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Catch Up Pediatric Patients: MMR Vaccine

Catch Up Pediatric Patients: MMR Vaccine

There is a measles cluster in Philadelphia that started with an infant and spread to unvaccinated individuals. It has resulted in now 7 confirmed cases of measles among Philadelphia residents and an index case in Delaware county.

To prevent further spread, review your pediatric patients’ records for MMR vaccine and recall any patients who are not up to date. Consider nurse-only visits to get patients in faster. 

Measles is highly infectious and can be especially dangerous to children under 5, pregnant people, and immunocompromised individuals. CDC recommends children get their first MMR dose at 12-15 months and the second dose at 4-6 years. 

You can order a free measles flyer below.

Vaccine Product Available Through VFC: Abrysvo

Vaccine Product Available Through VFC: Abrysvo

Abrysvo is a maternal RSV vaccine available through the Vaccines for Children (VFC) program. 

RSV is surging and the pediatric infant immunization Beyfortus supply is severely limited. Abrysvo will play an important role in protecting infants against severe RSV disease this season. Most infants born to mothers who have received Abrysvo will not need to receive Beyfortus. 

Please note that the availability of Abrysvo for VFC providers is limited. Only sites that care for pregnant people under 19 can order, and orders will be limited to 5 doses per site at a time.

Abrysvo

Abrysvo is a Pfizer product now available through the Vaccines Children (VFC) program.

  • CVX code: 305
  • CPT code: 90678
  • NDC number: 00069-0344-01

V-safe, one of several systems CDC uses to closely monitor the safety of vaccines, will be used as a health check for pregnant people who receive a maternal RSV vaccine.

For more information, review the package insert.

Additional resources:

FDA page
VIS

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

Administration Errors: RSV for Infants

Administration Errors: RSV for Infants

On November 30, CDC alerted immunization programs that they have received reports of infants being mistakenly administered RSV vaccines intended for adults. Infants should only receive the RSV preventive antibody, nirsevimab (Beyfortus, Sanofi).

RSV vaccines (Arexvy by GSK and Abrysvo by Pfizer) are recommended only for adults and have not been evaluated for safety or effectiveness in infants or children. Practices that carry both adult RSV vaccine and pediatric RSV preventive antibody products should review their immunization administration safety procedures to ensure only the correct product is administered to recipients. This is an opportunity to re-educate and re-train staff on RSV immunization formulations and practices.

In the event that a vaccine administration involving RSV vaccine occurs, CDC encourages vaccinators to promptly report errors to the Vaccine Adverse Event Reporting System (VAERS). Also, inform parents of error so that these infants can receive the correct product and be monitored for adverse reactions. 

CDC Clinical Guidance (updated December 7, 2023)

Because there are no data on the efficacy/effectiveness of RSV vaccines in preventing RSV disease in this age group, the infant should receive nirsevimab if otherwise eligible based on maternal RSV vaccination status. There is no specific recommendation for a minimum interval between administration of incorrect RSV vaccine and nirsevimab. Some experts suggest:

• That it could be reasonable to consider waiting 48 to 72 hours before proceeding with nirsevimab administration. This time frame is when we would expect side effects to the RSV vaccine, such as fussiness, would be most likely.

• Consideration should be given to administering nirsevimab in the limb opposite to where the RSV vaccine was administered to avoid potential interaction or binding of RSV antibody and vaccine, thereby reducing the effectiveness of nirsevimab.

If further clinical guidance is needed, connect with our medical experts at vaccines@phila.gov or CDC experts at NIPINFO@cdc.gov.

Quality Improvement Opportunity for VFC Providers

Quality Improvement Opportunity for VFC Providers

The Immunization Quality Improvement for Providers (IQIP) Program is a CDC initiative to help providers implement strategies that support their immunization activities.

VFC-enrolled practices are chosen by the CDC for IQIP enrollment each year. However, starting this project year (July 1, 2023 to June 30, 2024), VFC-enrolled practices may self-enroll in IQIP.

Practices that do not have pediatric patients capitated to them (e.g., shelter sites, sexual health clinics, and birthing hospitals) are not eligible to participate.

Why self-enroll in IQIP?

IQIP helps practices meet their goals of efficient and effective vaccination processes to ensure timely and complete vaccine coverage for all children.

How can IQIP participation serve pediatric departments and physicians?

  • IQIP efforts can be converted to group quality improvement (QI) projects, which can be eligible to fulfill the American Board of Pediatrics maintenance of certification (MOC) Part 4 requirements
  • IQIP can help residency programs develop QI projects and educational opportunities
  • Through IQIP, departments can meet national immunization quality metrics

What does IQIP offer?

Provider Quality Assurance (PQA) nurses through the Philadelphia Department of Health (PDPH) Immunization Program, in partnership with the CDC, offer guidance, practical recommendations, and technical support to practices aiming to increase their vaccination coverage rates.

The focus of IQIP is based on four CDC core strategies:

1. Facilitate patient return for vaccination
2. Leverage Immunization Information Systems (IIS) functionality to improve immunization practice.
3. Give a strong vaccine recommendation
4. Strengthen vaccination communications

Get in touch!

To enroll your practice in IQIP, contact your VFC Program PQA nurse Beth Smith at beth.smith@phila.gov, Dom Shannon at dom.shannon@phila.gov, or Jennifer Malins at jennifer.malins@phila.gov.

For more information on how IQIP can serve pediatric departments and physicians, please contact our newly onboarded Immunization Program Medical Specialist, Dr. Mayssa Abuali, at mayssa.abuali@phila.gov.

Learn more about IQIP!

Vaccine Shipment Delays During the December Holiday

Vaccine Shipment Delays During the December Holiday

Submit orders by Friday, December 8!

During the holiday season – from mid-December to early January – the distribution center that ships vaccine provided through the Vaccines for Children (VFC), Vaccines for Adults at Risk (VFAAR), and Bridge Access programs will have reduced shipping capacity. Orders submitted during this time will take longer than usual to ship.

To make sure that you have the vaccines you need during this time, submit orders by 12:00 PM on Wednesday, December 8. These will be processed and shipped out as usual. Be sure to check the status of your order within 2 business days of submitting.

Continue to check for tracking information daily as FedEx and UPS shipping delays continue. Use this job aid to assist you with reviewing this information.

Orders submitted after Friday, December 8 may not be delivered until the week of January 2, at the earliest. The distribution center will return to normal operations on January 2.

For assistance with completing your reconciliation or submitting your order, email our team at DPHProviderhelp@phila.gov.

Nirsevimab (Beyfortus) Updates

Nirsevimab (Beyfortus) Updates

Due to the unprecedented demand for nirsevimab, supply of this product is extremely limited through both the Vaccines for Children (VFC) program and the private market. Below is an update on available supply and tips on how to prioritize use of available doses. This a rapidly evolving situation. The information in this advisory reflects the most up-to-date information available to our program at this time. Updates released after this advisory will supersede this communication.

VFC Supply 

The CDC has set up an allocation system to distribute the supply of VFC doses still available from their distribution centers. At this time, no 100 mg doses have been allocated to Philadelphia. A limited number of 50 mg doses will be available later in November and December.  

The current VFC supply shipped and allotted to Philadelphia will not cover all eligible infants. Infants face the highest risk of RSV-related hospitalization in the first 5 months of life, especially in the first month.

To facilitate more equitable access to these products for eligible infants when they are most at risk, our program will implementing the following:

  • Redistribution of shipped doses. Given the supply of these products, our program will be redistributing doses that were shipped to sites last month in line with the current CDC recommendations. We will be reaching out to specific sites during the week of November 13, 2023 to coordinate picking up and delivering doses. We are basing the amounts moved on sites’ reported VFC-eligible population younger than 1 year of age, the amount of product received, and the subsequent usage.
  • Prioritization of birthing hospitals. To protect eligible infants when they are at highest risk for hospitalization, we will be prioritizing distribution of the 50 mg doses to birthing hospitals.

Private Supply

Per this press release from 11/6/23, Sanofi is contacting providers about distribution plans for doses available through the private market. New orders for the 100 mg dose are no longer being accepted, as the demand exceeded the available supply for the season. Distribution of the 50 mg doses in the private market is being managed to fulfill existing orders and provide equitable access to remaining doses. Please reach out to your Sanofi representative for more information.

Protecting infants from RSV this season

Given the limited availability of nirsevimab this season, consider these measures to protect infants:

  • Schedule outpatient appointments for unimmunized infants 0-2 months born during RSV season before they are > 5kg and no longer eligible for the 50 mg dose
  • Utilize Synagis for qualifying infants
  • Vaccinate eligible pregnant people with Abrysvo

Additional strategies are outlined in this CDC health advisory from 10/23/23.

Our program understands that this has been a challenging roll out. The Philadelphia VFC program was not aware of supply issues when fulfilling initial provider orders. We appreciate your understanding as our program works to more equitably distribute doses throughout the city as we navigate the national supply limitations. Sanofi and the CDC are working to address the issues that affected distribution this season to better prepare for the 2024 – 2025 season. 

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. 

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