asymptomatic and unaware that they are infected with HBV. Because they carry HBsAg in their blood, they are capable of infecting others.
Hepatitis B immune globulin is a preparation obtained from the blood plasma from donor pools selected for a high antibody content of anti-HBs. In some situations, HBIG is administered with hepatitis B vaccine to provide additional protection against HBV infection.

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References
Centers for Disease Control and Prevention. Hepatitis B Virus: A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States, Recommendations of the Advisory Committee on Immunization Practices (ACIP), Part 1: Immunization of Infants, Children, and Adolescents. MMWR, December 23, 2005, Vol. 54, No. RR-16, 1-32.
Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine Preventable Diseases, CDC, 10th Edition, (2007) Washington, D.C.: Public Health Foundation.
United States Department of Health and Human Services, Healthy People 2010-Conference Edition, Immunization and Infectious Diseases, November 30, 1999.
Centers for Disease Control and Prevention. Managing a Hepatitis B Prevention Program: A Guide to Life as a Program Coordinator, [manual], April, 2007.

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Appendix
A---Flow Chart for Perinatal Hepatitis B Prevention Case Management B---Perinatal Hepatitis B Prevention Case Management Referral Form C---Patient Notification Letters
C-1-----Sample Letter for Pregnant Women Testing Positive for HBsAg C-2-----Sample Letter for Foster Parents of Infants Born to HBsAg (+) Women D---Patient Test Notification Letter: Provider tool E---Hepatitis B Alert for Infant: Provider tool F---HIPAA Form for Perinatal Hepatitis B Prevention Program G---Hepatitis B Alert for HBsAg Positive Pregnant Woman: Provider tool H---Georgia Public Health Laboratory Service Manual Excerpt I---Questions Frequently Asked About Hepatitis B J---Guidelines for Standing Orders in Labor & Delivery and Nursery Units to Prevent Hepatitis B Virus Transmission to Newborns (4/08) K--- Child with Chronic Hepatitis B: Provider tool (7/08) L---If You Have Chronic Hepatitis B Virus (HBV) Infection (8/05) M---Example Hepatitis B Interviewing/Counseling Format N-- Hepatitis B Facts: Testing and Vaccination (3/08)

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FLOW CHART FOR FOLLOWING BABIES BORN TO HBsAg-POSITIVE FEMALES Appendix A
Georgia Perinatal Hepatitis B Prevention Program

Perinatal Hepatitis B Prevention Program (PHBPP) initiates Case Management Form on HBsAg-positive PREGNANT women aged 10 through 50
years.

Case Management Form is sent to appropriate Health District. If EDC or birth hospital is not documented on
the Case Management Form, Health District should obtain EDC and birth hospital from either the client or her physician, and forward the information back to the PHBPP.

Health District contacts HBsAg-positive pregnant woman about HBsAg test results and its impact on her, her baby, and any
household/sexual contacts.

Contact investigation is conducted for household and sexual contacts.

NOTE: Reinforce message with client to make delivery hospital medical personnel are aware of her positive HBsAg results by
providing her with education and written materials.

Health District will notify: 1. Mother to take baby for
second dose of hepatitis B vaccine; and 2. PHBPP of date of second dose for tracking system entry. 3. PHBPP will remind Health District when second dose is overdue.
Remember to send the test date information & results to the PHBPP!
6/23/09

Health District notifies PHBPP of infant's HBIG & first dose for entry into tracking system.

Health District contacts delivery hospital shortly after client's EDC date to verify: 1. The baby's birth.
2. The administration of HBIG and hepatitis B vaccine within 12 hours of delivery.

Health District will notify: 1. Mother that baby should receive third dose of hepatitis B vaccine;
and
2. PHBPP of date of third dose for tracking system entry. 3. PHBPP will remind Health Department when third dose is overdue.

If baby is NEGATIVE for HBsAg & POSITIVE for Anti-HBs, then the baby is IMMUNE and perinatal case is closed.
If baby is NEGATIVE for HBsAg and Anti-HBs, a 2nd series of hepatitis B vaccine and follow-up testing is recommended.

NOTE: There is a window of 7 days after birth to administer HBIG if the infant did not receive it within 12 hours of delivery.
Health District will: 1. Remind mother to take baby in to the health department or pediatric provider at 9-18 months for post vaccination testing (PVT) 2. PHBPP will notify Health District when PVT is overdue.

If baby is POSITIVE for HBsAg and NEGATIVE for Anti-HBs, then the baby is infected and will be reported to the CDC.

NOTE: Baby should be tested for HBsAg and Anti-HBs.

Health District

County Code

HBsAg POSITIVE CLIENT'S NAME

PERINATAL HEPATITIS B PREVENTION

Case Management Referral Form

Date of Birth

Revised August 2000
Sex

Race

Ethnicity

Pregnant?

Return Updates & Completed Forms to:

Georgia Immunization Program Two Peachtree NE, 13th Floor
Atlanta, Georgia 30303 404-657-3158 Fax: 404-657-1463

EDC

Referral Date

ADDRESS

Client's Telephone No.

Name of Client's Physician's Name & Telephone Delivery Hospital

Hospital Address

Hospital Telephone

HBsAg Date

Repeat HBsAg

Result

Date

Results

Chronically Infected?

/ /

Other Hepatitis Test(s) Performed

Test Type

Test Date / / / /
/ /

Results

HBsAg Positive Client Disposition Client had miscarriage or termination
Client HBsAg Negative at delivery Client moved from jurisdiction to (list location below) : Client never Located or Lost to Follow-up Other (explain):

INFANT INFORMATION

Name

Date of Birth

Select All that Apply: Infant never located/lost to follow-up
Caretaker non-compliant Infant diagnosed with hepatitis B Infant moved from jurisdiction to:
Infant died Other (explain):

Baby's Birth Weight
Post-vaccination Testing done?
Post-vaccination Testing done?

Sex
Date / / Date / /

INFANT INFORMATION

HBIG Date

HB Vaccine Dose #1

Given Within 12 hours?

HB Vaccine Dose #2 HB Vaccine Dose #3

/ /

/ /

/ /

/ /

HBsAg Results Anti-HBs Results

HB Vaccine Dose #4 HB Vaccine Dose #5 HB Vaccine Dose #6

HBsAg Results Anti-HBs Results

/ /

/ / Form Completed By:

/ /

Comments:

Appendix B 1

Relationship To HBsAg Positive
Client *

Contact Demographic Information

PERINATAL HEPATITIS B PREVENTION
Case Management Referral Form Household/Sexual Contact Follow-Up
Contact HBsAg Testing Information

Contact Vaccination Information

Contact Name

Anti-HBs

HBIG Date

Date of Birth Sex Race Ethnicity

Date

HBsAg Results Results Anti-HBc Results (if needed)

HB Vaccine Dose #1 HB Vaccine Dose #2 HB Vaccine Dose #3

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

/ /

* Please indicate the relationship of the client to the HBsAg Positive Pregnant Woman (i.e., son, daughter,spouse, sexual partner, etc.)

Appendix B 2

Comments:

Appendix C-1
Sample Letter for Pregnant Women Testing Positive for HBsAg (Insert your health department letterhead here.)

Date:

______________________

Name:

_________________________________________________

Address: _________________________________________________

City/State/Zip_________________________________________________

Dear ___________________________:
During your pregnancy you tested positive for the hepatitis B virus. Hepatitis B can be a serious disease. Not only does this virus affect your liver, but also it can be passed to your baby at the time of birth. To be protected from this disease, your baby will need to get several shots. The first two (2) shots are given within a few hours after birth. They are hepatitis B immune globulin (HBIG) and dose 1 of hepatitis B vaccine.
Your baby will later need dose 2 of hepatitis B vaccine at one month of age and dose 3 at six months of age. After completing these shots, your baby's doctor will do some blood tests to see if your baby is protected. The blood test should be done when the baby is between 9 and 18 months of age. In some cases, the baby may need more shots to prevent infection.
After the blood work is done and if your baby needs no further hepatitis B shots, we will close your case until your next pregnancy.
It is possible that your sexual partner and other people living in your household could get infected. We recommend that they be tested and vaccinated for hepatitis B also, if they haven't been already. It is important that you discuss with your doctor whether you need further follow up for your infection. Your doctor may refer you to a gastroenterologist (GI doctor) who specializes in liver diseases.
We encourage you to show this letter to your doctor and later to your baby's doctor. If you have any questions, please call me.
Sincerely,

Telephone no. ________________________________

Appendix C-2
INSERT YOUR HEALTH DEPARTMENT LETTERHEAD HERE
Sample Letter for Foster Parents of Infants born to HBsAg (+) Women
Date
Name Address City/State/Zip
Dear ___________________________:
Thank you for making the decision to care for BABY FIRST/LAST NAME (DOB) in your home. As the foster parent(s), it is important that you know BABY FIRST NAME may have been exposed to the hepatitis B virus during childbirth. Hepatitis B is a serious disease that affects the liver. To be protected from the disease, your baby will need to get several shots. The first two (2) shots should have been given within a few hours after birth. They are hepatitis B immune globulin (HBIG) and dose 1 of hepatitis B vaccine.
Your baby will later need dose 2 of hepatitis B vaccine at one month of age and dose 3 at six months of age. After completing these shots, the baby's doctor will do some blood tests to see if the baby is protected. The two tests that are needed are called HBsAg and anti-HBs. The blood test should be done when the baby is between 9 and 18 months of age. When the test results are back, please ask the doctor to call our office to report them to us. In some cases, the baby may need more shots to prevent infection.
After the blood work is done and if your baby needs no additional hepatitis B shots, we will no longer continue tracking the baby.
We encourage you to show this letter to the baby's doctor. If you have any questions or concerns, please feel free to call me at XXX-XXX-XXXX.
Sincerely,
Your Name Job Title

Patient notification letter regarding hepatitis B test results

Dear ___________________________________ , Date of birth:_______________Today's date:____________
Your hepatitis B test results are recorded here and the explanation checked below.
Date of testing: ___________ HBsAg: ______ anti-HBs: _____ anti-HBc: _____ IgM anti-HBc: _____
[ ] Susceptible: (HBsAg, anti-HBs, and anti-HBc are negative) Your test results show that you have never been infected with the hepatitis B virus. This means that you could develop hepatitis B virus infection in the future. You should receive the three doses of hepatitis B vaccine to protect yourself from this disease. After the 1st dose, the 2nd dose is usually given one month later and the 3rd dose is usually given five months after that. Please call the clinic to make an appointment to start your hepatitis B vaccination series.
[ ] Immune due to past infection: (HBsAg is negative; anti-HBs and anti-HBc are positive) Your results show that you had hepatitis B virus infection in the past but that the disease is gone and you will not get the disease again. You do not need the shots to protect you. You are already protected.
[ ] Immune due to vaccination: (HBsAg and anti-HBc are negative; anti-HBs is positive) Your results indicate that you are protected from hepatitis B virus infection because you most likely received the hepatitis B vaccine. You are immune or safe from hepatitis B.
[ ] Acutely infected with hepatitis B: (HBsAg, anti-HBc, and IgM anti-HBc are positive; anti-HBs is negative) Your results show that you have recently developed hepatitis B virus infection and that you are infectious. Please contact the clinic to discuss what further evaluation needs to be done.
[ ] Resolving hepatitis B virus infection: (HBsAg is negative; anti-HBc and IgM anti-HBc are positive; anti-HBs is negative) Your results show that you were recently infected with hepatitis B virus, but that your infection is resolving. You are no longer infectious to others.
[ ] Chronically infected with hepatitis B virus: (HBsAg and anti-HBc are positive; IgM anti-HBc and anti-HBs are negative) Your test results show that you are infected with the hepatitis B virus. It is important for you to come into the clinic soon for further evaluation and to receive additional information about hepatitis B. It is also important for you to learn how to take care of yourself and how to protect others from this infection. Hepatitis B can cause serious liver damage in some people, even if they feel fine. Call us now to make an appointment for further evaluation and education about hepatitis B.
[ ] Indeterminate results: (only anti-HBc is positive) Your test results suggest that you may have been in contact with the hepatitis B virus at some time in the past. You may not be protected from this disease. Please make an appointment to come to discuss the meaning of your hepatitis B tests and what plan of action needs to be taken.
Please call the clinic if you have questions about this information or to schedule the appointment(s) indicated above.
Sincerely,

____________________________________ ____________________________________

Clinician's signature

Clinician's name (print or type)

Item #P4140 (4/02)

Created by the Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

HEPATITIS B ALERT

Appendix E

PLEASE FILE IN THIS HIGH-RISK INFANT'S CHART
Confidentiality Notice: This information is confidential and intended only for the person(s) to whom the information was sent. If you are not the named recipient(s) of this information your are strictly prohibited from reading, copying or distributing this information. If you have received this information in error, please notify the sender by telephone immediately and return it to the senders address shown below.
DATE:
TO:

FROM:

OFFICE: ( )

FAX: ( )

REGARDING: INFANT OF HEPATITIS B INFECTED MOTHER

INFANT'S NAME: MOTHER'S NAME: OB PROVIDER:

DOB: ________________ DELIVERY HOSPITAL: ____________
TELEPHONE #: ________________

PLEASE ENSURE THAT THIS HIGH-RISK INFANT RECEIVES:
Hepatitis B vaccine (Engerix-B, 10mcg or Recombivax-HB, 5 mcg) 0.5cc, IM within 12 hours of birth Dose #2 at 1-2 months of age Dose #3 at 6 months of age Serology (HBsAg and anti-HBs) at 3-12 months after dose #3.

REFERENCE: 2006 RED BOOK, AAP, p. 351-352 & MMWR 12/23/05/Vol. 54/No. RR-16 pg.14

Please provide me with information about the immunoprophylaxis this infant received.

HBIG

/ / Time Given_______ ml dose given

Manufacturer

HEP B-1

/ / Time Given_______ mcg dose given

Merck

GSK

HEP B-2

/ /

mcg dose given

Merck

GSK

HEP B-3

/ /

mcg dose given

Merck

GSK

Please provide post vaccination serology test results and check box indicating POSITIVE or NEGATIVE

TEST

DATE OF RESULTS

POSITIVE

NEGATIVE

HBsAg
ANTIHBs

/ /___ / / ___

Appendix F 1

Appendix F 2

Appendix F 3

Appendix F 4

Appendix G

To
From: Phone:

HEPATITIS B ALERT
(Hospital Name) (Labor & Delivery Staff) (Mother/Baby Unit Staff) (Infection Control Staff)
Fax:

PLEASE PLACE THIS IMPORTANT INFORMATION INTO THE

FOLLOWING PATIENT'S PRENATAL FILE THANK YOU!

Patient's Name:

Birth Date:

EDC:

Obstetrician:

HBsAg Date:

HBsAg Results:

Please ensure that this mother's baby receives the following vaccines within 12 hours of birth:
1) Hepatitis B Immune Globulin (HBIG), 0.5 ml IM
AND
2) Hepatitis B Vaccine
Engerix B Pediatric Formulation (Glaxo SmithKline) Dosage: 10 mcg (0.5ml)
OR
Recombivax-HB Pediatric/Adolescent Formulation (Merck) Dosage: 5mcg (0.5ml)

Please notify the outpatient pediatric provider of this infant's high-risk status THANK YOU!
REFERENCE: 2006 RED BOOK, AAP, PAGE 347

Immunization Program Manual

Appendix H 1
GA Immunization Program

[Excerpt from the Georgia Division of Public Health Laboratory Services Manual, pages IV-57 through IV-64]
MICROBIAL IMMUNOLOGY UNIT INFECTIOUS DISEASE SEROLOGY
404-327-7970
INTRODUCTION The Microbial Immunology Unit performs many infectious disease serology. Serology for HIV (Human Immunodeficiency Virus), is performed in the Virology Unit. Various serologic procedures are performed for a variety of bacterial, parasitic, and viral agents. Hepatitis B serology is performed for county health departments, and Georgia Department of Human Resources (GDHR) agencies, only. Tests not performed in the Public Health Laboratory are forwarded to CDC, if they provide the requested testing.
SPECIMEN COLLECTION/LABELING/REQUISITION FORM
Collection: Using Universal Precautions, and standard venipuncture technique, collect approximately six milliliters of whole blood (for serum) in a red top tube (no additive), labeled with patient's identifier (name, first and last, or number), date, and name of the submitter. Use a marker that will not fade, smear, or run during transportation. Use proper size needle (large enough to prevent hemolysis of the red blood cells) for the vein location and age of the patient. Allow blood specimen to clot, at least 30 minutes undisturbed, at room temperature, and transport, or place in the refrigerator for transporting. Collect blood specimens in, or transfer them to non-breakable, leak resistant tubes. Specimens should be transported as soon as possible, do not hold over 7 days. Specimens over 14 days old are unacceptable. Many of the procedures we perform are not approved for use with plasma. Therefore, please submit only serum or whole blood without anticoagulants, not plasma.
Collect cerebrospinal fluids (CSF) according to proper hospital procedure. CSF contaminated with blood or grossly contaminated with bacteria is unacceptable.
Labeling: All specimens must be labeled with patient identification (name or number), in acceptable testing condition, and accompanied by a completed requisition form. If the form is not specific for one test or a set of tests, the specific testing requested must be hand-written in the proper area, e.g., "viral serology" is not acceptable, the specific agent, e.g., "CMV", must be clearly requested. Failure to provide proper patient information may result in testing delays.
Requisition Form: Use Form #3432 for all tests performed by the Microbial Immunology Unit. There is a single requisition form for all serological tests performed, including the RPR and EIA tests for syphilis, Premarital serology (including rubella on females), Hepatitis B (GDHR facilities and county health departments only), and Other Serology. Completely fill out the form and include the following information:
1. Unique patient identifier (name or number). 2. TEST(S) REQUESTED (Please check only the corresponding
box for test(s) requested). 3. Date specimen collected. 4. Submitter's name, address, and code number, where applicable. 5. For hepatitis the reason for testing, e.g., routine, or prenatal.

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Immunization Program Manual

Appendix H 2
GA Immunization Program

6. Any information the submitter needs for patient identification, e.g., chart number, address.
7. The date of onset of illness, if applicable. 8. Race, sex, and age, where applicable, e.g., hepatitis testing.
SHIPMENT OF SPECIMENS
Use outfit #0500, available from Laboratory Services and Supply, 404-327-7920, and follow the specific instructions below. Specimens may be mailed or delivered to the laboratory by courier.
Shipping Instructions for USPS and Couriers: Place the tubes of blood in protective, leak resistant, double-walled containers, e.g., aluminum and cardboard box, for transport. Wrap the requisition form around the inner (aluminum) can, secure with a rubber band and place in the outer container. If a screw-cap outer container is used, the screw-cap must be secured with tape or the Postal Service will return it for taping. Up to 50 milliliters of blood may be transported in one package (U.S. postal regulations). Therefore, an individual tube of blood may be placed in the metal can, with the requisition form secured to the outside by a rubber band, and several aluminum cans placed in one cardboard box for transporting.
Shipping Instructions for Courier Services Only: Tubes of blood may be placed in leak proof biohazard bags. Wrap brown absorbent material around the tube, then secure with a rubber band. Place the requisition form in the sleeve located on the outside of the bag.
REPORTING AND INTERPRETATION OF RESULTS
Table 1 (pages 3-5) summarizes the interpretation of results for all serological tests performed in the Microbial Immunology Unit. Table 2 (page 6) gives the turnaround times for all of the same serological tests. Turn-around-time after the receipt of the specimen depends on the testing methodology and the frequency of testing. The frequency of testing depends on the demand for a specific test. Several tests are performed daily, while others are performed weekly. The turnaround time for specimens referred to CDC depends on CDC's schedule, which varies from laboratory to laboratory.
UNACCEPTABLE SPECIMENS
1. Spinal fluid obviously contaminated with bacteria or blood; 2. All specimens:
a) Not approved for testing by the indicated method, e.g., plasma for RPR. b) Grossly hemolyzed, lipemic, turbid, or contaminated. c) Over 14 days old. d) Broken in transit. e) Insufficient quantity for testing. f) No identification on specimen. g) Name on tube and form does not match.
The submitter will be notified of all rejected specimens. Most serologic services are available to both the public and private sectors. However, hepatitis B testing is limited to the public health care providers, and not available to the private providers.

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Immunization Program Manual

Appendix H 3
GA Immunization Program

Agent

California

IgG 1

Encephalitis IgM1

Cytome-

galovirus

IgG

(CMV)

IgM

Table 1. Testing Results
Test Result Interpretation1

Method

Negative

Positive2

Diagnostic

IFA1

IgG <1:16 IgG >1:16 Four-fold rise in titer

IgM <1:16 IgM > 1:16 between paired sera4

EIA1

No IgG Detected No IgM Detected

IgG Detected IgM Detected

IgM detected and/or
significant rise in
titer between paired sera4,5

Presumptive3 > 1:16
IgM Equivocal

Eastern

IgG

Equine

IgM

Encephalitis

Epstein-Barr Virus (EBV)

VCA1 IgG
VCA IgM

EBNA1 IgG

IFA EIA

HBs 1

Hbe1

Hepatitis B

EIA

Virus (HBV)6 Anti-HBs

1

AntiHBc1

Herpes

Type 1

Simplex

EIA

Virus (HSV)

Type 2

IgG <1:16 IgM <1:16

IgG >1:16 Four-fold rise in titer IgM > 1:16 between paired sera 4

> 1:16

No IgM Detected No IgM Detected No IgG Detected
Negative
Negative
Negative Negative

IgG Detected IgM Detected IgG Detected
Positive
Positive
Positive Positive

Current Infection: Positive VCA IgG and IgM, and EBNA IgG Negative
Recurrent Infection: Positive VCA IgG, IgM and EBNA IgG

Positive VCA IgM Only

Positive HBs

None

No IgG Detected

IgG Detected

Significant difference between paired sera 4 5

None

Lymphogranuloma

IFA

Venereum (LGV)

<1:10

> 1:10

Four-fold rise in titer between paired sera 4

> 1:10

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Immunization Program Manual

Appendix H 4
GA Immunization Program

Agent Mumps
Murine typhus
Mycoplasma Pneumonia IgG
Parvo-Virus

Method EIA IFA EIA
EIA

Q-Fever

IFA

Rocky Mountain Spotted Fever (RMSF)

IFA

IgG

EIA

Rubeola

(Measles

IgM

Rubella (German Measles)

IgG
IgM EIA
Premarital

St. Louis

IgG

Encephalitis IgM

Syphilis

RPR1

IFA Agg 1

Confirmatory EIA

EIA

FTA

IFA

Test Result Interpretation1

Negative

Positive2

No IgG Detected

IgG Detected

<1:16

> 1:16

No IgG Detected No IgG Detected
No IgM Detected
Phase I <1:16
Phase II <1:16
< 1:16

IgG Detected IgG Detected
IgM Detected
Phase I >1:16
Phase II >1:16
1:16

No IgG Detected
No IgM Detected
No IgG Detected
No IgM Detected
NonImmune

IgG Detected
IgM Detected
IgG Detected
IgM Detected
Immune

Diagnostic Significant difference between paired sera 4,5 Four-fold rise in titer between paired sera 4 Significant difference between paired sera 4,5 IgM detected and/or significant increase between paired sera 4,5
Four-fold rise in titer between paired sera 4
Four-fold rise in titer between paired sera 4 IgM detected and/or significant increase between paired sera 4,5
IgM detected and/or significant increase between paired sera 4,5
Not Applicable

Presumptive3 None > 1:128 None None
Phase I > 1:128 Phase II > 1:128 > 1:128 IgM Equivocal
Not Applicable
Not Applicable

IgG <1:16 IgM <1:16

IgG >1:16 IgM > 1:16

Four-fold rise in titer between paired sera 4

> 1:16

NonReactive
NonReactive

Reactive > 1:1
Reactive

RPR and EIA Reactive

Reactive RPR and Equivocal EIA

NonReactive

Reactive

RPR, EIA, FTA

Equivocal EIA

Hepatitis - 10/2006

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Immunization Program Manual

Agent Syphilis
Toxoplasmosis

VDRL (CSF1) IgG
IgM

Method Agg1
EIA

EIA Varicella Zoster

West Nile

IgG

EIA

Virus

IgM

Western

IgG

IFA

Equine

IgM

Encephalitis

Appendix H 5
GA Immunization Program

Test Result Interpretation1

Negative Nonreactive

Positive2 Reactive

Diagnostic VDRL Reactive

Presumptive3 Reactive VDRL

No IgG Detected
No IgM Detected
No IgG Detected
No IgG Detected No IgM Detected
IgG <1:16 IgM <1:16

IgG Detected
IgM Detected

IgM detected and/or significant increase between paired sera 4,5

IgG Detected
IgG Detected IgM Detected
IgG >1:16 IgM > 1:16

Significant increase between paired sera 4,5 IgM detected and/or significant increase between paired sera 4,5
Four-fold rise in titer between paired sera 4

IgM Equivocal
None
IgM Equivocal
> 1:16

Agg. CSF EBV VCA EBV EBNA EIA FTA HBs Hbe

Abbreviations (in alphabetical order)1

Agglutination Cerebrospinal Fluid Epstein-Barr Virus capsid antigen Epstein-Barr nuclear antigen Enzyme Immunoassay Fluorescent treponemal antibody Hepatitis B surface antigen Hepatitis B E antigen

Anti-HBs Anti-HBc IFA IgG IgM RPR VDRL

Hepatitis B surface antibody Hepatitis B core antibody Indirect Fluorescent Antibody Immunoglobulin G Immunoglobulin M Rapid Plasma Reagin Venereal Disease Research Laboratory

2 A positive result indicates natural or acquired immunity, especially for vaccine-preventable diseases

3 Presumptive results identify a significant result for a single (not paired) serum, and need confirmation by clinical symptoms, recollection of specimen for retesting, or if applicable, submission of a convalescent specimen.

4 Paired sera (acute and convalescent) dates of collection and date of onset of illness are needed for proper interpretation of results.

5 A significant difference is determined by instructions given in individual enzymeimmunoassay procedures, and may differ between manufacturers.

6 Performed for county health departments and DHR facilities only.

FOR ADDITIONAL INFORMATION REGARDING TEST INTERPRETATION CALL THE MICROBIAL IMMUNOLOGY LABORATORY AT (404) 327-7970

Hepatitis - 10/2006

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Immunization Program Manual
Table 2. Turnaround Times

Appendix H 6
GA Immunization Program

Agent
California Encephalitis IgG2/IgM2
Cytomegalovirus IgG/ IgM Eastern Equine Encephalitis IgG/ IgM Epstein-Barr virus
VCA2 IgG/IgM EBNA2 IgG
Hepatitis A Hepatitis B Diagnosis
Surface antigen Total antibody core antibody e-antigen (performed on surface antigen- positive
specimens only) Herpes simplex 1&2 Lymphogranuloma Venereum Mumps Murine typhus Mycoplasma Parvovirus IgG/ IgM Q Fever IgG Rocky Mountain Spotted Fever Rubella
Immune Status (EIA)2
IgG/ IgM Rubeola IgG/ IgM St. Louis Encephalitis IgG/ IgM Syphilis
RPR2 Non-Reactive RPR Reactive Confirmatory Non-Reactive Confirmatory Reactive FTA2 Non-Reactive FTA Reactive Toxoplasmosis IgG /IgM West Nile Virus IgG/ IgM Western Equine Encephalitis IgG/ IgM Varicella zoster VDRL2 (CSF2only)

Turnaround Time (Working Days) 1
10-12 days
5-7 days 10-12 days
5-7 days 5-7 days 10-12 days
3 days 3 days 3 days 7 days
5-7 days 10-12 days 5-7 days 5-7 days 5-7 days 7-10 days 5-7 days 5-7 days
1-3 days 5-7 days 5-7 days 10-12 days
1-2 days 2-3 days 2-3 days 2-3 days 5-7 days 5-7 days 5-7 days 10-12 days 10-12 days 5-7 days 5-7 days

1 Special arrangements may be made in the case of an emergency. 2 Abbreviations: IgG, Immunoglobulin; G; IgM, Immunoglobulin M; VCA, Epstein-Barr viral capsid antigen; EBNA, Epstein-Barr nuclear antigen; EIA, Enzyme Immunoassay; RPR, Rapid Plasma Reagin; FTA, Fluorescent treponemal antibody; VDRL, Venereal Disease Research Laboratory; CSF, Cerebrospinal Fluid.

Hepatitis - 10/2006

6

1573 Selby Avenue, Suite 234 St. Paul, MN 55104
(651) 647-9009 Fax (651) 647-9131 www.immunize.org www.vaccineinformation.org
QUESTIONS FREQUENTLY ASKED ABOUT HEPATITIS B

What is hepatitis B? Hepatitis B is a serious public health problem that affects people of all ages in the United States and around the world. In 2001, an estimated 78,000 people contracted hepatitis B virus (HBV) infection in the United States. Hepatitis B is caused by a highly infectious virus that attacks the liver and can lead to severe illness, liver damage, and in some cases, death.
The best way to be protected from hepatitis B is to be vaccinated with hepatitis B vaccine, a vaccine used in the U.S. for more than two decades and proven safe and effective.
Who is at risk for HBV infection? About 5% of people in the U.S. will get infected with HBV sometime during their lives. If you engage in certain behaviors, your risk may be much higher. You may be at risk if you: have a job that exposes you to human
blood
share a household with someone who has lifelong HBV infection
inject drugs
have sex with a person infected with HBV
have sex with more than one partner during a six-month period
received blood transfusions in the past before excellent blood testing was available (1975)
are a person whose parents were born in Asia, Africa, the Amazon Basin in South America, the Pacific Islands, Eastern Europe, or the Middle East
were born in an area listed above
were adopted from an area listed above
are an Alaska native

have hemophilia
are a patient or worker in an institution for the developmentally disabled
are an inmate of a long-term correctional facility
travel internationally to areas with a high prevalence of hepatitis B
The largest outbreak of hepatitis B in the U.S. occurred in 1942 in military personnel who were given vaccine to protect them from yellow fever. It was unknown at the time that this vaccine contained a human blood component that was contaminated with HBV. The outbreak caused 28,585 cases of hepatitis B with jaundice.
How is HBV spread? HBV is found in blood and certain body fluids--such as serum, semen, and vaginal secretions--of people infected with HBV. HBV is not found in sweat, tears, urine, or respiratory secretions. Contact with even small amounts of infected blood can cause infection.
Hepatitis B virus can be spread by:
unprotected sex
injecting drug use
an infected mother to her child during birth
contact with the blood or open sores of an infected person
human bites
sharing a household with a chronically infected person
sharing items such as razors, toothbrushes, or washcloths
pre-chewing food for babies or sharing chewing gum
using unsterilized needles in ear or body piercing, tattooing, or acupuncture

using the same immunization needle on more than one person
Hepatitis B virus IS NOT spread by:
casual contact like holding hands eating food prepared by an infected
person kissing or hugging sharing silverware, plates, or cups visiting an infected person's home sneezing or coughing
What are the symptoms of hepatitis B? Most people who get HBV infection as babies or children don't look or feel sick at all. Similarly, almost half of adults who get infected don't have any symptoms or signs of the disease. If people do have signs or symptoms, they may experience any or all of the following: loss of appetite yellowing of skin and eyes (jaundice) nausea, vomiting fever weakness, tiredness, inability to work
for weeks or months abdominal pain and/or joint pain dark urine
I'm not in a risk group. How did I get HBV infection? Many people don't know when or how they acquired the infection. When they get the blood test results indicating they've been infected with HBV, they are taken by surprise. Studies have demonstrated that 3040% of people who acquire HBV infection are unable to iden-
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tify their own risk factors explaining why they have the disease.
Do people usually recover from HBV infection? Nearly 95% of adults recover after several months. They clear the infection from their bodies and become immune. This means they won't get infected with HBV again. They are no longer contagious and cannot pass HBV on to others.
Unfortunately, of those who become newly infected with HBV, about 5% of adults and up to 90% of children under age five are unable to clear the infection from their bodies; they become chronically infected.
How do I know if I have or have had HBV infection? The only way to know if you are currently infected with HBV, have recovered, are chronically infected, or are susceptible, is by having blood tests. The three standard blood tests are the following:
HBsAg (hepatitis B surface antigen): when this is "positive" or "reactive," it means the person is currently infected with HBV and is able to pass the infection on to others.
Anti-HBc [or HBc-Ab] (antibody to hepatitis B core antigen): when this is "positive" or "reactive," it may mean the person has had contact with HBV. This is a very complicated test to explain because the "anti-HBc" could possibly be a "false-positive" test result. The interpretation of this positive test usually depends on the results of the other two blood tests (see Interpretation table at right). Blood banks routinely run an "anti-HBc," but they do not routinely run an "anti-HBs."
Anti-HBs [or HBs-Ab] (antibody to hepatitis B surface antigen): when this is "positive" or "reactive," it means the person is immune to HBV infection, either from vaccination or from past infection. If the person was previously infected, s/he cannot pass the disease on to others. (To repeat, this test is not routinely done by blood banks.)

Interpretation of the Hepatitis B bank to release these results to your phy-

Blood Test Results

sician. Your physician may want to re-

peat the blood tests or perform

Tests

Results

Interpretation

additional tests such as an "anti-

HBsAg anti-HBc anti-HBs

negative negative negative

susceptible

HBs." Bring this information sheet along with you to your doctor visit.
And remember, you cannot

HBsAg anti-HBc anti-HBs

negative negative positive with >10mIU/mL*

immune due to vaccination

contract HBV from donating blood because the equipment used during blood donation is sterile.

HBsAg anti-HBc anti-HBs

negative positive positive

immune due to natural infection

CHRONIC HEPATITIS B VIRUS INFECTION

HBsAg

positive

anti-HBc IgM anti-HBc anti-HBs

positive positive negative

newly infected

What does it mean to be chronically infected with

HBsAg anti-HBc IgM anti-HBc

positive positive negative

chronically infected

hepatitis B virus? People who do not recover from HBV infection are chronically

anti-HBs

negative

infected, and there are over one

HBsAg anti-HBc anti-HBs

negative positive negative

four interpretations possible

million chronically infected people in the United States today. A chronically infected

person is someone who has had

*Postvaccination testing, when it is recommended, should be done 12 months after the final dose.
1. May be recovering from acute HBV infection. 2. May be distantly immune, and the test is not sensitive enough to detect a very low level of

HBV in her/his blood for more than six months. While approximately 5% of adults who acquire HBV infection become chronically infected, children less

anti-HBs in serum. 3. May be susceptible with a "false positive"
anti-HBc. 4. May be chronically infected and have an unde-

than five years of age have a greater risk. The younger the child is at the time of infection, the greater the risk that the

tectable level of HBsAg present in the serum.

child will have a lifelong infection.

What does it mean if my blood bank said I tested positive for hepatitis B and can no longer

Many babies born to chronically infected mothers will also become chronically infected with HBV unless the babies are given two shots in the hospital and at

donate blood?

least two more during the 6 months after

If the blood bank told you your test was birth to protect them from the infection.

"positive," it is important to find out

A chronically infected person usually

which test was positive. If the "HBsAg" has no signs or symptoms of HBV infec-

was positive, this means that you are

tion but remains infected for years or for

either chronically infected with HBV or a lifetime and is capable of passing HBV

were recently infected. If only the

on to others. Sometimes chronically

"anti-HBc" was positive, it is most likely infected people will spontaneously clear

that you either had a "false-positive" test the infection from their bodies, but most

or are immune to hepatitis B. It is impor- will not. Although most chronically

tant that you understand the full meaning infected people have no serious prob-

of your test results. If you are not sure

lems with hepatitis B and lead normal,

how to interpret these test results, call

healthy lives, some develop liver prob-

your blood bank for an explanation or

lems later. Chronically infected people

have the blood bank send the test results are at significantly higher risk than the

to your physician. You may need to pro- general population for liver failure or

vide written permission for the blood

liver cancer.

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Questions Frequently Asked About Hepatitis B

Page 2

How can I take care of myself if I am chronically infected with HBV? A person with HBV infection should see a physician knowledgeable about the management of liver disease every 612 months. The physician will do blood tests to check the health of the liver as well as test for evidence of liver cancer. It is best for chronically infected people to avoid alcohol because alcohol can injure the liver. Additionally, your physician should know about all the medicines you are taking, even over-the-counter drugs, because some medicines can hurt the liver. If there are any liver test abnormalities, consultation with a liver specialist regarding your need for further testing and treatment is important.
If your liver disease has progressed... If your physician tells you your liver disease has progressed, here are some extra precautions you should take: Get a yearly influenza vaccination.
Patients with severe liver disease (cirrhosis) should also receive pneumococcal vaccine.
Get vaccinated against hepatitis A. Hepatitis A can further damage your liver.
Don't eat raw oysters. They may carry the bacteria Vibrio vulnificus, which can cause serious blood infections in people with liver disease. Approximately 40% of people with this blood infection die.
What can I do to protect others from HBV infection? People with HBV infection might feel healthy but are still capable of passing the infection on to other people. To protect others from getting HBV infection, it is important to protect them from contact with your infected blood and other infectious body fluids, including semen and vaginal secretions. Sweat, tears, urine, and respiratory secretions do not contain hepatitis B virus. Hepatitis B virus transmission via saliva has only been documented through biting.

Important DOs and DON'Ts for people with chronic HBV infection
DO:
Cover all cuts and open sores with a bandage.
Discard used items such as bandaids and menstrual pads carefully so no one is accidentally exposed to your blood.
Wash your hands well after touching your blood or infectious body fluids.
Clean up blood spills. Then reclean the area with a bleach solution (one part household chlorine bleach to 10 parts water).
Tell your sex partner(s) you have hepatitis B so they can be tested and vaccinated (if not already infected). Partners should be tested after the three doses are completed to be sure the vaccine worked.
Use condoms (rubbers) during sex unless your sex partner has had hepatitis B or has been immunized and has had a blood test demonstrating immunity. (Condoms may also protect you from other sexually transmitted diseases.)
Tell household members to see their doctors for testing and vaccination for hepatitis B.
Tell your doctors that you are chronically infected with HBV.
See your doctor every 612 months to check your liver for abnormalities including cancer.
If you are pregnant, tell your doctor that you have HBV infection. It is critical that your baby is started on the hepatitis B shots within a few hours of birth.
DON'T:
Share chewing gum, toothbrushes, razors, washcloths, needles for ear or body piercing, or anything that may have come in contact with your blood or infectious body fluids
Pre-chew food for babies
Share syringes and needles
Donate blood, plasma, body organs, tissue, or sperm

What are the long-term effects of HBV infection? Each year, approximately 5,000 people in the U.S. die of HBV-related liver failure and another 1,500 die from HBV-related liver cancer. HBV infection is the most common cause of liver cancer worldwide and ranks second only to cigarettes as the world's leading cause of cancer.
Is there a cure for hepatitis B? As of this writing, there are three FDAapproved medications (interferon, lamivudine, and adefovir) that can help a person who is already infected with HBV. Their use is reserved for people who have certain blood test abnormalities. Be sure to ask your doctor if you are a candidate for treatment or if you might benefit from enrolling in a clinical trial. Researchers continue to seek additional cures for hepatitis B.
Why is hepatitis B so serious in pregnant women? Pregnant women who are infected with HBV can transmit the disease to their babies. Many of these babies develop lifelong HBV infections, and up to 25% will develop liver failure or liver cancer later in life. All pregnant women should be tested early in pregnancy to determine if they are infected with HBV. If the blood test is positive, the baby should be vaccinated at birth with two shots, one of hepatitis B immune globulin (HBIG) and one of hepatitis B vaccine. The infant will need at least two additional doses of hepatitis B vaccine by 6 months of age.
How can hepatitis B be prevented? The vaccine can provide protection in 9095% of healthy young adults. The vaccine can be given safely to infants, children, and adults usually in three doses over an approximate 6-month period. Even pregnant women can be safely given these shots if their risk factors warrant it. Hepatitis B shots are very safe, and side effects are rare. Hepatitis B vaccine is our first vaccine that prevents cancer--liver cancer.
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Page 3

Questions Frequently Asked About Hepatitis B

At what age are hepatitis B shots routinely given? In the U.S., hepatitis B shots are routinely recommended for all children 018 years of age. For babies, the first hepatitis B shot is recommended to be given in the hospital at birth. Older children and teens should be vaccinated at the earliest opportunity. Any adult who is at risk for HBV infection should start the vaccine series immediately.
Where can I get hepatitis B shots? Check with your clinic first. Children's health insurance usually covers the cost of this vaccine since it is routinely recommended for all U.S. children. If your child is uninsured, ask your local health department for assistance. For adults, contact your health provider first to find out if the vaccine is covered under your health plan. If you are uninsured, call your local health department for advice.
How many shots are needed? Usually three shots are needed for the best protection against HBV, but some protection is provided from receiving as little as one dose. The shots are usually given on a schedule of 0, 1, and 6 months, but there is great flexibility in the timing of these injections. As with all other vaccines, if you fall behind on the schedule, you just continue from where you left off. Hepatitis B shots will not help or cure a person who is already infected with the hepatitis B virus.
What should I do if I'm in a risk group? If you are in a risk group for hepatitis B (risk groups are listed on page 1), get vaccinated! All people in risk groups should protect themselves from HBV

infection. Every day you delay getting vaccinated increases your chances of getting this highly contagious liver disease. The problems caused by hepatitis B--liver cancer and liver failure--are too great. See your doctor or visit your health department.
How does hepatitis B differ from hepatitis A and C? Hepatitis A, B, and C are all viruses that attack and injure the liver, and all can cause similar symptoms. Usually, people get hepatitis A from household or sexual contact with a person who has hepatitis A. Hepatitis C, formerly known as hepatitis non-A non-B, is caused by the hepatitis C virus and is spread in much the same way as HBV. Both hepatitis B and C can cause lifelong liver problems while hepatitis A does not. Vaccines to prevent hepatitis A are now available. There is no vaccine yet for hepatitis C. If you've had hepatitis A or C in the past, it is still possible to get hepatitis B.
Where can I receive more information about hepatitis B? Contact your local and state health departments for more information. You can also contact the following organizations:
Immunization Action Coalition Hepatitis B Coalition (651) 647-9009 www.immunize.org www.vaccineinformation.org
American Liver Foundation (800) 465-4837 www.liverfoundation.org
Centers for Disease Control and Prevention (888) 443-7232 Hepatitis Hotline, automated (800) 232-2522 Immunization Hotline www.cdc.gov/hepatitis www.cdc.gov/nip

Hepatitis B Foundation (215) 489-4900 www.hepb.org
Hepatitis Foundation International (800) 891-0707 www.hepfi.org
Parents of Kids with Infectious Diseases (PKIDS) (877) 557-5437 www.pkids.org
What is the Immunization Action Coalition (IAC)? The Immunization Action Coalition is a nonprofit organization that works to prevent hepatitis B and all other vaccinepreventable diseases in people of all ages. The Hepatitis B Coalition, a program of IAC, promotes vaccination for children 018 years of age, screening for all pregnant women, testing and vaccination for risk groups, and education and treatment for chronically infected people.
IAC relies on financial support from the Centers for Disease Control and Prevention, corporations, foundations, health professionals, and other private citizens to maintain its activities. Financial contributions are always needed, greatly appreciated, and tax-deductible. You can send your check to IAC at the address below or donate online at www.immunize.org/join
Deborah L. Wexler, MD Executive Director
Immunization Action Coalition 1573 Selby Ave., Suite 234 St. Paul, MN 55104 www.immunize.org
www.vaccineinformation.org
This article was written in response to more than 5,000 letters sent to Dr. Wexler after she wrote a letter to "Dear Abby" about hepatitis B in 1993. It was updated in September 2003.

Questions Frequently Asked About Hepatitis B

Page 4

Guidelines for Standing Orders in Labor & Delivery & Nursery Units to Prevent Hepatitis B Virus (HBV) Transmission to Newborns
To obtain the Centers for Disease Control and Prevention (CDC) recommendations for preventing hepatitis B in infants and children, visit CDC's website at www.cdc.gov/mmwr/PDF/rr/rr5416.pdf

In December 2005, the Centers for Disease Control and Prevention (CDC) published new recommendations of the Advisory Committee on Immunization Practices (ACIP) for prevention of hepatitis B virus (HBV) infections in infants and children. The American Academy of Pediatrics, American Academy of Family Physicians, and American College of Obstetricians and Gynecologists have endorsed these recommendations. To obtain a copy, go to www.cdc.gov/mmwr/PDF/rr/rr5416.pdf.
The guidelines below were developed to help all hospitals establish standing orders and protocols in their labor and delivery and nursery units. The content has been reviewed by CDC staff for consistency with CDC recommendations. To protect all infants, CDC recommends that all delivery hospitals institute standing orders and protocols to ensure healthcare professionals do the following: Administer hepatitis B vaccine to all newborns who
weigh at least 2 kg (4.4 lb) before discharge from the nursery. Identify all infants born to mothers who are hepatitis B surface antigen (HBsAg) positive or to mothers with unknown HBsAg status. Administer appropriate immunoprophylaxis to all these infants.
Labor and Delivery (L&D) Procedures
Upon admission, review the HBsAg1 status of all pregnant women. Be sure to review a copy of the mother's original laboratory report to verify that the correct test was performed during this pregnancy and to verify the test date. Do not rely on a transcribed test result!
For women with a documented HBsAg lab report Place a copy of the original laboratory report of the mother's
HBsAg1 test result into (1) the mother's L&D record and (2) the infant's medical record. If the mother is HBsAg positive, alert the nursery staff. If the mother is HBsAg negative during a prenatal visit but was at risk for acquiring HBV infection during this pregnancy (e.g., not in a long-term, mutually monogamous relationship; had an HBsAg-positive sex partner; had evaluation or treatment for a sexually transmitted disease; currently uses or recently used injection drugs), perform a repeat test for HBsAg.1 Instruct the laboratory to call L&D and the nursery with the HBsAg test result ASAP.
For women without a documented HBsAg lab report Perform HBsAg1 testing ASAP on women who do not have a docu-
mented HBsAg test result from the current pregnancy. Instruct the lab to call L&D and the nursery with the newly obtained
HBsAg test result ASAP.

Nursery Procedures
Procedures to follow for ALL newborns 1. Review a copy of the mother's original HBsAg1 lab report to ensure
test was ordered and interpreted accurately. 2. Provide appropriate management based on (1) the mother's HBsAg
status and (2) the infant's birth weight. Manage infants who weigh less than 2 kg differently from those who weigh 2 kg or more. See descriptions below and footnotes 2, 5, 6. 3. Give the mother an immunization record card that includes the hepatitis B vaccination date. Explain the need for the complete hepatitis B vaccine series to protect her baby. Remind her to bring the card with her each time her baby sees a provider.
For infants born to HBsAg-negative mothers Administer single-antigen hepatitis B vaccine (0.5 mL, IM) before discharge to all infants weighing at least 2 kg at birth.2, 3, 4 Document the hepatitis B vaccine dose in the infant's medical record, including date, time, site of administration, and lot number.
For infants born to mothers with unknown HBsAg status Administer single-antigen hepatitis B vaccine (0.5 mL, IM) within 12 hours of birth.3, 5 Do not wait for test results to return before giving this dose of vaccine. Document the hepatitis B vaccine dose appropriately. Confirm that the laboratory has received serum for the mother's
HBsAg1 test. Verify when the HBsAg result will be available and that it will be reported to L&D and the nursery ASAP. If the nursery does not receive the report at the expected time, call the laboratory for the result. If the mother's HBsAg1 test result is positive, do the following:
Administer hepatitis B immune globulin (HBIG 0.5 mL, IM) to the infant ASAP. Document the HBIG dose appropriately in the infant's medical record. There is little benefit in giving HBIG if more than 7 days have elapsed since birth. Alert the mother's and infant's physician(s) of the test result. Follow the instructions below for infants born to HBsAg-positive mothers. If the infant must be discharged before the HBsAg result is known: Document contact information for the parents (e.g., addresses, telephone numbers, emergency contacts) in case further treatment is needed. Obtain the name, address, and phone number of the mother's
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Guidelines for Standing Orders in Labor & Delivery and Nursery Units to Prevent HBV Transmission. . . continued from page 1

and the infant's healthcare providers. Notify the mother's and the infant's healthcare providers that the mother's HBsAg test result is pending.
For infants born to HBsAg-positive mothers Administer HBIG (0.5 mL, IM) and single-antigen hepatitis B
vaccine3, 6 (0.5 mL, IM) at separate injection sites within 12 hours of birth. Document the hepatitis B vaccine and HBIG doses appropriately in the infant's medical record. Notify the local or state health department of the infant's birth and the date and time of administration of HBIG and hepatitis B vaccine doses. Obtain the name, address, and phone number of the infant's primary care provider. Notify the provider of the infant's birth, the date and time of HBIG and hepatitis B vaccine doses administered, and the importance of additional on-time vaccination and postvaccination testing of the infant for HBsAg and antibody to HBsAg after completion of the hepatitis B vaccine series. Provide advice to the mother. Tell her
That she may breast-feed her infant upon delivery, even before hepatitis B vaccine and HBIG are given About the importance of her infant completing the full hepatitis B vaccine series on schedule That blood will need to be drawn from the infant after completion of at least 3 doses of the hepatitis B vaccine series at age 918 months (generally at the next well-child visit) to determine if the infant needs further management About modes of HBV transmission and the need for testing and vaccination of susceptible household, sexual, and needle-sharing contacts That she needs to have a medical evaluation for chronic hepatitis

B, including an assessment of whether she is eligible for antiviral treatment.
Footnotes
1. Be sure the correct test for HBsAg (hepatitis B surface antigen) was/is ordered. The HBsAg test should not be confused with other hepatitis B serologic tests, including antibody to HBsAg (anti-HBs or HBsAb) and antibody to hepatitis B core antigen (anti-HBc or HBcAb).
2. Infants weighing less than 2 kg whose mothers are documented to be HBsAg negative should receive the first dose of vaccine 1 month after birth or at hospital discharge. The mother's HBsAg status must be part of the infant's medical record.
3. Federal law requires that you give parents a Hepatitis B Vaccine Information Statement (VIS) before vaccine administration. To obtain a VIS, download it from the IAC website at www.immunize.org/vis or call your state health department.
4. Exceptions to giving the birth dose of hepatitis B vaccine are allowed on a case-by-case basis and only in rare circumstances. If a birth dose is not administered, a copy of the mother's negative HBsAg test result from the current pregnancy must be placed in the infant's medical record and the attending physician must write a specific order directing staff not to administer the birth dose in the hospital. Infants who don't receive the first dose of hepatitis B vaccine before hospital discharge should receive the first dose no later than age 2 months.
5. An infant weighing less than 2 kg whose mother's HBsAg status is unknown should receive HBIG and hepatitis B vaccine within 12 hours of birth. Do not count the hepatitis B vaccine dose as the first dose in the vaccine series. Reinitiate the full hepatitis B vaccine series at age 12 months.
6. An infant weighing less than 2 kg whose mother is HBsAg positive should receive the first dose of hepatitis B vaccine and HBIG within 12 hours of birth. Do not count the hepatitis B vaccine dose as the first dose in the vaccine series. Reinitiate the full hepatitis B vaccine series at age 12 months.

To access a CDC web page that includes a text version of the recommendations, a "Dear Colleague" letter that explains details of the recommendations, an archived net conference, brochures, slide sets, and more, go to: www.cdc.gov/ncidod/diseases/hepatitis/b/acip.htm

page 2

What the Physician Can Do to Help the Child with Chronic Hepatitis B Virus Infection
Sarah Jane Schwarzenberg, M.D. Division of Pediatric Gastroenterology, Hepatology and Nutrition
University of Minnesota
Although children with chronic hepatitis B virus (HBV) infection may follow many different clinical courses, these recommendations will help all of them maintain good health. 1. A yearly physical
Every child with hepatitis B needs a yearly check-up with his/her primary physician to make sure the child is healthy and growing normally.
2. Laboratory studies to monitor liver health At the first clinical visit, liver enzymes (ALT and AST), INR, a complete blood count, alpha-fetoprotein (AFP) and ultrasound are usually obtained. Thereafter, liver enzymes should be checked yearly in the healthy child with HBV.
3. Screening for hepatocellular carcinoma There are no definitive guidelines for screening children with HBV for hepatocellular carcinoma. AFP is a tumor marker and is increased in 85% of individuals with hepatocellular carcinoma, often before clinical evidence of cancer is present. It may be elevated at a time when the tumor can be resected completely. We recommend yearly AFP in the child with HBV, and twice yearly testing with hepatic ultrasound in the child with cirrhosis and HBV. It should be noted that even close monitoring of these tests does not guarantee early diagnosis of hepatocellular carcinoma.
4. Hepatitis B testing every 3-5 years Few children convert from HBsAg to anti-HBs (HBsAb), especially if they acquired the disease in the perinatal period. It is important to occasionally check to see if the patient is still infected.
5. Referral to a pediatric gastroenterologist Any child with an AST >2 times the upper limit of normal, evidence of hepatic dysfunction, failure to thrive, an elevated AFP, a need for family counseling, or abnormalities on hepatic ultrasound should be referred to a pediatric gastroenterologist for evaluation.
6. Treatment Although medications are available to treat hepatitis B, they are generally useful only in patients with on-going hepatic injury (active hepatitis). Consultation with a pediatric gastroenterologist will help identify those patients who would benefit from medical therapy.
7. Vaccination of household members All members of the child's household and caregivers who have close contact with the child should be vaccinated against hepatitis B, even if pregnant.
8. Hepatitis B education Each child with hepatitis B and his/her parents should receive age-appropriate hepatitis B education. This should include methods for prevention of transmission of the virus and assistance for the child in dealing with his/her positivity throughout the school years and as a teenager. Older children should receive counseling on the use of condoms to prevent viral transmission to their sexual partners.
9. Maintaining personal health Immunization against hepatitis A is recommended to prevent a second injury to the liver. Ethanol should be avoided. When prescribing other medications, care must be taken to avoid or monitor those with known hepatotoxicity.
For more information regarding the child with hepatitis B, please contact Dr. Sarah Jane Schwarzenberg in the division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Minnesota, Department of Pediatrics, 420 Delaware Street SE, Minneapolis, Minnesota 55455; Telephone (612) 624-1133.
www.immunize.org/catg.d/p2170.pdf Item #P2170 (7/08)
Immunization Action Coalition 1573 Selby Ave. St. Paul, MN 55104 (651) 647-9009 www.immunize.org www.vaccineinformation.org

If you have chronic hepatitis B virus (HBV) infection . . .

If you have chronic hepatitis B virus infection (HBV), you are not alone. Today, approximately 1.25 million people in the United States are chronically infected with HBV. The majority of infected people feel healthy for their entire lives and do not demonstrate any evidence of ongoing liver damage. Other people progress to levels of more severe disease. Some people ultimately develop liver scarring (cirrhosis), liver failure, or liver cancer. It is important that you take care of yourself. And because it is possible to spread HBV to others, you have to know how to protect your family, friends, and others from this disease.
How you can take care of yourself
People who have chronic HBV infection need regular monitoring of their liver condition to determine whether their disease is progressing, whether treatment is needed, or whether a liver cancer is developing. Make sure you do the following:
! See your doctor for evaluation of your liver's condition once or twice a year. Certain blood tests need to be performed periodically to monitor your liver's health. Discuss with your doctor if you are a candidate for antiviral medication. These medicines are given to certain people with chronic liver disease.
! Discuss with your doctor about getting periodic ultrasounds, alpha-fetoprotein blood tests, or other studies to make sure there is no evidence of a developing liver cancer. Physicians may recommend different schedules for ultrasounds and blood tests depending on the patient's age, sex, ethnicity, age at which the infection was initially acquired, family history, HBeAg status, and liver enzymes. Usually, ultrasounds and blood tests are recommended every six to 12 months.
! Review with your physician all medications you take. Even some "over-thecounter" medications can injure your liver.
! If you are pregnant, tell your physician that you have chronic HBV infection. It is essential that your baby be given hepatitis B immune globulin (HBIG) and started on hepatitis B vaccine within 12 hours of birth.
! Avoid alcoholic beverages. Alcohol can damage your liver.

If your liver disease has progressed...
If your liver disease progresses, here are some extra precautions you should take:
! Get your yearly influenza vaccine. Patients with severe liver disease should also receive pneumococcal polysaccharide vaccine.

! Clean up your blood spills. Then reclean the area with bleach solution (one part regular household bleach to 10 parts water).
! Do not share toothbrushes, razors, needles for ear piercing, nail files, clippers, nail scissors, washcloths, or anything that may have come in contact with your blood or body fluids.

! Get vaccinated against hepatitis A. Hepatitis A can further damage your liver.

! Do not share food that has been in your mouth (e.g., chewing gum) and do not pre-chew food for babies.

! Don't eat raw oysters. Raw oysters may carry the bacteria Vibrio vulnificus which can cause a serious blood infection in individuals with liver disease. Approximately 40% of these cases are fatal.
How to protect others from HBV infection
People can get HBV infection from you by coming in contact with your blood, serum, semen, or vaginal fluids. HBV has also been transmitted by human bites. Although HBV has been detected in low concentrations in other body fluids, including tears, sweat, urine, feces, and breast milk, these fluids have not been associated with transmission. Fortunately, HBV is not spread by sneezing or coughing, or from casual contact such as holding hands. Here are some important guidelines for you to follow so that others are protected:
! Tell your sex partner(s) that you are infected with HBV. Your sex partner(s) must see a physician for hepatitis B blood testing. If, according to the blood tests, your partner has never had hepatitis B, he or she should be vaccinated. After the series of three shots is completed, your partner needs to return to the doctor for blood testing to make sure the vaccine protected him or her. Use condoms until your partner is proven to be protected from HBV.
! Make sure all household members see their physicians for hepatitis B testing and vaccination.
! Tell your health care providers that you are infected with HBV.
! Cover all cuts and open sores with a bandage.

! Do not share syringes and needles. ! Do not donate blood, plasma, body
organs, tissue, or sperm. ! Know that if someone is exposed to your
blood--be it a family member, a friend, or even a stranger--preventive treatment is available for that person. If the exposed person receives HBIG and starts the hepatitis B vaccine series within a few days, that person has an excellent chance of being protected from HBV! ! Learn more about hepatitis B so you can make the best decisions for yourself and provide the best protection for your family and friends.
More resources...
If you have further questions, contact one of these trusted resources:
Immunization Action Coalition
(651) 647-9009 www.immunize.org
American Liver Foundation
(800) 465-4837 www.liverfoundation.org
Centers for Disease Control and Prevention
(888) 443-7232 www.cdc.gov/hepatitis
Hepatitis B Foundation
(215) 489-4900 www.hepb.org
Hepatitis Foundation International
(800) 891-0707 www.hepfi.org
National Digestive Diseases Information Clearinghouse
(301) 654-3810 www.niddk.nih.gov

! Throw away used personal items such as tissues or menstrual pads in a bag so others will not be exposed to your blood.
! Wash your hands well after touching your blood or body fluids.

Parents of Kids with Infectious Diseases (PKIDS)
(877) 557-5437 www.pkids.org

www.immunize.org/catg.d/p4120eng.pdf Item #P4120 (8/05)

Immunization Action Coalition 1573 Selby Ave. St. Paul, MN 55104 (651) 647-9009 www.vaccineinformation.org www.immunize.org

Georgia Immunization Program Manual

Appendix M1 Division Of Public Health

Interviewing/Counseling Format Hepatitis B

Example Interviewing/Counseling Format
Hepatitis B

I.

Introduction, professional role, and purpose

Purpose: To let the patient know what is going to take place is to his/her benefit,

that he /she is going to be dealing with a competent person, and that there should

be no fears about discussing otherwise personal information.

A. Introduce yourself and anyone else present to the patient. B. Tell the patient that you have been trained and have experience in helping people who have
hepatitis B to understand and manage their disease. C. Inform the patient that part of your job is to ensure that no one else find out about the patient's
infection and that problems are minimized for everyone who may be involved.

II. Patient Assessment

Purpose:

To establish rapport, get the patient accustomed to talking, reduce the

possibility of patient concerns interfering with the rest of the process, gather

information that can be used in later sections, and give the patient sufficient

information to be able to understand and support disease intervention behaviors.

Targeted medical information can preempt inappropriate strategies that the patient

may be developing to take care of the problem. By getting the patient to talk during

this section, issues may arise that can be used as motivations or as benchmarks

against inconsistencies later on in the interview/counseling session.

A. Patient Concerns 1. Ask the patient about problems or questions regarding the disease and how it has been handled thus far. 2. Address concerns even if they are involved in other elements of the format.

B. Socio-sexual Information 1. Question patient conversationally about where he/she lives, telephone number, alternate locating information, who living with, employment, travel, recreation social groups. 2. Question the patient about current employment and/or past jobs where they may have had to handle blood or other body fluids. 3. Explain reasons for questions if patient shows signs of concern.

C. Medical History and Disease Comprehension 1. Ask what patient knows about the disease. 2. Compliment correct responses, tactfully correct any misconceptions, and add any information that directly supports disease intervention behaviors. 3. Ask about past hepatitis/liver problems. 4. Impress upon the patient that the disease is serious, people usually don't know that they have it until it is too late, that routine tests may not discover the disease, and that it is often passed unintentionally.

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Interviewing/Counseling Format Hepatitis B

III. Disease Intervention Behaviors A. Assure examination of household, sexual, and needle-sharing contacts 1. Explain that the medical facts just discussed clearly show that the patient's household contacts, sexual contacts, and needle-sharing contacts are in need of an exam as soon as possible. 2. Ask for the names and birthdays of all the children in the home. 3. Explain that other adults in the household need to be notified that they have been exposed to someone with a serious disease. This has to be done so that they can be tested for the infection and given vaccine as necessary. 4. Ask for the names and birthdays of all the adults in the house besides the husband/boyfriend. 5. Explain that the sex partners and needle-sharing partners (sex/NS partners) need to be notified privately that they have been exposed to someone with a serious disease. This has to be done in a way that doesn't embarrass them or the patient, but ensures that the examination takes place immediately by someone who knows enough about the circumstances to do the right things medically. 6. Tell the patient that you can work together to come up with the plan for notifying the sex/NS partners, and that you have to know about each of the sex/NS partners since a certain date in order to do that. 7. If the patient seems hesitant about talking about sex/NS partners, problem solve and explain the different plans and give different examples of how you would handle referrals. 8. Ask for the names of each of the sex/NS partners since the significant date you have established for the interview period. Do not be concerned if the patient doesn't supply the whole name, but emphasize that you want to discuss every partner during that period, regardless of how much they know about them. Continue to probe for partners even after the patient has indicated there are no more. Use some other identifier for sex/NS partners if the patient can't remember a name or nickname. 9. When further probing fails to produce other sex/NS partners, ask and record the last date of exposure beside each person's name. 10. Confront problems indicated by exposure gaps and conflicts with previously gathered information. 11. If you have not already done so, explain referral methods. 12. Gather locating information including full name, nicknames, address, telephone numbers, living-with status, employment, age, race, sex, marital status, physical descriptions, directions to home, description of home, etc. 13. Determine methods of sex/NS partner referral for each partner and agree to best approaches. 14. Coach patient on any contact referrals (referrals they prefer to make, themselves) and give guidelines and deadlines.

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Interviewing/Counseling Format Hepatitis B

B. Reduce Risk Purpose: This section is important for all patients to hear, but is especially important for those who appear to have contracted the infection sexually. The information should be tailored to each patient.

1. The patient should be instructed that it is possible for her to spread the hepatitis B virus to others. She should be told of ways to prevent this spread: a. Household articles that could become contaminated with blood (such as toothbrushes and razors) should not be shared. b. Cuts or skin lesions should be covered to prevent the spread of infectious secretions or blood. c. When seeking medical or dental care, those responsible for care should be informed of HbsAg status. d. If sexual partner(s) are not immune to hepatitis B, the partner should be advised to take precautions, including "safer sex" and vaccination, if warranted. e. "Safer sex" should be practiced for the prevention of many sexually transmitted diseases, including hepatitis B, syphilis, gonorrhea, chlamydial infection, and HIV/AIDS. f. Blood, plasma, body organs, other tissue or sperm should not be donated. g. Enroll or stay in a drug treatment program if using illicit drugs.

2. Medical follow-up is needed for evaluation of chronic hepatitis B. Patients with progressive liver disease may need to be referred to a liver specialist for consideration of interferon therapy.

3. Other recommendations include: a. Limiting the number of sex partners. b. Limiting anonymous sex. c. Routine checkups for STDs and liver function.

C. Respond to Disease Suspicion Purpose: In spite of current status, the patient should understand how to respond to signs that the infection has worsened.

1. Discuss clinical symptoms of hepatitis B. 2. Tell patient to return to provider immediately if symptoms appear.

D. Complete Vaccine Series for All Exposed Purpose: The understanding of the multi-dose regimen is particularly important and these messages should be delivered in concert with individualized pamphlets. The case manager should be reinforcing messages expressed by the provider and verifying that the patient understands and intends to comply with the plan.

1. Emphasize the need for all exposed to complete the series, especially the baby and children of the household. Remind the patient that she is directly responsible for her baby's and other children's health. She should remind the nurses and her baby's doctor that she is a carrier of hepatitis B virus and her baby needs to complete the highrisk vaccine series.
2. Establish a specific schedule so that the patient is aware when the vaccine is due to be given to her baby.
3. Discuss contraindications and potential side effects. 4. Identify and discuss potential compliance problems.

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IV. Conclusion A. Ask what questions or problems remain. B. Review and reinforce all components of compliance plan. C. Reinforce commitments to communicate information. D. Make arrangements for the next visit, if indicated.
Centers for Disease Control and Prevention. Managing a Hepatitis B Prevention Program: A Guide to Life as a Program Coordinator. [manual] April 2007.

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Hepatitis B Facts: Testing and Vaccination

Who should be vaccinated?
The following persons should receive routine hepatitis B vaccination, according to the Centers for Disease Control and Prevention (CDC): Routine vaccination: All newborns at birth prior to hospital discharge All children and teens ages 0 through 18 years All persons who wish to be protected from hepatitis B virus (HBV) infec-
tion. CDC states it is not necessary for the patient to disclose a risk factor to receive hepatitis B vaccine. Persons who are at risk for sexual exposure: Sexually active persons who are not in long-term, mutually monogamous relationships Sex partners of HBsAg-positive persons Persons seeking evaluation or treatment for an STD Men who have sex with men Persons at risk for infection by percutaneous or mucosal exposure to blood: Current or recent injection-drug users Household contacts of HBsAg-positive persons Residents and staff of facilities for developmentally challenged persons Healthcare and public safety workers with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids Persons with end-stage renal disease and those receiving dialysis Others: Travelers to areas with moderate or high rates of HBV infection Persons with chronic (life-long) liver disease Persons with HIV infection
Refugees, immigrants, and adoptees from countries where HBV infection is endemic should have hepatitis B testing. Adults should discuss their need or desire for hepatitis B vaccination with their healthcare providers.
For certain people at risk, postvaccination testing is recommended. Consult ACIP recommendations for details (see references).
Hepatitis B lab nomenclature
HBsAg: Hepatitis B surface antigen is a marker of infectivity. Its presence indicates either acute or chronic HBV infection.
Anti-HBs: Antibody to hepatitis B surface antigen is a marker of immunity. Its presence indicates an immune response to HBV infection, an immune response to vaccination, or the presence of passively acquired antibody. (It is also known as HBsAb, but this abbreviation is best avoided since it is often confused with abbreviations such as HBsAg.)
Anti-HBc (total): Antibody to hepatitis B core antigen is a nonspecific marker of acute, chronic, or resolved HBV infection. It is not a marker of vaccineinduced immunity. It may be used in prevaccination testing to determine previous exposure to HBV infection. (It is also known as HBcAb, but this abbreviation is best avoided since it is often confused with other abbreviations.)
IgM anti-HBc: IgM antibody subclass of anti-HBc. Positivity indicates recent infection with HBV (within the past 6 mos). Its presence indicates acute infection.
HBeAg: Hepatitis B "e" antigen is a marker of a high degree of HBV infectivity, and it correlates with a high level of HBV replication. It is primarily used to help determine the clinical management of patients with chronic HBV infection.
Anti-HBe: Antibody to hepatitis B "e" antigen may be present in an infected or immune person. In persons with chronic HBV infection, its presence suggests a low viral titer and a low degree of infectivity.
HBV-DNA: HBV Deoxyribonucleic acid is a marker of viral replication. It correlates well with infectivity. It is used to assess and monitor the treatment of patients with chronic HBV infection.

Hep B testing before vaccination
Serologic testing prior to vaccination may be undertaken based on your assessment of your patient's level of risk and your or your patient's need for definitive information (see information in the left column). If you decide to test, draw the blood first, and then give the first dose of vaccine at the same office visit. Vaccination can then be continued, if needed, based on the results of the tests. If you are not sure who needs hepatitis B testing, consult your state or local health department.

Tests
HBsAg antiHBc antiHBs

Results
negative negative negative

Interpretation Vaccinate?

susceptible

vaccinate if indicated

HBsAg antiHBc antiHBs

negative
negative
positive with >10mIU/mL

immune due to vaccination

no vaccination necessary

HBsAg antiHBc antiHBs

negative positive positive

immune due to natural infection

no vaccination necessary

HBsAg antiHBc IgM antiHBc antiHBs

positive positive positive negative

acutely infected

no vaccination necessary

HBsAg antiHBc IgM antiHBc antiHBs

positive positive negative negative

chronically infected

no vaccination necessary (may need treatment)

HBsAg antiHBc antiHBs

negative positive negative

four
interpretations possible*

use clinical judgment

*1. May be recovering from acute HBV infection 2. May be distantly immune, but the test may not be sensitive enough to detect a very low level of antiHBs in serum 3. May be susceptible with a false positive antiHBc 4. May be chronically infected and have an undetectable level of HBsAg present in the serum

Managing chronic HBV infection
When you identify a patient who is chronically infected with HBV, make sure you consult a specialist knowledgeable in the treatment of liver disease so your patient's care is optimized. Chronically infected persons need medical evaluation every 612 mos to assess the status of their liver health and their need for antiviral therapy, as well as to screen for liver cancer. In addition, persons with chronic HBV infection should be educated about their disease and how to protect others.
Household members and sex partners should be tested for HBV infection and given the first dose of hepatitis B vaccine at the same visit. (Vaccinating a person who has already been infected will do no harm). If testing indicates HBV susceptibility, complete the hepatitis B vaccination series. If testing indicates the presence of HBV infection, consultation and further care with a physician knowledgeable about chronic hepatitis B is needed.
References
1. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the U.S.: Recommendations of the ACIP, Part 1: Immunization of Infants, Children and Adolescents, MMWR, Dec. 23, 2005, Vol. 54(RR-16)
2. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the U.S.: Recommendations of the ACIP, Part II: Immunization of Adults, MMWR, Dec. 8, 2006, Vol. 55(RR-16)
www.immunize.org/catg.d/p2110.pdf Item #P2110 (3/08)

Immunization Action Coalition 1573 Selby Ave. St. Paul, MN 55104 (651) 647-9009 www.immunize.org www.vaccineinformation.org

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State Hepatitis Program

Background:
The State Hepatitis Program provides hepatitis B vaccine when indicated to eligible children and adults through the Perinatal Hepatitis B Prevention Program, the Vaccines for Children Program, the STD/HIV Program and Family Planning Program. Hepatitis A vaccine is provided to eligible children through the Vaccines for Children Program, highrisk adults, and to both children and adults in outbreak situations.

Groups recommended for routine vaccination:

Hepatitis B Hepatitis B vaccine is recommended for all persons aged zero through 18 years, and adults at highest risk for the hepatitis B virus. These high-risk groups are as follows:
Persons with occupational risk Clients and staff of institutions for the developmentally disabled Hemodialysis patients Recipients of certain blood products Household contacts and sexual partners of HBV carriers Adoptees from countries where HBV infection is endemic International travelers who plan to spend more than 6 months in areas with
high rates of HBV infection and who will have close contact with the local population Injecting drug users Sexually active homosexual and bisexual men Sexually active heterosexual men and women who are diagnosed as having recently acquired other sexually transmitted diseases, and for persons who have a history of sexual activity with more than one partner in the previous 6 months.
NOTE: Persons seen for evaluation of sexually transmitted diseases should be considered candidates for vaccination. Inmates of long-term correctional facilities
Hepatitis A Hepatitis A vaccine is recommended for persons aged > 12 months of age who are at increased risk for infection or severe outcomes from the disease. These groups include the following: Travelers to countries where hepatitis A is endemic Men Who Have Sex with Men Users of Injecting and Noninjecting Drugs Persons Who Have Clotting-Factor Disorders Persons Working with Nonhuman Primates Persons With Chronic Liver Disease

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Provision of vaccine for routine vaccination by the State Hepatitis Program:
The State Immunization Program provides hepatitis B vaccine to VFC and PeachCare eligible children aged birth through 18 years, household and sexual contacts to acute and chronic hepatitis B cases (which includes perinatal cases), and persons seeking evaluation for an STD at a public STD/HIV or Family Planning Clinic.
Hepatitis A vaccine is not routinely provided by the State Immunization Program but is provided to persons aged 12 months and older in outbreak situations.
Serologic testing:
Prevaccination serology for hepatitis B: Prevaccination serology is not indicated before routine vaccination of infants, children and adults. Prevaccination serology should be performed on persons who are at highest risk for infection with the hepatitis B virus (HBV). Those clients at highest risk are defined as:
Injecting drug users Sexually active homosexual and bisexual men Sexually active heterosexual men and women with more than one sex
partner within a 6 month period Alaska natives Pacific Islanders Children of immigrants from endemic countries Family members of Hepatitis B surface antigen (HBsAg) positive persons
Persons being evaluated in STD/ HIV and Family Planning clinics should first be assessed for high-risk factors and serologic testing performed if indicated. The first dose of hepatitis B vaccine should be administered at the same visit as serologic testing. Draw the blood before administering vaccine. After the results of the serologic tests are received and the client is found to be susceptible, the second and third doses should be administered according to the client's age as specified in the ACIP recommended schedule.
Prevaccination Serology for Hepatitis A: Prevaccination serology for hepatitis A is not indicated for routine vaccination of children and adults. Antibody production in response to HAV infection results in lifelong immunity to hepatitis A infection. Vaccination of persons who are immune because of prior infection does not increase the risk for adverse events. In populations that have expected high rates of prior HAV infection, prevaccination testing may be considered to reduce costs by not vaccinating persons who have prior immunity. Testing of children is not indicated because of their expected low prevalence of infection. For adults, the decision to test should be based upon the following information:
a) the expected prevalence of immunity; b) the cost of vaccination compared with the cost of serologic testing (including
the cost of an additional visit); and c) the likelihood that testing will not interfere with initiating vaccination.

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Persons for whom prevaccination testing will likely be most cost-effective include:
Adults who were either born in or lived for extensive periods in geographic areas that have a high endemicity of HAV infection;
Older adolescents and adults in certain population groups (i.e., American Indians, Alaska Natives, and Hispanics);
Adults in certain groups that have a high prevalence of infection (e.g., injecting drug users).
Post-vaccination serology for Hepatitis B Testing for immunity to hepatitis B following vaccination is not routinely recommended but should be considered for persons whose subsequent management depends on knowing their immune status. This would include:
Infants born to HBsAg -positive women Dialysis patients, persons with weakened immune systems and health care
workers who have direct contact with blood or body fluids
When indicated, post-vaccination testing for children and adults should be done 1 to 2 months after completion of the vaccine series to provide definitive information on response to the vaccine. Infants born to HBsAg-positive women should be tested 3 to 9 months after the third dose of hepatitis B vaccine.
Post-vaccination serology for Hepatitis A Post-vaccination serologies are not indicated in persons receiving hepatitis A vaccine due to the high rate of response among children and adults. No test sensitive enough to detect low anti-HAV concentrations is approved for routine diagnostic use in the United States.

NOTE: Please refer to Chapter 2, "Vaccines to Prevent Hepatitis B" for specific vaccine administration guidelines for hepatitis B vaccines.

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Resources 1. Centers for Disease Control and Prevention. Protection Against Viral Hepatitis. Recommendations of the Immunization Practices Advisory Committee. MMWR, February 09, 1990, Vol. 39 (RR-2). 2. Centers for Disease Control and Prevention. Hepatitis B Virus: A Comprehensive Strategy for Eliminating Transmission In the United States Through Universal Childhood Vaccination. Recommendations of the Advisory Committee on Immunization Practices. MMWR, November 22, 1991, Vol. 40(RR-13); 1-19. 3. Centers for Disease Control and Prevention. Immunization of Health-Care Workers: Recommendations of the Advisory Committee on Immunization Practices and the Hospital Infection Control Practices Advisory Committee (HICPAC), MMWR, December 26, 1997, Vol.46 (RR-18). 4. Centers for Disease Control and Prevention. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. Recommendations of the Immunization Practices Advisory Committee, Part 1: Immunization of Infants, Children, and Adolescents. MMWR, December 23, 2005, Vol. 54 (RR-16). 5. Centers for Disease Control and Prevention. Prevention of Hepatitis A Through Active or Passive Immunization. Recommendations of the Immunization Practices Advisory Committee. MMWR, May 19, 2006, Vol. 55 (RR-7). 6. Centers for Disease Control and Prevention. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. Recommendations of the Immunization Practices Advisory Committee, Part II: Immunization of Adults. MMWR, December 8, 2006, Vol. 55 (RR-16).

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Hepatitis B Vaccination In STD, HIV and Family Planning Clinics Guidelines for Public Health

Background The goal of hepatitis B immunization is to prevent transmission of chronic HBV infection, which in turn prevents chronic liver disease and liver cancer. While routine vaccination of infants in the United States will eventually produce a population highly immune to hepatitis B, further efforts must be extended to prevent transmission among groups at highest risk for infection (see list, below). To reach the Healthy People 2010 target for persons aged 19-24 years and 25-39 years (2.4 cases per 100,000 and 5.1 cases per 100,000, respectively), hepatitis B vaccination programs must continue to focus on susceptible persons at the highest risk of infection. Approximately 79% of newly acquired cases of hepatitis B are associated with high-risk sexual activity or injection-drug use. Vaccinating susceptible persons attending public Sexually Transmitted Disease (STD), HIV and Family Planning clinics in Georgia will reduce the transmission of HBV to sexually active adolescents and adults.
High-risk Groups for whom Hepatitis B Vaccination is Recommended
1. Persons with occupational risk. Any health-care or public-safety worker may be at risk for HBV exposure, depending on the tasks performed. Workers who perform tasks involving contact with blood or blood-contaminated body fluid should be vaccinated. For persons in health-care fields, vaccination should be completed during training in schools of medicine, dentistry, nursing, laboratory technology, and other allied health professions, before trainees have their first contact with blood.
2. Clients and staff of institutions for the developmentally disabled. Susceptible clients in institutions for the developmentally disabled, as well as staff who work closely with clients, should be vaccinated. Susceptible clients and staff who live or work in smaller residential settings with known HBV carriers should also receive hepatitis B vaccine. Clients discharged from residential institutions into community programs should be screened for HBsAg so that appropriate measures can be taken to prevent HBV transmission. These measures should include both environmental controls and appropriate use of vaccine.
Staff of nonresidential day-care programs for the developmentally disabled (e.g., schools, sheltered workshops) attended by known HBV carriers have a risk of infection comparable with that of health-care workers and therefore should be vaccinated. The risk of infection for other clients appears to be lower than the risk for staff. Vaccination of clients in day care programs may be considered. Vaccination of classroom contacts is strongly encouraged if a classmate who is an HBV carrier behaves aggressively or has special medical problems (e.g., exudative dermatitis, open skin lesions) that increase the risk of exposure to his or her blood or serous secretions.
3. Hemodialysis patients. Hepatitis B vaccination is recommended for susceptible hemodialysis patients. Vaccinating patients early in the course of their renal disease is encouraged because patients with uremia who are vaccinated before they require dialysis are more likely to respond to the vaccine. Although their seroconversion rates and anti-HBs titers are lower than those of healthy persons, patients who respond to vaccination will be protected from infection, and the need for frequent serologic testing will be reduced.

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4. Recipients of certain blood products. Patients who receive clotting-factor concentrates have an increased risk of HBV infection and should be vaccinated as soon as their specific clotting disorder is identified. Prevaccination testing is recommended for patients who have already received multiple infusions of these products.
5. Household contacts and sex partners of HBV carriers. All household and sexual contacts of persons identified as HBsAg positive should be vaccinated. Hepatitis B vaccine should be administered at the age-appropriate dose to those determined to be susceptible or judged likely to be susceptible to infection.
6. Adoptees from countries where HBV infection is endemic. Adopted or fostered orphans or unaccompanied minors from countries where HBV infection is endemic should be screened for HBsAg. If the children are HBsAg positive, other family members should be vaccinated.
7. International travelers. Vaccination should be considered for persons who plan to spend more than 6 months in areas with high rates of HBV infection and who will have close contact with the local population. Short-term travelers who are likely to have contact with blood (e.g., in a medical setting) or sexual contact with residents of areas with high or intermediate levels of endemic disease should be vaccinated. Vaccination should begin at least 6 months before travel to allow for completion of the full vaccine series, although a partial series will offer some protection. The alternate four-dose schedule should provide protection if the first three doses can be delivered before departure.
8. Injecting drug users. All injecting drug users who are susceptible to HBV should be vaccinated as soon as their drug use begins. Because of the high rate of HBV infection in this population, prevaccination screening should be considered.
9. Sexually active homosexual and bisexual men. Susceptible sexually active homosexual and bisexual men should be vaccinated. Because of the high rate of HBV infection in this population, prevaccination screening should be considered. Men known to have HIV infection should be tested for anti-HBs response after completion of the vaccine series.
10. Sexually active heterosexual men and women. Vaccination is recommended for men and women who are diagnosed as having recently acquired other sexually transmitted diseases, for prostitutes, and for persons who have a history of sexual activity with more than one partner in the previous 6 months. Most patients seen in clinics for sexually transmitted diseases should be considered candidates for vaccination.
11. Inmates of long-term correctional facilities. Prison officials should consider undertaking screening and vaccination programs directed at inmates with histories of high-risk behaviors.

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Eligibility for Hepatitis B Vaccination in STD/HIV and Family Planning Clinics in Georgia
The following persons ARE ELIGIBLE to receive state-supplied hepatitis B vaccine if screened in any Public Health Clinic:
1. Men having sex with men 2. Injecting drug users 3. Individuals with multiple sex partners (more than 1 partner in the past six months) 4. Homeless Adults 5. Persons seeking STD/HIV screening services including HIV testing and counseling 6. HIV infected persons 7. Persons recently diagnosed with a sexually transmitted disease 8. Persons seeking Family Planning clinic 9. Sexual partners of persons with acute or chronic hepatitis B virus infection 10. Household contacts of persons with acute and chronic HBV infection 11. Hemodialysis/transplant patients 12. Persons who began the series using state-supplied vaccine and still need to
complete the series 13. Recipients of clotting factor concentrates
Persons NOT ELIGIBLE to receive state-supplied hepatitis B vaccine for routine immunizations include:
1. Public safety workers 2. Health care workers 3. Refugees 4. International travelers 5. Inmates 6. Staff of institutions for developmentally disabled
Postexposure Prophylaxis for Hepatitis B with Vaccine and HBIG Recommendations on postexposure prophylaxis are based on available efficacy data and on the likelihood of future HBV exposure of the person requiring treatment. In all exposures, a regimen combining HBIG with hepatitis B vaccine will provide both short- and long-term protection and is the treatment of choice. Please refer to Chapter 2, "Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Adult Populations (age 19 years)" in this manual for the eligibility requirements for persons to receive state-supplied HBIG.
Immunization Consent Requirements Vaccination against viral hepatitis for persons under the age of eighteen years without parental/guardian consent can occur in conjunction with STD/HIV examinations due to already existing laws and legal precedent relating to STD/HIV examination and treatment of minors (O.C.G.A. 31-17-7). In these instances, a minor is considered to be receiving hepatitis B vaccine as prophylaxis for all STDs, and therefore is covered under the aforementioned section of the Official Code of Georgia. Conversely, persons under 18 years of age cannot be vaccinated without parental/guardian consent in any other vaccination setting, including school vaccination programs, outbreak control settings where mass vaccinations are being given, and other clinic settings where STD/HIV evaluations and treatments are not conducted.
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Serology Testing Prevaccination serologic testing for susceptibility Pre-vaccination serology is cost effective and should be considered in persons who are at high risk for hepatitis B infection. Due to higher seroprevelance, the following high-risk groups should receive pre-vaccination testing:
1. Men having sex with men (MSM) 2. Intravenous drug users 3. Sexual/Household contacts of persons infected with HBV
Prevaccination testing should not interfere with administering vaccine during the visit for which immunization against hepatitis B is requested. To test high-risk patients for history of disease and the need for vaccine, order HBsAg and anti-HBs tests. Draw the blood before administering vaccine. The first dose of vaccine should be given at the same visit as the blood test. If the client is found susceptible to HBV (via negative serology), then doses 2 and 3 should be administered at the appropriate intervals. It is not cost-effective for groups with a low expected prevalence of HBV serologic markers, to receive prevaccination testing. Therefore, pre-vaccination serologies are not indicated before routine vaccination of infants, children and adults.
The Georgia Public Health Laboratory hepatitis serology consists of HBsAg, total anti-HBc and anti-HBs. Specific guidelines for ordering hepatitis B serologies can be found in the Georgia Public Health Laboratory Service Manual in the "Microbial Immunology Laboratory, Infectious Disease Serology section." (See Appendix in this chapter.) For additional information regarding the interpretation of hepatitis B serologies, please see Appendix N of the Perinatal Hepatitis B Prevention Program Guidelines.
Postvaccination Testing Hepatitis B vaccine, when given at the correct anatomic site produces protective antibody (antiHBs) in greater than 90% of healthy persons. Testing for immunity after vaccination is not recommended routinely but is advised for persons whose subsequent management depends on knowing their immune status (such as dialysis patients and health care workers with direct contact to blood and body fluids). Testing for immunity is also advised for persons for whom a suboptimal response may be anticipated, such as those who have received vaccine in the buttock, persons greater than or equal to 50 years of age, and persons known to have HIV infection. Post-vaccination testing should also be considered for persons at occupational risk who may have needle-stick exposures necessitating post exposure prophylaxis. When indicated, post-vaccination testing should be done between 1 to 3 months after completion of the vaccine series to provide definitive information on response to the vaccine.
Note: The post-vaccination serology recommendation for infants born to HBsAg positive women is 3-9 months after the third dose of hepatitis B vaccine.
Revaccination of persons who do not respond to the primary series produces adequate antibody in 15%-25% after one additional dose and in 30%-50% after three additional doses when the primary vaccination has been given in the deltoid. For persons who did not respond to a primary vaccine series given in the buttock, data suggest that revaccination in the arm induces adequate antibody in greater than 75%. Revaccination with one or more additional doses should be considered for persons who fail to respond to vaccination in the deltoid and is recommended for those who have failed to respond to vaccination in the buttock.
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Sexual Partners of Persons with Acute HBV Infection Sexual partners of HBsAg-positive persons are at increased risk of acquiring HBV infection, and HBIG has been shown to be 75% effective in preventing such infections. Data about the efficacy of HBIG beyond the 14-day cutoff is limited and the period after sexual exposure during which HBIG is effective is unknown, however, it is unlikely that this period would exceed 14 days. Testing of sexual partners for susceptibility is recommended at the same visit as the first dose of vaccine. If a sexual partner is found susceptible after serology, then administer doses 2 and 3 at the appropriate dosage and time intervals.
Household Contacts of Persons with Acute HBV Infection Since infants have close contact with primary care givers and they have a higher risk of becoming HBV carriers after acute HBV infection, prophylaxis of an infant less than 12 months of age with HBIG (0.5 mL) and hepatitis B vaccine is indicated if the mother or primary care giver has acute HBV infection. Prophylaxis with HBIG for other household contacts of persons with acute HBV infection is not indicated unless they have had identifiable blood exposure to the index patient, such as by sharing toothbrushes or razors. Hepatitis B vaccine is recommended for household contacts and the first dose should be administered at the same visit as the prevaccination serology. Be sure to draw blood for the serology before administering the vaccine. If the household contact is found susceptible after serology, then administer doses 2 and 3 at the appropriate dosage and time intervals. Such exposures should be treated similarly to sexual exposures. If the index patient becomes an HBV carrier, all household contacts should be given hepatitis B vaccine.
NOTE: Administering even one dose of hepatitis B vaccine allows seroconversion for 40% to 50% of persons receiving vaccine. Always encourage clients to complete the series, but do not withhold vaccine if uncertain that the client will return for the subsequent doses.
General Hepatitis B Vaccination Requirements Please see Chapter 2, "Vaccines to Prevent Hepatitis B", for specific vaccine administration guidelines.
Reporting Requirements All Georgia physicians, laboratories, and other health care providers are required by the authority of the Official Code of Georgia (Sections 31-12-2 and 31-22-7, Rules of the Department of Human Resources, chapter 290-5-3.02) to report persons with acute hepatitis B disease or persons who are HBsAg positive within 7 days to their County Health Department or District Health Office. Hepatitis B Cases may also be reported to the Notifiable Disease Unit of the Epidemiology Branch. The preferred method of reporting is through the State Electronic Notifiable Disease Surveillance System (SENDSS), available at http://sendss.state.ga.us/.
Positive serologies and acute cases can be reported by the County Health Department or Health District on State Form number 3095,Georgia Notifiable Disease Report Form. Interviewed cases are to be reported on the CDC Viral Case Report Form, number 53.1. Both forms are to be mailed to the Notifiable Disease Unit, Epidemiology Branch, Georgia Division of Public Health, 2 Peachtree Street, 14th Floor, Atlanta, Georgia 30303.

7. Hepatitis Hepatitis B Vaccination In STD, HIV and Family Planning Clinics 5 Guidelines for Public Health 6/2008

Georgia Immunization Program Manual

Division Of Public Health

Hepatitis B Vaccination In STD, HIV and Family Planning Clinics Guidelines for Public Health

Hepatitis B Counseling Interview Each person infected with HBV should be counseled regarding their infection and interviewed for household and sexual contacts. For more specific information, please refer to "Example
Interviewing/Counseling Format (for) Hepatitis B," found in the Appendix section of the Perinatal Hepatitis B Prevention Guidelines in this chapter.
References United States Department of Health and Human Services, Healthy People 2010-Conference Edition, Immunization and Infectious Diseases, November 30, 1999.
Centers for Disease Control and Prevention. Managing a Hepatitis B Prevention Program: A Guide to Life as a Program Coordinator, [brochure] September 1996.
Advisory Committee on Immunization Practices. Vaccines for Children Resolution Number 2/011, Vaccines to Prevent Hepatitis B, October 2001.
Centers for Disease Control and Prevention. Hepatitis B Virus: A Comprehensive strategy for Eliminating Transmission in the United States through Universal Childhood Vaccination. Recommendations of the Advisory Committee for Immunization Practices. MMWR, November 22, 1991, Vol.40 (RR-13) 1-17.
Centers for Disease Control and Prevention. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. Recommendations of the Immunization Practices Advisory Committee, Part II: Immunization of Adults. MMWR, December 8, 2006, Vol. 55 (RR-16); 5-13.

7. Hepatitis Hepatitis B Vaccination In STD, HIV and Family Planning Clinics 6 Guidelines for Public Health 6/2008

Georgia Immunization Program Manual
TABLE OF CONTENTS

Division Of Public Health

8. RECALL OF PATIENTS Recall of Immunization Patients Policy Statement (REPLACE) Immunization Documentation, "Moved or Gone Elsewhere" (MOGE) Categories (REPLACE)

Table of Contents 11/2009

Immunization Program Manual

GA Immunization Program

RECALL OF IMMUNIZATION PATIENTS POLICY STATEMENT
One of the national objectives recommended in the Health and Human Services document, Healthy People 2010, calls for the completion of primary immunizations for 90% of newborn children by the time they reach two years of age. This goal is endorsed by the Georgia Immunization Program and is one of the reasons that efforts to recall children for needed immunizations is so important.
In late 1985 and early 1986, the Immunization Program reviewed the immunization status for 2,858 children whose records were found in health departments in five (5) districts. Only 32% of those children had completed primary immunizations before age two (2) years. That level increased to 55% statewide by the end of 1989 and to 93.82% by the end of 1999. Although the adequate rates for children receiving immunizations in public health clinics has steadily risen, the number of children receiving their immunizations in public health clinics has decreased. In 199899, approximately 50% of immunizations were given by private providers, and in 2007, they gave more than 80% of the childhood immunizations. Therefore, the adequate rates for two year old children attending public health clinics is not indicative of the status for the majority of Georgia's two year old children. In order to attain and maintain 90% immunization levels for all two year olds in a community, each health unit should address five (5) issues:
1. Due to the increase in the administration of immunizations by private providers, it is important that public health ensure high levels of immunizations are maintained in each community regardless of who is providing immunization delivery services. Every effort should be made to educate and collaborate with other health providers in the community to assist them in their immunization service delivery.
2. Health districts are responsible for conducting an annual population based study to determine the immunization level of all two year old children born in Georgia. The State Immunization and Epidemiology Programs will provide annual training and instruction for conducting the population-based study.
3. All children brought to health department facilities for any reason should be screened for immunization history and served as necessary. Children attending specifically for immunizations should be screened for other health care needs and served as necessary.
4. Districts should utilize Clinical Assessment Software Application (CASA) which is provided free of charge by CDC/National Immunization Program to measure the progress of its patients toward completion of primary immunizations and to identify problems. The Georgia Immunization Program will conduct at least one annual CASA audit for each health district and will provide training in the use of this software application. As part of this application, categories for documenting that a child has moved or gone elsewhere for services (MOGE) were developed by the Immunization Coordinator's Advisory Committee. To provide consistency in measurement procedures, districts should utilize the categories for MOGE documentation. (See next page)
5. Each health department unit must devise and implement a system(s), which encourages compliance with the recommended schedules and allows for active recall of delinquent patients.

8. Recall Of Patients 11/2009

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Recall of Immunization Patients Policy Statement

GA Immunization Program Manual

Division of Public Health

Acceptable "MMMooovvveeddedoorroGGroonnGeeoEEnllsseeewwEhhlseerreeew((MMhOOeGGreEE")) CC(MrriitteeOrriiGaa E) Categories

An annual assessment is conducted to determine the immunization coverage levels of children 24-35 months of age in public health departments. This assessment is also conducted in private provider sites bi-annually. The Comprehensive Clinical Assessment Software Application (CoCASA) is used to assist in conducting this assessment. Moved or Gone Elsewhere (MOGE) is a process that is used in CoCASA to filter out patients that are no longer associated with the facility being assessed. By removing these patients, immunization practices may be assessed more accurately.
Clients should not be placed into a MOGE category only to improve immunization coverage rates. It is important that every effort is made to accurately identify the status of inactive children. Moved or Gone Elsewhere (MOGE) status is assigned when one of the following has occurred:
a Patient has moved out of the immediate area a Patient has gone to another practice a Patient has moved with no forwarding address a Patient has died a Patient has a medical exemption issued by a physician a Patient has a signed and notarized religious exemption
With the exception of patients that have died, or who have a medical or religious exemption, all patients assigned the status of MOGE must have documentation to show that at least 3 attempts were made to contact the patient. Once the status of the patient is identified, no further attempts are required. Acceptable documentation includes:
1. The family, a neighbor, the WIC Program, Post Office, DFACS, etc. has notified the clinic, either in writing or by phone, that the client has moved out of the area.
2. School, day care, Headstart, employer, etc., state that the family has moved out of the area.
3. Client reports that immunizations are being received from a private physician or other health care provider. Patient is identified in GRITS and is receiving immunizations from another provider.
4. The provider receives a request for client's records to be transferred out of state.
5. The provider receives a returned post card or letter, which has been stamped or documented as "Moved, left no forwarding address."
6. A home visit was made and there is confirmation that the client no longer resides at that location. Confirmation means that someone else is now residing at that address, or the manager of the development confirms they have moved. A person refusing to answer the door on a visit does not confirm the client no longer lives at that address.
7. Historical data is recorded for WIC certification and the patient is receiving immunizations from another provider.

8. Informed Request Policy - 11/2009

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Immunization Documentation, "Moved or Gone Elsewhere" (MOGE) Categories

GA Immunization Program Manual

Division of Public Health

Acceptable "Moved or Gone Elsewhere" (MOGE) Categories

8. Vital records birth certificate data was uploaded to the VEIS (Vital Events Information System) and the child has not received immunization services within 6 months of birth. Prior to MOGEing the child, please look the child up in GRITS. If the child's medical home is identified in GRITS, no further documentation is needed to MOGE. If the child's medical home can't be identified in GRITS, please make two additional attempts to contact.

8. Informed Request Policy - 11/2009

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Immunization Documentation, "Moved or Gone Elsewhere" (MOGE) Categories

Georgia Immunization Program Manual
TABLE OF CONTENTS

Division Of Public Health

9. VACCINE DISTRIBUTION AND STORAGE Distribution of Vaccines (REPLACE) Temperature Log Sheet Provider Agreement For Public Health Providers Provider Agreement Policy For Public Health Providers Fraud and Abuse Policy Vaccine Loss Policy For Public Health Providers Handling Of Vaccine During Inclement Weather Conditions (REPLACE) Temperature Conversion Chart Vaccine Management (Recommendations for Handling & Storage of Selected Biologicals, April 2009) (REPLACE) Chart of Refrigerated /Frozen Pack Needs Maintaining the Cold Chain during Transport Guidelines for Returning Vaccine Products to the Manufacturer for Disposal (Replace with Guidelines for Returning State or Public Health District Purchased Outdated, Deteriorated, Returned and Recalled Drugs) (and can be located in the Public Health Nurse Protocol Manual Drug Dispensing Procedure, Section D under Outdated, Deteriorated, Returned and Recalled Drugs at http://health.state.ga.us/pdfs/nursing/Protocol%20Manual/04.0%20Drug%20Dispensing%20Procedure.pdf) Form for Return of Outdated, Unused or Overstocked Drugs (REPLACE with McKesson Return of Federal Vaccine Form) Vaccine Storage and Handling Toolkit, Chapter 9 --- Vaccine Shipments (REMOVE) Title X Unaccompanied Minor without Insurance Information VFC Vaccine Log (REPLACE) Centralized Distribution Information and Instruction for VFC Providers (ADD)

Table of Contents 03/2010

Georgia Immunization Program Manual

Division Of Public Health

DISTRIBUTION OF VACCINES
1. The State Immunization Program will utilize comprehensive reports, submitted by individual clinics each month to evaluate current vaccine inventory and historical usage. Shipments of vaccines, sufficient to bring vaccine inventories to the level of a three-month supply, will be made if vaccine is available.
2. Comprehensive reports are to be submitted monthly via GRITS.
3. All vaccine shipments will be sent directly to Clinic/County offices.
4. Vaccines lost to expiration or to spoilage MUST be reported monthly to the State Immunization Program on the Comprehensive Report Form. This form is not available through Central Supply. It is generated through GRITS prepopulated with specific clinic contact information. For all other pharmaceuticals, the "For Return of Outdated, Unused, or Overstocked Drugs" form found in this section should be used. The Vaccine Wastage Log should no longer be used.
5. State supplied vaccines lost due to expiration or spoilage must be returned to McKesson. Instructions are available on the GRITS home page under the "Additional Resources" section. Enclosed guidelines for returning vaccine products to the manufacturer are applicable for locally purchased vaccine only.
6. When the state level supplies are diminished due to unavailability, standard quantities of vaccine to be shipped will be decreased by a reasonable proportion. When vaccine stocks are plentiful, shipments will be increased proportionately to return local inventory to appropriate levels.
7. When shortages occur at the state level, it may be necessary to move vaccine within the district. It also may be necessary to move vaccine from one district to another. It is the responsibility of the Immunization Program to evaluate total state needs and authorize movement of vaccine when necessary.
8. Details of all vaccine transfers must be reported to the state office via email at gavfc@dhr.state.ga.us. The following information must be included in the email: date of transfer, GIP ID numbers for sending and receiving sites, vaccine name, lot number, expiration date, and number of doses.
Each facility that stores vaccine must have AST or NIST-certified thermometers in both the refrigerator section and in the freezer section of the unit used for vaccine storage. Temperature readings must be taken and recorded twice daily; once in the morning and once in the evening. (See sample temperature log). If temperatures fall outside the acceptable range, the cause must be determined and corrected immediately. Failure to have thermometers and to record temperatures will jeopardize your status to receive vaccine and may result in counties/districts having to purchase replacement vaccine.
Each facility that stores vaccine must have adequate storage to assure vaccine integrity. Dormitory type refrigerators are not acceptable. Routinely placing vaccine in portable coolers during the clinic day is also unacceptable. Refrigerators must have externally separately sealed doors for the refrigerator and freezer compartments. Dual thermostats/temperature controls for each compartment are also strongly required. An emergency plan must be developed by each facility for handling vaccine storage in the event of a power outage. This plan must be reviewed and updated annually, at minimum, to determine if all parties listed in the plan are aware of their responsibilities.
Providers are encouraged to visit the CDC's storage and handling toolkit for additional resources at http://www2a.cdc.gov/vaccines/ed/shtoolkit/

9. Vaccine Distribution and Storage 11/2009

1

Distribution Of Vaccines

Document temperatures twice daily, and keep temp logs on file for at least 3 years!

Fahrenheit (oF)Temperature Log

MONTH/YEAR:____________________________________

REFRIGERATOR

Day of Time
Month

Staff Initials

35-46 oF
>49 48 47 46 45 44 43 42 41 40 39 38 37 36 35 34 33 <32

FREEZER < 5 oF
>8 7 6 5 4 <3

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Instructions: Place an "X" in the box that corresponds with the temperature (columns), day of the month, and am or pm (rows) for

your temperature check. Then enter your initials and the time you monitored the temperature in the appropriate boxes.

If the temperature is in the gray range:

1. Store the vaccine under proper conditions as quickly as possible-do not discard.

2. Call the Georgia Immunization Program at (404)657-5013 or the vaccine manufacturers to determine whether the potency of the

vaccine has been affected.

3. Document action taken on Page 2 of this log.

SEE REVERSE SIDE FOR DOCUMENTATION

12/20/04

TEMPERATURE DOCUMENTATION FOR EQUIPMENT PROBLEMS

When temperatures are outside the acceptable ranges, please consult with vaccine manufacturers or the Georgia VFC Program at (404) 657-5013 to determine appropriate actions to take. Common actions are:

1. Move vaccines and other biologicals to other controlled storage 2. Notify supervisor 3. Attempt to adjust thermostat of suspect storage unit

DATE TIME TEMP.

PROBLEM

4. Check condition of storage unit (i.e.,electricity supply, seals, lint on coils) 5. Recheck the temperature in two hours 6. Call Maintenance if problem persists

ACTION TAKEN

RESULTS

INITIAL

Form 3185 DPH (2/2005)

Document temperatures twice daily, and keep temp logs on file for at least 3 years!

Celsius (oC)Temperature Log

MONTH/YEAR:_______________________________

REFRIGERATOR 2-8 oC

FREEZER < -15 oC

ROOM

Day of Time Month

Staff Initials

>11 10 9 8 7 6 5 4 3 2 1 0 <-1 >-12 -13 -14 -15 -16 -17 -18 -19 <-20

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Instructions: Place an "X" in the box that corresponds with the temperature (columns), day of the month, and am or pm

(rows) for your temperature check. Then enter your initials and the time you monitored the temperature in the appropriate boxes.

TEMP

If the temperature is in the gray range:

1. Store the vaccine under proper conditions as quickly as possible - do not discard.

2. Call the Georgia Immunization Program at (404)657-5013 or the vaccine manufacturers to determine whether the

potency of the vaccine has been affected and

3. Document action taken on Page 2 of this log.

SEE REVERSE SIDE FOR DOCUMENTATION

12/20/2004

TEMPERATURE DOCUMENTATION FOR EQUIPMENT PROBLEMS

When temperatures are outside the acceptable ranges, please consult with vaccine manufacturers or the Georgia VFC Program at (404) 657-5013 to determine appropriate actions to take. Common actions are:

1. Move vaccines and other biologicals to other controlled storage 2. Notify supervisor 3. Attempt to adjust thermostat of suspect storage unit

DATE TIME TEMP.

PROBLEM

4. Check condition of storage unit (i.e.,electricity supply, seals, lint on coils) 5. Recheck the temperature in two hours 6. Call Maintenance if problem persists

ACTION TAKEN

RESULTS

INITIAL

Form 3185 DPH (2/2005)

Provider Agreement For Public Health Providers
Georgia Immunization Program (GIP)
In order to receive state or federally funded vaccine at no cost from GIP, each clinic site must agree to the following conditions which are further defined in the enclosed Provider Agreement Policy document:

1. I agree that vaccine supplied by GIP will be administered only to a child 18 years of age who: (a) is on Medicaid (or qualifies through a Medicaid waiver), or (b) has no health insurance, or (c) who is an American Indian or Alaskan native, or (d) has health insurance that does not pay for the vaccine, or (e) has insurance through PeachCare for Kids; or is deemed otherwise eligible for state supplied vaccine in public health departments.
2. I agree that state supplied vaccine will be administered only to those adults who are designated in the GIP's Adult Immunization Guidelines.
3. I will maintain Patient Eligibility Screening Records for a period of three years. If requested, I will make such records available to the Georgia Department of Human Resources (DHR), Division of Public Heath (DPH) or the United States Department of Health and Human Services (DHHS).
4. All clinic sites within my district will participate in a Quality Assurance Site Visit conducted yearly by an Immunization Program Consultant.
5. I will participate in the yearly assessment of immunization levels of each clinic site where childhood immunizations are administered in my district using the Comprehensive Clinical Assessment Software Application (CoCASA).
6. I will comply with the appropriate immunization schedule, dosage and contraindications that are established by the DHHS Advisory Committee on Immunization Practices, unless (a) in making a medical judgment in accordance with accepted medical practice, I deem such compliance to be medically inappropriate, or (b) the particular requirement is not in compliance with state laws, including laws relating to religious or other exemptions.
7. I will provide Vaccine Information Statements and maintain records in accordance with the National Childhood Vaccine Injury Act (NCVIA), which includes reporting clinically significant adverse events to the Vaccine Adverse Event Reporting Sytem (VAERS).
8. I will not impose a charge for the cost of any state supplied vaccine. 9. I will not impose a charge to the patient for administration of any vaccine purchased by the state in any
amount higher than the current state fee cap of $14.81 per injection. (Your clinics may charge less than $14.81 per injection.) 10. I will not deny administration of a state supplied vaccine to any eligible client due to the inability of the client or child's parent/guardian/individual of record to pay an administration fee. 11. I will comply with the DHR, DPH's requirements for ordering vaccine, for reporting vaccine usage, spoilage, expiration, physical inventories, and all other requirements as outlined on the monthly reporting forms. 12. I am not prohibited by Georgia law or any other applicable law from possessing dangerous drugs (i.e., vaccines). See Official Code of Georgia Annotated, Title 16, Chapter 13; Title 26, Chapter 4; Title 43, Chapter 34. 13. I will accept the responsibility to maintain the integrity of the drugs (i.e., vaccines) in accordance with all laws, regulations, and GIP recommendations pertaining to vaccine storage and handling procedures. 14. I will complete and submit the annual Provider Profile Update within 3- days of receipt to the VFC office. I understand that not submitting this update can lead to suspension of vaccine shipments 15. I understand that this agreement may be terminated by either party at any time for any reason. DHR has the discretion to terminate this agreement for failure of the provider to comply with all requirements. A written notice will be provided by the party initiating termination 30 calendar days prior to such termination.

Clinic Name

Mailing Address

Street Address and/or P.O. Box Number

City

State

Zip Code

Enrollment cannot be processed without completion of the signature page on the reverse side of this Provider Agreement.

Revised 08

Provider Agreement
(continued)
This agreement must be signed by the County Nurse Manager. Also, in order to prevent fraud, abuse, and for other related purposes, a copy of the professional license of the individual listed below must be submitted with this enrollment package.
By signing below, I agree to follow the 15 conditions listed on the reverse side of this Provider Agreement. Failure to abide by any of these conditions may result in termination of enrollment in GIP and applicable professional license review.

Name (Please print or type)

Title

Signature

Date

Revised 08

Georgia Immunization Program (GIP) Provider Agreement Policy for Public Health Providers
This document is the Georgia Department of Human Resources, Division of Public Health, Immunization Program's policy for program compliance. Noncompliance is defined as any intentional deviation from the signed Provider Agreement with the GIP. Each enrolled County Nurse Manager must sign a Provider Agreement stating that he/she agrees to the following conditions:
Provider Requirements
1. I agree that vaccine supplied by GIP will be administered only to a child 18 years of age who: a) Is on Medicaid (or qualifies through a Medicaid waiver). b) Has no health insurance (uninsured). c) Is American Indian or an Alaska Native. d) Has health insurance that does not pay for the vaccine (underinsured). e) Has insurance through PeachCare for Kids. f) Is deemed otherwise eligible for state supplied vaccine in public health departments.
Definitions for Vaccines for Children (VFC) eligible children: a) Medicaid has a current Medicaid card or Medicaid waiver at the time of service. b) Uninsured - has no health insurance. c) American Indian/Alaska Native self-reported by the patient. d) Underinsured - has insurance but vaccines are not a covered benefit.
Example: An insurance company may not cover certain immunizations, such as the Pneumococcal Conjugate vaccine. The child will qualify for VFC for that particular vaccine.
Example: An insurance company may cover immunizations up to a certain age. Until that age, the child is fully insured. After that age, the child is considered underinsured (has insurance but vaccines are not a covered benefit) and is then eligible to receive VFC vaccine.
Example: An insurance company may only provide $100.00 per year to cover the costs of immunizations. The child is fully insured up to $100.00. Once this amount is exhausted, the child is then eligible to receive VFC vaccine.
e) PeachCare for Kids has a current PeachCare for Kids card at the time of service.

1

Revised 08

Program Violations (examples should not be considered all-inclusive) a) A provider administers state supplied vaccine, then bills the recipient's insurance
for the cost of the vaccine. b) A provider charges the patient for the cost of the vaccine. c) A provider charges a Medicaid recipient any fee at all. d) A provider fails to purchase private stock vaccine for patients who are ineligible
for state supplied vaccine, and gives every patient seen in the clinic statesupplied vaccine, whether they are eligible or not. e) A provider administers state supplied vaccine to a child who has private insurance with a high deductible.
Example: Parent has a policy with a $1,000.00 deductible. The child is still considered fully insured and privately purchased vaccine should be administered.
f) A provider `borrows' VFC vaccine to administer to a privately insured patient. Providers are required to purchase vaccine for non VFC-eligible patients. "Borrowing" may only occur in rare situations (ex. delayed vaccine shipment, or vaccine damaged in transit). When borrowing occurs, provider must repay VFC as soon as possible, then complete and submit Vaccine Borrowing Report with the monthly paperwork. (See VFC Vaccine Borrowing Report, attached.)
Actions a) Educational training and follow-up visits will be conducted by a GIP
Representative. b) Vaccine shipments will be suspended until state supplied vaccine is replaced by
the provider. See Appendix A, Georgia Immunization Program (GIP) Vaccine Loss Policy. c) Excessive violations will result in a provider's ineligibility to receive state supplied vaccine.
2. I agree that state supplied vaccine will only be administered to those adults who are designated in the GIP's Adult Immunization Guidelines.
Program Violations (examples should not be considered all-inclusive) a) A provider administers vaccine to patients who are > 18 years of age
and not listed on the GIP's Adult Immunization Guidelines. b) A provider discontinues purchasing vaccine for travel immunization clinics, and
gives every patient state supplied vaccine instead. c) A provider charges adults who are eligible for state supplied vaccine for the cost
of the vaccine. d) A provider charges a Medicaid recipient of state supplied vaccine any fee at all.

2

Revised 08

Actions a) Educational training and follow-up visits will be conducted by a GIP Representative. b) Vaccine shipments will be suspended until state supplied vaccine is replaced by
the Provider. See Appendix A, Georgia Immunization Program (GIP) Vaccine Loss Policy. c) Excessive violations will result in a provider's ineligibility to receive state supplied vaccine.
3. I will maintain Patient Eligibility Screening Records for a period of three years. If requested, I will make such records available to the Georgia Department of Human Resources (DHR), Division of Public Health (DPH) or the United States Department of Health and Human Services (DHHS).
Program Violation Failure to maintain patient eligibility records for a period of three years.
Actions a) Educational training and follow-up visits will be conducted by a GIP
Representative. b) Excessive violations will result in a provider's ineligibility to receive state supplied
vaccine.
4. All clinic sites within my district will participate in a quality assurance site visit conducted yearly by an Immunization Program Consultant.
Program Violation Provider does not allow a site visit.
Actions a) If a site visit is not allowed within 60 calendar days of request, then vaccine shipments
may be suspended. b) Additional time may be allowed due to justifiable and extenuating circumstances.
5. I will participate in a yearly assessment of immunization levels of each clinic site where
childhood immunizations are administered in my district using the Comprehensive Clinical Assessment Software Application (CoCASA).
Program Violation Provider does not allow a CoCASA assessment.
Actions a) If a CoCASA assessment is not allowed within 60 calendar days of request, then
vaccine shipments may be suspended. b) Additional time may be allowed due to justifiable and extenuating circumstances.

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Revised 08

6. I will comply with the appropriate immunization schedule, dosage and contraindications that are established by the DHHS Advisory Committee on Immunization Practices (ACIP), unless (a) in making a medical judgment in accordance with accepted medical practice, I deem such compliance to be medically inappropriate, or (b) the particular requirement is not in compliance with state laws, including laws relating to religious or other exemptions.
Program Violations a) Inappropriate administration of vaccine.
Example: Mixing two vaccines in the same syringe (e.g., MMR and DTaP) for the purpose of reducing the number of injections needed.
Example: Administering pneumococcal conjugate vaccine to a 12 year old, when VFC guidelines allow for administration to children less than 5 years of age.
b) Non-compliance with ACIP recommendations for age and dose intervals. Example: Administering vaccines before the proper age (e.g., vaccinating a child with MMR and Varicella vaccine before the age of one year).
c) Provider fails to assess for immunization status and immunize children at the time they are seen. Example: Provider sees child for well-child visits but does not review immunization status and/or simply refers child to another facility for immunizations. Example: Provider sees child for sick visit but does not review immunization status to be administered once child is well.
Actions a) Mandatory participation in educational training provided by a GIP Representative. b) Excessive violations may result in suspension of vaccine shipments from GIP.
7. I will provide Vaccine Information Statements and maintain records in accordance with the National Childhood Vaccine Injury Act (NCVIA), which includes reporting clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS).
Program Violation Failure to provide and document distribution of current Vaccine Information Statements to patients.
Actions a) Educational training and follow-up visits will be conducted by a GIP
Representative. b) Excessive violations may result in suspension of vaccine shipments from GIP.

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Revised 08

8. I will not impose a charge for the cost of any state supplied vaccine.
Program Violation Imposing a charge for the cost of vaccine. Example: An office visit fee and administration fee can be charged to the patient,
but a fee cannot be charged for the cost of the vaccine.
Actions a) Educational training and follow-up visits will be conducted by a GIP
Representative. b) Excessive violations may result in suspension of vaccine shipments from GIP.
9. I will not impose a charge to the patient for administration of any vaccine purchased by
the state in any amount higher than the current state fee cap of $14.81 per injection. (Health departments may charge less than $14.81 per injection.)
Program Violation Imposing a charge greater than $14.81 per injection.
Actions a) Educational training and follow-up visits will be conducted by a GIP
Representative. b) Excessive violations may result in suspension of vaccine shipments from GIP.
10. I will not deny administration of a state supplied vaccine to any eligible client due to
the inability of the client or child's parent/guardian/individual of record to pay an administration fee.
Program Violations a) Denying vaccine to an adult who is eligible for state supplied vaccine due to inability to
pay the administration fee. b) Denying vaccine to a VFC eligible child due to inability to pay the administration fee. c) Denying a child/parent/guardian access to vaccine administration records due to
an outstanding bill on the part of the parent/guardian.
Actions a) Educational training and follow-up visits will be conducted by a GIP
Representative. b) Excessive violations may result in suspension of vaccine shipments from GIP.

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Revised 08

11. I will comply with the DHR, DPH's requirements for ordering vaccine, for reporting
vaccine usage, spoilage, expiration, physical inventories, and all other requirements as outlined on the monthly reporting forms.
Program Violation Failure to submit Comprehensive Report detailing vaccine usage, inventory, expiration, and spoilage on a monthly basis.
Actions a) Educational training and follow-up visits will be conducted by a GIP
Representative. b) Excessive non-reporting of vaccine usage, inventory, expired, spoiled and
returned vaccine may result in suspension of vaccine shipments from GIP. See Appendix A, Georgia Immunization Program (GIP) Vaccine Loss Policy.
12. I am not prohibited by Georgia law or any other applicable law from possessing dangerous drugs (i.e., vaccines). See Official Code of Georgia Annotated, Title 16, Chapter 13; Title 26, Chapter 4; Title 43, Chapter 34.
Program Violations a) Drug Enforcement Agency number has been revoked. b) License to practice medicine has been revoked, suspended, or annulled.
Action Immediate suspension of vaccine shipments from GIP.
13. I will accept the responsibility to maintain the integrity of the drugs (i.e., vaccines) in
accordance with all laws, regulations, and GIP recommendations pertaining to vaccine storage and handling procedures.
Program Violations a) Failure to properly store vaccine in accordance with the Centers for Disease
Control (CDC) guidelines. b) Failure to complete and utilize the Vaccine Disaster Recovery Plan. c) Failure to identify a primary and backup staff member responsible for vaccine
storage and handling. d) Failure to document temperatures twice daily.
Actions a) Educational training and follow-up visits will be conducted by GIP
Representatives. b) Vaccine replacement by provider. See Appendix A, Georgia Immunization
Program (GIP) Vaccine Loss Policy for Public Health Providers.

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14. I will complete and submit the annual Provider Profile Update within 30 days of receipt to the VFC office. I understand that not submitting this update can lead to suspension of vaccine shipments.
15. I understand that this agreement may be terminated by either party at any time for anyreason. DHR has the discretion to terminate this agreement for failure of the provider to comply with all requirements. a) Termination by either party must be in writing, at least 30 calendar days prior to termination. b) If I am terminating the agreement, I will notify GIP for vaccine pickup. c) If DHR is terminating the agreement, GIP staff will contact the provider to arrange for vaccine pickup.

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Georgia Vaccines for Children (VFC) Program Fraud and Abuse Policy
I. Background
The purpose of this policy is to provide programmatic direction for the prevention of fraud and abuse in the utilization of state-supplied and/or Vaccines for Children (VFC)funded vaccine. The Georgia Immunization Program (GIP) is required by federal granting authorities to implement VFC fraud and abuse prevention policies.
Vaccine supplied through GIP is funded through several state and federal sources. For simplification purposes, those funding sources can be divided into two primary groups: VFC and non-VFC funds. VFC funds may be used to purchase vaccine for children and adolescents who are birth through 18 years of age (less than 19), and who are:
Medicaid eligible Uninsured (have no health insurance) American Indian/Alaska Native Underinsured (have health insurance that does not pay for vaccinations), seen in
Federally Qualified Health Centers (FQHC) or Rural Health Centers (RHC)
Non-VFC funds are utilized to purchase vaccines for children and adolescents who are birth through 18 years of age (less than 19), and who are:
Underinsured, seen in their medical home PeachCare for Kids eligible
Given the vaccine usage constraints relative to vaccine funding, Georgia VFC-enrolled providers must ensure they are not misusing GIP-supplied vaccine. In order to accomplish this, providers must only give GIP-supplied vaccine to the aforementioned categories of adolescents and children. Misuse of VFC-funded vaccine may result in civil and/or criminal penalties if fraud and abuse were to occur.
The Fraud and Abuse Policy will be reviewed annually and updated if necessary. Training on fraud and abuse will take place as part of new employee orientation. Additionally, program staff (VFC staff and Immunization Program Consultants (IPCs)) will undergo annual updates, led by the Vaccine Manager.
II. Definitions
Fraud is defined by Medicaid as "an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person."
Abuse is defined by Medicaid as "provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in an unnecessary cost to the Medicaid

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program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care..."
Examples of fraud include, but are not limited to: Providing VFC vaccine to non VFC-eligible children; Selling or otherwise misdirecting VFC vaccine; Billing a patient or third party for VFC vaccine; Charging more than the established maximum regional charge ($14.81) for administration of a VFC vaccine to a federally vaccine-eligible child; Not providing VFC-eligible children VFC vaccine because of parents' inability to pay for the administration fee; Not implementing provider enrollment requirements of the VFC program; Failing to screen patients for VFC eligibility at every visit; Failing to maintain VFC records for a minimum of three (3) years or comply with other requirements of the VFC program; Failing to fully account for VFC vaccine through required monthly reporting of doses administered, doses wasted, and inventory on hand; Failing to properly store and handle VFC vaccine; Ordering VFC vaccine or reporting vaccine usage in quantities or patterns that do not match provider profile or otherwise involve over-ordering of VFC doses; Wastage of VFC vaccine due to negligence.
III. Compliance Assessment
In order to receive vaccine from Georgia's VFC program, VFC-enrolled providers must comply with reporting requirements for vaccine usage (including doses administered by eligibility category), wastage, and inventory. Every vaccine order submitted is compared to the most recent provider profile calculated by GIP and approved by the provider. The provider profile is an estimate of the number and category of VFC-eligible children the provider expects to see in a given year. These estimates are entered into the Centers for Disease Control and Prevention (CDC) - developed Vaccine Management System (VACMAN).
Aggregate vaccine orders exceeding annual profile data are identified by VACMAN. GIP staff contact providers that exceed profile amounts to determine if distribution of additional vaccine is justified, or if adjustments to the profile are needed.
Upon enrollment and at the time of the annual provider profile update, provider information is cross-checked against the List of Excluded Individuals/Entities on the Department of Health and Human Services (HHS) Office of Inspector General website. If located in the Exclusion database, providers are not allowed to participate in VFC.
VFC Program staff has been trained to routinely review monthly comprehensive reports for excessive use, underreporting, and anything that may look out of the ordinary. In addition, IPCs are required to review with the provider a vaccine accountability statement representative of at least six (6) months, which can help identify areas of potential fraud

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and/or abuse. Vaccine over- and under-reporting will be reviewed with provider, and unexplained amounts above the 5% allowance will be reported to the Vaccine Manager, who will respond accordingly.
VFC fraud or abuse determination is not a responsibility of GIP. However, GIP is required to report suspected VFC fraud and abuse to state and federal authorities. Unjustified, excessive, and/or repeated discrepancies between provider profile data, vaccine orders, and vaccine usage will be referred for further investigation as is required of the program.
IV. Referrals
At the Georgia Immunization Program, the Vaccine Manager is the person with primary responsibility for responding to suspected fraud and/or abuse. The Vaccine Manager will have authority to make decisions, referrals, and notification when appropriate. In the event that the Vaccine Manager is not available, the VFC Coordinator will assume responsibility. In the event that neither of these individuals is available, the Program Director will assume responsibility.
Should any individual, group, or practice want to report a suspected case of fraud and/or abuse, a dedicated Fraud and Abuse Hotline is being implemented. When the Hotline becomes operational, information will be communicated widely. Until then, all suspected cases may be reported directly to the Vaccine Manager, who can be reached via the VFC office. VFC numbers are (404) 657-5013 or outside Metro Atlanta (800) 848-3868. Referrals will include, as available or applicable:
a. Provider name and address; b. A description of the reason for the referral; c. If the referral was initiated in response to a complaint, a copy and/or
summary of the complaint and the complainant's name, address and telephone number, if available; and d. A summary of the result of any preliminary investigation conducted by GIP staff regarding allegations or suspicions of fraud or abuse.
Once a report is received, it will be reviewed for appropriate action. For example, if an employee from a practice calls to report that the practice is failing to properly store vaccine, the IPC assigned to the provider will be notified that a storage and handling visit needs to be made. It is expected that the IPC will take steps to resolve the issue, which may involve suspending vaccine shipment until the situation is resolved. In a second example where an IPC discovers that a provider is billing Medicaid inappropriately (inaccurate services, ineligible clients, etc.), then GIP will notify the Division of Program Integrity within five (5) business days.
When appropriate, GIP will refer suspected cases of fraud or abuse in writing (email acceptable) within five (5) business days of notification to the Division of Program Integrity, located in the Office of the General Counsel in the Department of Community Health (DCH) - Program Integrity. Notification will be made via DCH, Health

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Improvement and Wellness Specialist and/or Health Improvement and Wellness Director. GIP will also make notification of such referral action to the CDC, who may in turn notify the Centers for Medicare and Medicaid Services (CMS). Program Integrity will investigate complaints and refer, as needed, cases of fraud and abuse to the Office of the State Inspector General, Insurance and Safety Fire Commissioner, or to the Office of the Attorney General of Georgia.
V. Resolution
Determination of fraud or abuse is made by Program Integrity. Providers identified by Program Integrity to be engaged in VFC fraud or abuse will be inactivated (suspended) from the VFC program. Reinstatement to the VFC program will be contingent on the outcome of proceedings conducted by the Office of the Inspector General or the Attorney General's Office. Final resolution may include the following (not all-inclusive) interventions: remedial education, recoupment of funds, reinstatement without penalty, or referral for criminal prosecution or civil resolution.
Providers who have been cleared of suspected fraud due to excusable lack of knowledge will be required to work with IPC staff to undergo corrective action training sessions prior to reinstatement to the program. Trainings may include Provider Refresher, Vaccine Storage and Handling, and Vaccine Administration. IPC will be required to document all steps taken and will have authority to reinstate provider as active, which will then be verified by the Vaccine Manager. In all cases, provider will be required to submit a corrective action plan in which the practice will be expected to outline how to avoid a similar situation in the future.
In those instances that provider activities do not involve Medicaid or billing agencies, GIP will work with provider directly within the VFC policy guidelines. This may include requiring education, suspending vaccine shipments until corrective actions are taken, or termination from the VFC program. In any event that a provider's activities violate Medicaid requirements, the abovementioned notification steps will be taken to inform Program Integrity.

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APPENDIX A
Georgia Immunization Program (GIP) Vaccine Loss Policy for Public Health Providers
This document will serve as the Georgia Department of Human Resources, Division of Public Health, Immunization Program's policy for management of incidents that result in loss of state supplied vaccine. The action taken by the Georgia Immunization Program (GIP) will depend on the category of the vaccine loss. For this policy, lost vaccines fall under three categories: 1) negligence, 2) nonpreventable loss, and 3) noncompliance.
Category 1
Vaccine loss due to negligence is defined as, but not limited to, the following: a) Vaccine is stored improperly (i.e., refrigerating vaccine that should have been frozen, or freezing vaccine that should have been refrigerated). b) Vaccine is left out of the refrigerator or freezer. c) Refrigerator or freezer is unplugged. d) Door of the refrigerator or freezer is left ajar resulting in unit temperatures outside the acceptable range. e) Improper maintenance of recommended refrigerator and freezer temperatures resulting in vaccine spoilage, including prolonged storage of vaccines when out of range temperatures are recorded. (Note: Temperatures recorded on temperature logs will be considered official in making vaccine viability decisions. Also, a thermometer's margin of error will not be considered when temperatures are recorded at or below 32F/0C.) f) Predrawing or premixing vaccine, then not administering the vaccine. g) Discarding vaccine prior to the manufacturer's stated expiration date (e.g., discarding vaccine in a multi-dose vial 30 days after the vial is first used). h) Transporting/shipping vaccine with lack of or inappropriate coolants (e.g., packing refrigerated vaccines with dry ice or frozen vaccines with ice packs only). i) Failure to notify GIP when clinic hours change or the practice moves, resulting in vaccines being undeliverable and consequently spoiled. j) Vaccine expired due to the failure of the provider to notify GIP 3 months prior to the expiration date so that the vaccine might be transferred.
Action Plan The following incidents must be reported to GIP immediately upon being discovered by county staff member(s):
a) Vaccine not refrigerated or frozen within the recommended temperature range. b) Vaccine left outside the refrigerator or freezer; c) The refrigerator or freezer door is left ajar; d) Continued documentation of temperatures outside the recommended range; e) Vaccine is lost in transit to a satellite facility; or f) Vaccine is undeliverable and spoiled due to a change in office hours.

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APPENDIX A
Call 1-800-848-3868 and explain the circumstances to the customer service representative. Be prepared to furnish the following information:
a) Last known temperature of the refrigerator and freezer; b) Current temperature of the refrigerator and freezer; c) Duration of time the vaccines were stored outside the recommended temperature
range; and d) Lot numbers and expiration dates of all vaccines in question.
Vaccines should be kept in the appropriate storage environment (refrigerator or freezer) until a decision is made concerning their viability.
The GIP staff will contact the vaccine manufacturers and determine if the vaccines in question are salvageable. If they are not, the provider will be required to purchase replacement vaccines. This decision will be made by the Vaccine Manager based on past vaccine loss history and the number of vaccine doses lost. The provider will be required to replace VFC vaccine losses due to negligence when those losses are valued at more than 5 percent of the number of doses of state supplied vaccines available to be administered by the provider in the past 12 months. For example, state supplied MMR is shipped to a clinic site in the past 12 months totals 1,000 doses. A vaccine loss of 75 doses of MMR occurs. A 5% loss would equal 50 doses. In this case, the provider would be required to purchase and replace 25 doses of MMR to be administered to clients eligible for state supplied vaccine.
When replacement of lost vaccine is required: a) The provider must mail or fax invoices for replacement vaccine to the Vaccine Manager within 10 calendar days; b) The assigned Immunization Program Consultant will verify, by site visit, the replacement of the lost vaccines within 30 calendar days of the incident; c) The provider will submit to the Vaccine Manager a description of the incident in writing within 10 calendar days that discusses the circumstances of the loss and the steps taken to ensure that vaccine is protected in the future; and d) A follow up visit will be conducted by the assigned Immunization Program Consultant within 6 months of the incident to monitor vaccine storage and handling policies.
When replacement of vaccine is not required: a) The provider will submit a letter to the GIP Vaccine Manager describing the incident within 10 calendar days that discusses the circumstances of the loss and the steps taken to ensure that vaccine is protected in the future; b) Vaccine shipments will be resumed upon receipt of the aforementioned letter.
Any vaccine that is deemed not usable due to negligent circumstances must be returned to the DHR Pharmacy at 146-B Memorial Drive, Atlanta, GA 30303, at the provider's expense.

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APPENDIX A

Category 2
Vaccine loss due to nonpreventable circumstances, such as: a) Area power outages due to severe weather or other unavoidable and unanticipated causes; b) Refrigerator failure; or c) Transport company error (i.e., FedEx or Drug Transport, Inc.). Failure of the provider to notify GIP of a change in any clinic's office hours or address will not be considered a transport company error.
Action Plan If the provider discovers a power outage has occurred or that the refrigerator storing vaccines has malfunctioned, then GIP should be notified immediately by calling 1-800-8483868. The provider should be prepared to supply the following information to the GIP staff:
a) Last known temperature of the refrigerator and freezer; b) Current temperature of the refrigerator and freezer; c) Duration of time the vaccines were stored outside the recommended temperature
range; and d) Lot numbers and expiration dates of the vaccines in question.
Vaccines should be kept in the appropriate storage environment (refrigerator or freezer) until a decision is made concerning their viability.
The GIP staff will contact the vaccine manufacturers and determine the status of the vaccines. If the vaccines are determined to be viable, but the power to the office has not been restored or the refrigerator is still in disrepair, then the provider should enact their Vaccine Disaster Recovery Plan. Vaccines must be transported immediately to an alternate refrigerator/freezer. If no plan is in place, then the GIP staff member will assist the provider in determining a plan of action.
If the vaccines in question are not salvageable, then GIP will advise the provider concerning disposal or return of the spoiled vaccines. As soon as power is restored or a replacement refrigerator is acquired, the clinic staff should monitor and document temperatures of the refrigerator and freezer for 5 days. If adequate temperatures are maintained, then replacement vaccines will be shipped to the provider from GIP.
Category 3
Vaccine loss due to noncompliance with GIP written policies, such as: a) State supplied vaccine is not accounted for by doses administered and inventory reports. This can be reflected by usage data or inventory discrepancies that reflect lost vaccine supply. Examples include the following: Failure to document doses administered in provider clinical information systems; Failure to submit to GIP usage/doses administered reports as required; Failure to document patient eligibility in provider clinical information systems; Failure to report inventory; Inaccurate reporting of inventory; or Failure to report expired/wasted vaccine.

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APPENDIX A

b) State supplied vaccine is knowingly administered to clients who are not eligible for the free vaccine, including the following: Administration of state supplied vaccine to patients who are over 18 years of age and not listed as eligible in the Adult Immunization Guidelines; Administration of state supplied vaccine in travel or refugee clinics (i.e., a provider fails to purchase private stocks of vaccine for administration to patients for whom the cost of the vaccine would be reimbursed by the Refugee Health Program).
c) Accepting reimbursement from insurance companies or patients for state supplied vaccine as evidenced by: Administering state supplied vaccine to a child and subsequently billing the child's insurance for the cost of the vaccine; Charging the patient for the cost of the vaccine; or Charging a Medicaid recipient any fee at all.
Action Plan If a provider is found to be in violation of written GIP policies, then the action taken will depend upon the policy violated, as follows:
a) Vaccine is unaccounted for in doses administered reports: Vaccine usage and inventory must be reported to GIP. Vaccine accountability statements will be processed by GIP. These accountability statements detail vaccine loss over a defined period. If accountability statements indicate unaccounted for state supplied vaccine in excess of 5% for any vaccine for any 3-month reporting period: 1. The assigned Immunization Program Consultant will be informed; and 2. A site visit will be conducted before the next reporting period to investigate possible reasons for the vaccine inventory discrepancies; and Future vaccine accountability statements must reflect 5% or less of vaccine loss. Possible consequences include, but are not restricted to: 1. A decrease in shipment of state supplied vaccine; or 2. Provider replacing unaccounted for vaccines exceeding 5% of the total number of doses of vaccine available to be administered within the provider in the past 12 months.
For example, if 10% of a provider's state supplied varicella vaccine is unaccounted for, then that provider may be asked to purchase 5% of the varicella lost as replacement vaccine. Or, future shipments of varicella will be decreased so that only the vaccine accounted for is replaced.
Decisions concerning the consequences of having unaccounted for vaccine will be made after receiving input from the Immunization Program Consultant, the Vaccine Manager and the Immunization Program Director.
b) State supplied vaccines are knowingly administered to clients who are ineligible.

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APPENDIX A
The Vaccine Manager will notify the provider by letter detailing the following: Name of the client vaccinated; Date the vaccine was given; Each vaccine that was administered; Deadline for replacement of the vaccine; Request for invoices for replacement vaccine; Request for an action plan to prevent further misuse of state supplied vaccine; and Notification of future chart reviews by assigned Immunization Program Consultant.
Upon receipt of written notification, any infractions or continued administration of state supplied vaccine to clients not eligible may result in suspended vaccine shipments from GIP.
c) Accepting reimbursement from insurance companies or patients for state supplied vaccine. Public health clinics found billing insurance companies or charging patients for state supplied vaccine will be notified of the infraction by letter from the Vaccine Manager. The letter will include the following: Name of the client vaccinated; Date the vaccine was given; Each vaccine that was administered and billed; Deadline for replacement of the vaccine; Request for invoices for replacement vaccine; Request for an action plan to prevent further fraudulent billing; and Notification of future chart reviews by assigned Immunization Program Consultant.
Continued acceptance of reimbursement from insurance companies or patients for state supplied vaccine after receiving notification by letter may result in suspended vaccine shipments from GIP.
Reports from outside sources of fraudulent use of state supplied vaccine will be referred to the assigned Immunization Program Consultant. The Immunization Program Consultant will conduct a site visit and chart review within 5 business days of the report. Findings will be reviewed with the provider and reported to the Vaccine Manager. Any action to be taken will be decided after receiving input from the Immunization Program Consultant, the Vaccine Manager and the Immunization Program Director.

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Immunization Program Manual

Division Of Public Health

Georgia Immunization Program Handling of Vaccine During Inclement Weather Conditions

To protect vaccine in storage and to minimize the potential monetary loss from inclement weather conditions such as tornadoes; hurricanes; and tropical, ice, snow, rain, lightening, or wind storms, etc., emergency procedures at both the depot and provider level should be implemented immediately. A part of this implementation should include communication to all providers who receive publicly purchased vaccines, or at least to those in the geographic areas of highest risk.

When the state/local officials or a provider has reasonable cause to believe that weather conditions have the potential to disrupt power and/or flood any office where vaccine is stored, emergency procedures should be implemented IN ADVANCE OF THE EVENT.

In advance of the emergency, all providers should ensure the following:

A. Identification of an alternative storage facility (hospital, packing plant, state depot, etc.), with back-up power (generator), where the vaccine can be properly stored and monitored for the duration of the storm (provider needs to ensure that the receiving site is able to store multiple sites, if they have signed agreements with multiple sites). A written agreement (updated annually) is strongly advised;

B. The availability of staff to pack and move the vaccine;

C. The use of appropriate packing containers, cold packs, and dry ice (for varicella vaccine); and

D. The transport of the vaccine to the secure storage facility.

It is appropriate for providers to suspend vaccinations before weather conditions deteriorate. Sufficient time must be allowed for packing and transporting vaccine BEFORE the storm can adversely affect local conditions.

There are other precautions and appropriate measures one can take to protect vaccine inventories using the emergency procedures described below. The following includes some HELPFUL HINTS AND REFERENCE INFORMATION.

EMERGENCY PROCEDURES

A. List emergency phone numbers, companies, and points of contact for: 1. Electrical power company: 2. Refrigeration repair company: 3. Temperature alarm monitoring company: 4. Perimeter alarm repair company: 5. Perimeter alarm monitoring company: 6. Backup storage facility:

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Georgia Immunization Program Handling of Vaccine During Inclement Weather Conditions
7. Transportation to backup storage: 8. Dry ice vendor: 9. Emergency generator repair company: 10. National Weather Service:
Satellite tracking of significant weather is also available at http://www.goes.noaa.gov/ . 11. Manufacturers: a. Merck Vaccines: 800-672-6372 b. Aventis Pasteur: 800-VACCINE (800-822-2463) c. GlaxoSmithKline: 800-366-8900 d. Wyeth Lederle Labs: 800-666-7248 e. Med Immune: 877-633-4411 f. Novartis: 800-244-7668
B. Providers may contact the Georgia Immunization Program (GIP) for assistance in identifying hospitals, health departments or other facilities that could serve as emergency vaccine storage facilities and communicate this information. This might also be done at the district or county level and/or with assistance from the Office of Emergency Preparedness. The GIP will prioritize assistance and communication to target providers in areas at highest risk, e.g., low lying coastal or floodplain areas.
C. Entering vaccine storage spaces: Describe, when necessary, how to enter the building and vaccine storage spaces in an emergency if closed or after hours. Include a floor diagram and the locations of: 1. Doors 2. Flash lights 3. Spare batteries 4. Light switches 5. Keys 6. Locks 7. Alarms 8. Circuit breakers 9. Packing materials
D. Identify whom to call for the following items: 1. Equipment problems 2. Backup storage 3. Backup transportation 4. Security

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Georgia Immunization Program Handling of Vaccine During Inclement Weather Conditions
E. Identify what vaccines to pack first in an emergency and while the power is still working: 1. Pack the refrigerated vaccines first with an adequate supply of cold packs. 2. Remove and pack the varicella vaccine, using dry ice, immediately prior to transport
F. Pack and transport all vaccine or if that is not possible, determine the types and amount to save; e.g., save only the most expensive vaccines to minimize dollar loss or save some portion of all vaccines to ensure a short-term, complete supply for resuming the vaccination schedule. Priority should be given to those vaccines which would be the most expensive to replace (pneumococcal conjugate, varicella, DTaP/HepB/IPV, Hep B/Hib, MMR).
G. Follow vaccine packing procedures for transport to backup storage facilities: 1. Open refrigerated units only when absolutely necessary and only after you have made all preparations for packing and moving the vaccine to alternative storage sites. 2. Use properly insulated containers. 3. Do not place vaccines that cannot be frozen directly against cold packs. (Note: MMR can be stored frozen or refrigerated.) 4. Follow vaccine handling guidelines. The following are important tips to remember:
--Varicella vaccine is fragile and should be used within 72 hours of placing on wet ice or in a refrigerated environment.
--MMR vaccine can be refrigerated or frozen, but should be kept out of direct light.
--All other vaccines should be maintained at refrigerator temperature.
H. Move vaccine to backup storage according to pre-arranged plans. Pre-arranged plans should take into consideration the following:
1. How to load the transportation vehicle 2. Routes to take 3. Time enroute 4. Temperature monitoring (maintenance of temperature log with temperatures
checked twice daily) while vaccine is in backup storage
I. On returning inventory to the clinic/practice/pharmacy, vaccines should be checked carefully and placed in the appropriate refrigerator or freezer compartments. If the provider is not able to assure viability, GIP should be contacted before using any vaccines that may not be effective for protecting children and/or adults against disease.

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Fahrenheit to Celsius and Celsius to Fahrenheit Conversion

F C
-22 -30.0 -21 -29.4 -20 -28.9 -19 -28.3 -18 -27.8 -17 -27.2 -16 -26.7 -15 -26.1 -14 -25.6 -13 -25.0 -12 -24.4 -11 -23.9 -10 -23.3
-9 -22.8 -8 -22.2 -7 -21.7 -6 -21.1 -5 -20.6 -4 -20.0 -3 -19.4 -2 -18.9 -1 -18.3 0 -17.8 1 -17.2 2 -16.7 3 -16.1 4 -15.6 5 -15.0 6 -14.4 7 -13.9 8 -13.3 9 -12.8 10 -12.2 11 -11.7 12 -11.1 13 -10.6 14 -10.0 15 -9.4 16 -8.9 17 -8.3 18 -7.8 19 -7.2 20 -6.7 21 -6.1 22 -5.6 23 -5.0 24 -4.4 25 -3.9 26 -3.3 27 -2.8 28 -2.2 29 -1.7

F C
30 -1.1 31 -0.6 32 0.0 33 0.6 34 1.1 35 1.7 36 2.2 37 2.8 38 3.3 39 3.9 40 4.4 41 5.0 42 5.6 43 6.1 44 6.7 45 7.2 46 7.8 47 8.3 48 8.9 49 9.4 50 10.0 51 10.6 52 11.1 53 11.7 54 12.2 55 12.8 56 13.3 57 13.9 58 14.4 59 15.0 60 15.6 61 16.1 62 16.7 63 17.2 64 17.8 65 18.3 66 18.9 67 19.4 68 20.0 69 20.6 70 21.1 71 21.7 72 22.2 73 22.8 74 23.3 75 23.9 76 24.4 77 25.0 78 25.6 79 26.1 80 26.7 81 27.2

F C
82 27.8 83 28.3 84 28.9 85 29.4 86 30.0 87 30.6 88 31.1 89 31.7 90 32.2 91 32.8 92 33.3 93 33.9 94 34.4 95 35.0 96 35.6 97 36.1 98 36.7 99 37.2 100 37.8 101 38.3 102 38.9 103 39.4 104 40.0

C F
-30 -22.0 -29 -20.2 -28 -18.4 -27 -16.6 -26 -14.8 -25 -13.0 -24 -11.2 -23 -9.4 -22 -7.6 -21 -5.8 -20 -4.0 -19 -2.2 -18 -0.4 -17 1.4 -16 3.2 -15 5.0 -14 6.8 -13 8.6 -12 10.4 -11 12.2 -10 14.0
-9 15.8 -8 17.6 -7 19.4 -6 21.2 -5 23.0 -4 24.8 -3 26.6 -2 28.4 -1 30.2 0 32.0 1 33.8 2 35.6 3 37.4 4 39.2 5 41.0 6 42.8 7 44.6 8 46.4 9 48.2 10 50.0 11 51.8 12 53.6 13 55.4 14 57.2 15 59.0 16 60.8 17 62.6 18 64.4 19 66.2 20 68.0 21 69.8

C F
22 71.6 23 73.4 24 75.2 25 77.0 26 78.8 27 80.6 28 82.4 29 84.2 30 86.0 31 87.8 32 89.6 33 91.4 34 93.2 35 95.0 36 96.8 37 98.6 38 100.4 39 102.2 40 104.0

VACCINE MANAGEMENT
Recommendations for Storage and Handling of
Selected Biologicals
April 2009

Contents
DT, Td. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-3 DTaP, DTaP/Hib, DTaP-IPV, DTaP-IPV/Hib, DTaP-HepB-IPV, Tdap. . . . . . . . . . . . . . . . . C-4 HepA, HepB, Hep A/B, HepB-Hib.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-5 Hib. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-6 HPV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-7 IPV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-8 TIV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-9 LAIV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-10 MMR.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-11 MCV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-12 MPSV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-13 PCV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-14 PPSV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-15 Rotavirus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-16 Varicella (Chickenpox). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-17 Zoster (Shingles). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-18 Manufacturer Quality Control Office Telephone Numbers. . . . . . . . . . . . . . . . . . . . . . . C-19

DT: Diphtheria, Tetanus ToxoidsPediatric
Td: Tetanus, Diphtheria ToxoidsAdult
Shipping Requirements Should be shipped in insulated container. Maintain temperature at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Condition upon Arrival Should not have been frozen or exposed to freezing temperatures. Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Shelf Life Check expiration date on vial or manufacturer-filled syringe.
Instructions for Use Inspect visually for extraneous particulate matter and/or discoloration. If these conditions exist, the vaccine should not be used. Shake vial or manufacturer-filled syringe well before use. Discard vaccine if it cannot be resuspended with thorough agitation.
Shelf Life After Opening Single-Dose Vials: The vaccine should be administered shortly after withdrawal from the vial. Multidose Vials: Withdraw single dose of vaccine into separate sterile needle and syringe for each immunization. The vaccine should be administered shortly after withdrawal from the vial. Unused portions of multidose vials may be refrigerated at 35 to 46F (2 to 8C) and used until expired, if not contaminated or unless otherwise stated in the manufacturer's product information. Manufacturer-Filled Syringes: The vaccine should be administered shortly after the needle is attached to the syringe.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

DTaP: Diphtheria Toxoid, Tetanus Toxoid, Acellular Pertussis VaccinePediatric DTaP/Hib: Diphtheria Toxoid, Tetanus Toxoid, Acellular Pertussis Vaccine Combined
with Haemophilus influenzae type b Conjugate VaccinePediatric (TriHIBit) DTaP-IPV: Diphtheria Toxoid, Tetanus Toxoid, Acellular Pertussis Vaccine, Inactivated
Polio VaccinePediatric (Kinrix) DTaP-IPV/Hib: Diphtheria Toxoid, Tetanus Toxoid, Acellular Pertussis Vaccine, Inactivated Polio Vaccine combined with Haemophilus influenzae type b Conjugate
VaccinePediatric (Pentacel) DTaP-HepB-IPV: Diphtheria Toxoid, Tetanus Toxoid, Acellular Pertussis Vaccine,
Hepatitis B Vaccine, Inactivated Polio VaccinePediatric (Pediarix) Tdap: Tetanus Toxoid, Diphtheria Toxoid, Acellular Pertussis VaccineAdult
Shipping Requirements Should be shipped in insulated container. Maintain temperature at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Condition upon Arrival Should not have been frozen or exposed to freezing temperatures. Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Shelf Life Check expiration date on vial, container, or manufacturer-filled syringe.
Instructions for Reconstitution* or Use Inspect visually for extraneous particulate matter and/or discoloration. If these conditions exist, the vaccine should not be used. Shake vial or manufacturer-filled syringe well before use. Discard vaccine if it cannot be resuspended with thorough agitation.
Shelf Life After Reconstitution* or Opening Single-Dose Vials: The vaccine should be administered shortly after withdrawal from the vial. Manufacturer-Filled Syringes: The vaccine should be administered shortly after the needle is attached to the syringe.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.
* DTaP/Hib (TriHIBit) is ActHIB (sanofi pasteur) reconstituted with Tripedia (sanofi pasteur). Once reconstituted, this combination vaccine must be used within 30 minutes or discarded. The only DTaP vaccine that can be used to reconstitute the ActHIB for TriHIBit is Tripedia. No other brand of DTaP is approved for this use. DTaP-IPV/Hib (Pentacel is ActHIB (sanofi pasteur) reconstituted with a DTaP-IPV solution. Once reconstituted, this combination vaccine must be used within 30 minutes or discarded. This combination arrives with the DTaP-IPV vials and the ActHIB vials packaged together. Do not store them separately and do not administer them separately.

Hepatitis Vaccines: HepA: Hepatitis A, HepB: Hepatitis B, HepA-HepB: Hepatitis A/B (Twinrix),
HepB-Hib: Hepatitis B/Haemophilus influenzae type b (Comvax)
Shipping Requirements Should be shipped in insulated container. Maintain temperature at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Condition upon Arrival Should not have been frozen or exposed to freezing temperatures. Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Shelf Life Check expiration date on vial or manufacturer-filled syringe.
Instructions for Use Inspect visually for extraneous particulate matter and/or discoloration. If these conditions exist, the vaccine should not be used. Shake vial or manufacturer-filled syringe well before use. Discard vaccine if it cannot be resuspended with thorough agitation.
Shelf Life After Opening Single-Dose Vials: The vaccine should be administered shortly after withdrawal from the vial. Manufacturer-Filled Syringes: The vaccine should be administered shortly after the needle is attached to the syringe.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

Hib: Haemophilus influenzae type b Conjugate Vaccine
Shipping Requirements Should be shipped in insulated container. Maintain temperature at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Condition upon Arrival Should not have been frozen or exposed to freezing temperatures. Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Vaccine: Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures. Diluent: May be refrigerated or stored at room temperature (68 to 77F [20 to 25C]). Do not freeze or expose to freezing temperatures.
Shelf Life Check expiration date on vial.
Instructions for Reconstitution* or Use Inspect visually for extraneous particulate matter and/or discoloration. If these conditions exist, the vaccine should not be used. Shake vial or manufacturer-filled syringe well before use. Discard vaccine if it cannot be resuspended with thorough agitation.
Shelf Life After Opening Single-Dose Vials: The vaccine should be administered shortly after withdrawal from the vial.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.
*ActHIB (sanofi pasteur) reconstituted with 0.4% sodium chloride diluent should be used within 24 hours after reconstitution. If sanofi pasteur DTaP-Tripedia is used to reconstitute ActHIB, the TriHIBit vaccine must be used within 30 minutes of reconstitution. Only sanofi pasteur DTaP-Tripedia or the diluent shipped with the product may be used to reconstitute the sanofi pasteur ActHIB product. No other brand of DTaP is licensed for use in reconstitution of ActHIB.

HPV: Human Papillomavirus Vaccine
Shipping Requirements Should be shipped in insulated container. Maintain temperature at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Condition upon Arrival Should not have been frozen or exposed to freezing temperatures. Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures. Protect from light at all times.
Shelf Life Check expiration date on vial or manufacturer-filled syringe.
Instructions for Use Inspect visually for extraneous particulate matter and/or discoloration. If these conditions exist, the vaccine should not be used. Shake vial or manufacturer-filled syringe well before use. Discard vaccine if it cannot be resuspended with thorough agitation.
Shelf Life After Opening Single-Dose Vials: The vaccine should be administered shortly after withdrawal from the vial. Manufacturer-Filled Syringes: The vaccine should be administered shortly after the needle is attached to the syringe.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

IPV: Inactivated Polio Vaccine
Shipping Requirements Should be shipped in insulated container. Maintain temperature at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Condition upon Arrival Should not have been frozen or exposed to freezing temperatures. Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Shelf Life Check expiration date on vial or manufacturer-filled syringe.
Instructions for Use Inspect visually for extraneous particulate matter and/or discoloration. If these conditions exist, the vaccine should not be used. Shake vial or manufacturer-filled syringe well before use. Discard vaccine if it cannot be resuspended with thorough agitation.
Shelf Life After Opening Multidose Vials: Withdraw single dose of vaccine into separate sterile needle and syringe for each immunization. The vaccine should be administered shortly after withdrawal from the vial. Unused portions of multidose vials may be refrigerated at 35 to 46F (2 to 8C) and used until expired, if not contaminated or unless otherwise stated in the manufacturer's product information. Manufacturer-Filled Syringes: The vaccine should be administered shortly after the needle is attached to the syringe.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

TIV: Trivalent Inactivated Influenza Vaccine
Shipping Requirements Should be shipped in insulated container. Maintain temperature at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Condition upon Arrival Should not have been frozen or exposed to freezing temperatures. Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures. Protect Fluarix and FluLaval from light at all times by storing in original package.
Shelf Life Formulated for use during current influenza season. Check expiration date on vial or manufacturer-filled syringe.
Instructions for Use Inspect visually for extraneous particulate matter and/or discoloration. If these conditions exist, the vaccine should not be used. Shake vial or manufacturer-filled syringe well before use. Discard vaccine if it cannot be resuspended with thorough agitation.
Shelf Life After Opening Single-Dose Vials: The vaccine should be administered shortly after withdrawal from the vial. Multidose Vials: Withdraw single dose of vaccine into separate sterile needle and syringe for each immunization. The vaccine should be administered shortly after withdrawal from the vial. Unused portions of multidose vials may be refrigerated at 35 to 46F (2 to 8C) and used until expired, if not contaminated or unless otherwise stated in the manufacturer's product information. Manufacturer-Filled Syringes: The vaccine should be administered shortly after the needle is attached to the syringe.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

LAIV: Live Attenuated Influenza Vaccine
Shipping Requirements Initially shipped to authorized distributors in the frozen state 5F (-15C). Shipped from the distributor to healthcare facilities in the refrigerated state at 35 to 46F (2 to 8C).
Condition upon Arrival Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures. If LAIV is inadvertently frozen, the vaccine should be moved immediately to the refrigerator and may be used until the expiration date printed on the package.
Shelf Life Formulated for use during current influenza season. Check expiration date on package.
Instructions for Use LAIV is a colorless to pale yellow liquid and is clear to slightly cloudy; some particulates may be present but do not affect the use of the product. After removal of the sprayer from the refrigerator, remove the rubber tip protector. Follow manufacturer's instructions to deliver dose into one nostril. Then remove the dose-divider clip and deliver the remainder of the dose into the other nostril.
Shelf Life After Opening Single-Dose Sprayer: The vaccine should be administered shortly after removal from the refrigerator.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

MMR: Measles, Mumps, Rubella Vaccine
Shipping Requirements Vaccine: Should be shipped in insulated container. Must be shipped with refrigerant. Maintain temperature at 50F (10C) or less. If shipped with dry ice, diluent must be shipped separately. Diluent: May be shipped with vaccine, but do not place in container with dry ice.
Condition upon Arrival Maintain at 50F (10C) or less. Do not use warm vaccine. Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Vaccine: Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Protect from light at all times, since such exposure may inactivate the vaccine viruses. Diluent: May be refrigerated or stored at room temperature (68 to 77F [20 to 25C]). Do not freeze or expose to freezing temperatures. Note: MMR vaccine may be stored in the refrigerator or freezer.
Shelf Life Check expiration date on vial.
Instructions for Reconstitution and Use Reconstitute just before use according to the manufacturer's instructions. Use only the diluent supplied to reconstitute the vaccine.
Shelf Life After Reconstitution, Thawing or Opening Single-Dose Vials: After reconstitution, use immediately or store at 35 to 46F (2 to 8C) and protect from light. Discard if not used within 8 hours of reconstitution. Multidose Vials: Withdraw single dose of reconstituted vaccine into separate sterile needle and syringe for each immunization. The vaccine should be administered shortly after withdrawal from the vial. Unused portions of multidose vials may be refrigerated at 35 to 46F (2 to 8C), but must be discarded if not used within 8 hours after reconstitution.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

MCV: Meningococcal Conjugate Vaccine
Shipping Requirements Should be shipped in insulated container. Maintain temperature at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Condition upon Arrival Should not have been frozen or exposed to freezing temperatures. Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Shelf Life Check expiration date on vial or manufacturer-filled syringe.
Instructions for Use Inspect visually for extraneous particulate matter and/or discoloration. If these conditions exist, the vaccine should not be used. Shake vial or manufacturer-filled syringe well before use. Discard vaccine if it cannot be resuspended with thorough agitation.
Shelf Life After Opening Single-Dose Vials: The vaccine should be administered shortly after withdrawal from the vial. Manufacturer-Filled Syringes: The vaccine should be administered shortly after the needle is attached to the syringe.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

MPSV: Meningococcal Polysaccharide Vaccine
Shipping Requirements Should be shipped in insulated container. Maintain temperature at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Condition upon Arrival Should not have been frozen or exposed to freezing temperatures. Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Vaccine: Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures. Diluent: May be refrigerated or stored at room temperature (68 to 77F [20 to 25C]). Do not freeze or expose to freezing temperatures.
Shelf Life Check expiration date on vial.
Instructions for Reconstitution and Use Reconstitute just before using according to the manufacturer's instructions. Use only the diluent supplied to reconstitute the vaccine.
Shelf Life After Reconstitution or Opening Single-Dose Vials: Use within 30 minutes of reconstitution. Multidose Vials: Unused portions of multidose vials may be refrigerated at 35 to 46F (2 to 8C) and used up to 35 days after reconstruction.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

PCV: Pneumococcal Conjugate Vaccine
Shipping Requirements Should be shipped in insulated container. Maintain temperature at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Condition upon Arrival Should not have been frozen or exposed to freezing temperatures. Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Shelf Life Check expiration date on vial or manufacturer-filled syringe.
Instructions for Use Inspect visually for extraneous particulate matter and/or discoloration. If these conditions exist, the vaccine should not be used. Shake vial or manufacturer-filled syringe well before use. Discard vaccine if it cannot be resuspended with thorough agitation.
Shelf Life After Opening Single-Dose Vials: The vaccine should be administered shortly after withdrawal from the vial. Manufacturer-Filled Syringes: The vaccine should be administered shortly after the needle is attached to the syringe.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

PPSV: Pneumococcal Polysaccharide Vaccine
Shipping Requirements Should be shipped in insulated container. Maintain temperature at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Condition upon Arrival Should not have been frozen or exposed to freezing temperatures. Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Shelf Life Check expiration date on vial.
Instructions for Use Inspect visually for extraneous particulate matter and/or discoloration. If these conditions exist, the vaccine should not be used. Shake vial or manufacturer-filled syringe well before use. Discard vaccine if it cannot be resuspended with thorough agitation.
Shelf Life After Opening Single-Dose Vials: The vaccine should be administered shortly after withdrawal from the vial. Multidose Vials: Withdraw single dose of vaccine into separate sterile needle and syringe for each immunization. The vaccine should be administered shortly after withdrawal from the vial. Unused portions of multidose vials may be refrigerated at 35 to 46F (2 to 8C) and used until expired, if not contaminated or unless otherwise stated in the manufacturer's product information.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

Rotavirus Vaccine
Shipping Requirements Should be shipped in insulated container. Maintain temperature at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures.
Condition upon Arrival Should not have been frozen or exposed to freezing temperatures. Refrigerate upon arrival. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Refrigerate immediately upon arrival. Store at 35 to 46F (2 to 8C). Do not freeze or expose to freezing temperatures. Protect from light at all times, since such exposure may inactivate the vaccine viruses.
Shelf Life Check expiration date on package.
Instructions for Reconstitution or Use Each dose of RotaTeq is supplied in a container consisting of a squeezable plastic, latex-free dosing tube with a twistoff cap, allowing for direct oral administration. The dosing tube is contained in a pouch. Remove the dosing tube from the pouch, screw the cap clockwise to puncture the tube, and screw the cap off counter-clockwise so that the liquid can be squeezed from the tube during oral administration of the vaccine. Each dose of Rotarix is supplied as a vial of lyophilized vaccine. The 1mL of diluent is supplied in a prefilled oral applicator with a plunger stopper (contains latex), and a transfer adapter for reconstitution.
Shelf Life After Opening Pouched Single-Dose Tubes: RoteTeq vaccine should be administered shortly after withdrawal from the refrigerator. The dosing tube should not be returned to the refrigerator once the screw cap has been removed. Oral Applicator: Rotarix should be administered within 24 hours of reconstitution.
Special Instructions Rotate stock so that the earliest dated material is used first. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

Varicella (Chickenpox) Vaccine
Shipping Requirements Vaccine: Should be shipped in insulated container. Must be shipped with dry ice only, at 5F (-15C) or colder. Should be delivered within 2 days. Diluent: May be shipped with vaccine, but do not place in container with dry ice.
Condition upon Arrival Should be frozen. Vaccine should remain at 5F (-15C) or colder until arrival at the healthcare facility. Dry ice should still be present in the shipping container when the vaccine is delivered. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Vaccine: Freeze immediately upon arrival. Maintain vaccine in a continuously frozen state at 5F (-15C) or colder. No freeze/thaw cycles are allowed with this vaccine. Vaccine should only be stored in freezers or refrigerator/freezers with separate external doors and compartments. Acceptable storage may be achieved in standard household freezers purchased in the last 10 years, and standard household refrigerator/freezers a separate, sealed freezer compartment. "Dormitory-style" units are not appropriate for the storage of varicella vaccine. Do not store lyophilized vaccine in the refrigerator. If lyophilized vaccine is inadvertently stored in the refrigerator, it should be used within 72 hours. Lyophilized vaccine stored at 35 to 46 F (2 to 8C) which is not used within 72 hours should be discarded. Protect the vaccine from light at all times since such exposure may inactivate the vaccine virus. In order to maintain temperatures of 5F (-15C) or colder, it will be necessary in most refrigerator/freezer models to turn the temperature dial down to the coldest setting. This may result in the refrigerator compartment temperature being lowered as well. Careful monitoring of the refrigerator temperature will be necessary to avoid freezing killed or inactivated vaccines. Diluent: May be refrigerated or stored at room temperature (68 to 77F [20 to 25C]). Do not freeze or expose to freezing temperatures.
Shelf Life Check expiration date on vial.
Instructions for Reconstitution and Use Reconstitute just before use according to the manufacturer's instructions. Use only the diluent supplied to reconstitute the vaccine.
Shelf Life After Reconstitution, Thawing or Opening Single-Dose Vials: Discard reconstituted vaccine if it is not used within 30 minutes of reconstitution. Do not freeze reconstituted vaccine.
Special Instructions Rotate stock so that the earliest dated material is used first. If this vaccine is stored at a temperature warmer than 5F (-15C), it will result in a loss of potency and a reduced shelf life. If a power outage or some other situation occurs that results in the vaccine storage temperature rising above the recommended temperature, the healthcare provider should contact Merck, the vaccine manufacturer, at 1-800-9VARIVAX for an evaluation of the product potency before using the vaccine. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

Zoster (Shingles) Vaccine
Shipping Requirements Vaccine: Should be shipped in insulated container. Must be shipped with dry ice only, at 5F (-15C) or colder. Should be delivered within 2 days. Diluent: May be shipped with vaccine, but do not place in container with dry ice.
Condition upon Arrival Should be frozen. Vaccine should remain at 5F (-15C) or colder until arrival at the healthcare facility. Dry ice should still be present in the shipping container when the vaccine is delivered. If you have questions about the condition of the material at the time of delivery, you should 1) immediately place material in recommended storage; and 2) then follow your state health department immunization program policy and contact either the manufacturer's Quality Control office or the immunization program for guidance.
Storage Requirements Vaccine: Freeze immediately upon arrival. Maintain vaccine in a continuously frozen state at 5F (-15C) or colder. No freeze/thaw cycles are allowed with this vaccine. Vaccine should only be stored in freezers or refrigerator/freezers with separate external doors and compartments. Acceptable storage may be achieved in standard household freezers purchased in the last 10 years, and standard household refrigerator/freezers a separate, sealed freezer compartment. "Dormitory-style" units are not appropriate for the storage of varicella vaccine. Do not store lyophilized vaccine in the refrigerator. Protect the vaccine from light at all times since such exposure may inactivate the vaccine virus. In order to maintain temperatures of 5F (-15C) or colder, it will be necessary in most refrigerator/freezer models to turn the temperature dial down to the coldest setting. This may result in the refrigerator compartment temperature being lowered as well. Careful monitoring of the refrigerator temperature will be necessary to avoid freezing killed or inactivated vaccines. Diluent: May be refrigerated or stored at room temperature (68 to 77F [20 to 25C]). Do not freeze or expose to freezing temperatures.
Shelf Life Check expiration date on vial.
Instructions for Reconstitution and Use Reconstitute just before use according to the manufacturer's instructions. Use only the diluent supplied to reconstitute the vaccine.
Shelf Life After Reconstitution, Thawing or Opening Single-Dose Vials: Discard reconstituted vaccine if it is not used within 30 minutes of reconstitution. Do not freeze reconstituted vaccine.
Special Instructions Rotate stock so that the earliest dated material is used first. If this vaccine is stored at a temperature warmer than 5F (-15C), it will result in a loss of potency and a reduced shelf life. If a power outage or some other situation occurs that results in the vaccine storage temperature rising above the recommended temperature, the healthcare provider should contact Merck, the vaccine manufacturer, at 1-800-MERCK90 for an evaluation of the product potency before using the vaccine. Note: All vaccine materials should be disposed of using medical waste disposal procedures. Contact the state health department for details.

Chart of Refrigerated/Frozen Pack Needs for Different Climates

Outside Temperature
Greater than 75F to 110F (greater than 24C to 43C)

Number of Faces* Covered
with Packs
2***

Temperature of Packs
23F (-5C)

Comment**
Up to 48 hours delivery with 10 hours at 110F
(43C)

32F to 75F (0C to 24C)
Colder than 32F (C)

2*** 4
4 to 6****

23F (-5C) 41F (+5C) 50F (+10C)

Up to 48 hours delivery
Up to 24 hours delivery
About 24 hours exposure to mix of
outdoors and heated areas

0F (-18C) or colder

6****

68F (+20C)

Prolonged, 24 to 48 hours continuous
exposure to 0F (-18C)

* Faces would include the interior surfaces of the box, including the walls, floor and lid (above the vaccines and insulating material).
** Applies when high quality insulated boxes with walls of 1 inches to 2 inches expanded polystyrene, 1 inch isocyanurate, or 3 inches polyurethane insulation were used.
*** 3 for the medium-sized box tested by CDC (10x10x7 inches--interior dimensions).
**** Essentially the entire surface area is covered with packs.

Refrigerated/Frozen Packs.

Maintaining the Cold Chain During Transport

When transporting vaccines, think about how each vaccine was packed when you first received it from the manufacturer or distributor. Use this as a model for how to repack the individual vaccines in order to transport them at their appropriate temperature. Keep a temperature log. Record the temperature during transport and periodically (e.g., at least once each hour) during the entire time the vaccine is kept in the transport container to ensure it remains within the recommended range.

Vaccines

Special Instructions

Inactivated vaccines

Diphtheria-tetanuspertussis (DTaP, DT, Tdap, Td)
Haemophilus influenzae type b
Human papillomavirus Hepatitis A Hepatitis B Influenza, inactivated Meningococcal Pneumococcal Poliovirus, inactivated Combination products
of these vaccines
Measles, mumps, rubella (MMR)
Rotavirus

Keep cold at 3546F (28C) and do not freeze. Use refrigerated or frozen packs depending on the time of the year and the situation (e.g., frozen packs for hot weather while transporting outdoors, refrigerated packs for cold weather). Make sure vaccines are kept in their original boxes. Place some insulation (e.g., crumpled paper, bubble wrap) between the vaccine boxes and the refrigerated or frozen packs to prevent the inactivated vaccine from directly touching the refrigerated or frozen packs. Put crushed paper in the cooler to keep the vaccines from shifting during transport. During hot weather, keep the insulated container in a cool place (air-conditioned interior of car). Do not leave the vaccine container unattended or in the trunk of a parked car. During cold weather, do not leave the container in an unheated area because vaccine must not freeze. In cold weather, include a freeze indicator in the vaccine container.
Keep cold at 3546F (28C). MMR may be frozen. If MMR is transported with inactivated vaccines, follow the packing instructions for inactivated vaccines indicated above. If you are transporting diluent in the same cooler with the MMR, refrigerate the diluent in advance to help maintain the cold temperature in the cooler.

Live virus vaccines

Varicella (VAR) MMR+VAR (MMRV) Zoster (shingles)
Influenza, live

Transport only the quantity needed in a special freezer unit or in an insulated container with dry ice; clearly mark the vaccine with the date and time it was removed from the original freezer unit. It is extremely important to include a thermometer in the container with the vaccine. If using dry ice, pack the container with enough to ensure the temperature is maintained at 5F (-15C) or colder. If dry ice is not available, you may transport VAR (not MMRV or zoster) with frozen packs. If the temperature within the container exceeds 5F (-15C) but doesn't go above 46F (8C), the expiration date of the VAR vaccine is reduced to 72 hours. VAR vaccine that has reached temperatures above 46F (8C) or has exceeded the 72 hour limit cannot be used. Note: MMRV and zoster vaccines must always be transported with dry ice or in a special freezer unit that can reliably maintain temperatures of 5F (-15C) or colder. For this reason, transport of MMRV or zoster to off-site clinics is not advised.
For information on transporting live, attenuated intranasal influenza vaccine (FluMist), refer to the package insert.

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Technical content reviewed by the Centers for Disease Control and Prevention, Nov. 2006.

www.immunize.org/catg.d/p3049.pdf Item #P3049 (11/06)

Immunization Action Coalition 1573 Selby Ave. St. Paul, MN 55104 (651) 647-9009 www.immunize.org www.vaccineinformation.org

GA Immunization Program Manual

Division Of Public Health

Pharmacy Section
Guidelines for Returning State or Public Health District Purchased Outdated, Deteriorated, Returned and Recalled Drugs
GEORGIA DEPARTMENT OF COMMUNITY HEALTH DIVISION OF PUBLIC HEALTH
9. Vaccine Distribution and Storage Guidelines For Returning Vaccine Products To 1
The Manufacturer For Disposal 11/2009

GA Immunization Program Manual

Division Of Public Health

These Guidelines are located in the Public Health Nurse Protocol Manual (Drug Dispensing Procedure, Section D) under Outdated, Deteriorated, Returned and Recalled Drugs at http://health.state.ga.us/pdfs/nursing/Protocol%20Manual/04.0%20Drug%2 0Dispensing%20Procedure.pdf

9. Vaccine Distribution and Storage Guidelines For Returning Vaccine Products To 2
The Manufacturer For Disposal
11/2009

GEORGIA IMMUNIZATION PROGRAM McKesson Return of Federal Vaccine Form

Date:
Contact Person Provider Name Address

VFC PIN:

Phone # Fax # All nonviable vaccines must be returned to McKesson for excise tax credit processing. To return wasted/expired vaccine to McKesson, follow these steps: 1. Fax a copy of the completed McKesson Return of Federal Vaccine Form to VFC at (404) 657-5736 or outside Metro Atlanta at (800) 372-3627. Faxing this form will initiate a request for a return label. If you call UPS or FedEx directly, you will be charged for the retrieval of the box(es). 2. Returns can be sent in the McKesson shipping container or a container of your own. If you use your own container, ensure that vials are secure (so that they don't break during transport). 3. You must include a copy of the completed McKesson Return of Federal Vaccine Form in the box with the non-viable vaccines that are to be returned to McKesson. 4. Keep a copy of this form for your records. * Do not return H1N1 vaccine to McKesson. All H1N1 vaccine must be disposed of locally/at your clinic site. ** UPS will pick up all boxes to return to McKesson, even when packages are shipped to you via Fed Ex or DHL. *** Once you have the label and affix it to the box, simply give to your UPS driver the next time s/he is in your office.
A specific pickup is not necessary.

All columns below are required.

NDC # *

Vaccine

# Doses Manufacturer

Lot #

Expiration Date

Reason Code

* The NDC Number can be found on each individual vaccine vial.
Return Reason Codes: 3 - Spoilage (e.g., Refused or not needed after prepared) 4 - The expiration date has passed 5 - Damaged in transit from McKesson 6 - Failure to store or handle properly (e.g., Vaccine left out overnight) 7 - Refrigeration failure (report to VFC immediately!!!) 11 - Lost or unaccounted for in inventory
This form is for return purposes only. All wasted/expired/spoiled doses must be listed on the monthly Comprehensive Report.
Rev. 1/2010

Directions: This form must be completed and submitted to the Georgia Immunization Program on a monthly basis. The log must document only the administration of any VFC vaccine to unaccompanied minors (through age 18 years of age) because they present without insurance information. Please remember that an unaccompanied minor younger than 18 may only independently sign for Hep A, Hep B, and HPV. 18-year olds may sign for all vaccines on their own. Please keep one copy for your clinic's records and send one to the State Immunization Program to the address or fax number below:

By mail: Georgia Immunization Program 2 Peachtree St, NW Suite 13-476 Atlanta, GA 30303 Attention: Monica Trigg

By email: mntrigg@dhr.state.ga.us

By FAX: (404) 657-5736 (800) 372-3627

Title X Unaccompanied Minor without Insurance Information VFC Vaccine Log
Month: ___________ Year: 2009 Site Name: _____________________ GIP/VFC ID #: _________

Date

Patient's Age

Administered

Mark VFC Vaccines Administered age 18 only

HPV Hep A Hep B Flu Hep AB MCV4 MMR Pneumo T d Tda p Varicella

TOTALS
(enter total number of patients seen in first box)

Revised 3/09

Georgia Immunization Program
Centralized Distribution Information and Instructions for VFC Providers Revised 1/2010

Troubleshooting Problems / Issues

Instructions

You have a change in your vaccine delivery address, days, and/or hours available for vaccine deliveries.

Notify your PPOC (Project Point of Contact) prior to placing you vaccine order.

Your office/clinic will be closed for an extended period of time.
Your office hours change at all (this includes unscheduled days that the office is closed or you are unable to receive vaccines).

Your PPOC is: Vaccines for Children Program (404) 657-5013

You receive a partial or split vaccine shipment.

Notify your PPOC on Day 1 of the partial or split shipment.

You receive more vaccines than were ordered. You received vaccines that you did not order.

Notify your PPOC who will arrange for vaccine transfer between providers. Viable vaccine cannot be returned to McKesson.

The temperature monitor is tripped, or you suspect the vaccine shipment was compromised in any way.
You have nonviable vaccines that need to be returned.

Follow the instructions for the interpretation of the temperature monitors. The instructions will be attached to the two temperature monitors located in each vaccine shipment box. If there are any questions about how to interpret the temperature monitor readings or you suspect the shipment is compromised in any way:
1. Label the vaccines "Do Not Use" and continue to store them at recommended temperatures until a final determination is made.
2. Immediately contact your PPOC for further instruction. McKesson must be contacted by your PPOC within 2 hours of vaccine receipt.
1. Fax a copy of the completed McKesson Return of Federal Vaccine Form to VFC at (404) 657-5736 or outside Metro Atlanta at (800) 372-3627. Faxing this form will initiate a request for a return label. If you call UPS or FedEx directly, you will be charged for the retrieval of the box(es).
2. Returns can be sent in the McKesson shipping container or a container of your own. If you use your own container, ensure that vials are secure (so that they don't break during transport).
3. You must include a copy of the completed McKesson Return of Federal Vaccine Form in the box with the non-viable vaccines that are to be returned to McKesson.
4. Keep a copy of this form for your records.

* Do not return H1N1 vaccine to McKesson. All H1N1 vaccine must be disposed of locally/at your clinic site.
** UPS will pick up all boxes to return to McKesson, even when packages are shipped to you via Fed Ex or DHL.
*** Once you have the label and affix it to the box, simply give to your UPS driver the next time s/he is in your office.
Scheduling a specific pickup is not necessary. Your UPS driver can pick up the return during their regular visit(s) to your practice.
Other Important Information
McKesson is no longer accepting box returns. Providers are encouraged to keep one or two boxes on hand in the event an emergency occurs or vaccine needs to be transferred. Please check to see if there is a local recycling program in your area.
It is imperative that you continue to submit monthly comprehensive reports. Make sure to notify your PPOC of any changes to hours, address, contact, etc.
You must immediately open all vaccine packages, check the temperature monitor devices, inspect the vaccines and store them at the appropriate temperatures once the package is delivered.
Direct-ship vaccines, such as varicella, will continue to be shipped by the manufacturer, not McKesson.
Influenza vaccine may arrive in separate shipments.
During periods of vaccine shortage, vaccine may be shipped incrementally throughout the month and may arrive in separate shipments.
Vaccine Shipping Timeframes
Vaccine deliveries may take from one to three weeks to arrive at your location. At the time your order is placed, please ensure that your available delivery times are up to date and that you have at least a month's supply of vaccine on hand to decrease the likelihood of running out of vaccine in the event of a prolonged delivery time.

GEORGIA IMMUNIZATION PROGRAM McKesson Return of Federal Vaccine Form

Date:
Contact Person Provider Name Address

VFC PIN:

Phone # Fax # All nonviable vaccines must be returned to McKesson for excise tax credit processing. To return wasted/expired vaccine to McKesson, follow these steps: 1. Fax a copy of the completed McKesson Return of Federal Vaccine Form to VFC at (404) 657-5736 or outside Metro Atlanta at (800) 372-3627. Faxing this form will initiate a request for a return label. If you call UPS or FedEx directly, you will be charged for the retrieval of the box(es). 2. Returns can be sent in the McKesson shipping container or a container of your own. If you use your own container, ensure that vials are secure (so that they don't break during transport). 3. You must include a copy of the completed McKesson Return of Federal Vaccine Form in the box with the non-viable vaccines that are to be returned to McKesson. 4. Keep a copy of this form for your records. * Do not return H1N1 vaccine to McKesson. All H1N1 vaccine must be disposed of locally/at your clinic site. ** UPS will pick up all boxes to return to McKesson, even when packages are shipped to you via Fed Ex or DHL. *** Once you have the label and affix it to the box, simply give to your UPS driver the next time s/he is in your office.
A specific pickup is not necessary.

All columns below are required.

NDC # *

Vaccine

# Doses Manufacturer

Lot #

Expiration Date

Reason Code

* The NDC Number can be found on each individual vaccine vial.
Return Reason Codes: 3 - Spoilage (e.g., Refused or not needed after prepared) 4 - The expiration date has passed 5 - Damaged in transit from McKesson 6 - Failure to store or handle properly (e.g., Vaccine left out overnight) 7 - Refrigeration failure (report to VFC immediately!!!) 11 - Lost or unaccounted for in inventory
This form is for return purposes only. All wasted/expired/spoiled doses must be listed on the monthly Comprehensive Report.
Rev. 1/2010

Georgia Immunization Program Manual
TABLE OF CONTENTS

Division Of Public Health

10. DISTRICT/COUNTY INSERTS Empty section for the District/County to use for items considered necessary to complement or supplement the material provided by the State Program

Table of Contents 11/2009

Georgia Immunization Program Manual
TABLE OF CONTENTS

Division Of Public Health

11. TRANSMITTAL MEMOS Section for filing memos which accompany revised pages, forms or documents

Table of Contents 11/2009

DHR

Jim Martin, Commissioner Kathleen E. Toomey, M.D., M.P.H., Division Director
Michael Chaney, Program Manager

Georgia Department of Human Resources Division of Public Health Prevention Services Branch Georgia Immunization Program Two Peachtree Street, NW RM 13-476 Atlanta, Georgia 30303-3142 Tel: (404) 657-3158Fax (404) 657-1463

February 26, 2003

M E M O R A N D U M

TO:

District Health Directors

District Immunization Coordinators

County Immunization Personnel

Community Health Centers

Immunization Program Staff

FROM:

Michael Chaney, Manager Georgia Immunization Program

SUBJECT: Update to the Immunization Program Manual
Enclosed are the updated packets of information for the Georgia Immunization Program Manual (Immunization Program Manual Transmittal [03-1]).
To update your manuals you will need to distribute the packets to each of your clinics that administer vaccine and instruct them to substitute, add, and/or remove pages as indicated below. Each district is being sent the number of packets verified in December, 2002. If additional packets are needed, please utilize one of your copies to make duplications.
You will need to reference the Table of Contents page for each section in order to maintain the proper order. Changes to the Immunization Program Manual are as follows:
Remove old cover page and replace with the new one---Immunization Program Manual, Vol. 03-1, January 2003
Replace--the forward page Remove and replace----the entire Table of Contents pages
Section 1---"Introduction" Updated: Table of Contents page for this section Introduction to the Manual Immunization Program Staff list o Central Office Staff list o Field Staff list o GRITS Staff list District Immunization Coordinators' list Request for Immunization Forms (Form 3184)

AN EQUAL OPPORTUNITY EMPLOYER

Transmittal 03-1 February 26, 2003 Page 2
Removed: Immunization Resources---for this information refer to Attachments A and B in Section 14 "Quality Assurance"
Retained: Vaccine Products Licensed for Use in the United States, 2001
Section 2---"Recommended Schedule and Guidelines" Updated: Table of Contents page for this section Immunization Program Vaccine Guidelines Approval sheet o A line has been added for the District Health Director's signature, signifying that he/she has reviewed and approved the annual update. Immunization Guidelines for DHR Clinics All vaccine guidelines o New charts in the HIB and Hepatitis B vaccine documents o Pneumococcal vaccine guidelines relevant to the issue of cochlear implants and risk for meningitis Recommended Childhood Immunization Schedule, 2003 Summary of Rules for Childhood Immunization Screening Questionnaire for Child and Teen Immunization (English/Spanish) Added: Catch-up Schedule for Children with Lapsed Immunizations Standards for Pediatric Immunization (moved from Section 8, "Recall of Patients") Recommended Adult Immunization Schedule United States, 2002-2003 Adult documents moved from Section 12, "Adult Immunizations" o Summary of Recommendations for Adult Immunization o Screening Questionnaire for Adult Immunization (English/Spanish) o Standards for Adult Immunization o Guidelines for Vaccinating Pregnant Women Retained: Eligibility Criteria for State Supplied Vaccines for Adult Populations Recommended and Minimum Ages and Intervals Between Vaccine Doses
Section 3---"Informed Request Policy" Updated: Table of Contents page for this section Informed Request Policy o Form numbers corrected o Website URL corrected New VISs for Pneumococcal Conjugate (English only), Influenza (English and Spanish), MMR (English only), and MMR--Interim (Spanish) After the Shots (English/Spanish)
AN EQUAL OPPORTUNITY EMPLOYER

Transmittal 03-1 February 26, 2003 Page 3
Retained: All other VISs except those listed above Personal Immunization Record (English and Spanish)
Section 4 ---"Adverse Events Following Immunizations" Updated: Table of Contents page for this section Policy for Reporting Vaccine Adverse Events Following Immunization (VAERS) o Clarification of the point that this is a surveillance or reporting system o Submitting a VAERS report does not submit a claim for compensation VAERS report form--Remember, for public health, the form is sent to the Immunization Program at 2 Peachtree. Only private providers send it to the Maryland address. Commonly Asked Questions About the National Vaccine Injury Compensation Program NVICP Vaccine Injury Table Added: Frequently Asked Questions About VAERS VAERS Table of Reportable Events VAERS brochure Retained: Handling of Emergencies Following the Administration of Vaccines
Section 5---"Requirements of School/Daycare Law" Updated: Table of Contents page for this section Summary of Immunization Policies Relative to Georgia Law Official Code of Georgia (updated only to reflect more current date---no Code changes) DHR Rules (not updated but replace just for consistency) Give `Em Your Best Shot (English/Spanish) Policy Guide 3231INS Policy Guide 3231REQ Added: Historical Statement Listing Dates of Immunization Requirements Retained: School Certificate of Immunization Form 3231 Supplemental Vaccine Certification Form (Measles and Varicella) Form 3189 Guidelines for Public Health Clinics Documentation of Varicella Disease Immunization Guidelines for Child Care Facility Operators and School Personnel, Form 3258
AN EQUAL OPPORTUNITY EMPLOYER

Transmittal 03-1 February 26, 2003 Page 4
Section 6---Surveillance and Reporting Updated: Table of Contents page for this section VPD District Contacts list Added: Resources for Influenza Prevention and Control Influenza Outbreak Control in a Long-Term Care Facility Retained: Procedure for Investigation and Reporting of Vaccine Preventable Diseases Memorandum on Vaccine Preventable Diseases Reporting and Followup Procedures All Vaccine Preventable Disease Fact Sheets Georgia Notifiable Disease Report Form, Form 3095 All disease worksheets (diphtheria, measles, mumps, pertussis, rubella, and tetanus) Virology Request Form, Form 3595
Section 7---"Hepatitis" Updated: Table of Contents page for this section Entire "Perinatal Hepatitis B Prevention Program Guidelines" o Information streamlined in an attempt to make the section more user-friendly. o Some of the hepatitis B and HBIG vaccine charts that already appear in Section 2, under "Hepatitis B Guidelines", were removed from the this section o More current copies of forms and documents in the Appendix were added. o The Hepatitis B VISs both English and Spanish were deleted from this section and may be accessed in Section 2. Retained: State Hepatitis Program Hepatitis B Vaccination in STD, HIV, and Family Planning Clinics, Guidelines for Public Health
Section 8---"Recall of Patients" Updated: Table of Contents page for this section Recall of Immunization Patients Policy Statement Removed: Standards for Pediatric Immunization Practices---refer to Section 2, "Recommended Schedule and Guidelines" Retained: Immunization Documentation, "Moved or Gone Elsewhere" (MOGE)
AN EQUAL OPPORTUNITY EMPLOYER

Transmittal 03-1 February 26, 2003 Page 5
Section 9---"Vaccine Distribution and Storage" Updated: Table of Contents page for this section Distribution of Vaccines Temperature Log sheet o New, graph-like form to plot temperature readings instead of just listing them Guidelines for Returning Vaccine Products to the Manufacturer for Disposal Guidelines for Vaccine Packing and Shipping o No content changes, just a more legible copy Added: Vaccine Wastage Log o New form to be used instead of the form for returning outdated or unused drugs o Directions for using this form are found in "Distribution of Vaccines" at the beginning of this section Retained: Vaccine Management (Handling and Storage Recommendations) Form for Return of Outdated, Unused or Overstocked Drugs
Section 10---"District/County Inserts" No changes
Section 11---"Transmittal Memos" No changes
Section 12 ---Remove and discard all contents of this section---Replace Table of Contents page only for this section.
The contents of this entire section have been moved to other, more relevant sections. The following documents can now be found in Section 2, "Recommended Schedule and Guidelines:"
Standards for Adult Immunization Practice Eligibility Criteria for State Supplied Vaccine for Adults Summary of Recommendations for Adult Immunization Guidelines for Vaccinating Pregnant Women Screening Questionnaire for Adult Immunization (English/Spanish) The following documents can be found in the ACIP Recommendations Manual: Adolescent Immunizations ACIP Recommendations Immunization of Health Care Workers ACIP Recommendations
AN EQUAL OPPORTUNITY EMPLOYER

Transmittal 03-1 February 26, 2003 Page 6
Section 13---"Travel Information" Updated: Table of Contents page for this section Yellow Fever Vaccination Clinics in Georgia Retained: Foreign Travel Information Vaccines and Biologics Used in U.S. and Foreign Markets Translation of Foreign Vaccine-Related Terms Routine Childhood Vaccines by Country
Section 14---"Quality Assurance" Updated: Table of Contents page for this section---replace simply for continuity Attachment A, "Immunization References, Video Information, Resources, and Training Sessions" was updated and now includes information previously contained in Section 1. Attachment B, "Immunization Education and Training Materials (CDC)" Retained: Quality Assurance/Quality Improvement for Immunization Practices for Public Health Nurses and Immunization Support Staff Attachments C through I
Recommendations for updating manuals: Complete the initial manual update as part of a district group meeting. Assign a specific person in each center (add this responsibility to their PMF) to ensure that the manual(s) in their center are updated and kept current.
We hope that the process of updating your manuals will be easier this time around, and that you will continue to contact us any time there are questions or concerns about the manual or any other immunization issue.
MEC: dbg
c: Kathleen E. Toomey, M.D., M.P.H. Rosalyn Bacon, M.P.H. Ruth Gilmore, RN, BSN Diana Gaskins, BSN, MSN
AN EQUAL OPPORTUNITY EMPLOYER

Jim Martin, Commissioner Georgia Department of Human Resources Division of Public Health Kathleen E. Toomey, M.D., M.P.H., Director 2 Peachtree Street NW Suite 15.470 Atlanta, Georgia 30303-3142 404-657-2700 FAX: 404-657-2715
September 22, 2003

TO:

District Health Directors

District Immunization Coordinators

FROM:

Michael Chaney, Manager Georgia Immunization Program

SUBJECT:

Georgia Immunization Program Manual Update
Table of Contents, complete Table of Contents pages, Sections 2 and 3 Guidelines Approval Document Eligibility Criteria for State Supplied Vaccines for Adult Populations Influenza Vaccine Guidelines Vaccine Information Statement, Inactivated Influenza Vaccine (English)(5/6/03) Vaccine Information Statement, Inactivated Influenza Vaccine (Spanish) (5/6/03) Vaccine Information Statement, Live Attenuated Influenza Vaccine (English)
(9/04/03)
Manual Update Documentation Form

The eligibility criteria for adult populations has been updated to clarify some groups that are covered and to
add others: "Persons with occupational exposure" was added as a group not covered for HBIG. Since some hepatitis A vaccine is now supplied, this section was added completely. More specific information was added regarding the eligibility to receive hepatitis B vaccine for persons with HIV infection or those seeking services from STD clinics. Under MMR, the term "post-partum women" was defined more clearly, and further information was offered in a footnote.

The influenza guidelines will be a completely new addition to Section 2, "Recommended Schedule and Guidelines," in the program manual. Since the Vaccines for Children Program (VFC) will be offering a limited amount of the trivalent inactivated influenza vaccine this year, we felt it was important to provide some guidance regarding eligibility for this vaccine, as well as the usual information about dosage, recommendations, schedule, contraindications, etc. The new live attenuated influenza vaccine (LAIV), FluMistTM has been mentioned in this document, but since it will not be provided by the VFC Program, providers are referred in general to the vaccine package insert and/or the manufacturer or ACIP recommendations for detailed information.

The two types of influenza Vaccine Information Statements (VIS) included in this transmittal are specific to each vaccine formulation and should be used only when that formulation is administered. In the initial version of the VIS for inactivated influenza vaccine, the 3rd paragraph under Part 4 contained the phrase "To allow these people first access to the vaccine, others should wait until November to get the shot." That one sentence has now been changed to "Influenza vaccine is expected to be plentiful in 2003, so no one should have to wait to get the shot." Both versions contain the original date of 5/6/03. If providers have already obtained a supply of the first VIS, they will not need to replace it with the newer version. If a client is receiving the live, intranasal influenza vaccine, that particular VIS must be given and discussed with the client prior to administration.

An Equal Opportunity Employer www.dhr.georgia.gov

Transmittal September 22, 2003 Page 2 As with the prior two updates/transmittals, hard copies will not be sent but should be downloaded from the program website at www.health.state.ga.us/programs/immunization. The links to the complete manual as well as to the updates can be found on the first page of the Immunization Program website, as well as on the Publications page. Please update your immunization program manuals with these documents, placing them in the manual as indicated on the new table of contents pages which are included there as well. The Transmittal Documentation form which is included in the updated documents should be completed by the District Immunization Coordinators and forwarded to the Immunization Program Office by the date indicated at the bottom of the form. Please be sure to contact the program office at (404) 657-3158 if you have questions regarding any part of this update. MEC:dg Enclosures
An Equal Opportunity Employer www.dhr.georgia.gov

Jim Martin, Commissioner
Georgia Department of Human Resources Division of Public Health Kathleen E. Toomey, M.D., M.P.H., Director 2 Peachtree Street NW Suite 15.470 Atlanta, Georgia 30303-3142 404-657-2700 FAX: 404-657-2715

October 1, 2003

M E M O R A N D U M

TO:

District Health Directors

District Immunization Coordinators

FROM:

Michael Chaney, Manager Georgia Immunization Program

SUBJECT:

Revision of Georgia Certificate of Immunization, Form 3231 Revision of Policy Guide 3231 REQ Revision of Policy Guide 3231 INS

The Georgia Certificate of Immunization, Form 3231 and the Policy Guides 3231 REQ and INS have been revised. The Georgia Certificate of Immunization, Form 3231, has one revision. This revision is located in the "Notes" section at the bottom left of the form. The word "birth date" was added and the phrase "name of parent/guardian" was deleted. The first change was made to emphasize the necessity of having the date of birth in order to accurately assess the immunization dates entered on the form. Although the name of parent or guardian is desired information in order to more fully identify the child, it was felt that persons who strictly audited records might fail to accept an otherwise adequate certificate if the parent's name was omitted, and a child might unnecessarily be excluded from day care or school for lack of that one piece of information.
The revision of Item #2 under "Instructions for completing certificates" on the 3231 INS, reflects the above change.
Policy Guide 3231 REQ, side one, has three revisions, one related to the guidelines for spacing the 4th dose of DTaP; one concerning the guidelines for the administration of the 3rd dose of hepatitis B vaccine; and one for the number of doses of polio vaccine required for children entering school. (A summarized version of this requirements form is also included). After considerable research through all the available print resources and references and numerous exchanges with experts from the National Immunization Program and the Hepatitis Branch at CDC, the decision was made to make the changes necessary to be consistent with their recommendations. On side one, under the "Minimum Ages for Initial Immunization and Minimum Intervals Between Doses," the three footnotes pertinent to these vaccines will now read:
[1] One dose of DTP/DTaP/DT must be on or after the 4th birthday. If the 4th dose was on or after the 4th birthday, the 5th dose is not needed. The 4th dose should be administered a minimum of 6 months after the 3rd dose. However, the 4th dose does not need to be repeated if administered 4 months after dose 3. Total doses of diphtheria and tetanus toxoids should not exceed 6 before the 7th birthday.
[2] The 3rd dose of hepatitis B vaccine should be given a minimum of 4 months after the 1st dose and 2 months after the 2nd dose and not before 24 weeks of age.
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Transmittal October 1, 2003 Page Two
[3] Provided that minimum ages and intervals have been maintained, a child who has received 4 doses of all OPV, all IPV or combination of IPV and OPV is considered to be adequately immunized. If the 3rd dose of an all IPV or all OPV series is given on or after the 4th birthday, a 4th dose is not needed.
The changes will not require that a child who has a valid certificate on file replace their certificate with a revised form. These revisions will be in effect as of October 1, 2003 and may be used in administering or assessing vaccinations and/or issuing and assessing immunization certificates from this point on. You may continue to utilize printed copies of the Certificate of Immunization (Form 3231 dated 2000) until your supplies are depleted. Orders for bulk quantities of these forms will be filled starting January 1, 2004. Prior to January 1, 2004, if you desire to utilize the revised forms, you may duplicate the attached copies of Form 3231 and Forms 3231 REQ and 3231 INS.
According to the Rules of the Department of Human Resources, Division of Public Health, Chapter 290-5-4-.04, "Immunization shall be deemed to exist when certification is made by a physician or a qualified employee of a local Board of Health or the State Immunization Program, on a form provided by or approved by the Department of Human Resources." Therefore, if you desire to utilize a certificate not produced by the GA Immunization Program or not generated by the Georgia Registry of Immunization Transaction and Services (GRITS) or the Aegis system, approval for the form generated by that particular system must be obtained from the Georgia Immunization Program office. On the other hand, if you are currently utilizing an approved system generated Immunization Certificate it will be necessary for you to update this form with your vendor and obtain re-approval prior to January 31, 2004. For your convenience, a diskette containing the PDF version of the Certificate of Immunization (Form 3231) is included in the mailing of this memo. This PDF copy may be used to print duplicate copies or to share with your vendor. Please file this memo with your Immunization Program Manual. These revisions are in the process of being made to the appropriate sections of the Immunization Program Manual and we will notify you when these are included in the web copy of the manual. Please contact the program office if you have questions or need clarification of these new guidelines.
c: Kathleen E Toomey, M.D., M.P. H. Mr. Martez Hill
MEC:dg
An Equal Opportunity Employer www.dhr.georgia.gov

Maria Greene, Acting Commissioner
Georgia Department of Human Resources Division of Public Health Kathleen E. Toomey, M.D., M.P.H., Director 2 Peachtree Street NW Suite 15.470 Atlanta, Georgia 30303-3142 404-657-2700 FAX: 404-657-2715

February 25, 2004

MEMORANDUM

TO:

District Health Directors

District Immunization Coordinators

FROM:

Michael Chaney, Manager Georgia Immunization Program

SUBJECT: Updates to the Georgia Immunization Program Manual

This year the Recommended Childhood and Adolescent Immunization Schedule will be published twice: once in January and again later in the year, probably June or July. The complete manual update will take place at the time the second Recommended Immunization Schedule is published.

Below is a listing of the documents included in this update:

Table of Contents Cover page Foreward

Chapter 1--Introduction Vaccine and Related Products Distributed in the United States, 2003 [REPLACE]

Chapter 2--Recommended Schedule and Guidelines GA DHR Immunization Program Vaccine Guidelines Approval Sheet [ADD--do not replace other approval sheets] Eligibility Criteria for State Supplied Vaccines for Adult Populations [REPLACE] o A sentence was added in the opening paragraph stating that these guidelines apply to persons seeking care in all public health clinics. o New groups eligible for hepatitis A and hepatitis B vaccines were added. o Clarification was made regarding groups eligible for MMR. Hepatitis A Vaccine Guidelines [NEW--ADD] o Although hepatitis A vaccine is not a routinely recommended vaccine for all populations, the State does provide the vaccine for specific groups. These guidelines will provide only basic information, and providers are encouraged to access the resources recommended therein whenever administering state-supplied or private stocks of this vaccine. Recommended Childhood and Adolescent Immunization Schedule---United States, January-June 2004 [REPLACE] o No changes in scheduling or dosing information. o Two graphics changes were made: The date was changed to reflect the partial year, i.e. January-June 2004. Under Td, the color of the bar in the last column was changed from gold to green to indicate that adolescents ages 13-18 need to have their tetanus vaccination status assessed and a catch-up booster dose administered if needed.

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District Health Directors District Immunization Coordinators February 25, 2004 Page Two
o There were 8 editorial changes made, mostly for clarification purposes: A note was added directly under the schedule informing providers that significantly adverse events following immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS). A website and phone number to submit a VAERS report were also listed. There were 3 edits made in the hepatitis footnote. These all relate to the minimal age for administering the 3rd dose. This dose should not be administered before 24 weeks of age (previously stated 6 calendar months). There were 3 other footnote edits made, one in each DTaP, Hib, and pneumococcal footnote. A statement regarding when the final dose of the primary series of each of these vaccines should be administered was added to each footnote. In the influenza footnote, recommendations and dosing information for the live attenuated influenza vaccine (LAIV) were added. This footnote is expected to be expanded in the July 2004 schedule to include a full recommendation for routinely immunizing all children 6-23 months of age in addition to the current recommendations of immunizing all children at high risk and their contacts.
Recommended Adult Immunization Schedule by Age Group and Medical Conditions United States, 2003-2004 [REPLACE] o Additional information was added to the tetanus footnote regarding the use of tetanusdiphtheria toxoids as prophylaxis in wound management and adding previously unvaccinated pregnant women as possible candidates for a primary Td series. o Clarification regarding the number of doses of the measles component of the MMR vaccine. o Guidance regarding the use of intranasally administered, live, attenuated influenza vaccine for healthy persons aged 5-49 years. o Recommendations regarding administering influenza vaccine to pregnant women with or without pre-existing chronic diseases or conditions. o Addition of information regarding influenza and consideration of HIB vaccine for asplenic persons.
Summary of Rules for Childhood Immunization (9/03) [REPLACE] Summary of Recommendations for Adult Immunization (9/03) [REPLACE]
Chapter 3--Informed Request Policy Vaccine Information Statements---the first 6 VISs listed below changed only in the fact that the web address for accessing the National Vaccine Injury Compensation Program (VICP) changed. The varicella VIS is the only one that noted this change on the Spanish version as well as the English. [REPLACE ALL LISTED] o DTaP o Polio o HIB o Hepatitis B o Varicella--English and Spanish o Pneumococcal Conjugate o Meningitis Clarification that the vaccine can prevent 4 types of meningococcal disease has been added and now includes the importance of serogroup A which is of most concern to travelers to Africa. The website of the CDC Travelers Health, www.cdc.gov/travel, is provided
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District Health Directors District Immunization Coordinators February 25, 2004 Page Three Chapter 12--Travel
Travel and Yellow Fever Vaccination Clinics in Georgia [REPLACE] Vaccines and Biologics Used in U.S. and Foreign Markets [REPLACE] Translations of Foreign Vaccine-Related Terms [REPLACE] In addition to the above documents, this update also includes the revised Table of Contents pages to be placed in the front of the manual and then with each revised chapter, and the Manual Update Documentation sheet. District Immunization Coordinators should carry out the process of downloading this update from the Immunization Program website and updating their district's manuals. The update documentation sheet should be faxed or mailed back to the Georgia Immunization Program office by the deadline indicated on the form. Please contact the Georgia Immunization Program office at (404) 657-3158 if you have any questions or comments pertaining to this update. Cc: Kathleen E. Toomey, MD, MPH Rosalyn Bacon, MPH
An Equal Opportunity Employer www.dhr.georgia.gov

B. J. Walker, Commissioner
Georgia Department of Human Resources Division of Public Health Kathleen E. Toomey, M.D., M.P.H., Director 2 Peachtree Street NW Suite 15.470 Atlanta, Georgia 30303-3142

July 14, 2004

TO:

District Health Directors

District Immunization Coordinators

FROM:

Michael Chaney, Manager (Signed by Michael Chaney on 8/4/04) Georgia Immunization Program

SUBJECT: Updates to the Georgia Immunization Program Manual

The second Recommended Childhood and Adolescent Immunization Schedule has been published by the Advisory Committee on Immunization Practices (ACIP). As promised in February, this schedule is being sent as an update along with all the other manual updates not already completed. The following pages will contain a brief review of the changes to the documents being replaced, deleted, or added.

Cover page (REPLACE) Foreword (REPLACE) Table of Contents (REPLACE)---complete set, plus the Table of Contents pages with each section

Chapter 1---Introduction (REPLACE ALL BUT VACCINE PRODUCTS LIST) Updated databases and contact information Revision of the Request for Immunization Information form, Form 3184.

Chapter 2---Recommended Schedule and Guidelines Vaccine Guidelines Approval form (REPLACE) Immunization Guidelines for DHR Clinics (REPLACE)---in Part II, both new Eligibility Criteria charts are referenced Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Adult Populations (age 19 years) (REPLACE)---recently approved and added to manual at this time Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Child/Adolescent Populations (age 18 years)---(ADD) Each of the 10 sets of guidelines is being revised, mostly to update the references contained therein. (REPLACE ALL) Other specific changes to guidelines o Hepatitis B Pg. 2, changes to footnotes 3 and 4 Pg. 4, updated #2 to reflect eligible patients on the Adult Eligibility Guidelines; rewording of footnote 1 Pg. 6, new chart added, taken from VFC Resolution on hepatitis B Pg. 8, addition to guidelines for treatment of Unvaccinated Person if source is HBsAg positive o DTaP Pg. 4, added "D" with references to information on the use of tetanus-containing products, including tetanus immune globulin (TIG), for wound management o HIB Pg. 2, added eligible group for state supplied vaccine Pg. 3, corrected ages on booster doses in #2 of Schedule Pg. 4, corrected Recommended Regimen for number of doses for 7-11 month old children getting their first dose
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District Health Directors District Immunization Coordinators July 14, 2004 Page Two
o Polio Pg. 2, added eligible group for state supplied vaccine
o Pneumococcal Pg. 2, added information to first bullet under eligible groups for state supplied vaccine Pg. 3, added information to footnote #3 Pg. 6, deleted Pnu-Immune as brand of available vaccine; added other groups to eligible groups for state supplied vaccine
o MMR Pg. 2, revised section on eligible groups for state supplied vaccine
o Varicella Updated references only
o Combination Vaccines Pg. 4, added to last sentence under Indications for Use Pg. 5, corrected ages under age column in first table Pg. 7, revised section on eligible groups for state supplied vaccine; added footnote to Recommended Schedule Pg. 8, in first table, revised Minimum Interval Between Doses for Dose 3; revised Contraindications and Precautions section for clarity Pg. 10, in Minimum Age and Dose Interval information, corrected last sentence of footnote 3 Pg. 11, added information to Contraindications and Precautions section
o Influenza Pg. 2, corrected last bullet under eligible groups for state supplied vaccine Pg. 3, corrected last bullet under recommended influenza vaccine schedule and added another Pg. 5, added contraindications specific to LAIV
o Hepatitis A Pg. 3, added bullet under eligible groups for state supplied vaccine
Recommended Childhood and Adolescent Immunization Schedule, July-December 2004 (REPLACE)
Summary of Rules for Childhood and Adolescent Immunization (REPLACE) Summary of Recommendations For Adult Immunization (6/04) (REPLACE) Screening Questionnaires for Child and Teen Immunization (English/Spanish) (REPLACE) Screening Questionnaires for Adult Immunization (English/Spanish) (REPLACE) Standards for Adult Immunization Practices (REPLACE) Guidelines for Vaccinating Pregnant Women (REPLACE)
Chapter 3---Informed Request Policy Informed Request Policy (REPLACE)---additions under "VIS use is mandatory!" section Specific VISs (REPLACE) o English version of MMR VIS, dated 1-15-03 ( Publication date did not change. The word "to" was added in the first sentence of Section 3 for clarification purposes.) o Spanish version of MMR VIS, dated 1-15-03 o English versions of Influenza VISs, both Inactivated and Intranasal, dated 5-24-04 o Spanish version of meningitis VIS, dated 7-28-03 Personal Immunization Record (REPLACE)---the former English and Spanish versions have now been combined into one record, and reformatted to include adult immunization
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District Health Directors District Immunization Coordinators July 14, 2004 Page Three
Chapter 4---Adverse Effects Following Immunization Handling of Emergencies Following the Administration of Vaccines (REPLACE)---correction to chapter reference in item #2. VAERS brochure (REPLACE) Commonly Asked Questions About the National Vaccine Injury Compensation Program (REPLACE)
Chapter 5---Requirements of School/Daycare Law Summary of Immunization Policies Relative to Georgia Law (REPLACE) o Clarification of term "30 day waiver" under I.J., by removing words "grace period." o Clarification added to II.A. as to who may issue Certificates of Immunization in Georgia Historical Statement Listing Dates for School and Daycare Immunization Requirements (REPLACE)---new dates added at end of document Policy Guide 3231 REQ (REPLACE)---correction of symbols in paragraph on grace period and in footnote 1 on Side 1 Immunization Requirements and Recommendations for University of Georgia System Students
Chapter 6---Surveillance and Reporting Contact Persons for VPD Surveillance in Epidemiology, Immunization Program, and District Health Units (REPLACE) Virology Request Form (REPLACE)---now called Viral Culture Submission Form, Rev. 9/02
Chapter 7---Hepatitis Appendix for Perinatal Hepatitis B Prevention Program Guidelines o C---DHR Patient Notification Letter (Sample) (REPLACE) updated letterhead o E--Hepatitis B Alert (Infant) (REPLACE)---updated reference o G---Hepatitis B Alert (HBsAg Positive Woman) (REPLACE)---updated reference o H---Georgia Public Health Laboratory Service Manual Excerpt (REPLACE) o I---Questions Frequently Asked About Hepatitis B (REPLACE) o N---Hepatitis B Facts: Testing and Vaccination (REPLACE) Hepatitis B Vaccination in STD, HIV and Family Planning Clinics, Guidelines for Public Health (REPLACE) o Pg. 3, added to list of persons who are eligible and those who are not eligible to receive state supplied hepatitis B vaccine. o Pgs. 3 and 4---updated references.
Chapter 8---Recall of Patients (NO CHANGES)
Chapter 9---Vaccine Distribution and Storage Distribution of Vaccines (REPLACE)---additional information added to #5 and #6. Temperature Log Sheets---Fahrenheit sheet, headings added (REPLACE). Celsius sheets are new. (ADD) Provider Agreement for Public Health Districts (ADD) Provider Agreement Policy for Public Health Districts (ADD) Vaccine Loss Policy for Public Health Districts (ADD) Handling of Vaccine During Inclement Weather Conditions (ADD) Guidelines for Returning Vaccine Products to the Manufacturer for Disposal (REPLACE)---under Merck & Co., section I deleted. Vaccine Wastage Log (REPLACE)---"Lot Number" added to column headed "Manufacturer" An Equal Opportunity Employer www.dhr.georgia.gov

District Health Directors District Immunization Coordinators July 14, 2004 Page Four
Chapter 10---District/County Inserts
Chapter 11---Transmittal Memos (PLACE THIS DOCUMENT THERE WHEN UPDATE IS COMPLETED)
Chapter 12---Travel Information Foreign Travel Information (REPLACE) o Updated information in all sections o Section added entitled "Routine Childhood Vaccines by Country" and how to access that information Routine Childhood Vaccines by Country (REMOVE)
Chapter 13---Quality Assurance
Appendices
Attachment A - Immunization Reference Video Information and Resources, Training Sessions (REPLACE)
Attachment B - NIP Order Form (REPLACE) Attachment C - Post Test (REPLACE) Attachment D - Post Test Answers (REPLACE) Attachment E - IM (Intramuscular) Injections (REPLACE) Attachment E - SC (Subcutaneous) Injections (REPLACE) Attachment I - QA/QI Review Assessment Tool (REPLACE)
A Manual Update Documentation Form is included with this memo. Immunization Coordinators should access this complete manual update from the program website, update the manuals in their district, complete this documentation form, and return it to the program office by the due date noted at the bottom of the form.
In addition to this letter, the Table of Contents will also provide instruction as to which documents to add, replace, or remove entirely. For any other questions, please do not hesitate to contact the Georgia Immunization Program office at 404-657-3158.

Attachment

c:

Kathleen E. Toomey, MD, MPH

Rosalyn K. Bacon, MPH

An Equal Opportunity Employer www.dhr.georgia.gov

B. J. Walker, Commissioner
Georgia Department of Human Resources Division of Public Health Stuart T. Brown, M.D., Acting Director 2 Peachtree Street NW Suite 15.470 Atlanta, Georgia 30303-3142 404-657-2700 FAX: 404-657-2715

MEMORANDUM

February 1, 2005

TO:

District Health Directors

District Immunization Coordinators

FROM:

Michael Chaney, Manager Georgia Immunization Program

SUBJECT:

Georgia Immunization Program Manual Update

The 2005 Recommended Childhood and Adolescent Immunization Schedule has been published by the Advisory Committee on Immunization Practices (ACIP). It will be included along with a few other updated documents. Following is a brief review of the changes to the documents being replaced, deleted, or added.

Cover page (REPLACE) Division of Public Health, Policy and Procedure Approval (REPLACES PAGE TITLED "FOREWORD") Table of Contents (REPLACE)---complete set, plus the Table of Contents pages with each section

Chapter 1---Introduction (REPLACE ALL BUT THE INTRODUCTION TO THE MANUAL) Updated databases and contact information Revision of the Request for Immunization Information form, Form 3184 Updated version of the Vaccine Products Licensed for Use in the U.S., March 2004.

Chapter 2---Recommended Schedule and Guidelines Vaccine Guidelines Approval form (ADD TO MANUAL, LEAVING PREVIOUS APPROVAL FORMS AS WELL) Immunization Guidelines for DHR Clinics (REPLACE)---a paragraph plus 8 points were added to provide guidelines to those administering vaccines, particularly addressing the issue of pre-drawing vaccines. Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Adult Populations (age 19 years) (REPLACE) sentence added regarding the vaccination of adults with private insurance correction to HBIG guidelines, Item 2: "...within 7 days of exposure." Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Child/Adolescent Populations (age 18 years) (REPLACE) --- correction to HBIG guidelines, Item 2: "...within 7 days of exposure." Vaccine Guidelines (REPLACE ONLY THE FOLLOWING 2 SETS OF GUIDELINES) Hepatitis B o corrections to tables on pgs. 4 and 7 regarding the administration of HBIG to persons with blood exposure to an infected person o reference added to Contraindications and Precautions section, noting that when indicated this vaccine may be given to pregnant and lactating women. Diphtheria, Tetanus, and Pertussis---under Vaccine Description, clarification was made to the bullet under DT, that this vaccine is the one of choice for children <7 years of age who have any contraindication to pertussis vaccine, not to DTP or DTaP. Recommended Childhood and Adolescent Immunization Schedule 2005 (REPLACE)

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District Health Directors District Immunization Coordinators February 1, 2005 Page Two
Catchup Schedule for Children with Lapsed Immunizations (REPLACE and REPOSITION AS NOTED IN THE TABLE OF CONTENTS)---information did not change but the slight change in formatting makes the document easier to read. Repositioned to follow Childhood Schedule since it is an extension of the schedule document. Recommended and Minimal Ages and Intervals Between Vaccine doses (Table 1) (REPOSITION ONLY AS NOTED IN THE TABLE OF CONTENTS) Recommended Adult Immunization Schedule United States, 2004-2005 (REPLACE and REPOSITION AS NOTED IN THE TABLE OF CONTENTS). Repositioned for organizational purposes. Summary of ACIP General Recommendations (ADD)---this one page document summarizes 10 of the most central immunization recommendations found in the larger ACIP document. Summary of Rules for Childhood Immunization (3/04) (DELETE)---this information can be found in the individual Vaccine Guidelines in this chapter, as well as in the ACIP statements. Summary of Recommendations for Adult Immunization (6/04) (DELETE)---this information can be found in the individual Vaccine Guidelines and the corresponding ACIP statements. Guidelines for Vaccinating Pregnant Women (DELETE)---all this information for administering routinely recommended vaccines to pregnant women can be found in the individual Vaccine Guidelines. For questions pertaining to "travel vaccines" such as yellow fever and typhoid, the specific ACIP statements may be accessed.
Chapter 3---Informed Request Policy Informed Request Policy (REPLACE)----slight wording changes in the paragraphs under the heading "VIS use is mandatory!", reflective of the fact that providers must distribute certain VISs required by the National Childhood Vaccine Injury Act. The Immunization Program website was updated as well. Hepatitis A Vaccine Information Statements (English and Spanish) (REPLACE)----these VISs have been available but are now being included as part of an official manual update. Personal Immunization Record (DELETE)---this form is available for order using Form 3184, but a photocopy of the form will no longer be included in the manual. After the Shots (REPLACE)---an updated version of this IAC form. A chart showing ibuprofen dosing information was added.
Chapter 4---Adverse Events Following Immunizations---no changes
Chapter 5---Requirements of School/Day care Law Summary of Immunization Policies Relative to Georgia Law (REPLACE)---on page 3, Item III. C. was added to address vaccine requirements for entrance to 6th grade. Health departments are also encouraged to conduct audits of this grade in addition to the kindergarten inventories done yearly. Official Code of Georgia, Annotated (REPLACE)---the section of the Code outlining the registry law was added. Historical Statement Listing Dates of Immunization Requirements (REPLACE)---updated to reflect the recommendation for routine influenza vaccination of 6-23 month old children, and also to make note of the month PCV deferrals were withdrawn. Give `Em Your Best Shot (English and Spanish) (DELETE)---these pamphlets are available for order using Form 3184, but a photocopy will no longer be included in the manual. They can also be viewed on the Parental Resources page on the Immunization Program website. Policy Guide 3231REQ (REPLACE)---a sentence was added to the polio footnote on Side 1 and references to the old 2004 immunization schedule were deleted. Immunization Guidelines for Child Care Facility Operators and School Personnel, Form 3258 (DELETE)---this pamphlet is still available for order using Form 3184, but a photocopy will no longer be included in the manual. It may also be viewed on the School Resources page on the Immunization Program website.
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District Health Directors District Immunization Coordinators February 1, 2005 Page Three

Chapter 6---Surveillance and Reporting Contact Persons for VPD Surveillance in Epidemiology, Immunization Program, and District Health Units (REPLACE)---updated contact information Notifiable Disease Report form (Form 3095) (REPLACE)---updated form

Chapter 7---Hepatitis Perinatal Hepatitis B Pevention Program Guidelines (REPLACE ONLY PG. 7) ---correction made to last sentence under H. 3: "...within the past seven (7) days."

Chapter 8---Recall of Patients---no changes

Chapter 9---Vaccine Distribution and Storage Temperature Log Sheets (Fahrenheit and Celsius) (REPLACE)---temperature charts were reformatted to emphasize when recorded temperatures are too warm or too cool for refrigerated and frozen vaccines. Vaccine Management (Handling and Storage Recommendations (REPLACE) ---updated document

Chapter 10---District/County Inserts---no changes

Chapter 11---Transmittal Memos (PLACE THIS DOCUMENT AND A COPY OF THE "UPDATE DOCUMENTATION FORM" HERE WHEN THE UPDATE IS COMPLETED THROUGHOUT THE DISTRICT.)

Chapter 12---Travel Information Foreign Travel Information (REPLACE) updated ordering information for the International Certificate of Vaccination updated contact information for clinics wishing to be Yellow Fever Vaccination sites more detail added to instructions for accessing Routine Childhood Vaccines by Country Designated Yellow Fever Vaccination Clinics in Georgia (REPLACE)---updated information

Chapter 13---Quality Assurance Appendices Attachment A---Immunization References,Video Information, Resources and Training Sessions (REPLACE)----contact information, material ordering addresses and costs, and the educational presentations list were updated. Attachment B---NIP Order Form. Since this online order form changes at irregular intervals, please access the website address listed on the Table of Contents page to get the most current form. Attachment I---QA/QI Review Assessment Tool (REPLACE)---questions and references updated to correspond with current CDC site visit data requirements.

A slightly revised version of the Manual Update Documentation Form is included in this update. Please read carefully, complete, and submit to the Immunization Program Office by the date indicated. As in the past, this particular transmittal as well as the updated Complete Immunization Program Manual will be available on the program website. They can be linked from the index page of the website or also found in the Publications section.

Please follow the instructions to REPLACE/DELETE/ADD sections as outlined in this memo and also on each Table of Contents page. For any questions, please contact the Georgia Immunization Program office at 404-6573158.

Attachment c: Rosalyn K. Bacon, M.P.H.

An Equal Opportunity Employer www.dhr.georgia.gov

B. J. Walker, Commissioner
Georgia Department of Human Resources Division of Public Health Stuart T. Brown, M.D., Director 2 Peachtree Street NW Suite 15.470 Atlanta, Georgia 30303-3142 404-657-2700 FAX: 404-657-2715

October 5, 2005

MEMORANDUM

TO:

District Health Directors

District Immunization Coordinators

FROM:

Michael Chaney, Manager Georgia Immunization Program

SUBJECT:

Updates to the Georgia Immunization Program Manual

This update will contain both new information, and information that was approved and forwarded separately earlier this year, namely the meningococcal vaccine guidelines and Vaccine Information Statements (VISs). Please use this document as well as the updated Table of Contents pages to assist you in adding or replacing materials in your program manual.

Below is a listing of the documents included in the update as well as guidance for adding or replacing same:

Transmittal Memo---use this to assist in adding and replacing documents, then place in Chapter 11, Transmittal Memos.

Manual Update Documentation page---complete this, send a copy to the state program office, and place the form in Chapter 11, Transmittal Memos.

Table of Contents:
Cover page (REPLACE) Complete set of Table of Contents pages (REPLACE)

Chapter 1---Introduction
Table of Contents page (REPLACE) Georgia Immunization Program Staff, Central Office (REPLACE) District Immunization Coordinators (REPLACE) Request for Immunization Forms---Form 3184 (REPLACE)
o New VISs added, plus the Spanish Word to the Wise pamphlet, and a Georgia Vaccine Administration record that will fit into a medical record

Chapter 2---Recommended Schedule and Guidelines
Table of Contents page (REPLACE) GA DHR Immunization Program Vaccine Guidelines Approval Sheet (ADD--do not remove previous
sheets)
Eligibility Criteria for State-Supplied Vaccines for Adult Populations (REPLACE)
o Revised heading of column for persons not eligible for state-supplied vaccine o Addition to the MMR eligibility criteria
Eligibility Criteria for State-Supplied Vaccines for Child/Adolescent Populations (REPLACE)
o Revised heading of column for persons not eligible for state-supplied vaccine

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District Health Directors District Immunization Coordinators October 5, 2005 Page Two
Vaccine Guidelines (REPLACE)
o Tdap and MCV4 vaccines added to each of the Simultaneous Vaccine Administration sections of the guidelines listed here.
o Diphtheria, Tetanus, and Pertussis (REPLACE) Addition of Tdap to each relevant section of this set of guidelines
o Measles, Mumps, and Rubella (REPLACE) Added reference to MMRV, or ProQuad
o Varicella (REPLACE) Added reference to MMRV, or ProQuad
o Combination Vaccines (REPLACE) Information provided on completing the Twinrix series with single antigen hepatitis A and hepatitis B vaccine Corrected information on minimum interval between doses #2 and #3 for Twinrix Preliminary information on ProQuad
o Influenza (REPLACE) Manufacturer information updated Addition of another risk group to Eligible Groups for State-supplied Vaccine and Recommended Influenza Vaccine Schedule Updated references
o Hepatitis A (REPLACE) Addition of references to the change in licensure for Vaqta, making it available for children as young as 12 months
o Meningococcal Disease (ADD)
Suggested Intervals between Administration of Antibody-containing Products and Measles-containing and
Varicella Vaccines (Table 4) (ADD)
Chapter 3---Informed Request Policy
Table of Contents page (REPLACE) Vaccine Information Statements
o Tdap (English) (ADD) o Influenza, Inactivated (English and Spanish) (REPLACE) o Influenza, Live Intranasal (English and Spanish) (REPLACE) o Meningococcal Vaccines (English and Spanish ) (REPLACE)
After the Shots (English and Spanish) (REPLACE)
o Each of these documents was changed in order to coincide with recommendations made in the Georgia Nursing Protocol manual, in terms of the level of fever signifying a need for medical evaluation; and the addition of dosages for ibuprofen products. This was approved in 4/2005.
Chapter 7---Hepatitis
Table of Contents page (REPLACE) Perinatal Hepatitis B Prevention Program Guidelines (REPLACE)
Appendix (REPLACE THE FOLLOWING ONLY)
A---Flow Chart for Following Babies Born to HBsAg Positive Females C---Sample Patient Notification Letter H---Georgia Public Health Laboratory Service Manual Excerpt (replace pages 3,5, and 6 only) J---Labor and Delivery and Nursery Unit Guidelines to Prevent HBV Transmission K---What the Physician Can Do to Help the Child with Chronic Hepatitis B Virus Infection (title
change)
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District Health Directors District Immunization Coordinators October 5, 2005 Page Three
L---If You Have Chronic Hepatitis B Virus (HBV) Infection (title change) N---Hepatitis B Facts: Testing and Vaccination
Chapter 9---Vaccine Distribution and Storage
Table of Contents page (REPLACE) Distribution of Vaccines (REPLACE)
o Changes to Items 2,3 and 6; deletion of the item referring to districts returning shipping containers with FedEx mailers; and the addition of a new item, now designated #8
Temperature Conversion Chart (ADD)
o Reference with pre-printed values, showing equivalent Fahrenheit and Celsius temperatures
Vaccine Management (Recommendations for Handling and Storage of Selected Biologicals, June 2005)
(REPLACE)
Chart of Refrigerated/Frozen Pack Needs (ADD)
o Recommendations on the number of frozen packs to use in transporting vaccines, based on such criteria as outside temperature and number of boxes being transported
Maintaining the Cold Chain during Transport (ADD)
o Immunization Action Coalition (IAC) document outlining instructions for transporting each specific type of vaccine
Vaccine Administration Record (ADD)
o A complete immunization record appropriate for including in a paper chart or medical record
Chapter 12---Travel
Table of Contents page (REPLACE)
o Updated reference to CDC publication, Health Information for International Travel
Chapter 13---Quality Assurance
Table of Contents page (REPLACE) Quality Assurance/Quality Improvement for Immunization Practice for Public Health Nurses and
Immunization Support Staff (REPLACE) o Updated to include web-based training of offerings by district "certified" trainers; and the requirement to access immunization records in GRITS prior to administering vaccines.
Attachment A (REPLACE) Attachment H (REPLACE)
As always, this transmittal as well as an updated version of the complete Immunization Program Manual will be posted on the Immunization Program website at www.health.state.ga.us/programs/immunization and can be accessed from the main web page or from the link to Publications. If you have any questions about this update, please contact the Georgia Immunization Program office at 404-657-3158.
Attachment c: Stuart T. Brown, M.D.
Rosalyn K. Bacon, M.P.H.
An Equal Opportunity Employer www.dhr.georgia.gov

B. J. Walker, Commissioner
Georgia Department of Human Resources Division of Public Health Stuart T. Brown, M.D., Director 2 Peachtree Street NW Suite 15.470 Atlanta, Georgia 30303-3142 404-657-2700 FAX: 404-657-2715

March 30, 2006

MEMORANDUM

TO:

District Health Directors

District Immunization Coordinators

FROM:

Michelle Conner, Director Georgia Immunization Program

SUBJECT:

Georgia Immunization Program Manual Updates

Below is a listing of the documents included in the update as well as guidance for adding or replacing same:
Transmittal Memo---use this to assist in adding and replacing documents, then place in Chapter 11, Transmittal Memos.
Manual Update Documentation page---Immunization Coordinators are to complete this, send a copy to the state program office by the deadline, and place the form in Chapter 11, Transmittal Memos.
Table of Contents:
Cover page (REPLACE) Complete set of Table of Contents pages (REPLACE)
Chapter 1---Introduction
Table of Contents page (REPLACE) Georgia Immunization Program Staff: Central Office and Immunization Program Consultants (REPLACE) District Immunization Coordinators (REPLACE) Request for Immunization Forms---Form 3184 (REPLACE)
o New VISs added
Updated Vaccines and Related Products table (IAC) (DELETE) U.S. Vaccines (ADD)
Chapter 2---Recommended Schedule and Guidelines
Table of Contents page (REPLACE) GA DHR Immunization Program Vaccine Guidelines Approval Sheet (ADD--do not remove previous
sheets)
Immunization Guidelines for DHR Clinics (REPLACE)
o Updated references
Eligibility Criteria for State-Supplied Vaccines for Adult Populations (DELETE) Eligibility Criteria for State-Supplied Vaccines for Child/Adolescent Populations (DELETE) Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents,
and Adults (ADD) o This table combines the preceding 2 that are being deleted, and contains all the vaccines supplied by the Georgia Immunization Program and the eligibility criteria for each
Immunization Program Vaccine Guidelines (REPLACE ALL)
o Some sets of guidelines were updated with new content based on new provisional or other ACIP guidelines; some updates were merely for format or updated references

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District Health Directors District Immunization Coordinators March 30, 2006 Page Two
Recommended Childhood and Adolescent Immunization Schedule 2006 (REPLACE) Catch-up Schedule for Children with Lapsed Immunizations (REPLACE) Recommended and Minimum Ages and Intervals Between Vaccine Doses (Table 1) (REPLACE) Recommended Adult Immunization Schedule United States, 2005-2006 (REPLACE) Screening Questionnaires for Child and Teen Immunization (English/Spanish) (REPLACE ENGLISH) Screening Questionnaires for Adult Immunization (English/Spanish) (REPLACE ENGLISH) Standards for Child and Adolescent Immunization Practices (REPLACE)
Chapter 3---Informed Request Policy
Table of Contents page (REPLACE) Vaccine Information Statements
o Tdap (Spanish) (ADD) o Hepatitis A (English) (REPLACE) o Influenza, Inactivated (English and Spanish) (REPLACE) o Influenza, Live Intranasal (English and Spanish) (REPLACE) o Meningococcal Vaccines (Spanish ) (REPLACE)
Chapter 5---Requirements of School/Daycare Law
Immunization Requirements & Recommendations for University System of Georgia Students (REPLACE)
o Updated requirements based on new ACIP recommendations for Tdap, meningococcal conjugate vaccine, and varicella immunity status
Chapter 9---Vaccine Distribution and Storage
Table of Contents page (REPLACE) Provider Agreement Policy for Public Health Districts (REPLACE)
o Addition made to Program Violations, under Requirement 1, regarding the failure to purchase private vaccine stock for patients who are ineligible for state supplied vaccine
Guidelines for Fraud and Abuse Prevention for Public Health Districts (ADD) Vaccine Administration Record (REPLACE)
o New vaccines added
Chapter 12---Travel Information
Travel and Yellow Fever Vaccination Clinics in Georgia (REPLACE)
Chapter 13---Quality Assurance
Table of Contents page (REPLACE) Attachment A (REPLACE) Attachment I (REPLACE)
Chapter 14---Standard Operating Guidelines for Mass Vaccination Clinics (ADD COMPLETE NEW CHAPTER)
December 15, 2005 memo regarding development of these guidelines Guidelines for use by districts and clinics in planning mass vaccination activities Appendix A: Sample Medication Dispensing/Vaccination Site Flowchart Appendices B1, B2, B3, B4: Sample Vaccination Site Command Charts
As always, this transmittal as well as an updated version of the complete Immunization Program Manual will be posted on the Immunization Program website at www.health.state.ga.us/programs/immunization and can be accessed from the main web page or from the link to Publications. If you have any questions about this update, please contact the Georgia Immunization Program office at 404-657-3158.
Attachment c: Stuart T. Brown, M.D.
Rosalyn K. Bacon, M.P.H.
An Equal Opportunity Employer www.dhr.georgia.gov

B. J. Walker, Commissioner Georgia Department of Human Resources Division of Public Health Stuart T. Brown, M.D., Director 2 Peachtree Street NW Suite 15.470 Atlanta, Georgia 30303-3142 404-657-2700 FAX: 404-657-2715
December 8, 2006

MEMORANDUM

TO:

District Health Directors

District Program Managers

District Administrators

District Immunization Coordinators

FROM:

Michelle Conner, Director Georgia Immunization Program

SUBJECT:

Georgia Immunization Program Manual Updates

Below is a listing of the documents included in the update as well as guidance for adding or replacing same:
Transmittal Memo---use this to assist in adding and replacing documents, then place in Chapter 11, Transmittal Memos.
Manual Update Documentation page---Immunization Coordinators are to complete this, send a copy to the state program office by the deadline, and place the form in Chapter 11, Transmittal Memos.

Cover page (REPLACE)

Division of Public Health, Policy and Procedure Approval (REPLACE)

Table of Contents:
Complete set of Table of Contents pages (REPLACE)
Chapter 1---Introduction
Table of Contents page (REPLACE) Introduction to the Manual (REPLACE) Georgia Immunization Program Staff: Central Office and Immunization Program Consultants (ADD---DO
NOT REMOVE CURRENT IMMUNIZATION PROGRAM CONSULTANT LIST UNTIL 1-1-07)
District Immunization Coordinators (REPLACE) Request for Immunization Forms---Form 3184 (REPLACE)
o New VISs and GRITS brochure added

Chapter 2---Recommended Schedule and Guidelines
Table of Contents page (REPLACE) DHR GA Immunization Program Vaccine Guidelines Approval Sheet (ADD--do not remove previous
sheets)
Immunization Guidelines for DHR Clinics (REPLACE)
o Updated format and addition of information about GRITS documentation of immunizations
Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents,
and Adults (REPLACE) o Updated criteria and addition of new vaccines

District Health Directors

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District Program Managers District Administrators District Immunization Coordinators December 8, 2006 Page Two
Immunization Program Vaccine Guidelines
o Vaccines to Prevent Diphtheria, Tetanus, and Pertussis (REPLACE) o Vaccines to Prevent Measles, Mumps, and Rubella (REPLACE) o Vaccines to Prevent Varicella (REPLACE) o Combination Vaccines (REPLACE) o Vaccines to Prevent Influenza (REPLACE) o Vaccines to Prevent Hepatitis A (REPLACE) o Vaccines to Prevent Meningococcal Disease (REPLACE) o Vaccines to Prevent Rotavirus Gastroenteritis (ADD) o Vaccines to Prevent Human Papillomavirus Infection (ADD)
Recommended Adult Immunization Schedule, by Vaccine and Age Group, United States, October 2006-
September 2007 (REPLACE)
Screening Questionnaires for Child and Teen Immunization (English/Spanish) (REPLACE ENGLISH) Screening Questionnaires for Adult Immunization (English/Spanish) (REPLACE ENGLISH)
Chapter 3---Informed Request Policy
Table of Contents page (REPLACE) Informed Request Policy (REPLACE) Vaccine Information Statements
o Tdap (English and Spanish) (REPLACE) o Hepatitis A (Spanish) (REPLACE) o Influenza, Inactivated (English and Spanish) (REPLACE) o Influenza, Live Intranasal (English and Spanish) (REPLACE) o Meningococcal Vaccine (English) (REPLACE) o Rotavirus Vaccine (English and Spanish) (ADD) o HPV (Human Papillomavirus) Vaccine (English and Spanish) (ADD) o Shingles Vaccine (English and Spanish) (ADD)
Vaccine Administration Record (ADD)
o This form has been updated with new vaccines, and prior to this update, was found in Chapter 9.
Chapter 4 ---Adverse Events Following Immunizations
Table of Contents page (REPLACE) VAERS Table of Reportable Events (DELETE) National Vaccine Injury Compensation Program Vaccine Injury Table (REPLACE)
Chapter 5---Requirements of School/Daycare Law
Table of Contents page (REPLACE) Summary of Immunization Policies Relative to Georgia Law (REPLACE)
o Section III, B. updated to include requirement for health departments to conduct inventories of 6th grades, along with kindergarten inventories; new reporting deadline.
o Section III, C. deleted
Historical Statement Listing Dates of Immunization Requirements (REPLACE)
o New dates added
Chapter 6---Surveillance and Reporting
Table of Contents page (REPLACE) Procedure for the Investigation and Reporting of Vaccine Preventable Diseases (REPLACE) Memorandum on Vaccine Preventable Diseases Reporting and Follow-up Procedures (DELETE) Contact Persons for VPD Surveillance at the District Health Office (REPLACE)
o Updated contact information
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District Health Directors District Program Managers District Administrators District Immunization Coordinators December 8, 2006 Page Three
Vaccine Preventable Disease Fact Sheets (references not specifically used in to make this update were not
updated at this time) o Hepatitis A Fact Sheet and Q&A (REPLACE) o Hepatitis B Fact Sheet and Q&A (REPLACE) o Haemophilus influenzae Invasive Disease Fact Sheet and Q&A (REPLACE) o Measles Fact Sheet and Q&A (REPLACE) o Mumps Fact Sheet (REPLACE) o Pertussis Fact Sheet and Q&A (REPLACE)
This document has undergone considerable revision, including the addition of an
appendix, Pertussis Specimen Collection and Submission. o Polio Fact Sheet and Q&A (REPLACE) o Rubella Fact Sheet and Q&A (REPLACE) o Streptococcus pneumoniae Fact Sheet and Q&A (REPLACE) o Tetanus Fact Sheet (REPLACE)
Resources for Influenza Prevention and Control (REPLACE)
o Updated manufacturer contacts and treatment information
Influenza Outbreak Control in a Long Term Care Facility (REPLACE)
o Updated treatment information
GPHL Microbial Immunology Submission Form (ADD) GPHL Molecular Biology Submission Form (ADD)
Chapter 7---Hepatitis
Table of Contents page (REPLACE) Perinatal Hepatitis B Prevention Program Guidelines (REPLACE)
o Updated information and references o Appendices
Appendix A---Flow Chart for Following Babies Born to HBsAg + Females (REPLACE) Appendix C-1 (to replace Appendix C)---Sample Letter to Pregnant Women Testing Positive for HBsAg (REPLACE) Appendices C-2 and C-3---Sample Letters for Foster Parents of Infants Born to HBsAg (+) Women, and for Adoptive Parents of Infants Born to HBsAg (+) Women (ADD) Appendix E---Hepatitis B Alert for High Risk Infant's Chart (REPLACE) Appendix F---Hepatitis B Alert Wallet Reminder Card (DELETE) Appendix F---HIPAA Form for Perinatal Hepatitis B Prevention Program (ADD) Appendix H---Georgia Public Health Laboratory Service Manual Excerpt (REPLACE) Appendix J---Guidelines for Standing Orders in Labor & Delivery and Nursery Units to Prevent Hepatitis B Virus Transmission to Newborns (REPLACE)
Chapter 8---Recall of Patients
Table of Contents page (REPLACE)
Chapter 9---Vaccine Distribution and Storage
Table of Contents page (REPLACE) Distribution of Vaccines (REPLACE)
o Changes made to reflect VMBIP plan
Maintaining the Cold Chain During Transport (REPLACE)
o Updated form from IAC
Vaccine Wastage Log (DELETE)
o Information on this form is documented elsewhere now District Health Directors
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District Program Managers District Administrators District Immunization Coordinators December 8, 2006 Page Four
Vaccine Administration Record (DELETE)
o Updated form now to be placed in Chapter 3, Informed Request Policy
Guidelines for Vaccine Packing and Shipping (REPLACE with Vaccine Storage and Handling Toolkit,
Chap. 10---Vaccine Shipments) Chapter 10 and 11
Table of Contents pages (REPLACE)
Chapter 12---Travel Information
Table of Contents page (REPLACE) Foreign Travel Information (REPLACE)
o Updates to information about accessing and purchasing "Health Information for International Travel," (the Yellow Book)
Travel and Yellow Fever Vaccination Clinics in Georgia (REPLACE)
Chapter 13---Quality Assurance
Table of Contents page (REPLACE) Attachment A (REPLACE)
o Updated references and contact information
Attachment E (REPLACE)
o New vaccine added and references updated Chapter 14---Standard Operating Guidelines for Mass Vaccination Clinics
Updated guidelines including new appendices
As always, this transmittal as well as an updated version of the complete Immunization Program Manual will be posted on the Immunization Program website at www.health.state.ga.us/programs/immunization and can be accessed from the main web page or from the link to Publications. If you have any questions about this update, please contact the Georgia Immunization Program office at 404-657-3158. Attachment c: Stuart T. Brown, M.D.
Rosalyn K. Bacon, M.P.H. Janice Carson, M.D.
An Equal Opportunity Employer www.dhr.georgia.gov

B. J. Walker, Commissioner Georgia Department of Human Resources Division of Public Health Stuart T. Brown, M.D., Director 2 Peachtree Street NW Suite 15.470 Atlanta, Georgia 30303-3142 404-657-2700 FAX: 404-657-2715
June 30, 2008

MEMORANDUM

TO:

District Health Directors

District Program Managers

District Administrators

District Immunization Coordinators

FROM:

Deborah Jelks, Acting Director Georgia Immunization Section

SUBJECT: Georgia Immunization Program Manual Updates

In the interest of saving resources and space, we are not asking you to replace whole documents with this update, but only the specific pages that have been revised. A notation has been made in the footer of those documents as to the pages that have been updated. Below is a listing of those documents included in the update as well as guidance for adding, deleting, or replacing same:
Transmittal Memo---use this to assist in adding and replacing documents, then place in Chapter 11, Transmittal Memos.
Manual Update Documentation page---Immunization Coordinators are to complete this, send a copy to the state immunization program office attention nurse consultant by the deadline noted on the form, and place it in Chapter 11, Transmittal Memos.

Cover page (REPLACE)

Division of Public Health, Policy and Procedure Approval (REPLACE)

Table of Contents:
Complete set of Table of Contents pages (REPLACE)
Chapter 1---Introduction
Table of Contents page (REPLACE) Georgia Immunization Program Staff: Central Office and Immunization Program Consultants
(REPLACE)
District Immunization Coordinators (REPLACE) Request for Immunization Forms---Form 3184 (REPLACE) U.S. Vaccines (REPLACE)

Chapter 2---Recommended Schedule and Guidelines
Table of Contents page (REPLACE) DHR GA Immunization Program Vaccine Guidelines Approval Sheet (ADD--do not remove previous
sheets)
Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Children,
Adolescents, and Adults (2/08) (REPLACE)

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District Health Directors District Program Managers District Administrators District Immunization Coordinators June 30, 2008 Page Two
Immunization Program Vaccine Guidelines (REPLACE pages or entire document as indicated)
o Hepatitis B--page 4 only o Pneumococcal--page 2 only o Combination--page 8 only o Influenza--entire document o Hepatitis A--pages 1,6,and 7 o Meningococcal--entire document
Recommended Childhood and Adolescent Immunization Schedule 2008 (REPLACE) Catch-up Schedule for Children with Lapsed Immunizations 2008 (REPLACE) Adult Schedule 2007-2008 (REPLACE) Screening Questionnaires for Child and Teen Immunization (English/Spanish) (REPLACE BOTH) Screening Questionnaires for Adult Immunization (English/Spanish) (REPLACE BOTH)
Chapter 3---Informed Request Policy
Table of Contents page (REPLACE) Vaccine Information Statements
o MMR 3/13/08 (English) (REPLACE) o Varicella 3/13/08 (English) (REPLACE) o Influenza Inactivated 7/24/08 (English) (REPLACE) o Influenza Live Intranasal 7/24/08 (English and Spanish) (REPLACE) o Vacuna Intranasal Viva Contra (Influenza) 10/04/07 (Spanish) (REPLACE) o Meningococcal Vaccine 1/28/08 (English) (REPLACE ) o Rotavirus Vaccine 8/28/08 (English) (REPLACE) o Multi VIS 01/30/08 (English and Spanish) (ADD)
Chapter 4 ---Adverse Events Following Immunizations
Table of Contents page (REPLACE) Vaccine Adverse Event Reporting System Form VAERS FDA (REPLACE) Frequently Asked Questions About VAERS (REPLACE)
o Updated contact information
VAERS Brochure (REPLACE)
Chapter 6---Surveillance and Reporting
Table of Contents page (REPLACE) Contact Persons for VPD Surveillance at the District Health Office (REPLACE)
o Updated contact information Vaccine Preventable Disease Fact Sheets (REPLACE pages or entire document as indicated)
o Diphtheria Fact Sheet (REPLACE PGS. 3 and 4) o Hepatitis A Fact Sheet and Q & A (REPLACE) o Hepatitis B Fact Sheet and Q & A (REPLACE PG. 5) o Haemophilus influenzae Invasive Disease Fact Sheet and Q & A (REPLACE PGS. 3 and 5) o Measles Fact Sheet and Q & A (REPLACE PGS. 5, 6 and 8) o Mumps Fact Sheet (REPLACE PGS. 2 and 3) o Pertussis Fact Sheet and Q & A (REPLACE PGS. 5, 7, 8 and 9) o Polio Fact Sheet and Q & A (REPLACE PGS. 4, 5 and 6) o Rubella Fact Sheet and Q & A (REPLACE PGS. 4 and 6) o Streptococcus pneumoniae Fact Sheet and Q & A (REPLACE PG. 2) o Tetanus Fact Sheet (REPLACE PG 3) Georgia Notifiable Disease Report, Form 3095 (Rev. 8/04) (REPLACE)
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District Health Directors District Program Managers District Administrators District Immunization Coordinators June 30, 2008 Page Three
Chapter 7---Hepatitis
Table of Contents page (REPLACE) Appendices for Perinatal Hepatitis B Prevention Program Guidelines
o Atachment - G Hepatitis B Alert (HBsAg Positive Woman) (REPLACE)
State Hepatitis Program (REPLACE) Hepatitis B Vaccination in STD, HIV and Family Planning Clinics, Guidelines for Public
Health(REPLACE)
Chapter 8---Recall of Patients
Table of Contents page (REPLACE) Recall of Immunization Patients Policy Statement (REPLACE) Acceptable "Moved or Gone Elsewhere" (MOGE) Categories (REPLACE)
o Additional descriptions and clarifications of MOGE categories
Chapter 9---Vaccine Distribution and Storage
Table of Contents page (REPLACE) Provider Agreement for Public Health Providers (REPLACE) Provider Agreement Policy for Public Health Providers (REPLACE) Fraud and Abuse Policy (REPLACE) Vaccine Loss Policy for Public Health Providers (REPLACE) Vaccine Management (Recommendations for Handling and Storage of Selected Biologicals,
November, 2007) (REPLACE)
Chapter 12
Table of Contents pages (REPLACE) o Travel and Yellow Fever Vaccination Clinics in Georgia (REPLACE)
Chapter 13
Table of Contents pages (REPLACE) Appendices
o Attachment A---(REPLACE PG. 6) o Attachment H (REPLACE)
As always, this transmittal as well as an updated version of the complete Immunization Program Manual will be posted on the Immunization Program website at www.health.state.ga.us/programs/immunization and can be accessed from the main web page or from the link to Publications. If you have any questions about this update, please contact the Georgia Immunization Program office at 404-657-3158.
Attachment c: Sandra E. Ford, M.D.
Morris Govan Michelle Conner, BSN, MS, MBA
An Equal Opportunity Employer www.dhr.georgia.gov

December 14, 2009

MEMORANDUM

TO:

District Health Directors

District Program Managers

District Administrators

District Immunization Coordinators

FROM:

Deborah Jelks, Acting Director Georgia Immunization Section

SUBJECT: Georgia Immunization Program Manual Updates

In the interest of saving resources and space, we are not asking you to replace whole documents with this update, but only the specific pages that have been revised. A notation has been made in the footer of those documents as to the pages that have been updated. Below is a listing of those documents included in the update as well as guidance for adding, deleting, or replacing same:
Transmittal Memo---use this to assist in adding and replacing documents, then place in Chapter 11, Transmittal Memos.
Manual Update Documentation page---Immunization Coordinators are to complete this, send a copy to the state immunization program office attention nurse consultant by the deadline noted on the form, and place it in Chapter 11, Transmittal Memos.
Cover page (REPLACE)
Division of Public Health, Policy and Procedure Approval (REPLACE)
Table of Contents: Complete set of Table of Contents Pages (REPLACE)
Chapter 1 Introduction Table of Contents Page (REPLACE) Georgia Immunization Program Staff: Central Office and Immunization Program Consultants (REPLACE) District Immunization Coordinators (REPLACE) Request for Immunization Forms --- Form 3184 (REPLACE) U.S. Vaccines (REPLACE)

Equal Opportunity Employer

District Health Directors District Program Managers District Administrators District Immunization Coordinators December 14, 2009 Page Two
Chapter 2 Recommended Schedule and Guidelines Table of Contents Page (REPLACE) DCH GA Immunizations Program Vaccine Guidelines Approval Sheet (ADD) - (Do Not Remove Previous Sheets) Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults (11/09) (REPLACE) Georgia Department of Community Health, Immunization Program Vaccine Guidelines(REPLACE ALL) Recommended Childhood and Adolescent Immunization Schedule 2009/ Catch-up Schedule for Children with Lapsed Immunization 2009 (REPLACE) Recommended and Minimum Ages and Intervals Between Vaccine Doses (Table1) (REPLACE) Recommended Adult Immunization Schedule 2009 (REPLACE) Screening Questionnaires for Child and Teen Immunization (English/Spanish) (REPLACE BOTH) Screening Questionnaires for Adult Immunization (English/Spanish) (REPLACE BOTH)
Chapter 3 Informed Request Policy Table of Contents Page (REPLACE) Vaccine Information Statements o Td English (Remove) o Vacuna Contra Tetanos y Difteria (Td) (Keep) Spanish Td until Spanish Combination of Td/Tdap Combination is available o Tdap English (Remove was replaced with a Td/Tdap Combination English) o Vacuna Contra Tetanos, Difteria Y Tos Ferina (Tdap) (Keep) Tdap Spanish until Spanish Combination of Td/Tdap Combination is available o Td/Tdap Combination (English) (Interim) (ADD) (REPLACES Td and Tdap English Pages only) o Pneumococcial Conjugate English (REPLACE) o Pneumococcal Polysaccharide English (REPLACE) o Vacuna Desactivada Contra (Influenza) 07/24/08 (Spanish) (REPLACE) o Vacuna Intranasal Viva Contra (Influenza) 7/24/08 (Spanish) (REPLACE) o Rotavirus Vaccine (REPLACE) o Refusal to Vaccinate Form (ADD)
Chapter 4 Adverse Events Following Immunizations Table of Contents Page (REPLACE) Policy for Reporting Vaccine Adverse Events Following Immunizations (REPLACE) Commonly Asked Questions About the National Vaccine Injury Compensation Program (REMOVE) (See National Vaccine Injury Compensation Program (VICP) Web Page below for link) National Vaccine Injury Compensation Program (VICP) Web Page (ADD) (Link to Frequently Asked Questions http://www.hrsa.gov/vaccinecompensation/) National Vaccine Injury Compensation Program Vaccine Injury Table (REPLACE)
Chapter 5 Requirements of School/Day Care Law Table of Contents Page (REPLACE) Historical Statement Listing Dates of Immunization Requirements (REPLACE)
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District Health Directors District Program Managers District Administrators District Immunization Coordinators December 14, 2009 Page Three
Chapter 6 Surveillance and Reporting Table of Contents Page (REPLACE) VPD Surveillance Contacts Table 2009 (REPLACE) Hepatitis A Fact Sheet and Q & A (REPLACE) Hepatitis B Fact Sheet and Q & A (REPLACE) Haemophilus influenzae Invasive Disease Fact Sheet and Q & A (REPLACE)
Chapter 7 Hepatitis Table of Contents Page (REPLACE) Perinatal Hepatitis B Prevention Program Guidelines (REPLACE) Appendix List (REPLACE) Appendix A (REPLACE) Appendix J (REPLACE) Appendix K (REPLACE) Appendix M (REPLACE) Appendix N (REPLACE) Sample Letter C-3 (REMOVE)
Chapter 8---Recall of Patients Table of Contents Page (REPLACE) Recall of Immunization Patients Policy Statement (REPLACE) Immunization Documentation, "Moved or Gone Elsewhere" (MOGE) Categories (REPLACE)
Chapter 9---Vaccine Distribution and Storage Table of Contents Page (REPLACE) Distribution of Vaccines (REPLACE) Handling Of Vaccine During Inclement Weather Conditions (REPLACE) Chart of Refrigerated /Frozen Pack Needs (REMOVE) Maintaining the Cold Chain During Transport (REMOVE) Guidelines for Returning Vaccine Products to the Manufacturer for Disposal (See These Guidelines are located in the Public Health Nurse Protocol Manual Drug Dispensing Procedure, Section D under Outdated, Deteriorated, Returned and Recalled Drugs at http://health.state.ga.us/pdfs/nursing/Protocol%20Manual/04.0%20Drug%20Dispensing%20Pr ocedure.pdf) Form for Return of Outdated, Unused or Overstocked Drugs(REPLACE with McKesson Return of Federal Vaccine Form) Vaccine Storage and Handling Toolkit, Chapter 10---Vaccine Shipments (REMOVE) Title X Unaccompanied Minor without Insurance Information VFC Vaccine Log (REPLACE) Centralized Distribution Information and Instruction for VFC Providers (ADD)
Chapter 12---Travel Information Table of Content Page (REPLACE) Travel and Yellow Fever Vaccination Clinics in Georgia (REPLACE)
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District Health Directors District Program Managers District Administrators District Immunization Coordinators December 14, 2009 Page Four Chapter 13--- Quality Assurance
Table of Content Page (REPLACE) Appendices
o Attachment A (REPLACE) o Attachment D (REPLACE) o Attachment G (REPLACE) Chapter 14---Standard Operating Guidelines For Mass Vaccination Clinics Table of Content Page (REPLACE) Standard Operating Guidelines for Conducting Mass Vaccination Clinics (REPLACE) As always, this transmittal as well as an updated version of the complete Immunization Program Manual will be posted on the Immunization Program website at www.health.state.ga.us/programs/immunization and can be accessed from the main web page or from the link to Publications. If you have any questions about this update, please contact the Georgia Immunization Program office at 404-657-3158. Attachment c: Sandra E. Ford, M.D. Michelle Conner, BSN, MS, MBA
Equal Opportunity Employer

Carladenise A. Edwards, Ph.D., Interim Commissioner March 30, 2010

Sonny Perdue, Governor

2 Peachtree Street, NW Suite 15-470 Atlanta, GA 30303-3142 www.dch.georgia.gov

MEMORANDUM

TO:

District Health Directors

District Program Managers

District Administrators

District Immunization Coordinators

FROM:

Deborah Jelks, Acting Director Georgia Immunization Section

SUBJECT: Georgia Immunization Program Manual Updates

In the interest of saving resources and space, we are not asking you to replace whole documents with this update, but only the specific pages that have been revised. A notation has been made in the footer of those documents as to the pages that have been updated. Below is a listing of those documents included in the update as well as guidance for adding, deleting, or replacing same:
Transmittal Memo---use this to assist in adding and replacing documents, then place in Chapter 11, Transmittal Memos.
Manual Update Documentation page---Immunization Coordinators are to complete this, send a copy to the state immunization program office attention nurse consultant by the deadline noted on the form, and place it in Chapter 11, Transmittal Memos.
Cover page (REPLACE)
Division of Public Health, Policy and Procedure Approval (REPLACE)
Table of Contents: Complete set of Table of Contents Pages (REPLACE)
Chapter 1 Introduction Table of Contents Page (REPLACE) Georgia Immunization Program Staff: Central Office and Immunization Program Consultants (REPLACE) District Immunization Coordinators (REPLACE) Request for Immunization Forms --- Form 3184 (REPLACE) U.S. Vaccines (REPLACE)

Division of Public Health M. Rony Francois, MD, MSPH, PhD, Director of Public Health and State Health Officer Phone: 404-657-2700 Fax: 404-657-2715
Equal Opportunity Employer

District Health Directors District Program Managers District Administrators District Immunization Coordinators March 30, 2010 Page Two
Chapter 2 Recommended Schedule and Guidelines Table of Contents Page (REPLACE) DCH GA Immunizations Program Vaccine Guidelines Approval Sheet (ADD) - (Do Not Remove Previous Sheets) Eligibility Criteria for Vaccines Supplied by the Georgia Immunization Program for Children, Adolescents, and Adults (11/09) (REPLACE) Georgia Department of Community Health, Immunization Program Vaccine Guidelines(REPLACE ALL) Recommended Childhood and Adolescent Immunization Schedule 2009/ Catch-up Schedule for Children with Lapsed Immunization 2009 (REPLACE) Recommended and Minimum Ages and Intervals Between Vaccine Doses (Table1) (REPLACE) Recommended Adult Immunization Schedule 2009 (REPLACE) Screening Questionnaires for Child and Teen Immunization (English/Spanish) (REPLACE BOTH) Screening Questionnaires for Adult Immunization (English/Spanish) (REPLACE BOTH)
Chapter 3 Informed Request Policy Table of Contents Page (REPLACE) Vaccine Information Statements o Td English (Remove) o Vacuna Contra Tetanos y Difteria (Td) (Keep) Spanish Td until Spanish Combination of Td/Tdap Combination is available o Tdap English (Remove was replaced with a Td/Tdap Combination English) o Vacuna Contra Tetanos, Difteria Y Tos Ferina (Tdap) (Keep) Tdap Spanish until Spanish Combination of Td/Tdap Combination is available o Td/Tdap Combination (English) (Interim) (ADD) (REPLACES Td and Tdap English Pages only) o Pneumococcial Conjugate English (REPLACE) o Pneumococcal Polysaccharide English (REPLACE) o Vacuna Desactivada Contra (Influenza) 07/24/08 (Spanish) (REPLACE) o Vacuna Intranasal Viva Contra (Influenza) 7/24/08 (Spanish) (REPLACE) o HPV Gardasil (Human Papillomavirus 03/30/10 (English) (REPLACE) o HPV Cervarix (Human Papillomavirus 03/30/10 (English) (ADD) o Rotavirus Vaccine (REPLACE) o Refusal to Vaccinate Form (ADD)
Chapter 4 Adverse Events Following Immunizations Table of Contents Page (REPLACE) Policy for Reporting Vaccine Adverse Events Following Immunizations (REPLACE) Commonly Asked Questions About the National Vaccine Injury Compensation Program (REMOVE) (See National Vaccine Injury Compensation Program (VICP) Web Page below for link) National Vaccine Injury Compensation Program (VICP) Web Page (ADD) (Link to Frequently Asked Questions http://www.hrsa.gov/vaccinecompensation/) National Vaccine Injury Compensation Program Vaccine Injury Table (REPLACE)
Division of Public Health M. Rony Francois, MD, MSPH, PhD, Director of Public Health and State Health Officer Phone: 404-657-2700
Fax: 404-657-2715
Equal Opportunity Employer

District Health Directors District Program Managers District Administrators District Immunization Coordinators March 30, 2010 Page Three
Chapter 5 Requirements of School/Day Care Law Table of Contents Page (REPLACE)
Historical Statement Listing Dates of Immunization Requirements (REPLACE)
Chapter 6 Surveillance and Reporting Table of Contents Page (REPLACE) VPD Surveillance Contacts Table 2009 (REPLACE) Hepatitis A Fact Sheet and Q & A (REPLACE) Hepatitis B Fact Sheet and Q & A (REPLACE) Haemophilus influenzae Invasive Disease Fact Sheet and Q & A (REPLACE)
Chapter 7 Hepatitis Table of Contents Page (REPLACE) Perinatal Hepatitis B Prevention Program Guidelines (REPLACE) Appendix List (REPLACE) Appendix A (REPLACE) Appendix J (REPLACE) Appendix K (REPLACE) Appendix M (REPLACE) Appendix N (REPLACE) Sample Letter C-3 (REMOVE)
Chapter 8---Recall of Patients Table of Contents Page (REPLACE) Recall of Immunization Patients Policy Statement (REPLACE) Immunization Documentation, "Moved or Gone Elsewhere" (MOGE) Categories (REPLACE)
Chapter 9---Vaccine Distribution and Storage Table of Contents Page (REPLACE) Distribution of Vaccines (REPLACE) Handling Of Vaccine During Inclement Weather Conditions (REPLACE) Vaccine Management (Recommendations for Handling & Storage of Selected Biologicals, April 2009 (REPLACE) Guidelines for Returning Vaccine Products to the Manufacturer for Disposal (See These Guidelines are located in the Public Health Nurse Protocol Manual Drug Dispensing Procedure, Section D under Outdated, Deteriorated, Returned and Recalled Drugs at http://health.state.ga.us/pdfs/nursing/Protocol%20Manual/04.0%20Drug%20Dispensing%20Pr ocedure.pdf) Form for Return of Outdated, Unused or Overstocked Drugs(REPLACE with McKesson Return of Federal Vaccine Form) Vaccine Storage and Handling Toolkit, Chapter 9 ---Vaccine Shipments (REMOVE) Title X Unaccompanied Minor without Insurance Information VFC Vaccine Log (REPLACE) Centralized Distribution Information and Instruction for VFC Providers (ADD)
Division of Public Health M. Rony Francois, MD, MSPH, PhD, Director of Public Health and State Health Officer Phone: 404-657-2700
Fax: 404-657-2715
Equal Opportunity Employer

District Health Directors District Program Managers District Administrators District Immunization Coordinators March 30, 2010 Page Four Chapter 12---Travel Information
Table of Content Page (REPLACE) Travel and Yellow Fever Vaccination Clinics in Georgia (REPLACE) Chapter 13--- Quality Assurance
Table of Content Page (REPLACE) Appendices
o Attachment A (REPLACE) o Attachment D (REPLACE) o Attachment G (REPLACE) Chapter 14---Standard Operating Guidelines For Mass Vaccination Clinics Table of Content Page (REPLACE) Standard Operating Guidelines for Conducting Mass Vaccination Clinics (REPLACE) As always, this transmittal as well as an updated version of the complete Immunization Program Manual will be posted on the Immunization Program website at www.health.state.ga.us/programs/immunization and can be accessed from the main web page or from the link to Publications. If you have any questions about this update, please contact the Georgia Immunization Program office at 404-657-3158. Attachment c: M. Rony Francois, MD, MSPH, Ph.D Jevon C. Gibson, MA
Division of Public Health M. Rony Francois, MD, MSPH, PhD, Director of Public Health and State Health Officer Phone: 404-657-2700
Fax: 404-657-2715
Equal Opportunity Employer

DISTRICT ___ ____

MANUAL UPDATE: IMMUNIZATION PROGRAM MANUAL
TRANSMITTAL DATE: March 30, 2010
Manual update(s) have been completed at the following sites on the indicated dates:

____________________________ ___________ _________________________________

(Site)

(Date)

(Person responsible for update)

____________________________ ___________

(Site)

(Date)

_________________________________ (Person responsible for update)

____________________________ ___________ _________________________________

(Site)

(Date)

(Person responsible for update)

____________________________ ___________ _________________________________

(Site)

(Date)

(Person responsible for update)

____________________________ ___________ _________________________________

(Site)

(Date)

(Person responsible for update)

____________________________ ___________ _________________________________

(Site)

(Date)

(Person responsible for update)

____________________________ ___________ _________________________________

(Site)

(Date)

(Person responsible for update)

____________________________ ___________ _________________________________

(Site)

(Date)

(Person responsible for update)

Please submit one (1) form for your District. Or, if individual counties/clinics complete a form, please collect all and combine on (1) form before submitting to State office. Fax document to Immunization Education Section Nurse Consultant Penny Conner, Thank you.

DUE: July 30, 2010 FAX 404-657-1463

______________ __________ District Immunization Coordinator
_____________________________ Date

Equal Opportunity Employer

Georgia Immunization Program Manual
TABLE OF CONTENTS

Division Of Public Health

12. TRAVEL INFORMATION* Foreign Travel Information Travel and Yellow Fever Vaccination Clinics in Georgia (REPLACE) Vaccines and Biologics Used in U.S. and Foreign Markets Translation of Foreign Vaccine-Related Terms into English
*For travel information specific to travel vaccines or destinations, consult the ACIP Recommendations manual and/or the Center for Disease Control and Prevention's current edition of Health Information for International Travel.

Table of Contents 11/2009

GA Immunization Program Manual

Division Of Public Health

FOREIGN TRAVEL INFORMATION
In general, U.S. citizens who are up-to-date with regard to the ACIP recommendations do not need any additional immunizations. When advising individuals regarding foreign travel, recommend they check their immunization record to see if they are due to receive any of the vaccines routinely recommended by the ACIP.
The ACIP may recommend other vaccines and prophylaxis with regard to specific itineraries. Therefore, it is important that if you administer vaccines for travel purposes, you have a system for keeping current information regarding travel requirements for specific countries. The ACIP Recommendations notebook provides reasonably detailed information about the vaccines that might be indicated for foreign travel. These recommendations should be referred to for specific vaccine dosage and administration information and guidelines. Additional information resources are included under the Travel Resource Information section.
Certification for International Travel
The International Health Regulations adopted by the World Health Organization only addresses requirements for Yellow Fever Vaccine.
Smallpox was deleted as a required vaccine in 1982. Many adults are not up-to-date for Tetanus/diphtheria (Td/Tdap) and should consider getting this
vaccine for travel anywhere. Prophylaxis against malaria is recommended for travel to many parts of the world. To order International Certificate of Vaccination: Ordering Information
No longer available in single copy: For 25 copies ($31.00) request S/N 017-001-00561-4 For 100 copies ($51.00) request S/N 017-001-00562-2
Certificates may be purchased from: Superintendent of Documents P.O. Box 371954 Pittsburgh, PA 15250-7954 (202) 512-1800
For direct travel from the United States only a few countries require certificates. No vaccinations are required for return to the United States.
Certification Requirements for Yellow Fever: When Yellow Fever Vaccine is required for travel, an immunization certificate that has been stamped with an official stamp should be issued after the traveler receives his vaccination.
Certification for Yellow Fever requires one dose of vaccine and is valid for 10 years beginning 10 days after primary vaccination.
Georgia Requirements to Administer Yellow Fever Vaccine The Immunization Program of the Georgia Division of Public Health designates sites which may administer Yellow Fever Vaccines.
To apply to become a designated Yellow Fever site and receive the official stamp for Yellow Fever Vaccination send a request to: Georgia Department of Human Resources 2 Peachtree Street, NW, Suite 13.285 Atlanta GA 30303-3142 Attention: Yellow Fever Program
You may also fax a letter of request to: (404) 657-1463. Additional information about the application and stamp can be obtained from Jeanette Ivey at (404) 657-3158.
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12. Travel Information 1/2010 Foreign Travel Information

GA Immunization Program Manual

Division Of Public Health

FOREIGN TRAVEL INFORMATION

Travel vaccine clinics and designated Yellow Fever Vaccination Centers for Georgia are listed in this section and on the Immunization Program website at http://health.state.ga.us/programs/immunization/ travel.
How to Obtain Travel Vaccines The state pharmacy does not purchase and distribute any vaccines or preventive medications that
might be recommended for travel. Providers must obtain these from the drug manufacturer.
Travel Resource Information
Travelers and immunization travel clinics may refer to the following resources when seeking information about recommendations and requirements:
Centers for Disease Control and Prevention Fax Information Service.............1-888-232-3299 Malaria Hotline........................... 770-488-7788 Internet Address: http://www.cdc.gov (click on Travelers' Health)
Health Information for International Travel ("The Yellow Book"). This book is published every 2 years (most recent edition is 2010.) It contains all immunization requirements, disease risk and precautions, and prevention information for travel to other countries. The book should be used in conjunction with updated sources of information available through the CDC's Fax Information services. It can also be accessed online at http://wwwn.cdc.gov/travel/content/yellowbook.home-2010.aspx
Epidemiology and Prevention Branch Division of Public Health Georgia Department of Community Health (404) 657-2588
Immunization Program Division of Public Health Georgia Department of Community Health (404) 657-3158
The embassies and consulates of the countries to be visited may be of some assistance, as well, especially if certain vaccines are required prior to entry.
Routine Childhood Vaccines by Country This information may be accessed from the World Health Organization (WHO) website at http://www.who.int/countries/en Select a country, then "Immunization Profile."

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Designated Yellow Fever Vaccination Clinics in Georgia

Designated Yellow Fever Vaccination Clinics
International Hot Line for Yellow Fever 1-888-332-4559 CDC Travel Information
Yellow Fever Vaccine Only---these offices will not be able to offer any travel vaccines except YF yellow fever vaccine
O These offices can offer other travel vaccines in addition to the yellow fever vaccine
Students only---these offices can only offer yellow fever vaccine to the students at this S particular school or institution

E

Employees only---these offices only offer yellow fever vaccine to their employees

City
Albany Albany Albany
Alpharetta Americus

Services Address

Phone

YF

Joseph A. Whaley, Jr., R.Ph. Dougherty County Health Department

1710 South Slappey Blvd.

Albany, Georgia 31701

229-430-6225

O

Palmyra Occupational Health

2000 Palmyra Road

Albany, Georgia 31701-1528

229-434-2173

O

Craig E. Smith, MD, MS, FACP, FIDSA

229-436-1361

Infectious Diseases Consultants of

Southwest Georgia

808 Thirteenth Avenue

Albany, Georgia 31701

O

Fulton County Dept. of Health and Wellness 404-332-1958

North Fulton Regional Health Center

3155 Royal Drive, Suite 125

Alpharetta, Georgia 30022

O

Michael S. Busman, M.D.

Brett Law, M.D.

David Khan Vay Taing, M.D.

Sumter Family Medicine & Sports

Medicine Center

922 East Jefferson Street, Suite B

Americus, Georgia 31709

229-924-2383

12. Travel Information 3/2010

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Designated Yellow Fever Vaccination Clinics in Georgia

Athens Athens Atlanta Atlanta Atlanta Atlanta Atlanta Atlanta

O

Jean Chin, M.D.

University Health Service

University of Georgia

370 River Road

Athens, Georgia 30602

O

Claude A. Burnett III, M.D., M.P.H.

Clarke County Health Department

345 North Harris Street

Athens, Georgia 30601-2470

706-542-1162 706-542-8600

O

Crawford F. Barnett, Jr., M.D.

Paces Pavillion

3193 Howell Mill Road N.W. Suite 302

Atlanta, Georgia 30327-2100

404-262-1414

O

Howard J. Cohen, M.D.

Atlanta Infectious Disease Specialist

960 Johnson Ferry Road, Suite 500

Atlanta, Georgia 30342

404-851-0081

O

Steven I. Marlow, M.D.

Atlanta Clinical Care

404-459-0002

5673 Peachtree Dunwoody Rd., Suite 330

Atlanta, Georgia 30342

S

William Manns, M.D.

Georgia Tech Health Services

740 Ferst Street

Atlanta, Georgia 30332

404-894-2584

O

Fulton County Health & Wellness Center

404-730-5835

Northeast Health Center

265 Boulevard Dr, N.E., Third Floor

Atlanta, Georgia 30312

O

Christine Zurawski, M.D., M.P.H.

Ronald Devine, M.D.

404-351-2572

Infectious Disease Solutions/P'tree Travel

Clinic

Piedmont Professional Bldg.

35 Collier Road, Suite M245

Atlanta, Georgia 30309

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Designated Yellow Fever Vaccination Clinics in Georgia

Atlanta Atlanta Atlanta Atlanta Atlanta Atlanta Atlanta Atlanta Atlanta

O

John Ralph Destito, M.D.

Doctors Express

1800 Howell Mill Road, NW, Suite 130

Atlanta, Georgia 30318

O

Phyllis E. Kozarsky, M.D.

The Emory Travelwell Clinic

550 Peachtree Street Medical Office Tower 7th Floor

Atlanta, Georgia 30308-2246

O

Alex E. Rikhter, M.D., P.C.

1140 Hammond Drive, Suite G 7105

Atlanta, Georgia 30328

O

Jalola Zuberi, M.D.

Morehouse Medical Associates

75 Piedmont Rd, Suite 700

Atlanta, Georgia 30303

O

Julia E. Ballard, M.D.

Medical Director

Piedmont Minor Emergency Clinic

3108 Piedmont Road, N.E.

Atlanta, Georgia 30305-2790

404-355-8775
404-686-5885 404-686-8114
770-351-0900 404-756-1430
404-237-1918 404-237-1755

S

Joanne E. Williams, M.D., Ph.D.

404-727-7551

Emory University Health Service

1525 Clifton Road, Room 233, 2nd Floor

Atlanta, Georgia 30322

O

Robert Capparell, M.D.

Mitchell A. Blass, M.D.

404-459-4393

World Travel Care

5671 Peachtree Dunwoody Rd, Suite 300

Atlanta, Georgia 30342-1701

O

James M. Adkins, M.D.

AdventureMD LLC

784 Springside Court

Atlanta, Georgia 30342

404-428-2694

O

Nicholas Beaulieu

404-815-1957

Highland Urgent Care & Family Medicine

920 Ponce de Leon

Atlanta, Georgia 30306

12. Travel Information 3/2010

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Division Of Public Health

Designated Yellow Fever Vaccination Clinics in Georgia

Atlanta Atlanta Atlanta Atlanta Atlanta Atlanta

O

Richard Kauffman

Vinings Family Healthcare Center &

770-436-2444

Internal Medicine

4199 Paces Ferry Road, N.W., Suite A

Atlanta, Georgia 30339

O

Maxim Health Systems

2250 North Druid Hills Road, Suite 229

Atlanta, Georgia 30329

O

Ronald Clayton Pirtle, M.D.

Kroger Pharmacy # 298

1700 Monroe Drive

Atlanta, Georgia 30324

YF

Alvin Cheatham, M.D.

The AeroClinic

Hartsfield-Jackson Atlanta Intl. Airport

Airport Atrium, Suite 315

6000 North Terminal Pkwy

Atlanta, Georgia 30320

YF

Amina Hassanali, M.D.

Amina Medical Consultant, Inc.

2840 N.E. Expressway, Suite 116

Access Road, NE

Atlanta, Georgia 30345

866-844-9257 404-872-0785 404-684-6600
404-929-1402

O

Joseph G. Saulsbury II, M.D.

Concentra Medical Center Midtown

688 Spring Street

Atlanta, Georgia 30308

404-881-1155

Atlanta

O

Amy L. Varner, M.D.

Inman Park Physicians of

404-524-2424

Atlanta Medical Center

240 North Highland Avenue, Bldg.3, Suite E

Atlanta, Georgia 30307

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Designated Yellow Fever Vaccination Clinics in Georgia

Atlanta
Augusta Augusta Augusta Augusta Bainbridge Brunswick Buford Carrollton

O

Janet Anne Dey, M.D.

Piedmont Health Center

1830-C Piedmont Road

Atlanta, Georgia 30324

404-874-1111

O

MCG Health, Inc.

Inpatient Pharmacy

1120 15th Street, Room BA 5300

Augusta, Georgia 30912-3130

706-721-2236

YF

Richmond County Health Dept.

950 Laney Walker Boulevard

Augusta, Georgia 30901

706-721-5806 706-721-5808

O

Doctor's Hospital Ctr. For Occup. Medicine 706-396-1140

Michael Suls, M.D.

2215 Tobacco Road, #F

Augusta, Georgia 30906

O

Nathan A. Wilson, M.D. FAAP

Covenant Pediatrics

3121 Peach Orchard Road, Suite 102

Augusta, Georgia 30906

706-792-5040

O

Memorial Hospital & Manor

1500 East Shotwell Street

Bainbridge, Georgia 39819

229-246-3500

O

Mary Fleming, M.D.

Glynn County Health Department

2747 4th Street

Brunswick, Georgia 31520

912-264-3961

O

Lloyd M. Hofer, M.D.

Buford Health Center

2755 Sawnee Avenue

Buford, Georgia 30518

770-614-2401

O

Carroll County Health Dept.

1004 Newnan Road

Carrollton, Georgia 30116

770-836-6667

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Division Of Public Health

Designated Yellow Fever Vaccination Clinics in Georgia

Cartersville Cave Spring Chamblee Chamblee College Park Columbus Columbus Columbus Columbus

YF

Aman Mongia, M.D.

Center for Infectious Diseases

100 Market Place Blvd. Suite 207

Cartersville, Georgia 30120

O

Susan M. Butler-Sumner, M.D.

Cave Spring Medical Center

28 Rome Road

Cave Spring, Georgia 30124

O

Nipun Patel, M.D.

Premier Family Clinic

3646-D Chamblee Tucker Road

Chamblee, Georgia 30341

O

S. Elizabeth Ford, M.D., MBA, F.A.A.P.

District Health Director

North DeKalb Health Center

3807 Clairmont Road, N.E.

Chamblee, Georgia 30341-4911

O

Eric Benning, M.D.

College Park Regional Health

Fulton County Health Department

1920 John E. Wesley Avenue

College Park, Georgia 30337

O

Prima Rao Foster, M.D.

Carl Andrew Foster, M.D.

Capri Medical Group

6400 Flat Rock Road

Columbus, Georgia 31907

O

David McMichen, M.D.

Ace Acute Care Express

7901 Veterans Parkway

Columbus, Georgia 31909

O

Rachna Anil Patel, M.D.

Concentra Medical Centers

1051 Talbotton Road

Columbus, Georgia 31904

YF

Michael Walsh, M.D.

Family Practice Center 1800 10th Avenue

Columbus, Georgia 31901

678-721-6971 706-777-8775 770-493-6767 770-454-1144 Ext. 4602 404-765-4155
706-478-5858
706-321-1223 706-322-2511 706-571-1120

12. Travel Information 3/2010

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Division Of Public Health

Designated Yellow Fever Vaccination Clinics in Georgia

Columbus Columbus Columbus Conyers Covington Covington Cumming Decatur

YF

Zsolt Koppanyi, M.D.

West Central Health District

P.O. Box 2299

2100 Comer Avenue

Columbus, Georgia 31902-2299

706-321-6300

YF

Jack D. Sherrer, Jr. M.D.

Occupational Medicine of Columbus

7301 Northlake Drive

Columbus, Georgia 31904

706-221-1600

O

Kevin Donald Lokkesmoe, M.D.

706-507-1213

Urgent Care and Occupational Medicine

4328 Armour Road

Columbus, Georgia 31904

O

Lloyd M. Hofer, M.D. Health Director

Rockdale County Health Department

985 Taylor Street

Conyers, Georgia 30012

770-785-4345

O

Lloyd M. Hofer, M.D. Newton County Health Department

8203 Hazelbrand Road

Covington, Georgia 30014

770-786-9086

YF

Rose Afroz Rahman, M.D

East Metro Primary Care

5211 Adams Street

Covington, Georgia 30014

770-787-1040

O

Priya Vamsi Bayyapureddy, M.D.

Windermere Medical Clinic

3850 Windermere Parkway, Suite 105

Cumming, Georgia 30041

678-455-2800

O

Mark Mulligan, M.D.

Carlos Del Rio, M.D.

Hope Clinic of Emory

Vaccine Resource Center

603 Church Street

Decatur, Georgia 30030

404-377-3719

12. Travel Information 3/2010

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Division Of Public Health

Designated Yellow Fever Vaccination Clinics in Georgia

Decatur Decatur Decatur Decatur Duluth Dunwoody East Point Ellijay Fayetteville

O

S. Elizabeth Ford, M.D., MBA, F.A.A.P.

404-294-3762

District Health Director

Central Health Center

440 Winn Way

Decatur, Georgia 30030

O

Robin H. Dretler, MP

Infectious Disease

Specialists of Atlanta, PC

2665 North Decatur Rd., Suite 330

Decatur, Georgia 30033

404-297-9755

O

Chad Donald Costley, M.D.

Ponce Preventive Care, LLC

402 W. Ponce de Leon Avenue

Decatur, Georgia 30030

404-537-2521

O

Adam Matthew Bressler, M.D.

Safe Passage Travel Medicine, P.C.

2665 North Decatur Road, Suite 330

Decatur, Georgia 30033

404-304-9855

YF

Young W. Kang, M.D.

River Parc Internal Medicine

4855 River Green Parkway #140

Duluth, Georgia 30096

678-417-0077

O

Charles W. Wilson, Jr., RPh.

The Medicine Shoppe

770-455-1144

4675 North Shallowford Rd., Suite 101

Dunwoody, Georgia 30338

O

H. Stacy Vereen, M.D.

Senior Aviation Medial Examiner

Flight Health, Inc.

1603 Ware Avenue,

East Point, Georgia 30344

404-761-2166

O

Harold Wendell Pitts, M.D.

Gilmer County Health Department

International Travel Clinic

28 Southside Church Street

Ellijay, Georgia 30540

706-635-4363

O

Fayette Co. Health Dept.

140 Stonewall Avenue, Suite 107

Fayetteville, Georgia 30214

770-305-5416

12. Travel Information 3/2010

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Division Of Public Health

Designated Yellow Fever Vaccination Clinics in Georgia

Fayetteville Fort Benning Gainesville Greensboro Hapeville Johns Creek Jonesboro LaGrange Lawrenceville Lawrenceville

O

Ronald Eugene Devine, M.D.

678-435-3040

Infectious Disease Solutions/P'tree Travel

1265 Highway 54, Suite 202

Fayetteville, Georgia 30214

O

Readiness Processing Center

MEDDAC

7950 Martin Loop, Building 9224

Fort Benning, Georgia 31905-5637

Military Staff Only

706-544-1362

O

Hall Co. Health Dept. Travel Clinic

1290 Athens Street

Gainesville, Georgia 30507

770-531-5657

O

James Edward Southerland, M.D.

TenderCare Clinic

803 South Main Street

Greensboro, Georgia 30642

706-453-1201

O

Robin Renee Armenia, DO

Concentra Medical Centers

3580 Atlanta Avenue

Hapeville, Georgia 30354

404-768-3351

O

Rajender Singh, M.D.

Sohum Medicenter

9995 Jones Bridge Road

Johns Creek, Georgia 30022

678-366-1200

YF

Alpha F. Bryan, M.D.

Clayton County Health Department

1117 Battlecreek Road

Jonesboro, Georgia 30236

678-610-7199

O

Behzad Razavi, M.D.

Emory Clark Holder Clinic

303 Smith Street

LaGrange, Georgia 30240

706-812-4293

O

Lloyd M. Hofer, M.D.

770-339-4283

Gwinnett County Public Health Services

(formerly Lawrenceville Health Center)

455 Grayson Hwy, Suite 300

Lawrenceville, Georgia 30045

YF

Daniel Henson, M.D.

Care Here Clinic, Group 3001

1600 North Brown Road

Lawrenceville, Georgia 30043

678-823-0040

12. Travel Information 3/2010

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Designated Yellow Fever Vaccination Clinics in Georgia

Lawrenceville Loganville Macon Marietta Marietta Marietta Marietta McDonough Monroe

O

Philip Norton Henderson, M.D.

Premier Immediate Care

289 Grayson Highway

Lawrenceville, Georgia 30045

O

Constance O. George-Adebayo, M.D.

Christ the King Medical Center

3531-3533 Highway 81 South

Loganville, Georgia 30052

Macon-Bibb County Health Dept.

O

171 Emery Highway

Macon, Georgia 31217

O

John (Jack) Kennedy, M.D.

Travel Health Services

Cobb County Board of Health

1650 County Services Parkway

Marietta,.Georgia 30008

YF

Passport Health

James L. Bean, Jr. MD

2625 Sandy Plains Road, Suite 204

Marietta, Georgia 30066

678-376-1300 770-554-8015 478-745-0411 770-514-2485
770-649-1675

YF

Mark S. Wood, M.D.

Site Medical Director

770-494-1152

Lockheed Martin Aeronautics Company

86 South Cobb Drive

Marietta, Georgia 30063-0454

O

Thomas Gary Sheftel, M.D.

Kenmar Pharmacy

833 Campbell Hill Street

Marietta, Georgia 30060

770-427-0202

O

Henry County Health Department

McDonough Center

135 Henry Parkway

McDonough, Georgia 30253

770-954-2250

O

Alice Louise Edwards, M.D.

678-325-0241

Head to Toe Research & Wellness, LLC

150 Martin Luther King Jr. Boulevard

Monroe, Georgia 30655

12. Travel Information 3/2010

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Designated Yellow Fever Vaccination Clinics in Georgia

Norcross

O

Norcross

O

Norcross

O

Peachtree City

YF

Peachtree City

O

Perry

O

Powder Springs

O

Riverdale

O

Rome

O

Norcross Health Center 5030 Georgia Belle Court Suite 2071 Norcross, Georgia 30093
Jane T. St. Clair, M.D. WellBeings Occupational Healthcare 3300 Holcomb Bridge Road Suite 110 Norcross, Georgia 30092
Amanda Vaidwantee Sahai, M.D. Concentra Medical Centers 1905 Beaver Ruin Road, Suite 175 Norcross, Georgia 30071
Elizabeth Nega, M.D. Health e-Station 526 Cross Town Drive Peachtree City, Georgia 30269
Jeffery Van Curtis, M.D. The Doctor's Office, LLC 3000 Shake Rag Hill Peachtree City, Georgia 30269
Bruce D. Sampson, MD, PC Houston Primary Care Associates 1019 Keith Drive, Suite A Perry, Georgia 31069
Albert M. Edwards II, M.D. Bethesda Family Practices Assoc. 4039 Atlanta Street Powder Springs, Georgia 30127
Richard C. Prokesch, M.D. Infectious Diseases Associates, PC 6285 Garden Walk Blvd, Suite A Riverdale, Georgia 30274
John S. Hostetler, M.D. The Harbin Clinic 1825 Martha Berry Blvd. Rome, Georgia 30165-1698

770-638-5700 770-449-5161 770-441-0444 770-692-1914 770-631-9999 478-987-2556 770-943-3139 770-991-1500 706-236-6460

12. Travel Information 3/2010

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Designated Yellow Fever Vaccination Clinics in Georgia

Roswell Roswell Roswell Roswell Savannah Savannah Savannah Sugar Hill Suwanee

O

James L. Bean, Jr., M.D.

Passport Health

990 Holcomb Bridge Rd. - Suite 4

Roswell, Georgia 30076

770-649-1675

E

Thomas L. Fariss, M.D.

Kimberly-Clark Corp.

1400 Holcombe Bridge Rd.

Roswell, Georgia 30076

Employees Only

770-587-8286

O

Michael P. Dailey, M.D.

770-255-1069

Infectious Disease Services Of Georgia

11660 Alpharetta Highway, Suite 430

Roswell, Georgia 30076

O

Howard J. Cohen, M.D.

Atlanta Infectious Disease Specialist

1350 Upper Hembree Road, Suite A

Roswell, Georgia 30076

770-442-1990

O

Chatham County Health Department

2011 Eisenhower Drive

Savannah, Georgia 31401

912-356-2441

O

George G. Haberman, M.D.

Industrial Medicine

1903 Abercorn Street

Savannah, Georgia 31401

912-232-5169

O

Richard S. Roth, M.D.

Nenad Avramovski, M.D.

Travel Medicine Consultants

5354 Reynolds Street, Suite 421

Savannah, Georgia 31405

912-354-1606

O

Robert Thomas Dambach, Jr., M.D.

Christopher Borrego, M.D.

Tri County Internal Medicine

4720 Nelson Brogdon Boulevard

Sugar Hill, Georgia 30518

770-945-1990

O

Ernest E. Coker, M.D.

770-822-4120

Greater Atlanta Primary Care Associates

2020 Lawrenceville Suwanee Rd, Suite 101

Suwanee, Georgia 30024

12. Travel Information 3/2010

12

Designated Yellow Fever Vaccination Clinics in Georgia

Revised 5/24/2010

GA Immunization Program Manual

Division Of Public Health

Designated Yellow Fever Vaccination Clinics in Georgia

Suwanee Suwanee Thomaston Tifton
Tucker Union City Valdosta Warner Robins Waycross Woodstock

O

James Louis Roth, M.D.

Vaccines On The Go

4255 Johns Creek Parkway Suite A

Suwanee, Georgia 30024

O

Philip Norton Henderson, M.D.

Premier Immediate Care

2696 Lawrenceville-Suwanee Road

Suwanee, Georgia 30024

O

Upson County Health Dept.

314 East Lee Street

Thomaston, Georgia 30286-34256

O

Marcy Corkern, R.Ph.

Samuel W. Lokey, R.Ph.

Moon's Pharmacy

717 West Second Street

Tifton, Georgia 31794

O

Anwan Wellness Medical Center

2227 Idlewood Road, Suite 1

Tucker, Georgia 30084

O

Shashikant A. Daya, M.D.

Airport Primary Care

4651 Flat Shoals Parkway

Union City, Georgia 30291

O

Lynne Feldman, M.D.

Lowndes County Health Dept.

206 South Patterson St., 1st. Fl.

Valdosta, Georgia 31603-5619

O

David N. Harvey, II, M.D.

Houston County Board of Health

98 Cohen Walker Drive

Warner Robins, Georgia 31088-2729

YF

Ware County Health Department

604 Riverside Avenue

Waycross, Georgia 31501

O

Cherokee Family Medical Center

9766 Highway 92, Suite 200

Woodstock, Georgia 30188

770-896-8284 678-376-1300 706-647-7148 229-382-3711
678-205-2039 404-806-8181 229-333-5257 478-218-2000 912-283-1875 770-926-8717

12. Travel Information 3/2010

13

Designated Yellow Fever Vaccination Clinics in Georgia

Revised 5/24/2010

Vaccines and Biologics Used in U.S. and Foreign Markets
This table lists many vaccine products that are (or have been) used in the U.S. and in international markets. While we have checked and rechecked our sources for this information, we do not claim complete accuracy.

Product or trade name

Antigen(s)

Manufacturer* (country)

A.D.T.

Diphtheria, tetanus (adsorbed)

Commonwealth (Australia)

A.K.D.S.

Diphtheria, tetanus, pertussis

_____ (U.K.)

AC Vax
Y Acel-Imune

Meningococcus (polysaccharide) Diphtheria, tetanus, (acellular) pertussis

GSK (U.K.) WYE (U.S.)

ACTAcel

Diphtheria, tetanus, pertussis, Hib

AVP (Argentina)

ActHIB

Haemophilus influenzae type b (PRP-T)

AVP (U.S.)

Aimmugen

Hepatitis A (inactivated)

Chemo-Sero-Therapeutic Resh Inst (Japan)

Aldiana

Diphtheria (absorbed)

Sevac (Czechoslovakia)

Alditeana

Diphtheria, tetanus (absorbed)

Sevac (Czechoslovakia)

Alditerpera

Diphtheria, tetanus (adsorbed), pertussis

Sevac (Czechoslovakia)

Amaril

Yellow fever

AVP (France)

AMC

Haemophilus influenzae, type b

______ (Cuba)

Anadifterall

Diphtheria (adsorbed)

CHIR (Italy)

Anatetall

Tetanus (adsorbed)

CHIR (Italy)

Arilvax
Attenuvax Y

Yellow fever Measles (live, further attenuated)

MEDI (U.K.) MRK (U.S.)

AVAC-1, AVA

Anthrax

(for U.S. military use)

AVAXIM
B-CAPSA Y

Hepatitis A
Haemophilus influenzae type b (polysaccharide, 1987 to 1989)

AVP (______) Mead Johnson (U.S.)

BayGam

Human immunoglobulin

Bayer Corporation (U.S.)

BayHep B

Hepatitis B immune globulin (human)

Bayer Corporation (U.S.)

BayRab

Rabies immune globulin

Bayer Corporation (U.S.)

BayTet

Tetanus immune globulin (human)

Bayer Corporation (U.S.)

BCG

Tuberculosis

Multiple manfacturers and countries

Begrivac
Biavax II Y Biavax Y

Influenza (split virus) Rubella, mumps (live) Rubella, mumps (live)

CHIR (Germany) MRK (U.S.) MRK (U.S.)

BIG

Botulism immune globulin (not a vaccine)

Biken-HB

Hepatitis B (recombinant)

Y = product no longer distributed in U.S.

BIK (Japan)
* Key to manufacturer abbreviation at end of table

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #P5120 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Product or trade name

Antigen(s)

Manufacturer* (country)

Bimmugen

Hepatitis B (recombinant, adsorbed, yeast derived)

Chemo-Sero-Therapeutic Resh Inst (Japan)

BioThrax

Anthrax (adsorbed)

BPT (U.S.)

Biviraten Berna

Measles, mumps (live)

BER (Switzerland)

BVAC

Botulinum antitoxin

(for U.S. military use)

C.D.T.

Diphtheria, tetanus (pediatric, adsorbed)

Commonwealth (Australia)

Celluvax
Cendevax Y Certiva Y

Pertussis (acellular) Rubella (live) 3/70 to 1976 Diphtheria, tetanus, (acellular) pertussis

CHIR (Italy) RIT/SmithKline & French (U.S.) Baxter Hyland (U.S.)

Cocquelucheau

Pertussis (adsorbed)

AVP (France)

Comvax

Hepatitis B, Haemophilus influenza type b

MRK (U.S.)

Daptacel

Diphtheria, tetanus, (acellular) pertussis

AVP (U.S.)

D.S.D.P.T.

Diphtheria, tetanus, pertussis (adsorbed)

Dong Shin Pharm (Korea)

D.T. Bis Rudivax

Diphtheria, tetanus, rubella

AVP (France)

Di Te Per Pol Impfstoff Diphtheria, tetanus, pertussis, polio

BER (Switzerland)

Di-Te-Pol

Diphtheria, tetanus, polio

Statens Seruminstitut (Denmark)

Dif-Tet-All

Diphtheria, tetanus

CHIR (Italy)

DIFTAVAX

Diphtheria, tetanus, polio

AVP (_______)

DiTe Anatoxal

Diphtheria, tetanus (adsorbed)

BER (Switzerland)

Ditoxim

Diphtheria, tetanus (adsorbed)

Dong Shin Pharm (Korea)

Double Anigen B.I.

Diphtheria, tetanus

Bengal Immunity Co (India)

Dryvax

Smallpox

WYE (U.S.)

DT
DT Y

Diphtheria, tetanus (for pediatric use) Diphtheria, tetanus (for pediatric use)

AVP (U.S.) WYE (U.S.)

DT TAB

Diphtheria, tetanus, Salmonella typhi, Paratyphi A & B

AVP (France)

DTaP (generic)
DTwP (generic) Y

Diphtheria, tetanus, (acellular) pertussis Diphtheria, tetanus, (whole-cell) pertussis

AVP, WYE, GSK (U.S.) AVP, WYE, GSK (U.S.)

Dual Antigen SII
Ecolarix Y

Diphtheria, tetanus (adsorbed) Measles, rubella (live)

Serum Institute of India (India) RIT/SmithKline (U.S.)

eIPV

Polio (inactivated, enhanced potency)

AVP (U.S.)

Engerix-B

Hepatitis B

GSK (U.K., U.S.)

Epaxal Berna

Hepatitis A - virosomal vaccine

BER (Switzerland)

Ervevax RA 27/3

Rubella (live)

Y = product no longer distributed in U.S.

GSK (Belgium)
* Key to manufacturer abbreviation at end of table

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #P5120 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Product or trade name Flu Shield Y
Fluad, Agrippal-S1 FluMist
Fluogen Y
Fluvirin Fluzone Funed-CEME GenHevac B Pasteur Gunevax Havrix H-BIG HbOC HBY Heprecomb
Heptavax B Y
Hevac B Hexavac
HibTITER Hinkuys karokoe HPV-77; DK-5 HPV-77; DK-12 HRIG Humotet-anti Tetanus Hyper-Tet (now called "BayTet") IBV Immune Globulin Intramuscular (Human) Imogam Rabies - HT Imovax Imovax Parotiditis Imovax Polio Imovax Sarampion

Antigen(s)

Manufacturer* (country)

Influenza Influenza Influenza (live, attenuated, intranasal) Influenza Influenza Influenza Diphtheria, tetanus, pertussis Hepatitis B Rubella Hepatitis A Hepatitis B immune globulin Chemical abbreviation for HibTITER Hepatitis B (recombinant) Hepatitis B (yeast derived) Hepatitis B (plasma-derived) 1982 to ___ Hepatitis B (plasma derived) Diphtheria, tetanus, pertussis, polio, hepatitis B, Hib Haemophilus influenzae type b (HbOC) Pertussis (adsorbed) Rubella (live) 1969-1979 Rubella (live) 1970-1973 Rabies immune globulin Tetanus Tetanus immune globulin

WYE (U.S.) CHIR (Italy) MEDI (U.S.) PD (U.S.) EVN (U.S.) AVP (U.S.) Belo Horizonte (Brazil) AVP (________) CHIR (Italy) GSK (U.K., U.S.) NABI, Bayer Corporation (U.S.) WYE (U.S.) KGC (Japan) BER (Switzerland) MRK (U.S.) AVP (France) AVP (Europe)
WYE (U.S.) Natl. Public Health Institute (Finland) MRK (U.S.) MRK (U.S.) AVP; Bayer Corporation (U.S.) Wellcome (U.K.) Bayer Corporation (U.S.)

Polio (inactivated) Broad-spectrum immune globulins
Rabies immune globulin Rabies Mumps Polio Measles

Statens Seruminstitut (Denmark) MA, BPT, New York Blood Ctr, Bayer Corporation, CEN (U.S.) AVP (U.S.) AVP (U.S.) AVP (France) AVP (France) AVP (France)

Y = product no longer distributed in U.S.

* Key to manufacturer abbreviation at end of table

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #P5120 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Product or trade name

Antigen(s)

Imovax D.T.

Diphtheria, tetanus

Imovax Gripe

Influenza

Imovax R.O.R.

Measles, rubella, mumps (live)

Imovax Rubeola

Measles

Imovax Mumps

Mumps

Imovax Oreillons

Mumps

Imovax Rabies I.D.

Rabies vaccine (HDCV)

Imovax Rabies I.M.

Rabies vaccine (HDCV)

Infanrix

Diphtheria, tetanus, (acellular) pertussis

Ipad TP

Tetanus, polio

IPOL

Polio (enhanced potency, inactivated)

IPV

Polio (inactivated)

Istivac

Influenza

JE-VAX

Japanese encephalitis

Kaksoisrokote Dubbelvaccin

Diphtheria, tetanus (adsorbed)

Kikhoste-Vaksine
Lancy Vaxina Y

Pertussis Smallpox

Lavantuu tirokote
Liovax Y Lirubel Y

Typhoid Smallpox Measles, rubella (live) 4/74 to 6/78

Lirugen
Lirugen Y

Measles Measles (live) 2/65 to 6/78

LM - 3 RIT

Measles, mumps, rubella (live)

LM - 2 RIT

Measles, mumps (live)

LTEANAS Imuna
LYMErix Y Lyovac Attenuvax Y Lyovac Meruvax Y M-R Vax II Y M-Vax Y

Tetanus (adsorbed) Lyme disease Measles (live, attenuated) Rubella (live) Measles, rubella (live) Measles (live) 5/63 to 1979

Masern-Impfstoff SSW
Measles Vaccine DK3 Y

Measles (live) Measles (live) 1964 to 1972

Manufacturer* (country)
AVP (______) AVP (______) AVP (France) AVP (International) AVP (______) AVP (France) AVP (U.S.) AVP (U.S.) GSK (Belgium, U.S.) AVP (France) AVP (U.S.) General term for inactivated polio vaccine AVP (_______) AVP (U.S.) Natl. Public Health Institute (Finland)
Statens Institutt for Folkehelse (Norway) Swiss Serum and Vaccine Institute (Switzerland) Central Pub Health Lab (Finland) CHIR (Italy) Dow/PitneyMoore (U.S.) AVP (Int'l) Dow (U.S.) Dong Shin Pharm (Korea) Dong Shin Pharm (Korea) Imuna sp. (Slovakia) GSK (U.S.) MRK (U.S.) MRK (U.S.) MRK (U.S.) WYE (U.S.) _____ (Germany) Philips Roxane, Inc. (U.S.)

Y = product no longer distributed in U.S.

* Key to manufacturer abbreviation at end of table

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #P5120 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Product or trade name
Measles Y

Antigen(s)
Measles (inactivated) 1963 to 1966 Measles (live) 12/64 to 1974

Mencevax A

Meningococcus (polysaccharide) (Group A)

Meningitec

Meningococcus (conjugate) (Group C)

Menomune-A/C/Y/W-135 Meningococcus (polysaccharide) (Groups A,C, Y, W-135)

Menpovax 4

Meningococcus (polysaccharide) (Groups A & C)

Menpovax A+C
Meruvax Y

Meningococcus (Groups A & C) Rubella (live) 6/69 to ____

Meruvax II
Mevilin-L Y MMR Y MMR (generic) Y

Rubella (live) Measles (live) Measles, mumps, rubella (live) 6/71 to ____ Measles, mumps, rubella (live) 4/74 to 6/78

M-M-R II

Measles, mumps, rubella (live)

Moniarix

Pneumococcal (polysaccharide)

Mopavac Sevac
MOPV Y

Measles, mumps (live, attenuated) Polio (live, Sabin, monovalent types I, II, III)

Morbilvax

Measles (live, attenuated)

Morubel

Measles, rubella (live, attenuated)

Moruman Berna

Measles immunglobulin

Morupar

Measles, mumps, rubella (live, attenuated)

Movivac
M-R VAX Y

Measles (live, attenuated) Measles, rubella (live) 7/71 to ____

Mumaten Berna
Mumps (generic) Y Mumps (generic) Y Mumps (generic) Y Mumpsvax Y

Mumps (live) Mumps (live) 4/74 to 6/78 Mumps (inactivated) 1950 to 1978 Mumps (inactivated) 1950 to 1977 Mumps (live)

Mutagrip

Influenza

Nabi-HB

Hepatitis B immune globulin

Nothav
OmniHIB Y

Hepatitis A Haemophilus influenzae type b (PRP-T)

OPV

General term for oral polio vaccine

Manufacturer* (country)
Eli Lilly (U.S.)
SmithKline/RIT (Belgium) WYE (U.K., Australia) AVP (U.S.)
CHIR (Italy)
CHIR (Italy) MRK (U.S.) MRK (U.S.) Glaxo Operations MRK (U.S.) Dow Chemical (U.S.) MRK (U.S.) SmithKline/RIT (Belgium) Institute of Sera and vaccines (Czechoslovakia) WYE (U.S.) CHIR (Italy) CHIR (Italy) BER (Switzerland) CHIR (Italy) ____ (Czechoslovakia) MRK (U.S.) BER (Switzerland) Dow Chemical (U.S.) WYE (U.S.) Eli Lilly (U.S.) MRK (U.S.) AVP (______) NABI (U.S.) CHI (Italy) GSK, AVP (U.S.)

Y = product no longer distributed in U.S.

* Key to manufacturer abbreviation at end of table

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #P5120 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Product or trade name
Orimune Y

Antigen(s)
Polio vaccine (oral, trivalent)

Manufacturer* (country)
WYE (U.S.)

Pariorix

Mumps (live)

SmithKline/RIT (Belgium)

Pavivac-Sevac

Mumps (live)

Institute of Immunology (Croatia)

PCV, PCV7

General term for pneumococcal conjugate (7valent)

Pediarix

Diphtheria, tetanus, (acellular) pertussis, hepatitis B, IPV

GSK (U.S.)

PedvaxHIB

Haemophilus influenzae type b (PRP-OMP)

MRK (U.S.)

Penta

Diphtheria, tetanus, (acellular) pertussis, Hib, AVP (Canada) IPV

Pentacel

Diphtheria, tetanus, pertussis, polio, Hib

AVP (Canada)

Pentacoq

Diphtheria, tetanus, pertussis, polio, Hib

AVP (_____)

PENTAct-HIB

Diphtheria, tetanus, pertussis, polio, Hib

AVP (_____)

Pentavac

Diphtheria, tetanus, pertussis, polio, Hib

AVP (_____)

Pentavalente
Pfizer Vax-Measles K Y Pfizer Vax-Measles L Y

Diphtheria, tetanus, pertussis, hepatitis B, Hib _____ (Mexico)

Measles (inactivated) 3/63 to 1970

Pfizer (U.S.)

Measles (live) 2/65 to 1970

Pfizer (U.S.)

Pluserix

Measles, mumps, rubella

GSK (_____)

Pneumovax 23
PNU-IMUNE 23 Y

Pneumococcal (polysaccharide) Pneumococcal (polysaccharide)

MRK (U.S.) WYE (U.S.)

POLIAcel

Diphtheria, tetanus, pertussis, polio, HIB

AVP (Argentina)

PPV, PPV23

General term for pneumococcal polysaccharide (23-valent)

Prevnar

Pneumococcal (7-valent, conjugate)

WYE (U.S.)

Priorix
ProHIBiT Y

Measles, mumps, rubella (live) Haemophilus influenzae type b (PRP-D)

GSK (U.K.) AVP (U.S.)

PRP-OMP

Chemical abbreviation for PedvaxHIB

PRP-T
Purivax Y

Chemical abbreviation for ActHIB Polio (inactivated) 1956 to 1965

MRK (U.S.)

QUADRAcel

Diphtheria, tetanus, pertussis, polio

AVP (Argentina)

QUADRAcel/Hibest
Quadrigen Y

Diphtheria, tetanus, pertussis, polio, Hib DTP + polio (1959-1968)

AVP (Argentina) PD (U.S.)

Quatro-Virelon

Diphtheria, tetanus, polio

CHI (Germany)

Quintuple

Diphtheria, tetanus, pertussis, Hib, Polio

GSK (Mexico)

R-HB Vaccine

Hepatitis B (recombinant)

Y = product no longer distributed in U.S.

Mitsubishi Chem Corp (Japan)
* Key to manufacturer abbreviation at end of table

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #P5120 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Product or trade name

Antigen(s)

Manufacturer* (country)

R-VAC RA27/3 RabAvert Recombivax HB Respigam, RSV-IVIG
RIG (generic) Rimevax Rimparix RIT - LM-2 RIT - LM-3
RotaShield, RRV-TV Y
Rouvax Rubeaten Berna
Rubella (generic) Y
Rubellovac
Rubelogen Y Rubeovax Y
Rudi-Rouvax Rudivax RVA (generic) Sabin Sahia Salk
Sandovac
Serobacterin Y
Sii Triple Antigen Stamaril Synagis (palizivumab)
T. Polio T.A.B.

Rubella (live) Rubella (live) Rabies (PCEC) Hepatitis B (recombinant) Respiratory syncytial virus immune globulin (not a vaccine) Rabies immune globulin Measles (live) Measles (live) Measles, mumps (live) Measles, mumps, rubella (live) Rotavirus -- 8/98 to 7/99 Measles (live, attenuated) Rubella (live) Rubella (live) 12/69 to 1972 Rubella Rubella (live) 12/69 to 1972 Measles (live) 2/63 to 1971 Measles, rubella (live) Rubella (live, attenuated) Rabies vaccine adsorbed General term for oral (live) polio vaccine Polio (live, oral) General term for injectable (inactivated) polio vaccine Influenza Pertussis 1945 to 1954 Diphtheria, tetanus, pertussis Yellow fever (live, attenuated) Respiratory syncytial virus immune globulin (not a vaccine) Tetanus toxoid, polio Typhoid, paratyphoid (A & B)

Serum Institute (India) MRK (U.S.) CHI (U.S.) MRK (U.S.) MEDI (U.S.)
Bayer Corporation, AVP (U.S.) SmithKline/RIT (Belgium) SmithKline/RIT Dong Shin Pharm (Korea) Dong Shin Pharm (Korea) WYE (U.S.) AVP (France) BER (Switzerland) Philips Roxane (U.S.) CHIR (Germany) PD (U.S.) MRK (U.S.) AVP (France) AVP (France) BP (U.S.)
Multiple manufacturers
____ (Germany) MRK (U.S.) Serum Institute (India) AVP (France) MEDI (U.S.)
AVP (Canada) - Institute Pasteur (Tunisia) - __________ (Egypt) - Pharmaceutical Industries Corp. (Burma)

Y = product no longer distributed in U.S.

* Key to manufacturer abbreviation at end of table

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #P5120 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Product or trade name

Antigen(s)

Manufacturer* (country)

T-Immun

Tetanus (adsorbed)

____ (Austria)

Td (generic)

Tetanus, diphtheria (adult formulation)

AVP, BP (U.S.)

Te/Vac/Ptap

Tetanus

______ (Yugoslavia)

Te Anatoxal

Tetanus

BER (Europe)

Telvaclptap

Tetanus

______ (Yugoslavia)

Tetagrip

Tetanus, influenza

AVP (France)

Tetamun SSW

Tetanus (fluid, nonadsorbed)

Veb Sachsisches Serumwerk (Germany)

Tetamyn

Tetanus

Bioclon, S.A. De C.V. (Mexico)

Tetanol

Tetanus (adsorbed)

CHIR (Germany)

Tetasorbat SSW

Tetanus (adsorbed)

Veb Sachsisches Serumwerk (Germany)

Tetavax

Tetanus (adsorbed)

AVP (France)

Tetracoq 05

Diphtheria, tetanus, pertussis, polio

AVP (France)

TetrAct-HIB
Tetramune Y Tetravax Y

Diphtheria, tetanus, pertussis, Hib
Diphtheria, tetanus, pertussis, Hib
Diphtheria, tetanus, pertussis, polio - 1959 to 1965

AVP (________) WYE (U.S.) MRK (U.S.)

Tice BCG

Bacillus Calmette-Gurin vaccine (for TB)

OTC (U.S.)

TIG

Tetanus immune globulin (generic)

Bayer Corporation (U.S.)

TOPV

Trivalent oral polio vaccine

Multiple manufacturers and countries

Titifica

Typhoid and para typhoid

______ (Italy)

Tresivac Lyopholized

Measles, mumps, rubella

Serum Institute (India)

Triacel

Diphtheria, tetanus, (acellular) pertussis

AVP (______)

Triacelluvax

Diphtheria, tetanus, (acellular) pertussis

CHIR (Europe)

TriHIBit
Tri-Immunol Y

Diphtheria, tetanus, (acellular) pertussis, Hib Diphtheria, tetanus, pertussis

AVP (U.S.) WYE (U.S.)

Trimovax
Trinivac Y

Measles, mumps, rubella (live)

AVP (France)

Diphtheria, tetanus, pertussis 1952 to 1964 MRK (U.S.)

Tripacel

Diphtheria, tetanus, (acellular) pertussis

AVP (________)

Tripedia

Diphtheria, tetanus, (acellular) pertussis

AVP (U.S.)

Triple antigen

Diphtheria, tetanus, pertussis

- Chowgule & Co. (India) - CSL Limited (Australia)

Triple Sabin

Polio (live, oral)

______ (Mexico)

Triple

Diphtheria, tetanus, pertussis

_____ (Cuba, Mexico)

Triple Viral

Measles, mumps, rubella

Y = product no longer distributed in U.S.

________ (Mexico)
* Key to manufacturer abbreviation at end of table

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #P5120 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Product or trade name

Antigen(s)

Manufacturer* (country)

Trivacuna Leti

Diphtheria, tetanus (adsorbed), pertussis

Laboratory Leti (Spain)

Trivax

Diphtheria, tetanus (plain), pertussis

Wellcome (U.K.)

Trivax-ad

Diphtheria, tetanus (adsorbed), pertussis

- EVN (UK) - Wellcome (UK)

Trivax-Hib

Diphtheria, tetanus, pertussis, Hib

GSK (UK)

Trivb

Diphtheria, tetanus, pertussis

Brazil (_______)

Triviraten
Trivivac Y

Measles, mumps, rubella (live, attenuated) Diphtheria, tetanus, pertussis

BER (Switzerland) MRK (U.S.)

Trivivac Sevac

Measles, mumps, rubella (live, attenuated)

Institute of Sera & Vaccines (Czechoslovakia)

TT

Tetanus toxoid (generic)

AVP (U.S.)

TT vaccine

Tetanus toxoid (adsorbed)

_____ (India)

Tussitrupin Forte

Pertussis

Staatliches Institut (Germany)

Twinrix

Hepatitis A & B (adult formulation)

GSK (U.K., U.S.)

Twinrix Junior

Hepatitis A & B (pediatric formulation)

GSK (U.S.)

Ty21a (Vivotif Berna)

Typhoid (live, oral, lyophilized)

BER (Switzerland)

Tyne

Tuberculosis (BCG)

Sweden

Typherix

Typhoid

GSK (U.K.)

Typhim Vi (ViCPs)
Typhoid Vaccine Y

Typhoid (parenteral, injectable) Typhoid (inactivated, parenteral)

AVP (U.S., France) WYE (U.S.)

Typhopara-typhoidique Typhoid and para typhoid

___ (France)

VA-Mengoc-BC

Meningococcal (Groups B & C)

Finlay Vacunas y Sueros Centro de Investigation (Cuba)

Vaccin Difteric Adsorbit Diphtheria toxoid (adsorbed)

Cantacuzino Institute (Romania)

Vaccin Combinat Diftero- Diphtheria, tetanus (adsorbed) Tetanic

Cantacuzino Institute (Romania)

Vaccinum Morbillorum Vivum

Measles (live)

Moscow Research Institute (Russia)

Vacina Triplice Viral

Measles, mumps, rubella

_________ (Brazil)

Vacina Triplice

Diphtheria, tetanus, pertussis

Instituto Butantan (Brazil)

Vacina Dupla

Diphtheria, tetanus

Instituto Butantan (Brazil)

Vaksin Cacar

Smallpox

___ (Indonesia)

Vaksin Serap

Diphtheria, tetanus, pertussis

Perum Bio Farma (Indonesia)

Vaksin Campak Kerig

Measles (live, attenuated)

Pasteur Institute (Indonesia)

Vaksin Kotipa

Cholera, typhoid and paratyphoid A, B & C

Perum Bio Farma (Indonesia)

Vamoavax

Measles, mumps (live)

Y = product no longer distributed in U.S.

Institute of Immunology (Croatia)
* Key to manufacturer abbreviation at end of table

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #P5120 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Product or trade name

Antigen(s)

Manufacturer* (country)

Vaqta Varicellon Varie Varilrix Varivax Vaxem-Hib Vaxicoq Vaxigrip Vaxipar VCDT VDA Vaccin Difteric Adsorbit ViCPs (Typhim Vi) VIG
Virelon T 20 Virovac Massling, Perotid, Rubella Vivotif Berna (Ty21a) VT (Vacina Triplice) VTV (Vacina Triplice Viral) VVR VZIG Welltrivax trivalente YF-VAX Zaantide Zaantite Zaditeadvax Zaditevax Zamevax A+C
Zamovax Zamruvax Zaruvax

Hepatitis A (inactivated) Varicella zoster immunoglobulin Smallpox (lyophilized) Varicella (live, Oka strain) Varicella (live) Haemophilus influenzae type b Pertussis (adsorbed) Influenza Mumps (live) Diphtheria, tetanus Diphtheria

MRK (U.S.) Behringwerke Aktiengesellischaft (Germany) Institute of Sera and Vaccine (Czechoslovakia) GSK (Australia, Belgium) MRK (U.S.) CHIR (Italy) AVP (France) AVP (______) CHIR (Italy) Cantacuzino Institute (Romania) Cantacuzino Institute (Romania)

Typhoid (inactivated, injectable)
Variola (smallpox) immune globulin (not a vaccine)
Polio (live, oral, trivalent)
Measles, mumps, rubella

AVP (U.S.) Distributed by CDC
Behringserke Aktiengesellischaft (Germany) _________ (Sweden)

Typhoid (oral, live) Diphtheria, tetanus, pertussis Measles, mumps, rubella

BER (Switzerland) Instituto Butantan (Brazil) _____ (Brazil)

Measles (live, attenuated) Varicella zoster immune globulin (generic) Diphtheria, tetanus, pertussis Yellow fever Diphtheria anti-toxin Tetanus anti-toxin Diphtheria, tetanus Diphtheria, tetanus Meningococcus (polysaccharide, Groups A & C) Measles (live) Measles, rubella (live) Rubella (live)

Cantucuzino Institute (Romania) MA (U.S.) _____ (Spain) AVP (U.S.) Inst. of Immunology (Croatia) Inst. of Immunology (Croatia) Inst. of Immunology (Croatia) Inst. of Immunology (Croatia) Inst. of Immunology (Croatia)
Inst. of Immunology (Croatia) Inst. of Immunology (Croatia) Inst. of Immunology (Croatia)

Y = product no longer distributed in U.S.

* Key to manufacturer abbreviation at end of table

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #P5120 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Product or trade name
Zatetravax Zatevax Zatribavax Zatrivax

Antigen(s)

Manufacturer* (country)

Diphtheria, tetanus, pertussis, parapertussis Tetanus Diphtheria, tetanus, pertussis Measles, rubella, mumps (live)

Inst. of Immunology (Croatia) Inst. of Immunology (Croatia) Inst. of Immunology (Croatia) Inst. of Immunology (Croatia)

*Abbreviations: AVP = Aventis Pasteur (includes Connaught Laboratories and Pasteur Mrieux Connaught); BER = Berna Products Corporation (includes Swiss Serum and Vaccine Institute Berne); BIK = The Research Foundation for Microbial Diseases of Osaka University; BPT = BioPort (successor entity for Michigan Biologic Products Institute); CEN = Centeon L.L.C. (includes Armour Pharmaceutical Company); CHIR = Chiron Corporation (includes Sclavo); EVN = Evans Medical Limited; KGC = Korea Green Cross Corporation; GSK = GlaxoSmithKline (includes ...); MA = Massachusetts Public Health Biologic Laboratories; MEDI = MedImmune (purchased Aviron); MRK = Merck & Co., Inc.; NABI = Nabi Pharmaceuticals (formerly North American Biologicals, Inc.); OTC = Organon Teknika Corporation; PJP = PowderJect Pharmaceuticals; PD = Parke Davis; WYE = Wyeth Pharmaceuticals, (includes Wyeth-Lederle, Wyeth Laboratories, Lederle Laboratories, Praxis Biologics).

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #P5120 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Translation of Vaccine-Related Terms Into English
The table below lists many of the terms you will find on immunization records of persons born outside of the U.S., along with their translation into English. In most cases, the term refers to the name of a disease against which the person may have been vaccinated. While we have checked and rechecked our sources for this information, we do not claim complete accuracy.

Term (Anti) ....... Besee Bonicy, Bionica BMR Bof Bus-buska Cachumba Cagaarshowga A, B Chripka Clera Coqueluche Dabayl Detepe Difteri
Difteria
Diftria Difteriei Difterija Difterite (La) Diphtrie Diphtherie Di Te DiTePe Di-Te-Per Dje...ja paraliza DKTP

English Translation (Against) name of disease BCG Diphtheria Measles, Mumps, Rubella Mumps Varicella Mumps Hepatitis A, B Influenza Cholera Pertussis Poliomyelitis DTP Diphtheria
Diphtheria
Diphtheria Diphtheria Diphtheria Diphtheria (The) Diphtheria Diphtheria DT DTP DTP Poliomyelitis Diphtheria, Tetanus, Pertussis, Inactivated Polio

Language
Multiple languages Bosnian, Croatian, Serbian Polish Dutch Dutch Somali Portuguese Somali Slovak Spanish French, Portuguese, Spanish Somali Bosnian, Croatian, Serbian Swedish, Norwegian, Haitian Creole
Albanian, Spanish, Romanian, Portuguese
Slovak Romanian Bosnian,Croatian, Serbian Italian French German Romanian Slovak Romanian Bosnian, Croatian, Serbian Dutch

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #5121 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Term
DTC, DT Coq Duf Duple Duplex Epatit A, B Epatite A, B Febra Galbena Fievre jaune Flou Fruthi Furuq Gelekoorts Gordelroos Gowracato Griep (Anti) Gripa Gripa

English Translation
DTP Polio Diphtheria, Tetanus Diphtheria, Tetanus Hepatitis A, B Hepatitis A, B Yellow Fever Yellow Fever Influenza Measles Smallpox Yellow Fever Varicella Diphtheria Influenza (Against) influenza Influenza (flu)

Language
French Somali Spanish (Cuba) Sweden Haitian Creole Italian Romanian French Haitian Creole Albanian Somali Dutch Dutch Somali Dutch Romanian Bosnian, Croatian, Romanian, Serbian

(La) Gripe Grippe Gruzlica Grypa Gula Febern Hablobaas Haemophilus nooca b
Hemfilo tipo b Hepatita A, B (Anti) Hepatite A, B Hepatite A, B Hepatitei A, B Hepatitis tipo A, B Holera Infilowense Jadeeco

(The) influenza Influenza Tuberculosis Influenza Yellow Fever Varicella Haemophilus influenzae type b
Haemophilus influenzae type b Hepatitis A, B (Against) hepatitis A, B Hepatitis B Hepatitis A, B Hepatitis A, B Cholera Influenza Measles

Portuguese, Spanish French, German Polish Polish Swedish Somali Somali
Spanish Romanian Portuguese French Romanian Spanish Romanian Somali Somali

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #5121 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Term
Jadeeca Been, Jadeeco Been

English Translation Rubella

Language Somali

Joonis A Joonis B Kasalj hripavac Keuchhusten Kikhosta Kikhoste Kinderlhmung Kinkhoest Koklich Kolera Kopper Krzamak Krztuscowi, Krztusiec Kusma l'Haemophilus b Lawoujl Longontsteking Male boginje Malmouton Mami (Die) Masern Mssling Mazelen Meslinger Misela Morbillo (La) Numona Odra (Les) Oreillons Oreion, Oreionului Ospa Ospice

Hepatitis A Hepatitis B Pertussis Pertussis Pertussis Pertussis Poliomyelitis Pertussis Pertussis Cholera Smallpox Measles Pertussis Mumps Haemophilus influenzae, type b Measles Pneumonia Rubella Mumps Mumps (The) Measles Measles Measles Measles Measles Measles (The) Pneumonia Measles (The) Mumps Mumps Smallpox Measles

Somali Somali Croatian German Swedish Norwegian German Dutch Haitian Creole Swedish Norwegian Slovak Polish Norwegian French Haitian Creole Dutch Bosnian, Serbian Haitian Creole Samoan German Swedish Dutch Norwegian Samoan Italian Spanish Polish French Romanian Polish Bosnian

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #5121 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Term
Paperas Paralisia infantil Parotidite epidmica Parotiditis Parotite Parotitis P|ssjura Pertosse Pertusisi Pljuskavice, Kozice Pneumoniei Pocken Podstawowe Pojar German Pojarul Pokken Polio Poliomielite Poliomielitic Poliomielitis Poliomylite Polmonite Polyo Przypominajace Pulmona Qaamow-Qashiir Qaaxo-Tiibii Qanja Barar Ribeyl Rode hond Rda Hund Rde hunder ROR Rosolia

English Translation
Mumps Poliomyelitis Mumps Mumps Mumps Mumps Mumps Pertussis Pertussis Varicella Pneumonia Smallpox Primary Rubella Measles Smallpox Polio Poliomyelitis Poliomyelitis Poliomyelitis Polio Pneumonia Polio Booster Pneumonia Mumps Tuberculosis Mumps Rubella Rubella Rubella Rubella Measles, Mumps, Rubella Rubella

Language
Spanish Portuguese Portuguese Spanish Italian Slovak Swedish Italian Albanian Serbian Romanian German Polish Romanian Romanian Dutch Swedish Italian Romanian Spanish French Italian Haitian Creole Polish Spanish Somali Somali Somali Haitian Creole Dutch Swedish Norwegian French Italian

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #5121 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Term
Rtein (La) Rougeole Rubeola Rubola Rbola Rubole Rubeolei, Rubeola Rujeola, Rujeolei Rupela Sambabaha (Anti) Sarampin Sarampin Aleman Sarampin Comun Sarampo Saranpyon Smittkoppor Stelkramp Stivkrampe Subinuira Swinka Tallaakla Qaaxada Taytano Tering Tetnica Tetnica Tetano Ttano Tetanos (Anti) Ttanos (or AT) Ttanos Tetans Tetanosul Tetanozi Tezec, T"cowi

English Translation
Rubella (The) Measles Rubella Rubella Rubella Rubella Rubella Measles Rubella Pneumonia (Against) measles Rubella Measles Measles Varicella (Chickenpox) Smallpox Tetanus Tetanus Influenza Mumps BCG Tetanus Tuberculosis Tetanus Tetanus Tetanus Tetanus Tetanus (Against) tetanus Tetanus Tetanus Tetanus Tetanus Tetanus

Language
German French Bosnian Spanish Portuguese French Romanian Romanian Samoan Somali Spanish Spanish Spanish Portuguese Haitian Creole Swedish Swedish Norwegian Czech Polish Somali Somali Dutch Spanish Portuguese Italian Portuguese, Spanish Romanian Spanish French Haitian Creole Romanian Albanian Polish

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

Item #5121 (10/03)

Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Term
Tos Ferina Tosse Asinina Triplice Trippel Tubercolosi Tuberculose (Die) Tuberkulose Tuse convulsiva, Tusei convulsive
Upala plua Vaioloso Vannkopper (La) Varicela Varicel|, Varicelei Variola, Variolei (La) Variole Veliki boginje Veliki kasalj Viruela Vodene kozice Wareento Wundstarrkrampf Xiiqdheer Zpal,plc Zapalenie pluc Zauske ZauSnjaci Zei Genpeter utica A, B

English Translation Whooping Cough Whooping Cough DTP Diphtheria, Tetanus, Pertussis Tuberculosis Tuberculosis (The) tuberculosis Pertussis

Language Spanish Italian Portuguese Sweden Italian French German Romanian

Pneumonia Smallpox Varicella (The) chickenpox Varicella (chickenpox) Smallpox (The) Smallpox Smallpox Pertussis Smallpox Varicella Pneumonia Tetanus Pertussis Pneumonia Pneumonia Mumps Mumps Mumps Hepatitis A, B

Bosnian, Croatian, Serbian Italian Norwegian Spanish Romanian Romanian French Bosnian, Croatian, Serbian Bosnian, Serbian Spanish Croatian Somali German Somali Slovak Polish Bosnian Croatian, Serbian German Bosnian, Croatian, Serbian

Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health

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Immunization Action Coalition 1573 Selby Avenue St. Paul, MN 55104 (651) 647-9009 www.immunize.org

Georgia Immunization Program Manual
TABLE OF CONTENTS

Division Of Public Health

13. QUALITY ASSURANCE Quality Assurance/Quality Improvement for Immunization Practice for Public Health Nurses and Immunization Support Staff Appendices Attachment A - Immunization Reference Video Information and Resources, Training Sessions (REPLACE) Attachment B - Post Test Attachment C - Post Test Answers Attachment D IM/SC (Intramuscular) & (Subcutaneous) Injections (REPLACE) Attachment E - Vaccine Administration Techniques Post Test Attachment F - Vaccine Administration Techniques Post Test Answer Key Attachment G - Clinical Skills Checklist (REPLACE) Attachment H - QA/QI Review Assessment Tool

Table of Contents 11/2009

DIVISION OF PUBLIC HEALTH
QUALITY ASSURANCE/ QUALITY IMPROVEMENT FOR IMMUNIZATION PRACTICE FOR PUBLIC HEALTH NURSES AND IMMUNIZATION SUPPORT STAFF
July 2007

QUALITY ASSURANCE / QUALITY IMPROVEMENT
Review Date:
Review Site(s):
REVIEW TEAM MEMBERS:
1. 2. 3. 4. 5. 6.
i

TABLE OF CONTENTS
PAGE # INTRODUCTION / PURPOSE................................................................................................................................................1 SECTION I
CREDENTIALING..........................................................................................................................................................2 SECTION II
TRAINING / EDUCATION .................................................................................................................................................3 SECTION III
POLICIES AND PROCEDURES................................................................................................. .........................................12 SECTION IV
CLINICAL PRACTICE ...................................................................................................................................................13 SECTION V
STORAGE, HANDLING AND LABELING OF DRUGS ..............................................................................................................14 SECTION VI
MANAGEMENT OF DRUG REACTIONS.............................................................................................................................15 SUMMARY PAGE................................................................................................................................................................16 ATTACHMENTS.................................................................................................................................................................
ii

QUALITY ASSURANCE /QUALITY IMPROVEMENT FOR IMMUNIZATION PRACTICE FOR PUBLIC HEALTH NURSES
AND SUPPORT STAFF
Introduction
The Georgia Immunization Program, under the Division of Public Health, produces both an Immunization Program Manual and an ACIP Recommendations Notebook that outline the recommended Policies and Procedures for administering vaccines by registered nurses and licensed practical nurses and for providing immunization services. An advisory committee consisting of district immunization coordinators and pediatricians, a state pharmacist and the Immunization Program management team, review and update these manuals on an ongoing basis. Each district is responsible for having written policies and procedures for the administration of vaccines that have been reviewed and signed annually by the health director or their designee. Districts are encouraged to either utilize the Policies and Procedures outlined in the Georgia Immunization Program Manual and the ACIP Recommendations Notebook, or to write their own which should be consistent with those outlined in these two references.
Purpose
The purpose of this quality assurance tool is to document the training /education expectations and the parameters of clinical practice immunization services. Use of this tool will help promote consistency in practice across programs on a statewide basis. Quality assurance will provide an opportunity to identify excellence in practice, as well as opportunities for improvement. The components of this tool may be used to conduct QA reviews of training programs, administration of vaccines by both registered nurses and licensed practical nurses, and the provision of immunization services by support staff. These reviews may be done by Public Health staff from either the local and/or state level.
1

SECTION I - CREDENTIALING

Nurse or Site:

EXPECTATIONS

Yes

No

1a. Professional Licensure for RN's:
Each Registered Professional Nurse (RN) practicing under the District's Policies and Procedures is currently licensed by the Georgia Board of Nursing. Documentation shall include verification of license per internet (www.sos.state.ga.us).

1b. Professional Licensed for Practical Nurse (LPN):
Each Licensed Practical Nurse functioning under the health district's Policies & Procedures (P&P) is currently licensed by the Georgia Board of Examiners of Licensed Practical Nurses. Documentation shall include verification of license per internet (www.sos.state.ga.us).

2a. Scope of Practice for RN's:
The district's written P&P for the administration of vaccines and provision of immunization services are consistent with the Division of Public Health's Scope of Practice Guidelines for Expanded Role of RNs and Nurse Practitioners.

2b. Scope of Practice for LPN's:
The district's written P&P for administration of vaccines and provision of immunization services are consistent with the Division of Public of Health's Polices regarding the Administration and Distribution of drugs by Licensed Practical Nurses (LPN's).

For each LPN administering vaccines and providing immunization services,
there is documentation of ongoing supervision by a RN, physician, dentist and/or podiatrist.

3. Clinical Preceptorship/Peer Review for RN's & LPN's:
Prior to practicing under P&P, written documentation of completion of a clinical preceptorship, consistent with the recommended Policies & Procedures outlined in Section II of this document must be on file.

Date:
COMMENTS
2

Nurse or Site:

Date:

SECTION II A TRAINING / EDUCATION
FOR REGISTERED NURSES (RN's) & LICENSED PRACTICAL NURSES (LPNS): NOTE: This section may be used to review an individual nurse's (RN or LPN) training and preparation for practicing under Immunization Policies & Procedures (P&P). A copy may be placed in the nurse's personnel file. It may also be used to review the training and preparation of a group of nurses who are practicing under Immunization Policies and Procedures. The self-study and didactic training sections should be completed and documented prior to completing the preceptorship. Each nurse should complete the following:
DOCUMENTATION

EXPECTATIONS

Yes

No

(Date completed/

Reviewers Initial)

COMMENTS

INITIAL TRAINING REQUIRED

The nurse has completed the following: A SELF-STUDY
Familiar with and has access on-site to: Georgia Immunization Program Manual + (Also available on line)
Advisory Committee on Immunization Practices (ACIP) Recommendations Manual+ (Also available on line)
Health District Policies & Procedures for Vaccine Administration (Signed annually by the District Health Director or his/her designee)
Health District Policies & Procedures for Administration of Travel Vaccines (If district administers travel vaccines)
Health District Emergency Policies & Procedures Georgia Notifiable Disease Fact Sheets+ (District must be able to access on line)
Manual for the Surveillance & Reporting of Vaccine Preventable Diseases Manual, CDC+ (District must be able to access on line)
Vaccine package inserts.
+ See Attachment A for detailed information on these references
Most Current version
3

Nurse or Site:
EXPECTATIONS
INITIAL TRAINING REQUIRED - Cont'd.
B. DIDACTIC/CLASSROOM TRAINING COMPLETED:
Basic Epidemiology: Prevention of Vaccine Preventable Diseases: (VPD's)
- Attend or view and complete and pass post tests for the CDC Satellite Immunization Training Sessions (live, webcast, or taped session) on: Epidemiology & Prevention of Vaccine Preventable VPD's +* (includes basic vaccine pharmacology).
Storage and Handling: - View all components of the CDC's Storage and Handling Tool Kit +*(DVD
or webcast )and complete and pass post tests for: How to Handle Your Vaccine Supply (See attachments A,C & D) or - Attend Vaccine Storage & Handling training session provided by the GA Immunization Program +* Vaccine Administration Techniques - Vaccine Administration Techniques training session +* (Contact GA Immunization Program consultant (IPC) or District Immunization Coordinator) or - View Immunization Techniques Video/DVD +* and pass post test. (see attachments A, E, F, and G) GA Requirements for Day Care and School Attendance: Attend Training Session on GA Requirements for Attending Day Care & School (Provided by District "Certified Trainer" or Georgia IPC- see attachment A) Complete CPR Certification Class provided by the district or other entity (must be currently certified). Forms, Reports, & Records - Instructed in purpose of and has access to the following forms, reports, and records:
+ See Attachment A for detailed information on these references
Most Current version

DOCUMENTATION

Yes

No

(Date Completed/

Reviewers Initial)

Date:
COMMENTS
4

Nurse or Site:
EXPECTATIONS
a. Patient Record (written and computerized) and how to access Immunization status.
b. Vaccine Information Statements* c. Certificates and Statements for School and Day Care Attendance*
d. Determination of Coverage and Fees (VFC Eligibility, Medicaid, PeachCare, Private Insurance, HMO coverage) and how to apply for Medicaid and PeachCare.
e. Informed Consent f. Vaccine Adverse Event Reporting System (VAERS) g. Tracking and Follow up Moved or Gone Elsewhere (MOGE) h. Notifiable Disease Reports i. Vaccine Preventable Disease (VPD) worksheets* j. Immigration Forms* k. Employee Immunization Record l. District Immunization documentation forms and charting process* m. Precall and Recall process and related forms and letters
n. Clinical Assessment Software Application (WinCASA/ CoCASA) report* o. GA Registry of Immunization Transactions & Services (GRITS) (Knows how
to access and query for an existing immunization record to determine current immunization status and need for vaccinations) p. Current population based immunization study and child care and school audit results Tour of Immunization clinic, including information about where vaccine emergency cart trays and immunization forms are stored. Informed how to access district immunization coordinator and the GA Immunization Program "On-Call" resource phone line and area IPC . Attend at least one (1) training on cultural competencies.
+ See Attachment A for detailed information on these sessions or videos.
* Most current version

DOCUMENTATION

YES
(Date Completed/
Reviewer's Initial

NO

Date:
COMMENTS

5

Nurse or Site:
EXPECTATIONS
C. PRECEPTORSHIP / CLINICAL: The extent and duration of the preceptorship/clinical may vary according to the needs of each individual nurse. However, there shall be documentation that the nurse can satisfactorily perform the required clinical skills on the attached check list (Attachment H) and that the preceptor has observed the required encounters prior to the nurse being allowed to administer vaccines without direct supervision. The minimum number of observed encounters should be two per age group indicated.
D. HAVE ACCESS ON-SITE TO REFERENCE MATERIALS & RECORDS: Epidemiology & Prevention of Vaccine Preventable Diseases. CDC+* Red Book, AAP,+ (vaccine recommendations section) (at least 1copy at district) Current Guide to Contraindications to Childhood Vaccinations, CDC+ Control of Communicable Diseases in Man, Heymann, A.S.,+ Current Year Drug Reference (refer to current Nurse Protocol manual, Drug
Dispensing Procedure, for list of acceptable drug references) GA Registry of Immunization Transactions & Services (GRITS) (Needs to be able to
access and query for an existing immunization record to determine current immunization status and need for vaccinations)
+ See Attachment A for detailed information on these sessions or videos
* Most current version

DOCUMENTATION
YES
(Dated Completed/ Reviewer's Initial)

Date:

NO

COMMENTS

6

Nurse or Site:
EXPECTATIONS
ONGOING TRAINING - REQUIRED
Each Nurse should annually complete the following: A. SELF-STUDY:
Review of current year's District Policies and Procedures for Administration of Vaccines (if separate from the GA Immunization Program Manual)
Review of current GA Immunization Program Manual and current updates for the ACIP Recommendations Notebook
B. DIDACTIC/CLASSROOM TRAINING Participation in at least one training per year to keep updated on current policies and procedures concerning administration of vaccines. Recommended training sessions could include but are not limited the following: (Multiple presenter topics available from GA Immunization Program and CDC National Center for Immunization and Respiratory Diseases-Immunization Services +) CDC Satellite Immunization Training Sessions + (live, webcast, or recorded): - Vaccine Safety - Immunization Updates (Childhood or Adult) - Surveillance & Prevention of Vaccine Preventable Diseases - International Travel Immunization Program training sessions+ (Provided by GA Immunization Program staff or District "Certified Trainer")
Cultural Competency Update
+ See Attachment A for detailed information on these sessions or videos
* Most current version

DOCUMENTATION

Yes

No

(Date Completed/

Reviewer's Initial)

Date:
COMMENTS

7

Nurse or Site:

Date:

C. PEER REVIEW / CLINICAL:
At least once annually, a supervisor or peer shall observe, evaluate, and document on skills checklist (Attachment G) the process of the nurse assessing, preparing, administering vaccines, and documenting the information provided to infants and children, adolescents and adults (at least one encounter for each).
OTHER
a. Have Access On-Site to: District Policies and Procedures for Administration of Vaccines.+ (if separate from the GA Immunization Program Manual)
GA Immunization Program Manual . ACIP Recommendations Notebook. Epidemiology & Prevention of Vaccine Preventable Diseases. CDC+ Red Book, AAP+, (Vaccine Recommendations section) (at least one
copy at district)
Current Guide to Contraindications to Childhood Vaccinations, CDC+ Control of Communicable Diseases in Man, Heymann, A.S., + Current year drug reference (refer to current Nurse Protocol manual, Drug
Dispensing Procedure, for list of acceptable drug references) Health District's P&P for Administrating Travel vaccines (If applicable)
GA Notifiable Disease Fact Sheets (available at district) Manual for Surveillance & Reprinting of VPD Manual CDC+ (available at
district) Vaccine Package Inserts GA Registry of Immunization Transactions & Services (GRITS) (Needs to
be able to access and query for an existing immunization record to determine current immunization status and need for vaccinations))
+See Attachment A for detailed information on these sessions or videos.
* Most current version

DOCUMENTATION

Yes

No

Support Staff or Site:

COMMENTS
8 Date:

SECTION II B TRAINING / EDUCATION
FOR SUPPORT STAFF: NOTE: This section may be used review an individual support staff person's (i.e. clerical, epidemiological, outreach and other personnel) training and preparation for providing service. A copy may be placed in the staff person's personnel file. If may also be used to review the training and preparation of a group of support staff who are providing immunization services. The self study and didactic training should be completed and documented prior to completing the perceptorship. Each staff person should complete the following:
DOCUMENTATION

EXPECTATIONS

Yes

No

(Date Completed/

Reviewer's Initial

COMMENTS

INITIAL TRAINING REQUIRED

The Support Staff has completed the following: A. SELF STUDY

Familiar with the following references and has access to:

Georgia Immunization Program Manual+
Health District Policies and Procedures for Vaccine Administration* (signed annually by the District Health Director or his/her designee)
Health District Policies and Procedures for Administration of Travel Vaccines+ (If district administers travel vaccines).
B. DIDACTIC / CLASSROOM TRAINING
Tour of immunization clinic, including information about where vaccines, emergency carts trays and immunization forms are stored, and proper vaccine storage and handling techniques.
Instructed how to access District Immunization Coordinator or designated immunization resource person and GA Immunization Program "On Call" resource phone line and area IPC for immunization inquires.
+ See Attachment A for detailed information on these references
* Most Current Version

9

Support Staff or Site:
SECTION II B TRAINING / EDUCATION
INITIAL TRAINING REQUIRED (Continued) WinCASA/ CoCASA training (required only for persons designated by the districts) Instructed in purpose of and has access to the following forms, reports, and records: a Patient record (written and computerized) and how to assess immunization status. b Vaccine Information Statements* c Certificates and Statements for School and Day Care Attendance* d Determination of Coverage and fees (VFC Eligibility, Medicaid, PeachCare, Private Insurance, HMO coverage) and how to apply for Medicaid and PeachCare. e Informed Consent f Vaccine Adverse Event Reporting System (VAERS) g Tracking and Follow up (MOGE) h Notifiable Disease Reports i VPD Worksheets j Immigration forms k Employee Immunization Records l District Immunization document forms and charting process m Precall and Recall process and related forms and letters n WinCASA/ CoCASA report (when indicated) o GA Registry of Immunization Transactions& Services (GRITS) (Knows how to access and query for an existing immunization record to determine current immunization status and need for vaccinations)
+ See Attachment A for detailed information on these references
* Most Current Version

Date:

DOCUMENTATION

YES
(Date Completed/
Reviewer's Initial)

NO

COMMENTS

10

Support Staff or Site:
EXPECTATIONS
A. PRECEPTORSHIP / CLINICAL: (see Skills Check List Attachment H) The extent and duration of the preceptorship may vary according to the needs of each person. However, there shall be documentation that the person can satisfactorily perform the required clinical skills on the attached check list (Attachment H)
CONTINUING (ONGOING) TRAINING - REQUIRED A. Self Study
Review of current year's District Policies and Procedures for Administration of Vaccines (if separate from the GA Immunization Program Manual)
Review of current GA Immunization Program Manual and current schedules and updates.
B. Didactic/Classroom Training Participation in at least one training per year to keep updated on current policies and procedures concerning administration of vaccines. (see attachment A for listing of training sessions)
C. Clinical Practice Document that the support person can satisfactorily perform the required clinical skills on the attached Skill CheckList (Attachment H).
+ See Attachment A for detailed information on these references
* Most Current Version

DOCUMENTATION

YES
(Date Completed/
Reviewer's Initial)

NO

Date:
COMMENTS

11

Site:

SECTION III POLICIES & PROCEDURES
EXPECTATIONS
The district utilizes the Policies & Procedures in the GA Immunization Program Manual and the ACIP Recommendations Manual and both manuals are current.
The District writes their own Policies and Procedures (P&P) for the Administration of Vaccines and Provision of Immunization Services. The P&P are consistent with the recommendations outlined in the GA Immunization Program Manual and the ACIP Recommendations Manual.
Are available upon request in the setting where RN/LPN practices under the Policies and Procedures.
Are reviewed, revised or updated annually, or as GA Immunization Program recommends change.
Are signed by licensed Physician. Bear a current review date. Include a provision for immediate consultation with a physician or designee. Include a provision for the supervision of the LPN by a RN, Physician, Dentist,
and/or Podiatrist.
+ See Attachment A for detailed information on these references
* Most Current Version

DOCUMENTATION

YES
(Date Completed/
Reviewer's Initial)

NO

Date:
COMMENTS

12

Site:
SECTION IV -- CLINICAL PRACTICE
EXPECTATIONS
Direct observations of clinical nursing practice will be documented on the Clinical Skills Checklist (see Attachment H) for each nurse administering vaccines and each staff person involved in the provision of immunization services.

DOCUMENTATION

YES
(Date Completed/
Reviewer's Initial)

NO

Date:
COMMENTS

+ See Attachment A for detailed information on these references
* Most Current Version
13

Site:

Date:

SECTION V VACCINE STORAGE, HANDLING , ETC.

This section will be documented on a separate report (see Attachment I. This document is updated annually based on CDC requirements. Please check with your Immunization Program Consultant {IPC} for current version)

14

Site:

SECTION VI MANAGEMENT OF DRUG REACTIONS
DOCUMENTATION

EXPECTATIONS

YES
(Date Completed/
Reviewer's Initial)

NO

A. Clinic site has most current written, Policies and Procedures for handling anaphylactic

(allergic) reactions and/or blood drawing.

B. Clinic site has appropriate emergency equipment and supplies are readily available.

C. Clinic site has an emergency alert communication system that is known by all staff.

D. Clinic site has posted local emergency telephone numbers, (i.e., EMS, Hospital, etc.) for

easy access.

E. Each RN and LPN has current CPR certification.

F. Each RN and LPN has received orientation/training updates in emergency procedures

within one (1) month of employment.

G. Each RN and LPN has participated in training updates as needed and in mock emergency

drills at least once a year.

H. There must be at least one annual mock emergency drill which includes infants, toddlers,

children and adults.

I. One person (designee) coordinates training and scheduling, implementation and evaluation

of the mock emergency drills.

J. Copies of records on anaphylactic reactions are distributed as follows:

Sent with patient to emergency room, if applicable;

Retained by the clinic for patient record; and

Sent to District Office with incident report.

K. Review of emergency preparedness for drug reactions is conducted at least once annually.

L. Each RN and LPN is familiar with the Vaccine Adverse Event Reporting System (VAERS)

and the policies and procedures for reporting vaccine adverse events following

immunizations.

Incomplete

+ See Attachment A for detailed information on these references
* Most Current Version

Date:
COMMENTS

15

Support Staff or Site:

Date:

Summary

FINDINGS:

RECOMMENDATIONS:

16

Georgia Immunization Program Manual

Attachment A
Division Of Public Health

Immunization Resources

Publications:

Name Georgia Immunization Program Manual
Advisory Committee on Immunization Practices (ACIP) Recommendations Manual
Georgia Notifiable Disease Fact Sheets
GA VFC Provider Operations Guide
Manual for the Surveillance of Vaccine Preventable Diseases, CDC The Red Book - Report of the Committee on Infectious Diseases, American Academy of Pediatrics, 2009

Ordering Information Can be downloaded from program website http://health.state.ga.us/programs/immuniza tion/index.asp
No longer available as a complete manual. Single copies of each report may be ordered from the National Immunization Program, CDC; or can be viewed and downloaded at http://www.cdc.gov/vaccines/pubs/ACIPlist.htm

Approximate Cost

Disease-specific fact sheets are available online: http://health.state.ga.us/siteindex/d.asp#dis eases and click on specific disease to view fact sheet (i.e. Notifiable Disease: xxxxxx)
Available for private VFC providers. Contact VFC Program Office or Immunization Program Consultant
Available only on CDC website at www.cdc.gov/vaccines/pubs/survmanual/default.htm

Free

American Academy of Pediatrics 141 Northwest Point Blvd. Elk Grove Village, IL 60007-1098 1-847-434-4000 1-847-434-8000 (Fax) Elk Grove, Illinois (Published every 3 years) www.aap.org

$114.95

1 13. Quality Assurance 6/2009 Immunization References, Video Information, Resources and Training Sessions

Georgia Immunization Program Manual

Attachment A
Division Of Public Health

Immunization Resources

Name Current Guide to Contraindications to Childhood Vaccinations, CDC, 2003
The Pink Book Epidemiology & Prevention of Vaccine Preventable Diseases, CDC, 11th edition, 2009
Control of Communicable Diseases Manual, 18th edition, 2004

Ordering Information Access from CDC's website at http://www.cdc.gov/vaccines/recs/vacadmin/downloads/contraindications_guide.p df
One copy provided for each public health facility; or Order from Public Health Foundation 1-877-252-1200 (toll free) Access from CDC's website: http://www.cdc.gov/vaccines/pubs/pinkbook /default.htm
Engineer's Book Store 748 Marietta St., NW Atlanta, GA 30318 404-221-1669

Approximate Cost
$35.00+ shipping from Public Health Foundation at http://bookstore.phf.org
$27.00 + tax + shipping from Public Health Foundation at http://bookstore.phf.org/

IAC Express Internet news service of the Immunization Action Coalition
Immunize Georgia, (newsletter) Children's Healthcare of Atlanta and Georgia Immunization Program

Order from: Immunization Action Coalition http://www.immunize.org/subscribe/
Order from: Immunize Georgia Angie Matthiessen 1680 Tullie Circle Atlanta, GA 30329 (404) 785-7225 E-mail: angie.matthiessen@choa.org

Immunize Georgia---Your Monthly News and Resource Update (email newsletter)

To register for the electronic subscription, send an email request to: angie.matthiessen@choa.org

Free Free
Free

2 13. Quality Assurance 6/2009 Immunization References, Video Information, Resources and Training Sessions

Georgia Immunization Program Manual

Attachment A
Division Of Public Health

Immunization Resources

Name Morbidity & Mortality Weekly Report (MMWR)
NEEDLETIPS Published biannually

Ordering Information Order electronic subscription: http://www.cdc.gov/mmwr
To order paper copy, contact: Superintendent of Documents P.O. Box 371954 Pittsburgh, PA 15250-7954 202-512-1800
Order from: Immunization Action Coalition at http://www.immunize.org/subscribe/nt.asp

Approximate Cost Free
$373.00/year or
$4.25 per copy for a single issue of MMWR Weekly
Free

Training Tools
Vaccine Storage and Handling Toolkit
Immunization Administration
Copies of the CDC Satellite Immunization Training Courses
Immunization: You Call the Shots--- web-based training course

Order from CDC online order form at https://www2.cdc.gov/nchstp_od/PIWeb/nip orderform.asp
or view online at www2a.cdc.gov/nip/isd/shtoolkit/splash.html

One CD available free

View Attachment D of the Georgia Immunization Program Manual Can be downloaded at http://health.state.ga.us/programs/immuniza tion/index.asp Or view appendix D of the Pink book online at http://www.cdc.gov/vaccines/pubs/pinkbook /downloads/appendices/appdx-full-d.pdf

Free

View webcasts at: http://www2a.cdc.gov/phtn/calendar.asp
or order the DVD using the CDC online order form at:

One DVD available free

https://www2.cdc.gov/nchstp_od/PIWeb/nip orderform.asp
Access from the CDC website at http://www.cdc.gov/vaccines/ed/youcallthes hots.htm

Free

3 13. Quality Assurance 6/2009 Immunization References, Video Information, Resources and Training Sessions

Georgia Immunization Program Manual

Attachment A
Division Of Public Health

Immunization Resources

Telephone and Fax:
GA Immunization Program "On Call" Phone Line 404-657-3158
GA Vaccines for Children Program 800-848-3868, 800-372-3627 (Fax)
CDC Immunization Information Hotline (English & Spanish) 800-232-4636
Public Health Foundation 202-218-4400
GA Chapter, American Academy of Pediatrics 404-881-5020
GA Chapter, American Academy of Family Physicians 404-321-7445 or (800) 392-3841
Affiliated Computer Services (ACS) Georgia Health Partnership Customer Interation Center Providers:............................................................................................ 1-800-766-4456 ............................................................................................................ 404-298-1228 For claim status, eligibility verification, provider enrollment, Electronic Manual Claims (EMC) assistance (GA Better Health and Health Check Services)., and to reach your ACS Field Representative - www.ghp.georgia.gov
Members:.................................................................................1-866-211-0950 ................................................................................................ 770-570-3373 TDD/TTY...................................................................................1-866-211-0951
Health Check Services........................................................................................404-657-7882 Health Check and Immunization policy questions ............................ 1-800-377-3557
Other Resources Children's Health Care Of Atlanta (Immunize Georgia)...........................404-785-7225
Vaccine Manufacturers Bayer Pharmaceutical .........................1-800-842-2937 Merck National Service Center.................1-800-672-6372 Merck Vaccine Customer Help Line........ 1-800-982-7482 Sanofi Pasteur...................................1-800-822-2463 GlaxoSmithKline.................................... ..1-800-366-8900 Wyeth-Lederle Laboratories.................. 1-800-666-7248

4 13. Quality Assurance 6/2009 Immunization References, Video Information, Resources and Training Sessions

Georgia Immunization Program Manual

Attachment A
Division Of Public Health

Immunization Resources

Internet Addresses:
GA Immunization Program http://health.state.ga.us/programs/ immunization/index.asp
CDC Home Page Immunization www.cdc.gov
CDC Travel Information www.cdc.gov/travel/destinat.htm
All Kids Count www.allkidscount.org
Immunofacts www.immunofacts.com
GA Chapter, American Academy of Pediatrics www.gaaap.org
National Vaccine Program Office www.hhs.gov/nvpo

Immunization Action Coalition www.immunize.org
Every Child by Two www.ecbt.org
American Academy of Pediatrics www.aap.org
GA Academy of Family Physicians www.gafp.org
Georgia Health Partnership www.ghp.georgia.gov/wps/portal
Immunize Georgia's Little Guy's (CHOA) www.choa.org

Education Presentations:
Georgia Immunization Program Presentations1 CDC Satellite Training Programs2 Educating Physicians In Your Community (EPIC)3
1Contact your Immunization Program Consultant to schedule (see page 6 for program offerings) 2Contact your Immunization Program Consultant for dates and locations 3Contact GA Chapter: Academy Of Pediatrics to schedule

5 13. Quality Assurance 6/2009 Immunization References, Video Information, Resources and Training Sessions

Georgia Immunization Program Manual

Attachment A
Division Of Public Health

Immunization Resources

Georgia Department of Human Resources is an approved provider of continuing nursing

education by the Georgia Nurses Association, an accredited approver by the American

Nurses Credentialing Center's Commission on Accreditation.

Title of Presentation

Length of

Certification Credits

Presentation

Adolescent and Adult Immunizations
Childhood Immunization Update (Combination review of the immunization schedule and GA requirements for daycare & school attendance) Childhood Immunization Requirements (for WIC and Clerical Personnel) Epidemiology & Prevention of Viral Hepatitis From A-E (Contact Lynne Mercedes (404) 657-3171)* GA Requirements for School and Day Care Attendance (presentation for health care providers, day care, and school personnel)
GRITS (GA Registry of Immunization Transaction and Services) Overview GRITS Train-The-Trainer Training Perinatal Hepatitis B Prevention (Inservice for Birthing Hospital) (Contact Kate Spruit (404) 657-3151)* Review Of The Recommended Immunization Schedule Vaccine Administration Techniques (Contact Nurse Consultant (404)463-6639)* Vaccine Storage & Handling

1 Hour 1 Hour
1 Hour 3 Hours
1 Hour
1 Hour 5 Hours 1 Hour
1 Hour 1 Hour 1 Hour

CH 1.0 Hours #115-07 (approval expires 10/4/09) CH 1.0 Hours #122-08 (approval expires 02/27/10)
CH 3.0 Hours # 130-08 (approval expires 02/13/11)
CH 1.0 Hours #134-08 (approval expires 02/01/11)
Day Care certification ECE-2
CH 1.0 Hours #133-08 (approval expires 01/01/11) CH 1.0 Hours #135-08 (approval expires 02/01/11) CH 1.0 Hours #136-08 (approval expires 02/01/11)

To schedule a training session: Contact your Georgia Immunization Program Consultant at 404-657-3158
* Contact the appropriate Coordinator or Consultant

6 13. Quality Assurance 6/2009 Immunization References, Video Information, Resources and Training Sessions

Georgia Immunization Program Manual

Attachment A
Division Of Public Health

Immunization Resources

Training Resources for Cultural Competencies
Ibrahim Kria, Anthropologist (404) 297-7156 iakria@gdph.state.ga.us "Cultural Competency Training Program" Georgia Refugee Health Program (404) 679-4981

7 13. Quality Assurance 6/2009 Immunization References, Video Information, Resources and Training Sessions

POST TEST

Attachment B

"How to Protect Your Vaccine Supply"

Please mark one correct answer for each question. Each question counts 10 points. A passing score is 80%.

1. The type of refrigerator/freezer utilized to store vaccine should be:

6. You can tell if the temperature in your freezer does not go above freezing if :

A. Standard refrigerator with separate freezer door and seal
B. Dormitory type refrigerator with small hanging freezer inside
C. Dormitory type refrigerator and separate dormitory type freezer
2. Which vaccines go in the freezer?

A. A penny on top of a cup of ice does not become covered with ice.
B. The cola you put in there at 7:00AM explodes by lunch time.
C. The freezer needs to be defrosted.
7. When handling varicella vaccine, which of the following are very important?

A. IPV & DTaP B. Td, Hib C. Varicella D. DT and Pneumococcal
3. The temperature in the refrigerator and freezer should be checked:

A. Keep at 5F or below and protect it from light.
B. Dry ice must be present when the vaccine is delivered.
C. Discard reconstituted vaccine if not used within 30 minutes.
D. All of the above

A. Once a day B. Twice a day C. Once a week D. Once a month
4. To stabilize temperature in the refrigerator it is helpful to keep the following in there:
A. All vaccine diluents B. Large plastic containers filled with
water C. Lunch
5. Vaccine should never be stored in which part of the refrigerator?
A. Floor B. Door C. Lower right-hand corner

8. The expiration date on the vial of vaccine you are holding is today's date. This vaccine is ok to use.
A. True B. False
9. When rotating the vaccine stock,
A. Use short dated vaccine first. B. Use the longest date vaccine first as this
is the "freshest." C. Rotating stock is not that important as
long as you don't use anything outdated. D. Always over-order to make sure nothing out dates.
10. You should have a sign on your refrigerator/freezer plug to prevent accidental unplugging.

A. True B. False

July 2007

1

POST TEST Answers
"How to Protect Your Vaccine Supply"

Attachment C

Please mark one correct answer for each question. Each question counts 10 points. A passing score is 80%.

1. The type of refrigerator/freezer utilized to store vaccine should be:

6. You can tell if the temperature in your freezer does not go above freezing if :

A. Standard refrigerator with separate freezer door and seal
B. Dormitory type refrigerator with small hanging freezer inside
C. Dormitory type refrigerator and separate dormitory type freezer
2. Which vaccines go in the freezer?

A. A penny on top of a cup of ice does not become covered with ice.
A. The cola you put in there at 7:00AM explodes by lunch time.
B. The freezer needs to be defrosted.
7. When handling varicella vaccine, which of the following are very important?

A. IPV & DTaP B. Td, Hib C. Varicella D. DT and Pneumococcal
3. The temperature in the refrigerator and freezer should be checked:
A. Once a day B. Twice a day C. Once a week D. Once a month

A. Keep at 5F or below and protect it from light. B. Dry ice must be present when the vaccine is
delivered. C. Discard reconstituted vaccine if not used within
30 minutes. D. All of the above
8. The expiration date on the vial of vaccine you are holding is today's date. This vaccine is ok to use.
A. True B. False

4. To stabilize temperature in the refrigerator it is helpful to keep the following in there:
A. All vaccine diluents B. Large plastic containers filled with water C. Lunch
5. Vaccine should never be stored in which part of the refrigerator?

9. When rotating the vaccine stock,
A. Use short dated vaccine first. B. Use the longest date vaccine first as this is the
"freshest." C. Rotating stock is not that important as long as
you don't use anything outdated. D. Always over-order to make sure nothing out
dates.

A. Floor B. Door C. Lower right-hand corner

10. You should have a sign on your refrigerator/freezer plug to prevent accidental unplugging.
A. True B. False

July 2007

1

Attachment D

Vaccine Administration: Administer I.M. (Intramuscular) Injections

Administer these vaccines via I.M. (intramuscular) route: DTaP, DT, Td, Tdap, Hib, Hepatitis A, Hepatitis B, Influenza, Pneumococcal Conjugate (PCV), Meningococcal Conjugate (MCV), and Human Papillomavirus Vaccine (HPV). Administer IPV &
Pneumococcal Polysaccharide (PPSV) either IM or subQ.

When you administer these vaccines, follow the age recommendations indicated in the current Advisory Committee on Immunization Practices (ACIP) schedules.

Patient's Age

Site (see illustrations below)

Infants

Vastus lateralis muscle in

(birth to 12 months of age) anterolateral aspect of middle or

upper thigh

Needle Size
5/8" (0-28 days of age) 1" needle (1-12 months of age) 22-25 gauge

Needle Insertion
Use a needle long enough to reach deep into the muscle.
Insert needle at an 80 to 90 angle to the skin with a quick thrust.
Retain pressure on skin around injection site with thumb and index finger while needle is inserted.

80-90 angle
Skin

Toddlers
(12 to 36 months of age)

Vastus lateralis muscle preferred
until deltoid muscle has developed adequate mass (approximately age 36 months)

5/8" for deltoid
1" needle for vastus lateralis 22-25 gauge

The Epidemiology and Prevention of Vaccine Preventable Diseases (Appendix D-Subcutaneous tissue

12) states the following regarding the need to aspirate: "Aspiration is the process of

pulling back on the plunger of the syringe prior to injection to ensure that the medication is not injected into a blood vessel. Although this practice is advocated

Muscle

by some experts, the procedure is not required because no large blood vessels

exist at the recommended injection sites."

Toddlers
(>36 months of age)

Densest portion of deltoid muscle 1" to 2" needle above armpit and below acromion 22-25 gauge

Multiple injections given in the same extremity should be separated as far as possible (preferably 1" to 1" with minimum of 1" apart).

Children and Adults

For the above vaccines, the gluteus maximus (buttocks) is not a recommended site for any age.

Multiple vaccines should not be mixed in a single syringe unless specifically licensed and labeled for administering in one syringe.

IM Site For Older Toddlers, Children and Adults.

IM Site For Infants and Toddlers (birth to 36 months of age)

Needle size and site: Decide on the needle size and

site of injection based upon each patient's:




n



2 IM Sites

n

Deltoid

age volume of material to be administered the size of the muscle
and the depth below the muscle surface into which the material is to be injected.

Vastus lateralis

Needle size and site: The needle length should depend

on the patient's weight:

n
n
2 IM Sites

1 1/2'' for Males 118 kg (260 lbs) 1" for Males 60-118 kg (130-260 lbs)
1 1/2" for women 90 kg (200 lbs) 1'' for women 60-90 kg (132-198 lbs) (The Red Book, 2006, American Academy of Pediatrics)

Insert needle at 80-90 angle into vastus lateralis muscle in anterolateral aspect of middle

or upper thigh.

Insert needle at 80-90 angle into densest portion of deltoid muscle above armpit and below acromion.

References: 2006 Red Book, American Academy of Pediatrics, 27th edition; Morbidity and Mortality Weekly Report (MMWR), "General Recommendations on Immunization", December 1, 2006, Vol. 55/No. RR-15
Adapted from the MN and CA Departments of Health Vaccine Administration charts, June 2001. (This information is intended for the education of licensed medical personnel.) Epidemiology and Prevention of Vaccine Preventable Diseases, 11th ed

Attachment D

Vaccine Administration: subQ (Subcutaneous) Injections

Administer these vaccines via subQ (subcutaneous) route: MMR,

When you administer these vaccines, follow the age recommendations indicated in

Varicella, MMRV, Meningococcal Polysaccharide (MPSV), and zoster

the current Advisory Committee on Immunization Practices (ACIP) schedules.

vaccine. Administer IPV & Pneumococcal Polysaccharide (PPV) either

subQ or IM.

Patient's Age

Site (see illustrations below)

Needle Size

Needle Insertion

Infants

Fatty area of the thigh 5/8" to 3/4" needle

Insert needle at 45 angle to the skin.

(birth to 12 months of age)
and

or outer aspect of upper arm

Toddlers
(12 to 36 months of age)

23-25 gauge

Pinch up on subQ tissue to prevent injection into muscle.
The Epidemiology and Prevention of Vaccine Preventable Diseases (Appendix D-12) states the following regarding the need to aspirate: "Aspiration is the process of pulling back on the plunger of the syringe prior to injection to ensure that the medication is not injected into a blood vessel. Although this practice is advocated by some experts, the procedure is not required because no large blood vessels exist at the recommended injection sites."

45 angle Skin Muscle

Children and Adults Outer aspect of upper 5/8" to 3/4" needle

arm

23-25 gauge

Multiple injections given in the same extremity should be

separated as far as possible (preferably 1" to 1 " with

minimum of 1" apart).

Multiple vaccines should not be mixed in a single syringe unless specifically licensed and labeled for administering in one syringe.

SubQ Site for Infants and Toddlers (birth to 36 months)

SubQ Site for Children and Adults

Outer Aspect

n n 2 subQ Sites

Outer Aspect

subQ Site

n

Insert needle at 45 angle into fatty area of anterolateral thigh or outer Insert needle at 45 angle into outer aspect of upper arm or fatty area of the thigh. aspect of upper arm. Make sure you pinch up on subQ tissue to prevent Make sure you pinch up on subQ tissue to prevent injection into muscle. injection into muscle.
References: 2006 Red Book, American Academy of Pediatrics, 27th edition; Morbidity and Mortality Weekly Report (MMWR), "General Recommendations on Immunization", December 1, 2006, Vol. 55/No. RR-15 Epidemiology and Prevention of Vaccine Preventable Diseases, 11th ed
Adapted from the MN and CA Departments of Health Vaccine Administration charts, June 2001. (This information is intended for the education of licensed medical personnel.)

POST-TEST

ATTACHMENT E July 2007

1. Indicate the site for (a) an intramuscular, and (b) a subcutaneous immunization on an adult.

2. Please mark the site for an infant or toddler's DTaP immunization.

3. Please indicate above with arrows the angle of the needle used for (a) an intramuscular and (b) a subcutaneous immunization.

4. If the following three vaccines were to be administered simultaneously to an adult, which site

and method of immunization would be used for each:

Type of Vaccine

Route of Injection

Site

Influenza

Pneumococcal

Td

5. What factors should be considered when determining the needle size and site for an intramuscular injection? a. Patient's age b. Volume of material to be administered c. Size of the muscle d. Depth below muscle surface into which the material is to be injected e. All of the above

6. Circle the site which is never recommended for immunizations.

Deltoid

Vastus Lateralis

Anterolateral Thigh

Gluteus Maximus

7. Check the pediatric vaccines which may be given to a child on the same visit as a TB

skin test:

__Varicella

__DTaP

__Hib

__MMR

8. Vaccines can be mixed in a single syringe when: a. Vaccines are licensed and labeled to be mixed b. There is need to decrease the number of injections to be given c. Giving all live or all inactivated vaccines.

NAME ____________________________________DATE _______________SCORE ____________

1

ATTACHMENT F July 2007

POST-TEST ANSWER KEY

Score 10 points for correct answers to 1a, 1b, 2, 3a and 3b. Score 10 points for completely correct answers to questions 4 through 8. Passing score = 80%

A small circle

A 90

B large oval

B 45

1. Indicate the sites for (a) an intramuscular, and (b) a subcutaneous immunization on an adult.

2. Please mark the site for an infant or toddler's DTaP immunization.

3. Please indicate above with arrows the angle of the needle used for (a) an intramuscular and (b) a subcutaneous immunization.

4. If the following three vaccines were to be administered simultaneously to an adult, which site

and method of immunization would be used for each:

Type of Vaccine

Route of Injection

Site

Influenza

Intramuscular

Either deltoid*

Pneumococcal

Either SC or IM

SC upper arm; IM deltoid*

Td

Intramuscular

Either deltoid*

*Note: Different arms preferred. Separate sites required.

5. What factors should be considered when determining the needle size and site for an intramuscular injection? a. Patient's age b. Volume of material to be administered c. Size of the muscle d. Depth below muscle surface into which the material is to be injected e. All of the above

6. Circle the site which is never recommended for immunizations.

Deltoid

Vastus Lateralis

Anterolateral Thigh Gluteus Maximus

7. Check below the pediatric vaccines which may be given to a child on the

same visit as a TB skin test:

Varicella

DTaP

Hib

MMR

8. Vaccines can be mixed in a single syringe when:

a. Vaccines are licensed and labeled to be mixed

b. There is need to decrease the number of injections to be given

c. Giving all live or all inactivated vaccines.

NAME ____________________________________DATE _______________SCORE ____________

1

CLINICAL SKILLS CHECKLIST Support Staff

Attachment G December 2009

Clinic site Program/type of client visit

Name and title of person being reviewed

Date

Time

Reviewer

To assure the quality of client services, this form is used to record the findings from observation of RN's,/LPN's performance. For each line, mark under the number that most closely fits the consistency of the RN's, LPN's, performance with programmatic standards and policies and procedures. Comments must be specific and objective. This form may be used for one observation per age group indicated. A minimum of two observations per age group are required for completion of preceptorship. A minimum of one observation per age group is required annually.

RATING CODE: (1) = Unsatisfactory (2)= Needs improvement (3 )= Satisfactory (4) = Not applicable

STANDARDS

Infant

Child

Adolescent

Adult

12 3 4123 4 123412 34

Support Staff: Interview Process/Application Cordial during interview and immunization fee assessment and collection process Introduces self and observer Is wearing a clearly visible ID badge (designating professional licensure) Uses explicit terminology to explain immunization status Accurately acquires and documents appropriate demographic data and insurance coverage (Medicaid, PeachCare, VFC, etc.) Demonstrates appropriate use of current immunization schedule to obtain prior immunization history and enters information into client's immunization record accurately. Process includes accessing, querying, and reviewing records in GRITS.

1

STANDARDS

Infant

Child

12 3 4123 4

Attachment G

December 2009

Adolescent

Adult

123412 34

Provides appropriate type, translation, and most current Vaccine Information Statements (VIS) for patient or caregiver to review prior to receiving immunizations Issues immunization certificates for school and day care attendance in accordance with Georgia laws and rules and regulations Demonstrates appropriate vaccine coding, including hepatitis B coding, according to district and state policies Demonstrates appropriate use of "next immunization date due" and understanding of the relationship of "next immunization date due" to precall/recall activities Demonstrates knowledge of Clinical Assessment Software Application (WinCASA/ CoCASA) Demonstrates knowledge and appropriate use of MOGE and documents records accordingly Demonstrates coordination of other programs (ex: Child Health, WIC, FP, STD, etc.) with immunizations by reviewing and entering immunization history and referring for immunizations as needed Demonstrates coordination of visits involving other programs (ex: Child Health, WIC, etc.) with immunizations by scheduling appointments according to due date of next Health Check, WIC re-certification or certification, etc., when feasible Provides client with current immunization record and next immunization date due when indicated Computer/Automation: Computer security procedure followed Data and/or billing system correctly entered
Computer screen turned away from clients

2

FEEDBACK/STRATEGIZING
FOLLOW-UP PLAN
Signature of Reviewer:
Date:

SUMMARY
Signature of Clinician:
Date:

Attachment G December 2009

3

Attachment G December 2009

CLINICAL SKILLS CHECKLIST Nursing

Clinic site Program/type of client visit

Name and title of person being reviewed

Date

Time

Reviewer

To assure the quality of client services, this form is used to record the findings from observation of RN's,/LPN's performance. For each line, mark under the number that most closely fits the consistency of the RN's, LPN's, performance with programmatic standards and policies and procedures. Comments must be specific and objective. This form may be used for one observation per age group indicated. A minimum of two observations per age group are required for
completion of preceptorship. A minimum of one observation per age group is required annually for peer review.

RATING CODE: (1) = Unsatisfactory (2)= Needs improvement STANDARDS

(3 )= Satisfactory (4) = Not applicable Infant Child Adolescent

Adult

1 2 3 4 1 2 3 4 1 2 3 4 1 2 34

Nursing
Interview Process
1. Cordial with client displaying excellent customer service 2. Uses simple, explicit immunization terminology 3. Introduces self and observer 4. Is wearing a clearly visible ID badge 5. Listens attentively 6. Conducts session in language participant speaks/understands 7. Reviews appropriate immunization-screening questions prior to administration according to district
and state policies and procedures (allergies, fever, immunocompetence, previous reactions, blood products, etc.) and counsels client appropriately 8. Demonstrates appropriate knowledge of true contraindications and precautions when assessing and administering vaccines
9. Evaluates immunizations from computer and or personal immunization record and accurately determines immunizations needed. Process includes accessing, querying, and reviewing records in GRITS.
10. Explains to client/parent/caregiver appropriate immunizations needed in a accurate and professional manner
4

STANDARDS

Infant

Child

Attachment G

December 2009

Adolescent

Adult

1 2 3 4 1 2 3 4 1 2 3 4 1 2 34

11. Has client/caregiver review current, appropriately translated, Vaccine Information Statement (VIS) for each vaccine to be administered and answers questions or concerns prior to administering vaccine
Administration Techniques
1. Uses immunization resources appropriately (Georgia Immunization Program Manual, ACIP Manual, District Policies and Procedures (P&P), CDC's Recommendations for Travel, CDC's Epidemiology and Prevention of Vaccine Preventable Diseases, The Red Book , etc.) to assess and administer vaccine indicated for age
2. Utilizes current recommended schedule and recommendations and district policies and procedures to assess and administer adult and childhood vaccines
3. Uses accelerated vaccination schedule when appropriate 4. Checks expiration date and lot number of each vaccine before administering 5. Follows universal precautions and appropriate hand washing techniques during immunization
administration 6. Appropriately prepares site for administration 7. Uses appropriate needle length and gauge for type of injection 8. Uses appropriate route of administration for each vaccine (IM, SQ, PO, ID, intranasal) 9. Administers vaccine in appropriate site
10. Uses correct technique for administering injectable vaccines 11. Uses correct technique for administering oral vaccines 12. Utilizes appropriate positioning techniques to administer vaccine
Documentation:
1. Documents according to P&P, the type of vaccine administered, date of administration, manufacturer, lot number, site, route, nurses' initials, and VIS publication date
2. Demonstrates knowledge of informed request policy. Reviews current VIS for each vaccine, answers questions, and has client sign appropriate consent
3. Demonstrates use of VAERS (Vaccine Adverse Event Reporting System) reporting system according to Georgia Immunization Program regulations
4. Appropriately accounts for vaccine wasted 5. Accurately documents immunizations administered and next due date on clinic record 6. Accurately documents next vaccine due and "date next immunization due" on client's personal
immunization record 7. Documents certificates issued in accordance with district P&P 8. Documents MOGE (Moved or Gone Elsewhere) criteria according to Georgia Immunization Program
standards

5

STANDARDS

Infant

Child

Attachment G

December 2009

Adolescent

Adult

1 2 3 4 1 2 3 4 1 2 3 4 1 2 34

9. Follows hepatitis B guidelines according to Georgia Immunization Program recommendations (also correctly determines High Risk or VFC eligibility)
Counseling/Education
1. Informs client/parent of any immunization problem (delinquent immunization status, screening for private provider use/MOGE status)
2. Schedules follow-up as indicated (return visit coordinated with other clinics, labs, voucher pick-ups, etc.)
3. Provides appropriate referrals as needed (to private providers, Children First, CMS, etc.) 4. Provides "After the Vaccines" document (in most appropriate translation) explaining side effects for
any vaccine administered 5. Provides client with appropriate immunization certificate(s) according to the GA laws and rules and
regulations for school and day care attendance, and an updated immunization history, including next immunization "due date"
Computer/Automation 1. Computer security procedure followed per district policy 2. Data and/or billing correctly entered 3. Correct immunization procedure codes, lot numbers, etc. entered correctly according to Georgia
Immunization Program standards 4. Demonstrates knowledge of Clinic Assessment Software Application (WinCASA/ CoCASA) criteria
and Immunization Action Plan (IAP) contract deliverables 5. Demonstrates knowledge of completing monthly IAP report to District Immunization Coordinator per
Georgia Immunization Program standards
Storage and Handling
1. Demonstrates appropriate Vaccine Storage and Handling techniques according to Georgia Immunization Program standards
Other (specify)

6

FEEDBACK/STRATEGIZING
FOLLOW-UP PLAN
Signature of Reviewer:
Date:

SUMMARY
Signature of Clinician:
Date:

Attachment G December 2009

7

Attachment G December 2009

CLINICAL SKILLS CHECKLIST Student Nurse

Clinic site Program/type of client visit

Name and title of person being reviewed

Date

Time

Reviewer

To assure the quality of client services, this form is used to record the findings from observation of student nurse performance. For each line, mark under the number that most closely fits the consistency of the student nurses, performance with programmatic standards and policies and procedures. Comments must be specific and objective.

RATING CODE: (1) = Unsatisfactory (2)= Needs improvement (3 )= Satisfactory (4) = Not applicable

STANDARDS

InfaInntfant ChCilhdild AdAodloelsecsecenntt

AdAudltult

123412341 2 34 1 2 3 4

Nursing

Interview Process
1. Cordial with client displaying excellent customer service
2. Uses simple, explicit immunization terminology
3. Introduces self and preceptor.
4. Is wearing a clearly visible ID badge
5. Listens attentively
6. Conducts session in language participant speaks/understands under supervision of the preceptor.
7. Reviews appropriate immunization-screening questions prior to administration according to district and state policies and procedures (allergies, fever, immunocompetence, previous reactions, blood products, etc.) and counsels client appropriately under the supervision of the preceptor.
8. Demonstrates appropriate knowledge of where to find information pertaining to true contraindications and precautions when assessing and administering vaccines

9. Assists in evaluating immunizations from computer and or personal immunization record and accurately determines immunizations needed. Process includes accessing, querying, and reviewing records in GRITS.
10. Explains to client/parent/caregiver appropriate immunizations needed in a accurate and professional manner under the supervision of the preceptor.

8

STANDARDS
11. Has client/caregiver review current, appropriately translated, Vaccine Information Statement (VIS) for each vaccine to be administered and answers questions or concerns prior to administering vaccine with preceptor present.
Administration Techniques
1. Uses immunization resources appropriately (Georgia Immunization Program Manual, ACIP Manual, District Policies and Procedures (P&P), CDC's Recommendations for Travel, CDC's Epidemiology and Prevention of Vaccine Preventable Diseases, The Red Book , etc.) to assess and administer vaccine indicated for age
2. Utilizes current recommended schedule and recommendations and district policies and procedures to assess and administer adult and childhood vaccines
3. Understands use of accelerated vaccination schedule when appropriate 4. Checks expiration date and lot number of each vaccine before administering 5. Follows universal precautions and appropriate hand washing techniques during immunization
administration 6. Appropriately prepares site for administration 7. Uses appropriate needle length and gauge for type of injection 8. Uses appropriate route of administration for each vaccine (IM, SQ, PO, ID, intranasal) 9. Administers vaccine in appropriate site
10. Uses correct technique for administering injectable vaccines 11. Uses correct technique for administering oral vaccines 12. Utilizes appropriate positioning techniques to administer vaccine
Documentation:
1. Documents according to P&P, the type of vaccine administered, date of administration, manufacturer, lot number, site, route, student nurses' initials, preceptors initials, and VIS publication date
2. Demonstrates knowledge of informed request policy. Reviews current VIS for each vaccine, answers questions, and has client sign appropriate consent under supervision of preceptor.
3. Demonstrates knowledge of VAERS (Vaccine Adverse Event Reporting System) reporting system according to Georgia Immunization Program regulations
4. Appropriately accounts for vaccine wasted 5. Accurately documents immunizations administered and next due date on clinic record 6. Accurately documents next vaccine due and "date next immunization due" on client's personal
immunization record 7. Documents certificates issued in accordance with district P&P 8. Demonstrates knowledge of MOGE (Moved or Gone Elsewhere) criteria according to Georgia
Immunization Program standards

Attachment G

December 2009

Infant Child Adolescent

Adult

123412341 2 34 1 2 3 4

9

STANDARDS
9. Follows hepatitis B guidelines according to Georgia Immunization Program recommendations (also correctly determines High Risk or VFC eligibility)

Attachment G

December 2009

Infant Child Adolescent

Adult

123412341 2 34 1 2 3 4

Counseling/Education
1. Informs client/parent of any immunization problem (delinquent immunization status, screening for private provider use/MOGE status) under supervision of preceptor.
2. Assists with scheduling follow-up as indicated (return visit coordinated with other clinics, labs, voucher pick-ups, etc.)
3. Demonstrates knowledge of procedure for referrals (to private providers, Children First, CMS, etc.) 4. Provides "After the Vaccines" document (in most appropriate translation) explaining side effects for
any vaccine administered 5. Provides client with appropriate immunization certificate(s) according to the GA laws and rules and
regulations for school and day care attendance, and an updated immunization history, including next immunization "due date"
Computer/Automation 1. Computer security procedure followed per district policy 2. Correct immunization procedure codes, lot numbers, etc. entered correctly according to Georgia
Immunization Program standards under supervision of preceptor.
3. Demonstrates basic knowledege of GRITS (what is it used for, what information is gained
from the program)./ 4. Demonstrates knowledge of Clinic Assessment Software Application (WinCASA/ CoCASA) criteria.
Storage and Handling 1. Demonstrates appropriate Vaccine Storage and Handling techniques according to Georgia
Immunization Program standards
Other (specify)

10

Attachment G December 2009

Description of Student Nurse Performance

SUMMARY

________________________________________________________________________________________________

Signature of Reviewer:

Signature of Student Nurse:

Date:

Date:

11

Attachment H

2008 GIP Provider Site Visit Questionnaire (for Public Health Department Sites)

Date:

Please fill out and return to (IPC ) at

@dhr.state.ga.us

**Please save as a Microsoft Word Document using your County name**

If you have questions, please contact (IPC) at:

Facility Name:

Address:

City:

State:

Zip:

GIP ID Number: Telephone:

GRITS Org ID: Fax Number:

District:

County:

Reviewer's (IPC) Name:

Contact Person for Immunization: Email:

Hours of Operation: Open

Monday

-

Tuesday

-

Wednesday

-

Thursday

-

Friday

-

Saturday

-

Closed
-

Open During Lunch Hours
(Select One) Yes No Yes No Yes No Yes No Yes No Yes No

Type of Practice: Public Health Dept Clinic
Specialty Type for Practice: Multi-specialty

Family Planning or STD/HIV Only

Teens Only

Public Health SV Survey 08.doc

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Revised 11/13/2007

! = If "incorrect", corrective action statements to address problem required for Question 32.

SECTION I. VFC COMPLIANCE Questions (1-7) should be answered by interviewing the provider.
1. a. ! What is the vaccine administration fee charged to non-Medicaid VFC eligible children (uninsured, American
Indian/Alaska Native, underinsured)? _______________________
b. ! What is the vaccine administration fee charged to adults who receive state-supplied vaccine?
_______________________________ (Cap for both adults and children = $14.81 per injection)

2. Under what circumstances would a client be referred to another facility for immunization services?

Not applicable, clients are never referred

Vaccine is unavailable

Client is under-insured

Client/parent is unable to pay administration fee

Client/parent is unable to pay office visit fee

Other (specify)

3. Which of the following vaccines are NOT routinely recommended for clients in this facility (including adults)?

DTaP

Influenza (during flu season) Pneumococcal Polysaccharide*

Hepatitis A

Meningococcal Conjugate

Polio

Hepatitis B

MMR

Rotavirus

HIB

MMR-V

Td

Human Papillomavirus

Pneumococcal Conjugate

Tdap

Other: ________________________

Varicella

*High-risk adults, adults over age 65 years, and high risk children > 2 years of age.

4. ! When does this clinic provide patients with copies of the Vaccine Information Statements (VIS) to keep?

Every time the patient receives a vaccination When the client receives the first dose of vaccine within a particular series (e.g. 1st dose of DTaP) Does not provide Other (specify)_________________________________

5. In order to complete the annual provider profile, how does this clinic determine the number of VFC-eligible patients in this clinic? Note: "Provider profile" is the number of children (not doses) by age category that the provider
expects to immunize within a 12-month period. The VFC Program requires annual updates of this information. Use doses administered data Use benchmarking data Use Medicaid and billing data Immunization Information System (GRITS) Other (please describe): _____________________________________________________

6. ! When does the clinic/practice screen children for VFC eligibility?
First immunization visit to the office only Every immunization visit Does not screen for VFC eligibility Not applicable, clinic serves 100% VFC eligible children and has appropriate Comprehensive Certification form with up-to-date signature on file. Other (specify) __________________________________________________________________

7. (A) ! Does this clinic/practice always notify the Immunization Program when publicly purchased vaccine has been

involved in a cold chain failure, has expired or been wasted?

Yes

No

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Revised 11/13/2007

(B) Does this clinic/practice always notify the Immunization/VFC Program of short-dated vaccine at least

three months prior to the date of expiration so that vaccine may be transferred to another provider?

Yes

No

8. ! When does this clinic prepare vaccine for administration to patient?

Immediately before administration Other: specify process___________________________

Questions 9-10 should be answered based on a physical review of clinic's written plan and VISs.
9. ! Does the clinic have a written plan for vaccine management include the following (review for accuracy):

Designation of primary vaccine coordinator and at least one back-up staff
Proper vaccine storage and handling
Vaccine shipping (includes receiving & transport) Procedures for vaccine relocation in the event of a power failure or mechanical difficulty or emergency situation (emergency plan) Has the emergency plan been reviewed or updated annually or since change in responsible staff? Vaccine ordering and reporting (i.e., should be monthly) Inventory control (e.g., stock rotation)
Vaccine wastage

Yes

No

10. ! Please identify the publication date for each of the VIS currently being used in this clinic/practice and then
check the appropriate status for each VIS. (If not using VISs or using outdated VISs, leave current VISs.

VACCINE*
DTaP (5/17/07) E & S Polio (1/1/2000) E & S MMR (1/15/03) E & S Hepatitis B (7/18/07) E & S Varicella (1/10/07) E & S Hepatitis A (3/21/06) E & S Hib (12/16/98) E & S Pneumococcal Conjugate (9/30/02) E & S Inactivated Influenza (7/16/07) E & S

VIS VERSION BEING USED IN THIS FACILITY

Current

Outdated

None Used

Does Not Administer

Live, Intranasal Influenza (10/04/07) E & S Td (6/10/94) E & S Adult Pneumococcal Polysaccharide (PPV23) (7/29/97) E & S
Meningococcal Conjugate (MCV) (8/16/07) E & S
Tdap (07/12/06) E & S
Rotavirus (4/12/06) E & S
Human Papillomavirus (2/2/07) E & S
Shingles (9/11/06) E & S
Other ______________________

VIS website: http://www.cdc.gov/vaccines/pubs/vis/default.htm Current VIS publication dates as of 11/13/07

Public Health SV Survey 08.doc

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Revised 11/13/2007

Questions (29-31) should be answered based on a review of patient charts, electronic medical records, patient log (electronic or manual) which records VFC eligibility status, or GRITS.

29. What is the VFC eligibility screening coverage in this clinic/practice? (Screening of children for eligibility for VFC or

state-supplied vaccine, not immunization coverage rates.)

VFC screening coverage of 100%

VFC screening coverage of at least 95%

VFC screening coverage of at least 90%

VFC screening coverage below 90%

30. What methodology was used to determine VFC eligibility screening coverage during this site visit? CDC Lot Quality Assurance (LQA) Protocol (Review of at least 30 randomly selected records, or ALL records if 30 not available. Records may be client charts or in clinic's information system.) CoCASA

31. Do all immunization records contain the following documentation required by statute 42 US Code 300aa-25? (9 one box per item)

Required Documentation

Yes No

Name of vaccine given

Date vaccine was given

Date VIS was given

Name of vaccine manufacturer

Lot number

Name and title of person who gave the vaccine

Address of clinic where vaccine was given

Publication date of VIS

SECTION II. Standards for Pediatric & Adolescent Immunization Practices

Vaccine Administrative Policy

1. How does the clinic/practice offer immunization services to patients? (Check all that apply)

During well-child visits

Immunization-only appointments

Walk-in immunizations

Dedicated days/times for immunizations

Off-site immunizations

During other visits such, as STD, FP, WIC or SHAPP

(circle all that apply)

Other (specify)

2. Is an office visit fee charged in addition to any vaccine administration fees for an imm-only visit? Yes No
If yes, what is the amount of the office visit fee if immunization is the only service?

3. Is a physical exam required before immunizations are given? Yes No

Assessment of Vaccination Delivery (Share information re: True Contraindications to Immunization.) 4. Does the clinic routinely immunize when the client has:

A "cold" Low grade fever (e.g. 100.4F [38C] or lower) Recently been exposed to infectious illness Mild diarrhea Convalescing from an acute illness

Yes

No

Situational































Public Health SV Survey 08.doc

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Revised 11/13/2007

Effective Communication about Vaccine Benefits and Risks

5. Does the clinic staff know how to obtain foreign-language Vaccine Information Statements (VIS) for

patients/families whose first language is not English?

Yes

No

Proper Storage and Administration of Vaccines and Documentation of Vaccinations 6. Does the clinic/practice have a copy or have access to a copy of the most recent version of the following

documents? (If no, leave current copy.)

Yes No

Recommended Childhood Immunization Schedule



Revised Standards for Child and Adolescent Immunization Practices



Current Guide to Contraindications to Childhood Vaccines, CDC



Vaccine Management: Recommendations for Handling & Storage of Selected Biologicals



2006 Red Book, AAP (District)



Standards for Adult Immunization Practices



Georgia Immunization Program Manual



Epidemiology & Prevention of VPD's (Pink Book) 10th edition, January,2007, CDC



Current ACIP (Advisory Committee of Immunization Practices) Manual



Health District's P&P for Administration of Vaccines



Health District's Policies and Procedures for Administration of Travel Vaccines



Health District's Management of Adverse Drug Reactions



Vaccine Package Inserts



Communicable Diseases in Man; 18th edition, Heymann (District)



Surveillance and Reporting of Vaccine Preventable Diseases Manual, CDC (only available online)

http://www.cdc.gov/nip/publications/surv-manual/default.htm

7. Are up-to-date, written vaccination protocols accessible at all locations where vaccines are administered? Yes No (Ask to see a copy.)

8. Who gives immunization injections? (Check all that apply)

MD

NP

PA

RN

LPN

MA

9. How do persons who administer vaccines and staff who manage or support vaccine administration receive

ongoing education regarding immunization? (Check all that apply.)

No ongoing training

In-house training by health dept./professional

In-house training by staff at least once a year

organization at least once a year

Distribution of written materials

Off-site conferences or workshops at least once a

Other (specify)

year

______________________________________ Web-based training or satellite broadcasts

10. Does the clinic document ongoing education regarding immunization for persons who administer vaccines and staff who manage or support vaccine administration? Yes No

11. Does the clinic simultaneously administer all vaccines for which the client is eligible? Yes No

12. What size needles are generally used for intramuscular injections? (Check ONE only)

5/8 " (inch)

1 " (inch)

7/8 " (inch)

Depends on age/size

Other (specify)

13. Does the clinic pre-fill syringes? (This does not refer to manufacturer-prefilled syringes.) Yes No

Public Health SV Survey 08.doc

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Revised 11/13/2007

14. Does the clinic have VAERS forms and know how to report to VAERS? (If not, leave copy.) Yes No

15. Does the clinic require staff who have contact with patients to be immunized or show proof of immunity against

the following vaccine-preventable diseases? (Check all that apply)

None required Measles/Mumps/Rubella

Hepatitis B

Hepatitis A

Varicella

Influenza

Td/Tdap

Other (specify)

Implementation of Strategies to Improve Vaccination Coverage

16. How does the clinic remind patients of their next appointment? (Check all that apply)

Mail

Written appointment slip given at last visit

Telephone

Does not remind patients of next appointment

Verbally at last visit

Other (specify)

17. How does the clinic contact patients who miss their appointments? (Check all that apply)

Mail

Telephone

Does not contact patients who miss their appointments

Other (specify)

18. How does the clinic identify patients if no appointment is made and immunizations are due/overdue? (Check

all that apply)

Cannot identify patients due/overdue for immunizations Immunization registry

Computer (office-based, not connected to a registry)

Paper-based "tickler" system or

Other (specify)

chart review

19. How frequently does the practice generate reminder/recall notices (or phone calls) to patients who are

due/overdue for a vaccination? (Check all that apply)

Quarterly

Monthly

No regular schedule

Weekly

Clinic/practice does not distribute recall notices to patients

20. Is a district- or clinic-based patient record review and vaccination coverage assessment performed at least

once a year (check all that apply)?

No

Yes

If Yes, By clinic/district staff

By immunization/VFC program

By other external reviewer

When was the most recent district- or clinic-based patient record review and vaccination coverage

assessment? Date:

(month/day/year)

21. Does the clinic participate in GRITS?

Yes

No

If yes, what date were shots last entered/uploaded?__________________

22. What community-based approaches does the clinic use to increase immunization coverage?

(Check all that apply)

No community-based approaches used

Participates in health fairs

Provides off-site immunization services

Conducts community-based outreach/education

Partners schools/school nurses

Other (specify)

23. Is the provider using Form 3231 with a Revision Date of 3/2007?

Yes

No

Public Health SV Survey 08.doc

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Revised 11/13/2007

24. What is the source of the Form 3231 that the provider uses routinely? Printed from GRITS Form ordered from GIP and completed manually Form printed from provider's clinical information system If printed from provider's system: Has the form been approved by GIP? Yes No Does the form display all required components in the correct format? Yes No Other
Describe_______________________________________________________________________

SECTION III DELIVERY OF SERVICES

1. Are immunizations available at this site during all regular business hours?

YES

NO

2. Are the regular business hours offered as a rigid 8am to 5pm schedule?

YES

NO

3. Are immunization services routinely provided after hours?

YES

NO

4. Are immunization services routinely provided on weekends?

YES

NO

N/A

5. Do you periodically monitor wait time for your walk-in clients?

YES

NO

N/A

6. Do you provide counseling, education and materials on how to apply for Medicaid or Peach Care for Kids?

YES

NO

7. Are WIC services provided in the same building as Immunization services?

YES

NO

8. Are clients receiving Immunization services being referred to WIC services, if needed?

YES

NO

9. Are you sharing Immunization past due list with WIC for referral back to Immunization services?

YES

NO

10. How are you compensated for vaccine administration? (Check all that apply)

Medicare Reimbursement/Medicaid

State Funding

Private Pay

Other, please explain

11. Do you charge a vaccine administration fee in addition to the visit fee if seen in other programs (HIV, STD, FP,

SHAPP, etc.)?

YES

NO

SECTION IV - INITIAL TRAINING OR ORIENTATION NURSING STAFF
1. Does the District provide and document the completion of an orientation training for all RN's and LPN's consistent with required self-study and didactic training listed in the QA tool:

a. Review all the required references listed under Self-Study

YES

NO

b. Attend or view and complete and pass post tests of the following CDC Satellite Immunization Training

Sessions live or video taped:

Epidemiology & Prevention of Vaccine Preventable Diseases

YES

NO

c. View video and complete and pass the post tests for: (must answer YES to one of these)

Public Health SV Survey 08.doc

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Revised 11/13/2007

i. The Storage and Handling Tool Kit produced by CDC

YES

NO

http://www2a.cdc.gov/nip/isd/shtoolkit/splash.html

or

ii. Attend Vaccine Storage & Handling presentation given by a GA Immunization Program Consultant

YES

NO

d. Vaccine Administration Techniques (must answer YES to one of these) i. Attend Vaccine Administration Techniques training session provided by the GA Immunization Program

YES

NO

or

ii. View the video and pass post-test for Vaccine Administration Techniques developed by CA Department of

Health, 2001.

YES

NO

e. GA Requirements for Attending Day Care & School presentation provided by the GA. Immunization Program

Consultant

YES

NO

f. Tour of immunization clinic, including information about where vaccines emergency cart trays and

immunization forms are stored, and proper vaccine storage and handling techniques

YES

NO

g. Informed how to access district immunization coordinator or designated immunization resource person and GA

Immunization Program "on call" resource phone line for immunization inquiries

YES NO

2. Does the District provide and document the completion of an immunization preceptorship for all RN's and LPN's

consistent with the recommendations outlined in the Georgia Immunization Manual and the Quality Assurance

review?

YES

NO

3. Does the District provide and document the completion of at least (1) annual immunization training program for all RN's and LPN's consistent with the recommendations outlined in the Georgia Immunization Manual and the

Quality Assurance review?

YES

NO

4. Does the district document the self-study of the current year's P&P for the Administration of Vaccines by each

nurse?

YES

NO

5. Does the District annually review the clinical practice skills of all RN's and LPN's as outlined in the QA review?

YES

NO

TRAINING & EDUCATION SUPPORT STAFF

6. Does the District provide and document the completion of orientation training for ALL staff that supports the

provision of Immunization services (i.e., clerical, epidemiological, outreach and other), which is consistent with

the recommendations outlined in the Georgia Immunization Manual and the Quality Assurance review?

YES

NO

7. Does the District provide and document the completion of a preceptorship for ALL staff that supports the

provision of Immunization services (i.e., clerical, epidemiological, outreach and other), which is consistent with

the recommendations outlined in the Georgia Immunization Manual and the Quality Assurance review?

YES

NO

8. Does the District provide and document the completion of annual training programs for ALL staff that support

the provision of Immunization services (i.e., clerical, epidemiological, outreach and other), which is consistent

with the recommendations outlined in the Georgia Immunization Manual and the Quality Assurance review?

YES

NO

9. Does the District annually review the clinical practice skills of all support staff as outlined in the QA review?

YES

NO

Public Health SV Survey 08.doc

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Revised 11/13/2007

SECTION I (Continued) TEMPERATURE-DEPENDENT VACCINES

Questions (11-28) should be answered based on a physical review of clinics' refrigerator(s) and freezer(s).
11. ! What type of storage units does this clinic use to store vaccines, including varicella? Check all that apply.

(Dual thermomstats/temperature controls are preferred if using household unit.)

Varicella Vaccine
Stand alone freezer Stand alone refrigerator Dormitory style refrigerator/freezer
Combined refrigerator/freezer with separate refrigerator and freezer doors (e.g. household style appliance) Combined refrigerator/freezer with a single door
Does not administer vaccines requiring freezer storage

All Other Vaccines
Stand alone freezer Stand alone refrigerator Dormitory style refrigerator/freezer
Combined refrigerator/freezer with separate refrigerator and freezer doors (e.g. household style appliance)
Combined refrigerator/freezer with a single door

12. ! Are working thermometers placed in a central area of each refrigerator and freezer?

Refrigerator

Freezer

#1. #2. #3. #4. #5. #1. #2. #3. #4. #5.

Yes Have thermometer but not placed properly No thermometer

13. (A) What type of thermometer is used by the clinic (check all that apply)?

Refrigerator

Freezer

#1. #2. #3. #4. #5. #1. #2. #3. #4. #5.

Standard Fluid Filled

Continuous Recording

Min-Max

Dial

Digital

Other (specify)

(B) ! For each type of thermometer used by the facility, indicate if thermometer is certified (check all that apply).

Refrigerator

Freezer

#1.

#2.

#3.

#4.

#5.

#1.

#2.

#3

#4

#5

Standard Fluid Filled Continuous Recording Min-Max
Dial
Digital Other (specify)

YES___ NO ___
YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___

YES___ NO ___
YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___

YES___ NO ___
YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___

YES___ NO ___
YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___

YES___ NO ___
YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___

YES___ NO ___
YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___

YES___ NO ___
YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___

YES___ NO ___
YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___

YES___ NO ___
YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___

YES___ NO ___
YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___ YES___ NO ___

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Revised 11/13/2007

14. ! How often are refrigerator and freezer temperatures recorded (check all that apply)?

Once a day Less than once a day Twice a day More than twice a day

Refrigerator

Freezer

#1. #2. #3. #4. #5. #1. #2. #3. #4. #5.

15. Record the highest and lowest temperatures logged in the last 3 months. Please indicate if recordings are Celsius (oC) or Fahrenheit (oF). (If no log is available for the past 3 months, record the highest and lowest temperatures
from available logs.)

Lowest

Refrigerator (2-8C / 35-46F)

#1.

#2.

#3.

#4.

#5.

____C ____C ____C ____C ____C ____F ____F ____F ____F ____F

Freezer(-15C / 5F or lower)

#1.

#2.

#3.

#4.

#5.

____C ____C ____C ____C ____C ____F ____F ____F ____F ____F

Highest

____C ____C ____C ____C ____C ____C ____C ____C ____C ____C ____F ____F ____F ____F ____F ____F ____F ____F ____F ____F

Log available for

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

last 3 months?

NO NO NO NO NO NO NO NO NO NO

If any of the lowest and/or highest temperatures are out of the recommended range, then GO TO question 16. If the temperatures are within the recommended guidelines, SKIP to question 19.

16. ! During past 3 months, how many times were the temperatures outside the recommended range?

Refrigerator (2-8C / 35-46F)

Freezer (-15C / 5F or lower)

#1. #2. #3. #4. #5. #1. #2. #3. #4. #5.

Below Guidelines

Above Guidelines

17. ! When the temperatures were outside the recommended range, what action did the provider take?
(9 all that apply)
Adjusted thermostat in refrigerator/freezer Measured temperature with different thermometer to check accuracy of original reading Moved vaccine to a different refrigerator/freezer maintained at proper temperature Called the vaccine manufacturer to determine the potency of the vaccine Called the local/state immunization program for assistance Did not do anything

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18. ! Does the clinic have written documentation of the action taken when the temperatures were outside the

recommended range?

Yes

No

19. Record the current temperatures. (THIS IS NOT OPTIONAL.)

Refrigerator (2-8C / 35-46F)

Freezer (-15C / 5F or lower)

#1. #2. #3. #4. #5. #1. #2. #3. #4. #5.

Practice Thermometer

____C ____C ____C ____C ____C ____C ____C ____C ____C ____C ____F ____F ____F ____F ____F ____F ____F ____F ____F ____F

Reviewer's Thermometer

____C ____C ____C ____C ____C ____C ____C ____C ____C ____C ____F ____F ____F ____F ____F ____F ____F ____F ____F ____F

20. ! Are current temperatures within the guidelines according to the reviewer's thermometer?

(Refrigerator: 2-8C / 35-46F, Freezer: -15C / 5F or lower)

Refrigerator

Freezer

#1.

#2.

#3.

#4.

#5.

#1.

#2.

#3.

#4.

#5.

YES

YES YES YES

YES

YES

YES

YES

YES

YES

NO

NO

NO

NO

NO

NO

NO

NO

NO

NO

21. ! Is food stored with vaccines in the refrigerator and freezer?

Refrigerator

Freezer

#1.

#2.

#3.

#4.

#5.

#1.

#2.

#3.

#4.

#5.

YES

YES YES YES

YES

YES

YES

YES

YES

YES

NO

NO

NO

NO

NO

NO

NO

NO

NO

NO

22. ! Are vaccines stored in the doors of the refrigerator and freezer or in the vegetable bins?

Refrigerator

Freezer

#1.

#2.

#3.

#4.

#5.

#1.

#2.

#3.

#4.

#5.

YES

YES YES YES

YES

YES

YES

YES

YES

YES

NO

NO

NO

NO

NO

NO

NO

NO

NO

NO

23. ! Is vaccine stored in the middle of the storage unit and stacked with air space between the stacks and side/back

of the unit to allow cold air to circulate around the vaccine?

(Discuss placing MMR nearest freezer and HepB nearer bottom of unit.)

Refrigerator

Freezer

#1.

#2.

#3.

#4.

#5.

#1.

#2.

#3.

#4.

#5.

YES

YES YES YES

YES

YES

YES

YES

YES

YES

NO

NO

NO

NO

NO

NO

NO

NO

NO

NO

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Revised 11/13/2007

24. ! Is there a "DO NOT DISCONNECT" sign on the refrigerator/freezer electrical outlet?

Refrigerator

Freezer

#1.

#2.

#3.

#4.

#5.

#1.

#2.

#3.

#4.

#5.

YES

YES YES YES YES

YES

YES

YES

YES

YES

NO

NO

NO

NO

NO

NO

NO

NO

NO

NO

25. ! Is there a "DO NOT DISCONNECT" sign on the circuit breaker?

Yes

No

Don't Know

26. ! Are short-dated vaccines stored in front and used first, rotating stock effectively?

Refrigerator

Freezer

#1.

#2.

#3.

#4.

#5.

#1.

#2.

#3.

#4.

#5.

YES

YES YES YES YES

YES

YES

YES

YES

YES

NO

NO

NO

NO

NO

NO

NO

NO

NO

NO

27. ! Can the clinic physically differentiate privately purchased vaccine from publicly purchased vaccine? To answer
yes, clinic must be able to demonstrate how this is done.
Yes, clinic can physically differentiate public vaccine from private vaccine.
No, clinic cannot physically differentiate public vaccine from private vaccine. Not applicable, clinic has no private stock. Other method (please specify)_________________________

(*Should investigate if this clinic vaccinates fully insured children or provides adult immunizations for employment purposes, such as Hepatitis B for public safety workers. If so, private stock is required.)

28. ! Upon checking the provider's vaccine supply, did you find any unreported wasted or expired vaccine?

Yes

No

Section V Non-Refrigerated Vaccine Diluent

1. Is there designated storage areas for non-refrigerated vaccine diluent?

YES

NO

N/A stores diluent in refrigerator

2. Is the storage areas for non-refrigerated vaccine diluent sufficient to insure proper sanitation, temperature, light,

ventilation, moisture control, segregation and security?

YES

NO

N/A stores diluent in refrigerator

3. Is vaccine diluent stored or separated by physical barriers from drug items for external use and/or cleaning

supplies?

YES

NO

N/A stores diluent in refrigerator

SECTION VI RECORD KEEPING/ POLICIES & PROCEDURES

1. Is there a backup for the person responsible for vaccine storage and handling?

YES

NO

2. When state-supplied vaccine arrives a. Is it counted? b. Are the contents of shipment compared with packing slip? c. Are the contents refrigerated and/or frozen immediately?

YES

NO

YES

NO

YES

NO

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Revised 11/13/2007

3. When vaccines are received in the clinic, are the vaccine name, lot number, expiration date, manufacturer and

quantity and the name of the person receiving the drugs/vaccines documented in GRITS?

YES

NO

4. When vaccines are shipped or moved from the clinic, are the details of these vaccine transfers recorded in GRITS

and also reported to the State Office?

YES

NO

5. Are all vaccine records (including eligibility, storage and handling, etc.) kept on file for a minimum of 3 years?

YES

NO

6. Which of the following is applicable in this district? (check one)
The district utilizes the Georgia Immunization Program manual and the ACIP recommendations
manual as the district's official Policies and Procedures for administering vaccines. The district writes its own Immunization Policies and Procedures?

7. Do the district's Policies and Procedures bear a current review date and physician signature?

YES

NO

8. If the district writes its own Policies and Procedures for the administration of vaccines, are the Policies and

Procedures consistent with the Policies and Procedures outlined in the current Georgia Immunization Program

manual and ACIP manuals?

YES

NO

N/A

Questions (35-36) should be answered based on results of the Site Visit.

32. Are corrective actions recommended for this site?

Yes

No (STOP here)

If "yes," complete the Corrective Action Summary. Be sure all "!" issues are addressed.
33. Please indicate your plan for following-up with the site to ensure recommendations were implemented. Provide technical assistance at time of site visit, no further follow-up is needed Telephone call Site Visit Suspended delivery of vaccine until storage/handling problems resolved Other:

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Revised 11/13/2007

Georgia Immunization Program Manual
TABLE OF CONTENTS

Division Of Public Health

14. STANDARD OPERATING GUIDELINES FOR MASS VACCINATION CLINICS Standard Operating Guidelines for Conducting Mass Vaccination Clinics (REPLACE) Appendix A: Sample Vaccination/Administration Site Flowchart Appendices B1, B2, B3, B4: Sample Vaccination Site Command Charts Appendices C1, C2, C3: Sample Clinic, District and State Vaccination Reports

Table of Contents 11/2009

Georgia Immunization Program Manual

Division Of Public Health

Standard Operating Guidelines for Conducting Mass Vaccination Clinics

Introduction
Any mass vaccinating effort in response to a bioterrorism or naturally occurring event will require pre-event planning and coordination of vaccines, personnel, facilities, communication, and other support activities. The purpose of this annex to the Immunization Program Manual is to provide standard operating guidelines and generic templates for the vaccinating processes that meet State and federal laws related to mass vaccination clinics. The guidelines will include the following information to assist districts and local clinics in planning and including mass vaccination activities in their written emergency operations plan:
Guidelines for the administration of routinely supplied vaccines Determination of need for mass vaccination clinic(s) Mass clinic goals Vaccine supply Storing and handling vaccines Authority to vaccinate Suggested roles and responsibilities Informed consent Documentation of vaccination Adverse events following vaccination Recommended references
The templates included in the appendices are not meant to be all-inclusive and should be adapted according to the type of event and the number of persons that need to be served.
In providing these guidelines, the assumption applies that districts have made arrangements for and have addressed the following issues in their written emergency operations plans:
The securing of appropriate administration site facilities and medical supplies The provisions for staffing The addressing of liability, training and education issues The establishment of communication, security, transportation, and storage and handling procedures The establishment of guidelines for the requesting, obtaining, administration, and documentation of
vaccines routinely provided to the districts and local health departments
Guidelines for the Administration of Routinely Supplied Vaccines The guidelines for administration of vaccines routinely provided by the State Immunization Program
outlined in the "Recommended Schedule and Guidelines" section of the Georgia Immunization Program Manual should be followed and a written copy of this manual must be readily accessible to clinics. In addition, this manual may be accessed through the Georgia Immunization Program web site: http://health.state.ga.us/programs/immunization/index.asp
These guidelines are based upon ACIP Recommendations located on the following web site: http://www.cdc.gov/vaccines/pubs/acip-list.htm
Clinics must be able to access the ACIP recommendations either as written copies located on site or through the above mentioned web site. In an emergency situation, a current hard copy must be accessible. If a district chooses to write their own guidelines, these guidelines must be consistent with the current information contained in the Georgia Immunization Program Manual and the current ACIP Recommendations.

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Standard Operating Guidelines for Conducting Mass Vaccination Clinics

Georgia Immunization Program Manual

Division Of Public Health

Standard Operating Guidelines for Conducting Mass Vaccination Clinics
Determination of Need for Mass Vaccination Clinic(s) Prior to the implementation of a mass vaccination clinic(s), determination of persons/populations who are considered to be "at risk" and need to receive vaccinations should be done by state and local health officials based on epidemiologic surveillance, reporting information and current CDC and ACIP recommendations.
Recommendations outlined in the current Georgia Immunization Program Manual and the following documents and/or web sites should be referenced regarding exposure to vaccine preventable diseases:
Georgia Notifiable Disease Manual (Not available as a complete manual. Disease-specific fact sheets are available online at: http://health.state.ga.us/siteindex/d.asp#diseases: (Click on specific disease to view fact sheet {i.e. Notifiable Disease: xxxxxx})
Georgia Smallpox Plan CDC Surveillance and Reporting of Vaccine Preventable Disease Manual Current ACIP Recommendations Statements at:http://www.cdc.gov/vaccines/pubs/acip-list.htm CDC Bioterrorism web site: www.bt.cdc.gov
The need to establish a mass clinic(s) will be dependent upon the number of persons who need to be vaccinated and the accessibility of appropriate vaccination sites.
Mass Clinic Goals The goal of a mass vaccination clinic should be to vaccinate with the appropriate vaccine(s) and provide accompanying education to persons who have been determined to be "at risk" by epidemiological surveillance, public health reporting and CDC/ ACIP recommendations. Other arrangements should be made to vaccinate or dispense medications to persons who are unable to attend the mass dispensing /vaccination sites.
District and local plans should include estimates for how many persons can be vaccinated within designated time periods, utilizing a designated number of sites and stations at each site according to the current CDC recommendations.
District and local plans should also address the dispensing of medication at a mass clinic site, since there is a possibility that administration of vaccine(s) and dispensing of medications may need to occur simultaneously. In this incidence, nursing protocols that are included in the current Nurse Protocol Manual and the Protocol Manual for Chemical and Biological Agents should be referenced. See Appendix A to this document for samples of Vaccine Administration /Dispensing Flow charts.
Vaccine Supply The provision and distribution of vaccines routinely supplied to public health clinics from the State and federally funded Vaccines for Children (VFC) Program is outlined in the "Vaccine Distribution and Storage" section of the Georgia Immunization Program Manual. District and local clinics should assess current vaccine supplies, estimate the amount of vaccine(s) needed for response, and request any additional vaccine needed according to guidelines outlined by the State Immunization Program and CDC. Vaccine usage and supply inventories should be documented according to the guidelines outlined in "Vaccine Distribution and Storage" section of the Georgia Immunization Program Manual.
In the event that an emergency situation may warrant the administration of vaccine(s) that are not routinely provided by the State or VFC program, the State Immunization Program, working in collaboration with Pharmacy, Epidemiology and Emergency Preparedness will follow CDC's guidelines for obtaining and administering vaccines. If an investigational new drug (IND) is recommended by CDC, guidance for requesting obtaining and administering this drug(s) will be obtained from the CDC and FDA and communicated to the districts.
Storing and Handling of Vaccine(s) The storage and handling of vaccines that are routinely provided by the State and VFC is outlined in the "Vaccine Distribution and Storage" section of the Georgia Immunization Program Manual and should be adhered to. The guidelines include instructions and templates for documenting storage temperatures and transporting vaccines if indicated. Guidelines detailed in the "Georgia Immunization Program (GIP) Vaccine Loss Policy for Public Health Districts" for reporting short-dated vaccine, rotation of stock, and returning unused vaccine should be followed.

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Standard Operating Guidelines for Conducting Mass Vaccination Clinics

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Division Of Public Health

Standard Operating Guidelines for Conducting Mass Vaccination Clinics

Authority to Vaccinate Georgia law empowers certain licensed health professionals to administer vaccines. There are no provisions in the Code or in the state's rules and regulations that explicitly give individuals who are not licensed health care professionals the same authority. However, the Georgia Emergency Act of 1981 may be interpreted to provide non-licensed health care professionals the authority to vaccinate by deeming such individuals emergency management workers and volunteers that are engaged in emergency management activities. It also appears that this issue can be resolved through the rules and regulations process. DCH can develop a rule that specifically authorizes volunteers, who are not licensed health care professionals, to administer the smallpox vaccine.

Various health professionals are currently considered to have the authority to administer vaccines under the Georgia Code due to their job duties, job descriptions, protocols, or delegation from a physician. Some of these professionals can only administer medications/drugs while under the supervision of another. Following is a list of health professionals followed by the statute that provides them with the authority to administer medications/ drugs, i.e. vaccinate:

Physicians. O.C.G.A. 43-34-20 (2.1) & (3). Pharmacists. O.C.G.A. 26-4-4, 26-4-5 (30)(A) and (31). Licensed Practical Nurse (LPN). O.C.G.A. 43-26-3 (6) and 43-26-32 (7). Registered Professional Nurse (RN). O.C.G.A. 43-26-3 (6) and (8) and O.C.G.A. 43-34-26.1 (b). Advanced Practice Nurses Certified Nurse Midwife, Certified Registered Nurse Anesthetist, Certified
Nurse Practitioner and Clinical Nurse Specialist. O.C.G.A. 43-26-3 (1), (6) and (8) and 43-34-26.1 (b)(1)(B). Physician's Assistant (PA). O.C.G.A. 43-34-105 and O.C.G.A. 43-34-26.1 (b). Medical Student, Intern or Resident. O.C.G.A. 43-34-26 (b)(5) and (b)(10)(A). Certified Emergency Medical Technicians. O.C.G.A. 31-11-53. Paramedics. O.C.G.A. 31-11-54. Certified Cardiac Technicians. O.C.G.A. 31-11-55.

The Code does not give the following professionals explicit authority to administer drugs. Acupuncturists. O.C.G.A. 43-34-62 (1) and (4) (acupuncture does not include administering drugs). Veterinarians. O.C.G.A. 43-50-3 (5) (can only administer drugs to animals). Chiropractors. O.C.G.A. 43-9-1 (2) (cannot use drugs). Dentists. O.C.G.A. 43-11-1 (5) and 43-11-17 (can prescribe drugs, but can only perform procedures in the oral cavity).

Suggested Roles and Responsibilities District and local health departments written plans should include:
Plans for recruitment, liability, training and use of personnel, including volunteers Detailed description of process of triage, registering and administering vaccine to appropriate individuals.
Process should include venue specific roles and responsibilities for command and support personnel as outlined in CDC's Incident Command guidelines (See Appendix A) Lay out of clinic plan and flow chart List of supplies needed Plans to vaccinate first responders in a separate setting prior to implementation of a mass vaccination clinic, when indicated (i.e. smallpox) Plans for utilizing teams of personnel to administer and/or dispense medication to persons that would be unable to attend a mass clinic Plans for identifying persons who require personalized attention in the mass clinic setting due to physical, mental, or communication issues

See Appendices B1, B2, B3, B4 to this document for sample templates of Dispensing/ Vaccination Site Command charts and Appendices C1, C2 and C3 for sample templates of Clinic, District and State Vaccination Report Forms.

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Georgia Immunization Program Manual

Division Of Public Health

Standard Operating Guidelines for Conducting Mass Vaccination Clinics
Informed Consent Prior to administering vaccines, informed consent should be secured. Consent for treatment is documentation that the person has been provided information about the purposes, risks, benefits, and alternatives for care. In Georgia, the legal definition of a person authorized to make a request for immunization is cited as the Georgia Medical Consent Law located in the Official Code of Georgia, Annotated, Title 31, Chapter 9, 12/2001. A copy of this law and an explanation of the informed consent process and the mandated use of current Vaccine Information Statements (VIS) prior to vaccinating are located in the "Informed Request Policy" section of the Georgia Immunization Program Manual. The policies outlined in this section should be referenced and utilized by districts in conducting vaccination clinics.
Documentation of Vaccination Required documentation of vaccine administration is outlined in the "Informed Request Policy" section of the Georgia Immunization Program Manual. Documentation of each vaccine administered and the receipt by vaccine recipients (or their parent or legal representative) of the current appropriate VIS is required in the vaccine recipient's medical record. Georgia law requires that vaccines administered to individuals of all ages must be documented in the Georgia Registry of Immunization Transactions and Services (GRITS). This legal requirement is referenced in the "Requirements of Law" section of the Immunization Program Manual. GRITS may be utilized as an individual's medical record of immunization. In addition, immunizations may be recorded on form number 25-IMM-002 E, "Georgia Vaccine Administration Record", which is located in the "Informed Request Policy" section of the Georgia Immunization Program Manual.
When vaccines are administered in a mass vaccination clinic situation, each clinic is responsible for tracking, documenting, and reporting the number of doses of each vaccine administered during designated time periods. The Vaccine Site Coordinator is ultimately responsible for submitting summary reports of the number of doses administered to the District Command Site at the designated times. See Appendix C 1, "Clinic Site Vaccination Report" for a suggested tabulating template. In addition, each clinic site is responsible for tracking, documenting and keeping a record of the number of personnel working in the mass vaccination clinic.
The District Command Site is responsible for collecting, tabulating, and reporting to the Georgia Immunization Program, the total number of vaccines doses administered in all of the sites located within their district for the time periods that have been established in collaboration with the State Immunization Program and the EOC. See Appendix C 2, "District Command Site Vaccination Report" for a suggested tabulating template. The District Command Sites should submit the total number of doses administered, requests for additional vaccine, and any other pertinent information as part of their "Situation Report" which is located on the web based EOC. See Appendix C 3," Georgia Immunization Vaccination Report" for a suggested tabulating template.
Screening for contraindications to vaccines shall be completed prior to administration of a vaccine. Sample forms (one for children and teens and another for adults) that can be utilized to screen for contraindications to the vaccines routinely recommended by ACIP and to document the screening process are located in the " Recommended Schedule and Guidelines " section of the Georgia Immunization Program Manual.
In the event of an emergency situation where an investigational new drug (IND) might be recommended by CDC, an IND consent form for off-labeled use must be utilized. In this instance, guidance and forms obtained from the CDC and FDA will be utilized and distributed to the districts.
Adverse Events Following Vaccination Each district shall follow the "Medical Emergency Procedures" included in the current State Nurse Protocol Manual or develop and utilize emergency protocols and procedures consistent with those outlined in the State Nurse Protocols.
Each district should utilize the guidelines outlined in the Quality Assurance Standards for the "Management of Drug Reactions" that are included in the "Quality Assurance/Quality Improvement for Immunization Practice for Public Health Nurses and Immunization Support Staff" section of the Georgia Immunization Program Manual.

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Standard Operating Guidelines for Conducting Mass Vaccination Clinics

Any adverse reaction or event occurring after the administration of a routinely recommended vaccine should be documented and reported to the Vaccine Adverse Event Reporting System (VAERS) according to the guidelines established in the "Adverse Events Following Vaccination" section of the Georgia Immunization Program Manual. VAERS is a national vaccine safety surveillance program. Reporting an event to VAERS does NOT file a claim for compensation.
The National Childhood Vaccine Injury Act created the Vaccine Injury Compensation Program (VICP) to compensate individuals whose injuries may have been caused by vaccines recommended by the CDC for routine use. VICP provides liability protection to both vaccine companies and health care providers. If there is an adverse reaction requiring medical treatment, that treatment should be paid for by the individual or their insurance company, not the administrator or the vaccine company. If the reaction is one covered by the VICP, an individual can file a claim with VICP. A civil claim can only be filed against the vaccine company and/or the vaccine administrator after first filing a claim under the VICP and then rejecting the decision of the Court. Information on VICP can be obtained from the "Adverse Events Following Vaccination" section of the Georgia Immunization Program Manual.
Recommended References Current versions of reference materials should be readily accessible for individuals administering the vaccines routinely recommended by the ACIP. A listing of these references is located in the "Quality Assurance/Quality Improvement for Immunization Practice for Public Health Nurses and Immunization Support Staff" section of the Georgia Immunization Program Manual.
Additional references specifically providing guidelines for mass influenza vaccination clinic planning can be found at the CDC website: http://www.cdc.gov/flu/professionals/vaccination/vax_clinic.htm
Plans for "Pandemic Influenza Vaccine Distribution and Use" are also addressed in Section F of the Georgia Pandemic Flu Plan, located at the following web site: http://health.state.ga.us/pandemicflu/GAPanfluSOP.asp

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Standard Operating Guidelines for Conducting Mass Vaccination Clinics

Appendix A: SAMPLE- MEDICATION DISPENSING/VACCINATION SITE FLOWCHART

Triage

Rx-Storage and Repackaging area.

EXIT

Exit
No Exposure Exits

PUBLIC ARRIVE AT DISPENSING SITE
Greeter
May complete form and be assessed in line.
Enter
HEALTH SCREENERS
Initial Triage (1 min) 1. Are you really exposed? 2. Visual checks for illness. 3. Registration forms (If not completed). 4. Disease Ed materials

YES

NO
Sick or Special Needs?

Educator/Counselor Answer questions and assist patients as required w/forms Check weight
Patients fill out forms Wait for mass counseling area or registration desk

Mass Counseling Area +/- 50 People per group. Educate on disease treatment, etc.

Educator
Answer questions and assist patients as required

Sick Assessment
Area

Adapted from District 5-2 SNS plan Updated 10/2006

NO YES

REGISTRATION
Registration Desk(s) 1. Check forms 2. Check weight (if not done prior) & note allergies 3. Uncomplicated, mark forms with letter E (express) in upper right corner. Direct to Express 4. Others--Direct to Complicated Station.
Registration Desk(s) 1. Check forms 2. Check weight (if not done prior) & note allergies 3. Uncomplicated, mark forms with letter E (express) in upper right corner. Direct to Express 4. Others -Direct to Complicated Station
Registration Desk(s) 1. Check forms 2. Check weight (if not done prior) & note allergies 3. Uncomplicated, mark forms with letter E (express) in upper right corner. Direct to Express 4. Others -Direct to Complicated Station.
Special Needs Registration Desk 1. Translators 2. Disabled, sight, or hearing impaired assistance 3. Same requirements as other registration desks
Optional dispensing
station

If necessary get Consult.

COMPLICATED Station 4

EXPRESS Station 3

EXPRESS Station 2

EXPRESS Station 1

DISPENSE/VACCINATION

Dispensing /Vaccination

Station(s)

1. Review forms

2. Medical counseling

3. Label 4. Drug Info

Nurse/RPH

5. Dispense/Vaccination drugs

6. Documentation

Vaccination Observation Area

Dispensing/Vaccination

Station(s)

1. Review forms

2. Medical counseling

3. Label 4. Drug Info

Nurse/RPH

5. Dispense/Vaccination drugs

6. Documentation

Reaction Y or N?

Dispensing/Vaccination

NO

Station(s)

1. Review forms

2. Medical counseling

3. Label 4. Drug Info

Nurse/RPH

5. Dispense/Vaccination drugs

6. Documentation

Dispensing/Vaccination

Station(s)

1. Review forms

2. Medical counseling

3. Label 4. Drug Info

RPH Preferred

5. Dispense/Vaccination drugs

6. Documentation

Yes

Sick holding area waiting for transport

Adverse Reaction Station

Note: Security and Data Collection staff need to be positioned appropriately.

Dispensing/Vaccination Command Chart

Note. Normally, there will not be a need for BOTH a Vaccine Administration Chief and a Dispensing Chief

District Health Command Center
Dispensing/Vaccination Operations Site Coordinator

Security Chief

Operations Chief
Triage Team Leader
Registration Team Leader
Special Needs Team Leader
Data Team Leader

Vaccine Administration
Chief
Observers
Adverse Reaction Team
Vaccine Administrators
Express Complicated
Appendix B1
(Adapted from District 3-1 SNS Plan 11/05)

Dispensing Chief
Dispensers
Express Complicated Pharmacy Tech Support

Dispensing/Vaccination Site Operations: Roles & Responsibilities

Supervises Subordinates Identifies staffing needs Receives staffing reports Orients subordinate staff members Assures Confidentiality of patient information

Dispensing/Vaccination Operations Site Coordinator
Operations Chief

Triage Team Leader
Trains/Orients Staff - Triage Area Greeter - Health Screener - Supply/Forms Router - Triage Area Educator - Triage Area Counselor - Sick Assessment Educator - Primary Care Provider

Special Needs Registration Team
Leader
Trains/Orients Staff -Registrar Special Needs - Special Needs Interpreter - Special Needs Runner

Registration Team Leader
Trains/Orients Staff - Registrar Express

Data Team Leader
Trains/Orients Staff - Data Entry

Appendix B2
(Adapted from District 3-1 SNS Plan 11/05)

Dispensing/Vaccination Site Vaccine Administration: Roles & Responsibilities

Supervises Subordinates Identifies staffing needs Receives staffing reports Orients subordinate staff members Assures Confidentiality of patient information

Dispensing/Vaccination Site Coordinator
Vaccine Administration Chief

Observers
Observes for a set time Escorts to adverse reaction team as required Uses standard codes

Adverse Reactions Team
Legally able to medically assess and administer medication

Vaccine Administrators
(Express)
Handles routine patients

Vaccine Administrators (Complicated)
Physician on-site Handles possible contraindications or other complications

Appendix B3
(Adapted from District 3-1 SNS Plan 11/05)

Dispensing/Vaccination Site Dispensing: Roles & Responsibilities

Supervises Subordinates Identifies staffing needs Receives staffing reports Orients subordinate staff members Assures Confidentiality of patient information

Dispensing/Vaccination Site Coordinator
Dispensing Chief

Dispensers (Express)
Must be licensed Pharmacist, a nurse operating under protocol, or a physician

Dispensers (Complicated)
Must be licensed Pharmacist, or a physician

Pharmacy Tech Support)
Trains/Orients Staff

Appendix B4
(Adapted from District 3-1 SNS Plan 11/05)

Appendix C 1

Clinic Site Vaccination Report

Date:_____________Report Time Period:_____________________________ Site Name and Number:________________________________________________________ Vaccination Operations Site Coordinator:__________________________________________ Vaccination Operations Site Coordinator Phone/Radio Number:________________________ Type of Vaccine Administered:__________________________________________________ (Use separate form for each type of vaccine administered

Time Period 2400 - 0100 0100 - 0200 0200 - 0300 0300 - 0400 0400 - 0500 0500 - 0600 0600 - 0700 0700 - 0800 0800 - 0900 0900 - 1000 1000 - 1100 1100 - 1200 1200 - 1300 1300 - 1400 1400 - 1500 1500 - 1600 1600 - 1700 1700 - 1800 1800 - 1900 1900 - 2000 2000 - 2100 2100 - 2200 2200 - 2300 2300 - 2400 SHIFT TOTALS:

# of Doses Administered 0

Vaccine Administrative Chief

____________________________________________ Signature Of Vaccination Operations Site Coordinator
This report should be completed by the Vaccination Operations Site Coordinator at each vaccination site and submitted to the District Command Center at the designated times.

October 2006

Site #1 Site #2 Site #3 Site #4 Site #5 Site #6 Site #7 Site #8 Site #9 Site #10 Site #11 Site #12 Site #13 Site #14 Site #15

Appendix C 2
District Command Site Vaccination Report
Type of Vaccine Administered: _______________________ (Use separate form for each type of vaccine administered)
Time Period 2400 - 0100 #Doses Given 0100 - 0200 #Doses Given 0200 - 0300 #Doses Given 0300 - 0400 #Doses Given 0400 - 0500 #Doses Given 0500 - 0600 #Doses Given 0600 - 0700 #Doses Given 0700 - 0800 #Doses Given 0800 - 0900 #Doses Given 0900 - 1000 #Doses Given 1000 - 1100 #Doses Given 1100 - 1200 #Doses Given 1200 1300 #Doses Given
10/2006

Page 1
HR Total
0 0 0 0 0 0 0 0 0 0 0 0

Appendix C 2
District Command Site Vaccination Report
Type of Vaccine Administered: _______________________ (Use separate form for each type of vaccine administered)

Page 2

Site #1 Site #2 Site #3 Site #4 Site #5 Site #6 Site #7 Site #8 Site #9 Site #10 Site #11 Site #12 Site #13 Site #14 Site #15

Time Period

HR Total

1300 - 1400

#Doses Given

0

1400 - 1500

#Doses Given

0

1500 - 1600

#Doses Given

0

1600 1700

#Doses Given

0

1700 - 1800

#Doses Given

0

1800 - 1900

#Doses Given

0

1900 - 2000

#Doses Given

0

2000 - 2100

#Doses Given

0

2100 - 2200

#Doses Given

0

2200 - 2300

#Doses Given

0

2300 - 2400

#Doses Given

0

24 Hr Total

#Doses Total

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

This Excel summary report may be utilized by District Command Sites to tally the number of vaccine doses administered during the designated time periods. The total amounts should be reported at designated times to the Georgia Immunization Program.

10/2006

Appendix C 3

Type of Vaccine Administered: ___________________ (Use separate form for each type of vaccine administered)

District# 1-1 1-2

2

3-1 3-2 3-3

Time Period

2400 - 0100

#Doses Given

0100 - 0200

#Doses Given

0200 - 0300

#Doses Given

0300 - 0400

#Doses Given

0400 - 0500

#Doses Given

0500 - 0600

#Doses Given

0600 - 0700

#Doses Given

0700 - 0800

#Doses Given

0800 - 0900

#Doses Given

0900 - 1000

#Doses Given

1000 - 1100

#Doses Given

1100 - 1200

#Doses Given

1200 1300

#Doses Given

GA Immunization Program Vaccination Report

3-4

3-5

4

5-1 5-2

6

10/2006

Page 1

7

8-1 8-2 9-1 9-2

10 HR Total

0 0 0 0 0 0 0 0 0 0 0 0 0

Appendix C 3
Type of Vaccine Administered: ___________________ (Use separate form for each type of vaccine administered)

GA Immunization Program Vaccination Report

District# 1-1 1-2

2

3-1 3-2 3-3

3-4

3-5

4

5-1 5-2

6

Time Period

1300 - 1400 #Doses Given

1400 - 1500 #Doses Given

1500 - 1600 #Doses Given

1600 1700 #Doses Given

1700 - 1800 #Doses Given

1800 - 1900 #Doses Given

1900 - 2000 #Doses Given

2000 - 2100 #Doses Given

2100 - 2200 #Doses Given

2200 - 2300 #Doses Given

2300 - 2400 #Doses Given

24 Hr Total

#Doses Total

0

0

0

0

0

0

0

0

0

0

0

0

This excel report may be utilized by the GA Immunization Program to tabulate number of vaccine doses administered during a given time period.

10/2006

Page 2

7

8-1 8-2 9-1 9-2

10 HR Total

0

0

0

0

0

0

0 0 0 0 0 0 0 0 0 0 0 0

1

1