Job Corps Webinar:

Immunizations

John Kulig MD MPHLead Medical Specialist

September 29 & 30, 2010

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Learning Objectives

Participants will be able to:• List current PRH requirements for

immunizing students ages 16 to 24 after review of their immunization history

• Describe current CDC vaccine recommendations

• List a variety of resources to expand the availability of vaccines

Which vaccines does PRH-6 require?

• Tetanus and diphtheria toxoid (Td)• Inactivated polio vaccine (IPV) for students

under age 18 years• Combined measles, mumps and rubella

vaccine• Hepatitis B vaccine series for health personnel

and health occupations training students • Immunizations shall begin within 14 days after

a student’s arrival and shall be documented on the Job Corps Immunization Record

[[PRH 6.10 R1]]

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Which additional vaccines does CDC recommend?

• Refer to TAG B: Immunizations and Communicable Disease Control, for optional immunizations that may be recommended but not required by the center physician, based upon availability.[PRH 6.10 R1]

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Tetanus-diphtheria-pertussis

PRH requirement: • Td booster if no documentationCDC recommendation:• Tdap (Adacel® or Boostrix ®)

• 5 years after last DPT or Td• alternative to tetanus toxoid and

tetanus diphtheria booster

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Polio

PRH requirement:• inactivated polio vaccine (IPV)

for students under age 18 years if no documentation

CDC recommendation:• administer a total of 4 doses

under age 18 to those not previously vaccinated

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Measles-Mumps-Rubella (MMR)

PRH requirement:• MMR vaccine if no documentation

• await HIV screening results

CDC recommendation:• administer 2 doses of MMR

vaccine at least 28 days apart to those not previously vaccinated

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Hepatitis B

PRH requirement• required for health personnel and

health occupations training students

• optional for all othersCDC recommendation• administer the 3-dose series to

those not previously vaccinated

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Meningococcal

PRH requirement• optionalCDC recommendation• one dose of meningococcal

conjugate vaccine (MCV4) (Menactra® or Menveo ®)

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Varicella

PRH requirement• optional• varicella titers may be a cost

effective alternative to vaccination – see

TAG-BCDC recommendation• administer two doses of varicella

vaccine for all adolescents and adults without evidence of immunity

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Hepatitis A

PRH requirement• optionalCDC recommendation• administer two doses of

hepatitis A vaccine at least 6 months apart to those not previously vaccinated

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Human Papillomavirus

PRH requirement• optionalCDC recommendation• administer 3 doses for females

through age 26 (HPV4 or HPV2)• permissive recommendation for

males through age 26 (HPV4 only)

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Influenza

PRH requirement• optional• recommended via Information

NoticeCDC recommendation• administer annual seasonal

influenza vaccine to everyone in the US age 6 months and older

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Pneumococcal

PRH requirement• optionalCDC recommendation• based upon the presence of

risk factors

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Haemophilus influenzae B

PRH requirement• optionalCDC recommendation• based upon the presence of

risk factors

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Tuberculin skin testingPRH requirement [PRH 6.10 R1]:• A tuberculosis skin test (Mantoux) is

required of all new students who do not have documented proof of a previous negative Mantoux (PPD) test taken within the last 12 months.

• Annual tuberculin testing should be done for students in health occupations and for students at increased risk of infection.

• In addition, students in health occupations shall receive a Mantoux test prior to clinical work experience in accordance with state or local health department requirements.

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Tuberculin skin testing• Results of tuberculin skin testing should be

interpreted without regard to a prior history of BCG vaccination.

• Refer to Treatment Guidelines in TAG M: Health Care Guidelines, for management of students with a positive Mantoux (PPD) test.

• For students with a positive PPD, local health departments will often provide chest films and nine (9) months of isoniazid prophylaxis at no cost to centers.

• For Job Corps students being treated with isoniazid (INH) for latent tuberculosis, neither supplemental pyridoxine (vitamin B6) nor monitoring of liver function studies is routinely indicated. 1919

Immunization waivers

• The center physician may grant waivers of immunization requirements for valid medical and/or religious reasons.

• Such a waiver shall be clearly documented by the center physician in the student’s health record and include an explanation as to why the decision was made.

[PRH 6.12 R7]

Vaccine Adverse Event Reporting System (VAERS)

• Report all clinically significant postvaccination reactions to the Vaccine Adverse Event Reporting System (VAERS)

• Reporting forms and instructions on filing a VAERS report are available at www.vaers.hhs.gov or by telephone at 800-822-7967

Immunization resourcesVaccine Information Statements (VIS)• A Vaccine Information Statement (VIS) is a one-

page (two-sided) information sheet, produced by CDC. VISs inform vaccine recipients — or their parents or legal representatives — about the benefits and risks of a vaccine. The law requires that VISs given out whenever certain vaccinations are given.

• VISs are required by the National Childhood Vaccine Injury Act of 1986. Their purpose is to inform vaccine recipients, or parents of children getting vaccines, about the benefits and risks of vaccines.

• Download current VISs from: http://www.cdc.gov/vaccines/pubs/vis/default.htm

Vaccines for Children (VFC)

Why should I join VFC?• It will enhance your ability to provide

government purchased vaccine to your eligible patients and reduce Wellness Center costs.

• You can provide all ACIP-recommended vaccines to your eligible patients.

• Any provider authorized to prescribe vaccines under your state law can be a VFC Provider.

Vaccines for Children (VFC)

How do I become a VFC Provider?• First, contact your State VFC Program

Coordinator.• Ask for a Provider Enrollment Package to

be mailed to you. • Complete the State’s Provider Enrollment

forms and return them as soon as possible.

• Prepare your office and staff for a site visit to go over the administrative requirements of the program and to ensure proper storage and handling of vaccines when you receive them.

Vaccines for Children (VFC)Is Medicaid federally mandated to cover ACIP’s VFC-recommended vaccines for theMedicaid population?• Yes, all of ACIP’s VFC-recommended vaccines are part of the EPSDT benefit package for Medicaid children under age 21. Immunizations through age 18 years are covered by the VFC program. Children 19 years through 20 years

are covered by Medicaid program funds.

http://www.cdc.gov/vaccines/programs/vfc/projects/faqs-doc.htm

Immunization resources• Vaccines for Children Program (VFC)

http://www.cdc.gov/vaccines/programs/vfc/default.htm• State and local health departments• Vaccine manufacturers: GlaxoSmithKline http://www.bridgestoaccess.com/ Merck

http://www.merck.com/merckhelps/vaccines/home.html

Novartis http://www.pharma.us.novartis.com/info/about-us/our-patient-caregiver-resources/paf-enrollment.jsp

• Partnership for Prescription Assistance Partnership for Prescription Assistance http://www.pparx.org/en/prescription_assistance_progrhttp://www.pparx.org/en/prescription_assistance_programsams

Immunization resources

• Centers for Disease Control (CDC)Vaccines and Immunizations http://www.cdc.gov/vaccines/

• Immunization Action Coalition (IAC)

Vaccination Information for Healthcare Professionals http://www.immunize.org/

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Open Discussion Questions Comments

Best Practices

Please identify yourself by name

and center