From all of us at the Maine Immunization Program, we would like to extend warm wishes for a happy and vaccine-preventable disease-free year!

As you prepare for 2018, we remind you to:

• Review, update and sign your Provider Agreement,
• Complete and submit a Varicella/MMR-V Eligibility form if you are looking to receive frozen vaccine for the first time (click here to find the form in the Storage and Handling section),
• Calibrate any outdated data loggers,
• Complete any necessary required training after February 1 to ensure that you are completing the most up-to-date training.

What is the Difference Between the Two Meningococcal Vaccines?

Vaccines are available that can help prevent meningococcal disease https://www.cdc.gov/meningococcal/), which is any type of illness caused by Neisseria meningitidis bacteria. There are two types of meningococcal vaccines available in the United States:

• Meningococcal conjugate vaccines (Menactra® and Menveo®)
• Serogroup B meningococcal vaccines (Bexsero® and Trumenba®)

All 11- to12- year- olds should be vaccinated with a meningococcal conjugate vaccine. A booster dose is recommended at age 16 years. Teens and young adults (16- through 23- year- olds) also may be vaccinated with a serogroup B meningococcal vaccine.

In addition to a meningococcal conjugate vaccine, certain preteens and teens should get a serogroup B meningococcal vaccine if they:

• Have a rare type of disorder (complement component deficiency)
• Are taking the medicine called Soliris®
• Have a damaged spleen or their spleen has been removed
• Are part of a population identified to be at increased risk because of a serogroup B meningococcal disease outbreak.

Maine Immunization Program Frequently Asked Questions

Q: A 4-year-old's vaccine records show that she had 4 IPVs, given at 2m, 4m, 6m, and age 2. Should she have a booster dose? A: Yes. In June, 2009, ACIP updated its recommendations to clarify that an additional dose must be given at age 4-6 years, even if the child previously received 4 doses (either as IPV or as part of a combination vaccine containing IPV). Q: I need to know how to catch-up a child who is 12- years- old and received 1 dose of DTaP vaccine at age 2 years and 1 dose of Tdap at age 11 years. A: This child needs to complete the primary series with 1 dose of Td, administered no earlier than 6 months after the Tdap dose given at age 11 years. After that, the child needs a booster dose of Td every 10 years. An easy way to determine how to catch up a child is to consult "Recommended Immunization Schedules for Persons Aged 0 Through 18 Years, U.S." The schedule is approved by the U.S. CDC, AAP, and AAFP and is released early in each calendar year. It includes a catch-up schedule for children who have fallen behind (see www.cdc.gov/vaccines/ schedules/index.html). Q: Can I give a tuberculin skin test (TST) on the same day as a dose of MMR vaccine? A: A TST can be applied before or on the same day that MMR vaccine is given. However, if MMR vaccine is given on the previous day or earlier, the TST should be delayed for at least 28 days. Live measles vaccine given prior to the application of a TST can reduce the reactivity of the skin test because of mild suppression of the immune system. Q: I have patients who claim to remember receiving MMR vaccine but have no written record, or whose parents report the patient has been vaccinated. Should I accept this as evidence of vaccination? A: No. Self-reported doses and history of vaccination provided by a parent or other caregiver are not considered to be valid. You should only accept a written, dated record as evidence of vaccination.

VAX Facts

True or False: It’s ok to give a vaccine that is not licensed for a specific dose in a series because it has all the same antigens, if I just don’t have the correct vaccine in stock.

This is false. Knowingly giving a vaccine to a child, or adult, that you know is not licensed for that child or adult’s age group or dose number is an administration error and steps should be taken to make sure this does not happen. The dose might not even be medically valid. This is especially true with pediatric combination vaccines (i.e. Kinrix, Pentacel & Pediarix). How can this be avoided in the future? There are a few steps your practice can take to make sure you have the correct vaccine in stock for the correct patients: 

1. Review charts for patients that will be coming in and getting vaccines over the next 4-6 weeks and base your vaccine order on that review.
2. If you are a smaller practice and do not want to order an entire box for one dose of vaccine, call around to other providers in your area to see if they have doses that can be transferred to you.
3. Call the Maine Immunization Program, or check the Vaccines Available list on the ImmPact home page, to see if there  are any providers looking to transfer specific vaccines.
4. Use single antigen vaccines.

Remember, if you have any questions about which vaccine to use, please call the Maine Immunization Program’s Education Line at:    207-287-9927.

You're Not Done if you Just Give One

According to the U.S. CDC's National Immunization Survey only 39.1% of teens who were age 16 or 17 had received the recommended second dose of meningococcal conjugate vaccine (known as MenACWY or MCV4). This important booster is recommended at age 16 to boost waning immunity. In addition, a relatively new vaccine against meningococcal serogroup B disease is recommended at age 16.

Check out MCV4: You’re Not Done If You Give Just One; Give 2 Doses to Strengthen Protection. This website was developed by the Immunization Action Coalition, in collaboration with Sanofi Pasteur. The title features MCV4, but this page is filled with free tools to help providers increase rates for ALL recommended adolescent vaccines, not just MCV4. Items found on the site include the Top 10 Ways to Improve Adolescent Immunization Rates, an educational handout for 16-year-olds, slide sets, Q&As, and other useful tools.

The Give2MCV4.org website is a great place to download and use helpful materials for improving adolescent immunizations! 

Two Dose Flu Recommendations for Children 6 months - 8 years-old

Some children 6 months through 8 years of age require two doses of influenza vaccine if they're getting vaccinated for the first time. Those who have only previously received one dose of vaccine should get two doses of vaccine this season. All children who have previously  received two doses of vaccine (at any time) only need one dose of vaccine this season.

The second dose should be given at least 28 days after the first dose. The first dose “primes” the immune system; the second dose provides immune protection. Children who only get one dose, but need two doses, may have reduced or no protection from a single dose of flu vaccine.

Below is an easy guide for determining the number of doses of doses needed for certain patients:

http://www.immunize.org/catg.d/p3093.pdf

The Importance of Vaccinating All of Your Patients Against the Flu

BuzzFeed reports on 20-year-old Arizona mother of two who dies one day after receiving flu diagnosis

BuzzFeed reported that a 20-year-old mother of two young children from Arizona died on November 28, one day after receiving a flu diagnosis from an urgent care center. Alani Murrieta died from pneumonia caused by the flu. After experiencing difficulty breathing, she went to the hospital, where she received IV antibiotics. While being moved to the ICU, her heart stopped beating. Doctors were able to resuscitate her, but her heart stopped again while she was in the ICU, and her doctors were not able to resuscitate her a second time. She was not known to have any pre-existing health conditions.

Read the complete BuzzFeed article: A 20-year-old Arizona woman died from the flu one day after being diagnosed (12/4/17)