Flu Advisory

MMS Flu Advisory: Billing For Flu Vaccine

Posted in Flu, Flu Advisory on January 29th, 2013 by Erica Noonan – Comments Off on MMS Flu Advisory: Billing For Flu Vaccine

In response to the flu vaccine crisis, MassHealth wants to inform physicians, group practices and independent nurse practitioners that they will be reimbursed for privately-purchased flu vaccine if they exhaust state-provided supply from local boards of health or the Massachusetts Department of Public Health.

In accordance with 130 CMR 433.443 (c)(2)(a), reimbursement for privately-purchased vaccine can be obtained by using the following codes: 90655, 90656, 90657, 90658, 90660, 90661 and 90662.

For questions, please contact MassHealth Customer Service at providersupport@mahealth.net  or call  (800) 841-2900.

 

MMS Flu Advisory: DPH Issues Orders for Antiviral Prescribing and Guidance for Clinicians and Institutions

Posted in Flu, Flu Advisory on January 14th, 2013 by MMS – Comments Off on MMS Flu Advisory: DPH Issues Orders for Antiviral Prescribing and Guidance for Clinicians and Institutions

The state Department of Public Health (DPH) has issued orders allowing pharmacists to compound oral suspension of oseltamivir onsite (a non-sterile procedure) in light of a shortage. Such compounding does not require consultation with the prescriber where the prescription does not specifically authorize compounding.

DPH advises physicians prescribing oseltamivir oral suspension to prescribe medication in mg (milligrams) rather than ML or tsp, and include the statement, “May substitute compounded suspension” although this statement is not required for pharmacists to compound the suspension. Oseltamivir oral suspension is especially important to treat pediatric patients and certain adults with difficulty swallowing oral dosage forms. The orders, and guidance for prescribers and pharmacists, regarding oseltamivir oral suspension are available here.

The DPH has also issued separate guidance, effective today for acute care hospitals and emergency rooms, long term care facilities and EMS personnel to help manage the large influx of patients with influenza like illness (ILI).

DPH provided recommendations to acute care hospitals and emergency rooms regarding (1) Reducing or eliminating the need for boarding patients in the emergency department, and (2) Authorization and guidelines for use of alternate space for treatment of ambulatory patients presenting with Influenza-like Illness (ILI).

DPH also advises long term care facilities that a diagnosis of influenza is not a valid reason for denial of admission to a long term care facility. The advice includes 2012-13 Influenza and Pneumococcal Disease Control Recommendations.

The policy for EMS personnel addresses dispatch/triage, field treatment and transport, and post-transport guidance.

MMS Flu Advisory: January 13, 2013

Posted in Flu Advisory on January 11th, 2013 by MMS – Comments Off on MMS Flu Advisory: January 13, 2013

Sign up to receive MMS Flu Advisories by emailDuring the first week of 2013 (December 30-January 5), Influenza-like illness (ILI) activity in Massachusetts has decreased from the previous week but is still much higher than what is typically seen at this time of year.  In the U.S., influenza activity remained elevated, but may be decreasing in some areas.

The proportion of outpatient visits for influenza-like illness (ILI) was 4.3%; above the national baseline of 2.2%.

Twenty-four states and New York City experienced high ILI activity; 16 states, including Massachusetts, experienced moderate ILI activity; 5 states experienced low ILI activity; 5 states experienced minimal ILI activity, and the District of Columbia had insufficient data. Forty-seven states, including Massachusetts, reported widespread geographic influenza activity.

Antiviral efficacy and supply: According to the CDC, the majority of currently circulating influenza viruses are susceptible to the neuraminidase inhibitor antiviral medications oseltamivir and zanamivir; however, rare sporadic cases of oseltamivir-resistant 2009 H1N1 and A (H3N2) viruses have been detected worldwide.

Antiviral treatment with oseltamivir or zanamivir is recommended as early as possible for patients with confirmed or suspected influenza who have severe, complicated, or progressive illness; who require hospitalization; or who are at greater risk for serious influenza-related complications.

Additional information on recommendations for treatment and chemoprophylaxis of influenza virus infection with antiviral agents is available at http://www.cdc.gov/flu/antivirals/index.htm.

Not everyone with influenza needs to be treated with antivirals. DPH advises that clinicians should appropriately evaluate patients, typically through an inperson assessment, prior to prescribing antivirals for a patient. Prescribing antivirals indiscriminately by phone is not advised. Additionally, antiviral treatment should be considered for previously vaccinated individuals if indicated, particularly for patients over the age of 65.

There may be occasional temporary shortages of oseltamivir and zanamivir at the pharmacy level in specific locations. Pediatric suspension of oseltatnivir is in critically short supply. To meet demand for pediatric patients, pharmacists must compound the antiviral medication as needed.

In light of these factors, MDPH recommends that practitioners who choose to prescribe oseltamivir and zanamivir do so electronically or by verbal order over the phone so that the patient’s pharmacy has adequate time to prepare the drug for patient pick-up or can inform the clinician if that pharmacy is unable to fulfill the prescription.

Flu Vaccine Availability

Flu vaccine is still available for purchase from distributors and manufacturers.  A list of distributors with flu vaccine can be found at http://www.preventinfluenza.org/ivats/.

Please see the table below for a list of manufacturers and the formulations they have available.

Manufacturer

Trade Name

Dose/ Presentation

Age Group

Sanofi Pasteur:  800-822-2463 Fluzone High-Dose® 0.5 mL prefilled syringe

> 65 yrs

Sanofi Pasteur:  800-822-2463 Fluzone
Intradermal®
0.1 mL prefilled microinjection syringe

18-64 yrs

Novartis:  800-244-7668 Agriflu® 0.5 mL prefilled syringe

> 18 yrs

GlaxoSmithKline: 866-475-8222 FluLuval™, Inactivated 5.0 mL multidose vial

> 18 yrs

CSL Biotherapies: 888-435-8633 Afluria®, Inactivated 0.5 mL prefilled syringe and 5.0 mL multidose vial

> 9 yrs

MedImmune: 877-358-6478 FluMist®  Live attenuated intranasal 0.2 mL sprayer,divided dose

2–49 yrs

Standing orders, VISs, screening forms and other materials are available at http://www.mass.gov/eohhs/provider/guidelines-resources/services-planning/diseases-conditions/influenza/school-flu-clinics.html.

Early finding of vaccine efficacy

Findings from early data released today suggest that this season’s vaccine so far is reducing the risk of having to go to the doctor for influenza by about 60% for people who got vaccinated. (See MMWR Report, Interim Vaccine Effectiveness Estimates section.)

For flu resources for physicians and patients, visit www.massmed.org/flu

MMS Issues Q&A on Seasonal Flu

Posted in Flu, Flu Advisory, Public Health on December 13th, 2012 by MMS Communications – Comments Off on MMS Issues Q&A on Seasonal Flu

The Massachusetts Medical Society, adding its voice to those encouraging patients to get a flu shot, has issued a Q&A on Seasonal Flu to news publications across the state.  The Centers for Disease Control and Prevention has indicated that this year’s flu season has arrived unusually early – the earliest arrival in almost a decade, in fact – and that the season could be more severe than those of previous years.

The Q&A, written for the patient population, covers such areas as complications from the flu, categories of those individuals who are most at risk, who should not be vaccinated, how the flu vaccine is given, and best preventive measures. It also lists websites to visit for more information, and the Flu Vaccine Finder, to help patients find locations offering flu shots. The Q&A may be read here.

MMS Flu Advisory: ACIP Recommendations for 2012-13 Flu Season

Posted in Flu Advisory on August 17th, 2012 by MMS – Comments Off on MMS Flu Advisory: ACIP Recommendations for 2012-13 Flu Season

Sign up to receive MMS Flu Advisories by e-mailThe August 17 Morbidity and Mortality Weekly Report (MMWR) includes the recommendations of the Advisory Committee on Immunization Practices for the prevention and control of influenza with vaccines for the 2012-13 flu season in the U.S.

The report:

  • identifies influenza vaccine virus strains included in the U.S. seasonal influenza vaccine for 2012–13;
  • includes an updated vaccination schedule for children aged 6 months through 8 years and a description of available vaccine products and indications;
  • discusses febrile seizures associated with administration of influenza and 13-valent pneumococcal conjugate (PCV-13) vaccines;
  • provides vaccination recommendations for persons with a history of egg allergy; and
  • discusses the development of quadrivalent influenza vaccines for use in future influenza seasons.

The full report can be found at www.cdc.gov/mmwr/pdf/wk/mm6132.pdf.

Information about issues related to influenza vaccination that are not addressed in this update are available in CDC’s Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (www.cdc.gov/mmwr/pdf/rr/rr5908.pdf).

MMS Flu Advisory: Influenza A(H3N2)v Virus

Posted in Flu Advisory on August 16th, 2012 by MMS – Comments Off on MMS Flu Advisory: Influenza A(H3N2)v Virus

Sign up to receive MMS Flu Advisories by e-mailSource: Massachusetts Department of Public Health

Between July 12, 2012 and August 9, 2012, 153 confirmed H3N2v cases have been identified in four states: Indiana (120 cases), Ohio (31 cases), Illinois (1 case) and Hawaii (1 case). The majority of H3N2v cases have been in children, although some adults have been infected, and linked to recent direct or indirect exposure to pigs at agricultural fairs, either through exhibiting pigs or walking through a swine barn. The Mass. Department of Public Health has issued an advisory with the following key points:

  1. The number of H3N2v influenza cases identified in the United States has increased and almost all have been associated with agricultural fairs and contact with swine.
  2. Health care providers should suspect H3N2v in patients presenting with influenza like illness (ILI) prior to the traditional flu season and should ask patients about any recent exposure to swine.
  3. Rapid influenza diagnostic tests (RIDTs) and commercially-available RT-PCR tests are not reliable for the identification of H3N2v influenza. All specimens should be sent to the Hinton State Laboratory for testing. Call 617-983-6800 to speak to an epidemiologist.
  4. To date H3N2v has appeared to be similar to seasonal flu in terms of duration and severity of illness, risk groups, infectious period, and clinical management. Providers should consider prompt presumptive antiviral treatment of suspect cases. However, to date, human-to-human transmission of H3N2v has been very limited.
  5. Because this virus is spread to people by close contact with pigs, common sense precautions for preventing diseases spread by animals are recommended for those caring for and exhibiting animals (e.g., frequent hand washing before and after exposure).
  6. Everyone not involved in the care and handling of pigs should avoid direct contact with pigs.
  7. Immunocompromised patients should avoid pigs and swine barns.
  8. Seasonal influenza vaccine is recommended for everyone, beginning at six months of age.

MMS Flu Advisory: State Issues 2010-11 Flu Season Recommendations

Posted in Flu, Flu Advisory on September 2nd, 2010 by MMS – Comments Off on MMS Flu Advisory: State Issues 2010-11 Flu Season Recommendations

Flu Advisory BoxThe annual flu vaccine is now recommended for everyone 6 months of age and older.

The Massachusetts Department of Public Health has distributed recommendations and resources for health care providers related to vaccine dosing, high risk groups, Medicare reimbursement, surveillance and testing, chemoprophylaxis and treatment, and infection control.

Please see the full document (.pdf) for information about:

  • Massachusetts regulations requiring licensed clinics, dialysis centers, hospitals, and long-term care facilities to provide every employee with information about the risks and benefits of flu vaccine and to provide flu vaccine at no cost to all employee;
  • High risk groups, including two groups newly identified as at increased risk: American Indians/Alaska Natives and people who are morbidly obese;
  • An algorithm to determine dosing recommendations for children;
  • Use of trivalent inactivated influenza vaccine (TIV) for people at higher risk of influenza complications;
  • Screening for possible reactive airway disease before using LAIV for children aged 2 – 4 years, and not using LAIV in children with asthma or a recent wheezing episode;
  • Use only of oseltamivir or zanamivir for chemoprophylaxis or treatment of influenza;
  • Medicare reimbursement for administration of flu and pneumococcal vaccines;
  • How to purchase vaccine, and target populations and dosing for each vaccine;
  • Testing and treatment recommendations, including use of antivirals and infection control.

MMS Flu Advisory: 2010-11 Seasonal Flu; Vaccine Distribution; Health Care Worker Vaccine Requirements

Posted in Flu, Flu Advisory on August 5th, 2010 by MMS – Comments Off on MMS Flu Advisory: 2010-11 Seasonal Flu; Vaccine Distribution; Health Care Worker Vaccine Requirements

Flu Advisory BoxSeasonal Flu in U.S.

Influenza A (H3N2) virus infections have been recently detected in people in 12 states across the U.S., including two small localized outbreaks in Iowa, according to a CDC Health Alert. Sporadic cases of influenza and localized summer outbreaks from seasonal influenza viruses are detected each summer. Clinicians are reminded to consider influenza as a possible diagnosis when evaluating patients with acute respiratory illnesses, including pneumonia, even during the summer months. See CDC alert and recommendations.

Antigenic characterization of the influenza A (H3) viruses received at CDC are pending. However, based on hemagglutinin gene sequencing data from four viruses isolated from July specimens, these viruses are expected to be antigenically similar to A/Perth/16/2009-like H3N2 viruses. An A/Perth/16/2009-like H3N2 virus is included in the 2010-11 seasonal influenza vaccine. Perth-like H3N2 viruses were first identified in early 2009, but have not yet circulated widely in the United States. Past influenza vaccines did not contain this strain, so vaccination with last year’s seasonal vaccine would not be expected to provide substantial protection against this H3N2 Perth-like strain.

ACIP Seasonal Influenza Vaccination Recommendations

Highlights include:

  1. Annual vaccination be administered to all persons aged >=6 months for the 2010-11 influenza season
  2. Children aged 6 months-8 years whose vaccination status is unknown or who have never received seasonal influenza vaccine before (or who received seasonal vaccine for the first time in 2009-10 but received only 1 dose in their first year of vaccination) as well as children who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine regardless of previous influenza vaccine history should receive 2 doses of a 2010-11 seasonal influenza vaccine (minimum interval: 4 weeks) during the 2010-11 season
  3. Vaccines containing the 2010-11 trivalent vaccine virus strains A/California/7/2009 (H1N1)-like (the same strain as was used for 2009 H1N1 monovalent vaccines), A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens be used
  4. Information about Fluzone High-Dose, a newly approved vaccine for persons aged >=65 years; and
  5. Information about other standard-dose newly approved influenza vaccines and previously approved vaccines with expanded age indications.

Seasonal Flu Vaccine Distribution Underway

MedImmune has begun shipping intranasal influenza vaccine. GSK, Novartis, and Sanofi Pasteur have begun distribution of 2010-11 injectable seasonal influenza vaccine. Centers for Medicare and Medicaid Services (CMS) has confirmed that the new high dose formulation vaccine for patients 65 years and older, Fluzone HD, is covered by Medicare Part B and will be reimbursed for the upcoming 2010-2011 influenza season. CMS has updated its various pricing files to include Fluzone High-Dose vaccine in the “July 2010 AWP NDC – HCPCS Crosswalk File” for Medicare Part B Drugs.

Health Care Professional (HCP) Vaccine Requirements

The Massachusetts Department of Public Health (MDPH) has released its 2010-11 recommendations and guidelines for health care worker vaccination. (.pdf)

Sources: CDC; MMWR 2009;58:[No. RR-10]); MDPH

Seasonal Influenza (H3N2) Infections; ACIP 2010-11 Seasonal Flu Recommendations; Seasonal Flu Vaccine Distribution; MA 2010-11 Health Care Worker Vaccine Requirements

Seasonal Flu in U.S.

Influenza A (H3N2) virus infections have been recently detected in people in 12 states across the U.S., including two small localized outbreaks in Iowa, according to a CDC Health Alert. Sporadic cases of influenza and localized summer outbreaks from seasonal influenza viruses are detected each summer. Clinicians are reminded to consider influenza as a possible diagnosis when evaluating patients with acute respiratory illnesses, including pneumonia, even during the summer months. See CDC alert and recommendations. Antigenic characterization of the influenza A (H3) viruses received at CDC are pending. However, based on hemagglutinin gene sequencing data from four viruses isolated from July specimens, these viruses are expected to be antigenically similar to A/Perth/16/2009-like H3N2 viruses. An A/Perth/16/2009-like H3N2 virus is included in the 2010-11 seasonal influenza vaccine. Perth-like H3N2 viruses were first identified in early 2009, but have not yet circulated widely in the United States. Past influenza vaccines did not contain this strain, so vaccination with last year’s seasonal vaccine would not be expected to provide substantial protection against this H3N2 Perth-like strain.

ACIP has released its 2010 Seasonal Influenza Vaccination Recommendations.

Highlights include:

1. Annual vaccination be administered to all persons aged >=6 months for the 2010-11 influenza season;

2. Children aged 6 months-8 years whose vaccination status is unknown or who have never received seasonal influenza vaccine before (or who received seasonal vaccine for the first time in 2009-10 but received only 1 dose in their first year of vaccination) as well as children who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine regardless of previous influenza vaccine history should receive 2 doses of a 2010-11 seasonal influenza vaccine (minimum interval: 4 weeks) during the 2010-11 season;

3. Vaccines containing the 2010-11 trivalent vaccine virus strains A/California/7/2009 (H1N1)-like (the same strain as was used for 2009 H1N1 monovalent vaccines), A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens be used;

4. Information about Fluzone High-Dose, a newly approved vaccine for persons aged >=65 years; and

5. Information about other standard-dose newly approved influenza vaccines and previously approved vaccines with expanded age indications.

Seasonal Flu Vaccine Distribution Underway

MedImmune has begun shipping intranasal influenza vaccine. GSK, Novartis, and Sanofi Pasteur have begun distribution of 2010-11 injectable seasonal influenza vaccine. Centers for Medicare and Medicaid Services (CMS) has confirmed that the new high dose formulation vaccine for patients 65 years and older, Fluzone HD, is covered by Medicare Part B and will be reimbursed for the upcoming 2010-2011 influenza season. CMS has updated its various pricing files to include Fluzone High-Dose vaccine in the “July 2010 AWP NDC – HCPCS Crosswalk File” for Medicare Part B Drugs.

Health Care Professional (HCP) Vaccine Requirements

The Massachusetts Department of Public Health (MDPH) has released its 2010-11 recommendations and guidelines for health care worker vaccination.

Sources: CDC; MMWR 2009;58:[No. RR-10]); MDPH

DPH Rescinds Emergency Flu Vaccine Orders of Fall 2009

Posted in Flu, Flu Advisory on May 25th, 2010 by MMS – Comments Off on DPH Rescinds Emergency Flu Vaccine Orders of Fall 2009

Flu Advisory BoxMassachusetts Department of Public Health Commissioner John Auerbach has rescinded the emergency order he issued in September 2009 to allow certain designated health care professionals—EMTs-paramedic level, pharmacists, and dentists—and medical and nursing students to administer seasonal and H1N1 influenza vaccine.

He also rescinded the emergency order issued November 6, 2009 which allowed for certain compounding and dispensing of Tamiflu® by licensed pharmacies.

Order Flu Vaccine for 2010-2011 Flu Season

Posted in Flu, Flu Advisory on March 17th, 2010 by MMS – Comments Off on Order Flu Vaccine for 2010-2011 Flu Season

Flu Advisory BoxPhysicians are encouraged to order their 2010-2011 flu vaccine now.

The Massachusetts Department of Public Health (MDPH) will not supply influenza vaccine to nursing homes and private providers for vaccination of adults. Please note that the universal distribution of H1N1 vaccine for the 2009 – 2010 influenza season was a special program fully funded by the federal government. There will be no such program in place for seasonal influenza vaccine for 2010-2011 season.As in previous years, MDPH plans to provide some state-supplied influenza vaccine to the following provider types:

  • Pediatric care providers
  • Schools (K-12)
  • Obstetricians
  • VNAs (for public vaccination clinics)
  • Public sites that provide care to adults
  • Community health centers
  • Local health departments
  • State hospitals and agencies
  • Free community-based clinics
  • TB clinics
  • Correctional facilities
  • Integrated Counseling, Testing and Referral Sites
  • Health care for the homeless

MDPH will not be able to supply a sufficient number of doses to meet all of the demand even at the sites listed above. Providers will be notified what their allocation of doses will be by early summer. All providers should plan to purchase some influenza vaccine for the 2010-2011 flu season.

All providers should determine how much vaccine they will need for their patients and employees in 2010 – 2011, and place orders for vaccine with manufacturers or distributors as soon as possible.

To purchase seasonal influenza vaccine, contact your regular vaccine distributor or the vaccine manufacturers. Locate a vaccine distributor (Excel spreadsheet)

View a list of influenza vaccine products (pdf) expected to be available for the 2010 – 2011 flu season, and the age indications for each.

If you have questions about the availability of seasonal flu vaccine, please contact the MDPH Vaccine Unit at 617-983-6828.