Bulletin

Download our 2019-2020 paper influenza flu reporting form here: Influenza Immunization Reporting Form

Update your Digital Data Logger (DDL) software today

 Please update to the latest version of the LogTag software, which makes small but important changes to how the digital data loggers  (DDL) work and prevent future compatibility issues.

This update will not affect downloading processes or your daily responsibilities and will take about 1 minute to do. Please do this update by Friday, 1/25.

How to update your software

To update your software:

• Visit https://logtagrecorders.com/software/lta2/download/
• Download Installer: Itanalyzer_2.9r8.exe
• Run the program you downloaded
• Complete this electronic form, https://goo.gl/forms/oGG29vvXweWvenxx2, to let us know when you have successfully downloaded the software or to let us know about issues you experienced.

If you need administrative or IT permission to download software, please contact your IT department as soon as possible.

If you have any questions about this update please contact:

Alexis Bridges and Adam Howsare

Storage & Handling Coordinators

TempCheck@phila.gov

Phone: 215-685-6777

Digital Data Logger Download Reminder During the Holiday Season

To make sure that your vaccines stay properly monitored over the busy holiday season, please be aware of the date indicator on your digital data loggers (DDLs). To prevent any gaps in temperature monitoring, please download your DDL files if the date indicator is approaching the 30 day capacity. With many offices having adjusted  holiday hours or staff members taking time off, the 30 day capacity on your DDL could be reached.

To prevent this, we suggest that you download your DDL files before they reach their 30 day memory capacity. This may mean downloading your DDL earlier than you normally would. This will ensure that they continue to        record temperature readings for your storage units over the holidays.

After you download your DDL files, remember to:

1) Email both your LTD (yellow and blue) and CSV (green) files to TempCheck@phila.gov

2) Upload your CSV files into the Clinic Tools module in PhilaVax

Contact the VFC or VFAAR program if you need assistance or have additional questions:

Storage and Handling Coordinators

Alexis Bridges       phone: 215-685-6777

Adam Howsare     phone: 215-685-6777

TempCheck@phila.gov

VFC & VFAAR Coordinator

Jillian Brown          phone: 215-685-6424

Jillian.Brown@phila.gov

Vaccine Shipment Delays During the Holiday Season

Submit orders by December 7^th

To make sure that you receive vaccines when you need them, submit orders by 3:00 PM on Friday, December 7. These will be processed and shipped out as usual. Be sure to check the status of your order 2 business days after submitting.

Orders submitted between Monday, December 10 and Friday, December 28 may not be delivered until the week of January 8th. The distribution center will return to normal operations on January 2.

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

Contact the VFC or VFAAR program if you need assistance.

Provider Education Coordinators

Joani Schmeling      phone: 215-685-6490

Mohan Nagaraja      phone: 215-685-6872

 DPHProviderhelp@phila.gov

VFC & VFAAR Coordinator

Jillian Brown          phone: 215-685-6424

Jillian.Brown@phila.gov

Vaccine Order Specialists

Christine Wilson      phone: 215-685-6728

Christine.Wilson@phila.gov   

Charma Miller         phone: 215-685-6667

Charma.Miller@phila.gov

VFC/VFAAR Re-enrollment is right around the corner!

The Philadelphia VFC/VFAAR annual re-enrollment period is November 1-30, 2018. Re-enrollment is a requirement for the VFC/VFAAR programs. Failure to complete the re-enrollment form will result in un-enrollment from the program.

We’re very excited to announce that for the first time, enrollment will be done electronically through PhilaVax. This will save you time and allow us to process enrollment forms quicker.

To get you ready for re-enrollment, complete these three steps now (if you have done so already).

1. Complete the Clinic Tools Training

The electronic enrollment form is part of the Clinic Tools module in PhilaVax. You will not be able to access the enrollment form until you complete this training.

If you have not completed the Clinic Tools training, sign up now:  https://vax.phila.gov/index.php/notices/register-for-a-required-clinic-tools-training/

If you have completed the Clinic Tools training, check to make sure the contact and staff information for your site is up-to-date. Submit any updates to our program through the module.

2. Renew your PhilaVax User Confidentiality Agreement

You must log into the PhilaVax IIS to access and complete the electronic form. If you have not completed the 2018 user confidentiality agreement renewal process or do not have a PhilaVax user account, use the link below to complete it now.

3. Make sure your site’s Medical Director has a PhilaVax Account

Your medical director needs an active PhilaVax account in order to sign the enrollment form. You will not be able to submit the enrollment form without the medical director’s signature.

Click here to complete a PhilaVax User Confidentiality Agreement:

https://docs.google.com/forms/d/1nQ6Kp4WrlVEsx0Ud1QrxCdYRiYP3Rpd70xE0E0RKKsc

If you have trouble accessing the above link or your PhilaVax account and need to update your password, you can email PhilaVax@phila.gov or call 215-685-6784.

Additional information and instructions will be communicated closer to the start of the re-enrollment period on November 1st.

Attention: All flu vaccine from the 2018-19 season will be expiring on June 30th, 2019! Please account for unused VFC/VFAAR flu vaccine at your site using PhilaVax:

• Process a return for the unopened vials online in the Vaccines Returns module
• Complete an adjustment to account for open vials on the Inventory on-hand page

The following flu vaccine products are for the upcoming 2019-2020 flu season. They will be available through the VFC and VFAAR programs this fall. Remember: order flu vaccine throughout the season, as you need it. Keep vaccinating patients until product expires. Additional resources:

• How to order flu vaccine
• Flu season toolkit

For VFC Providers and City Health Centers

For VFAAR Providers

City Health Centers not included

VFC and VFAAR flu vaccine is now available to order. Remember: order flu vaccine throughout the season, as you need it. Keep vaccinating patients until product expires. Additional resources:

• Flu vaccine products available to order
• Flu season toolkit

To place your first order

1. Submit your temperature logs since your last order
2. Log in to PhilaVax
3. Complete a reconciliation
4. On the Vaccine Order page, check the box next to “Will this be an influenza order?”
5. Order what your site needs for 4 to 6 weeks. Be sure that you have room in your fridge to store all of the flu vaccine and other vaccine you order.
6. Check the status of your order 2 business days later in the PhilaVax IIS. Approved: your flu vaccine is on its way. Rejected: Click on view next to your order to review the notes from the VFC staff. Once all issues are resolved, resubmit your order.

To place subsequent orders

Subsequent flu vaccine orders don’t require a reconciliation, as long as you’ve completed one within 60 days.

Order flu vaccine as often as you need – there is no minimum time period between orders.

The Immunization Program will make every effort to fulfill your flu vaccine request. If the product you request is only available in limited quality, your order may be reduced and we will add a note to the comment box.

Receiving, storing, handling, and administering flu vaccine

• Flu vaccine may arrive separately from other vaccines, even if you order it at the same time. Contact us immediately if the temperature monitor indicates an out-of-range temperature when you receive the vaccines.
  • Christine Wilson: 215-685-6728
  • Charma Miller: 215-685-6667
  • TempCheck: 215-685-6777
• The day you receive a flu vaccine order, log in to PhilaVax IIS and electronically add the doses to your inventory.

PhilaVax will be down for maintenance on Tuesday, July 31 from 5 PM to 10 PM. During this time, you will not be able to log in to PhilaVax.

You can resume using the system by 7 AM on August 1.

ProQuad vaccine now available through the VFC program

ProQuad is now available through the Philadelphia Vaccines for Children (VFC) program. ProQuad is a combination MMR (measles, mumps, and rubella) and Varicella vaccine. This combined vaccine lets you administer more vaccines with fewer injections.

About ProQuad

The CDC’s Advisory Committee on Immunization Practices recommends ProQuad for a patient’s second dose of MMR and varicella vaccine. As a first dose, ProQuad is associated with a slightly higher risk of febrile seizure, so use separate MMR and varicella vaccines for the first dose unless a parent prefers ProQuad.

• More information: https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/mmr.html
• Vaccine Information Statement: http://www.immunize.org/vis/mmrv.pdf

Ordering ProQuad

Order ProQuad through PhilaVax at https://vax.phila.gov the way you normally order other vaccines. Before you order ProQuad for your VFC-eligible patients, you should also stock enough privately-purchased ProQuad to treat patients who are not eligible for VFC.

Protect adults from shingles with the new Shingrix vaccine

Shingrix (recombinant zoster vaccine) is a vaccine to protect healthy adults age 50 and older from shingles. You can now order Shingrix through the Vaccines for Adults At Risk program (VFAAR) for adults 50+ and uninsured.

About Shingrix

Administer Shingrix to adults age 50 and older, with two doses separated by 2 to 6 months.

• ACIP recommendations
• Brief fact sheet for providers
• VIS
• More information

Ordering Shingrix

Order Shingrix through PhilaVax at https://vax.phila.gov the way you normally order other vaccines. We recommend ordering a small amount, initially, to gauge demand. We will work with you to help figure out how much to order: our VFAAR coordinator will review orders and make adjustments to avoid wastage. Before you order Shingrix for your VFAAR-eligible patients, you should also stock enough privately-purchased Shingrix to treat patients who are not eligible for VFAAR.

Storing and Handling

Shingrix must be stored in the refrigerator. Administer it immediately after reconstitution or store it in the refrigerator and use it within 6 hours. Do not freeze Shingrix. If Shingrix freezes, it is spoiled.

Over the next few weeks, you’ll notice some changes to kids.phila.gov. We hope these changes will make it easier to find resources that will be helpful for you in your job.

The website looks a little different

We re-organized the information on the website so that it will be easier for you to find resources that you need to vaccinate Philadelphia’s residents. Take a look. If there’s something you’d like to see on the site, feel free to email us at Vaccines@phila.gov.

And the URL will change—so update your bookmark!

On Tuesday, June 26th, the  web site’s URL will change. You’ll find the site at https://vax.phila.gov. So update your bookmarks: starting June 26th, you won’t be able to find us at the old URL.  Use the new URL to access PhilaVax, the Immunization Information System, the same way you do now. So make sure to update your bookmark.

Good news! PhilaVax is adding a new tool called Clinic Tools.

Clinic Tools makes it easier to communicate temperature and clinic information with the VFC/VFAAR programs. Through Clinic Tools, you’ll be able to:

• Keep track of storage units and data loggers
• Upload temperatures directly to PhilaVax (no more faxing in paper logs, though you still need to keep them filed for 3 years)
• Maintain up-to-date clinic contact information
• Access and complete your annual VFC/VFAAR enrollment form

Register for a required Clinic Tools training

We need to train you to use this tool. You can attend the training from your own computer. Click here to register. Unable to register? Give us a call at  215-685-6872 (Mohan) or 215-685-6490 (Joani), or email us at  DPHProviderHelp@phila.gov and we can help you out.

Training dates

Morning times: 10 AM – 10.30 AM

• December 11

The VFC/VFAAR Emergency Vaccine Management Plan has been updated for 2018. This document helps both you and us prepare for an emergency – like if the power goes out or if your refrigerator or freezer stops working.

If you haven’t already done this, we need you to update your information on the Emergency Management Plan and send it to us. To update your plan:

• Download the Emergency Management Plan here
• Print a copy of the plan
• Complete the first page and fax it to us at 215-238-6948
• Gather the supplies needed for emergency transport (listed on pages 6-7) and store them near your storage units
• Post the Emergency Vaccine Management Plan near your storage units

Keep vaccines safe while defrosting – check out our guidance

Freezers can sometimes build up too much ice. When you need to defrost your VFC/VFAAR unit, we can help you move or store your vaccine while you defrost your primary unit. Contact us for defrosting guidance.

The Philadelphia Department of Public Health has updated storage and handling guidelines for the Vaccines for Children (VFC) and Vaccines for Adults At Risk (VFAAR) programs. This update includes:

1. New policies
2. New forms
3. New tools
4. Contact us

These new guidelines help ensure that the cold chain is preserved and vaccines are protected.

New policies
These policies ensure that each dose of vaccine administered to patients is viable and effective. Please share this information with all staff who work with VFC and VFAAR vaccines.

Using Digital Data Loggers: Monitor all VFC/VFAAR vaccine with a certified, calibrated digital data logger (DDL) during:

• Routine onsite vaccine storage
• Vaccine transport
• Mass vaccination clinics

PDPH will store back-up DDLs at our offices. You may need a back-up thermometer to:

• Defrost units
• Monitor new units
• Identify issues with your primary DDL

If you need a back-up thermometer, contact TempCheck at 215-685-6777.

Recording vaccine temperature: Continue to use paper temperature logs to check and record vaccine storage unit temperatures twice a day. Record the min and max temperatures at the start of each clinic day.

We will review paper temperature logs at our yearly compliance visits, or during unannounced storage and handling visits. Keep copies of both paper and digital temperature logs on file for at least 3 years.

Storing vaccine: To protect the viability of vaccine, it’s important to store vaccines at acceptable temperatures in appropriate storage units.

Dormitory-style (or bar-style) units – refrigerators with one exterior door and an evaporator plate (cooling coil) for freezing – are not reliable enough to safely store VFC/VFAAR vaccine.

Freezers that are part of a household combination refrigerator/freezer unit are also not acceptable for storing VFC/VFAAR vaccine. For vaccines that must be stored in a freezer, you must use a standalone freezer unit.

Never use dorm-style units or household freezers – even to temporarily store vaccine while your’e defrosting your main units.

New forms

Updated forms are designed to help you maintain the cold-chain at your site. Please download and review the updated documents and fill out the necessary forms. Download them here.

• Paper temperature logs: use the new log with your certified, calibrated DDLs. Please review the instructions to make sure you’re documenting temperatures correctly.
• Vaccine management plan: this ensures that you can protect the viability of VFC/VFAAR vaccine. Keep this near the vaccine storage units.
• Emergency vaccine management plan: Keep this near your vaccine storage units. Fax page 1 to VFC/VFAAR, and whenever you make updates.
• Out-of-range Temperature Response Form: use this to document when vaccines are exposed to out-of-range temperatures, determine if you can still use the vaccines, and report your findings.

New tool: Clinic Tools, a new feature coming to PhilaVax

We have a new tool in PhilaVax: Clinic Tools, which makes it easier for you to meet program requirements.

Over the next few months, we will contact Vaccine Coordinators to conduct Clinic Tools trainings – after which your site can use Clinic Tools to:

• Submit temperature logs online
• Keep up-to-date clinic information like phone numbers, address, staff information, and delivery hours

Contact us if you need assistance

We know that changes can be confusing, so don’t hesitate to be in touch if you have questions about what to do.

Questions about storage and handling, out of range temperatures, or the DDLs? Contact Adam Howsare and Alexis Bridges at 215-685-6777 or TempCheck@phila.gov.

The Philadelphia Department of Public Health is issuing recommendations on when healthcare providers should recommend and administer the meningococcal serogroup B (MenB) vaccine to patients. In October 2014 and January 2015, the FDA licensed two MenB vaccines for people age 10 to 25 years.

Guidelines on when to recommend the MenB vaccine, and answers to common questions, are below.

Recommend MenB vaccine to people over age 10 if they’re at increased risk

For patients at higher risk, the Advisory Committee on Immunization Practices (ACIP) recommendation for MenB is a Category A recommendation: routinely recommend this to people with conditions that increase the risk of meningococcal disease.

Certain conditions affect a person’s ability to mount an effective immune respose against meningococcal disease. Give MenB vaccine to patients who:

• Have complement deficiency
• Have functional or anatomic asplenia (including patients with a history of sickle cell disease)
• Take eculizumab (Solaris), an immunosuppressive medication that supresses complement

Also give MenB vaccine to people who are part of a MenB outbreak – for example, to students at a high school or university with an active MenB outbreak. Make this determination in consultation with the Health Department.

Individual clinical decision: give MenB to people age 16 to 23

For most patients, the ACIP recommendation for the MenB vaccine is a Category B recommendation: the vaccine may be given to patients age 16 to 23 – preferably between 16 and 18 – to provide short-term protection from most strains of serogroup B meningococcal disease.

Meningococcal infections are fairly rare, with fewer than 500 reported cases per year in the United States and 50 to 60 cases due to serogroup B among adolescents and young adults. The highest rates of infection are among adolescents, especially older adolescents, even those who do not attend college or live in a dormitory. Giving the vaccine to people age 16 to 18 will protect them when they are at the highest risk of infection.

MenB questions and answers

How are MenB vaccines different from the other meningococcal vaccine that we give to adolescents?

There are now two types of meningococcal vaccine:

• MCV4 (quadrivalent meningococcal conjugate vaccine) protects against 4 different meningococcal serogroups: A, C, W, and Y. It is routinely recommended for all 11-12 year olds with a booster dose at 16 years.
• MenB vaccines only protect against serogroup B.

There is no single vaccine that protects against all of these types (A, B, C, W, and Y) at the same time.

Can MenB be given simultaneously with MCV4?

Yes, MenB and MCV4 can be administered at the same visit but if possible, in different arms. Since the MCV4 booster and Men B are recommended for the same age range, simultaneous administration may happen.

How many doses of the MeB vaccine do I need to give?

The 2 different MenB vaccines have different dosing schedules:

• Bexsero: give in 2 doses (0 and >1 month after the first dose), regardless of risk status
• Trumenba: give in 2 doses (0 and 6 months after the first dose) for healthy adolescents. Give in 3 doses (0, 1-2 months, and 6 months after the first dose) to adolescents with high risk conditions or during a MenB outbreak

Does it matter which MenB vaccine I offer?

You can use either one of the MenB vaccines – the CDC does not have a preference for either product. However, the two MenB vaccines are not interchangeable: you should use the same MenB vaccine for all doses in the series.

If your patient has HIV, the CDC recommends the 3-dose Trumenba series, though the 2-dose Bexsero may also be used.

Why is there a Category B recommendation for MenB vaccines?

The ACIP bases their recommendation on tow main factors:

1. An overall low prevalence of meningococcal disease. The ACIP considered the number of potential cases prevented with different recommendation strategies. Targeting older adolescents, young adults, and individuals with high risk conditions would prevent the most cases for the number of individuals vaccinated.
2. The ACIP is awaiting more data on duration of protection and vaccine effectiveness. Right now we know that vaccination increases antibodies against meningococcal B which is used as a measure of protection rather than reduction in clinical disease. The low prevalence of disease makes it difficult to measure the impact of actual infection. We also do not know how long protection will last. Based on current data, antibody levels are still elevated at about 3 years. This is why the vaccine is recommended for short term protection, targeting older adolescents.

Should I recommend it to teens going off to college?

MenB has been associated with recent outbreaks, many of which have been on college campuses. Therefore, some colleges may recommend or require both MCV4 and MenB vaccination.

Age 16 to 23 is the highest age-related risk period for any older adolescent and young adult, even if they are not attending college. The risk of exposure to meningococcus is associated with many behaviors that any adolescent and young adult may engage in, such as intimate kissing, tobacco exposure, large social gathering, and living in a dormitory. This is why MenB vaccine should be preferentially administered to people age 16 to 18.

Am I required to keep it on hand and offer it like the rest of the vaccines on the schedule?

No, there is no requirement to have MenB in stock because of the recommendation to offer vaccination for certain high risk conditions or at your discretion.

However, having MenB vaccine in stock will help ensure that you can provide MenB vaccination for your patients whom you do want to vaccinate and avoid missed opportunities. It is also important to have MenB available if you have patients with any high risk conditions for whom MenB vaccines should be given.

Am I in trouble if I don’t offer it?

Because MenB has a Category B recommendation, there are no penalties if you choose not to offer the vaccine. However, you may be asked about MenB during your regular VFC program audit visit so that we can help answer any questions that you may have.

Will private insurers pay for it?

Health plans are required to cover new vaccine recommendations without cost sharing within one year of the publication of the new recommendation. MenB recommendations were published in October 2015.

I’m just not sure how to proceed with this Category B recommendation.

This is a new vaccine that can help prevent meningococcal disease due to serogroup B for the age group at highest risk of infection. We do not see a lot of meningococcal disease but when we do, there can be significant morbidity and mortality that is difficult to predict. A higher proportion of the disease we do see is due to serogroup B which, until now, we have not been able to prevent through vaccination. When your patients come to clinic for their MCV4 booster, the MenB vaccine can be offered as an option to all 16-18 year old patients. Parents or teens may also request MenB.

The only way to see any of the potential benefits of vaccination is to provide the vaccine.