2012 Immunization News Archive

Recommended Immunization Schedules for Persons 0 Through 18 Years of Age — United States, 2012

February 16, 2012 -- On February 9, 2012, the Centers for Disease Control and Prevention published the approved Recommended Immunization Schedules for Persons 0 Through 18 Years of Age — United States, 2012 in the Morbidity and Mortality Weekly Report (MMRW) February 10, 2012 / 61(05);1-4. We are pleased to bring this year's childhood immunization schedule to the attention of our immunization partners.

The article is presented for your review below.

Each year, the Advisory Committee on Immunization Practices (ACIP) publishes immunization schedules for persons 0 through 18 years of age. These schedules summarize recommendations for currently licensed vaccines for children 0 through 6 years of age, 7 through 18 years of age, and catch-up immunization for persons 4 months through 6 years of age, and include recommendations in effect as of December 23, 2011.

Vaccination providers are being advised to use all three schedules and their respective footnotes together and not separately.

A parent-friendly schedule for children and adolescents is available online.

Changes to the previous schedules include the following:

Recommended immunization schedule for persons 0 through 6 years of age:

• Quadrivalent meningococcal conjugate vaccine (MCV4) purple bar has been extended to reflect licensure of MCV4-D (Menactra) use in children as young as 9 months of age.
• A wording change has been introduced in the hepatitis A (HepA) vaccine yellow bar; wording now states, "Dose 1." A new yellow and purple bar has been added to reflect HepA vaccine recommendations for children 2 years of age and older.
• Guidance is provided for administration of hepatitis B (HepB) vaccine in infants with birthweights less than 2,000 grams and 2,000 grams or more. Clarification is provided for doses after administration of the birth dose of HepB vaccine.
• Rotavirus (RV) vaccine footnotes have been condensed.
• Haemophilus influenzae type b (Hib) conjugate vaccine footnotes have been condensed, and use of Hiberix® for the booster (final) dose has been clarified. Guidance for use of Hib vaccine in persons 5 years of age and older in the catch-up schedule has been updated.
• Pneumococcal vaccine footnotes have been condensed.
• Guidance is provided for use of measles-mumps-rubella (MMR) vaccine in infants 6 through 11 months of age. Footnotes in the catch-up schedule have been condensed.
• HepA vaccine footnotes have been updated to clarify that the second dose of HepA vaccine should be administered 6 to 18 months after dose 1.
• MCV4 footnotes have been updated to reflect recent recommendations published in the MMWR.
• Influenza vaccine footnotes have been updated to provide guidance on live, attenuated influenza vaccine (LAIV) contraindications.
• Influenza vaccine footnotes also have been updated to clarify dosing for children aged 6 months through 8 years for the 2011-2012 and 2012-2013 seasons.

Recommended immunization schedule for persons 7 through 18 years of age:

• Updated to include number of doses for each vaccine.
• Information regarding the recommended age (16 years) for the booster dose of MCV4 has been added.
• Tdap vaccine recommendations for children 7 through 10 years of age have been updated.
• Human papillomavirus (HPV) vaccine footnotes have been updated to include routine recommendations for vaccination of males.
• Varicella (VAR) vaccine footnotes have been condensed.
• Inactivated poliovirus vaccine (IPV) footnotes have been updated to include upper age limit for routine vaccination. IPV footnotes in the catch-up schedule have been condensed, and relevant wording added to the catch-up schedule.

Catch-up immunization schedule for persons 4 months through 18 years of age who start late or who are more than 1 month behind:

• HepA vaccine and HepB vaccine footnotes have been removed. Relevant wording has been added to the schedule.
• MCV4 vaccine has been added along with corresponding footnotes.

The recommended immunization schedules for persons 0 through 18 years of age and the catch-up immunization schedule for 2012 are approved by the ACIP, the American Academy of Pediatrics, and the American Academy of Family Physicians.

The National Childhood Vaccine Injury Act requires healthcare providers to provide parents/guardians or patients with copies of Vaccine Information Statements before administering each dose of the vaccines listed in the schedules.

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Distribution of Standard Vaccine Temperature Logs

February 10, 2012 -- The Bureau of Immunization is pleased to share with our immunization partners the availability of a standard vaccine temperature log for use in monitoring temperatures in vaccine storage units. We feel these new temperature logs emphasize the importance of protecting your investments, both in those you serve, and in the vaccines you administer. Recalling and revaccinating children can be inconvenient, time-consuming and costly, often leaving them underprotected for some time. Replacing a compromised vaccine supply is definitely costly. Vaccine accountability and storage and handling issues are always an opportunity for quality control. This tool will assist providers in protecting their vaccine inventory.

The Bureau has printed a set of Vaccine Temperature Logs and distributed them statewide to all providers currently enrolled in our Vaccines for Children (VFC) Program. Each provider on our VFC Program mailing list with a valid address should be receiving a 6 months supply of logs for the refrigerator and freezer. These logs are designed such that each sheet can be used to document AM and PM readings for 15 days for a single storage unit. They should be arriving soon, if not already.

There are several reasons why we believe these will be useful:

The standardized form will decrease occurrence of temperature excursions without immediate action. We have noted that many providers are still using columnar-style log sheets. This chart format clearly identifies out-of-range temperatures, minimizing misinterpretation by staff. Temperature readings are entered by hand, and users are prompted to take action when the temperature is outside acceptable vaccine storage temperature ranges.

The standardized form increases ease of identifying out-of-range temperatures. Review of temperature excursion events from the past several years indicates that the overwhelming majority occur in offices where columnar temperature logs are in use. The temperature chart makes noting out-of-range temperatures simpler by eliminating a need to scan a list. Excursion time endpoints are clear on the chart.

The standardized form increases the efficiency of Bureau Field Staff time by providers during office visits. Reducing the variance in forms allows field staff to interpret the data provided more quickly, thereby increasing the efficiency of the time they spend in each provider's office. Working with multiple forms requires field staff to use additional time to interpret data. Less time interpreting temperature charts means more time spent providing training, technical assistance and improving coverage rates.

We strongly recommend that each provider begin using these standardized forms. Additional copies can be printed using the pdf file located on the VFC Program Forms webpage.

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Childhood Immunization Champion Award

February 7, 2012 -- The Centers for Disease Control and Prevention (CDC) would like to introduce the Childhood Immunization Champion Award, a new annual award to recognize individuals who make a significant contribution toward improving public health in their communities through their work in childhood immunization. We realize that each of you has an Immunization Champion in your midst. Let's take the opportunity to garner some accolades for the great immunization partners in our state. One CDC Immunization Champion from each of the 50 states and the District of Columbia will be honored during National Infant Immunization Week (NIIW), April 21-28, 2012.

Nominations are due to Laura Rutledge, Executive Community Health Nursing Director, Bureau of Immunization, by February 20, 2012 at the email listed below. Note: Please disregard the Due Date of February 10 on the application. (Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.)
Immunization@doh.state.fl.us

Included at the CDC's Childhood Immunization Champion Award webpage, are various resources you can use to promote this new award program and solicit nominations for deserving Champions from your community. These resources include a one page flyer, posting information for Facebook and Twitter, a web link, a newsletter notice and the award logo. For more information, contact Helen Fox Fields at hfields@immunizationmanagers.org.

Award Criteria

A CDC Childhood Immunization Champion is an individual who meets one or more of the following criteria:

• Has provided community leadership on immunization issues and collaborated with others to build support for increasing immunization rates among infants and young children.
• Has used creative and/or innovative strategies to promote infant and young child immunization and meet unique immunization challenges within their community, state or region, including, for example, reaching hard-to-reach or under-immunized populations.
• Has been a visible immunization champion in a community and/or medical system by acting as a spokesperson, advocate, and/or educator.
• Has been an advocate for immunization policy advancements.

Eligibility

Champions can include healthcare professionals (e.g., physicians, nurses, physicians' assistants, nurse practitioners, medical assistants, etc.), coalition members, parents, and other immunization leaders who meet the award criteria. State immunization program managers, state and federal government employees of health agencies, and individuals who have been affiliated with and/or employed by pharmaceutical companies are not eligible to apply (see page 6 of the nomination packet for more details). It is important to consider who the employer is when determining eligibility. If an individual's salary is paid directly by a health agency within the state or federal government, they would be considered a state or federal government.

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Recommended Adult Immunization Schedule --- United States, 2012

February 6, 2012 -- The Bureau of Immunization is pleased to notify our partners of the release of the Recommended Adult Immunization Schedule — United States, 2012, in the Morbidity and Mortality Weekly Report (MMWR) February 3, 2012/61(04);1-7. The recommended immunization schedules for adults is approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics, and the American Academy of Family Physicians.

Each year, the ACIP reviews the recommended Adult Immunization Schedule to ensure that the schedule reflects current recommendations for the licensed vaccines. The primary changes include:

• A new footnote to links for the full ACIP vaccine recommendations and where to find additional information on specific vaccine recommendations for travelers.
• Table summarizing precautions and contraindications was added.
• Tetanus-diphtheria-pertussis (Tdap) and tetanus-diphtheria (Td) vaccines - Footnote for updated to indicate:
  • Tdap vaccine is recommended for all persons who are close contacts of infants younger than 12 months of age (e.g., parents, grandparents, and childcare providers) and who have not received Tdap previously.
  • Tdap vaccine is recommended for pregnant women during later pregnancy (>20 weeks gestation).
  • Other adults who are close contacts of children younger than 12 months of age continue to be recommended to receive a one-time dose of Tdap vaccine.
• Human papillomavirus (HPV) vaccine - Footnote updated to include routine vaccination of males 11-12 years of age, with catch-up vaccination recommended for males 13-21 years of age. Also now recommended for previously unvaccinated males 22-26 years of age who are immunocompromised, or who test positive for human immunodeficiency virus (HIV) infection, or who have sex with men.
• Hepatitis B vaccine - Footnote updated to include the recommendation to vaccinate adults younger than 60 years of age who have diabetes, as soon as possible after diabetes is diagnosed. Also now recommended at the discretion of the treating clinician for adults with diabetes who are 60 years of age or older based on a patient's likely need for assisted blood glucose monitoring, likelihood of acquiring hepatitis B, and likelihood of immune response to vaccination.
• Zoster vaccine – Notes recently approved by FDA for administration to persons 50 years of age and older; however, the ACIP continues to recommend that vaccination begin at 60 years of age.
• Influenza vaccine - Footnote revised to specify age indications for the different licensed formulations of trivalent inactivated influenza vaccine (TIV).
• Measles-mumps-rubella (MMR) vaccine - Footnote simplified to focus only on routine use of this vaccine in adults. Readers referred to the ACIP's MMR and healthcare personnel recommendations regarding the use of MMR vaccine in outbreak settings.
• Meningococcal conjugate vaccine (MCV4) and meningococcal polysaccharide vaccine (MPSV4) - Specific information added for specific age and risk groups.

The National Childhood Vaccine Injury Act requires healthcare providers to provide parents/guardians or patients with copies of Vaccine Information Statements (VIS) before administering each dose of the vaccines listed in the schedules.

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Immunization Update

January 29, 2012 -- As a result of considerable interest being expressed in the following issues, the Bureau of Immunization would like to provide the following questions and answers (Q&A) to all County Health Departments (CHDs). We hope this information will be useful in implementing the new polio requirement for kindergarten students and completing the Form DH 681, Religious Exemption from Immunization.

1. When will the new requirement for the polio (IPV) vaccine series be required for entry into kindergarten?

• Effective for the 2012/2013 school year, the final dose of the IPV vaccine must be administered on or after the student's 4th birthday for entry into kindergarten. The effective date for the new IPV requirement is changed to the 2012/2013 school year due to the lengthy delay in finalizing the Rule (Chapter 64D-3.046, Florida Administrative Code [FAC]) change.
• A 5th dose is required If the 4th dose was administered prior to the 4th birthday.
• A 4th dose is not necessary if the 3rd dose was administered on or after the 4th birthday.
• Students in grades 1 through 12 do not have to be recalled if all 4 polio doses were administered prior to 4th birthday. This requirement applies only to students entering kindergarten, effective for school year 2012/2013.

2. What is the process for providing parents/guardians with a Form DH 681, Religious Exemption from Immunization?

• The CHD will provide a Form DH 681 to a parent/guardian, if requested due to their objection to immunizations for religious tenets or practices.
• The electronically signed Form DH 681 can be accessed by the CHD in Florida SHOTS (Florida State Health Online Tracking System), printed and signed by the parent/guardian to take to the school.
• The CHD can/should point out the specific language on the Form DH 681 (while the parent is signing the form) and also referenced in Section 1003.22, Florida Statute (FS) that: children identified as not being immunized against any communicable disease that is present in a Florida school, preschool or childcare facility shall be temporarily excluded for a time specified by the CHD director or administrator.
• No other information or procedures should be requested of the parent/guardian for obtaining the Form DH 681.
• The authority for this process is referenced in the following: Section 1003.22, FS; Chapter 64D-3.046, FAC, and the Immunization Guidelines Florida Schools, Childcare Facilities and Family Daycare Homes, Effective July 2011.

Immunization Update - Clarification

February 6, 2012 -- The Bureau of Immunization would like to provide further detail/clarification to the January 19, 2012 Immunization Update regarding the process for the provision of the Form DH 681, Religious Exemption from Immunization to parents and/or guardians.

• The County Health Department (CHD) will provide a Form DH 681 to a parent/guardian, if requested in writing because immunizations are in conflict with their religious tenets or practices. Note that the Form DH 681 is a request in writing and the parent need not supply any additional information as proof of their religious tenets or practices.
• The Form DH 681 is accessed by the CHD in Florida SHOTS.
• The electronically certified/signed Form DH 681 represents the parent's (or guardian's) affirmation that a religious conflict exists and that they understand that: children identified as not being immunized against any communicable disease that is present in a Florida school, preschool or childcare facility shall be temporarily excluded for a time specified by the CHD director or administrator.
• The Form DH 681, once electronically certified/signed, will be part of the child's electronic immunization record and accessible to the child's healthcare provider in Florida SHOTS. While the healthcare provider may access, view and print the Form DH 681, only CHDs may issue or rescind the form.
• The parent's or guardian's name will be printed on the electronic signature line.
• No other information or procedures should be requested of the parent/guardian for obtaining the Form DH 681.
• The authority for this process is referenced in the following: Chapter 1003.22, FS; Chapter 64D-3.046, FAC, and the Immunization Guidelines Florida Schools, Childcare Facilities and Family Daycare Homes, Effective July 2011.

Please contact the Florida SHOTS staff at (877) 888-SHOT (7468) if you have questions regarding the electronic Form DH 681.

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Vaccine Information Statement (VIS) - Tdap

January 25, 2012 -- On January 24, 2012, the Centers for Disease Control and Prevention (CDC) published a new Vaccine Information Statement (VIS) that can be used for both tetanus-diphtheria-pertussis (Tdap) and tetanus-diphtheria (Td) vaccines. (Tdap VIS)

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Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes

January 11, 2012 -- The Bureau of Immunization is pleased to announce the final release of the revised Immunization Guidelines for Florida Schools, Childcare Facilities, and Family Daycare Homes, Effective July 2011, and incorporated by reference in amended Chapter 64D-3.046, Florida Administrative Code, which became effective December 29, 2011.

The guidelines, which provide technical assistance to healthcare providers, schools, childcare facility operators, family daycare home operators, school health personnel, and County Health Department (CHD) personnel, are only updated when there are any legislative changes to childcare and/or school requirements.

Updates and clarifications to school and childcare requirements include:

• Effective January 1, 2012, pneumococcal conjugate vaccine (age-appropriate doses) is now required for all children 2 to 59 months of age attending childcare facilities.
• The DH Form 680, Florida Certification of Immunization, has also been updated with minor revisions. The updated DH Form 680 provides a selection for either Code 1 (K to 12) or Code 8 (7th Grade requirement). Providers should select Part A Code1 for children who have completed the requirements for Kindergarten. Providers should enter Part A Code 8 for students who have completed the requirements for and are entering grade 7. Please note: Providers should not complete Part B (Temporary Medical Exemption) if a student entering Kindergarten has completed the Kindergarten requirements.
  
• Effective 2012/2013 school year: there must be documentation of at least one dose of polio vaccine administered on or after the 4th birthday. The requirement is 4 doses with the following exceptions:
  • If 4th dose administered prior to 4th birthday a 5th dose is required.
  • If 3rd dose is administered after the 4th birthday a 4th dose is not required.
• The DH 681 Form, Religious Exemption from Immunization, can be accessed by CHDs through the Florida SHOTS (Florida State Health Online Tracking System). The DH 681 will no longer be available from the Department of Health Distribution Center (once supplies are gone). Please contact the Florida SHOTS staff at (877) 888-SHOT (7468) if you have questions regarding the electronic DH 681.

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Meningococcal Vaccine Information Statement Available in Haitian Creole.

January 10, 2012 -- The Immunization Action Coalition (IAC) recently posted the updated Meningococcal Vaccine Information Statements (VIS) in Haitian Creole. (Haitian Creole VIS)

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Bureau of Immunization Online Training Series

January 10, 2012 -- The Bureau of Immunization film module webinar series is now available for CME/CE credits. (Online Training Series)

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Recommendations on the Use of Quadrivalent Human Papillomavirus Vaccine in Males

January 6, 2012 -- In the December 23, 2011, Morbidity and Mortality Weekly Report, the Centers for Disease Control and Prevention published Recommendations on the Use of Quadrivalent Human Papillomavirus Vaccine in Males – Advisory Committee on Immunization Practices (ACIP), 2011. (HPV Recommendations for Males)