J Promoting Health and Wellness Policy

7/31/2019 J Promoting Health and Wellness Policy

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HEALTHY FAMILIES MASSACHUSETTSPOLICIES&PROCEDURES

PROMOTING HEALTH AND WELLNESS

Health promotion and wellness for both child and parent is important to healthy childdevelopment and to overall well-being. Healthy parents and children are able to grow, play,learn, and, most importantly, interact positively with each other. Families should be able toaccess health care resources for both routine well care, and during times of illness or medicalcrisis. Supporting access to health care resources, promoting consistent preventative healthcare, and encouraging healthy habits are an essential part of HEALTHY FAMILIESMASSACHUSETTS (HFM) service delivery.

HFM promoting health and wellness policies and procedures are divided into the followingsections: Health care access; Health care follow-up; and Ongoing health care engagement.

Attached to this policy are the following appendices: Massachusetts Department of Public Health Immunization Schedule 2011

I. Health Care AccessProgram staff must have a working knowledge of the health care systems and providers inthe catchment area they serve. This should be reflected in the formal and informalcollaborative relationships with community health care providers, as well as programparticipation in activities such as high school or community health fairs, participation incommunity educational forums, etc. Programs are expected to maintain positive, workingrelationships with health care providers, particularly those where pregnant adolescentsand/or young parents are likely to be treated.

A. Primary Care ProvidersWhen participants have a primary health care provider, they have an essentialcomponent to ensure their health and well-being and the health and well-being of theirchildren Programs must determine if program participants and their children have a


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There is regular discussion between the home visitor and participant to trackany changes in the access to or status of the participants or childs primary

care provider. All primary participants without a primary care provider are referred to one.

Secondary participants and others in the extended family who wish to beconnected to a health care provider should also be offered referrals.

All children of participants are connected to a primary health care provider.All program children must have a documented medical/health careprovider.

Furthermore, Programs must also be aware of instances where families may choose to use

non-Western medical providers that align with their cultural beliefs.Knowing about these diverse health care providers (homeopathic medicine,herbal remedies, spiritually-based healing practices, etc,) supports theprograms effectiveness in talking with families about medical homes andsupports cultural competence within the program.

In addition to referrals for primary care providers, programs should providereferrals to dental care on a regular basis and for mental health care, andother health care needs, as appropriate.

B. Medical homeA medical home is defined as the place where a participant and his/her child(ren) gofor consistent medical care over an extended period of time. It is, most likely, where theparticipants primary care provider is located, though not always. Identifying a medicalhome is important in that participants and their children then have a predictable, stableaccess point for health care services. This increases the likelihood that participants willuse medical resources as intended, e.g. rely on the pediatricians office for illness care,use the emergency room for acute care needs only, etc. Connections to a medical homealso make it more likely that participants and their children receive consistent andappropriate medical care, which supports optimal health and development. Homevisitors routinely must discuss the importance of a medical home with participants, help

participants establish a medical home, and promote accessing the medical home in homevisit discussions with participants.

C. InsuranceHaving health insurance is essential to participants accessing health care resources;without this, health care costs can be a barrier to participants and their children

i i d d ll d t P t ff t b f t i l


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discussion must include identifying any barriers to medical insurance enrollment, ifappropriate. Home visitors are strongly encouraged to explore the access to medical

insurance of secondary participants in the program, as well as to extended familymembers.

D. Additional healthcare access supportsHome visitors must discuss with participants other barriers to accessing health care,such as:

affordable, reliable transportation to their health care provider; linguistic match to health providers in the area and/or need for medical

interpretation services; and/or unique barriers to the participant and the participants family to accessing

health care.

II. Health Care Follow-upHFM programs promote the health and well-being of HFM participants by routinelyfollowing up and tracking on health care issues with participants such as

A. ImmunizationsA good regime of wellchild preventative care includes appropriate immunizations.HFM programs support this important health practice by the following:

1. Home visitors must discuss the importance of immunizations and the timely receiptof immunizations. Home visitors are also expected to support the participantsdiscussion of this topic with their childs primary health care provider, as well asexplore and respect the reasons why some parents may choose not to immunize their

children. Home visitors must document these discussions in the home visitingrecord in the PDS.

2. HFM programs must ensure that home visitors provide information and resources tosupport participants to fully immunize their children by age two. All children ofparticipants, regardless of age, must have up-to-date immunizations recorded inPDS that follow the Massachusetts Department of Public Healths (DPH)immunization schedule (please see Appendix A). Any child of a participant whose

parents have declined immunization is not included in the calculations of theprograms immunization rate.

NOTE: HFM defines fully immunized as having all required immunizations up-to-date according to the DPH schedule for 2 year olds. Participant children included inthis analysis are those HFM eligible children i e first born children who are 2 years


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documentation from the childs pediatrician, or participant report. Home visitorswho are present at the well-child visit at which immunizations are administered may

also record this information. If a parent chooses not to have their child immunized,home visitors must check the appropriate box in the immunization record in the PDSand discussions on this topic must be recorded in the appropriate home visit records.HFM supervisors are responsible for timely review of this information in the PDSand in case review.

B. Medical visitsHFM views receiving adequate medical care as a key component in parenting:

participants and their children must receive adequate medical care in order to grow anddevelop, to achieve their goals, and to function well as a family. Medical visits are oftwo types: well care visits and acute care visits.

1. Well-care visits are important aspects of ongoing health care and promoting positivehealth outcomes for program participants and eligible children. Receiving routinepreventative care supports self-care and long-term planning for participants.Reducing participant reliance on emergency room care supports the potential for

long-term relationships with primary health care providers as well as developingpositive health care practice. To encourage well-care visits, on a regular basis, homevisitors should:

Talk with participants in advance of dental/well child/medical home visitsto reinforce the benefits of the visit and prepare for any questions theparticipant may want to ask;

Discuss the importance of a medical home versus emergency room care; Discuss health-related topics, including family planning, prenatal visits,

postnatal visits, well-baby visits, developmental assessments, mental health,and dental health;

Discuss the visit with participants after the visits has occurred to reviewinformation, and follow up with additional resources if needed;

Explore participants access to reliable transportation (private or public) totravel to health care appointments;

Explore linguistic match to health care resource in the area and/or need forinterpretation services; and

Identify any unique barriers to the participant and the participants family toaccessing health care resources

2. Programs should track acute care visits as these visits often represent somedisruption in the lives of participants and their children. These may be emergency

i it h it li ti ( l d d l d) Wh th t


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Discuss specifics of emergency room visits to determine appropriateness,follow up with additional information, and provide additional parent

support as warranted, e.g., clarify how to determine an emergency versusroutine health care need, validate participant decision to seek acute care,etc., and follow up with additional resources if needed.

3. Programs must document all medical visits participants disclose, e. g, well-childvisits, prenatal visits, postpartum visits, etc, in the PDS, including as muchinformation as possible as to reasons for the visit, whether scheduled appointmentsare kept, etc. Regular case review in supervision includes discussion of these

medical visits. Supervisors must document this discussion in their supervision log.III. Ongoing Health Care Engagement

HFM has a focus on health and wellness, and therefore, home visitors will routinelydiscuss health and wellness topics with participants based on their needs and interests.Additionally, health and wellness issues are a regular part of case review.

A. During the Family Profile process with new participants, programs ensure thatdiscussions about the families connection to health care providers and insurance takeplace. This information is documented in the Family Profile forms.

B. Home visitors must seek consent to release information from the participant to facilitatethe exchange between the program and the participants health care providers. Should aparticipant elect not to consent to this exchange, home visitors will explore anddocument the reasons why and follow up solely with the participant.

C. At a minimum, all participants must have one discussion over the course of servicedelivery and/or once every twelve months of program participation, on the topic of

family planning. This discussion takes place during a home visit; ideally morefrequently than once or once a year. This is intended to support the HFM goal ofreducing the rate of subsequent pregnancies. According to the HFM performancemeasures, at a maximum 15% of participants experience a subsequent pregnancy duringtheir time in HFM. All health and wellness discussions are noted in the appropriatehome visit record.

D. Home visitors support participants in planning and follow up with well-care and acute-care, as well as follow up with health care providers and resources, as appropriate andas authorized by the participant;

E. Home visitors must discuss appropriate use of healthcare resources with participatingfamilies and document the use of those medical resources as presented by the family.

F. At least every six months, home visitors must follow up with families on their new orongoing connection to a health care provider and document this in the Parent and ChildStatus Reports in the PDS


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This schedule includes recommendations in eect as o December 21, 2010. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated andeasible. The use o a combination vaccine generally is preerred over separate injections o its equivalent component vaccines. Considerations should include provider assessment, patient preerence,and the potential or adverse events. Providers should consult the relevant Advisory Committee on Immunization Practices statement or detailed recommendations: http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically signifcant adverse events that ollow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at http://www.vaers.hhs.gov or by

telephone,800-822-7967.

1. Hepatitis B vaccine (HepB). (Minimum age: birth)

At birth: Administer monovalent HepB to all newborns before hospital discharge. If mother is hepatitis B surface antigen (HBsAg)-positive, administer HepB

and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth. If mothers HBsAg status is unknown, administer HepB within 12 hours

of birth. Determine mothers HBsAg status as soon as possible and, ifHBsAg-positive, administer HBIG (no later than age 1 week).

Doses ollowing the birth dose: The second dose should be administered at age 1 or 2 months. Monovalent

HepB should be used for doses administered before age 6 weeks. Infants born to HBsAg-positive mothers should be tested for HBsAg and anti-

body to HBsAg 1 to 2 months after completion of at least 3 doses of the HepBseries, at age 9 through 18 months (generally at the next well-child visit).

Administration of 4 doses of HepB to infants is permissible when a combina-tion vaccine containing HepB is administered after the bir th dose.

Infants who did not receive a birth dose should receive 3 doses of HepB ona schedule of 0, 1, and 6 months.

The nal (3rd or 4th) dose in the HepB series should be administered noearlier than age 24 weeks.

2. Rotavirus vaccine (RV). (Minimum age: 6 weeks) Administer the rst dose at age 6 through 14 weeks (maximum age: 14

weeks 6 days). Vaccination should not be initiated for infants aged 15 weeks0 days or older.

The maximum age for the nal dose in the series is 8 months 0 days If Rotarix is administered at ages 2 and 4 months, a dose at 6 months is

not indicated.3. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP).

(Minimum age: 6 weeks) The fourth dose may be administered as early as age 12 months, provided

at least 6 months have elapsed since the third dose.4. Haemophilus infuenzaetype b conjugate vaccine (Hib). (Minimum age:

6 weeks) If PRP-OMP (PedvaxHIB or Comvax [HepB-Hib]) is administered at ages 2

and 4 months, a dose at age 6 months is not indicated. Hiberix should not be used for doses at ages 2, 4, or 6 months for the pri-

The supplemental dose of PCV13 should be administered at least 8 weeks

after the previous dose of PCV7. SeeMMWR

2010:59(No. RR-11). Administer PPSV at least 8 weeks after last dose of PCV to children aged2 years or older with certain underlying medical conditions, including acochlear implant.

6. Inactivated poliovirus vaccine (IPV). (Minimum age: 6 weeks) If 4 or more doses are administered prior to age 4 years an additional dose

should be administered at age 4 through 6 years. The nal dose in the series should be administered on or after the fourth

birthday and at least 6 months following the previous dose.7. Infuenza vaccine (seasonal). (Minimum age: 6 months for trivalent inactivat-

ed inuenza vaccine [TIV]; 2 years for live, attenuated inuenza vaccine [LAIV]) For healthy children aged 2 years and older (i.e., those who do not have

underlying medical conditions that predispose them to inuenza complica-

tions), either LAIV or TIV may be used, except LAIV should not be given tochildren aged 2 through 4 years who have had wheezing in the past 12 months.

Administer 2 doses (separated by at least 4 weeks) to children aged 6 monthsthrough 8 years who are receiving seasonal inuenza vaccine for the rst timeor who were vaccinated for the rst time during the previous inuenza seasonbut only received 1 dose.

Children aged 6 months through 8 years who received no doses of monovalent2009 H1N1 vaccine should receive 2 doses of 20102011 seasonal inuenzavaccine. SeeMMWR 2010;59(No. RR-8):3334.

8. Measles, mumps, and rubella vaccine (MMR). (Minimum age: 12 months) The second dose may be administered before age 4 years, provided at least

4 weeks have elapsed since the rst dose.9. Varicella vaccine. (Minimum age: 12 months)

The second dose may be administered before age 4 years, provided at least3 months have elapsed since the rst dose.

For children aged 12 months through 12 years the recommended minimuminterval between doses is 3 months. However, if the second dose wasadministered at least 4 weeks after the rst dose, it can be accepted as valid.

10. Hepatitis A vaccine (HepA). (Minimum age: 12 months) Administer 2 doses at least 6 months apart. HepA is recommended for children aged older than 23 months who live in

areas where vaccination programs target older children, who are at increased

Range ofrecommendedages for certainhigh-risk groups

Range of

recommendedages for allchildren

Vaccine Age Birth1

month2

months4

months6

months12

months15

months18

months1923months

23years

46years

Hepatitis B1 HepB

Rotavirus2 RV RV RV2

Diphtheria, Tetanus, Pertussis3 DTaP DTaP DTaP seeootnote3

Haemophilus infuenzae type b4 Hib Hib Hib4

Pneumococcal5 PCV PCV PCV

Inactivated Poliovirus6 IPV IPV

Inuenza7

Measles, Mumps, Rubella8 see ootnote8

Varicella9 see ootnote9

Hepatitis A10

Meningococcal11

HepBHepB

DTaP DTaP

Hib

IPVIPV

MMR

VaricellaVaricella

MMR

PCV

HepA Series

MCV4

Infuenza (Yearly)

PPSV

HepA (2 doses)

Recommended Immunization Schedule for Persons Aged 0 Through 6 YearsUnited States 2011For those who fall behind or start late, see the catch-up schedule


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This schedule includes recommendations in eect as o December 21, 2010. Any dose not administered at the recommended age should be administered at asubsequent visit, when indicated and easible. The use o a combination vaccine generally is preerred over separate injections o its equivalent component vaccines.Considerations should include provider assessment, patient preerence, and the potential or adverse events. Providers should consult the relevant Advisory Committeeon Immunization Practices statement or detailed recommendations: http://www.cdc.gov/vaccines/pubs/acip-list.htm . Clinically signicant adverse events that ollowimmunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at http://www.vaers.hhs.gov or by telephone, 800-822-7967.

1. Tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap).(Minimum age: 10 years or Boostrix and 11 years or Adacel)) Persons aged 11 through 18 years who have not received Tdap should receive

a dose ollowed by Td booster doses every 10 years thereater. Persons aged 7 through 10 years who are not ully immunized against

pertussis (including those never vaccinated or with unknown pertussis vac-cination status) should receive a single dose o Tdap. Reer to the catch-upschedule i additional doses o tetanus and diphtheria toxoidcontainingvaccine are needed.

Tdap can be administered regardless o the interval since the last tetanusand diphtheria toxoidcontaining vaccine.

2. Human papillomavirus vaccine (HPV). (Minimum age: 9 years)

Quadrivalent HPV vaccine (HPV4) or bivalent HPV vaccine (HPV2) is recom-mended or the prevention o cervical precancers and cancers in emales.

HPV4 is recommended or prevention o cervical precancers, cancers, andgenital warts in emales.

HPV4 may be administered in a 3-dose series to males aged 9 through 18years to reduce their likelihood o genital warts.

Administer the second dose 1 to 2 months ater the rst dose and the thirddose 6 months ater the rst dose (at least 24 weeks ater the rst dose).

3. Meningococcal conjugate vaccine, quadrivalent (MCV4). (Minimum age:2 years) Administer MCV4 at age 11 through 12 years with a booster dose at age 16 years. Administer 1 dose at age 13 through 18 years i not previously vaccinated.

Persons who received their rst dose at age 13 through 15 years should receivea booster dose at age 16 through 18 years.

Administer 1 dose to previously unvaccinated college reshmen living in adormitory.

Administer 2 doses at least 8 weeks apart to children aged 2 through 10 yearswith persistent complement component deciency and anatomic or unctionalasplenia, and 1 dose every 5 years thereater.

Persons with HIV inection who are vaccinated with MCV4 should receive 2doses at least 8 weeks apart

time or who were vaccinated or the rst time during the previous infuenzaseason but only received 1 dose.

Children 6 months through 8 years o age who received no doses o mon-ovalent 2009 H1N1 vaccine should receive 2 doses o 2010-2011 seasonalinfuenza vaccine. See MMWR 2010;59(No. RR-8):3334.

5. Pneumococcal vaccines. A single dose o 13-valent pneumococcal conjugate vaccine (PCV13) may

be administered to children aged 6 through 18 years who have unctional oranatomic asplenia, HIV inection or other immunocompromising condition,cochlear implant or CSF leak. SeeMMWR 2010;59(No. RR-11).

The dose o PCV13 should be administered at least 8 weeks ater the previ-ous dose o PCV7.

Administer pneumococcal polysaccharide vaccine at least 8 weeks ater thelast dose o PCV to children aged 2 years or older with certain underlyingmedical conditions, including a cochlear implant. A single revaccinationshould be administered ater 5 years to children with unctional or anatomicasplenia or an immunocompromising condition.

6. Hepatitis A vaccine (HepA). Administer 2 doses at least 6 months apart. HepA is recommended or children aged older than 23 months who live

in areas where vaccination programs target older children, or who are atincreased risk or inection, or or whom immunity against hepatitis A isdesired.

7. Hepatitis B vaccine (HepB).

Administer the 3-dose series to those not previously vaccinated. For thosewith incomplete vaccination, ollow the catch-up schedule.

A 2-dose series (separated by at least 4 months) o adult ormulationRecombivax HB is licensed or children aged 11 through 15 years.

8. Inactivated poliovirus vaccine (IPV). The nal dose in the series should be administered on or ater the ourth

birthday and at least 6 months ollowing the previous dose. I both OPV and IPV were administered as part o a series, a total o 4 doses

should be administered regardless o the childs current age

Vaccine Age 710 years 1112 years 1318 years

Tetanus, Diphtheria, Pertussis1

Human Papillomavirus2

see footnote2

Meningococcal3

Infuenza4

Pneumococcal5

Hepatitis A6

Hepatitis B7

Inactivated Poliovirus8

Measles, Mumps, Rubella9

Varicella10

Tdap

HPV (3 doses)(emales)

MCV4MCV4

Tdap

HPV series

MCV4

Infuenza (Yearly)

Pneumococcal

HepA Series

Hep B Series

IPV Series

MMR Series

Varicella Series

Range ofrecommendedages forcatch-upimmunization

Range ofrecommendedages for allchildren

Range ofrecommendedages for certainhigh-risk groups

Recommended Immunization Schedule for Persons Aged 7 Through 18 YearsUnited States 2011For those who all behind or start late, see the schedule below and the catch-up schedule


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1. Hepatitis B vaccine (HepB). Administerthe3-doseseriestothosenotpreviouslyvaccinated. TheminimumageforthethirddoseofHepBis24weeks. A2-doseseries(separatedbyatleast4months)ofadultformulationRecombivaxHBislicensedforchildrenaged11through15years.

2. Rotavirus vaccine (RV). Themaximumagefortherstdoseis14weeks6days.Vaccinationshouldnotbeinitiatedforinfantsaged15weeks0daysorolder.

Themaximumageforthenaldoseintheseriesis8months0days. IfRotarixwasadministeredfortherstandseconddoses,athirddoseisnotindicated.

3. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). Thefthdoseisnot necessaryif thefourthdosewasadministeredat age4

yearsorolder.4. Haemophilus infuenzae type b conjugate vaccine (Hib).

1doseofHibvaccineshouldbeconsideredforunvaccinatedpersonsaged5yearsorolderwhohavesicklecelldisease,leukemia,orHIVinfection,orwhohavehadasplenectomy.

Iftherst2doseswerePRP-OMP(PedvaxHIBorComvax),andadministeredatage11monthsoryounger,thethird(andnal)doseshouldbeadministeredatage12through15monthsandatleast8weeksaftertheseconddose.

Iftherstdosewasadministeredatage7 through11months,administerthesecond dose at least 4 weeks later and a nal dose at age 12 through 15 months

6. Inactivated poliovirus vaccine (IPV). Thenaldoseintheseriesshouldbeadministeredonorafterthefourthbir thdayandatleast6monthsfollowingthepreviousdose.

Afourthdoseisnotnecessaryifthethirddosewasadministeredatage4yearsorolderandatleast6monthsfollowingthepreviousdose.

Intherst6monthsoflife,minimumageandminimumintervalsareonlyrecom-mendedif thepersonisat riskforimminentexposuretocirculatingpoliovirus(i.e.,traveltoapolio-endemicregionorduringanoutbreak).

7. Measles, mumps, and rubella vaccine (MMR). Administertheseconddoseroutinelyatage4 through6years.Theminimumintervalbetweenthe2dosesofMMRis4weeks.

8. Varicella vaccine. Administertheseconddoseroutinelyatage4through6years.

Iftheseconddosewasadministeredatleast4weeksaftertherstdose,itcanbeacceptedasvalid.

9. Hepatitis A vaccine (HepA). HepAisrecommendedforchildrenagedolder thanage23monthswholiveinareaswherevaccinationprogramstargetolderchildren,orwhoareatincreasedriskforinfection,orforwhomimmunityagainsthepatitisAisdesired.

10. Tetanus and diphtheria toxoids (Td) and tetanus and diphtheria toxoids andacellular pertussis vaccine (Tdap). DosesofDTaParecountedaspartoftheTd/Tdapseries. Tdap should be substituted for a single dose of Td in the catch-up series for

PERSONS AGED 4 MONTHS THROUGH 6 YEARS

VaccineMinimum Age

for Dose 1

Minimum Interval Between Doses

Dose 1 to Dose 2 Dose 2 to Dose 3 Dose 3 to Dose 4 Dose 4 to Dose 5

HepatitisB1 Birth 4 weeks8 weeks

(andatleast16weeksafterrstdose)

Rotavirus2 6wks 4 weeks 4 weeks2

Diphtheria,Tetanus,Pertussis 3 6wks 4 weeks 4 weeks 6 months 6 months3

Haemophilus infuenzae typeb4 6wks

4 weeksifrstdoseadministeredatyoungerthanage12months

8 weeks (as fnal dose)ifrstdoseadministeredatage1214months

No urther doses neededifrstdoseadministeredatage15monthsorolder

4 weeks4

ifcurrentageisyoungerthan12months

8 weeks (as fnal dose)4

ifcurrentageis12monthsorolderand rstdoseadministeredatyoungerthanage12monthsand

seconddoseadministeredatyoungerthan15months

No urther doses neededifpreviousdoseadministeredatage15monthsorolder

8 weeks (as fnal dose)Thisdoseonlynecessary

forchildrenaged12monthsthrough59monthswhoreceived3dosesbefore

age12months

Pneumococcal5

6wks


8 weeks (as fnal dose or healthy children)ifrstdoseadministeredatage12monthsorolder

orcurrentage24through59months

No urther doses neededforhealthychildrenifrstdose

administeredatage24monthsorolder

4 weeksifcurrentageisyoungerthan12months

8 weeks

(as fnal dose or healthy children)ifcurrentageis12monthsorolder

No urther doses neededforhealthychildrenifpreviousdoseadministeredatage

24monthsorolder

8 weeks (as fnal dose)Thisdoseonlynecessary

forchildrenaged12monthsthrough59monthswho

received3dosesbeforeage12monthsorforchildren

athighriskwhoreceived3dosesatanyage

InactivatedPoliovirus 6 6wks 4 weeks 4 weeks 6 months6

Measles,Mumps,Rubella 7 12mos 4 weeks

Varicella8 12mos 3 months

HepatitisA9 12mos 6 months

PERSONS AGED 7 THROUGH 18 YEARS

Tetanus,Diphtheria/Tetanus,Diphtheria,Pertussis 10

7yrs10 4 weeks


6 monthsifrstdoseadministeredat12monthsorolder

6 monthsifrstdoseadministeredat

youngerthanage12months

HumanPapillomavirus 11 9yrs Routine dosing intervals are recommended (emales)11

HepatitisA9 12mos 6 months

HepatitisB1 Birth 4 weeks8 weeks

(andatleast16weeksafterrstdose)

InactivatedPoliovirus 6 6wks 4 weeks 4 weeks6 6 months6

Measles,Mumps,Rubella 7 12mos 4 weeks

Varicella8 12mos

3 monthsifpersonisyoungerthanage13years

4 weeksifpersonisaged13yearsorolder

The table below provides catch-up schedules and minimum intervals between doses for children whose vaccinations have been delayed. A vaccineseries does not need to be restarted, regardless of the time that has elapsed between doses. Use the section appropriate for the childs age

Catch-up Immunization Schedule for Persons Aged 4 Months Through 18 Years Who Start Late or Who Are More Than 1 Month BehindUnited States 2011


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Recommended PCV13 schedules for administering doses to children < 24 months of age,

by PCV vaccination history and ageAge at

Exam

(months)

Vaccination history:

Total Number of PCV7 and/or

PCV13 Doses Received Previously

Recommended PCV13 Regimen1

0 doses 3 doses, 8 weeks apart; fourth dose at age 12-15 months

1 dose 2 doses, 8 weeks apart; fourth dose at age 12-15 months

2-6

months

2 doses 1 dose; 8 weeks after the most recent dose; fourth dose at age 12-15 months

0 doses 2 doses, 8 weeks apart; third dose at 12-15 mos.7-11 months

1 or 2 doses before age 7 months 1 dose at age 7-11 mos, with a second dose at 12-15 mos, 8 weeks later

0 doses 2 doses, 8 weeks apart

1 dose before age 12 months 2 doses, 8 weeks apart

1 dose at 12 months 1 dose, 8 weeks after the most recent dose2

2 or 3 doses before age 12 months 1 dose, 8 weeks after the most recent dose2

12-23

months

4 doses of PCV7 or other age-

appropriate, complete PCV7 schedule1 supplemental dose, 8 weeks after the most recent dose

3

1Minimum interval between doses is 8 weeks, except for children vaccinated at age


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Immunization Best Practices

1. Vaccinate staff.

Vaccinate all personnel who have contact with patients with all

recommended vaccines.

2. Assess at every visit.

Review immunization status and administer all immunizationsdue at all types of visits (e.g., acute care and well child).

3. Schedule optimally. Hepatitis B: Give first dose at birth.

Give any dose of vaccine not given at the recommended age at

any following visit when indicated and feasible.

Schedule immunizations prior to the maximum ACIP

recommended age to ensure that children have received all of the

recommended antigens by age 24 months.

No research indicates alternative schedules or delayingvaccines is safer than the recommended schedule. Experts decide

the best time to give immunizations to ensure infants are

protected as soon as possible. For help talking to parents about

vaccine concerns, see this article by Ari Brown, MD:

www.immunize.org/catg.d/p2068.pdf, or CDCs website:

www.cdc.gov/vaccines/spec-grps/hcp/conversations.htm.

4. Adhere to correct intervals and ages.(a) Minimum intervals:

Do not give vaccines before the recommended minimum ageor interval for that antigen.

Consider doses administered before the minimum age and/or

minimum interval invalid.

If an invalid dose has been given, count from the last (invalid)

dose in order to determine when to give the next valid dose.

(b) Maximum intervals:

There are no maximum intervals; it is not necessary to restart

the series of any vaccine due to extended intervals between

doses.

5. Follow only true contraindications.

Do not defer vaccination for children who present with a mild

acute illness, with or without fever. Follow only true

contraindications as outlined by the ACIP.

6. Use Vaccine Information Statements (VIS).Provide patient, parent, or legal representative with a copy of the

VIS with each dose of vaccine administered, and answer

questions regarding vaccine risks and benefits. It is theproviders responsibility to maintain copies of the most up to

date VISs in their office. Subscribe to CDCs e-mail update for

VISs at www.cdc.gov/vaccines/pubs/vis/default.htm, click on

Get E-Mail Updates, and enter your e-mail address. Many

other resources are available to help address questions about

vaccine safety (see box below).

8. Document. Document in the patients chart the date a patient moves or

goes elsewhere for care (MOGE).

Document chickenpox disease on the immunization record.

Document contraindications to vaccines.

Document parent refusal or deferral of any vaccine.

Provide the patient or parent/legal guardian with an

immunization card documenting the vaccines given and the date

the next doses are due.

9. Carry out reminder/recall.

Identify children who are due or overdue for immunizations

(e.g., computer billing system, other electronic tracking systems,

tickler system, stickers on charts).

Send out reminder or recall notices at least twice a year Verify patients address and telephone number at each

encounter; obtain a second contact number for back-up.

10. Develop a systematic approach. Designate anImmunization Coordinatorto coordinate and

monitor all immunization activities. TheImmunization

Coordinatorkeeps current with information about

immunization, and communicates current schedules, guidelines,

and policies to all staff.

Have all providers in a practice formally agree to adhere to acommon immunization schedule (based on ACIP guidelines).

Post agreed upon common schedule throughout the practice.

11. Follow appropriate procedures for vaccine storage and

handling. Formally designate one staff member to monitor vaccine

ordering, receiving and storage.

Consult the MDPH document Vaccine Management Checklist

for detailed instructions on proper vaccine storage and handling.

Maintain up-to-date, written protocols for vaccine storage andhandling procedures and share with all staff who handle vaccine.

12. Report adverse events.Report clinically significant adverse events that follow

immunization to the Vaccine Adverse Event Reporting System

(VAERS). Find guidance on obtaining and completing a VAERS

form at: www.vaers.hhs.gov or by calling 1-800-822-7967.

13. Report cases.

Report suspect cases of vaccine-preventable diseases to yourlocal board of health and to the MDPH Immunization Program,

617-983-6800 or toll free 888-658-2850. For information

regarding disease reporting and control measures see the Guide

to Surveillance and Reporting (www.mass.gov/dph/epi).

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Documents

J Promoting Health and Wellness Policy