ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES VACCINES FOR CHILDREN PROGRAM VACCINES TO PREVENT ROTAVIRUS GASTROENTERITIS

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5 Resolution No. 2/06-2 ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES VACCINES FOR CHILDREN PROGRAM VACCINES TO PREVENT ROTAVIRUS GASTROENTERITIS The purpose of this resolution is to add rotavirus vaccine to the Vaccines for Children Program. Eligible Groups Infants aged 6 weeks through 32 weeks. Recommended Schedule for Rotavirus Vaccines Dose Primary 1 Primary 2 Primary 3 Age 2 months 4 months 6 months Dosage Intervals for Rotavirus Vaccines Age (Dose 1) Dosing Interval (Dose 1 to 2) (Dosing Interval Dose 2 to 3) 6 12 weeks* 4 10 weeks 4 10 weeks * The first dose of rotavirus vaccine should be initiated for infants between 6 and 12 weeks of age because of insufficient data on the safety of the first dose of the vaccine in older infants. Note: The last dose of rotavirus vaccine should be administered by 32 weeks of age. Recommended Dosages Refer to product package inserts. Contraindications The following conditions are contraindications to administration of rotavirus vaccine: a. Serious Allergic Reaction to Vaccine Components Severe hypersensitivity or anaphylactic reaction to the vaccine or a constituent of the vaccine or after receiving a previous dose of rotavirus vaccine.

6 Precautions The following are precautions to administration of rotavirus vaccine: a. Acute Gastroenteritis Rotavirus vaccine should not be administered to infants with acute, moderate to severe gastroenteritis until the condition improves. However, infants with mild acute gastroenteritis can be vaccinated, particularly if the delay in vaccination may be substantial and might make the child ineligible to receive vaccine (e.g., older than 12 weeks of age before vaccination is initiated). Rotavirus vaccine has not been studied among infants with concurrent gastroenteritis among whom its immunogenicity and efficacy can theoretically be compromised. b. Moderate to Severe Illness Infants with moderate to severe illness should be vaccinated as soon as they have recovered from the acute phase of the illness. c. Preexisting Chronic Gastrointestinal Disease Practitioners should consider the potential risks and benefits of administering rotavirus vaccine to infants with preexisting chronic gastrointestinal disease. Infants with preexisting chronic gastrointestinal conditions and not undergoing immunosuppressive therapy should benefit from rotavirus vaccination and the benefits outweigh the theoretical risks. However, the safety and efficacy of rotavirus vaccine have not been established for infants with these preexisting conditions (e.g. congenital malabsorption syndromes, Hirschsprung s disease, short-gut syndrome, or persistent vomiting of unknown cause). d. Intussusception Following administration of a previously licensed rotavirus vaccine which is no longer available, an increased risk of intussusception was observed. Available pre-licensure data from a large trial of over 70,000 infants designed to evaluate the risk of intussusception shows no evidence of an association between intussusception and the currently licensed rotavirus vaccine, which is also biologically different (i.e., different rotavirus strain, lower rates of viral shedding, less reactogenicity in terms of fever, vomiting, and diarrhea) than the previous vaccine. However, additional post-licensure surveillance data are required to confirm that the vaccine is not associated with intussusception at a lower rate than would have been detected in pre-licensure trials. The risks and benefits of vaccination should be considered when vaccinating infants with a previous episode of intussusception. Some data suggest that infants with a history of intussusception may be at higher risk of a repeat episode than other infants. Therefore, until post-licensure data on safety of rotavirus vaccine are available, administration of rotavirus vaccine to infants with a previous episode of intussusception should be withheld. e. Altered Immunocompetence Practitioners should consider the potential risks and benefits of administering rotavirus vaccine to infants who are potentially immunocompromised. No safety or efficacy data are available for the administration of rotavirus vaccine to infants who are potentially immunocompromised including: Infants with blood dyscrasias, leukemia, lymphomas of any type, or other malignant neoplasms affecting the bone marrow or lymphatic system. Infants on immunosuppressive therapy (including high-dose systemic corticosteroids). Infants with primary and acquired immunodeficiency states, including HIV/AIDS or other clinical manifestations of infection with human immunodeficiency viruses; cellular immune deficiencies, and hypogammaglobulinemic and dysgammaglobulinemic states. There is insufficient data from the clinical trials to support administration of rotavirus vaccine to infants with indeterminant HIV status who are born to mothers with HIV/AIDS. Infants who have received a blood transfusion or blood products, including immunoglobulins within 42 days. Adopted and Effective: February 22, 2006

7 ROTAVIRUS VACCINE W H A T Y O U N E E D T O K N O W 1 What is rotavirus? Rotavirus is a virus that causes severe diarrhea, mostly in babies and young children. It is often accompanied by vomiting and fever. Rotavirus is not the only cause of severe diarrhea, but it is one of the most serious. Each year in the United States rotavirus is responsible for: more than 400,000 doctor visits more than 200,000 emergency room visits 55,000 to 70,000 hospitalizations deaths Almost all children in the U.S. are infected with rotavirus before their 5th birthday. Children are most likely to get rotavirus disease between November and May, depending on the part of the country. Your child can get rotavirus infection by being around other children who are already infected. 2 Rotavirus vaccine Better hygiene and sanitation have not been very good at reducing rotavirus disease. Rotavirus vaccine is the best way to protect children against rotavirus disease. Rotavirus vaccine is an oral (swallowed) vaccine; it is not given by injection. Rotavirus vaccine will not prevent diarrhea or vomiting caused by other germs, but it is very good at preventing diarrhea and vomiting caused by rotavirus. About 98% of children who get the vaccine are protected from severe rotavirus diarrhea, and about 74% do not get rotavirus diarrhea at all. Children who get the vaccine are also much less likely to be hospitalized or to see a doctor because of rotavirus infection. 3 Who should get rotavirus vaccine and when? Children should get 3 doses of rotavirus vaccine. They are recommended at these ages: First Dose: 2 months of age Second Dose: 4 months of age Third Dose: 6 months of age The first dose should be given between 6 and 12 weeks of age. The vaccine has not been studied when started among children outside that age range. Children should have gotten all 3 doses by 32 weeks of age. Rotavirus vaccine may be given at the same time as other childhood vaccines. Children who get the vaccine may be fed normally afterward. 4 Some children should not get rotavirus vaccine or should wait A child who has had a severe (life-threatening) allergic reaction to a dose of rotavirus vaccine should not get another dose. A child who has a severe (life threatening) allergy to any component of rotavirus vaccine should not get the vaccine. Tell your doctor if your child has any severe allergies that you know of. Children who are moderately or severely ill at the time the vaccination is scheduled should probably wait until they recover. This includes children who have diarrhea or vomiting. Ask your doctor or nurse. Children with mild illnesses should usually get the vaccine. Check with your doctor if your child has any ongoing digestive problems. Rotavirus 4/12/06

8 Check with your doctor if your child s immune system is weakened because of: - HIV/AIDS, or any other disease that affects the immune system - treatment with drugs such as long-term steroids - cancer, or cancer treatment with x-rays or drugs Check with your doctor if your child recently had a blood transfusion or received any other blood product (such as immune globulin). In the late 1990s a different type of rotavirus vaccine was used. This vaccine was found to be associated with an uncommon type of bowel obstruction called intussusception, and was taken off the market. The new rotavirus vaccine has been tested with more than 70,000 children and has not been associated with intussusception. However, once a person has had intussusception, from any cause, they are at higher risk for getting it again. So as a precaution, it is suggested that if a child has had intussusception they should not get rotavirus vaccine. 5 What are the risks from rotavirus vaccine? A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. The risk of rotavirus vaccine causing serious harm, or death, is extremely small. Getting rotavirus vaccine is much safer than getting the disease. Mild problems Children are slightly (1-3%) more likely to have mild, temporary diarrhea or vomiting within 7 days after getting a dose of rotavirus vaccine than children who have not gotten the vaccine. Moderate or severe reactions have not been associated with this vaccine. If rare reactions occur with any new product, they may not be identified until thousands, or millions, of people have used it. Like all vaccines, rotavirus vaccine will continue to be monitored for unusual or severe problems. Vaccine Information Statement (Interim) Rotavirus (4/12/06) 6 What if there is a moderate or severe reaction? What should I look for? Any unusual condition, such as a high fever or behavior changes. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness. What should I do? Call a doctor, or get the person to a doctor right away. Tell your doctor what happened, the date and time it happened, and when the vaccination was given. Ask your doctor, nurse, or health department to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS web site at or by calling VAERS does not provide medical advice. 7 The National Vaccine Injury Compensation Program In the rare event that you or your child has a serious reaction to a vaccine, a federal program has been created to help pay for the care of those who have been harmed. For details about the National Vaccine Injury Compensation Program, call or visit their website at 8 How can I learn more? Ask your doctor or nurse. They can give you the vaccine package insert or suggest other sources of information. Call your local or state health department. Contact the Centers for Disease Control and Prevention (CDC): - Call (1-800-CDC-INFO) - Visit CDC s National Immunization Program website at: department of health and human services Centers for Disease Control and Prevention National Immunization Program

9 HEPATITIS A VACCINE W H A T Y O U N E E D T O K N O W 1 What is hepatitis A? Hepatitis A is a serious liver disease caused by the hepatitis A virus (HAV). HAV is found in the stool of persons with hepatitis A. It is usually spread by close personal contact and sometimes by eating food or drinking water containing HAV. Hepatitis A can cause: mild flu-like illness jaundice (yellow skin or eyes) severe stomach pains and diarrhea People with hepatitis A often have to be hospitalized (up to about 1 person in 5). Sometimes, people die as a result of hepatitis A (about 3-5 deaths per 1,000 cases). A person who has hepatitis A can easily pass the disease to others within the same household. Hepatitis A vaccine can prevent hepatitis A. 2 WHO? Who should get hepatitis A vaccine and when? Some people should be routinely vaccinated with hepatitis A vaccine: All children 1 year (12 through 23 months) of age. Persons 1 year of age and older traveling to or working in countries with high or intermediate prevalence of hepatitis A, such as those located in Central or South America, Mexico, Asia (except Japan), Africa, and eastern Europe. For more information see Children and adolescents through 18 years of age who live in states or communities where routine vaccination has been implemented because of high disease incidence. Men who have sex with men. Persons who use street drugs. Persons with chronic liver disease. Persons who are treated with clotting factor concentrates. Persons who work with HAV-infected primates or who work with HAV in research laboratories. Other people might get hepatitis A vaccine in special situations: Hepatitis A vaccine might be recommended for children or adolescents in communities where outbreaks of hepatitis A are occurring. Hepatitis A vaccine is not licensed for children younger than 1 year of age. WHEN? For children, the first dose should be given at months of age. Children who are not vaccinated by 2 years of age can be vaccinated at later visits. For travelers, the vaccine series should be started at least one month before traveling to provide the best protection. Persons who get the vaccine less than one month before traveling can also get a shot called immune globulin (IG). IG gives immediate, temporary protection. For others, the hepatitis A vaccine series may be started whenever a person is at risk of infection. Two doses of the vaccine are needed for lasting protection. These doses should be given at least 6 months apart. Hepatitis A vaccine may be given at the same time as other vaccines. Hepatitis A 3/21/06

10 3 4 Some people should not get hepatitis A vaccine or should wait Anyone who has ever had a severe (lifethreatening) allergic reaction to a previous dose of hepatitis A vaccine should not get another dose. Anyone who has a severe (life threatening) allergy to any vaccine component should not get the vaccine. Tell your doctor if you have anysevere allergies. All hepatitis A vaccines contain alum and some hepatitis A vaccines contain 2-phenoxyethanol. Anyone who is moderately or severely ill at the time the shot is scheduled should probably wait until they recover. Ask your doctor or nurse. People with a mild illness can usually get the vaccine. Tell your doctor if you are pregnant. The safety of hepatitis A vaccine for pregnant women has not been determined. But there is no evidence that it is harmful to either pregnant women or their unborn babies. The risk, if any, is thought to be very low. 6 What are the risks from hepatitis A vaccine? A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. The risk of hepatitis A vaccine causing serious harm, or death, is extremely small. Getting hepatitis A vaccine is much safer than getting the disease. Mild problems soreness where the shot was given (about 1 out of 2 adults, and up to 1 out of 6 children) headache (about 1 out of 6 adults and 1 out of 25 children) loss of appetite (about 1 out of 12 children) tiredness (about 1 out of 14 adults) If these problems occur, they usually last 1 or 2 days. Severe problems serious allergic reaction, within a few minutes to a few hours of the shot (very rare) Vaccine Information Statement Hepatitis A (3/21/06) 42 U.S.C. 300aa-26 5 What if there is a moderate or severe reaction? What should I look for? Any unusual condition, such as a high fever or behavior changes. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness. What should I do? Call a doctor, or get the person to a doctor right away. Tell your doctor what happened, the date and time it happened, and when the vaccination was given. Ask your doctor, nurse, or health department to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS web site at or by calling VAERS does not provide medical advice. The National Vaccine Injury Compensation Program In the event that you or your child has a serious reaction to a vaccine, a federal program has been created to help pay for the care of those who have been harmed. For details about the National Vaccine Injury Compensation Program, call or visit their website at 7 How can I learn more? Ask your doctor or nurse. They can give you the vaccine package insert or suggest other sources of information. Call your local or state health department. Contact the Centers for Disease Control and Prevention (CDC): - Call (1-800-CDC-INFO) - Visit CDC websites at: or department of health and human services Centers for Disease Control and Prevention National Immunization Program

11 Medicaid Billing Instructions For Vaccines for Children (VFC)-eligible patients, birth through 18 years of age, providers must document the correct CPT code(s) on the CMS 1500 claim form in order to receive reimbursement for the administration of a vaccination(s) given to a VFC-eligible patient from VFC vaccine stock. This applies to Medicaid children only. An office visit or an EPSDT screening visit may be billed in addition to vaccination administration fees. The vaccination administration fee for American Indian, Alaskan Native, uninsured, and underinsured patients must be collected from the parent or guardian, not Medicaid. The administration fee must be waived if the parent or guardian cannot pay. Underinsured children can only receive VFC vaccine from a Federally Qualified Health Center (FQHC), Rural Health Center (RHC) or county health department. The following CPT codes must be used when billing Medicaid for the $8.00 administration fee (for each immunization administered) to Medicaid children: NEW Rotavirus (PRV) (6weeks thru 32 weeks) Hepatitis A, 2-dose pediatric formulation (12 months and older) Hepatitis A & B, 3-dose adult formulation (18 yrs of age only) Haemophilus influenzae type b (Hibtiter) Haemophilus influenzae type b (Pedvax) Haemophilus influenzae type b (ActHib) Influenza, preservative-free (6-35 months) Influenza, preservative-free (3 yrs and older) Influenza (6-35 months) Influenza (3 yrs and older) Pneumococcal Conjugate 7 valent (PCV) Diphtheria, Tetanus, Acellular Pertussis (DTaP) Diphtheria, Tetanus (DT) Measles, Mumps, Rubella (MMR) Measles, Mumps, Rubella and Varicella (MMRV), (12 months to 12 yrs) Poliomyelitis (IPV) Tetanus, Diphtheria (Td), preservative-free Varicella (Chickenpox) Tetanus, Diphtheria (Td) Tetanus, Diphtheria, Acellular Pertussis (Tdap) (10 yrs-18 yrs) Diphtheria, Tetanus, Acellular Pertussis and Haemophilus influenzae type b (DTaP-Hib) Diphtheria, Tetanus, Acellular Pertussis, Hepatitis B, and Poliomyelitis (DTaP-Hep B-IPV)

12 90732 Pneumococcal Polysaccharide 23 valent (PPV) (2 yrs-18 yrs) Meningococcal Polysaccharide (MPSV4), (2-18 yrs of age) Meningococcal Conjugate (MCV4), (11-18 yrs of age) Hepatitis B Hepatitis B and Haemophilus influenzae type b (Hep B-Hib) These CPT codes should be used for administration fees for vaccines received through the VFC program ONLY. You should never bill the above CPT codes with the non-standard immunization codes. Note: Billing Instructions For 19 years and Above Payment for immunizations against communicable diseases for adults will be made if the physician normally charges patients for this service. Vaccines are reimbursable on a fee-for-service basis and should be supplied using non-vfc stock and billed on a HCFA 1500 claim form. The administration fee (procedure code 90471) may be billed separately if an office visit fee is not billed. For a more information, please see the Alabama Medicaid Provider Manual, Appendix H or visit their web site at 7/21/06

13 Date: VFC Provider Name Contact Person Phone # ( ) Fax # ( ) VACCINE ORDER FORM ALABAMA VACCINES FOR CHILDREN PROGRAM Phone: Shipping Address Special Delivery Instructions (e.g. days/hours closed): Order ALL vaccines at one time for a 3-month period, and reorder when your clinic is down to a 2-week supply. This will ensure your clinic does not run out of vaccine and that vaccine is used before it expires. If the pre-filled syringes or requested vaccine brands are not available, you will receive what is currently available. DO NOT FILL IN SHADED AREAS. Please fax your order to Dell Ross at VACCINE TYPES BRAND OF CHOICE PREFILLED SYRINGES IF AVAILABLE ( to select) DT (6 wks thru 6 yrs) Medical contraindication to pertussis vaccine ONLY DTaP (6 wks thru 6 yrs) DTaP-HepB-IPV (6 wks thru 6 yrs) DTaP-Hib (1 yr thru 18 mo) 4 th Dose ONLY EIPV (6 wks thru 18 yrs) Hep A 2 dose (1 yr thru 18 yrs) Diphtheria and Tetanus Toxoids Absorbed USP Tripedia Daptacel Infanrix Pediarix TriHIBit IPOL Vaqta Havrix VFC INVENTORY ON HAND (DOSES) NUMBER OF DOSES ORDERING Hep A & B 3 dose (18 yrs ONLY) Hep B-PF (Birth thru 18 yrs) Hep B/Hib (6 wks thru 5 yrs) Hib (6 wks thru 5 years) Twinrix Engerix-B Recombivax Comvax ActHib Pedvax Meningococcal conjugate (MCV4) (High school entry & college freshmen living in dormitories ONLY) MMR with diluent (1 yr thru 18 yrs) MMRV (1 yr to 12 yrs) (Shipped Separately) Pneumococcal 7 valent conjugate (PCV7) (6 wks thru 59 mos) Pneumococcal polysaccharide 23 valent (PPV23) (2 yrs thru 18 yrs) High risk ONLY Rotavirus (PVR) (6 weeks thru 32 weeks), ORAL ADMINISTRATION ONLY Td (7 yrs thru 18 yrs) Tdap (10 yrs thru 18 yrs) Tdap (11 yrs thru 18 yrs) Varicella (1 yr thru 18 yrs) (Shipped Separately) Menactra M-M-R II ProQuad Prevnar Pneumovax 23 RotaTeq Decavac Boostrix Adacel Varivax Pre-filled syringe only * SPECIAL ANNUAL ORDER: INFLUENZA VACCINE Influenza (TIV) (6 mos thru 18 yrs) Influenza preservative-free (TIV-PF) (6 mos thru 35 mos) Live, attenuated influenza vaccine (LAIV - FluMist) (5 yrs thru 18 yrs) Healthy persons ONLY REMARKS: ADPH-IMM-502 Rev. 05/06

14 VACCINE STORAGE & HANDLING EMERGENCY OPERATING PROCEDURES VFC Providers PURPOSE: This plan is intended to provide Alabama VFC providers with detailed emergency operating procedures for vaccine storage and handling. A copy of this procedure must be available to all responsible immunization staff. POWER OUTAGE OR WEATHER CONDITIONS To protect vaccine in storage and to minimize the potential monetary loss from a power outage or weather condition (i.e., hurricane, tornado, ice storm, flooding or any other weather emergency), clinic staff should immediately begin to implement emergency procedures in ADVANCE OF THE EVENT if there is reasonable cause to believe that weather conditions have the potential to disrupt power or flood or destroy areas where vaccines are stored. In advance of the emergency, immunization staff should ensure the following: Identification of an alternative storage facility, if necessary (e.g., hospital, packing plant, state depot, refrigeration trucking business, etc.) with backup power (generator), where vaccines can be properly stored and monitored for the duration of the problem or weather condition. The availability of staff to pack and move vaccines. The use of appropriate packing containers, cold packs, and dry ice (for Varivax and ProQuad vaccines). The transport of vaccines to a secure storage facility. 07/21/06 1

15 Sufficient time must be allowed for packing and transporting vaccine BEFORE weather conditions adversely affect local conditions, such as flooding, iced roads, or destruction. Identify whom to call (fill in names and telephone numbers of contacts) Backup storage/refrigeration service/location: 2 nd Backup storage/refrigeration service/location: Dry ice vendor (for transporting Varivax and/or ProQuad vaccines): Power company: Generator company: Propane company: Telephone repair: Refrigeration repair company: Alarm monitoring company (if applicable): National Weather Service: In Birmingham , in Huntsville , in Mobile Vaccine Manufacturers: Merck sanofi pasteur VACCINE ( ) GlaxoSmith Kline Wyeth Lederle Labs MedImmune Entering vaccine spaces You should be able to describe, when necessary, how to enter the building and vaccine storage spaces in an emergency or after hours. If necessary, prepare a floor diagram and the locations of - 1. Doors 2. Flash lights 3. Spare batteries 4. Light switches 5. Keys 2

16 6. Locks 7. Alarms 8. Circuit breakers 9. Packing materials Identify what vaccines to pack first in an emergency while the power is still working Pack and transport all vaccine or if that is not possible, determine the types and amounts to save. Save only the most expensive vaccines to minimize dollar loss or save some portion of all vaccines to ensure a short-term, complete supply needed to resume vaccination clinics. First priority should be given to those vaccines which would be the most expensive to replace, such as ProQuad, Menactra, Prevnar, Varivax, Pediarix, Twinrix, Adacel, Boostrix, and TriHIBit. Follow vaccine packing procedures for transport to backup storage facilities Open refrigerated units only when absolutely necessary and only after you have made all preparations for packing and moving the vaccine to alternative storage sites. Use properly insulated containers. Inventory all vaccines before transporting. 3

17 POWER OUTAGE: VFC SPOILED VACCINES REPORTING SHEET VACCINE MFR TM # SPOILED VFC DOSES DTAP SANOFI Tripedia VFC PIN NUMBER IF KNOWN DTAP GSK Infanrix DTAP-HIB SANOFI TriHIBit NAME OF CLINIC EIPV SANOFI IPOL FLU SANOFI Fluzone TYPE OF UNIT FLU CHIRON Fluvirin 1 = Refrigerator/Freezer Combo, 2 = Dorm-style Refrigerator, FLU GSK Fluarix 3= Other Refrigerator, 4 = Freezer HEP A - 2-DOSE GSK HAVRIX HEP A - 2-DOSE MERCK VAQTA HEP A and B GSK Twinrix IF MAXIMUM TEMPERATURE READING IS AVAILABLE: HEP B-PEDIATRIC GSK ENGERIX-B MAX. TEMP. REFRIGERATOR IN DEGREES F HEP B-PEDIATRIC MERCK RECOMBIVAX HB MAX. TEMP. FREEZER IN DEGREES F HEP B-HIB MERCK COMVAX TIME DURATION OUT OF TEMP RANGE (IN HOURS) HIB SANOFI ActHIB (If duration not recorded, use full duration of power outage) HIB MERCK PedvaxHIB MENINGO CONJUGATE (MCV4) SANOFI Menactra IF MAXIMUM TEMPERATURE READING NOT AVAILABLE: MMR MERCK M-M-R II 1st FRIG TEMP RECORDED AFTER POWER MMRV (MMR + VARICELLA) MERCK ProQuad 1st FREEZER TEMP RECORDED AFTER POWER PNEUMO POLY (PPV23) MERCK Pneumovax HRS. BETWEEN WHEN POWER RESTORED PNEUMO CONJ (PCV 7) WYETH Prevnar AND TEMP RECORDED (Estimate if necessary) TD SANOFI Tetanus & Diphtheria Tox TDAP GSK BOOSTRIX FACILITY TYPE TDAP SANOFI ADACEL 1 = Area Depot, 2 = County Health Department, ROTAVIRUS (PVR) MERCK RotaTeq 3 = Other Public Clinic, 4 = Private Provider VARICELLA MERCK Varivax Do not open freezers and refrigerators until power is restored. Continue to monitor temperatures. Report power outages and spoiled vaccine to the Alabama VFC Program. Call Do not discard affected vaccines until you have discussed the incident with the Alabama VFC Program. Do not administer affected vaccines until you have discussed the incident with the Alabama VFC Program. Spoiled VFC vaccine must be returned to the Alabama VFC Program. Fax this form to when completed.

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