January 2019 Vaccine Advisory Committee Report

January 2019 Vaccine Advisory Committee Update to be Distributed to WANP 1/24/2019

Good Morning to All. Thank you for taking the time to read the update from the Washington State Vaccine Advisory Committee. I know you are all busy doctors and have a lot of moving pieces in life and practice. Thank you for your ongoing commitment to public health, to the protection of our patients and communities and to our most important principle of prevention.

Infectious Disease:

We are in the midst of a measles outbreak and numbers of cases are expected to rise. At our VAC meeting on 1/17/19 the most important update was about the spread of Measles. We’ve recently seen an increase in the measles cases in the area, primarily in Clark County. At time of writing (1/23/2019) 23 confirmed cases and 3 suspected cases are being investigated by public health. Of the 23 cases 20 are unimmunized individuals and 3 are not verified. Measles is preventable with the MMR vaccine. Children are due for 1 vaccine at 12 months old and 1 at 4 years old. Most of these cases have been in school aged children. There was one case in King County reported on 1/23/2019 that is under investigation.

Key Points:

-Measles is extremely contagious. It can be spread in the air for 2 hours after an infected person leaves that area. Many cases are spread within schools, shopping areas, sports and through travel and people can become infected without having any direct contact with the infected person.

-About 30% of measles cases have complications like pneumonia, diarrhea and ear infections. Some have substantially more serious complications such as encephalitis that can lead to seizure disorders, deafness, intellectual disability and death. It also makes pregnant women more prone to complications and preterm labor.

-After someone has been exposed symptoms may not develop for 1-3 weeks (leaving lots of time to infect others).

YOU can help prevent spread of measles and save lives:

-Make sure your vaccinations are up to date or you have confirmed titers of immunity.

-Get your patients vaccinated on time.

-Help dispel myths and vaccination and teach your patients the facts about vaccine preventable diseases.

-It is preferable that suspected measles patients not be seen in clinic since they’re potentially exposing other patients and staff. Many docs see patients outside or in their car for evaluation rather than in clinic. If a patient plans to come in, be seen in urgent care or an ED they should CALL AHEAD so we can be prepared rather than just showing up (unless of course they have a medical emergency).

Brief Review of Symptoms:

-It can be hard to identify

-Symptoms are red eyes, cough, high fever, runny nose. There is also a distinct rash that develops later, typically starting at the head and working its way down the body.

-The Department of Health requests that if you have a suspected case please call your local health jurisdiction. Labs need to be ordered through the state, not through commercial labs (this is partly so they can track the case and partly to keep things moving in a timely manner). They can get results in hours versus up to 14 days in a commercial lab.

Here are some useful tools:

Number of measles cases in Clark County climbs to 23


http://ndsforvaccines.com/naturopathic-doctors-guide-mmr-vaccine/(For those who haven’t seen this resources please check in out. This article was written by our very own Leila Tomsivec and can be a helpful tool for vaccine hesitant parents).

https://seattlemamadoc.seattlechildrens.org/category/vaccines-2/(This is a local Pediatrician-Mom blog with a bounty of useful, easy to read information for parents and docs! If you haven’t read her blog before please check it out. Under the “vaccines” tab there are many wonderful articles).


Other Infectious Disease Conditions (Less Info on these but valuable none the less);

AFM (Acute Flacid Myelitis)-In 2018 there ach a total of 13 cases. 10 were confirmed and 3 were suspected. As you can imagine, the work up for this is very extensive involving multiple specialists. Each case has had an MRI reviewed by 2 CDC neurologists. It generally presents with rapid progression of paralysis post URI in children. There is still no clear cause.

Varicella– It was mentioned at the VAC that it is important to have lab testing and not just a clinical diagnosis. Reminder that after 1 dose of Varicella about 20% will get the wild disease. Children need 2 doses to have the best coverage (also due on ACIP schedule at 12 months and 4 years. There is a combination product called MMRV available through VFC so kids can have less pokes. In some of the schools most effected by the recent outbreak the under vaccination rate is as high as 20%.

Influenza– This flu season is well under way and has been primarily H1N1 A. 99% of H1N1 and 100% of H3N2 are antigenically very similar to circulating viruses so this is considered to be a very well matched vaccine year. Activity in Washington is still on the rise. H1N1 generally attack younger children more than the elderly (of course anyone can be susceptible to any strain). There is more flu vaccine available through VFC and there is not expected to be a shortage. As a reminder, you can order flu vaccine at any time through VFC (not just during designated ordering times).

In Other News:(the infectious disease update was the important part so that was listed first in case you’re short on time)

  1. The FDA licensed a new Hexavalent vaccine called Vaxelis which contains DTP, Polio, Hep B, HiB. It will be a 3 dose series between 6 months of age and 4 years. It will be available in 2020. More updates to come on that (little information available at time of writing).
  2. There has been an ongoing Hepatitis A outbreak across the country which has effected primarily homeless population. To date there have been 103 deaths. Roughly 50% of patients have been hospitalized which is a high proportion for Hep A. Part of this VAC meeting was providing feedback to the DOH on how much outbreak response funding should be spent on Hep A vaccine vs MMR. There are many items to take into consideration including total morbidity, mortality, communicability and health equity. If you have an opinion about this feel free to email me.
  3. A Technical Advisory Committee was formed to discuss the “conditional Status” at the State Board of Health. “Conditional Status” refers to the state law on how long children can remain in school when they are not up to date on vaccinations. Currently Washington state allows for 30 day leeway time. There are different laws protecting military children and the homeless. The State Board of Health makes the ultimate decision on this and the TAG did not make any changes to recommendations. One item that I have brought up is the need to weigh out infectious disease risk vs other social risks of children not being in school such as increased drug use, increased teen pregnancy etc.
  4. It is time for self-nominations (yes, your clinic has to nominate itself!) for the Immunize Washington Awards! This is a great way to show our patients, their families and our communities our commitment to preventative medicine and keeping our communities safe. Check out the link here https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/PublicHealthSystemResourcesandServices/Immunization/ImmunizeWA


If you have any questions or feedback please feel free to contact me by email any time mkoehnke@healhtpointchc.org.

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