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WIC Immunization Screening and Referral
Staff Training GuideDeveloped by
The National WIC-Immunization Workgroup
USDA/Food and Nutrition Service CDC/National Immunization Program National WIC Association American Academy of Pediatrics Association of State and Territorial Health Officials Association of Immunization Managers Every Child By Two
OCTOBER 2002
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Training ObjectivesThis training will help you to:
Understand how vaccines can help prevent life-threatening diseases
Understand the recommended childhood immunization schedule
Relate the importance of immunizations to keeping WIC infants/children healthy and to WIC program goals
Understand the the new USDA Immunization Screening and Referral policy and identify policy requirements
Screen immunization records using an easy tool: “Easy IZ Guide”
Talk to parents about their child’s immunization status
Determine effective ways to refer patients to immunization services
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Module 1
Communicable Diseases and Vaccines
Why Immunize Infants and Children?
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Not long ago, parents lived in fear of diseases we can now prevent
The vaccine became available in 1955; now no polio in the U.S.!
Polio still exists in other parts of the world; easily imported
In 1916, polio killed 6,000 people & paralyzed 27,000
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Measles Today, many do not know measles can be
serious For every 1,000 infants/children who have
measles:– 50 get pneumonia– 1 gets brain inflammation– 1 or 2 die
During the U.S. outbreak in 1989-91 there were– Almost 56,000 cases– 123 deaths
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Vaccines Prevent Serious Childhood Diseases
Diphtheria Tetanus (lockjaw) Pertussis (whooping
cough) Measles Mumps Rubella (German measles)
Hib Pneumococcus Hepatitis B Hepatitis A Polio Varicella
(chickenpox)
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Even chickenpox is a serious illness
Before the vaccine, almost everyone got chickenpox
Six out of every 100,000 infants who get chickenpox die.
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Vaccines Prevent Diseases that have no cure
Some diseases prevented by vaccines cannot be treated when a person gets the disease
Tetanus can be prevented by vaccine, but there is no medication that cures tetanus disease
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We have (almost) forgotten some diseases like diphtheria
During the 1920’s about 150,000 cases/year and 15,000 deaths occurred
Now in the U.S. a few cases occur, but there are outbreaks in countries of former Soviet Union
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Complications from Hepatitis B infection can come later in life
Hepatitis B virus invades the liver causing cirrhosis and cancer
Infected infants are at greatest risk for serious complications
No cure In 1996, 4,000 to 5,000 deaths/year in
US
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Pertussis (whooping cough): After 1-2 weeks of ‘cold’
symptoms, 1-6 weeks of coughing bouts
Complications /1,000 cases:– Pneumonia 95– Seizures 14– Brain inflammation 2– Death 2
– Hospitalization 320
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All Preventable Diseases in Children are Serious
Diphtheria Tetanus (lockjaw) Pertussis (whooping cough) Measles Mumps Rubella (German measles)
Hib Pneumococcus Hepatitis B Hepatitis A Polio Varicella
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0
100
200
300
400
500
600
700
800
900
1950 54 58 62 66 70 74 78 82 86 90 94 98
Cas
es X
1,0
00 1st Measles VaccineLicensed in 1963
Vaccines are Key to Prevention Measles, 1950-2000
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Why not wait? Infants and young children are very
vulnerable to infectious diseases
An outbreak can be anywhere.
Disease is a plane ride away.
If there’s an outbreak, it may be too late.
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You don’t always know when a child has been exposed to a disease. …Protect them first rather than wait!
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Immunizations are one of the most important ways to protect children!
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Module 2
Recommended Childhood Immunization Schedule
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Vaccines that prevent disease
Diphtheria Tetanus (lockjaw) Pertussis (whooping cough) Measles Mumps Rubella (German measles)
Hib Pneumococcus Hepatitis B Hepatitis A Polio Varicella
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Vaccines that prevent disease
Diphtheria Tetanus (lockjaw) Pertussis (whooping cough) Measles Mumps Rubella (German measles)
Hib Pneumococcus-PCV7 Hepatitis B Hepatitis A Polio-IPV Varicella (chickenpox)
DT
aP
MM
R
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Recommended Childhood Immunization ScheduleUnited States, 2002
VaccineAge
Birth1
mo2
mos4
mos
Hepatitis B1
Diphtheria, Tetanus, Pertussis2
Haemophilus influenzae Type b3
Inactivated Polio4
Measles, Mumps, Rubella5
Varicella6
Pneumococcal7
Hepatitis A8
Influenza9
Hep B #1
Hep B #2
4-6 yrs
6 mos
12mos
15mos
18mos
24mos
11-12 yrs
13-18 yrs
Hep B #3
DTaP DTaP DTaP DTaP TdDTaP
Hib Hib Hib Hib
IPV IPV IPV IPV
MMR #1 MMR #2
Varicella
PCVPCVPCVPCV
Hepatitis A series
Influenza (yearly)
This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1, 2001, for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible. Indicates age groups that warrant special effort to administer those vaccines not previously given. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine’s other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations.
Vaccines below this line are for selected populations
range of recommended ages catch-up vaccination
Hep B series
MMR #2
Varicella
PPVPCV
only if mother HBsAg ( - )
preadolescent assessment
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Hepatitis B vaccine Dose #1 - Birth or up to 2 months Dose #2 - 1 to 2 months Dose #3 - 6 to 18 months
Catch up as soon as possible.
The series never needs to be restarted when there has been a long time between doses.
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Recommended Childhood Immunization ScheduleUnited States, 2002
VaccineAge
Birth1
mo2
mos4
mos
Hepatitis B1
Diphtheria, Tetanus, Pertussis2
Haemophilus influenzae Type b3
Inactivated Polio4
Measles, Mumps, Rubella5
Varicella6
Pneumococcal7
Hepatitis A8
Influenza9
Hep B #1
Hep B #2
4-6 yrs
6 mos
12mos
15mos
18mos
24mos
11-12 yrs
13-18 yrs
Hep B #3
DTaP DTaP DTaP DTaP TdDTaP
Hib Hib Hib Hib
IPV IPV IPV IPV
MMR #1 MMR #2
Varicella
PCVPCVPCVPCV
Hepatitis A series
Influenza (yearly)
This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1, 2001, for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible. Indicates age groups that warrant special effort to administer those vaccines not previously given. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine’s other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations.
Vaccines below this line are for selected populations
range of recommended ages catch-up vaccination
Hep B series
MMR #2
Varicella
PPVPCV
only if mother HBsAg ( - )
preadolescent assessment
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DTaPDTaP stands for: “Diphtheria, Tetanus, & acellular Pertussis”
The first 4 doses are usually given at ages:– Dose #1 - 2 months– Dose #2 - 4 months– Dose #3 - 6 months– Dose #4 - 15 to 18 months (or 12 months)
The first booster is usually given before school when the child is 4-6 years of age.
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Recommended Childhood Immunization ScheduleUnited States, 2002
VaccineAge
Birth1
mo2
mos4
mos
Hepatitis B1
Diphtheria, Tetanus, Pertussis2
Haemophilus influenzae Type b3
Inactivated Polio4
Measles, Mumps, Rubella5
Varicella6
Pneumococcal7
Hepatitis A8
Influenza9
Hep B #1
Hep B #2
4-6 yrs
6 mos
12mos
15mos
18mos
24mos
11-12 yrs
13-18 yrs
Hep B #3
DTaP DTaP DTaP DTaP TdDTaP
Hib Hib Hib Hib
IPV IPV IPV IPV
MMR #1 MMR #2
Varicella
PCVPCVPCVPCV
Hepatitis A series
Influenza (yearly)
This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1, 2001, for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible. Indicates age groups that warrant special effort to administer those vaccines not previously given. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine’s other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations.
Vaccines below this line are for selected populations
range of recommended ages catch-up vaccination
Hep B series
MMR #2
Varicella
PPVPCV
only if mother HBsAg ( - )
preadolescent assessment
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Recommended Childhood Immunization ScheduleUnited States, 2002
VaccineAge
Birth1
mo2
mos4
mos
Hepatitis B1
Diphtheria, Tetanus, Pertussis2
Haemophilus influenzae Type b3
Inactivated Polio4
Measles, Mumps, Rubella5
Varicella6
Pneumococcal7
Hepatitis A8
Influenza9
Hep B #1
Hep B #2
4-6 yrs
6 mos
12mos
15mos
18mos
24mos
11-12 yrs
13-18 yrs
Hep B #3
DTaP DTaP DTaP DTaP TdDTaP
Hib Hib Hib Hib
IPV IPV IPV IPV
MMR #1 MMR #2
Varicella
PCVPCVPCVPCV
Hepatitis A series
Influenza (yearly)
This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1, 2001, for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible. Indicates age groups that warrant special effort to administer those vaccines not previously given. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine’s other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations.
Vaccines below this line are for selected populations
range of recommended ages catch-up vaccination
Hep B series
MMR #2
Varicella
PPVPCV
only if mother HBsAg ( - )
preadolescent assessment
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Recommended Childhood Immunization ScheduleUnited States, 2002
VaccineAge
Birth1
mo2
mos4
mos
Hepatitis B1
Diphtheria, Tetanus, Pertussis2
Haemophilus influenzae Type b3
Inactivated Polio4
Measles, Mumps, Rubella5
Varicella6
Pneumococcal7
Hepatitis A8
Influenza9
Hep B #1
Hep B #2
4-6 yrs
6 mos
12mos
15mos
18mos
24mos
11-12 yrs
13-18 yrs
Hep B #3
DTaP DTaP DTaP DTaP TdDTaP
Hib Hib Hib Hib
IPV IPV IPV IPV
MMR #1 MMR #2
Varicella
PCVPCVPCVPCV
Hepatitis A series
Influenza (yearly)
This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1, 2001, for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible. Indicates age groups that warrant special effort to administer those vaccines not previously given. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine’s other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations.
Vaccines below this line are for selected populations
range of recommended ages catch-up vaccination
Hep B series
MMR #2
Varicella
PPVPCV
only if mother HBsAg ( - )
preadolescent assessment
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Recommended Childhood Immunization ScheduleUnited States, 2002
VaccineAge
Birth1
mo2
mos4
mos
Hepatitis B1
Diphtheria, Tetanus, Pertussis2
Haemophilus influenzae Type b3
Inactivated Polio4
Measles, Mumps, Rubella5
Varicella6
Pneumococcal7
Hepatitis A8
Influenza9
Hep B #1
Hep B #2
4-6 yrs
6 mos
12mos
15mos
18mos
24mos
11-12 yrs
13-18 yrs
Hep B #3
DTaP DTaP DTaP DTaP TdDTaP
Hib Hib Hib Hib
IPV IPV IPV IPV
MMR #1 MMR #2
Varicella
PCVPCVPCVPCV
Hepatitis A series
Influenza (yearly)
This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1, 2001, for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible. Indicates age groups that warrant special effort to administer those vaccines not previously given. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine’s other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations.
Vaccines below this line are for selected populations
range of recommended ages catch-up vaccination
Hep B series
MMR #2
Varicella
PPVPCV
only if mother HBsAg ( - )
preadolescent assessment
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Recommended Childhood Immunization ScheduleUnited States, 2002
VaccineAge
Birth1
mo2
mos4
mos
Hepatitis B1
Diphtheria, Tetanus, Pertussis2
Haemophilus influenzae Type b3
Inactivated Polio4
Measles, Mumps, Rubella5
Varicella6
Pneumococcal7
Hepatitis A8
Influenza9
Hep B #1
Hep B #2
4-6 yrs
6 mos
12mos
15mos
18mos
24mos
11-12 yrs
13-18 yrs
Hep B #3
DTaP DTaP DTaP DTaP TdDTaP
Hib Hib Hib Hib
IPV IPV IPV IPV
MMR #1 MMR #2
Varicella
PCVPCVPCVPCV
Hepatitis A series
Influenza (yearly)
This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1, 2001, for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible. Indicates age groups that warrant special effort to administer those vaccines not previously given. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine’s other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations.
Vaccines below this line are for selected populations
range of recommended ages catch-up vaccination
Hep B series
MMR #2
Varicella
PPVPCV
only if mother HBsAg ( - )
preadolescent assessment
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Recommended Childhood Immunization ScheduleUnited States, 2002
VaccineAge
Birth1
mo2
mos4
mos
Hepatitis B1
Diphtheria, Tetanus, Pertussis2
Haemophilus influenzae Type b3
Inactivated Polio4
Measles, Mumps, Rubella5
Varicella6
Pneumococcal7
Hepatitis A8
Influenza9
Hep B #1
Hep B #2
4-6 yrs
6 mos
12mos
15mos
18mos
24mos
11-12 yrs
13-18 yrs
Hep B #3
DTaP DTaP DTaP DTaP TdDTaP
Hib Hib Hib Hib
IPV IPV IPV IPV
MMR #1 MMR #2
Varicella
PCVPCVPCVPCV
Hepatitis A series
Influenza (yearly)
This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1, 2001, for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible. Indicates age groups that warrant special effort to administer those vaccines not previously given. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine’s other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations.
Vaccines below this line are for selected populations
range of recommended ages catch-up vaccination
Hep B series
MMR #2
Varicella
PPVPCV
only if mother HBsAg ( - )
preadolescent assessment
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Recommended Childhood Immunization ScheduleUnited States, 2002
VaccineAge
Birth1
mo2
mos4
mos
Hepatitis B1
Diphtheria, Tetanus, Pertussis2
Haemophilus influenzae Type b3
Inactivated Polio4
Measles, Mumps, Rubella5
Varicella6
Pneumococcal7
Hepatitis A8
Influenza9
Hep B #1
Hep B #2
4-6 yrs
6 mos
12mos
15mos
18mos
24mos
11-12 yrs
13-18 yrs
Hep B #3
DTaP DTaP DTaP DTaP TdDTaP
Hib Hib Hib Hib
IPV IPV IPV IPV
MMR #1 MMR #2
Varicella
PCVPCVPCVPCV
Hepatitis A series
Influenza (yearly)
This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1, 2001, for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible. Indicates age groups that warrant special effort to administer those vaccines not previously given. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine’s other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations.
Vaccines below this line are for selected populations
range of recommended ages catch-up vaccination
Hep B series
MMR #2
Varicella
PPVPCV
only if mother HBsAg ( - )
preadolescent assessment
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Module 3
Facts about Vaccines & Answers to Common Vaccine Questions
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Everyone should know key vaccine information!
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Vaccines are one of the most important ways to protect children!
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Vaccines are safe
Many billion vaccinations have been given safely
Every vaccine that is made meets strict safety requirements.
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Disease risks outweigh Vaccine risks
Vaccines have common side effects (such as fever or soreness at the injection site). These are mild.
Vaccines can have more severe side effects (such as an allergic reaction). These are rare.
The potential harm from the diseases far outweighs the potential for vaccine side effects
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Waiting can be Risky
Vaccinate early! You never know when an exposure
or outbreak may occur Once an outbreak has been
identified, it may be too late
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Not vaccinating is risky
The decision not to vaccinate is
a choice to remain at risk for
disease
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Do vaccines overload the immune system?
Infants/children are exposed to germs every day.
The number of “germs” they get from vaccines is small compared with what they get from their daily environment.
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Does MMR vaccine cause autism?
Dales, et al, JAMA, Vol 285, No. 9, March 2001
The apparent rise in autism didn’t happen with the increase of MMR.
% of Children receiving MMR vaccine; Caseload of autistic children by year of birth, California, 1980-94
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Some parents may have questions about vaccines
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Module 4
WIC’s Role: Helping Kids Stay Healthy
Did you know that…
Many low-income infants/children don’t receive their immunizations on time or at all?
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WIC’s Role: Helping Kids Stay Healthy
WIC is an adjunct to health care– WIC supports immunization services
WIC refers and educates– WIC helps parents understand their child’s
need for immunizations– WIC shares information on where
infants/children can get their immunizations
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WIC’s Role: Helping Kids Stay Healthy
Infants/children who are up to date on their shots are less likely to suffer from other health problems like anemia and lead toxicity
Good nutrition and immunizations go hand in hand to help WIC children stay healthy
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Breastfeeding and ImmunizationsSome interesting facts:
Breastfeeding: babies’ “first immunization” Mothers who intend to breastfeed are more
likely to get infant immunized Breastfed babies have better responses to
vaccines Breastfeeding babies handle shots better
while breastfeeding (less pain)
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Breastfeeding and Immunizations
WIC helps babies get their first immunization – breastfeeding
WIC can help babies further strengthen their immunity against disease by helping them get properly vaccinated
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Breastfeeding and Immunizations
WIC helps mom breastfeed. WIC helps kids get immunized. What a great combination!
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Module 5
New WIC Immunization Screening and Referral Policy
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Overview of December 2000 White House Memorandum
Low-income infants/children are not as well immunized as higher income infants/children
WIC has access to the largest number of low-income infants/children and holds great potential to improve immunization rates
Immunization screening and referral should become a standard part of WIC certification. Screening should be conducted using a documented record of immunizations.
WIC benefits are never to be denied for lack of immunization records or shots.
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Overview of USDA Policy Memorandum (2001)
Outlined a minimum immunization screening and referral requirement in WIC
To be implemented in all WIC agencies by March 1, 2003
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WIC Minimum Requirement for Immunization Screening and Referral
Advise parents of any infant or child under two years of age to bring immunization records to certification
Screen using a documented immunization record, rather than parent’s memory or verbal assurance
Determine the child’s age, then count the number of doses of DTaP vaccines the child has received
Provide information on recommended immunization schedule
Provide referral if needed
Encourage parent to bring the immunization record to next certification visit
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Diagram of the WIC Minimum RequirementFor Immunization Screening and Referral
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Module 6
Using Documented Immunization Records for Screening and Referral in WIC
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What is a documented immunization record?
It is a record that has details of each immunization dose given
Acceptable records are:– A personal immunization record carried by the
parent that has been prepared by the provider
– A printout from an official source such as a registry, the health department, doctor’s office or clinic
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Why is it important to use a documented immunization record?
A documented record of shots is more accurate than the parent’s memory.
When asked, parents typically overestimate their child’s immunization status
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Advise parents to bring immunization records
Make certification appointment Instruct parent/caregiver to bring the
immunization record Explain importance
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WIC benefits are not tied to immunization records
Reassure parents that immunization records are requested as part of the WIC certification and health screening process, but are not required to obtain WIC benefits
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Sample Script
“Please bring Miguel’s shot record to your
appointment. Immunization records are
not required to obtain WIC benefits, but
they are an important part of the health
screening WIC provides. We want to
help you make sure your child is up to
date on shots.”
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Help Parents Remember to Bring RecordHelpful Tips:
Phone call indicating time of appointment and reminder to bring the shot record.
Postcard indicating time of appointment and reminder to bring the shot record.
Promotional posters in the waiting room reminding parents to bring shot record to WIC appointments.
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Thank parent each time they bring record!
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Module 7
Counting DTaP Vaccinations
What are the advantages of counting
DTaP doses?
How do I count DTaP doses?
61
What is a DTaP vaccine?
The vaccine contains a combination of:– D = Diphtheria Toxoid– T = Tetanus (Lockjaw) Toxoid– aP = Pertussis Vaccine
(Whooping cough)
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Why was DTaP selected?DTaP was selected to screen theimmunization status of WIC infants/children under two years of age because:
It is a good reflection of the up-to-date status of the child’s other immunizations
It is easier and quicker than counting the doses of all 11 vaccines
63
Up-To-Date Means….DTaP Vaccine
By Age Minimum Number of Doses
Birth through 1month 0
3 months 1
5 months 2
7 months 3
19 months 4
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Personal / Hand Held Records
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Variations on DTaP Vaccine
DTaP (Diphtheria, Tetanus, acellular Pertussis)
DTP (Diphtheria, Tetanus, Pertussis) DT (Pediatric Diphtheria & Tetanus) DTaP/Hib (Diphtheria, Tetanus, acellular
Pertussis & Hib)
Td (Adult Tetanus & Diphtheria)
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Close up View of an Infant/Child’s Record
Vaccine Type Mo/Day/Yr of dose
Health Provider Date Next dose due
DTaP/DTP
DT/TdDiphtheria
Tetanus
Pertussis
(Specify Type)
1 Tripedia
9/3/02 A.Coulter, MD/Kids Clinic
11/3/02
2Tripedia
11/14/02 A.Coulter, MD/Kids Clinic
01/14/03
3 Infanrix
01/21/03 A.Coulter, MD/Kids Clinic
10/21/03
4 Daptacel
10/21/03 Cordova Co. H.D., AZ
7/3/06
5
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Module 8
Talking to parents about their child’s immunization status
68
Congratulate ParentSample Script “You’re doing a great job of protecting your [baby/child] against very serious diseases like whooping cough. Please remember that there may be other vaccines, besides the one protecting him/her against Whooping Cough that your [baby/child] may not yet have received. Congratulations! Keep up the good work and remember to get each immunization on time.”
69
Urgency MessageSample script
“Your [baby/child] has not received all the shots [he/she] needs to be protected from Whooping Cough and other very serious, and sometimes deadly diseases. You need to contact your doctor right away to schedule an appointment for immunizations.”
70
Providing Education Provide copy of recommended
immunization schedule Provide other educational materials
if desired
71
Module 9
Making Effective ReferralsReferring WIC participants for
Immunizations
72
Barriers to Childhood Immunizations
No health care provider Cost (money) Transportation (no car or bus) Waiting time for appointment Waiting time in office Not knowing what shots are due or when
they are due
73
Effective referrals Identify providers who offer
immunizations Establish relationships with providers Help clients choose a provider
74
Identify providers who offer immunizationsWith assistance from Immunization program,
develop list of:
Private providers (pediatricians/family practice doctors)
Walk-in clinics Appointment only clinics Mobile vans On-site immunization services
75
Medical Home
Why important?
Comprehensive care in one location Child and family develop relationship
with physician Better follow-up
76
Vaccines for Children (VFC) Program
Provides no-cost vaccines for children if they are at least one of the following: – Medicaid eligible– Without health insurance or under-insured– American Indian or Alaska Native
Allows infants/children to receive immunizations at their medical home
77
Establish Relationships Establish relationships with local
providers, especially office staff
Discuss appointment procedures and obtain other necessary information
78
Be Specific
Provide address, phone number, days/hours open
Tell parent what to expect− requires well child exam?− has bilingual staff?− appointment only?
79
Follow-up with WIC parent if possible
Ask if child received shots
If no, find out if there was a barrier.
Ask for assistance from immunization staff at local health department
80
Help problem-solve
Share what clients are telling you about barriers encountered
Let the immunization program know about the barriers that WIC clients are facing.
81
Diagram of the WIC Minimum RequirementFor Immunization Screening and Referral
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Module 10
Hands-On Practice
Screening Immunization Records and
Comparing to the Recommended
DTaP Schedule
83
Hands-On Practice During the practice use the Easy IZ
Tool or an Immunization Schedule Compare an immunization record to
the recommended Easy IZ Tool or schedule
Determine if the infant/child is likely to be underimmunized.
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Easy IZ Tool1. Ask for the infant/child’s immunization record.2. What is the age of the infant/child in months?3. Count the number of entries in the DTaP, DTP,
DT and DTaP/Hib sections on the infant/child’s immunization record.
4. Look at the DTaP doses column of the Easy IZ tool
5. Does the infant/child have all of the doses due now for his or her age?
6. Look at the Action column and follow the actions described on the back side of the form.
85
Back of Easy IZ Tool Urgency Message Congratulate Parent Refer for Immunizations Remind parent to bring immunization
record to WIC visits Provide immunization schedule to
parent
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Example One of an Infant/Child’s Record
87
#1 - Close up view of Infant/Child’s record
DTaP
DT
DTP
# DTaP DT DTP Mo Day Yr Name of provider or Health Department
Date Next dose due
1
2
3
4
5
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Example Two of an Infant/Child’s Record
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#2 - Close up view of Infant/Child’s record
Vaccine Type Mo/Day/Yr of dose
Health Provider Date Next dose due
DTaP/DTP
DT/TdDiphtheria
Tetanus
Pertussis
(Specify Type)
1
2
3
4
5
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Module 11
Hands-On Practice
“What To Do When…”
Situations and Possible Responses
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What To Do When…Parent forgets to bring record
Educate about importance Encourage to bring next time Provide immunization schedule Provide referral
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When parent forgets to bring recordSample Script
“The WIC program is required to screen
immunization records for all infants/children under
age two at WIC certifications. Vaccines can help
prevent serious diseases. We want to make sure
your child is up to date. Please bring your child’s
shot record to your next WIC appointment.”
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Important Reminder
WIC benefits are never to be denied for lack of immunization records or shots.
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What To Do When…Parent cannot find record
Educate about importance Encourage parent to talk to provider Provide immunization schedule Provide referral
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Sample Script“It is important to have a personal record of your child's vaccinations. If you don't have a record, ask your child's health care provider to give you one. Bring this record with you every time you seek medical care for your child. Make sure your health care provider records all your child's vaccinations on the record. Your child will need it to enter daycare, kindergarten, junior high, etc.”
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What To Do When…Parent skips WIC appointment because of no IZ record
Encourage parent to always come to her scheduled appointments even if she can’t locate the immunization record.
Assure her that WIC benefits will never be denied for lack of immunization records.
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What To Do When…Parent brings multiple records
Encourage her to talk to her provider about consolidating the records onto one.
Provide referral
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What To Do When…Record lists incomplete dates
Screen record for appropriate number of DTaPs
Encourage parent to review record with health care provider
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What To Do When…Entries are hard to read
Encourage parent to talk to provider Do not screen record Make referral
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What To Do When…Parent does not want WIC to screen child’s record
Educate about importance Provide referral Provide appropriate materials
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What To Do When…Records are from another country
Encourage parent to talk to child’s health care provider.
Do not screen record if hard to interpret. Provide referral.
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Congratulations!
You’ve completed the immunization screening and referral training.
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Thank you for all you do for WIC participantsWe appreciate your hard work and dedication to the infants and young children served by WIC.
Your efforts will help improve immunization rates and keep kids healthy.
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