2016-2017 Back to School

Immunizations and HPV Vaccination

Presented by: EverThrive Illinois, Illinois Department of Public Health, and Rush SBHC at Orr Academy

PRIORITY AREAS

Child and Adolescent Health

Maternal and child mortality

Healthy Lifestyles

Health Reform

Immunizations

VISION

EverThrive Illinois envisions an Illinois that works towards equity and

social justice, fosters the development of healthy families, and

provides fair access to quality health care – the basic rights of all

human beings.

Agenda

Introduction

Kristen Nuyen, EverThrive Illinois, CAHI

School required immunizations for the 2016-2017 school year

and HPV vaccination

Jan Daniels, Regional Immunization Program Specialist, IDPH

Increasing immunization rates in a SBHC – case example

Lauren Ellis, FNP, Rush SBHC at Orr Academy

Conclusion

Elise Balzer, EverThrive Illinois, Immunizations Initiative

2016-2017

Immunization Requirements

for School ATTENDANCE

Janet Daniels

Illinois Department of Public Health

Regional Immunization Coordinator

August 11, 2016

IDPH MISSION

Protect the health and wellness

of the people in Illinois through

the prevention, health

promotion, regulation, and the

control of disease and injury.

Disclosures

I have no relevant financial relationships with

the manufacturer(s) of any commercial

products(s) and/or provider(s) of commercial

services discussed within this CNE activity.

I do NOT intend to discuss an unapproved or

investigative use of a commercial

product/device in my presentation.

Laboratory Evidence of Immunity

- + IgG or titers accepted for measles, rubella, mumps and varicella.

- Hepatitis B infection: HBsAg, anti-HBc and/or anti-HBs.

- Lab evidence of immunity is not allowed for Hib, pneumococcal, diphtheria, tetanus, pertussis, polio or meningococcal vaccines.

______ _______________________

Students Affected by School Requirements

- Public AND Private Schools

- Rules Target Students by Grade.

- Students attending ungraded school programs (including special education), must comply in accordance with grade equivalent:

* Kindergarten = 5 years of age * 6th graders = 11 years of age

* 9th graders = 15 years of age

School Compliance Aid

Mandated Intervals Between Shots

1 Month = 4 Weeks / 28 Days

2 Months = 8 Weeks / 56 Days

4 Months = 16 Weeks/112 Days

One year of age = On or after the first

birthday.

For Preschool hepatitis B only:

6 months of age = 24 weeks = 168 daysA “4 day grace period” can only be applied

with provision of a provider note. These must

be reviewed by IDPH.

For LIVE virus vaccines (i.e. MMR, Varicella or

FluMist) if the interval between any 2 live

doses is < 28 days, the vaccine administered

second cannot be counted as valid and must

be repeated.

The “4 day grace period” is not accepted on

28 day interval between 2 live-virus vaccines.

6 KEY POINTS for Immunity Reviews

1. Any vaccine dose administered at an interval less

than required in Illinois or prior to the age required

cannot be accepted as valid.

2. If a health care provider* feels that a child is

adequately immunized, or a specific immunization is

not necessary or indicated, then the provider must

submit documentation (provider note) to school

authorities.

3. When a health care provider claims a child is

immune, the provider must submit laboratory

documentation of the child’s immunity to school

authorities.

6 KEY POINTS for Immunity Reviews

4. All proof of immunity documentation must be

reviewed by designated IDPH Immunization staff

with parental consent.

5. While waiting for the notes to be reviewed, consider

the student as in compliance but unprotected.

6. If IDPH determines the provider statement is not

acceptable to prove immunity, then the student

is no longer considered to be in compliance and

is subject to the exclusion provision of the law.

Superintendent of Schools (ISBE)

Weekly Message June 25, 2015SECURING AND SUBMITTING PARENTAL PERMISSION WITH ANY STUDENT DOCUMENTATION

– Reviewed record must be accompanied by signed statement of written permission from parent.

– Must be signed and dated, oral consent does not meet the consent requirements.

– Schools may create a form or letter that meets requirements

– Any request pending at IPDH must be resubmitted with a copy of the written parental consent.

ISSRA, 105 ILCS 10/1 et seq., and FERPA 20 USC§1232g; 34 CFR Part 99.

When Submitting Records for IDPH

Review

• Reviewed record must be accompanied by signed statement of written permission from parent.

• Include student’s name, D.O.B. and current grade level.

• All physician’s notes/statements and current Certificate Child Health Examination Form.

• School contact information; including phone number, fax number and if possible email address.

• Make sure that ALL documents being submitted are legible.

Required Immunizations

School Year 2016-2017

Kindergarten – 12th grade

• DTaP

• Polio

• MMR

• Varicella

• Hepatitis B

• Tdap

• Meningococcal Conjugate

Preschool/Early Childhood/Childcare Center

• DTaP

• Polio

• MMR

• Varicella

• Hepatitis B

• Hib

• Pneumococcal Conjugate

List of Non-immunized Child Care

Facility Attendees or Students Child and Student Health Examination and Immunization Code

Part 665/Section 665.290

Every child care facility and attendance center shall

maintain an accurate list of all children and students who

have not presented proof of immunity against any or all of

the required immunizations as noted in Section 665.240 or

Section 665.280.

The requirements also apply to children who transfer into Illinois child care facilities, school programs and schools from

• Other programs or schools in Illinois• Other schools in other states regardless of the age or grade level at which the child transfers.

Minimum Immunization Requirements for

Those Entering a Child Care Facility

or School in Illinois, Fall-2016

RELIGIOUS OBJECTION

• Must detail specific religious belief which

conflicts with the specific immunization

and or exam.

• Must use the Certificate of Religious

Objection form

• Must be signed by health care provider

(MD/DO; APN; PA) responsible for the

performing the health exam.

• Provider signature attests to informing

the parents of the benefits of

immunization and health risk of not

vaccinating to the student and to the

community.

• Local school authority is responsible for

determining whether written statement

constitutes a valid religious objection.

School ComplianceTwo types of exemptions allowed in Illinois:

Medical and ReligiousMEDICAL OBJECTION

• Must indicate the student’s medical

condition that contraindicates the

specific immunization

• Must be written by a MD, DO, APN

or PA

• The medical objection

documentation should be received

and honored by appropriate school

personnel.

• These students must be placed on a

susceptible list and subject to

immediate exclusion if vaccine-

preventable disease or contact is

identified at the school.

“Students eligible to remain in public

school beyond grade 12 (special

education) shall meet the requirements

for 12th grade.”

Which means these students must be

compliant with requirements for Tdap, 2

doses of MMR, Meningococcal

(MCV4), Varicella, Hepatitis B and Polio

Valid Certificate of Child Health Exams

• What health exam forms can be submitted and accepted for school year 2016-2017?

• The 02-13 and 11/15 versions and other electronically generated forms approved after 2/13 are the versions that can be accepted for 2016-2017.

• After January 1, 2017 only forms approved after 11/1/15 are acceptable.

• Some electronic forms have been approved for use and a statement denoting that approval will appear on the form. These forms will closely resemble the State mandated form. The approved form will include the statement “Approved SHP (date of approval)”.

NEW FORM Established

11/2015

I-CAREIllinois Comprehensive Automated Immunization

Registry Exchange

• Schools can now access immunization records from the State Immunization Registry, I-CARE.

• Allows view and printing of child immunization records.

• Must register for I-CARE by completing the memorandum of agreement , then going on line to sign on through the web portal

• To register for I-CARE either email dph.icare@illinois.gov

or call 800-526-4372

Religious Exemption and general questions regarding requirements in the

School Code: Jessica Gerdes, ISBE, 312-814-8252, JGerdes@isbe.net

General health requirements and child health exams or approved forms:

Vyki Jackson, IDPH, 217/524-1844, victoria.jackson@illinois.gov

Specific immunization requirements and medical exemptions: IDPH-

Immunization Program 217/785-1455 or refer to IDPH Regional Contact List.

Vision and Hearing Screening and Referral: IDPH Vision & Hearing

Program, 217/782-4733.

Dental Examinations: IDPH Division of Oral Health 217/785-4899

WHO TO CONTACT

Human

Papillpmavirus

Preteen &Teen

HPV

Vaccination

HPV

Increase routine

vaccination coverage

levels for adolescents

1 dose of Tdap for adolescents by age 13-15 years

80%

2 doses of varicella vaccine by age 13-15 years

80%

1 dose of MCV4 by age 13-15 years 80%

3 doses of HPV for both males and

females by age 13-15 years --- 80%

ILLINOIS*

13-17 Year Old Adolescents With 3

Doses of HPV

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Completed 3 dose HPV Series

Completed 3 dose HPV Series

*Excludes City of Chicago

HPV Vaccinations In Illinois• IDPH Immunization Program has partnered with EverThrive

Illinois, IAFP, IICAAP, IPHCA to educate healthcare

providers downstate Illinois about the importance

adolescents completing the 3 dose series of HPV

vaccination to prevent cancer.

• Stakeholder meetings are being held throughout

Illinois, including a media campaign and developing tool kits

for school health clinics and Federally Qualified Healthcare

Centers.

• In May, 2016, over 37,000 reminders in 22 counties in

Illinois were sent to remind parents of adolescents to

complete the HPV series.

HPV Toolkit for School Health

Centers

http://www.everthriveil.org/resources/hpv-toolkit-school-health-centers

Questions???

Please type any questions into the question box in the lower

right hand of the screen

Thank you!

THANK YOU

janet.daniels @illinois.gov

Visit our website @

www.dph.illinois.gov

Follow us on Twitter @www.twitter.com/IDPH

Like us on Facebook @www.facebook.com/IDPH.illinois

Rush SBHC at

ORR Academy

A Culture Change:

Increasing vaccine

rates and coverage

Rush School Based Health Centers:

Some background

– 3 SBHC’s: Orr Academy, Simpson Academy and Crane Med Prep

– Population:

– 80% African American, 20% Hispanic

– 90% live at or below poverty level

• The Rush SBHC at Orr Academy celebrated its 30th anniversary this spring!

• This year, the Orr building is adding KIPP kindergarteners and 5th graders.

Vaccine Data for Orr:• 2013 Aug-Oct (compliance season):

– 47 vaccines administered

• 2014 Aug- Oct (compliance season): – 274 vaccines administered

– 483% increase from the 2013

– Represents a culture change in the clinic

• 2014-2015 school year: 966 vaccines given

• 2015-2016 school year: 869 vaccines given (more students were up to date)

• The school went from the being in the red zone to the green zone in terms of compliance!

What changed?

• Two new staff members became

immunization champions

• Made immunizations a priority

• Created a collaborative approach with clinic

staff and CPS staff to increase immunization

rates.

Strategies to increase vaccine

compliance: Identification

• Review and administer vaccines at every visit!

• Work with the school nurse to get copies the Impact Report and a list of the non-compliant students

• Ask the school to help get the non-compliant kids into the clinic

Immunization during Pregnancy

• Confirm all pregnant students received their Tdap in their third trimester

• Support cocooning (everyone around babies needs to be up to date and well!)

Data Management

• Integrate I-CARE and CPS Impact Vaccine Reports into your system– Keep copies in chart if paper records

– If electronic record, enter into EHR (at our site the MA performs this task)

• If possible, enter your info into I-CARE. This can decrease unnecessary vaccines and help you track your student’s coverage.

• Use a template or “smart phrase” for vaccine visits to make charting faster

Consents

• Include vaccine administrations as part of the general consent

• Remember HPV vaccines can administered with a minor consent if the student is sexually active

Patient

Discussion

– Treat “optional vaccines” the same

as all vaccines.

• “The recommended vaccines for your age

group are …” or “You are due for …” instead

of separating out the Flu, HPV and Men B

vaccines from the MMR, Tdap, etc.

ADDRESSING

BARRIERS:

Time

– Helps to have a clinical coordinator have the print outs of I-CARE and the CPS list ready when the patient is roomed.

– Keep a printout of the vaccine schedule and catch up schedule in the exam rooms in case you need clarification about a vaccine schedule.

ADDRESSING

BARRIERS:

Fear• Students:

– Offer to have a friend or staff member hold their hand.

– Education. Ask student which vaccine is most important to them. After educating them about scheduled vaccines, many will either get all recommended vaccines or get one at that visit and come back the next day for the other.

– Show a picture of genital warts.

• Parents: Hear their concerns and validate them. Respectfully, educate about the potential disease prevented by the vaccine.

Genital Warts

Education Examples

• Even when treated, Meningitis kills 10-15% of infected. Of those who survive 10-20% will suffer from effects such as losing their hearing, their arms or legs, or having brain damage. (CDC VIS statement)

• 14 million people get HPV yearly in America, mostly teens. More than 4,000 women die yearly from cervical cancer. The HPV vaccine helps prevent against this cancer as well as throat, anal and penile cancer. (CDC VIS Statement). 77% reduction in cancer causing HPV strains in girls after they started giving the HPV 3 dose vaccine in an Australian study.

ADDRESSING BARRIERS:

Providers

• Providers:

– Don’t categorize students by high risk vs low

risk for the HPV vaccine.

• You never know when that student’s first HPV

exposure will be and the vaccine needs to be

administered BEFORE they encounter HPV.

ADRESSING BARRIERS: Recall

• Great ideas

– Tell students to put a reminder in their phone calendar for the 2nd/ 3rd dose of a series.

• If you can’t use your EHR, use I-Care to generate lists of students who need vaccines

– Have a list of these kids at the front desk. Call these students down during slow times

– Create reminder letters using I-CARE

– Call kids and parents when vaccines are due

Using I-Care to help with Recall:

Running Reports

Creating Reminder Letters

Creating Reminder Letters

Pick which letters you

want to generate

Reminder letter with your text and

due vaccine listed

Creating Reports

You will get an e-mail notification your report

is ready. Go to I-CARE: Reports: Results

Report lists vaccines

overdue and due later

Troubleshooting/Tips

This way when you click “Only active patients” on your report, you won’t get

tons of patients that no longer come to your clinic.

Inactivate students you no longer see

Take Home Points

• Need a culture where it’s habit to

check, double check, offer, and

administer vaccines regularly.

• Target immunizations as a priority

• Be your clinic’s Immunization

Champion!

Thanks!

Questions??

Please type any questions into the question box in

the lower right hand of the screen

Thank you!

Community Resources for HPV

Vaccination

•Provider resources•Sample conversations

•Parents

•Adolescents

Health Care Providers You are the Key to

Cancer prevention!

Sample parent-

provider conversations

HPV Vaccination

Facts and Highlightes

Information on HPV

and other vaccine

preventable disease

recommendations

Guidelines for best

practices

Visit our website at www.everthriveil.org

Find us on Twitter @EverThriveIL

Like us on Facebook at http://bit.ly/like_EverThriveIL

Elise Balzer

Email: ebalzer@everthriveil.org

Phone: 312-763-2389

Or Kristen Nuyen

Email: knuyen@everthriveil.org knuyen@evertheiveil.org

Phone: 312-491-8161

Thank you!

There are so many helpful tools available!

Health care providers should give a STRONG recommendation for HPV as you would any other vaccine

If you have any questions or are interested in any of these resources, please contact us at