The Vac-Scene Newsletter (Volume 6, No. 3

State Board of Health Examines Vaccine Costs

The State Board of Health is analyzing the issue of how to support the escalating costs of the public-funded universal vaccine program in Washington. A vaccine task force was formed to review the program and make recommendations to the State Board of Health.

The cost of supporting new Advisory Committee on Immunization Practices (ACIP) recommendations (e.g. routine use of hepatitis A in high incidence areas; pneumococcal vaccine) has created a financial challenge to this state's universal vaccine distribution system. Washington State receives approximately 52% of funding from the federal government for VFC-eligible children, and the state supplements this funding such that all children are eligible for free vaccines.

The task force discussed issues such as:

the value of the universal vaccine distribution system in terms of its overall efficiency, convenience to providers, and contribution to child immunization rates;
using ACIP recommendations to determine which vaccines are included in the state vaccine program repertoire;
whether the state should seek other funding sources to support the program

The State Board of Health will be examining the issue further this summer.

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News from the PHSKC Vaccine Distribution Program: Hepatitis A; OPV; Benchmarking

Hepatitis A Vaccine For All Children in King County

Beginning July 2000, the PHSKC Vaccine Distribution Program will begin supplying hepatitis A vaccine to providers in King County for routine immunization of all children ages 2 through 18 years. The expanded availability of vaccine is in response to the Advisory Committee on Immunization Practices (ACIP) recommendation which identified Washington as one of eleven states with higher than average rates of hepatitis A (i.e. >20 cases per 100,000 population, or twice the 1987-1997 national average). King County is one of 13 counties in Washington State scheduled to receive the vaccine based on high incidence rates.

How To Order Hepatitis A Vaccine

We will begin accepting requests for hepatitis A vaccine for routine immunization on June 19th. The State Supplied Vaccine Request Form is to be used to request vaccine in the usual manner. Providers are encouraged to combine their request for the hepatitis A vaccine along with their monthly vaccine order if possible.

It is particularly important to continue offering and recommending hepatitis A vaccine for children 2-18 years of age who are in any of the following high risk groups as identified by the ACIP:

American Indians, Alaskan Natives and Pacific Islanders
migrant Hispanic children
those living in communities where there are high rates of hepatitis A
all foster children
homeless children and street teens
children attending therapeutic child care programs
males who have sex with other males
injecting drug users
individuals working with non-human primates
those with clotting factor disorders
those with chronic liver disease

For more detailed information about the updated recommendations for hepatitis A providers can go to: http://www.cdc.gov/nip/. Click on ACIP Statements.

OPV Supply to End

King County's inventory of public-funded oral polio vaccine (OPV) expires on June 30, 2000. OPV will no longer be supplied through the vaccine program because of the ACIP recommendation (January 2000) for routine use of an all-IPV schedule. OPV has been available since January 2000 only for children who already began the series with OPV and whose parents wished to complete the series with OPV, and for children traveling in less than 4 weeks to a country where polio is endemic. Manufacturers of OPV in the US have ceased production of this vaccine.

Freezers should be checked carefully before the end of June so that no OPV remains in use beyond the expiration date. All unopened dispettes of OPV should be returned to the PHSKC Central Pharmacy (2124 4th Avenue, Seattle, Washington, 98121) so the state can be refunded excise tax. If you have questions, please call 206-296-4782.

Benchmarking in August

All health care providers receiving public-funded vaccine are asked to participate in a benchmarking activity during the month of August this year. This statewide survey provides valuable information needed for continued federal funding to purchase vaccine.

Training materials and supplies will be provided in the next few weeks. A report detailing results from last year's benchmarking will be made available to providers this summer.

Your participation again this year is greatly appreciated.

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News from CHILD Profile

CHILD Profiles governing board has voted to eliminate subscription fees for providers participating in the immunization registry. This change is effective immediately.

This change and others are the result of a strategic planning process just completed for CHILD Profile. Stakeholders participating in the strategic planning process identified subscription fees as one of the barriers encountered by providers. Eliminating fees will allow participation in CHILD Profile to be universal in Washington State. HEALTHradius, developer of CHILD Profile's web-based interface, supports this change. Access to the standard services will be free for all providers who participate in the registry, whether through CHILD Web or the original CHILD Profile text-based system.

Another outcome of the strategic planning process is an increased emphasis on "populating" the registry with already-existing electronic immunization data from sources such as health plans. This approach increases the value of the registry in an efficient way -- getting historical and recent data into the system without creating extra work for providers. CHILD Profile has recently begun loading immunization records from health plans and Medical Assistance Administration. As a result of two small health plan data loads, there has already been a 14 percent increase in the number of children under age six with immunization records in the system!

CHILD Profile staff continues to upgrade existing program modules for ease of use by health care providers. An enhancement of the Vaccine for Children (VFC) module has been released. This module helps providers to produce the "benchmarking" report on children's eligibility for federally funded vaccines. This can be done through a paper documentation system or through the CHILD Profile VFC module.

If you have questions about CHILD Profile or would like to participate in the registry, please call Sherry Riddick at 425-339-5246.

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Did You Know??

The following questions and answers have appeared in Needle Tips & the Hepatitis B Coalition News. The answers have been provided by William L. Atkinson, MD, MPH, of the CDC's National Immunization Program. Refer to the Immunization Action Coalition website at: www.immunize.org/ and click on "Ask the Experts" for additional questions/answers.

Is it safe to give a vaccine directly into an area where there is a tattoo?

Yes, both intramuscular (IM) and subcutaneous (SC) vaccines may be given through a tatoo.

Why are some vaccinations given subcutaneously (SC) while others must be given intramuscularly (IM)?

In general, inactivated vaccines are administered IM, and live virus vaccines are given SC. Inactivated polio vaccine (IPV) may be given either SC or IM. Vaccines intended to be given IM may cause local reactions (such as irritation, induration, skin discoloration, inflammation and granuloma formation) if injected into subcutaneous tissue. Response to the vaccine may also be reduced if not given by the recommended route. ACIP recommends that any dose of vaccine given via a nonstandard route or site of administration should not be counted, and the person should be revaccinated according to age.

What length and gauge of needle is recommended for SC and IM vaccines given to children and adults?

In both children and adults, SC injections (MMR, varicella, IPV) should be given with a 5/8- to 3/4-inch, 23-25 gauge needle. For IM injections in infants and children, a minimum needle length of 7/8-inch should be used for anterolateral thigh injections, and a minimum of 5/8-inch for deltoid IM injections is recommended. For adults, a 1- to 1½-inch needle is recommended, depending on muscle mass.

Is it acceptable to draw up vaccines at the beginning of the day?

The ACIP recommends against pre-drawing vaccine, primarily because of the increased possibility of administration and dosing errors. Many vaccines look alike after drawing into a syringe. In addition, some vaccines have a very limited shelf life after reconstitution (e.g. varicella vaccine must be administered within 30 minutes). If you decide to pre-draw syringes, it is strongly recommended that you draw up only inactivated vaccines (hep B, DTaP, IPV, Hib) and only enough for a single day's use. Make sure the syringes are clearly marked to avoid administration errors. Pre-drawn doses should be kept refrigerated.

An 11-year old with no immunization record recently immigrated to the USA. What do I do?

An attempt should be made to locate an immunization record. If no record can be found, the person should be revaccinated as indicated for his/her age. You should never presume that anyone without documentation has received vaccine. The child will need the following vaccines: Td, IPV, hep B, MMR, and varicella (or a reliable history of the disease).

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AAP Recommendations on the Use of Pneumococcal Vaccines

The AAP Committee on Infectious Diseases (COID) has issued a recommendation statement on the use of pneumococcal vaccines (conjugated and polysaccharide) in infants and children. The heptavalent pneumococcal conjugate vaccine (PCV7, also known as Prevnar) is recommended for universal use in children 23 months of age and younger. In contrast, the AAP is not recommending universal immunization of low and moderate risk children 24 months of age and older (however this remains under investigation). Both Prevnar and the 23-valent pneumococcal polysaccharide vaccine should be given to high-risk children 24 monthsof age and older.

The full statement of the COID can be found on the AAP website www.aap.org and will be published in an upcoming issue of Pediatrics. At this time, Prevnar is NOT available through the Washington State public-funded vaccine program.

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