News From the PHSKC Vaccine Distribution Program
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Influenza 2000
Public Health - Seattle & King County is planning to begin its influenza campaign on November 6th, due to anticipated delays in the nationwide manufacturing of influenza vaccine this year. We are hoping to make public-funded vaccine available to all public and private providers by early November.
Once our vaccine distributor receives its shipment of flu vaccine, providers who receive public vaccines will be notified by mail and instructed on how to place orders. As in prior years, providers will be instructed to submit a single vaccine request for the entire influenza season. The request will be reviewed by vaccine program staff and compared with prior year's data on doses administered by the provider or clinic. Then, the influenza vaccine will be allocated in a one-time shipment to each office.
State-supplied influenza vaccine will be available only for children 6 months through 18 years who meet the following high risk criteria:
- chronic illness (pulmonary, such as chronic bronchitis & asthma; cardiovascular; metabolic diseases, including diabetes mellitus; renal dysfunction; hemoglobinopathies, such as sickle cell disease)
- immunosuppression - including immunosuppression caused by medications
- chronic aspirin therapy (due to risk of Reye's syndrome following influenza infection)
A reproducible copy of the new Vaccine Information Statement (VIS) for Influenza 2000-01 is included with this issue of the Vac Scene. It may also be downloaded from www.immunize.org
Pneumococcal Vaccine: Which One is Public-Funded?
The state-supplied pneumococcal vaccine available to providers through public health continues to be the 23-valent polysaccharide vaccine for high-risk children (age 2 through 18 years) who meet the following criteria: asplenia; sickle cell disease; nephrotic syndrome; cerebral spinal fluid leaks; immunosuppression; or persons living in environments or social settings with an identified increased risk of pneumococcal disease or its complications.
REMINDER: Routine revaccination of immunocompetent persons who receive this 23-valent vaccine is NOT recommended. However, it is not contraindicated to revaccinate someone at high risk who does not recall having received a prior dose.
People with severe immunosuppressive conditions who are at highest risk of disease and who are more likely to experience rapid declines in vaccine induced antibody should be revaccinated according to the following intervals:
- Any person aged > 2 years for whom it has been 5 years since receipt of first dose. Revaccination 3 years after the previous dose may be considered for children at highest risk for severe pneumococcal infection who would be aged 10 years or less at time of revaccination.
- Persons aged > 65 years, if they received their first dose > 5 years prior, and were age < 65 years at the time of primary vaccination.
PrevnarTM is the newly licensed pneumococcal conjugate vaccine (7-valent) for children age 6 weeks to 9 years, but it is not yet available through the state-supplied vaccine program. PrevnarTM has been recommended by the federal Advisory Committee on Immunization Practices (ACIP) and it will be approved by the National Immunization Program for use in the Vaccines for Children (VFC) Program. However, the recommendation has not officially been published in the MMWR and is not expected to be until at least September.
As with any new recommended vaccine, the Washington Department of Health (DOH) goes through a process of getting recommendations from the state Vaccine Advisory Committee (VAC). The purpose of the VAC is to provide recommendations to the DOH Immunization Program on current immunization issues. The VAC has met and made preliminary recommendations for implementation of PrevnarTM. Discussions are currently taking place at the Department of Health to determine the best approach to secure additional funding for this vaccine. Providers will be notified as soon as the vaccine becomes available.
Benchmarking During August 2000
All health care providers who receive state-supplied vaccine should have received a benchmarking training packet and a supply of green survey (benchmarking) forms to use for the benchmarking process. This year, DOH mailed each clinic a customized patient survey form, pre-printed with the clinic's name, followed by a master copy of the benchmarking survey form for clinics to use to make additional photocopies, if necessary.
The DOH-assigned identification number that appears in the top right corner of the form only pertains to statewide benchmarking and is not to be confused with the vaccine program ID number that Public Health-Seattle & King County assigns each provider who contracts to receive vaccines. The vaccine program ID number must be used with all communications about the contract or about ordering, receiving vaccines. If you do not remember your vaccine program ID number it can be found near the clinic address on the packing slip that is enclosed in each delivery of state-supplied vaccines.
Measles Vaccine: 2 Doses Required for Kindergarten 2000-01
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Just a reminder: Beginning this school year, all children entering kindergarten will need to show proof of having received two doses of measles-containing vaccine given after the first birthday and at least 28 days apart, and at least one dose each of mumps and rubella vaccine. Two doses of MMR are recommended and preferred for fulfillment of this requirement.
Two doses of measles-containing vaccine continue to be required for all students in 6th Grade and students new to the district.
Note: Parents may exempt their child from receiving vaccines required by Washington State for school entry based on medical, religious or philosophic reasons.
Aventis Pasteur has issued a voluntary recall of three lots of IMOVAX® Rabies I.D. (Intradermal Rabies Vaccine). In the course of routine stability testing, it was learned that the potency of lot P0313-2 had fallen below specification 24 months after manufacturing. Although this product met all specifications at the time of release, its potency fell below specification prior to the product's expiration date. Lots P0030-2 and N1204-2 are also being recalled as a precautionary measure, as all three lots were prepared from the same initial bulk lot.
Aventis Pasteur has sent recall notices to all providers who have received vaccine from these lots. These vaccines would have been used for pre-exposure prophylaxis sometime between March 1999 and the present. A toll-free number has been set up for medical inquiries about the recall: (800) 752-9340.
As a precaution, patients who were vaccinated with one of these lots for pre-exposure prophylaxis and who remain at risk for rabies exposure should either be tested to measure the presence of antibodies and be vaccinated as needed (if the testing does not substantially delay vaccination), or be revaccinated. Aventis Pasteur recommends that patients be revaccinated with one dose of IMOVAX® Rabies, for intramuscular use.
Immunization Update 2000: A CDC Satellite Course
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Region X of the U.S. Public Health Service and Public Health – Seattle & King County are co-sponsoring CDC's Immunization Update 2000, on Thursday, September 14th , 9:00-11:45 AM.
Anticipated topics include new recommendations for the use of: pneumococcal conjugate vaccine; influenza vaccine for the 2000-01 influenza season; meningococcal vaccine; and hepatitis B vaccine for adolescents. Recent vaccine safety issues will also be discussed. Continuing education credits will be available for a variety of health professions.
For detailed information about the program, please refer to the enclosed registration form. If you need additional information, call Amy Patton, 206-205-5803, or email amy.patton@metrokc.gov., at the Blanchard Plaza Building in Seattle.
CDC's Pneumococcal Conjugate VIS Now Available!
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The Centers for Disease Control & Prevention (CDC) has developed an interim Vaccine Information Statement (VIS) for pneumococcal conjugate vaccine for infants and children which is now available on the Immunization Action Coalition website at: www.immunize.org/vis/pnPCV7.pdf. (please note: you will need the Adobe Acrobt Reader program installed on your computer in order to view the VIS. To download the Reader program for free, just click here). Foreign language translations are not yet available.
This new VIS should not be confused with the pneumococcal polysaccharide VIS (date 7/29/97), which is used for persons 2 years and older who are at high-risk for invasive pneumococcal disease.
Public-Funded Hepatitis A Vaccine for 18-Year-Olds
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Since July 1, 2000, children 2-18 years of age in several Washington counties (including King) have been eligible to receive state-supplied hepatitis A vaccine. The vaccine currently supplied by the Washington Department of Health (DOH) is the pediatric formulation of Merck's VAQTA, which is licensed for children age 2 through 17 years. While Merck's application to the FDA for licensure of this vaccine in 18-year-olds is expected to be approved in the near future, giving this vaccine to 18-year-olds is an "off-label" use of the product.
To extend vaccine availability to 18 year olds, DOH has ordered a small supply of SmithKline Beecham's Havrix pediatric formulation of hepatitis A vaccine. The PHSKC Vaccine Distribution Program will notify providers when pediatric Havrix becomes available for ordering.
