Immunization UpdateImmunization Update

Winton G. King, M.D.

Region III Medical Consultant

Job Corps Health and

Wellness Conference

June 7, 2005

Presentation OutlinePresentation Outline

Overview of Immunization Program TagB CDC Guidelines for Children, Adolescents, and

Adults VFC Program Proposed Changes New Vaccines

Overview of Immunization Overview of Immunization ProgramProgram

Purpose of Program

Avoid outbreaks of communicable disease to protect against loss of life and loss of time from work and training.

Support the federal government public health effort in maintaining high levels of immunization in the community.

TAG BTAG B

Required basic immunizations– Td– IPV– MMR– Mantoux tuberculin skin test

Immunizations required at Immunizations required at enrollment without documentationenrollment without documentation

Td booster IPV booster [<18 years] MMR 1 Dose NOTE STUDENTS RAISED OUTSIDE

OF USA RECEIVE PRIMARY SERIES

Required immunizations for students Required immunizations for students on entry with documented on entry with documented

proof of prior immunizationsproof of prior immunizations Td within 10 years none

over 10 years booster

IPV <18years <3 doses booster 3 doses none

IPV >18Years none

MMR 1dose after 12 months 1dose 2 doses after 12 months none

CDC GuidelinesCDC Guidelines(see handout)(see handout)

Children

Adolescents

Adults

VFC ProgramVFC Program

What is the VFC Program?• Established in 1994 to provide vaccinations to children as

part of routine care• Covers underinsured children• Children on Medicaid• Native Americans• Alaska natives at their doctor`s office• Provides free vaccines to doctors who serve eligible

children• Administered by the CDC who contracts w/ manufacturers

to buy at a reduced rate

VFC ProgramVFC Program

How to Join the VFC Program?

1. Contact State VCF Program

2. Ask for Provider Enrollment Package

3. Complete form and return promptly

4. Prepare for site visit

5. Inform patients of VCF program

VFC ProgramVFC Program

Why should Job Corps join?• Reduce out of pocket costs• Provide all ACIP-recommended vaccines• Receive customer service• Minimize paperwork• Order vaccines easily

CDC Vaccine Price ListCDC Vaccine Price ListVaccine CDC Cost/Dose Private Sector

Cost/Dose

Varicella $52.25 $66.81

dT $9.75 $14.99

e-IPV $10.42 $21.80

Menactra $68.00 $82.00

Hepatitis A Adult

$18.75 $63.51

MMR $16.67 $40.37

Hepatitis B Adult

$19.36/$21.23 $59.70

CASE FOR CHANGECASE FOR CHANGE

CDC RECOMMENDS

IT IS GOOD MEDICAL PRACTISE

DECREASES MEDICAL LIABILITY

Medical facts re Medical facts re Meningoccocal DiseaseMeningoccocal Disease

Meningoccocal disease fatality rate can

be as high as 25% in the 15 –24 age

group.

83% of cases in the 15-24 age group are

caused by the four serotypes in Menectra

Medical facts re PertussisMedical facts re Pertussis

20,000 cases reported in 2004 the highest number of cases in 40years

40% of those cases were in 10-19 year olds In the last decade, 700% increase in reported cases

of adolescent pertussis. It is estimated that over a ten year period,if this

vaccine is instituted in the USA,there will be a decrease of 1.8 million cases of pertussis and a subsequent savings of 1.6 billion dollars

New vaccinesNew vaccines

Menectra:– newly licensed meningoccocal – conjugate vaccine– recommended for adolescents and college students

Targeted groups: – 11-12 year olds– 15 year olds– College freshmen in dorms– other groups at high risk[military recruits]

New vaccines cont`dNew vaccines cont`d

Boostrix Tdap– containing tetanus toxoid, acellular pertussis

and low dose diphtheria.– Licensed to be given to individuals10-18 as a

single dose.

Produced by GlaxoSmith Kline

FUTURE NEW VACCINESFUTURE NEW VACCINES

By 2010 vaccines against meningitis

pneumonia,rotavirus caused diarrhea and

human papilloma virus

By 2015 vaccines against HIV/AIDS

Malaria and pulmonary tb

Case for new Case for new recommendationsrecommendations

• Follow CDC guidelines in toto• Add the following immunizations

HepB Varicella Menectra Boostrix

50-Year Timeline in 50-Year Timeline in ImmunizationImmunization

1950s – 1960s 1955 Inactivated Polio Vaccine Licensed 1961 Monovalent OPV 1963 Trivalent OPV Licensed 1st Measles Vaccine 1964 ACIP Formed 1964 20 cases of Congenital Rubella Syndrome 1967 Mumps vaccine licensed 1969 Rubella vaccine licensed

50-Year Timeline in 50-Year Timeline in ImmunizationImmunization

1970s MMR vaccine licensed Smallpox vaccination ceases in the US 1977 Last indigenous case smallpox

(Somalia) 1979 Last case of wild virus polio (US)

50-Year Timeline in 50-Year Timeline in ImmunizationImmunization

1980s 1980 Smallpox declared eradicated from the world 1982 Hepatitis B vaccine becomes available 1986 The National Childhood Vaccine Injury Act

established. 1989-1991 Major resurgence of measles in

USA.55,000 cases compared to a low of 1497 cases in 1983.Two dose MMR is recommended

50-Year Timeline in 50-Year Timeline in ImmunizationImmunization

1990s 1990 The Vaccine Adverse Reporting System

[VAERS] Established 1990 HIB polysaccharide conjugate vaccine

licensed for infants. 1991 Hep B recommend for all infants. 1994 VFC program established

– Polio elimination in USA certified

50-Year Timeline in 50-Year Timeline in ImmunizationImmunization

1990s (cont’d) 1995 1st harmonized childhood immunization endorsed by

ACIP,AAPAND AAFP is published– Varicella vaccine licensed– Hep A vaccine licensed

1996 A cellular Pertussis vaccine licensed for use in infants

1998 1st rotavirus vaccine licensed 1999 FDA recommends removing mercury and

thimerosol from vaccines

50-Year Timeline in 50-Year Timeline in ImmunizationImmunization

2000s 2000 800,000 children die from measles

annually.Measles declared no longer endemic in USA

Pneumococcal conjugate vaccine recommended for all young children

2003 Measles declared no longer endemic in USA

50-Year Timeline in 50-Year Timeline in ImmunizationImmunization

2000s (cont’d) 1ST Live attenuated flu vaccine licensed for use in

5-49 year old persons 2004 Inactivated flu vaccine recommended for

all children 6-23 months 2005 rubella no longer endemic in USA April 12,2005 marks the 50th anniversary of the 1st

Polio vaccine