Skip to content Skip to left sidebar Skip to footer

Author: Rishi Sharma

Pneumococcal Vaccination for Asthmatic Pediatric Patients 

Pneumococcal Vaccination for Asthmatic Pediatric Patients 

This blog post is part of a series highlighting important changes in the 2024 ACIP immunization schedules. This series is written alongside newly onboarded Immunization Program Medical Specialist, Dr. Mayssa Abuali.

Dr. Abuali is board certified in general pediatrics, pediatric infectious diseases, and pediatric hospital medicine. Dr. Abuali has served the Philadelphia pediatric community for the past 10 years. She served as the Director of the Einstein Pediatric Inpatient Service at St. Christopher’s Hospital for Children and as the Director of the Einstein Pediatric New Arrivals clinic.

The 2024 ACIP immunization schedule for children and adolescents includes an important change regarding pneumococcal vaccine guidance.  
 
In addition to all children 2 – 23 months, pneumococcal vaccination is recommended for children with moderate persistent or severe persistent asthma aged 2 to 18 years.  

Patients who are asthmatic and previously only vaccinated with PCV13 or PCV15 should receive an additional dose of PCV20 (or PPSV23) for additional protection.*  

Asthma disproportionally affects children from low socioeconomic status and communities of color. “Many of these children end up hospitalized with status asthmaticus secondary to viral infections, and some may develop superimposed bacterial pneumonia,” says Dr. Mayssa Abuali, Immunization Program Medical Specialist.  

With PCV20 anticipated to be more widely available than PPSV23 in pediatric practices and greater clarity in the latest recommendation, clinicians should seize the opportunity to protect this vulnerable population.  
 
*PCV20: pneumococcal conjugate 20-valent vaccine 
PPSV23: pneumococcal polysaccharide vaccine 

Dosing of Moderna COVID-19 Vaccine (2023-2024 Formula)

Dosing of Moderna COVID-19 Vaccine (2023-2024 Formula)

FDA released important information to ensure correct administration of the Moderna COVID-19 vaccine (2023-2024 formula) for individuals 6 months through 11 years.  

The announcement states that providers who administer Moderna COVID-19 vaccine (2023-2024 formula) to individuals ages 6 months through 11 years should ensure that the correct volume of the vaccine (0.25 mL) is withdrawn from the vial and administered to the patient. 

Providers should discard the vial and excess volume after extracting a single 0.25mL dose. Excess volume should not be used to administer an additional dose. Additionally, never combine partial doses from multiple vials to make one dose for a patient.

FDA shared this information after learning some providers may not recognize that the single dose vial of Moderna COVID-19 vaccine (2023-2024 formula) contains more than 0.25 mL of the vaccine and may be withdrawing the entire contents of the vial to administer. FDA has not identified any safety risks associated with administration of the higher dose in individuals 6 months through 11 years of age, and no serious adverse events related to this issue have been identified.  

For additional information, see the FDA announcement, updated Moderna fact sheet, and the vaccine administration resources listed at the end of this email.

If you have any questions, please email vaccines@phila.gov.   

Supply Updates and Borrowing VFC Doses

Supply Updates and Borrowing VFC Doses

The nirsevimab supply shortage continues to evolve and is not expected to resolve soon. Review this CDC advisory with updates about nirsevimab supply and recommendations to prioritize the use of the limited supply of this product.

With these limitations, the Immunization Program wants to remind providers that borrowing of VFC vaccine should be extremely limited. The goal of the Vaccines for Children (VFC) program is to vaccinate VFC eligible children. Given this landscape, please be aware of the following:

  •  It is neither practical nor feasible for the Philadelphia VFC program to allow borrowing during these times of supply constraints.
  • While there are supply constraints for nirsevimab, VFC supply stock should remain prioritized for VFC eligible children. 
  • If you have questions about borrowing, you can email victor.obeck@phila.gov. To borrow vaccine, you must first reach out to victor.obeck@phila.gov to request a borrowing form. Private vaccine borrowed without approval may not be replaced.

These constraints do not apply to COVID-19 vaccine. Please ensure that you have COVID-19 vaccine on hand for your VFC-eligible, private, and CHIP-insured patients. If your site still needs to access COVID-19 vaccine privately, you can reach out to our local pharmaceutical representatives listed below:

Novavax: Rich Aceto – raceto@novavax.com
Pfizer: Brian Bengston – brian.bengston@pfizer.com
Moderna: Lynne Timby – lynne.timby@modernatx.com

Nirsevimab (Beyfortus) and COVID-19 Updates

Nirsevimab (Beyfortus) and COVID-19 Updates

Nirsevimab

Due to high demand and limited supply cited by the CDC, nirsevimab (Beyfortus) ordering through VFC has been put on hold as of October 17, 2023. The CDC is working with Sanofi to secure a supply of this immunization within the next 2 – 3 weeks. 

We will provide an update when nirsevimab becomes available for ordering. Please continue to immunize eligible children with your current supply.

COVID-19

For children under 5, access to COVID-19 vaccine is currently limited as most pharmacies are not vaccinating this age group. As a provider enrolled in the Vaccines For Children (VFC) program, here’s how to ensure these kids get the vaccine they need:

  • Order COVID-19 vaccine through the VFC program
  • Borrow VFC doses of COVID-19 vaccine to immunize your privately and CHIP insured patients while you wait for COVID-19 supply from the manufacturers*

*To request a borrowing form and learn more about the guidelines of this limited-time option, contact our VFC coordinator at victor.obeck@phila.gov. We highly encourage continuing to offer COVID-19 vaccine at every opportunity. 

What does commercialization mean for VFC providers?

The Department of Public Health’s federal COVID-19 program has formally ended. COVID-19 vaccines are now part of the routine immunization schedule.

With the exception of certain specialty providers, all Vaccines for Children (VFC) providers are required to stock COVID-19 vaccine inventory for both privately/CHIP insured patients and VFC eligible patients.

Learn more in this blog post that consolidates recent COVID-19 vaccine updates and lists available COVID-19 products.

Resources

Nirsevimab:

Recommendations and ordering guidance
MMWR
FDA page
Package insert
Immunization Information Statement (use this instead of VIS!)
Product and ordering information (AAP)

COVID-19:

Pfizer 2023-24 COVID-19 Vaccine

Comirnaty 12+

2023-24 COVID Vaccine 5 yrs – 11 yrs

2023-24 COVID Vaccine 6 mo – 4 yrs

Moderna 2023-24 COVID-19 Vaccine

Spikevax 12+

2023-24 COVID Vaccine 6 mo – 11 yrs

Have other questions about nirsevimab, COVID-19, or VFC? Contact our VFC coordinator at victor.obeck@phila.gov.

2023-2024 Novavax Now Available to Order

2023-2024 Novavax Now Available to Order

Novavax COVID-19 vaccine, adjuvanted (2023-2024 formula) is now available to order. 2023-2024Novavax is authorized for individuals 12 years and older. 

This product package contains two multi dose vials each containing five doses. The NDC for this product is NDC # 80631-0105-02. 

It can be ordered through PhilaVax following the same steps used to order all other 2023-2024 COVID-19 vaccine products.  Vaccines for Children (VFC) and Bridge Access Program (BAP) providers can order Novavax for eligible patients. 

As a reminder, your practice can now: 

1) Order COVID-19 vaccine through the Vaccines for Children (VFC) program

2) Order COVID-19 vaccine for privately insured adults, and 

3) Enroll in the Bridge Access Program (BAP) to procure COVID-19 vaccine for uninsured or underinsured adults. BAP vaccines can only be used for uninsured and underinsured patients aged 18 and up. 

When possible, VFC providers should vaccinate eligible 18-year-olds with VFC vaccine before using BAP vaccine. 

This new blog post highlights important changes in this new period of COVID-19 vaccination, including:

  • The Department of Public Health’s COVID-19 program has formally ended.
  • Bivalent COVID-19 vaccines are no longer authorized for use.
  • The Advisory Committee on Immunization Practices (ACIP) approved the use of updated (monovalent) COVID-19 vaccines.
  • Providers can order the updated COVID-19 vaccine for privately insured patients by directly contacting the manufacturers for each product (see below for more information). 
  • With the exception of certain specialty providers, all Vaccines for Children (VFC) providers are required to stock COVID-19 vaccine inventory for both privately/CHIP insured patients and VFC eligible patients.  
  • Philadelphia vaccine providers are encouraged to enroll in the Bridge Access Program to provide updated COVID-19 vaccines for uninsured or underinsured adults 18 years and older. 
Read the blog post!

If you have any questions about ordering COVID-19 vaccine, contact dphproviderhelp@phila.gov. 

Beyfortus (nirsevimab) Now Available Through VFC

Beyfortus (nirsevimab) Now Available Through VFC 

On July 17, 2023, FDA licensed AstraZeneca and Sanofi’s Beyfortus (nirsevimab) for the prevention of respiratory syncytial virus (RSV) lower respiratory tract disease (LRTD).

On August 3, the ACIP voted unanimously to recommend nirsevimab for use in infants during the RSV season, which is October through March.

VFC Ordering 

Beyfortus (nirsevimab) (5 x 0.5mL syringes) and (5 x 1.0mL syringes) is available to order through the Vaccines for Children (VFC) program starting today, October 2, 2023.

VFC providers who see patients recommended to receive nirsevimab this season are required to include both dosages of nirsevimab in their next VFC order. VFC providers will need to provide nirsevimab for their privately and CHIP insured patients, as applicable.

Dosage and Administration

RSV comes in two dosages: 

  • 50 mg 
  • 100 mg 

Both dosages are administered as an intramuscular injection with a single-dose, pre-filled syringe, and should be ordered to properly administer by weight. 

Eligible Patients

  • Infants aged <8 months born during or entering their first RSV season
    • 1 dose of nirsevimab (50 mg for infants <5 kg and 100 mg for infants ≥5kg) 
  • Children aged 8-19 months who are at increased risk of severe RSV disease and entering their second RSV season
    • 200 mg nirsevimab, administered by two 100 mg syringes

Children at increased risk include those: 

  • with chronic lung disease resulting from premature birth who required medical support at any time during the six-month period before the start of their second RSV season
  • who are severely immune compromised
  • with cystic fibrosis who have severe lung disease or whose weight is less than the 10th percentile compared with other babies of the same length
  • who are American Indian and Alaska Native

Reporting 

All doses of nirsevimab administered in Philadelphia must be reported to PhilaVax. 

Storage and Handling

Store refrigerated between 36°F to 46°F (2°C to 8°C) through the expiration date.  

Nirsevimab may be kept at room temperature 68°F to 77°F (20°C to 25°C) for a maximum of 8 hours. After removal from the refrigerator, nirsevimab must be used within 8 hours or discarded.

Reporting Adverse Events

Nirsevimab is the first drug product to be included in the VFC program. If nirsevimab is administered: 

Additional resources:
MMWR
FDA page
Immunization Information Sheet for Patients
Package insert

If you have any questions, please email victor.obeck@phila.gov.