Immunization Requirements for the 2006-2007 School Year -
New since June, the date for final implementation of the new requirements is Dec. 31, 2006, with schools directed to work towards full compliance by that date. Exclusion from school will not take place before that date. For children turning 7 years of age by that date, the appropriate diphtheria-tetanus booster will be Td, without the pertussis component.
The earlier note is repeated here:
At School Entry the major change is that MMR immunizations that were given up to 4 days before a child's first birthday are now acceptable as a first dose. All Pre-schoolers and Kindergarten children up to age 5 are now required to have Pneumococcal Conjugate Vaccine PCV7 (Prevnar); the number of doses depends on the age of the child. Similarly, a child at age 5 (60 months) or at kindergarten entry is now required to have a second MMR in any child care or educational setting. Children in Grades 6-9 will now (next school year) be required to have a Hepatitis B series of 3 and a Varicella immunization or documented history of the disease (parental statement of month/year & symptoms to the public or school health nurse meets this requirement, or a serology can be drawn). This is another year of incremental increases in requirements for older children that had been previously established. All school-entry immunizations are being entered into Immunet (www.mdimmunet.org/) , the state immunization registry, except when a parent opts out. This will be a handy reference for registered physicians in the future.
Since a second dose of Varicella vaccine in being recommended for school entry, the initial immunization at age 1 year, and the booster before school can be this combination vaccine.
This vaccine (Menactra) is in short supply, even at the Health Department. We are administering what vaccine we have to students entering college this Fall, and developing a waiting list for children still in high school who are asking for the vaccine (as is recommended). We expect supplies to slowly increase so this backlog will be erased.
This new vaccine has been approved, but only for young women, and not for the obvious vector, young men. The cost of the series of three injections may be $300-500, and this may greatly limit access to this cancer-preventing advance. The vaccine does not cover all HPV strains, so PAP smears or other HPV surveillance will continue to be necessary.
The recommendations for the up-coming season include expanded coverage for the pre-school group, now from >5 months up to <60 months. Adequate supplies are still expected. In addition, Garrett County is considering offering the nasal spray vaccine free to all children K-Grade 5, but this is still in negotiation, and further information will be passed on later.
Pandemic Influenza -
The best over view of the current situation that I have seen is given by Dr. Mike Magee. Click Here to View
Medical Economics had an article which made the following seven points: Click Here to View Entire Article
1. Know where to turn for help. (We hope that in Garrett County that will be the local health department, 301-334-7770, Eric Cvetnick, Jennifer Lee-Steckman or William Pope)
2. Anticipate Staffing needs . Expect staff to be out with illness- their own or family.
3. Educate Patients. Stay home if ill and keep away from public gatherings.
4. Develop a strategy for infection control. Office procedures, signs, supplies, hand-washing attention.
5. Determine who's first in line for vaccines. Recently there was mention of "pre-pandemic" vaccinations for healthcare workers, to be followed by pandemic specific vaccine when it is available.
6. Plan to refocus your practice when a pandemic strikes. We have discussed having local HCP's staff a triage center (on rotation) for all patients with influenza symptoms, to separate those clearly infected from those requiring other care.
7. "Federalizing" vaccines. This has become necessary because the current system is not meeting needs- will it be expanded to non-pandemic vaccines?
A special checklist has been developed by the CDC for doctors' offices to help them plan and prepare their practice and office in advance for a pandemic. Click Here for checklist.
The latest version of the Federal Pandemic Influenza Plan was released May 3, and adds additional areas of consideration. The basics of prevention continue to be infection control: voluntary home isolation, respiratory hygiene, hand washing and social distancing. Face masks for the general public are not of proven benefit, but can be used voluntarily. Although the current influenza virus is thought to spread by droplets, (surgical mask adequate) healthcare workers directly caring for patients may start with airborne precautions, (N95 mask, etc.) until the level of contagiousness of a pandemic virus is established by studies. Click Here to access plan. A State Pandemic Influenza Plan, version 6 "DRAFT" has seen limited distribution, but is not ready for public release. We are bringing together a local draft version, based on the state plan with local input for release at the end of this month.
Medicare Part D-
Some winners, some losers....