Back to School Immunization Guide

Exemption Rates

 

Summer is winding down and it’s time to gear up for a new school year. That means more kids coming in for vaccines. What do you need to know about immunizations for back to school this year?

  • Old religious exemptions to immunization signed prior to March 2014 are no longer valid. Senate bill 895 removed the provision that allowed old religious exemptions that were in place before the implementation of the new nonmedical exemption process. This is a great opportunity to discuss vaccines with parents who claimed an exemption for their child years ago. Parents will have two options:
    1. If the child has received the vaccines, the parent needs to fill in the vaccine dates on the Certificate of Immunization Status, sign the form and turn it into the school.
    2. If the parent wants a nonmedical exemption for their child, they need to get education about the benefits and risks of immunization from a health care practitioner or the online vaccine education module. If you are a health care practitioner and provide education to the parent, print off and complete the Vaccine Education Certificate available at healthoregon.org/vaccineexemption (go to the “For Providers Only” section at the bottom of the page). Mark “yes” next to each vaccine you provided education about for which the parent wants to claim an exemption. The online vaccine education module is also available at the same web address.
  • Remind parents to update immunization records with their child’s school or daycare every time their child receives a vaccine.
  • Make sure to screen for and give all recommended vaccines when you give school-required vaccines. When a student comes in for Tdap vaccine, give HPV and meningococcal vaccines as well. Adolescents can be a hard population to reach, and you might not see the patient again for several years. And don’t forget about flu vaccine!

Update from the 2014-2015 school year

For the first time in more than a decade, Oregon’s nonmedical exemption rate decreased: 5.8% of kindergartners had a nonmedical exemption to one or more vaccine in 2015 compared to 7.0% in 2014. Check out the graph above to see the nonmedical exemption rate over time. Thank you to clinics, schools and child care programs for helping to implement the new process for claiming a nonmedical exemption, and helping protect more kids against vaccine preventable diseases!

 

 

 

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Flu Season Update

The 2014-2015 flu season brought a new, drifted A strain of influenza that was not in the virus selection for the season’s vaccine. As a result, the effectiveness of the vaccine was lower than expected.  This has many people asking, “Why bother with a flu shot each season?”

Each year  the A strains that begin on the East Coast die out over the Mid-West allowing the B strains to take the lead somewhere over the Rockies en route to the West Coast. Every year the Centers for Disease Control and Prevention (CDC) begins tracking the influenza (flu) season in early October and select the vaccine strains that will be used to manufacture vaccine around February. If  a strain drifts into a new influenza virus after the vaccine manufacturing process begins, the new strain will not be included in the current season’s vaccine, but the  vaccine will still protect against the other most deadly strains identified during the winter season in the southern hemisphere.

The CDC reported that among the 2014-2015 seasonal influenza A viruses, 52,518 (50.1%) were subtyped; 52,299 (99.6%) were influenza A (H3N2) viruses, and 219 (0.2%) were A (H1N1) pdm09 viruses. In addition, three variant influenza A viruses (one H3N2v and two H1N1v) were identified.  In response to the CDC findings, this year the 2015-2016 flu vaccine mix has two or three new strains included.


 

Vaccine Strains included
FluMist® (live) nasal

flu vaccines

·A/Bolivia/559/2013 (H1N1)
(an A/California/7/2009 (H1N1)pdm09-like virus)·A/Switzerland/9715293/2013 (H3N2)-like virus

·B/Phuket/3073/2013-like (B/Yamagata lineage) virus

·B/Brisbane/60/2008 (B/Victoria/2/87 lineage)

Inactivated (injectable)

trivalent vaccines

·A/California/7/2009 (H1N1)pdm09- like virus

·A/Switzerland/9715293/2013 (H3N2)-like virus

·B/Phuket/3073/2013-like (B/Yamagata lineage) virus

Inactivated (injectable)

quadrivalent vaccines

·Same three strains as the injectable trivalent, plus:

·B/Brisbane/60/2008-like (B/Victoria lineage) virus


Here at the Oregon Immunization Program our flu season takes off with the delivery of the first available flu vaccines, sometime in late summer or early fall. The CDC recommends an annual flu vaccine for all individuals without contraindications ages 6 months and older.  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6421a5.ht
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Advisory Committee on Immunization Practices (ACIP) Update

The Advisory Committee on Immunization Practices (ACIP) meets quarterly to discuss, inform and determine how United States vaccines can best be utilized. Here are some brief notes about the decisions made by the ACIP in June. Full ACIP proceedings and recommendations can be found here: http://www.cdc.gov/vaccines/acip/index.html

Meningitis B vaccines: Rather than a blanket recommendation for routine vaccination, ACIP voted to enact a permissive recommendation “A serogroup B meningococcal (MenB) vaccine series may be administered to adolescents and young adults 16 through 23 years of age to provide short term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccines is 16 through 18 years.” http://www.cdc.gov/vaccines/programs/vfc/downloads/resolutions/2015-06-15-mening.pdf

Influenza: The spacing and number of doses for individuals six months through eight years of age was simplified: If a child between six months and nine years old has ever had two doses in any previous season(s), even if not consecutive seasons, only one dose is needed in the current season. CDC has no preference for any one flu vaccine brand or presentation over another.

Pneumococcal: The spacing of pneumococcal vaccines for adults 65 years and older has changed from a minimum of eight weeks, to 12 months between PCV 13 and PPSV23. This brings the recommendation into line with the Centers for Medicare and Medicaid Services (CMS) payment program. Adults 65 and older are recommended for a 2-dose series of one dose of each pneumococcal vaccine at least 12 months apart. CMS will fund one of each as long as the two doses are at least 11 months apart. Both pneumococcal vaccines cannot be given at the same visit. ACIP promotes giving adults 65 and older the recommended pneumococcal vaccine at the same visit as the flu vaccine. For details see page 8 and 10 of the pneumococcal vaccine standing orders.

Tdap: ACIP again considered routine TDAP boosters for adolescents and adults, but opted to maintain the recommendation for only one adult booster dose and a Tdap booster dose with each pregnancy.

Zoster (Shingles): Merck is proceeding with an application to the Federal Drug Administration for a new inactivated, adjuvanted 2-dose vaccine that shows 97% protection levels. This new vaccine may be recommended for stem cell recipients in the future. http://www.nejm.org/doi/full/10.1056/NEJMoa013441

HPV: No changes. Clinicians can complete any HPV 3-dose series with either HPV2, HPV4 or HPV9 for women and any HPV4 or HPV9 for men.

Yellow Fever: ACIP voted that a single primary dose of yellow fever vaccine provides long-lasting protection and is adequate for most travelers. See the MMWR for specifics on high-risk populations. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a5.htm

General Recommendations: ACIP approved the entire document. This is an update to the July 2011 issue. Some of the areas of change relate to Altered Immunocompetence based upon the IDSA Clinical Practice Guidelines published in 2013. New conditions, medications, and combination therapies were added as well as guidelines of when to withhold select vaccines, including both live and inactivated vaccines. http://www.pharmacist.com/updates-vaccine-recommendations-focus-acips-june-meeting?desktop_view=no

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Partnership Spotlight: Family Care and the Oregon Food Bank

We love hearing about innovative partnerships that work to bring organizations together around immunizations and preventive health measures. If you are wanting to spotlight an organizational partnership, please email Alison.dent@state.or.us.

Giving Back to Oregon Food Bank
What’s better than one organization striving to do good in the community? Two organizations that partner to meet the same goal.

In early fall, 2014, a partnership between FamilyCare, Inc., and Oregon Food Banks took root, with FamilyCare donating to Oregon Food Bank $5 per adult member vaccinated between September and December 15 of that year.

On Wednesday, April 8, 2015, Bill Murray, Chief Operating Officer of FamilyCare presented a check for $40,610 to Oregon Food Bank. This amount represented the 8,122 flu immunizations FamilyCare providers distributed to adult members during that 12-week window. Also in attendance were dozens of FamilyCare employees who generously donated their time to the Oregon Food Bank.

Increasing access to influenza vaccine and nutritious foods are both ways to improve community health. In total, FamilyCare’s contracted clinics and providers delivered more than 16,000 vaccinations to adults and children this flu season. FamilyCare also hosted its own flu vaccine drives around the community, including at Wallace Medical Concern and the Lloyd Center as well as at the Hmong New Year celebration and at Oregon’s Diabetes Expo. These efforts helped to vaccinate an additional 1,000 members of our community, bringing the total to just over 17,000 vaccinations during the 2014/2015 flu season.

“This flu vaccine initiative allowed us to dive into many areas critical to FamilyCare,” says Lamar Tillman, a Provider Education Services representative and one of the internal leads on the project. “We were able to educate the population about health and reduce their risk of getting sick while also building stronger partnerships with our providers and the community.”


FamilyCare, Inc. is a Medicare and Medicaid managed care organization providing patient‐centered healthcare to Oregonians for more than 30 years. FamilyCare was the first health plan in Oregon to integrate models of physical and mental health and was the first Coordinated Care Organization in the tri‐county area certified by the Oregon Health Authority. The health plan serves more than 115,000 members. FamilyCare’s mission is, “Creating healthy individuals through innovative systems.”

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Meningococcal B Update for Oregon Providers

This message comes to you as an update on the meningococcal disease outbreak at the University of Oregon, including some recommendations for you for the upcoming spring break when we expect many UofO students to head home to other areas of the state.

Outbreak Update:

There is an outbreak of serogroup B meningococcal disease at the University of Oregon. There have been 5 confirmed cases among University of Oregon undergraduates since January of this year, one of which was fatal. Ongoing vaccination efforts have vaccinated about 9,000 undergraduates to date, but the goal is to vaccinate all (22,000) undergraduates, and all University of Oregon graduate students and staff with immune deficiencies.

What you need to know:

  • Both Trumenba (Pfizer) and Bexsero (Novartis) vaccines are available on the private market for providers to purchase.
  • Spring break is Friday, March 20th through Sunday, March 29th. Students may be  returning home and seeking vaccination or may present to care.
  • Current standing orders exist for pharmacies to vaccinate all University of Oregon undergraduates due to the outbreak.
  • Undergraduate students of any age from other colleges/universities who live at the 13th & Olive apartments (Capstone buildings) in Eugene are also covered by the standing orders.
  • Others who should be vaccinated are staff or graduate students at the University of Oregon who live in campus residence halls, fraternities or sororities, or who are high risk (those with asplenia, sickle cell disease, or terminal complement component deficiency).
  • Serogroup B vaccine is available at Walgreens, Safeway and Albertsons stores near the University of Oregon. Individuals seeking vaccination outside the Eugene area should call ahead to their local pharmacy, and if the vaccine is not in stock it can be ordered within a day or so.
  • Most insurance companies, including Oregon’s Medicaid CCO Plans, have been paying for the vaccine as given by local pharmacies.
  • Some students may be seeking the first dose, or the second dose. Individuals should stick with one vaccine brand for the series whenever possible.
  • All students who have had the disease to date did not present with classic meningeal signs, but with disseminated meningococcal disease found on blood culture. Other presenting symptoms include fever and rash.

Please be aware of this situation and let returning students and concerned parents know where they can get vaccinated, and who the vaccine is currently recommended for.

Will the newly licensed mening B vaccines be available through the Vaccines For Children (VFC) program?

Yes, probably in late April.  We will keep you posted.  The vaccines will be available for any VFC-eligible child (through age 18) with one of the high-risk conditions listed in our current model standing order.  Those are:

RECOMMENDATIONS FOR USE

  1. Approved for the following high‐risk individuals ≥10 years of age. Those with:

 functional or anatomic asplenia

 sickle cell disease

 terminal complement component deficiency (e.g., C5–C9, properidin, factor H, factor D,

and patients taking Eculizumab [Soliris®]) AND

 microbiologists who work routinely with isolates of Neisseria meningitidis

  1. B. University of Oregon outbreak control (expires 6/30/2015):

Approved for the following individuals ≥11 years of age:

  • University of Oregon undergraduate students.
  • University of Oregon graduate students, faculty and staff who:
  1. live in campus residence halls, fraternities, or sororities
  2. who are at high risk (see above)

3.) Undergraduate students of any college living in the 13th & Olive apartments

(Capstone Buildings), including but not limited to undergraduates from the University

of Oregon, Lane Community College, and Northwest Christian University

  1. Others may be vaccinated only with a specific physician prescription.

Where can I find the current recommendations for the new vaccines?

You can find all of our model standing orders here:  https://public.health.oregon.gov/preventionwellness/vaccinesimmunization/immunizationproviderresources/pages/stdgordr.aspx

Should we have vaccine on hand now?

That is a decision for each clinic/health system/pharmacist.  Both vaccines are currently available for purchase on the private market.

I have questions; whom should I call?

Your local health department! You can find contact information here: https://public.health.oregon.gov/ProviderPartnerResources/LocalHealthDepartmentResources/Pages/lhd.aspx

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Having Difficult Conversations- Working through Conflict and Uncertainty with Motivational Interviewing

With the minefield of subjects growing ever larger, talking to patients and community members can become a difficult process when it comes to scientifically sophisticated and divisive topics. We know that having tactics, training, and reinforcements makes talking about difficult subjects a lot easier and ultimately more successful. In the public health and medical communities, we know that these instances are not only inevitable but sometimes a weekly occurrence, and the health of our communities depends on these conversations.

This is exactly what Immunize Oregon and Oregon AWARE had in mind when they created the “Having Difficult Conversations” seminar. The seminar focuses on the basic techniques of motivational interviewing and its applications in patient education settings, specifically around the topics of immunizations and antibiotic use. Motivational interviewing (MI) is a method that works on facilitating and engaging intrinsic motivation within the client in order to change behavior. Typically used for more traditional behavior change counseling such as smoking cessation, motivational interviewing is a goal-oriented, client-centered counseling and conversation style that can helping clients explore and resolve ambivalence. These methods are easily applied to the charged and emotionally driven conversations that surround for other health topics, like immunizations. Combining MI techniques, local statistics, case studies, and plenty of group and individual practice, this seminar strives to provide participants with alternatives to stonewalling and conflict through empathy and empowerment.

The seminar has gleaned positive reviews on practical applications and confidence building with regards to these tricky patient/community member interactions. After the initial presentation, Immunize Oregon and Oregon AWARE saw the potential for this to be a tool for partners and providers throughout the state. The scope of the seminar was expanded so that it could be tailored to varying group sizes and provider types. Immunize Oregon and Oregon AWARE hope to be able to provide this seminar to as many groups as possible and are offering a series of free presentations at the Portland State Office Building. If you are interested in attending, please click on the date you want to register for, as we do require an RSVP to attend.

Thursday April 23, 2015 from 9:00am-11:00am

Tuesday May 19, 2015 from 2:00pm-4:00pm

Friday June 26, 2015 from 8:00am-10:00am

We hope to add more workshops later in the year in different locations, so stay tuned for future dates!

For more information about the seminar or scheduling a presentation please email katherine.h.mcguiness@state.or.us or tessa.r.jaqua@state.or.us .

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University of Oregon Meningococcal Update and Immunization Efforts

As of March 1st, 2015, 4 students at the University of Oregon have contracted type B meningococcal disease, and one of these students has died. The Oregon Immunization Program is working Lane County health officials, the University of Oregon, and other Oregon Health Authority programs to prevent the spread of this disease. To find the most up to date information on this emergency, please visit our 2015 Meningococcal Update website.

There are vaccine options available for students U of O students in the form of mass vaccination clinics at Matthew Knight arena from March 2-5, and over 15 pharmacies in Lane County, including Safeways, Walgreens and Albertsons, are offering the vaccine to students. You can find out more details about those events and participating pharmacies by visiting https://healthcenter.uoregon.edu/getthevax.aspx

 

Meningitis: What It Is, How it Spreads and Symptoms to Look For

Meningitis is a disease caused by the inflammation of the protective membranes covering the brain and spinal cord.  Meningitis is usually caused by bacteria or viruses, but can also be caused by physical injury, cancer or certain drugs.  Neisseria meningitidis is a bacterium that causes meningitis and other serious infections. The 6 subtypes of these bacteria are responsible for most meningococcal disease worldwide. Type B causes approximately 50% of the cases in Oregon and is suspected to be the cause of the most recent outbreak in Eugene (2015). 

Meningitis is generally transmitted through direct exchange of respiratory and throat secretions by close personal contact, such as sharing drinks or kissing. Fortunately, none of the bacteria that cause meningitis are as contagious as the common cold or the flu. In order for the illness to spread, a person would need to have close contact with the patient for several hours in a seven day period. 

Meningococcal disease can progress rapidly, and early symptoms are not easily recognized and are difficult to distinguish from other more common infections like the flu. These include:

• Fever
• Headache
• Stiff Neck
• Confusion
• Drowsiness
• Rash

Students who notice these symptoms (in themselves, friends, or others), should contact the University Health Center at 541-346-2770. 

If the symptoms are unusually sudden or severe, they should consider going directly to a local emergency room.

Some people are carriers of the bacteria and show no symptoms. The disease is unpredictable, and no one really knows all the reasons why some carriers become sick while others do not.

 

How You Can Prevent the Spread of Meningitis

Get vaccinated. In an emergency, such as the one we are in now, people over the age of 10 can be vaccinated.

Do Not Share:

• drinking glasses/cups
• water bottles
• utensils
• toothbrushes
• cosmetics
• cigarettes/e-cigarettes/hookah

 

Don’t drink out of a common source such as a punchbowl

Cough into a sleeve or tissue

Know that kissing poses a risk

Wash and sanitize your hands often

Resources

Oregon Health Authority Meningococcal Disease Fact Sheet

University of Oregon Health Center

Lane County Vaccine Clinics

CDC Website on Meningococcal Disease

CDC Website on Meningococcal B Vaccines


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