New Immigrant and Refugee Pediatric Vaccination

This blog post was written alongside Dr. Mayssa Abuali, who has served the Philadelphia pediatric community for the past 10 years.

At the first domestic health visit with new immigrant or refugee pediatric patients, clinicians should review all available vaccine records, perform any testing, and update or revaccinate, as appropriate. Vaccine doses administered outside the United States should be accepted as valid, if schedules and doses are compatible with the Advisory Committee in Immunization Practices (ACIP) recommendations. If there’s no proof of receiving the required vaccines, it must be given during the medical exam.

Catch-up vaccines:

• Work closely with Philadelphia School District nurses to catch up a student’s vaccines. This ensures timely school enrollment and protection of other students from vaccine preventable diseases.  
• Pay careful attention to intervals between vaccines as well as minimum required ages, and not only the number of doses previously received.  
• Attach any relevant serology to the child’s health assessment form or vaccine records. For example, include varicella and hepatitis A IgG titers and indicate if the child is immune by serology or natural disease.

Polio vaccination: In April 2016, the oral polio vaccine (OPV) was changed from a trivalent to a bivalent formulation to decrease the risk of vaccine-associated paralytic disease. Any oral polio vaccine given after April 2016 is invalid in the United States and will not count towards the child’s required polio series. Inactivated polio injectable vaccine (IPV) doses are needed to replace invalid OPV doses.

Transcribing vaccines: Many countries place the day before the month (i.e. day/month/year). Train your team to remember such date formats when transcribing international vaccine records into EMR.

Schedule follow-ups: Provide a scheduled follow-up visit for the vaccine before the patient leaves the clinic and indicate “catch-up vaccination initiated; follow-up scheduled on _” on the child health assessment form.

New Meningococcal Vaccine for Pediatric Patients 

This blog post is part of a series highlighting essential changes in the 2024 ACIP immunization schedules.

This series is written alongside 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.

A new meningococcal vaccine has been added to the 2024 childhood immunization schedule. 

Penbraya contains five meningococcal serogroups (Groups A, B, C, W, and Y) and is approved for ages 10 years and up.    

Currently, children must receive vaccination against meningococcal serogroups A, C, W, and Y (MenACWY, Menveo, or MenQuadfi) at age 11 or 12 years with a booster at 16 years. Separate meningococcal B vaccines (MenB, Bexsero, or Trumenba) can be given to 16 – 23-year-olds before entering college, joining the military, or during outbreak situations.  

Penbraya is an option for certain children and adolescents who need MenB and MenACWY vaccines at the same visit. This group may include:  

• Adolescents aged 16-23 years due for their MenACWY booster and in need of MenB before entering college or other crowded living situations at the same visit.   
• High-risk children aged 10 years and older with complement deficiency, functional or anatomic asplenia (including sickle cell disease), or receiving complement inhibitors. 

Second doses:  

• A second dose of Penbraya should be given 6 months after the first dose for those needing both MenB and MenACWY protection.  
• If only MenB is needed, then Trumenba must be used for the second dose in 6 months as that is the MenB component present in Penbraya. Bexsero and Trumenba are not interchangeable.   

Travel: Those traveling to the sub-Saharan Africa meningitis belt or for Hajj (Saudi Arabia) require MenACWY vaccination. MenB is currently not recommended for travel.   

The current meningococcal vaccines are both safe and effective. According to pediatric infectious disease expert, Dr. Mayssa Abuali, “Protection does wane with time, so boosters are necessary in cases of continued risk.”  

We will inform providers when this product is available to order through the Vaccines for Children (VFC) Program. Learn more about meningococcal vaccines.