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Protection Against Harmful Diseases

Vaccination remains one of the easiest, safest, and most efficient ways to protect humans from dangerous diseases. By means of the body’s innate defenses, vaccinations help create resistance to infection by preparing the immune system to respond quicker to a virulent encounter and avoid serious illness.

According to the World Health Organization (WHO), today there are vaccines for several diseases, some of which include diphtheria, influenza, measles, pertussis, tetanus, hepatitis and now, COVID. The WHO estimates that existing vaccines save the lives of approximately 3 million people yearly. Those that get vaccinated help reduce the spread of disease, in some cases preventing severe illness or even death.

In this course, we will examine the immunization duties of the pharmacist. From counseling patients on vaccination recommendations, assessing for vaccination appropriateness, administering vaccines, and monitoring patients for adverse events, pharmacists play a significant role in providing immunization services to the public. Via a discussion of regulatory requirements, we will review some of the recent authority changes and the most current vaccination recommendations.

What is Vaccination, Immunization, and Inoculation?

The words vaccination, immunization and inoculation are often erroneously used interchangeably. Each has its own unique meaning although for the most part, they refer to similar concepts.

Vaccination – describes the actual administration of an antigen, through any known route of administration, either nasally, intramuscularly, or orally, for the purpose of inducing immunity.

Immunization – refers to the specific process or act by which an individual achieves immunity or resistance to a communicable disease. This process occurs as a result of an administered vaccine.

Inoculation – is also the act or process of introducing an antigen into a living being with the objective to promote antibody production. It also refers to the implant of a toxin or harmful microorganism in a live environment, person, animal, or plant for the intent of research.

Despite of their differences, vaccination and immunization are designed to protect people from deadly diseases. They produce an acquired (adaptive) immune response. Upon attacking and neutralizing the specific antigen, memory cells are left behind to initiate an assault should the pathogen be re-encountered, reducing the possibility of symptomatic illness if infection occurs.

Role of the Pharmacist in Vaccination Administration

Pharmacists have always been strong promoters of health and illness prevention. They are the most accessible healthcare professional to the public and are highly regarded and trusted by their patients. As part of their role in disease prevention, pharmacists advocate for as well as administer vaccinations.

Now more than ever, it is imperative to make the counseling time with the patient more informative and engaging. By routinely screening patients for their vaccination needs, a pharmacist can identify those that can benefit from vaccines they have yet to receive.

In order to participate in the immunization effort, pharmacists must be properly trained in both, counseling patients to help guide them as to what vaccines they need based on CDC recommendations, evaluate for precautions/contraindications, and in how to correctly administer the vaccines. Since each state has different rules governing their pharmacists and the authority given to them for vaccination, pharmacists must be familiar with the vaccination administration rules established by their state.

Pharmacist Legal Authority to Vaccinate

For the privilege to administer vaccines, pharmacists must check with their state board to receive true legal authority. Each state has specific legislation authorizing a pharmacist to administer vaccines that depends on several different factors.

For example, some states allow pharmacists to vaccinate only on the order of a physician or doctor’s protocol, yet other states allow the pharmacist to prescribe and administer vaccinations independently. Then, there are states that allow a pharmacist to administer only certain predetermined, listed vaccines.

Authority also is dependent on the age of the individual receiving the vaccine. Some states allow a pharmacist to vaccinate children as young as 2 years of age. While other states, have authorized a pharmacist to immunize people of any age.

The pharmacy technicians, as of recently, following the need for vaccinators during the COVID pandemic, have also been given authority by some states to administer vaccinations. The table in an upcoming slide best summarizes current vaccination administration rules.

Vaccination Administration Rules by State

When looking at a pharmacist’s authority to administer vaccinations in each state, there are three principal categories to consider. First, which vaccines are pharmacists allowed to administer? Those vaccines recommended by CDC/ACIP, or all those vaccines specifically approved by the FDA, or just the precise vaccines that the state statue lists?

Second, does the pharmacist have independent authority? Is the pharmacist free to decide which vaccines are necessary and administer them or does she have to receive a prescription from a physician or follow a prearranged doctor’s protocol?

Lastly, is the patient’s age relevant? If so, is it for certain specific vaccines or any vaccine? Since certain vaccines are age specific, like the shingles, pneumococcal, and HPV, are pharmacists bound by the age recommendations?

The table in the following slide depicts the best way to summarize these three main categories as it relates to the pharmacist vaccination authorization in each state.

Types of Vaccines

Prescriber Protocol or Prescription

Age Limits

*only certain vaccines, 2*with prescription, 3*adult dose/any age

These tables are intended to demonstrate the complexity of the various, sometimes overlapping requirements between states. To review specific pharmacist and pharmacy technician vaccination administration authority, check with your state board of pharmacy.

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Training Requirements for Vaccination Administration

The PREP Act

As with all pharmacist’s responsibilities, vaccination administration also requires extensive training prior to becoming a routine undertaking. Due to the declaration of a national state of public health emergency because of COVID-19, the PREP (Public Readiness and Emergency Preparedness) Act was activated.

The PREP Act empowers the Secretary of the Department of Health and Human Services to afford, by activation of the PREP Act, protection from liability (for those without deliberate wrongdoing), from a resultant loss following administration of countermeasures for diseases. The disease must be deemed a significant high risk to public health. The PREP Act also indemnifies those institutions or persons participating in the advancement process, production, testing, and dissemination of the countermeasures.

Under the PREP Act, the Department of Health and Human Services has given new authority to pharmacists and pharmacy interns. A pharmacist can order and administer vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP). The vaccines must be those approved by the Food and Drug Administration (FDA).

The pharmacy interns, under the supervision of a pharmacist, are allowed to administer these same vaccines. The authority has been extended to vaccinate any person that is of the age of three and over. This mandate supersedes any state law or regulation currently in place for the remainder of the COVID-19 pandemic.

The PREP Act, also expanded the vaccination administration authority for other qualified vaccinators besides pharmacists, pharmacy interns and pharmacy technicians. For vaccination training, the Act concurs with the state board requirements for an ACPE (Accreditation Counsel for Pharmacy Education) vaccine administration training course. Additionally, a basic cardiopulmonary resuscitation course is also required, such as BLS which is what is traditionally recommended for pharmacists.

To clarify, the Public Readiness and Emergency Preparedness Act is designed to specifically provide protection from liability, it differs from, and does not depend on other emergency declarations.

State Board of Pharmacy

The state boards of pharmacy, as mentioned before, have similar but different directives for their vaccination authority and may have their own distinct training requirements as well. In the state of Texas, the training obligations include the completion of an ACPE 20-hour vaccine administration certification course. The course must include practical instruction on injection technique, clinical assessment of vaccine indications and contraindications, and detailed instruction on what to do in case of emergencies such as vaccine reactions.

The course must include written study material, contain hands-on training in vaccine administration, and meet Center for Disease Control and Prevention (CDC) training guidelines. More specifically, it should cover the recommended standards for pediatric, adolescent, and adult immunization practices and immunization schedules. It should provide a basic overview in immunology, the essentials on vaccine protection and vaccine preventable diseases.

Discussion on vaccine management, storage and obtaining informed consent is also required in the course. Emphasis should be given on the physiology and vaccine administration techniques. The 20-hour course is also expected to contain the ins and outs of pre- and post-vaccine assessment and required counseling. It should give guidance on the immunization record requirement and record retention.

Finally, the course must include information on the possible vaccine adverse events. It should give instruction on how to identify adverse events as well as to how to properly respond to them. Moreover, it should provide directives on how to document and report them. A minimum of 3 hours of continuing education dedicated to vaccination related material every two years is required for license renewal in Texas.

During the Public Health Emergency due to COVID-19, the PREP Act for the vaccine administration authority was amended to allow all pharmacists to vaccinate children ages 3 to 18, regardless of their state laws. The training requirements remain the same.

Centers for Disease Control and Prevention (CDC)

The CDC, because of the availability of the COVID-19 vaccine, and the great need to recruit many vaccinators to help with the massive effort of trying to vaccinate every individual that wants to receive it, have their own training requirements.

The CDC website offers the CDC Training Modules. One of their modules gives a general overview of vaccination best practices for healthcare providers. The site also offers detailed training on each specific vaccine available for use, currently the Janssen COVID-19 vaccine (Johnson and Johnson), Moderna COVID-19 vaccine, and Pfizer-BioNTech COVID-19 vaccine.

A second training is called the “You call the shots: Vaccine Administration”. This is an additional initial requirement that provides a certificate as proof of completion. It can also be used to meet continuing education obligations. It is composed of a sequence of modules which include a discussion about vaccine preventable illnesses and provides an explanation on the most recent vaccination recommendations.

Each vaccine or disease state such as polio, chickenpox and influenza are referenced separately in their own individual CDC module. These educational training sessions are frequently updated and contain the latest recommendations and best practices.

The third training requirement is “You call the shots: Vaccine Storage and Handling”. The proper handling and storage of vaccines is crucial for them to work as expected. Consequently, emphasis is given to obtaining the necessary knowledge on the managing and storing of each vaccine.

The CDC explicitly states that the modules on their website can be used as training or modules from another site such as state or local health department, worksite, medical professional organization, even from a nursing or medical school. As long as it is documented training and is available for review by regulatory inspectors.

Outside the CDC, a comparable program would include training in the following: pre- and post-clinical considerations, the management and storage of vaccines, preparations and administration requirements, recommendations on how to address vaccine induced anaphylaxis, documentation and reporting requirements for vaccines, and counseling information.

Recommended Vaccinations for Children

The best way a parent can protect their children from serious diseases is by vaccinating them against these diseases. To avoid a severe bout of these illnesses that can probably cause hospitalization or even death, early immunization is key.

The following vaccination schedule for children has been recommended by the Advisory Committee on Immunization Practices (ACIP). Then reviewed, approved, and subsequently adopted by the American Academy of Pediatrics, Centers for Disease Control and Prevention (CDC), and American Academy of Family Physicians.

Vaccination Recommendations for Children

Birth – Hepatitis B (HepB-1stdose)

Before being discharged from the hospital, newborns receive the first dose of the Hepatitis B series which is given to help prevent chronic liver swelling that may result in liver damage or liver cancer.

One to Two Months – HepB-2nddose, Diphtheria, tetanus, and whooping cough (pertussis) (DTaP), Haemophilus Influenzae type b (Hib), Polio (IPV), Pneumococcal (PCV-13), Rotavirus (RV).

These preliminary vaccines will require boosters and are provided at this early age to initiate immunity and start providing protection.

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By Vaccine for Ages Birth to 6 years old

After two months, vaccines are repeated throughout different age groups. Below is the approximate schedule recommended for each specific vaccine.

Hepatitis B – This vaccine is given to prevent liver disease and is given in a series of 3 doses, at birth, one or two months, and a third dose at six to eighteen months of age.

Rotavirus (RV) – The rotavirus is a virus that can cause vomiting, diarrhea, and dehydration. This vaccine is also offered in a series of 3 doses which are given at two, four and six months.

Diphtheria, tetanus, pertussis (DTap) – Diphtheria is a serious bacterial infection that can cause problems breathing, paralysis, heart failure and can result in death. Tetanus is a life-threatening bacterial infection that affects the nervous system and produces muscle stiffness. Pertussis refers to a very contagious bacterial disease that causes strenuous coughing fits which can make it difficult to breath and can be deadly for babies under one year old. This combination is given to children that are two, four and six months old, fifteen to eighteen months, and four to six years of age for a total of five doses.

Haemophilus influenzae type b (Hib) – Depending on where the infection is in the body, this bacterium can cause pneumonia, sepsis, or meningitis. Four doses are required through age 6 and are given at two, four, six, and between twelve and fifteen months.

Pneumococcal (PCV13) – This bacterial infection can be found in the ear, sinus, lungs or bloodstream. It can cause debilitating symptoms like excessive coughing, shortness of breath and chest pain. Children are given four doses at two, four, six months and another dose at twelve to fifteen months.

Polio (IPV) – This viral infection can affect a person’s spinal cord and cause paralysis and it can also cause a form of meningitis. Vaccination for polio is recommended at two, four and one more dose at age six months to eighteen months.

Influenza (flu) – The symptoms associated with this viral infection are fever, muscle ache, cough, extreme fatigue, and can lead to pneumonia. The recommendation is to have all children be vaccinated against this illness annually, starting after the age of six months. Two doses four weeks apart should be given to children between six months and eight years old.

Measles, Mumps and Rubella (MMR) – Measles is a highly contagious viral disease. Development of a rash of pustules occurs after 10 to 12 days following exposure. Complications can include pneumonia, encephalitis and even death. Mumps is also a viral infection. It involves swelling of the parotid (salivary) glands. Severe cases can lead to loss of hearing, meningitis, encephalitis, and inflammation of sex organs (testicles and ovaries). Rubella, also known as German measles or 3-day measles is most dangerous for the fetus, when a mother becomes infected during pregnancy. The first dose of MMR is given at between twelve and fifteen months, the second dose between four and six years of age.

Varicella – Otherwise known as chickenpox, manifests in the form of a rash with fatigue, headache, and fever. Vaccine is normally administered between twelve and fifteen months with a booster between four and six years of age.

Hepatitis A (Hep A) – This viral infection of the liver is highly transmissible and can linger for up to two months. The symptoms include abdominal pain, tiredness, nausea and yellowing of the skin. The scheduled time for vaccination is one dose between twelve and twenty-three months of age and a second 6 months after the first dose.

This table summarizes the ACIP/CDC vaccination recommendations for children < age 6.

Recommended Vaccinations for Children 7 to 18 years of Age

Influenza – As discussed in the last segment, influenza vaccine should be administered yearly to children after the age of six months. Between the ages of 6 months to eight years, children should receive two doses of influenza vaccine four weeks apart. Otherwise in the seven to eighteen age group, children should be given a yearly dose of influenza vaccine.

Tetanus, Diphtheria, and pertussis (Tdap) – For this age group, Tdap is recommended instead of the DTap with the younger group. Following the three doses of DTap through age six months (discussed earlier), another dose at age eleven years to twelve years should be administered using the Tdap version of the vaccine.

Human Papillomavirus (HPV) – This virus causes one of the most frequently sexually transmitted infections (STI). According to the CDC, there were approximately 43 million HPV infections for the age group of late teens to early twenties in 2018. HPV exists in many different strains. These viruses are responsible for causing genital warts and some cancers.

HPV vaccine should be administered between ages eleven and twelve but can be given as early as nine years old for those at increased risk due to weaken immune systems. If the vaccination series begins at age 9 to 14, then only two doses can be given with the second one following the first after six to twelve months. If the vaccination series begins after the age of 15, then the series should include three shots, the second following the first after one or two months, then the third shot at the 6-month mark after the initial dose.

Meningococcal (MenACWY) (MenB) – This bacterial disease can cause severe illness such as infections of the lining of the spinal cord and brain also known as meningitis. Complications can include sepsis and even death. The MenACWY, which covers meningococcal strains A, C, W and Y should be administered at age eleven to twelve years with a booster to be given at the age of sixteen. On the other hand, MenB is effective against the meningococcal serogroup B. The MenB vaccine becomes an option for teens between the ages of sixteen and eighteen only if they opt to receive it and their doctor approves it.

Pneumococcal (PCV13) – This bacterium can cause infections in the sinuses, ears, or lungs. Three doses are given before the age of 6 years of age. In the seven to eighteen group, this vaccine is only recommended for those children suffering from conditions that place them at higher risks for serious illness.

Hepatitis B (Hep B) – This viral infection mentioned earlier does not require a booster for this age group unless a previous dose was missed, or the child is trying to “catch up” with doses.

Hepatitis A (Hep A) – Exactly as with HepB, there is no recommended dose for this age group. The only doses to be administered of this vaccine are for the purposes of catching up.

Polio (IPV) – The three doses given before age six represent the recommended doses through age eighteen. This vaccine is only given to bring a vaccination record up to date.

Measles, Mumps and Rubella (MMR) – For this vaccine, the two doses given before age six are considered sufficient. The time period between the age of seven to eighteen is used to take missed doses.

Chickenpox (Varicella) – The series of two shots given before age six represent the doses recommended before age eighteen. Here too there are no doses give during this age period unless a dose was skipped.

This table shows the ACIP/CDC recommended vaccination schedule for children 7 – 18 years old.

* Dark Blue: Teens 16 to 18 yr. may receive MenB vaccine. According to CDC as of February 12, 2021

Recommended Vaccinations for Adults

Influenza inactivated (IIV), or Influenza recombinant (RIV4) – an annual dose is recommended for those nineteen and over. It should be administered at the start of the flu season around September or October.

or Influenza live attenuated (LAIV4) – this nasal, live, flu vaccine can be substituted for either of the two above. LAIV4 is not recommended for children under 2 years or for people over the age of 49.

Tetanus, diphtheria, pertussis (Tdap or Td) – 1 dose Td/Tdap following a wound, then 1 Td/Tdap booster once every ten years. For pregnant women, it is recommended to get 1 dose of Tdap with every pregnancy during the gestational weeks of 27 to 36.

Measles, Mumps, Rubella (MMR) – From age 19 to 64, individuals should receive either one or two doses if they were born in the year 1957 or after. Doses are dependent on indication.

Chickenpox (Varicella) – For those born after 1980 or after, the recommendation is to take 2 doses at least 4 to 8 weeks apart. Those that are past age 40 can take the 2 doses if they are healthcare workers with negative titers that have never had a previous dose. Varicella is contraindicated in those severely immunocompromised.

Zoster (Recombinant) – This preparation is for shingles (herpes zoster). Shingles is a viral infection that expresses into a blistering rash that is very painful, lasts a long time and may have neurological involvement. This vaccine is recommended for those that are 50 years of age and older. It is given in 2 doses that should be administered 2 to 6 months apart. There is a minimum of 4 weeks apart required. If second dose is administered too soon, it must be repeated.

Human Papillomavirus (HPV) – If the first dose is being administered after the age of 15, then adults need to take the 3-dose series. The second dose should follow the first after 1 or 2 months, then the third should be administered at the six-month interval. Between the ages of 27 and 45, the physician may deem it necessary to indicate use based on an individual’s health conditions or lifestyle.

Pneumococcal (PCV13) – Recommended for those adults that have a risk factor or have another indication for the vaccine. Administration is recommended for those immunocompetent people that are aged 65 and older. If they have received a dose before, once they reached the age of 65, a second dose should be administered after 5 years. The doses should be at least 5 years apart.

Pneumococcal (PPSV23) – Once again, if there is an additional risk factor or indication, an immunocompetent individual, older than 65 years of age should receive one or two doses depending on physician directive. This too should be separated by five years from any preceding dose.

Additional information regarding PPSV23 and PCV13

Again, recommended for immunocompetent individuals 65 years of age and older.
Do not administer both PPSV23 and PCV13 concomitantly.
When both PPSV23 and PCV13 are both indicated, administer PCV13 first.
A period of at least one year must follow PCV13 administration before giving PPSV23.

Hepatitis A (HepA) – This vaccine requires two or three doses depending on brand used. This is only recommended for adults over the age of 19 if there is a risk factor or other indication.

Hepatitis B (HepB) – Recommendations included for those over the age of 19 are to administer the vaccine to those with at least one risk factor or another indication for use. It is also given in either two or three doses depending on vaccine used.

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Meningococcal (MenACWY) – Only recommended for those past the age of 19 if there is an additional risk factor or indications such as medical condition, travel to countries where disease is prevalent, or first year college students. The vaccine should be administered as one or two doses depending on reason for use.

Meningococcal B (MenB) – Again only recommended past the age of 19 for those with at least one risk factor or special condition. It is administered in two or three doses depending on the vaccine or the indication for use.

Haemophilus influenzae type b (Hib) – Advised for those that have at least one risk factor or other medical reason for use. It is given in a series of one to three doses depending on the indication for use.

The vaccines should be administered as directed for those with an incomplete vaccination record or if vaccination documentation is lost. There is no need to add or restart doses to vaccine series if the intervals between doses are extended beyond recommendations.

CDC vaccination recommendations for adults after the age of 19 years of age.

*LAIV 4 not recommended for age group.

According to CDC as of February 12,2021

*1. Tdap after every pregnancy, 1 dose after a wound.

*2. If initial dose before age 15, 2 doses, otherwise 3 doses.

*3. On shared clinical decision making only.

Recommended Vaccinations for Adults with Specific Health Conditions

Pregnancy – During pregnancy, the only vaccines that are recommended are the Influenza IIV & RIV4 (inactivated) yearly, and the Tdap, 1 dose with each pregnancy after the 26th week of gestation. If there is a risk factor or other reason to use, may vaccinate with PPSV23, HepA, HepB, and MenACWY. MenB should only be given if benefit of administration outweighs the risks. Avoid: Live attenuated influenza (LAIV4), MMR, Varicella, and HPV.

Immunocompromised (except HIV) – These individuals may be vaccinated with inactivated Influenza IIV & RIV4 but not the live attenuated LAIV4. They should receive a dose of Td or Tdap followed by a booster after 10 years. The HPV can be administered in a series of 3 doses before the age of twenty-six.

Following the separation parameters for the Pneumococcal, immunocompromised people who meet the age requirement, can receive one dose of PCV13, and one, two or three doses of PPSV23. The HepA, HepB, MenACWY and MenB may be administered only if the individual has a specific risk factor or indication for it. The Hib should only be administered to those immunocompromised that have received a Hematopoietic stem cell transplant.

Avoid: LAIV4, MMR and Varicella.

HIV Infection CD4 count <2003 – There are different recommendations for those with CD4 count less than 2003 compared to those with a count greater than 2003. For this group, they are able to receive one yearly dose of IIV or RIV4, the one dose of Tdap followed by a Td or Tdap booster 10 years later, the 3 doses of HPV prior to age 26, one dose of PCV13 and up to 3 does of PPSV23 if age appropriate and there is an indication for it, HepA, HepB and MenACWY depending on age requirements or lack of records to show vaccination. The MenB may be given only if there is a risk factor or other specific reason. Avoid: MMR and Varicella

HIV Infection CD4 count >2003 – This group is eligible for the same vaccines listed for the under <2003 designation plus a couple of additional vaccinations. They may take one or two doses of the MMR depending on indication and the Varicella if the physician deems it necessary.

Asplenia (complement deficiencies) – This disease causes patients to be immunocompromised. The vaccinations that are recommended include the annual dose of IIV or RIV4, the Tdap dose followed by the Td or Tdap booster ten years later, one or two doses of MMR if indicated, two doses of the Varicella vaccine, 2 doses of the shingles vaccine after the age of 50, one dose of PCV13, one to three doses of PPSV23 if age appropriate and indication requirements met, one or two doses of MenACWY if indicated, two to three doses of MenB depending on which brand use and reasons for receiving it, and one dose of the Hib.

Avoid: LAIV4

End-Stage Renal Disease/Hemodialysis patients – For this population, it is best to administer the inactive IIV or RIV4 flu vaccines. They qualify for the one dose of the Tdap, followed by a booster ten years later, one or two doses of MMR depending on reason to be given, two doses of the Varicella, two doses of the shingles after age 50, two or three doses of HPV before age 26 subject to the original date the series was started or condition patient is in, one dose of the PCV13, one to three doses of PPSV23 following proper age and purpose for receiving it. The HepB is two, three or four doses based on the vaccine used or condition. The Hep A, MenACWY, MenB and Hib are only given if the patient has a risk factor or specific indication for it.

Avoid: Precaution with LAIV4, give only if benefits outweigh risks.

Heart/Lung Disease and Alcoholism – For this specific group, an annual IIV or RIV4, a dose of the Tdap with a second dose after ten years, one or two doses of the MMR depending on the indication, two doses of the Varicella, the RZV or shingles should be given in two doses after the age of 50. The HPV, as usual, should be given in two or three doses depending on what age the series was started/or condition, to be given before age 26. One dose of PCV13 is recommended. The PPSV23 can be given in one to three doses depending on age/indication. The HepA, HepB, MenACWY, MenB and Hib should only be given if there is a specific risk factor or indication.

Chronic Liver Disease – The recommendation is to give the IIV or RIV4 annually. The Tdap original dose should be followed by a booster ten years later. One or two doses of the MMR may be given if indicated. The two doses of Varicella are also recommended. The two doses of RZV or shingles should be given after the age of 50. PPSV23 is advised in one to three doses according to age or indication. The HepA to be given in two to three doses and the HepB in two to four doses accordingly. The PCV13, MenACWY, MenB, and Hib should only be given for a risk factor or other specific reason.

Avoid: Can give LAIV4 with precaution only if benefits outweigh the risks.

Diabetes – The inactivated IIV and RIV4 influenza vaccines are preferred, to be given annually. The Tdap spaced by 10 years with its booster, one or two doses of the MMR if indicated, and two doses of the Varicella are acceptable. The two doses of RZV should be given after age 50. The HPV may be given in two or three doses as per suggested schedule up to age 26. PPSV23 is advised in a 1 to 3 dose series based on age and indication. The HepB is recommended in two to four doses only up to the age of 60 years old. After the age of 60, it is only advisable if doctor indicates it for some reason. The PCV13, MenACWY, MenB and Hib are only used for these patients if there is a risk factor or other indication.

Avoid: LAIV4 only to be used if benefits outweigh risks.

Healthcare Personnel – This group is advised to receive either the IIV or RIV4 or the LAIV4 annually. The Tdap, MMR, Varicella, RZV, HPV, and HepB in the usual recommended doses. They are advised to get the PCV13, PPSV23, HepA, MenACWY, MenB, and Hib only if they have a risk factor or other indication.

Men that have sex with men is the last category under specific health conditions according to the CDC. They recommend the same vaccinations for them as the healthcare personnel accept this group should also receive the HepA.

The table on the next slide summarizes the vaccination recommendations for each of the special health groups.

*LAIV 4 not recommended. **Precaution with LAIV

According to the CDC as of February 12, 2021

*1. Tdap after every pregnancy, 1 dose after a wound.

*2. If initial dose before age 15, 2 doses, otherwise 3.

*3. On shared clinical decision making only.

*4. Precaution, benefit may outweigh the risk.

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*LAIV 4 not recommended. **Precaution with LAIV4

According to CDC as of February 12, 2021

*3. On shared clinical decision making only.

There are other vaccines available that are not for routine immunization. Vaccines for Typhoid, Yellow Fever, and Japanese Encephalitis among others are considered travel vaccines and are recommended based on travel to certain regions of the globe. Additional information about these is found on the CDC website.

Considerations Prior to Immunization

Timing and Spacing – Vaccination scheduling requires significant attention. Proper spacing of vaccinations increases the probability of acquiring the desired immunization. Some vaccinations can be given at the same time, while others require specific spacing time. There is also the demand versus supply issue. Sometimes patients may receive their first dose, but the second dose is not available at the designated interval as needed.

Special Precautions and Contraindications – Both precautions and contraindications refer to conditions that may increase the risk of a vaccine recipient experiencing a severe adverse reaction. Examples of contraindications include a patient that is pregnant who should not receive live attenuated vaccines because of the risk to the fetus. Severely immunocompromised patients also should never be given a live vaccine. Precautions have a lower probability to cause injury than contraindications and include those conditions in which the benefit outweighs the risk of harm. As when a patient is suffering from an acute illness, it is still advisable to vaccinate them against influenza, even though the adverse events may overlap symptoms of the illness. Deciding to vaccinate under precautions require special monitoring.

Prevention/Management of Adverse Events – The most serious adverse event to prepare for is anaphylaxis. Having an Epinephrine shot available to administer in case of an emergency is a requirement to all vaccinators. Equally as important, how to calm down a patient that is agitated about an adverse event is vital, because how this incident is handled can decide whether the patient will continue to trust the vaccination process in the future. Furthermore, promptly managing adverse events and reporting them can be crucial in maintaining the respective authorities informed on every aspect of the vaccine related incident.

Irrespective of the fast-paced environment of a busy pharmacy, it is still essential to take the time and consider exactly which vaccinations are being administered and what were the vaccines that have been administered to the patient in the past 30 days, if any. Then a review of the patient’s profile for precautions and/or contraindications should be completed, regardless of whether a vaccine has already been prepared by the technician and it is ready to be administered. Just before administration, a final check of the location of the epinephrine is warranted. You will want to make sure it is there if you need to reach for it.

Vaccination Counseling Strategies

When it comes to vaccinations, there are pre-vaccination counseling talking points and post vaccination counseling. Both are crucial to properly inform the patient on what vaccinations they are getting and what to expect.

Pre-vaccination counseling – There are several opportunities to speak to a patient about getting vaccinated. Therefore, it is advisable to have a list of recommended vaccines accessible at your pharmacy ready to distribute to patients. When a patient drops off a prescription, they can be shown the list and asked what vaccines they are due. The pharmacist should be available to discuss vaccines and answer any questions a patient may have. A pharmacist should bring up the following points to their patient:

Vaccinations save lives, they are safe and effective in preventing disease. Everyone should be current on all applicable vaccinations.
A vaccination record to help decide what vaccinations still need to be given would be helpful, but not necessary.
Discuss specific vaccination information such as name, what it is for, and scheduling considerations.
A call to consult their doctor, if the patient desires, can be made by the pharmacy without the patient having to wait until their next office visit with their physician.

Post vaccination counseling – At the time of pick up, when counseling on the drug that is being dispensed, you can mention the importance of maintaining an updated vaccination regimen. Refer to the printed list of vaccines available for patient distribution. If the patient decides to receive the vaccine, the following should be referenced in their post-vaccination counseling:

Repeat the name of the vaccine and what disease it helps prevent.
Mention any boosters needed and the expected timeline.
Discuss the possible side effects for the injection site and otherwise.
Caution about the possibility of adverse events and the need to report them.

It always helps to reassure the patient that you are there for them if they experience any issues. Ask them to call you if they have any questions when they get home or if they require your assistance. For the most part, everything usually goes as expected but there are times when things can go awry. How to properly address any challenges post vaccinations will be discussed in an upcoming slide.

Vaccination Administration Practices

Consistency and organization are always paramount in ensuring any task will be conducted as smoothly as possible, especially when having the goal of minimizing issues and ending with a favorable outcome. To maintain structure, there are three separate steps to consider in the vaccination process, the preparation step, the actual vaccine administration component, and the post-administration element.

Preparation Step – This step includes the initial consultation with the patient to inquire that the vaccine is desired by the patient and that all preliminary qualifications are met.

Verify that the patient is within the age parameters for the vaccine if applicable.
Ask the patient if they have previously received the vaccination in question to determine appropriateness and suggest other vaccinations that could be considered.
Inquire if they have received any vaccinations in the past 30 days to determine if proceeding is suitable.
Ask if they plan to get another vaccine in the upcoming weeks to clear up any conflicts with the current vaccination request, if any exist.
Review the consent form and confirm that it was completed in its entirety, it was signed, and dated.
Perform the Drug Utilization Review (DUR) and review the patient’s profile to note any precautions or contraindications.

Vaccination Administration Step – This step includes the gathering of the supplies, preparing the syringe, and going to the vaccine administration designated area.

To save time, all supplies should be kept at or around the vaccine preparation area.
A small basket, lined with a clean paper towel, should be used to carry the adhesive bandage strip, an alcohol wipe, and a cotton ball.
Remember to check the expiration date on the vaccine vial prior to withdrawing into syringe.
Once the vaccination syringe is prepared and needle capped, it should be placed in the basket along with the other items.
The basket and the patient’s receipt should be carried over and placed on a table near the patient.
The sharps container should be placed next to the basket to make all necessary items readily accessible.
Before administering the vaccination, verify that the patient on the chair, ready to receive the vaccine, is the one on the receipt. Do not say their name, ask them their name, to avoid confusion. Confirm which vaccine they are about to receive.
Following vaccine administration, immediately place the used syringe in the sharps container.

Post-Administration Step – This final step involves monitoring the patient, counseling the patient, answering any questions, and scheduling any booster doses.

Review with the patient the name of the vaccine, what it is for, possible administration side effects and warn of potential adverse events. Remind them to report any adverse events.
Provide the patient a Vaccine Information Sheet (VIS) as required.
Answer all of the patients’ questions and provide additional information if requested.
Monitor the patient in the pharmacy waiting area at least 15 to 30 minutes for any adverse reaction. Epinephrine should be readily accessible in case its use is required.
Schedule for the patient any upcoming future booster doses if needed.

This step includes wiping down with disinfectant the table used during the vaccination. The sharps container should be placed back in its original location, out of the reach of children. The basket used to carry supplies to the vaccination area should also be washed and/or disinfected. The consent form needs to be properly stored for regulatory inspection.

Check your Knowledge Question and Scenario 5

Check your Knowledge Question and Scenario 5 – Answers

Vaccination Administration Technique

The administration of vaccines starts with proper aseptic technique. The hands of the vaccinator should be washed with water and soap or with an antiseptic, waterless hand sanitizer. Hands need to be cleansed before preparing vaccines and in between vaccinations of different patients. The use of gloves is not required unless vaccinator has open wounds or needs protection to avoid touching any patient bodily fluids. If gloves are worn, they must be replaced with each subsequent patient.

Vaccine preparation should be performed in an uncluttered area with low risk of contamination. The vaccine should be withdrawn into the syringe using proper sanitization method by first removing the vial cap then wiping down the rubber stopper with an alcohol wipe. It is best to allow the alcohol to dry before penetrating the rubber stopper with the needle. The needle should be capped during syringe transportation. Once prepared, the immediate use of the syringe is recommended. All syringes either filled by a pharmacist or prefilled by the manufacturer that have been withdrawn or reconstituted but are not used by the end of the day, must be discarded. There is specific guidance regarding shelf-life span of each vaccine after reconstitution. Some vaccines, like the Varicella, must be tossed out 30 minutes after reconstitution. The MMR, on the other hand, can be refrigerated in a dark place between 2o and 8o C for a maximum of 8 hours before being tossed out.

Selecting the proper size needle for the patient is important. This will facilitate the delivery of the vaccine to the desired region. Whether a vaccine needs to be administered intramuscularly or subcutaneously is also a factor that needs to be considered. The best needle for intramuscular administration would be a 22 or 25 gauge and it can be on a 1 or 3 ml syringe. The table below reflects the needle size recommendations for adult individuals based on body weight.

All vaccinators should be well versed in how to avoid exposure to blood borne pathogens. Should they occur, needlestick injuries must be documented and reported. To avoid needlestick incidents, it is best to recap used needles and discard them immediately after use.

The table below shows the needle sizes and the injection sites recommended for intramuscular injections in children, depending on age. Notice the gauge size is the same for all age groups.

If multiple injections are administered in the same extremity, the needle punctures should be reasonably separated, at least by one inch. For subcutaneous injection in both children and adults, the 5/8” needle is best, also with a 23 to 25 gauge to be given in the outer upper arm or the fatty area of the thigh.

Vaccine Administration Route – Adhering to the manufacturer recommended route of administration is crucial to maintain vaccine efficacy and reduce the risk for injection site adverse events. Injectable vaccines are either administered intramuscularly or subcutaneously.

Intramuscular injection route – The preferred sites for this route of administration is the deltoid muscle of the upper arm and the anterolateral portion of the thigh. Proper administration involves avoiding injury to the local, vascular, and neural tissue. A long needle is considered ideal and is expected to deliver the vaccine deep enough into to the muscle, preventing seepage into the surrounding area. Intramuscular injections are administered by inserting the needle and positioning the syringe perpendicular to the arm, at a 90o degree angle. The location should be at least 2 inches down from the bony prominence of the shoulder. A curved thumb and forefinger should mark the needle targeted area with a C. After waiting for the alcohol to dry from wiping the area, the needle should be inserted in the middle of the C.

Subcutaneous injection route – This type of administration requires pinching up the subcutaneous tissue to avoid piercing into the muscle. The needle should be injected at a 45o angle to the arm. The preferred administration site for the subcutaneous route is the back of the upper arm.

Vaccine Route and Dose

Below are the advised dose and route of administration for the ACIP/CDC recommended vaccines.

Vaccine	Route	Dose
DTaP, DT, Td, Tdap	IM	0.5 ml
DTaP-HepB-IPV	IM	0.5 ml
DTaP/Hib	IM	0.5 ml
DTaP-IPV/Hib	IM	0.5 ml
DTap-IPV	IM	0.5 ml
Hib	IM	0.5 ml
Hib-MenCY	IM	0.5 ml
HepA	IM	< 18 yrs. – 0.5 ml > 19 yrs. – 1.0 ml
HepB	IM	< 19 yrs. – 0.5 ml > 20 yrs. – 1.0 ml
HepA-HepB	IM	> 18 yrs. – 1.0 ml
LAIV	Intranasal Spray	0.1 ml in each nostril (total dose of 0.2 ml)
IIV	IM	6 to 35 mos. – 0.25ml or 0.5ml > 3 yrs. – 0.5 ml

For some brand products, the dose may vary slightly, such as in High-Dose Fluzone prefilled syringes hold a volume of 0.7 ml and that is the recommended dose for that product. In case of a reconstituted product, only the 0.5 ml should be withdrawn from the vial regardless of any remaining liquid in the vial.

Management of a Post-vaccination Minor and Major Complications

There are some side effects that can be expected following a vaccination. For instance, a slight fever, fatigue, swelling and redness or itching at the injection site can occur. These are usually mild and transient symptoms that are expected to clear up on their own. The suggestions below will help manage these and more pressing incidents both at the pharmacy/clinic where the vaccination was administered or at the patient’s home.

Pre-vaccination jitters – If the patient is alarmingly nervous about getting the vaccine once they see the needle, advised them to sit or lie horizontal and take in a few deep breaths to calm down.

Dizziness or light headedness – If the patient displays signs of imminent fainting, seem weak and complain of nausea, ask them to lay down. Loosen any restrictive clothing, and apply a cool, wet cloth on their face and neck until they start feeling better.

Falls but conscious – check for physical injuries, do not move if physical injuries, make sure they lay flat with feet elevated. Call 911 if appropriate.

Falls and is unconscious – check for physical injuries, they should lay flat with feet elevated. Call 911 if not immediately recovered.

Pre-vaccination jitters – If the patient is alarmingly nervous about getting the vaccine once they see the needle, advised them to sit or lie horizontal and take in a few deep breaths to calm down.

Falls but conscious – check for physical injuries, do not move if physical injuries, make sure they lay flat with feet elevated. Call 911 if appropriate.

Falls and is unconscious – check for physical injuries, they should lay flat with feet elevated. Call 911 if not immediately recovered.

Symptoms at injection site – If patient complains of redness, itchiness, soreness or swelling at the injection site, they can apply a cold compress to injection site, take an analgesic or an antihistamine and use an antipruritic for the itching.

Bleeding – Slight bleeding can be managed by applying pressure on the injection site with a cotton ball and placing a bandage strip over it. If there is continuous bleeding, placing a gauze on the injection site and applying pressure along with raising the injection site, usually the arm, above the patient’s heart is recommended.

Occasionally, but rarely, there is an unforeseen severe reaction immediately or soon after the administration of a vaccine. Generally, these serious effects manifest themselves in the form of anaphylaxis. This is a clear indicator that the individual may be having an allergic reaction to an ingredient found in the vaccine and constitutes a medical emergency. Listed on the next slide are the recommended steps to follow in case of a medical emergency following vaccine administration.

Anaphylactic indicators can take 15 to 30 minutes to appear or may take even longer than that. The symptoms to look for would be generalized and would involve more than one body system. There could be widespread hives, itching, swelling of the lips, throat, face, or eyes. The individual could feel their throat closing, shortness of breath, wheezing. There could be gastrointestinal symptoms such as nausea, vomiting and diarrhea with cramping or abdominal pain. A fast heart rate with dizziness and hypotension can also occur. The steps below are suggested to be used in anaphylactic type emergencies.

First, evaluate the patients breathing, airway and mental activity.
Call 911 by activating the emergency response system and ask for emergency medical services.
If there is no airway obstruction and patient is not vomiting, place them flat on the floor, facing up.
Administer Epinephrine immediately – an adult dose of 0.3 mg is to be injected with an autoinjector into the outer thigh and can be given even through clothes.
The dose may be repeated every 5 to 15 minutes if there is no symptom improvement while waiting for EMS. The number of doses and the time they were given should be documented and conveyed to EMS.
Patient should be transported to the hospital for further treatment and at least a 4-hour observation period.

Basic Life Support – CPR Education

It is crucial to have all the necessary materials and equipment accessible in the vaccination area for managing a medical emergency such as a post-vaccination anaphylaxis episode. An epinephrine autoinjector dual pack, antihistamines like diphenhydramine or cetirizine, and a blood pressure cuff with a pulse reader should all be included in the supply list.

Another important part of the rescue process involves having basic life support skills. It is a state board requirement that all vaccinators have a current Basic Life Support (BLS) certification which should be renewed every two years.

The American Heart Association has designed the Basic Life Support (BLS) course for healthcare professionals to train in cardiopulmonary resuscitation, chest compressions and rapid defibrillation. The program includes instruction on good quality CPR for infants, children, and adults, proper and efficient breath ventilations using a barrier device, early use of an Automated External Defibrillator (AED), multiple rescuer simulation and airway obstruction removal for infants/adults that are chocking. These valuable skills can make the difference between life and death in an anaphylaxis situation.

Vaccination Documentation and Record Retention

The state board of pharmacy has specific directives regarding consent forms that an individual completes and signs prior to receiving a vaccination or immunization from a pharmacist. The records are expected to be filed by patient last name and are to be easily accessible for inspection by an agency of authority. The form must contain the following information:

Copy of vaccination protocol and note deviations if applicable.
Complete name and address of the patient including contact information like a phone number.
Age of the patient if under 14 years of age (most include regardless).
Contact information of patient’s doctor such as name, address, and phone number.
Name, lot number, manufacturer of the vaccine (also should include expiration date).
Amount in ml or cc of vaccine that was administered.
Location of the vaccine site such as right arm, left arm, etc.
Route of administration used for the vaccine such as IM, SQ, PO, etc.
All contact information of the vaccinator, like name, facility address, and title.

The record retention requirement states vaccination records must be available for at least two years for inspection, but some institutions opt to keep them indefinitely.

Organizing a Community Vaccination Event

A public vaccination event is an opportunity for a pharmacist to bring vaccines and vaccination supplies to a community center, church, or other accessible venue in order to facilitate immunization for the community. Although it may seem like an astronomical undertaking, with the cooperation of community and area public health leaders along with proper organization, there is a great probability of success.

First, based on the site to be served, you must decide how many vaccination stations you will have. In order to improve efficiency, each station should be autonomous. It should have an authorized healthcare professional administering the vaccines, healthcare staff assisting in preparing vaccine syringes, and support staff to help with the administrative component such as accepting, checking, and filing consent forms. It is essential to confirm the licenses and authority of all the vaccinators to remain compliant with all legal existing statues.

Before proceeding with any plans, research should be completed regarding any legal issues, insurance billing requirements, and technological support needed. Keeping close contact with the venue management is necessary to ensure clear and timely communication. Likewise enlisting and managing volunteers is also important to make sure the event will be fully staffed. Moreover, coordinating with any media contacts will help promote the event and secure a higher attendance.

Great care must be taken to safeguard the vaccines and ensure they will be transported, stored, and maintained properly. A checklist with quantities of all the necessary supplies will prevent leaving vital items behind and help keep track of the materials used.

Consider ways of notifying attendees of the event if they need a subsequent dose of a vaccine taken. They can either be sent messages through text or email. They can also be given a reminder card at the event to help them plan ahead.

Make sure to include an Emergency Medical Activation Plan. In case of a medical emergency all personnel should have clear instructions of their role in managing the incident. As required, all vaccinators are expected to have a current Basic Life Support (BLS) certification.

At the event, support staff should ensure all legal requirements are being met. Individuals should be fully completing the consent forms, signing them, and receiving their Vaccine Information Sheets (VIS). The vaccinator information portion should also be completed as directed. All forms should be kept safe and in accordance with HIPAA requirements.

Upon the conclusion of the event, ensure all sharps containers are accounted for and disposed of as required. All documents with patient information should be transported back to the pharmacy or facility and filed accordingly. The unused vaccines should be maintained properly stored at the recommended temperatures.

Any and all billing should be completed and finalized. Each vaccination given should be reported to the local immunization information system, if required. If there were any adverse events, they should also be reported but to the

Vaccine Adverse Event Reporting System (VAERS).

By providing vaccination events for their community, a pharmacist can help increase vaccination rates and save lives.

Tackling Vaccination Hesitancy

Due to high accessibility to the community, pharmacists can increase vaccination rates by educating, promoting, and administering vaccines. There are several factors that contribute to vaccine hesitancy and a pharmacist is an excellent healthcare source to help demystify the immunization process for the public.

Often patients hesitate due to unfounded concerns, misunderstandings, and misinformation. Below are three main reasons people decide against vaccination.

Distrust – in the government promoting the vaccine, in the vaccine’s efficacy, and in the publicized safety data.

Misconception – believing their risk for getting the vaccine preventable disease is relatively low.

Inconvenience – time, location for vaccination, or a language barrier preclude them from getting vaccinated.

The fear of adverse effects is also one of the major causes for people to refuse a vaccination. According to the Immunization Action Coalition, low vaccination rates among adults could likewise be due to individuals not hearing a recommendation for a vaccine from a healthcare professional and not being aware that they are deficient in their age-appropriate recommended vaccinations.

Check your Knowledge Question and Scenario 6

Check your knowledge Question and Scenario 6 – Answers

How to overcome vaccination hesitancy

A pharmacist can clear up misconceptions and misinformation about vaccines. They can explain efficacy and safety data to their patients to help dispel any apprehensions. Furthermore, by asking open-ended questions, they can discover exactly what barriers need to be addressed. The following suggestions can help to engage and educate the patient.

Approach the patient with an open mind and prepared to listen to their concerns.
Recommend age-appropriate vaccinations.
Inform the patients how the vaccines work and how the immune system responds to avoid illness.
Provide current efficacy and safety information on vaccines of interest.
Relate the potential consequences of not getting a vaccine for a preventable disease, in a risk vs benefit model.
Review the possible side effects and how they are managed.
Offer to obtain a vaccine consultation from their primary care physician to diminish any doubts.

In order to increase vaccination rates and reduce the incidence of preventable diseases, pharmacist must seize the opportunity to connect with their patients and advocate for immunization. Every healthcare professional should be consistently engaged in the massive effort to tackle vaccination hesitancy and help each person reach all vaccination goals.

CDC Federal Retail Pharmacy Program for COVID-19 Vaccination

The disease of Covid-19 is caused by a virus known as SARS-CoV-2 which is the culprit microorganism responsible for the current global pandemic. Symptoms may appear after 2 to 14 days following exposure. The emerging symptoms may range from mild such as fatigue, fever or chills, headache, cough, to more severe, like shortness of breath or difficulty breathing.

The CDC, in partnership with 21 chain and independent national pharmacy partners along with the cooperation of states and territories, have formed the Federal Retail Pharmacy Program for COVID-19 Vaccination. This is a vigorous effort by these entities to promote and provide greater accessibility to the COVID-19 vaccine. From their launch date in February, this program has grown to include 40,000 vaccination sites. This will help to more rapidly increase the number of vaccinated people which will eventually result in the end of the pandemic.

The program started by allocating vaccine supply per jurisdiction, distributed between the number of stores for select pharmacy partners. Since the program’s expansion, and the increase of available vaccine product, the pharmacy partners are able to redistribute product to improve supply demands and equity needs. All program partners are committed to maintain high accessibility to vaccination for every area in the United States especially the hardest-hit communities.

Food and Drug Administration (FDA) COVID-19 Vaccine Updates

As of May 2021, the COVID-19 Vaccines authorized for emergency use in the United States continue to be the Pfizer-BioNTech, the Moderna and the Janssen (Johnson and Johnson). The FDA has concluded a review of the Pfizer-BioNTech application for emergency use in adolescents between 12 through 15 years of age. This approval request has been granted.

Another recent development coming from the FDA is the announcement of approval for an extended thawing out period for the Pfizer-BioNTech vaccine. Formerly, a thawed, undiluted vial of the vaccine could only stay in the refrigerator between 2oC to 8o C (36o F to 46o F) for five days. The new authorization allows for up to one month of refrigerated storage at the specified temperatures.

The FDA continues to be a valuable source for vaccine and vaccination information. They have extensive educational information about the approval process of vaccines, from a vaccine’s development process to its post-approval vaccine safety surveillance programs. The FDA consistently manage vaccines and is committed to bringing the public safe and effective immunization.

Active Learning

A strong advocate, vaccine educator and promoter, the Immunization Action Coalition (IAC) is dedicated to preventing disease with the use of immunization. As a fervent partner of the CDC, it is committed to educating patients, parents, healthcare workers and government agencies on the safety and efficacy of vaccinations.

The IAC website contains a wealth of information and resources on vaccines and vaccination processes.

There are over 250 educational materials for healthcare professionals and information handouts for patients in many languages. In collaboration with the CDC, the IAC provides valuable data about vaccine preventable diseases and their vaccines.

Visit the IAC website at the link below for an in-depth discussion with a vaccine expert, review detailed state law mandates by vaccine, brush up on ACIP recommendations, or print/download a free adult vaccinating guide. The IAC website is an excellent resource for any vaccinating pharmacist.

https://www.immunize.org/

Conclusion

Vaccination remains the best and simplest way to reduce vaccine preventable diseases in the United States and throughout the globe. The data demonstrates that vaccines are safe and effective and can reduce the incidence of severe illness. It is the responsibility of every healthcare professional to support and encourage vaccination.

The best way for a healthcare professionals to remain current on vaccinations and vaccination practices is through continuous practical training and education. All vaccinators should be familiar with the ACIP/CDC vaccine recommendations to be able to convey accurate information to their patients. Additionally, vaccinators must be BLS-CPR certified in order to manage a medical emergency timely and accordingly.

A pharmacist continues to maintain a significant role in the public vaccination initiative. By recommending vaccines and dispelling misconceptions and myths, they can help to reduce vaccine hesitancy. Often by listening attentively and easing a patient’s concerns by providing information on the safety and efficacy of vaccines, a pharmacist can help increase vaccine rates and reduce the frequency of preventable diseases.

References

Hennessy, M., Stay on Top of Vaccine Recommendations to Counsel Patients. Pharmacy Times. August 2019. Volume 85, Issue 8.
U.S. Department of Health and Human Services. Requirements for joining the Expanded Covid-19 Vaccination Workforce. April 13, 2021. https://www.phe.gov/emergency/events/COVID19/
COVIDvaccinators/Pages/Training.aspx. Accessed May 20, 2021
Duda, K, RN. What is the Difference Between Immunization and Vaccination? Verywell Health. May 4, 2021. https://www.verywellhealth.com/the-difference-between-immunization-and-vaccination-4140251. Accessed May 20, 2021.
Centers for Disease Control and Prevention. Training and Education – Healthcare Professionals that have Administered Vaccine in the last 12 Months. March 4, 2021. https://www.cdc.gov/vaccines/covid-19/training-education/index.html#recent-hcp. Accessed May 21, 2021.
Centers for Disease Control and Prevention. 2021 Recommended Vaccinations for Infants and Children (birth through 6 years). February 12, 2021. https://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html. Accessed May 21, 2021.
Texas State Board of Pharmacy. Texas State Board of Pharmacy Board Rules. March 12, 2021. §295.15 Administration of Immunizations or Vaccinations by a Pharmacist under Written Protocol of Physician. https://www.pharmacy.texas.gov/files_pdf/TSBP%20Rules_MASTER%20FILE.pdf. Accessed May 2, 2021.
Centers for Disease Control and Prevention. 2021 Recommended Vaccinations for Adults for Ages 19 Years or Older. February 12, 2021. https://www.cdc.gov/vaccines/schedules/downloads/adult/
adult-combined-schedule.pdf. Accessed May 24, 2021.
Centers for Disease Control and Prevention. General Best Practice Guidelines for Immunization: Vaccination Administration. May 4, 2021. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html. Accessed May 26, 2021.
APhA. Planning and Conducting a Large-Scale Immunization Event. August 2018. https://aphanet.pharmacist.com/sites/default/files/832113R0_APhAEventGuide3.pdf. Accessed May 29, 2021.
Terrie, YC. The Role of the Pharmacist in Overcoming Vaccine Hesitancy. US Pharmacist. April 16, 2021. 45(4)28-31. https://www.uspharmacist.com/article/the-role-of-the-pharmacist-in-overcoming-vaccine-hesitancy. Accessed May 29, 2021.Food and Drug Administration. FDA Vaccine News and Updates. May 25, 2021. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines. Accessed May 30, 2021.