NVAC: New standard, schedule updates for adult immunizations

Immunization Update

Now that the revised Standards for Adult Immunization Practice from the National Vaccine Advisory Committee (NVAC) are in place for all vaccine providers, what does this mean for pharmacists?

The update includes pharmacists as a main immunizer and will help fuel the important role they have in improving adult immunization rates, especially in light of the Recommended Adult Immunization Schedule for 2015. 

“The NVAC Adult Immunization Standards position pharmacists as an important member of the immunization neighborhood by assessing, discussing, referring, administering, and documenting vaccinations and related services they provide to their adult patients,” said Mitchel C. Rothholz, BSPharm, MBA, APhA’s Chief Strategy Officer. “The standards place the same expectations on all health care professionals serving adult patients and position the needs of the patient as the central focus.”

CDC said the updated NVAC standards call on all health professionals to take steps to help ensure that their adult patients are fully immunized—even if they can’t provide the vaccinations themselves. Practice standards that CDC recommends for health professionals include assessing immunization status of all patients at every clinical encounter, strongly recommending vaccines that patients need, administering needed vaccines or referring patients to a provider who can administer those vaccines, and documenting vaccines received by patients. (See sidebar below for more information.)

CDC-recommended practice
standards for health care

Assess immunization status of patients at every clinical encounter.

  1. Stay informed with the latest recommendations.
  2. Implement protocols and policies.

Strongly recommend vaccines that patients need.

  1. Describe the benefits of vaccines and the costs of getting sick.
  2. Address patient questions and concerns.

Administer needed vaccines or refer patients to a vaccination provider.

  1. Offer the vaccines you stock.
  2. Refer patients to providers in the area that offer vaccines you don’t stock or can’t administer.

Document vaccines patients have received.

  1. Participate in your state’s immunization registry, if available.
  2. Follow up to make sure patients received recommended vaccines.

While pharmacists are certainly capable of administering all types of vaccines for both adults and children, laws vary in each U.S. state and territory on what types of vaccines pharmacists can administer and to whom. Reporting capabilities are also limited for pharmacists. Only about one-half of all jurisdictions require pharmacists to report to a state’s immunization registry, and Immunization Information Systems don’t yet give pharmacists bidirectional capability, where they can see and contribute to the patient’s immunization record. 

2015 adult immunization schedule

Each year, CDC’s Advisory Committee on Immunization Practices (ACIP) reviews the recommended adult immunization schedule to make sure it reflects current recommendations for licensed vaccines. The Recommended Adult Immunization Schedule for 2015, which ACIP recommended, includes changes from the previous year’s schedule. The 2015 schedule, published February 3 in the Annals of Internal Medicine, makes a recommendation for routine administration of the 13-valent pneumococcal conjugate vaccine (PCV13) in series with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for all adults aged 65 years or older, a revision on contraindications and precautions for the live attenuated influenza vaccine, and FDA’s decision to expand the approved age for use of recombinant influenza vaccine (RIV) for all adults aged 18 years and older.

Boosting adult immunization rates

NVAC revised the standards for Adult Immunization Practices in 2013 for several reasons. First, adult immunization rates in the United States are low. According to a recent report from CDC, adult coverage in 2013 did not improve from the previous year. There were, however, slight improvements in Tdap rates for adults aged 19 years and older, herpes zoster vaccination among adults aged 60 or older, and HPV vaccination rates among males aged 19 to 26 years. CDC said improvement is essential to help reduce health consequences of vaccine-preventable diseases and that all health professionals should routinely assess their adult patients’ vaccination needs and either offer the needed vaccinations or refer the patient to a provider who can administer the vaccines. 

Adult immunization practice standards were also revised because most adults are not aware they need vaccines, according to CDC. The agency said a recommendation from a health professional can be the strongest factor in getting patients vaccinated and more health professionals should be routinely assessing patients’ vaccination status. 

CDC has developed guidance and tools for health professionals to use in implementing activities around the new standards.

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