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May/June 2019

Change to School Requirement for Tdap

The Advisory Committee on Immunization Practices (ACIP) recommends that adolescents routinely receive meningococcal conjugate; tetanus, diphtheria, acellular pertussis (Tdap); and human papillomavirus (HPV) vaccines.  Centers for Disease Control and Prevention (CDC) routinely recommends Tdap as a single dose for those 11 through 18 years of age with preferred administration at 11 through 12 years of age.  If an adolescent is not fully vaccinated, check the ACIP recommendations and catch-up schedule to determine what is indicated.  Those who receive a dose of Tdap or diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) at age 7-10 years inadvertently or as part of the catch-up series should still receive the routine dose of Tdap at age 11-12 years.

To align with ACIP, the Virginia General Assembly passed legislation effective July 1, 2019 affecting school immunization requirements for Virginia.  The legislation changes §32.1-46 of the Virginia Code which relates to immunizations, by requiring the booster dose for acellular pertussis vaccine prior to seventh grade.  Therefore, in the upcoming 2019-20 school year, seventh graders, not sixth graders, will be required to have received the Tdap vaccine. All new students enrolling into grades eight through twelve must also have a Tdap booster.  Although a student who has received Tdap vaccine at age 7 years or older will meet the school vaccination requirement for Tdap, it may not comply with CDC recommendations

National Infant Immunization Week (NIIW)

This year marks the 25th anniversary of National Infant Immunization Week (NIIW). From April 27-May 4, 2019, NIIW will highlight the importance of protecting infants from vaccine-preventable diseases and will celebrate the achievements of immunization programs in promoting healthy communities throughout the United States.  NIIW is an annual observance to highlight the importance of protecting infants from vaccine-preventable diseases and celebrate the achievements of immunization programs and their partners in promoting healthy communities. As part of this week, CDC will announce the winners of its CDC Childhood Immunization Champion Award here: https://www.cdc.gov/vaccines/events/niiw/champions/profiles.html
This annual award recognizes individuals who make a significant contribution toward improving public health through their work in childhood immunization. Virginia’s nominee is Donna Deadrick, Carilion Childrens Pediatric Medicine, Roanoke.

Shipping Hours

CDC requires at least 1-4 hour window as a minimum for provider hours of operation.  In order for shippers to be able to deliver vaccine, providers must be on site with appropriate staff available to receive vaccine at least one day per week other than Monday, and for at least four consecutive hours during that day.

Vaccine Information Statements (VISs)

These are the VISs that have changed since 2018.

  • DTaP (8/24/18)
  • Hepatitis B (10/12/18)
  • Measles/Mumps/Rubella (MMR) (2/12/18)
  • Measles/Mumps/Rubella & Varicella (MMRV) (2/12/18)
  • Meningococcal ACWY (MenACWY & MPSV4) (8/24/2018)
  • Rotavirus (2/23/18)
  • Varicella (Chickenpox) (2/12/18)
  • Zoster / Shingles (Live) (2/12/18)
  • Zoster / Shingles (Recombinant) (2/12/18)

CDC VISs are available here: https://www.cdc.gov/vaccines/hcp/vis/current-vis.html

Gold Star Awards (Feb/Mar)

Outstanding VVFC Compliance

Chesapeake Peds. Gr. Bridge, Chesapeake
Chesapeake Peds. Oakbrooke, Chesapeake
Commonwealth Pediatrics, Richmond
Monument Avenue Pediatrics, Richmond
Pine Grove Pediatrics, Manassas
Sacoto Pediatrics, Falls Church
Sentara Pratt Med. Gp. Peds., Fredericksburg
Wythe Physician Practices, Max Meadows

Adult Vaccine Update

Outbreak Resource

Hep A and Measles outbreaks are occurring in multiple states across the U.S. increasing awareness of the importance of protection through vaccination. Helpful resources can be found here:

  • The Immunization Action Coalition (IAC) resource for healthcare professionals titled Hepatitis A and Hepatitis B Vaccines: Be Sure Your Patients Get the Correct Dose. Changes were made to incorporate the recently licensed 2-dose Heplisav-B vaccine. http://www.immunize.org/catg.d/p2081.pdf
  • CDC Measles website for Healthcare Professionals www.cdc.gov/measles/hcp

Heplisav-B

Heplisav-B, manufactured by Dynavax is available to order on the Adult Order Form.  Refer to the April 20, 2018 MMWR: Recommendations of the ACIP for Use of Hepatitis B Vaccine with a Novel Adjuvant: https://www.cdc.gov/mmwr/volumes/67/wr/mm6715a5.htm

COCA Call: Hepatitis A Outbreaks in Multiple States

2018 CDC Holiday Shipping Calendar

The Holiday Shipping Schedules address both McKesson and Merck Direct Ship. Please be sure to review the note below the schedules for important details about the timing of vaccine shipments.

Holiday Shipping Schedule November 2018

SHIPPING = Normal shipping expected for routine orders for McKesson and Merck
LIMITED SHIPPING = McKesson to ship Priority orders only
NO SHIPPING = No McKesson & Merck shipping expected for these days

Holiday Shipping Schedule December 2018

SHIPPING = Normal shipping expected for routine orders for McKesson and Merck
LIMITED SHIPPING = McKesson to ship Priority orders only
NO SHIPPING = No McKesson & Merck shipping expected for these days

Download the PDF version HERE

VIIS and the Virginia Early Hearing Detection and Intervention Program Collaboration

All newborns born in the state of Virginia are required by law to receive a newborn hearing screen prior to discharge from the hospital. In 2016, the hearing screening rate in Virginia was 99.2%. The Virginia Early Hearing Detection and Intervention (EHDI) Program monitors the newborn hearing screening of all babies born within the state of Virginia, as well as hearing re-screening and diagnostic records for all infants from birth to 36 months of age that reside in the state of Virginia. This information is maintained in an online database called the Virginia Infant Screening and Infant Tracking System (VISITS).

The hearing screening test is performed on all newborns shortly after birth. It is the first step in a process designed to identify children with hearing loss as early as possible, to ensure that all newborns can benefit from interventions that will help them develop to their full potential. Language development is largely dependent on hearing and begins very early in a child’s life. Re-screening a newborn prior to 1 month of age and diagnosing a hearing loss prior to 3 months of age is important in providing the child with appropriate resources in a timely manner. These resources will help children achieve their best linguistic and literacy abilities, and improve their chances for educational success.

In order to ensure appropriate and timely follow-up hearing rescreens, the Virginia EHDI program has collaborated with the Virginia Immunization Information System (VIIS), to allow the child’s Primary Care Provider (PCP) easy access to view the newborn hearing screening results. The Virginia EHDI program and VIIS are scheduling site visits and/or GoTo meetings with PCP offices to provide training and education to view the screening results and discuss recommendations for children in need of rescreening. If a child fails or misses the newborn hearing screening in the hospital, as the PCP, you can make an audiology referral to ensure the child has a hearing rescreen or diagnostic evaluation performed. For a list of preferred audiology facilities within the state of Virginia you may visit the http://EHDIPALS.org website or refer to the back of the letter you receive from the Virginia EHDI program with hearing screening results and recommendations.

If you are interested in scheduling a site visit or if you would like more information about the Virginia EHDI Program contact Kathleen Watts: Kathleen.Watts@vdh.virginia.gov or Deepali Sanghani: Deepali.Sanghani@vdh.virginia.gov via phone at 804-864-7719 or fax at 804-864-7771. Please visit the VA EHDI Program website at: http://www.vdh.virginia.gov/early-hearing-detection-and-intervention/

BackPage September/October 2018

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The BackPage
Vaccine News Alert

Sept/Oct 2018

Flu VIS


The current influenza VIS, dated 8/7/15, is still valid for the 2018-19 influenza season. It will remain valid through upcoming flu seasons unless there are significant changes to CDC’s recommendations, in which case subscribers will be notified of any change.


Flu Borrowing

For seasonal influenza vaccine, providers may use private-stock seasonal influenza vaccine to vaccinate VFC-eligible children if VFC seasonal influenza stock is not yet available. Those private stock doses used on VFC-eligible children can later be replaced when VFC stock becomes available. This one directional borrowing exception is unique to seasonal influenza vaccine.


Flu Vaccine is Available

The first shipments of flu vaccine have arrived at the CDC depots. Please notify Susan Kocen if you are ready to begin administering flu vaccine.


FluLaval and Fluarix Vaccine

The dose for FluLaval and Fluarix for this flu season is (0.5-mL) for all children in the indicated age range of 6 months and older.


Vaccine Storage Unit Assessment

Because vaccine borrowing occurs, a private dose of vaccine is occasionally administered to a VFC-eligible patient. A private storage unit may be used to store VFC vaccine when a storage unit fails. Because these types of events occur, storage units that contain only private stock must be reviewed during compliance visits. Private storage units that don’t meet CDC storage and handling requirements will require follow up.


Vaccine Supply

Hep B - To ensure equitable access to hepatitis B vaccines, CDC is placing Recombivax HB and Engerix B under allocation. The recommendations for hepatitis B vaccination of infants have NOT changed. To expedite order approval, please indicate if you have no preference for Hep B on the order form until supply improves. If you indicate “no preference” we will substitute brands only if necessary. Orders may be reduced, but providers can re-order as necessary. Sample schedules are posted on the CDC Current Vaccine Shortages and Delays web page located here: https://www.cdc.gov/vaccines/hcp/clinical-resources/shortages.html


New Vaccine NDCs

HPV – A new NDC for Gardasil syringes will be available soon and will be added to the vaccine order form. Tdap – A new latex free NDC for Adacel will be available soon and will been added to the vaccine order form.


 

Adult Vaccine Update

Shingrix Supply - Due to high levels of demand for Shingrix vaccine, GSK has implemented order limits and providers have experienced shipping delays. It is anticipated these order limits and shipping delays will continue throughout 2018. In response, GSK has increased the US supply available for 2018 and plans to release doses to all customer types on a consistent and predictable schedule for the rest of 2018.Ask the Experts Q&A

Q: I want to begin providing vaccines for my adult patients but reimbursement for these vaccines is confusing. Can you provide guidance?

A: In 2017, the Immunization Action Coalition revised its comprehensive 142-page guide titled Vaccinating Adults: A Step-by-Step Guide. The guide was written to assist medical practices to improve their adult vaccination services. Two of the chapters (7A and 7B) address financial considerations and provide guidance on how to obtain reimbursement for adult vaccines. The guide is available free of charge on the IAC website at www.immunize.org/guide. In addition, the National Adult and Influenza Immunization Summit has created a web section on this topic at www.izsummitpartners.org/naiis-workgroups/access-provider-workgroup/coding-and-billing.


Gold Star Awards (June/July)

Outstanding VVFC Compliance
Bon Secours Hanover Pediatrics, Mechanicsville
Bon Secours Pediatrics, Mechanicsville
Centerville Family Practice, Manakin Sabot
Century Pediatrics, Fredericksburg
Century Pediatrics, Garrisonville
Century Pediatrics, Woodbridge
Children’s Health, Fredericksburg
Family Care Pediatrics, Galax
Infant, Child, & Adolescent Clinic, Alexandria
MWMG Family & Internal Med., Bowling Green
Practice of Carolyn Boone, Richmond
Valley Health-Page Memorial Hosp., Luray
Woodbridge Pediatrics, Woodbridge

Process Improvement
The Practice of Carlos Cruz in Alexandria uses a pharmaceutical grade refrigerator and has a back-up data logger. Their EMR interface exchanges data with the immunization registry and includes patient eligibility.


109 Governor Street, 6th Floor
Richmond, Virginia 23218
Toll Free:800-568-1929 or Richmond 804-864-8055
vvfc@vdh.virginia.gov
http://www.vdh.virginia.gov/immunization/vvfc/


Developed by the Division of Immunization 2017

July/August 2018

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The BackPage
Vaccine News Alert

July/August 2018

FAMIS Plus vs FAMIS


FAMIS Plus is Medicaid for children. Children with FAMIS Plus are VFC-eligible. FAMIS is Virginia’s health insurance program for children. Children with FAMIS are insured and not VFC-eligible.


Flu Vaccine

It is time to return last year’s expired flu vaccine. Please notify the order center of any circumstances that should be considered for distribution planning for the upcoming flu season.


Flu Borrowing

For seasonal influenza vaccine, providers may use private-stock seasonal influenza vaccine to vaccinate VFC-eligible children if VFC seasonal influenza stock is not yet available. Those private stock doses used on VFC-eligible children can later be replaced when VFC stock becomes available. This one directional borrowing exception is unique to seasonal influenza vaccine.


CDC Webinar Series on "The Pink Book"

CDC is again presenting a 15-part webinar series to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). This is a live series of weekly 1-hour webinars that will start June 6 and run through September 26. Recordings of sessions will be available online within 2 weeks after each webinar. All sessions begin at 12:00 a.m. (ET). Continuing education will be available for each event.


CE Credit

To receive continuing education for CDC’s You Call the Shots training follow the steps located here: https://tceols.cdc.gov/Home/Steps


Safe Removal of Fridge Tag 2L

Instructions to safely remove a Fridge Tag 2L from a PC can be found here: http://www.vdh.virginia.gov/content/uploads/sites/11/2018/05/RemoveFT2LSafely.pdf


Catch Up Job Aids

CDC recently developed several new job aids to help providers figure out exactly what is needed for children who are behind schedule with PCV13, Hib, DTaP, and/or Tdap vaccines. Although this information is available in the annual U.S. Catch-Up Immunization Schedule for Persons Aged 4 Months through 18 Years Who Start Late or Who Are More Than 1 Month Behind, the format of these resources makes it easier to determine what is needed (number of doses and timing) in a particular situation. The job aids are located here: https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html


Hepatitis A and Hepatitis B Vaccine Resource

Hep A outbreaks are occurring in multiple states across the U.S. increasing awareness of the importance of protection through Hep A vaccine. IAC recently revised its resource for healthcare professionals
titled Hepatitis A and Hepatitis B Vaccines: Be Sure Your Patients Get the Correct Dose. Changes were made to incorporate the recently licensed 2-dose Heplisav-B vaccine. http://www.immunize.org/catg.d/p2081.pdf


Hep B Supply

To ensure equitable access to hepatitis B vaccines, CDC is placing Recombivax HB and Engerix B under allocation. The recommendations for hepatitis B vaccination of infants have NOT changed. Providers should continue to follow the recommended schedule outlined in the Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger. Updates for vaccine supply (and sample schedules) are posted on the CDC Current Vaccine Shortages and Delays web page located here: https://www.cdc.gov/vaccines/hcp/clinical-resources/shortages.html

Tip: To expedite order approval, please indicate if you have no preference for Hep B on the order form until supply improves. If you indicate “no preference” we will substitute brands only if necessary. Orders may be reduced, but providers can re-order as necessary.


 

Adult Vaccine Update

Recombinant Zoster Vaccine Administration Errors

CDC published Notes from the Field: Vaccine Administration Errors Involving Recombinant Zoster Vaccine—United States, 2017–2018 in the May 25 issue of MMWR (pages 585–6). The complete article is located here: https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6720a4-H.pdf

Gold Star Awards (April/May)

Outstanding VVFC Compliance
Carilion Family Medicine-Giles, Pearisburg
Fall Hill Pediatrics, Fredericksburg
Lewis Gale Clinic, Salem
Metropolitan Pediatrics, Arlington
Practice of Jacqueline Hoang, Springfield
Practice of Jocelyn Trent, Woodbridge
Richeson Drive Pediatrics, Lynchburg
Winchester Family Health Center, Winchester


109 Governor Street, 6th Floor
Richmond, Virginia 23218
Toll Free:800-568-1929 or Richmond 804-864-8055
vvfc@vdh.virginia.gov
http://www.vdh.virginia.gov/immunization/vvfc/


Developed by the Division of Immunization 2017

May/June 2018

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The VVFC BackPage
Vaccine News Alert

May/June 2018

Guidance for the Hepatitis B Series during a Recombivax HB® Shortage

The manufacturing issue related to hepatitis B vaccine that Merck began experiencing in 2017 is expected to continue throughout 2018. As a result, Merck’s supply of pediatric hepatitis B vaccine will be intermittent during 2018 and Merck will not be distributing its adult hepatitis B vaccine. GSK has confirmed that it can continue to support full demand for pediatric hepatitis B vaccine in the United States throughout 2018, using a combination of monovalent pediatric hepatitis B vaccine and its DTaP-HepB- IPV pediatric combination vaccine (Pediarix). The expected monovalent supply will provide sufficient vaccine to cover the hepatitis B birth dose for all children as well as additional pediatric hepatitis B vaccine for second and third doses. CDC has developed guidance for providers that is available at the link provided below. The recommendations for hepatitis B vaccination of infants have NOT changed. Providers should continue to follow the recommended schedule outlined in the Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger. Updates for vaccine supply (and sample schedules) are posted on the CDC Current Vaccine Shortages and Delays web page located here: https://www.cdc.gov/vaccines/hcp/clinical-resources/shortages.html


 

National Infant Immunization Week (NIIW)

National Infant Immunization Week (NIIW), observed from April 21–28 this year, started on Saturday! NIIW is an annual observance to highlight the importance of protecting infants from vaccine-preventable diseases and celebrate the achievements of immunization programs and their partners in promoting healthy communities. As part of this week, CDC announced the winners of its CDC Childhood Immunization Champion Award, found here:

https://www.cdc.gov/vaccines/events/niiw/champions/profiles-2018.html

This annual award recognizes individuals who make a significant contribution toward improving public health through their work in childhood immunization.  The following are recognized for their stellar work in childhood immunizations in Virginia:

  • Donna Deadrick, BSNCarilion
    Children’s Pediatric Medicine
  • Cyrelda Fermin, M.D.
    Infant, Child & Adolescent Clinic
  • Cathie Harrington, PNP FNP
    Wythe Physicians Practices

 

Eligibility: Clarification for Underinsured

Eligibility for the VFC Program as “underinsured” is rare.  Unless insurance coverage for vaccines is verified by the provider prior to administration of vaccine, for the purposes of the VFC Program, these children are considered insured and are not eligible to receive vaccines at that immunization encounter.  Note: Children whose health insurance covers the cost of vaccinations are not eligible for federally purchased vaccines, even when a claim for the cost of the vaccine and its administration would be denied for payment by the insurance carrier because the plan’s deductible has not been met. A child verified as underinsured is VFC eligible ONLY at a Federally Qualified Health Center/Rural Health Center (FQHC/RHC).  Private providers cannot use VFC vaccine on underinsured children.  Health Departments provide immunizations to underinsured and insured clients using vaccine purchased with other funding (not VFC funded vaccine).


 

IAC posts 19 translations of the MMR, MMRV, varicella, zoster-recombinant, and zoster-live VISs

As part of its cooperative agreement with CDC, IAC recently posted updated or new translations of the MMR, MMRV, varicella, zoster-recombinant (Shingrix), and zoster-live (Zostavax) VISs in Arabic, Burmese, Cambodian (Khmer), Chinese-Simplified, Chinese-Traditional, Farsi, French, Haitian-Creole, Hmong, Indonesian, Japanese, Korean, Portuguese, Russian, Somali, Tagalog, Thai, Turkish, and Vietnamese.


 

New VISs

CDC has released updated VISs.  They are available at: https://www.cdc.gov/vaccines/hcp/vis/current-vis.html

  • DTaP (5/17/07)
  • Hepatitis A (7/20/16)
  • Hepatitis B (7/20/16)
  • Hib (Haemophilus Influenzae type b) (4/2/15)
  • HPV – Gardasil-9 (12/2/16)
  • Influenza – Live, Intranasal (8/7/15)
  • Influenza – Inactivated (8/7/15)
  • Measles/Mumps/Rubella (MMR) (2/12/18)
  • Measles/Mumps/Rubella & Varicella (MMRV) (2/12/18)
  • Meningococcal ACWY (MenACWY & MPSV4) (3/31/2016)
  • Serogroup B Meningococcal (MenB) (8/9/16)
  • Pneumococcal Conjugate (PCV13) (11/5/15)
  • Pneumococcal Polysaccharide (PPSV23) (4/24/15)
  • Polio (7/20/16)
  • Rotavirus (2/23/18)
  • Tdap (Tetanus, Diphtheria, Pertussis) (2/24/15)
  • Td (Tetanus, Diphtheria) (4/11/17)
  • Varicella (Chickenpox) (2/12/18)
  • Zoster / Shingles (Live) (2/12/18)
  • Zoster / Shingles (Recombinant) (2/12/18)

 

Gold Star Awards (Feb/Mar)

Image Exceptional Immunization Rates
Pediatric Associates of Charlottesville
Outstanding VVFC Compliance
Pediatric Associates of Charlottesville


109 Governor Street, 6th Floor
Richmond, Virginia 23218
Toll Free:800-568-1929 or Richmond 804-864-8055
vvfc@vdh.virginia.gov
http://www.vdh.virginia.gov/immunization/vvfc/


Developed by the Division of Immunization 2017