Wisconsin Council on Immunization Practices Meeting

Wisconsin Council on Immunization Practices Meeting

March 13, 2015

119 E. Olin Ave., Madison

Topics Discussed

A)  Dan gave a handout of the Organizational Chart for the Immunization Section

B)  Influenza

i)  Tom Haupt reported on influenza surveillance. Influenza disease continues. This season the influenza hit the elderly very hard this year.

So far there has been 4000 hospitalizations in WI. 72% of hospitalizations were in age >65 years. Majority of cases of the influenza cases did not match the vaccine strain.

WI had 53 pregnant women hospitalized this season, 41% of these pregnant women were immunized. Take away message is that we still need to promote vaccination of pregnant women. Pregnancy appears to be a strong risk factor for influenza disease in this age range.

So far there have been 6 pediatric deaths in the state. The age range was 6mo-12 years. None of these kids were fully vaccinated. One child had an underlying health condition, the others were “healthy” kids. Several had just recently turned 6 months of age, but the children hadn’t yet received their flu vaccination due to waiting for their 6 month “well baby” check-up to receive it. The message here is don’t wait for the “well baby” check-up to get vaccinated. Three of the six children were foster kids.

There was little problem of anti-virals not working during this this year’s flu season.

ii)  Non-Mumps Parotitis and Influenza –Tom reported that in WI, 97 patients were tested for mumps due to parotitis. All of these cases ended up being negative for mumps. The buccal swabs were then tested for influenza. 43/97 were found to be positive for influenza A H3

iii)  Highly Pathogenic Avian Influenza-HPAI; Tom reported that there are 54 avian influenza outbreaks in the US right now. The strain is H5N2. This is highly pathogenic to birds (seeing this in commercial turkey flocks). This is being seen in Minnesota, Kansas and Missouri. This is the first time it is being seen in the migratory route of the Mississippi fly zone. WI has two main commercial turkey plants, one in Barron County and one in Jefferson County. This could also affect chickens. If this is seen in WI, public health will need to monitor workers at these farms for 10 days. These individual will also be offered prophylaxis (ten days of Tamiflu, twice a day). So far there has been no bird to human transmission.

iv)  Vaccine doses administered to-date; Ashley Petit distributed a handout regarding influenza doses entered in WIR. At this point, there have been less doses administered this year as compared to last year. Member of WCIP commented that they saw that their patients, who generally did get the vaccine, refused the vaccine this year, due to media coverage stating that this year’s “vaccine didn’t work”. The public is not hearing the message that vaccination still does protect against severe disease.

v)  2014 School based clinics-Jackie Nelson stated that for the 2014-15 influenza season, 45 LHDs did school based mass clinics (10 LHDs did mass clinics using other vaccines, but not including influenza vaccines). For the 2015-16 influenza season, 52 LHDs plan to do mass clinics (29 LHDs will also do additional vaccines along with flu)

vi)  2015 Pre-book by the State Immunization Program. Jackie reported that in 2014 -15, 298,000 doses were ordered; For the 2015-16 season, 272,000 doses have been ordered.

vii) Non preferential ACIP vote for influenza vaccine –Dr. Temte reported that ACIP recommended annual influenza vaccination for everyone 6 months and older with either the live attenuated influenza vaccine (LAIV) or the inactivated influenza vaccine (IIV), with no preference expressed for either vaccine, when either one is otherwise appropriate.

C)  Suspect measles update-Stephanie Schauer reported that there have been 117 measles cases in the US, 73% were linked to California; At this time there are no cases in WI; 159 cases have been investigated in WI; They had been seeing some rash due to post vaccination (anywhere from one week post vaccine to one month post vaccine) Clinicians need to be vigilant of clinical symptoms and of travel history. .

D)  Dr. Jay Gold stated that MetaStar has submitted to CMS an application for a grant to increase rates of immunizations in adults for influenza, pneumococcal, and zoster-focusing on disparities and rural populations. They will be working with homecare agencies to increase the adult rates.

E)  National Adult Immunization Plan-Dan Hopfensperger distributed a handout that addressed the need to increase the focus on adults immunizations—National goals will be to a) Strengthen the Adult Immunization Infrastructure b) Improve Access to Adult vaccines c) Increase community demand for adult immunizations d) Foster innovation in adult vaccine development and vaccination related technologies

F)  HPV-Tracy Andrews gave an update on the HPV grant

i)  Sixteen immunization coalitions were given funding to improve HPV rates.

Activities included PSA’ at movie theaters; PSA’s on radio stations; Print advertising;

Lunch and Learn to providers including receptionist staff; Bus shelter adds; bus adds; Facebook/Twitter info; Billboards

ii)  CDC has a lot of printable HPV material on their website.

iii)  Other activities which the State Immunization program are looking at are:

Working with Cancer Coalitions-WI Cancer Control program, WWWP; Looking at funding AAP to provide a training session in Northern WI regarding HPV (similar to training done in June 2014 in Madison); implementing reminder recalls being sent from the State Immunization Program

iv)  The State Immunization Program will apply for a one year extension on this grant extending it to October 2016

v)  Phase in of HPV9-Dr. Temte stated that ACIP approved the use of HPV9 at their February 2015 meeting. There are no recommendations to revaccinate those who have completed their HPV series. Some people are choosing to wait or delay vaccination until HPV9 is available. The Vaccines For Children program will not make HPV9 available until the ACIP recommendations are published.

G)  School immunization law-Bette Carr DPI Nursing Consultant, distributed information regarding FERPA vs. Immunization Sharing. Per Dale King, Director of Family Policy Compliance Office, US Dept of Education, “schools may not share Personally Identifiable Information (PII) with others, except in very few circumstances”. Per Bette, FERPA guidelines do not allow schools to release student’s names or immunization information to LHDs or DA’s without a parents consent. Dan Hopfensberger will have the State Immunization legal counsel look at DPI’s legal stance on this.

H)  VFC

i)  Meningococcal B vaccine provision-Per Dan this will not be implemented until ACIP stance is published. Some of the committee raised questions on how this will be implemented in an outbreak situation. Who will pay for the vaccine in an outbreak situation?

ii)  Provision of VFC vaccines to pharmacies-Budget bill is asking MA to pay pharmacies for the administration fee for all vaccines for children age 6-18, right now they will only pay for influenza vaccine administration.

iii)  Birth-dose Hepatitis B Program update-A request has gone out that VFC vaccine only be used with those who don’t have insurance; give others Hep B from private purchased inventory. Some hospitals are choosing not to re-enroll in the program because of this. It is the State Immunization Program’s hope that those hospitals will just choose to purchase this privately. Many already have it in their policies to give Hep B birth dose. 50% of all births are MA eligible.

iv)  Tdap cocooning program update-Stephanie Schauer reported on requiring participants to record Tdap in WIR if using VFC vaccine. The State is not receiving much push back on this.

I)  Ruth Koepke distributed a handout regarding Tdap and Influenza vaccines administration during pregnancy. Per Ruth’s presentation, uptake of use of vaccines has increased each month since the Tdap recommendation has been initiated. Influenza administration varies by month of the year. There is more uptake of administering influenza vaccines during the “flu season” months.

J)  WIR-

i)  They are moving forward in Administrative Rules changes regarding meningococcal dose in adolescence.

ii)  A memo was sent requiring mandatory WIR documentation if one is using VFC vaccine.

iii)  As of 3/20, WIR will be able to show Meningococcal B vaccine. The prompting on this will only show up once the first dose is given. The program is waiting on ACIP guidance on the scheduling of this.

iv)  They are looking to recruit long-term care facilities to enter vaccines into WIR.

K)  Review of February 2015 ACIP meeting-The meeting was shortened due to threat of snow and freezing rain. Topics of Influenza, HPV9, Meningococcal B, were discussed earlier. ACIP moved to remove the 10 years revaccination recommendations for Yellow Fever for most people. (WHO has done this as well)

L)  The State Immunization Program has been asked by employers to vaccinate J-1 Visa student workers at WI Dells with MMR. These students come to work during the tourist season, but don’t come with vaccination records. The State Immunization feels they cannot provide vaccine for this. They are stating that this is the responsibility of the employer. Talks regarding this continue at this time.

M)  Dan Hopfensberger announced that he will be retiring in June from the State Immunization Program after 36 years of service.