Adult Immunization - Welcome to NYSACHO - New York … Adult Meetings/Northeastern/Joyce.pdf ·...

10/27/2016

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Adult ImmunizationNew York State Updates

Diana Joyce, RN MPA BSNAdult & Adolescent Immunization CoordinatorNYSDOHBureau of Immunization

October 27, 2016 2

Let’s talk about:• NYS Adult Influenza and Pneumococcal Vaccine

Coverage• NYSIIS; Adult Consent and Reporting• Vaccine For Adults Program• Pharmacists as Immunizers• Maternal Immunization • Vaccine Preventable Disease Update and• Meningococcal B Vaccines

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How are we doing with Flu and PneumococcalVaccine coverageIn New York State?

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US vs NYS Flu Vaccine Coverage, 2009-16

Source: www.cdc.gov/flu/fluvaxview

0%

20%

40%

60%

80%

100%

HP 2020 Target

US children

NY children

US adults

NY adults

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Flu Vaccine Coverage by Age, 2015-16


0%10%20%30%40%50%60%70%80%90%

100%

6 m+ 6 m - 4y

5 - 12 y 13 - 17y

18 - 49y

50 - 64y

65 y+

U.S.

N.Y.

HP 2020 Target

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NYS Flu Vaccine Coverage by Race and Ethnicity, 2010-15


0%

10%

20%

30%

40%

50%

60%

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16

White

Black

Hispanic

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Healthcare ProviderInfluenza VaccineCoverage

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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Hospitals Nursing Homes ADHCPs D&TCs Hospices Home HealthAgencies

LHCSAs

Median HCP Influenza Vaccination Rates, by Year and Facility/Agency Type, 2013/14 - 2015/16

2013‐14 2014‐15 2015‐16 HP 2020 Target Median 2015‐16

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9


47%

60%

47% 47%

54%

88% 89% 89%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16

Median NYS HCP Flu Vaccination Rates by Year and Facility Type, Hospitals and Nursing Homes, 2008 - 2015

Hospitals

Nursing Homes

Overall

HP 2020 Target

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Pneumococcal Vaccine CoverageIn NYS

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Adults aged 65 and Over PneumococcalVaccination Rates in NYS

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 2012 2013 2014

Adults 65+ years who have ever had a pneumococcal vaccination, BRFSS, 2011-2014

U.S. New York HP 2020 Target

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NYS AdultVaxView Pneumococcal Vaccination Rates

Coverage for adults >18 years who completed BRFSS interviews 2008-2014

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BRFSS NYS Data 2014 Pneumococcal Vaccine Coverage Age 65 or Older

http://www.cdc.gov/vaccines/imz‐managers/coverage/adultvaxview

65.4%NYS

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NYSIIS Adult Consent and ReportingCreated by Dina Hoefer

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Consent for Adult Immunization Reporting to NYSIIS

• Amendments to PHL 2168 passed by the Legislature and effective July 12, 2013

• Revised consent requirements for persons 19 years of age or older

– Individuals who are 19 years or older can consent to have their immunizations registered in NYSIIS and CIR verbally, eliminating the express written consent requirement

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• Expressed need for written consent was eliminated

• All health care providers and pharmacists that administer immunizations to persons 19 years of age or older are still required to obtain consent to submit immunization information

• Now it may be acquired verbally or included in your organization’s existing consent form

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• Adult consent must still be documented; either by

– Manually switching the consent indicator to “yes” in NYSIIS

– Insuring consent is documented in electronic medical record (EMR) and electronically submitted to NYSIIS

• The option to withdraw consent is still in effect

• The NYSIIS Withdrawal Consent form is available from the NYSIIS home page under “Forms” or the NYSIIS website

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• Amendments to PHL 2168 passed by the Legislature and effective Oct 24, 2014

– Bill S7253A-2013; A9561A-2013

– Expanded authorized users

– Changed reporting requirements for adult immunizations

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• Impact

– Consent still required

– Burden of consent on the provider (not DOH)

– RN’s and Pharmacists are REQUIRED to report consented adult immunizations

– Messaging and education on changes to law

• Notification letter published and emailed on March 18, 2015

– More information on PHL 2168 http://www.health.ny.gov/prevention/immunization/information_system/laws_and_regulations/

Amendments to PHL 2168Passed by the Legislature and effective Oct 24, 2014

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Adult Immunizations in NYSIIS

0

100000

200000

300000

400000

500000

600000

700000

800000

900000

2008 2009 2010 2011 2012 2013 2014 2015 2016*

Doses by Year ReportedAge at Immunization 19 years+

Doses

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Lifetime Registry

Patient Entered into NYSIIS <19

Patient Entered into NYSIIS 19+

Immunization given at <19

82,919,113 1,537,286

Immunization given at 19+

164,069 2,640,226

Total 83,093,182 4,177,512

Vaccines for AdultsLeveraging Changing Vaccine Use to Expand Adult Vaccine Access in New York State

Elizabeth Rausch-Phung, M.D., M.P.H.Immunization Program ManagerNew York State Department of Health

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NYS VFA Vaccines

• Hepatitis A

• Hepatitis B

• Hepatitis A/B

• HPV**

• MMR*

• MenACWY**

• MenB**

• PCV13**

• PPSV23*

• Tdap*

• Td*

• Influenza (in season)**Previously offered through MSFWIP but not AHVP**Newly added to both programs

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Eligible sites in NYS outside of NYC

• LHDs

• FQHCs, rural health centers, and community health centers

• Tribal health centers

• Migrant health clinics

• College health clinics

• STD clinics

• Methadone and addiction treatment centers

• County jails

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Eligible Patients

• Uninsured and underinsured adults seeking care at any enrolled site

• Eliminated previous requirements for participating sites to screen patients foro Hepatitis A/B risk statuso MSFW status

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NYS VFA

• 227 active sites • 10,580 doses ordered

through the VFA between 8/1/2015 and 4/6/2016

• 48 LHDs (84%) had more than 1 active adult PIN prior to launch of the VFA (median: 3 adult PINs)

LHD

FQHC

Tribal

Migrant

College

STD

Addiction

Jail

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Pharmacists asImmunizers

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Partners in Protection • New York State Education laws § 6527, 6801, and 6909 permit pharmacists

who obtain additional certification to administer to adults aged 18 years and older:• Influenza vaccines• Pneumococcal vaccines• Meningococcal vaccines• Tetanus, Diphtheria, and Pertussis containing vaccines• Herpes Zoster vaccine

• May administer vaccines under patient specific or non-patient specific orders• Per NYS Public Health law § 2168, pharmacists must:

report all immunizations to persons aged 18 in NYSIIS or the City Immunization Registry (CIR)

report immunizations for persons aged 19 or older to NYSIIS or the CIR upon consent of the patient

• Vaccines not entered in either registry must be reported annually to the Certified Pharmacist Immunization Survey

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Pharmacies and Reporting to NYSIIS

• Pharmacies are increasingly obtaining consent to report immunizations to NYSIIS

• Overall, Pharmacies have reported 17% of adult vaccinations found in NYSIIS – Trend showing increasing contribution from year to year

• All events recorded in NYSIIS are available for providers

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Pharmacies and Reporting to NYSIIS

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Number of Pharmacies Reporting to NYSIIS Jan 2014‐ July 2016

GRP_NAME Number of Stores

Rite Aid 423

CVS Store 378

Walgreens Pharmacy 165

Walmart 112

Kinny Drugs 76

Target Pharmacy 61

Price Chopper 54

Tops Pharmacy 52

Wegmans Pharmacy 47

Stop and Shop Pharmacy 46

Hannaford Pharmacy 45

Medicine Shoppe 4

Kmart Pharmacy 3

Shoprite Pharmacy 3

SaluMed Pharmacy 2

Single Stores 73

Total 1544

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0

20000

40000

60000

80000

100000

120000

Jan Feb Mar April May Jun July Aug Sept Oct Nov Dec

Vaccinations Administered by Pharmacies Reported to NYSIISMonthly for 2014‐2016

2014 2015 2016

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Pharmacy Vaccine Administration; 7/1/2105-6/30/2016 NYSIIS Data

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76,644

79,194

123,921

18‐49 50‐64

Vaccines Administered by Pharmacies2015 – 2016 Season

By Age Group

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35

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

2013‐14 2014‐15 2015‐16

Total Vaccine Doses Reported by NYS Pharmacies, by Data Source and Year

NYSIIS CIR CPIS All Sources

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Flu Vaccine, TdapVaccine and Pregnancy

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Influenza Vaccine

• Advisory Committee on Immunization Practices (ACIP) recommends Inactivated Influenza Vaccine (IIV) for pregnant women

• The live flu vaccine has never been advised for pregnant women • Historically LAIV or IIV could be given to a breast feeding

mother• During pregnancy maternal antibodies cross the placenta and

provide protection to the newborn• Influenza vaccine allows the pregnant woman to develop antibodies

against the flu that provides protection to the newborn baby for up to 6 months of age

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0%

20%

40%

60%

2012 2013

33.6% 42.5%

Before Pregnancy During Pregnancy

46.8%54.4%

NYS Flu Vaccine Coverage Among New Mothers, NYS, 2012-13

Source: NYS Pregnancy Risk Assessment Monitoring System (PRAMS)

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Tdap Vaccine• Recommended vaccination is between 27-36 weeks which allows

for maternal antibody response including passive anti-body transfer to infant

• Substantial transport of maternal Immunoglobulin G (IgG) occurs after 30 weeks gestation

• This timeframe maximizes anti-pertussis antibodies crossing from mother to baby

• Studies have determined higher levels of IgG to pertussis in newborn umbilical cord blood when immunized between 27-36 weeks gestation

MMWR/ February 22, 2013 / Vol. 62/ No. 7

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Tdap Vaccine Recommendations During Pregnancy

0%

10%

20%

30%

40%

50%

60%

70%

2011 2012 2013

7.4% 11.3%23.2%

Tdap vaccine coverage among mothers with a recent live birth, PRAMS, NYS excluding NYC, 2011-2013

Before Pregnancy During Pregnancy After Pregnancy

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Cocooning

Cocooning

Surround infants with a vaccinated family (including extended)

Vaccinate family & friends 2 weeks before “meeting” the baby

NYS PHL § 2805-h

• Hospitals with NICUS must offer influenza vaccine annually, September 1 to April 1, to all persons who are parents, or who are reasonably anticipated to be caregivers in the households of newborns being treated in NICUs.

• Hospitals with newborn nurseries or obstetric services must offer Tdap vaccine to parents and anticipated caregivers of all newborns treated in the hospital following birth

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NYSDOH Bureau of Immunization Initiatives

• Collaborative project with the School of Public Health, SUNY Albany Focus on maternal Influenza and Tdap immunization

Kicked off with a live webcast on July 21st

4 additional webinars are planned with a variety of subject matter experts and providers of obstetrical care.

Some topics include:o Business practices including billing and implementing an immunization program in an office

o Using electronic medical records to improve maternal Tdap and Flu vaccine rates

o Overview of maternal immunization recommendations and applicable NYS requirements

o Communicating with patients

• Link to website:

http://www.albany.edu/sph/cphce/phl_0716.shtml

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Vaccine PreventableDisease UpdatesCreated by Kathy Sen, RN BSNVPD Surveillance Officer

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Mumps

• Mumps-Viral vaccine preventable disease• No longer very common in the US• Year to year variation in the numbers of cases• As of September 10, 2016, 44 states have

reported infections in 1,897** people to the CDC

• Past/Present outbreaks have been reported from universitycampuses and high school aged students

**case count is preliminary and subject to change

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Mumps• People with 2 doses of the MMR vaccine are about

9 times less likely to get mumps than unvaccinated people with the same exposure

• Vaccine is still the best protection against mumps• Some people who receive 2 doses of MMR can still

get mumps, especially if they have prolonged, close contact with someone who has the disease

• If a vaccinated person does get the mumps, they will likely have less severe illness than an unvaccinated person

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http://www.immunize.org/photos/mumps-photos.asp

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VPD Case Reports, 2015 – New York State (excludes NYC)

Disease Cases Incidence/100,000

Haemophilus Influenzae, Type B (< 5 years old) 3 0.0

Hepatitis A 49 0.4

Hepatitis B, Acute 31 0.3

Measles 1 0.0

Mumps 24 0.2

Rubella 0 0.0

Pertussis 616 5.5

S. Pneumo Invasive‐ Resistant 20 0.2

S. Pneumo Invasive‐ Intermediate 23 0.2

S. Pneumo Invasive ‐ Sensitive 630 5.6

S. Pneumo Invasive ‐ Unknown 131 1.2

Tetanus 1 0.0

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NYS Tdap, MenACWY, and HPV Coverage Rates

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2008 2009 2010 2011 2012 2013 2014 2015

≥1 Tdap

≥1 MenACWY

≥1 HPV ‐ girls

≥3 HPV ‐ girls

≥1 HPV ‐ boys

≥3 HPV ‐ boys

HP 2020

NIS Teen 2008-2015

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Meningococcal BVaccines

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What Do You Need to Know about MenB Vaccines?

• The Centers for Disease Control and Prevention(CDC) and NYSDOH do not have a preference for which meningococcal B vaccine is used

• The same vaccine product must be used for all doses Bexsero® (0, ≥1 month after first dose) Trumenba® (0, 1 through 2 months after first dose, 6 months after first

dose)• ACIP recommends patients age 16 through 23 years may be administered

a MenB vaccine at the discretion of the provider• This is based on available antibody data • Goal is to provide maximum protection during the highest risk timeframe

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Vaccine Recommendation

• ACIP recommends MenB vaccines may be administered to those aged 16 to 23 Clinical decision to vaccinate Assessment/discussion of risks and benefits with each individual

patient/parent• Preferred age is 16 to 18 years• This provides short-term protection against most strains of

serogroup B meningococcal disease• Category B recommendation • Vaccines may be administered at the same time as other

vaccines, preferably at a different anatomical site

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6441a3.htm

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NYSIIS MenB Coverage Estimates

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To Sum it All Up• Adults need vaccines too• Even with high childhood vaccination rates, many diseases still persist• Vaccination per recommended ACIP guidelines provides protection across

the lifespan• Effective strategies include:

• Communicating with patients• Utilization of vaccine information databases

NYS-NYSIIS NYC-CIR

• Reminder recall notices• Adhering to national and professional standards of care• Know community resources to refer patients to

Local pharmacies, health departments, travel clinics etc.• Know federal, state and your professional licensure laws

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Reminder/Recall Notice

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Questions?

Contact NYSDOH at:[email protected]

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ResourcesCenters for Disease Control and Prevention (CDC)http://www.cdc.gov/vaccines/index.htmlNew York State Department of Health

o Bureau of Immunizationhttp://www.health.ny.gov/prevention/immunization/Immunization Action Coalitionhttp://www.immunize.org/ACOGhttp://immunizationforwomen.org/

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