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 [email protected]
or call 800-526-4372
Religious Exemption and general questions regarding requirements in the
School Code: Jessica Gerdes, ISBE, 312-814-8252, [email protected]
General health requirements and child health exams or approved forms:
Vyki Jackson, IDPH, 217/524-1844, [email protected]
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: [email protected]
Phone: 312-763-2389
Or Kristen Nuyen
Email: [email protected] [email protected]
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
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