EDUCATION
APhA Pharmacy-Based
IMMUNIZATION DELIVERY
A National Certificate Training Program
Module 1. Pharmacists, Vaccines, and Public Health
EDUCATION
16623
© 2017, American Pharmacists Association. All rights reserved.
EDUCATION
A Brief History of Vaccines
Learning Objectives
At the completion of this activity, participants will be able to:
1. Describe the effects of immunizations on morbidity
and mortality rates of vaccine-preventable diseases in
the United States.
2. Discuss Healthy People 2020 targets for vaccination
rates in the United States.
Most histories of vaccination trace their roots to Edward Jenner,
who developed a vaccine that could protect against smallpox
in the late 1700s (although there is evidence that vaccination
was performed in other cultures centuries earlier). Jenner tested
his theory that smallpox disease could be prevented by inoculating people with a related virus. He prevented smallpox by
inoculating a child with liquid from a cowpox pustule from a
milkmaid and published his work in 1798.3,4
Jenner’s work paved the way for additional research into
vaccines, with the first licensed vaccines in the United States
approved in 1914; before that time, other vaccinations had
been used without regulatory oversight. These vaccines were
followed by development of vaccines for a wide range of
diseases (Table 1.1).3,4 Following the introduction of singleagent vaccines, many combination vaccines have been
developed, such as the DTP vaccine, which protects against
diphtheria, tetanus, and pertussis. Newer versions of vaccines
also have been developed and in many cases have replaced
the originally introduced versions.3,4 For a more complete
history of vaccines, visit www.immunize.org/timeline and
www.historyofvaccines.org/content/timelines/all.
3. Explain the expansion of the role of pharmacists as
vaccine providers and describe the status of pharmacists’ authorization to administer vaccines throughout
the United States.
4. Describe strategies for pharmacists to advocate for
pharmacy-based delivery of vaccines.
5. Discuss the role of pharmacists as immunizers in
emergency preparedness activities.
6. Identify resources that are useful for immunization
providers and educators.
Impact of Vaccines
In the early to mid 1900s, people lived in fear of being
stricken with polio, diphtheria, smallpox, tetanus, and other
devastating diseases. With the licensure of the combined
Vaccines and Public Health
Immunization programs in the United States during
the past century have nearly eliminated many of the
vaccine-preventable diseases that were once common.2
In fact, routine vaccinations have prevented so much
disease and averted so many deaths that many people
may not even be aware of the devastation that can
be caused by vaccine-preventable diseases. Despite the
current successes, it is only through ongoing immunization
efforts that these diseases will remain under control.
Module 1. Pharmacists, Vaccines, and Public Health
Death Rate per 100,000 Population per Year
Immunizations are considered one of the greatest public health
achievements in history.1 There have been significant
reductions in the rates of infectious diseases in the
Figure 1.1. U.S. Death Rate From Infectious Diseases 1900–1996
United States since the year 1900 (Figure 1.1).2 Many
1,000 40 States
public health achievements have contributed to this
Influenza Pandemic
Have Health
success, including improved sanitation and the advent
Departments
of antibiotics. The use of vaccines to prevent diseases
800
has been a key contributor to reducing rates of deaths
caused by infectious diseases as well. Note the spike
in the death rate that was associated with the 1918
600
Last Human-to-Human
influenza pandemic, which resulted in 20 million
Transmission of Plague
deaths, including 500,000 in the United States.2
First Use
of Penicillin
400
200
First Continuous
Municipal Use
of Chlorine in
Water in the
United States
0
1900
1920
Salk Vaccine
Introduced
Passage of Vaccination
Assistance Act
1940
Year
1960
1980
2000
Source: Reference 2.
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diphtheria and tetanus toxoids and pertussis vaccine in 1949,
state and local health departments instituted vaccination
programs that helped increase the distribution of vaccines.
In 1955, the introduction of the Salk poliovirus vaccine led
to federal funding of state and local childhood vaccination
programs. In 1962, a federally coordinated vaccination
program was established through the passage of the
Vaccination Assistance Act—landmark legislation that has
Table 1.1. Examples of Vaccines and Year Introduced
a
Year
Disease
1798
Smallpoxa
1914
Rabies, tetanus, typhoid
1915
Pertussis
1923
Diphtheria
1935
Yellow fever
1945
Influenza
1955
Polio
1963
Measles
1967
Mumps
1971
MMR (including measles, mumps, and rubella)
1974
Meningococcal
1977
Pneumococcal
1981
Hepatitis B
1985
Haemophilus influenzae type b
1995
Hepatitis A, varicella
1998
Rotavirus
2006
Herpes zoster, human papillomavirus
been renewed continuously and now supports the purchase
and administration of a full range of childhood vaccines.3,4
Table 1.2 highlights accomplishments of vaccination efforts
in the United States, comparing the recent number of
cases with the historical peak number of cases for selected
diseases.5-7 In addition to decreasing the number of cases
of these diseases, the number of hospitalizations and deaths
associated with them also have shown significant decreases.
Despite these successes, work remains to be done. As shown
in Table 1.2, there has been a recent resurgence of pertussis
and there continue to be outbreaks of measles and mumps in
this country.
To date, smallpox is the only disease that has been eradicated
from the planet, allowing vaccination to be discontinued.
Smallpox was a devastating disease—approximately 30% of
those who contracted smallpox died and those who survived
were often scarred or blinded. After the development of
the process of vaccination to prevent smallpox disease, the
smallpox vaccine gradually reduced the viral menace around
the world. Even so, 10 million people contracted smallpox
worldwide in 1966, which resulted in 2 million deaths. A
concerted global vaccination effort wiped out the virus
completely, and the World Health Organization declared
the global eradication of smallpox in 1980. In addition to
avoiding the human toll of this disease, health care expenditures of $1 billion each year have been avoided because
there is no longer any need to routinely vaccinate people
against smallpox.8
Vaccines are incredibly cost-effective preventive health
services. In addition to saving lives, vaccines prevent illness
and reduce costs. It has been estimated that among children
Not licensed in the United States until later.
Source: References 3 and 4.
Table 1.2. Rates of Selected Vaccine-Preventable Diseases in the 21st Century—United States
Disease
Max. Cases
Year
Cases 2012
Cases 2013
Cases 2014
Cases 2015
Cases 2016
Diphtheria
206,939
1921
1
0
1
0
0
Haemophilus influenza type b
~20,000
1980’s
30
18
27
16
22
Measles
894,134
1941
55
184
628
188
72
Mumps
152,209
1968
229
438
1,151
422
5311
Pertussis
265,209
1934
48,277
24,231
28,660
13,004
1,634
Rubella
Congenital rubella syndrome
2.5 Million
~30,000
1964–
1965
9
3
9
0
8
1
4
1
2
0
Tetanus
601
1948
37
19
21
17
2
Varicella
221,983
1984
13,447
9,987
9,058
5,373
815
Source: References 5–7.
Module 1. Pharmacists, Vaccines, and Public Health
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EDUCATION
born between 1994 and 2003, routine childhood vaccination
has prevented:
•
•
•
•
•
322 million cases of disease.
1.4 million hospitalizations.
56,300 deaths.
$4.2 billion of direct health care costs.
$1.5 trillion of societal costs.
Despite the successes of vaccination efforts across the United
States, risks remain. More than 40,000 adults in the United
States die each year from vaccine-preventable diseases, such
as influenza or pneumococcal diseases, or complications from
the diseases, such as pneumonia.9 Increasing vaccination rates
could help reduce the toll from these illnesses.
Importantly, many diseases that are rare in the United States
remain endemic in other parts of the world. International
travelers may contract diseases overseas and infect unvaccinated or under-vaccinated individuals upon their return to
the United States, resulting in an outbreak.10 For example,
worldwide, there are estimated to be 20 million cases of
measles and 164,000 measles-related deaths each year;
several recent measles outbreaks in the United States have
been traced to international travelers.
In 2011, there were 222 measles cases in the United States
that arose from 16 different outbreaks of 3 to 21 cases per
outbreak. Of these cases, 39% occurred in individuals older
than 20 years of age and 14% were in those younger than
1 year of age, who were too young to be vaccinated. It is
important to note that in 84% of these cases, the individuals
were unvaccinated or their status was unknown. The same
year, there were 28,000 cases of measles in Europe.
Additionally, there were a total of 5,311 mumps cases
reported in 2016 in the United States.7
The number of pertussis cases in the United States is increasing
with the highest incidence in infants. In 2012, there were
more than 48,000 cases of pertussis reported, resulting in the
deaths of 14 infants, who were too young to be vaccinated.
These recent outbreaks of measles, mumps, and pertussis
demonstrate that vulnerability to these diseases still exists,
highlighting the need for continued vaccination efforts.
Current Vaccination Rates
Due to several national programs and concerted efforts to
fully immunize children, immunization rates for young children
are high in the United States. In 2014, rates were 90% or
greater for children aged 19 to 35 months for many of the
routinely recommended childhood vaccinations, although
room for improvement remains (Table 1.3).11
While childhood immunization rates are reasonably
high, vaccination rates for adolescents vary. For some
vaccines, such as hepatitis B, vaccination coverage is
above 90%. For others, such as human papillomavirus
(HPV), vaccination rates remain disappointing (Table 1.4).12
Rates are also suboptimal in adults, leaving many patients
vulnerable to vaccine-preventable diseases (Table 1.5).13
Notably, vaccination rates are lower for minorities than
they are for whites.
Table 1.3. Vaccination Rates in U.S. Children 19–35 Months of
Age—2014
Vaccine
Rate
Diphtheria, tetanus, pertussis (4+ doses DTP, DT, or DTaP)
84%
Polio (3+ doses)
93%
Measles, mumps, and rubella (1+ doses)
92%
Haemophilus influenzae type b (primary series +booster dose)
82%
Hepatitis B (3+ doses)
92%
Varicella (1+ doses)
91%
Pneumococcal conjugate vaccine (4+ doses)
83%
Combined 7-vaccine series
72%
Source: Reference 11.
Table 1.4. Vaccination Rates in U.S. Adolescents 13–17 Years of
Age—2011 and 2014
Vaccine
2011
2014
Tdap ≥1 dose after age 10 years
78%
88%
Meningococcal (MenACWY) ≥1 dose
71%
79%
Human papillomavirus coverage
Females ≥3 doses
Males ≥3 doses
35%
1%
40%
22%
Measles, mumps, and rubella ≥2 doses
91%
91%
Hepatitis B ≥3 doses
92%
91%
Varicella ≥2 doses among adolescents with no
history of disease
80%
85%
Tdap = tetanus and diphtheria toxoids and acellular pertussis.
Source: Reference 12.
Module 1. Pharmacists, Vaccines, and Public Health
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EDUCATION
Table 1.5. Vaccination Rates in U.S. Adults—2014
Vaccine (Target Group)
Vaccination
Rate
Influenza (aged ≥19 years)
43%
Influenza (aged 50–64 years)
48%
Influenza (aged ≥65 years)
62%
Influenza (HCP)
65%
Pneumococcal (aged ≥65 years)
61%
Pneumococcal (aged 19–64 years, high risk)
20%
Tetanus in past 10 years (aged ≥19 years)
62%
Tdap in past 9 years (aged ≥19 years)
20%
Tdap (HCP) 2005–2011
42%
Hepatitis B (≥3 doses, 19–49 years)
32%
Hepatitis B (HCP)
61%
Human papillomavirus (≥1 dose, aged 19–26
years)
Females
Males
Herpes zoster (aged ≥60 years)
Target vaccination rates have been established by Healthy
People 2020, a national public health initiative that provides
science-based, 10-year national objectives for improving
the health of all Americans. Healthy People 2020 provides
measurable objectives and goals intended to promote
high-quality, longer lives free of preventable disease,
disability, injury, and premature death. Table 1.6 shows the
Healthy People 2020 goals for selected adult vaccination
parameters along with baseline data from 2008.9
Pharmacists as Immunizers
Pharmacists can advance public health through immunizations
in several ways: educating and advocating, facilitating vaccinations by other health care professionals in their pharmacies,
and administering vaccines to their patients. Pharmacists
are logical providers of immunization services due to their
accessibility and role as medication experts and experience
providing high-quality patient care services.
40%
8%
A Brief History of Pharmacists as Vaccine Providers
28%
In the late 1800s and early 1900s, pharmacists supplied
physicians with smallpox and other vaccines as well as diphtheria
and other antitoxins. In later decades, the profession adopted
several roles involving immunizations: storage, preparation,
distribution, and education.14 This early involvement of
HCP = health care personnel; Tdap = tetanus and diphtheria toxoids and acellular
pertussis.
Source: Reference 13.
Table 1.6. Healthy People 2020 Baseline Data and Vaccination Goals for Adults
Objective
Baseline Data
Targets for 2020
Increase the percentage of adults vaccinated annually against seasonal influenza
Noninstitutionalized adults aged 18–64 years
25% in 2008
80%
Noninstitutionalized high-risk adults aged 18–64 years
39% in 2008
90%
Noninstitutionalized high-risk adults aged ≥65 years
67% in 2008
90%
Institutionalized adults aged ≥18 years in long-term or nursing homes
62% in 2006
90%
Health care personnel
45% in 2008
90%
Increase the percentage of adults vaccinated against pneumococcal disease
Noninstitutionalized adults aged ≥65 years
60% in 2008
90%
Noninstitutionalized high-risk adults aged 18–64 years
17% in 2008
60%
Institutionalized adults
66% of persons in long-term care facilities and
nursing homes certified by the Centers for Medicare
and Medicaid Services reported having up-to-date
pneumococcal vaccinations in 2006
90%
7% of adults aged ≥60 years reported having ever
received zoster (shingles) vaccine in 2008
30%
Increase the percentage of adults vaccinated against zoster
Source: Reference 9.
Module 1. Pharmacists, Vaccines, and Public Health
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EDUCATION
pharmacists with immunology was short-lived and few pharmacists
administered immunizations during much of the 1900s.
The end of the 20th century saw a slow return of pharmacists
to vaccine advocacy and delivery (Figure 1.2).14-24 While there
were pockets of activity at the state level, a major meeting
in 1994 stimulated a rethinking of the role of pharmacists.
The meeting was initiated when the U.S. Secretary of Health
and Human Services (HHS), Donna Shalala, contacted the
American Pharmacists Association (APhA) to examine ways
that pharmacists could help the country increase immunization
rates. This led to the development of a model national immunization program for teaching pharmacists to immunize. Within
a year, more than 1,000 pharmacists across the country had
been taught to immunize through the APhA program.
In 1996, at APhA’s Annual Meeting and Exposition, the
Association called on pharmacists to get involved with
immunizations. At the time, there were many more restrictions on pharmacists’ ability to immunize than there are today.
APhA emphasized that all pharmacists, regardless of setting, can
be involved in immunization advocacy and host others in the
pharmacy. This remains true today. Many pharmacists are actively
involved in administering a wide range of vaccines. In situations
where pharmacists cannot administer vaccines themselves,
they can educate patients and caregivers about the benefits of
vaccines, and work to facilitate immunizations for patients.
In August 1997, the APhA Board of Trustees adopted guidelines for pharmacy-based immunization advocacy and administration (Figure 1.3).25 APhA’s certificate training program,
Pharmacy-Based Immunization Delivery, is a national certificate
program for pharmacists that has been designed around these
guidelines. As of 2017, more than 300,000 pharmacists have
been trained through the program.
Successes of Pharmacy-Based Immunization Delivery
Pharmacists in many health care delivery settings are
well-positioned to provide vaccination programs and
services.15,26-28 The unique and essential contributions of
pharmacists to immunization advocacy and delivery include:
• Pharmacists are repeatedly cited among America’s most
trusted professionals.
• Pharmacists are considered one of America’s most
accessible health care professionals.
• Pharmacists have received extensive education and training
about medications. Vaccines are medications and pharmacists
are responsible for the effective use of all medications.
Module 1. Pharmacists, Vaccines, and Public Health
• Pharmacists are experienced in product storage,
handling, and safeguarding inventory.
• Pharmacists can identify specific people who need
vaccines based on knowledge of the patient medication
history or patient-specific disease-related risk factors.
• Pharmacists can offer a useful bridge between patients
and physicians by identifying an individual patient’s
needs and facilitating referrals to health care providers
when appropriate.
• Pharmacists can offer extended hours of access in the
evening, on the weekends, and during holidays, if
immunizations are offered at those times.
• Pharmacists are often located in local neighborhoods,
providing convenient access for most patients.
• Pharmacists are adept at electronic communications and
can offer computerized records, facilitating the delivery
of documentation.
• Most pharmacies are capable of billing Medicare and
other third-party payers for the vaccine product as well
as administration of the vaccine.
Because of these benefits, pharmacists can help to improve
immunization rates. Research conducted when pharmacists
began to offer influenza vaccinations found that overall
vaccination rates improved.29
Today, pharmacists are widely accepted as providers of
vaccines. Patients are satisfied with pharmacists’ services
and believe that pharmacists are appropriate providers of
vaccines.30-32 In addition, the physician community now
generally welcomes pharmacists as immunizers. In 2002,
the American College of Physicians–American Society of
Internal Medicine position paper on the pharmacist’s scope
of practice stated that their group “supports the use of the
pharmacist as immunization information source, host of
immunization sites, and immunizer, as appropriate and
allowed by state law.”33 However, continued advocacy is
needed with organized medicine and other stakeholders to
support expanded immunization roles for pharmacists.
Pharmacists’ accessibility and promotion of vaccines have
had a substantial effect on public health. Community
pharmacies in the United States offer convenience, accessibility, and extended hours of operation for the delivery
of clinical services. The equivalent of the population of the
United States enters a pharmacy each week. Pharmacies
are geographically located in places where care is needed,
including inner cities and rural communities. Additionally,
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EDUCATION
Figure 1.2. Historical Perspective of Pharmacy-Based Immunization Delivery
Pharmacists oversee depots for diphtheria antitoxin.
Pharmacists serve as vaccine advocates and facilitate
vaccine delivery by hosting other health care providers to
administer the vaccines in pharmacies.
Mid to late
1800s
Late 1800s to
early 1900s
1984
Mid 1980s
to mid 1990s
Multiple breakthrough events occur:
• More than 70 pharmacists are trained in injection
technique through the GPhA Pharmacy and
Immunization Program; 3 weeks later, these pharmacists
help administer hundreds of doses of tetanus-diphtheria
toxoids (Td) during a flood emergency.
• The Washington State Pharmacists Association and
the University of Washington develop a formal training
program that leads to a certificate of competence for
pharmacist immunizers.
Georgia Pharmacy Association (GPhA) members help
distribute meningococcal vaccine to 22,000 residents of
Douglas County, Georgia, during a disease outbreak.
1995
APhA and the West Virginia University School
of Pharmacy partner on a 5-year grant from the
Centers for Disease Control and Prevention (CDC)
to develop the Pharmacy Immunization Project—a
demonstration project that involved nurses from public
health departments immunizing children and adults in
community pharmacies.
• The American Pharmacists Association (APhA) is
approached by the U.S. Secretary of Health and Human
Services to examine ways that pharmacists can help the
country increase immunization rates, prompting APhA
to adopt immunization within its strategic activities.
1996
One of the most significant recognitions of the role of the
pharmacist in immunizations is the inclusion of APhA as
a liaison member of the CDC Advisory Committee on
Immunization Practices (ACIP). Stephan L. Foster, PharmD,
FAPhA, is named as the first pharmacist to represent APhA
on ACIP and he continues to serve on the committee.
2001
American College of Physicians–American Society of
Internal Medicine publish a joint position paper supporting
pharmacists as immunization information sources, hosts of
immunization sites, and immunizers.
More than 300,000 pharmacists and student pharmacists
have been trained through APhA’s Pharmacy-Based
Immunization Delivery, a national certificate program for
pharmacists.
By year-end
1997
2002
2009­­­­–10
By 2017
Pharmacy-based immunizations on a large scale first
occur through the Colorado Influenza Alert Campaign,
with pharmacies hosting nurses to administer influenza
vaccine injections.
1993
1994
APhA partners with the Mississippi Board of Pharmacy, the
Mississippi Pharmacists Association, and the University of
Mississippi to develop a model immunization program for
teaching pharmacists to immunize.
Pharmacists supply physicians with smallpox vaccine.
More than 5 million doses of influenza vaccine are
administered in America’s pharmacies each year. An
estimated 15,000 pharmacies participate in vaccine
advocacy and facilitation. More than 1,000 pharmacists
across the country have been taught to immunize through
the APhA program that was developed in 1996.
Through a collaborative effort of multiple organizations,
the Association of State and Territorial Health Officials
releases a document titled “Operational Framework for
Partnering With Pharmacies for Administration of 2009
H1N1 Vaccine” that serves as a guide for state and
territorial health departments to establish partnerships
with pharmacies to administer vaccinations during the
2009 H1N1 influenza pandemic. Pharmacists administer
10% of all H1N1 vaccine doses in the United States and
are viewed as a crucial public health asset for their vital
role in the response to the pandemic.
Source: References 14–24.
Module 1. Pharmacists, Vaccines, and Public Health
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pharmacists are increasingly practicing in new models
of care that can expand patient access. This widespread
access has been recognized as a benefit by the Centers
for Disease Control and Prevention (CDC). As of November
2015, nearly one in four adults who received an influenza
vaccine were vaccinated in a community pharmacy or retail
setting.34
In a 2016 open letter to pharmacists, HHS recognized
pharmacists’ contributions to public health and thanked
pharmacists for their role in improving immunization rates;
(Figure 1.4).34 In this letter, HHS called upon pharmacists
to help increase immunization rates by finding new ways
to assess for vaccination needs, recommend, offer and
document additional immunizations.
Figure 1.3. Guidelines for Pharmacy Immunization Advocacy
Guideline 1. Priority to Prevention
Pharmacists should protect their patients’ health by being vaccine
advocates. Pharmacists should adopt one of three levels of
involvement in vaccine advocacy:
• Pharmacist as educator (motivating people to be immunized).
• Pharmacist as facilitator (hosting others who immunize).
• Pharmacist as immunizer (protecting vulnerable people,
consistent with state law).
Pharmacists should:
• Focus their immunization efforts on diseases that are the
most significant sources of preventable mortality among the
American people, such as influenza, pneumococcal, and
hepatitis B infections.
• Routinely determine the immunization status of patients,
then refer patients to the most appropriate provider for
immunization.
• Identify high-risk patients in need of targeted vaccines and
develop an appropriate immunization schedule.
• Protect themselves and prevent infection of their patients by
being appropriately immunized themselves.
Guideline 2. Partnership
• Identify high-risk patients in nursing homes and other facilities
and ensure that needed vaccinations are considered either
upon admission or in drug regimen reviews.
Guideline 3. Quality
Pharmacists must achieve and maintain competence to
administer immunizations. Before administering vaccines,
pharmacists should:
• Be properly trained and evaluated in disease epidemiology,
vaccine characteristics, injection technique, and related topics.
• Be properly trained in emergency responses to adverse events;
they should provide this service only in settings equipped with
epinephrine and related supplies.
• Question the patients and their families about
contraindications and inform them in specific terms about the
risks and benefits of immunization.
• Receive additional education and training on current
immunization recommendations, schedules, and techniques at
least annually.
Guideline 4. Documentation
Pharmacists should document immunizations fully and report
important events appropriately. Pharmacists should:
Pharmacists who administer immunizations do so in partnership
with their community. Pharmacists should:
• Maintain perpetual immunization records and offer a personal
immunization record to each patient.
• Support the immunization advocacy goals and other
educational programs of health departments in their cities,
counties, and states.
• Report adverse events following immunization to any
appropriate primary care provider and to the Vaccine Adverse
Event Reporting System (VAERS).
• Collaborate with community prescribers and health
departments.
• Assist their patients in maintaining a medical home, including
care such as immunization delivery.
• Consult with and report immunization delivery, as appropriate,
to primary care providers, state immunization registries [now
known as immunization information systems], and other
relevant parties.
• Identify high-risk patients in hospitals and other institutions and
ensure that appropriate vaccination is considered either before
discharge or in discharge planning.
Guideline 5. Empowerment
Pharmacists should:
• Educate patients about immunizations and respect
patients’ rights.
• Encourage appropriate vaccine use through information
campaigns for health care practitioners, employers, and the
public about the benefits of immunizations.
• Educate patients and their families about immunization in
readily understood terms.
• Document any patient education provided and obtain written
informed consent as recommended in their state before
immunizing.
Source: Reference 25.
Module 1. Pharmacists, Vaccines, and Public Health
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Immunization Success Stories
Each year, APhA recognizes pharmacists who have made
remarkable contributions to improve vaccination rates in their
communities through the Immunization Champion Awards.
APhA issues a call for Immunization Champion Award
nominations in November, announces winners in February,
and presents awards at the APhA Annual Meeting and
Exposition in March.
Expanding Opportunities to
Administer Vaccines
Opportunities for pharmacists to administer vaccines have
expanded over the past few decades regarding locations
where pharmacists immunize, types of vaccines administered
by pharmacists, and age-groups to which pharmacists administer vaccines.
Opportunities Based on Location
Opportunities for pharmacists to educate, facilitate, or
immunize exist at all levels of care. Every pharmacist can
and should identify patients who are vulnerable to vaccinepreventable diseases and routinely recommend vaccination at
every appropriate encounter.
Initial pharmacy-based vaccination efforts took place in
community pharmacies. However, pharmacists’ immunization
efforts are not limited to community pharmacy sites. Today,
pharmacists administer vaccines in a wide variety of practice
settings and processes of care such as:
•
•
•
•
•
•
•
•
•
•
•
•
Community pharmacies
Ambulatory care clinics
Community health centers
Health systems
Long-term care facilities
Home health care settings
Corporate sites
Community sites (shopping areas, airports, health fairs,
schools)
Patient-centered medical homes and other innovative
care models
MTM encounters
Medication reconciliation
Travel health clinics
Module 1. Pharmacists, Vaccines, and Public Health
Vaccine Needs for Travel Health
Patients traveling abroad often require specific vaccines
related to their destination. For training to meet patients’
unique travel-related health care needs, see APhA’s
Pharmacy-Based Travel Health Services advanced
competency training in the Continuing Education
section of www.pharmacist.com.
Opportunities for pharmacists in various settings are
numerous. For example, community pharmacists can use
information in their pharmacy database to determine
immunization needs for individual patients. Pharmacists can
identify individuals who need vaccines just by completing
a review of the patient’s age, medications, and medical
history. Patients with chronic diseases such as cardiovascular
disease, chronic lung disease, or diabetes are potential
candidates for many vaccines, and these patients can be
easily identified by the medications they take to manage
their disease. (More information about identifying patients
who require vaccines will be discussed in Module 4.)
Patients admitted to hospitals or long-term care facilities
will be cared for by a pharmacist at some point during
their stay. These settings provide ample opportunity for
pharmacists to promote, and often provide, immunizations.
Although the institutional setting is different from the
community pharmacy setting, the general roles of pharmacists
in promoting immunizations are the same: to educate, to
facilitate, and/or to administer.
Just as community pharmacists can identify vaccine needs
by reviewing a prescription profile, institutional pharmacists
can identify a patient’s vaccination status while conducting
medication reconciliation upon admission, unit transfer, or
discharge. They can advocate vaccinations on ward rounds
and at grand rounds for inpatients or get involved with
discharge planning to ensure patients receive necessary
vaccinations prior to discharge. When allowed by their
state pharmacy practice act and employer, institutional
pharmacists can become involved in administering vaccines
to patients. Pharmacists in this setting also can supply drug
information about vaccines; provide in-service training for
pharmacy, nursing, or other personnel; and become involved
in committees concerned with infection control. Other
potential roles include developing policies on vaccination
for employees, patients, and visitors. Institutional pharmacists
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Figure 1.4. Letter to Pharmacists From the Department of Health and Human Services Requesting
Help in Promoting and Providing Vaccinations
DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
Centers for Disease Control
and Prevention (CDC)
Atlanta, GA 30341-3724
September 29, 2016
Dear Pharmacist,
The Centers for Disease Control and Prevention (CDC) recognizes and appreciates the
increasingly important role that you play in public health, including vaccinating the
public against seasonal influenza and other vaccine-preventable diseases. In fact, as of
November 2015, nearly one in four adults who received an influenza vaccine were
vaccinated in a community pharmacy or retail setting
(http://www.cdc.gov/flu/fluvaxview/nifs-estimates-nov2015.htm), and there are now
more than 280,000 immunization trained pharmacists.
As of the middle of September, manufacturers reported having already distributed more
than 90 million doses of 2016-2017 flu vaccine. Please begin to vaccinate your
patients as you receive the influenza vaccine. Vaccination by the end of October is
recommended, if possible, however, please continue to vaccinate your patients
throughout the influenza season. Vaccine administered in December or later, even if
influenza activity has already begun, is likely to be beneficial during the majority of the
influenza seasons.
For the 2016-2017 season, ACIP has made several updates and clarifications to its
seasonal influenza vaccination recommendations:
• Only injectable influenza vaccines are recommended this flu season. People aged
6 months and older should receive an appropriate formulation of either an
inactivated influenza vaccine (IIV) or the recombinant influenza vaccine (RIV)
with no preference for any recommended vaccine over another. The various
vaccines are approved for different age groups. An age-appropriate vaccine
should always be used. While some LAIV may be available in the form of
FluMist Quadrivalent, that vaccine is not recommended for use this season
because of concerns about its effectiveness.
• The composition of 2016-2017 flu vaccines has been updated to better match
circulating viruses.
• An influenza vaccine with MF59 adjuvant (FLUADTM) is available for adults 65
years and older. People 65 years of age and older may receive this vaccine, highdose inactivated influenza vaccine (Fluzone High-Dose), or standard-dose
inactivated vaccine.
(continued on next page)
Module 1. Pharmacists, Vaccines, and Public Health
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Figure 1.4. Letter to Pharmacists From the Department of Health and Human Services Requesting
Help in Promoting and Providing Vaccinations (continued)
• The recommendations for flu vaccination of people with egg allergies have been
modified:
o Anyone with egg allergy can receive any licensed, age-appropriate, and
recommended flu vaccine. For those with a history of severe allergic
reaction to egg (any symptom other than hives), vaccination should occur
in a medical setting and be supervised by a health care provider who can
recognize and manage severe allergic conditions.
o CDC has prepared an algorithm summarizing the new recommendations
which is available at http://www.cdc.gov/flu/protect/vaccine/eggallergies.htm.
• Children 6 months through 8 years of age who have previously received two or
more total doses of any trivalent or quadrivalent influenza vaccine before July 1,
2016, only need one dose of 2016-2017 seasonal influenza vaccine. Children 6
months through 8 years of age who have not previously received two or more
total doses of any trivalent or quadrivalent influenza vaccine before July 1, 2016
will need two doses of 2016-2017 seasonal influenza vaccine. Children 9 years
of age and older need only one dose.
Vaccine manufacturers have projected that as many as 157 million to 168 million doses
of injectable flu vaccine will be available for the 2016-2017 season. Based on these
projections, the supply of injectable flu vaccine should be sufficient to meet any increase
in demand resulting from the recommendation to not use LAIV this season. Influenza
vaccine information for providers and patients is available at http://www.cdc.gov/flu.
As you and your colleagues begin your seasonal influenza vaccination efforts, please take
this opportunity to also assess the other vaccination needs of your patients. We encourage
and appreciate every effort you can make to implement the Standards for Adult
Immunization Practice in your pharmacy, i. e. to find new ways to assess for vaccination
needs, recommend, offer and document additional immunizations. Many pharmacies are
taking the opportunity to promote zoster, pneumococcal and Tdap vaccination to their
adult patients. Thank you for all that you do for your patients and for your continued
public health contribution to a well-functioning “immunization neighborhood” in
collaboration with healthcare providers in your communities.
Sincerely,
Nancy Messonnier, MD (CAPT, USPHS)
Director
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
Source: Reference 39.
Module 1. Pharmacists, Vaccines, and Public Health
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should advocate for all health care workers at the site to be
up to date with their immunizations.
Consultant pharmacists can increase immunization delivery in
a variety of ways. They can recommend vaccines during drug
regimen reviews; encourage mass immunization programs
for residents, staff, and visitors; and administer vaccines.
Federal regulations require all long-term care facilities that
receive funding from Medicare to offer influenza vaccine to
their residents annually and offer pneumococcal vaccine at
least once during each resident’s stay or risk losing federal
funding.35 Consultant pharmacists should take the lead in
helping facilities comply with this regulation, and they can
support vaccinations for staff and visitors.
Changes in Medicare rules have made it easier for institutions—both hospitals and nursing homes/long-term care
facilities—to implement standing orders for the administration
of influenza and pneumococcal vaccine to patients by nurses
and pharmacists. The goal of these changes is to improve
vaccination rates in these high-risk patient populations.
Notably, Medicare rules recognize pharmacists as one of the
providers in institutional settings that standing orders should
empower to administer vaccines.
Innovative health care delivery models, such as patientcentered medical homes and accountable care organizations,
that reward quality and are moving away from fee-for-service
payment models have dramatically expanded in recent years
due to financial pressures and the Affordable Care Act.
Performance-based payment for health care is growing, and
this payment structure is based on achievement of various
quality measures, many of which include vaccination rates.
For example, influenza and pneumococcal vaccination rates
are among the quality measures that are used to assess
accountable care organization performance. Immunization
rates also are considered by the Healthcare Effectiveness Data
and Information Set (HEDIS), which is a set of performance
measures widely used by the managed care industry and
other organizations.36 These developments offer important
opportunities for pharmacists to make an impact and assist
providers, health care teams, and plans meet quality metrics
resulting in enhanced compensation. Pharmacists can work
to improve immunization rates in their practices to help the
practices deliver high-quality care.
Pharmacists’ patient care services offer excellent opportunities
to advocate for immunizations and administer vaccines. Many
pharmacists regularly consider a patient’s vaccine needs
as part of any MTM encounter. Pharmacists who provide
Module 1. Pharmacists, Vaccines, and Public Health
disease-state management services for patients with chronic
conditions such as diabetes and asthma can include an
assessment of patients’ vaccination status in these efforts.
Finally, as a profession, pharmacists need to be role models
for patients. All pharmacists should receive an annual
influenza vaccination and be up to date on their other
vaccines unless they have valid medical contraindications.
Expanding Vaccination Offerings
Initially, pharmacists’ vaccination efforts focused on seasonal
influenza programs for adults. Today, pharmacists’ services are
expanding to offer year-round vaccines across the life span.
When pharmacists began their immunization activities a
few decades ago, many states did not allow pharmacists
to immunize. That is no longer the case. As of July 2009,
pharmacists in all 50 states, Puerto Rico, and the District
of Columbia have the authority to administer vaccines to
varying degrees (Figure 1.5).24 However, state-level limitations on a pharmacist’s authority to immunize remain,
such as restrictions based on the age of the patient or the
type of vaccine being administered; these restrictions are
subject to change at any time. Pharmacists must check
with their state board of pharmacy before initiating any
immunization service to determine their specific authority
to immunize.
As of July 2016, pharmacists in 48 states and territories
may administer any vaccine.24 In other states, pharmacists
are limited to certain subsets of vaccines. Pharmacists can
administer influenza, pneumococcal, and herpes zoster
vaccine in all states. Some states allow pharmacists to
administer vaccines under protocol while others require a
prescription to administer a vaccine. In many states, certain
vaccines are allowed by protocol but other vaccines require
a prescription.
Additionally, pharmacists in 27 states may administer vaccines
to patients of any age.24 Other states have age requirements
for pharmacists’ vaccination authority, ranging from patients
as young as 5 years of age in North Dakota, to patients
at least 19 years of age in Wyoming. Research has found
that parents are supportive of pharmacists vaccinating their
children and that immunization rates for children increase with
pharmacist involvement.37
Some states allow student pharmacists to administer vaccines
if certain criteria are met. Common criteria include that the
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student must be trained (e.g., through this certificate training
program) and must operate under the direct supervision of a
trained pharmacist. In 2017, Idaho because the first state to
implement a pilot program allowing pharmacy technicians to
administer immunizations. The results of this pilot may have
important implications for future roles of pharmacy technicians. State laws and regulations are continually changing
and pharmacists should regularly monitor their state rules and
regulations.
Collaborating to Improve
Immunization Rates
In areas where state practice acts continue to pose limitations
regarding which vaccines pharmacists may administer, all
pharmacies can serve as immunization information centers.
This service involves educating patients and families about who
needs specific vaccines, when they need them, and where
these vaccines are available. Pharmacists practicing in states
that limit their authority to administer vaccines are encouraged
to work with the state pharmacy association, board of
pharmacy, and colleges of pharmacy to change the state’s
pharmacy practice act. Through such change, pharmacists can
be in a position to better protect the public’s health.
As barriers to pharmacists’ ability to administer vaccines are
removed, pharmacists’ advocacy efforts in other arenas are
gaining prominence. Pharmacists can explore opportunities to
improve public health by advocating for vaccinations using a
variety strategies including collaborating with other members
of the health care team, becoming involved with state-level
efforts, joining immunization coalitions, and partnering with
health departments. (State and local health departments
organize, administer, and maintain vaccine campaigns, registries, and educational activities. Immunization coalitions are
organizations that foster collaboration among stakeholders to
increase immunization rates.)
The HPV vaccine provides one potential model for pharmacists’ collaboration with other members of the health care
community to increase vaccination rates. Immunization with
the HPV vaccine requires a 2- or 3-dose series; however, many
adolescents do not complete the series. The need to schedule
an appointment to obtain subsequent doses of the vaccine
may be a barrier to immunization by medical providers. If
the medical provider referred the patient to the pharmacist
for the second and third doses, and communicated with the
pharmacist, then the pharmacist could follow-up with the
patient to support full immunization.38
Figure 1.5. States Authorizing Pharmacists to Administer Influenza Vaccine and
Pharmacists Trained to Administer Vaccines
NABP = National Association of Boards of Pharmacy.
Source: Reference 24.
Module 1. Pharmacists, Vaccines, and Public Health
As pharmacists expand their
immunization roles, they are
becoming integrated in the
“immunization neighborhood.”
This term was coined by APhA
and is gaining acceptance from
a broad array of immunization
stakeholders. The immunization
neighborhood is defined as
“collaboration, coordination,
and communication among
immunization stakeholders
dedicated to meeting the immunization needs of the patient and
protecting the community from
vaccine-preventable diseases.”
This conceptual neighborhood
includes a variety of immunization
stakeholders who are working
to meet immunization needs of
their communities. Supporting
achievement of the immunization
neighborhood, the HHS National
Vaccine Advisory Committee
released a new version of the
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Adult Immunization Standards that identifies a role for every
health care professional, organization, and health system
(Table 1.7).39
Emergency Preparedness and Vaccines
Immunizing pharmacists play a critical role in emergency
preparedness efforts. During an emergency, pharmacists may
be called on to administer vaccines as well as to help with the
distribution of medications. For example, during a pandemic,
pharmacists can support immunization efforts to protect the
public. Pharmacists also could become involved in immunization efforts in the event of a bioterrorism attack with an
agent such as anthrax or smallpox. Natural disasters such as
hurricanes or floods also may call for mass vaccinations with
tetanus vaccines.40
Additionally, public confusion surrounding the number of
required doses of H1N1 vaccine and the target groups for
vaccination compared with the seasonal influenza vaccine
necessitated patient education for effective vaccination
programs. Pharmacists played a critical role in promoting
public health and wellness during this emergency.
Pharmacists who are interested in taking a more active role in
emergency preparedness efforts can join their local Medical
Reserve Corps (https://mrc.hhs.gov/HomePage) or Disaster
Medical Assistance Team (www.phe.gov/Preparedness/
responders/ndms/teams/Pages/dmat.aspx). In an emergency,
these teams and the Strategic National Stockpile may be
brought into the affected areas to provide medications and
mass vaccinations.
Sources of Immunization Information
To maintain a high-quality practice in immunizations, a
commitment must be made to stay up to date with ongoing
developments in immunization practice. Practice recommendations and immunization schedules are updated frequently as
new research and vaccines become available. In preparation
to become immunizers, pharmacists need to locate resources
to identify regularly updated information. Many high-quality
resources are available, but it is important to be aware that a
substantial amount of misinformation is also widely distributed.
More information about myths and misperceptions regarding
vaccines, and how to address them, will be discussed in
Module 4. Selected reputable resources are provided in the
following section.
Module 1. Pharmacists, Vaccines, and Public Health
Vaccine Recommendation Sources
National evidence-based vaccination recommendations are
written by the CDC Advisory Committee on Immunization
Practices (ACIP) and the Committee on Infectious Diseases
of the American Academy of Pediatrics (AAP). Other major
policy-setting groups include the American College of
Physicians (ACP), the American Congress of Obstetricians and
Gynecologists (ACOG), and the American Academy of Family
Practitioners (AAFP).41,42
The harmonized pediatric immunization schedule (indicating
who should receive which vaccines when) is a collaborative
effort of ACIP, AAP, ACOG, and AAFP. It is usually published
in January of each year with updates published as situations
warrant. The adult immunization schedule is also updated
annually and published every January or February.
ACIP meets multiple times per year to review newly available
information and update recommendations as necessary. These
recommendations and updates are published in Morbidity and
Mortality Weekly Report (MMWR), which can be accessed
online at www.cdc.gov/mmwr. Immunizing pharmacists should
remain current on recommendations from ACIP, and can sign
up at www.cdc.gov/vaccines/acip/ to receive an e-mail
whenever the website is updated. In addition, APhA conducts
educational programs after each ACIP meeting to provide
updates on the latest ACIP discussions and decisions.
Selected Online Resources
APhA provides multiple electronic resources that are indispensable for immunizing pharmacists. All of the following
resources are easily accessible at www.pharmacist.com/
immunization-center, APhA’s Immunization Center. Pharmacists
also can subscribe to APhA’s free electronic newsletter,
Immunizing Pharmacists News, by filling out the online form
available at this site. This newsletter scans the latest immunization information and provides items of interest to immunizing
pharmacists. For member access only, APhA has a robust
Immunizing Pharmacists e-Community that offers a forum for
immunizing pharmacists to network with other immunization
providers across the country, facilitated by the APhA Academy
of Pharmacy Practice and Management’s special interest
group for immunizing pharmacists.
Participants in this certificate training program have access to
a compilation of links and valuable resources for pharmacybased immunization delivery at www.pharmacist.com/
immunization-resources.
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Table 1.7. Summary of the 2013 National Vaccine Advisory Committee’s Standards for Adult Immunization Practices
Audience
Summary of Standards
All providers
Incorporate immunization needs assessment into every clinical encounter
Strongly recommend needed vaccines and either administer vaccines or refer patient to a provider who can
immunize
Stay up to date on, and educate patients about, vaccine recommendations
Implement systems to incorporate vaccine assessment into routine clinical care
Understand how to access immunization information systems (also known as IIS and immunizations registries)
Non-immunizing providers
Routinely assess immunization status of patients, recommend needed vaccines, and refer patient to an
immunizing provider
Establish referral relationships with immunizing providers
Follow-up to confirm patient receipt of recommended vaccines
Immunizing providers
Ensure professional competencies in immunizations
Assess immunization status in every patient care and counseling encounter and strongly recommend needed
vaccines
Ensure that receipt of vaccination is documented in patient medical record and immunization registry
Professional health care–related
organizations/associations/health
care systems
Provide immunization education and training of members, including trainees
Provide resources and assistance to implement protocols and other systems to incorporate vaccine needs
assessment and vaccination or referral into routine practice
Encourage members to be up to date on their own immunizations
Assist members in staying up to date on immunization information and recommendations
Partner with other immunization stakeholders to educate the public
Seek out collaboration opportunities with other immunization stakeholders
Collect and share best practices for immunization
Advocate policies that support adult immunization standards
Insurers/payers/entities that cover adult immunization services should assure their network is adequate to
provide timely immunization access and augment with additional vaccine providers if necessary
Public health departments
Determine community needs, vaccination capacity, and barriers to adult immunization
Provide access to all vaccinations recommended by the Advisory Committee on Immunization Practices for
insured and uninsured adults and work toward becoming an in-network provider for immunization services for
insured adults
Partner with immunization stakeholders and support activities and policies to improve awareness of adult
vaccine recommendations, increase vaccination rates, and reduce barriers
Ensure professional competencies in immunizations
Collect, analyze, and disseminate immunization data
Provide outreach and education to providers and the public
Work to decrease disparities in immunization coverage and access
Increase immunization registry access and use by vaccine providers for adult patients
Develop capacity to bill for immunizations
Ensure preparedness for identifying and responding to outbreaks of vaccine-preventable diseases
Promote adherence to applicable laws, regulations, and standards among adult immunization stakeholders
Source: Reference 47.
Module 1. Pharmacists, Vaccines, and Public Health
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The CDC website, www.cdc.gov/vaccines, is extensive,
providing up-to-date information regarding immunization
practices. Various e-mail subscriptions are available for free
from the CDC, providing a convenient way to stay current.
For example, to receive the table of contents of CDC’s
publication MMWR, pharmacists can subscribe to a
mailing list at www.cdc.gov/mmwr/mmwrsubscribe.html.
The Immunization Action Coalition (IAC) website, available
at www.immunize.org, offers a wide array of well-respected
resources for immunization providers and other audiences.
IAC provides several free e-mail publications and an e-mail
service to inform subscribers of news involving immunizations.
Pharmacists can sign up for the IAC e-mail publications by
visiting www.immunize.org/subscribe/. IAC also publishes
the quarterly newsletters Needle Tips and Vaccinate Adults!
available in print and online.
Other selected websites that offer useful information are listed
in Table 1.8.
Print Material
APhA’s Immunization Handbook is a valuable resource
that provides numerous guidelines, tips, and resources
for building and sustaining a successful immunization
practice. Written in a concise and quick look-up format,
this handbook is an essential resource for busy pharmacists. APhA also publishes The Pharmacist in Public Health:
Education, Applications, and Opportunities, which explores
activities for pharmacists in public health and provides
information to help pharmacists overcome challenges and
embrace opportunities as public health pharmacists. Both
books are available for purchase from the APhA Bookstore
at www.pharmacist.com/shop with discounted pricing for
APhA members.
The CDC and IAC have excellent print resources for
immunization providers, including ACIP statements, posters,
brochures, and patient education materials. The majority of
the materials can be downloaded for free from the previously
listed websites.
Epidemiology and Prevention of Vaccine-Preventable
Diseases (also known as “The Pink Book”) is published
by the CDC and is the most important reference for all
Table 1.8. Websites of Selected Organizations Useful to Immunizing Pharmacists
Organization
Website
American Academy of Pediatrics
www.aap.org
American College of Physicians
www.acponline.org
American Pharmacists Association Immunization Center
www.pharmacist.com/immunization-center
American Society of Consultant Pharmacists
www.ascp.com
Centers for Disease Control and Prevention
www.cdc.gov/vaccines
Centers for Medicare and Medicaid Services
www.cms.gov
Immunization Action Coalition
www.immunize.org
Immunization Coalition Directory
www.izcoalitions.org
Morbidity and Mortality Weekly Report
www.cdc.gov/mmwr
National Center for Immunization and Respiratory Diseases
www.cdc.gov/ncird
National Foundation for Infectious Diseases
www.nfid.org
National Disaster Medical System
www.phe.gov/preparedness/responders/ndms/Pages/default.aspx
National Vaccine Errors Reporting Program
verp.ismp.org
State health departments
www.cdc.gov/mmwr/international/relres.html
State immunization managers
www.immunizationmanagers.org
Vaccine Adverse Event Reporting System
vaers.hhs.gov
Vaccine Injury Compensation Program
www.hrsa.gov/vaccinecompensation
Module 1. Pharmacists, Vaccines, and Public Health
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pharmacists to have available in their practice (it is also
available online). It provides comprehensive information
on vaccine-preventable diseases. The AAP’s Red Book:
Report of the Committee on Infectious Diseases is another
worthy reference that focuses on pediatric illness. Facts and
Comparisons annually updates its major reference book,
ImmunoFacts: Vaccines and Immunologic Drugs. Another
recognized authoritative reference is Vaccines edited by
Plotkin, Orenstein, and Offit.
4.
College of Physicians of Philadelphia. The History of Vaccines.
Timelines. Available at: http://www.historyofvaccines.org/content/
timelines/all. Accessed May 19, 2017.
5.
Centers for Disease Control and Prevention; Atkinson W, Wolfe C,
Hamborsky J, eds. Epidemiology and Prevention of Vaccine-Preventable
Diseases. 12th ed., 2nd printing. Washington, DC: Public Health
Foundation; May 2012.
6.
Roush SW, Murphy TV; Vaccine-Preventable Disease Table Working
Group. Historical comparisons of morbidity and mortality for vaccinepreventable diseases in the United States. JAMA. 2007;298:2155–
63.
7.
Centers for Disease Control and Prevention. Notifiable diseases and
mortality tables. MMWR Morb Mortal Wkly Rep. 22017;66(05):ND82-ND-101.
8.
Grabenstein JD. Milestones in immunologic history: antiquity to 1919.
Hosp Pharm. 1994;29:477–8, 480–3.
9.
Healthy People 2020. Immunization and Infectious Diseases.
Available at: http://healthypeople.gov/2020/topicsobjectives2020/
overview.aspx?topicid=23. Accessed May 19, 2017.
Video Resources
Live CDC-sponsored video conferences are broadcast by satellite
(and online) several times a year. Titles include Epidemiology
and Prevention of Vaccine-Preventable Disease and Vaccines
for International Travel. Pharmacists may check the CDC
website for a listing of viewing sites and times. The CDC offers
live, video, and teleconference programs with continuing
pharmacy education (CPE) credit for pharmacists. APhA also
offers annual updates and CPE credit for educational activities
related to vaccines through its website; go to www.pharmacist.
com/education and click on APhA’s Educational Library.
Conclusion
Vaccines have significantly decreased the morbidity and
mortality associated with many diseases. Despite these
successes, shortfalls in vaccination rates still exist and more
needs to be done to avert needless vaccine-preventable
diseases and deaths. Pharmacists in all settings have an
opportunity to significantly affect patient care by getting
involved with immunizations as educators, facilitators, and in
many instances, immunizers. Participating in this certificate
training program is an important first step toward becoming
an immunizing pharmacist. Identifying resources that support
immunizing pharmacists and using them to remain abreast of
developments are also critical steps toward providing highquality patient care.
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42. Kroger AT, Duchin J, Vázquez M. General Best Practice Guidelines
for Immunization. Best Practices Guidance of the Advisory Committee
on Immunization Practices (ACIP). https://www.cdc.gov/vaccines/
hcp/acip-recs/general-recs/index.html. Accessed May 19, 2017.
34. American Pharmacists Association. CDC releases Dear Pharmacist
letter for seasonal influenza vaccination efforts. Available at: http://
www.pharmacist.com/cdc-releases-dear-pharmacist-letter-seasonalinfluenza-vaccination-efforts?dfptag=imz. Accessed May 19, 2017.
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