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MenQuadfi (MenACYW-TT), a New Meningococcal Vaccine, is Now Available for VFC

MenQuadfi (MenACYW-TT), a New Meningococcal Vaccine, is Now Available for VFC

To download a PDF version of this PDF, click here!

In 2020, the Food and Drug Administration licensed an additional meningococcal serogroups A, C, W, and Y (MenACWY) – MenQuadfi
(MenACYW-TT), from Sanofi Pasteur Inc.

MenQuadfi is now available for providers enrolled in the Vaccines for Children (VFC) program. This advisory includes an overview
of important information about MenQuadfi.

MenQuadfi is licensed for use in individuals 2 years and older in the United States.

Recommendations For Use

Eligible Groups for Receipt of VFC Supplies of MenQuadfi

VFC supplies of MenQuadfi may be given to VFC-eligible children aged 2 years through 18 years.

Licensed Dosing Schedule

MenQuadfi is for intramuscular use only.

MenQuadfi is approved for routine vaccination of children and teens, age 11 through 18 years: a single dose at age 11 or 12 years with a booster dose at age 16 years.

MenQuadfi may also be used for children at increased risk who are age 2 years and older (the primary dosing schedule and booster dose interval varies by age and indication):

  • People with functional or anatomic asplenia
  • People who have persistent complement component deficiency (an immune system disorder) or who take a complement inhibitor (eculizumab [Soliris] or ravulizumab [Ultomiris])
  • People who have HIV infection
  • People who are at risk during an outbreak caused by a vaccine serogroup
  • People age 2 months and older who reside in or travel to certain countries in sub-Saharan Africa as well as to other countries for which meningococcal vaccine is recommended (e.g., travel to Mecca, Saudi Arabia, for the annual Hajj)
  • Microbiologists who work with meningococcus bacterial isolates in a laboratory
  • First-year college students living in residence halls who are unvaccinated or undervaccinated; these students should receive a dose if they have not had a dose since turning 16 or if it has been more than 5 years since their previous dose

These recommendations are summarized in Table 3 of the recommendations published by ACIP in MMWR in 2020: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6909a1-H.pdf.

The Advisory Committee on Immunization Practices (ACIP) recommends that whenever feasible, the same manufacturer’s brand should be used to complete the series. However, if the previous brand is unavailable or unknown, any brand may be used to complete the series. Do not defer immunization solely to wait for a specific meningococcal vaccine brand to be available. From age 2 years and up the MenACWY vaccines are interchangeable.

Storage

  • MenQuadfi should be stored at 2º to 8ºC (36º to 46ºF). Do not freeze. Product which has been exposed to freezing should not be used. Do not use after the expiration date shown on the label.

How MenQuadfi is supplied

  • MenQuadfi is supplied in a single-dose vial in packages of 5 vials (NDC No. 49281-0590-05). The dosage for MenQuadfi is 0.5 mL. MenQuadfi does not contain a preservative. The vial stopper for this product is not made with natural latex rubber.

Ordering and Billing

MenQuadfi is available for ordering through the PhilaVax IIS as of today, June 8, 2021. Please contact Christine Wilson (Christine.Wilson@phila.gov) or Charma Miller (Charma.Miller@phila.gov) to add MenQuadfi to your next order. Please note, your practice must choose a single product to order for each antigen. We recommend that sites that are part of a system, or are affiliated, use the same vaccine presentations across sites to ensure continuity of care and help prevent administration errors.

  • CVX code: 203
  • CPT code: 90619

Resources

Vaxelis (DTaP-IPV-Hib-HepB), a Hexavalent Vaccine, is Now Available for VFC

Vaxelis (DTaP-IPV-Hib-HepB), a Hexavalent Vaccine, is Now Available for VFC

To download a PDF version of this notice, click here!

Vaxelis is now available for providers enrolled in the Vaccines for Children (VFC) program. This advisory includes an overview of important information about Vaxelis.

Vaxelis is a hexavalent combined diphtheria and tetanus toxoids and acellular pertussis (DTaP) adsorbed, inactivated poliovirus (IPV), Haemophilus influenzae type b (Hib, PRP-OMP), and hepatitis B (HepB) (recombinant) vaccine. In 2018, FDA licensed Vaxelis for use in children age 6 weeks through 4 years: it is indicated as a 3-dose series for infants at ages 2, 4, and 6 months. ACIP voted to add Vaxelis to the Vaccines for Children (VFC) Program in 2019. Vaxelis became commercially available in the United States in 2021.

Recommendations For Use

Eligible Groups for Receipt of VFC Supplies of Vaxelis

VFC supplies of Vaxelis may be given to VFC-eligible children from 6 weeks through 4 years of age (prior to the 5th birthday).

Licensed Dosing Schedule

Vaxelis is indicated for active immunization to prevent diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B, and invasive disease due to Haemophilus influenzae type b. Vaxelis is approved for use as a 3-dose series in children from 6 weeks through 4 years of age (prior to the 5th birthday). Vaxelis is indicated for use in infants at ages 2, 4, and 6 months.

Recommended minimum ages for administration of Vaxelis (DTaP-IPV-Hib-HepB) vaccine and intervals between doses — United States, 2020*

Age/Interval
Minimum age for any dose 6 weeks
Minimum interval between doses 1 and 2 4 weeks
Minimum age for dose 2 10 weeks
Minimum interval between doses 2 and 3 4 weeks
Minimum age for dose 3 24 weeks†
Maximum age for any dose 4 years, 364 days (do not administer on or after the fifth birthday)

† If the third dose of DTaP-IPV-Hib-HepB is given before age 24 weeks, an additional dose of hepatitis B vaccine should be given at
age ≥24 weeks to complete the hepatitis B series.

*DTaP-IPV-Hib-HepB can be used for children aged <5 years requiring a catch-up schedule. However, vaccine doses should not be
administered at intervals less than the minimum intervals indicated in this table.

For guidance on transitioning to Vaxelis and how it fits into the immunization schedule, visit: https://www.vaxelistransition.com.

The Advisory Committee on Immunization Practices (ACIP) recommends that whenever feasible, the same manufacturer’s brand should be used to complete the series. However, if the previous brand is unavailable or unknown, any brand may be used to complete the series. Do not defer immunization solely to wait for a specific brand to be available.

Storage

Vaxelis should be stored at 2º to 8ºC (36º to 46ºF). Do not freeze. Product which has been exposed to freezing should not be used. Do not use after the expiration date shown on the label.

How Vaxelis is supplied

Vaxelis is supplied in a single-dose vial in packages of 10 vials (NDC no. 49281-0590-05). The dosage for Vaxelis is 0.5 mL. Vaxelis does not contain a preservative. The vial stopper, syringe plunger stopper, and syringe tip cap are not made with natural rubber latex.

Administration

Just before use, shake the vial or syringe until a uniform, white, cloudy suspension results.

Inspect the vial or syringe for particulate matter and discoloration prior to administration. If either of these conditions exist, the product should not be administered.

Administer a single 0.5 mL dose of Vaxelis intramuscularly. In infants younger than 1 year, the anterolateral aspect of the thigh is the preferred site of injection. The vaccine should not be injected into the gluteal area.

Vaxelis should not be combined through reconstitution or mixed with any other vaccine. Discard unused portion. Vaxelis is for intramuscular use only.

Precautions and Contraindications

Do not administer Vaxelis to anyone with a history of severe allergic reaction to a previous dose of Vaxelis, any ingredient of Vaxelis, or any other diphtheria toxoid, tetanus toxoid, pertussis containing vaccine, inactivated poliovirus vaccine, hepatitis B vaccine, or Hib vaccine.

Do not administer Vaxelis to anyone with a history of encephalopathy within 7 days of a pertussis containing vaccine with no other identifiable cause.

Do not administer Vaxelis to anyone with a history of progressive neurologic disorder until a treatment regimen has been established and the condition has stabilized.

Ordering and Billing

Vaxelis is available for ordering through the PhilaVax IIS as of today, June 8, 2021. Please contact Jillian Brown (Jillian.Brown@phila.gov) to begin the process of transitioning to Vaxelis at your site. Please note, your practice must choose a single type of combination vaccine to use as part of the primary series. We recommend that sites that are part of a system or are affiliated use the same vaccine presentations across sites to ensure continuity of care and help prevent administration errors.

  • CVX code: 146
  • CPT code: 90697

Resources

Vaccine Information Statements (VIS):

CDC Morbidity and Mortality Weekly Report (MMWR): https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6905a5-H.pdf.

For guidance on transitioning to Vaxelis and how it fits into the immunization schedule, visit: https://www.vaxelistransition.com.

Product insert for Vaxelis includes additional vaccine information, found at: https://www.merck.com/product/usa/pi_circulars/v/vaxelis/vaxelis_pi.pdf.

Additional information on vaccines and vaccine preventable diseases can be found at: http://www.cdc.gov/vaccines/

FDA Pfizer Vaccine Storage Update

FDA Pfizer Vaccine Storage Update

On May 19th, the FDA announced the Pfizer COVID-19 Vaccine can now be stored at normal refrigerator temperatures for up to a month (30 days). This is much longer than was previously allowed under the FDA’s emergency authorization and will make storage and distribution of the vaccine easier.

The FDA is now authorizing undiluted, thawed Pfizer-BionTech COVID-19 vaccine vials to be stored in the refrigerator at 2°C to 8°C (35°F to 46°F) for up to 1 month (30 days). Previously, thawed, undiluted vaccine vials could be stored in the refrigerator for up to 5 days.

The FDA says the change should make the vaccine more widely available by making it easier for doctors’ offices to receive, store and administer the vaccine. “Making COVID-19 vaccines widely available is key to getting people vaccinated and bringing the pandemic to an end,” says Dr. Peter Marks, director of the FDA’s Center for Biologics and Research. PDPH hopes that this change will help providers vaccinate more patients in Philadelphia.

Click here to Download the New Pfizer EUA (5/19/2021)

To review the most recent EUA fact sheets for the Moderna and Janssen COVID-19 Vaccines, please click the links below:

Thank you for keeping Philadelphia safe and healthy.

If you have any vaccine storage and handling questions, please email tempcheck@phila.gov.

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

Adolescents 12+ May Consent to Receive Pfizer Vaccine

Adolescents 12+ May Consent to Receive Pfizer Vaccine

On 5/14, the Philadelphia Board of Health updated the Emergency Order Concerning COVID-19 Vaccine Information Statements to allow individuals 11 years of age and older to consent to his or her own immunization with a COVID-19 vaccine under an Emergency Use Authorization (EUA), without the approval or consent of a parent or guardian. In this case, an EUA Fact Sheet for Recipients and Caregivers would substitute for a Vaccine Information Statement.

Currently, the Pfizer COVID-19 vaccine is only authorized for 12 years of age and older. The language 11 years and older in the Philadelphia Board of Health order aligns with the original regulations that give individuals 11 years and older the ability to consent for approved vaccines with a Vaccine Information Statement. However, at this time, you should ONLY vaccinate individuals 12 years of age and older with the Pfizer product.

The unaccompanied minor presenting for vaccination can be vaccinated, subject to a vaccine provider’s determination that the minor is able to, and does provide, informed consent.

Click here to download PDPH’s Emergency Order Concerning COVID-19 Vaccine Information Statements

To view the original regulations, please go to Section 4, part b of the Regulations Governing the Immunization and Treatment of Newborns, Children and Adolescents document found here.

AAP Statement on Adolescent COVID-19 Vaccination and Co-Administration

Following the ACIP meeting on May 12, American Academy of Pediatrics (AAP) released a Policy Statement recommending vaccination for eligible children ages 12 and up with the federally authorized COVID-19 vaccine. The statement supports co-administration of COVID-19 vaccine with routine immunizations in order to catch children up on any missed vaccines caused by the pandemic:

For additional guidance regarding vaccinating adolescents and concurrent administration of other vaccines, please download:

Thank you for keeping Philadelphia safe and healthy.

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

COVID-19 Vaccine Wastage Guidance

COVID-19 Vaccine Wastage Guidance

PDPH is asking providers to ensure vaccination for all eligible patients, even if it means leaving some doses unused or wasted. Here is some information to help you increase vaccination and manage wastage:

1. Prioritize vaccinating eligible persons. Providers should vaccinate any eligible persons who wish to receive vaccine at their clinic location, even if it means puncturing a multi-dose vial and potentially wasting doses.

2. Do not miss an opportunity to vaccinate. PDPH understands that some, or all remaining doses in the vial, may need to be wasted to vaccinate a person. Not missing an opportunity to vaccinate is the more important goal.

3. Follow best practices while managing vaccine inventory. While we want to continue to follow the best practices of using every dose possible, we do not want it to be at the expense of missing an opportunity to vaccinate every eligible person when they are ready to get vaccinated.

4. No penalties for wasting COVID-19 vaccine. We are expecting an increase in COVID-19 vaccine wastage as vaccination efforts progress and opportunities are not missed.

5. Download and use the CDC COVID-19 Vaccine Expiration Date Tracker. This tool helps your site keep track of vaccine wastage.

6. Download and use the Vaccine Wastage Guide. This tool details the vaccine wastage protocols for the Pfizer, Moderna, and Janssen COVID-19 Vaccines.

7. Use the wastage reporting table. This table (below) provides guidance to determine if a dose should be reported as waste. Wastage does not negatively impact a provider, but is simply a means for accounting for inventory.

8. Implement CDC and Idaho tips for not missing opportunities and reducing wastage. See detailed tips below. We can all learn by sharing best practices.

9. Call PDPH if you need help! PDPH is happy to help manage inventory and discuss strategies to minimize vaccine wastage. Contact vaccines@phila.gov

10. Don’t wait, vaccinate!

Wastage Reporting Table:

Below are CDC recommendations ensuring there are no missed opportunities to vaccinate every eligible person:

  • Consider establishing and promoting standing vaccination days or half-days to increase likelihood of larger numbers of people presenting for vaccination on the same day.
  • Vaccinate family members or friends who accompany patients to medical visits even if they are not established patients at the vaccinating practice
  • Continue outreach to employers or other community partners that have a large membership or network to arrange vaccination events.
  • As contingency plan, vaccine providers should attempt to contact additional persons (i.e., from a waitlist or through personal contacts of persons being vaccinated) to use as many vaccine doses as possible.
  • Once punctured, multidose vials must be used within:
    • 12 hours (Moderna)
    • 6 hours (Pfizer)
    • 2 hours (J&J/Janssen)
  • The more Americans who get vaccinated the fewer COVID-19 cases, hospitalizations, outbreaks, and deaths that will occur.

For additional guidance on how to reduce wastage, please refer to the bullet points below written by the Idaho Immunization Program:

  • If feasible, prepare a Standby List strategy appropriate to your setting and the function of your site. “Standby lists” identify, in advance, people who are wanting to receive vaccine at your site.
  • Review your patient lists for those who may not have been vaccinated, and/or ask those who present for care if they are willing to be on waitlists.
  • If available, utilize your local COVID-19 Vaccine Pre-registration System to locate additional residents in your area who are willing to be on waitlist. These pre-registration systems were established by localities to identify people who wanted to be vaccinated. People would enter their name and contact information to receive a vaccine at a future date.
  • Review daily the clinic/appointment schedule to determine if it matches available vaccine inventory.
  • As a clinic or appointment day progresses, monitor no-shows and extra doses to anticipate potential need/ability to reach additional people.
  • Determine time of day that is appropriate for your site to activate the Standby List strategy.
  • Use the Standby List to call people who may be able to arrive at the administration site before the end of your vaccination clinic.
  • If individuals with future appointments are rescheduled for the end of the day, republish those future appointments as available by the end of the day.
  • For vaccines administered to standby patients, sites should use relevant registration and reporting mechanisms as well as ensure that second dose appointments are scheduled for the appropriate timeframe at the same location

Thank you for keeping Philadelphia safe and healthy from COVID-19.
If you have any questions, please email vaccines@phila.gov.

Pfizer Vaccine for Pediatric Providers

Pfizer Vaccine for Pediatric Providers

UPDATE: Please refer to the PDPH Emergency Order Concerning COVID-19 Vaccine Information Statements 5/14 for guidance.

On May 10, the US Food and Drug Administration (FDA) expanded the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine to adolescents ages 12-15 years. Yesterday, May 12, the CDC Director adopted the CDC’s Advisory Commitee on Immunization Practices’ (ACIP) recommendation that endorsed the safety and effectiveness of Pfizer-BioNTech COVID-19 vaccine in this population. Providers may begin vaccinating 12–15-year-old patients today. This advisory contains important information regarding administering Pfizer COVID-19 Vaccine to adolescents and teenagers.

If your site has not already enrolled as a COVID-19 Vaccine Provider, you can enroll now to make sure your adolescent patients can get vaccinated!

Click here to enroll in our COVID-19 Vaccine Program!

Ordering Partial Trays of Pfizer & Adolescent Vaccination Updates

Please use this guide to order a partial tray of Pfizer.

For the week of 5/10, orders must be received by noon on Friday, 5/14. Going forward, orders must be submitted by 5 pm on Wednesday.

Only use this process to order if you’re been directed to during your COVID vaccine enrollment process.

Offering COVID-19 Vaccine

There is no longer a residency requirement for COVID-19 vaccinations. You are free to vaccinate individuals who live outside of Philadelphia city limits going forward.

PDPH does not require COVID-19 Vaccine providers to offer vaccinations to the greater public unless a site is specifically interested in vaccinating more than their patients.

If your site is interested in offering the vaccine at an off-site location, offering the vaccine to the whole family, or have questions about offering the vaccine in your community, email vaccines@phila.gov so that we can connect you with the right Philadelphia Immunization Program team member.

Co-administration

Per the ACIP meeting on 5/12, COVID-19 vaccines may be administered without regard to timing. This includes simultaneous administration of other vaccines on the same day, as well as co-administration within 14 days. We will forward the MMWR documenting this decision once its is published.

Consent

The patient or their parent and guardian must have had the opportunity to have his/her questions answered satisfactorily before the immunization is given. Written consent for immunization is not required. Implicit consent is acknowledged by the presentation for vaccination of an adolescent with their parent or guardian. There is no Vaccine Information Sheet (VIS) for this vaccine. The FACT SHEET FOR RECIPIENTS AND CAREGIVERS about the Emergency Use Authorization (EUA) Pfizer-BioNTECH COVID-19 Vaccine to Prevent Coronavirus must be shared with the intended vaccine recipient or their parent or guardian prior to immunization.

Currently in Philadelphia, individuals 16 -18 years of age may authorize his or her own immunization with the Pfizer vaccine under the EUA, without the approval or consent of another person. At this time, individuals 12 to 15 years of age must have a parent’s implicit consent for vaccination under an EUA.

Click here to download PDPH’s Emergency Order Concerning COVID-19 Vaccine Information Statements. To view the original regulations, please go to Section 4, part b of the Regulations Governing the Immunization and Treatment of Newborns, Children and Adolescents document found here.

Wastage

As COVID-19 vaccine supply becomes more available and appointments become more sporadic, PDPH is asking providers to ensure vaccination for all eligible patients, even if it means leaving some doses unused or wasted.

Right now, it is critical that providers prioritize vaccinating eligible persons who are willing to be vaccinated over wasting vaccine. Providers should vaccinate any eligible persons who wish to receive vaccine at their clinic location, even if it means puncturing a multi-dose vial and potentially wasting doses. PDPH understands that some, or all remaining doses in the vial may need to be wasted to vaccinate a person.

Please download our Vaccine Wastage Guide here. You can find additional information on vaccine wastage guidance by reading this detailed Vaccine Wastage Advisory.

Pfizer Resources

Thank you for keeping Philadelphia safe and healthy.

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

Enroll Your Site as a COVID-19 Vaccine Provider!

Enroll Your Site as a COVID-19 Vaccine Provider!

Pfizer/BioNTech asked the Food and Drug Administration (FDA) on April 9th to expand the emergency approval of their COVID-19 vaccine to include its use in adolescents ages 12 to 15.

Enroll to make sure that adolescents can access COVID-19 vaccine when its available to them!  

How Do I Enroll?

To enroll as a COVID provider your site must be able to:

  • Be able to vaccinate at least 50 patients, 12 years of age and up, over a 2-week period
  • Report COVID-19 vaccination electronically within 24-hours of administration
  • Store the vaccine in monitored fridge and freezer storage units that are compliant with CDC Immunization requirements

(If your site is a VFC provider, you already meet the storage and handling and temperature reporting requirements to be a COVID-19 vaccine provider.)

To help you enroll in our COVID-19 Vaccine Provider program, we have created a Provider Agreement Guide which walks you step-by-step through the Enrollment Form. Please review the Provider Agreement Guide in its entirety before filling out the agreement form and survey. Once you have reviewed the guide, you can start filling out our Enrollment Form.

Enroll In Our COVID-19 Vaccine Program!

Have questions about the enrollment process?

Attend one of our Town Halls for VFC Providers interested in enrolling as COVID-19 Providers:

Virtual Town Hall for VFC Providers interested in enrolling as COVID-19 Providers

Dates and times:
Tuesday 5/4 at 12PM
Wednesday 5/5 at 5PM
Tuesday 5/11 at 5PM
Wednesday 5/12 at 12PM

Gotomeeting Link: https://global.gotomeeting.com/join/926918173

Meeting ID: 926 918 173

Dial In: +1 (669) 224-3412

Thank you for your continued work to keep our city safe and healthy!
If you have any questions, please email vaccines@phila.gov.

How to defrost your storage unit

How to defrost your storage unit

Storage units, especially freezers, can sometimes build up too much ice. When you need to defrost your VFC/VFAAR storage unit, TempCheck – our storage and handling coordinators – can help. TempCheck will help you safely storage the vaccine while you defrost the unit.

Use this guide to plan your defrost. Review it when you plan a defrost, and consult it during the defrost process.

If you have any questions, or if your vaccine is exposed to out-of-range temperatures during the defrost or transport process, contact TempCheck as soon as possible.

TempCheck
Adam Howsare and Alexis Bridges
TempCheck@phila.gov
215-685-6777

Plan and prepare

  1. Contact TempCheck to tell them that you are planning to defrost your unit. TempCheck will need to know when you plan to defrost, and where your back-up unit is. TempCheck will send you a backup DDL to monitor the back-up unit. Keep the packing material so you can send the DDL back to PDPH.
  2. Prepare the back-up DDL. Once you get the back-up DDL, temper the probe by putting it in your primary freezer. After 30 minutes, start up the DDL. Monitor temperatures for at least 1 hour. Alternatively, place the probe in your unit overnight and start the DDL the next morning.
  3. Move the vaccine. It’s time to move the vaccine. Leave the primary DDL in your primary unit while you defrost the primary unit.
    1. If your back-up unit is on-site: Move the vaccine and back-up DDL to your secondary unit. Note the time.
    2. If your backup unit is off-site: using the emergency transport guide, set up a hard-sided cooler for transport. Move the back-up DDL to the cooler. Place the probe in the middle. Move the vaccine into the cooler. Note the time. Transport the vaccine directly to the back-up location. Note the time the vaccine and DDL are moved into the back-up unit.

Defrosting your unit

  1. Note the time when you start defrosting your primary unit. The DDL will warm up, which will probably trigger an alarm.
  2. Allow the ice in the unit to melt.
  3. Turn the freezer back on. Wait until the DDL shows that the temperature is back in the normal range.
  4. Transfer the vaccines back into the freezer, using the same transport protocol that you used to move them to the back-up unit.

Dealing with the data

  1. Download the data from both data loggers and email it to TempCheck@phila.gov.
  2. Include the following information in the email:
    1. When you took the vaccine out of the primary unit
    2. When you put the vaccine into the back-up unit
    3. When you started defrosting the primary unit
    4. When you took the vaccine out of the back-up unit
    5. When you put the vaccine back into the defrosted primary unit
  3. Reconnect the DDL and continue temperature monitoring as usual
  4. Repackage the back-up DDL and send it back to PDPH.

ProQuad now available through VFC

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.

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.