Izcoordinators.org



California Department of Public Health,

Immunization Branch

Immunization Coordinator’s Manual

Table of Contents

I. The Scope of Work for Local Health Department Immunization Programs 1

II. California Department of Public Health, Immunization Branch Overview 1

Immunization Branch Mission Statement 1

Description of the Immunization Branch 1

A. Clinical and Policy Support 1

B. Registry and Immunization Rate Assessment 1

C. Vaccine Preventable Disease Epidemiology and Control 1

D. Information & Education Section 2

The Role of the Field Representative 2

III. Funding for California’s Immunization Program 2

VFC Funding 2

Section 317 Funding 2

State Funding 3

IV. Contracts 3

Contract Scope of Work for Immunization Programs 3

Types of Local/State Immunization Contracts 3

Invoices 4

Immunization Coordinator Responsibilities 6

V. Immunization Branch Programs 6

Local Health Department Immunization Programs 6

The Vaccines for Children Program 6

VFC Eligibility Guidelines 7

VFC Provider Enrollment Requirements 7

Flu Program 7

Immunization Coordinator Responsibilities 8

Perinatal Hepatitis B Program 8

Immunization Coordinator Responsibilities 9

Collaborative Efforts among WIC and Immunization Programs 9

Immunization Coordinator Responsibilities 9

VI. Vaccine Ordering and Distribution 9

Completing the Vaccine Order Form 9

Vaccine Order Submission 10

Ordering Frequency 10

Process for Vaccine Distribution 10

VII. Vaccine Storage & Handling 10

Vaccine Storage Equipment 11

Temperature Requirements for Vaccine Storage 13

Monitoring of Temperatures 13

Transferring Vaccines 13

Recommendations for Optimal Vaccine Storage 14

General Vaccine Management Policy 15

Policy on Vaccine Loss Due to Provider Negligence 17

Policy for Dealing with “Out-of-Range” Vaccine Storage 17

Completion of the Vaccine Storage and Handling Report 18

Immunization Coordinator Responsibilities 18

VIII. Immunization Campaigns and Observances 18

IX. Training and Conferences 19

Immunization Coordinator Responsibilities 19

X. Immunization and Vaccine-Preventable Disease Educational Materials 20

Ordering IZ Materials Online 20

Step 2: Ordering materials: 20

Step 3: Selecting item and quantity: 20

Step 4: Check out and submit your request 20

Immunization Coordinator Responsibilities 21

XI. Disease Surveillance and Outbreak Control 21

IZ Coordinator Responsibilities 21

XII. Regional Immunization Registries 23

Overview 23

Registry Contacts 23

How the Registry Works 23

Disclosure for Registry Participation 23

Functions of the Local Regional Registry 24

Registry Capabilities 24

Immunization Coordinator Responsibilities 24

XIII. The Assessment, Feedback, Incentives and eXchange Strategy (AFIX) 24

AFIX Process 25

1. Assessment of Immunization Coverage Rates 25

2. Feedback 26

3. Incentives 26

4. eXchange 26

AFIX in the Public Sector 26

AFIX for VFC Providers 26

Immunization Coordinator Responsibilities 27

Fall: Kindergarten and Childcare Self-Reporting Assessment 27

Childcare Self-Reporting Assessment: 27

Kindergarten Self-Reporting Assessment: 27

Spring: Selective Review and Kindergarten 28

Retrospective Survey 28

Immunization Coordinator Responsibilities 28

XV. LHD Reports 28

Quarterly Reports 28

Annual or Special Reports 28

XVI. The Immunization Coordinators’ Website 29

XVII. HELPFUL LINKS: 29

School / Childcare assessments: 29

Other helpful links: 29

XVIIII. Immunization Branch Glossary 30

XX. Appendix

• CDPH, Immunization Branch Organizational Chart

• CDPH, Immunization Branch Phone Directory

• Field Representative Map

• Map of California Immunization Registry Regions

• Scope of Work for California Immunization Programs

• Scheduled Campaign and Observances/Ongoing Campaigns

• CDPH, Immunization Branch Schedule of Activities, 2011

I. The Scope of Work for Local Health Department Immunization Programs

Immunization Coordinators are responsible for overseeing the Immunization Program for their local health department. The IZ Coordinator ensures that all of the objectives and activities included in the Contract Scope of Work are met—either by the IZ Coordinator or designated LHD staff members. IZ Coordinators requested a document that provided additional information on what is required for immunization contracts. The IZ Branch took the objectives from Contract Scope of Work and expanded by adding specific activities under each objective.

Please note that many of these objectives and activities are required by the Federal Government and are conditions for funding of the California Immunization Program and/or are statutory requirements of State and LHDs. The level of subvention contract funding awarded is not represented as sufficient for support of all the required activities; a significant amount of local support and funding is expected. Subvention contract funds must not be used to supplant (i.e., replace) local funds currently being expended for routine immunization services and activities.

The IZB acknowledges that all LHD immunization programs do not function in exactly the same way. In this document, we have laid out the main requirements and activities as they occur in the majority of LHDs. We understand there may be slight variations on how activities are carried out. In addition, the scope and breadth of activities will vary depending upon funding and infrastructure at the LHD. If you need additional assistance in determining the Scope of Work for your county, contact your Field Representative. The Expanded Scope of Work for California Immunization Programs is included in the Appendix.

II. California Department of

Public Health, Immunization

Branch Overview

Immunization Branch Mission Statement

The Immunization Branch (IZB) of the California Department of Public Health provides leadership and support to public and private sector efforts to protect the population against vaccine-preventable diseases.

Description of the Immunization Branch

The IZB is part of the California Department of Public Health, Center for Infectious Disease, Division of Communicable Disease Control. Within the IZB there are five sections:

A. Clinical and Policy Support

( Provides assistance with technical and medical issues related to immunizations

( Coordinates immunization activities in the Women, Infants, and Children (WIC) program

( Coordinates adolescent and adult immunization activities

( Reviews and analyzes immunization policy.

B. Registry and Immunization Rate Assessment

( Leads and coordinates efforts to institute statewide immunization tracking registries

• Administers statewide surveys to monitor immunization coverage levels in childcare facilities, as well as public and private schools

C. Vaccine Preventable Disease Epidemiology and Control

( Supports statewide system for surveillance of vaccine-preventable diseases

( Provides leadership and technical assistance on disease investigation and outbreak control

( Coordinates perinatal hepatitis B prevention efforts

D. Information & Education Section

( Develops strategies, materials and partnerships to educate the community on vaccine-preventable diseases

( Develops and delivers training to vaccine providers, health departments, public health educators and other provider communities

( Implements campaigns to encourage immunizations for vaccine-preventable diseases

E. Vaccine Management and Field Services Section

( Five regional Senior Field Representatives serve as consultants and liaisons for 61 Immunization Coordinators of the local health departments (LHDs) within their jurisdictions

( Operates the Vaccines for Children (VFC) Program – a federally-funded, state-operated, vaccine supply program that delivers free vaccine to participating providers for eligible children

( Regional VFC Representatives provide assistance and quality assurance to enrolled providers throughout California

Immunization Branch Contact Information

The IZB website can be accessed at . This website contains more information about the Branch, its activities, and links to other web sites.

Telephone Number: 510-620-3737

Fax number: 510-620-3774

The mailing address is:

California Department of Public Health, Immunization Branch

850 Marina Bay Parkway, Building P, Second Floor Richmond, CA 94804-6403

A complete listing of CDPH Immunization Branch staff is included in the Appendix.

The Role of the Field Representative

The Field Representative is the Coordinator’s link to the IZB. If the coordinator has questions or needs information or assistance with contracts, clarification, or assistance with any aspect of the Scope of Work for Immunization Programs, immunization recommendations, vaccine ordering, storage and handling, project implementation, training, presentations, or any issues relating to immunizations, they should contact their local Field Representative. The Field Representative is an excellent resource for the Coordinator. The Field Representative is also responsible for communicating the Coordinator’s needs to the IZB.

III. Funding for California’s Immunization Program

Funding for immunization services in California chas historically come from three main sources: the VFC Program, 317 funding, and State funding.

VFC Funding

Federal funding for immunization programs has fluctuated during the past decade. The measles epidemic in 1993 resulted in a large influx of money for immunization programs, followed by stabilization and then a decrease in funding. Currently the Centers for Disease Control and Prevention (CDC) provides funding for operations and vaccine purchases through the VFC program, which is an entitlement program. Each year the IZB estimates the State’s VFC vaccine needs, and the CDC then provides a vaccine budget for the State. This budget requires adherence to a monthly spending plan. The VFC Program is the single largest source of funding for the immunization programs in California.

Section 317 Funding

Since 1963 the CDC has provided grant support to help state and local health departments implement immunization programs. This funding, authorized in Section 317 of the Public Health Service Act, makes up the bulk of the IZB’s operational funding. The 317 funds pay for staff at the state level, funding to LHDs, and a vaccine budget.

State Funding

The State has historically provided limited funding for vaccines and operations. Unfortunately all local assistance funding for Community Health Centers and Collaborative Projects, as well as funding for the immunization registries was eliminated in FY 10/11, along with State funds to purchase influenza vaccine.

IV. Contracts

The State provides funding to LHDs via annual subvention (IAP) contracts. Once the federal grant figures are received, IZB management makes a decision on funding awards to each of the LHDs. The Field Representatives notify the LHD of their funding awards and assist counties with the development of budget applications as necessary. The contract period for most LHDs is the State fiscal year (July 1-June 30); however, some LHDs are on a calendar-year contract period (January 1-December 31). The State develops a scope of work for LHDs based on the CDC’s grant guidance.

Contract Scope of Work for Immunization Programs

A. Program Management:

Program planning, vaccine financing, staffing and training, allocation and utilization of funding, management plans, and partnerships and collaborations.

B. Vaccine Management and Accountability: Vaccine ordering, distribution, storage and utilization, and vaccine accountability at the provider level.

C. Immunization Information Systems:

Increase and enhance provider participation in the local or regional registry and increasing the child/adolescent/adult population included in the registry.

D. Provider Quality Assurance:

Provider Quality Assurance Review (QAR) site visits, provider education, training, and technical assistance on immunization practices.

E. Perinatal Hepatitis B Prevention:

Encouraging use of the birth dose by hospitals.

F. Adolescent Immunizations:

Working collaboratively with local public and private/nonprofit providers and agencies, and professional organizations to establish a platform on adolescent immunizations and increase coverage rates within the jurisdiction

G. Adult Immunizations:

Working collaboratively with local public and private/nonprofit providers and agencies, and professional organizations to establish a platform on adult immunizations and increase coverage rates within the jurisdiction.

H. Education, Information, Training, and Partnerships:

Development and dissemination of consumer information and educational materials including vaccine benefit and risk communication.

I. Epidemiology and Surveillance:

Disease surveillance and response, vaccine preventable disease (VPD) reporting, vaccine safety, and screening for perinatal Hepatitis B.

J. Population Assessment:

Performance and reporting of general and special population assessments.

K. WIC-Immunization Linkage:

Developing linkages between WIC and Immunization Programs to increase immunization rates of WIC clients.

Types of Local/State Immunization Contract Funds

A. Collaborative:

( Categorical state funds designed to encourage partnerships between public, private, and community organizations to increase immunization rates for children and adolescents

( Three-year funding cycle dependent upon continued funding by the governor and legislature

Please note that due to cut in State funding, collaborative funding was eliminated in FY 10-11 and will not be offered for FY2011/12

B. Community Health Center (CHC):

( Categorical state funds designed to assist community health centers with immunization services delivery

( Usually subcontracted to the CHC through the County/City’s immunization contract (some CHCs contract directly with the State)

( If the contract is awarded as a subcontract through the County/City, a management fee of 5% of the contract or a maximum of $1,000 is added to the administrator’s contract

Please note that due to cut in State funding, CHC funding was eliminated in FY 10-11 and will not be offered for FY2011/12.

C. Registry:

( Categorical state funds and Federal funds for development of the registry

( Approximately $3.15 million in State funds are available annually to LHDs to fund registry activities. In addition, $3.0 in federal funds and $1.1 in CMS matching funds is awarded

( Regional registries receive an allocation which they are to use for recruitment, training & retention of regional users.

( Awarded annually

Due to cut in State funds, local registry will no longer receive allocations for provider support and maintenance of registry activities. These activities will be streamlined through the state starting FY 2011/12.

D. Immunization Assistance Program:

( Federal funds for support of local immunization programs

E. Perinatal Hepatitis B:

( Federal funds for case management of infants born to HBsAg+ mothers

Contract Applications

A. Applications and budget packets are mailed to the LHDs in March (for fiscal-year contracts) or November (calendar-year contracts).

B. Contracts are submitted for review by the Branch in April (fiscal-year) and December (calendar-year).

C. Contracts are sent back to the LHDs for signature.

D. Signed contracts are sent to Contract Management, Accounting, and, if over $75,000, to the Department of General Services for state review and finally to Contract Management for state approval.

E. Copies of the approved contracts are forwarded to the IZB and Contractor.

F. The full process takes a minimum of 12 weeks for completion.

G. Obtaining signatures from the LHD (especially when the Board of Supervisors is involved) is usually the longest part of the process.

Common mistakes resulting in a prolonged contract approval process

( Incorrect fringe benefits rate: 40% is the maximum allowable rate for fringe benefits.

( Inclusion of infrastructure/indirect expenses: Rent and other infrastructure/indirect expenses are not allowed.

( Calculation errors: Amounts need to add down and across.

( Personnel calculation errors: The hourly rate multiplied by hours or the monthly salary multiplied by percentage is incorrect.

( Subcontract administration fee is incorrect: The allowable administration fee for subcontracts is 5% of the contract or a maximum of $1,000. This fee is not deducted from the subcontract but is added to the overall county contract.

( All justifications for personnel, operating expenses for contracts, and subcontracts must be included with the submission.

Invoices

Invoices should be submitted quarterly (or monthly by special arrangement. The most common problems that prolong the approval/payment process are:

( Inaccurate calculations: The total of the attached invoices does not equal the amount claimed. Rounding to the nearest dollar on the total invoice amount and subtotals can cause this problem. The invoice for the claim must be the exact total amount of the individual invoices submitted; no rounding is allowed.

( Inadequate information about personnel: Invoices for personnel must include the name of the person in each position, the position title, and the amount being billed for each individual. A grand total for all positions is not allowed.

( Changes in personnel titles or benefits: If the titles of the positions on the contract change (i.e., Office Assistant in application and they are billing for Administrative Clerk), staff benefits increase (say from 12% to 19%), then the contractor is required to send a letter explaining the changes for the file.

( Incomplete information about subcontracts: The name of each Subcontractor being billed for, their federal tax ID number, and the amount being billed for each subcontract must be included. Submission of a grand total for all subcontractors is not acceptable.

• Failure to submit quarterly contract report via Survey Monkey by the 15th of the month following the close of the quarter.

Transfers/Amendments

A. Informal Adjustment:

This can be accomplished by having the contractor send a letter to IZB describing the changes.

Personnel:

We can do an informal adjustment within the personnel line item as long as we do not add or delete positions and the total dollar amount remains the same. 

Operating:

Same rules apply. We can move money between Printing, General Expense (or whatever categories they designed within Operating in their contract).

Subcontracts:

We can do an informal adjustment for subcontracts. For example if a subcontractor wants to rearrange their money, that is fine as long as the overall amount is not changing.

B. Transfer Clause:

Contractor should send a line item budget which shows how much money is being moved between line items and a cover letter explaining why the changes are necessary. This will need approval by Greg Oliva at DCDC.

Line item shifts of up to $25,000 or ten percent of the annual contract total, whichever is less, may be made up to a cumulative maximum of $25,000 or 10%, whichever is less, for all line item shifts over the life of the contract.  There must be a substantial business justification for any shifts made.  Fund shifts which increase Indirect, Operating or General Expense line items are prohibited.  Line item shifts may be proposed/requested by either the California Department of Public Health or the Contractor in writing and must not increase or decrease the total contract amount allocated. 

C. Amendment:

Any changes above and beyond what has been described will require a formal amendment. This will require a summary sheet which shows how much money is being moved between line items, a cover sheet explaining why the changes are necessary, and revised Exhibit B and Exhibit C pages. This will require the full contract process which involves approval by CMU, DGS, and sign off by the county.

This process typically takes 3-4 months.

Note: Beginning with CY2011 and FY2011/12 contracts, all budget flexibility language will be removed from contracts per the Department of General Services. This means that money cannot be moved between line items. Please be sure to carefully review your proposed budget before sending to IZB for approval.

Contract Closure

At the end of the grant period the contract must be closed out. This includes submission of all invoices and a completed Contract Release form within 90 days of the close of the contract.

Immunization Coordinator Responsibilities

( Assist in the development and submission of contracts for LHDs and non-profit community health centers.

( Ensure that LHDs submit quarterly contract progress reports via Survey Monkey by the 15th of the month following the end of each quarter, and other reports in accordance with State guidelines and timelines.

• Ensure funded CHC’s submit quarterly progress reports by the 15th of the month following the end of the quarter.

V. Immunization Branch Programs

Local Health Department Immunization Programs

The CDC provides discretionary funding through Section 317 grant funds. This funding allows the State to expand eligibility for vaccines to some individuals outside the VFC eligibility criteria. In California, vaccines purchased using 317 funds are made available to LHDs for their clinics and county-run hospitals, California Youth Authorities, and juvenile halls to immunize children 0-18 years, as well as certain adult populations. Community health centers and school-based health clinics also receive vaccines purchased with 317 funds to immunize underinsured children 0-18 years.

California’s 317 funding is not an entitlement program, and the budget is limited. While there is now increased focus on providing adult vaccines and 317 funds can be used for adult vaccines, vaccines administered to adults cannot be provided at the expense of the childhood vaccine program. Currently, the State’s budget only allows for the limited provision to adults of Tdap, Td, MMR, Hepatitis A (for post-exposure prophylaxis), and Hepatitis B (for adults in household and sexual contacts of HbsAg+ pregnant women).

For complete, up-to-date information on adult immunization eligibility, refer to the California State Eligibility Table (available on the IZ Coordinator’s website). At the State level, vaccine purchases for LHDs are split between the VFC and 317 funds. At least 85% of vaccines are purchased with VFC funds and 10-15% with 317 funds.

Consistent with VFC Program policy, LHDs cannot charge for the cost of vaccines they receive from the State Program. While an administration fee of up to $17.55 per vaccine provided is allowable for patients that are uninsured, this fee must be waived if the patient cannot afford to pay it. LHDs may also bill Medi-Cal or CHDP under existing programs. Because the vaccine received from the State comes from a variety of funding sources, the LHD should provide immunizations to anyone who meets the eligibility criteria and presents requesting them at a LHD clinic.

The LHDs are required to recertify for VFC Program participation annually. They order their vaccine by the same process as private VFC providers.

Additional information on recertification and vaccine ordering are available on the VFC website ().

The Vaccines for Children Program

The Vaccines for Children (VFC) Program is a federally-funded, state-operated vaccine supply program. This national program is intended to help raise childhood IZ levels, especially among infants and young children with a target goal of vaccinating 90% of all two-year-old children. About 55 % of California’s children are eligible for the VFC Program. The VFC Program removes vaccine cost as a barrier to vaccination of eligible children. This public/private partnership allows participating private providers to administer VFC vaccines to eligible children without having to refer them to the public sector. California’s customer satisfaction surveys have consistently shown the vast majority of health providers to be very satisfied with the VFC Program.

The Centers for Disease Control has recently launched an initiative called VMBIP (Vaccine Management Business Improvement Plan) to centralize the nation’s vaccine distribution. All shipments of publically funded vaccine are required to be shipped directly to providers through the national distributor. In California, all local health department and VFC provider vaccine orders go through the VFC Program and are shipped by McKesson Specialty. A second phase of VMBIP will be launch on-line ordering for vaccines. On-line ordering is expected to begin the later part of 2010.

VFC Eligibility Guidelines

The California VFC Program was designed to meet the immunization needs of the State’s children. To be eligible to participate in the VFC Program, a child must be:

( Be eligible for Medicaid (Medi-Cal, Medi-Cal Managed Care, and/or Child Health and Disability Prevention [CHDP] Program eligible in California);

( Not have health insurance*; or

( Be American Indian or Alaskan native.

*Additionally, children who have health insurance that does not cover vaccines (underinsured) may receive VFC vaccines at federally qualified health centers (community/migrant health centers), and rural health clinics. Children who have health insurance that pays for vaccines and Healthy Families Program subscribers are not eligible to receive VFC vaccines.

VFC Provider Enrollment Requirements

Any provider that provides health care services for children up through the age of 18 years is eligible to participate. Enrollment in Medi-Cal and/or CHDP is not required, and providers are not required to accept children merely because the children are eligible for the VFC Program. To enroll in the VFC Program, a health care provider must complete and submit:

1. A signed Provider Enrollment Form: This form outlines the State-specific program requirements and policies that the provider must follow to participate in the program.

2. A Provider Profile Form: This form provides information about where the vaccine will be delivered and estimates of the number of VFC eligible.

3. A Provider Profile Supplemental Form: This form identifies the number of clinicians with prescription-writing privileges who will use VFC vaccine at this site.

4. A Certification of Capacity to Store Vaccine Form: This form documents the provider’s willingness and ability to comply with the storage and handling requirements of the VFC program.

Re-certification is required annually and is completed via the internet at . Instructions for re-certification will be sent by the VFC Office to each provider. Each provider must go to the website and complete the required forms to maintain active status in the VFC Program. Providers that do not have access to the internet can submit the forms by mail.

Those providers that do not submit their re-certification packages will have their vaccine ordering ability temporarily suspended until the recertification process is completed.

VFC Providers are required to submit to a Quality Assurance Review (QAR) which is done by the regional VFC Field Representative. At the QAR, the VFC Representative will review the Standards for Pediatric Immunization Practices and ensure that the practice is complying with all program requirements.

Flu Program

Consistent with the mission statement of the California Department of Public Health—“to protect and improve the health of all Californians”—the IZB provides flu vaccine to individuals at highest risk for influenza complications. The state funding provides vaccines for adults in this risk category. In addition, flu vaccine for children is distributed to private and public providers through the VFC Program. Each year, eligibility guidelines for the provision of flu vaccine, consistent with those published by the CDC and with California codes and regulations, are published. The California Health and Safety Code Section 104900 states:

The state department [of Health Services] shall provide appropriate flu vaccine to local government or private, non-profit agencies at no charge in order that the agencies may provide the vaccine, at minimal cost, at accessible location in the order of priority first, for all persons 60 years of age and older in this state and then to any other high-risk groups, identified by the United States Public Health Service [ACIP].

Prior to the flu season; allotments of flu vaccine for LHDs are determined based on funding levels, previous flu vaccine utilization/wastage, infrastructure capability, and other factors. The IZB forwards the proposed allotments to counties for their review and comment. Immunization Coordinators are encouraged and should review the proposed allotments with their local health officer to ensure that anticipated vaccine needs are met, including the need for mercury-free vaccines for indicated populations (see below).

In late summer or early fall, the IZB sends a letter outlining the instructions and guidelines for the current season’s flu program. Flu vaccine will be shipped to the counties when it becomes available. Typically, shipments begin in September or October and final shipments are processed in mid November. Counties should be advised to include the variability of receipt of flu vaccine as an uncontrollable factor when planning flu clinics. While the administration of flu vaccine traditionally begins in October, the new thinking is that immunization should continue into late spring to obtain higher immunization rates.

Injectable flu vaccine typically expires on June 30 each year.

Counties are required to administer flu vaccines in accordance with the eligibility guidelines distributed by the Branch for each flu season. In most instances, LHDs should vaccinate anyone presenting at a flu clinic; however, they should not advertise flu vaccines to populations other than those identified by the State eligibility guidelines. At the completion of the flu season, IZ Coordinators are required to submit a Flu Vaccine Accountability report summarizing utilization of provided vaccine. The Field Representative should be notified as soon as possible if the County has an excess of flu vaccine so that it can be redistributed if necessary.

The Mercury Free Act of 2004, which went into effect July 1, 2006, requires that vaccines administered to children under age 3 and known pregnant women contain only traces of mercury. Multi-dose vials contain a mercury-containing preservative, thimerosal, at levels that exceed the state legal limit. Preservative-free influenza vaccines are available for the indicated populations. Immunization Coordinators should continue to educate providers regarding the Mercury Free Act and the availability of mercury-free influenza vaccines from the VFC Program for use in children less than 3 years of age.

Immunization Coordinator Responsibilities

The Immunization Coordinator is responsible for coordinating flu clinics for the LHD and working with the community to distribute vaccine as necessary to ensure that high-risk adults have ample avenues of receiving low-cost vaccines. Local health departments must actively target underserved communities.

Perinatal Hepatitis B Program

The goal of the Perinatal Hepatitis B Program is to reduce transmission of Hepatitis B virus to infants. This goal is supported by the California Health and Safety Code prenatal hepatitis B screening law which requires that all women be serologically screened for hepatitis B surface antigen (HBsAg) during pregnancy. Laboratories and medical providers are required to report chronic cases of hepatitis B to local health departments which in turn identify which cases are pregnant women.

Local health departments provide case management to HBV-infected pregnant women, their infants and their contacts. Infants born to women who are infected with hepatitis B are protected if they receive post-exposure prophylaxis starting at birth, followed by the hepatitis B vaccine series. Infants who have completed the vaccine series need to be tested for their hepatitis B serologic status to identify whether they have developed immunity or if they have become infected.

In addition to case management, local health departments educate medical providers, including birth hospitals, in order to ensure screening, timely reporting of infection, and administration of post-exposure prophylaxis. Case managers also promote the screening and immunization of contacts to hepatitis B infected pregnant women and mothers.

For counties that receive funding to provide Perinatal Hepatitis B services, a detailed description of program responsibilities is included in the Scope of Work for Immunization Programs (in Chapter 1 of this document). This Scope of Work will be carried out by the IZ Coordinator or other staff designated by the county. For additional information, go to .

Immunization Coordinator Responsibilities

Local Health Departments (LHDs) that receive funding are responsible for the case management of HBsAg-positive pregnant women. Local Health Departments that do not receive funding should encourage the birth dose in hospitals in their jurisdiction and provide information on any HBsAg-positive women they identify to IZB.

Collaborative Efforts among WIC and Immunization Programs

Immunization staff at LHDs are encouraged to collaborate with local Women, Infants, and Children (WIC) Supplemental Nutrition programs to ensure they have the information, materials, and other resources needed to promote immunizations and educate WIC participants and WIC staff. In California 60 percent of the birth cohort are enrolled in the WIC program. The program serves 1.4 million participants each month, the majority of whom are vulnerable infants, young children, and pregnant women. While WIC programs nationwide are required to comply with a minimal immunization screening mandate, many local WIC agencies are willing to do more with assistance.

The success of WIC immunization interventions is enhanced by close collaborative relationships with local immunization program and immunization registry staff. WIC staff with up-to-date knowledge of immunizations, the childhood immunization schedule, vaccines, vaccine-preventable diseases, and the immunization registry and its use can help in promoting a consistent message throughout the local jurisdiction. The Immunization Branch provides information and materials to assist local efforts with WIC programs.

Immunization Coordinator Responsibilities

( Establish a working relationship with WIC programs in your jurisdiction.

( As the immunization expert, coordinate and provide immunization-related training and materials to WIC staff as feasible.

( Facilitate collaboration between WIC and the immunization registry and encourage WIC’s use of the registry.

( Provide WIC programs in your jurisdiction with funding for staff time to enroll children in the immunization registry and for incentive items for WIC parents and staff as feasible.

VI. Vaccine Ordering and Distribution

Completing the Vaccine Order Form

Both LHDs and VFC providers use the same California-specific Vaccine Order Form. All sections of the form must be complete for the order to be processed. The sections are:

A. Demographic information:

1. Provider name, PIN number, contact information, and shipping address

2. Days and hours when vaccine shipments can be received

B. Information about doses used, inventory on hand, and amount requested for each vaccine:

1. Doses Used: Calculate the number of doses used since the last order. This may include the number of doses wasted/expired if the amount is less than 10 doses for any single vaccine.

2. Doses on Hand: This is the inventory available in the storage units at the time of the order. The number of doses, lot number, and expiration date for each vaccine must be recorded. If you are obtaining a list of your inventory, it is important to compare this to the vaccine in the storage units to ensure an accurate count. An accurate printout from the registry may be attached to the order in lieu of re-entering the information on the order form. The total number of doses on hand should be written in on the front of the form if you have multiple lots or are attaching a printout.

C. Doses Ordered: Indicate the number of doses requested (not number of vials) and the presentation of the vaccine that you would like (i.e., vials prefilled syringes). Orders will be rejected if the inventories are incorrect.

D. Replacement instructions: Indicate whether you would like a substitute if the vaccine or the presentation you requested is not available or would rather wait until vaccines become available.

Vaccine Order Submission

The following documents should be transmitted to the VFC Office at the numbers listed on the order form:

A. The completed order form

B. A copy of the current inventory if printed from the registry

C. Copies of any “Return or Transfer of VFC Vaccines Report” forms generated since the previous order

Ordering Frequency

Frequency for ordering is based on annual vaccine usage. Exceptions are allowed with justification for a variety of reasons (e.g., emergency needs, inadequate storage space). The following table shows the ordering frequencies:

Ordering Frequency

|Doses/year |Ordering interval |

|>2000 |Monthly |

|500-2000 |Bimonthly |

| ................
................

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