Georgia immunization program manual, 2010 March

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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TABLE OF CONTENTS
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