Tennessee Immunization Program Updates

Tennessee Immunization Program Updates
Tennessee Immunization Program Updates
Kelly L. Moore, MD, MPH
Medical Director, State Immunization Program
Tennessee Public Health Association
Annual Educational Conference
Cool Springs, Tennessee September 16, 2011
• Vaccine financing in health departments
• Recent changes in federal recommendations
• Vaccines for healthcare personnel
• Tennessee immunization coverage levels
• Tennessee school/college requirements
• A little about TWIS
• Q and A
2011 TPHA Annual Conference
Major federal funding cuts impact vaccines available free in local health departments
• Cuts do not affect Vaccines for Children (VFC) Program or any aged 0‐6y
– Age 0‐18 AND: (a) Uninsured; (b) TennCare; (c) Native American; or (d) [in HD, FQHC only] Privately insured but plan excludes vaccines (“underinsured”)
• Adult vaccine changes:
– Routine vaccines limited to uninsured
– Vaccines given for post‐exposure prophylaxis as indicated (outbreak control)
• Childhood vaccine changes:
– 7 through 18 years, non‐VFC [private insurance with vaccine benefits] only vaccines the child needs to meet state school entry requirements
• Refer elsewhere for meningococcal, hepatitis A, HPV, or any other vaccine recommended but not required for that child
Influenza Vaccine 2011‐2012
6 months and up
Vaccination during pregnancy: 2 for 1 Same vaccine strains as 2010‐11
Protection for at least a year in general
– It is not too early to vaccinate in August or September
• Children <9 years who had no flu vaccine last season need 2 doses (at least 1 month apart) this season
– To assure adequate immunity to the 2009 H1N1 strain – Generally, 2 doses recommended only for vaccine naïve children or those who got 1 dose in their first season (if the immediately preceding season)
2011 TPHA Annual Conference
Influenza viruses circulating
2011 TPHA Annual Conference
Swine origin influenza viruses:
Key points from CDC’s MMWR, September 9, 2011
• “Clinicians who suspect influenza virus infection in humans with recent exposure to swine should obtain a nasopharyngeal swab from the patient for timely diagnosis at a state public health laboratory and consider empiric neuraminidase inhibitor antiviral treatment to quickly limit potential human transmission.” • “…no information currently is available regarding the capacity of this virus to transmit efficiently in swine, humans, or between swine and humans.” Tetanus‐diphtheria‐ acellular pertussis (Tdap)
• Routine at 11‐12y, for adults, next tetanus booster, anyone who cares for infants
• No waiting period between last Td and Tdap
• Age 7‐10, never completed DTaP? Give Tdap
• Over 65 and never had Tdap? Permissible – and recommended if caring for an infant or HCP
• Pregnant? Tdap Recommended! after 20 weeks
– Safe, effective. (provisional recommendation published, MMWR pending)
2011 TPHA Annual Conference
Meningococcal Conjugate Vaccine: 2nd Dose Recommended
• Most important age for protection 16‐21y
• Original recommendation: 1 dose at 11‐12
– Belief it would protect about 10 years
– Protection requires high circulating antibodies, titers dropped off 3‐5 years after dose
– Second dose strongly boosts titers, slower decline
• New recommendations:
1st dose age 11‐12 (13‐15 if late), 2nd dose at 16y Minimum of 8 weeks between 1st and 2nd doses
If already 16 or older at first dose, only 1 dose given
See ACIP recommendations for details
Healthcare Personnel Recommendation Review
• Hepatitis B (0, 1m, 6m)
– If working where routinely exposed to blood, check serology for anti‐HBs 1‐2 mo after #3
• Influenza annually
• MMR: – 2 doses or lab confirmation of immunity if born 1957 or later – Consider 2 doses for unvaccinated born before 1957 if no lab evidence of immunity in absence of outbreak
• Definitely give 2 doses in measles/mumps outbreak
• 1 dose in rubella outbreak
2011 TPHA Annual Conference
Healthcare Personnel
Recommendation Review
• Varicella: verify immunity
– History of disease (diagnosed), immunity, 2 doses 1m apart
• Tdap: 1 dose for all who have not had it
– No waiting period since last Td, no age limit
• Meningococcal? Only to microbiologists that handle N. meningitidis cultures
Travel Medicine: www.cdc.gov/travel and The YELLOW Book
2011 TPHA Annual Conference
Finding Yellow Fever Vaccination Clinics Near You
Tennessee YFV clinics all provide full travel medicine services and vaccines
2011 TPHA Annual Conference
2010 Tennessee Annual Survey of On‐Time Immunization of 24 Month Old Children
• About 1,500 TN children surveyed annually
• More state detail than CDC’s National Immunization Survey of 19‐35 month olds
• Goal: 90% coverage for each of 7 vaccines: DTaP, Polio, MMR, Hepatitis B, Hib, Varicella, PCV (TN reached goal for 5 of 7)
– 60% for Hepatitis A, 80% for rotavirus (HP 2020) Note: 96% 3+ DTaP
2011 TPHA Annual Conference
Note: 94.4% 3+ PCV
2009 vs. 2010 CDC National Immunization Survey for ages 13‐17 years (NIS‐Teen)
View original MMWR article at http://www.cdc.gov/mmwr/pdf/wk/mm6033.pdf
1+ Tdap
2009 US
55.6 (54.3‐ 48.0 56.8)
1+ Men‐
1+ HPV
3+ HPV (♀)
2009 TN
US change*
68.7 (67.5-69.8)
58.7 (52.4-64.8)
62.7 (61.5-63.9)
50.6 (44.4-56.8)
+ 9.1
48.7 (46.9-50.5)
33.1 (25.7-41.4)
+ 4.4
32.0 (30.3-33.6)
26.3 (19.7-34.2)
44.3 (42.4‐ 43.6 46.1)
2010 TN
53.6 (52.4‐ 52.1 54.9)
2010 US
26.7 (25.2‐ n/a
¥95% confidence intervals in parentheses
*Percentage point difference of point estimates (2010‐2009), confidence intervals wide
2011 TPHA Annual Conference
National Trends in Teen Vaccine Uptake: HPV Vaccine Falling Off the Curve
Tdap (1)
Meningitis (1)
HPV (1)
HPV (done)
Diseases Covered by Tennessee Child Care and School Immunization
Requirements (2010 changes in bold, italics)
TN Rule Chapter 1200-14-1-.29: http://www.tn.gov/sos/rules/1200/1200-14/1200-14-01.20101029.pdf
Child Care
New students,
Grades 1-12
All incoming
7th graders
H. flu type B (Hib)
Up to date/
Up to date/
Tetanus, Pertussis
Up to date
(no 4y dose)
(incl. 4y dose)
Same as K,
Tdap not req’d
Tdap booster
Measles, Mumps,
1 dose
2 dose
2 dose
2 dose
Up to date
(no 4y dose)
(incl. 4y dose)
(incl. 4y dose)
Hepatitis B
Up to date/
If training incl.
direct pt. care
Hepatitis A
1 dose
2 dose
1 dose
2 dose
2 dose
2 dose
2 dose
(or disease history)
Vaccines recommended by CDC, but not required for school: rotavirus (infants), influenza (all, annually), meningococcal
(adolescent), Human papillomavirus (adolescent). Visit http://health.state.tn.us/TWIS/requirements.htm or https://twis.tn.gov
for more information or for the Official Certificate.
Last updated by Tennessee Immunization Program: January 2011
2011 TPHA Annual Conference
Immunization Certificate: Revised May 2011
Section 1: school specific
• Section Numbers (easier navigation)
• Section 1 (school specific)
• Reminder that dates are required for doses of required vaccines (Section 2a)
• Medical exemption signed by MD, DO Health Departments only (not PA, APN)
• Section 2b: not required – cannot be factored in the provider assessment
• Section 3. “Provider Assessment” NOT VALID IF BLANK
• Clarified the categories (no actual changes in eligibility)
• Section 4. Name, address, phone of Qualified provider + signature/stamped signature – NOT VALID if BLANK!
• Clarified who is qualified. MD, DO, APN, PA or Health Department. Private practice RNs, office staff may not sign.
•TWIS will pre‐print most of this
Section 3
Section 4
College Immunization Requirements
Optional form available in TWIS (Secure Area)
If school will not accept a credible history of disease: Report to TIP (615‐741‐7247)
2011 TPHA Annual Conference
TN Immunization Registry
Demographics from
Birth Certificate Data
Tennessee Web
(TWIS) web portal
All TN Health Departments
[Through Patient Tracking
Billing Management
Information System
State Immunization
Information System
Non-HL7 Flat File
(In development)
HL7 2.3.1 Standard
Data Trading Partners
As of September 1, 2011…
3,692,117 People
30,184,012 Vaccine Doses
2011 TPHA Annual Conference
New TWIS Features 2011: Primarily for
the Vaccines for Children (VFC) Program
VFC Vaccine Inventory Management (VIM)
• Accept VFC vaccine shipments online
• Transfer or accept VFC vaccine among VFC providers • Manage VFC vaccine inventory and orders
– Submit VFC Vaccine Doses Accountability Reports – Report spoiled or wasted VFC vaccine doses
– Order vaccine online • Immunization Requirements College Form (not limited to VFC)
TWIS Features 2012
• Interactive Online User Manual
• Flat File Conversion (upload a batch of patient records without HL7 connection) • HL7 Batch File Upload – Bidirectional HL7 2.3.1 standards
– Update only HL7 2.5.1 standards
2011 TPHA Annual Conference
CMS Meaningful Use Grants:
Must choose 1 public health (PH) objective
The 3 PH objectives are: • Exchanging immunization registry data including queries, responses, and updates*
• Sending electronic laboratory results (ELR) ‐ Hospitals
• Sending syndromic surveillance data to PH agencies * Tennessee Department of Health (TDH) is exchanging immunization registry data https://twis.tn.gov
Meaningful Use Continued
Useful Links: • Office of eHealth‐ http://www.tn.gov/ehealth/meaningfuluse/
• Bureau of TennCare (Medicaid)‐
• Centers for Medicare & Medicaid Services (CMS)‐
• Visit the Tennessee Department of Health exhibit for TWIS and Meaningful Use Information
• Contact [email protected] in the TIP Registry Unit for information
2011 TPHA Annual Conference
Our world without vaccines…?
TN Immunization Program Team
• [email protected]
• 615‐741‐7247 or https://twis.tn.gov
2011 TPHA Annual Conference
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