Immunization Program
Vaccines for Children (VFC)
Updated: Wednesday, June 11, 2008 at 02:37 PM
Vaccines for Children (VFC) was established in 1993 to remove the barriers of cost and access to attaining childhood immunizations. The program is funded by the Centers for Disease Control and Prevention (CDC) and the State of Washington, and supplies vaccines to providers across the state. Almost 95% of public and private immunization providers in King County are currently enrolled. All children from birth up to the 19th birthday (hepatitis B up to the 20th birthday) are eligible to receive these vaccines; see below for vaccine-specific restrictions.
Please remember to contact the VFC Program at (206) 296-4774 whenever you have a question about vaccine storage and safety. It is important to consult with Public Health before making decisions about vaccine viability. We are here to help you protect your vaccine supply and provide safe immunizations.
SHIPMENTS: Please allow 8-10 business days from date of request for refrigerated vaccine shipments; allow 15 business days for frozen vaccine shipments.
IMPORTANT INFORMATION ON REFRIGERATORS
With the 2008 Provider Agreement (for participation in the VFC Program), the CDC has officially stated that "dorm-style" refrigerators are unacceptable for overnight vaccine storage. "Dorm-style" refrigerators are defined as smaller units with a freezer shelf inside the refrigerator. Stand-alone freezers, and refrigerators without freezers (commercial-type) may be better at maintaining required temperatures. So-called "lab" or other commercial-quality units are the best recommendation. However, a combination refrigerator/freezer unit sold for home use is acceptable for vaccine storage if the refrigerator and freezer compartments each have a separate external door. The following are some of the features of a reliable refrigerator for storing vaccines:
- It should contain vaccines only--no food or beverages, and no specimens, cultures or other medical materials that may contaminate by contact
- It should maintain a safe temperature range year-round, monitored by two or more certified thermometers (indicated by the "NIST" or "ASTM" designation)
- It should be large enough to store the clinic's vaccine supply at the busiest time of the year (usually August thru November)
- It should NOT have a freezer shelf inside the refrigerator.
Provider offices and clinics currently using a "dorm-style" refrigerator can get information and guidance in upgrading their vaccine storage equipment by contacting Public Health at (206) 296-4774 and asking for the VFC Program. Please begin planning now to replace any dorm-style refrigerator before December 31, 2008. Think of your new vaccine storage refrigerator as insurance that protects patient health and safeguards your practice against costly vaccine replacement.
You may wish to keep a dorm-style refrigerator to store a one-day supply of vaccine. This may be helpful in physically large provider offices in particular. However, this "one-day supply" must be returned to the larger, regular refrigerator at the end of each clinic day.
VFC SUPPLY REPORT:
DT is offered as an option for children with a previous reaction to the pertussis antigen in DTAP. Order conservatively and monitor expiration dates carefully. Please remember to return expired, unopened vials of DT vaccine to the VFC Program. Refer to the VFC Provider Manual or call (206) 296-4774 for details.
We are currently shipping the Daptacel (Sanofi Pasteur) brand of vaccine. NOTE: Daptacel has now been licensed for the 5th dose in an all-Daptacel series. According to CDC, Daptacel may also be used as the 5th dose in a DTaP series that contained other brands of DTaP. For additional information visit the FDA site, product approval information. www.fda.gov/cber/products/daptacel.htm
DTaP-IPV-Hepatitis B (PediarixTM)
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Availability of Pediarix™ may be limited due to funding constraints. In order to maximize the number of children who may benefit from this combination vaccine, Public Health recommends administering Pediarix™ at visits when DTaP, IPV and Hepatitis B vaccination is indicated. For example:
- For children who received the birth dose of hepatitis B vaccine, Pediarix™ could be administered at 2 and 6 months, and available DTaP vaccine would be used at 4 months*.
- Availability of Pediarix™ does not change the indication for the birth dose of hepatitis B vaccine, which should be administered. However, for children who have not received the birth dose of hepatitis B vaccine, Pediarix™ could be administered at 2, 4 and 6 months.
* Clinicians are not prohibited from using Pediarix™ at the 4 month visit.
What about using different formulations of DTaP-containing vaccine?
The CDC’s Advisory Committee on Immunization Practices General Recommendations on Immunization (MMWR December 1, 2006 / 55(RR15);1-48, available at: http://www.cdc.gov/nip/publications/acip-list.htm#genrecs), states that although using the same brand of DTaP is desirable whenever feasible, it is permissible to use any DTaP vaccine for the vaccination series.
Washington State VFC programs now provide the Havrix (GSK) brand of Hepatitis A vaccine, following supply issues with Merck's Vaqta brand. Pediatric Vaqta and Havrix are interchangeable and the routine schedule can be followed.
Washington State VFC programs now provide the Engerix (GSK) brand of Hepatitis B vaccine, following supply issues with Merck's Recombivax brand. Pediatric Recombivax and Engerix are interchangeable and the routine schedule can be followed.
Please note the special interim Hib vaccine usage recommendations described below. The recall of Merck-manufactured Hib vaccines was discussed in Broadcast Fax #13-2007; please refer to that announcement for more information. Following the interim usage instructions is extremely important. Public Health receives a monthly allocation, which must be distributed throughout King County. Each request will be carefully reviewed and may be reduced or deleted based on usage and inventory information--watch for confirmation faxes when product is on its way. Requests that cannot be fulfilled immediately will be held as backorders and shipped when product comes in. The shortage is expected to continue through the end of 2008.
Per the CDC, in consultation with the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians, and the American Academy of Pediatrics (AAP):
- Complete the primary series of Hib vaccination (at 2, 4, and 6 months) for all children.
- Continue to give the 4th dose (usually at 12-15 months) to children in specific high risk groups, including: children with asplenia, sickle cell disease, HIV-infection and certain other immunodeficiency syndromes, and malignant neoplasms. Hib vaccines are also recommended for use in prophylaxis for susceptible close contacts of patients with Hib disease.
- Temporarily defer administering the routine Hib vaccine booster dose (#4) for children not in these high risk groups.
- Providers should register and track children for whom the booster dose is deferred to enable recalling them when supply improves.
- Children who are behind schedule should complete the primary series according to age-appropriate recommendations.
- Native American/Alaskan Native children in communities with circulating Hib disease are also at increased risk, particularly in the first six months of life. Health care providers serving high-risk Native American/Alaskan Native children and using either PedVax or Comvax are advised to call Public Health for more detailed vaccine usage guidance (206-296-4774).
- To maximize the amount of available vaccine, providers should order only the number of doses of vaccine needed to meet immediate needs (i.e., a supply for up to 4 weeks) and should refrain from attempting to build an inventory of Hib vaccine. Requests for Hib vaccine will be carefully reviewed by Public Health and the state Department of Health (DOH).
- Details online.
Human papillomavirus vaccine
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Gardasil® is a quadrivalent vaccine that protects against four human papilloma virus types (6, 11, 16, 18), which are responsible for 70% of cervical cancers and 90% of genital warts. More information for parents and health care providers is available through the CDC Web site at www.cdc.gov/std/hpv/default.htm. The vaccine should be stored at 35-46F and protected from exposure to light. VFC Program usage guidelines:
A 3-dose series for adolescent females from 9 years of age up to the 19th birthday:
- Adolescent females 11-12 years of age
- Adolescent females 13-18 years of age who have not been previously vaccinated or who have not completed the full series.
PLEASE NOTE: Young women who have reached their 19th birthday are no longer eligible for state-supplied vaccine, even when the 3-dose series is incomplete. Health care providers may be interested in signing up for the Merck Vaccines Patient Assistance Program, which helps provide reduced cost adult vaccines. Contact your Merck representative or visit www.merck.com/merckhelps/vaccines/home.html.
- Females as young as 9 years of age may be vaccinated
Recommended intervals:
- 1st dose: at initial visit
- 2nd dose: 2 months after the first dose
- 3rd dose: 6 months after the first dose
Flu vaccine cannot be returned to the vaccine distributor until after expiration, June 30, 2008. A Vaccine Return form specifically for flu vaccine will be provided soon.
Sanofi-Pasteur's IPOL vaccine is available to all children from 6 weeks of age up to the 19th birthday. The recommended 4-dose schedule is 2 months, 4 months, 6-18 months, and a booster dose at 4-6 years of age.
First dose:
- children from 12 months up to the 19th birthday
- adults born in 1957 or later who are entering college
Second dose:
- children entering kindergarten or born on or after 9/1/1995
- children entering 6th grade
- transfer students in grades 7-12 who have not previously received a second dose
- adults born in 1957 or later who are entering college
NOTE: Please consult with Public Health regarding the appropriate use of MMR during measles outbreaks.
MMR-V vaccine (ProQuad) is unavailable until sometime in 2009. Requests for MMR-V vaccine cannot be accepted.
If you have questions, please speak with your Merck Representative or call the Merck National Service Center at 800-MERCK-90 (800-637-2590).
- A single dose of meningococcal vaccine (Menactra or MCV4) is recommended for adolescents 11-12 years of age
- A single dose for those adolescents who have not previously received MCV4, before high school entry (at approximately 15 years of age).
Other populations at increased risk for meningococcal disease:
- Who have terminal compliment component deficiencies
- Who have anatomic or functional asplenia
- Who travel to countries in which N. meningititidis is hyperendemic or epidemic, particularly if contact with the local population will be prolonged.
- Who are entering college as freshmen living in dormitories
- Military recruits
Children age 2 up to the 19th birthday meeting the following high risk criteria:
- children who travel to or reside in countries in which N. meningitidis is hyperendemic or epidemic, particularly if contact with the local population will be prolonged
- children who have terminal complement component deficiencies
- children who have anatomic or functional asplenia
- children previously vaccinated with MPSV4 who remain at increased risk for meningococcal disease
- providers may elect to vaccinate children infected with human immunodeficiency virus (HIV)
Pneumococcal conjugate (“Prevnar”) vaccine is supplied in boxes of 10 pre-filled syringes.
- All children from 2 months up to the 2nd birthday
- The first dose may be given as early as six weeks of age
- Children from 2 years up to the 5th birthday in consultation with health care provider
Catch-up vaccination
- For all healthy children 24-59 months of age who have not completed any recommended schedule for PCV7, administer one dose of PCV7.
- For all children with underlying medical conditions 24-59 months of age who have received 3 doses, administer one dose of PCV7.
- For all children with underlying medical conditions 25-59 months of age who have received <3 doses, administer 2 doses of PCV7 at least 8 weeks apart.
In addition, state-supplied PCV7 is available for children from 24 months of age up to the 5th birthday upon request of parents and after consultation with their health care provider.
Pneumococcal polysaccharide
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This vaccine is recommended, in addition to the pneumococcal conjugate vaccine, for children aged 2 years up to the 19th birthday who meet the following high risk criteria: asplenia, sickle cell disease, nephritic syndrome; cerebral spinal fluid leaks; immunosuppression; children living in special environments or social settings with an identified increased risk of pneumococcal disease or its complications (e.g., certain Native American populations).
Tdap (adolescent pertussis booster)
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Previously, the Washington State VFC Program supplied the Boostrix brand of Tdap vaccine (Glaxo Smith Kline). Beginning May 1, 2008, the ADACEL brand will be supplied (Sanofi-Pasteur). Please note that Adacel is NOT licensed for children under the age of 11 years; do not administer Adacel vaccine to 10-year olds.
The recommended age groups for this vaccine are: Children from 11 years of age up to the 19th birthday.
- A single dose of Tdap instead of Td for booster immunization against tetanus, diphtheria and pertussis if they have completed the recommended childhood DTP/DTaP vaccination. The preferred age for Tdap vaccination is 11-12 years.
- A 5-year interval between Td and Tdap is encouraged to reduce the risk of local or systemic reactions. However, intervals shorter than 5 years can be used.
Tdap is also recommended in other special circumstances. Refer to the recent mailing from Public Health regarding the correct selection of tetanus-diphtheria-pertussis containing vaccines.
The school requirement for Tdap vaccination is as follows: One dose Tdap IF student is 11 years old and IF it has been at least 5 years since the last DTaP, DT, or Td. Schools should not be requiring ten-year olds entering the 6th grade to be vaccinated with Tdap. Please note that Td will not satisfy the school requirement.
Note that Td supplied by the VFC Program is for CHILDREN ages 7 years up to the 19th birthday ONLY. Adults needing Td shots for wound prophylaxis, travel risks or boosters should be immunized from purchased supplies. Using state-supplied vaccine outside the VFC Guidelines is a violation of the Provider Agreement.
Washington State and King County’s VFC Programs have begun supplying health care providers with Td vaccine in pre-filled syringes, 10 to a box (“Decavac”). This is the same vaccine as the more familiar, generic Td in multi-dose vials however, it is preservative-free. Although VFC will begin offering Tdap vaccine in July 2006, health care providers are advised to continue carrying a supply of Td vaccine. Tdap is licensed for only one dose and there are a number of situations where Td vaccine will be the recommendation.
Rotavirus vaccine (RotaTeq®) has been shown to prevent 74% of all rotavirus gastroenteritis cases and 98% of severe cases. In addition, the rotavirus vaccine reduced the need for hospitalization for gastroenteritis due to rotavirus by 96 percent. More information for parents and health care providers is available through the CDC Web site.
The vaccine should be stored at 35-46ºF and protected from light exposure. VFC Program usage guidelines:
Infants aged 6 weeks up to 32 weeks:
- First dose: children 6-12 weeks of age
- Second dose: children 4 months of age (4 to 10 weeks after the first dose)
- Third dose: children 6 months of age (4 to 10 weeks after the second dose)
The first dose of rotavirus vaccine for infants should be given between 6 and 12 weeks of age because of insufficient data on the safety of the first dose in older infants.
Rotavirus vaccine should not be administered on or after 32 weeks of age, even if fewer than 3 doses have been administered.
Substitute House Bill 2475, regarding the scope of practice for Health Care Assistants (HCA), signed by Governor Gregoire on March 13, 2008, becomes effective June 12, 2008. This bill expands the scope of practice for HCAs by allowing them to administer all FDA approved vaccines given by "injection, orally, or topically, including nasal administration". As a result, HCAs may administer rotavirus (oral) and FluMist (intranasal) vaccines, in addition to injectable vaccines for children and adults. Also, physician assistants and osteopathic physician assistants are added to the list of professions that may assign specific duties, such as vaccine administration, to HCAs.
The usage guidelines for state-supplied varicella vaccine have been expanded:
- First dose: children 12-15 months of age, and children up to the 19th birthday who do not have varicella immunity.
- Second dose: children 4-6 years of age, and children up to the 19th birthday who do not have varicella immunity and who have not received two doses of varicella vaccine.
MMRV vaccine (ProQuad®) may be used when a child needs both MMR and varicella vaccination. Both MMRV (currently not available) and varicella vaccine are shipped directly to providers from the manufacturer; please allow 3 weeks between order date and vaccine delivery.
The new varicella (chickenpox) vaccine requirements to attend school, childcare, and preschool as of July 1, 2008, will impact children in the upcoming school year. If children receive all of the vaccines recommended for their age, they will also meet school vaccination requirements. The following information must be documented on the Certificate of Immunization Status (CIS).
Documented doses of varicella vaccine:
- One dose of varicella vaccine is required for children age 16 months up to kindergarten who are entering childcare or preschool and for children entering grades 1, 2, and 6.
- Two doses of varicella vaccine, received on or after the child’s first birthday and at least 28 days apart, are required for children entering kindergarten.
- Proof of provider diagnosis (CHILD Profile Immunization Registry-generated CIS or a signed note) or verification of a history of varicella disease or herpes zoster is required for children in childcare/preschool and entering kindergarten.
- Parent-reported history of disease is still acceptable, but only for children in first grade and above.
- Positive blood test (titer) for history of varicella disease;
- Exemption from immunity based on medical, religious, or personal reasons.
IMPORTANT! Varicella vaccine must be kept frozen at +5º F (-15ºC) or colder and must be used within 30 minutes of reconstitution. Provider freezers must be “certified” to receive and store varicella vaccine. Contact Public Health at 206-296-4774 for certification requirements.
Forms for King County health care providers
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The following forms are available in Microsoft Office formats. If you need assistance with these forms, please contact us.
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learn more
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Plain Talk About Child Immunizations
Facts about  childhood immunization; vaccine preventable disease, vaccine safety, the immune system and how vaccines work, legal requirements, and more.
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Child Care Health
 Info written for Child Care Health facilities including fact sheets, publications, classes and events schedule.
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 Stop Germs, Stay Healthy! Learn about respiratory etiquette, watch public service announcements, play the "Catch That Cough!" game and get free posters.
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Reportable Diseases in King County
 Health care providers, health care facilities, schools and child care programs are required to report communicable diseases to Public Health per Washington Administrative Code (WAC) 246-101-101.
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