This presentation from the Georgia Department of Public Health covers childhood immunization updates. It discusses the importance of vaccines in preventing diseases and herd immunity thresholds. Recent immunization schedule changes and ACIP recommendations for several vaccines including DTaP, hepatitis A, hepatitis B, Hib, HPV, influenza, measles/mumps/rubella, and varicella are summarized. Product updates and best practice guidelines for vaccine administration and storage are also reviewed.
Vaccines in immunocompromised children - Slideset by Professor Kathryn EdwardsWAidid
The slideset by Professor Edwards provides recommendations on vaccinations in immunocompromised children and underlines that innovative new approaches to vaccination are available and need to be explored.
Immunization of children with cancer is a burning topic. Not only concerned parents but also paediatric oncologists have so many questions and queries regarding this matter. This presentation will try to answer those questions with the help of recent and updated guidelines on immunization of both developed and developing countries.
Vaccines in immunocompromised children - Slideset by Professor Kathryn EdwardsWAidid
The slideset by Professor Edwards provides recommendations on vaccinations in immunocompromised children and underlines that innovative new approaches to vaccination are available and need to be explored.
Immunization of children with cancer is a burning topic. Not only concerned parents but also paediatric oncologists have so many questions and queries regarding this matter. This presentation will try to answer those questions with the help of recent and updated guidelines on immunization of both developed and developing countries.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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1. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Childhood Immunization
Update
DPH
Audience / Presenter’s Name / Date
2019
2. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Objectives
At the end of this presentation, participants will be able to:
• Recall the role vaccines have played in preventing diseases
• Discuss the importance of vaccines for children
• Recall two recent immunization updates
• Discuss the role of a vaccine champion
• Discuss GA Immunization law and DPH rules and regulations for schools
and child care attendance
• List at least two reliable sources for immunization information
3. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Topics for Discussion
• 2019 Immunization Schedule Changes
• ACIP Recommendations/Updates
• New and future vaccines for potential use in practice
4. GEORGIA DEPARTMENT OF PUBLIC HEALTH
The Impact of Vaccines in the United States
CDC. National Notifiable Diseases Surveillance System, 2017 Annual Tables of Infectious Disease Data. Available at www.cdc.gov/nndss/infectious-
tables.html. NNDSS finalized annual data as of November 28, 2018.
5. GEORGIA DEPARTMENT OF PUBLIC HEALTH
VPD Vaccination Rate
Needed for
Herd Immunity
Measles 92-94%
Pertussis 92-94%
Diphtheria 83-85%
Rubella 83-85%
Mumps 75-86%
Influenza 30-75%
MMWR. 2017 Nov 3; 66(43): 1171–1177
6. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Immunization Schedule Updates
• All staff must use the same
immunization schedule
• Schedules:
Children & Adolescents 0 through
18 years
Catch-up schedule for ages 4
months -18 years
Children and Adolescents 18 years
or younger based on medical
indications
Adults 19 years and older
Adults based on medical and other
indications
http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
http://www.cdc.gov/vaccines/schedules/hcp/adult.html
READ THE NOTES
7. GEORGIA DEPARTMENT OF PUBLIC HEALTH
http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
8. GEORGIA DEPARTMENT OF PUBLIC HEALTH
http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
9. GEORGIA DEPARTMENT OF PUBLIC HEALTH
http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
10. GEORGIA DEPARTMENT OF PUBLIC HEALTH
http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
11. GEORGIA DEPARTMENT OF PUBLIC HEALTH
What Does It All Mean?
Indication
-Information about the appropriate use of the vaccine
Recommendation
-ACIP statement that broadens and further delineates the Indication
found in the package insert
-Basis for standards for best practice
Requirement
-Mandate by a state that a particular vaccine must be administered and
documented before entrance to child care and/or school
12. GEORGIA DEPARTMENT OF PUBLIC HEALTH
General Best Practice Guidelines
• Altered
Immunocompetence
• Special Situations
• Vaccination Records
• Vaccination Programs
• Vaccine Information
Sources
• Timing and Spacing of
Immunobiologics
• Contraindications and
Precautions
• Preventing and Managing
Adverse Reactions
• Vaccine Administration
• Storage and Handling of
Immunobiologics
13. GEORGIA DEPARTMENT OF PUBLIC HEALTH
General Best Practice Updates
May 14, 2018
• Timing and Spacing, LAIV added, MPSV23 removed
July 18, 2018
• Hep A/ IG administration changed
• Three precautions removed from DTaP row
• Varicella updated for the use of aspirin or aspirin-containing products
• table 4-2 under contraindications and precautions, header changed to
conditions
• “Multiple vaccinations”, HepA and IG- this couplet added to the pairs
which should not be administered in the same limb
• Vaccine Administration, RZV Row/Dose Column state that only 0.5cc
should be withdrawn even if more vaccine remains in the vial
https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/general-recs-errata.html
14. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Diphtheria, Tetanus, and Pertussis Vaccines
(DTaP & Tdap)
Routine Recommendation
• DTaP: 5 dose series administered at 2, 4, 6, 15-18 months and 4-6 years
• Tdap: 1 dose administered at 11-12 years of age; administer 1 dose to
pregnant adolescent (preferably during the early part of gestational weeks
27-36)
Catch-up vaccination
• A 5th dose of DTaP is not necessary if dose 4 was administer at age 4 years
or older
• Children ages 7 through 10 years who receive DTaP or Tdap inadvertently
or as part of a catch-up series should receive Tdap for the routinely
recommended adolescent dose at 11-12 years of age
• For other catch-up guidance, please refer to immunization schedule notes
Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on
Immunization Practices (ACIP), MMWR/ April 27, 2018/ 67 (2); 1-44
15. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Hepatitis A Vaccine
Routine Recommendation
• Administer 2 dose series between the 1st and 2nd birthdays (Havrix 6-12
months apart or Vaqta 6-18 months apart)
Catch-up vaccination
• Administer 2 doses to children 2 years of age or older separated by 6
months
International Travel
• Infants age 6-11 months: 1 dose before departure; revaccinate with 2
doses (separated by 6-18 months), between 12 to 23 months of age.
• Unvaccinated children age 12 months and older: 1st dose as soon as travel
in considered
Prevention of Hepatitis A Through Active or Passive Immunization - Recommendations of the Advisory Committee on Immunization Practices
(ACIP) MMWR Vol. 55/No. RR-7 May 19, 2006
16. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Hepatitis A Vaccine Special Situations
• Administer a 2 dose series to at risk population
Chronic liver disease, clotting factor disorders, MSM, injection and non
injection drug users, homelessness, work with HepA virus (i.e. in
research labs or nonhuman primates with HepA infection)
Persons who anticipate close, personal contact with an international
adoptee during the first 60 days after arrival in the U.S. from a country
with high or intermediate endemicity (administer the 1st dose as soon as
the adoption is planned, at least 2 weeks before the adoptee’s arrival)
• Administer for post-exposure for all persons age 12 months or older
Hep A vaccine or IG may be administered to persons age 40 years or
older, depending on the provider’s risk assessment
MMWR/ February 15, 2019 / 68(6);153–156 MMWR November 2, 2018; 67(43); 1208–1210 MMWR 2018; 67(43); 1216-1220
17. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Hepatitis B Vaccine
Routine Recommendation
• Dose 1 @ birth
• Dose 2 @ 1-2 months of age
at least 1 month after first dose
• Dose 3 @ 6-18 months of age
minimum of 4 months after the first dose
minimum of 2 months after the second dose but not before an infant
is 24 weeks of age
• Administration of 4 doses is permitted when a combination vaccine
containing HepB is used after the birth dose
18. GEORGIA DEPARTMENT OF PUBLIC HEALTH
HEPLISAV-B (HepB-CpG)
Administration
• 2-dose vaccine series administered at least 4 weeks apart (0, 1 month) via IM injection
• Licensed for use in persons ≥ 18 years
Dosing Schedule
• The 2-dose series ONLY applies when both doses are Heplisav
• A series consisting of 1 dose of Heplisav and a different Hep B vaccine, should consist of
3 total doses using the 3-dose schedule minimum intervals
• Doses administered at less than the recommended minimum interval should be repeated
Serologic Testing
• Post vaccination Serologic Testing is recommended 1-2 months after final dose for:
hemodialysis patients; immunocompromised persons, including those with HIV;
healthcare personnel and/or partners of HBsAg-positive persons
MMWR Recommendations and Reports/ Vol. 67/ No. 15/ April 20, 2018
https://www.cdc.gov/vaccines/schedules/vacc-updates/heplisav-b.html
19. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Haemophilus influenzae type b
(Hib)
Routine Recommendation
• 4-dose series at 2, 4, 6, and 12-15 months (ActHIB, Hiberix, or Pentacel)
• 3-dose series at 2, 4, and 12-15 months (PedvaxHIB)
Catch-up vaccination
• Administer 1 dose for unvaccinated children ages 15-59 months
• Refer to catch-up immunization schedule for other catch-up guidance
Special situations
• Refer to immunization schedule notes for guidance when vaccinating high
risk children with medical indications (i.e. chemo, radiation, HSCT,
asplenia, elective splenectomy, HIV and immunoglobulin deficiency, early
complement deficiency)
20. GEORGIA DEPARTMENT OF PUBLIC HEALTH
HPV Vaccine
Routine Recommendation
• All adolescents 11-12 years old (can start at age 9)
• Number of doses dependent on age at initial vaccination
Age 9-14 years: 2-dose series at 0 and 6-12 months (minimum interval
of 5 months; repeat dose if administered too soon)
Age 15 years or older: 3-dose series at 0, 1-2 months, and 6 months
• Persons who completed a valid series with any HPV vaccine do not need
any additional doses
• Through 26 years old, if not previously adequately vaccinated
21. GEORGIA DEPARTMENT OF PUBLIC HEALTH
HPV Vaccine for
Special Population and Situations
Special situations
• Immunocompromised: aged 9-26 years, administer 3-dose
series
• History of sexual abuse or assault: begin series at age 9
• Pregnancy: vaccine is not recommended during pregnancy
If administered inadvertently while pregnant, no intervention
needed-delay further doses until after pregnancy
Pregnancy testing not needed before vaccination
23. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Influenza Vaccines
for 2018-2019 Season in the U.S.
• Trivalent Vaccines (IIV3):
A/Michigan/45/2015 (H1N1)
A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus (NEW)
B/Colorado/06/2017-like virus (Victoria lineage)- like virus (NEW)
• Quadrivalent Vaccines (IIIV4) will also include:
B/Phuket/3073/2013-like virus (Yamagata lineage)- like virus
• ACIP recommends annual influenza vaccine for all persons 6 months of
age and older who do not have contraindications
Recommendations and Reports Vol. 67 / No. 3 MMWR / August 24, 2018
24. GEORGIA DEPARTMENT OF PUBLIC HEALTH
FluMist Medimmune Nasal Spray
(LAIV4)
FluMist Medimmune nasal spray is licensed for healthy persons 2 through 49 years of age
Administration
• Pre-filled single-use sprayer contains 0.2mL of vaccine
• Ensure patient is in upright position
• 0.1mL to be sprayed into first nostril, then dose divider clip is removed from the sprayer
to administer second half of dose (remaining 0.1mL) into other nostril
Contraindications
• Children 2-4 yrs. of age with a diagnosis of asthma or who have had a history of
wheezing in the past 12 months; asthma in people 5 yrs. of age and older
• Persons who are immunocompromised, by medication or disease
• Close contacts and caregivers of severely immunosuppressed persons
• Pregnant women
• Persons who have received influenza antiviral medications within the previous 48 hrs
MMWR Recommendations & Reports/Vol. 67/No. 3, August 24, 2018
https://www.cdc.gov/flu/about/qa/nasalspray.htm
25. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Product Updates
FDA licensure and labeling changes:
• January 23, 2019 FDA approved use of the 0.5mL dose of Sanofi’s Fluzone
Quadrivalent influenza vaccine to include children age 6 through 35
months
• Approval of Afluria Quadrivalent (Seqirus) and Flublok Quadrivalent
(Protein Sciences)
• Expansion of the age indication for FluLaval Quadrivalent (GSK) and
Fluarix Quadrivalent (GSK) to age 6 months and older (previously licensed
for persons 3 years and older)
• Expansion of the age indication for Afluria (Seqirus) to include persons 5
years and older (previously recommended for persons 18 years and older)
• CDC published ACIP’s recommendations for the use of quadrivalent live
attenuated influenza vaccine (LAIV4) in the 2018-19 influenza season
26. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Dosing Algorithm for Children
Recommendations and Reports Vol. 67 / No. 3 MMWR / August 24, 2018
27. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Measles, Mumps, Rubella
Routine Recommendation
• 2- dose series at ages 12 through 15 months and 4 through 6 years (dose
2 may be given as early as 4 weeks after the 1st dose)
Catch-up vaccination
• Unvaccinated children and adolescents: 2 doses at least 4 weeks apart
Special situations
• International travel: 1 dose prior to departure for infants ages 6-11
months followed by routine 2 dose series at 12-15 months (12 months for
children in high-risk areas) and dose 2 as early as 4 weeks
• Administer a 2 dose series at least 4 weeks apart for unvaccinated children
12 months and older, prior to departure
28. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Varicella
Routine Recommendation
• 2-dose series at 12 through 15 months and 4 through 6 years
• The 2nd dose may be given as early as 3 months after the 1st dose (a dose
given after a 4-week interval may be counted)
Catch-up vaccination
• Administer 2 doses to persons 7-18 years without evidence of immunity
• Ages 7-12 years routine interval between doses 3 months (minimum
interval: 4 weeks)
• Ages 13 years and older minimum interval 4 weeks between doses
• The maximum age for use of MMRV is 12 years old
29. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Varicella Immunity
ACIP considers evidence of immunity to varicella to be:
• Documentation of 2 doses of vaccine given no earlier than age 12 months,
with at least 3 months between doses for children younger than age 13
years, or at least 4 weeks between doses for people age 13 years and older
• U.S.-born before 1980*
• A healthcare provider's diagnosis of varicella or verification of history of
varicella disease
• History of herpes zoster, based on healthcare provider diagnosis
• Laboratory evidence of immunity or laboratory confirmation of disease
*Note: Year of birth is not considered as evidence of immunity for healthcare
personnel, immunosuppressed people, and pregnant women
MMWR 2007;56(RR-4); 16-17
30. GEORGIA DEPARTMENT OF PUBLIC HEALTH
MMRV (ProQuad®)
Routine Recommendation
• May be administered to children 12 months through 12 years
of age
• Maximum age for MMRV use is 12 years old
31. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Spacing of Live Virus Vaccines
and Other Products
• PPD and live virus vaccine
Apply PPD at same visit as MMR
If MMR given first, delay PPD 4 weeks or longer if not given during the
same visit
If PPD given first, administer MMR when client returns for skin test
reading
• Spacing with antibody-containing products such as immune globulin (IG)
with live vaccines
MMWR 2007;56(RR-4); 16-17
32. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Polio
Routine Recommendation
• 4- dose series at 2, 4, 6 through 18 months, and 4 through 6 years
• Final dose after the fourth birthday and at least 6 months after the
previous dose
• 4 or more doses of IPV can be administered before the 4th birthday when
a combination vaccine containing IPV is used. However, a final dose after
the 4th birthday is still recommended
Catch-up vaccination
• Final dose to be given on or after the 4th birthday and at least 6 months
after the previous dose, regardless of the number of previous doses
• IPV is not routinely recommended for U.S. residents 18 years and older
In the first six months of life, use minimum ages and intervals only for travel to a polio-endemic region or during an outbreak
33. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Pneumococcal Vaccines
(PCV13) (PPSV23)
Routine Recommendation for PCV13
• 4-dose series at 2, 4, 6, and 12-15 months
Catch-up vaccination for PCV13
• 1-dose for healthy children 24-59 months with any incomplete* PCV13
schedule
Special situations
• High risk conditions include: chronic heart disease, chronic lung disease,
diabetes, CSF leak, cochlear implants, asplenia, sickle cell, asplenia, HIV,
lymphomas, Hodgkin disease, chronic liver disease, alcoholism, etc.
• When both PCV13 and PPSV23 are indicated, administer PCV13 first.
PCV13 and PPSV23 should not be administered during the same visit
34. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Serogroup A, C, W, Y Meningococcal Vaccines
Routine Recommendation
• 2-dose series to be administered at 11-12 years old and 16 years old
Catch-up vaccination
• Age 13-15 years, administer 1-dose and booster at age 16-18 years
(minimal interval 8 weeks)
• 1-dose at age 16-18 years old
Special situations
• 1 dose for first year college students who live in residential housing (if not
previously vaccinated at age 16 years or older) or military recruits
• Refer to immunization schedule notes for additional guidance when
vaccinating clients with medical indications and/or traveling to
hyperendemic or epidemic countries
35. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Serogroup B Meningococcal Vaccines
Clinical discretion
• May be given at clinical discretion to adolescents 16-23 years who are not
at increased risk (preferred age 16-18 years)
Bexsero: 2 doses at least 1 month apart
Trumenba: 2 doses at least 6 months apart. If 2nd dose given earlier than
6 months, give 3rd dose at least 4 months after the 2nd dose
Special situations
• Anatomic or functional asplenia, sickle cell disease, persistent
complement component deficiency (including eculizumab use)
Bexsero: 2-doses at least 1 month apart
Trumenba: 3-dose series at 0, 1-2, and 6 months
• Bexsero and Trumenba are not interchangeable
36. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Rotavirus Vaccine
Routine Recommendation
• Rotarix: 2-dose series at 2 and 4 months
• RotaTeq: 3-dose series at 2, 4, and 6 months
• If any dose in the series is either RotaTeq or unknown, default to 3-dose
series
Catch-up vaccination
• Do not start the series on or after age 15 weeks, 0 days
• Maximum age for final dose is 8 months, 0 days
38. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Just as a reminder……
Regardless of:
• the availability of vaccine
• the funding of the vaccine (VFC, state-supplied, or private
stock)
• whether the vaccine is required for school or child care or
not……….
FOLLOW ACIP Recommendations!!!
39. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Test Your Knowledge!
Q: We have adolescents in our practice who have received the
first 2 doses of the HPV series 1 or 2 months apart according to
the 3-dose schedule. Can we consider their HPV vaccine series to
be complete or do we need to give these patients a third dose?
A: People who have received 2 doses of HPV vaccine separated by
less than 5 months should receive a third dose 6–12 months after
dose #1 and at least 12 weeks after dose #2.
40. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Test Your Knowledge!
Q: Which patients should receive a 2-dose schedule of Trumenba
(MenB, Pfizer)?
A: Healthy adolescents who are not at increased risk for
meningococcal disease should receive 2 doses of Trumenba
administered at 0 and 6 months. If the second dose is given at an
interval of less than 6 months, a third dose should be given at
least 4 months after the 2nd dose.
Recommended Immunization Schedule for Children and Adolescents Aged 18 years or younger, United States, 2017
41. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Test Your Knowledge!
Q: If someone received MPSV4 or MenACWY at age 9 years, will
two additional doses of MenACWY be needed?
A: Yes. Doses of quadrivalent meningococcal vaccine (either
MPSV4 or MenACWY) given before 10 years of age should not be
counted as part of the routine 2-dose series. If a child received a
dose of either MPSV4 or MenACWY before age 10 years, they
should receive a dose of MenACWY at 11 or 12 years and a
booster dose at age 16 years.
Recommended Immunization Schedule for Children and Adolescents Aged 18 years or younger, United States, 2017
42. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Requirements for School and Childcare
Attendance
43. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Goal
• Vaccines work
Goal 100 % compliance rate
• Immunization Laws work
• Partnerships work
47. GEORGIA DEPARTMENT OF PUBLIC HEALTH
School Requirement Updates
• 3231 INS updated December 2017
48. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Certificate of Immunization
(Form 3231)
• Certificate on file at each facility or school
• Photocopies acceptable
• A licensed Georgia physician, APRN, PA or public health official
is responsible for completing the certificate
• Only physician offices and health clinics can obtain blank
certificates
49. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Valid Certificates
All certificates must be marked with:
• Child’s name
• Birth date
• Name and Address of Physician, APRN, PA, Qualified Board of
Health official or State Immunization Office Official
• Certified Signature
• Date of Issue
50. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Expiration Date
• Expires on the date entered as “Expiration Date”
• Must be replaced with a current certificate within 30 days
• Required for all children less than age four years
• Required for all children ages four through ten years who have
not completed K through 6th grade requirements or children
10 years and older who have not completed 7th grade or higher
requirements
• Required if a medical exemption for a vaccine(s) is marked
51. GEORGIA DEPARTMENT OF PUBLIC HEALTH
“Complete for School Attendance”
• Issued only to children who:
Are four years of age or older;
and
Have met all the requirements
for school attendance as
outlined in the Policy Guide
3231REQ; and
Have all the required vaccine
administration dates or natural
immunity dates filled in; and
Do not have a “Date of
Expiration”
52. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Exemptions
Medical
• Physical disability or condition
• Documented in the medical exemption box indicated for each
vaccine
• Reviewed annually
53. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Exemptions
Religious
• Documented on form 2208
• Form kept on file by the
school or facility in lieu of
a Certificate of
Immunization (form 3231)
• Do not expire
54. GEORGIA DEPARTMENT OF PUBLIC HEALTH
School Requirement Updates
• DPH Rules and Regulations 511-2-2-.07
55. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Child Care Requirements
• Number of vaccine doses
• Always need more doses
• Must have a current “expiration date”
56. GEORGIA DEPARTMENT OF PUBLIC HEALTH
School Requirements
• Any “new entrant” enrolling in a Georgia school at any grade or
level, must be age appropriately immunized with required
vaccines
• Number of doses depends on the child’s age
• “Complete for 7th Grade or higher ” is marked; certificate is
complete
57. GEORGIA DEPARTMENT OF PUBLIC HEALTH
3: Completing both boxes: When all
requirements have not been met
10: “Complete for School” checked for child
under age 4
9: No dose DTaP after 4th birthday
2: Doses Hep B spaced incorrectly
7: 1st dose MMR given before age 1 yr.
6: 1st dose varicella given before age 1 yr.
8: No 2nd dose varicella documented
5: Varicella Immunity not
documented by vaccine or
hx/dx/serology date
4: Address and/or contact information not
completed
1: No physician, APRN or PA signature
11. No dose of Tdap or MCV4 for students born on or after 1-
1-2002 entering 7th grade or “new entrants”
58. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Filing of Certificates
• Available for inspection by
health officials
• Photocopy acceptable
• Sent copy to the new
school/facility
• In the case of religious
exemption, form 2208 must be
on file in lieu of form 3231
59. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Tickler Filing System
Instructions located in the
Immunization Guidelines for
Child Care Facility Operators &
School Personnel (Form 3258)
• Set up by month and year
• Parent reminders
• Summary of GA
Immunization requirements
• Document follow-up
• Enforce requirements
61. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Responsibilities
• Physicians and Public Health Clinics
• Child Care and School
• Parent/Caregiver
62. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Become a Vaccine Champion!!
Critical Elements
• Appropriate storage and
handling of all vaccines
• Correct administration of
vaccines
• Education of patients and
parents about vaccines
• Every office and clinic needs a
vaccine champion
63. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Vaccine Champion
Key Characteristics
• Lead your immunization team
• Educate all staff about new vaccines and recommendations
• Educate new staff about vaccine storage, handling, & administration
• Initiate processes to improve immunization rates in your practice/facility
• Assure immunizations of all staff are up-to-date
64. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Improve Access To Immunizations
• Immunization only visits
• Walk-ins for immunizations
• Implement standing orders
• Early, extended, or weekend hours
• Mass vaccination clinics
65. GEORGIA DEPARTMENT OF PUBLIC HEALTH
VAERS
Public Health Reports should be faxed or mailed to the State Immunization Program. Fax number
(404)657-1463
66. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Vaccine Injury Compensation Program (VICP)
The National Vaccine Injury Compensation Program provides
compensation to individuals found to be injured by or have died
from certain childhood vaccines
• Established in 1988 by NCVIA
• Federal “no fault” system to compensate those injured
• Claim must be filed by individual, parent or guardian
• Must show that injury is on “Vaccine Injury Table”
67. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Should We Report Vaccine Errors to VAERS?
• The Vaccine Adverse Event Reporting System (VAERS) accepts all reports,
including reports of vaccination errors
• VAERS is primarily for monitoring adverse health events, and we
encourage reporting of clinically significant adverse health events
following vaccination
• Using clinical judgment, healthcare professionals can decide whether or
not to report a medical error. For example, a healthcare professional
might choose to report a vaccination error if the error might pose a safety
risk (e.g., administering a live vaccine to an immunocompromised patient)
or the error would be preventable with public health action or education
68. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Resources for Factual & Responsible
Vaccine Information
www.immunize.org
69. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Stay Current!
Sign up for listserv sites which provide timely information
pertinent to your practice
• www.immunize.org/resources/emailnews.asp
• AAP Newsletter
• CDC immunization websites (32 in all)
• CHOP Parents Pack Newsletter
• IAC Express
• Websites specific to particular vaccines
70. GEORGIA DEPARTMENT OF PUBLIC HEALTH
Internet Resources
Georgia Department of Public Health
http://dph.georgia.gov/immunization-section
https://dph.georgia.gov/train-trainer
CDC Immunization information
https://www.cdc.gov/vaccines/index.html
Send your clinical vaccine questions to NIPINFO@cdc.gov
CDC Flu information
https://www.cdc.gov/flu/
Immunization Action Coalition
www.immunize.org
71. GEORGIA DEPARTMENT OF PUBLIC HEALTH
State Resources
• GA Immunization Program Office
On call Help line: 404-657-3158
GRITS Help Line: 1-866-483-2958
VFC Help Line: 1-800-848-3868
Website http://dph.georgia.gov/immunization-section
Your local Immunization Regional Program Consultant (IRC)
Epidemiology: 1-866-782-4584
• GA Chapter of the AAP
• GA Academy of Family Physicians
72. GEORGIA DEPARTMENT OF PUBLIC HEALTH
It’s a Team Effort!
High Immunization rates begin with a team designed
plan!
What can your team do to improve rates?