2019/2020 Flu Immunization Guide

Flu vaccine efficacy varies from year to year depending on the similarity of the flu viruses the vaccine is designed to prevent and the flu viruses in the community. However, recent studies show that have supported the conclusion that flu vaccination benefits public health. The CDC recommends that everyone age 6 months and older receive a flu vaccine yearly by the end of October.  Benefits of vaccination include:

  • Preventing contracting the flu. In seasons where the vaccine is well matched, it reduces the risk of having to visit the doctor with flu by 40 percent to 60 percent.
  • Reducing the chance of flu-associated hospitalizations. Flu vaccines have reduced the number of adults hospitalized with flu by about 40 percent. A 2014 study showed the vaccine reduced the risk of flu-related pediatric intensive care unit admission by 74 percent.
  • Reducing the severity of flu if contracted. A 2018 study showed that among adults hospitalized with flu vaccinated patients were 59 percent less likely to be admitted to the ICU.

Fluzone Quadrivalent Influenza Vaccine is an injectable immunization approved for patients 6 months and up. Fluzone is an inactivated vaccine protecting against four strains of the flu. In addition, Fluzone is approved for pregnant women.

Another option for flu is FluMist Quadrivalent, which is a nasal-spray flu vaccine approved for ages 2 through 49. FluMist is a live attenuated influenza vaccine and is not for use in pregnant women.

Older Adults

For some, the flu is a mild illness. For older adults, especially those with chronic health conditions such as diabetes or heart disease, the flu can be far more serious. Older adults are at high-risk to develop serious complications from the flu such as pneumonia. It’s estimated that between 70 and 90 percent of flu related dates occurred in people over 65, and between 50 and 70 percent of seasonal-flu related hospitalizations occur in that age group. Adults age 50 to 64 can choose from any available flu vaccine. For adults 65 and older, the CDC recommends one of two vaccines developed specifically for that age group: the high dose flu vaccine and the adjuvanted flu vaccine.

The high dose vaccine, Fluzone High Dose, delivers 4X the amount of antigen as the regular dose Fluzone vaccine. Compared to Fluzone, Fluzone High dose provides between 24%1 and 51%2 better protection from influenza.

The adjuvanted vaccine, Flublok Quadrivalent, is approved for persons ages 18 and older. Flublok has 3X the HA of a standard-dose quadrivalent inactivated influenza vaccine. Flublock also prevents more cases of flu in adults 50+ than a standard-dose quadrivalent vaccine. People over 65 should talk to their doctor about the pneumococcal vaccination, which can help prevent pneumococcal pneumonia, a serious flu-related complication.

AAP Recommendations

Earlier this month, the AAP released their updated recommendations for the use of influenza vaccines and antiviral medications in children. These include no preference for the inactivated or live attenuated vaccine, updated guidelines for children receiving their first flu vaccine, and information about a new antiviral medication. The recommendations can be viewed online.

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1 24.2% Primary endpoint: the occurrence of laboratory-confirmed, protocol-defined, influenza-like illness caused by viral strains regardless of their antigenic similarity to vaccine components.

2 51.1% Secondary endpoint: the occurrence of culture-confirmed influenza caused by viral types/subtypes antigenically similar to those contained in the respective annual vaccine formulations in association with a modified Centers for Disease Control and Prevention-defined influenza-like illness.

Adolescent Immunization Resources

The Immunization Action Coalition and Sanofi Pasteur have collaborated a project to raise awareness of the low immunization rates for the meningococcal (MenACWY) vaccination. The project, titled “MenACWY: You’re Not Done if You Give Just One,” can be found at https://www.give2menacwy.org/ and contains a wealth of resources for medical practices.

The facts are stark: Meningococcal disease can be deadly, and survivors can suffer lifelong disabilities from contracting the disease. Unfortunately, the majority of administration opportunities are missed. Even during vaccine only visits, 86% of adolescents were not given MenACWY. 1

The recommended administration guidelines are to give the initial dose at 11-12 years of age and the second dose at 16 years of age. This factsheet provides important information about recommending and administering MenACWY.

Another helpful resource from the MenACWY project is the “Top 10 Ways to Improve Adolescent Immunization Rates” handout. The top 10 are:

  1. Immunize at every opportunity by considering every visit an opportunity to vaccinate.
  2. Use reminder and recall systems to automatically remind families of needed immunizations.
  3. Implement standing orders to allow nurses, pharmacists, and other healthcare personnel to vaccinate.
  4. Take part in an immunization registry to access comprehensive immunization records for every patient.
  5. Review your patients’ vaccination histories prior to visits and flag charts as indicated.
  6. Follow the U.S. recommended immunization schedule.
  7. Schedule vaccination-only quick visits to increase access for patients.
  8. Make vaccination education a priority, for parents as well as patients.
  9. Establish rapport with your adolescent patients by taking a nonjudgmental approach and being ready to listen and answer questions.
  10. Create a culture that values well-adolescent care by maintain the same set of high expectations you take with well-child visits.

Visit the “MenACWY: You’re Not Done if You Give Just One” website at https://www.give2menacwy.org/   for these and other great resources.

In the upcoming months, CPP will continue posting resources on increasing adolescent immunization rates and creating a culture of vaccination in your practice. Subscribe to our blog to stay up to date.

1. Wong CA. Taylor JA, Wright JA, et al. Missed opportunities for adolescent vaccination, 2006–2011. J Adolesc Health. 2013;53(4):492–497.

CDC Webinar – Strategies for Addressing Vaccine Misinformation in the Practice

On Wednesday, August 28, the CDC will be hosting a webinar from 1-2pm to assist providers in recommending vaccines and addressing vaccine hesitancy.

Speakers for the webinar include:

  • Dr. Amanda Cohn, Acting Chief Medical Officer, Vaccine Policy, Preparedness, Global Health, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
  • Chanie Sternberg, President & CEO, RefuahHealth Center
  • Dr. Corinna Manini, Chief Medical Officer, RefuahHealth Center
  • Dr. Todd Wolynn, CEO, Kids Plus Pediatrics

RefuahHealth is a health center in New York that serves patients in communities affected by ongoing measles outbreaks. They have worked to cultivate trust with parents concerning the safety and efficacy of vaccines.

Follow this link for more information and to register. Don’t wait to register for this timely and relevant information. And stay tuned to the CPP Blog. In the next few months, we will be posting a series on addressing vaccine hesitancy in your practice. Subscribe to our blog to stay up to date!

2019-2020 Flu Season Coding Help

Sanofi Pasteur has put together a wealth of coding resources for the 2019-2020 flu season. Coding and billing for vaccinations can be complicated, so these resources are designed to save your practice time.

Coding Webinars

Sanofi has scheduled two webinars to assist in flu coding. One is targeted at coding for patients of any age, and the other is specifically for pediatric patients. The all ages webinar is scheduled for August 20 and September 12, 18, and 19. The pediatric webinar is scheduled for August 21 and September 10. The webinar will cover essential coding and billing information, Medicaid billing and VFC, Medicare billing, and payment benchmarks.

More information can be found here, and registration is available at http://www.crackingthecodestraining.com/

Coding Guides

Sanofi has put together two coding guides to help with this year’s influenza season. The first is The Code to Success: Your Complete Guide to Coding and Billing for Sanofi Pasteur Influenza Vaccinations. This detailed guide will help you understand coding and billing, roster billing, Medicare payment and timelines, and quality reporting measures.

The second guide, 2019-2020 Proper Codes of Sanofi Pasteur Products, includes product codes, NDCs in billing format, IDC-10 codes, administration codes, and CVX codes for each vaccine. It has been updated to include this year’s flu vaccinations.

We hope these resources help you have a successful flu season. As always, feel free to reach out to CPP for more information or to find out how we can save you money on your vaccine purchases.

Group purchasing: Save money by aligning with other physicians

Medical Economics recently published an article highlighting the benefits of partnering with a group purchasing organization (GPO) or physician buying group (PBG). Practices can expect savings ranging from 5 percent to 25 percent by joining such a group. Highlights include:

  • Don’t base your GPO choice on what your hospital uses. Physician offices have different needs than hospitals. Find a group that fits your specific needs.
  • Revisit pricing every year or two and compare groups. The needs of a practice can change over time, and there is no one size fits all solution.
  • Know the difference between a GPO and PBG. GPOs are membership organizations that offer discounts on most everything involved in a medical practice such as capital equipment, supplies, and services. PBGs also offer discounts on supplies and services, but they primarily serve as vaccine buying groups. Due to their vaccine focus, PBGs are able to provide superior pricing.
  • Let your vendors do the work of pricing. Put your top purchased items out for bid to ensure you are getting the best price.
  • Check if your distributor performs additional services like stocking and ordering supplies.

To read more, visit Medical Economics online.

CPP 2nd Dose Grant

This post is the second in a series on increasing adolescent immunizations. For a case study on how one health system increased their overall adolescent vaccination rates, see our previous post.

The CPP 2nd Dose Program provides an opportunity to examine your practice’s 2nd dose immunization rates for vaccines that require more than one dose to complete the series, access resources to help implement a strategy in your office to raise those rates, and share successful strategies with other CPP members. Applicable vaccines include meningococcal ACWY, HPV, adult pneumococcal and/or adult hepatitis B (Heplisav-B only). 

The tables below show immunization rates for these vaccines for the most recent year available from the CDC:

National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13-17 Years—United States, 2017

Vaccine Coverage Among Adults in the United States, National Health Interview Survey, 2016

Participants in CPP’s 2nd Dose Program have already seen successes. Over 77% of member participants reported that their 2nd dose immunization rates were lower than they expected when they pulled the initial data from their EMR. After implementing an intervention in their practice to help improve these rates, participants saw a rise in their HPV and MCV4 completion rates by an average of 29% and 41%, respectively! 

Some best practices that were shared by the group include:

Check out the CPP 2nd Dose Program website for updated resources and details on how your practice can participate in this $1,000 grant opportunity!

How a Large Health System Increased Adolescent Vaccination Rates

This post is the first in a series on adolescent vaccination.

When Sanford Health, a rural not-for-profit health system based in the Dakotas, Minnesota, and Iowa, took a look at their adolescent vaccination rates, they were shocked by what they found. Baseline rates for the completion of the HPV series ranged from 15%-29% in their clinics, and rates for completion of the Meningococcal series ranged from just 8%-38%. Sanford decided to make system-wide changes to improve their adolescent vaccination rates.

Sanford began by creating an immunization strategy department lead by the Immunization Strategy Manager. A cross-department team gathered to form an enterprise immunization committee and craft a plan. The initial stage focused on increasing administration of the HPV vaccine at a test group of seven clinics. The strategy consisted of three parts:

  • Providers were given their immunization rates as well as those of their colleagues. This put accurate data into the providers’ hands and engendered a sense of competition between staff.
  • Sanford emphasized a “no missed vaccination opportunity” culture, encouraging providers to assess immunization status for every patient at every encounter.
  • The system sent reminder and recall letters to parents of adolescents.

Over the two year test period, HPV completion rates increased by an average of 15%, and zero-dose rates decreased an average of 22%. Armed with this data, Sanford made plans to expand the program. The organization added standing orders for most vaccines, enabling RNs, LPNs, and MAs to administer immunizations. These orders eliminated more missed opportunities and empowered staff to own their immunization rates.

Sanford, with the help of the Immunization Action Coalition and Sanofi Pasteur, also created a curriculum to train people to become immunization champions. The VAX Champ program created immunization champions content experts for each clinic. The program also trained its students to examine current vaccination rates and create plans to improve them. These interventions saw first and second dose rates for MenACWY climb steadily. In some clinics, second dose rates more than doubled.

Sanford Health’s efforts helped to not only increase adolescent vaccination rates but also advanced their mission to improve patient health. These steps can be applied to healthcare systems or offices of any size. Sanford’s success shows that with dedication and a solid plan adolescent immunization rates can improve.

Next in this series is a guide to CPP’s 2nd Dose Program that rewards members for improving second dose rates of several immunizations, including those that Sanford highlighted. For more information, visit our website.

2019-2020 Flu Vaccine Timeline

Recently, Sanofi Pasteur provided an update for the distribution of influenza vaccine for the 2019-2020 flu season.  Due to late-emerging A/H3N2 viruses that delayed the strain selection for the upcoming flu season, it is anticipated that the delivery of Sanofi Pasteur influenza vaccines will be approximately 3-4 weeks behind the shipping commitments previously communicated.  Sanofi Pasteur fully expects to manufacture and deliver every dose reserved by their customers, beginning with partial shipments to all customers in late-August or September, with all shipments completed by the end of November.

Each year, the World Health Organization (WHO) and U.S. Food and Drug Administration (FDA), with help from epidemiologists around the world, select the virus strains to be included in influenza vaccines for the upcoming season.  This year, due to late-emerging A/H3N2 viruses that circulated globally, the WHO and FDA decided to delay selection of the A/H3N2 strain by one month.  This allowed health authorities to collect additional data to help improve the match of the vaccine strain to the A/H3N2 strain anticipated to circulate during the 2019-2020 season.

Sanofi Pasteur fully supports this decision by health authorities to collect additional data and make a more informed selection.

If you have any questions, please feel free to contact the CPP office at 614-722-2145 or your Sanofi Pasteur representative.

Sanofi Pasteur’s Adacel (Tdap) Vaccine FDA Approved for Repeat Vaccination after 8 Years

The Food and Drug Administration recently approved the Adacel (Tdap) vaccine to be administered as soon as 8 years after a previous dose. Adacel, manufactured by Sanofi Pasteur, provides immunity to tetanus, diphtheria, and pertussis. The vaccine is approved for patients ages 10-64, and is available in a syringe made without natural rubber latex.

The current CDC recommendations for Tdap are as follows:

  • Adolescents should receive a single dose, preferably at age 11 or 12
  • All pregnant women should receive a single dose during pregnancy, preferably between weeks 27 and 36. By receiving this vaccine, pregnant mothers pass antibodies to their babies, reducing the risk of whooping cough.
  • Adults should receive a single dose of Tdap followed by a booster Td every 10 years.

FDA approval was based on clinical data from a study that showed no significant differences in adverse events when adults received Adacel versus Td 8-12 years after a previous dose of Adacel.  The approval of Adacel administration every 8 years provides more flexibility for physicians in both vaccine purchasing decisions and immunizations scheduling. Sanofi has provided study results to the CDC for consideration in future recommendations.

For more information or to purchase Adacel or any other immunization, visit our website or send us an email

AAP Releases “Immunization Information Technology Guide” for pediatricians

At CPP’s recent Vaccine Management Summit, 2D barcoding stood out as a topic of interest among attendees. CPP members will find a new AAP guide helpful as they continue to learn about this technology.

The AAP recently released a guide for pediatricians with information on two key information technology topics: immunization information systems and two dimensional barcoding. In addition, the AAP provides a detailed website for both topics that summarizes the information found in the new guide and provides relevant links.

Immunization Information Systems, also known as vaccine or immunization registries, are confidential computerized systems that capture vaccination data across the lifespan within a certain geographical area. The use of these systems can reduce healthcare costs and improve patient care. The benefits to pediatric practices of using these systems include minimizing duplicate vaccine administration, aiding in recalling patients overdue for vaccinations, reminding patients of upcoming immunizations, and identifying vulnerable patients during a disease outbreak.

Two Dimensional Barcode Scanning Technology can be used with the majority of pediatric vaccines. Recent studies show that the use of 2D scanning increase accuracy in vaccine documentation and reduces documentation time by an average of 21 seconds. 2D barcode scanning improves practice efficiency, increases vaccine inventory accuracy, and assists in proper billing. In addition, the technology benefits patients by improving safety and documentation, reducing errors, and identifying expired vaccines before they are administered to patients. The AAP’s 2D barcoding resources include practice uses, choosing a scanner, and getting the scanner to “work.”   

For practices not yet ready to implement 2D barcoding, CPP has other resources to help manage your vaccine inventory including a Vaccine Inventory Reconciliation Sheet. These resources can be found on our website.