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Issue 1162
IAC Express: Weekly immunization news and information

Issue 1162: January 13, 2015

Ask the Experts–Question of the Week: My patient is a 66-year-old male with a condition that requires treatment with intravenous…read more


TOP STORIES


IAC HANDOUTS
OFFICIAL RELEASES AND ANNOUNCEMENTS
FEATURED RESOURCES
JOURNAL ARTICLES AND NEWSLETTERS
EDUCATION AND TRAINING  
TOP STORIES
CMS modifies Medicare Part B coverage of pneumococcal vaccinations to align with new ACIP recommendations

The Centers for Medicare & Medicaid Services (CMS) has issued updated information on Medicare coverage of pneumococcal vaccination for adults age 65 years and older. The CMS MLN Matters article titled Modifications to Medicare Part B Coverage of Pneumococcal Vaccinations is reprinted below. 

Provider Types Affected

This MLN Matters Article is intended for physicians and other providers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Provider Action Needed

Change Request (CR) 9051 provides an update to the Medicare pneumococcal vaccine coverage requirements, to align with new Advisory Committee on Immunization Practices (ACIP) recommendations. Make sure your billing staffs are aware of these updates.

Background

Medicare Part B covers certain vaccinations including pneumococcal vaccines. Specifically, Section 1861(s)(10)(A) of the Social Security Act, which is available at http://www.ssa.gov/OP_Home/ssact/title18/1861.htm, and regulations at 42 CFR 410.57 (http://www.ecfr.gov/cgi-bin/text-idx?SID=85dbd4cb66820b751ffe58a6c58988df&node=se42.2.410_157&rgn=div8) authorize Medicare coverage under Part B for pneumococcal vaccine and its administration. For services furnished on or after May 1, 1981, through September 18, 2014, the Medicare Part B program covered pneumococcal pneumonia vaccine and its administration when furnished in compliance with any applicable State law by any provider of services or any entity or individual with a supplier number. Coverage included an initial vaccine administered only to persons at high risk of serious pneumococcal disease (including all people 65 and older; immunocompetent adults at increased risk of pneumococcal disease or its complications because of chronic illness; and individuals with compromised immune systems), with revaccination administered only to persons at highest risk of serious pneumococcal infection and those likely to have a rapid decline in pneumococcal antibody levels, provided that at least 5 years had passed since the previous dose of pneumococcal vaccine.

However, ACIP updated its guidelines regarding pneumococcal vaccines; now recommending the administration of two different pneumococcal vaccinations.

The Centers for Medicare & Medicaid Services (CMS) is updating the Medicare coverage requirements to align with the updated ACIP recommendations. Effective for dates of service on or after September 19, 2014, (and upon implementation of CR9051), Medicare will cover:
  • An initial pneumococcal vaccine to all Medicare beneficiaries who have never received the vaccine under Medicare Part B; and
  • A different, second pneumococcal vaccine one year after the first vaccine was administered (that is, 11 full months have passed following the month in which the last pneumococcal vaccine was administered).
Since the updated ACIP recommendations are specific to vaccine type and sequence of vaccination, prior pneumococcal vaccination history should be taken into consideration. For example, if a beneficiary who is 65 years or older received the 23-valent pneumococcal polysaccharide vaccine (PPSV23) a year or more ago, then the 13-valent pneumococcal conjugate vaccine (PCV13) should be administered next as the second in the series of the two recommended pneumococcal vaccinations. Receiving multiple vaccinations of the same vaccine type is not generally recommended. Ideally, providers should readily have access to vaccination history, such as with electronic health records, to ensure reasonable and necessary pneumococcal vaccinations.

Medicare does not require that a doctor of medicine or osteopathy order the vaccine; therefore, the beneficiary may receive the vaccine upon request without a physician’s order and without physician supervision.

Note that MACs will not search for and adjust any claims for pneumococcal vaccines and their administration, with dates of service on and after September 19, 2014. However, they may adjust such claims that you bring to their attention. 

Additional Information

The official instruction, CR9051 issued to your MAC includes two transmittals. The first updates the “Medicare Benefit Policy Manual,” Chapter 15 (Covered Medical and Other Health Services), Section 50.4.4.2 (Immunizations) and “Medicare Claims Processing Manual,” Chapter 18 (Preventive and Screening Services), Section 10.1.1 (Pneumococcal Vaccine) as attachments to that transmittal. It is available at http://www.cms.gov/Regulations- and-Guidance/Guidance/Transmittals/Downloads/R202BP.pdf on the CMS website. The second transmittal updates the “Medicare Claims Processing Manual” and that transmittal is available at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3159CP.pdf on the CMS website.

The Centers for Disease Control and Prevention (CDC) recommends that providers use two pneumococcal vaccines for adults aged ≥65. These vaccinations are 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23). For more information on these recommendations, visit http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6337a4.htm on the CDC website.

If you have questions, please contact your DME MAC at their toll-free number. The number is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/index.html under: How Does It Work? 


Related Links Back to top


CDC's Health Alert Network publishes an update regarding treatment of influenza patients with antiviral medications

On January 9, CDC's Health Alert Network published CDC Health Update Regarding Treatment of Patients with Influenza with Antiviral Medications. The "Summary" section is reprinted below.

Summary

Widespread influenza activity is being reported in most U.S. states, with influenza A (H3N2) viruses most common. H3N2-predominant flu seasons have been associated with more hospitalizations and deaths in older people and young children in the past. In addition, approximately two-thirds of H3N2 viruses that have been tested at CDC are antigenically or genetically different from the H3N2 vaccine virus. This difference suggests that vaccine effectiveness may be reduced this season. High hospitalization rates are being observed, similar to what was seen during the 2012–2013 influenza season. Hospitalization rates are especially high among people 65 years and older. In this context, the use of influenza antiviral drugs as an adjunct to vaccination becomes even more important than usual in protecting people from influenza. Antiviral medications are effective in treating influenza and reducing complications. Antivirals are available and recommended, but evidence from the current and previous influenza seasons suggests that they are severely underutilized.

This CDC Health Update is being issued
  1. to remind clinicians that influenza should be high on their list of possible diagnoses for ill patients, because influenza activity is elevated nationwide, and
  2. to advise clinicians that all hospitalized patients and all high-risk patients (either hospitalized or outpatient) with suspected influenza should be treated as soon as possible with one of three available influenza antiviral medications. This should be done without waiting for confirmatory influenza testing. While antiviral drugs work best when given early, therapeutic benefit has been observed even when treatment is initiated later.
Access the complete HAN advisory, which includes CDC's antiviral recommendations for the 2014–2015 influenza season.

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CDC updates the press about the 2014–15 influenza season

On January 9, CDC held a telebriefing for the press about the 2014–15 influenza season. The introductory statement from CDC director, Tom Frieden, MD, MPH, is reprinted below.

There continues to be a lot of interest in flu and we want to keep you up to date. I'll give you an update on the flu season, but I want to begin by providing what I hope is the take away message from this briefing. Antiviral flu medicines are underutilized. If you get them early, they could keep you out of the hospital and might even save your life. It appears that we're right in the middle of flu season this year, and so far it's shaping up to be a bad year for flu especially for older people and people with underlying conditions. We've seen a lot of flu. There's a lot of flu out there now and there's more to come.

Related Links Back to top


California Department of Public Health issues measles health advisory

On January 7, the California Department of Public Health issued a health advisory titled Measles Update: 7 Confirmed Measles Cases in the State of California in 2015: Look for Signs of this Highly Contagious Disease. The introductory paragraph is reprinted below.

Measles has been confirmed in seven California residents in 2015 and two Utah residents; all visited Disneyland or Disney California Adventure Park between December 17th and 20th, 2014. Testing is underway on three additional California residents who also visited Disneyland during this same time period. The California confirmed cases reside in five local health jurisdictions and range in age from 8 months to 21 years. Of the seven confirmed cases, six cases were unvaccinated for measles (2 were too young to be vaccinated, and 1 had received appropriate vaccination (two doses of MMR vaccine). Several large contact investigations are ongoing.


The complete document includes much important information to help clinicians diagnose and report measles cases.

Note: Two additional cases of measles have been confirmed since this health advisory was released. See California Department of Public Health Confirms Measles Cases for more information.

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IAC Spotlight! Share this collection of nearly 30 HPV-related videos with your patients, parents, and staff

January is Cervical Health Awareness Month. An important tie-in to this health observance for immunization providers is the importance of human papillomavirus (HPV) vaccination to prevent cervical cancer. IAC's Video Library on vaccineinformation.org has a collection of nearly 30 videos about HPV and HPV vaccination. The HPV-related videos include personal testimonies from women affected by HPV and cervical cancers, as well as public service announcements in English and Spanish. The videos are from the following organizations: Centers for Disease Control and Prevention, California Immunization Coalition’s "Shot-by-Shot" project, Vaccine Education Center at Children's Hospital of Philadelphia, National Cervical Cancer Coalition, Women’s Cancer Network, Cervical Cancer-Free America, PKIDs, and Immunization Action Coalition.

Related Links

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CDC updates the 2-D barcode for the revised pediatric multi-vaccine VIS and provides information about VISs in development

CDC recently updated the two-dimensional (2-D) barcode for the pediatric multi-vaccine Vaccine Information Statement (VIS) which was revised in October. This 2-D "data matrix" barcode technology was developed to help immunization providers record information about the VIS as is required by the National Childhood Vaccine Injury Act. The 2-D barcoded VIS allows providers to scan the name and edition date of a VIS into an electronic medical record, immunization information system (IIS), or other electronic database. Providers are required to maintain the edition date of the VIS in their medical record. The VIS barcode does not contain any data that is not currently on the VIS, and there is no requirement that immunizers supply VIS data to IIS. CDC also provided the following information about VISs in development:

Note: Two new vaccines, Trumenba (CVX 162) and Gardasil 9 (CVX 165), have recently entered the vaccine supply chain. Neither vaccine has a corresponding VIS. Trumenba is a meningococcal B vaccine and is sufficiently different from the quadrivalent vaccines that the current VIS would not be appropriate. The adverse events for Gardasil 9 are slightly different than those for the quadrivalent Gardasil vaccine, so using the existing VIS would be inappropriate. VIS documents for both vaccines are under development.

Related Links Back to top


IAC HANDOUTS
IAC updates seven translations of "When Do Children and Teens Need Vaccinations?"

Updated in August, IAC's handout for parents When Do Children and Teens Need Vaccinations? is now available in Spanish, Arabic, Chinese, French, Korean, Russian, and Vietnamese.

For your reference: English-language version.

Related Link IAC's Handouts for Patients & Staff web section offers healthcare professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely.

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OFFICIAL RELEASES AND ANNOUNCEMENTS
CDC announces that enhanced airport entry screening will end for travelers from Mali to the U.S.

On January 5, CDC issued a press release titled Enhanced Airport Entry Screening To End for Travelers from Mali to the United States. The first two paragraphs are reprinted below.

On Tuesday, January 6, 2015, the Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security (DHS) will remove Mali from the list of Ebola-affected nations subject to enhanced visa and port-of-entry screening.

Travelers from Mali will no longer be required to undergo enhanced screening and monitoring when entering the United States, nor will they be required to enter the country through the five designated airports that perform this screening. Also on January 6, CDC will remove the Alert Level 2 Travel Notice for Mali, which advised travelers to practice enhanced precautions when visiting that nation.


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FEATURED RESOURCES
Influenza is spreading and serious; please keep vaccinating your patients

According to CDC, U.S. influenza activity is high across most of the country with flu illnesses, hospitalizations, and deaths elevated. Flu season will probably continue for several weeks. While the influenza vaccine may not work as well as usual against some H3N2 viruses, vaccination can still offer protection for some people, reduce hospitalizations and deaths, and will protect against other influenza viruses. Influenza vaccination is recommended for everyone age six months of age and older. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to a clinic or pharmacy that provides vaccines or to the HealthMap Vaccine Finder to locate sites near their workplaces or homes that offer influenza vaccination services. Influenza antiviral drugs can treat influenza illness. CDC has issued guidance for clinicians on the use of antiviral treatment for the 2014–15 flu season. Early antiviral treatment works best.

Following is a list of resources related to influenza disease and vaccination for healthcare professionals and the public: Back to top


JOURNAL ARTICLES AND NEWSLETTERS
CDC reports on cases of acute flaccid myelitis in the U.S. among people age 21 years and younger

CDC published Notes from the Field: Acute Flaccid Myelitis Among Persons Aged ≤21 Years—United States, August 1–November 13, 2014 in the January 9 issue of MMWR (pages 1243–1244). The first seven sentences and the last paragraph are reprinted below.

In August 2014, physicians at Children's Hospital Colorado in Aurora, Colorado, noted a cluster of cases of acute limb weakness among children. Most patients were found to have distinctive abnormalities of the central spinal cord (i.e., gray matter) on magnetic resonance imaging, and most reported a respiratory or febrile illness preceding the onset of neurologic symptoms. On September 12, the Colorado Department of Public Health and Environment alerted CDC about this cluster. These cases coincided with a national outbreak of severe respiratory disease among children caused by enterovirus D68 (EV-D68).

On September 26, CDC issued a health advisory requesting state and local health departments to report cases and send specimens to CDC for testing. A case was defined as acute onset of focal limb weakness occurring on or after August 1, 2014, and a magnetic resonance image showing a spinal cord lesion largely restricted to gray matter in a patient aged ≤21 years.

As of November 13, CDC had verified reports of 88 cases in 32 states....

On November 7, CDC published interim clinical management considerations, summarizing expert opinion based on current evidence on management and care of children with acute flaccid myelitis. CDC continues to collaborate with partners nationally to investigate reported cases, risk factors, and possible etiologies of this condition. Although the specific causes of this illness are still under investigation, and causal relationship to EV-D68 has not yet been substantiated, being up to date on all recommended vaccinations is essential to prevent a number of severe diseases. Vaccine-preventable diseases include poliomyelitis, which is caused by poliovirus; infection with this enterovirus can present with acute flaccid paralysis. There are also numerous other vaccine-preventable diseases that can result in severe illness. Prevention of viral infections includes general hygienic measures, such as frequent hand washing with soap and water, avoiding close contact with sick persons, and disinfecting frequently touched surfaces. Additional information is available at http://www.cdc.gov/flu/protect/habits/index.htm. If a child appears to have a sudden onset of weakness in arms or legs, caregivers should contact a health care provider to have the child assessed for possible neurologic illness. Health care providers are encouraged to report patients meeting the case definition to their state or local health department. Health departments should report patients with illness meeting the case definition to CDC using a brief patient summary form and may contact CDC by e-mail to arrange further laboratory testing (limbweakness@cdc.gov). Additional information is available at http://www.cdc.gov/ncird/investigation/viral/sep2014.html.


Related Links Back to top


EDUCATION AND TRAINING
Spring Clinical Vaccinology Course to be held in Denver on March 13–15

The National Foundation for Infectious Diseases (NFID) and the Emory University School of Medicine Division of Infectious Diseases will sponsor a Clinical Vaccinology Course March 13–15 in Denver. This course focuses on new developments and issues related to the use of vaccines, including updated recommendations for vaccinations across the lifespan, and innovative and practical strategies for ensuring timely and appropriate vaccination. Continuing education credit is available for participants.

Related Links Back to top


ASK THE EXPERTS
Question of the Week

My patient is a 66-year-old male with a condition that requires treatment with intravenous immune globulin (IVIG) once a month. Can he receive zoster vaccine?

Answer: Yes. The concern about interference by circulating antibody (from the IVIG), which we have for varicella vaccine, does not apply to zoster vaccine. The amount of antigen in zoster vaccine is high enough to offset any effect of circulating antibody. Also, studies of zoster vaccine were performed on patients receiving antibody-containing blood products with no appreciable effect on efficacy.

About IAC's Question of the Week

Each week, IAC Express highlights a new, topical, or important-to-reiterate Q&A. This feature is a cooperative venture between IAC and CDC. William L. Atkinson, MD, MPH, IAC's associate director for immunization education, chooses a new Q&A to feature every week from a set of Q&As prepared by experts at CDC’s National Center for Immunization and Respiratory Diseases.

We hope you enjoy this new feature and find it helpful when dealing with difficult real-life scenarios in your vaccination practice. Please encourage your healthcare professional colleagues to sign up to receive IAC Express at www.immunize.org/subscribe.

If you have a question for the CDC immunization experts, you can email them directly at nipinfo@cdc.gov. There is no charge for this service.

Related Links Back to top

 

About IAC Express
The Immunization Action Coalition welcomes redistribution of this issue of IAC Express or selected articles. When you do so, please add a note that the Immunization Action Coalition is the source of the material and provide a link to this issue.
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IAC Express is supported in part by Grant No. U38IP000589 from the National Center for Immunization and Respiratory Diseases, CDC. Its contents are solely the responsibility of IAC and do not necessarily represent the official views of CDC. IAC Express is also supported by educational grants from the following companies: bioCSL Inc.; AstraZeneca; Merck Sharp & Dohme Corp.; Novartis Vaccines; Ortho Clinical Diagnostics, Inc.; Pfizer, Inc.; and Sanofi Pasteur.
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Video of the Week
CDC Expert Commentary - Ruling Out Poliovirus in Cases of Acute Flaccid Paralysis
CDC Expert Commentary - Ruling Out Poliovirus in Cases of Acute Flaccid Paralysis: In this CDC Expert Commentary from Medscape, Dr. Jane Seward. a medical epidemiologist at the Centers for Disease Control and Prevention (CDC), discusses how to identify or rule out poliomyelitis in cases of acute flaccid paralysis. Although poliovirus is no longer endemic in the United States, there is always the possibility that it could be imported. That's why it is important to exclude poliovirus infection in clinically compatible, unexplained cases of acute flaccid paralysis, to ensure that any case of poliomyelitis is quickly identified and investigated.
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