Weekly Vaccine Digest 02/16/2024 Los Angeles County Department of Public Health

County of Los Angeles, California sent this bulletin at 02/16/2024 01:58 PM PST

Weekly Vaccine Digest 02/16/2024

Los Angeles County Department of Public Health

Dear Colleagues and Partners!

Below are the LACDPH weekly vaccine administration and order updates, upcoming webinars, and newsworthy events. Attached you will find a pdf version of this document and the slide deck/links from LA DPH Provider Immunization Office Hours held Wednesday 2/14/24. To view the CDPH recordings, slides and other important information please visit https://eziz.org/.

 

If you received this email and would like to be added to our listserv, please contact our COVID-19 Provider Vaccine Call Center at covidvaccinereq@ph.lacounty.gov

Table of Contents

·      Page 1-5: LA County First Measles Case (LAHAN), Measles Clinical Considerations

·      Page 5-6: Order and Administration Reminders, VFC Updates

·      Pages 7-9: VFA Timeline and Upcoming Actions, MPOX Vaccinator Staffing Resources, Upcoming Webinars, LACDPH & CDPH Provider Office Hours Link

LAC DPH Health Alert First LA County Measles Case

Key Messages Since January 31st, the Los Angeles County Department of Public Health has been investigating a confirmed measles case in a resident with multiple potential sites of exposure to others. This is the first case in LA County since 2020.

  • LA County healthcare providers should be on alert for additional measles cases.
  • Healthcare providers should 1) assure that their patients are up to date on measles-containing vaccine (MMR or MMRV) or are otherwise immune, 2) immunize all international travelers aged 6 months or older for whom there is no documentation of immunity, and 3) immediately report suspect measles to Public Health.
  • All healthcare personnel should have documentation of immunity to measles.

 

Situation

An under-immunized LA County resident was confirmed to have measles on January 31, 2024. The individual was infected during an international trip and traveled to LA County during their infectious period. This is the first case of measles in LA County since February 2020.

Public Health is currently investigating multiple exposures related to this case. Locations where people may have been exposed include the airplane, the Tom Bradley International Terminal, and a chain restaurant in Northridge. Additional locations where possible exposures may have occurred are being investigated. See press release for more details.

Measles is a highly contagious, vaccine-preventable disease that requires high population immunity (95%) for transmission to be interrupted. Similar to this case, domestic measles cases often originate from unvaccinated or under-vaccinated U.S. residents who travel internationally and then transmit the disease to people who are not immune to measles. One person infected by measles can infect up to 90% of their close contacts who are not immune.

This measles case reflects the real threat of measles importation to LA County due to the ongoing global and domestic outbreaks. The Centers for Disease Control and Prevention (CDC) has reported a recent rise in domestic measles cases. Between December 1, 2023, and January 23, 2024, the CDC was notified of 23 confirmed U.S. cases of measles, including seven direct importations of measles by international travelers and two outbreaks with more than five cases each. See CDC clinician communication Stay Alert for Measles Cases (1-25-24).

All county residents who lack measles immunity are at elevated risk of infection, this includes adults, adolescents, and children. Among all children in LA County who entered kindergarten in the 2022-23 school year, 97% were up to date with measles vaccination. However, there was a significant proportion of schools (16%) reporting kindergarten measles vaccination coverage below 95%, creating pockets of susceptible students where measles transmission can occur. See the School Immunization Dashboard for more information about vaccine uptake in your community.

Actions Requested of Providers

Interrupting measles transmission in LA County requires high community vaccination rates, health care provider vigilance in suspecting and diagnosing measles, and isolating cases from susceptible individuals.

  • Vaccinate: Make sure that all patients and healthcare staff are either up to date with their measles vaccinations or immune to measles. All persons who do not have presumptive evidence of immunity should be vaccinated.
    • All healthcare personnel should have 2 documented doses of MMR or laboratory demonstration of immunity.
    • Prior to any international travel, travelers 6 months of age and older should be protected against measles, regardless of their destination.
    • If you do not offer measles vaccines in your practice:
      • For uninsured patients and patients whose insurance does not cover the full cost of vaccines, please reference the LA County Department of Public Health’s vaccine clinic locations website to identify nearby free and low-cost immunization clinics.
      • For insured patients, please refer the patient to a provider or pharmacy who can provide MMR vaccine as these patients will be ineligible to receive vaccine at the above immunization clinics.
  • Suspect: Consider measles in any patient who presents with a febrile rash and clinically compatible measles symptoms (e.g., cough, coryza, conjunctivitis), especially if they are unvaccinated or under-vaccinated or have any of the following risk factors in the past 4 weeks:
      • Travel, especially international or domestic through an international airport.
      • Contact with someone with a febrile rash illness.
      • Exposure to a known or possible measles case.
      • See the DPH Information for Providers to review symptoms and typical presentations of measles.
  • Isolate: Any patients with a febrile rash illness should be immediately identified and separated from other patients prior to or as soon as possible after entry into the facility.
      • Display posters at facility entrances advising patients with fever, rash, or cough to immediately notify facility staff prior to entering the building.
      • The patient should immediately don a well-fitting medical mask or respirator, be removed from waiting rooms and other common areas, and placed in a private room with a closed door on airborne precautions.
      • Any room used to accommodate a suspect measles case should not be used for at least two hours after the patient has left.
      • Do not send suspect measles cases to the Emergency Department (ED) for measles testing unless they require a higher level of care. If ED referral is necessary, be sure to notify the ED first.
  • Notify: Public Health should be contacted immediately, while the patient with suspect measles is still at the facility. Public Health will guide you through collection of specimens for testing (throat swab and urine samples for PCR and blood sample for serology) and management of the patient under investigation as well as asymptomatic contacts of a suspected or confirmed case. See the LA County specimen collection instructions for more details on quantities, storage, labeling, and shipping.
    • Los Angeles County Department of Public Health
      • Weekdays 8:30 am–5:00 pm: call 213-351-7800.
      • After-hours: call 213-974-1234 and ask for the physician on call.
    • Long Beach Health and Human Services:
      • Weekdays 8:00 am-5:00 pm: call 562-570-4302.
      • After hours: call the duty officer at 562-500-5537.
    • Pasadena Public Health Department:
      • Weekdays 8:00 am-5:00 pm: call 626-744-6089.
      • After hours: call 626-744-6043.

 

Additional Resources

CDC

 

CDPH

 

LAC DPH

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Measles Clinical Considerations

Clinical Disease: Measles in immunocompetent patients

  • High fever (>102 F)
  • 3 C’s – cough, conjunctivitis, coryza (runny nose)
  • MAY have Koplik spots – white or gray specks with erythematous base on the buccal mucosa – prior to rash onset
  • Rash appears 2-4 days after initial symptoms
  • USUALLY begins along face and hairline and spreads to trunk
  • Atypical rash presentation can be seen, especially in partially-immunized people
  • Patients are considered infectious from 4 days prior to rash onset until 4 days after rash onset
  • There is no treatment for measles

 

How do people get measles?

  • Measles is one of the most contagious diseases known
    • One person with measles can infect 9 out of 10 non-immune close contacts
  • It can be spread via droplet AND airborne transmission
  • Infected surfaces and airspace may remain infectious for up to 2 hours after the infected person has left

Measles Cases and Prevention

  • 26 confirmed US cases of measles since December 1, 2023
    • 7 direct importations by international travelers
    • 2 outbreaks of more than 5 cases each
  • As is typical with measles cases in the US, most were among people who had not received a measles vaccine
  • Ensure all patients and healthcare staff have documented vaccination or immunity to measles
  • For those who do not, vaccinate, vaccinate, vaccinate
    • One dose is 93% effective in preventing measles; effectiveness of two doses is 97%
    • 95% population immunity is required to interrupt transmission
    • Anybody age > 6 months planning for international travel should be protected prior to departure
      • Any dose administered prior to 12 months DOES NOT COUNT as part of MMR series – patient will require another 2 doses after they reach 12 months

When to suspect measles

  • Any patient with fever and rash with cough, runny nose, and conjunctivitis who:
    • Is unvaccinated or under-vaccinated
    • Has recent travel, especially internationally or through a US international airport
    • Had contact with another person with a febrile rash illness
    • Was exposed to a known or possible measles case

 

What to do if you suspect Measles

  • Isolate:
    • Ideally prior to entering the facility
    • Have the patient don a well-fitting medical mask
    • Place in private room with a closed door immediately
    • Observe airborne precautions
    • Do not reuse rooms until at least 2 hours after suspect case has left
    • Do not send to the ER unless they require higher level of care
  • NOTIFY:
    • Contact Public Health IMMEDIATELY, while the patient is still at the facility
      • Weekdays 7:30 AM – 5 PM: 213-351-7800
      • Non-business hours/weekends: 213-974-1234
    • Public Health will provide guidance on:
      • Specimen collection for testing
      • Management of the suspect case
      • Management of asymptomatic contacts of a suspected or confirmed case

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Order and Administration Reminders

  • REMINDER: In observance of Presidents’ Day on Monday, February 19, 2024, CDPH and the Provider Call Center will be closed. In addition, LAC DPH Provider Immunization Call Center will also be closed.
  • NOTE: CDPH COVID-19 Treatments webpage for the public has moved to
  • Please submit your vaccine orders by Monday at 5:00 pm to receive your vaccine order the following week. Orders submitted after Monday at 5:00 pm may take an additional week to deliver.
  • Please order a 1–2-week supply of COVID-19 vaccine through myCAvax and re-order as necessary as you assess patient demand.
  • REMINDER: February BAP Holiday Shipping Cadence can be found here.
  • The DPH warehouse delivers vaccine 3-7 business days after the order is placed in myCAvax. Please present a photo ID (work badge, school ID, driver’s license, etc.) and sign for the delivery when received.
  • REMINDER: Pfizer, Moderna, and Novavax are all available for ordering through myCAvax for Bridge Access Program (BAP) providers and through myVFCvaccines for Vaccines for Children (VFC) providers VFC providers may only report through myVFCvaccines.
    • VFC providers that report in the wrong system (myCAvax) should contact the Provider Call Center at ProviderCallCenter@cdph.ca.gov or call (833) 502-1245 for guidance on removing or updating the incorrect report BAP providers may only report through myCAvax.
    • BAP providers that report in the wrong system (myVFCvaccines) should contact the VFC Call Center at myVFCvaccines@cdph.ca.gov or call (877) 243-8832 for guidance on removing or updating the incorrect report
  • REMINDER: Job aid for Vaccine and Clinic Eligibility by Funding Source can be found here.
  • UPDATED: BAP Eligibility Resource can be found here
  • CA BAP Program Requirements can be found here.
  • Additional BAP Resources can be found here.
  • NOTE: CAIR Registry ID's - Under AB 1797, vaccine providers are required to enter here. immunization information into the California Immunization Registry (CAIR).

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VFC UPDATES

Recertification Past Due: Wednesday, January 31, 2024

  • Annual 2024 Recertification is through myVFCvaccines
    • Annual Recertification and Training is a federal requirement to maintain active status in the VFC Program and receive publicly purchased vaccines.
    • VFA Recertification in myCAvax - Tuesday, February 20 2024
    • The link to recertify is still available on providers' myVFCvaccines accounts if they did not have a chance to submit prior to the deadline. Please log-in to your myVFCvaccines account, and the link to Recertify will still display.
    • Eventual account termination from VFC Program on MARCH 1
  • All public and private providers must recertify yearly
    • Recertification maintains the PIN’s active status
  • All VFC providers must enroll in CAIR and provide a CAIR ID to recertify. If you’re not sure if your practice is already participating in an immunization registry, contact the CAIR Help Desk (CAIRHelpdesk@cdph.ca.gov or 800-578-7889). CAIR also has Local CAIR Representatives that can support you with any questions you may have.
  • Vaccine Supply, Recertification and Holiday Operation Hours can be found here.
  • Who, When, Where and What You Need to Do for VFC Recertification can be found here.
  • VFC Recertification FAQs can be found here.
  • VFC is actively reaching out to remaining provider sites to prevent suspension of order privileges

 

Ordering Requirement for VFC Providers

  • VFC requirement: Provider locations who have not ordered and administered all ACIP recommended vaccines for their patient population in the past 12 months will be terminated from the VFC Program.
  • CDPH is currently reviewing accounts who have not ordered VFC vaccines in the past 12 months
  • Coming soon: Survey to go out assessing providers’ barriers to ordering VFC vaccines
  • Survey results will be reviewed prior to account termination

 

VFC RSV Vaccine Supply Update

  • The following RSV immunizations are no longer available for ordering:
    • RSV vaccine ABRYSVO (NDC: 00069-0344-01)
    • Nirsevimab (Beyfortus ) 100mg
  • Ordering is still open for Nirsevimab (Beyfortus ) 50mg
  • Got unused/unexpired doses of prenatal ABRYSVO and nirsevimab? Save them for Fall 2024!
    • Both have a long shelf life, so label appropriately and keep them safe for the upcoming respiratory virus season.
    • Recently shipped products have expiration dates in 2025
    • Please note: unexpired doses cannot be returned to McKesson!

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 VFA Upcoming Actions for Providers

  • With the VFA program being released in myCAvax on Tuesday, February 20, 2024, all VFA providers must complete the recertification process and be prepared for the following trainings and programmatic milestones.nm
  • February 22, 2024
    • Registerand attend the VFA 101 Training for Providers at 11:00 AM PT.
    • NOTE: Your identified VFA key practice staff should register for the above training and will receive email in early February regarding training reminders and next steps.  
  • February 29, 2024
    • Registerand attend the VFA 102 Training for Providers at 11:00 AM PT.
    • NOTE: Your identified VFA key practice staff should register for the above training and will receive email in early February regarding training reminders and next steps.
  • VFA Providers will do a 2nd “Recertification” in myCAvax when those programs transition in February 2024.
    • Update Key Practice Staff for the adult programs
    • POR to sign updated 2024 VFA Provider Agreement

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MPOX Vaccinator Staffing Resources

To support efforts to reduce the spread of mpox, the California Department of Public Health is making turnkey vaccination teams available at no cost to Local Health Departments and Community Based Organizations (CBOs) based on availability and equitable selection process.

 

These staff are intended to supplement, rather than augment, existing resources and increase Local Health Jurisdictions’ (LHJ) ability to vaccinate and protect our communities.

Turnkey teams provide staff with all necessary PPE and ancillary supplies, except vaccine product which must be supplied by the LHJ. Teams can provide other supplies like tables, tents, and chairs if needed and administer at least 100 doses in an 8-hour span with a team of 4 staff.

 

For large events, more staff may be provided. CBOs are expected to support event planning, marketing and logistics with the vendor and may be asked to provide technical assistance and staffing support for line management and client flow.

 

Overview of Staffing Resources

  • Staffing Model Supported: At this time, CDPH is providing short term turnkey staffing teams.
  • Staff Scope: Mpox staff can only be used to support Mpox vaccine administration, these staff should not provide vaccines of other kinds, including COVID.
  • Staffing Types: Registered Nurses (RNs), Licensed Vocational Nurses (LVNs), and Administrative Staff

 

Requesting Resources

  • Requests should be submitted at least 7-10 business days before staff are needed onsite.
  • CDPH encourages CBOs interested in hosting an event to coordinate directly with their LHJ to complete the site request survey. CBOs can also complete the site request form

 

For additional information or any questions contact your local health jurisdiction or the CDPH turnkey events team. More information can also be found on the CDPH website here.

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UPCOMING WEBINARS

  • CDPH Infection Prevention Webinar
    • Webinar registration links for Webex can be found
  • Look Ahead: Training Opportunities for VFA Providers
  • Pediatric Information Session: Adolescents immunization updates and strategies to increase HPV vaccination
    • Tuesday, March 12, 2024, 12PM-1PM
    • Meeting registration can be found here

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LACDPH & CDPH Provider Office Hours Link

LA County Department of Public Health Provider Immunization Office Hours Information

  • Every other Wednesday from 9am-10am - Next meeting: 2/28/2024
    • NOTE: Effective 2/01/23 the Office Hours will be held on a biweekly basis
  • This has been meeting amended to discuss COVID, Mpox, Flu, RSV and Measles vaccines. The meeting link will remain the same.
  • MS Teams meeting link below; please create a recurring calendar invite with this link.
  • To request meeting slides, please email covidvaccinereq@ph.lacounty.gov

Microsoft Teams meeting

Join on your computer or mobile app

Click here to join the meeting

Or call in (audio only)

+1 323-776-6996,,350547595#   United States, Los Angeles

Phone Conference ID: 350 547 595#

 

California Department of Public Health Provider Office Hours Registration Link

  • Every Friday from 9am-10:30am.
  • NOTE: Friday CDPH Office Hours for today February 16,2024 was canceled. The next CDPH Office Hours will be held Friday, February 23, 2024
  • Complete one-time registration here.
  • Meeting recordings and slides can be found here.

 

Providers should add staff names to the Provider Listserv to receive weekly emails and updates. To be added, please email blanca.corona@cdph.ca.gov