Texas Providers Webinar August 17, 2021 DISCLAIMER

The information presented today is based on CDC’s recent guidance and MAY change.

August 17, 2021 Today’s Webinar Cadence

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Section Presented by Opening Remarks Antonio Aragon COVID-19 Updates Saroj Rai Vaccine Recommendations to Help Protect Jennifer Moore Adolescents Vaccine Recommendations to Help Protect Denise Starkey Adults Vaccine Recommendations to Help Protect Carolyn Smith Pregnant Persons COVID-19 Vaccine Product Updates Kaylee Tran

Moderator: Sarah Gant Live Q&A DSHS Subject Matter Experts Opening Remarks National Awareness Month National Immunization Awareness Month (NIAM) is an annual observance held in August to highlight the importance of for people of all ages.

Today: Effective Recommendations for Adolescent and Adult Back To School and COVID-19 Vaccine Coadministration Let’s Get Caught Up

Due to the COVID-19 pandemic, many COVID-19 and other vaccines may be children are 1 or more doses behind on administered without regard to timing. This some . As students start includes simultaneous administration of the to come back to school it’s important that COVID-19 vaccine on the same day, as well as we help make sure they are up to date. coadministration within 14 days.

Remember: During this drive to get Getting multiple vaccines at the same time immunizations caught up, it is critically has been proven to be safe. important to not miss opportunities to For more information on co-administration of COVID-19 co-administer vaccines whenever vaccines, please visit the CDC’s webpage on Interim possible. Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States. COVID-19 Vaccine Update FDA Authorizes Additional mRNA COVID-19 Vaccine Dose for Certain Immunocompromised Individuals

DSHS communication to all Providers sent on August 14, 2021

• On August 12, 2021, the food and Drug Administration (FDA) revised both Pfizer and Moderna COVID-19 Vaccine Emergency Use Authorization fact sheets to include guidance on administering an additional dose in certain immunocompromised individuals. • August 13, 2021, the Center for Disease and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommended that people whose are moderately to severely compromised receive an additional dose of mRNA COVID-19 vaccine at least 28 days after an initial two-dose mRNA series (Pfizer or Moderna). • Currently, there is insufficient data to support the use of an additional mRNA COVID-19 vaccine dose after a single-dose Janssen COVID-19 vaccination series in immunocompromised people. FDA and CDC are actively working to provide guidance on this issue. • Note: An additional dose is only recommended for individuals who are moderately or severely immunocompromised —CDC does not recommend additional doses shots for any other population at this time.

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html Updated Pfizer Emergency Use Authorization fact sheet Updated Moderna Emergency Use Authorization fact sheet Vaccine Recommendations to Help Protect Adolescents Vaccine Schedules and Guidance for Adolescents

Encourage and inform parents on all the vaccines needed for kids as we start to return to school

You can find schedules and a list of vaccine preventable diseases (VPDs) here: https://www.cdc.gov/vaccines/schedules/easy-to- read/adolescent-shell-easyread.html1 Let’s Get Kids Caught Up

Recommended Vaccines for Different Age groups

• HPV1- Although recommended for • Meningococcal disease3- (one dose Meningococcal disease8 children ages 11-12, the HPV of MenACWY vaccine) • Meningococcal can be given as early as 9 • HPV4 - (two doses of vaccine) (MenACWY)- given at 16 years to help protect both girls and boys • Tetanus5, diphtheria6, and whooping old (2nd dose) from HPV and cough7- (pertussis) (one dose of • Serogroup B meningococcal caused by HPV. Tdap vaccine) (MenB) may be given, • Influenza (Flu)2- Everyone 6 • Influenza (Flu)2- Everyone 6 months preferably at 16 through 18 months of age and older should of age and older should get a flu years (2 doses) get a flu vaccine every year. vaccine every year. • Influenza (Flu)2- Everyone 6 months of age and older should get a flu vaccine every year. Importance of Getting Caught Up Vaccine Preventable Diseases

Remember: There can be risks in delaying, skipping or rejecting 14 Diseases You Almost Forgot About (Thanks to Vaccines) some vaccines entirely. 1. Measles 2. Polio Diseases can spread quickly among people who are not 3. Meningococcal (MCV4 & MenB) immune, and just one case is enough to cause concern. 4. Tetanus 5. The Flu (Influenza) Vaccinations are the best way to protect against 6. Hepatitis A&B these diseases. 7. Rubella 8. Hib Vaccines also help maintain in a community 9. Whooping Cough (Pertussis) which can help slow the spread of an outbreak 10. Pneumococcal Disease 11. Rotavirus 12. Mumps For more information: 13. Chickenpox 14 Diseases You Almost Forgot About (Thanks to Vaccines) 14. Diphtheria Risks of Delaying or Skipping Vaccines | CDC1 Guidance for Getting Caught Up

CDC Catch-Up Immunization Coadministration of Vaccines Combination Vaccines Schedule COVID-19 vaccines and other Combining vaccines into fewer Always make recommendations vaccines may now be shots may mean that more by determining needed vaccines administered without regard to children will get recommended based on age, determining timing. This includes vaccinations on time. And that appropriate intervals for catch-up, simultaneous administration of means fewer delays in disease if needed, assessing for medical COVID-19 vaccine and other protection3. indications, and reviewing special vaccines on the same day, as well situations. as coadministration within 14 Visit Combination Vaccines4 for a days. list of common combination Visit the Catch-Up Immunization vaccines for children, and Schedule (CDC)1 for more Visit the Interim Clinical information on benefits, safety information. Considerations for Use of COVID- and effectiveness, and side 19 Vaccines | CDC2 for more effects. information. Human Papillomavirus

(HPV) Vaccination To prepare for common parent/patient How to boost HPV vaccination rates in your clinic questions on the HPV vaccine, review Answering Parents’ Questions about HPV Vaccine2 By making a strong recommendation for HPV vaccination in the same (link also below). way you would recommend other vaccines, you can increase HPV vaccination and protect more Texans from HPV- associated cancers. On average, 34,800 cases of HPV-associated cancers1 are diagnosed in the US each year. Providers should encourage the HPV vaccine girls and boys.

Tips for boosting HPV vaccinations: • Check patient’s immunization status at every visit • “Bundling:” administer HPV with other adolescent vaccines (ex. applicable meningococcal vaccines and Tdap) Flu, Tdap, and Meningococcal

How to recommend each one of these routine vaccines

Flu/Influenza Tdap Meningococcal

A yearly flu vaccine is the best Helps protect children and (MenACWY)4 meningococcal vaccines are way to protect children from flu adolescents from whooping cough currently recommended for use in adolescents and its potentially serious (pertussis)1, a serious and deadly aged 11 – 18 years, and persons with certain complications. disease, as well as diphtheria2 and underlying conditions. Serogroup B The Influenza (Flu) vaccine tetanus3 meningococcal (MenB)4 may be given, reduces the risk of flu illness, preferably at 16 through 18 years (2 doses) hospitalization, and death among children. Entering college students are required to show proof of an initial meningococcal5 vaccination or a booster dose during the five-year period prior to enrolling. They must get the vaccine at least 10 days before the semester begins.

Providers may emphasize to parents: “Vaccines help keep your child from missing school or childcare and you from missing work.” Your Recommendation is Critical

Parents consider their child’s healthcare professionals to be their most trusted Visit webpage, Vaccines at 13 to 18 source of information when it comes to Years1, for information on vaccines vaccines. This is true even for parents for pre-teens. Questions About Vaccines2 contains who are vaccine-hesitant or who have resources to prepare for parent’s questions and concerns on Vaccine considered delaying one or more Safety, and Side Effects. vaccines. Endnotes: Vaccine Recommendations to Help Protect Adolescents

Vaccine Schedules and Guidance for Adolescents Flu, Tdap, and Meningococcal/MMR 1. https://www.cdc.gov/vaccines/schedules/easy-to-read/adolescent-shell- 1. https://www.cdc.gov/vaccines/parents/diseases/child/pertussis.html easyread.html1 2. https://www.cdc.gov/vaccines/parents/diseases/diphtheria.html?CDC_ Let’s Get Kids Caught Up AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fparents%2F 1. https://www.cdc.gov/vaccines/parents/diseases/teen/hpv.html diseases%2Fchild%2Fdiphtheria.html 2. https://www.cdc.gov/vaccines/parents/diseases/teen/flu.html 3. https://www.cdc.gov/vaccines/parents/diseases/child/tetanus.html 3. https://www.cdc.gov/vaccines/parents/diseases/teen/mening.html 4. https://www.cdc.gov/vaccines/acip/recs/grade/mening-MenACWY-TT- 4. https://www.cdc.gov/vaccines/parents/diseases/teen/hpv.html EtR.html 5. https://www.cdc.gov/vaccines/parents/diseases/tetanus.html 5. https://dshs.texas.gov/immunize/school/college-requirements.aspx 6. https://www.cdc.gov/vaccines/parents/diseases/child/diphtheria.html Your Recommendation is Critical 7. https://www.cdc.gov/vaccines/parents/diseases/child/pertussis.html 1. https://www.cdc.gov/vaccines/parents/by-age/years-13-18.html 8. https://www.cdc.gov/vaccines/parents/diseases/teen/mening.html 2. https://www.cdc.gov/vaccines/parents/FAQs.html Importance of Getting Caught 1. https://www.cdc.gov/vaccines/parents/diseases/forgot-14- diseases.html Guidance for Getting Caught Up 1. https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html 2. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid- 19-vaccines-us.html 3. https://www.cdc.gov/vaccines/parents/diseases/index.html 4. https://www.cdc.gov/vaccines/parents/why-vaccinate/combination- vaccines.html Human Papillomavirus (HPV) Vaccination 1. https://www.cdc.gov/cancer/hpv/statistics/cases.htm 2. https://www.cdc.gov/hpv/hcp/answering-questions.html Audience Poll True or False Parents consider their healthcare professionals to be their #1 most trusted source of information when it comes to vaccines. Vaccine Recommendations to Help Protect Adults Adult Immunization Schedule

Stay updated on all the vaccine- preventable diseases1 and the vaccines that prevent them.

Also remember to reference the Adult Immunization Schedule2 for guidance on administering vaccines to patients 19+ years old. CDC Standards for Adult Immunization Practices

ASSESS Immunization Needs

DOCUMENT RECOMMEND Using Texas All recommended adult Immunization Registry vaccines

ADMINISTER/REFER To community vaccinators/medical home Immunization Status Assessment Key Strategies

Assessment is the critical first step Your patient’s vaccination needs will in ensuring that your adult change over time based on factors such as: patients get the vaccines they • Age need for protection against • Health conditions serious vaccine-preventable • Lifestyle diseases. • Travel • Occupation Whether you provide vaccines or not, assess immunization status at every clinical encounter.

Standards for Practice: Vaccine Assessment1: https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/assessment.html Vaccines for All Adults

All adults need immunizations to help them prevent getting and spreading serious diseases, including: • Seasonal Influenza (Flu) vaccine:1 important for people with chronic health conditions, pregnant women, and older adults. • Tdap vaccine: 2 adults recommended to take Tdap if it was not received as an adolescent to protect against pertussis. More information about vaccine recommendations for adults at • Td (tetanus, diphtheria) or Tdap booster https://www.cdc.gov/vaccines/adults/rec-vac/index.html4 shot: 3 recommended every 10 years. Vaccines for Adult 19-26 years

In addition to seasonal flu (influenza)1 vaccine and Td2 or Tdap3 vaccine (Tetanus, diphtheria, and pertussis), young adults aged 19 to 26 should get the HPV vaccine4 if not vaccinated in adolescence.

Visit Recommended Vaccines for Adults5 for more detail per age group: Vaccines for Adults 50+ years

Aging adults are more likely to have weaker immune systems, putting them at higher risk for certain diseases. In addition to a seasonal flu and Td or Tdap vaccine, adults 50+ should also get: • Shingles vaccine, to protect against the disease and its complications • PPSV23 (Pneumococcal polysaccharide vaccine), to protect against serious diseases like and Providers may recommend patients watch this short video bloodstream (https://youtu.be/hodb65EkorM)1 from the • PCV13 (Pneumococcal conjugate vaccine), which Alliance for Aging Research to understand protects against serious diseases like pneumonia how vaccines work and why they are so important for older adults. Provider’s Role in Vaccine Recommendations

Your recommendation is a critical factor in whether your patients receive the vaccines that they need.

Most adults are likely to receive them if recommended by their healthcare professionals. Vaccine Recommendation Your recommendation can make a difference.

S SHARE tailored reasons why vaccination is right for the patient. HIGHLIGHT positive experiences with vaccines (personal or in your practice), as appropriate, to H reinforce the benefits and strengthen confidence in vaccination. ADDRESS patient questions and concerns about the vaccine, including side effects, safety, and A vaccine effectiveness in plain and understandable language. REMIND patients that vaccines protect them and their loved ones against a number of common and R serious diseases. EXPLAIN the potential costs of getting the disease, including serious health effects, time lost (such as E missing work or family obligations), and financial costs.

Standards for Practice: Vaccine Recommendation1: https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/recommend.html Administration and Referral We can administer the flu vaccine in office. Unfortunately, we don’t have the Tdap in-house, but we can refer you to a local pharmacy who can administer the vaccine for you. After assessing your patient’s needs, administer their vaccines during their visit. Refer patients to other immunization providers in the area for vaccines that you may not stock.

Vaccine referral option: • Pharmacies • Medical Home • State or Local Health Department

Standards for Practice: Administration & Referral1: https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/referral.html1 Document Immunization Administration REMINDERS Texas Immunization Registry – ImmTrac2 • Providers must report COVID-19 administered vaccines within 24 Document1 immunization histories using the hours of doses administered. Texas Immunization Registry (ImmTrac2). We need • A Texas Immunization Registry adult vaccination records to be consolidated in one consent form must be completed location to: starting at age 18+  Ensures necessary vaccine series are SUPPORT completed for patients. • Texas Immunization Registry  Reduce chances for unnecessary doses of website: www.Immtrac.com • ImmTrac2 Customer Support: vaccines or missed opportunities. [email protected]  Provide reminder and recall options.  Provide a personal immunization record of received vaccines.

Standards for Practice: Document1: https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/referral.html1 Endnotes: Vaccine Recommendations to Help Protect Adults

Adult Immunization Schedule 1. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#vacc-adult 2. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html Immunization Status Assessment 1. https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/assessment.html Vaccines for All Adults 1. https://www.cdc.gov/vaccines/vpd/flu/index.html 2. https://www.cdc.gov/vaccines/vpd/pertussis/index.html 3. https://www.cdc.gov/vaccines/vpd/tetanus/index.html 4. https://www.cdc.gov/vaccines/adults/rec-vac/index.html Vaccines for Adult 19-26 years 1. Seasonal Flu Vaccination and Preventable Disease | CDC 2. https://www.cdc.gov/vaccines/vpd/tetanus/index.html 3. https://www.cdc.gov/hpv/index.html 4. https://www.cdc.gov/vaccines/adults/rec-vac/index.html 5. https://www.cdc.gov/vaccines/vpd/pertussis/index.html#vacc Vaccines for Adults 50+ years 1. https://www.youtube.com/watch?v=hodb65EkorM&feature=youtu.be 2. https://www.cdc.gov/vaccines/adults/rec-vac/index.html Provider’s Role in Vaccine Recommendations 1. https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/adult-immunization-standards.html 2. https://www.cdc.gov/vaccines/hcp/adults/downloads/standards-immz-practice-recommendation.pdf Vaccine Recommendation 1. https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/recommend.html Administration and Referral 1. https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/referral.html Document Immunization Administration 1. https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/documentation.html Audience Poll Choose One When should providers assess immunization status for adult patients?

A) Every few years B) At every clinical encounter C) Only when patients specifically ask D) Never Vaccine Recommendations to Help Protect Pregnant Persons CDC Recommendations for COVID-19 Vaccine and Pregnancy

• COVID-19 vaccination is recommended for all people 12 years and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. • Evidence about the safety and effectiveness of COVID-19 vaccination during pregnancy has been growing. These data suggest that the benefits of receiving a COVID-19 vaccine outweigh any known or potential risks of vaccination during pregnancy. • There is currently no evidence that any vaccines, including COVID-19 vaccines, cause fertility problems in women or men. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html Talking to Pregnant Women About Vaccines Resources for Providers to Use

When discussing vaccines during pregnancy, make a strong recommendation and allow time for patients to ask questions.

The CDC’s Talking to Pregnant Women 1 resource can prepare providers to answer questions on vaccinations while pregnant. Toolkit for Prenatal Care Providers

Providers who serve pregnant persons are encouraged to use the CDC’s comprehensive Toolkit for Prenatal Care Providers1 which contains resources on:

 Why Maternal Vaccines are Important  Implementation Resources  Maternal Vaccination Information Vaccines for Pregnant Persons

It is critical that patients understand the importance of vaccinating during pregnancy. If certain vaccines were not received before or during pregnancy, then vaccination after pregnancy is especially important. The CDC’s Vital Signs segment on Vaccinating Pregnant Women2 provides an overview on studies showing the safety of the Tdap and Influenza (Flu) vaccines for women and developing babies.

During Pregnancy  Tdap vaccine to help protect the baby against whooping cough  The Influenza (Flu) vaccine to help protect the pregnant person and the baby for several months after birth  Vaccines for travel ACIP Recommendations Guidelines for Vaccinating Pregnant Women

Per ACIP1: “Benefits of vaccinating pregnant women usually outweigh potential risks when the likelihood of disease exposure is high, when infection would pose a risk to the mother or fetus, and when the vaccine is The ACIP Guidelines for Vaccinating Pregnant Women webpage1 , shown here, offers general unlikely to cause harm.” vaccine recommendations for pregnant people. Endnotes: Vaccine Recommendations to Help Protect Pregnant Persons

CDC Recommendations for COVID-19 1. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html Vaccines for Pregnant Persons 1. https://www.cdc.gov/vaccines/pregnancy/vacc-during-after.html ACIP Recommendations 1. https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/guidelines.html Toolkit for Prenatal Care Providers 1. https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/index.html Talking to Pregnant Women About Vaccines 1. https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/downloads/talking-about-vaccines-508.pdf 2. https://www.cdc.gov/vitalsigns/maternal-vaccines/ COVID-19 Vaccine Product Updates COVID-19 August 11th Ordering Update

Starting on August 16, 2021, all COVID-19 vaccine order requests will be fulfilled using an improved ordering timeline, which will allow providers to receive vaccine in a timelier manner. You may receive a call from the DSHS Vaccine Shipment Team to confirm your order details, if needed. If you have any questions, please contact [email protected]. Please see below for the outline of the updates in the ordering timeline:

Minimum pack size Less than a minimum pack size If you place a minimum pack size order of COVID-19 If you place a “less than a minimum pack size” vaccine (450 doses of Pfizer & 140 doses of order (minimum pack sizes are 450 doses of Pfizer Moderna), your order will be placed through the & 140 doses of Moderna), your order will be CDC. processed and shipped through our state shipping • Please allow two business days for all pending vendor, Cold Chain Technologies (CCT). orders to be processed and confirmed for • Please allow two business days for all pending accuracy and validity prior to being placed with small dose orders to be processed and confirmed the CDC. for accuracy and validity prior to being shipped • If your order is denied for any reason, you will by the state. receive an email notification. • The new timeline for receiving small dose • The new timeline for receiving CDC deliveries will deliveries is 7-10 business days. be 5-7 business days.

VAOS Access Instructions: https://www.dshs.texas.gov/immunize/covid19/VAOS-Access-Instructions.pdf Example: Timeline for Ordering and Receiving COVID-19 Vaccines Once shipped, you will receive a VAOS email notification. This calendar shows an example timeline for vaccine order requests and when they might be delivered: Monday Tuesday Wednesday Thursday Friday

For Minimum Pack Size orders: once Day 1 Day 2 Day 3 Day 4 Day 5 order is confirmed it will arrive in 5-7 * Submit business days. WEEK 1 order requests in *Takes 48 hours to process VAOS For Less than Day 8 Day 9 Day 10 Day 11 Day 12 Minimum Pack Size Minimum Pack Size Orders Received(5- 7 orders: once order is WEEK 2 business days) confirmed it will arrive in 7-10 business days. Less than-

Day 15 Day 16 Day 17 Day 18 Day 19 NOTE! Orders Minimum Pack Size Orders Received (7- 10 cannot be modified, WEEK 3 business days) canceled or returned after they have been “exported.” J&J/Janssen COVID-19 Vaccine Availability Update 1) Reporting Waste in VAOS All COVID-19 Vaccine Providers should be reporting COVID-19 vaccine waste, including Janssen/J&J vaccine waste, daily. This allows Johnson & Johnson to help access the need by determining the available inventory of the Janssen/J&J COVID-19 Vaccine within the state of Texas.

Please contact the manufacturer before disposing of the vaccine. Vaccine Manufacturer Medical Information Contacts are found at the end of this presentation.

If you have any questions about how to report waste, please contact [email protected].

2) Vaccine Availability Since July 2, 2021, the Janssen/J&J COVID-19 vaccine is not available to order on VAOS. However, providers can request a transfer from providers who currently have the Janssen/J&J vaccine available in their stock. For more information, please review the GovDelivery email sent on July 5, 2021. Audience Poll Select All that Apply

If your organization is an immunization provider, which program(s) are you enrolled in? A) COVID-19 Vaccine B) TVFC C) ASN D) I don’t know/None Live Q&A Final Notes Take Our Survey!

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The follow-up email will come from Monitor your inbox GovDelivery for a follow-up email communication that contains a post- webinar survey, a link to access Make sure to take our 3-minute today’s webinar survey! materials, and links to register for future webinars! The email also This is where you can view today’s (and past) webinars, as well as Highlights and contains helpful the slides we presented. links and resources. COVID-19 Vaccine Provider Resources

The Provider Support Resources document is full of great resources that you can browse based on the type of question you may have! It includes these resources… … AND MORE! Vaccine Manufacturer Medical Information Contacts Thank You!