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
C)
D)
E)
F)
G)
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.
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. .
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 zosterfocusing on disparities and rural populations. They will be working with homecare
agencies to increase the adult rates.
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
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.
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
H)
I)
J)
K)
L)
M)
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.
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.
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.
WIRi) 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.
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)
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.
Dan Hopfensberger announced that he will be retiring in June from the State
Immunization Program after 36 years of service.