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September 21, 2007

Advisory No. 6. The 2007-2008 Influenza Season

The goal of the Vaccine Advisory is to disseminate, in a timely manner, practical information related to vaccines, vaccine-preventable diseases, and the vaccine programs managed by the Immunization Branch. The Immunization Branch welcomes readers’ input to improve the contents of this document.

September 21, 2007

Advisory No. 6. The 2007-2008 Influenza Season

This advisory contains:

1. Advisory Committee on Immunization Practices Recommendation for the 2007 - 2008 Influenza Season
   • Annual Influenza Vaccination is Recommended for the following people
   • Use of the Nasal Spray Flu Vaccine
   • Who Should Not Be Vaccinated
2. National Supply Update
   
3. Local Health Department – Vaccine Purchases off of State Contract
4. Texas Vaccines for Children Program
5. Medicare
6. Medicaid Billing Codes
7. School and Child-care Requirements
8. ImmTrac
9. Texas Surveillance Update
10. Additional Resources

1) ACIP Recommendation for the 2007 - 2008 Influenza
The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for groups at increased risk for severe complications from influenza, or for influenza-associated clinic, emergency department, or hospital visits.

ACIP emphasizes that immunization providers should offer influenza vaccine and schedule immunization clinics throughout the influenza season (see Timing of Vaccination).

ACIP recommends annual influenza vaccination for people at high risk for
complications from the flu, including:

• Children aged 6 months until their 5th birthday,
• Pregnant women,
• People 50 years of age and older,
• People of any age with certain chronic medical conditions, and
• People who live in nursing homes and other long term care facilities.

People who live with or care for those at high risk for complications from flu, including:

• Household contacts of persons at high risk for complications from the flu (see above)
• Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
• Health care workers.

Anyone who wants to decrease their risk of influenza.

Use of the Nasal Spray Flu Vaccine

Vaccination with the nasal-spray flu vaccine is an option for healthy persons aged 2-49 years (read Press Release on expanded use of FluMist) who are not pregnant, even healthy persons who live with or care for those in a high risk group. The one exception is healthy persons who care for persons with severely weakened immune systems who require a protected environment; these healthy persons should get the inactivated vaccine.

Who Should Not Be Vaccinated

Some people should not be vaccinated without first consulting a physician. They include:

• People who have a severe allergy to chicken eggs.
• People who have had a severe reaction to an influenza vaccination in the past.
• People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
• Children less than 6 months of age (influenza vaccine is not approved for use in this age group).
• People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.

The ACIP lists primary changes and updates contained in the 2007 recommendations, which  include:

• ACIP reemphasizes the importance of administering 2 doses of vaccine to all children aged 6 months–8 years if they have not been vaccinated previously at any time with either LAIV (doses separated by >6 weeks) or TIV (doses separated by >4 weeks), on the basis of accumulating data indicating that 2 doses are required for protection in these children (see Vaccine Efficacy, Effectiveness, and Safety).
• ACIP recommends that children aged 6 months–8 years who received only 1 dose in their first year of vaccination receive 2 doses the following year (see Vaccine Efficacy, Effectiveness, and Safety).
• ACIP reiterates a previous recommendation that all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others should be vaccinated (see Box and Recommendations for Using TIV and LAIV During the 2007–08 Influenza Season).
• ACIP recommends that health-care administrators consider the level of vaccination coverage among healthcare personnel (HCP) to be one measure of a patient safety quality program and implement policies to encourage HCP vaccination (e.g., obtaining signed statements from HCP who decline influenza vaccination) (see Additional Information Regarding Vaccination of Specific Populations).
• The 2007–2008 trivalent vaccine strains are A/Solomon Islands/3/2006 (H1N1)-like (new for this season), A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like viruses. (see Recommendations for Using TIV and LAIV During the 2007–08 Influenza Season).

The complete 2007 ACIP recommendations regarding the use of influenza vaccine and antiviral agents may be found on the ACIP website.

2) National Supply Update

A record number of 132 million doses of influenza vaccine have been projected for the 2007-2008 influenza season.  All providers are urged to vaccinate their patients until vaccine is no longer available or it expires.  CDC provides a number of resources to keep health care professionals up-to-date on influenza vaccine and its availability.  Visit the CDC webpage for the most current information on influenza vaccine supply issues.  The Food and Drug Administration also provides information on influenza vaccine and the number of vaccine lots released.

While flu vaccine orders are generally placed during the first quarter, health care providers seeking flu vaccine may contact the major distributors to check availability.  Flu Supply News is provided by a voluntary group of flu vaccine distributors who are committed to working with the Centers for Disease Control and Prevention to ensure that seasonal flu vaccine is efficiently distributed.  The goal of the initiative is to educate and inform stakeholders on the integral role of distribution and the integrity of the flu vaccine supply chain. 

• Flu Supply News 
• A list of flu vaccine distributors

3) Local Health Department – Purchase of vaccine off of the state contract. 
Local Health Departments can utilize the following term contract’s to obtain vaccine.  Please note that there are two TBPC Term Contracts.  Vaccine contracts are Vaccine and Biologicals Term Contract, Contract Number: 269-A2 and Influenza Vaccine Term Contract, Contract Number: 269-N3.

The Vaccines and Biologicals Term Contract 269-A2 for 2007 can be accessed on the Comptroller of Public Accounts website. You will have to navigate to Term Contracts and select contract number: 269-A2.

The Influenza Vaccine Term Contract 269-N3 for the 2007-2008 influenza season can also be accessed on Comptroller of Public Accounts website. You will have to navigate to Term Contracts and select contract number: 269-N3. Influenza Pricing will be on this contract.

In referencing either vaccine contracts listed above you will be able to obtain general contract information, specifications, vendor requirements, ordering procedures and additional requirements to purchase vaccine.

These contracts are available to all eligible State of Texas entities only and is not for personal purchase or purchase by commercial entities.

If additional information or help is needed regarding the influenza contract, please contact Purchaser, Michelle Croft with the Texas Building and Procurement Commission at (512) 463-6988 or email at Purchaser.C@tbpc.state.tx.us.

4) Texas Vaccines for Children Program
The Texas Vaccines for Children Program (TVFC) provides vaccine in accordance with ACIP recommendations to eligible children free of charge.  Please refer to the attached memo for a complete listing of children eligible for TVFC influenza vaccine.

5) Medicare
Specific information concerning Medicare will be sent as soon as it becomes available in a Supplement to Advisory No. 6. The 2007-2008 Influenza Season.

6) Medicaid Billing Codes
Medicaid billing codes for flu vaccines including Flumist are as follows:

CPT codes for the vaccines

• 90655-Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
• 90656- Influenza virus vaccine, split virus, preservative free, when administered to3 years and older, for intramuscular use
• 90657- Influenza virus vaccine, split virus, when administered to children 6-35 months of age for intramuscular use
• 90658- Influenza virus vaccine, split virus, when administered to3 years and older, for intramuscular use
• 90660- Influenza virus vaccine, live, for intranasal use
• 90060- Flumist is not approved by Medicaid. Currently in the process of getting it approved.
• Appropriate administrations codes must also be used for admin fee reimbursement
  90465-90468, or 90471-90474
  

Any questions concerning Medicaid billing and/or claims should be addressed by calling 1-800-925-9126.

7) Texas school or daycare requirements for the influenza vaccine
Currently the influenza vaccine is not required for school or daycare attendance.  The close of the 80th Legislative Session resulted in the passage of House Bill (HB) 3184, which requires the DSHS to publish information about the benefits of annual vaccination against influenza; and, together with the Department of Family & Protective Services (DFPS), ensure the information is annually distributed to parents of children attending child-care in August or September.  A newly created Flu Fact Sheet for Child-Care Settings will be mailed in September to child-care facility centers in Texas for distribution to all enrolled children.  Information on the immunization requirements for children attending child-care facilities, flu information targeting children, and the recommended immunizations can also be found on the updated web page under the heading Information for Child-Care Facilities.

Please visit the School and Child-Care Requirements webpage for these materials.

8) ImmTrac
ImmTrac users can report flu vaccines administered using the ImmTrac code “Influenza”.  Although ImmTrac can record flu vaccine doses administered, and doses will be reflected on the client immunization history, the ImmTrac immunization scheduler will not generate recommendations for Influenza vaccine at this time.  Providers should consult ACIP recommendations to determine when administration of Influenza vaccine is recommended.  Please visit the ImmTrac webpage for more information.

9) Surveillance Update
The official reporting period for the 2007-2008 influenza season begins October 1, 2007.  The State of Texas utilizes a sentinel surveillance system for influenza.  Activity is determined based on data from multiple sources, including reports of influenza-like illness from clinical practitioners who participate in the Sentinel Provider Surveillance Network (SPSN), specimens submitted to the DSHS laboratory for viral culture, and outbreak reports from hospitals, long-term care facilities, and schools.  Please visit the Sentinel Provider Surveillance Network for more information. If you are interested in participating in the SPSN, please contact Irene Brown, SPSN coordinator at (512) 458-7676. Flu Activity Reports are posted online.

10) Resources

For providers:

• CDC Influenza webpage
• MMWR Recommendations for Health Care Personnel
  Influenza Vaccination of Health-Care Personnel: Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the ACIP. February 24, 2006.
• CDC Flu Vaccination Resources for Health Care Professionals
  A complete list of approved links concerning influenza vaccine. 
• DSHS Immunization Branch Website
• Vaccine Information Statements (VIS)
  The VIS for live and attenuated influenza vaccines is available through the DSHS Immunization Branch. The following Web page provides the current VISs as well as the DSHS addenda for both VISs. Scroll down to the VIS needed and download both the VIS and the appropriate addendum.  The VISs are currently being translated to Spanish and will soon be available for downloading and for ordering hard copy.
• Flu News
  The Flu News webpage posts breaking news, and is linked to the What’s New? Web page, which lists all documents recently posted or updated on the CDC flu web site, including but not limited to press releases, recommendations, and surveillance reports.
• National Influenza Vaccine Summit
  The American Medical Association and CDC cosponsor the National Influenza Vaccine Summit Newsletter, formerly known the CDC Flu Vaccine Bulletin, with recent developments in vaccine supply, production, and distribution. 
• Influenza Vaccination Pocket Information Guide
  The Influenza Vaccination Pocket Information Guide is a quick reference tool that gives front-line healthcare personnel useful information about the use of both inactivated (injectable) and live (intranasal) influenza vaccines.  Also available is a pocket guide for pneumococcal polysaccharide vaccine (PPV) to help encourage vaccination of high-risk patients for pneumococcal disease.  A pdf version of this guide is available through this link.

For the public and health educators:

• CDC’s Flu Gallery
  Contains educational materials for promoting influenza vaccination.  The Gallery contains printed materials such as flyers and posters, in color and black and white, English and Spanish.
• Guidance to Individuals Seeking Flu Vaccination
  Individuals are encouraged to seek influenza vaccination from their usual healthcare provider, especially those who fall into any of the risk groups.  Other resources are also available.
  1. The American Lung Association hosts a web-based Flu Clinic Locator, which searches for clinics by zip code.  All organizations with clinics open to the public are welcomed to post their clinics on the site.  Organizations listed must agree to follow CDC guidelines and to update postings if they make changes.
  2. Local health departments and DSHS health service regional offices may also host clinics or maintain lists of local clinics on their websites.  Call or check the website of your local health department for more information.

We hope you generously forward this advisory to others who may benefit from this information.  

Texas Department of State Health Services Immunization Branch
P.O. Box 149347, Austin, Texas, 78714-9347. 1-800.252.9152
www.ImmunizeTexas.com

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Last Updated September 24, 2007