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| Summer/Fall 1999 | Vol. 6, No. 3 |
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| Summer/Fall 1999 | Vol. 6, No. 3 |
Inside this Issue:
Berrien Co. MCIR update, Late- breaking vaccine news, Interim Recommendations for Vaccination of Newborns, Thimerosal and Vaccine, Rotavirus Vaccine Fact Sheet, What can MCIR do for YOU, MCIR Regional Contact List,
BCHD keys its immunization data directly into MCIR on a daily basis.
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| Immunization clerk Charlotte Cummings keys immunization data into MCIR on a daily basis. |
This task is led by Charlotte Cummings, an immunization clerk who has worked with BCHD for over 26 years.
During 1998, staff members at BCHD saw 4,986 clients at six different clinic sites. They have entered over 10,000 shot records since they began using MCIR in May of 1998. Because of BCHD’s efforts, immunization providers can count on finding current immunization records for a large percentage of children living in Berrien County. Cummings enters the records every day. "It’s great to see that our children are up-to-date in MCIR," she says. "It would be nice if all of the doctors’ offices in Michigan would do the same."
Many private immunization providers in Berrien County — and elsewhere in the state — are not yet entering their data into MCIR on a regular basis. As a result, many children’s records are still incomplete in the registry.
Because BCHD would like all of their providers to be able to find complete and accurate records when using MCIR Link (computer system) or Interactive Voice Response (phone system), they are working closely with local doctors’ offices to help them better understand and use the MCIR system. This spring they organized and hosted several user groups where provider office staff got to greet, meet, and eat with their MCIR coordinator. Provider staff saw a demonstration of the MCIR software and found out how other offices are using MCIR. The user groups were well attended and received, and BCHD is looking forward to planning another series in the near future.
Irene Caroselli, team leader for public health nursing at BCHD, says that they like MCIR not only because it helps them to quickly find children’s immunization histories but also for its reporting capabilities. Data processor Nancy Hopgood says, "I love MCIR. Compared with our old computer system, it is much easier to use. The tailored assessments are so valuable for finding out which children are overdue."
For more information about participating in MCIR, contact your regional MCIR coordinator. The regional MCIR coordinators’ names and phone numbers are here.
Providers of childhood immunizations are required by law to submit immunization data to the Michigan Childhood Immunization Registry (Public Act 540 of 1996, Rules under Section 9206 of P.A. 540).
Important information about the postponement of rotavirus vaccine administration and the administration of hepatitis B vaccine to newborns.
Interim Recommendations for Vaccination of Newborns
Approved by the Michigan Advisory Committee on Immunizations
July 28, 1999
On July 8, 1999, a joint statement from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) was issued related to a suggested change in the timing of the first dose hepatitis B vaccine for some infants. This change is in response to a theoretical risk which could result from the minute amounts of mercury compounds (in the form of thimerosal) that are added to some vaccines to preserve them from microbial growth. This schedule change, which is likely to be temporary until thimerosal-free hepatitis B vaccines are available, is a proactive measure designed to increase the margin of safety that is built into the immunization schedule for exposure to mercury. As more vaccines have been added to the schedule, this margin of safety has been reduced. There have been no demonstrated mercury toxicity effects in any children who have received thimerosal-containing vaccines. This change is in line with efforts to assure that vaccines which we administer to our children are as safe as possible.
The Michigan Department of Community Health considers that the use of thimerosal-containing vaccines should be reduced or eliminated. The benefits and risks of vaccines containing thimerosal should be discussed with parents. The use of products containing thimerosal is preferable to withholding vaccinations, which protect against diseases that represent immediate threats to young infants (e.g., pertussis and Haemophilus influenzae). For hepatitis B vaccine, adjustments in timing within the ranges proposed in the immunization schedule provide additional opportunities to minimize exposure of small infants to thimerosal. It is anticipated that thimerosal-free hepatitis B vaccine will be available in the near future, although an exact time frame has not been stated. When sufficient supplies of this vaccine are available, it will be appropriate to resume the previous recommendation that immunization against hepatitis B begin within the first two months of life. Neither the CDC, AAP nor the Michigan Department of Community Health (MDCH) is recommending that previously vaccinated infants be tested for mercury.
Q 1. What is Thimerosal?
A: Thimerosal is a very effective preservative that contains mercury and has been used in some vaccines and other products since the 1940s. Thimerosal is the most widely used preservative in vaccines. The FDA estimates that it is used in more than 30 licensed vaccines and biologics. Mercury is excreted from the body over time.
Q 2. Why is Thimerosal used in vaccines?
A: Thimerosal is used as an extra safeguard against contamination. It may be used during processing or added to the final container to prevent contamination when multi-dose vials are opened. Before Thimerosal was marketed in the United States, a number of safety studies were conducted, first on animals and then on humans.
Thimerosal is an important preservative that protects vaccine against bacterial contamination. Disease outbreaks have occurred following contamination of multi-dose vaccine vials in the United States and from other countries. For example, in April, 1995, three infants died in India from toxic shock syndrome after administration of contaminated measles vaccine at one health center.
Q 3. Can all vaccines be made Thimerosal-free, or within accepted guidelines? If so, how quickly?
A: All vaccines either do not contain thimerosal or contain thimerosal within FDA guidelines. To further increase the margin of safety that already exists, clinicians can use the inherent flexibility in the current immunization schedule to fully vaccinate children and meet even the most conservative guidelines for cumulative mercury exposure. However, exposure to any form of mercury from any source should be minimized and Public Health Service agencies are working with private physician groups and vaccine manufacturers to expedite the process to reduce or eliminate thimerosal from vaccines used in the United States.
Q 4. What could happen if parents ignored recommendations to use thimerosal-containing vaccines during this transition period?
A: Children would be at very real risk from illnesses that can be prevented with safe and effective vaccinations. High rates of vaccination led to declines of 95% to 100% in the occurrence of vaccine preventable diseases in the United States. Despite this, the pathogens responsible for most vaccine preventable diseases still circulate and rates of disease would increase if vaccine coverage dropped. For example, if vaccination coverage among infants dropped from 95% to 70%, an additional 2,500 cases of pertussis would be expected to occur. Moreover, the risk of death from pertussis is greatest in young children. A second severe vaccine preventable disease among young children is Haemophilus influenzae type b (Hib). Before vaccine was introduced, this pathogen was the leading cause of meningitis and other severe invasive infections among children; now cases of invasive Hib disease have virtually disappeared. If vaccination for Hib declined to 70%, 2,000 excess cases would occur with 1,200 cases of meningitis, resulting in about 100 deaths and 180 children who would suffer mental retardation and hearing loss.
Q 5. If patients have a choice of vaccines, one with mercury or one without, which should they choose?
A: The most important thing is that parents not miss an opportunity to get their child immunized. We encourage parents to talk to their doctors. Every vaccine licensed by the FDA either contains no mercury or contains acceptable levels of thimerosal. Today, we=re discussing a minimal, if any, risk from minute levels of mercury-containing thimerosal versus the large and devastating risk of childhood diseases like bacterial meningitis and whooping cough if parents and physicians abandon vaccination during this transition period. Any missed vaccinations puts children at risk from disease.
Q 6. Why isn=t the federal government just recommending not using vaccines with thimerosal in them if there is concern?
A: Making vaccines safer and more effective is a constant goal for the federal government. No vaccine is 100 percent safe or effective. Decisions must be based on weighing risks and benefits of each vaccine. Today, we=re discussing a minimal, if any, risk from minute levels of mercury-containing thimerosal versus the large and devastating risk of childhood diseases like bacterial meningitis and whooping cough if parents and physicians abandon vaccination during this transition period. Any missed vaccinations puts children at risk from disease.
Q 7. How much mercury did my 6-month-old get in the last six months from vaccines? How dangerous is that?
A: Each dose of vaccine given your child met FDA requirements and should not be a concern to you now--your choice to vaccinate your baby was a sound one. The mercury levels being discussed are well within the safety margins; however, we are working toward further increasing the margin of safety that already exists. It is important that we limit the cumulative amount of mercury children are exposed to, but parents should not abandon vaccination as a means to do that.
Q 8. If there are vaccines that are mercury-free, why shouldn't I just ask for those?
A: The American Academy of Pediatrics, the Advisory Committee on Immunization Practices for CDC and the Surgeon General all recommend that parents do not let their child miss a vaccination when safe and effective vaccines are available. Today, we are discussing a minimal, if any, risk from cumulative levels of mercury from some vaccines versus the large and devastating risk of childhood diseases like bacterial meningitis and whooping cough if parents and physicians abandon vaccination during this transition period. The American Academy of Pediatrics, the Advisory Committee on Immunization Practices for CDC and the U.S. Surgeon General want parents to be fully informed about children=s vaccines and if you have questions or concerns, we encourage you to speak to your child=s trusted health care provider.
Q 9. I=ve heard that children may be getting toxic levels of mercury from vaccines. Is that true?
A: Everyone is exposed to mercury, even in some foods and household products. As part of an ongoing assessment of mercury in the environment and in products, many agencies have developed guidelines for acceptable levels of mercury--levels many times below any amount known to cause harm. Some children, depending on which vaccines they receive and the timing of those vaccines, are exposed to cumulative levels of mercury close to the safety ranges of guidelines. To further increase this margin of safety, clinicians and parents can take advantage of the flexibility within the existing immunization schedule. It=s important to understand that these highest acceptable levels include a Asafety cushion@ to take into account all the variables that people face in their exposures to mercury. No children are getting toxic levels of mercury from vaccines.
Q 10. Are there vaccines available to prevent childhood diseases without exposing them to mercury?
A: Yes, although you may discover that these vaccines are not immediately available from your health care provider. The American Academy of Pediatrics, the Advisory Committee on Immunization Practices for CDC and the Surgeon General all recommend that parents do not let their child miss a vaccination when safe and effective vaccines are available. Today, we have a minimal, if any, risk from minute levels of mercury-containing thimerosal in some vaccines versus the large and devastating risk of childhood diseases like bacterial meningitis and whooping cough if parents and physicians abandon vaccination during this transition period. The American Academy of Pediatrics, the Advisory Committee on Immunization Practices for CDC and the U.S. Surgeon General want parents to be fully informed about children=s vaccines and if you have questions or concerns, we encourage you to speak to your child=s trusted health care provider.
Q 11. Why is the Public Health Service and AAP making these recommendations now?
A: Although mercury is found in the environment, in food and in household products, exposure to mercury is of concern and, when possible, should be avoided. The Public Health Service agencies, the American Academy of Pediatrics, and vaccine manufacturers agree that thimerosal should be reduced or eliminated in vaccines. Some children, depending on which vaccines they receive and the timing of those vaccines, are exposed to cumulative levels of mercury close to the safety ranges of guidelines. The mercury levels being discussed are within the safety margins; however, we are working toward further increasing the margin of safety that already exists. It is important that we limit the cumulative amount of mercury children are exposed to, but parents should not abandon vaccination as a means to do that.
Q 12. Why are chemicals and other substances added to vaccines?
A: Many things in today's world, including foods and medicines, have chemicals added to them to prevent the growth of germs and reduce spoilage. Chemicals are added to vaccines for similar reasons, to inactivate a virus or bacteria and to stabilize it, helping to preserve the vaccine and prevent it from losing its potency over time.
Some additives are used in the production of vaccines. Vaccines may include suspending fluid (e.g., sterile water, saline, or fluids containing protein); preservatives and stabilizers (e.g., albumin, phenols, and glycine); and adjuvants or enhancers that help the vaccine improve its immunogenicity (ability to protect against disease).
Q 13. I understand some people are sensitive to thimerosal and must avoid it. Do they have problems with thimerosal-containing vaccines?
A: Most patients do not develop reactions to thimerosal given as a component of vaccines even when they=ve had a patch or intradermal tests for thimerosal that indicated hypersensitivity. Hypersensitivity to thimerosal usually consists of local, delayed reactions.
Q 14. How can I find out what chemical additives are in specific vaccines?
A: Ask your health care provider or pharmacist for a copy of the vaccine package insert. The package insert lists ingredients in the vaccine and discusses any known adverse reactions.
Q 15. What is mercury?
A: Mercury is a chemical element. As such it is neither created nor destroyed -- the same amount of mercury has existed since the earth was formed. Mercury is toxic to humans and wildlife. Organic forms of mercury are the forms of mercury to which humans and wildlife are generally exposed, usually from eating fish which have accumulated mercury in their muscle tissue. Uses and releases of mercury have been reduced very substantially in recent decades in the U.S. and most other industrialized countries.
Q 16. Who is most vulnerable to mercury?
A: Two groups are most vulnerable to methyl mercury: the fetus and children ages 14 and younger. Children may be at higher risk of mercury exposure than are adults because they eat more per pound of body weight and because they may be inherently more sensitive than adults since their nervous systems are still developing.
Q 17. Which population groups have the highest levels of mercury?
A: Groups that tend to have higher exposure include subsistence and frequent recreational fishers, people of Asian origin, and some Native American groups. The typical U.S. consumer eating fish from restaurants and grocery stores are not in danger of consuming harmful levels of mercury from fish and are not advised to limit fish consumption. Everyone is exposed to mercury, even in some foods and household products.
Q 18. How can parents learn more about children=s immunizations?
To learn more about children's immunizations, vaccinations, or baby shots from a CDC information specialist, please call CDC=s National Immunization Information Hotline: 1-800-232-2522, for English, 1-800-232-0233, for Spanish.
This set of questions and answers is available on CDC=s website at: http://www.cdc.gov/nip/Q&A/genqa/Thimerosal.htmBased on early surveillance reports of bowel obstructions among some infants, the Centers for Disease Control and Prevention (CDC) recommends that health care practitioners and parents postpone use of the rotavirus vaccine until November 1999.
As of June 1, 1999, an estimated 1.5 million doses of RRV-TV have been administered to children in the United States. As of July 7, 1999, fifteen (15) cases of intussusception (a type of bowel obstruction) among children who had recently received rotavirus vaccine have been reported to the Vaccine Adverse Event Reporting System (VAERS). An additional eight cases have been identified in the initial phase of an ongoing multi-state investigation.
Although vaccine adverse event reports and preliminary surveillance data do not provide sufficient evidence to determine if there is a relationship between the vaccine and intussusception, the CDC recommendation is made with the consideration that rotavirus season is still 4 to 6 months away in most parts of the U.S. In the interim, CDC will be undertaking additional data collection and analysis to determine if there is a relationship between the vaccine and intussusception.
Key Points B Rotavirus Illness and Infections
1) Rotavirus illness is very easy to catch. Children can spread rotavirus both before and after they become symptomatic. The virus is often transmitted from one infected child to another by contaminated hands or objects. Washing with soaps or cleansers will not kill the virus, but will help reduce the spread of rotavirus.
2) Rotavirus is the most common cause of severe gastroenteritis in infants and young children in the U.S. Virtually all children contract a rotavirus infection in the first 3-5 years of life. In the U.S., rotavirus illness tends to be seasonal, with the greatest number of cases occurring from November to May.
3) Rotaviral gastroenteritis usually starts with fever, an upset stomach, and vomiting, followed by diarrhea. The diarrhea can be mild to severe and generally will last 3 to 9 days. Severe diarrhea and dehydration occur primarily among children 3 months to 35 months of age.
4) In the first five years of life, four out of five children in the U.S. will develop rotavirus diarrhea. One in seven will require a clinic or emergency room visit. One in 78 will require hospitalization and one in 200,000 will die from rotavirus illness. As a result, rotavirus accounts for more than 500,000 physician visits and approximately 50,000 hospitalizations each year among children less than 5 years of age.
Key Points B Rotavirus Vaccine
1) Rotavirus vaccine is an oral, live-virus preparation that is administered to infants between the ages of 6 weeks and 1 year. The recommended schedule is a three-dose series, with doses usually administered at 2, 4, and 6 months of age.
2) Four vaccine efficacy trials suggested the vaccine is 49% to 68% effective against any rotavirus diarrhea; 69% to 91% effective against severe diarrhea; and 50% to 100% effective in preventing physician visits for evaluation and treatment of rotavirus diarrhea.
Did you know that the Michigan Childhood Immunization Registry (MCIR) now has more than 1.5 million children in its database representing over 11 million shot records? Electronic birth certificate (EBC) records are continuously being loaded into MCIR. Hospitals now have the ability to record and submit the hepatitis B shot administered at birth to MCIR via the EBC system. Most of the data from local health departments have been loaded into MCIR, and these represent about 50% of the immunizations given in Michigan.
Are you having trouble keeping up with all the changes to the recommended vaccine schedule? MCIR can be a great resource. MCIR has been designed to be flexible enough to accommodate variations in schedules by age and type of vaccine administered, and the MCIR schedule can be easily modified to meet the most recent ACIP recommendations.
The registry now has several new reports available to providers including reports that show the number of children in a given age range who have received particular vaccines and how many doses they have received. Another report will give you the number and percent of children compliant with the criteria you set. If you wish, it will also print out a list of children who did not meet the criteria you set for the report. This report allows a provider to assess his or her own practice, and it enables the provider to follow-up with the children who have fallen behind in their immunizations.
If you are a VFC provider, you are used to filling out your annual VFC provider profile. This is the form turned in annually estimating the number of children seen in your practice who qualify for the VFC program. If you keep track of VFC eligibility in MCIR, the provider profile can be generated from MCIR in a matter of minutes. MCIR can also generate doses administered reports for you. Both of these reports could be big time-savers for all providers.
And MCIR now has a vaccine inventory module. This module is optional for any provider who wishes to use it, and gives you the ability to inventory all your vaccines on-line. As you add administered doses into MCIR, they will automatically be deducted from your inventory.
The more data in MCIR, the more powerful a tool it becomes. Momentum for participation in MCIR has been moving along and is now picking up enough speed to make it useful to all immunization providers in the state. If you are not using MCIR as a resource for obtaining immunization records, you are missing out. Call your regional MCIR coordinator today if you are not already taking advantage of this great time-saving opportunity. Access to this data is as close as your computer or your fax machine. The regional MCIR coordinators’ names and phone numbers follow.
Region 1:
City of Detroit; Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw, and Wayne Counties
Contact: Julie Gleason-Comstock, Southeastern Michigan Childhood Immunization Registry
Phone: 313-873-0840
Region 2:
For Allegan, Ionia, Kent, Muskegon, & Ottawa Counties
Contact: Nancy Deising, C/O Kent County Health Department
Phone: 616-336-397
For Branch, Calhoun, Hillsdale, Jackson, and Lenawee Counties
Contact: Therese Hoyle, Fieldstone Center
Phone: 616-966-8083
For Berrien, Cass, Kalamazoo, St. Joseph, and Van Buren Counties
Contact: Laura Korten, Kalamazoo County Human Services Department
Phone: 616-373-5142
Region 3:
Barry, Clinton, Eaton, Gratiot, Ingham, and Montcalm Counties
Contact: Beverly Stowell, Mid-Michigan District Health Department
Phone: 517-831-5203, ext.320
Region 4:
Bay, Genesee, Huron, Lapeer, Midland, Saginaw, Sanilac, Shiawassee, and Tuscola Counties
Contact: Mel Trueblood, Genesee County Health Department
Phone: 810-257-3194
Region 5:
Alcona, Alpena, Antrim, Arenac, Benzie, Charlevoix, Cheboygan, Clare, Crawford, Emmet, Gladwin, Grand Traverse, Iosco, Isabella, Kalkaska, Lake, Leelanau, Manistee, Mason, Mecosta, Missaukee, Montmorency, Newaygo, Oceana, Ogemaw, Oscoda, Oseola, Otsego, Presque Isle, Roscommon, and Wexford Counties
Contact: Linda VanGills, District Health Department #10
Phone: 616-873-2193
Region 6:
All Upper Peninsula Counties (Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keweenaw, Luce, Mackinac, Marquette, Menominee, Ontonagon, and Schoolcraft Counties)
Contact: Doug Peterson, Delta-Menominee District Health Department
Phone: 906-789-8133
From the U.P. - OSF Medical Group nominated MCIR Site of Excellence
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| OSF Medical Group staff members find MCIR user-friendly. |
Region Six of the Michigan Childhood Immunization Registry (MCIR), which comprises the entire Upper Peninsula of Michigan, has nominated the Order of St. Francis (OSF) Medical Group to be a MCIR Site of Excellence. A MCIR Site of Excellence is a private provider who has shown enthusiasm and willingness to participate in MCIR, and understands the benefits that the practice will achieve as a MCIR participant.
OSF has three offices located in Escanaba, Gladstone, and Powers. Among the three offices, they administer a significant number of immunizations to children. The Escanaba and Gladstone offices are entering immunization data into MCIR electronically by computer link. The Powers office is reporting immunizations administered on paper forms, which are entered into MCIR at the Delta-Menominee District Health Department. In the near future, the Powers office will also enter immunization data by computer.
Benefits
OSF Medical Group’s Escanaba and Gladstone offices have been using MCIR since December 1998. Each staff member involved with MCIR reports enjoying the ease of finding a child’s record and being able to accurately assess immunization status and history. Additionally, they find MCIR user-friendly.
Many staff members have worked with computers on a limited basis and have found that they can easily maneuver through each screen to seek out the information they need to determine a child’s immunization status and history. In fact, many staff members have been able to increase their computer skills.