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Notes From the Immunization Program

COVID-19 Vaccine Commercialization

COVID-19 Vaccine Commercialization

Tuesday, September 12, 2023, marked the beginning of COVID-19 commercialization. Here are some important changes to be aware of in this new period of COVID-19 vaccination:  

  1. The Department of Public Health’s COVID-19 program has formally ended.  
  1. Bivalent COVID-19 vaccines are no longer authorized for use.  
  1. The Advisory Committee on Immunization Practices (ACIP) approved the use of updated (monovalent) COVID-19 vaccines. 
  1. 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). 
  1. 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.  
  1. 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. 

The new COVID-19 vaccine products are monovalent (single), Omicron variant XBB.1.5. Under the new recommendation, everyone over 6 months is eligible for an updated COVID-19 vaccine this fall.   

Providers can place COVID-19 vaccine orders for VFC eligible patients and/or the Bridge Access Program eligible patients through the PhilaVax immunization information systems (IIS). A step-by-step ordering guide is available to assist with this. 

Recommendations for COVID-19 Vaccine 

  • Everyone ages 5 years and older is recommended to receive 1 dose of a 2023-24 mRNA COVID-19 vaccine. 
  • Children ages 6 months – 4 years should complete a multi-dose initial series (2 doses of Modera or 3 doses of Pfizer mRNA COVID-19 vaccine) with at least one dose of the 2023-24 COVID-19 vaccine. 
  • People who are moderately or severely immunocompromised should complete a 3 dose initial series with at least one dose of the 2023-24 COVID-19 vaccine and may receive 1 or more additional 2023-24 COVID-19 vaccine doses. 
  • Bivalent mRNA COVID-19 vaccines are no longer recommended. 

Available Products 

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 

Additional Resources 

If your office needs assistance placing an order or has questions, please reach out to

Purchase Vaccine for Privately Insured Patients 

To procure vaccine on the private market, please contact your local sales representative: 

Guidance for Patients Regarding Vaccine Availability 

Patients are having some initial difficulty finding updated COVID-19 vaccine, especially pediatric doses. This is due to delays in shipping from manufacturers. The Health Department published recommendations for Philadelphians seeking updated COVID-19 vaccine doses. Read the recommendations here and consider sharing them with your patients. 

Back-to-School Immunization Resources

Back-to-School Immunization Resources

The PDPH Immunization Program and the School District of Philadelphia (SDP) want to remind you that now is the time to prepare your patients for back-to-school. Pennsylvania law requires all students (K-12) to be vaccinated while attending school. Students that do not have the required vaccines may be excluded from school until they receive the appropriate vaccines.   

Since the 2020 school year, national coverage with state-required vaccines among kindergarten students has continued to decline. To help you get your patients back on track with immunizations, schedule vaccination appointments now to get ahead of the back-to-school rush.  

We have created a series of short video trainings to support your practice. The videos cover topics including school immunization requirements, the ACIP child and adolescent immunizations schedule, information on specific vaccines, vaccine interval spacing, and Vaccine Adverse Event Reporting System (VAERS) reporting. 

Training Videos 

Click on the buttons below to view the training videos.

Training #1: School District Immunization Requirements & the Effects of the Pandemic  

Training #2: Child & Adolescent Immunization Schedule 

Training #3: Vaccine Interval Spacing 

Training #4: Review of Live Vaccines 
Training #5: DTaP or TdaP: Which One to Choose 
Training #6: Vaccine Adverse Event Reporting System (VAERS) Reporting 

Developments in RSV Biologics

Developments in RSV Biologics

Respiratory syncytial virus, or RSV, is a negative-sense, single-stranded RNA virus. It is a common respiratory virus that usually causes mild, cold-like symptoms. In most regions of the United States, RSV season starts in the fall and peaks in the winter.  

Although most people who develop RSV infection have mild illness, certain individuals are at risk for severe disease and death. It is estimated that between 60,000 and 160,000 older adults are hospitalized due to RSV, and between 6,000 and 10,000 older adults die due to RSV each year.  
Among children younger than 5 years, 58,000 to 80,000 are hospitalized each year due to RSV; and 100 to 300 die from it.  

Those at high risk for severe illness from RSV include: 

  • Premature infants 
  • Infants, especially those 6 months and younger 
  • Children younger than 2 years old with chronic lung disease or congenital heart disease 
  • Children with suppressed immune systems 
  • Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions 
  • Older adults, especially those 65 years and older 
  • Adults with chronic lung or heart disease 
  • Adults with weakened immune systems 

Vaccine Developments 

In 2004, the U.S. Food and Drug Administration (FDA) approved Synagis (manufactured by Sobi) the first monoclonal antibody used to prevent severe disease caused by RSV in high-risk infants. It must be given monthly throughout the RSV season. 

In May 2023, FDA voted in support of approval for RSVpreF, Pfizer’s vaccine candidate to prevent severe disease caused by RSV in infants through vaccination of pregnant people. RSVpreF is currently under FDA review for the prevention of medically attended lower respiratory tract disease (MA-LRTD) and severe MA-LRTD caused by RSV. The FDA’s decision on the potential approval of RSVpreF is expected in August 2023. 

Also in May, the FDA approved two RSV vaccines, Arexvy and Abrysvo, manufactured by GSK and Pfizer, respectively. FDA approved both vaccines for the prevention of lower respiratory tract disease caused by RSV in individuals 60 years of age and older.  

In June 2023, the ACIP voted to recommend Pfizer and GSK’s adult RSV vaccines for adults 60 and older using shared clinical decision making.  

In July 2023, FDA approved nirsevimab (AstraZeneca and Sanofi), a monoclonal antibody that will be used to protect newborns and infants born during or entering their first RSV season. In contrast to Synagis, it will only have to be given once in a season. Nirsevimab is the first passive immunization product to be considered for inclusion by the ACIP in the CDC immunization schedule as a vaccine-like seasonal immunization. The ACIP will meet to discuss recommendations for implementation and inclusion in the VFC program on August 3. 

Vaccine/Antibody Availability and Insurance Coverage 

RSV vaccines for older adults are expected to be available this fall.  
These vaccines will be covered by Medicare Part D, Medicaid, and Affordable Care Act-compliant insurance plans. It is not yet known whether Arexvy and Abryvo will be included in the Vaccines for Adults at Risk (VFAAR) program. 

CDC is assessing whether nirsevimab will be included in the Vaccines for Children (VFC) program, so its cost and availability is unknown at this time.  

Developments in RSV vaccines are ongoing. Updates to vaccine product availability and insurance coverage of available vaccines are expected in the coming months.  

Potential Risk for Resurgence in Mpox Cases

Potential Risk for Resurgence in Mpox Cases

Mpox cases in Philadelphia peaked in July 2022, and have since decreased significantly.

Around the country, there have been sporadic mpox cases in 2023. Chicago, however, has experienced a resurgence of mpox cases between April and May 2023.  
In May 2023, one mpox case was identified in Philadelphia after several months with no cases. More cases are expected to be identified in Philadelphia in the coming days and weeks.  
“Since there was one reported case in May, [I suspect] that there were others that were subclinical or went undiagnosed,” says Dr. Lenore Asbel, infectious disease expert at the Division of Disease Control.  
“As providers [and] the community were aware of the cases in Chicago, there [has been] a slight uptick in both providers offering and patients seeking vaccine. We are trying to be proactive as last year the increase coincided with Pride activities, travel, etc.” 

Mpox Cases in Chicago 

Of the mpox cases reported in Chicago, all were among men who were symptomatic, and none of these patients were hospitalized.  
9 out of the 13 patients who are known to have had mpox in Chicago between April 17 and May 5 had received 2 JYNNEOS vaccine doses.  

While patients who tested positive in Chicago were largely vaccinated, those who have been fully vaccinated are likely to develop milder symptoms than those who aren’t vaccinated. They are also less likely to transmit the virus to others.  
There have been 20 additional mpox cases reported in Chicago since May 5. Track reported mpox cases in Chicago here

What You Need to Know 

The CDC offers communication resources for providers to educate patients about mpox vaccination. Learn about how to reduce stigma when educating patients about mpox. 
Prepare your patients for the summer with resources for sexual health testing and mpox vaccination.  

Protecting Infants from Vaccine Preventable Diseases

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.

Schedule and Updates 

View the CDC immunization schedule for children and adolescents.  
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.  


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. 
Talk with parents and caregivers about their infant’s missing immunizations. Continue the conversation and offer educational resources for caregivers who are hesitant. 

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).  

Spring, Measles and Mumps

Medical Director Notes

Dr. Kristen Feemster

Dr. Kristen Feemster is the Medical Director of the Philadelphia Department of Public Health’s Immunization Program.

Spring, Measles and Mumps

2019 is on track to have the highest number of measles cases since the disease was declared eliminated from the U.S. in the year 2000. Why are we seeing these outbreaks and what can we do to protect our community?

This has been a busy spring for vaccine-preventable diseases! Temple University is experiencing a mumps outbreak among students and reported almost 150 cases as of mid-April. While, across the nation, the Centers for Disease Control and Prevention (CDC) reports more than 600 cases of measles so far this year. While we have not yet had any measles cases in Philadelphia, some of the largest outbreaks are right next door. The MMR vaccine prevents both measles and mumps, and most schools require it for entry. Despite that, 2019 is on track to have the highest number of measles cases since the disease was declared eliminated from the U.S. in the year 2000. Why are we seeing these outbreaks and what can we do to protect our community? 


Between January 2016 and July 2017, there were 150 mumps outbreaks (9,200 cases) across the country. Half of these outbreaks took place on college campuses despite the majority of students being vaccinated. Why? The effectiveness of two doses of MMR vaccine is 88% for mumps, meaning that out of 100 people, 12 may still get sick if exposed. Additionally, it appears that protection against mumps may decrease over time. How easy is it to be exposed to mumps? Mumps spreads through contact with saliva or respiratory droplets from an infected person. In a community like a college campus, where young students live in dormitories and socialize frequently, there are many opportunities for the mumps virus to spread. And, unfortunately, people with mumps can start spreading the virus before they know for sure that they are sick. The virus can be spread up to two days before developing the most common symptom, a swollen, painful jaw. The ability to spread the mumps virus before one knows that they are sick along with close personal contact inherit to dorm style living and college life, and a decreased protection from the MMR vaccine creates the ideal conditions for an outbreak. 


Unlike mumps, measles outbreaks are primarily occurring among unvaccinated individuals. The majority of our current measles cases are in New York City and state where returning travelers brought measles to some Orthodox Jewish communities where vaccination rates are low.  Large outbreaks have also occurred in Oregon where there are high rates of vaccine refusal among parents. The measles virus is so highly contagious, it is easy for it to spread quickly through a community if there are any unprotected people. How well does MMR vaccine work for measles? The effectiveness of 2 doses of MMR is 97% against measles AND immunity is lifelong. If we can maintain 95% or higher MMR vaccination rates we can prevent the spread of measles. 

Vaccine Hesitancy

While there is no explicit content barring vaccination in major religious texts and no evidence of any association between vaccines and autism, some parents still seek exemption on these grounds.

If MMR vaccine has been a part of the routine immunization schedule for decades, why do some communities have low MMR vaccination rates? In every state, MMR is one of the vaccines required for school attendance. And, nationally, MMR rates are greater than 90%. Yet, despite requirements, almost every state allows exemptions based upon personal or religious beliefs. And there are a wide range of reasons some parents refuse vaccination or choose to pursue an exemption. For example, some religious communities refuse vaccines based upon interpretation of religious teachings. And some parents refuse MMR vaccine because of vaccine safety concerns related to autism. While there is no explicit content barring vaccination in major religious texts and no evidence of any association between vaccines and autism, some parents still seek exemption on these grounds. 

Preventing Outbreaks

Simply, the best prevention tool that we have for both is the MMR vaccine.

What can we do to prevent or stop mumps and measles outbreaks? Simply, the best prevention tool that we have for both is the MMR vaccine. Be sure that your patients, whether children or adults, are up to date as per current recommendations. Early identification of cases of mumps and measles is also important. When we suspect cases, we can use appropriate isolation practices to prevent further spread. We can also identify contacts to make sure they are protected. 

For mumps specifically, it is time to implement requirements that all university and college students are up to date on their MMR vaccine and provide documentation of vaccine receipt. It is also important to consider a third MMR booster dose for people who are at risk of being exposed to mumps cases when there is an outbreak. At Temple, this has meant setting up vaccination clinics to provide MMR vaccine to students. 

For measles, we are encouraging providers to remain vigilant and consider measles when seeing patients with fever and a rash, especially if they have traveled domestically or internationally. Talk to your patients and their families about any vaccine-related concerns, especially if they have a history of vaccine refusal. Know about resources to help address specific questions, such as concerns about vaccine safety. And consider partnering with community leaders to communicate the importance of vaccination. 

Healthcare providers should also use our immunization registry, Philavax, to check your patients’ immunization histories and keep patients, especially students, up to date on their MMR. The Vaccines for Children (VFC) program can help you provide vaccines for publicly, under – or uninsured kids up to the age of 19. 

Working together we can keep measles and mumps from spreading any further this spring and keep everyone healthy to enjoy this wonderful weather.