VFC and VFAAR Re-Enrollment is Coming

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.

  1. 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.

  1. 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.

 

The historical impact of vaccines

Notes from the Medical Director

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

The historical impact of vaccines

It can be so easy to lose sight of the incredible impact that vaccines have had on our society. Mike Bostock, a data visualization specialist, reminds us of the history of the measles vaccine with the data visualization below.

Measles used to be incredibly common, but when the vaccine was introduced to the US in 1963, cases plummeted. Bostock’s visualization shows this clearly: moving from left to right, the darker colors begin to fade, just as the number of cases in each state decline immediately following the introduction of the vaccine.

If there are so few measles cases in the U.S., do we still need to maintain high immunization rates? Yes. The dramatic impact of measles vaccine introduction is testament to both the individual and community effects with immunizations.  Vaccinated children were no longer getting infected themselves, and they could no longer spread measles to others.  But to see the community effects of measles vaccines, we do need high vaccination rates.  Measles is one of the most contagious vaccine-preventable disease out there so almost everyone needs to be protected to stop transmission.  When we keep our measles vaccination rates above at least 92%, we eliminate measles outbreaks.

Measles still affects about 20 million people per year worldwide.  No other vaccine-preventable illness causes as many deaths.  Most cases occur in developing areas of Africa and Asia but there are also tens of thousands of cases in several European countries due to decreasing immunization rates. In fact, the Centers for Disease Control and Prevention has issued travel advisories for places from which many of us may receive visitors or visit ourselves.  So the likelihood of being exposed to measles is very real.  If communities do not maintain high immunization rates, outbreaks can happen here as well.

Here at the Philadelphia Department of Public Health, we’ve done similar work to highlight the history of vaccines and their important public health impact. The history of vaccine-preventable diseases in Philadelphia shows how these diseases used to kill nearly 3,000 Philadelphians per year. As more vaccines were licensed and distributed, this death toll fell steadily until the modern era, when vaccine-preventable diseases only kill 11 Philadelphians per year.  Let’s work together to make sure these trends don’t change.

 

Measles in the USA

Is it time for a Lyme vaccine?

Notes from the Medical Director

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

Is it time for a Lyme vaccine?

The New York Times recently reported what we’ve seen for several years now: that Lyme disease and other tick-borne diseases are spreading.

The US Centers for Disease Control and Prevention (CDC) and the Environmental Protection Agency (EPA) have both observed that Lyme disease has been rising. In fact, since 1990, Lyme disease cases in the USA have tripled.

So what’s going on? Well, climate change is probably a factor. Lyme disease is spread by blacklegged ticks, which are commonly found on deer and white-footed mice. Because of changes in weather patterns, their habitat is expanding – and, milder winters mean that fewer ticks die off each winter.

Health officials are pretty sure that this is only going to get worse. Whether you spend time in city parks or live in wooded areas, it is possible to find blacklegged ticks – and there are things we can do to prevent getting bitten by ticks.

What about a Lyme vaccine?

In 1998, a vaccine for Lyme disease was released. Four years later, the company that made it took it off the market: it just didn’t sell very well. There were concerns that the vaccine could be linked to autoimmune diseases, even though all of the studies about the vaccine found that it was safe. Plus, a lot of health care providers were unclear about who should get the vaccine.

That was several years ago. Now, with Lyme disease on the rise – and expected to continue rising – there are initiatives to develop a new vaccine to prevent Lyme disease and to also potentially prevent other infections spread by ticks. If a vaccine comes to market, then the US Advisory Committee on Immunization Practices (ACIP) would review the evidence and make recommendations about who should get the vaccine, and when.

Lyme disease can be serious – people with the disease can have symptoms that range from a rash to joint swelling to neurologic symptoms. No matter how it presents, Lyme disease is treatable and responds well to antibiotics, but it can sometimes take time for symptoms to go away completely. And while the CDC counts about 30,000 people per year in the USA getting Lyme disease, they’re pretty sure that the actual figure is much higher – up to ten times higher – due to cases not getting properly diagnosed or reported.

This is the time to build up our prevention tool box for Lyme disease. Preventing its spread will take a lot of different strategies: teaching the public to prevent tick bites, developing better insect repellents, and reducing tick habitat around people’s homes. But adding a vaccine to our prevention options could be another powerful tool.

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.

The return of the flu spray: what changed?

Notes from the Medical Director

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

The return of the flu spray: what changed?

For the 2018-19 flu season, the Advisory Committee on Immunization Practices (ACIP) added the intranasal live-attenuated influenza vaccine (LAIV) back to the list of recommended flu vaccines for children and adults. The LAIV is a flu vaccine given as a nasal spray instead of as a shot – which a lot of patients liked.

LAIV, the flu spray, was fist introduced in 2003. It initially appeared to work really well in children, so in 2014, the ACIP made a recommendation to prefer it. But 2 years later, they changed their minds, recommending against it for the past few seasons because of LAIV’s poor effectiveness.

So what changed? Why is it being reintroduced now? Let’s take a deeper dive.

How is LAIV different from other flu vaccines?

Most flu vaccines are “inactived influenza vaccines,” or IIVs. These are made by growing the flu virus in eggs, purifying it, and then inactivating the virus – killing it. It’s then given as a shot that teaches our immune system how to respond to an actual live flu virus – even though the IIV can’t reproduce to cause a flu infection.

We’ve been using this method to make flu vaccines since the 1940s. Since the flu virus changes each year, we have to make a new vaccine each year so that the vaccine matches up with the flu strain that’s likely to emerge most strongly each year.


  • IIV: inactivated virus, given with a shot
  • LAIV: weakened virus, given with a nasal spray

Unlike the IIV, the LAIV (live attenuated influenza vaccine) is made by growing the flu virus in egg cells, and then just weakening it instead of inactivating the virus. It’s then given as a nasal spray instead of a shot – and the weakened virus can reproduce just enough to spark an immune response in a patient’s body. Though the virus is live, it’s too weak to cause infection; and since it’s administered in the nose – which is how a lot of people are exposed to the flu – it can be an especially effective way to provide protection: following the same path the disease would follow.

So why was the LAIV removed from the list of recommended vaccines in 2016?

When LAIV was first introduced, it did appear to work a little better, especially in children. So in 2014, the ACIP gave LAIV a preferential recommendation – preferring the spray over the shot.

Shortly after that – once the spray was used more widely – the ACIP’s research showed that the spray stopped working as well as it initially did. For 3 years in a row, the spray didn’t perform any better than the shot. In fact, it was less effective. So, while the CDC worked to understand what happened, the ACIP removed their recommendation for the spray (LAIV).

So what happened?

Every flu vaccine protects against 3 to 4 strains of the flu. And, the CDC found that one of the flu strains in the spray didn’t reproduce well enough to spark a good immune response in patients. Since the spray relies on weakened but live virus to reproduce in order to trigger protection in a patient, this was a problem.

This flu strain was H1N1. We had several seasons where a lot of the flu disease was due to H1N1 – so the spray just didn’t provide as much protection as originally hoped.

Okay – so now the spray is back?

Yes. Once the CDC figured out the problem with the spray, the vaccine manufacturer replaced the H1N1 strain – which wasn’t reproducing well – with another strain that works better. They also checked to make sure that there’s a good immune response to the new LAIV.

The ACIP reviewed all of the changes and felt that the problem was addressed – so the spray was added back to the list of recommended flu vaccines for anyone between age 2 and 49.

Even though the ACIP recommends the spray, the American Academy of Pediatrics recommends the shot. Why do they disagree?

When the ACIP reviewed information about the new version of the spray – including studies on the spray’s effectiveness from other countries that continued to use it – they felt that the strong immune response was a good sign that the spray should work at least as well as the shot.

The AAP was also reassured, but they wanted to see more information on protection against the actual disease before they strongly recommended it. So, they decided to recommend the inactivated vaccine (the shot) over LAIV (the spray) until we learn more about the spray’s effectiveness once it’s used more broadly.

So what should I do?

Offer both vaccines.

The effectiveness of the flu vaccine always varies from year to year as researchers try to match the vaccine to the flu virus that they expect to dominate the flu season. Despite varying effectiveness, vaccination is our best method of protection against this virus that kills tens of thousands of people in the USA each year. Since some people decline the flu vaccine because of a fear of injections, having the spray available may increase the likelihood that patients will accept the vaccine.

Patients look to us – health care providers – to listen to their concerns and make recommendations that will keep them healthy. So let’s offer them choices that can help protect them, and let’s remind them that we get our flu vaccines to protect ourselves, our children, our patients, and our community too.

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.

Protect adults from shingles with the new Shingrix vaccine

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.

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.

Important changes to kids.phila.gov

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.

 

Register for a required Clinic Tools training

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

 

Reminder: we need your emergency management plan

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.

 

2018 Storage and Handling Update

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.

Recommendations for the Meningococcal Serogroup B Vaccine

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.