VFC-AFIX Quarterly Conference Call Minutes

January 18, 2012

Awardee Attendance

Present: AK, AL, AR, AZ, CA, Chicago, CO, CT, DC, DE, FL, GA, HI, Houston, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, Philadelphia, PR, RI, San Antonio, SC, SD, TN, TX, UT, VA, VI, VT, WA, WI, WV, WY

Summary

AFIX

• Staffing update
• AFIX Online Community

CoCASA

• CoCASA v7.0 is posted
• CoCASA Version History
• CoCASA Algorithm Reference
• HPV report

VFC

• Provider Resources & Childhood Immunization Champion Award
• Vaccine Storage & Handling update
• VFC and Provider Site Visits for Enrolled Hospitals update
• 2012 VFC Site Visit Questionnaire
• 2011 VFC Management Survey

2011 Quarterly Call Schedule

• Dates: January 19, April 20, July 20, & October 19

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Minutes

AFIX

• Staffing update:  Our new AFIX Lead, Hanan Awwad, has joined our branch.
• AFIX Online Community on phConnects
  • All AFIX Coordinators invited to join.  Post your questions to other coordinators.

CoCASA

• CoCASA v7.0 is posted: Separate installation directions for Windows 7.0 and Windows XP users are available from the website. Please review the downloading instructions before installing CoCASA.
• CoCASA Version History: See a full list of the enhancements and fixes[349 KB, 19 pages].
• CoCASA Algorithm Reference: Updated algorithm[314 KB, 8 pages]
• HPV report in CoCASA: New to CoCASA v7.0 is an HPV report. Components to the report were discussed during the call.

Provider Resources & Childhood Immunization Champion Award – Michelle Basket

• Michelle Basket discussed available resources for providers to stay informed on current vaccine safety information and strengthen communication between providers and parents. See the Provider Resources for Vaccine Conversations w/ Parents Toolkit contents.
• There is a new annual award that recognizes individuals who make a significant contribution toward improving public health through childhood immunization work. For more information on the award process and criteria, visit the CDC Childhood Immunization Champion Award website.

Vaccine Storage & Handling update – Patricia Beckenhaupt

• Patricia Beckenhaupt reviewed two all-awardee messages dated 12/9/2011 and 12/15/2011 related to a) vaccine transport for Varicella and b) vaccine in storage bins.
• Vaccine transport for Varicella
  • There was a revision in CDC guidance regarding emergency transport of Varicella containing frozen vaccines. In accordance with manufacturer recommendations, Varicella containing vaccines that are transported under refrigerated storage temperatures (36°F to 46°F, 2°C to 8°C) should be placed in a freezer between -58°F and +5°F (-50°C and -15°C) immediately upon arrival at the alternate storage facility.
  • Merck, the manufacturer of Varicella containing frozen vaccines, has changed the storage and handling recommendations in the Prescribing Information on these vaccines. Current guidance does not recommend the use of dry ice for storage of frozen vaccine. This has led to the development of revised guidance for emergency transport. Vaccine users should always follow the approved storage and handling recommendations in the vaccine Prescribing Information.
  • The CDC will be revising its transport guidance in the Vaccine Storage & Handling Guide, the updated Storage & Handling Toolkit, and in response to questions regarding transport of frozen vaccine.
• Vaccine stored in baskets/bins
  • This is to inform you of updated information from the National Institute of Standards and Technology (NIST) regarding bins used to store vaccine in refrigerators and/or freezer units. In the past providers were encouraged to use bins, baskets, or some other type of uncovered containers with slotted sides or openings to store vaccines. Recent NIST studies utilized uncovered bins with solid sides and demonstrated that these types of bins would be appropriate for storage of vaccines. Based on NIST studies:
    • Open bins can work as well as slotted bins for air circulation provided there is space for air circulation.
    • Location of the vaccine in the unit, especially if it is a common household refrigerator/freezer is a very important factor in exposure of vaccine to potentially harmful temperature ranges.
    • “Mapping” the temperature in a storage unit is a very important factor in determining where to keep the vaccine. “Mapping” refers to the process of assessing the temperature in different areas throughout the storage unit to determine where the temperature is appropriate for vaccine storage and most stable. If the storage unit is pharmaceutical/medical grade, then temperature variations may be less problematic and the consumer should ask the manufacturer for specific information on assurance of temperature consistency throughout the unit.
    • Vaccine should be kept in manufacturer boxes for the additional thermal layer protection. Keeping the vials in the manufacturers’ boxes provides an additional thermal layer protection to help maintain vaccine temperature during open/close door especially during busy clinic times and power outages.
  • This information will be included in the Vaccine Storage and Handling Toolkit and the Vaccine Storage and Handling Guide has been revised to reflect this new information. Updated information regarding bins can be found on page 7 of the guide. See Resources on Proper Vaccine Storage and Handling.
  • If you have questions regarding this guidance, please contact Patricia Beckenhaupt. A copy of the NIST study can be obtained from Pat as well.

VFC and Provider Site Visits for Enrolled Hospitals update - Charniece Tisdale

• Charniece provided an update on her project to relook at VFC Site Visit process for enrolled hospitals. VFC enrolled providers (including hospitals) are required to have a site visit at least once every other year. However, challenges with this process were identified in hospitals, including difficulty administering the questionnaire tool due to differing hospital procedures, requiring additional storage and handling procedures and reluctance to complete twice daily temperature logs.
• Charniece, a PHPS fellow, was assigned to the POB to specifically develop methods to assess compliance with VFC program requirements in hospitals. The process began with identifying questions pertaining to the following problem areas of monitoring: vaccine storage and handling, bundled services and billing practices and the magnitude of VFC vaccine supplied to hospitals. The first question asks how VFC vaccine storage and handling can be monitored in hospital and inpatient settings, given the challenges.
• The Joint Commission and the Centers for Medicaid and Medicare (CMS) were consulted to identify areas where overlap in monitoring activities similar to VFC site visits may exist, including standards and CMS Conditions of Participation (CoPs) that address safe storage and handling, periodic inspections of storage areas and abiding by manufacturer’s recommendations.
• In order to explore billing methods the question asks how to make sure that hospitals are not billing for VFC vaccine and are not charging above the maximum regional charge for administration fees.CMS staff indicated that it is difficult to determine billing for vaccines because of the size and complexity of bills; however, newborns born without complications to Medicaid mothers should not generate a separate bill or administration fees from the mother. The POB is still in the process of working with CMS to further understand the billing process and to determine how vaccine and vaccine administration costs can be extracted from hospital bills, and how activities are assessed in the CoPs.
• The question regarding vaccine magnitude asks how to address hospitals who receive small amounts of vaccine versus those who receive substantial amounts of vaccine. The results from a 2010 POB administered Vaccine Volume and Costs surveyillustrated that variance among hospitals was significant. For instance, one awardee provided $52 worth of hepatitis B vaccine doses to a hospital in 2010, while another awardee provided $176,000.
• Two concepts were explored: using Joint Commission and CMS’s standards as qualifiers for revising the storage and handling component of the site visit questionnaire for hospitals that are accredited and setting financial thresholds for implementing an alternative site visit or monitoring process. Discussions over the concepts are preliminary and still continue to be explored. Based on the feedback from the call, it appears that awardee opinions are split; some feel that due to the complexity of the provider site visit, birthing hospitals would pull out of the program and privately purchase their vaccines, while others feel uncomfortable with modifying storage and handling guidelines based on Joint Commission standards because of conflicting guidance and recommendations and lack of thorough surveillance.

2012 VFC Site Visit Questionnaire

• VIS dates for Polio, Hepatitis A and Meningococcal updated on questionnaire. Updated questionnaire attached to the 1/12/2012 all-awardee message containing information for the January VFC/AFIX Quarterly Call.

2012 VFC Management Survey

• Available for entry on the PAPA site and due March 1, 2012
• Based on feedback from the last call, the wastage table was revised to list combination vaccines separately.

2012 Quarterly Call Schedule

• Dates: January 18; April 18; July 18; October 17
• Time: 2:00 - 3:30 p.m. ET

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