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Author: Rishi Sharma

Increasing HPV Vaccine Uptake for All Ages 

Increasing HPV Vaccine Uptake for All Ages 

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. 
  • Implement standing orders for immunization in your practice. 
  • 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. 

What’s New With Pediatric Vaccines?

What’s New With Pediatric Vaccines?

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.  

ACIP Immunization Schedule Changes 

The changes in the Advisory Committee on Immunization Practices’ pediatric immunizations schedule  from 2022 to 2023 are:  

  • COVID-19 row: COVID-19 vaccination now recommended from age 6 months–18 years. 
  • Pneumococcal conjugate row: PCV15 has been added. It is interchangeable with PCV13. 
  • IPV row: A “See Notes” section has been added to the column for people aged 17–18 years. 

The changes in the catch-up immunization schedule for 2023 are:  

  • 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.” 

The changes in the immunization by medical indication schedule for 2023 are: 

  • COVID-19 row: A new row was added to summarize COVID-19 vaccination recommendations by medical conditions or other indications.  

View the full MMWR here. 

Product Changes

The changes in routine pediatric vaccine products from 2020-2021 to 2022-2023 are:  

  • MMR: Priorix added. 
  • Meningococcal conjugate (MCV4): Menactra discontinued, and MenQuadfi added. 
  • Pneumococcal conjugate (PCV15): Vaxneuvance added. 
  • Flu (IIV4):  
    • Flucelvax (multi-dose vial): now available at 6 mo+ instead of 2 yrs+.  
    • Flucelvax (single dose syringe): now available at 6 mo+ instead of 2 yrs+. 
    • Fluzone (multi-dose vial): now available at 6 mo+ instead of 3 yrs+.  
    • Afluria (pre-filled syringe): 0.25 mL pre-filled syringe for 6 – 36 months no longer available. 0.5 mL pre-filled syringe available at 3 yrs+.
    • Afluria (multi-dose vial): available at 6 months – 3 yrs for 0.25 mL dose and at 3 yrs+ for 0.5mL dose.

The American Academy of Pediatrics offers customizable reminder and recall resources for your practice to help ensure children are caught up on routine vaccinations. 
 
If you are not already a Vaccines for Children (VFC) provider, enroll your practice in the VFC program using this guide.  

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.

Order 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.

Register: Online Ordering 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.