Immunization - Vaccine Updates
(Last updated February 12, 2020)
Shared Clinical Decision Making Includes Pharmacists, Says CDC
On February 10, CDC released guidance as online FAQs that specifically address who is considered a health care provider with regard to its Advisory Committee on Immunization Practices’ (ACIP) shared clinical decision-making recommendations. “In this context, CDC defines a health care provider as anyone who provides or administers vaccines: primary care physicians, specialists, physician assistants, nurse practitioners, registered nurses, and pharmacists,” the agency wrote. This guidance is intended to aid states in implementing the recommendations. Read the FAQs.
CDC publishes "Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices—United States, 2019" in January 24 MMWR
CDC published Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices—United States, 2019 in the January 24 issue of MMWR (pages 77–83). The Introduction from the ACIP policy update is reprinted below.
Since 2005, a single dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine has been recommended by the Advisory Committee on Immunization Practices (ACIP) for adolescents and adults. After receipt of Tdap, booster doses of tetanus and diphtheria toxoids (Td) vaccine are recommended every 10 years or when indicated for wound management. During the October 2019 meeting of ACIP, the organization updated its recommendations to allow use of either Td or Tdap where previously only Td was recommended. These situations include decennial Td booster doses, tetanus prophylaxis when indicated for wound management in persons who had previously received Tdap, and for multiple doses in the catch-up immunization schedule for persons aged ≥7 years with incomplete or unknown vaccination history. Allowing either Tdap or Td to be used in situations where Td only was previously recommended increases provider point-of-care flexibility. This report updates ACIP recommendations and guidance regarding the use of Tdap vaccines.
CDC publishes updated ACIP recommendations for the use of PCV13 and PPSV23 pneumococcal vaccines for adults age 65 and older
CDC published Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices in the November 22 issue of MMWR (pages 1069–1075). Two important sections are reprinted below.
New Pneumococcal Vaccine Recommendations for Adults Aged ≥ 65 Years Old (page 1073)
PCV13. PCV13 vaccination is no longer routinely recommended for all adults aged ≥65 years. Instead, shared clinical decision-making for PCV13 use is recommended for persons aged ≥ 65 years who do not have an immunocompromising condition, CSF leak, or cochlear implant and who have not previously received PCV13.
CDC guidance for shared clinical decision-making. When patients and vaccine providers engage in shared clinical decision-making for PCV13 use to determine whether PCV13 is right for the specific individual aged ≥ 65 years, considerations may include the individual patient’s risk for exposure to PCV13 serotypes and the risk for pneumococcal disease for that person as a result of underlying medical conditions.
If a decision to administer PCV13 is made, it should be administered before PPSV23 (5). The recommended intervals between pneumococcal vaccines remain unchanged for adults without an immunocompromising condition, CSF leak, or cochlear implant (≥1 year between pneumococcal vaccines, regardless of the order in which they were received). PCV13 and PPSV23 should not be coadministered.
ACIP continues to recommend PCV13 in series with PPSV23 for adults aged ≥19 years (including those aged ≥ 65 years) with immunocompromising conditions, CSF leaks, or cochlear implants.
PPSV23 for adults aged ≥ 65 years. ACIP continues to recommend that all adults aged ≥ 65 years receive 1 dose of PPSV23. A single dose of PPSV23 is recommended for routine use among all adults aged ≥ 65 years. PPSV23 contains 12 serotypes in common with PCV13 and an additional 11 serotypes for which there are no indirect effects from PCV13 use in children. The additional 11 serotypes account for 32%–37% of IPD among adults aged ≥ 65 years. Adults aged ≥ 65 years who received ≥1 dose of PPSV23 before age 65 years should receive 1 additional dose of PPSV23 at age ≥ 65 years, at least 5 years after the previous PPSV23 dose.
Considerations for shared clinical decision-making regarding use of 13-valent pneumococcal conjugate vaccine (PCV13) in adults aged ≥ 65 years (page 1074)
- PCV13 is a safe and effective vaccine for older adults. The risk for PCV13-type disease among adults aged ≥ 65 years is much lower than it was before the pediatric program was implemented, as a result of indirect PCV13 effects (by preventing carriage and, thereby, transmission of PCV13-type strains). The remaining risk is a function of each individual patient’s risk for exposure to PCV13 serotypes and the influence of underlying medical conditions on the patient’s risk for developing pneumococcal disease if exposure occurs.
- The following adults aged ≥ 65 years are potentially at increased risk for exposure to PCV13 serotypes and might attain higher than average benefit from PCV13 vaccination, and providers/practices caring for many patients in these groups may consider regularly offering PCV13 to their patients aged ≥ 65 years who have not previously received PCV13:
- Persons residing in nursing homes or other long-term care facilities
- Persons residing in settings with low pediatric PCV13 uptake
- Persons traveling to settings with no pediatric PCV13 program
- Incidence of PCV13-type invasive pneumococcal disease and pneumonia increases with increasing age and is higher among persons with chronic heart, lung, or liver disease, diabetes, or alcoholism, and those who smoke cigarettes or who have more than one chronic medical condition. Although indirect effects from pediatric PCV13 use were documented for these groups of adults and were comparable to those observed among healthy adults, the residual PCV13- type disease burden remains higher in these groups. Providers/practices caring for patients with these medical conditions may consider offering PCV13 to such patients who are aged ≥65 years and who have not previously received PCV13.
Access the complete MMWR article:
CDC releases ACIP recommendations on the use of influenza vaccines for the 2019–20 influenza season
CDC has released Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2019–20 Influenza Season in the August 23 MMWR Recommendations and Reports. The Summary section is reprinted below.
This report updates the 2018–19 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2018;67[No. RR-3]). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. A licensed, recommended, and age-appropriate vaccine should be used. Inactivated influenza vaccines (IIVs), recombinant influenza vaccine (RIV), and live attenuated influenza vaccine (LAIV) are expected to be available for the 2019–20 season. Standard-dose, unadjuvanted, inactivated influenza vaccines will be available in quadrivalent formulations (IIV4s). High-dose (HD-IIV3) and adjuvanted (aIIV3) inactivated influenza vaccines will be available in trivalent formulations. Recombinant (RIV4) and live attenuated influenza vaccine (LAIV4) will be available in quadrivalent formulations.
Updates to the recommendations described in this report reflect discussions during public meetings of ACIP held on October 25, 2018; February 27, 2019; and June 27, 2019. Primary updates in this report include the following two items. First, 2019–20 U.S. trivalent influenza vaccines will contain hemagglutinin (HA) derived from an A/Brisbane/02/2018 (H1N1)pdm09–like virus, an A/Kansas/14/2017 (H3N2)–like virus, and a B/Colorado/06/2017–like virus (Victoria lineage). Quadrivalent influenza vaccines will contain HA derived from these three viruses, and a B/Phuket/3073/2013–like virus (Yamagata lineage). Second, recent labeling changes for two IIV4s, Afluria Quadrivalent and Fluzone Quadrivalent, are discussed. The age indication for Afluria Quadrivalent has been expanded from ≥5 years to ≥6 months. The dose volume for Afluria Quadrivalent is 0.25 mL for children aged 6 through 35 months and 0.5 mL for all persons aged ≥36 months (≥3 years). The dose volume for Fluzone Quadrivalent for children aged 6 through 35 months, which was previously 0.25 mL, is now either 0.25 mL or 0.5 mL. The dose volume for Fluzone Quadrivalent is 0.5 mL for all persons aged ≥36 months (≥3 years).
This report focuses on the recommendations for use of vaccines for the prevention and control of influenza during the 2019–20 season in the United States. A brief summary of these recommendations and a Background Document containing additional information are available at https://www.cdc.gov/
CDC publishes “Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices”
CDC published Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices (pages 698–702) in the August 16 issue of MMWR (pages 698–702). A summary made available to the press is reprinted below.
CDC recommends vaccination against human papillomavirus (HPV) at age 11 to 12 years, and now also recommends catch-up vaccination through age 26 years for all genders. Although CDC does not recommend catch-up vaccination for all adults ages 27 through 45 years, some people in this age range who are at risk for new HPV infection might benefit from vaccination. HPV vaccine prevents new HPV infections that can cause cancers and other health problems. Because vaccination provides the most benefit when given before exposure to any HPV, it is recommended for all 11- to 12-year-olds. Catch-up recommendations apply to people not vaccinated as preteens. This report updates CDC recommendations for adults in the United States. It harmonizes the catch-up age through age 26 years for all genders and adds guidance about HPV vaccination for adults ages 27 through 45 years who are at risk for new HPV infection and might benefit from vaccination. Although 9-valent HPV vaccine is licensed for use through age 45 years, CDC does not recommend it for all such adults, and clinicians need not discuss HPV vaccination with all adults over the age of 26 years because most people in this age range are unlikely to benefit from vaccination.
IAC develops "Don’t Be Guilty of These Preventable Errors in Vaccine Administration," a new resource for healthcare professionals
IAC has developed Don’t Be Guilty of These Preventable Errors in Vaccine Administration, a 4-page print resource describing common but preventable errors made in vaccine administration. This resource also provides information about what to do when errors are made and links to resources that will help prevent errors in the future.
This new resource is a companion piece to IAC's Don't Be Guilty of these Preventable Errors in Vaccine Storage and Handling!
IAC revises "Screening Checklist for Contraindications to Vaccines for Children and Teens" and "Screening Checklist for Contraindications to Vaccines for Adults"
IAC recently revised the following two screening checklists:
- Screening Checklist for Contraindications to Vaccines for Children and Teens
- Screening Checklist for Contraindications to Vaccines for Adults
The changes to the screening checklist for contraindications to vaccines for children and teens were: 1) to incorporate a history of thrombocytopenia or thrombocytopenia purpura as an additional precaution to MMR/MMRV vaccines and 2) to modify the T-lymphocyte criteria for HIV-infected children and receipt of varicella vaccine from counts to percentage at the 6th birthday (The checklist previously read "at the 8th birthday.")
A change to the screening checklist for contraindications to vaccines for adults was made to incorporate a history of thrombocytopenia or thrombocytopenia purpura as an additional precaution to administering MMR/MMRV vaccines.
IAC's screening checklists for vaccines have been updated
Immunization Action Coalition (IAC) recently updated the following checklists for vaccine contraindications.
- Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination
- Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination
- Screening Checklist for Contraindications to Vaccines for Adults
- Screening Checklist for Contraindications to Vaccines for Children and Teens
Seasonal Influenza Vaccination Resources for Health Professionals
The most current information for health care professionals regarding influenza vaccine recommendations (including persons with egg allergy), vaccine supply, and recommendations for using antiviral agents for influenza can be found on the CDC website at www.cdc.gov/flu/professionals/vaccination/index/htm.
CDC Releases Updated Vaccine Storage and Handling Toolkit
ICDC's Vaccine Storage and Handling Toolkit web page for healthcare professionals now contains a link to the newly updated Vaccine Storage and Handling Toolkit PDF guide for 2019. The Vaccine Storage and Handling Toolkit reflects best practices for vaccine storage and handling from Advisory Committee on Immunization Practices (ACIP) recommendations, product information from vaccine manufacturers, and scientific studies.
The Toolkit is designed to help health care providers find the information they need quickly and easily. The beginning chapters address the three main elements of an effective cold chain: a well-trained staff, reliable storage and temperature monitoring equipment, and accurate vaccine inventory management. The remaining chapters focus on emergency management of vaccine and developing plans and standard operating procedures for routine and emergency storage and handling.
Note: For more detailed information on storage and handling recommendations and guidance for individual vaccines, please refer to manufacturers’ package inserts found on the Immunization Action Coalition (IAC) website.
- More vaccine storage and handling resources from CDC
- CDC's training video: Keys to Storing and Handling Your Vaccine Supply
Draft Immunization Protocols
OPA annually drafts immunization protocols in compliance with the Ohio State Board of Pharmacy’s rules. Updated protocols for 2019 are now available. Use the following link to purchase the protocol package: Immunization Protocol Package form
HealthMap Vaccine Finder
HealthMap Vaccine Finder (http://flushot.healthmap.org) is a free, online service where users can search for locations offering flu vaccines, as well as other adult vaccines. This service partners with clinics, pharmacies, and health departments to provide accurate and up-to-date information about receiving the flu vaccine.
In 2012, Google passed the baton to HealthMap when it retired Google Flu Vaccine Finder. If you previously provided data to Google Flu Vaccine Finder and would like to still be included in the list of vaccine providers, you will need to register and upload your location data to HealthMap.
- Vaccine Information Statements (VISs)
The latest VISs can be obtained from the Centers for Disease Control and Prevention at https://www.cdc.gov/vaccines/hcp/vis/index.html
VISs are not updated annually or on any other routine schedule. An updated VIS with a new date is posted when there is a change in recommendations.
- The Quick Reference Information: Medicare Immunization Billing chart is now available in hardcopy or as a download from the Medicare Learning Network. This chart gives Medicare fee-for-service physicians, providers, suppliers, and other health care professionals quick information to assist with filing claims for influenza, Pneumococcal Polysaccharide (PPV), and Hepatitis B (HBV) vaccines and their administration. To download, view and print the chart, click on the following link:
- Recommended Immunization Schedules for Persons Aged 0 Through 18 Years—United States
- Recommended Adult Immunization Schedule—United States
- Links to the Ohio Revised Code and the Ohio Administrative Code for the sections that cover immunizations by pharmacists:
Adult immunizations (ORC 4729.41)
Definitions (OAC 4729-5-01)
Pharmacy intern professional functions (OAC 4729-5-08)
Record keeping (OAC 4729-5-27)
Course requirements in the administration of immunizations (OAC 4729-5-36)
Protocols for the administration of immunizations (OAC 4729-5-37)
Immunization administration (OAC 4729-5-38)