Introduction
Healthcare professionals who administer vaccinations play a key role in maintaining public health. Vaccines are responsible for saving between 2 and 3 million lives annually. Despite their proven effectiveness in preventing the spread of disease, there is significant room for improvement in the United States.
Studies have shown that approximately 12% of parents refuse to allow their child to have at least one recommended childhood vaccine, and over 30% of parents delay one or more childhood vaccines, putting their children at risk of vaccine-preventable diseases at a time when they are most vulnerable.
In addition, less than 45% of adults receive the recommended flu vaccine annually (US Department of Health and Human Services, 2021).
Importance of Vaccination
High vaccination rates are required to create the ‘herd immunity’ necessary to protect individuals and the community from vaccine-preventable diseases. To ensure high vaccination rates, the community must have trust in vaccinations. Vaccine confidence represents the public’s trust in vaccines, vaccine providers, and the vaccine development, licensure, and recommendation process.
Low vaccine confidence can result in patients being more likely to delay or refuse recommended vaccinations. Vaccine providers are responsible for supporting public confidence in vaccines to prevent vaccine-preventable diseases from re-emerging (US Department of Health and Human Services, 2021). Appropriate administration of immunizations is critically important to ensure vaccines are safe and effective and therefore plays a crucial role in maintaining public vaccine confidence.
Vaccine administration errors can erode public confidence in vaccines, so healthcare professionals involved in vaccine administration should be thoroughly trained to follow guidance from the Centers for Disease Control and Prevention (CDC) and facility protocols on vaccine delivery. Ensuring vaccines are administered properly can significantly impact public health and prevent disease spread (US Department of Health and Human Services, 2021).
Preparing to Administer a Vaccination
Determine Which Vaccinations the Patient Needs:
- Assessing Vaccination History:
Providers should assess the patient’s immunization history before administering any vaccinations to a patient. This allows the provider to determine what vaccinations are necessary for a given patient and administer as many required vaccines in one visit as possible.
If the patient’s vaccination record is unavailable, vaccines indicated for the patient’s age, medical condition, and other risk factors should be administered to avoid missed vaccination opportunities (CDC, 2021).
- Provider’s role in vaccination:
Healthcare providers have a responsibility to educate patients on the importance of vaccination. Studies have shown that a strong recommendation from a healthcare provider on immunization leads to a patient being four to five times more likely to receive a vaccination. Using presumptive language is an effective method for initiating vaccine conversations.
Starting the conversation with strong language, such as “You need two vaccines today” rather than asking “Are you interested in receiving vaccines today?” can result in significantly more parents choosing to vaccinate their children (CDC, 2021).
- Vaccination Schedules in the US:
In the United States, vaccines are typically given as recommended by the Advisory Committee on Immunization Practices (ACIP). The vaccine schedule published by the ACIP is designed to be used as a tool to help patients, parents, and providers make sure that protection against disease is initiated when patients are most vulnerable.
The vaccine schedules take into account the burden and timing of vaccine-preventable illnesses and the immunogenicity of the vaccines used to prevent them. Two schedules are available – one for children from birth to 18 years of age and one for adults. The vaccine schedules are updated annually to incorporate new evidence that arises.
- What would you do?
Jeremy, who is two weeks shy of his fourth birthday, is in your office for a standard physical. His chart shows that he has had all age-appropriate immunizations, the exam shows that he is in good health, and Jeremy’s mother reports that he is enjoying and doing well in preschool.
Jeremy’s mother is concerned that there have been measles outbreaks reported in several preschools and elementary schools in your city and asks if it would be possible to give Jeremy his second dose of the mumps measles-rubella vaccine even though he is not quite four. How do you respond? – See recommendations on the next slide.
Solution:
CDC Recommendations:
CDC recommends all children get two doses of MMR vaccine starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Children can receive the second dose earlier as long as it is at least 28 days after the first dose. Most of the vaccines recommended in the immunization schedules require two or more doses to initiate an adequate immune response.
Evidence has shown that following the recommended intervals between doses and the recommended ages to administer them provides the best immune protection available from the vaccinations. In general, reducing the timing between doses can prevent the adequate development of an immune response. There are, however, a few exceptions to this rule. For example, vaccine doses given up to 4 days before the minimum dosing interval or age is reached are considered valid; this can help reduce missed opportunities to vaccinate.
Doses given five days or more before the minimum dosing interval or age should be regarded as invalid and must be repeated when appropriate. Earlier ages or shorter intervals are also acceptable when patients need to be brought up to date quickly; for example, administering a second measles mumps rubella vaccine to a patient before age four due to a measles outbreak (CDC, 2021).
There are also times when scheduled vaccine doses are administered late. Late doses should be given at the next available clinic visit. Research shows that longer than recommended intervals between vaccine doses do not affect the overall immune response when the schedule is completed. This means restarting the vaccine series or administering additional doses of any vaccine is unnecessary if the patient is late (CDC, 2021).
Screening Patients
Before administering vaccines, patients should be screened for contraindications and precautions using standardized screening tools. It is important to screen patients every time vaccines are given, even if they received the same vaccine previously, because their health status or allergies may have changed since the last dose. Using screening tools before vaccine administration helps prevent adverse reactions, such as anaphylaxis (CDC, 2021).
Screening is commonly completed using questionnaires that are given to the patient to fill out before vaccination. The Immunization Action Coalition (2022) recommends asking patients 11 core questions before administering immunizations to prevent adverse events from occurring:
- Are you sick today? While there have not been any studies showing that illness decreases the efficacy of vaccines or increases adverse events, patients with moderate to severe acute infections should delay vaccination until they have improved. This will ensure that if adverse events occur, they can be isolated from illnesses. Mild illnesses are not considered contraindications to vaccinations, and patients receiving antibiotics should not be denied vaccinations.
- Do you have any allergies to vaccine components, latex, medications, or food?
- Have you ever had a serious reaction after receiving a vaccination? Patients who have experienced anaphylactic reactions to vaccines or vaccine components, including latex, should not receive these products in an outpatient setting. It may be appropriate to administer these in a controlled, supervised medical setting after approval by their provider. Those who have skin reactions to latex should only receive vaccines that do not contain latex as a part of their packaging and should only receive bandages that do not contain latex.
- Do you have a chronic lung, heart, or kidney condition, or have asthma, diabetes, a blood disorder, no spleen, a cochlear implant, a spinal fluid leak, a complement component deficiency, or take aspirin daily? These medical conditions are considered precautions for certain vaccines; the manufacturer’s package insert should be consulted before administration to verify if it is appropriate to administer the vaccine.
- Do you have an immune system condition such as cancer, leukemia, or HIV/AIDS? Patients with compromised immune systems typically have a contraindication to receiving live virus vaccines.
- Do you have a sibling or parent with an immune system condition? Certain vaccines, such as measles, mumps, rubella, or varicella, should not be given to patients with a family history of hereditary or congenital immunodeficiency.
- In the past three months, have you taken medications affecting your immune system, such as prednisone, steroids, chemotherapy, or radiation? Patients on high doses of steroids, or those taking chemotherapy or radiation treatments, should generally delay vaccination with live virus vaccines until therapy has ended.
- Have you had a seizure, brain disorder, or other nervous system condition? Patients with a history of certain nervous system conditions, such as encephalopathy caused by a vaccine, should avoid revaccination with that product.
- Have you received a blood transfusion or immune globulin treatment in the past year? Some live virus vaccines should be delayed in patients with a recent history of these treatments.
- For women: Are you pregnant or planning to become pregnant in the next month? Live virus vaccines should not be given to pregnant women or within one month before pregnancy due to potential risks to the baby.
- Have you received any vaccines in the last 28 days? Patients who received a live virus vaccine in the past 28 days should wait before receiving another live virus vaccine.
