VACCINE REMINDER/RECALL TO ADDRESS NEW SCHOOL … · 6/16/2020 · Department of Health in...

VACCINE REMINDER/RECALL TO ADDRESS NEW SCHOOL REQUIREMENTS AND COVID-19 IMPACT ON VACCINATIONDepartment of Health in partnership with the Washington Chapter of the American Academy of Pediatrics

Annika Hofstetter, MD, PhD, MPH Katherine Graff, BSN, RNGeneral Pediatrician and

Health Services ResearcherSchool and Child Care Imm.

Nurse Consultant

WCAAP, UW, Seattle Children’s Department of Health

Our Presenters

Chrystal AveretteIQIP Coordinator

Department of Health

Phillip Wiltzius, MS, CHESSchool and Child Care Health

Educator

Department of Health

Facilitator

Washington State Department of Health | 4

All lines will be muted during the presentation

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We will answer on-topic questions at the end of the webinar

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This webinar is being recorded, and will be accessible on our webinar web page at a later date: https://www.doh.wa.gov/YouandYourFamily/Immunization/ImmunizationNews/ImmunizationTraining/NewSchoolRequirementsWebinar

Webinar Expectations

https://www.doh.wa.gov/YouandYourFamily/Immunization/ImmunizationNews/ImmunizationTraining/NewSchoolRequirementsWebinar


School Vaccination Requirement Updates

COVID-19 Impact on Vaccination

Reminder/Recall – The Evidence

Reminder/Recall Steps

WAIIS Reminder/Recall Functionality

Outline

SCHOOL VACCINATION REQUIREMENT UPDATES

Katherine Graff


The Washington State Board of Health updated the language in school and child care immunization rules in Chapter 246-105 of the Washington Administrative Code (WAC).

Changes effective August 1, 2020 address:• 2019 ACIP Immunization Schedule Reference – Tdap change• Immunization documentation• Conditional status

More information at: www.doh.wa.gov/schoolimms2020

Policy Updates

http://app.leg.wa.gov/wac/default.aspx?cite=246-105

http://www.doh.wa.gov/schoolimms2020


Per Advisory Committee on Immunization Practices:• Tdap (or DTaP given in error) administered at 7 to 9 years of age does not count for

the recommended dose at 11 to 12 years of age.• Another Tdap should be given at age 11 to 12 years of age.

• Tdap (or DTaP given in error) administered at age 10 years can count for the recommended dose at 11 to 12 years of age.

• WAIIS forecast has been updated to reflect this change.

Beginning in the 2020-2021 school year:• The Tdap requirement changes from grade 6 to grade 7.• Students in 7th grade must have a Tdap on or after 10 years of age.• Students in 8th to 12th grades need a Tdap on or after 7 years of age.

Tdap Requirement


On or before the first day of attendance, all students must have turned in documentation of:• Full immunization by vaccination or titer for all of the diseases for which full

immunization is required, or• A Completed Certificate of Exemption (COE) form, or• Initiation of a schedule towards full immunization.

Documentation must be turned in before the child can start school or child care.

Documentation Requirements


Effective the 2020-2021 school year, vaccination records for school or child care entry must be medically verified.

This impacts:• All students attending a new child care, private school or school district.• Any documentation turned in starting 08/01/2020.

This does not impact:• Students staying at the same school or attending a new school within the same

district.



Medically verified documentation options include a:• Certificate of Immunization Status (CIS) printed from the IIS.

• Validated CIS• CIS printed from MyIR (wa.myir.net)

• Complete hardcopy CIS form filled out by hand.• Must be validated by a health care provider signature, or• Validated by a school nurse, child care health consultant, administrator

or designee with medical vaccination records attached.• Schools using the IIS School Module can verify immunizations are complete in the

WAIIS in lieu of a CIS.



The new rule language clarifies “Conditional Status.”

Previously, students had 30 days from the 1st day of attendance to turn in immunization documentation.

Starting on August 1, 2020:• Students must turn in paperwork before they can start school.• No automatic 30 day conditional period from the 1st day of school is given.• Students must have all vaccinations they are eligible to receive on or before the 1st

day of attendance.

Conditional Status


If the child needs more doses after having all the doses they are eligible to receive:

• The student can attend school in “Conditional Status” while completing the catch-up schedule.

• The Parent or guardian must acknowledge conditional status entry and timelines on the CIS.

• Documentation of vaccination must be turned into the school or child care facility within 30 days of the next dose due date on the ACIP catch-up schedule.

Conditional Status


Recommendations:• Send out reminder/recall messaging to parents now to reduce the amount of

appointments in late summer.• Provide acceptable immunization records to parents.• Add missing immunization dates into the IIS, including historical dates.• Be aware of school start dates in your area, and consider allowing quick walk-in

appointments for immunizations during those times.

Health Care Provider Considerations

COVID-19 IMPACT ON VACCINATION

Dr. Annika Hofstetter


Santoli et al. MMWR 2020

Impact of COVID-19


Monthly Percent Change in Vaccines Administered Comparing Average Number in 2015-2019 with 2020, Various Age Groups, Washington State

REMINDER/RECALL – THE EVIDENCE


What is Vaccine Reminder/Recall? It is a strategy that:• (A) Identifies patients due or overdue for vaccines• (B) Sends messages to patients/families in order to increase timely and up-to-date

vaccination.

How does it work?• Reminder/recall addresses common reasons for missing doses, i.e., forgot or missed

appointments, not aware of vaccine schedule.• Serves as a CUE TO ACTION for patients and families.

Vaccine Reminder/Recall

Jacobson Vann et al., Cochrane Database of Systematic Review, 2018


Reminder/Recall Effectiveness• Demonstrated in diverse patient populations and settings• Examined using various reminder/recall types, messaging content, targeted

vaccines, etc.

Vaccine Reminder/Recall

Outcome No. of studies

No. of participants

Risk Ratio, 95% CI

Childhood vaccinations 23 31,099 1.22 (1.15-1.29)Adolescent vaccinations 10 30,868 1.29 (1.17-1.42)Childhood influenza vaccination 5 9,265 1.51 (1.14-1.99)

Jacobson Vann et al., Cochrane Database of Systematic Review, 2018


Childhood Vaccine Reminder/Recall

Dini, et al., AJPM, 2000

Phone + Letters (61%)Phone or Letter Only (57%)Control (47%)


• CRT of HPV vaccine recall (message type per preference) vs. usual care• Increased, more timely HPV vaccine completion in recall vs. usual care arm

HPV Vaccine Recall

Kempe, et al., Pediatrics, 2016


Influenza Vaccine Reminders (Dose 2)

Stockwell, et al., Pediatrics, 2015


Other Examples:• Infants without 12-month appointments: Text message reminders had a positive

effect on timely MMR vaccination.• Young children (19-25 mo.) : Centralized reminder/recall messages increased the

odds of receiving any needed vaccine, especially with a practice endorsement (name/# in message).

• Adolescents: Receipt of an email notification resulted in a higher likelihood of influenza vaccination.

Reminder/Recall Interventions

Hofstetter, et al., Vaccine, 2015; Kempe, et al., Academic Pediatrics, 2017; Dombkowski, et al., Vaccine, 2017

REMINDER/RECALL STEPS


1. Identify patients to target with reminder/recall2. Select reminder/recall type to use in your practice3. Develop reminder/recall message content4. Send reminder/recall messages5. Track process and outcome measures

Reminder/Recall Steps


STEP 1: Identify patients to target with reminder/recall• Patient age• Vaccine types: any vs. only school required• Status: coming due, due now, past due

Considerations: Priority patients, practice logistics such as staff time, resources, workflow

Patient Identification


STEP 2: Select reminder/recall type for your practice• Telephone (person-to-person, auto-dialer)• Letter• Postcard• Text message• Email

Considerations: Patient population, practice logistics such as staff time, resources, workflow

Reminder/Recall Types

Clark, et al., Pediatrics, 2011; Hofstetter, et al. Prev med, 2013; Kempe, et al., Pediatrics, 2016; Jacobson Vann, et al., Cochrane Database of Systematic Review 2016


STEP 3: Develop message content• Basic message: who, what, where, when• Educational message: info above + why important• Interactional message: patient/families can seek more information by interacting

with messaging system

Considerations: • Can customize as needed

Message Content


Plain: Emanuel is due for shots. Please bring him to Audubon Clinic: M-F 9-3.

Educational: Emanuel is due for important shots that are safe and protect millions of children like him. Come to Audubon Clinic: M-F 9-3.

Educational – Interactive: Reply 1, 2, 3, 4, or 5 if you want info about:1 = infection risk; 2 = shots recommended for children like Emanuel; 3 = shots important; 4 = shots effective; 5 = very safe.

Example Messages

Hofstetter, et al., AJPM, 2015; Stockwell, et al., Pediatrics, 2015; Hofstetter, et al., Vaccine, 2015, 2017.


STEP 4: Send reminder/recall messages• # messages• Interval between messages• Timing during day

Considerations: • Downstream impact on practice• Will families be instructed to call practice? Staffing needs? Appointment availability?

Send Reminder/Recall Messages

Hofstetter, et al., Prev Med, 2013


STEP 5: Tracking process and outcome measuresProcess Measures• # patients sent message(s)• # patients with appointments made

Outcome Measures• # patients who received needed vaccine doses

Denominator• # patients due/overdue for vaccines

Tracking Measures


Practices can utilize the IIS to help prepare and track vaccine reminder/recall messages for their patients

Advantages• Free, save resources, easy to access• Based upon all available vaccine records

Disadvantages• May include patients no longer seen in a given practice• May not include updated contact information or all vaccine records (if not entered

into the IIS)

WAIIS Reminder/Recall Functionality

WAIIS REMINDER/RECALL STEPS

Chrystal Averette


Getting Started• Make sure you have reminder/recall functionality enabled in your WAIIS account (if

not, contact the WAIIS Help Desk)• Access under Reminder/Recall heading in menu:

WAIIS Reminder/Recall Steps


Step 1: Set reminder/recall criteria• Select For all patients you own (“By Ownership”)• Select a Due Date Timeframe – DUE NOW• Enter a Patient Age Range or Birth Date Range• Select a Vaccine Series or Customize (by vaccine, dose #)• Select Due for all selected vaccines• Click Generate Patient List button



Step 2: Preview and edit patient list


• Remove patients• Inactivate patients• Limit by contact

method• Remove patients after

certain # of contacts


Step 3: Choose reminder/recall output



Step 4: Deliver messages• Print and send IIS-generated letters (including labels)• Print and send IIS-generated postcards• Call families using IIS-generated phone # lists• Leave phone messages using IIS-generated autodialer content• Send email via WAIIS



Step 5: Track reminder/recall output• Select “Make This Count Towards # of Recall Attempts”

• This step occurs when generating list• Run report to track who received doses within 30, 60, 90 days after reminder-recall

message sent



Washington State Department of Health• www.doh.wa.gov/schoolimms2020 (August 1 Rule Changes) • www.doh.wa.gov/Portals/1/Documents/Pubs/348-310-ReminderRecallResources.pdf

(Reminder/Recall Resources PDF)• www.doh.wa.gov/Portals/1/Documents/Pubs/348-573-ReminderRecallGuidePub.pdf

(IIS Ref Guide to Reminder/Recall)• www.youtube.com/watch?v=244Nh8n73mQ&list=PL82Z-swK0-

4lKe1hl3spRI6vFY6nCq5iK&index=23&t=0s (Improving Imm. Rates in the IIS webinar)• https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/PleaseContinueVa

ccinatingPatients.pdf (Vaccination Guidance for Providers during COVID-19 )

Resources (1/2)

http://www.doh.wa.gov/schoolimms2020

http://www.doh.wa.gov/Portals/1/Documents/Pubs/348-310-ReminderRecallResources.pdf

http://www.doh.wa.gov/Portals/1/Documents/Pubs/348-573-ReminderRecallGuidePub.pdf

http://www.youtube.com/watch?v=244Nh8n73mQ&list=PL82Z-swK0-4lKe1hl3spRI6vFY6nCq5iK&index=23&t=0s

https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/PleaseContinueVaccinatingPatients.pdf


Washington Chapter of American Academy of Pediatrics• https://wcaap.org/vaccines/

Within Reach• https://immunitycommunitywa.org/

Resources (1/2)

https://wcaap.org/vaccines/

https://immunitycommunitywa.org/


School requirement changes and COVID-19 impact on vaccine administrations present the need for timely vaccination of Washington State children and adolescents.

Reminder/recall is an evidence-based strategy shown to improve on-time vaccination in diverse populations and settings.

Reminder/recall can be tailored to best meet the needs of each practice and the patients its serves.

Consider using the WAIIS to help generate and track reminder/recall messages in your practice!

Conclusions


• Kathy Bay, DOH• Michelle Izumizaki, WCAAP

Acknowledgements

Questions?

To request this document in another format, call 1-800-525-0127. Deaf or hard ofhearing customers, please call 711 (Washington Relay) or email [email protected].

VACCINE REMINDER/RECALL TO ADDRESS NEW SCHOOL … · 6/16/2020 · Department of Health in...

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