{"id":106,"date":"2019-09-30T14:03:43","date_gmt":"2019-09-30T14:03:43","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/chapter\/deciphering-immunization-codes-making-evidence-based-recommendations\/"},"modified":"2019-12-30T16:56:16","modified_gmt":"2019-12-30T16:56:16","slug":"deciphering-immunization-codes-making-evidence-based-recommendations","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/chapter\/deciphering-immunization-codes-making-evidence-based-recommendations\/","title":{"raw":"Deciphering immunization codes: making evidence-based recommendations","rendered":"Deciphering immunization codes: making evidence-based recommendations"},"content":{"raw":"<h2>Josh Rickard, PharmD, BCPS, CDE<\/h2>\r\n<h2>Stephanie F James, PhD, MBA<\/h2>\r\n<h2>Lindsey Childs-Kean, PharmD, MPH, BCPS<\/h2>\r\n<div class=\"textbox key-takeaways\">\r\n<h3 class=\"import-Normal\"><strong class=\"import-Heading2Char\">Topic Area<\/strong><\/h3>\r\n<p class=\"import-Normal\" style=\"text-align: center\">Immunizations<\/p>\r\n\r\n<\/div>\r\n<div class=\"deciphering-immunization-codes:-making-evidence-based-recommendations\">\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<p class=\"import-Normal\">At the end of this case, students will be able to:<\/p>\r\n\r\n<ul>\r\n \t<li>Recall the resources available from the CDC pertaining to adult vaccination recommendations<\/li>\r\n \t<li>Determine an appropriate vaccination plan using a patient case<\/li>\r\n \t<li>Identify important education points to provide to patients during consultations<\/li>\r\n<\/ul>\r\n<\/div>\r\n<h2 class=\"import-Normal\"><strong class=\"import-Heading2Char\">Introduction<\/strong><\/h2>\r\n<p class=\"import-Normal\">According to the \u2018Oath of the Pharmacist,\u2019 pharmacists promise to devote their lives to others through the pharmacy profession. A major part of this oath is to consider the welfare of humanity and assure optimal outcomes in all patients.<a href=\"#t1\"><sup>1<\/sup><\/a> Although pharmacists may work in different practice settings, each has the opportunity to be a key component of disease prevention by becoming a vaccine advocate.<a href=\"#t2\"><sup>2<\/sup><\/a> Pharmacists can promote the use of vaccines by providing immunization administration services, screening patients in each practice setting, conducting patient counseling, and provide widespread public education regarding vaccine use.<a href=\"#t2\"><sup>2<\/sup><\/a> Although pharmacists are immunizers in every state, it is important to review your state\u2019s laws regarding pharmacist delivered immunization services. Up-to-date information can be found on the American Pharmacists Association\u2019s website.<a href=\"#t3\"><sup>3<\/sup><\/a><\/p>\r\n<p class=\"import-Normal\">There are many resources the pharmacist can turn to for vaccines schedules and patient education documents. The CDC\u2019s website will link the pharmacist to many different materials for providers and patients regarding many different topics for vaccines.<a href=\"#t4\"><sup>4<\/sup><\/a> One of these documents that the pharmacist should always review are the immunization schedules that are available for children and adults. The CDC has different documents organizing the immunization schedules by age groups or comorbid conditions. They also include documents that outline contraindications, as well as a mobile phone application for quick access to the vaccine schedules.<a href=\"#t5\"><sup>5<\/sup><\/a> The CDC website also has links for more patient-friendly information (including an easy to read schedule) as well as a library of previous immunization schedules, specific changes for each year\u2019s recommendations, and specific Advisory Committee on Immunization Practices\u2019 recommendation.<a href=\"#t6\"><sup>6,7<\/sup><\/a> An emerging role for pharmacists is in travel health, which include the administration of travel vaccinations. The CDC has a comprehensive resource for clinicians to identify the appropriate vaccines each patient needs depending on the country of travel.<a href=\"#t8\"><sup>8<\/sup><\/a><\/p>\r\n<p class=\"import-Normal\">Another resource available to pharmacists is a website from the Immunization Action Coalition (IAC). The IAC works closely with the CDC to provide information and education to health care providers and the community to increase immunization rates.<a href=\"#t9\"><sup>9<\/sup><\/a> On this website are many documents for both health care providers and patients on many different vaccine related topics including documentation, vaccine hesitancy, temperature logs, promotional material, and much more. There are also educational resources for patients in other languages such as Spanish, Korean, Russian and French.<a href=\"#t10\"><sup>10<\/sup><\/a> A valuable resource included in the website is the \u2018Ask the Experts\u2019 section where experts from the CDC answer questions pertaining to each vaccine, as well as administration, billing, safety, and recommendations.<a href=\"#t11\"><sup>11<\/sup><\/a><\/p>\r\n\r\n<h2 class=\"import-Normal\"><strong class=\"import-Heading2Char\">Case<\/strong><\/h2>\r\n<div class=\"textbox exercises\">\r\n<h3>Scenario<\/h3>\r\nYou are a pharmacist in a pharmacotherapy management clinic.\r\n\r\n<\/div>\r\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">CC<\/span>: \u201cThis is my first time here.\u201d<\/p>\r\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">HPI<\/span>: Michael Smith is a 57 year old male presenting to your clinic.<\/p>\r\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">PMH<\/span>: T2DM; hypertension; gastroesophageal reflux disease; seasonal allergies<\/p>\r\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">FH<\/span>:<\/p>\r\n\r\n<ul>\r\n \t<li>Mother: HTN, T2DM, died at 71 (NSTEMI)<\/li>\r\n \t<li>Father: HLD, COPD<\/li>\r\n<\/ul>\r\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">SH<\/span>:<\/p>\r\n\r\n<ul>\r\n \t<li>Tobacco: denies<\/li>\r\n \t<li>Alcohol: socially, one or two drinks weekly<\/li>\r\n<\/ul>\r\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Medications<\/span>:<\/p>\r\n\r\n<ul>\r\n \t<li>Metformin 1000 mg PO BID<\/li>\r\n \t<li>Atorvastatin 40 mg PO daily<\/li>\r\n \t<li>Lisinopril 10 mg PO daily<\/li>\r\n \t<li>Cetirizine 10 mg PO daily<\/li>\r\n \t<li>Omeprazole 20 mg PO before breakfast<\/li>\r\n<\/ul>\r\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Allergies<\/span>: NKDA<\/p>\r\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Vitals<\/span>:<\/p>\r\n\r\n<ul>\r\n \t<li>BP 146\/98<\/li>\r\n \t<li>HR 88 bpm<\/li>\r\n<\/ul>\r\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Labs<\/span>:<\/p>\r\n\r\n<ul>\r\n \t<li class=\"import-Normal\">BMP (fasting)<\/li>\r\n \t<li class=\"import-Normal\">Na 142 mmol\/L<\/li>\r\n \t<li class=\"import-Normal\">K 4.5 mm\/L<\/li>\r\n \t<li class=\"import-Normal\">Cl 102 mmol\/L<\/li>\r\n \t<li class=\"import-Normal\">CO<sub>2<\/sub> 27 mmol\/L<\/li>\r\n \t<li class=\"import-Normal\">Glucose 153 mg\/dL<\/li>\r\n \t<li class=\"import-Normal\">BUN 18 mg\/dL<\/li>\r\n \t<li class=\"import-Normal\">SCr 0.97 mg\/dL<\/li>\r\n \t<li class=\"import-Normal\">Ca 8.8 mg\/dL<\/li>\r\n \t<li class=\"import-Normal\">HgA1c 9.1%<\/li>\r\n<\/ul>\r\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Blood count<\/span>:<\/p>\r\n\r\n<ul>\r\n \t<li class=\"import-Normal\">WBC 9.2 K\/mcL<\/li>\r\n \t<li class=\"import-Normal\">RBC 4.03 M\/mcL<\/li>\r\n \t<li class=\"import-Normal\">HGB 14.3 gm\/dL<\/li>\r\n \t<li class=\"import-Normal\">Hct 37.2%<\/li>\r\n<\/ul>\r\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Liver function<\/span>:<\/p>\r\n\r\n<ul>\r\n \t<li class=\"import-Normal\">Alk Phos 80 U\/L<\/li>\r\n \t<li class=\"import-Normal\">ALT 20 U\/L<\/li>\r\n \t<li class=\"import-Normal\">AST 24 U\/L<\/li>\r\n<\/ul>\r\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Other information<\/span>:<\/p>\r\n\r\n<ul>\r\n \t<li class=\"import-Normal\">10 year ASCVD Risk: 15.3%<\/li>\r\n \t<li class=\"import-Normal\">Vaccination history per state registry: none<\/li>\r\n<\/ul>\r\n<h2 class=\"import-Normal\"><strong>Case Questions<\/strong><\/h2>\r\n<p class=\"import-Normal\">1. One of the first items you evaluate in your clinic are the vaccinations each patient is eligible to receive. Using the most recent vaccine CDC schedule, which vaccines would the patient be eligible to receive?<\/p>\r\n<p class=\"instructor-notes\"><em>Pneumococcal polysaccharide vaccine (PPSV23, <\/em><em>Pneumovax<\/em><em> 23<\/em><sup><em>\u00ae<\/em><\/sup><em>), recombinant zoster (Shingrix<\/em><sup><em>\u00ae<\/em><\/sup><em>), <\/em><em>Tdap<\/em><em>, Influenza, Hepatitis B series<\/em><\/p>\r\n<p class=\"import-Normal\"><span style=\"color: #000000\"><span style=\"font-size: 1rem;text-align: initial\">2. What if the patient was 67 years old? What vaccines would you screen for?<\/span><\/span><\/p>\r\n\r\n<\/div>\r\n<div class=\"deciphering-immunization-codes:-making-evidence-based-recommendations\">\r\n<p class=\"instructor-notes\"><em>Pneumococcal conjugate vaccine (PCV13, <\/em><em>Prevnar<\/em><em> 13<\/em><sup><em>\u00ae<\/em><\/sup><em>) followed by a Pneumococcal polysaccharide vaccine (PPSV23, <\/em><em>Pneumovax<\/em><em> 23<\/em><sup><em>\u00ae<\/em><\/sup><em>) one year later, <\/em><em>Tdap<\/em><em>, Influenza, and zoster<\/em><\/p>\r\n<p class=\"import-Normal\">3. The patient is interested in receiving the above vaccines, but states that he is concerned with overwhelming his immune system. How would you respond to this patient?<\/p>\r\n<p class=\"instructor-notes\"><em>Multiple vaccinations can be administered simultaneously on the same day but at different sites, with few exceptions, without altering the immune response.<\/em><\/p>\r\n<p class=\"import-Normal\">4. The patient found his immunization record from his previous primary care provider. According to his immunization record, he has received one dose of the hepatitis B vaccine two years ago. How should you proceed with finishing his vaccination series?<\/p>\r\n<p class=\"instructor-notes\"><em>According to the CDC recommendations, the pharmacist would just start where they left off with the second dose of the vaccine. In this patient, you should give a dose today and then another dose in 5 months to complete the series. There is no need to repeat the first dose.<\/em><\/p>\r\n5. The patient reports that he will be traveling to Egypt with his family and is curious to what vaccines are recommended prior to his trip. Using the CDC\u2019s travel health database, what vaccines would the pharmacists potentially recommend, depending on the activity of his trip?\r\n<p class=\"instructor-notes\"><em>Hepatitis A, Hepatitis B, Yellow Fever, Typhoid, and Rabies<\/em><\/p>\r\n6. A physician in your clinic asks you if patients taking methotrexate for rheumatoid arthritis are eligible to receive Zostavax<sup>\u00ae<\/sup>. How would you answer this?\r\n<p class=\"instructor-notes\"><em>Generally, patients with immunosuppression, generally, should not receive live vaccines until the patient becomes immunocompetent according to the ACIP\u2019s recommendations. However, if the patient is using low-dose immunosuppressive therapy, the ACIP recommends the patient to receive the vaccine. According to the IDSA, low dose immunosuppression of methotrexate would be considered \u22640.4mg\/kg\/week. If the patient is taking higher doses, the recombinant vaccine (Shingrix<\/em><sup><em>\u00ae<\/em><\/sup><em>) should be recommended.<\/em><\/p>\r\n\r\n<h2 class=\"import-Normal\"><strong class=\"import-Heading2Char\">Author Commentary<\/strong><\/h2>\r\n<p class=\"import-Normal\">Pharmacists are well respected and easily accessible, particularly those involved in community pharmacy. Hence, they often function as a first resource for many people and parents and serve, not only to counsel patients on current medications, but also to suggest over-the-counter products for common ailments such as fever and sore throat. Because some infectious diseases may initially present with mild symptoms common among many infections, it is imperative that pharmacists are aware of which diseases are endemic or circulating in the community, so they may ask relevant questions to assess disease exposure and vaccination status. Such conversations between the pharmacist and patient may result in patients receiving appropriate referrals and care to further prevent spread of vaccine-preventable diseases.<\/p>\r\n\r\n<h2 class=\"import-Normal\"><strong class=\"import-Heading2Char\">Patient Approaches and Opportunities<\/strong><\/h2>\r\n<p class=\"import-Normal\">As pharmacists, it is important to consider the impact of infectious disease on the lives of our patients. Regardless of practice site, pharmacists can screen patients for immunizations for which they are eligible, recommend and counsel patients regarding the importance of immunization, educate on vaccine safety, and discuss concerns regarding myths related to vaccination. Pharmacists are uniquely positioned to provide immunization services within community pharmacies and outpatient clinics and should utilize opportunities to promote immunization and public health whenever possible.<\/p>\r\n\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Important Resources:<\/h3>\r\n<p class=\"import-Normal\"><em>Related chapters of interest:<\/em><\/p>\r\n\r\n<ul>\r\n \t<li><a href=\"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/chapter\/interprofessional-collaboration-transforming-public-health-through-team-work\/\">Interprofessional collaboration: transforming public health through team work<\/a><\/li>\r\n \t<li><a href=\"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/chapter\/chapter-1\/\">An ounce of prevention: pharmacy applications of the USPSTF guidelines<\/a><\/li>\r\n<\/ul>\r\n<p class=\"import-Normal\"><em>External resources:<\/em><\/p>\r\n\r\n<ul>\r\n \t<li class=\"import-Normal\">Centers for Disease Control and Prevention. Immunization Schedules. <a class=\"rId186\" href=\"https:\/\/www.cdc.gov\/vaccines\/schedules\/index.html\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/schedules\/index.html<\/span><\/a><\/li>\r\n \t<li class=\"import-Normal\">Centers for Disease Control and Prevention. Travelers\u2019 Health. <a href=\"https:\/\/wwwnc.cdc.gov\/travel\">https:\/\/wwwnc.cdc.gov\/travel<\/a><\/li>\r\n \t<li class=\"import-Normal\">Immunization Action Coalition. <a class=\"rId187\" href=\"http:\/\/www.immunize.org\"><span class=\"import-Hyperlink\">http:\/\/www.immunize.org<\/span><\/a><\/li>\r\n \t<li class=\"import-Normal\">Centers for Disease Control and Prevention. Manual for the Surveillance of Vaccine-Preventable Diseases. <a class=\"rId188\" href=\"https:\/\/www.cdc.gov\/vaccines\/pubs\/surv-manual\/index.html\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/pubs\/surv-manual\/index.html<\/span><\/a><\/li>\r\n \t<li class=\"import-Normal\">Centers for Disease Control and Prevention. Community immunity definition.\u00a0<a href=\"https:\/\/www.cdc.gov\/vaccines\/terms\/glossary.html#commimmunity\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/terms\/glossary.html#commimmunity<\/span><\/a><\/li>\r\n<\/ul>\r\n<\/div>\r\n<div class=\"textbox shaded\">\r\n<h3 class=\"import-Normal\"><strong class=\"import-Heading2Char\">References<\/strong><\/h3>\r\n<ol>\r\n \t<li>Oath of a Pharmacist. American Associations of Colleges of Pharmacies. <a class=\"rId190\" href=\"https:\/\/www.aacp.org\/sites\/default\/files\/2018-05\/oath2018.pdf\"><span class=\"import-Hyperlink\">https:\/\/www.aacp.org\/sites\/default\/files\/2018-05\/oath2018.pdf<\/span><\/a>. Updated November 3, 2017. Accessed January 30, 2019.<\/li>\r\n \t<li>ASHP\u00a0guidelines\u00a0on the\u00a0pharmacist's\u00a0role\u00a0in\u00a0immunization. <em>Am J Health <\/em><em>Syst<\/em><em> Pharm<\/em>.\u00a02003;60(13):1371-7.<\/li>\r\n \t<li>Types of Vaccines Authorized to Administer. Immunization Center. APhA. <a class=\"rId191\" href=\"http:\/\/media.pharmacist.com\/practice\/IZ_Authority_012019.pdf\"><span class=\"import-Hyperlink\">http:\/\/media.pharmacist.com\/practice\/IZ_Authority_012019.pdf<\/span><\/a>. Updated January 2019. Accessed January 31, 2019.<\/li>\r\n \t<li>Immunization Schedules. Centers for Disease Control and Prevention. <a class=\"rId192\" href=\"https:\/\/www.cdc.gov\/vaccines\/schedules\/index.html\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/schedules\/index.html<\/span><\/a>. Updated February 6, 2018. Accessed January 31, 2019.<\/li>\r\n \t<li>Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States 2018. Centers for Disease Control and Prevention. <a class=\"rId193\" href=\"https:\/\/www.cdc.gov\/vaccines\/schedules\/hcp\/adult.html\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/schedules\/hcp\/adult.html<\/span><\/a>. Updated April 24, 2018. Accessed January 31, 2019.<\/li>\r\n \t<li>Immunization Schedule for Adults (19 Years of Age and Older). Centers for Disease Control and Prevention. <a class=\"rId194\" href=\"https:\/\/www.cdc.gov\/vaccines\/schedules\/easy-to-read\/adult.html\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/schedules\/easy-to-read\/adult.html<\/span><\/a>. Updated May 2, 2018. Accessed January 31, 2019.<\/li>\r\n \t<li>Resource Library. Immunization Schedules. Centers for Disease Control and Prevention. <a class=\"rId195\" href=\"https:\/\/www.cdc.gov\/vaccines\/schedules\/resource-library\/index.html\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/schedules\/resource-library\/index.html<\/span><\/a>. Updated February 6, 2018. Accessed January 31, 2019.<\/li>\r\n \t<li>Travelers\u2019 Health. Centers for Disease Control and Prevention. <a class=\"rId196\" href=\"https:\/\/wwwnc.cdc.gov\/travel\"><span class=\"import-Hyperlink\">https:\/\/wwwnc.cdc.gov\/travel<\/span><\/a>. Accessed February 6, 2019.<\/li>\r\n \t<li>About Us: The Immunization Action Coalition. Immunization Action Coalitions. <a href=\"http:\/\/www.immunize.org\/aboutus\/\"><span class=\"import-Hyperlink\">http:\/\/www.immunize.org\/aboutus\/<\/span><\/a>. Updated April 17, 2018. Accessed January 31, 2019.<\/li>\r\n \t<li>Handouts for Patients and Staff. Immunization Action Coalition. <a class=\"rId198\" href=\"http:\/\/www.immunize.org\/handouts\/\"><span class=\"import-Hyperlink\">http:\/\/www.immunize.org\/handouts\/<\/span><\/a>. Updated January 27, 2019. Accessed January 31, 2019.<\/li>\r\n \t<li>Ask the Experts. Immunization Action Coalition. <a class=\"rId199\" href=\"http:\/\/www.immunize.org\/askexperts\/\"><span class=\"import-Hyperlink\">http:\/\/www.immunize.org\/askexperts\/<\/span><\/a>. Updated November 5, 2018. Accessed January 31, 2019.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<div class=\"textbox examples\">\r\n<h3>Glossary and Abbreviations<\/h3>\r\n<ul>\r\n \t<li><a href=\"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/front-matter\/glossary\/\">Glossary<\/a><\/li>\r\n \t<li><a href=\"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/front-matter\/abbreviations\/\">Abbreviations<\/a><\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>","rendered":"<h2>Josh Rickard, PharmD, BCPS, CDE<\/h2>\n<h2>Stephanie F James, PhD, MBA<\/h2>\n<h2>Lindsey Childs-Kean, PharmD, MPH, BCPS<\/h2>\n<div class=\"textbox key-takeaways\">\n<h3 class=\"import-Normal\"><strong class=\"import-Heading2Char\">Topic Area<\/strong><\/h3>\n<p class=\"import-Normal\" style=\"text-align: center\">Immunizations<\/p>\n<\/div>\n<div class=\"deciphering-immunization-codes:-making-evidence-based-recommendations\">\n<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<p class=\"import-Normal\">At the end of this case, students will be able to:<\/p>\n<ul>\n<li>Recall the resources available from the CDC pertaining to adult vaccination recommendations<\/li>\n<li>Determine an appropriate vaccination plan using a patient case<\/li>\n<li>Identify important education points to provide to patients during consultations<\/li>\n<\/ul>\n<\/div>\n<h2 class=\"import-Normal\"><strong class=\"import-Heading2Char\">Introduction<\/strong><\/h2>\n<p class=\"import-Normal\">According to the \u2018Oath of the Pharmacist,\u2019 pharmacists promise to devote their lives to others through the pharmacy profession. A major part of this oath is to consider the welfare of humanity and assure optimal outcomes in all patients.<a href=\"#t1\"><sup>1<\/sup><\/a> Although pharmacists may work in different practice settings, each has the opportunity to be a key component of disease prevention by becoming a vaccine advocate.<a href=\"#t2\"><sup>2<\/sup><\/a> Pharmacists can promote the use of vaccines by providing immunization administration services, screening patients in each practice setting, conducting patient counseling, and provide widespread public education regarding vaccine use.<a href=\"#t2\"><sup>2<\/sup><\/a> Although pharmacists are immunizers in every state, it is important to review your state\u2019s laws regarding pharmacist delivered immunization services. Up-to-date information can be found on the American Pharmacists Association\u2019s website.<a href=\"#t3\"><sup>3<\/sup><\/a><\/p>\n<p class=\"import-Normal\">There are many resources the pharmacist can turn to for vaccines schedules and patient education documents. The CDC\u2019s website will link the pharmacist to many different materials for providers and patients regarding many different topics for vaccines.<a href=\"#t4\"><sup>4<\/sup><\/a> One of these documents that the pharmacist should always review are the immunization schedules that are available for children and adults. The CDC has different documents organizing the immunization schedules by age groups or comorbid conditions. They also include documents that outline contraindications, as well as a mobile phone application for quick access to the vaccine schedules.<a href=\"#t5\"><sup>5<\/sup><\/a> The CDC website also has links for more patient-friendly information (including an easy to read schedule) as well as a library of previous immunization schedules, specific changes for each year\u2019s recommendations, and specific Advisory Committee on Immunization Practices\u2019 recommendation.<a href=\"#t6\"><sup>6,7<\/sup><\/a> An emerging role for pharmacists is in travel health, which include the administration of travel vaccinations. The CDC has a comprehensive resource for clinicians to identify the appropriate vaccines each patient needs depending on the country of travel.<a href=\"#t8\"><sup>8<\/sup><\/a><\/p>\n<p class=\"import-Normal\">Another resource available to pharmacists is a website from the Immunization Action Coalition (IAC). The IAC works closely with the CDC to provide information and education to health care providers and the community to increase immunization rates.<a href=\"#t9\"><sup>9<\/sup><\/a> On this website are many documents for both health care providers and patients on many different vaccine related topics including documentation, vaccine hesitancy, temperature logs, promotional material, and much more. There are also educational resources for patients in other languages such as Spanish, Korean, Russian and French.<a href=\"#t10\"><sup>10<\/sup><\/a> A valuable resource included in the website is the \u2018Ask the Experts\u2019 section where experts from the CDC answer questions pertaining to each vaccine, as well as administration, billing, safety, and recommendations.<a href=\"#t11\"><sup>11<\/sup><\/a><\/p>\n<h2 class=\"import-Normal\"><strong class=\"import-Heading2Char\">Case<\/strong><\/h2>\n<div class=\"textbox exercises\">\n<h3>Scenario<\/h3>\n<p>You are a pharmacist in a pharmacotherapy management clinic.<\/p>\n<\/div>\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">CC<\/span>: \u201cThis is my first time here.\u201d<\/p>\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">HPI<\/span>: Michael Smith is a 57 year old male presenting to your clinic.<\/p>\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">PMH<\/span>: T2DM; hypertension; gastroesophageal reflux disease; seasonal allergies<\/p>\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">FH<\/span>:<\/p>\n<ul>\n<li>Mother: HTN, T2DM, died at 71 (NSTEMI)<\/li>\n<li>Father: HLD, COPD<\/li>\n<\/ul>\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">SH<\/span>:<\/p>\n<ul>\n<li>Tobacco: denies<\/li>\n<li>Alcohol: socially, one or two drinks weekly<\/li>\n<\/ul>\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Medications<\/span>:<\/p>\n<ul>\n<li>Metformin 1000 mg PO BID<\/li>\n<li>Atorvastatin 40 mg PO daily<\/li>\n<li>Lisinopril 10 mg PO daily<\/li>\n<li>Cetirizine 10 mg PO daily<\/li>\n<li>Omeprazole 20 mg PO before breakfast<\/li>\n<\/ul>\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Allergies<\/span>: NKDA<\/p>\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Vitals<\/span>:<\/p>\n<ul>\n<li>BP 146\/98<\/li>\n<li>HR 88 bpm<\/li>\n<\/ul>\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Labs<\/span>:<\/p>\n<ul>\n<li class=\"import-Normal\">BMP (fasting)<\/li>\n<li class=\"import-Normal\">Na 142 mmol\/L<\/li>\n<li class=\"import-Normal\">K 4.5 mm\/L<\/li>\n<li class=\"import-Normal\">Cl 102 mmol\/L<\/li>\n<li class=\"import-Normal\">CO<sub>2<\/sub> 27 mmol\/L<\/li>\n<li class=\"import-Normal\">Glucose 153 mg\/dL<\/li>\n<li class=\"import-Normal\">BUN 18 mg\/dL<\/li>\n<li class=\"import-Normal\">SCr 0.97 mg\/dL<\/li>\n<li class=\"import-Normal\">Ca 8.8 mg\/dL<\/li>\n<li class=\"import-Normal\">HgA1c 9.1%<\/li>\n<\/ul>\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Blood count<\/span>:<\/p>\n<ul>\n<li class=\"import-Normal\">WBC 9.2 K\/mcL<\/li>\n<li class=\"import-Normal\">RBC 4.03 M\/mcL<\/li>\n<li class=\"import-Normal\">HGB 14.3 gm\/dL<\/li>\n<li class=\"import-Normal\">Hct 37.2%<\/li>\n<\/ul>\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Liver function<\/span>:<\/p>\n<ul>\n<li class=\"import-Normal\">Alk Phos 80 U\/L<\/li>\n<li class=\"import-Normal\">ALT 20 U\/L<\/li>\n<li class=\"import-Normal\">AST 24 U\/L<\/li>\n<\/ul>\n<p class=\"import-Normal\"><span style=\"text-decoration: underline\">Other information<\/span>:<\/p>\n<ul>\n<li class=\"import-Normal\">10 year ASCVD Risk: 15.3%<\/li>\n<li class=\"import-Normal\">Vaccination history per state registry: none<\/li>\n<\/ul>\n<h2 class=\"import-Normal\"><strong>Case Questions<\/strong><\/h2>\n<p class=\"import-Normal\">1. One of the first items you evaluate in your clinic are the vaccinations each patient is eligible to receive. Using the most recent vaccine CDC schedule, which vaccines would the patient be eligible to receive?<\/p>\n<p class=\"instructor-notes\"><em>Pneumococcal polysaccharide vaccine (PPSV23, <\/em><em>Pneumovax<\/em><em> 23<\/em><sup><em>\u00ae<\/em><\/sup><em>), recombinant zoster (Shingrix<\/em><sup><em>\u00ae<\/em><\/sup><em>), <\/em><em>Tdap<\/em><em>, Influenza, Hepatitis B series<\/em><\/p>\n<p class=\"import-Normal\"><span style=\"color: #000000\"><span style=\"font-size: 1rem;text-align: initial\">2. What if the patient was 67 years old? What vaccines would you screen for?<\/span><\/span><\/p>\n<\/div>\n<div class=\"deciphering-immunization-codes:-making-evidence-based-recommendations\">\n<p class=\"instructor-notes\"><em>Pneumococcal conjugate vaccine (PCV13, <\/em><em>Prevnar<\/em><em> 13<\/em><sup><em>\u00ae<\/em><\/sup><em>) followed by a Pneumococcal polysaccharide vaccine (PPSV23, <\/em><em>Pneumovax<\/em><em> 23<\/em><sup><em>\u00ae<\/em><\/sup><em>) one year later, <\/em><em>Tdap<\/em><em>, Influenza, and zoster<\/em><\/p>\n<p class=\"import-Normal\">3. The patient is interested in receiving the above vaccines, but states that he is concerned with overwhelming his immune system. How would you respond to this patient?<\/p>\n<p class=\"instructor-notes\"><em>Multiple vaccinations can be administered simultaneously on the same day but at different sites, with few exceptions, without altering the immune response.<\/em><\/p>\n<p class=\"import-Normal\">4. The patient found his immunization record from his previous primary care provider. According to his immunization record, he has received one dose of the hepatitis B vaccine two years ago. How should you proceed with finishing his vaccination series?<\/p>\n<p class=\"instructor-notes\"><em>According to the CDC recommendations, the pharmacist would just start where they left off with the second dose of the vaccine. In this patient, you should give a dose today and then another dose in 5 months to complete the series. There is no need to repeat the first dose.<\/em><\/p>\n<p>5. The patient reports that he will be traveling to Egypt with his family and is curious to what vaccines are recommended prior to his trip. Using the CDC\u2019s travel health database, what vaccines would the pharmacists potentially recommend, depending on the activity of his trip?<\/p>\n<p class=\"instructor-notes\"><em>Hepatitis A, Hepatitis B, Yellow Fever, Typhoid, and Rabies<\/em><\/p>\n<p>6. A physician in your clinic asks you if patients taking methotrexate for rheumatoid arthritis are eligible to receive Zostavax<sup>\u00ae<\/sup>. How would you answer this?<\/p>\n<p class=\"instructor-notes\"><em>Generally, patients with immunosuppression, generally, should not receive live vaccines until the patient becomes immunocompetent according to the ACIP\u2019s recommendations. However, if the patient is using low-dose immunosuppressive therapy, the ACIP recommends the patient to receive the vaccine. According to the IDSA, low dose immunosuppression of methotrexate would be considered \u22640.4mg\/kg\/week. If the patient is taking higher doses, the recombinant vaccine (Shingrix<\/em><sup><em>\u00ae<\/em><\/sup><em>) should be recommended.<\/em><\/p>\n<h2 class=\"import-Normal\"><strong class=\"import-Heading2Char\">Author Commentary<\/strong><\/h2>\n<p class=\"import-Normal\">Pharmacists are well respected and easily accessible, particularly those involved in community pharmacy. Hence, they often function as a first resource for many people and parents and serve, not only to counsel patients on current medications, but also to suggest over-the-counter products for common ailments such as fever and sore throat. Because some infectious diseases may initially present with mild symptoms common among many infections, it is imperative that pharmacists are aware of which diseases are endemic or circulating in the community, so they may ask relevant questions to assess disease exposure and vaccination status. Such conversations between the pharmacist and patient may result in patients receiving appropriate referrals and care to further prevent spread of vaccine-preventable diseases.<\/p>\n<h2 class=\"import-Normal\"><strong class=\"import-Heading2Char\">Patient Approaches and Opportunities<\/strong><\/h2>\n<p class=\"import-Normal\">As pharmacists, it is important to consider the impact of infectious disease on the lives of our patients. Regardless of practice site, pharmacists can screen patients for immunizations for which they are eligible, recommend and counsel patients regarding the importance of immunization, educate on vaccine safety, and discuss concerns regarding myths related to vaccination. Pharmacists are uniquely positioned to provide immunization services within community pharmacies and outpatient clinics and should utilize opportunities to promote immunization and public health whenever possible.<\/p>\n<div class=\"textbox key-takeaways\">\n<h3>Important Resources:<\/h3>\n<p class=\"import-Normal\"><em>Related chapters of interest:<\/em><\/p>\n<ul>\n<li><a href=\"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/chapter\/interprofessional-collaboration-transforming-public-health-through-team-work\/\">Interprofessional collaboration: transforming public health through team work<\/a><\/li>\n<li><a href=\"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/chapter\/chapter-1\/\">An ounce of prevention: pharmacy applications of the USPSTF guidelines<\/a><\/li>\n<\/ul>\n<p class=\"import-Normal\"><em>External resources:<\/em><\/p>\n<ul>\n<li class=\"import-Normal\">Centers for Disease Control and Prevention. Immunization Schedules. <a class=\"rId186\" href=\"https:\/\/www.cdc.gov\/vaccines\/schedules\/index.html\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/schedules\/index.html<\/span><\/a><\/li>\n<li class=\"import-Normal\">Centers for Disease Control and Prevention. Travelers\u2019 Health. <a href=\"https:\/\/wwwnc.cdc.gov\/travel\">https:\/\/wwwnc.cdc.gov\/travel<\/a><\/li>\n<li class=\"import-Normal\">Immunization Action Coalition. <a class=\"rId187\" href=\"http:\/\/www.immunize.org\"><span class=\"import-Hyperlink\">http:\/\/www.immunize.org<\/span><\/a><\/li>\n<li class=\"import-Normal\">Centers for Disease Control and Prevention. Manual for the Surveillance of Vaccine-Preventable Diseases. <a class=\"rId188\" href=\"https:\/\/www.cdc.gov\/vaccines\/pubs\/surv-manual\/index.html\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/pubs\/surv-manual\/index.html<\/span><\/a><\/li>\n<li class=\"import-Normal\">Centers for Disease Control and Prevention. Community immunity definition.\u00a0<a href=\"https:\/\/www.cdc.gov\/vaccines\/terms\/glossary.html#commimmunity\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/terms\/glossary.html#commimmunity<\/span><\/a><\/li>\n<\/ul>\n<\/div>\n<div class=\"textbox shaded\">\n<h3 class=\"import-Normal\"><strong class=\"import-Heading2Char\">References<\/strong><\/h3>\n<ol>\n<li>Oath of a Pharmacist. American Associations of Colleges of Pharmacies. <a class=\"rId190\" href=\"https:\/\/www.aacp.org\/sites\/default\/files\/2018-05\/oath2018.pdf\"><span class=\"import-Hyperlink\">https:\/\/www.aacp.org\/sites\/default\/files\/2018-05\/oath2018.pdf<\/span><\/a>. Updated November 3, 2017. Accessed January 30, 2019.<\/li>\n<li>ASHP\u00a0guidelines\u00a0on the\u00a0pharmacist&#8217;s\u00a0role\u00a0in\u00a0immunization. <em>Am J Health <\/em><em>Syst<\/em><em> Pharm<\/em>.\u00a02003;60(13):1371-7.<\/li>\n<li>Types of Vaccines Authorized to Administer. Immunization Center. APhA. <a class=\"rId191\" href=\"http:\/\/media.pharmacist.com\/practice\/IZ_Authority_012019.pdf\"><span class=\"import-Hyperlink\">http:\/\/media.pharmacist.com\/practice\/IZ_Authority_012019.pdf<\/span><\/a>. Updated January 2019. Accessed January 31, 2019.<\/li>\n<li>Immunization Schedules. Centers for Disease Control and Prevention. <a class=\"rId192\" href=\"https:\/\/www.cdc.gov\/vaccines\/schedules\/index.html\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/schedules\/index.html<\/span><\/a>. Updated February 6, 2018. Accessed January 31, 2019.<\/li>\n<li>Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States 2018. Centers for Disease Control and Prevention. <a class=\"rId193\" href=\"https:\/\/www.cdc.gov\/vaccines\/schedules\/hcp\/adult.html\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/schedules\/hcp\/adult.html<\/span><\/a>. Updated April 24, 2018. Accessed January 31, 2019.<\/li>\n<li>Immunization Schedule for Adults (19 Years of Age and Older). Centers for Disease Control and Prevention. <a class=\"rId194\" href=\"https:\/\/www.cdc.gov\/vaccines\/schedules\/easy-to-read\/adult.html\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/schedules\/easy-to-read\/adult.html<\/span><\/a>. Updated May 2, 2018. Accessed January 31, 2019.<\/li>\n<li>Resource Library. Immunization Schedules. Centers for Disease Control and Prevention. <a class=\"rId195\" href=\"https:\/\/www.cdc.gov\/vaccines\/schedules\/resource-library\/index.html\"><span class=\"import-Hyperlink\">https:\/\/www.cdc.gov\/vaccines\/schedules\/resource-library\/index.html<\/span><\/a>. Updated February 6, 2018. Accessed January 31, 2019.<\/li>\n<li>Travelers\u2019 Health. Centers for Disease Control and Prevention. <a class=\"rId196\" href=\"https:\/\/wwwnc.cdc.gov\/travel\"><span class=\"import-Hyperlink\">https:\/\/wwwnc.cdc.gov\/travel<\/span><\/a>. Accessed February 6, 2019.<\/li>\n<li>About Us: The Immunization Action Coalition. Immunization Action Coalitions. <a href=\"http:\/\/www.immunize.org\/aboutus\/\"><span class=\"import-Hyperlink\">http:\/\/www.immunize.org\/aboutus\/<\/span><\/a>. Updated April 17, 2018. Accessed January 31, 2019.<\/li>\n<li>Handouts for Patients and Staff. Immunization Action Coalition. <a class=\"rId198\" href=\"http:\/\/www.immunize.org\/handouts\/\"><span class=\"import-Hyperlink\">http:\/\/www.immunize.org\/handouts\/<\/span><\/a>. Updated January 27, 2019. Accessed January 31, 2019.<\/li>\n<li>Ask the Experts. Immunization Action Coalition. <a class=\"rId199\" href=\"http:\/\/www.immunize.org\/askexperts\/\"><span class=\"import-Hyperlink\">http:\/\/www.immunize.org\/askexperts\/<\/span><\/a>. Updated November 5, 2018. Accessed January 31, 2019.<\/li>\n<\/ol>\n<\/div>\n<div class=\"textbox examples\">\n<h3>Glossary and Abbreviations<\/h3>\n<ul>\n<li><a href=\"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/front-matter\/glossary\/\">Glossary<\/a><\/li>\n<li><a href=\"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/front-matter\/abbreviations\/\">Abbreviations<\/a><\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-106\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li><strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/\">CC BY-NC: Attribution-NonCommercial<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section>","protected":false},"author":53384,"menu_order":13,"template":"","meta":{"_candela_citation":"[{\"type\":\"original\",\"description\":\"\",\"author\":\"\",\"organization\":\"\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by-nc\",\"license_terms\":\"\"}]","CANDELA_OUTCOMES_GUID":"","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-106","chapter","type-chapter","status-publish","hentry"],"part":3,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/wp-json\/pressbooks\/v2\/chapters\/106","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/wp-json\/wp\/v2\/users\/53384"}],"version-history":[{"count":10,"href":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/wp-json\/pressbooks\/v2\/chapters\/106\/revisions"}],"predecessor-version":[{"id":319,"href":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/wp-json\/pressbooks\/v2\/chapters\/106\/revisions\/319"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/wp-json\/pressbooks\/v2\/parts\/3"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/wp-json\/pressbooks\/v2\/chapters\/106\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/wp-json\/wp\/v2\/media?parent=106"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/wp-json\/pressbooks\/v2\/chapter-type?post=106"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/wp-json\/wp\/v2\/contributor?post=106"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-public-health-in-pharmacy-practice\/wp-json\/wp\/v2\/license?post=106"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}