Adult Immunizations - NYSACHO

11/19/2018

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Adult ImmunizationsNew York State Updates

Sarah Hershey, RN, BSNAdult and Adolescent Immunization CoordinatorNew York State Department of HealthBureau of Immunization

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Disclosures

• Per ACCME standard 6.2, this presenter has no financial relationship(s), or any other relationships that would create a conflict of interest, with any vaccine manufacturers mentioned in the presentation.

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Agenda• Standards for Adult Immunization Practice

• New York State Immunization Information System (NYSIIS)

• Adult Immunization Provider Visits

• Pharmacists as Immunizers

• New York State Adult Immunization Data

• Vaccines for Adults Program

• Vaccine Preventable Diseases (VPD) Surveillance Update

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Adults Need Vaccinations Too!!

Influenza, Td/Tdap, Pneumococcal (PCV, PPSV), Herpes Zoster, MMR, Varicella, Meningococcal (MenACWY, MenB), HPV, Hepatitis A, Hepatitis B, Hib

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Standards for Adult Immunization Practice

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Standards for Adult Immunization Practice• Assess the immunization status of all patients at

every clinical encounter.

• Strongly Recommend the vaccines that your patients need.

• Administer the needed vaccines or Refer your patients to a vaccination provider.

• Document the vaccines your patients received.

https://www.cdc.gov/vaccines/hcp/adults/for‐practice/standards/index.html

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Assess Patients’ Immunization Needs• Assessing patients’ vaccination status at every

clinical encounter will help avoid missed opportunities.

• Make routine vaccination assessment part of the work flow in your practice.

• Routine assessment of patients’ vaccination status will make a difference.

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Make a Strong Recommendation: S.H.A.R.E.

• S - Share: why the recommended vaccine is right for them.

• H - Highlight: positive experiences• A - Address: patient questions and concerns• R - Remind: patients that vaccines protect them

and their loved ones.• E - Explain: potential costs of the disease.

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Administer or Refer• Administer recommended vaccines

• Stock vaccines at your practice• Train and educate staff on vaccine administration• Make it convenient for patients to receive needed

vaccines.• Refer patients to an immunization provider for

vaccines you do not stock• Why is this important?• What can you do?

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Document the Vaccines Patients Received

• Document in the patient’s medical record

• Provide each patient with documentation of vaccines received

• Document vaccination in NYSIIS, with consent

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New York StateImmunizationInformation System(NYSIIS)

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Benefits of NYSIIS for Your Practice

• Provides a complete, confidential vaccination record in one place and is a Lifetime Registry

• Improved patient care• Recommending needed immunizations• Avoid unnecessary immunizations• Assessment of immunization series completion• Avoid missed opportunities

• Ability to utilize reminder and recall notifications

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Benefits of NYSIIS continued

• Utilize reports to monitor the immunization coverage rates for your practice

• Access to multiple users: Record and/or read• Primary care providers• Specialty providers such as obstetrics• Emergency room and urgent care providers• Schools• Public health for case management and outbreak control• Pharmacists

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Adult Immunization Provider Visits

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What are Adult Provider Visits?

• Local Health Departments have been providing visits with providers in their counties who provide adult immunizations

• Purpose of the visits:• Adult immunization rates are low• Provider recommendation is the number one predictor of

patients getting vaccinated• Review of Standards of Adult Immunization Practice• Review of providers’ current adult immunization practices• Development of an Action Plan• Follow-up

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How Adult Visits Benefit Providers

• Local Health Department staff are your communities’ immunization subject matter experts

• They are knowledgeable about the standards

• They are knowledgeable about NYSIIS

• Resources are provided

• An Action Plan is developed

• Follow-up is provided to identify barriers to implementation and provide technical assistance as needed

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Pharmacists as Immunizers

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Pharmacists as Immunizers

• New York State Education Law §§ 6527, 6801, 6802 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

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NYS Adult Immunization Data

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NYS data available at: https://www.health.ny.gov/diseases/communicable/influenza/surveillance/2017‐2018/flu_report_current_week.pdf

New York State Influenza Surveillance

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Laboratory-Confirmed Influenza

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https://gis.cdc.gov/grasp/fluview/mortality.html

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Flu Vaccination and Pregnancy

• Pregnant women and their infants are at increased risk of severe influenza-related illness

• ACIP recommends all women who are or may become pregnant during the flu season receive influenza vaccine

• Flu vaccination during pregnancy:• Reduced risk of flu-associated acute respiratory infection

in pregnant women by up to one-half• Can help protect infants from influenza after birth

https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6638a2.pdf

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Influenza and Tdap Coverage Among Pregnant Women: Data from Internet Panel Survey, United States, April 2018

Recommendation/Referral Provided

Influenza Vaccine Received

Tdap Vaccine Received

Recommendation and offer 63.8% 73.5%

Recommendation, no offer 37.6% 38.3%

Recommendation, no offer, referral received

47.9% 56.1%

Recommendation, no offer, no referral received

30.1% 18.5%

No Recommendation 9.0% 1.6%

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Receipt of Flu Shot Before or During Pregnancy, by Year, PRAMS, NYS (excluding NYC)

2012 2013 2014 2015 2016

Before 0.132 0.119 0.108 0.09 0.103

During 0.336 0.425 0.479 0.484 0.4995

0

0.1

0.2

0.3

0.4

0.5

0.6

Percen

tage

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NYS “Flu Mask” Regulation• Requires healthcare facilities, agencies and hospices licensed

under Article 28, 36 or 40 to:o Annually document the influenza vaccination status for all personnel

employed by or affiliated with the facility or agency, whether paid or unpaid, who engage in activities such that if they were infected with influenza, they could potentially expose patients or residents to the disease

o During the influenza season*, ensure that all personnel not vaccinated against influenza for the current season wear a surgical or procedure mask while in areas where patients or residents may be present

o The NYSDOH annually sends out notifications when influenza is prevalent, and posts them at www.health.ny.gov/flumaskreg

*Influenza season defined as the period of time during which influenza is determined to be prevalent by the NYS Commissioner of Health.

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NYS HCP Influenza Vaccination Rates by Year and Facility Type, Hospitals and Nursing Homes, 2008/09 – 2017/18

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2008-092009-102010-112011-122012-132013-142014-152015-162016-172017-18

Hospitals

Nursing Homes

Overall

HP 2020 Target

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Median HCP Influenza Vaccination Rates, by Year and Facility/Agency Type, 2013/14 – 2017/18

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

100%

Hospitals Nursing Homes ADHCPs D&TCs Hospices Home HealthAgencies

LHCSAs

2013-14 2014-15 2015-16 2016-17 2017-18 HP 2020 Target Median 2017-18

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Influenza Vaccination Coverage Among Health Care Personnel, United States, 2017-18 Influenza Season

• Coverage rate for HCP overall was 78.4%; similar to 78.6% for 2016-17 season• Over 90% of physicians, nurses, nurse practitioners, and pharmacists were

vaccinated.• However, only 71% of assistants/aides, and 72.8% of nonclinical personnel were

vaccinated.• Vaccination was highest in settings with employer vaccination requirements

(94.8%)• If no requirement, vaccination rate was higher for HCP who had access to

free, on-site vaccinations over multiple days (76%) than employers who have no polices related to vaccination promotion (47.6%)

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6738a2‐H.pdf

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Adult Vaccination Coverage in NYSYEAR VACCINE AGE COVERAGE

2016 Tdap 18 – 64 years 29.5%

≥ 65 years 14.5%

2016 Td or Tdap 18 – 49 years 61.4%

50 – 64 years 53.3%

≥ 65 years 42.1%

2016 Pneumococcal 18 – 64 years 32.3%

≥ 65 years 69.3%

2014 Zoster ≥ 60 years 26.4%

Source: https://www.cdc.gov/vaccines/imz‐managers/coverage/adultvaxview/index.html

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Vaccines for Adults Program

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Vaccines for Adults Program (VFA)• Program to provide vaccines for uninsured or underinsured adults 19

years and older, and students enrolled in a post-secondary institution in NYS (fully insured post-secondary students are only eligible for MMR under the VFA program)

• Available Vaccines: Hepatitis A, Hepatitis B, HPV, MMR, PCV13, PPSV23, Tdap, Td, Influenza, Meningitis, Zoster

• Providers enroll in program through the NYSDOH, Bureau of Immunization

• For more information: contact the Bureau of Immunization: (518) 473-4437; [email protected] , or by visiting the following website: https://www.health.ny.gov/prevention/immunization/providers/state_vaccines_for_adults_program.htm

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Vaccine Preventable Diseases (VPD) Update

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Reported Pertussis Cases in New York State*Confirmed and Probable Cases Reported as of 09/21/2018**

Year #Cases

1997 200

1998 357

1999 818

2000 571

2001 175

2002 409

2003 895

2004 2132

2005 662

2006 1044

2007 631

2008 437

2009 275

2010 701

2011 864

2012 2739

2013 778

2014 880

2015 626

2016 677

2017 546

2018** 264

*Data represents New York State excluding New York City.**Cases (Confirmed or Probable) as of 9/21/2018. 2018 Case counts are preliminary and subject to change

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*Data represents New York State excluding New York City.**Cases (Confirmed or Probable) as of 09/21/2018. 2018 Case counts are preliminary and subject to change.

Year #Cases

1997 16

1998 14

1999 12

2000 14

2001 4

2002 5

2003 3

2004 5

2005 33

2006 51

2007 24

2008 21

2009 346

2010 964

2011 10

2012 5

2013 11

2014 11

2015 24

2016 204

2017 298

2018** 63

Reported Mumps Cases in New York State*Confirmed and Probable Cases Reported as of 09/21/2018**

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Age Distribution of Reported Mumps Cases, New York State*Age Group #Cases Percent

<=1 Year 4 0.7%

2‐10 Years 15 2.7%

11‐17 Years 27 4.8%

18‐24 Years 342 60.6%

25‐30 Years 65 11.5%

31‐40 Years 46 8.2%

41‐50 Years 25 4.4%

51‐60 Years 30 5.3%

60+ Years 10 1.8%

Total Cases = 564

Average Age 25 years

Median Age 21 years

Range 9m to 90yrs

Outbreak Associated

n = 384 (67.8%)

Sporadic Casesn = 182 (32 2%)

*Data represents New York State excluding New York City. Confirmed and Probable Cases Reported between 01/01/2016 and 09/21/2018

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Number of Reported Mumps Cases in New York State* by OutbreakConfirmed and Probable Cases Reported between 01/01/2016 and 04/30/2018**

Outbreak #Cases % of Total

Sporadic Cases/Clusters 173 32%

Syracuse University (Fall 2017) 151 28%

SUNY New Paltz (Fall 2016) 88 16%

Nassau – Long Beach (Summer 2016) 51 9.4%

SUNY Geneseo (Fall 2016) 27 5%

SUNY Albany (Spring 2017) 25 4.6%

Hockey Team (Winter 2017) 7 1.3%

Capital District Gym (Summer 2017) 6 1.1%

SUNY Buffalo (Winter 2016) 6 1.1%

Children’s Camp (Summer 2017) 5 0.9%

Syracuse University (Spring 2017) 3 0.6%

NYC Office / Nassau Co. (Spring 2018) 3 0.6%

Total 545

*Data represents New York State excluding New York City.**Case counts are preliminary and subject to change.

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Measles • Measles is still common in many parts of the world including

some countries in Europe, Asia, the Pacific, and Africa.– Over 41,000 measles cases in Europe in the first 6 months

of 2018• The majority of measles cases are unvaccinated.• Anyone who is not immune is at risk of getting infected when

they travel internationally.• International travelers continue to bring measles into the U.S.• Although measles is no longer endemic in the U.S. we still see

measles cases due to international travel/visitors • Measles can spread when it reaches a community in the U.S.

where groups of people are unvaccinated.


Measles Cases in New York State from 1997 – 2018*

*As of June 2018

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Measles in New York State in 2018

• International traveler; unvaccinated; exposures at multiple NYC/NYS venues; exposures at an urgent care and a hospital (multiple exposures)• One secondary case in NYS – likely unvaccinated

• International businessman in NYC; hospitalized in NYS (no hospital exposures)• Unvaccinated toddler traveled abroad; multiple exposures in NYS including health

care settings• Two international travelers visiting NYC with family; both unvaccinated with history of

recent exposure to measles prior to travel to US; exposures at multiple NYC/NYS venues; both hospitalized in NYC• 7 secondary cases – 3 from NYS; 3 from other states; one international traveler

• International traveler on bus tour across NYS; multiple exposures • Out-of-state resident (secondary case); exposures at a NYS medical office and lab

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Maculopapular Rash: Goes from head to trunk to extremities

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Secondary Cases of Measles• Several secondary cases had two documented doses of MMR• Secondary immune response

o Clinical presentation: milder prodrome and milder symptoms

o Viral specimens for PCR Nasopharyngeal swab was negative Urine was positive

o Less contagious• Although vaccination did not prevent disease in these cases it

did modify the illness

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Measles Secondary Immune Response


Secondary Immune Response

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Measles Vaccination• MMR vaccine is the best protection against measles • Ensure all of your adult patients have documented

immunity to measles– At least one documented dose; If in doubt vaccinate

• Ensure that international travelers are vaccinated– Two documented doses recommended

• All healthcare providers should be immune to measles


Measles Takeaway Messages• Measles cases have a significant public health impact• Recognize disease:

– Fever, rash, cough, coryza, conjunctivitis– Ask about a history of travel or contact with international travelers

and vaccination status• Suspect measles? Report immediately to your LHD• Appropriate testing should be done• Take appropriate steps to prevent the spread of measles

– If sending a suspect case to health care facility call ahead– Virus remains in air for up to 2 hours– Airborne infection control

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Resources• NYSDOH Vaccines and Immunization:

https://www.health.ny.gov/prevention/immunization/• Adult Immunization Schedule: https://www.cdc.gov/vaccines/hcp/adults/for-

practice/adult-recommendations.html• Standards for Adult Immunization Practice:

https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/index.html• CDC Adult Vaccination Resources:

https://www.cdc.gov/vaccines/hcp/adults/index.html• Immunization Action Coalition: http://www.immunize.org/• Take a Stand: https://www.standingorders.org/• National Adult and Influenza Immunization Summit:

https://www.izsummitpartners.org/• The Pink Book: https://www.cdc.gov/vaccines/pubs/pinkbook/index.html

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Questions??

Contact NYSDOH at:[email protected]

Documents

Adult Immunizations - NYSACHO