Emergency Preparedness: Vaccine Storage and Handling

Emergencies can happen at any time. Whether it’s a severe weather condition, natural disaster, power outage, or unexpected closure due to a pandemic, the end result could compromise vaccine storage conditions. Practices should have standard operative procedures (SOPs) in place for such emergencies.

What if your office needed to close for an extended period of time? In that case, you may need a system for monitoring temperatures remotely. Consider purchasing a phone-enabled or internet-aware alarm to alert you of temperature excursions. Multiple staff members should be on the notification list to ensure appropriate action can be taken, if needed. In addition, your data logger should have enough memory to store at least one month of data, and the data recording should loop when memory is full. This FAQ document from the AAP contains detailed information on data loggers and vaccine monitoring.

Emergencies can happen anytime, including after hours. Work with your facility’s building manager to ensure emergency access. Your storage and handling SOPs should include instructions and a map/diagram for accessing vaccine storage units and the locations of flashlights, keys, circuit breakers, and other useful items.

In a situation where a storage unit is no longer functioning or during a power outage, vaccines may remain inside the unit as long as appropriate temperatures are maintained. It is important to not open the storage unit door unless power is restored or you need to pack the vaccines for transport. Monitor your digital data logger to determine when you need to take additional steps.

If you cannot monitor temperature inside the unit without opening the door, wait until power is restored to record the temperature. At that point, record the room temperature and the temperature inside the unit. Follow your procedure for a temperature excursion and be sure to mark effected vaccines “Do NOT Use” until a decision can be made about whether or not to use them.

If you have external temperature monitoring, record the room temperature and unit temperature as soon as the power goes out. Also record the minimum and maximum temperatures reached. If a temperature excursion should occur, follow your SOPs.

If you have a generator or backup battery power source, this can prevent the need to move vaccines to another location. Both generators and back up battery power sources must be tested quarterly and serviced annually. In addition, ensure you have enough fuel on hand to run your generator for 72 hours.

Even if your practice has a backup power source, you need to establish an alternative storage facility. Establish a working agreement with at least on alternative storage facility such as a hospital, long-term care facility, the Red Cross, or a commercial pharmacy. Ensure that you have 24-hour access to your alternative facility. You can also have a back up storage unit at your facility to use as an alternate.

The CDC’s Vaccine Storage and Handling Toolkit includes a section for establishing SOPs and emergency management. These can be found on pages 25-26 and 30-34.

The Immunization Action Coalition produced a useful Emergency Response Worksheet. It includes instructions, a table for recording vaccines, and helpful numbers. If your practice is in the state of Ohio, the Ohio AAP has a Vaccine Emergency Management Plan with Ohio specific information.

Coming next: what to do in a situation where your vaccines must be transported.

Handling Vaccine Temperature Anomalies and Refrigerator Repairs

Effective refrigeration is an important part of managing your vaccine program. Does your practice know what to do in the case of a temperature anomaly? What about when your vaccine refrigerator needs to be repaired?

Here are 6 tips for when vaccine temperatures go outside of normal limits:

  • Investigate and determine how long the vaccine temperatures have been out of range
  • Check to see if the refrigerator door is ajar or making an unusual noise
  • Inventory the vaccine affected currently in the refrigerator
  • Move vaccines to a temporary refrigerator that is working appropriately 
  • Contact the vaccine manufactures to determine the status of the vaccines
  • Document the entire incident, results and actions taken to prevent another temperature excursion

The Immunization Action Committee created a helpful form to complete after an unacceptable vaccine storage event. This handout and other storage and handling tools can be found here: https://www.immunize.org/clinic/storage-handling.asp

If you determine that a refrigerator needs to be repaired after a temperature anomaly, here some sources of good refrigerator repair information:

  • Refrigerator manufacturer
  • Your medical supplies and equipment provider
  • Commercial appliance repair company
  • Other medical practices or hospitals in your area
  • Restaurant equipment repair companies

CPP Buying Group has a robust collection of Vaccine Storage and Handling resources. In addition, we can help with the purchase of a new vaccine refrigerator or freezer. Our Vaccine Storage Equipment Educational Program (VSEEP) provides grants of up to $750 to offset the cost of vaccine storage equipment. Contact our office for more information.

HPV Best Practices and Toolkit

Both the National Foundation for Infectious Diseases and the American Academy of Pediatrics have a wealth of resources to aid in improving HPV vaccination rates. These include clinical resources, printable documents for patient education, videos, and webinars. Below is an overview of the resources provided by each organization.

The AAP’s HPV Champion Toolkit has resources to help you:

  • Educate other healthcare professionals
  • Discuss HPV vaccination with parents
  • Make necessary changes in your practice to improve HPV vaccination rates.

The site includes a collection of printable resources for clinicians, caregivers, and preteens/teens. Materials for caregivers are available in multiple languages. It also contains a plan for implementing a change in your office related to the HPV vaccine. The plan uses the Plan, DO, Study, Act (PDSA) improvement cycle, and provides resources for introducing standing orders, giving strong recommendations, using reminder recall systems, and more. In addition, there are teaching tools including a communication simulation app and slide decks to be used in grand rounds or resident training.

The NFID’s Best Practices to Increase HPV Immunization Rates contains resources to increase HPV vaccination rates and educational tools to share with patients. Resources include a Call to Action published by the NFID and links to the Association of Immunization Managers conference calls discussing increasing vaccination rates. In addition, there are links to standing orders for both adults and children and teens, articles and videos, and infographics. Finally, the NFID houses a collection of information titled Communication on HPV Vaccination. These resources include a guide to addressing parents’ questions, various fact sheets, and public service announcements.

Both organizations provide useful information to increase HPV vaccination rates in your practice. If you are working on improving HPV rates, why not take a look at CPP’s Second Dose Program where you can earn a grant for raising rates on the second dose administration of several vaccine series.

Measles Awareness Toolkit

Measles is a highly contagious infectious disease that can result in severe complications and even death. According to the Centers for Disease Control and Prevention (CDC), more than 1,200 individual cases of measles have been confirmed in 2019 in 31 states—the largest number of cases since measles was eliminated in the US in 2000.

To help combat measles and raise awareness, The National Foundation for Infectious Diseases (NFID) has compiled a wealth of information concerning Measles. They have launched a campaign to raise awareness about the risks associated with measles and the importance of prevention through vaccination. This Measles Awareness Toolkit includes short videos and infographics to share via social media.

Below are helpful resources your practice can use to educate and raise awareness about measles.

Measles Information from the NFID:

Webcast: Helping to Prevent Disease in Adults 50 Years of Age and Older

This Thursday, January 30, Sanofi Pasteur presents a webcast on influenza prevention. Join Dr. John J Russell, Clinical Professor of Family and Community Medicine at Thomas Jefferson University, and a panel of subject matter experts.

Program objectives include:

  • Examine the medical burden of influenza and its economic impact in adults 50 years of age and older
  • Explore the role that influenza can play in exacerbation of chronic conditions, leading to adverse outcomes
  • Review clinical evidence of two influenza vaccines that were compared to standard-dose influenza vaccines in older adults

There are three times to choose from: 12:15pm, 1:30pm, and 3:15pm EST.

Click here for more information.

Register here.

We’re In! 2020 HPV Cancer Prevention Initiative Launch Webinar

The announcement below is from the National HPV Vaccination Roundtable. The webinar is on Jan 28, 2020 01:00 PM in Eastern Time (US and Canada).

As part of Cervical Cancer Awareness Month, the National HPV Vaccination Roundtable invites health systems and public health organizations to join the launch event of the HPV Cancer Prevention Initiative We’re In! 2020.

This initiative targets health systems, including community health center systems, integrated delivery systems, medical groups, accountable care organizations, and private practices. We also believe there is an important role to play for HPV/cancer coalitions, state health organizations and other public health partners. Join us to hear how your organization can get involved.

Hear from national thought leaders from the Office of Health and Human Services and the Centers for Disease Control, in addition to a physician leader and HPV Roundtable members. Attendees will receive access to free brand-new resources and We’re In! 2020 communication tools for print and digital formats.

Register here: https://zoom.us/webinar/register/4615753954075/WN_WGQZGypxSQWJFiAMGIU3ww

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.

_____________________________________

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.

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.

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!