Immunization - Vaccine Updates
(Last updated 06/12/2014)
Flu Vaccine News
Ohio Pharmacists May Administer MMR Vaccine Effective June 9, 2014
As of June 9, 2014, trained Ohio pharmacists are able to administer measles, mumps and rubella (MMR) vaccine to persons 18 years of age and older. Pharmacists who administer the vaccine must meet the training requirements of Ohio Board of Pharmacy Rule 4729-5-36, and work under a physician-established protocol. OPA is working on a supplemental home-study course for pharmacists whose immunization training program did not include training for measles, mumps and rubella disease/vaccine.
Guidance document on this rule change can be found at http://pharmacy.ohio.gov/Documents/Pubs/Special/Pharmacists%20Can%20Now%20Administer%20the%20Measles,%20Mumps,%20and%20Rubella%20%28MMR%29%20Vaccine.pdf (Revised June 9, 2014)
Zoster Prescription Requirement Ends May 22:
Update Your Protocol
As of May 22, 2014, trained Ohio pharmacists are able to administer Zostavax (herpes zoster vaccine) without a prescription. The patient receiving the vaccine must meet the age criteria listed in the FDA-approved labeling. Pharmacists who administer the vaccine must meet the training requirements of Ohio Board of Pharmacy Rule 4729-5-36, and work under a physician-established protocol.
Guidance document on this rule change can be found at http://pharmacy.ohio.gov/Documents/LawsRules/RuleChanges/Guidance%20Document%20for%20Pharmacist%20Administration%20of%20Zostavax%20%28Herpes%20Zoster%20Vaccine%29.pdf
Pharmacists currently administering Zostavax need to update their protocol to delete the requirements for a patient-specific prescription and administration of the vaccine within 30 days of issuance of the prescription.
For pharmacists who have completed a board-approved immunization training program and whose training did not include zoster vaccine, OPA’s home-study CE article Immunizations for Selected Vaccine-Preventable Diseases in Adults is approved as a supplemental course.
To order this Home-Study CE, Click Here
CDC Health Advisory and Reminder for Influenza Vaccine
Pharmacists should encourage anyone who has not received the 2013-14 influenza vaccine to get one NOW. Influenza activity in the U.S. is widespread and it is not too late to vaccinate.
On December 24, 2013 CDC Issued a Health Advisory Notice to Clinicians: Early Reports of pH1N1-Associated Illnesses for the 2013-14 Influenza Season. “From November through December 2013, CDC has received a number of reports of severe respiratory illness among young and middle-aged adults, many of whom were infected with influenza A (H1N1) pdm09 (pH1N1) virus. Multiple pH1N1-associated hospitalizations, including many requiring intensive care unit (ICU) admission, and some fatalities have been reported. The pH1N1 virus that emerged in 2009 caused more illness in children and young adults, compared to older adults, although severe illness was seen in all age groups. While it is not possible to predict which influenza viruses will predominate during the entire 2013-14 influenza season, pH1N1 has been the predominant circulating virus so far. For the 2013-14 season, if pH1N1 virus continues to circulate widely, illness that disproportionately affects young and middle-aged adults may occur.”
CDC recommends annual influenza vaccination for everyone 6 months and older. Anyone who has not yet been vaccinated this season should get an influenza vaccine now. While annual vaccination is the best tool for prevention of influenza and its complications, treatment with antiviral drugs (oral oseltamivir and inhaled zanamivir) is an important second line of defense for those who become ill to reduce morbidity and mortality. Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who is hospitalized; has severe, complicated, or progressive illness; or is at higher risk for influenza complications. The complete health advisory can be found at http://emergency.cdc.gov/HAN/han00359.asp
According to CDC, nearly half of the U.S. is reporting widespread influenza activity, with most cases being attributed to the H1N1 virus. For information on influenza activity, visit http://www.cdc.gov/flu/weekly/index.htm#ISTE
The Centers for Disease Control and Prevention (CDC) recently posted the summary recommendations Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—(ACIP)—United States, 2013-14. Trivalent and quadrivalent influenza vaccines have been approved for the 2013-14 season, and both formulations will be available.
Provider Information for 2013-14 Influenza--NEW
A "Provider Information" document to supplement the 2013-14 influenza VISs has been posted by the CDC and is now available. This document summarizes information from the current ACIP influenza recommendations, and is intended as a quick reference for providers to use when discussing influenza vaccine with their patients, or answering patients' questions. It provides detailed information on topics dealt with more superficially on the influenza VISs themselves.
Key Points in the Latest Recommendations
• Routine annual influenza vaccination of all persons aged six (6) months and older continues to be recommended.
• 2013-14 U.S. trivalent influenza vaccines will contain an A/California/7/2009 (H1N1)-like virus, an H3N2 virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011, and a B/Massachusetts/2/2012-like virus. Quadrivalent vaccines will include an additional vaccine virus, a B/Brisbane/60/2008-like virus.
• Several new, recently-licensed vaccines will be available for the 2013-14 season, and are acceptable alternatives to other licensed vaccines indicated for their respective age groups.
• Within approved indications and recommendations, no preferential recommendation is made for any type or brand of licensed influenza vaccine over another.
• In general, health-care providers should begin offering vaccination soon after vaccine becomes available, and if possible, by October.
Full information may be found at http://www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm#primary-changes.
HealthMap Vaccine Finder
HealthMap Vaccine Finder (http://flushot.healthmap.org) is a free, online service where users can search for locations offering flu vaccines, as well as other adult vaccines. This service partners with clinics, pharmacies, and health departments to provide accurate and up-to-date information about receiving the flu vaccine.
In 2012, Google passed the baton to HealthMap when it retired Google Flu Vaccine Finder. If you previously provided data to Google Flu Vaccine Finder and would like to still be included in the list of vaccine providers, you will need to register and upload your location data to HealthMap.
Draft Immunization Protocols
OPA annually drafts adult immunization protocols in compliance with the Ohio State Board of Pharmacy’s rules. Updated protocols for 2013 are now available. To purchase the protocol package, visit the Immunization section of the OPA website, www.ohiopharmacists.org.
“MLN Matters® Article #MM8433: Influenza Vaccine Payment Allowances - Annual Update for 2013-2014 Season.”
Advisory Committee on Immunization Practices—(ACIP)—United States, 2013-14
IAC's screening checklists for vaccines have been updated
Immunization Action Coalition (IAC) recently updated and renamed the following checklists for vaccine contraindications.
- Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination, (formerly titled "Screening Questionnaire for Inactivated Injectable Influenza Vaccination")
- Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination (formerly titled "Screening Questionnaire for Live Attenuated Intranasal Influenza Vaccination")
- Screening Checklist for Contraindications to Vaccines for Adults (formerly titled "Screening Questionnaire for Adult Immunization")
CDC makes important changes to its recommendations for vaccine storage and handling
CDC recently made several important changes to its recommendations for vaccine storage and handling. They are published in the document Interim Vaccine Storage and Handling Guidance. The introduction is reprinted below.
In response to recent scientific studies on equipment used for vaccine storage and a better understanding of best practices for vaccine storage and handling, the Centers for Disease Control and Prevention (CDC) is providing interim guidance on appropriate vaccine storage and handling practices. This guidance is intended for use by all public and private sector providers and, while recognizing that cost may be a barrier, we encourage practices to move toward implementing these recommendations as soon as possible. CDC is currently evaluating the most efficient and cost effective method to phase these recommendations in and more guidance is forthcoming.
With the goal of improving the way providers store and handle vaccines nationwide, several important changes have been made to previous recommendations issued by CDC, including:
1. Use of a biosafe glycol-encased probe or a similar temperature buffered probe rather than measurement of ambient air temperatures, and;
2. Use of digital data loggers with detachable probes that record and store temperature information at frequent programmable intervals for 24 hour temperature monitoring rather than non-continuous temperature monitoring, and;
3. Use of stand-alone refrigerator and stand-alone freezer units suitable for vaccine storage rather than combination (refrigerator+freezer) or other units not designed for storing fragile biologics, such as vaccines, and;
4. Discontinuing use of dorm-style or bar-style refrigerator/
freezers for ANY vaccine storage, even temporary storage, and;
5. Weekly review of vaccine expiration dates and rotation of vaccine stock
- Access CDC's Vaccine Storage and Handling web section
- Access IAC's Clinic Resources: Storage & Handling web section
“Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions:
Recommendation of the Advisory Committee on Immunization Practices (ACIP)”
On October 12, 2012 CDC published ACIP recommendations on use of PCV13 and PPSV23 vaccines in adults. Adults with specified immunocompromising conditions who are eligible for pneumococcal vaccine should be vaccinated with PCV13 during their next pneumococcal vaccination opportunity.
Pneumococcal vaccine-naïve persons. ACIP recommends that adults aged ≥19 years with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants, and who have not previously received PCV13 or PPSV23, should receive a dose of PCV13 first, followed by a dose of PPSV23 at least 8 weeks later (Table). Subsequent doses of PPSV23 should follow current PPSV23 recommendations for adults at high risk. Specifically, a second PPSV23 dose is recommended 5 years after the first PPSV23 dose for persons aged 19–64 years with functional or anatomic asplenia and for persons with immunocompromising conditions. Additionally, those who received PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years, or later if at least 5 years have elapsed since their previous PPSV23 dose.
Previous vaccination with PPSV23. Adults aged ≥19 years with immunocompromising conditions, functional or anatomic asplenia, CSF leaks, or cochlear implants, who previously have received ≥1 doses of PPSV23 should be given a PCV13 dose ≥1 year after the last PPSV23 dose was received. For those who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23.
To access the complete published CDC recommendations, see pages 816–819 of MMWR at http://www.cdc.gov/mmwr/pdf/wk/mm6140.pdf
Recommendations for Influenza Vaccination, Persons with Egg Allergy and Use of Antivirals
The most current information for health care professionals regarding influenza vaccine recommendations (including persons with egg allergy), vaccine supply, and recommendations for using antiviral agents for influenza can be found on the CDC website at www.cdc.gov/flu/professionals/.
- Medicaid Payment for Influenza Vaccine Administration at the Pharmacy
Medicaid will pay pharmacies for administration of seasonal influenza vaccine for dates of service October 1 through May 31 each year. Payment for influenza vaccine administration will be made to pharmacies only for Medicaid consumers who do not reside in long-term care facility (LTCF). The updated ODJFS flu shot document with complete details for this year will be available here.
For information on which managed care organizations will reimburse pharmacists for flu shots, see the “Quick Links for Medicare/Medicaid on the OPA Home page or Click Here (it’s a Members Only item)
- Barcodes added to VISs --Beginning in April 2012, new and updated Vaccine Information Statements (VISs) will contain a two-dimensional (2D) "data matrix" barcodes. Currently this technology is designed primarily to help immunization providers record required information about the VIS, by allowing them to scan the name and edition date of a VIS into an electronic medical record, immunization information system, or other electronic database. Further details can be found at http://www.cdc.gov/vaccines/pubs/vis/vis-barcodes.htm
- Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) in Adults Aged 65 Years and Older-- In February 2012, ACIP recommended Tdap for all adults aged 65 years and older. This recommendation supersedes previous Tdap recommendations regarding adults aged 65 years and older. Details on the update can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6125a4.htm .
- Use of Hepatitis B Vaccination for Adults with Diabetes Mellitus--
On October 25, 2011, ACIP recommended that all previously unvaccinated adults aged 19 through 59 years with diabetes mellitus (type 1 and type 2) be vaccinated against hepatitis B as soon as possible after a diagnosis of diabetes is made. Data on the risk for hepatitis B among adults aged ≥60 years are less robust. Therefore, ACIP recommended that unvaccinated adults aged ≥60 years with diabetes may be vaccinated at the discretion of the treating clinician after assessing their risk and the likelihood of an adequate immune response to vaccination. A summary of the recommendations and the rationale used by ACIP to inform their decision making can be found in Morbidity and Mortality Weekly Report (MMWR) December 23, 2011 / 60(50);1709-1711 at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6050a4.htm .
- Summary of Recommendations for Adult Immunization
January 2012 - This summary provided by the Immunization Action Coalition was updated in January 2012 and can be found at http://www.immunize.org/catg.d/p2011.pdf
- Vaccine Information Statements (VISs)
The latest VISs can be obtained from the Centers for Disease Control and Prevention at www.cdc.gov/vaccines/pubs/vis/default.htm.
VISs are not updated annually or on any other routine schedule. An updated VIS with a new date is posted when there is a change in recommendations.
- The Quick Reference Information: Medicare Immunization Billing chart is now available in hardcopy or as a download from the Medicare Learning Network. This chart gives Medicare fee-for-service physicians, providers, suppliers, and other health care professionals quick information to assist with filing claims for influenza, Pneumococcal Polysaccharide (PPV), and Hepatitis B (HBV) vaccines and their administration. To download, view and print the chart, click on the following link:
- Links to the Ohio Revised Code and the Ohio Administrative Code for the sections that cover immunizations by pharmacists:
Adult immunizations (ORC 4729.41)
Definitions (OAC 4729-5-01)
Pharmacy intern professional functions (OAC 4729-5-08)
Record keeping (OAC 4729-5-27)
Course requirements in the administration of immunizations (OAC 4729-5-36)
Protocols for the administration of immunizations (OAC 4729-5-37)
Immunization administration (OAC 4729-5-38)
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