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Pharmacists have become the driving force behind immunizations in the US.
Immunization has been the most cost-effective way to prevent dangerous infectious diseases in the US for decades. Amendments to the Public Readiness and Emergency Preparedness Act during the COVID-19 pandemic expanded the authority of pharmacists and pharmacy technicians to administer vaccinations. This brought to light the value of pharmacists in this role.1
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Despite the wide availability of vaccines, vaccination rates remain suboptimal, especially in underserved areas. Pharmacists are qualified educators and providers and are essential for promoting the importance of immunizations.2 The health care landscape is confusing for many patients, but as accessible practitioners, pharmacists can and do provide an enormous service to the public by recommending vaccines and tracking vaccine administration.
Influenza
For most individuals who need only 1 dose of influenza vaccine each year, September and October are good times to be vaccinated against influenza. Most adults, especially those 65 years and older, should generally not get vaccinated earlier in the year (eg, July or August) because protection may decrease over time. However, early vaccination can be considered for any person who is unable to return later to be vaccinated.3
Patients 65 years and older should receive a high-dose influenza vaccine. This can help those in this age group build a stronger immune response against the infection. High-dose influenza vaccines contain 3 to 4 times as much viral antigen as the standard vaccines or have the same amount of antigen but include an adjuvant to boost immune response.4 Examples include the Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine, and Fluad Quadrivalent adjuvanted flu vaccine.3
COVID-19
The COVID-19 vaccine is intended to provide acquired immunity against SARS-CoV-2, the cause of COVID-19. The initial focus of COVID-19 vaccines was to prevent symptomatic and perhaps severe illness. The first vaccines were made available in 2020 through accelerated means by emergency use authorization.
COVID-19 vaccines were initially 2-dose vaccines, apart from the single-dose Janssen COVID-19 vaccine. Unfortunately, as immunity tends to decrease over time and the virus mutates, booster doses to maintain immunity are required. The COVID-19 virus thus behaves similarly to the influenza virus. A new vaccine was developed to provide immunity against currently circulating COVID-19 strains in 2023, and further vaccines will be made available based on emerging strains as necessary.5
The CDC recommends that all adults receive 1 dose of the 2023-2024 updated COVID-19 vaccine. Immunocompromised patients can receive additional doses, and patients over 65 years should receive an additional dose at least 4 months after the first.4 Available COVID-19 vaccines include Comirnaty (Pfizer and BioNTech), Spikevax (Moderna), and the Novavax COVID-19 vaccine.6
Kathleen Kenny, PharmD, RPh, earned her doctoral degree from the University of Colorado Health Sciences Center. She has more than 25 years’ experience as a community pharmacist and works as a clinical medical writer based in Homosassa, Florida.
Tetanus, Diphtheria, and Pertussis
Vaccines are available to help prevent tetanus, an infection caused by Clostridium tetani bacteria; diphtheria, an infection caused by Corynebacterium diphtheriae bacteria; and pertussis, an infection caused by Bordetella pertussis bacteria. Three kinds of vaccines used in the United States today help protect against these infections7:
• Diphtheria, tetanus, and pertussis (DTaP) vaccine: indicated for infants and children younger than 7 years
• Tetanus, diphtheria, and pertussis (Tdap) vaccine: indicated for all adults and children ages 7 and older
• Tetanus and diphtheria (Td) vaccine: indicated for adults with an allergy to pertussis-containing vaccines and as a booster to Tdap
The CDC recommends that adults who have never received Tdap receive a single dose of Tdap. They can get this at any time, regardless of when they last received a tetanus vaccine. This should be followed by either a Tdap booster or a tetanus shot every 10 years.7
When available, Boostrix (GSK) should be used for adults 65 years or older because Adacel (Sanofi Pasteur Inc) is only approved for use in individuals up to 64 years of age. However, providers should not miss an opportunity to vaccinate patients 65 and older with Tdap. Therefore, they may administer the Tdap vaccine they have available, and it will be valid.7
Pneumococcal
The pneumococcal vaccine protects against Streptococcus pneumoniae bacteria, which can cause pneumococcal disease, meningitis, sepsis, sinusitis, and ear infections. There are 2 types of pneumococcal vaccines: conjugate vaccines and polysaccharide vaccines. The recommended pneumococcal conjugate vaccines (PCVs) include PCV13 (Prevnar 13; Pfizer); PCV15, for patients ages 2 through 18 years (Vaxneuvance from Merck & Co, Inc); and PCV20 (Prevnar 20; Pfizer). The different vaccines are recommended for different patient populations based on their age and medical status.8
The CDC recommends PCV15 or PCV20 for adults who have never received a PCV and who are 65 years or older, as well as those aged 19 through 64 years with certain risk conditions. If PCV15 is used, it should be followed by a dose of PPSV23 (Prevnar 20, Pfizer; Pneumovax23, Merck & Co, Inc). Adults 65 years or older have the option to get PCV20 if they have already received PCV13 (but not PCV15 or PCV20) at any age and PPSV23 at or after 65 years.8
Respiratory Syncytial Virus
New respiratory syncytial virus (RSV) vaccines are available for adults 60 years and older. The decision should be based on a discussion between the clinician and the patient.9
Clinicians are aware of underlying conditions that may increase the risk of severe RSV illness, and the patients who are most likely to benefit from these vaccines. Adults 60 years and older who are at increased risk include those with certain chronic medical conditions such as chronic lung or heart disease, immunocompromised patients, older adults, and those living in nursing homes.9
The RSV vaccine is recommended as a single dose, and studies are ongoing to determine whether and when boosters may be necessary. For adults 60 and older who have not already received an RSV vaccine and decide with their providers to get one, the CDC encourages providers to maximize the benefit of vaccination by recommending that patients receive their vaccine in late summer or early fall, just prior to the RSV season.9
Zoster
Shingles, also called herpes zoster, is a disease that triggers a painful rash. It is caused by reactivation of the same varicella-zoster virus that causes chickenpox, and approximately 1 in 3 adults who had chickenpox will develop shingles later in life.10 However, a vaccine is available to reduce the risk of developing shingles as well as postherpetic neuralgia, a long-term complication of shingles.
The CDC recommends 2 doses of the recombinant zoster vaccine, separated by 2 to 6 months for immunocompetent adults 50 years and older, regardless of whether they report having had prior infection with herpes zoster. For patients who are or will be immunodeficient and would benefit from completing the series in a shorter time, the second dose may be administered 1 to 2 months after the first.11
Administering Multiple Vaccines
Patients will often need more than 1 vaccine in a single visit. The CDC recommends giving all necessary vaccines in the same visit to reduce the risk of missing opportunities.12 Administer vaccines that are known to cause local reactions in separate limbs if possible. These include COVID-19, pneumococcal, zoster, and tetanus-containing vaccines. If administering multiple vaccines in the same limb, separate the injection sites by at least 1 inch.12
Vaccine Resources
Before considering vaccine information found online, check that the information comes from a credible source and is updated on a regular basis. All vaccine and immunization web content should be researched, written, and approved by subject matter experts, including physicians, researchers, epidemiologists, and analysts. Content must be based on peer-reviewed data. Several reputable websites are listed in the Table.
