Announcements. Introducing Vijay Pathangi. VTrckS Tip of the Month Jill King, Director of Vaccine Operations. November 26, Volume 5, Issue 11

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1 November 26, 2013 Volume 5, Issue 11 In this Issue Announcements Introducing Vijay Pathangi VTrckS Tip of the Month VFC Holiday Shipping Hours New Age Indication for Menveo Zostavax (Shingles) Vaccine Annual VFC Provider Enrollment Respiratory Syncytial Virus (RSV) Announcements Upcoming CHIRP user group meetings are scheduled on the following dates: December 19 th Marion County Health Department The meetings will be held 9:30 11:30 am (local time) with a CHIRP training session from 1:30 3:30 pm (local time). National Influenza Vaccination Week is December 8-14, This is a national observance to continue highlighting the importance of influenza vaccination. The Centers for Disease Control & Prevention (CDC) website has some excellent materials including posters, flyers and a media toolkit. Here s the link to the CDC site: Introducing Vijay Pathangi Vijay Pathangi has joined the CHIRP team as its technical lead. Prior to joining the CHIRP team Vijay worked as the lead programmer for the WIC program. Over the past 10 years he has been assisting various programs including Lead and Healthy Homes, TB/HIV, Trauma, Finance and others within ISDH. Welcome Vijay! VTrckS Tip of the Month Jill King, Director of Vaccine Operations When completing your Inventory on Hand supporting document, always delete any vaccines when you have depleted the doses in that lot number. Any newly ordered vaccines will be automatically pre-populated at the time the vaccine is shipped out. This prevents you from having lengthy reports with multiple vaccines to scroll through. To delete the line, check the box to the left of the Vaccine Brand name, under the trash can icon, and then hit the update button at the bottom of the screen. This will streamline your information and make reporting the next month much easier.

2 The VacZine Volume 5, Issue 11 Page 2 of 6 VFC Vaccine Holiday Shipping Schedule Jill King, Director of Vaccine Operations With the upcoming holiday season, we would like to minimize the occurrence of returned vaccine shipments due to office closures. These unsuccessful deliveries are very costly and could result in a delay in re-shipment of vaccine supplies following the holiday season. The Immunization Division, in accordance with the Centers for Disease Control and Prevention (CDC) will be instituting the following Holiday Vaccine Shipping Schedule for all vaccine orders and shipments: November 2013 November 26 th Limited Shipping via McKesson and Merck November 27 th 29 th No Shipping via McKesson and Merck December 2013 December 23 rd - Limited Shipping via McKesson and Merck December 24 th - 25 th - No Shipping via McKesson and Merck December 26 th - Limited Shipping via McKesson and Merck December 30 th - Limited Shipping via McKesson and Merck December 31 st - No Shipping via McKesson and Merck January 2014 January 1st No Shipping via McKesson and Merck January 2 nd Limited Shipping via McKesson and Merck Providers should notify the Immunization Division if they will be closed any additional days during the holiday season. Do not process orders in VTrckS if you have planned dates for office closure. We cannot control when these shipments will be delivered during the holidays. New Age Indication for Menveo Erin Thurston, Health Educator

3 The VacZine Volume 5, Issue 11 Page 3 of 6 In October 2013, The Centers for Disease Control and Prevention s Advisory Committee of Immunization Practice (ACIP) voted on the use of the meningococcal conjugate vaccine Men ACWY-CRM (Menveo, Novartis) in infants and toddlers at an increased risk for meningococcal disease. Once approved by the CDC, this new recommendation will be published in a future edition of the Morbidity and Mortality Weekly Report (MMWR). Menveo prevents invasive meningococcal disease caused by Neisseria meningitides serogroups A, C, Y and W-135. It does not prevent disease caused by serogroup B which is responsible for causing more than 50% of infant cases of meningococcal disease. This recommendation is indicated for children age 2 through 23 months and who fall under the following high-risk categories: Complement component deficiencies Functional or anatomic asplenia, including those with sickle cell disease Those living in areas experiencing outbreaks Those living or traveling to areas with high rates of meningococcal disease, including Sub-Saharan Africa and Hajj The recommended schedule for Menveo is to administer at 2, 4, 6 and 12 months. Children ages 7-23 months should receive a 2-dose primary series, with the second dose on or after 12 months of age. A booster dose is recommended 3 years after the primary series and every 5 years thereafter if the patient remains at high risk for meningococcal disease. Menveo can be coadministered with other routine infant vaccines. Menveo is the third meningococcal vaccine indicated for infants and toddlers at increased risk for the disease. MenHibrix (GlaxoSmithKline) and Menactra (Sanofi Pasteur) are also available for patients with high risk conditions, but with the following exceptions. MenHibrix is not recommended for infants traveling to areas with high rates of meningococcal disease and Menactra should not be given to patients at 9 months with functional or anatomical asplenia to avoid potential interference with pneumococcal vaccine (see table below). Children who remain at high-risk for meningococcal disease should receive a booster dose 3 years after their primary series and then every 5 years thereafter. Either Menactra or Menveo can be used for the booster dose of vaccine. Meningococcal Vaccination for Children 2 to 23 Months (High-Risk) Vaccine Primary Vaccination Indication for Vaccination Not Indicated MenACWY-D (Menactra) CHIRP: MCV4P HibMenCY-TT (MenHibrix) CHIRP: Meningococcal C/Y-HIB PRP MenACY-CRM (Menveo) CHIRP: MCV4O Dose 1: 9 months Dose 2: 12 months 3 month interval between doses Doses at 2, 4, 6 & months Age 2-6 Months: Doses at 2, 4, 6 & 12 months Age 7 23 Months: Dose 1: 7 months Dose 2: 12 months 3 month interval between doses. Min age dose #2 is 12 months Complement deficiencies Outbreaks Travel Complement deficiencies Outbreaks Asplenia Complement deficiencies Outbreaks Asplenia Travel Asplenia (until at least 4 weeks after PCV series is completed) Travel Booster Dose N/A

4 The VacZine Volume 5, Issue 11 Page 4 of 6 ZOSTAVAX (Shingles) Vaccine Sharon Griffin, Health Educator It is estimated that 1 million or more cases of zoster (shingles) occur each year in the United States. Shingles, or herpes zoster, is a viral infection caused by the chickenpox virus that becomes dormant in nerves. When VZV reactivates, it causes herpes zoster (shingles). On October 25, 2006, the Centers for Disease Control and Prevention (CDC) recommended ZOSTAVAX for all adults 60 years of age and older, regardless of their shingles status. ZOSTAVAX is a live attenuated vaccine manufactured by Merck and Company for the prevention of herpes zoster (shingles). The vaccine is not recommended for therapeutic treatment of shingles or postherpetic neuralgia, a serious and debilitating complication of shingles. Per the manufacturer, ZOSTAVAX is contraindicated in: persons with a history of anaphylactic or anaphylactoid reaction to gelatin, neomycin, or any other component of the vaccine; persons with a history of primary or acquired immunodeficiencies; persons on immunosuppressive therapy; pregnant women or women of childbearing age. To maintain potency, ZOSTAVAX must be stored frozen between -58 F and +5 F (-50 C and -15 C). Use of dry ice may subject ZOSTAVAX to temperatures colder than -58 F (-50 C). ZOSTAVAX is a one-time vaccination and is available in pharmacies as well as physician s offices and in some local health departments. The CDC does not have a recommendation for routine use of ZOSTAVAX for persons 50 to 59 years of age, even though the product is licensed down to age 50. There was some discussion at the October ACIP meeting regarding the age recommendations for use of Zostavax in the younger age group. While the burden is high in the year olds, the goal of vaccination is to prevent shingles-related complications such as PHN which more often occurs in older adults. The duration of the shingles vaccine effectiveness is not currently known. Annual VFC Provider Enrollment Dana Greenwood, Nurse Consultant All VFC providers must re-enroll in the program annually. This year, the Immunization Program will conduct the provider reenrollment during the month of December. The re-enrollment takes place by , and the primary Vaccine Coordinator for each provider site will receive the enrollment packet via during the first few days of December. The packet will include 3 forms: the provider agreement, provider profile and provider storage unit certification forms. Provider enrollment must be completed by 12/31/13. There are many different sources providers can use to complete their profile numbers. Please note that you will need to report the source of data used to build the profile numbers. Options include: CHIRP Reports Electronic Medical Record (EMR) Reports Tally Sheets Medicaid Data Previous year s doses administered Other Please remember that your provider profile includes all children vaccinated at your practice, not just the VFC-eligible children. If your facility utilizes the CHIRP Immunization Registry and maintains Vaccine Inventory for both public and private vaccine, you can determine these numbers using the VFC Profile Reports, by reviewing your total vaccinations administered during the 2013 calendar year. PROVIDER POPULATION Provider Population based on patients seen during the previous 12 months. Report the number of children who received vaccinations at your facility, by age group. Only count a child once based on the status at the last immunization visit, regardless of the number of visits made. The following table documents how many children received VFC vaccine, by category, and how many received non-vfc vaccine. VFC Vaccine Eligibility Categories # of children who received VFC Vaccine by Age Category <1 Year 1-6 Years 7-18 Years Total

5 The VacZine Volume 5, Issue 11 Page 5 of 6 Enrolled in Medicaid No Health Insurance American Indian/Alaska Native Underinsured in FQHC/RHC or Deputized Facility (LHD) This row is intended for use only by LHD s, FQHC/RHC s and a select few providers. Most providers in the VFC program are not deputized. If you are not a FQHC/RHC and are not deputized, you will document your underinsured children below in the non-vfc section Total VFC: Non-VFC, Publicly-Funded Vaccine Eligibility Categories (State) Other Underinsured # of children who received non-vfc Vaccine by Age Category <1 Year 1-6 Years 7-18 Years Total This row will apply to providers who do not meet the criteria for underinsured above in the table. Please note these are still publiclyfunded doses Non-VFC Vaccine Eligibility Categories Insured (private pay/health insurance covers vaccines) Total Non-VFC: Total Patients (must equal sum of Total VFC + Total Non- VFC) Respiratory Syncytial Virus Dana Greenwood, Nurse Consultant Respiratory syncytial virus (RSV) is a significant cause of both upper and lower respiratory infections in children less than 1 year of age. The virus is transmitted through respiratory droplets or contact with the nasal or oral secretions from an infected person, including contact with contaminated surfaces. Passive immunization is the best way to reduce the burden of hospitalization and disease in high-risk infants. A product called palivizumab (Synagis) is recommended for use in infants and children at high-risk for serious complications from RSV, including infants and children receiving medical treatment for chronic lung disease of prematurity/bronchopulmonary dysplasia or congenital heart disease, and infants who are born premature. The patient s current age and level of prematurity are important considerations in determining the need for Synagis. The timing for use of this product is based upon the onset and duration of the RSV season which can vary widely from year to year. Indiana Medicaid approved dosing to begin in mid-october, because we saw 10% virology in Indiana in early October. Typically dosing begins on November 1 st. While Synagis can help prevent development of serious RSV disease, it is not used to treat children already suffering from serious RSV disease, and it also cannot prevent infection with RSV. Doses of Synagis that are administered can be entered into CHIRP using the CHIRP code: RSV-IgIM (RSV-MAb-palivizumab).

6 The VacZine Volume 5, Issue 11 Page 6 of 6 About The VacZine The VacZine is published each month by the ISDH Immunization Division. To unsubscribe from the VacZine, please reply to this message with Unsubscribe in the subject line. Immunization Division Phone: (800) Fax: (317) Division Staff Dave McCormick, Director Brittney Carelock, MPH, Deputy Director of Field Operations Jill King, Director of Vaccine Operations Dana Greenwood, RN, MPH, Chief Nurse Consultant Vijay Pathangi, BS, CHIRP Technical Lead Kevin McCormack, Business Manager Caitlin Gill, MPH Assessment Epidemiologist Click here for a full list of Division Staff Public Health & Preparedness Commission Art Logsdon, Assistant Commissioner Joan Duwve, MD, MPH, Chief Medical Officer