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03-01A SOW Attachment 01A - Seasonal Influenza with Vaccines.pdf

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Department of Veterans Affairs
Veterans Health Administration
Washington, DC 20420

VHA DIRECTIVE 1013(1)
Transmittal Sheet
August 12, 2020

PREVENTION AND CONTROL OF SEASONAL INFLUENZA WITH VACCINES

1. REASON FOR ISSUE: This Veterans Health Administration (VHA) directive provides
policy for the prevention and control of seasonal influenza through the use of influenza
vaccines.

2. SUMMARY OF MAJOR CHANGES:

a. Amendment, dated October 2, 2020, updates the following information:

(1) Updated link to the Vaccine Information System from the CDC website.

(2) Paragraph 3: Updated definition of a Health Care Personnel.

(3) Paragraph 5: Updated guidance for recording the administration of influenza
vaccines, documentation requirements for the administration of the influenza vaccine to
HCP, and management adverse event in an employee annual influenza vaccination
program.

(4) Paragraph 8: Updated References.

(5) Appendix A: Updated guidance regarding Influenza Vaccine and Antiviral

Medications with Activity Against Seasonal Influenza Viruses.

(6) Appendix B: Updated guidance regarding Delay or Shortage of Seasonal

Influenza Vaccine.

b. This VHA directive provides updated and detailed requirements for the prevention

and control of seasonal influenza with vaccines. Major changes include updated
responsibilities in paragraph 5 and updated reference listing in paragraph 8.

3. RELATED ISSUES: VHA Directive 1192.01, Seasonal Influenza Prevention Program
for VHA Health Care Personnel, August 10, 2020.

4. RESPONSIBLE OFFICE: The Assistant Under Secretary for Health for Clinical
Services (11SPEC12), is responsible for the contents of this directive. Questions
relating to this directive may be referred to the National Infectious Diseases Service at
513-246-0270.

5. RESCISSIONS: VHA Directive1013(3), Prevention and Control of Seasonal Influenza
with Vaccines, dated February 5, 2015, is rescinded.

August 12, 2020

VHA DIRECTIVE 1013(1)

6. RECERTIFICATION: This VHA directive is scheduled for recertification on or before
the last working day of August 2025. This VHA directive will continue to serve as
national VHA policy until it is recertified or rescinded.

BY DIRECTION OF THE OFFICE OF THE
UNDER SECRETARY FOR HEALTH:

/s/ Lucille B. Beck, PhD.
Senior Advisor to the Under Secretary for
Health

NOTE: All references herein to Department of Veterans Affairs (VA) and VHA
documents incorporate by reference subsequent VA and VHA documents on the same
or similar subject matter.

DISTRIBUTION: Emailed to the VHA Publication Distribution List August 14, 2020.

August 12, 2020

VHA DIRECTIVE 1013(1)

PREVENTION AND CONTROL OF SEASONAL INFLUENZA WITH VACCINES

CONTENTS

1. PURPOSE 1

2. BACKGROUND 1

3. DEFINITION 3

4. POLICY 3

5. RESPONSIBILITIES 3

6. TRAINING 7

7. RECORDS MANAGEMENT 7

8. REFERENCES 7

APPENDIX A

APPENDIX B

INFLUENZA VACCINE AND ANTIVIRAL MEDICATIONS WITH ACTIVITY AGAINST
SEASONAL INFLUENZA VIRUSES A-1

DELAY OR SHORTAGE OF SEASONAL INFLUENZA VACCINE B-1

August 12, 2020

VHA DIRECTIVE 1013(1)

PREVENTION AND CONTROL OF SEASONAL INFLUENZA WITH VACCINES

1. PURPOSE

This Veterans Health Administration (VHA) directive provides policy for the
prevention and control of seasonal influenza through the use of influenza vaccines.
AUTHORITY: Title 38 United States Code (U.S.C.) §§ 1701(6)(D), (9)(G), and (10),
1704, and 1712(e). NOTE: Refer to VHA Directive 1192.01, Seasonal Influenza
Prevention Program for VHA Health Care Personnel, August 10, 2020, for detailed
information regarding policy for influenza vaccination of health care personnel (HCP).

2. BACKGROUND

a. The influenza vaccination program is an essential component of the Department
of Veterans Affairs (VA) health promotion and disease prevention programs. Influenza is
a cause of substantial morbidity and mortality in the United States (U.S.). Influenza
vaccination is the most effective way to primarily protect against the disease and
resultant complications. Vaccination also reduces the risk of transmitting influenza to
family members, visitors, other patients, coworkers and health care personnel. VHA has
made influenza vaccination a priority. The influenza vaccine for seasonal influenza is a
safe and cost-effective means for preventing and controlling influenza.

b. The influenza vaccination program is based on annual recommendations of the

Centers for Disease Control and Prevention (CDC) Advisory Committee on
Immunization Practices (ACIP), as published in the Morbidity and Mortality Weekly
Report (MMWR). The program is consistent with The Joint Commission accreditation
standards and VHA National Center for Health Promotion and Disease Prevention
Guidance Statements on Clinical Preventive Services-Immunizations.

c. Because influenza viruses are always changing, each year’s influenza vaccine is
formulated to protect from the influenza viruses most likely to cause disease that year.
Influenza A and B are the two types of influenza viruses that cause seasonal influenza,
typically during the fall and winter months. The trivalent influenza vaccine formulations
contain two influenza A virus strains and one influenza B virus strain, while quadrivalent
influenza vaccine formulations contain the same strains as trivalent vaccines, also
contain a second B virus strain.

d. Each year the National Center for Health Promotion and Disease Prevention
(NCP), VHA Office of Patient Care Services collaborates with appropriate offices and
programs within VA Central Office as described in VHA Directive 1120.05, The National
Center for Health Promotion and Disease Prevention and the Coordination and
Development of Clinical Preventive Services Guidance, dated July 31, 2020, to produce
and post a VHA Clinical Preventive Services Guidance Statement on Seasonal
Influenza Immunization. This Guidance Statement is a clinical resource to VHA staff for
the care of adult Veteran patients. It is available from the Guidance Statement home
page at http://vaww.prevention.va.gov/Guidance_on_Clinical_Preventive_Services.asp

August 12, 2020

VHA DIRECTIVE 1013(1)

(navigate to current year’s Influenza Immunization Guidance Statement from this page).
NOTE: This is an internal VA website that is not available to the public.

e. Abbreviations and naming conventions for influenza vaccines from the Advisory

Committee on Immunization Practices (ACIP) are defined as follows:

(1) Primary influenza vaccine types include: IIV=inactivated influenza vaccine,
RIV=recombinant influenza vaccine, and LAIV=live attenuated influenza vaccine.

(2) Numerals following letter abbreviations indicate the number of influenza virus

hemagglutinin antigens represented in the vaccine: “3” for trivalent vaccines which
include two influenza A strains and one influenza B strain; “4” for quadrivalent vaccines
which include two influenza A strains and two influenza B strains.

(3) Prefixes are used when necessary to refer to some specific vaccine types: “a” for

adjuvanted vaccine (e.g., aIIV3); “cc” for cell culture-based vaccine (e.g., ccIIV4); “HD”
for high-dose vaccine (e.g., HD-IIV3); and “SD” for standard-dose vaccine (e.g., SD-
IIV4).

f. All vaccines against seasonal influenza are covered under the National Vaccine
Injury Compensation Program (VICP) and have been added to the Vaccine Injury Table
that lists the vaccines covered under VICP. As required by Federal law under the
National Childhood Vaccine Injury Act (codified at 42 U.S.C. §§ 300aa-1 to 300aa-34),
all health care providers who administer any vaccine covered by the VICP must provide
a copy of the relevant current edition of vaccine information materials, specifically
Vaccine Information Statements (VIS) prior to administration of each dose of the
vaccine. NOTE: For VHA policy for VIS, see paragraph 5.e.(5)(a) and (b).

(1) Vaccine Information Statements (VISs) are developed by the CDC. The VIS for

IIV, which covers influenza vaccines given by injection with a needle, and the VIS for
LAIV are available in several languages. The VISs, in English, for influenza vaccines
are available from the CDC website at https://www.cdc.gov/vaccines/hcp/vis/current-
vis.html.

(2) The appropriate VIS must be provided to the parent or legal representative of any
child to whom the provider intends to administer such vaccine, and to any adult or legal
representative of any adult to whom the provider intends to administer such vaccine.

(3) The materials must be supplemented with visual presentations or oral
explanations, as appropriate. NOTE: If the Food and Drug Administration (FDA)
approves any updated licensing for any of the influenza vaccine products, any new or
interim VIS need to be used as soon as available from the CDC.

g. The immunization standard for long-term care facilities from the Department of

Health and Human Services, Centers for Medicare and Medicaid Services became
effective October 7, 2005. Participating Medicare and Medicaid long-term care facilities
are required to offer each resident immunization against influenza annually., as well as
lifetime immunization against pneumococcal disease.

August 12, 2020

VHA DIRECTIVE 1013(1)

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