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Notes From the Immunization Program

Protect Your Patients from Flu, COVID-19, and RSV 

Protect Your Patients from Flu, COVID-19, and RSV 

There are currently high rates of respiratory illness nationwide, including flu, COVID-19, and RSV. Continue to recommend immunization to prevent severe illness and hospitalization. Below, review eligibility recommendations from the CDC and stay updated on flu products available to order through the Vaccines for Children (VFC) program.

Recommendations for Flu Immunization and Co-Administration  

CDC recommends: 

  • Everyone aged six months and older should get an annual influenza vaccination. 
  • If needed, influenza and other vaccines (e.g., COVID-19, RSV) may be given at the same visit. 
  • Infants six months and older may receive influenza and COVID-19 vaccines at the same visit when they receive the RSV preventive antibody, nirsevimab.  

Please ensure that children under nine years of age who have received only one dose of influenza vaccine across all previous seasons return for their second dose four weeks later (refer to figure).  

No longer available for ordering:  

  • FluMist (AstraZeneca / 66019-0310-10) 

Available to order for VFC-eligible patients 

  • Fluzone (Sanofi / 49281-0639-15) 
  • Flucelvax (Sequirus / 70461-0323-03) 
  • FluLaval (GSK / 19515-0814-52)  

VFC Products Available for the 2023-2024 Flu Season 

You can order flu vaccine anytime—no need to wait between orders or complete a reconciliation. 

As a reminder, educational and promotional print materials related to flu and COVID-19 immunization are available to order on our website

Additional Resources 

New Immigrant and Refugee Pediatric Vaccination

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

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

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 

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 dphproviderhelp@phila.gov

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.  

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. 
 
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.