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Author: Rishi Sharma

Current Recommendations for Hepatitis B Vaccination

Notes From the Immunization Program:
Current Recommendations for Hepatitis B Vaccination

The Advisory Committee on Immunization Practices (ACIP) has modified its recommendations for hepatitis B (HBV) vaccination. The ACIP now recommends that all adults aged 19-59 years and adults aged 60 and older with risk factors receive hepatitis B vaccines. 

Ensure these groups are up to date on hepatitis B vaccination:  

  • Infants  
  • Children aged <19  
  • Adults aged 19-59  
  • Adults aged 60 and older with risk factors for hepatitis B  
  • Risk factors include sexual exposures, people at risk by percutaneous or mucosal exposure, and others. A complete list can be found here

Adults aged 60 and older without known risk factors may also be vaccinated.

Why hepatitis B and why now?

In 2019, the United States saw a rise in acute hepatitis B cases. Opioid use, which remains a growing public health concern in Philadelphia, has contributed to this increase in cases nationally.  
 
To counter the rising incidence of acute hepatitis B in the U.S., ACIP expanded its recommendations for hepatitis B vaccination in November 2021. 

However, a national survey conducted in February 2022 revealed that 55% of family physicians were unaware of the updated hepatitis B vaccine recommendations, and only 8% had fully implemented the new recommendations. 

In Philadelphia, we have seen a small rise in the numbers of adults receiving hepatitis B vaccination following the new recommendations. However, the urge to vaccinate Philadelphians remains high. Pennsylvania has the fourth highest number of newly reported chronic HBV cases in the nation and Philadelphia accounts for most of these cases. Syringe exchange programs help decrease risky injection among drug users in Philadelphia, yet obstacles to safe injection persist.  

Healthcare professionals can continue to decrease morbidity by promoting hepatitis B vaccination. A vaccine recommendation from patients’ provider is the strongest predictor of whether patients get vaccinated. 

Strategies for increasing hepatitis B vaccination rates:

  1. Do not assume that hepatitis B vaccination has been completed. ACIP guidelines state that only written documentation should be accepted as evidence of previous vaccination. 
  2. Use Philadelphia’s immunization information system (IIS) to verify whether patients have received hepatitis B vaccination. Providers can register with PhilaVax IIS by completing this form. 
    • A PhilaVax login enables providers to use the ‘Patient Search’ module to quickly search for a patient and access prior vaccinations received in the city of Philadelphia or surrounding jurisdictions. PhilaVax also hosts a vaccine recommender tool which highlights patients’ overdue vaccinations. 
  3. Use every opportunity to offer hepatitis B vaccine to unvaccinated patients, even sick visits. If you don’t stock hepatitis B vaccine, refer patients to another local hospital, health center, pharmacy, or organization that can vaccinate.  
    • Patients who are uninsured or underinsured can visit a local Federally Qualified Health Center (FQHC), Vaccines for Children (VFC) provider, or Vaccines for Adults at Risk (VFAAR) provider to receive vaccine at no or low cost.  
  4. Document hepatitis B immunizations and maintain updated records. 
    • Participate in Philadelphia’s immunization information system (IIS) to report immunizations given.  

Prepare Your Practice to Fight Flu This Winter

Notes From the Immunization Program:
Prepare Your Practice to Fight Flu This Winter

Less than 30 percent of Philadelphians were vaccinated against flu in 2020. Presently, seasonal flu activity is elevated across the country. Ensure your practice is prepared to fight flu this winter.  

Remind patients to get vaccinated. Send email, text, or phone call reminders to patients to get vaccinated against flu this season. CDC developed an appointment reminder email template which you can customize for your practice and patient population. 
 
Make a strong vaccine recommendation. Offer flu vaccine and share specific reasons why the flu vaccine is right for the patient.  

  • Young children: “Young children, even those who are healthy, are at high risk of serious flu-related complications. Flu vaccination can reduce the risk of flu-associated death by 65% (nearly two-thirds) among healthy children.” 
  • Pregnant people: “Pregnant people are at high risk of severe flu illness due to changes in the body caused by pregnancy. Complications of the flu can include preterm delivery, pneumonia, and material and fetal death. The flu vaccine is safe and recommended during pregnancy and can also protect your baby for several months after birth.” 
  • Adults 65 years and older: “People who are 65 years and older are at high risk of serious complications due to flu. Most flu-related hospitalizations and deaths have occurred in people 65 years and older.” 
  • Adults with certain medical conditions: “People with certain chronic conditions, like asthma, diabetes, and heart disease, are at high risk of serious complications from flu. These include inflammation of the heart, brain, or muscle tissue” 
  • Healthy adults: “Most healthy adults don’t die from the flu, but your rate of hospitalization can be cut nearly in half by getting the flu shot.” 

Discuss practical matters with patients. There are costs to skipping vaccinations, such as the flu shot: 

  • If patients get the flu, they may miss several days of work which can result in lost wages.  
  • Patients who are hospitalized due to the flu can face expensive medical bills. 

When discussing the costs of declining vaccination, remember to acknowledge patient concerns. This is particularly important for marginalized patients who have experienced discrimination in medical settings.  
 
Black, Latinx, and indigenous patients experience higher rates of severe flu than white patients. Taking the time to engage with patients in decision making can improve health outcomes, particularly among vulnerable patients.  

Continue the conversation. If patients remain hesitant to receive the flu vaccine after counseling, offer educational materials. CDC has informational handouts which you can use at no cost to your practice. 
 
Additionally, this Flu Toolkit is available for health care providers in Philadelphia. It contains guidance on patient counseling, vaccine ordering updates, and flu vaccine promotional posters (available to order).  

Ensure Patients Are Up to Date With Polio Vaccination

Ensure Patients Are Up to Date With Polio Vaccination

Vaccine-derived poliovirus has been detected in environmental samples and infected one unvaccinated person in New York this year. In some Philadelphia neighborhoods, polio vaccination rates among children remain low. 

Prevent community transmission by ensuring patients are up-to-date with polio vaccines in their upcoming well or sick visit. 

According to the American Academy of Pediatrics, delaying immunizations at sick visits can lower immunization rates. Use every opportunity to vaccinate!

What is polio?

  • A potentially disabling and life-threatening disease caused by poliovirus. 
  • Usually spread through the fecal-oral route, and sometimes through the oral-oral route.
  • Most people infected with polio have no apparent symptoms. Some experience mild symptoms (e.g. sore throat, fever, nausea).
  • 1% of polio cases result in paralysis. Paralytic polio can result in death, especially among people diagnosed as adults.
  • Up to 40% of children diagnosed with polio experience new symptoms in adulthood (post-polio syndrome).

Who should get vaccinated?

Pediatric

  • All unvaccinated children should receive the polio vaccine (IPV).
  • CDC recommends 3 doses of IPV for primary series and 1 booster dose for children at the following ages: 
    • Dose 1: 2 months old
    • Dose 2: 4 months old
    • Dose 3: 6 through 18 months old
    • Booster: 4 through 6 years old
  • Unvaccinated or partially vaccinated children should receive IPV vaccination as soon as possible in accordance with the recommended catch-up schedule.

Adult

  • Unvaccinated or partially vaccinated adults who are at increased risk of infection (e.g. international travelers) should receive their completed series of IPV in the following intervals:
    • Dose 1: at any time
    • Dose 2: 1-2 months after Dose 1
    • Dose 3: 6-12 months after Dose 2

Monkeypox Vaccine Deliveries Paused for Thanksgiving

Monkeypox Vaccine Deliveries Paused for Thanksgiving

Monkeypox vaccine deliveries will be paused during the week of Thanksgiving, November 21 – 25, 2022. The last delivery for monkeypox vaccine will be on Monday, November 21. 

Ordering will remain open this week until Thursday, by 5pm. Remember to submit your temperatures to tempcheck@phila.gov and complete a reconciliation of vaccine on hand for your order to be approved.

Click the button below to submit your order request for monkeypox vaccine.

Deliveries for monkeypox vaccine will resume on the week of November 28.

Thank you for keeping Philadelphia safe and healthy! If you have any questions, please contact Kenya Mack at Kenya.Mack@phila.gov

Health Department Publishes Request for Proposal for HIV Testing in Pharmacies

Health Department Publishes Request for Proposal for HIV Testing in Pharmacies

PHILADELPHIA—The Health Department is making four to six grants of up to $75,000 available to increase the availability of low-barrier HIV testing and connection to care services in select priority zip codes in Philadelphia. The request for proposals is part of the Health Department’s community-driven Plan to End the HIV Epidemic in Philadelphia, which envisions decreasing new HIV infections by 75% by 2025 and by 90% by 2030. Grant submissions may be made by applicants who operate pharmacies in the listed priority zip codes, and may address HIV testing, information distribution, linkage to care, and participation in training.

The accessibility of pharmacies for HIV testing presents a unique opportunity for pharmacists to contribute to the identification of undiagnosed HIV. An estimated 90% of urban consumers live within two miles of a pharmacy. A CDC-funded feasibility study offering rapid, point-of-care testing in community pharmacies and retail clinics found that pharmacies and retail clinics represent a vast, largely untapped potential for the delivery of HIV testing in settings that are more accessible and, for some people, less stigmatizing than traditional testing.

With this RFP, the Health Department’s goal is to expand opportunities for HIV testing in neighborhoods in Philadelphia with the highest incidence of persons newly diagnosed with HIV in 2019 through community-based retail pharmacies.

Eligible applicants are independent and non-independent pharmacies currently operating in the priority areas listed in this request for proposals or with appropriate justification and prior approval of the Department in an immediately adjacent ZIP code neighborhood. Based on local analysis of recent data on HIV testing, newly diagnosed HIV, and HIV testing resources by zip code, the Health Department has identified 13 priority zip codes for this RFP.  

To learn more about the request for proposals, all documentation is available on the eContractPhilly website, under Opportunity 21221013101712. The Health Department’s Community Plan to End the HIV Epidemic in Philadelphia can be downloaded here

Temperature Reporting for Online Vaccine Ordering

Temperature Reporting for Online Vaccine Ordering

Temperature logs must be submitted on the same day as any order placed for federal vaccine (VFC, VFAAR, flu, COVID-19, or monkeypox)!

Temperature logs are to be uploaded in PhilaVax and emailed to tempcheck@phila.gov. The logs must show that the unit is within the appropriate temperature ranges and that there have been no alarms. This reporting guide can assist you in submitting your DDL temperature files.

For more information on ordering and how to upload your temperature log, please attend the next online ordering training on November 10, 2022 from 10:00AM – 11:00AM EST. Click the link below to register for the training.

If your site uses a privately purchased DDL or cannot upload in PhilaVax, please contact tempcheck@phila.gov.

Thank you for keeping Philadelphia safe and healthy! 

Immunization Records Review for Childcare Facilities

Immunization Records Review for Childcare Facilities

Hello Childcare Provider:

On an annual basis, the Pennsylvania Department of Health in collaboration with the Philadelphia Department of Public Health conducts an immunization records review of a random sample of childcare facilities from the Department of Human Services list of childcare group settings throughout the Commonwealth. This year, your facility has been chosen.   

The goal of this review is to ensure that all children receive their required immunizations and are protected against vaccine preventable diseases.

During the review, we will examine the immunization records for all children enrolled at your facility and validate their completeness. Per the regulations for childcare facilities, all ACIP recommended vaccines are required for children unless an exemption is on file. This includes an annual flu vaccine.

On the day of the review, we will need access to the Child Health Assessment Form (CD 51) for all children enrolled in your facility who are 2 months through 59 months of age, with a date of birth from 9/2/2017 – 7/1/2022.

The deadline to submit requested information is September 30, 2022.

Please review the attachments below:

HIPAA Letter

Philadelphia Department of Public Health’s correspondence letter 

2022 Recommended Immunization for Children (Birth-6 years old)

Thank you for your commitment to keeping children safe and healthy! If you have any questions, please email tanya.jones@phila.gov.

Monkeypox Vaccine Update: Expanded Eligibility & Second Doses

Monkeypox Vaccine Update: Expanded Eligibility & Second Doses

There is now vaccine supply to begin administering a complete two-dose Jynneos vaccine series to each individual who is eligible for vaccine.

Updates

Eligibility for a first dose now includes:
• People of all ages. Subcutaneous administration continues to be required for those <18.
• People with a history of STI in the past 12 months, as well as individuals who plan to have multiple or anonymous sex partners, or those plan to meet new sexual partners via social media.

Eligibility for a second dose now includes:
• People who have received a first Jynneos vaccine dose through either intradermal or subcutaneous administration. This dose should be given intradermally to those 18 and older unless there is a contraindication.

Eligibility has also expanded to include those with a history of STI in the past 12 months (from 6 months previously) and to start offering preexposure prophylaxis to people at high risk for becoming infected. The interval between doses for both subcutaneous and intradermal injections is at minimum 28 days. Individuals who test positive for monkeypox after their first dose should not receive a second dose of vaccine. Individuals whose second doses have been delayed do not need to restart the two-dose vaccine series.

There is no age requirement for Jynneos vaccine eligibility, although those less than 18 years of age must receive the vaccine subcutaneously. Individuals 18 and older will be given intradermal vaccination, regardless of which method was used for the first vaccine, unless there is a contraindication.

Complete eligibility criteria include:

People who meet the following condition:

• Gay, bisexual, transgender, non-binary, and other men who have sex with men, transgender, or non-binary persons

AND meet ONE of the following criteria:

• Have had multiple or anonymous sex partners in the last 14 days
• Have had any newly diagnosed STI in the past 12 months, including gonorrhea, chlamydia, early syphilis, or HIV
• Have recently attended or plan to attend any venue where anonymous sex or sex with multiple partners will occur (e.g. saunas, bathhouses, sex clubs, sex parties) in the next 30 days
• Have met recent partners or plan to meet new partners in the next 30 days through social media platforms (such as Grindr, Tinder or Scruff), or at clubs, raves, sex parties, saunas

Additionally, the following people are eligible:

• Sex workers (of any sex or gender), and/or
• Anyone with known close contact (skin-to-skin) with someone with monkeypox in the past 14 days

When using an intradermal strategy, there may be unused doses in a single vial. All efforts should be made to give doses to the above eligible individuals. If there are doses that would go wasted, they may be given to other individuals not included in the above criteria. Healthcare workers directly involved in testing and examining those with possible monkeypox illness and staff involved in environmental cleaning and disinfection protocols should be prioritized.

Thank you for keeping Philadelphia safe and healthy! If you have any questions about these updates, please contact vaccines@phila.gov.

Aetna Better Health Medicaid Coverage Discontinued

Aetna Better Health Medicaid Coverage Discontinued

Aetna Better Health of Pennsylvania (ABH-PA) Medicaid Coverage was Discontinued Wednesday, August 31st, 2022. As of Thursday, September 1, 2022, patients with this plan will no longer be covered by this plan. Letters were sent to ABH-PA plan members to help them with the transition. They can also call the phone number on the back of their card for more information.

As a provider, please:

  • Continue to vaccinate these patients. They are still VFC and medicaid eligible.
  • Do not charge patients out of pocket for care or vaccine administration. 
  • Support patients identify, or as they identify, a new provider if their new Medicaid plan is out of network. Email our team at vaccines@phila.gov with any questions.

These changes do not affect the Aetna Better Health of Pennsylvania Kids Children’s Health Insurance Program (CHIP). Aetna Better Health CHIP will remain in place following the changes to their Medicaid program. 

Questions?

You can direct questions regarding the closure of ABH-PA to their dedicated mailbox at PAMedicaidClosureProviderRelationsMailbox@AETNA.com

Other questions can be directed to vaccines@phila.gov. Thank you for keeping Philadelphia safe and healthy!