1. Immunization Update Call 7/9/2013
CDPH Immunization Branch
These slides are posted on the
Immunization Coordinators’ website

2. Topics Covered on Today’s Call
Hep A
CAIR Update
Influenza
VFC Update
Legislation Update
LHD Contracts
Upcoming Meetings
CAIR Flu Demo

3. Hep A Update As of 7/3/13: 140 cases in US, 69 in CA
Illness onset dates 3/31/2013 – 6/24/2013
Outbreak strain found in 56 cases
15 CA case, 1 WI case exposed in CA
Outbreak genotype 1B frequent in North Africa, Middle East, but not in the Americas
FDA and CDC: Most likely vehicle appears to be pomegranate seeds from a Turkish company used in the Townsend Farms Organic Antioxidant Blend sold at Costco and 2 other recalled products.

4. CAIR Update
Working on hiring 1 full time person and 1 temp for Help Desk
Recert continues until July 31, 2013

5. Avian Influenza A (H7N9) Virus in China
No new cases detected in last month
Similar to H5N1 virus, prototype vaccine will be evaluated in small clinical trials to establish dosages and schedule
No larger vaccine efforts at this time - only planning in case of broader spread
Opportunity to review your preparedness plans for the next pandemic
Seasonal influenza vaccine delivery, including school-located immunization, is a foundation for delivery of pandemic vaccine

6. U.S. Influenza Vaccine, 2013-2014 Season, Licensed for children and adults
Ages
Trade Name
Mfr.
Presentation
VFC?
6-35 mo
Fluzone® Fluzone® Quadrivalent      
sanofi pasteur
0.25 mL single-dose syringe
0.25 mL single-dose syringe 
Yes No
2-49 yrs
FluMist® Quadrivalent
MedImmune
0.2 mL intranasal sprayer
≥3 yrs* 
Fluzone®
Fluzone® Quadrivalent
0.5 mL single-dose vial
0.5 mL single-dose syringe
5.0 mL multidose vial
≥3 yrs   
Fluarix® 
Fluarix® Quadrivalent
GSK
≥4 yrs
Fluvirin®         
Novartis
≥9 yrs**
Afluria®    
CSL / Merck
0.5 mL single-dose syringe 
*Fluzone is licensed down to 6 months, but typically can only be given to patients 3 yrs and older in CA
**Afluria is licensed for 5 yrs and older, but ACIP recommends for 9 amd older

7. U.S. Influenza Vaccine, 2013-2014 Season Licensed only for adults
Ages
Trade Name
Mfr
Presentation
≥18 yrs  
Flucelvax®        
Novartis
0.5 mL single-dose syringe 
≥18 yrs
FluLaval®
ID Biomedical
5.0 mL multidose vial
18-49 yrs
FluBlok® (Recombinant)
Protein Sciences
0.5 mL single-dose syringe
18-64 yrs
Fluzone® Intradermal   
sanofi pasteur
0.1 mL prefilled microinjection system
≥65 yrs  
Fluzone® High-Dose     

8. Flu Communications Updated 2013-14 Flu Resources on EZIZ.org
Flu Print Materials Fax-back Form (deadline in Aug)
CDPH Press Release (TBD)
Social Media Messaging
Weekly Flu Messages to Providers (Sept)
Week 1: General Public
Week 2: Childcare and School-aged Children
Week 3: Healthcare Workers
Week 4: Pregnant Women
CDC Flu Season Launch Press Event (TBD)

9. Flu Packets Materials to be included with flu shipments:
Flu ID Guide - 859
Flu Prevention Tips Poster – IMM 969 ES
Babies Need You Flyer – IMM 823 ES

10. Flu Vaccine Supply Update
FDA approved sanofi license for QIV product. Single dose vials and syringes (both 0.25 and 0.5 mL) will be available this season
GSK announced that they will be producing fewer doses Fluarix TIV than anticipated and pre-booked (issues related to filling capacity)-will not affect Fluarix QIV orders

11. 2013-2014 CDPH Flu Purchase Doses ordered Reserve available?
Fluzone multidose vials
200,040
Yes
Fluvirin multidose vials
200,050
Fluvirin syringes
130,000
Yes, but <300 doses
Flumist sprayers
90,000
Pediatric Fluzone
20,000

12. California Flu Program Health and Safety Code 120392.3
The department shall provide appropriate flu vaccine to local governmental or private, nonprofit agencies at no charge in order that the agencies may provide the vaccine, at a minimal cost, at accessible locations.
Started in 1970s…

13. California Flu Program Health and Safety Code 120392.3
…the department may provide guidance to local agencies as to whether one or more population groups shall have priority for the flu vaccine offered through this program.
In developing this guidance, the department shall consider the influenza recommendations of … ACIP or other criteria in order to ensure that the vaccination program is efficient and effective in meeting public health goals.

14. Limited quantities of state-purchased Tdap available to LHDs
~60,000 doses of Tdap (adacel)
Expiration date in 2015
Guidelines for requests will be distributed shortly
No restrictions, but intended for those at greatest need who have limited access to vaccine
Pregnant women at highest priority
Students
Flu clinic attendees
Consider current and possibly new partners
Consult field rep if considering new partners

15. Preparing for VFC’s 2013-2014 Flu Season
Total doses pre-booked: 2.3M doses
Products:
Sanofi Fluzone 0.25mL SDS (TIV)
Sanofi Fluzone 5mL multi-dose vials (TIV)
GSK Fluarix 0.5mL SDS (QIV))
MedImmune FluMist (QIV)

16. Preparing for VFC’s 2013-2014 Flu Season
VFC Order Confirmation was launched June 25th, 2013.
Allocations are based on:
total doses received by the clinic during the season
VFC Pre-booked doses for CA
Provider must confirm allocations by July 26th, 2013.

17. Preparing for VFC’s 2013-2014 Flu Season
Provider communications
6/25/2013: 2013/2014 VFC Flu Order Confirmation program letter
7/05/2013: Order Confirmation Reminder & 2012/2013 Flu Vaccine Return Reminder
Pending:
Targeted reminders to providers without Flu order confirmations
VFC Program Influenza Letter

18. Products available to local health departments
Trivalent vs. Quadrivalent
Ages
VFC?
State-purchased?
Flumist sprayers 4
2-49 years
(healthy persons)
YES
485,000
90,000
Fluzone vials 3
> 6 months
500,000
200,000
Fluzone 0.25 ml syringes
6-35 months
705,000
20,000
Fluarix syringes
> 3 years
630,000 NO
Fluvirin vials
> 4 years
Fluvirin syringes
130,000

19. VFC Vaccine Supply Update: Limited or no Availability
Pentacel
Limited supply until September 2013
CDC allocated limited doses of this vaccine in June and July; doses are still insufficient to re-open ordering for this product
Product will be re-opened for ordering in CA when allocations doses are adequate to fulfill provider orders (fully or at least at 50% of historic usage)
Adequate supply of single antigen (DTaP, Hib, Polio) as alternative to Pentacel
Pediarix
Continue to have 50% monthly allocations.
Supply expected to return back to normal September 2013
Bostrix
Single dose syringes- Currently unavailable at McKesson

20. Relocation of Sacramento’s McKesson Depot
Effective July 13, 2013, the CDC McKesson Sacramento distribution depot will be moved to Aurora, CO.
Provider Orders:  There will be no disruptions with provider orders  

21. Vaccine Returns Return Reconciliation’ Updated Vaccine Return Address
Submitted vaccine returns (VFC Return Forms) must match returns received by McKesson in order to receive returned doses
CDC is generating monthly reconciliation reports for all states to address discrepancies
Updated Vaccine Return Address
All vaccine returns must be sent to McKesson’s Memphis warehouse
New address is reflected on postage paid labels and on VFC Vaccine Return Forms (paper-based and On-line form)
LHD’s Flu Return Reports
State products have been added to the on-line Return Form

22. Program Communications
Program Letters
VFC Provider Participation Requirement (6/14/13)
Fax Blasts
Responding to Power Outages (6/27/13)
June Vaccine Tips: Kinrix Licensure
Online Ordering and Call Center Update (7/3/13)

23. Review of Legislation -AB 2109 (Pan)
Starting in 2014, parents seeking PBEs need to document for schools:
Receipt of info about immunizations and communicable diseases from health care practitioners, who are also required to document providing of such information.
Documentation may not be signed >6 months prior to when immunization is required (typically, start of school year).
Authorized health care practitioners will include licensed physicians, nurse practitioners, physician assistants, naturopathic doctors and credentialed school nurses.
Which required immunizations the student has received and not received.

24.  Reimbursement for administration MediCal beneficiaries, 2013-2014
Reimbursement - $9 ~$26 per injection in California
100% federal funding to cover increased payments
Applies to public health clinics?
Still awaiting clarification from federal government

25. LHD Contracts Current Contracts end June 30, 2013
New and improved SOW is up at CMU for review with our Draft Contract Model.
Received final budget numbers from CDC!
No carryover: first year in a new grant cycle.
Resulted in 6% cut to IZB.
IZB absorbed a greater proportion of cut.
3% cuts to LHDs. Exception: those with minimum of $25,000 are not being cut.

26. LHD Contracts Application letter and packet sent on July 8th.
Due July 22nd.
Once received, will be reviewed for accuracy and then our contract analysts will package and send to LHDs for signature.
Please try and have Board sign as quickly as possible.
Once signed, go back to Contracts Management, Department of General Services, and Accounting for signatures.

27. Upcoming Meetings
Next all county call – August 13th, 2013