Immunization
Addressing Vaccine
Misconceptions
H EAT HE R N F O L Z, P H A R MD
P GY 2 P H A RMAC Y R ESI DE NT B U T LER U N I VERSI T Y C O PHS
I N D I A NA P H A R MAC I STS A L L I A NC E M I DYEA R M E ET I N G
9.17.15
T H I S S P EA K ER H A S N O A C T UA L O R P OT E NT I A L C O NF LI C TS O F
I N T EREST TO D I S C LOSE
Objectives
 Identify four common vaccine
misconceptions held by health care
professionals and patients
 Explain the background for these concerns
 Develop an educated plan
to address these issues
“An ounce of prevention is
worth a pound of cure”
-Benjamin Franklin
Indiana Vaccine Law
As of July 1, 2013, pharmacists may administer the
following vaccines under physician protocol
 Influenza
 Herpes zoster
 Pneumonia
 Tetanus, diphtheria, acellular pertussis
 Human papillomavirus
 Meningitis
Indiana General Assembly Archive. House Bill 1464. http://www.in.gov/apps/lsa/session/billwatch/billinfo?year
=2013&session=1&request=getBill&doctype=HB&docno=1464. Accessed: 1 August 2015.
Misconception #1:
Egg allergy = No flu shot ever, ever, ever
Photo: http://cdn.bgr.com/2015/06/egg.jpg
Anaphylaxis treatment should
be available when administering
all vaccines
Egg Allergies
Severe egg
allergy
Refer
*1) Administer
by healthcare
Recombinant
provider familiar with egg
allergy reactions
2) Observe at least 30 mins
after administration
Hives
Tolerates
cooked egg
Recombinant
Recombinant
Regular
inactivated*
Regular
inactivated
Flublok®
~2% of children are
allergic to eggs
• Approved January 2013
• Completely egg-free
• Approved for ages 18-49 years
Immunization Action Coalition. Administering Vaccines. http://www.immunize.org/askexperts/administeringvaccines.asp. Accessed: 18 July 2015.
Misconception #2:
You cannot administer zoster and
pneumonia vaccines together
Photo: http://www.buffalonews.com/life-arts/10-preventive-steps-to-protect-your-health-20150410
Zostavax and Pneumonia Vaccines
• Package inserts for Zostavax and Pneumovax 23
state: “consider administration of the two vaccines
separated by at least 4 weeks”
• Statement mandated by FDA, but not supported by
the CDC’s Advisory Committee on Immunization
Practices (ACIP)
• Randomized controlled trial showed ↓ antibody
titers with concurrent administration; clinical
significance unknown
Pneumovax23 [package insert] 2011. Zostavax [package insert] 2014.
American Pharmacists Association. http://www.pharmacist.com/node/33635?is_sso_called=1. Accessed: 18 July 2015.
ACIP Vaccine Spacing Guide
Antigen Combination
2 or more inactivated*
Inactivated and live
2 or more live
Recommended Minimum
Interval
Simultaneously or at any
interval
Simultaneously or at any
interval
28 days, IF NOT GIVEN SAME
DAY
*2 exceptions to this rule
1) Prevnar 13 and Pneumovax 23 – separate by 12 months
2) Prevnar 13 and Menactra – give Menactra 4 weeks after Prevnar 13
PL Detail-Document, Pneumococcal Vaccination in Adults: Who Gets What and When? Pharmacist’s Letter. November 2014.
Misconception #3:
Too many vaccines at once overwhelm
the immune system
Photo: http://www.biopharma-reporter.com/Bio-Developments/GSK-invests-further-in-vaccines-with-190m-buy-of-GlycoVaxyn
Separate IM vaccines by
at least 1 inch
Simultaneous Administration:
More than one vaccine given on the same day, at different
sites, and not combined in the same syringe
• ACIP: all needed vaccines should be
administered during the office visit
• No upper limit for the number of
vaccines that can be administered
•ACIP: vaccination should not be deferred
because multiple ones are needed
CDC. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm#Tab1. Accessed: 18 July 2015.
Immunization Action Coalition. http://www.immunize.org/askexperts/administering-vaccines.asp. Accessed: 18 July 2015.
Courtesy of Centers for Disease Control and Prevention
www.vaccineinformation.org/photos/varicdc013.jpg
www.vaccineinformation.org/photos/zostcdc001.jpg
Misconception #4:
I have had shingles before, so I do not
need the shingles vaccine
Zoster Vaccine
• FDA approved: adults 50 and older
• ACIP recommended: adults 60 and older
•ACIP supports receiving the zoster vaccine
even with a past history of herpes zoster
• Screening for history of chickenpox infection
is not necessary
CDC. http://www.cdc.gov/vaccines/vpd-vac/shingles/hcp-vaccination.htm. Accessed: 2 August 2015.
Question 1
What is the name of the only egg-free
influenza vaccine?
A. Fluzone®
B. Flublok®
C. FluMist®
D. Flucelvax®
Question 2
What is the maximum number of
vaccines recommended to be given in
one day?
No max! Let’s see both arms! 
Question 3
Which vaccine pairs should NOT be administered as
described below (per ACIP)?
A. Zostavax and Pneumovax 23 on the same day
B. Zostavax and Prevnar 13 on the same day
C. MMR then nasal influenza vaccine 2 weeks later
D. MMR and nasal influenza vaccine on the same
day
Immunization
Addressing Vaccine
Misconceptions
H E AT H E R N F O L Z , P H A R M D
P GY 2 P H A R M A C Y R E S I D E N T B U T L E R U N I V E RS I T Y C O P H S
I N D I A N A P H A R M A C I ST S A L L I A N C E M I DY E A R M E E T I N G
9.17.15