Immunization Update
Maria G. Tanzi, PharmD
Fewer vaccinations have been given during the COVID-19 crisis, leaving many pediatric and adult patients at risk for vaccine-preventable diseases. As more and more states lift shelter-in-place orders, resuming immunization efforts with appropriate precautions will be essential. And with the influenza season coming up, pharmacists should expect an increased push and demand for the influenza vaccine. As the public seeks ways to protect themselves and loved ones during the pandemic through immunization, what should pharmacists keep in mind?
Providing adult vaccinations
As the pandemic progressed, CDC released guidance stating that adult vaccination visits should be postponed in areas with community transmission of COVID-19, except in select cases. These exceptions included in-person visits scheduled for some other reason during which patients can receive vaccination without increasing their risk of COVID-19 exposure and when a patient and their clinician believe that the potential benefit of vaccination outweighed the risk of exposure to the virus.
In late May, CDC revised its guidance to pharmacies to begin offering immunizations and other direct patient care services based on the degree of COVID-19 community transmission and potential for patient harm if care is deferred. At the time this article was written, the agency had yet to release its revised guidance to all immunization providers regarding administration of adult vaccines.
In the interim, CDC removed the original guidance that included the word “postpone” from its website, giving further insight for providers to begin to reinstate or broaden the offering of vaccinations. The updated guidance will provide information on screening of patients, wearing of masks for providers and patients, and other considerations.
Pharmacies should also consider prioritizing older adults or adults with underlying conditions for vaccination due to their increased risk of disease and complications if vaccination is deferred.
PPE, precautions essential
As some pharmacists may not yet be comfortable administering vaccinations because of close proximity to the patient during these encounters, CDC has provided some guidance to help protect the pharmacy staff.
The agency recommends that pharmacies develop a strategy for screening patients for fever and symptoms of COVID-19 prior to providing vaccinations. This can be done via temperature screens for the patient and a detailed questionnaire to help determine if patients may be sick.
In addition, if staff are sick (e.g., fever, symptoms of COVID-19), they should be instructed to stay home and away from the workplace until they have recovered.
The use of personal protective equipment (PPE) is another essential component to protect patients and pharmacy staff from COVID-19. CDC recommends that health care providers use a face mask at all times while in the facility. All patients entering the pharmacy should also wear a face covering to help minimize the spread of COVID-19. Medical or surgical face masks are preferred over cloth face coverings for health care professionals.
The agency recommends eye protection in areas with moderate to substantial community transmission. Pharmacists should align with recommendations from their public health departments and approaches used within medical or clinical practices in their communities.
Of course, hand hygiene is essential, with handwashing performed before and after vaccine administration. If worn, gloves should be changed and hand hygiene performed between patients.
Improving immunization rates
When providing immunization services, pharmacists should use the process of Accessing, Recommending, Administering/Referral, and Documentation.
Identify patients who need recommended vaccinations, including pediatric patients who need catch-up vaccines. Educate them on the importance of getting their immunizations, including a discussion of benefit vs. risk, and make a strong recommendation for the specific vaccines.
Administer the vaccine with the appropriate precautions and PPE requirements outlined above. Refer the patient to another provider if you are unable to do so, or if administering the vaccine is not included in your scope of practice or authority. If referring a patient to a medical office or clinic, let the provider know the referral is coming from you.
Remind patients, parents, and/or caregivers that as social distancing requirements are relaxed, children and adults who are not protected by vaccines will be more vulnerable to diseases such as measles, influenza, etc.
Staying up to date on currently available vaccinations can help pharmacists prepare for a COVID-19 vaccine when it becomes available.