The Philadelphia Vaccines for Children (VFC)/ Vaccines for Adults at Risk (VFAAR) annual re-enrollment period is now open!
Sites enrolled in VFC and/or VFAAR must submit a re-enrollment form by June 30th in order to continue to participate in these programs. Follow these 3 easy steps, for a smooth re-enrollment!
1. Complete this survey Your answers will help us better support you throughout the next year. A submission is required to complete re-enrollment for your site.
2. Update Clinic Tools Update the information indicated for your site in the Clinic Tools, Clinic Information module. Use these job aids to guide you through making needed changes to the clinic tools page:
The vaccine coordinator and medical director must log into the PhilaVax IIS to access, complete and sign the electronic re-enrollment form. If you have not completed the 2023 User Confidentiality Agreement to renew your account or do not have a PhilaVax user account, use the link below to complete it now.
If you have trouble accessing the above link or you have a PhilaVax account and need to update your password, you can email PhilaVax@phila.gov for assistance.
Vaccine Temperature Monitoring: New Paper Temperature Logs Available
To ensure that the vaccine at your site is viable when administered to patients, consistent temperature monitoring is an important part of participating in the program. Our program requires sites to maintain active and passive monitoring. The passive monitoring is recorded by the Digital Date Logger (DDL) and reported to our program regularly. The active monitoring is recorded on the paper temperature logs.
The public health emergency declaration for COVID-19 recently ended on May 11. In the past year, there have been major updates to COVID-19 vaccine recommendations. Here are the highlights:
May 5, 2022 – FDA Limits Use of Janssen COVID-19 Vaccine to Certain Individuals
Summary: The FDA limited the authorized use of the Janssen COVID-19 vaccine to adults for whom other authorized or approved COVID-19 vaccines are not accessible or clinically appropriate, and to adults who elect to receive the Janssen COVID-19 vaccine because they would otherwise not receive a COVID-19 vaccine.
July 13, 2022 – FDA Authorizes Emergency Use of Novavax COVID-19 Vaccine, Adjuvanted
Summary: The FDA issued an EUA for the Novavax COVID-19 vaccine, adjuvanted for the prevention of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adults.
April 18, 2023 – FDA Authorizes Changes to Simplify Use of Bivalent mRNA COVID-19 Vaccines
Summary: Current bivalent vaccines (original and omicron BA.4/BA.5 strains) have been authorized to be used for all doses administered to individuals 6 months of age and older, including for an additional dose or doses for certain populations. The monovalent Moderna and Pfizer-BioNTech COVID-19 vaccines are no longer authorized for use in the United States.
Eligibility
CDC recommends that people ages 6 months and older receive at least 1 bivalent mRNA COVID-19 vaccine.
Everyone aged 6 years and older should get 1 updated Pfizer-BioNTech or Moderna COVID-19 vaccine to be up to date.
For those with most types of private insurance, COVID-19 vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) will be covered without co-pay when provided by an in-network provider.
For people with Medicare, COVID-19 vaccinations will continue to be covered under Medicare Part B without cost sharing. Medicare Advantage plans will also continue to cover COVID-19 vaccinations in-network without cost sharing.
For people who have Medicaid, COVID-19 vaccinations will continue to be covered without co-pay or cost sharing through September 30, 2024, and will generally cover ACIP-recommended vaccines for most beneficiaries thereafter.
Through the “Bridge” Program, people who are uninsured will continue to be able to access COVID-19 vaccine at no cost.
Protecting Infants from Vaccine Preventable Diseases
National Infant Immunizations Week is April 24 to April 30 this year, serving as a reminder to protect infants in Philadelphia from vaccine preventable diseases.
Over the years, immunization providers in the United States have reached major milestones in protecting infants through vaccines. Through immunization, we can now protect infants and children from 15 vaccine-preventable diseases before age 2.
There are important updates to COVID-19 immunization recommendations for infants:
Previously unvaccinated: Children 6 months through 5 years of age who are unvaccinated may receive a two-dose series of the Moderna bivalent vaccine (6 months through 5 years of age) OR a three-dose series of the Pfizer-BioNTech bivalent vaccine (6 months through 4 years of age).
Previously vaccinated:Children 6 months through 4 years who previously completed their full two- or three-dose monovalent Moderna/Pfizer COVID-19 primary vaccination series are now recommended to receive a dose of Moderna/Pfizer’s updated (bivalent) COVID-19 vaccine.
Children 6 months through 5 years of age who have received one, two, or three doses of a monovalent COVID-19 vaccine should receive a bivalent vaccine, but the number of doses that they receive will depend on the vaccine and their vaccination history.
Healthy People 2030
Philadelphia immunization providers have made measurable progress in infant immunization coverage. However, immunization rates fell during the COVID-19 pandemic, and have not yet returned to pre-pandemic levels.
In Philadelphia, vaccination coverage with 4 doses of the DTaP vaccine in children between 0 and 2 years old was around 84% in 2021.
Healthy People 2030 objective IID-06 is: Increase the coverage level of 4 doses of the DTaP vaccine in children by age 2 years. The target for this objective is 90%.
Philadelphia providers have an opportunity to increase immunization coverage for this metric to reach or exceed the target by 2030.
Local Data
In addition to increasing DTaP vaccine coverage, Philadelphia providers can improve infant immunization coverage by focusing on addressing disparities.
Local data shows that influenza vaccination coverage among infants was lowest at 55.8% among the lowest income group in the data set, as compared with 84.3% among the highest income group in the set. In addition, influenza vaccination coverage was 61.2% among Black infants and 61.9% among Hispanic infants, as compared with 73.8% among white infants.
Rotavirus coverage was 65.7% among the lowest income group, as compared with 87.1% among the highest income group. Rotavirus coverage was 70.3% among Black infants and 69.8% among Hispanic infants, as compared with 84.1% among white infants.
Preexisting social determinants of health such as economic burden, lack of transportation, and lower rate of insurance coverage contribute to these disparities. However, immunization providers can use multiple strategies to close the gaps in vaccination coverage.
Strategies to increase vaccination rates among Black, Hispanic, and American Indian/Alaska Native communities include strongly recommending flu vaccination and making culturally appropriate vaccine recommendations (e.g. using materials with images representative of those in the community, addressing community-specific concerns and misinformation, and using the predominant language spoken in the community, such as Spanish).
Providers can also work toward increasing vaccination coverage among low-income populations by using evidence-based strategies such as immunization reminders, standing orders to provide vaccination whenever appropriate, and immunization information systems. Additionally, review immunization schedules with parents at the child’s first visit to show vaccines that are upcoming.
Resources
Improving communication between providers and patients is crucial to increasing immunization coverage among infants in your office.
Download and print coloring sheets for National Infant Immunizations Week.
Increasing human papillomavirus (HPV) vaccination rates can be tricky, particularly due to the stigma associated with sexual behavior among adolescents. International HPV awareness day was March 4, and served as a reminder to continue local HPV vaccine promotion efforts.
Nationally, HPV is estimated to cause 36,000 new cases of cancer each year. We have an opportunity to eradicate HPV-associated cancers, and yet too many people are not getting a safe and effective vaccine that prevents six different cancers associated with HPV including oral pharyngeal and cervical cancer.
The HPV vaccine is approved for ages 9 years through 45 years. The American Cancer Society and American Academy of Pediatrics (AAP) recommend vaccination at age 9.
Are We Making Progress?
Healthy People 2030 vaccination objective IID-08 aims to increase the proportion of adolescents who receive recommended doses of the HPV vaccine. This objective is measured by tracking the proportion of adolescents aged 13–15 years receiving 2 or 3 doses of HPV vaccine.
The objective’s target is 80%, and the latest national data indicate that 54.5% of adolescents have received the recommended doses. This is a slight improvement from previous years, but there is still progress to be made to achieve the desired target.
Strategies for Increasing Vaccination Uptake
Receiving a health provider recommendation for the HPV vaccine is the most effective strategy for improving vaccination rates. However, barriers such as parental hesitancy (for adolescents), insufficient provider recommendation, and time constraints can inhibit HPV vaccine uptake.
Here are some tools and resources to boost HPV vaccine uptake in your practice:
Administrative processes:
Set your electronic health record and pharmacy notifications for patients aged 9 years through 45 years. Starting at age 9 has been shown to increase vaccine completion by 22 times.
Review your patients who have not completed their 2 or 3 dose series and proactively recall patients to complete the series. Check adult patients through age 45 to ensure they have started and completed their HPV series.
If you are not able to stock vaccine at your facility, leverage your local pharmacy to administer vaccinations to patients.
Identify an immunization champion at your facility – the person who will take the lead of your standing orders program.
Clinical encounters:
Make a strong recommendation for HPV vaccines for all patients aged 9 years through 45 years. Data shows that your recommendation may improve vaccination rates by up to 5 times.
For adults aged 26 years through 45 years, engage in shared decision making to help determine whether the patient will benefit from vaccination. A vaccination recommendation should be made in all healthcare settings to include acute, non-acute, GYN, dental, and pharmacy locations.
Encourage same day vaccination in your facility.
This toolkit from the American Academy of Pediatrics (AAP) has patient-focused materials (social media graphics, videos, and articles) which can promote awareness of the HPV vaccine. Additionally, this AAP resource contains professional resources and printable PDFs to promote HPV vaccine education.
This month, the Advisory Committee on Immunization Practices published updated immunization schedules for 2023. COVID-19 vaccine has been added to the routine pediatric immunization schedule for ages 6 months and up, among other important additions. There have been several recent changes to vaccine products for pediatric patients as well.
Pneumococcal conjugate row: Language has been revised. The text now reads “This dose is only necessary for children aged 12–59 months regardless of risk, or aged 60–71 months with any risk, who received 3 doses before age 12 months.”
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:
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.
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.
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.
Documenthepatitis B immunizations and maintain updated records.
Participate in Philadelphia’s immunization information system (IIS) to report immunizations given.
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.
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
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:
