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PA Bulletin, Doc. No. 13-194


Summary of Selected Morbidity and Mortality Weekly Report Articles on Pediatric/Adolescent Immunizations

[43 Pa.B. 745]
[Saturday, February 2, 2013]

 In accordance with 31 Pa. Code §§ 89.806(a) and 89.807(b) (relating to coverage of child immunizations; and immunizing agents, doses and AWPs), the Department of Health (Department), Bureau of Communicable Diseases, Division of Immunization is updating 31 Pa. Code Chapter 89, Appendices G and H (relating to ACIP recommendations prescribing child immunization practices; and immunizing agents and doses). The Department has primary responsibility for the interpretation and the implementation of 31 Pa. Code §§ 89.806 and 89.807. See 31 Pa. Code § 89.801(b) (relating to authority and purpose; implementation).

 Health Insurance policies are required by the Childhood Immunization Insurance Act (act) (40 P. S. §§ 3501—3508) and regulations promulgated thereunder, 31 Pa. Code Chapter 89, Subchapter L (relating to childhood immunization insurance) to include coverage for certain childhood immunizations, unless the policies are exempted by the act and 31 Pa. Code § 89.809 (relating to exempt policies). The childhood immunizations covered are those that meet Advisory Committee on Immunization Practices (ACIP) standards in effect on May 21, 1992. See 31 Pa. Code § 89.806(a). A list of the Morbidity and Mortality Weekly Report (MMWR) publications containing ACIP recommendations issued under the ACIP standards in effect on May 21, 1992, appears in 31 Pa. Code Chapter 89, Appendix G.

 The Department is required to update the list of these MMWR publications appearing in 31 Pa. Code Chapter 89, Appendix G. See 31 Pa. Code § 89.806(a). The additions to the list are as follows, the remainder of the list at 31 Pa. Code Chapter 89, Appendix G remains in full force and effect:

August 17, 2012, Vol. 61/No. 32

Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2012-13 Influenza Season

 In 2010, the Advisory Committee on Immunization Practices (ACIP) first recommended annual influenza vaccination for all persons aged 6 months or older in the United States. Annual influenza vaccination of all persons aged 6 months or older continues to be recommended. This document: 1) describes influenza vaccine virus strains included in the United States seasonal influenza vaccine for 2012-2013; 2) provides guidance for the use of influenza vaccines during the 2012-2013 season, including an updated vaccination schedule for children aged 6 months through 8 years and a description of available vaccine products and indications; 3) discusses febrile seizures associated with administration of influenza and 13-valent pneumococcal conjugate (PCV-13) vaccines; 4) provides vaccination recommendations for persons with a history of egg allergy; and 5) discusses the development of quadrivalent influenza vaccines for use in future influenza seasons. Information regarding issues related to influenza vaccination that are not addressed in this update is available in CDC's Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010 and associated updates.

August 31, 2012, Vol. 61/No. 34

National and State Vaccination Coverage Among Adolescents Aged 13-17 Years—United States, 2011

 Since 2005, the Advisory Committee on Immunization Practices (ACIP) has expanded the routine adolescent vaccination schedule with administration of the following vaccines at ages 11 or 12 years: meningococcal conjugate (MenACWY), 2 doses; tetanus, diphtheria, acellular pertussis (Tdap), 1 dose; human papillomavirus (HPV), 3 doses; and influenza, 1 dose annually. To assess vaccination coverage among adolescents aged 13 through 17 years, CDC analyzed data from the National Immunization Survey-Teen (NIS-Teen). This report summarizes the results of that assessment, which indicated that, from 2010 to 2011, vaccination coverage increased for >=1 dose Tdap on or after age 10 years (from 68.7% to 78.2%), >=1 dose MenACWY (from 62.7% to 70.5%) and, among females, for >=1 dose of HPV (from 48.7% to 53.0%) and >=3 doses of HPV (from 32.0 to 34.8%). Vaccination coverage varied widely among States. Interventions that increase adolescent vaccination coverage include strong recommendations from health-care providers, urging consideration of every health visit as an opportunity for vaccination, reducing out-of-pocket costs and using reminder or recall systems. Despite increasing adolescent vaccination coverage, the percentage point increase in >=1 dose HPV coverage among adolescent females was less than half that of the increase in >=1 dose of Tdap or MenACWY. The causes of lower coverage with HPV vaccine are multifactorial; addressing missed opportunities for vaccination, as well as continued evaluation of vaccination-promoting initiatives, is needed to protect adolescents against HPV-related cancers.

 NIS-Teen collects vaccination information for adolescents aged 13 through 17 years in the 50 States, the District of Columbia, selected areas, and the United States Virgin Islands, using a random-digit-dialed sample of landline and, starting in 2011, cellular telephone numbers. Parent/guardian respondents provide vaccination and sociodemographic information on adolescents in their care. After the parent/guardian grants permission to contact their child's vaccination provider, a questionnaire is mailed to that provider to obtain a vaccination history from the medical record. A total of 23,564 adolescents (12,328 males and 11,236 females) are included in the national estimates.

August 24, 2012, Vol. 61/No. 33

Vaccination Coverage Among Children in Kindergarten— United States, 2011-12 School Year

 In 2011, CDC reported 17 outbreaks of measles and 222 measles cases, most of which were imported cases in unvaccinated persons. This was the highest number of measles cases in any year in the United States since 1996 and highlights the importance of monitoring measles vaccination coverage at the local level. To identify areas of undervaccination for measles and other vaccine-preventable diseases, State and local health departments monitor compliance with school immunization requirements using annual school vaccination assessment reports, supported as a CDC immunization funding objective for the 64 grantees, including the 50 States, the District of Columbia (DC), five cities and eight other reporting areas. CDC also monitors progress toward meeting Healthy People 2020 objectives for the vaccination of children entering kindergarten. This report summarizes vaccination coverage, exemption rates, and reporting methods from the 2011-2012 school year kindergarten vaccination assessments submitted by 56 grantees, including 49 States, DC, one city and five other reporting areas. Median coverage with 2 doses of measles, mumps and rubella (MMR) vaccine was 94.8% among 47 reporting states and DC. Total exemption rates, including medical, religious and philosophic exemptions, among 49 reporting States and DC, ranged from <0.1% to 7.0% (median: 1.5%). Although Statewide levels of vaccination coverage are at or very near target levels, locally low vaccination coverage for extremely transmissible diseases such as measles remains a threat to health. Monitoring MMR vaccination coverage at the local and state level will continue to be critical as long as the risk for measles importation and outbreaks exist.

September 7, 2012, Vol. 61/No. 35

National, State, and Local Area Vaccination Coverage Among Children Aged 19-35 Months—United States, 2011

 High vaccination coverage in children by age 2 years has resulted in historically low levels of most vaccine-preventable diseases in the United States, but coverage must be maintained to reduce the burden of disease further and prevent a resurgence of these diseases, particularly in populations with lower vaccination coverage. This report describes national, state, and selected local area vaccination coverage by age 19 through 35 months for children born during January 2008 through May 2010, based on 2011 National Immunization Survey (NIS) results. Vaccination coverage remained above the national Healthy People 2020 target of 90% for >=1 dose measles, mumps, rubella vaccine (MMR) (91.6%), >=3 doses of hepatitis B vaccine (HepB) (91.1%), >=3 doses of poliovirus vaccine (93.9%), and >=1 dose of varicella vaccine (90.8%). For the birth dose of HepB, coverage increased from 64.1% in 2010 to 68.6% in 2011; for the more recently recommended >=2 doses of hepatitis A vaccine (HepA) and rotavirus vaccines, coverage increased from 49.7% to 52.2% and from 59.2% to 67.3%, respectively; and for the full series of Haemophilus influenzae type b vaccine (Hib), coverage increased from 66.8% to 80.4%, reflecting recovery from the Hib shortage that occurred during December 2007 through September 2009. The percentage of children who had not received any vaccinations remained at <1%. Children living below the poverty level had lower coverage than children living at or above poverty for >=4 doses of diphtheria, tetanus toxoid and acellular pertussis vaccine (DTaP) and >=4 doses of pneumococcal conjugate vaccine (PCV) (by 6 percentage points each); the full Hib series (by 8 percentage points); and for rotavirus vaccination (by 10 percentage points). Continued partnerships among national, state, local, private, and public entities are needed to sustain current coverage levels and ensure that coverage for the more recently recommended vaccines continues to increase for all children.

 Persons with a disability who require an alternative format of this notice (for example, large print, audiotape, Braille) should contact Department of Health, Wayne Fleming, Public Health Program Administrator, Division of Immunizations, Room 1026, Health and Welfare Building, Harrisburg, PA 17120, (717) 787-5681 or for speech and/or hearing impaired persons at V/TT (717) 783-6154 or the Pennsylvania AT&T Relay Service at (800) 654-5984 (TT).

Acting Secretary

[Pa.B. Doc. No. 13-194. Filed for public inspection February 1, 2013, 9:00 a.m.]

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