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Published on July 16, 2009 AAP News 2009, doi:aapnews.20090716-1 © 2009 American Academy of Pediatrics
Practice implications for reinstatement of Hib booster dosefrom the AAP Committee on Infectious Diseases and the AAP Department of Practice.Since the Centers for Disease Control and Prevention (CDC) announced a reinstatement of the booster dose of Haemophilus influenzae type b (Hib) vaccine, practices have raised questions regarding the recommendations and how to order enough Hib-containing vaccine to implement the booster dose for their patients. The Hib vaccine booster dose was reinstated for all children 12 through 15 months of age. When office supplies are adequate, older children (15 through 59 months) for whom a Hib booster dose was deferred should begin to receive the Hib booster at the next routinely scheduled visit or medical encounter. While Merck has not yet returned to the market with its Hib-containing vaccines, sanofi pasteur has increased production and supply of both of its Hib-containing vaccines, monovalent Hib vaccine, PRP-T (ActHib), and DTaP-IPV/Hib (Pentacel), making this step toward resolution of the Hib vaccine shortage possible. However, mass recall of children for their catch-up Hib booster dose is not recommended at this time because it could result in some children being unable to complete the primary series on schedule. The issues pediatric practices are facing in ordering vaccine were discussed with sanofi pasteur leadership, which shared the following information. Monovalent vs. combination product Sanofi pasteur indicates that allocation limits for ordering both monovalent and combination products are still in effect. According to the manufacturer, practices that previously ordered monovalent vaccine for the primary series doses should still be receiving the same amount. However, those practices will need to order the combination product to provide the booster dose and the limited catch-up. Sanofi pasteur reports that it is basing the increase in allocation of vaccine to meet the reinstatement recommendations on the individual practice’s 18-month ordering history. Practices will have to decide how to handle administration of the combination product. Some may choose to use the combination product at the beginning of the series and a monovalent dose to complete the series. As recommended by the CDC, children who need the Hib booster and who already have received four doses of DTaP should receive monovalent Hib vaccine as their Hib booster dose if available. However, if DTaP-IPV/Hib is the only Hib-containing vaccine available, this combination product can be used to complete the series of Hib vaccination, even if the child already has received all the necessary doses of DTaP and IPV. Supply is expected to improve with the return of Merck’s Hib-containing vaccines to the market, as well as possible licensure of other monovalent Hib products. Until that time, practices likely will need to use combination vaccine product to fully implement CDC recommendations. Vaccines for Children (VFC) The CDC is committed to working with the VFC program in each state to reinstate the booster dose with the Hib-containing vaccines that are available as soon as possible to meet this public health need. Payment for combination vaccine product Because some practices will be using Hib combination products for the first time, sanofi pasteur has a reimbursement support center available for pediatricians and their office staff. For assistance with contracts and coding, call 800-822-2463. The majority of payers are paying for the product. The Academy continues to work with payers on adequate payment for administering combination products. Communication Offices should not have seen a change, particularly a decrease, in Hib vaccine allocations. If difficulties persist, sanofi pasteur suggests reporting the problems to the practice representative or calling the customer service line. Pediatricians soon will be receiving a letter from sanofi pasteur detailing ordering practices and procedures. The letter also will be posted on the sanofi pasteur Web site, www.vaccineshoppe.com. Pediatricians are encouraged to report any difficulties directly to their representative or through the customer service center. The Academy recognizes the burden this change places on practices. It thanks pediatricians for their work to keep children fully protected against Hib despite the numerous challenges this shortage and the changing recommendations continue to pose. Resources Recommendations regarding reinstatement of the Hib booster dose are available on the AAP News Web site, http://aapnews.aappublications.org/cgi/content/full/aapnews.20090625-1. A Q&A for providers regarding reinstatement of the Hib booster dose is available from the CDC at www.cdc.gov/vaccines/vpd-vac/hib/faqs-return-to-booster-hcp.htm. A Q&A for parents is available at www.cdc.gov/vaccines/vpd-vac/hib/faqs-return-to-booster-parents.htm. To reach the sanofi customer service center or reimbursement support, visit www.vaccineshoppe.com or call 800-822-2463. For information from the Academy on combination vaccines, visit www.cdc.gov/vaccines/vpd-vac/hib/faqs-return-to-booster-parents.htm. To report insurance administrative and claims processing concerns using the AAP Hassle Factor Form, log onto the AAP Member Center at www.aap.org/moc. Under Practice Management Online, click on Hassle Factor Form.
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