Medical Director Notes

Dr. Kristen Feemster

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

New School Year & New Immunization Requirements!

With new immunization requirements, children who do not receive all required vaccines within the first 5 days of school may be excluded.

As students prepare to return to school there is always a rush for annual physicals and increased requests for immunization records. On top of the back-to-school rush, September is when new flu vaccine becomes widely available to medical providers. This is an important time to make sure kids have what they need for a healthy school year. You may also have been especially busy this year considering recent changes to school and day care immunization requirements. The Philadelphia Department of Public Health (PDPH) wants to help you understand these changes and help you communicate them to your patients.

New Immunization Requirements for the School District of Philadelphia

As you know, the state of Pennsylvania implemented changes to school immunization requirements for the 2017-18 school year. Most notably, a new requirement calls for a second MCV4 dose for entering 12th graders and a change in the provisional enrollment period from 8 months to 5 days. Children who do not receive all required vaccines within the first 5 days of school may be excluded until they get what they need. This year, School District of Philadelphia is implementing a program to more actively enforce requirements.  All parents have received letters about school requirements with notification that proof of vaccination is required by the first day of school and necessary for attendance.

This notification from the school district may have caused anxiety for some families, and many of you may be especially busy this year as parents bring their children in for immunization visits or to request immunization records. To help reduce the overwhelming number of students seeking vaccine, our immunization program is working with the school district to update student records so that up to date students do not need to come to a clinic. We also sent out letters to children who were missing any of the required doses earlier this summer in hopes they would get vaccinated before the back-to-school rush.

New Flu Vaccine Requirements for Daycare Attendees

As flu season approaches you may notice more requests from parents of children who attend daycare. Flu vaccine is routinely recommended for everyone 6 months of age and older and is especially important for young children. This year, the Board of Health in Philadelphia passed a new regulation requiring flu vaccination for all children 6 months – 5 years old who attend any group child care facility in Philadelphia. Child care attendees need to receive a flu vaccine every year between September 1st and December 31st.

Why the New Requirement?

  • During the 2017-18 season, there were more than 3,000 confirmed cases of influenza, about 1,500 hospitalizations and 50 deaths in the city.
  • Young children less than 5 years old are one of the groups at highest risk for severe flu.
  • There are many opportunities for respiratory virus transmission in childcare settings
  • Vaccination is the most important tool available to prevent the flu and is routinely recommended for everyone over 6 months of age.

So remember to recommend flu vaccines for your young patients!

New Immunization Recommendations

The Advisory Committee on Immunization Practices (ACIP) had a busy meeting in June with several new recommendations that have just been or will soon be published.  Here are some important highlights:

Hepatitis A

  • Catch-up vaccination for all children and adolescents ages 2 through 18 years who have not previously received Hepatitis A vaccine. This is especially important in light of the Hepatitis A outbreak currently affecting our city.


  • The catch-up vaccination schedule is now harmonized. HPV vaccination continues to be routinely recommended for all adolescents ages 11-12 years. Catch-up vaccination is recommended for all persons through age 26 years.
  • HPV vaccination may now be given to adults ages 27 through 45 years using shared clinical decision-making. This recommendation is based upon limited potential benefit of vaccination among adults who are more likely to have been previously exposed to HPV and less likely to have new partners.

Serogroup B Meningococcus (MenB)

  • Anyone ages 10 years and older with conditions that put them at high risk for meningococcal disease (complement deficiency, no spleen, work with meningococcus in a lab) should get a booster dose of Men B one year after completing the primary MenB series, followed by a booster dose every 2 to 3 years. This recommendation is based upon evidence showing that immunity after MenB vaccines is not long-lasting. Booster doses make sure that high risk persons are well-protected.
  • Anyone ages 10 years and older who is at risk for MenB due to an outbreak should receive a booster dose if they have been previously vaccinated but it has been 1 or more years since completing the primary series.

Thank you for all your work supporting a healthy Philadelphia!