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Drug and Biologic Coverage Policy

Effective Date ...... 7/1/2021 Next Review Date ...... 4/1/2022 Coverage Policy Number ...... 9001

Routine

Table of Contents Related Coverage Resources

Coverage Policy ...... 1 Preventive Care Services General Background ...... 2 Covid-19 Coding/Billing Information ...... 3 References ...... 7

INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Policies are based. For example, a customer’s benefit plan document may contain a specific exclusion related to a topic addressed in a Coverage Policy. In the event of a conflict, a customer’s benefit plan document always supersedes the information in the Coverage Policies. In the absence of a controlling federal or state coverage mandate, benefits are ultimately determined by the terms of the applicable benefit plan document. Coverage determinations in each specific instance require consideration of 1) the terms of the applicable benefit plan document in effect on the date of service; 2) any applicable laws/regulations; 3) any relevant collateral source materials including Coverage Policies and; 4) the specific facts of the particular situation. Coverage Policies relate exclusively to the administration of health benefit plans. Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations.

Coverage Policy

The Affordable Care Act (ACA) requires individual and group health plans to cover in-network routine immunizations without cost sharing (e.g., deductibles, coinsurance, copayments) unless the plan qualifies under the grandfather provision or for an exemption.

Coverage of routine immunizations is generally subject to the terms, conditions and limitations of a preventive services benefit as described in the applicable plan’s schedule of copayments. Please refer to the applicable benefit plan document to determine benefit availability and the terms and conditions of coverage.

Many benefit plans specifically exclude immunizations that are for the purpose of travel or to protect against occupational hazards and risks. For any benefit exclusion, coverage will not be provided even if the medical necessity criteria described below are met. Please refer to the applicable benefit plan document to determine benefit availability and the terms, and conditions of coverage.

This Coverage Policy does not pertain to Therapeutic (such as those used for treatment of infectious disease and oncology) nor does it apply to Respiratory Syncytial , non-routine vaccines and immune globulins [such as, but not limited to Rabies or Rho(D) immune globulins]. If coverage is available for routine immunizations, the following conditions of coverage apply:

Page 1 of 8 Drug and Biologic Coverage Policy: 9001 Routine immunizations with a U.S. Food and Drug Administration (FDA) licensed vaccine are covered as medically necessary when used in accordance with a recommendation by the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Practices (ACIP).

Routine immunizations are covered according to the provisional recommendations of the ACIP until the recommendations are officially published in the Morbidity and Mortality Weekly Report (MMWR).

General Background

Disease prevention vaccines are those products which are designed to trigger acquired immunity against certain infectious diseases. Disease prevention vaccines are administered to healthy individuals to prevent a disease. In most cases these vaccines are administered prior to exposure to the disease, but in some cases, the vaccine is administered after an exposure has occurred.

Routine vaccines are those recommended for everyone in the United States, depending on age and vaccine history and are available for the prevention of 18 diseases:

Chickenpox (Varicella) Mumps Diphtheria Pneumococcal Flu (Influenza) Polio (Poliomyelitis) Hepatitis A Rotavirus Rubella (German Measles) Hib (Haemophilus influenzae type b) Shingles (Herpes Zoster) HPV (Human Papillomavirus) Tetanus (Lockjaw) Measles Whooping cough (Pertussis) Meningococcal

A therapeutic vaccine by definition is a vaccine which prevents or eases the severity of the problems from an or disease that has already occurred. Therapeutic vaccines are also under development in oncology such as for prostate cancer.

Vaccines must be licensed by the U.S. Food and Drug Administration’s (FDA) Center for Biologics Evaluation and Research (CBER) prior to use in the United States (U.S.). Before the FDA approves a license, vaccines are tested for safety and efficacy. Vaccines approved for marketing may also be required to undergo additional studies to further evaluate the vaccine and often to address specific questions about the vaccine's safety, effectiveness, or possible side effects.

The Advisory Committee on Immunization Practices (ACIP) The ACIP is comprised of experts in fields associated with immunization, who have been selected by the Secretary of the U.S. Department of Health and Human Services to provide advice and guidance to the Secretary, the Assistant Secretary for Health, and the Centers for Disease Control and Prevention (CDC) on the control of vaccine-preventable diseases. The ACIP is the only entity in the federal government that makes such recommendations.

Subsequent to the licensing of a new vaccine by the FDA, the ACIP will review the vaccine and provide advice and guidance regarding the most appropriate selection of vaccines for administration to children and adults in the U.S. Recommendations include age for vaccine administration, number of doses and dosing interval, and precautions and contraindications. Additional guidance may be provided for “catch up” age ranges, periodic re- , guidance regarding high risk sub-groups who should receive the vaccine and guidance for individual decision making.

The ACIP meets three times each year and submits their recommendations to the Director of the CDC and the Department of Health and Human Services (HHS) for approval. ACIP recommendations are considered provisional until published in the CDC’s Morbidity and Mortality Weekly Report (MMWR). The MMWR represents the official CDC recommendations for immunization of the U.S. population.

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NOTE: On February 21, 2018, the ACIP voted that for the 2018-19 influenza season, immunization providers may choose to administer any licensed, age appropriate, (including LAIV, IIV, and RIV). This is a change from when LAIV was not recommended by the ACIP for the 2017-2018 influenza season.

ACIP Recommendations The ACIP recommendations are developed using an evidence-based method based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Key factors considered in development of recommendations include balance of benefits and harms, type or quality of evidence, values and preferences of the people affected, and health economic analyses. Category A recommendations are made for all persons in an age- or risk-factor-based group. Category B recommendations are made for individual clinical decision making.

The Affordable Care Act (ACA) designates the ACIP as the source for recommended routine immunizations for children, adolescents, and adults. A recommendation from the ACIP is considered in effect when it has been adopted by the Director of the CDC and published in the MMWR or when it is listed on the Immunization Schedules of the CDC. ACA requires coverage of routine immunizations when prescribed by a health care professional consistent with the ACIP recommendation.

Other Vaccination Recommendations The United States Preventive Services Task Force (USPSTF) recognizes the importance of immunizations in primary disease prevention. However, the USPSTF does not wish to duplicate the significant investment of resources made by others to review new evidence on immunizations in a timely fashion and make recommendations. The USPSTF therefore will not update its 1996 recommendations.

The American Academy of Pediatrics (AAP) contributes collaboratively to the literature review, analyses of data, and deliberations as a liaison to several of the disease specific working groups for the ACIP.

Combination Vaccines Several of the routinely administered childhood vaccines have been combined into single products. These are called combination vaccines. Some combination vaccines are routinely used in the United States (e.g. DTaP- Diphtheria, Tetanus, acellular Pertussis and MMR – Measles, Mumps and Rubella). The advantage of combination vaccines is that children get the protection of all the component vaccines while getting fewer injections.

ACIP includes the combined vaccine in recommendations for use when any component of the combination is indicated, and if the other components are not contraindicated. They further note that the combined vaccine is to be used in its FDA indicated population and age range.

The American Board of Internal Medicine’s (ABIM) Foundation Choosing Wisely® Initiative The American Academy of Allergy, Asthma & Immunology’s Choosing Wisely Initiative states do not routinely avoid influenza vaccination in egg-allergic patients.

Centers for Medicare & Medicaid Services - National Coverage Determinations (NCDs) There are no CMS National Coverage Determinations for Routine Immunizations.

Coding/Billing Information

Note: 1) This list of codes may not be all-inclusive. 2) Deleted codes and codes which are not effective at the time the service is rendered may not be eligible for reimbursement.

Routine Disease Prevention Vaccines Considered Medically Necessary when criteria in the applicable policy statements listed above are met:

Page 3 of 8 Drug and Biologic Coverage Policy: 9001 CPT®* Description Codes 90619 Meningococcal , serogroups A, C, W, Y, quadrivalent, tetanus carrier (MenACWY-TT), for intramuscular use 90620 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB- 4C), 2 dose schedule, for intramuscular use 90621 Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB-FHbp), 2 or 3 dose schedule, for intramuscular use 90630 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use 90632 (HepA), adult dosage, for intramuscular use 90633 Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use 90634 Hepatitis A vaccine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramuscular use 90636 Hepatitis A and (HepA-HepB), adult dosage, for intramuscular use 90644 Meningococcal conjugate vaccine, serogroups C & Y and Haemophilus influenzae type b vaccine (Hib-MenCY), 4 dose schedule, when administered to children 6 weeks -18 months of age, for intramuscular use 90647 Haemophilus influenzae type b vaccine (Hib), PRP-OMP conjugate, 3 dose schedule, for intramuscular use 90648 Haemophilus influenza type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, for intramuscular use 90649 Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use 90650 Human Papillomavirus vaccine, types 16, 18, bivalent (2vHPV), 3 dose schedule, for intramuscular use 90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use 90653 Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use 90654 Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use 90655 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use 90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use 90657 Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use 90658 Influenza virus vaccine, trivalent (IIV3), split virus,0.5 mL dosage, for intramuscular use 90660 Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use 90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use 90662 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use 90670 Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use 90672 Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use 90673 Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use 90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use 90680 , pentavalent (RV5), 3 dose schedule, live, for oral use 90681 Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use 90682 Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use 90685 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use 90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use 90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use

Page 4 of 8 Drug and Biologic Coverage Policy: 9001 CPT®* Description Codes 90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use 90694 Influenza virus vaccine, quadrivalent (allV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use 90696 Diphtheria, tetanus , acellular and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use 90697 Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP- IPV-Hib-HepB), for intramuscular use 90698 Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenzae type B, and inactivated poliovirus vaccine (DTap-IPV/Hib), for intramuscular use 90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP) when administered to individuals younger than 7 years, for intramuscular use 90702 Diphtheria and tetanus toxoids adsorbed (DT) when administered to individuals younger than 7 years, for intramuscular use 90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use 90710 Measles, mumps, rubella and (MMRV), live, for subcutaneous use 90713 Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use 90714 Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use 90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use 90716 Varicella virus vaccine (VAR), live, for subcutaneous use 90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV), for intramuscular use 90732 Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use 90733 Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135,quadrivalent (MPSV4), for subcutaneous use 90734 Meningococcal conjugate vaccine, serogroups A, C, W,Y, quadrivalent, diphtheria toxoid carrier (MenACWY-D), or CRM197 carrier (MenACWY-CRM), for intramuscular use 90736 Zoster (shingles) vaccine (HZV), live, for 90739 Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use 90740 Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use 90743 Hepatitis B vaccine (HepB), adolescent, 2 dose schedule, for intramuscular use 90744 Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use 90746 Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use 90747 Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 4 dose schedule, for intramuscular use 90748 Hepatitis B and Haemophilus influenzae type b vaccine (Hib-HepB), for intramuscular use 90750 Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for 90756 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use

HCPCS Description Codes Q2034 Influenza virus vaccine, split virus, for intramuscular use (Agriflu) Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

Page 5 of 8 Drug and Biologic Coverage Policy: 9001 HCPCS Description Codes Q2036 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval) Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin) Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone) Q2039 Influenza virus vaccine not otherwise specified

Vaccine administration codes:

CPT®* Description Codes 90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered 90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure) 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) 90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) 90473 Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid) 90474 Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

HCPCS Description Codes G0008 Administration of influenza virus vaccine G0009 Administration of G0010 Administration of hepatitis B vaccine J3530 Nasal vaccine inhalation

Not Covered-pending FDA approval, pending ACIP recommendation or not recommended by ACIP:

CPT®* Description Codes 90587 , quadrivalent, live, 3 dose schedule, for subcutaneous use 90626 Tick-borne virus vaccine, inactivated; 0.25 mL dosage, for intramuscular use 90627 Tick-borne encephalitis virus vaccine, inactivated; 0.5 mL dosage, for intramuscular use 90660 Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use (Effective for Dates of Service 09/15/2016 through 06/30/2018) 90664 Influenza virus vaccine live (LAIV), formulation, for intranasal use 90666 Influenza virus vaccine (IIV), pandemic formulation, split virus, preservative free, for intramuscular use 90667 Influenza virus vaccine (IIV), pandemic formulation, split virus, adjuvanted, for intramuscular use 90668 Influenza virus vaccine (IIV), pandemic formulation, split virus, for intramuscular use 90671 Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use 90677 Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use

Page 6 of 8 Drug and Biologic Coverage Policy: 9001 CPT®* Description Codes 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use

Not Covered- Immunizations for the purpose of travel are excluded under most benefit plans:

CPT®* Description Codes 90625 , live, adult dosage, 1 dose schedule, for oral use 90690 , live, oral 90691 Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use 90717 Yellow vaccine, live, for subcutaneous use 90738 Japanese encephalitis virus vaccine, inactivated, for intramuscular use

*Current Procedural Terminology (CPT®) ©2020 American Medical Association: Chicago, IL.

References

1. Centers for Disease Control and Prevention (CDC). ACIP Recommendations. GRADE Evidence Tables. Accessed February 26, 2021. Available at: http://www.cdc.gov/vaccines/acip/recs/grade/table-refs.html

2. Centers for Disease Control and Prevention (CDC). ACIP Vaccine Recommendations. Accessed June 18, 2021. Available at: http://www.cdc.gov/vaccines/hcp/acip-recs/index.html

3. Centers for Disease Control and Prevention (CDC). Current Vaccine Shortages and Delays. Accessed February 26, 2021. Available at: https://www.cdc.gov/vaccines/hcp/clinical- resources/shortages.html#chart

4. Centers for Disease Control and Prevention (CDC). Human Papillomavirus (HPV) ACIP Vaccine Recommendations. Accessed March 1, 2021. Available at: https://www.cdc.gov/vaccines/hcp/acip- recs/vacc-specific/hpv.html

5. Centers for Disease Control and Prevention (CDC). Immunization Schedules. Accessed March 1, 2021. Available at: http://www.cdc.gov/vaccines/schedules/hcp/index.html

6. Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger —United States, 2021. February 12, 2021. Accessed March 1, 2021. Available at: https://www.cdc.gov/mmwr/volumes/70/wr/mm7006a1.htm

7. Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older —United States, 2021. February 12, 2021. Accessed March 1, 2021. Available at: https://www.cdc.gov/mmwr/volumes/70/wr/mm7006a2.htm

8. Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. August 16, 2019. Accessed March 1, 2021. Available at: https://www.cdc.gov/mmwr/volumes/68/wr/mm6832a3.htm

9. Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report. Licensure of a Diphtheria and Tetanus Toxoids and Acellular Pertussis, Inactivated Poliovirus, Haemophilus influenzae Type b Conjugate, and Hepatitis B Vaccine, and Guidance for Use in Infants. February 7, 2020. Accessed March 1, 2021. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6905a5.htm

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10. Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices —United States, 2012-21 Influenza Season. Accessed March 1, 2021. Available at: https://www.cdc.gov/mmwr/volumes/69/rr/rr6908a1.htm

11. Centers for Disease Control and Prevention (CDC). Recommended Vaccines by Disease. Accessed March 1, 2021. Available at: https://www.cdc.gov/vaccines/vpd/vaccines-diseases.html

12. Centers for Disease Control and Prevention (CDC). Routine Vaccines. Accessed March 1, 2021. Available at: https://wwwnc.cdc.gov/travel/diseases/routine

13. Centers for Disease Control and Prevention (CDC). Supplemental information and guidance for vaccination providers regarding use of 9-valent HPV. Accessed March 1, 2021. Available at:https://www.cdc.gov/hpv/downloads/9vhpv-guidance.pdf

14. Centers for Disease Control and Prevention (CDC). Vaccines and Immunizations/Vaccine Information Statements (VIS)/ May 8, 2017 -4 is no longer available. Accessed March 1, 2021. Available at:https://www.cdc.gov/vaccines/hcp/vis/what-is-new.html#gard4

15. Centers for Disease Control and Prevention (CDC). Vaccine Information Statements (VISs), Dates of Current and Past Vaccine Information Materials. Accessed March 1, 2021. Available at: https://www.cdc.gov/vaccines/hcp/vis/vis-dates.html

16. Health and Human Services. Center for Consumer Information and Insurance Oversight. Affordable Care Act Implementation. FAQs-Set 12. Accessed March 1, 2021. Available at: https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12.html

17. U. S. Food and Drug Administration (FDA). Vaccines, Blood and Biologics. Vaccines Licensed for Immunization and Distribution in the US with Supporting Documents. Accessed June 18, 2021. Available at: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm093833.htm

18. U.S. Preventive Services Task Force. Recommendations for Primary Care Practice. Published Recommendations. Immunizations for adults. Accessed March 1, 2021. Available at:https://www.uspreventiveservicestaskforce.org/BrowseRec/ReferredTopic/232

19. U.S. Preventive Services Task Force. Recommendations for Primary Care Practice. Published Recommendations. Immunizations for children. Accessed March 1, 2021. Available at:https://www.uspreventiveservicestaskforce.org/BrowseRec/ReferredTopic/233

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