Oklahoma immunization update, 03/2013

              Oklahoma Immunization Update
March 2013
PREVENTION and PREPAREDNESS SERVICES
IMMUNIZATION SERVICE
PLEASE POST & DISTRIBUTE TO ALL NURSING AND MEDICAL STAFF
Oklahoma Clinics Achieve High Immunization Levels
The Oklahoma State Department of Health Immunization
Service would like to recognize the following clinics for their
efforts to increase the immunization levels of children 19
through 35 months of age who have received the primary
series of 4 DTaP, 3 polio, 1 MMR, 3 Hib, 3 HepB and 1
varicella:
· Indian Health Care Resource Center, Tulsa - 80%
· Warren Clinic Owasso - 100%
· Dr. Thomas Salyer, D.O., Idabel – 84%
The Indian Health Care Resource Center in Tulsa increased
their immunization rate from 64% in 2010 to 80% for the
first quarter of 2013. This increase was the result of clinic
staff calling the parents of children who were behind on
their immunizations and scheduling appointments for
them. If children missed a scheduled appointment, clinic
staff called and followed up with the parent to re-schedule
the appointment. They also utilized flu clinics to check for
other immunizations needed or past due.
Warren Clinic Owasso achieved a 100% immunization level
in the first quarter of 2013 by focusing on use of the OK BY
ONE schedule. The OK BY ONE Schedule simplifies the
childhood schedule to 4 visits and is designed to increase
the percentage of children who receive the 4th dose of DTaP
on time. Use of the OK BY ONE schedule helped clinic staff
reduce missed opportunities to vaccinate to zero. The clinic
supervisor, Becky Day states, “We were fortunate to have
Dr. Chelsea Galutia join our practice last fall. She is a
diligent, proactive provider who carefully monitors the
vaccination records of her patients. I am confident that her
efforts are the reason for this excellent result.”
Dr. Thomas Salyer’s Office in Idabel achieved a rate of 84%.
Wanda Salyer, office manager, states, “As the office
manager I can say that ALL our employees work hard to get
the vaccines given on time. Starting with our front office
staff, and ending with our nurses. They deserve the
recognition. Job well done!” Dr. Salyer’s staff pulls patient
charts a week in advance of the appointment to determine
what vaccines are due. Charts are reviewed a second time
the day before the appointment. If a parent is hesitant
about their child receiving immunizations, the nurse
explains that by not staying on schedule she will not be
able to use combination vaccines to the fullest benefit and
this will result in the child receiving more needle sticks
overall. Some parents will still not allow more than 2 shots
per visit, but with perseverance the clinic staff reached 84%
up-to-date.
Updated Recommendations for Use of Tdap Vaccine in
Pregnant Women Published
The Centers for Disease Control and Prevention (CDC) has
published updated recommendations for use of Tdap
vaccine in pregnant women. These recommendations
replace the provisional recommendations posted in October
2012. The Advisory Committee on Immunization Practices
(ACIP) recommends that healthcare personnel administer a
dose of Tdap to pregnant women during each pregnancy,
irrespective of the patient’s prior history of receiving Tdap.
To maximize the maternal antibody response and passive
antibody transfer to the infant, optimal timing for Tdap
administration is between 27 and 36 weeks gestation.
However, Tdap may be administered any time during
pregnancy.
Vaccination of women with Tdap during pregnancy is
expected to provide some protection to infants from
pertussis until they are old enough to be vaccinated
themselves. Provisional pertussis case counts in the U.S.
for 2012 surpassed the last peak year, 2010, with 41,880
cases and 14 deaths in infants <12 months of age.
In considering whether or not women might receive repeat
doses of Tdap during consecutive pregnancies in a short
period of time, the ACIP reviewed birth statistics in the U.S.
This review revealed that among women with more than
one pregnancy, only 2.5% have an interval ≤12 months
between births, approximately 5% of women have four or
more babies, and for women of lower socioeconomic
status, the interval between pregnancies is generally ≥18
months. The ACIP concluded that the interval between
most pregnancies is likely longer than the persistence of
maternal anti-pertussis antibodies, and most women would
receive only 2 Tdap doses and a small proportion would
receive ≥4 doses of Tdap.” (MMWR Feb. 22, 2013, Vol. 62,
No.7, p. 132).
The ACIP also evaluated data on the safety of repeat doses
of Tdap in pregnant women and “concluded that experience
with tetanus toxoid-containing vaccines suggest no excess
risk for severe adverse events for women receiving Tdap
with every pregnancy.” (MMWR Feb. 22, 2013, Vol. 62, No.
7, p. 133). Safety monitoring in pregnant women following
Tdap administration will include enhanced monitoring of
the Vaccine Adverse Event Reporting System (VAERS) and
utilization of the Vaccine Safety Datalink (VSD). The
recommendations are available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a
4.htm?s_cid=mm6207a4_w.
For an online version of this Update, visit the Immunization Service web page at:
http://www.ok.gov/health/Disease,_Prevention,_Preparedness/Immunizations/Information_for_Health_Professionals/index.html.
The OK BY ONE Schedule is available at: http://www.ok.gov/health2/documents/IMM_Parents_OK_BY_ONE_Flyer.pdf