News from Public Health's Vaccines for Children Program*
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When to order, when to report
We have been receiving questions from providers regarding due dates for reports and vaccine orders. The following are some steps to (hopefully) make life a little easier for vaccine coordinators at each provider site.
- Temperature logs and usage reports are due by the 15th of every month; each report should cover the previous calendar month.
- It is not necessary to submit temperature logs and usage reports when you place an order for vaccine.
- Your vaccine order can be submitted at any time during the month. Reports affect a vaccine order only when a temperature log or usage report is overdue.
- Orders are filled first thing in the morning on Mondays, Tuesdays and Wednesdays (except in holiday weeks). It is important to allow eight (8) business days for your order to arrive, although it will usually take less time.
- Occasionally, providers experience higher-than-expected demand. Don't run out of vaccine! VFC recommendation is to maintain a 30 day supply. Let us know when you have a special need for more vaccine.
Please call with any questions about the VFC ordering and reporting process at (206) 296-4774.
*Vaccines For Children (VFC) is the vaccine distribution program of Public Health-Seattle & King County, supported with federal, state and local funds. It is also the name of the federal program that provides the federal share of vaccine. There are no eligibility requirements for children to participate in the program in Washington State.
2003 site visits
You may receive a letter from the VFC Program informing you that your site has been selected for a site visit in 2003. The selection process is randomized; however, each provider enrolled in the program will be visited at some point, as required by the Centers for Disease Control and Prevention. The focus of the visit will be to strengthen the partnership between the provider and the VFC Program.
The site visits should reinforce that that the Public Health Immunization Program is a resource for information and training for you and your office staff. It is also an opportunity for you to tell us about your site's accomplishments with regard to immunizations. As per our federal partners, we must also be assured that the Provider Agreement is being observed, and we will discuss with you any educational needs that become apparent. We encourage you to let us know how we can best identify and meet your immunization-related needs.
We recognize that, although our Immunization Program staff deals with immunizations all day, for most health care providers immunizations are but one part of a large number of responsibilities. We very much appreciate the effort you put into providing high quality immunization services to prevent illness among King County's children.
VFC Provider Manual Update
Watch the mail for your copy of the VFC Provider Manual update. This packet will include a new Washington State Department of Health Materials Order Form, an improved State Supplied Vaccine Request Form, an updated Emergency Storage Protocol, and a new Vaccine Return Form. Let us know if there is other information you would like to see in the Provider Manual.
Contract renewal
Watch the mail for your copy of the Outside Provider Agreement renewal, arriving in late December or early January. The completed and signed Agreements must be received by our VFC Program by January 31, 2003 to assure timely delivery of vaccine.
VFC influenza vaccine
VFC staff is filling orders for influenza vaccine for the 2002-2003 flu season. Children 0-18 years of age with high-risk medical conditions or children whose household contacts are at high risk for complications from the flu are eligible for VFC's state-supplied flu vaccine.
The Centers for Disease Control & Prevention (CDC) is also encouraging health care providers to immunize healthy children ages 6 months through 23 months against the flu because this population is at substantially increased risk for influenza-related hospitalizations. However, healthy children ages 6-23 months are not eligible for state-supplied influenza vaccine for the 2002-2003 flu season. Providers must purchase influenza vaccine for this population.
Although influenza vaccine is now strongly encouraged by the Advisory Committee on Immunization Practice (ACIP) for all children 6-23 months old, ACIP has chosen to delay consideration of a universal recommendation extending VFC coverage to this cohort. Consideration of a universal influenza vaccination recommendation will depend upon data from studies conducted during the next few influenza seasons.
In the coming weeks, Susan Tower and Krista Rietberg of Public Health's Immunization Program will be delivering certificates to the following VFC-enrolled providers. The certificates acknowledge the achievement of a 90% or greater up-to-date immunization rate for their two-year-old patients. Congratulations (and thanks) to all!
- Carolyn Downs Family Medical Center
- Country Doctor Community Clinic
- Eastside Community Health Center
- Federal Way Community Health Center
- Kent Multicare Clinic
- North Seattle Pediatrics
- Pediatric Associates/Factoria
- Pediatrics Northwest
- Seahurst Pediatrics
- Seattle Indian Health Board
- UW Medical Center Family Medicine
- Valley Family Care
- Virginia Mason/Issaquah
- Women's Health Specialists
- Woodinville Primary Care
Conditional Status Ends January 1st, 2003
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Children will be expected to be fully immunized when they return to school after January 1, 2003. The statewide extension of conditional status required for school attendance in place since last August in response to shortages of diphtheria, tetanus and pertussis (DTaP) vaccine is no longer in effect. The Washington Department of Health is reinstating minimum immunization requirements for children in school or licensed childcare. Vaccine supplies in the state are now sufficient to immunize children who had to delay getting shots earlier this year.
Influenza vaccine-It's not too late to vaccinate
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Providers are reminded to give flu vaccinations through the flu season. Besides having an adequate supply in Washington State, distribution sites across the country report ample supplies. Although January through March is considered our peak flu season, flu shots can be given as long as current supplies last, particularly for those traveling to areas known to be experiencing high influenza activity. It is preferred that the flu shot be received 14 days prior to travel exposure; however, in the case of a shorter interval, some protection against influenza is thought to be better than no protection.
New Pediatric Combination Vaccine approved
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The Food and Drug Administration (FDA) has announced the approval of a new combination vaccine (Pediarix*, SmithKline Beecham Vaccines) that includes DTaP, IPV, and Hepatitis B vaccines in one intramuscular injection The new vaccine has the potential for decreasing from 15 to 9 the number of immunization injections that are given in the first year to children in the United States.
Pediarix* is recommended for administration as a 3-dose primary series to infants at approximately 2, 4, and 6 months of age. Pediarix* should not be administered to infants before the age of 6 weeks, and therefore is not indicated for infants born to mothers who are HBsAg-positive or whose hepatitis B status is unknown. Such infants should receive hepatitis B vaccine within 12 hours of birth and complete their immunization according to a schedule indicated for infants at high risk for hepatitis B infection.
While it is not yet established if the Washington Department of Health will include Pediarix* in its 2003 VFC contract, private providers will have the option to purchase the new vaccine directly from the manufacturer.
Danish study examines MMR and autism
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Based on a cohort of over 500,000 children that received the MMR vaccine, Danish researchers report no statistical relationship between the age of the child during receipt of the MMR vaccine, the duration of time since vaccination, or the date of vaccination and the development of autistic disorder.
The research, recently published in the New England Journal of Medicine, conducted a retrospective study of all children born in Denmark from January 1991 through December 1998. MMRvaccination status was compared to diagnoses of autistic disorders attempting to establish the statistical relative risk of developing an autistic disorder. Those immunized with MMR had no greater incidence of autistic disorders than did those who were immunized. The conclusions of the study provide strong evidence against the hypothesis that MMR vaccination causes autism. For the full text go to: http://content.nejm.org/cgi/content/short/347/19/1477
Varicella Vaccine Efficacy Issue
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Current ACIP recommendations do not support the need for a second varicella dose to those children under 13 nor do they recommend routine post-vaccination titer. However, an editorial in a recent New England Journal of Medicine (December 12, 2002), written as a comment about an article on varicella outbreak in a day-care center (same issue), has generated conversation regarding the potential need for a second dose of varicella for children under 13 years of age.
According to the article, the effectiveness of the vaccine among the daycare center's immunized children was only 44 percent, much lower than that previously reported and representing a much higher "breakthrough" varicella rate than the usual 10 to 15 percent of vaccinated persons.
Several risk factors for the apparent vaccine failure are suggested, although the one most likely implicated in this incident was a longer interval between vaccination and exposure. To review the ACIP recommendations for the use of varicella vaccine, see:
www.cdc.gov/mmwr/preview/mmwrhtml/00042990.htm
Read the NEJM editorial at (membership required):
http://content.nejm.org/cgi/content/full/347/24/1962
