# Presentation: 305321

## Immunization Update

- Winton G. King, M.D.
- Region III Medical Consultant
- Job Corps Health and
- Wellness Conference
- June 7, 2005

## Presentation Outline

- Overview of Immunization Program
- TagB
- CDC Guidelines for Children, Adolescents, and Adults
- VFC Program
- Proposed Changes
- New Vaccines

## Overview of Immunization Program

- Purpose of Program
- Avoid outbreaks of communicable disease to protect against loss of life and loss of time from work and training.
- Support the federal government public health effort in maintaining high levels of immunization in the community.

## TAG B

- Required basic immunizations
- Td
- IPV
- MMR
- Mantoux tuberculin skin test

## Immunizations required at enrollment without documentation

- Td  booster
- IPV  booster [<18 years]
- MMR 1 Dose
- NOTE STUDENTS RAISED OUTSIDE OF USA RECEIVE PRIMARY SERIES

## Required immunizations for students on entry with documented proof of prior immunizations

- Td    	within 10 years                none
- 	         	over 10 years                   booster
- IPV	<18years   <3 doses         booster
- 		          	3 doses                             none
- IPV  	>18Years                          none
- MMR   	1dose after 12 months      1dose
-             	2 doses after 12 months    none

## CDC Guidelines(see handout)

- Children
- Adolescents
- Adults

## VFC Program

- What is the VFC Program?
- Established in 1994 to provide vaccinations to children as part of routine care
- Covers underinsured children
- Children on Medicaid
- Native Americans
- Alaska natives at their doctor`s office
- Provides free vaccines to doctors who serve eligible children
- Administered by the CDC who contracts w/ manufacturers to buy at a reduced rate

## VFC Program

- How to Join the VFC Program?
- Contact State VCF Program
- Ask for Provider Enrollment Package
- Complete form and return promptly
- Prepare for site visit
- Inform patients of VCF program

## VFC Program

- Why should Job Corps join?
- Reduce  out of pocket costs
- Provide all ACIP-recommended vaccines
- Receive customer service
- Minimize paperwork
- Order vaccines easily

## CDC Vaccine Price List

| Vaccine | CDC Cost/Dose | Private Sector
Cost/Dose |
| --- | --- | --- |
| Varicella | $52.25 | $66.81 |
| dT | $9.75 | $14.99 |
| e-IPV | $10.42 | $21.80 |
| Menactra | $68.00 | $82.00 |
| Hepatitis A Adult | $18.75 | $63.51 |
| MMR | $16.67 | $40.37 |
| Hepatitis B Adult
 | $19.36/$21.23
 | $59.70 |

## CASE FOR CHANGE

-     CDC RECOMMENDS
-     IT IS GOOD MEDICAL PRACTISE
-     DECREASES  MEDICAL LIABILITY

## Medical facts re Meningoccocal Disease

- Meningoccocal disease fatality rate can
- 	be as high as 25% in the 15 –24 age
- 	group.
- 83% of cases in the 15-24 age group are
- 	caused by the four serotypes in Menectra

## Medical facts re Pertussis

- 20,000 cases reported in 2004 the highest number of cases in 40years
- 40% of those cases were in 10-19 year olds
- In the last decade, 700% increase in reported cases of adolescent pertussis.
- It is estimated that over a ten year period,if this vaccine is instituted in the USA,there will be a decrease of 1.8 million cases of pertussis and a subsequent savings of 1.6 billion dollars

## New vaccines

- Menectra:
- newly licensed meningoccocal
- conjugate vaccine
- recommended for adolescents and college students
- Targeted groups:
- 11-12 year olds
- 15 year olds
- College freshmen in dorms
- other groups at high risk[military recruits]

## New vaccines cont`d

- Boostrix Tdap
- containing tetanus  toxoid, acellular pertussis and low dose diphtheria.
- Licensed to be given to individuals10-18 as a single dose.
- Produced by GlaxoSmith Kline

## FUTURE NEW VACCINES

- By 2010 vaccines against meningitis
- 	pneumonia,rotavirus caused diarrhea and
- 	human papilloma virus
- By 2015 vaccines against HIV/AIDS
- 	Malaria and pulmonary tb

## Case for new recommendations

- Follow CDC guidelines in toto
- Add  the following immunizations
- HepB
- Varicella
- Menectra
- Boostrix

## 50-Year Timeline in Immunization

- 1950s – 1960s
- 1955 Inactivated Polio Vaccine Licensed
- 1961 Monovalent OPV
- 1963 Trivalent OPV Licensed
- 	    1st Measles Vaccine
- 1964 ACIP Formed
- 1964 20 cases of Congenital Rubella Syndrome
- 1967 Mumps vaccine licensed
- 1969 Rubella vaccine licensed

## 50-Year Timeline in Immunization

- 1970s
- MMR vaccine licensed
- Smallpox vaccination ceases in the US
- 1977 Last indigenous case smallpox (Somalia)
- 1979 Last case of wild virus polio (US)

## 50-Year Timeline in Immunization

- 1980s
- 1980 Smallpox declared eradicated from the world
- 1982 Hepatitis B vaccine becomes available
- 1986 The National Childhood Vaccine Injury Act established.
- 1989-1991 Major resurgence of measles in USA.55,000 cases compared to a low of 1497 cases in 1983.Two dose MMR is recommended

## 50-Year Timeline in Immunization

- 1990s
- 1990 The  Vaccine Adverse Reporting System [VAERS] Established
- 1990 HIB polysaccharide conjugate vaccine licensed for infants.
- 1991  Hep B recommend for all infants.
- 1994  VFC program established
- Polio elimination in USA certified

## 50-Year Timeline in Immunization

- 1990s (cont’d)
- 1995  1st harmonized childhood immunization endorsed by ACIP,AAPAND AAFP is published
- Varicella vaccine licensed
- Hep A vaccine licensed
- 1996   A cellular Pertussis vaccine licensed  for use in 		    infants
- 1998   1st rotavirus vaccine licensed
- 1999   FDA recommends removing mercury and thimerosol from vaccines

## 50-Year Timeline in Immunization

- 2000s
- 2000   800,000 children die from measles annually.Measles declared no longer endemic in USA
- Pneumococcal conjugate vaccine recommended for all young children
- 2003  Measles declared no longer endemic in USA

## 50-Year Timeline in Immunization

- 2000s (cont’d)
- 1ST Live attenuated flu vaccine licensed for use in 5-49 year old persons
- 2004   Inactivated flu vaccine recommended for          	    all children 6-23 months
- 2005    rubella no longer endemic in USA
- April 12,2005 marks the 50th anniversary of the 1st Polio vaccine