2014 APhA Pharmacy-Based

IMMUNIZATION DELIVERY

IMMUNIZATION DELIVERY

A National Certificate Training Program

Module 1. Pharmacists, Vaccines, and Public Health

© 2014, American Pharmacists Association. All rights reserved.

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A Brief History of Vaccines

Learning Objectives Most histories of vaccination trace their roots to Edward Jenner,
who developed a vaccine that could protect against smallpox
At the completion of this activity, participants will be able to: in the late 1700s (although there is evidence that vaccination
was performed in other cultures centuries earlier). Jenner tested
1. Describe the effects of immunizations on morbidity his theory that smallpox disease could be prevented by inocu-
and mortality rates of vaccine-preventable diseases in lating people with a related virus. He prevented smallpox by
the United States. inoculating a child with liquid from a cowpox pustule from a
milkmaid and published his work in 1798.3,4
2. Discuss Healthy People 2020 goals for vaccination
rates in the United States.
Jenner’s work paved the way for additional research into
3. Explain the recent expansion of the role of pharma- vaccines, with the first licensed vaccines in the United States
cists as vaccine providers and describe the status of approved in 1914; before that time, other vaccinations had
pharmacists’ authorization to administer vaccines been used without regulatory oversight. These vaccines were
throughout the United States. followed by development of vaccines for a wide range of
diseases (Table 1.1).3,4 Following the introduction of single-
4. Describe strategies for pharmacists to advocate for agent vaccines, many combination vaccines have been
pharmacy-based delivery of vaccines. developed, such as the DTP vaccine, which protects against
diphtheria, tetanus, and pertussis. Newer versions of vaccines
5. Discuss the role of pharmacists as immunizers in also have been developed and in many cases have replaced
emergency preparedness activities. the originally introduced versions.3,4 For a more complete
history of vaccines, visit www.immunize.org/timeline and
6. Identify resources that are useful for immunization www.historyofvaccines.org/content/timelines/all.
providers and educators.

Impact of Vaccines
In the early to mid 1900s, people lived in fear of being
Vaccines and Public Health stricken with polio, diphtheria, smallpox, tetanus, and other
Immunizations are considered one of the greatest public health devastating diseases. With the licensure of the combined
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
Death Rate per 100,000 Population per Year

public health achievements have contributed to this

Have Health Influenza Pandemic
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
influenza pandemic, which resulted in 20 million Last Human-to-Human
Transmission of Plague
deaths, including 500,000 in the United States.2
First Use
400 of Penicillin
Immunization programs in the United States during First Continuous Salk Vaccine
the past century have nearly eliminated many of the Municipal Use Introduced
vaccine-preventable diseases that were once common.2 of Chlorine in Passage of Vaccination
200
Water in the Assistance Act
In fact, routine vaccinations have prevented so much United States
disease and averted so many deaths that many people
may not even be aware of the devastation that can 0
be caused by vaccine-preventable diseases. Despite the 1900 1920 1940 1960 1980 2000
Year
current successes, it is only through ongoing immunization
Source: Reference 2.
efforts that these diseases will remain under control.

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diphtheria and tetanus toxoids and pertussis vaccine in 1949, been renewed continuously and now supports the purchase
state and local health departments instituted vaccination and administration of a full range of childhood vaccines.3,4
programs that helped increase the distribution of vaccines.
In 1955, the introduction of the Salk poliovirus vaccine led Table 1.2 highlights accomplishments of vaccination efforts
to federal funding of state and local childhood vaccination in the United States, comparing the recent number of
programs. In 1962, a federally coordinated vaccination cases with the historical peak number of cases for selected
program was established through the passage of the diseases.5-7 In addition to decreasing the number of cases
Vaccination Assistance Act—landmark legislation that has 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
Table 1.1. Year of Vaccine Introduction
in Table 1.2, there has been a recent resurgence of pertussis
Year Disease and there continue to be outbreaks of measles and mumps in
1798 Smallpoxa this country.
1914 Rabies, tetanus, typhoid
1915 Pertussis To date, smallpox is the only disease that has been eradicated
1923 Diphtheria from the planet, allowing vaccination to be discontinued.
1935 Yellow fever
Smallpox was a devastating disease—approximately 30% of
those who contracted smallpox died and those who survived
1945 Influenza
were often scarred or blinded. After the development of
1955 Polio
the process of vaccination to prevent smallpox disease, the
1963 Measles
smallpox vaccine gradually reduced the viral menace around
1967 Mumps the world. Even so, 10 million people contracted smallpox
1971 MMR (including measles, mumps, and rubella) worldwide in 1966, which resulted in 2 million deaths. A
1974 Meningococcal concerted global vaccination effort wiped out the virus
1977 Pneumococcal completely, and the World Health Organization declared
1981 Hepatitis B the global eradication of smallpox in 1980. In addition to
1985 Haemophilus influenzae type b avoiding the human toll of this disease, health care expen-
1995 Hepatitis A, varicella
ditures of $1 billion each year have been avoided because
there is no longer any need to routinely vaccinate people
1998 Rotavirus
against smallpox.8
2006 Herpes zoster, human papillomavirus
a Not licensed in the United States until later.
Vaccines are incredibly cost-effective preventive health
Source: References 3 and 4.
services. In addition to saving lives, vaccines prevent illness

Table 1.2. Rates of Selected Vaccine-Preventable Diseases in the 21st Century—United States

Cases Cases Cases Cases

Disease Max. Cases Year
2009 2010 2011 2012

Diphtheria 206,939 1921 0 0 0 0

Haemophilus influenzae type b ~20,000 1980s 35 23 14 21
Measles 894,134 1941 71 63 222 55
Mumps 152,209 1968 1,991 2,612 404 199
Pertussis 265,209 1934 16,858 27,550 18,719 41,880
Paralytic poliomyelitis 21,269 1952 0 0 0 0

Rubella 2.5 million 1964– 3 5 4 8

Congenital rubella syndrome ~30,000 1965 2 0 0 2
Tetanus 601 1948 18 26 36 36
Varicella 221,983 1984 20,480 15,427 14,513 11,477
Source: References 5–7.

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and reduce costs. It has been estimated that for each birth Current Vaccination Rates
cohort vaccinated with the routine vaccination schedule in the Due to several national programs and concerted efforts to
United States9: fully immunize children, immunization rates for young children
• 33,000 lives are saved. are high in the United States. In 2012, rates were 90% or
greater for children aged 19 to 35 months for many of the
• 14 million cases of disease are prevented.
routinely recommended childhood vaccinations, although
• $9.9 billion of direct health care costs are reduced. room for improvement remains (Table 1.3).11
• $33.4 billion of indirect costs are saved.
While childhood immunization rates are reasonably
Despite the successes of vaccination efforts across the United high, vaccination rates for adolescents vary. For some
States, risks remain. More than 40,000 U.S. adults die each vaccines, such as hepatitis B, vaccination coverage is
year from vaccine-preventable diseases, such as influenza or above 90%. For others, such as human papillomavirus
pneumococcal diseases, or complications from the diseases, (HPV), vaccination rates remain disappointing (Table 1.4).12
such as pneumonia.9 Increasing vaccination rates could help
reduce the toll from these illnesses. Table 1.3. Vaccination Rates in U.S. Children
19–35 Months of Age—2011
Importantly, many diseases that are rare in the United States Vaccine Rate
remain endemic in other parts of the world. International
Diphtheria, tetanus, pertussis (4+ doses DTP, DT, or DTaP) 83%
travelers may contract diseases overseas and infect unvac-
cinated or under-vaccinated individuals upon their return to Polio (3+ doses) 93%
the United States, resulting in an outbreak.10 For example, Measles, mumps, and rubella (1+ doses) 91%
worldwide, there are estimated to be 20 million cases of Haemophilus influenzae type b (primary series + booster dose) 81%
measles and 164,000 measles-related deaths each year;
Hepatitis B (3+ doses) 90%
several recent measles outbreaks in the United States have
been traced to international travelers. Varicella (1+ doses) 90%
Pneumococcal conjugate vaccine (4+ doses) 82%
In 2011, there were 222 measles cases in the United States
Hepatitis A (2+ doses) 53%
that arose from 16 different outbreaks of 3 to 21 cases per
Rotavirus (2+ doses) 69%
outbreak. Of these cases, 39% occurred in individuals older
than 20 years of age and 14% were in those younger than Source: Reference 11.

1 year of age, who were too young to be vaccinated. It is

Table 1.4. Vaccination Rates in U.S. Adolescents
important to note that in 84% of these cases, the individuals
13–17 Years of Age—2011 and 2012
were unvaccinated or their status was unknown. The same
year, there were 28,000 cases of measles in Europe. Vaccine
2011 2012
(N = 23,564) (N = 19,199)
Additionally, there were a total of 6,584 mumps cases
reported in 2006 in the United States. Tdap ≥1 dose after age 10 years 78.2% 84.6%
Meningococcal ≥1 dose 70.5% 74.0%
The number of pertussis cases in the United States is increasing
Human papillomavirus coverage
with the highest incidence in infants. In 2012, there were
Females ≥1 dose 53.0% 53.8%
more than 40,000 cases of pertussis reported, resulting in the
Males ≥1 dose 8.3% 20.8%
deaths of 14 infants, who were too young to be vaccinated.
These recent outbreaks of measles, mumps, and pertussis Measles, mumps, and rubella
91.1% 91.4%
demonstrate that vulnerability to these diseases still exists, ≥2 doses
highlighting the need for continued vaccination efforts. Hepatitis B ≥3 doses 92.3% 92.8%
Varicella among adolescents with
no history of disease
92.3% 94.7%
≥1 dose
68.3% 74.9%
≥2 doses

Tdap = tetanus and diphtheria toxoids and acellular pertussis.

Source: Reference 12.

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Rates are also suboptimal in adults, leaving many patients science-based, 10-year national objectives for improving
vulnerable to vaccine-preventable diseases (Table 1.5).13 the health of all Americans. Healthy People 2020 provides
Notably, vaccination rates are lower for minorities than measurable objectives and goals intended to promote
they are for whites. high-quality, longer lives free of preventable disease,
disability, injury, and premature death. Table 1.6 shows the
Target vaccination rates have been established by Healthy Healthy People 2020 goals for selected adult vaccination
People 2020, a national public health initiative that provides parameters along with baseline data from 2008.9

Table 1.5. Vaccination Rates in U.S. Adults—2011

Vaccine (Target Group) Vaccination Rate Pharmacists as Immunizers
Pharmacists can advance public health through immunizations
Influenza (aged 50–64 years) 47.2%
in several ways: educating and advocating, facilitating vacci-
Influenza (aged ≥65 years) 64.9% nations by other health care professionals in their pharmacies,
Influenza (HCP) 66.9% and administering vaccines to their patients. Pharmacists
are logical providers of immunization services due to their
Pneumococcal (aged ≥65 years) 64.5%
accessibility and role as medication experts and experience
Pneumococcal (aged 19–64 years, high risk) 20.1%
providing high-quality patient care services.
Tdap in past 6 years (aged 19–49 years) 12.5%
Tdap (HCP) 2005–2011 26.8%
Hepatitis B (≥3 doses, aged 19–49 years) 35.9%
A Brief History of Pharmacists as Vaccine Providers
In the late 1800s and early 1900s, pharmacists supplied
Hepatitis B (HCP) 63.2% physicians with smallpox and other vaccines as well as diphtheria
Human papillomavirus (≥1 dose, females) 21.5% and other antitoxins. In later decades, the profession adopted
Herpes zoster (aged ≥60 years) 15.8% several roles involving immunizations: storage, preparation,
HCP = health care personnel; Tdap = tetanus and diphtheria toxoids and
distribution, and education.14 This early involvement of
acellular pertussis. pharmacists with immunology was short-lived and few pharmacists
Source: Reference 13. administered immunizations during much of the 1900s.

Table 1.6. Healthy People 2020 Baseline Data and Vaccination Goals for Adults
Objective Baseline Data Goals 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 90%
nursing homes certified by the Centers for Medicare
and Medicaid Services reported having up-to-date
pneumococcal vaccinations in 2006
Increase the percentage of adults vaccinated against zoster
7% of adults aged ≥60 years reported having ever 30%
received zoster (shingles) vaccine in 2008
Source: Reference 9.

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The end of the 20th century saw a slow return of pharmacists • Pharmacists can identify specific people who need
to vaccine advocacy and delivery (Figure 1.2).14-24 While there vaccines based on knowledge of the patient medication
were pockets of activity at the state level, a major meeting history or patient-specific disease-related risk factors.
in 1994 stimulated a rethinking of the role of pharmacists. • Pharmacists can offer a useful bridge between patients
The meeting was initiated when the U.S. Secretary of Health and physicians by identifying an individual patient’s
and Human Services (HHS), Donna Shalala, contacted the needs and facilitating referrals to health care providers
American Pharmacists Association (APhA) to examine ways when appropriate.
that pharmacists could help the country increase immunization
rates. This led to the development of a model national immuni- • Pharmacists can offer extended hours of access in the
zation program for teaching pharmacists to immunize. Within evening, on the weekends, and during holidays, if
a year, more than 1,000 pharmacists across the country had immunizations are offered at those times.
been taught to immunize through the APhA program. • Pharmacists are often located in local neighborhoods,
providing convenient access for most patients.
In 1996, at APhA’s Annual Meeting and Exposition, the • Pharmacists are adept at electronic communications and
Association called on pharmacists to get involved with can offer computerized records, facilitating the delivery
immunizations. At the time, there were many more restric- of documentation.
tions on pharmacists’ ability to immunize than there are today.
• Most pharmacies are capable of billing Medicare and
APhA emphasized that all pharmacists, regardless of setting, can
other third-party payers for the vaccine product as well
be involved in immunization advocacy and host others in the
as administration of the vaccine.
pharmacy. This remains true today. Many pharmacists are actively
involved in administering a wide range of vaccines. In situations
Because of these benefits, pharmacists can help to improve
where pharmacists cannot administer vaccines themselves,
immunization rates. Research conducted when pharma-
they can educate patients and caregivers about the benefits of
cists began to offer influenza vaccinations found that
vaccines, and work to facilitate immunizations for patients.
overall vaccination rates improved. For example, a study
that compared changes in influenza vaccination rates in
In August 1997, the APhA Board of Trustees adopted guide-
states that allowed pharmacists to immunize and those that
lines for pharmacy-based immunization advocacy and admin-
did not allow pharmacists to immunize found that states
istration (Figure 1.3).25 APhA’s certificate training program,
allowing pharmacists to immunize have higher influenza
Pharmacy-Based Immunization Delivery, is a national certificate
vaccination rates.29 This study also found that the growth of
program for pharmacists that has been designed around these
immunization rates was the same or greater in states where
guidelines. As of 2013, more than 230,000 pharmacists have
pharmacists immunize (Table 1.7).
been trained through the program.
Table 1.7. Effect of Pharmacists as Immunizers
on Influenza Vaccination Rates
Successes of Pharmacy-Based Immunization Delivery
Pharmacists in many health care delivery settings are States That
States
well-positioned to provide vaccination programs and That Did
Allowed
Not Allow P
services.15,26-28 The unique and essential contributions of Pharmacists
Value
Pharmacists
pharmacists to immunization advocacy and delivery include: to Immunize
to Immunize
After 1997
• Pharmacists are repeatedly cited among America’s most After 1997

trusted professionals. Adults aged 18–64 years

• Pharmacists are considered one of America’s most 1995 immunization rate 20.5% 16.6% <.01
accessible health care professionals. 1999 immunization rate 25.5% 21.6% <.01
Overall change 5.0% 5.0%
• Pharmacists have received extensive education and training
about medications. Vaccines are medications and pharmacists Adults aged ≥65 years
are responsible for the effective use of all medications. 1995 immunization rate 57.7% 61.2% .10
1999 immunization rate 68.4% 64.7% <.01
• Pharmacists are experienced in product storage,
Overall change 10.7% 3.5%
handling, and safeguarding inventory.
Source: Reference 29.

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Figure 1.2. Historical Perspective of Pharmacy-Based Immunization Delivery

Mid to late Pharmacists supply physicians with smallpox vaccine.

1800s
Pharmacists oversee depots for diphtheria antitoxin. Late 1800s to
early 1900s
Pharmacy-based immunizations on a large scale first
1984 occur through the Colorado Influenza Alert Campaign,
with pharmacies hosting nurses to administer influenza
Pharmacists serve as vaccine advocates and facilitate Mid 1980s vaccine injections.
vaccine delivery by hosting other health care providers to
administer the vaccines in pharmacies. to mid 1990s

Multiple breakthrough events occur: Georgia Pharmacy Association (GPhA) members help
1993 distribute meningococcal vaccine to 22,000 residents of
• More than 70 pharmacists are trained in injection Douglas County, Georgia, during a disease outbreak.
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 APhA and the West Virginia University School
the University of Washington develop a formal training 1994 of Pharmacy partner on a 5-year grant from the
program that leads to a certificate of competence for Centers for Disease Control and Prevention (CDC)
pharmacist immunizers. 1995 to develop the Pharmacy Immunization Project—a
demonstration project that involved nurses from public
• The American Pharmacists Association (APhA) is health departments immunizing children and adults in
approached by the U.S. Secretary of Health and Human community pharmacies.
Services to examine ways that pharmacists can help the
country increase immunization rates, prompting APhA
to adopt immunization within its strategic activities.

APhA partners with the Mississippi Board of Pharmacy, the

Mississippi Pharmacists Association, and the University of
Mississippi to develop a model immunization program for 1996 More than 5 million doses of influenza vaccine are
administered in America’s pharmacies each year. An
teaching pharmacists to immunize.
By year-end estimated 15,000 pharmacies participate in vaccine
advocacy and facilitation. More than 1,000 pharmacists
1997 across the country have been taught to immunize through
One of the most significant recognitions of the role of the the APhA program that was developed in 1996.
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, 2001
FAPhA, is named as the first pharmacist to represent APhA
on ACIP and he continues to serve on the committee.

Through a collaborative effort of multiple organizations,

American College of Physicians–American Society of the Association of State and Territorial Health Officials
Internal Medicine publish a joint position paper supporting
pharmacists as immunization information sources, hosts of
2002 releases a document titled “Operational Framework for
Partnering With Pharmacies for Administration of 2009
immunization sites, and immunizers. H1N1 Vaccine” that serves as a guide for state and
2009­­­­–10 territorial health departments to establish partnerships
with pharmacies to administer vaccinations during the
2009 H1N1 influenza pandemic. Pharmacists administer
More than 230,000 pharmacists and student pharmacists 10% of all H1N1 vaccine doses in the United States and
have been trained through APhA’s Pharmacy-Based By year-end are viewed as a crucial public health asset for their vital
Immunization Delivery, a national certificate program for
pharmacists.
2013 role in the response to the pandemic.

Source: References 14–24.

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Today, pharmacists are widely accepted as providers of pharmacist as immunization information source, host of
vaccines. Patients are satisfied with pharmacists’ services immunization sites, and immunizer, as appropriate and
and believe that pharmacists are appropriate providers of allowed by state law.”33 However, continued advocacy is
vaccines.30-32 In addition, the physician community now needed with organized medicine and other stakeholders to
generally welcomes pharmacists as immunizers. In 2002, support expanded immunization roles for pharmacists.
the American College of Physicians–American Society of
Internal Medicine position paper on the pharmacist’s scope Pharmacists’ accessibility and promotion of vaccines have
of practice stated that their group “supports the use of the had a substantial effect on public health. There are more

Figure 1.3. Guidelines for Pharmacy Immunization Advocacy

Guideline 1. Priority to Prevention • Identify high-risk patients in nursing homes and other facilities
and ensure that needed vaccinations are considered either
Pharmacists should protect their patients’ health by being vaccine
upon admission or in drug regimen reviews.
advocates. Pharmacists should adopt one of three levels of
involvement in vaccine advocacy: Guideline 3. Quality
• Pharmacist as educator (motivating people to be immunized). Pharmacists must achieve and maintain competence to
• Pharmacist as facilitator (hosting others who immunize). administer immunizations. Before administering vaccines,
• Pharmacist as immunizer (protecting vulnerable people, pharmacists should:
consistent with state law). • Be properly trained and evaluated in disease epidemiology,
vaccine characteristics, injection technique, and related topics.
Pharmacists should:
• Be properly trained in emergency responses to adverse events;
• Focus their immunization efforts on diseases that are the
they should provide this service only in settings equipped with
most significant sources of preventable mortality among the
epinephrine and related supplies.
American people, such as influenza, pneumococcal, and
hepatitis B infections. • Question the patients and their families about
contraindications and inform them in specific terms about the
• Routinely determine the immunization status of patients,
risks and benefits of immunization.
then refer patients to the most appropriate provider for
immunization. • Receive additional education and training on current
immunization recommendations, schedules, and techniques at
• Identify high-risk patients in need of targeted vaccines and
least annually.
develop an appropriate immunization schedule.
• Protect themselves and prevent infection of their patients by Guideline 4. Documentation
being appropriately immunized themselves. Pharmacists should document immunizations fully and report
Guideline 2. Partnership important events appropriately. Pharmacists should:
Pharmacists who administer immunizations do so in partnership • Maintain perpetual immunization records and offer a personal
with their community. Pharmacists should: immunization record to each patient.
• Support the immunization advocacy goals and other • Report adverse events following immunization to any
educational programs of health departments in their cities, appropriate primary care provider and to the Vaccine Adverse
counties, and states. Event Reporting System (VAERS).
• Collaborate with community prescribers and health
Guideline 5. Empowerment
departments.
Pharmacists should:
• Assist their patients in maintaining a medical home, including
care such as immunization delivery. • Educate patients about immunizations and respect
patients’ rights.
• Consult with and report immunization delivery, as appropriate,
to primary care providers, state immunization registries [now • Encourage appropriate vaccine use through information
known as immunization information systems], and other campaigns for health care practitioners, employers, and the
relevant parties. public about the benefits of immunizations.
• Identify high-risk patients in hospitals and other institutions and • Educate patients and their families about immunization in
ensure that appropriate vaccination is considered either before readily understood terms.
discharge or in discharge planning. • Document any patient education provided and obtain written
informed consent as recommended in their state before
Source: Reference 25.
immunizing.

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than 62,000 community pharmacies in the United States APhA issues a call for Immunization Champion Award
that offer convenience, accessibility, and extended hours nominations in November, announces winners in February,
of operation for the delivery of clinical services.34,35 The and presents awards at the APhA Annual Meeting and
equivalent of the population of the United States enters Exposition in March.
a pharmacy each week. Pharmacies are geographically
located in places where care is needed, including inner
cities and rural communities. This widespread access has Expanding Opportunities to
been recognized as a benefit by the Centers for Disease
Control and Prevention (CDC).36 Administer Vaccines
Opportunities for pharmacists to administer vaccines have
During the 2010–11 influenza season, it is estimated that expanded over the past few decades regarding locations
pharmacists administered almost 20% of all influenza where pharmacists immunize, types of vaccines administered
vaccines provided to adults in the United States. The by pharmacists, and age-groups to which pharmacists admin-
estimated number of influenza vaccine doses administered ister vaccines.
by pharmacists during the season was between 17 million
and 25 million.37,38 In a 2012 open letter to pharmacists, Opportunities Based on Location
HHS recognized pharmacists’ contributions to public health Opportunities for pharmacists to educate, facilitate, or
and thanked pharmacists for their role in improving immuni- immunize exist at all levels of care. Every pharmacist can
zation rates; (Figure 1.4 shows the first 2 pages of the and should identify patients who are vulnerable to vaccine-
letter).39 In this letter, HHS called upon pharmacists to help preventable diseases and routinely recommend vaccination at
increase immunization rates by helping to raise awareness, every appropriate encounter.
providing vaccines, partnering with other organizations, and
improving collaboration with other health care providers. Initial pharmacy-based vaccination efforts took place in
The complete letter, available at www.pharmacist.com/ community pharmacies. However, pharmacists’ immunization
cdc-and-hhs-request-help-pharmacists-promoting-and- efforts are not limited to community pharmacy sites. Today,
providing-vaccinations, also includes a helpful list of pharmacists administer vaccines in a wide variety of practice
resources for pharmacists. A second letter in 2013, available settings and processes of care such as:
at www.pharmacist.com/cdc-hhs-urge-more-vaccination- • Community pharmacies
coverage, reaffirmed many of the same messages as the
• Ambulatory care clinics
2012 letter.
• Community health centers
Immunization Success Stories • Health systems
Each year, APhA recognizes pharmacists who have made • Long-term care facilities
remarkable contributions to improve vaccination rates in their • Home health care settings
communities through the Immunization Champion Awards.
• Corporate sites
The 2013 award winners achieved many notable accomplish-
ments, including pharmacists who have40 : • Community sites (shopping areas, airports, health fairs,
schools)
• Administered 1,200 influenza vaccines in a rural • Patient-centered medical homes and other innovative
community of only 4,000 residents. care models
• Fully integrated immunization services with medication • MTM encounters
therapy management (MTM) services. • Medication reconciliation
• Conducted flu clinics in low-income housing facilities, • Travel health clinics
retirement facilities, schools, and business.
• Offer an HPV vaccination service at a university’s
student health center.
• Establish student pharmacist–run free influenza vaccine
clinics in underserved areas that have enhanced
collaborations with area health care professionals.

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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

June 26, 2012

Dear Pharmacists and Community Vaccinators,

Thank you all for your tremendous efforts this past year to raise immunization rates in the United States.
Outbreaks of pertussis (“whooping cough”), influenza, and measles, and continued low vaccination rates
for human papillomavirus (HPV), Tdap (tetanus, diphtheria, and pertussis), zoster vaccines and others
are critical reminders of the ongoing efforts that are needed.

Pharmacists and community vaccinators are uniquely positioned to promote and provide vaccines to
people in a wide range of communities. In addition, their extensive reach into diverse communities
allows greater access to vaccines for those who may not have a medical home, and who traditionally
have had lower rates of vaccine use.

The Centers for Disease Control and Prevention (CDC) and the Department of Health and Human
Services (DHHS) ask for your continued support and efforts to help address vaccination needs in your
communities. We know you are asked to do a lot to help your patients, but as trusted health care
professionals, research shows that your recommendation to receive needed vaccines is vital.

As just one example, only about 10 percent of adults living with an infant report having had Tdap
vaccination.1 But, a 2012 survey conducted by Harris Interactive found that 45% of unvaccinated adults
who have been in contact with babies under 2 years in the past 5 years or expect to be in contact with
them in the next 12 months would consider getting Tdap vaccine if a family member asked. However,
83% would consider getting Tdap vaccine if they were asked by their doctor or other healthcare
professional.2 These results underscore the importance of your recommendation for protecting your
patients and their families.

Specifically, CDC and HHS are asking pharmacists and other vaccine providers to:
1. Increase awareness among their patients about recommended vaccines, especially for adults and
adolescents where vaccination rates are lagging.
2. Ensure that the people who visit your pharmacies or clinics are aware of which vaccinations they
need by assessing their vaccine needs and offering those vaccines, e.g.:
a. Offer Tdap vaccine to replace one dose of Td. This is especially important for anyone
who will be around infants given outbreaks of pertussis in the United States.
b. Inform pregnant women that they are recommended to receive Tdap vaccine after week
20 of pregnancy and influenza vaccine anytime during pregnancy.
c. Offer yearly influenza vaccine for everyone 6 months and older.
d. Offer zoster vaccine for adults 60 years and older.
e. Offer pneumococcal polysaccharide vaccine for everyone 65 years and older.
3. For patients with certain medical conditions, recommend and offer vaccinations specifically
recommended based on their high risk conditions, e.g.:

1
Centers for Disease Control and Prevention (CDC). Adult Vaccination Coverage — United States, 2010. Morb Mortal Wkly Rep
2012;61(04);66-72. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a2.htm.
2
Online survey of 4,247 adults ages 18 and older, of whom 237 were parents of children aged 2 and under, conducted by Harris Interactive
on behalf of Sounds of Pertussis®, May 9-11 and May 11-15, 2012.
1
(continued on next page)

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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)

a. Remind patients with diabetes that they need influenza vaccine, pneumococcal
polysaccharide vaccine, and hepatitis B vaccine.
b. Consider targeting immunization messages to patients within your prescription database
based on their medications and/or age.
c. Incorporate immunization reminders to patients and caregivers during counseling and
medication therapy management (MTM) encounters.
4. Enter adult immunizations into vaccine registries (i.e. immunization information systems) in states
where this is possible and provide documentation to the patient (consent form and/or
immunization card) and/or their primary care provider to ensure appropriate recording of
immunizations.
5. Partner with state and local health departments, immunization coalitions, medical providers, and
others in your communities to increase collaboration and outreach to those who need vaccines.

Details about the vaccines recommended for adults and for children can be found at:
http://www.cdc.gov/vaccines and an adult scheduler and “quiz” for patients to find out which vaccines
they may need can be found at http://www.cdc.gov/vaccines/schedules/Schedulers/adult-scheduler.html.
Additional information about pertussis for patients and healthcare professionals can be found at
www.cdc.gov/pertussis/index.html.

Additional links to find contacts for state and local health department immunization programs and
coalitions, and educational resources for vaccine providers and patients are included below.

Thank you, again, for your energy, enthusiasm, and efforts in improving the health of our communities.

Sincerely,

Anne Schuchat, MD
RADM, US Public Health Service
Assistant Surgeon General
Director, National Center for Immunization and Respiratory Diseases

Source: Reference 39.

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Consultant pharmacists can increase immunization delivery in

Vaccine Needs for Travel Health a variety of ways. They can recommend vaccines during drug
Patients traveling abroad often require specific vaccines regimen reviews; encourage mass immunization programs
related to their destination. For training to meet patients’ for residents, staff, and visitors; and administer vaccines.
unique travel-related immunization needs, see APhA’s Federal regulations require all long-term care facilities that
Pharmacy-Based Travel Health Services advanced receive funding from Medicare to offer influenza vaccine to
competency training in the Continuing Education their residents annually and offer pneumococcal vaccine at
section of www.pharmacist.com. least once during each resident’s stay or risk losing federal
funding.41 Consultant pharmacists should take the lead in
helping facilities comply with this regulation, and they can
Opportunities for pharmacists in various settings are support vaccinations for staff and visitors.
numerous. For example, community pharmacists can use
information in their pharmacy database to determine Changes in Medicare rules have made it easier for institu-
immunization needs for individual patients. Pharmacists can tions—both hospitals and nursing homes/long-term care
identify individuals who need vaccines just by completing facilities—to implement standing orders for the administration
a review of the patient’s age, medications, and medical of influenza and pneumococcal vaccine to patients by nurses
history. Patients with chronic diseases such as cardiovascular and pharmacists. The goal of these changes is to improve
disease, chronic lung disease, or diabetes are potential vaccination rates in these high-risk patient populations.
candidates for many vaccines, and these patients can be Notably, Medicare rules recognize pharmacists as one of the
easily identified by the medications they take to manage providers in institutional settings that standing orders should
their disease. (More information about identifying patients empower to administer vaccines.
who require vaccines will be discussed in Module 4.)
Innovative health care delivery models, such as patient-
Patients admitted to hospitals or long-term care facilities centered medical homes and accountable care organizations,
will be cared for by a pharmacist at some point during that reward quality and are moving away from fee-for-service
their stay. These settings provide ample opportunity for payment models have dramatically expanded in recent years
pharmacists to promote, and often provide, immunizations. due to financial pressures and the Affordable Care Act.
Although the institutional setting is different from the Performance-based payment for health care is growing, and
community pharmacy setting, the general roles of pharmacists this payment structure is based on achievement of various
in promoting immunizations are the same: to educate, to quality measures, many of which include vaccination rates.
facilitate, and/or to administer. For example, influenza and pneumococcal vaccination rates
are among the 33 quality measures that are used to assess
Just as community pharmacists can identify vaccine needs accountable care organization performance.42 Immunization
by reviewing a prescription profile, institutional pharmacists rates also are considered by the Healthcare Effectiveness Data
can identify a patient’s vaccination status while conducting and Information Set (HEDIS), which is a set of performance
medication reconciliation upon admission, unit transfer, or measures widely used by the managed care industry and
discharge. They can advocate vaccinations on ward rounds other organizations.43 These developments offer important
and at grand rounds for inpatients or get involved with opportunities for pharmacists to make an impact and assist
discharge planning to ensure patients receive necessary providers, health care teams, and plans meet quality metrics
vaccinations prior to discharge. When allowed by their resulting in enhanced compensation. Pharmacists can work
state pharmacy practice act and employer, institutional to improve immunization rates in their practices to help the
pharmacists can become involved in administering vaccines practices deliver high-quality care.
to patients. Pharmacists in this setting also can supply drug
information about vaccines; provide in-service training for Pharmacists’ patient care services offer excellent opportunities
pharmacy, nursing, or other personnel; and become involved to advocate for immunizations and administer vaccines. Many
in committees concerned with infection control. Other pharmacists regularly consider a patient’s vaccine needs
potential roles include developing policies on vaccination as part of any MTM encounter. Pharmacists who provide
for employees, patients, and visitors. Institutional pharmacists disease-state management services for patients with chronic
should advocate for all health care workers at the site to be conditions such as diabetes and asthma can include an
up to date with their immunizations. assessment of patients’ vaccination status in these efforts.

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Finally, as a profession, pharmacists need to be role models When pharmacists began their immunization activities a
for patients. All pharmacists should receive an annual few decades ago, many states did not allow pharmacists
influenza vaccination and be up to date on their other to immunize. That is no longer the case. As of July 2009,
vaccines unless they have valid medical contraindications. In pharmacists in all 50 states, Puerto Rico, and the District
a survey of influenza vaccination rates of among health care of Columbia have the authority to administer vaccines to
providers during the 2012–13 season, 72.0% of providers varying degrees (Figure 1.5).24 However, state-level limita-
reported that they were vaccinated.44 Coverage rates were: tions on a pharmacist’s authority to immunize remain,
such as restrictions based on the age of the patient or the
• 92.3% among physicians.
type of vaccine being administered; these restrictions are
• 89.1% among pharmacists. subject to change at any time. Pharmacists must check
• 88.5% among nurse practitioners/physician assistants. with their state board of pharmacy before initiating any
immunization service to determine their specific authority
• 84.8% among nurses.
to immunize.
Influenza vaccination coverage was highest among
As of October 2013, pharmacists in 45 states may admin-
hospital-based providers (83.1%) and lowest among
ister any vaccine.24 In other states, pharmacists are limited
providers at long-term care facilities (58.9%). Factors
to certain subsets of vaccines. Pharmacists can administer
associated with increased vaccination rates included
influenza and herpes zoster vaccine in all states; South
on-site vaccination, free vaccination, and vaccination
Dakota is the only state that does not allow pharmacists
offered on multiple days.44
to administer pneumococcal vaccine. Some states allow
pharmacists to administer vaccines under protocol while
Expanding Vaccination Offerings others require a prescription to administer a vaccine. In
Initially, pharmacists’ vaccination efforts focused on seasonal many states, certain vaccines are allowed by protocol but
influenza programs for adults. Today, pharmacists’ services are other vaccines require a prescription.
expanding to offer year-round vaccines across the life span.
Additionally, pharmacists in 22
states may administer vaccines
to patients of any age.24 Other
Figure 1.5. States Authorizing Pharmacists to Administer Influenza Vaccine and
states have age requirements for
Pharmacists Trained to Administer Vaccines
pharmacists’ vaccination authority,
ranging from patients as young as
250,000
5 years of age in North Dakota, to
patients at least 19 years of age in
200,000
Wyoming. Research has found that
parents are supportive of pharma-
cists vaccinating their children
150,000 and that immunization rates for
children increase with pharmacist
involvement.45
100,000
Some states allow student pharma-
cists to administer vaccines if certain
50,000 criteria are met. Common criteria
include that the student must be
trained (e.g., through this certificate
0
training program) and must operate
under the direct supervision of a
trained pharmacist. No state allows
NABP = National Association of Boards of Pharmacy.
a pharmacy technician to admin-
Source: Reference 24.
ister immunizations. State laws and

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regulations are continually changing and pharmacists should stakeholders dedicated to meeting the immunization needs
continually monitor their state rules and regulations. of the patient and protecting the community from vaccine-
preventable diseases.” This conceptual neighborhood
includes a variety of immunization stakeholders who are
Collaborating to Improve working to meet immunization needs of their communities.
Supporting achievement of the immunization neighborhood,
Immunization Rates the HHS National Vaccine Advisory Committee released
In areas where state practice acts continue to pose limitations a new version of the Adult Immunization Standards that
regarding which vaccines pharmacists may administer, all identifies a role for every health care professional, organi-
pharmacies can serve as immunization information centers. zation, and health system (Table 1.8).47
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 Emergency Preparedness and Vaccines
that limit their authority to administer vaccines are encouraged Immunizing pharmacists play a critical role in emergency
to work with the state pharmacy association, board of preparedness efforts. During an emergency, pharmacists may
pharmacy, and colleges of pharmacy to change the state’s be called on to administer vaccines as well as to help with the
pharmacy practice act. Through such change, pharmacists can distribution of medications. For example, during a pandemic,
be in a position to better protect the public’s health. pharmacists can support immunization efforts to protect the
public. Pharmacists also could become involved in immuni-
As barriers to pharmacists’ ability to administer vaccines are zation efforts in the event of a bioterrorism attack with an
removed, pharmacists’ advocacy efforts in other arenas are agent such as anthrax or smallpox. Natural disasters such as
gaining prominence. Pharmacists can explore opportunities to hurricanes or floods also may call for mass vaccinations with
improve public health by advocating for vaccinations using a tetanus vaccines.48
variety strategies including collaborating with other members
of the health care team, becoming involved with state-level The 2009–10 influenza season was complicated by the
efforts, joining immunization coalitions, and partnering with pandemic outbreak of the H1N1 strain of influenza virus.
health departments. (State and local health departments During the 2009 H1N1 influenza pandemic, pharmacies
organize, administer, and maintain vaccine campaigns, regis- played a significant role in serving as vaccine centers for
tries, and educational activities. Immunization coalitions are the administration of H1N1 vaccine. The Association of State
organizations that foster collaboration among stakeholders to and Territorial Health Officials issued a report detailing
increase immunization rates.) opportunities to partner with pharmacists to facilitate the
administration of H1N1 vaccine.49 Pharmacists, working with
The HPV vaccine provides one potential model for pharma- local health departments and the CDC, were identified as
cists’ collaboration with other members of the health care critical public health stakeholders, involved in administering
community to increase vaccination rates. Immunization with vaccines as well as compounding and dispensing antiviral
the HPV vaccine requires a 3-dose series; however, many medication and providing other patient care services. Public
adolescents do not complete the series. The need to schedule access to the vaccine through pharmacies was viewed
an appointment to obtain subsequent doses of the vaccine as a public health asset, particularly during times of the
may be a barrier to immunization by medical providers. If holiday season when traditional providers and public health
the medical provider referred the patient to the pharmacist departments were closed. Pharmacists were responsible for
for the second and third doses, and communicated with the the administration of 10% of all H1N1 vaccine doses that
pharmacist, then the pharmacist could follow-up with the were administered in the United States during the 2009–10
patient to support full immunization.46 influenza season.50

As pharmacists expand their immunization roles, they are Additionally, public confusion surrounding the number of
becoming integrated in the “immunization neighborhood.” required doses of H1N1 vaccine and the target groups for
This term was coined by APhA and is gaining acceptance vaccination compared with the seasonal influenza vaccine
from a broad array of immunization stakeholders. The necessitated patient education for effective vaccination
immunization neighborhood is defined as “collaboration, programs. Pharmacists played a critical role in promoting
coordination, and communication among immunization public health and wellness during this emergency.

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Table 1.8. 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 Provide immunization education and training of members, including trainees
organizations/associations/health Provide resources and assistance to implement protocols and other systems to incorporate vaccine needs
care systems 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.

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Pharmacists who are interested in taking a more active remain current on recommendations from ACIP, and can sign
role in emergency preparedness efforts can join their local up at www.cdc.gov/vaccines/acip/ to receive an e-mail
Medical Reserve Corps (www.medicalreservecorps.gov/ whenever the website is updated. In addition, APhA conducts
HomePage) or Disaster Medical Assistance Team (www. a webinar after each ACIP meeting to provide updates on the
phe.gov/Preparedness/responders/ndms/teams/Pages/ latest ACIP discussions and decisions.
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. In addition, A Selected Online Resources
Pharmacist’s Guide to Pandemic Preparedness is a resource APhA provides multiple electronic resources that are indis-
designed for pharmacists to support preparedness efforts.51 pensable 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,
Sources of Immunization Information Immunizing Pharmacists News, by filling out the online form
To maintain a high-quality practice in immunizations, a available at this site. This newsletter scans the latest immuni-
commitment must be made to stay up to date with ongoing zation information and provides items of interest to immunizing
developments in immunization practice. Practice recommenda- pharmacists. For member access only, APhA has a robust
tions and immunization schedules are updated frequently as Immunizing Pharmacists e-Community that offers a forum for
new research and vaccines become available. In preparation immunizing pharmacists to network with other immunization
to become immunizers, pharmacists need to locate resources providers across the country, facilitated by the APhA Academy
to identify regularly updated information. Many high-quality of Pharmacy Practice and Management’s special interest
resources are available, but it is important to be aware that a group for immunizing pharmacists.
substantial amount of misinformation is also widely distributed.
More information about myths and misperceptions regarding Participants in this certificate training program have access to
vaccines, and how to address them, will be discussed in a compilation of links and valuable resources for pharmacy-
Module 4. Selected reputable resources are provided in the based immunization delivery at www.pharmacist.com/
following section. immunization-resources.

The CDC website, www.cdc.gov/vaccines, is extensive,

Vaccine Recommendation Sources providing up-to-date information regarding immunization
National evidence-based vaccination recommendations are practices. Various e-mail subscriptions are available for free
written by the CDC Advisory Committee on Immunization from the CDC, providing a convenient way to stay current.
Practices (ACIP) and the Committee on Infectious Diseases For example, to receive the table of contents of CDC’s
of the American Academy of Pediatrics (AAP). Other publication MMWR, pharmacists can subscribe to a
major policy-setting groups include the American College mailing list at www.cdc.gov/mmwr/mmwrsubscribe.html.
of Physicians (ACP) and the American Academy of Family
Practitioners (AAFP).52,53 The Immunization Action Coalition (IAC) website, available
at www.immunize.org, offers a wide array of well-respected
The harmonized pediatric immunization schedule (indicating resources for immunization providers and other audiences.
who should receive which vaccines when) is a collaborative IAC provides several free e-mail publications and an e-mail
effort of ACIP, AAP, and AAFP. It is published in January of service to inform subscribers of news involving immunizations.
each year with updates published as situations warrant. The Pharmacists can sign up for the IAC e-mail publications by
adult immunization schedule is also updated annually and visiting www.immunize.org/subscribe/. IAC also publishes
published every January or February. the quarterly newsletters Needle Tips and Vaccinate Adults!
available in print and online.
ACIP meets multiple times per year to review newly available
information and update recommendations as necessary. These Other selected websites that offer useful information are listed
recommendations and updates are published in Morbidity and in Table 1.9.
Mortality Weekly Report (MMWR), which can be accessed
online at www.cdc.gov/mmwr. Immunizing pharmacists should

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Print Material in their practice. It provides comprehensive information on

APhA’s Immunization Handbook is a valuable resource vaccine-preventable diseases. The AAP’s Red Book: Report
that provides numerous guidelines, tips, and resources of the Committee on Infectious Diseases is updated every
for building and sustaining a successful immunization few years and is a worthy reference covering pediatric
practice. Written in a concise and quick look-up format, illness in particular. Facts and Comparisons annually
this handbook is an essential resource for busy pharma- updates its major reference book, ImmunoFacts: Vaccines
cists. APhA also publishes The Pharmacist in Public Health: and Immunologic Drugs. Another recognized authoritative
Education, Applications, and Opportunities, which explores reference is Vaccines edited by Plotkin, Orenstein, and Offit.
activities for pharmacists in public health and provides
information to help pharmacists overcome challenges and
embrace opportunities as public health pharmacists. Both Video Resources
books are available for purchase from the APhA Bookstore Live CDC-sponsored video conferences are broadcast by satellite
at www.pharmacist.com/shop with discounted pricing for (and online) several times a year. Titles include Epidemiology
APhA members. and Prevention of Vaccine-Preventable Disease and Vaccines
for International Travel. Pharmacists may check the CDC
The CDC and IAC have excellent print resources for website for a listing of viewing sites and times. The CDC offers
immunization providers, including ACIP statements, posters, live, video, and teleconference programs with continuing
brochures, and patient education materials. The majority of pharmacy education (CPE) credit for pharmacists. APhA also
the materials can be downloaded for free from the previously offers annual updates and CPE credit for educational activities
listed websites. related to vaccines through its website; go to www.pharmacist.
com/education and click on APhA’s Educational Library.
Epidemiology and Prevention of Vaccine-Preventable
Diseases (also known as “The Pink Book”) is published
approximately every 2 years by the CDC and is the most
important reference for all pharmacists to have available

Table 1.9. Websites of Selected Organizations and Manufacturers 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 Network for Immunization Information www.immunizationinfo.org
National Pharmacy Response Teams www.phe.gov/Preparedness/responders/ndms/teams/Pages/nprt.aspx
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

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Conclusion
12. Centers for Disease Control and Prevention. National and state
vaccination coverage among adolescents aged 13–17 years—United
Vaccines have significantly decreased the morbidity and States, 2012. MMWR Morb Mortal Wkly Rep. 2013;62:685–93.
mortality associated with many diseases. Despite these 13. Centers for Disease Control and Prevention. Noninfluenza
successes, shortfalls in vaccination rates still exist and more vaccination coverage among adults—United States, 2011. MMWR
Morb Mortal Wkly Rep. 2013;62:66–72.
needs to be done to avert needless vaccine-preventable
diseases and deaths. Pharmacists in all settings have an 14. Grabenstein JD. Pharmacists and immunization: increasing
involvement over a century. Pharm Hist. 1999;41:137–52.
opportunity to significantly affect patient care by getting
involved with immunizations as educators, facilitators, and in 15. Hogue MD, Grabenstein JD, Foster SL, Rothholz MC. Pharmacist
involvement with immunizations: a decade of professional
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involvement. J Am Pharm Assoc. 2006;46:168–82.
training program is an important first step toward becoming
16. Shaffer M. Flu shot fever. Am Druggist. 1994;209:30–1, 35.
an immunizing pharmacist. Identifying resources that support
immunizing pharmacists and using them to remain abreast of 17. Debrovner D. Beyond chicken soup. Am Druggist. 1994;209:21–4.
developments are also critical steps toward providing high- 18. Spring B. Washington state pharmacists train to offer immunizations.
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19. Ukens C. Immunization programs shot in arm for community RPhs.
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33. Keely JL; American College of Physicians–American Society of 43. National Committee for Quality Assurance. Summary Table of
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