ncip - Immunization Branch

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ncip - Immunization Branch

NORTH CAROLINA IMMUNIZATION PROGRAM (NCIP)COVERAGE CRITERIA FOR ALL CHILDREN PRESENT IN NORTH CAROLINAEffective: December 15, 2011The purpose of this document is to distinguish which cohorts of persons, present in North Carolina, are eligible for vaccine from the North Carolina Immunization Program(NCIP). North Carolina Immunization Program (NCIP) vaccine is generally available for children through the age of 18 in compliance with recommendations made by theAdvisory Committee for Immunization Practices (ACIP) and the Vaccines for Children (VFC) program. Exceptions for adult vaccine usages are noted below. ACIPrecommends certain vaccines for certain cohorts who are not covered by NCIP vaccine. Health care providers must use privately-purchased vaccine for those cohorts who wishto have vaccine and are not covered by this coverage criteria. For the current recommendations for each vaccine, please see the ACIP statements found at:http://www.cdc.gov/vaccines/pubs/ACIP-list.htm. Current Procedural Terminology ® (CPT) codes have been added for your reference.VACCINE AGES COVERED ELIGIBILITY CRITERIA FORNCIP VACCINE USAGEDT Pediatric >2 months through 6 Only administered when pertussis-containing vaccine is medicallyyearscontraindicated.DTaP >2 months through 6yearsDTaP, Hep B, and > 2 months through 6polio combination years(Pediarix)DTaP, polio, andHib combination(Pentacel)DTaP/IPVcombination(Kinrix)EIPV(Polio)Hep A/Hep BCombinationHepatitis APediatric use> 2 months through 4years> 4 years through 6yearsState supplied Pentacel can no longer be used universally now thatthe Hib shortage is over.>2 months through17 years> 18 years Any person who meets one or more of the ACIP recommendedcoverage groups can receive a three dose series of the combinationHep A/Hep B vaccine at the local health department or atFederally Qualified Health Centers (FQHC) and Rural HealthCenters (RHC).12 months through18 yearsState-supplied Hep A/Hep B vaccine cannot be used for theaccelerated schedule, four dose series or for persons withdocumented history of a completed hepatitis A or B series.Cohort **ACIP Recommendation Highlights CPTCodeUNIVE90702RSALVFC90700ONLYVFC Currently licensed for the primary series at ages 2, 4, and 6 90723ONLY months of age. Not approved for the fourth dose of IPV or thefourth and fifth doses of DTaP.VFCONLYVFCONLYVFCONLYADULTUSEVFCONLYCurrently licensed for a 4-dose series at ages 2, 4, 6 and 15-18months.Currently licensed only for the 4-6 year booster dose of DTaPand polio vaccinesSee ACIP recommendations for administration to persons >18years of age.Persons at risk for infection include:• Sex partners of hepatitis B surface antigen (HBsAg)positivepersons• Sexually active persons who are notin a long-term, mutually monogamous relationship (e.g.,persons with more than one sex partner during the previous 6months)• Persons seeking evaluation or treatment for a sexuallytransmitted disease• Men who have sex with men• Household contacts of HBsAg-positive persons• Persons who have chronic liver diseases such as Hepatitis B &C or HIV positive• Persons who have been incarcerated• IV Drug Users9069890696907139063690633Page 1 of 7Effective: December 15, 2011


VACCINE AGES COVERED ELIGIBILITY CRITERIA FORNCIP VACCINE USAGEInfluenza > 6 months through As of December 8, 2011 state-supplied 2011-2012 influenza vaccinePediatric use 18 yearsmay be administered universally regardless of insurance status toanyone 6 months and older.InfluenzaAdult useAdults 18 years ofage and olderAs of December 8, 2011 state-supplied 2011-2012 influenza vaccinemay be administered universally regardless of insurance status toanyone 6 months and older.Cohort **ACIP Recommendation Highlights CPTCodeUniver- Refer to annual flu memo from Immunization Branch and 90655:sal ACIP flu guidelines.Preservativefree,6 mo.through 35mo.90656:Preservativefree,3 yrs. &up90657:Preservativecontaining,6mo. through35 mo.90658:Preservativecontaining,3yrs. & up90660:PreservativefreeIntranasal,liveUniversalRefer to annual flu memo from Immunization Branch andACIP flu guidelines.90656:Preservativefree,3 yrs. &up90658:Preservativecontaining,3yrs. & up90660:Preservativefree,Intranasal,liveFormatted: LeftPage 3 of 7Effective: December 15, 2011


VACCINE AGES COVERED ELIGIBILITY CRITERIA FORNCIP VACCINE USAGEMeningococcal 9 months through 18Conjugate years of age(Menveo andMenactra*)*Menactra islicensed startingat 9 months ofage. Menveostarts at 2 yearsof ageMeningococcalConjugateMenveo® onlyMMRPediatric useMMRAdult useAdults 19 yearsthrough 55 years> 12 months through18 yearsCertain other adults,(19 and older)• Children 9 months through 10 years that are defined as highrisk• Children 2 years through 10 years who have anatomic orfunctional asplenia• All children 11 years through 18 years of age• A single dose of meningococcal vaccine is available forunvaccinated first year college students living in dormitoriesCan be given to:● any VFC-eligible patient or● any person entering a four-year college or university in NorthCarolina for the first timeOne dose of measles containing vaccine is available for:1. Immigrants with refugee status of any age withoutdocumentation of a prior MMR may receive MMR at the localhealth department.2. All susceptible persons without documentation of a prior MMRmay receive MMR at the local health department, hospital,Federally Qualified Health Center (FQHC), or Rural Health Center(RHC).3. Two doses of MMR can be given to any person entering a fouryearcollege or university in North Carolina for the first time, inaddition to, all students attending any other post-high schooleducational institutions (i.e. community colleges and technicalschools because:2 doses of measles containing vaccine is required by law for‣ all persons born in 1957 or later entering a North Carolinacollege/university*** for the first time on or after July 1, 1994and thatTwo doses of mumps are also recommended and available for allstudents attending post-high school educational institutions (i.e.Cohort **ACIP Recommendation Highlights CPTCodeVFC • Children aged 9 months through 10 years who are at 90734 (forincreased risk for meningococcal disease, including Menveoo Children who have complementanddeficiencies (e.g., C5-C9, properidin, factor Menactra)H or factor D);ADULTUSEVFC orcollegeentryADULTUSEoooChildren with HIV infection;Travelers to or residents of countries inwhich meningococcal disease ishyperendemic or epidemic;Children who are part of an outbreak of avaccine-preventable serogroup• Children aged 2 through 10 years who have anatomicor functional asplenia• All children aged 11 through 18 years of agehttp://www.cdc.gov/vaccines/programs/vfc/acip-vfcresolutions.htmContraindications include:• Pregnancy• Pregnancy should be avoided for 4 weeks followingvaccination• Known severe immunodeficiencyAllergy to eggs is NOT a valid contraindication to receivingMMR vaccine.Contraindications include:• Pregnancy• Pregnancy should be avoided for 4 weeks followingvaccination• Known severe immunodeficiencyAllergy to eggs is NOT a valid contraindication toreceiving MMR vaccine.907349070790707Page 4 of 7Effective: December 15, 2011


community colleges and technical schools).VACCINE AGES COVERED ELIGIBILITY CRITERIA FORNCIP VACCINE USAGEMMRV > 12 months through Per the manufacturer, no MMRV orders will be taken after February12 years1, 2011 due to limited supply.PneumococcalConjugate13-valent(PCV13)All children > 2through 59 monthsCertain children >60months through 18years with high riskconditions.The ACIP Recommends these age groups be vaccinated:• All children 2 through 59 months of age• Children 60 through 71 months of age with certain underlyingmedical conditionsThe ACIP recommendation indicates children 6 through 18 years ofage who are at increased risk for invasive pneumococcal diseasebecause of certain conditions may be vaccinated with PCV13.*Supplemental dose: A single supplemental dose of PCV 13 isrecommended for all children 14 through 59 months of age whohave already completed their PCV 7 series.Cohort **ACIP Recommendation Highlights CPTCodeVFC For the first dose of measles, mumps, rubella, and varicellaONLY vaccine given at 12-47 months of age, either MMRV orseparate MMR and varicella vaccines can be used. Thepotential benefits and risks of both vaccination options shouldbe discussed with the parents or caregivers.Contraindications include:• PregnancyContraindications include:• Pregnancy• Pregnancy should be avoided for 4 weeks followingvaccination• Known severe immunodeficiency• a personal or family (i.e., sibling or parent) history ofseizures of any etiologyUpdated recommendations can be found at:http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5903a1.htm?s_cid=rr5903a1_eVFCONLYSee links below for more information regarding vaccination ofhealthy children (including the recommendation for a boosterdose of PCV13) as well as those who are considered high risk.Complete provisional ACIP recommendations are online at:http://www.cdc.gov/vaccines/recs/provisional/downloads/pcv13-mar-2010-508.pdfA list of underlying medical conditions that indicate the needfor PCV13 is online at:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5909a2.htm90670PneumococcalPolysaccharide23-valent(PPSV23)> 2 years through 18yearsAvailable only for high-risk childrenVFCONLYSee link below for updated Provisional Recommendations forthe use of Pneumococcal Vaccines. The recommendations forrevaccination with PPSV23 in high risk children < 10 years oldwere updated December, 200890732http://www.cdc.gov/vaccines/recs/provisional/downloads/pneumo-Oct-2008-508.pdfPage 5 of 7Effective: December 15, 2011


VACCINE AGES COVERED ELIGIBILITY CRITERIA FORNCIP VACCINE USAGECohort **ACIP Recommendation Highlights CPTCodeRotavirus > 6 weeks through 7monthsVFCONLYSee FDA recommendations (May 14, 2010) at:http://www.cdc.gov/vaccines/vpd-vac/rotavirus/default.htm90680—3-dose(Rotateq)TdPediatric useTdAdult useMassBiologicsTd onlyTdapPediatric use> 7 years through 18yearsCertain adults 19years of age or oldermay receive statesuppliedTd.Children 7 through18 years1. Available for doses 1 through 3 if child did not receiveadequate doses before age 7.2. Recommended as a booster dose every 5-10 years.1. Can be given to any person 19 years of age or older entering aNorth Carolina college/university*** (where Td is required by NCImmunization Law) for the first time who has not had a booster in10 years, or has not completed the 3 dose primary series.2. Any person 19 years of age or older can receive Td at the localhealth department, FQHC, or RHC.3. Can be given to any person 19 years of age or older being seenin a hospital emergency department for wound management.Can be given to:• any VFC-eligible patient or• any person entering a four-year college or university in NorthCarolina for the first timeany person seen in a LHD, FQHC, RHC, hospital emergencydepartment or urgent care center for wound management90681—2-dose(Rotarix)UNIVERSAL 90714ADULTUSEVFC orcollegeentryChildren age 7-10 may receive a Tdap vaccine in certainsituations. Review this document for complete details:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6001a4.htm9071490715Page 6 of 7Effective: December 15, 2011


VACCINE AGES COVERED ELIGIBILITY CRITERIA FORNCIP VACCINE USAGECohort **ACIP Recommendation Highlights CPTCodeTdapAdult useBoostrix® onlyVaricella(Chickenpox)Certain adults (19years of age andolder) may receivestate-supplied Tdap.> 12 months through18 years1. Can be given to any person 19 years of age and older entering aNorth Carolina college/university*** (where Tdap is required byNC Immunization Law) for the first time whohas never received Tdap.2. Local health departments can administer one dose of statesuppliedTdap vaccine to pregnant (≥ 20 weeks gestation) and postpartum women 19 years of age and older, if the woman is beingserved by the local health department in some capacity (other thansimply receiving the Tdap vaccination) and there is nodocumentation of a previous Tdap vaccination.3. Can be given to any person 19 years of age and older being seenin a LHD, FQHC, RHC, hospital emergency department or urgentcare center for wound management.4. NCIP providers may administer one dose of state-supplied Tdapto health care workers (HCW) employed at their facilities.5. Local health departments may administer one dose of statesuppliedTdap to health care workers in their communities.One dose is required for all children born on or after April 1, 2001prior to entering kindergarten. However 2 doses are recommendedand available for VFC children.ADULTUSEVFCONLYPage 7 of 7Effective: December 15, 2011ACIP immunization recommendations for health careworkers may be found at:http://www.cdc.gov/mmwr/preview/mmwrhtml/00050577.htm.Contraindications include:• Pregnancy• Pregnancy should be avoided for 4 weeks followingvaccination• Known severe immunodeficiencyVFC- Vaccines for Children: Children through 18 years of age that meet at least one of the following criteria are eligible for VFC vaccine: Medicaid eligible, Uninsured, American Indian or AlaskanNative, Underinsured or Unaccompanied minors without proof of insurance presenting to local health department Title X clinics.Underinsured children are children who have commercial (private) health insurance but the coverage does not include vaccines; children whose insurance covers only selected vaccines (VFC-eligible fornon-covered vaccines only), or children whose insurance caps vaccine coverage at a certain amount - once that coverage amount is reached, these children are categorized as underinsured. Note:Children whose health insurance covers vaccinations are not eligible for VFC vaccines, even when a claim for the cost of the vaccine and its administration would be denied for payment by the insurancecarrier because the plan’s deductible had not been met or because the insurance did not cover the total cost of the vaccine.** ACIP Recommendation Highlights - Information in this section is abbreviated and NOT inclusive of all recommendations, precautions, or contraindications. Review the full ACIPRecommendations for each vaccine on the CDC website at http://www.cdc.gov/vaccines/pubs/ACIP-list.htm Full and final recommendations are published as MMWR Recommendations andReports. Updates are often sent out as Provisional Recommendations with the most pertinent information included before the final recommendations are released.There isalso separate documentation for Contraindication/Precautions for all vaccines on the CDC web site at:http://www.cdc.gov/vaccines/recs/vac-admin/contraindications-vacc.htm.***Students attending colleges within the North Carolina Community College System are exempt from North Carolina Immunization Law for college/university entry. However, some programs atcommunity colleges, such as medical programs, may have requirements specific to their program, but this does not allow them to receive state supplied vaccine unless it is specifically stated in thecoverage criteria.Local health department (LHD) providers may administer NCIP vaccine offsite, without requesting permission from the Branch, as long as certain conditions are met. Refer to the memo dated May 6,2011 for complete details.NCIP vaccines Menveo® (MCV4), MassBiologics Td and Boostrix® (Tdap) may be administered to patients ages 19 and older who meet the NCIP coverage criteria.9071590716

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