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October ACIP Meeting

The Advisory Committee on Immunization Practices (ACIP) met October 19 and 20 in Atlanta, GA. ACIP-

approved recommendations do not become official until they are approved by the Centers for Disease Control

and Prevention (CDC) Director and published in the Morbidity and Mortality Weekly Report (MMWR). The

following is a summary from the Immunization Action Coalition about the meeting.

Hepatitis B Vaccine

The rate of acute hepatitis B virus (HBV) infections in the United States has declined by more than 90 percent

since recommendations for hepatitis B vaccine (HepB) were first issued in 1982. The ACIP have updated HepB

recommendations multiple times; since 2005, they published five statements which offered recommendations

based on differing criteria such as the recipient’s age, chronic health condition, pregnancy status, or occupation.

At the October meeting, ACIP voted to approve a single guidance document that consolidated these previously

published recommendations into a comprehensive statement. The committee reemphasized the importance of

the HepB birth dose as a safety net against chronic HBV infection passed from a mother to her infant by

recommending that all infants of hepatitis B surface antigen (HBsAg)-negative mothers be immunized with

HepB within 24 hours of birth. This recommendation removes previous policy language that allowed for a

delay in administering the birth dose in certain rare circumstances and on a case-by-case basis. Additional areas

updated on the statement include prioritization of HBsAg-positive women for HBV management and therapy,

guidance on post-vaccination serologic testing for infants whose mother’s HBsAg status remains unknown

indefinitely (e.g., infant surrendered anonymously after birth), and provision of specific examples of chronic

liver disease to further define whom to vaccinate.

Tdap Vaccine

Immunization Newsletter

Fall 2016

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Previous ACIP recommendations called for prenatal care providers to vaccinate all pregnant women with

tetanus-diphtheria-acellular pertussis (Tdap) vaccine during each pregnancy with optimal timing for this dose

designated between 27 and 36 weeks gestation. Following a presentation of data indicating increased

immunogenicity of the vaccine when mothers were vaccinated earlier, ACIP voted to recommend

administering Tdap vaccination early in the 27- through 36-week “window” to maximize passive

antibody transfer to the infant. The new recommendations also clarify that persons 7–10 years of age who

receive Tdap as part of a catch-up series may be given an additional Tdap for the routinely recommended

adolescent dose at 11–12 years of age.

Human Papillomavirus (HPV) Vaccine

Although the ACIP recommended HPV vaccine for females since 2006 and males since 2011, the 2015 NIS-

Teen indicated that in adolescents 13–17 years of age, less than one-half (41.9%) of girls and less than one-third

(28.1%) of boys had received the recommended three doses. On October 7, the Food and Drug Administration

(FDA) approved adding a 2-dose schedule for 9vHPV (Gardasil 9, Merck) vaccine for adolescents 9–14 years

of age. After reviewing the immunogenicity data and efficacy trials of the 2-dose schedule, ACIP voted to

recommend that younger adolescents who begin the series at 9 through 14 years of age receive two doses

of HPV at least six months apart, rather than the previously recommended 3-dose series. The ACIP now

recommends two doses (not three) for anyone who receives the first dose before their 15th birthday, regardless

of age at series completion. It is anticipated this schedule will increase vaccine initiation and series completion

in the U.S. Teens and young adults who start the series later, at 15–26 years of age, will continue to need three

doses.

According to CDC’s official press release, “CDC encourages clinicians to begin implementing the 2-dose

schedule in their practice to protect preteen patients from HPV cancers.” The 9vHPV vaccine will soon be the

only HPV vaccine available in this country; Merck will distribute only 9vHPV after the end of October.

Supplies of 2vHPV (Cervarix, GlaxoSmithKline) in the U.S. are expected to be depleted by November. 9vHPV

may be used to complete a series begun with 4vHPV or 2vHPV.

Meningococcal Serogroup B Vaccine

In 2015, ACIP recommended routine meningococcal serogroup B (MenB) vaccination for persons 10 years of

age or older who were at increased risk of meningococcal infection. The committee also recommended the

vaccine be provided to healthy adolescents and young adults 16 through 23 years of age. ACIP did not express a

preference for the use of MenB-4C (Bexsero®, GlaxoSmithKline) or MenB-FHbp (Trumenba®, Pfizer),

although the same product must be used for the entire series.

Bexero® has previously been recommended for use with a 2-dose schedule for high-risk individuals and in

outbreak settings, and may be administered to healthy individuals 16 through 23 years of age. In April, the FDA

approved a label change giving Trumenba® a 2-dose (0, 6 months) or 3-dose (0, 1–2, 6 months) schedule. The

ACIP voted to recommend that providers who use Trumenba® continue to use the 3-dose schedule when

vaccinating persons at increased risk of meningococcal serogroup B disease (e.g., persons with persistent

complement component deficiencies or anatomical or functional asplenia) or during serogroup B outbreaks.

The 2-dose schedule of Trumenba® at 0, 6 months can be used for routine vaccination for healthy persons

16 through 23 years of age.

Child and Adolescent Immunization Schedule

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ACIP annually updates the recommended immunization schedule for children and adolescents. Although ACIP

voted on edits for the 2017 schedule during the October meeting, the final schedule is not slated for publication

until February 2017. Many changes approved for the 2017 schedule incorporate policies previously approved by

ACIP during 2016. The majority of the edits involve changes to help improve readability and usability of the

document. Users should review the schedule in 2017 when it is published for specific details.

One of the significant formatting changes in the schedule was made to the age columns. The vaccine

recommendations for adolescents 16 years of age wereplacing in a separate column from the

recommendations for persons 17 through 18 years of age. In making this distinction, ACIP is highlighting the

importance of the 16-year-old visit to administer the recommended meningococcal conjugate (Men-ACWY)

booster dose, as well as to provide the opportunity to deliver MenB vaccine and catch-up on other

recommended adolescent vaccines such as HPV and Tdap. Previously there was one column for ages 16

through 18 years.

Adult Immunization Schedule

Similar to the child and adolescent schedule, the updated adult immunization recommendations are scheduled

for publication in early 2017. In addition to multiple revisions being made to improve the readability and clarity

of the schedule, a significant change to the table format is that the ages 27 through 59 years will be shown as

one age group in a single column. Previously the age groups were in two columns, one for 27 through 49 years,

and the other for 50 through 59 years.

All recommendations approved by ACIP are provisional until the director of CDC approves them, and they are

published in MMWR. Presentation slides from the October meeting should be posted on the ACIP website in the

next 4–6 weeks.

Immunization Program Student Intern Summer Projects

This past summer, the NDDoH Immunization

Program had the opportunity to work with three

Master of Public Health (MPH) students from the

University of North Dakota (UND) and North

Dakota State University (NDSU) on different

projects evaluating immunization program activities

and vaccine preventable disease prevalence.

The two students from UND evaluated the

effectiveness of the immunization program’s

reminder/recall efforts. Since 2013, the

Immunization Program has been conducting a

statewide recall of infants and adolescents for their

routine immunization recommendations, and

kindergarten and 7th graders for school-required

immunizations. We have seen an increase in

immunization rates for adolescents, but have not

seen the same

positive impact

for infants and

school-aged

kids. One

student, Ben

Larson, spent the summer evaluating adolescent

recall effectiveness and comparing the effectiveness

of automated phone calls vs. postcards vs. letters.

The second student, Ellen Lu, has been evaluating

the effectiveness of the infant and back-to-school

recall. Both students used NDIIS immunization

data, and the individual immunization recall files to

(1)send recall notices to evaluate the impact of the

Immunization Program recall efforts on

immunization rates; (2) determine if recall is more

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effective for certain vaccines; (3) evaluate the

timeliness of immunization after recall; (4) evaluate

where children are receiving immunizations after

recall, based on type of provider administering the

vaccine; and (5) to identify geographic areas in

North Dakota with the highest concentration of kids

receiving recall notices and whether recall is more

effective in rural vs. urban areas.

Enija Shiwakoti, the student from NDSU, was

tasked with evaluating the prevalence of human

papillomavirus (HPV) testing and disease diagnoses

in North Dakota. HPV is not a mandatory reportable

condition, so the HPV-related diseases are not

tracked or investigated by the NDDoH. The purpose

of this project was to collect baseline HPV-related

disease diagnosis and treatment information for

North Dakota residents in the years 2013-2015,

based on insurance billing data from Blue

Cross/Blue Shield of North Dakota and Sanford

Health Plan; for baseline data so the the impact of

HPV vaccination can be evaluated in the future.

This will also be used to evaluate the potential

impact on the NDDoH of making HPV a reportable

condition in the future in North Dakota.

All three students are currently finalizing their data

analysis and are working on completing their final

reports for the immunization program.

2015 Infant NIS Data Released

On Oct. 6, 2016, the Centers for Disease Control and Prevention (CDC)

released 2015 Infant National Immunization Survey (NIS) data in Morbidity

and Mortality Weekly Report (MMWR). The MMWR is available at

http://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6539.pdf. Immunization

rates for the 4:3:1:3:3:1:4 series

(4 DTaP, 3 polio, 1 MMR, 3 or 4 Hib, 3 HepB, 1 varicella, and 4 PCV)

increased from 71.3% in 2014 to 80.2% in 2015 in North Dakota (see graph below).

68.9 69.7

43.4

65.8

79.1

72.2 72.0 71.3

80.2

66.5 68.4

44.3

56.6

68.5 68.4 70.4 71.6 72.2

40

50

60

70

80

90

100

2007 2008^ 2009^ 2010^ 2011 2012 2013 2014 2015

Immunization (4:3:1:3:3:1:4) Rates of Children 19 - 35 Months: North Dakota vs. U.S. (NIS Data)

^Hib shortage

ND

US

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NDDoH Immunization Program Awarded New Grant to Increase HPV Vaccination Rates Using AFIX

The NDDoH Immunization Program recently received a new, two-year grant: Increasing HPV Vaccine

Coverage by Strengthening Adolescent AFIX Activities, Financed in Part by 2016 Prevention and Public Health

Funds. The NDDoH requested funding to increase and improve the quality of adolescent Assessment Feedback

Incentive eXchange (AFIX) visits in North Dakota. Additional AFIX visits will focus on increasing human

papillomavirus (HPV) vaccination rates at the largest and poorest performing providers in the state.

The anticipated long-term outcome of this project is to decrease provider-level missed vaccination opportunities

among adolescents, leading to increased and sustained immunization coverage levels among adolescents and

decreased morbidity and mortality caused by vaccine-preventable diseases.

Mid-term outcomes of this project are to (1) increase provider adoption and execution of quality improvement

(QI) strategies, increase practice-level vaccination coverage rates among visited providers (especially for

initiation and completion of HPV vaccination series),(2) increase the number of providers who strongly

recommend HPV vaccination to parents, (3) improve knowledge regarding HPV disease and HPV vaccination

among providers, and (4) improve communication skills among providers and provider staff regarding HPV

disease and HPV vaccination.

Short term outcomes of this project are to (1) increase the number of providers who agree to implement QI

strategies to 100%, (2) increase knowledge and use of CDC resources (including AFIX standards) among staff

conducting adolescent AFIX visits, (3) ensure staff conducting AFIX activities receive technical assistance and

guidance to improve the quality of AFIX visits; (4) and have increased access to tools to improve QI and HPV

communication with providers, increase provider awareness of adolescent coverage rates within their practice,

increase provider awareness of Healthy People 2020 goals for adolescent immunization rates, and increase

participation in site visits by physicians and clinic decision makers.

North Dakota State University Center for Immunization Research and Education requested funding to conduct

fifty additional AFIX visits each year during the project, recruit and train physicians to conduct clinician-to-

clinician AFIX, provide continuing medical education credits for AFIX, and to evaluate the project. Funding

was also requested for required travel and staffing at the NDDoH to coordinate grant activities and oversee the

project.

Hepatitis A Outbreaks

This year in the United States, two major outbreaks

of hepatitis A occurred due to contaminated foods.

Hepatitis A is an infection caused by a virus.

Symptoms typically last less than two months and

include fever, nausea, abdominal discomfort, dark

urine, and jaundice. Hepatitis A does not lead to

chronic infection. A person who is infected can

spread the disease from two weeks before to one

week after symptom onset. Hepatitis A is found in

the stool of infected people and is spread from

person to person when food, drinks, or other objects

are contaminated. Foods and drinks most likely to

be contaminated include fruits, vegetables, raw

shellfish, and untreated water or ice. Person to

person transmission can occur due to inadequate

handwashing after using the bathroom or caring for

an infected person. After exposure to the hepatitis A

virus, it can take anywhere from 15 to 50 days for

symptoms to start. This length of time makes it

difficult for patients to recall foods they have eaten,

and in turn, difficult to determine the source of the

outbreak.

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One of the hepatitis A outbreaks is occurring in

Hawaii. As of September 28, 282 cases of hepatitis

A were reported by the Hawaii Department of

Health. Raw scallops served at Genki Sushi

restaurants were identified as the likely source of

the outbreak. The product is no longer being sold,

purchased, or consumed in the state, and the

restaurants selling the scallops were closed

temporarily.

The other outbreak is occurring in multiple states

and was linked to frozen strawberries used in some

Tropical Smoothie Café restaurants. There have

been 131 cases reported out of Arkansas, Maryland,

New York, North Carolina, Oregon, Virginia, West

Virginia, and Wisconsin as of September 30. The

restaurants have removed the strawberries and

switched to another supplier.

Hepatitis A vaccine is routinely recommended for

children 12 – 23 months and is required to receive

child care attendance in North Dakota. Contacts of

hepatitis A cases who have not received a hepatitis

A vaccine in the past should talk with their health

care provider about receiving a hepatitis A vaccine

or hepatitis A immune globulin, depending on their

age and how recently they were exposed. Contacts

are defined as household members and sexual

contacts, anyone sharing food or eating or drinking

utensils with an infected person, anyone consuming

foods prepared by an infected person, or anyone

sharing illicit drugs with an infected person.

In addition to receiving the vaccine, hepatitis A can

be prevented by proper hand washing. Infected

individuals should not prepare or handle food

during the contagious period.

In North Dakota, there have been two confirmed

cases of hepatitis A in 2016.

2016 North Dakota Immunization Conference Overview and Evaluation Results

The 2016 North Dakota Immunization Conference took place in Bismarck on August 3 and 4. With over 275

participants and 27 speakers, it was a very busy two days. Keynote topics ranged from speaking with vaccine-

hesitant parents to recent ACIP recommendations and increasing adult immunizations. Immunization awards

were given out to 30 providers for achievements in increasing immunization rates during a luncheon awards

ceremony. The conference concluded with a powerful musical presentation by Christine Baze who is a cervical

cancer survivor, founder of the Yellow Umbrella Organization, and participant in the ‘Someone You Love’

film. We hope all participants walked away with a renewed and invigorated approach to keeping North

Dakotans safe from vaccine-preventable diseases.

The Immunization Program reviewed the evaluations from

conference participants. While the reviews were overwhelmingly

positive, there is definite room for improvement. The

Immunization Program is currently looking for another venue to

host our conference; frankly, we have outgrown the space! The

Immunization Program takes your evaluations very seriously, and

we will work hard to make the 2018 Immunization Conference

even better. If you have ideas for speakers or topics you would

like to learn more about, email Abbi Berg at alberg@nd.gov.

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2015 Adolescent National Immunization Survey Data Released

On August 25, 2016, CDC released 2015 Adolescent NIS data in MMWR. The MMWR is available at

www.cdc.gov/mmwr/volumes/65/wr/mm6533a4.htm?s_cid=mm6533a4_w.

North Dakota’s adolescent (13–17 years) rates drastically increased compared to 2014 for starting and

completing the HPV vaccination series for both males and females (see graph below).

North Dakota’s rates for all adolescent vaccines were above the national average (see graph below).

60.9

41.737.6

25.3

70.5

47.1

62.3

38.4

0

10

20

30

40

50

60

70

80

HPV1 - Female HPV3 - Female HPV1 - Male HPV3 - Male

North Dakota HPV Vaccination Rates (NIS) 2014 vs. 2015

2014

2015

86.481.3

62.8

41.9

49.8

28.1

83.1

88.9 91.6

70.5

47.1

62.3

38.4

89.8

0

10

20

30

40

50

60

70

80

90

100

Tdap MCV4 HPV1 -Female

HPV3 -Female

HPV1 - Male HPV3 - Male Var (2)

North Dakota and U.S. Adolescent (13 - 17) Immunization Rates: 2015 NIS

US

ND

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New Immunization Educational Resources Available!

The NDDoH Immunization Program has new influenza vaccination posters available for free to healthcare

providers and other stakeholders. Posters are available in two sizes, 8 x 14 and 11 x 17. To order free influenza

posters, please visit www.ndflu.com/Education/Influenza/FluOrder.aspx. The new posters that are available

promote influenza vaccination to the following groups:

Elderly

Pregnant women

Healthy adults

Children

The NDDoH immunization program also has new HPV vaccination posters available for order. One poster

directed towards adolescent boys and the other for adolescent females. The HPV posters are available to order

for free at www.ndhealth.gov/immunize/order/.

NDDoH and NDSCR Participate in Data Match Project

Recently, the North Dakota Immunization

Information System (NDIIS) completed a data

match project in cooperation with the North Dakota

State Cancer Registry (NDSCR). The purpose of

this project was to assess shared information

between the registries to evaluate the potential for

additional data sharing in the future. We also

reviewed shared information on HPV-related cancer

cases to evaluate the potential for using this data for

future tracking of disease outcomes and vaccine

efficacy in North Dakota’s population.

The CDC estimates that 79% of cancers in tissues in

areas of the body such as the genitals, anus, and

oropharynx, among both males and females, are

attributable to chronic HPV infection. Higher rates

of vaccination against HPV-subtypes will translate

to decreased cancer incidences among our

population. As of the end of 2012, in North Dakota,

the incidence rates of HPV-associated cancers was

at 6.5 per 100,000 for cervical cancers in females;

oropharyngeal cancer rates were 1.3 for females and

6.7 for males, and the combined overall incidence

of HPV-associated cancers was 9.5 per 100,000

people.

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The results from the registry data match project

showed that, from the licensure of the first HPV

vaccine in 2006 through the end of 2013, 54.3% of

all cancer diagnosed patients had a record in the

NDIIS. Approximately 89.7% of HPV-related cases

in the NDSCR were also represented with a record

in the NDIIS. Additionally, according to the HPV-

related cases data, young adults were initiating the

3-dose series at an average age of 21 years, and

completion of a 3-dose HPV vaccine series

occurred on average at age 22 years. Only 25.6% of

individuals in the dataset completed the full 3-dose

series. No males with an HPV-related cancer

diagnosis had been vaccinated with HPV-vaccine in

the period studied. Furthermore, among the

individuals that did complete the series, it was

found to take an average of 18 months for

completion. Routine recommendations from the

ACIP call for initiation of the HPV vaccine series at

age 11, for both boys and girls, and completion

within in a 6-month timeframe. Teens and young

adults may be vaccinated up to age 26 years for

females and age 21 years for males, but up to age 26

years for males in high-risk health categories.

Overall, a significant number of individuals

diagnosed with cancer, and specifically with HPV-

related cancers, represented within the NDSCR had

immunization records in the NDIIS. The crossover

of information also verifies these two state public

health registries collect similar data and that there

would be value to future research projects on HPV

vaccine and HPV-related cancers as well as other

vaccines and disease outcomes

Online Journal of Public Health Informatics publishes Immunization Program article

In 2015, Mary Woinarowicz, Manager of the NDIIS, evaluated the impact of electronic health record (EHR)

interoperability on the quality of immunization data in the NDIIS. NDIIS doses administered data was evaluated

for completeness of the patient and dose-level core data elements for records that belong to interoperable (IPs)

and non-interoperable providers (NIPs). Data was compared to three months before

electronic health record (EHR) interoperability enhancement to data at three, six, nine

and twelve months post-enhancement following the interoperability go live date of

the state’s major health systems. Doses administered per month and by age group,

timeliness of vaccine entry and the number of duplicate clients added to the NDIIS

was also be compared, in addition to, immunization rates for children 19-35 months

of age and adolescents 11-18 years of age. Earlier this year, Disease Control

submitted the paper to the Online Journal of Public Health Informatics. The journal

accepted the article and published it in the September 2016 issue. View the full article at

http://ojphi.org/ojs/index.php/ojphi/issue/view/490.

North Dakota Presents at the National Immunization Conference

This past September, the CDC hosted the 47th National Immunization Conference in Atlanta. The theme for

this year’s conference was “Immunization: it takes a community” and included presentations focused on adult

immunization, immunization information systems (i.e. immunization registries), immunization program issues,

health and risk communication, epidemiology and surveillance of vaccine preventable disease, and childhood

and adolescent immunization. North Dakota gave three presentations at this year’s conference.

Mary Woinarowicz, Manager of the North Dakota Immunization Information System (NDIIS) presented on

challenges and lessons learned throughout the reminders and recall efforts conducted by the North Dakota

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Immunization Program. Reminder/recall functionality was implemented in the NDIIS in 2010 along with the

immunization forecaster. In 2012, the immunization program conducted a reminder/recall pilot project that

targeted infants 19-35 months of age in Divide, McKenzie, Mountrail, and Williams counties. In 2013, the

immunization program began a statewide recall program targeting adolescents and had continued recall efforts

for infants state-wide, kids entering kindergarten and 7th grade for school required immunizations and have

started sending reminders to kids turning 11 years for HPV vaccine. The immunization program has used

feedback from parents and providers to make adjustments to our reminder and recall efforts to improve our

programs and increase immunization rates in North Dakota.

Kylie Hall, Project Manager for the Center for Immunization Research and Education at North Dakota State

University gave two presentations around school immunization rates and exemptions and the impact of schools

enforcing immunization requirements. Kylie’s first presentation discussed their research around school

immunization rates. They found that despite declining school immunization rates in North Dakota, most parents

are vaccinating their children on time. They also found that it is too easy to get an immunization exemption in

North Dakota, but exemptions are not the sole reason for our declining immunization rates. A major

contributing factor is a lack of school enforcement of immunization requirements. Schools that enforce

immunization requirements have significantly higher immunization rates than schools that do not enforce. If all

North Dakota schools enforced immunization requirements and schools did not allow parents to claim an

exemption out of convenience, we would see a significant impact on our school immunization rates.

The second presentation Kylie gave discussed the Center’s findings after they conducted focus groups and one-

on-one interviews with school immunization stakeholders. Through their interviews, they found school

administrators disagreed over whether or not schools were the most appropriate avenue for enforcement and

school immunization practices were reflective of the superintendent’s philosophies. Non-enforcing schools were

concerned about the number of children who would potentially miss school, how attendance impacts graduation

and school funding, and, increased workload for school staff if they were to enforce immunization

requirements. However, when looking at schools that do enforce, they found very few children excluded from

school and that most children excluded were back to school within a few days. They concluded that state

leadership and school administrators play an important role in the enforcement of immunization requirements,

which schools are an appropriate avenue for enforcement because they are a main point of contact for almost all

North Dakota children and because they have a large potential for the spread of disease.

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Vaccine Returns and Wastages for Quarter Three (July–September 2016)

A new feature of the Immunization Newsletter will give providers an update on quarterly vaccine returns and

wastages. This quarter saw large numbers of doses and a large amount of dollars lost, mainly because influenza

vaccine expired at the end of quarter two and doses were returned during this quarter. Ninety percent of the

reported vaccine that expired this month was influenza vaccine!

Reported Vaccine Returns and Wastage Data for ND Providers for Quarter Three

Wastage Reason Total Vaccine Lost in Dollars

Expired Vaccine $97,392.29

Failure to Store Properly Upon Receipt $883.40

Refrigerator Too Cold $2,826.11

Spoiled in Transit $1,142.50

Broken Vial or Syringe $262.51

Open Vial and Not All Doses Administered $920.45

Vaccine Drawn into Syringe but Not Administered $1,925.02

Other $8,486.66

Total $113,838.94

There is always going to be wastage of influenza vaccine; there is simply no way around it. Flu pre-booking is

done early in the year before the doses ship, and ultimately each year there is something that affects influenza

vaccine uptake, such as a change in recommendations, vaccine delays, or another unforeseeable circumstance.

However, there are a few ways to reduce influenza vaccine wastage.

1) Use last year’s pre-book as a guide and pre-book based on usage and expiration. If your provider pre-

booked 500 doses of influenza but ended up returning over 100 doses because they expired, perhaps the

pre-booked amount is too high.

2) Make pre-booking vaccine decisions based on your patient population. Has your population or provider

population changed? Is your facility seeing a surge in Medicaid or privately insured patients?

3) Keep in mind any new updates on influenza vaccine such as vaccine efficacy or availability. This

information often isn’t available when pre-booking but something to keep in mind.

4) Begin vaccinating as soon as your facility has received the supply. There will be patients who want

vaccine in September, and you might not see them again during the influenza season.

5) Children under eight years of age may need two doses this influenza season, so this is all the more

reason to start early. Also, continue to vaccinate until the vaccine expires for patients who need two

influenza doses this season.

6) Use NDIIS’s reminder/recall system to call in patients who are due for influenza season. This is a great

way to get patients up-to-date as well as use up vaccine inventory that might otherwise be wasted.

7) Offer community or school vaccination clinics to get patients vaccinated that you may not normally see

in your practice.

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New CDC Public Health Advisor for ND Immunization Program!

Hello, my name is Andy Noble. I am a CDC Public Health Advisor who

joined the North Dakota Immunization Program in August, and I am

currently working to develop a statewide adult immunization program.

From 2000-2002, I worked as a Health Program Specialist for Contra-

Costa Health Services in Concord, CA where I developed, implemented,

and evaluated various public health programs. From 2002-2013, I was the

Quality Assurance and Education/Outreach Coordinator for the Idaho Immunization Program (IIP). While in

this role, I managed the QA and education sections of the IIP. In 2013, I became Idaho’s Primary Care Program

Manager. In this role, I evaluated Idaho’s population to determine access to healthcare, developed, and

implement programs to increase access to care for identified underserved populations throughout the state.

I enjoy spending time with my family, playing tennis, fly fishing, mountain biking, and doing Judo with my

daughters.

Unannounced VFC Storage and Handling Visits: What to Expect

CDC expects each state to conduct two types of

visits as part of the Vaccine for Children (VFC)

program. The VFC site visit is the most common

and is familiar to most providers. This visit is

required to take place at least every other year for

each provider of VFC vaccine. The Unannounced

Storage and Handling (USH) visits are done as

needed as long as each awardee goes to 5-10% of

the enrolled providers each year.

The NDDoH VFC staff determines who should

have an unannounced visit. Providers not scheduled

for a VFC visit during the calendar year or those

who have had temperature excursions are

candidates for this visit.

The USH visit reviews some of the same documents

and items as a regular VFC site visit. Key staff,

review vaccine management plans, temperature

logs, data logger information and thermometer

calibration certificates.

As the name implies, storage units are the focus of

this visit. Vaccine placement in the units and

expiration dates are other components of this visit.

Overall space in each unit is important to note, so

the reviewer knows that the provider has adequate

space to store vaccine during the busier times of the

year, such as influenza season. ‘Do not Unplug or

Disconnect’ signs are also regularly checked during

this visit.

Due to the visit being unannounced, the VFC

reviewer shows up at the clinic unexpectedly. It is

important for more than one employee to know

where all of the VFC documents are stored, as well

as having access to the data logger files so the visit

can take place even if the primary coordinator isn’t

present on the day of the visit. This preparation

enables the reviewer to review all of the documents

during the visit and determine if the VFC has bet

requirements.

If the VFC discovers unmet requirements during the

USH visit, the reviewer provides education and

explanation. If the site cannot correct items during

the visit, follow-up steps are implemented. The

VFC sends a packet of information to the provider

following the visit with the steps required to

meet VFC requirements with the due dates for

each requirement.

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2016-2017 Influenza Vaccine Update

The 2016-2017 influenza vaccination season is in full swing and like every

other year there are important updates that providers should know.

Flumist® (LAIV4) Not Recommended for 2016-2017 Season

In light of low effectiveness against influenza A(H1N1)pdm09 in the

United States during the 2013-14 and 2015-16 seasons, for the 2016-

17 season, ACIP made the interim recommendation that providers do

not use LAIV4.

New Vaccine Licensures

A quadrivalent formulation of Flucelvax® (cell culture-based inactivated influenza vaccine [ccIIV4],

was licensed by FDA in May 2016, for persons aged ≥4 years. CIIV4 is an acceptable alternative to

other vaccines licensed for persons in this age group. There is no preference for any particular vaccine

product. Providers may have received this influenza vaccine as part of an allocation so pay

particular attention to the age indication as it differs from other influenza vaccine products.

An MF59-adjuvanted trivalent inactivated influenza vaccine (aIIV3), Fluad® was licensed by FDA in

November 2015 for persons aged ≥65 years. AIIV3 is an acceptable alternative to other vaccines

licensed for persons in this age group. ACIP and CDC do not express a preference for any particular

vaccine product.

Influenza Vaccine Allocations

As soon as the CDC releases Influenza vaccine doses, NDIIS will allocate them. NDIIS immunization

program staff enters all influenza vaccine allocations into the database on the provider’s behalf. The

primary and secondary contact from the NDIIS vaccine ordering module will receive an email each time

an influenza vaccine order is placed on their behalf. Providers should contact the immunization program

immediately if they feel they have enough inventory and don’t want any further doses of influenza

vaccine. Doses will continue to be automatically sent to providers until 100% of pre-booked doses have

been sent out. As a reminder, influenza vaccine is not available for provider order until all pre-booked

allocations have been sent out.

Changes to Egg Allergy Recommendations

There is no longer a recommendation that egg-allergic recipients be observed for 30 minutes post-

vaccination for signs and symptoms of an allergic reaction. Providers should consider observing all

patients for 15 minutes after vaccination to decrease the risk of injury should they experience syncope,

per the ACIP General Recommendations on Immunization.

Persons with a history of severe allergic reaction to egg (i.e., any symptom other than hives) should be

vaccinated in an inpatient or outpatient medical setting (including but not necessarily limited to

hospitals, clinics, health departments, and physician offices), under the supervision of a healthcare

provider who is able to recognize and manage severe allergic conditions.

14

Overview of Recommended Immunizations for Health Care Workers in North Dakota

Due to the risk of exposure to vaccine-preventable

diseases, the Hospital Infection Control Practices

Advisory Committee (HICPAC) has encouraged

any facility or organization that provides direct

patient care to develop a comprehensive

immunization policy for all Healthcare personnel

(HCP). The American Hospital Association has also

endorsed the concept of vaccination programs for

hospital personnel and patients. Facilities should

review immunization records and immunity status

for HCP at the time of hire and on a regular basis (at

least annually) or in conjunction with routine annual

disease-prevention measures to ensure all HCP are

up to date with recommended vaccines. The

definition of HCP includes, but is not limited to,

physicians, nurses, nursing assistants, therapists,

technicians, emergency medical service personnel,

dental personnel, pharmacists, laboratory personnel,

autopsy personnel, students and trainees,

contractual staff not employed by the healthcare

facility, and persons (e.g., clerical, dietary,

housekeeping, laundry, security, maintenance,

administrative, billing, and volunteers) not directly

involved in patient care but potentially exposed to

infectious agents.

The following immunizations are recommended for

HCP to reduce the likelihood of contracting and

transmitting vaccine-preventable diseases among

coworkers, patients, and family members.

Hepatitis B: If documented evidence of a complete hepatitis B vaccination series and an up-to-date blood test

demonstrating hepatitis B immunity is not available, then the HCP should receive the hepatitis B series and

post-vaccination serologic testing.

Dose Recommended Interval Minimum Interval

One Today

Two Four weeks following dose one Four weeks following dose one

Three Four to six months after dose two Eight weeks between dose two and three and 16 weeks between dose one and dose three

Get anti-HBs serologic tested 1–2 months after dose #3.

Influenza: Get one dose of influenza vaccine annually.

Measles, Mumps, Rubella (MMR): HCP born in 1957 or later that have not had the MMR vaccine or do not

have an up-to-date blood test demonstrating immunity to measles or mumps (i.e., no serologic evidence of

immunity or prior vaccination), should get two doses of MMR vaccine separated by a minimum of 28 days.

HCP with two documented doses of MMR are not recommended to be serologically tested for immunity; but if

they are tested and results are negative or equivocal for measles, mumps, and/or rubella, these HCP should be

considered to have presumptive evidence of immunity to measles, mumps, and/or rubella and are not in need of

additional MMR doses.

HCP born in 1957 or later and have not had the MMR vaccine or

do not have an up-to-date blood test demonstrating immunity to

rubella, are recommended to receive one dose of MMR.

However, HCP may receive two doses, because the rubella

component is in the MMR vaccine.

15

HCP born before 1957 lacking laboratory evidence of measles, mumps, and rubella immunity or laboratory

confirmation of disease, should consider vaccination with two doses of MMR vaccine separated by a minimum

of 28 days. For unvaccinated personnel born before 1957 who lack laboratory evidence of measles, mumps and

rubella immunity or laboratory confirmation of disease, healthcare facilities should recommend two doses of

MMR vaccine during an outbreak of measles or mumps and one dose during an outbreak of rubella.

Varicella (Chickenpox): The ACIP recommends that all HCP be immune to varicella. Evidence of immunity

in HCP includes documentation of two doses of varicella vaccine given at least 28 days apart, laboratory

evidence of immunity, laboratory confirmation of disease, or diagnosis or verification of a history of varicella or

herpes zoster (shingles) by a healthcare provider.

Tetanus, Diphtheria, and Pertussis (Tdap): HCP who have not received the Tdap vaccine are recommended

to receive one dose of Tdap, regardless of the date of the previous dose of Td vaccine. The Td vaccine should

be administered to all HCP at ten-year intervals following Tdap. Pregnant HCP should receive a dose of Tdap

during each pregnancy.

Meningococcal: HCP (laboratory workers) routinely exposed to isolates of Neisseria meningitidis should get

meningococcal conjugate vaccine (MCV4) and meningococcal B (MenB) vaccine.

HCP Recommended to Receive MCV4: Clinical microbiologists and research microbiologists who

might be exposed routinely to isolates of N. meningitidis should receive a single dose of MCV4 and

receive a booster dose every five years if they remain at increased risk.

HCP Recommended to Receive MenB: Clinical microbiologists and research microbiologists who

might be exposed routinely to isolates of N. meningitidis should receive two or three doses of Men B

vaccine, depending on the brand of vaccine used.

Additional Resources

Healthcare Personnel Vaccination Recommendations:

www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/A/healthcare-rec.pdf

Vaccine-related frequently asked questions: www.immunize.org/askexperts/

Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization

Practices (ACIP):

www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm

16

Provider Rate Previous Quarter Q3 2015

1 First District Health Unit – Burke County 100% 100% 100%

2 First District Health Unit – Renville County 100% 100% 100%

3 Steele County Health Department 100% 66.7% 66.7%

4 Traill District Health Unit 100% 100% 0.0%

5 West Fargo Family Health‡ 100% 100%

6 Northland Community Health Center – McClusky‡

100% 66.7%

7 Turtle Mountain Family Medicine 100% 100% 75.0%

8 Northwood Deaconess Clinic – Larimore‡ 100% 100%

9 Walsh County Health District 97.3% 91.1% 89.8%

10 Altru Family Medicine Center 96.3% 95.6% 86.8%

11 City-County Health District 95.7% 100% 92.0%

12 Altru Family Medicine South Clinic 95.7% 91.3% 72.9%

13 First District Health Unit – Bottineau County 95.0% 95.1% 89.5%

14 MidDakota Main Clinic 94.1% 84.2% 62.5%

15 Lake Region District Health Unit – Ramsey County

94.0% 91.3% 90.6%

16 Lake Region District Health Unit – Benson County

93.3% 94.4% 92.0%

17 Foster County Public Health 92.3% 88.5% 92.9%

18 West River Health Services – New England 91.7% 81.8% 72.7%

Immunization Honor Roll:

Quarter 3, 2016

Achievement of Healthy People 2020 Goal of 80% for the4:3:1:3:3:1:4 † Vaccine Series

17

Provider Rate Previous Quarter Q3 2015

19 Trinity Health Center West Pediatrics 91.2% 90.7% 90.8%

20 Rolette County Public Health District 90.7% 91.8% 90.6%

21 Altru Family Medicine Residency 90.4% 90.0% 84.8%

22 West River Health Services – Bowman 90.3% 88.2% 89.5%

23 Independent Family Doctors 90.2% 79.3% 77.9%

24 Sanford North Mandan Clinic 90.1% 83.3% 94.7%

25 Nelson-Griggs District Health Unit 90.0% 88.9% 87.5%

26 Upper Missouri District Health Unit – Williams County

89.8% 87.8% 63.5%

27 Richland County Health Department 88.9% 94.4% 87.5%

28 Indian Health Services – Belcourt 88.1% 83.5% 87.1%

29 Sanford 2nd Ave Clinic – Jamestown 87.6% 87.7% 78.5%

30 Independent Doctors‡ 87.5% 100%

31 First Care Rural Health Clinic 87.2% 87.0% 92.9%

32 Essentia Health - Wahpeton 86.9% 84.6% 88.3%

33 MidDakota Gateway Pediatrics Clinic 87.2% 87.0% 92.9%

34 Sanford Clinic – Mayville 86.7% 82.0% 82.7%

35 First District Health Unit – Minot 86.5% 83.1% 79.5%

36 Lake Region District Health Unit – Eddy County

86.2% 86.2% 93.3%

37 Midgarden Family Clinic 86.1% 82.4% 88.9%

38 First District Health Unit – Ward County 85.7% 100% 75.0%

39 Cavalier County Health District 85.7% 97.0% 91.7%

18

Provider Rate Previous Quarter Q3 2015

40 Sanford Clinic – Valley City 84.6% 88.5% 80.6%

41 Essentia Health – Valley City 84.6% 88.5% 80.6%

42 MidDakota Kirkwood Main Clinic 84.2% 77.9% 79.7%

43 Sanford Health Dickinson 83.9% 82.8% 79.0%

44 Coal Country Community Health Clinic 83.9% 84.2% 77.4%

45 First District Health Unit – McLean County 83.3% 60.0% 100%

46 Pembina County Public Health 83.3% 78.6% 93.8%

47 Health Tracks 83.3% 80.0% 80.0%

48 Early Childhood Tracking 83.3% 76.3% 72.2%

49 Heart of America Johnson Clinic – Rugby 82.9% 82.9% 89.4%

50 Trinity Health Southridge Family Medicine 82.6% 70.8% 72.7%

51 Upper Missouri District Health Unit – McKenzie County

82.4% 78.8% 74.7%

52 Ransom County Public Health 82.4% 79.6% 82.1%

53 Altru Clinic Pediatrics 82.1% 79.8% 81.2%

54 St. Alexius - Minot 82.0% 76.4% 72.5%

55 Bismarck-Burleigh Public Health 81.8% 77.5% 73.5%

56 Towner County Public Health 81.8% 83.3% 73.3%

57 Sanford Clinic – Oakes 81.8% 85.7% 55.6%

58 Sanford Children’s Clinic – Bismarck 81.8% 79.5% 75.6%

59 St. Alexius Mandan Clinic North 81.7% 76.7% 79.5%

60 Upper Missouri District Health Unit – Mountrail County

81.5% 76.0% 68.0%

19

Provider Rate Previous Quarter Q3 2015

61 Viscito Family Medicine 80.6% 82.3% 80.5%

62 Pediatric Arts Clinic 80.2% 72.6% 80.5%

63 First District Health Unit – McHenry County 80.0% 81.8% 84.6%

64 First District Health Unit – Sheridan County 80.0% 100% 88.9%

65 Sanford Health Dickinson East Clinic 80.0% 87.2% 94.8%

66 Northland Community Health Center – Turtle Lake

80.0% 60.0% 50.0%

67 Northwood Deaconess Clinic - Northwood 80.0% 72.7% 83.3%

68 Essentia Clinic – Lisbon 80.0% 85.7% 100%

20

Immunization Honor Roll:

Quarter 3, 2016

Achievement of Healthy People 2020 Goals for Tdap, Meningococcal, and Varicella Vaccines †

Provider

Tdap

Rate

MCV4

Rate

Varicella

Rate

HPV Rate

(Female)

HPV Rate

(Male)

1 City-County Health District 97.8% 96.3% 95.5% 61.4% 64.1%

2 Lake Region District Health Unit – Benson County

98.1% 98.1% 98.1% 91.3% 67.7%

3 First District Health Unit – Bottineau County

89.5% 87.7% 93.2% 61.9% 53.9%

4 First District Health Unit – Burke County

98.0% 96.1% 96.1% 73.9% 53.6%

5 First District Health Unit – Ward County

98.1% 96.2% 96.2% 80.8% 63.0%

6 Fargo Cass Public Health 98.3% 97.4% 97.4% 35.3% 28.8%

7 Cavalier County Health District 98.1% 97.1% 98.1% 70.0% 65.4%

8 Avera Clinic 100% 100% 100% 0.0% 0.0%

9 Upper Missouri District Health Unit – Divide County

91.1% 90.4% 98.1% 32.1% 36.4%

10 Lake Region District Health Unit – Eddy County

98.4% 98.4% 98.4% 88.6% 55.6%

11 Custer Health – Grant County 91.2% 91.2% 92.5% 31.7% 25.6%

12 Nelson-Griggs District Health 95.0% 94.0% 95.0% 39.0% 30.5%

13 First District Health Unit – McHenry County

97.2% 98.1% 99.1% 78.0% 75.9%

14 Upper Missouri District Health Unit – McKenzie County

93.8% 93.3% 98.9% 64.4% 60.0%

21

Provider

Tdap

Rate

MCV4

Rate

Varicella

Rate

HPV Rate

(Female)

HPV Rate

(Male)

15 First District Health Unit – McLean County

95.1% 95.1% 97.6% 58.8% 42.6%

16 Custer Health – Morton County 93.3% 92.7% 96.4% 54.8% 37.5%

17 Upper Missouri District Health Unit – Mountrail County

86.2% 84.2% 92.8% 43.8% 36.7%

18 Lake Region District Health Unit – Pierce County

90.7% 88.4% 95.3% 35.7% 6.7%

19 Lake Region District Health Unit – Ramsey County

88.9% 88.9% 91.9% 74.6% 65.6%

20 Ransom County Public Health 96.5% 97.7% 97.7% 67.1% 64.8%

21 First District Health Unit – Renville County

100% 100% 98.0% 62.5% 57.7%

22 Richland County Health Department 100% 100% 100% 57.1% 40.0%

23 First District Health Unit – Sheridan County

100% 100% 100% 50.0% 44.4%

24 Central Valley Health District 95.9% 95.5% 93.4% 34.2% 31.0%

25 Walsh County Health District 97.8% 97.8% 98.4% 83.8% 70.3%

26 Dickey County Health District 99.4% 99.4% 98.7% 81.2% 83.1%

27 First District Health Unit – Garrison 100% 100% 100% 58.3% 38.5%

28 Foster County Public Health 100% 100% 100% 80.3% 80.3%

29 Kidder County District Health Unit 96.0% 94.0% 92.0% 22.2% 38.7%

30 Emmons County Public Health 90.3% 89.3% 92.2% 6.0% 9.4%

31 McIntosh District Health Unit 95.2% 98.4% 91.9% 46.7% 22.6%

32 Wells County District Health Unit 90.1% 88.9% 90.1% 40.9% 16.7%

22

Provider

Tdap

Rate

MCV4

Rate

Varicella

Rate

HPV Rate

(Female)

HPV Rate

(Male)

33 Lamoure County Health Department 96.7% 96.7% 92.8% 46.5% 40.0%

34 Rolette County Public Health District 93.4% 93.4% 97.3% 70.2% 59.8%

35 Towner County Public Health 95.3% 95.3% 97.7% 62.5% 36.8%

36 Custer Health – Beulah 96.2% 92.3% 92.3% 54.5% 20.0%

37 Wells County District Health Unit – Harvey

97.7% 97.7% 97.7% 100% 48.0%

38 Indian Health Services – Belcourt 97.1% 96.4% 97.6% 51.2% 46.9%

39 Spirit Lake Indian Health Services 91.6% 90.2% 97.3% 51.5% 43.0%

40 Trenton Community Clinic 85.4% 84.3% 91.0% 48.8% 25.0%

41 Heath Tracks 90.5% 95.2% 95.2% 54.5% 40.0%

42 Early Childhood Tracking 96.7% 96.7% 100% 73.3% 86.7%

43 Indian Health Services – PHN Dunseith

100% 100% 100% 100% 0.0%

44 Trinity Medical Arts South Pediatrics 95.2% 95.1% 95.8% 51.2% 43.0%

45 Sanford Health Dickinson 89.2% 88.9% 91.4% 44.9% 36.4%

46 Heart of America Johnson Clinic – Maddock

90.0% 80.0% 90.0% 50.0% 66.7%

47 Sanford Family Medicine North Fargo

96.5% 97.2% 96.5% 48.7% 41.9%

48 UND Center for Family Medicine 90.7% 91.2% 91.2% 44.4% 44.1%

49 West River Health Services – Mott 100% 100% 90.9% 33.3% 40.0%

50 Northland Community Health Center – Rolla

91.6% 90.4% 97.6% 69.4% 68.1%

23

Provider

Tdap

Rate

MCV4

Rate

Varicella

Rate

HPV Rate

(Female)

HPV Rate

(Male)

51 Northland Community Health Center – Rolette

100% 100% 100% 45.5% 40.0%

52 Sanford North Mandan Clinic 97.2% 97.2% 93.8% 56.1% 34.3%

53 Heart of America Johnson Clinic – Rugby

94.9% 93.9% 95.9% 31.1% 35.8%

54 West River Health Services – New England

100% 100% 100% 44.4% 23.1%

55 Trinity Community Clinic Western Dakota

88.9% 88.1% 91.3% 29.4% 19.7%

56 Altru Clinic – Devils Lake 100% 100% 97.9% 30.0% 44.4%

57 Sanford Clinic – Hillsboro 88.1% 87.3% 91.0% 36.8% 40.3%

58 Sanford Clinic – Valley City 89.4% 90.8% 92.9% 41.2% 27.5%

59 Heart of America Johnson Clinic – Dunseith

88.9% 88.9% 91.4% 55.0% 43.9%

60 Sanford Dickinson East Clinic 93.3% 93.8% 90.0% 46.4% 27.5%

61 Essentia Health – Casselton 84.0% 84.0% 92.0% 57.1% 30.0%

62 MidDakota Clinic Gateway Family Practice

97.9% 98.2% 97.5% 33.1% 31.9%

63 Independent Family Doctors 99.4% 98.1% 93.4% 28.1% 33.8%

64 Sanford Clinic – Enderlin 100% 100% 91.7% 63.6% 30.8%

65 Sanford Family Medicine – Bismarck 88.6% 88.6% 90.9% 37.1% 33.3%

66 Northland Community Health Center – Turtle Lake

100% 97.3% 97.3% 40.0% 14.3%

67 Essentia Health – Valley City 98.4% 98.4% 95.3% 53.3% 53.1%

68 St. Alexius Mandan Clinic North 96.5% 94.8% 93.6% 30.0% 36.7%

24

Provider

Tdap

Rate

MCV4

Rate

Varicella

Rate

HPV Rate

(Female)

HPV Rate

(Male)

69 Midgarden Family Clinic 97.6% 97.6% 95.2% 46.7% 50.0%

70 Trinity Health Center West 99.1% 99.1% 99.1% 76.4% 67.3%

71 MidDakota Kirkwood Main Clinic 98.6% 98.6% 95.7% 45.6% 34.2%

72 St. Alexius Minot 99.0% 97.9% 93.8% 36.7% 28.3%

73 First Care Rural Health Clinic 90.5% 91.9% 93.2% 70.0% 36.4%

74 Altru Family Medicine South 99.3% 99.3% 96.7% 51.3% 60.3%

75 Altru Family Medicine Residency 96.2% 95.7% 93.8% 49.4% 36.4%

76 Coal Country Community Health Clinic

98.0% 5.5% 95.5% 35.2% 31.1%

77 Sanford 2nd Ave Clinic – Jamestown 96.6% 95.6% 96.6% 63.7% 47.2%

78 Clinicare 95.8% 95.8% 94.4% 40.5% 27.6%

79 Dakota Boys and Girls Ranch – Minot

100% 100% 100% 75.0% 66.7%

80 Pediatric Arts Clinic 98.5% 99.2% 98.5% 23.3% 23.1%

81 Valley Community Health Center – Larimore

100% 100% 90.0% 43.8% 21.4%

82 Sanford OB/GYN Clinic – Bismarck 100% 100% 100% 100% 0.0%

83 Sanford Children’s North Bismarck Clinic

99.2% 98.7% 95.8% 59.8% 59.8%

84 Northwood Deaconess Clinic – Northwood

96.2% 98.1% 100% 66.7% 34.2%

85 Turtle Mountain Family Medicine 100% 100% 94.1% 66.7% 34.2%

86 Northwood Deaconess Clinic – Larimore

100% 100% 100% 0.0% 40.0%

25

Provider

Tdap

Rate

MCV4

Rate

Varicella

Rate

HPV Rate

(Female)

HPV Rate

(Male)

87 Northland Community Health Center – Ray

100% 80.0% 100% 50.0% 0.0%

88 Anne Carlsen Center 100% 100% 100% 100% 57.1%

89 Parshall Clinic 100% 97.5% 97.5% 40.0% 65.0%

90 Twin Buttes Clinic 100% 92.3% 92.3% 20.0% 50.0%

91 White Shield Clinic 100% 100% 100% 25.0% 41.7%

92 MHA Bismarck 100% 100% 100% 75.0% 0.0%

Storage and Handling Fast Fact Check

Myth:

When transporting vaccines from our clinic to a remote location, it is

acceptable for us to use the original coolers that the vaccine was

shipped in.

Truth:

Transport vaccines only when necessary (e.g., for a mass immunization clinic, in an

emergency, or to ensure vaccines that are about to expire can be used rather than wasted).

Vaccines that will be used at an off-site or satellite facility should be delivered directly to that

facility. If that is not possible, transport of vaccines should be done using a portable vaccine

refrigerator with a temperature monitoring device placed with the vaccines. If this is not available,

use qualified containers and pack-outs with a temperature monitoring device. If you must

transport vaccines, transport only what is needed for the workday. The total time for transport

and workday should be a maximum of eight hours.

Immediately upon arrival at an off-site facility, store vaccines in an appropriate storage unit with a

temperature monitoring device, and temperatures should be read and recorded a minimum of two times

during the workday.

Keep vaccines in the portable vaccine refrigerator only if you cannot store them in an on-site storage unit

during an off-site clinic:

• Place a temperature monitoring device (preferably with a probe in a thermal buffer) as close as

possible to the vaccines, and read and record temperatures at least hourly.

26

• Keep the container closed as much as possible.

• Remove only one multidose vial or ten doses at a time for preparation and administration by each

person administering vaccines.

Myth:

Our clinic had a power outage, but only for a short period. Both the refrigerator and freezer alarmed with

warm temperatures because of the power outage. All of the vaccines can still be considered viable though

because it was only a short time and we didn’t open the doors.

Truth:

Vaccines exposed to temperatures outside the recommended ranges can have reduced potency

and protection. Storage and handling errors can cost thousands of dollars in wasted vaccine and

revaccination. Errors can also result in the loss of patient confidence when repeat doses are

required. It is better not to vaccinate than to administer a mishandled dose of vaccine. Label

exposed vaccines, “DO NOT USE,” and place them in a separate container apart from other

vaccines in the storage unit. Contact the vaccine manufacturer(s) for further guidance on whether

to use affected vaccines and for information about whether you will need to recall patients for

revaccination. Be prepared to provide documentation of the event (e.g., temperature log data) to

ensure you receive the best guidance. Contact the Immunization Program to notify them of the

temperature excursion.

Myth:

Our clinic does not need to order vaccine this month, so we don’t need to download our data loggers and

send them to the Immunization Program.

Truth:

Most data loggers have the capability to maintain the data up to 4,000 readings. After this time, the

data logger with either starts to delete data or stop recording, depending on the type of data

logger that the provider has. For best practice, download the data logger monthly. This practice

will also be a good way to monitor for potential unit failures. Submit copies of data logger’s

temperature recording charts to the NDDoH Immunization Program monthly for each unit

containing state-supplied vaccine. Keep temperature logs on hand for a minimum of three years.

Keep records of both electronic data logger temperature charts and paper temperature logs.

Myth:

Between back to school immunizations and flu shot clinics, we won’t have time to download and send our

monthly temperature data to the Immunization Program. Simply faxing copies of our paper temperature

records to the NDDoH will be sufficient for this month.

27

Truth:

The NDDoH Immunization Program only accepts electronic copies of temperature logs unless

otherwise specified by the Program. Temperature monitoring data must be downloaded and sent

to the Immunization Program in PDF format via email every month to be eligible to place VFC

vaccine orders. If you are unable to email your monthly temperature logs for some reason, please

contact the Immunization Program.

Calendar of Events

October 12th – NDDoH Immunization Lunch and Learn

October 18th – Someone You Love: The HPV Epidemic in

Grand Forks, ND

October 19th – 20th - ACIP Meeting in Atlanta, GA

October 22nd - 25th - AAP National Conference and Exhibition

in San Francisco, CA

November 9th – NDDoH Immunization Lunch and Learn

November 4th - 6th - NFID Fall 2016 Clinic Vaccinology Course

in Philadelphia, PA

December 4th – 10th – National Influenza Vaccination Week

December 14th – NDDoH Immunization Lunch and Learn

28

Immunization Program

Molly Howell, MPH

Immunization Program Manager

mahowell@nd.gov

Abbi Berg, MPH

Vaccines for Children Manager

alberg@nd.gov

Lexie Barber, MPH

Immunization Surveillance Coordinator

abarber@nd.gov

Mary Woinarowicz, MA

NDIIS Sentinel Site Coordinator

mary.woinarowicz@nd.gov

Miranda Baumgartner, MBA

VFC/AFIX Coordinator (West)

mlbaumgartner@nd.gov

Sherrie Meixner

VFC/AFIX Coordinator (East)

smeixner@nd.gov

Dominick Fitzsimmons

NDIIS Coordinator

dfitzsimmons@nd.gov

Kelsie Howes

Administrative Assistant

khowes@nd.gov

Terry Dwelle, MD, MPHTM Kirby Kruger Tracy K. Miller Molly Howell

State Health Officer Chief, Medical Services Section State Epidemiologist Immunization Program Manager

Director, Disease Control Assistant Director, Disease Control

Published by the North Dakota Department of Health Division of Disease Control,

2365 E. Main Ave., P.O. Box 5520, Bismarck, N.D. 58506-5520

Publication is available in alternative forms; for more information, contact Kelsie Howes, editor, Immunization Newsletter.

EQUAL OPPORTUNITY EMPLOYER

Immunization Program

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