Immunization - Vaccine Updates
(Last updated 10/08/2014)
CDC releases supplemental information for healthcare providers to accompany the 2014–15 influenza VISs
On October 3, CDC posted Provider Information: Influenza VISs on its website as a PDF document. These provider guidelines supplement the 2014–15 influenza VISs and summarize relevant ACIP recommendations; include more detailed information about indications, schedules, and precautions; and contain other information giving providers a quick reference to help address common patient questions.
CDC publishes ACIP recommendations for use of PCV13 and PPSV23 vaccines in adults age 65 and older
CDC published Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP) in the September 19 issue of MMWR (pages 822–825). A portion of the "ACIP Recommendations for PCV13 and PPSV23 Use" section is reprinted below.
ACIP Recommendations for PCV13 and PPSV23 Use
Both PCV13 and PPSV23 should be administered routinely in series to all adults aged ≥65 years.
Pneumococcal vaccine-naïve persons. Adults aged ≥65 years who have not previously received pneumococcal vaccine or whose previous vaccination history is unknown should receive a dose of PCV13 first, followed by a dose of PPSV23. The dose of PPSV23 should be given 6–12 months after a dose of PCV13. If PPSV23 cannot be given during this time window, the dose of PPSV23 should be given during the next visit. The two vaccines should not be coadministered, and the minimum acceptable interval between PCV13 and PPSV23 is 8 weeks.
Previous vaccination with PPSV23. Adults aged ≥65 years who have previously received ≥1 doses of PPSV23 also should receive a dose of PCV13 if they have not yet received it. A dose of PCV13 should be given ≥1 year after receipt of the most recent PPSV23 dose. For those for whom an additional dose of PPSV23 is indicated, this subsequent PPSV23 dose should be given 6–12 months after PCV13 and ≥5 years after the most recent dose of PPSV23.
Potential Time-Limited Utility of Routine PCV13 Use Among Adults ≥65 Years. The recommendations for routine PCV13 use among adults aged ≥65 years will be reevaluated in 2018 and revised as needed.
ACIP recommendations for routine use of PCV13 in adults aged ≥19 years with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants remain unchanged.
CDC publishes 2014–15 influenza vaccination recommendations in MMWR
CDC published Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014–15 Influenza Season in the August 15 issue of MMWR. The first paragraph of the report is reprinted below.
This report updates the 2013 recommendations by the Advisory Committee on Immunization Practices (ACIP) regarding use of seasonal influenza vaccines. Updated information for the 2014–15 influenza season includes 1) antigenic composition of U.S. seasonal influenza vaccines; 2) vaccine dose considerations for children aged 6 months through 8 years; and 3) a preference for the use, when immediately available, of live attenuated influenza vaccine (LAIV) for healthy children aged 2 through 8 years, to be implemented as feasible for the 2014–15 season but not later than the 2015–16 season. Information regarding issues related to influenza vaccination not addressed in this report is available in the 2013 ACIP seasonal influenza recommendations…
The report includes the preferential recommendation to use LAIV in healthy children 2 through 8 years of age when the nasal spray flu vaccine is immediately available and if the child has no contraindications or precautions to that vaccine. However, if the nasal spray vaccine is not immediately available, children in this age group should get the flu shot (IIV). Vaccination should not be delayed to obtain the nasal spray flu vaccine.
The complete article with 2014-15 influenza vaccination recommendations can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6332a3.htm .
2014-15 Influenza Vaccine Information Statements Now Available
On August 19, CDC issued two new influenza Vaccine Information Statements (VISs) for use during the 2014–15 influenza season. The VIS for inactivated influenza vaccine (IIV) is intended for use with all non-live virus formulations—trivalent, quadrivalent, cell-culture, recombinant, intradermal, and high-dose. The VIS for live attenuated intranasal influenza vaccine (LAIV) is intended for use when administering nasal-spray vaccine.
CDC updates its Vaccine Storage & Handling Toolkit
In May, CDC released an updated version of its Vaccine Storage & Handling Toolkit, originally published online in 2012. The toolkit is based on the recommendations of the Advisory Committee on Immunization Practices (ACIP), equipment manufacturers' product information, and studies from the National Institute for Scientific Technology. Here's a direct link to the updated PDF document.
The toolkit outlines best practice strategies and recommendations on the following topics:
- Points to consider in selecting, maintaining, and using vaccine storage units and thermometers
- Consistent maintenance of the cold chain
- Routine storage and handling practices
- Inventory management
- Emergency procedures for protecting vaccine inventories
On the toolkit web page, you'll also find related resources such as training materials, slide sets, and other helpful items.
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.
For pharmacists who have completed a board-approved immunization training program and whose training did not include measles, mumps and rubella vaccine, OPA’s home-study CE article Immunizations for Measles, Mumps, Rubella is approved as a supplemental course.
To order this Home-Study CE, Click Here
Guidance document on this rule change can be found at Pharmacists Can Now Administer the Measles, Mumps, and Rubella (MMR) Vaccine 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, TCSLINKTOFORM[2,Click Here]
Flu Vaccine News
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
“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/.
- 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)