VAC Update 4/18/2019

Hello WANP Members,

Happy Spring to everyone. I hope this update finds each of you happy and healthy. Below is an outline of updates from the Washington State Vaccine Advisory Committee. Unfortunately, it’s been a very busy several months in terms of vaccine preventable disease in our state in light of the measles outbreak. Please see notes below. As always, if you have any questions please feel free to email me at mkoehnke@healthpointchc.org

Legislative

  1. Bill 1638

The legislative session ends April 20th. All of the bills have died except 1 bill (1638) that had some movement on 4/17/19. Bill 1638 is concerning personal and philosophical exemption for measles, mumps and rubella. This bill removes the personal and philosophical exemption as an option for measles, mumps and rubella from school and child care immunization requirements. It also allows for documentation of antibody titer or a health care provider attestation of history of the disease as proof of immunization. Governor Inslee is in support of Bill 1638 which is in the process of moving through the senate. The VAC will help support providers through these changes as they take place and I will send out more information as it is available.

  • Childcare Immunization Rule Making

Board and Department staff convened a Technical Advisory Committee to update chapter 246-105 WAC in July and October. The purpose was to discuss recommended changes to the rule and the process for conditional status. There were not substantial changes to conditional status that resulted from this. The Board and Department staff sent the draft rule to stakeholders and also to the public to allow for additional commentary. Many school RNs and local health officers commented and most expressed that the current rule language is too permissive and leaves students vulnerable to both getting and spreading vaccine preventable diseases. In addition, stakeholders commented on the administrative burden to schools due to tracking requirements for kids in conditional status. No formal action was taken by The Board on this issue but they directed staff to continue to review the laws related to immunization status and to work with the Board Counsel. In March, the Board Counsel advised that presentation of paperwork is due on or before the first day of attendance. The paperwork can take several forms (documentation of full immunization, initiation of immunizations or exemption from immunizations).  Staff will continue to work on the rule language to make clear what is due on the first day of school and what process should be taken for students not up to date on immunizations. They will continue to seek feedback from stakeholders and the public for a hearing on the rule later this year.

  • New ACIP TDaP Recommendations

TDaP recommendations were updated in 4/2018 (previously, if a child received TDaP between ages 7-10 they would not need another dose at age 11). The ACIP Recommendations call for a TDaP at age 11-12 years for the following reasons;

            -if a child received TDaP between 7-10 yrs as part of a catch-up series

            -received a dose by mistake

            -received a dose early to be prepared for a school requirement.

Please take note that IIS Child Profile has not been updated to reflect this change and it is being worked on to get that updated.

Vaccine Supply

  1. Supply of Zoster vaccine is slowly increasing but still in short supply. You can get on a waiting list if you have patients in need.
  2. Note that Engerix and Recombivax HB are interchangeable. Providers may receive doses that are not of their preferred presentation. The antigen content differs between Engerix and Recombivax HB but they are interchangeable. The dosage recommendations may vary by product. You can always check the CDC Current Vaccine Shortages and Delays for updated information.

Infectious Disease Information

  1. Hepatitis B

There is currently a cluster of Hepatitis B in Spokane, Washington which is primarily in 20+ year IV Drug uses of the homeless population.

  • Measles

As of 3/18/19 there were 74 confirmed cases of measles in Washington. 53 of those were in young children ages 0-10. 63 of those cases were in unimmunized persons, 3 of them had 1 MMR and 7 could not be verified (no record was available). In other words, none of the people who were infected had 2 confirmed MMR vaccines. Of the confirmed cases 43 were lab confirmed and 30 were epilinked. The Measles outbreak has cost the state over $1,600,000. Nearly 89 Clark County Public Health staff and 170 DOH staff have worked more than 7,500 hours to control this preventable outbreak. Our Epidemiologist provided the following reminders;

-Disease outbreaks do not respect jurisdiction boarders.

-People infected with measles in WA traveled to locations in Georgia, Hawaii, and Oregon

-Measles virus from WA outbreak genetically matched to a wild strain of measles virus from Eastern Europe

-There have been recent flare ups of measles in Eastern Europe and Israel.

In 2019 (just in the first quarter) we have had 555 cases of measles in the USA. For reference in the entire 12 month period of 2014 we had 667 cases. There are currently outbreaks in NY, NYC, NJ, CA and WA.

An outbreak can be declared over when 2 full incubation periods have passed (42 days) since the date of rash onset in the last known case. IF we have no additional cases that means our outbreak in Washington can be declared over on 4/25. We will have to wait to hear from our public health officials to see if our outbreak can truly be declared over at that point. It is believed that the reason there wasn’t a worse outbreak here in Washington is because of the fairly high MMR coverage in Seattle kindergarten aged children. In Clark County 849 students were excluded from school because of undervaccination status.

At least 15 exposed infants and 3 pregnant women have required immunoglobulin because of the outbreak.

I’ve attached a few documents below that may be useful for your practice and to help talk with vaccine hesitant parents and dispel myths about vaccines and vaccine preventable disease. Please see if any of the below are of interest to you and your practice;

Hand Out for Parents- Quick Facts on Measles

https://www.cdc.gov/measles/about/parents-top4.pdf

Article written by our colleague Matt Brignall and posted on ndsforvaccines.com (there is also a wealth of other information available to you and to your patients here)

This is a video clip from Dr. Paul Offit who practices at the Children’s Hospital of Philadelphia. This information is pretty basic and is aimed more at parents and the general public but I like that he lays things out in a simple format in short videos. He also has a number of short videos on things like safety and ingredients that may be valuable teaching tools.

https://www.chop.edu/news/vaccine-news-briefs

Here’s a piece from local pediatrician Wendy Sue Swanson on measles and breastfeeding- a quick and informative read

https://seattlemamadoc.seattlechildrens.org

If your clinic does not offer vaccinations for children and you want to start check out this link to the VFC program;

https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/PublicHealthSystemResourcesandServices/Immunization/ChildhoodVaccineProgram/ProviderEnrollment

We also had an excellent presentation from a local pharmacist who encouraged providers to use pharmacists more as a resource to help get their patients vaccinated.

As always, if you have questions or feedback please feel free to email me. Have a very happy and healthy Spring!

Dr. Mary Koehnke ND, FABNP

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