Immunization Policies And Procedures Manual September 2017

Immunization Policies andProcedures ManualLouisiana Department of HealthOffice of Public HealthImmunization ProgramRevised September 2017i

Center for Community and Preventive HealthBureau of Infectious DiseasesImmunization ProgramTABLE OF CONTENTSI. POLICY AND GENERAL CLINIC POLICY . 1PURPOSE . 1POLICY ON CLINIC SCHEDULING . 2POLICY ON PUBLICITY FOR IMMUNIZATION ACTIVITIES. 4POLICY ON EDUCATIONAL ACTIVITIES (HEALTH EDUCATION IN IMMUNIZATION CLINICS) . 5POLICY ON CHECKING IMMUNIZATION STATUS OF ALL CHILDREN RECEIVING SERVICES THROUGHTHE HEALTH DEPARTMENT . 6POLICY ON MAXIMIZING TIME SPENT WITH PARENTS DURING IMMUNIZATION CLINICS . 7POLICY ON ASSISTANCE TO FOREIGN TRAVELERS . 9II. POLICY REGARDING CLINIC ORGANIZATION . 10PROTOCOL FOR IMMUNIZATION CLINIC ORGANIZATION . 10ORDERING OF IMMUNIZATION SUPPLIES . 13VACCINE STORAGE REQUIREMENTS . 15POLICY ON POWER OUTAGES . 40HANDLING OF VACCINE IN THE CLINIC AREA . 42POLICY ON TRANSPORTING VACCINE . 44POLICY ON EXPIRATION OF VACCINES AND BIOLOGICS . 47POLICY ON VACCINE TRANSFERS . 48VACCINE TRANSFER REPORT IMMUNIZATION PROGRAM (EPI-6; REV 09/2012) . 50POLICY ON VACCINE USAGE AND INVENTORY . 51POLICY ON MOBILE VACCINATION UNITS . 53III. GENERAL POLICY REGARDING IMMUNIZATION . 56VACCINE ADMINISTRATION RECORD; VACCINE FOR CHILDREN (VFC) PATIENT ELIGIBILITYSCREENING RECORD; AND REGISTRY AUTHORIZATION . 56POLICY ON ROUTE OF ADMINISTRATION. 58TECHNIQUES FOR ADMINISTRATION OF INJECTIONS . 59POLICY ON INFORMING PARENTS OF POTENTIAL VACCINE REACTIONS . 64REPORTING OF ADVERSE VACCINE REACTIONS . 65SIMULTANEOUS ADMINISTRATION OF VACCINES . 67MIXING VACCINES . 68CHILDREN WITH INTERCURRENT ILLNESS . 69POLICY ON IMMUNIZATIONS OF HIV-INFECTED INDIVIDUALS. 70POLICY ON IMMUNE GLOBULIN, BLOOD PRODUCTS AND ROUTINE VACCINATION . 72POLICY REGARDING UNRULY AND RESISTING CHILDREN . 73ii

RECOMMENDED HANDLING OF THE RESISTING CHILD WHEN A PROCEDURE MUST BE DONE . 74POLICY ON THE MANAGEMENT OF EMERGENCY REACTIONS. 75PROTOCOL ON VACCINE REACTIONS AND THEIR MANAGEMENT. 76CARDIAC ARREST PROTOCOL . 79ANAPHYLAXIS PROTOCOL . 80PROTOCOL FOR BRONCHOSPASM . 84PROTOCOL FOR RASH AND URTICARIA . 85PROTOCOL FOR DIZZINESS AND FAINTING . 86EMPLOYEE VACCINATION POLICY . 88REFUSAL OF VACCINATION AND RELEASE FROM RESPONSIBILITY . 91VACCINE SCHEDULE . 93SCHOOL ENTRY REQUIREMENTS IN ACCORDANCE TO R.S. 17:170 STUDENT IMMUNIZATIONS-SCOPEOF REQUIREMENT . 97POLICY ON ISSUANCE OF THE STATE OF LOUISIANA UNIVERSAL CERTIFICATE OF IMMUNIZATIONSFOR SCHOOL/ CHILD CARE - PRESCHOOL REGISTRATION . 100GUIDELINES FOR EXCLUSION FROM SCHOOL OR DAYCARE . 101POLICY ON IMMUNIZATION RECORDS UTILIZING LINKS . 103HIGHER LEARNING ENTRY REQUIREMENTS FOR STUDENTS IN LOUISIANA . 105POLICY ON COMMUNICABLE DISEASE REPORTING . 106V. POLICY REGARDING SPECIFIC IMMUNIZATIONS . 108POLICY ON DTAP, DT, TD AND TDAP VACCINATIONS . 108POLICY ON THE ADMINISTRATION OF HAEMOPHILUS INFLUENZAE TYPE B CONJUGATE VACCINES . 113POLICY ON HEPATITS A VACCINE . 117ADMINISTRATION OF IMMUNE SERUM GLOBULIN (ISG) PROPHYLAXIS OR HEPATITIS A VACCINEFOR HEPATITIS A CONTACTS . 121POLICY ON UNIVERSAL HEPATITIS B VACCINATION . 123PERINATAL HEPATITIS B PREVENTION PROGRAM – SCREENING AND PREVENTION OF HEPATITIS BTRANSMISSION IN HIGH-RISK INFANTS . 126HEPATITIS B SURVEILLANCE AND FOLLOW-UP FORM . 134POLICY ON HUMAN PAPILLOMAVIRUS (HPV) VACCINES. 136POLICY ON INFLUENZA VACCINE . 139POLICY ON MEASLES VACCINATION . 146POLICY ON MENINGOCOCCAL (GROUP A, C, Y AND W-135) VACCINATION . 148POLICY ON MENINGOCOCCAL DISEASE (MENB) SEROGROUP B VACCINATION . 150POLICY ON MUMPS VACCINATION . 151POLICY ON PNEUMOCOCCAL CONJUGATE VACCINE (PCV) . 152POLICY ON PNEUMOCOCCAL POLYSACCHARIDE VACCINE (PPSV) . 157POLICY ON POLIOMYELITIS VACCINATION . 160POLICY ON ADMINISTRATION OF RABIES VACCINATION . 162POLICY ON LIVE, ORAL ROTAVIRUS VACCINATION . 168iii

POLICY ON RUBELLA VACCINATIONS . 171POLICY ON VARICELLA, ZOSTAVAX AND MMRV COMBINATION VACCINATION . 172POLICY ON THE IMMUNIZATION OF ADOLESCENTS . 176POLICY ON THE IMMUNIZATION OF HIGH RISK ADULTS WITH HEPATITIS VACCINE. 177POLICY ON USAGE OF COMBINATION VACCINES . 181VI. MISCELLANEOUS IMMUNIZATION INFORMATION . 185PROCEDURES FOR VACCINE PROTECTION AND HURRICANE/DISASTER PREPAREDNESS . 186EMERGENCY RESPONSE PLAN & WORKSHEET (PART 1) . 191IMMUNIZATION GUIDELINES FOR DISPLACED CHILDREN - POST-NATURAL DISASTER . 194VACCINES FOR CHILDREN (VFC) DISCREPANCY OR MISUSE POLICY . 197POSSIBLE ORIGINS OF SUSPECTED DISCREPANCIES AND/OR MISUSE: . 197FOREIGN-BORN PERSONS AND IMMUNIZATIONS WITH FREQUENTLY ASKED QUESTIONS . 201FREQUENTLY ASKED QUESTIONS ABOUT IMMUNIZATIONS AND FOREIGN-BORN PERSONS . 202SPECIAL CONSIDERATION FOR EMERGENCY PROTOCOL TO BE FOLLOWED IN A NON-MEDICALFACILITY: . 206VACCINATION OF HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS. 208iv

I. POLICY AND GENERAL CLINIC POLICYPURPOSEOne of the major goals of the Office of Public Health (OPH) is to promote health through theprevention of illness and death. Immunization has proven to be a safe and effective way ofpreventing the morbidity and mortality of many infectious diseases. The low cost and highefficacy of vaccination ensures that every dollar spent on vaccination is repaid many times overbecause of reduced hospital costs, in addition to lives that remain productive. Accordingly, theOffice of Public Health has made immunization of every child in Louisiana a high priority. TheLouisiana Legislature supported this philosophy by requiring immunization for all children inschools and child care facilities in Louisiana.Immunization is a complicated subject. It requires knowledge about numerous vaccines,preparation for the rare side effects, and effective communication with people. Thisimmunization manual is published so that Office of Public Health personnel will have clearguidelines regarding immunization policies for clinics conducted by OPH, and will always haveaccess to the latest information about vaccination. The authors have organized this section of themanual into:I.Policy and General Clinic PolicyII.Policy Regarding Clinic OrganizationIII.General Policy Regarding ImmunizationIV.OPH Program Vaccine PoliciesV.Policies Regarding Specific ImmunizationsVI.Miscellaneous Immunization InformationIt is hoped that this Immunization Manual will provide quick and simple answers to the manyquestions that arise during immunization clinics.Immunization Policies and Procedures Manual1

POLICY ON CLINIC SCHEDULINGPolicy:1. The scheduling of times and places for immunization clinics is a local and regionalresponsibility.2. Clinics shall be held at times and places that effectively promote vaccination and makeefficient use of staff time and facilities.3. Scheduling shall be periodically reviewed to ensure that the schedule still fulfills programgoals.4. During power outage and/or Louisiana Immunization Network for Kids Statewide (LINKS)system failure individuals should bring their personal immunization record to the clinic.Individuals without their personal immunization record shall be given age appropriatevaccinations.5. Individuals being served at the time of power or system failure would have their vaccinationsrecorded in the Vaccine Administration Record, Vaccine for Children (VFC) Patient EligibilityScreening, AND Registry Authorization (Imm-5, Revised). A copy of the record brought by theparent should be attached to the Imm-5 form. Providers should be aware that this is the only formthat is mandated by the Vaccine Injury Act of 1986. To obtain a blank copy of the VFC VARform in LINKS, sign-onto LINKS registry, go to ‘REPORTS’ and scroll down to ‘STATEREPORTS’ and then select ‘VFC VAR BLANK’ to print copies.6. A copy of the patient’s updated immunization record will be mailed no later than a week aftersystem becomes operational.Rationale:The goal of the OPH Immunization Program is to provide immunization services and educationin the most effective and efficient manner. Effective immunization clinics promote highvaccination coverage levels by being held in locations and at times that provide access to theindividuals and families who need vaccinations. Effective clinics promote vaccination byproviding prompt service in a pleasant atmosphere. Efficient immunization clinics correctlyvaccinate a maximum number of children with limited staff time and resources. Because oftremendously varying conditions in this large and diverse state, immunization clinics are bestscheduled by staff most familiar with local conditions using clinic audit results and assessmentsto identify local needs.Clinic scheduling to promote access is encouraged. Clinics are expected to provideimmunizations to walk-in clients during all business hours whenever possible. Clinics are also2

encouraged to provide regularly scheduled extended hours on weekends or evenings. Thisimproves access for working families and can improve immunization coverage.3

POLICY ON PUBLICITY FOR IMMUNIZATION ACTIVITIESPolicy:Local and regional staff will have primary responsibility for public information regarding parishhealth unit immunization clinics as prescribed by the Department of Health and Hospitals/Officeof Public Health (DHH/OPH) policy. Assistance may be requested from the ImmunizationProgram Office in New Orleans.Rationale:Local public events such as immunization clinics are best publicized through the local media andother sources of local public information through the DHH Office of Public Health MediaCommunications Section. In addition to the local news media (newspaper, radio and TV, ifavailable), there are many sources of local public information such as school, church, andvoluntary organizations. OPH staff should maintain an effective liaison with these groups toensure adequate public knowledge of local OPH activities. Public information campaigns arealso carried out by the state "Shots for Tots" activities and the United States Centers for DiseaseControl and Prevention.4

POLICY ON EDUCATIONAL ACTIVITIES (HEALTH EDUCATION INIMMUNIZATION CLINICS)Policy:1. A concentrated effort shall be made by local and regional offices to provide health educationand information regarding immunization at every opportunity.2. The design and implementation of health education programs is the responsibility of local andregional personnel. Assistance and materials may be requested from the Immunization Programin New Orleans.3. On a regular basis, every regional and parish health unit will review its efforts in healtheducation, and strive to improve this component of the immunization program.Rationale:Education strengthens a patient’s / parent’s ability to act on their own behalf in the prevention ofdisease, by giving the patient or parent knowledge-- the most powerful of all tools. Healtheducation is a dynamic process, which enlists the many skills, interests, and the resourcefulnessof the persons involved. Health information is a passive approach using printed or audio-visualmaterials. There are many opportunities to present educational material regarding immunization.Some examples are: Pre-Clinics: Media publicity, activity in schools, speakers for community groups. During Clinic: In the waiting room; coloring books, posters for walls, pamphlets fordistribution, use of audio-visual presentations such as immunization video tapes andsmall conferences. With the nurse: this is the best time for person-to-person educational process (healtheducation); the potential benefits are highest during this time. After Clinic: Printed information on immunizations and side effects given to parents;availability of personnel in the event if problems or questions arise.5

POLICY ON CHECKING IMMUNIZATION STATUS OF ALL CHILDRENRECEIVING SERVICES THROUGH THE HEALTH DEPARTMENTPolicy:The Immunization status of all children receiving services through the health department shall bereviewed at

immunization manual is published so that Office of Public Health personnel will have clear guidelines regarding immunization policies for clinics conducted by OPH, and will always have access to the latest information about vaccination. The authors have organized this section of the manual into: I. Policy and General Clinic Policy II.