Immunization Administration During Coronavirus Disease Pandemic

Coronavirus disease (COVID-19) is a respiratory illness that has rapidly spread across the globe since it was first recognized in late 2019. It is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and is thought to spread mainly via respiratory droplets.¹

Since the beginning of the COVID-19 pandemic, a number of measures were implemented to decrease the spread of the disease, including stay-at-home and shelter-in-place orders, use of face coverings in public places, and amplified hand hygiene recommendations.

It is thought that the stay-at-home and shelter-in-place measures may have inadvertently contributed to the significant decrease in the number of non-influenza doses and measles-containing doses of vaccines for the Vaccines for Children Program-funded, Advisory Committee on Immunization Practices-recommended, non-influenza childhood vaccines.²

This raises a concern about a potential decrease in immunization rates for the upcoming influenza immunization season. Additionally, the rapid spread and manner of transmission of the SARS-CoV-2 virus, and decreased availability of personal protective equipment (PPE) present a challenge to safe administration of immunizations in a community pharmacy setting.

In order to address some of these concerns, the Centers for Disease Control and Prevention (CDC) has provided guidance for administration of pediatric and adult immunizations.^3,4

In the guidance documents, the CDC identifies the deferral of pediatric immunizations as an action that may result in patient harm.⁴ Consequently, the CDC recommends that pediatric immunizations be administered as soon as feasible in areas with substantial community transmission of COVID-19, with priority given to at-risk populations.

In areas with minimal to moderate community transmission of COVID-19, the CDC recommends creating plans for administering pediatric immunizations to all patients. Finally, in areas with minimal or no community transmission of COVID-19, the CDC recommends continuing to provide immunization services to all pediatric patients.

When it comes to adult immunizations, the CDC recommends vaccine administration at the pharmacy if this can be done without additional risk to the patient or the health care provider with priority given to high risk populations.³ Additionally, pharmacies are encouraged to develop strategies to screen patients for COVID-19 symptoms prior to provision of adult immunization services.

Finally, it is recommended that health care providers follow universal precautions and use appropriate PPE while administering immunizations, including masks and gloves in all areas, and eye protection in areas with moderate to substantial community transmission of COVID-19.

In addition to adhering to the CDC recommendations, pharmacies should consider workflow changes intended to minimize risk to both patients and the pharmacy staff providing immunization services. Some strategies that should be considered include scheduling appointments, hosting in-store immunization clinics on specific days, filling out consent forms electronically, completing third party claim processing prior to patient arrival, and using a drive-through window to collect paperwork.

Additionally, pharmacies should consider having patients wait outside (in their car or the parking lot) and notifying them electronically or via phone when the pharmacist is ready to administer their immunization. It is important to keep in mind that many of these workflow changes may require additional staffing. Finally, consideration is being given to the possibility of administering immunizations “curbside,” as the Tennessee Department of Health recently released guidance for provision of immunization services in this manner.⁵

As we move closer to the influenza immunization season, it is important to keep in mind that many patients rely on pharmacists to administer the influenza vaccine. Therefore, it is crucial that pharmacies and pharmacists begin to plan for safe administration of these immunizations and help their patients feel safe coming to the pharmacy to receive their immunizations.

This is necessary to avoid a decrease in influenza immunization rates and a potential increase in influenza illnesses in the upcoming season. Additionally, with the possibility of a SARS-CoV-2 vaccine becoming available between October 2020 and January 2021, pharmacies and pharmacists need to be ready to administer immunizations to patients in our communities.

References

• What you should know about COVID-19 to protect yourself and others. Centers for Disease Control and Prevention. Updated June 1, 2020. Accessed June 10, 2020. https://www.cdc.gov/flu/about/keyfacts.htm.
• Santoli JM, Lindley MC, DeSilva MB, et al. Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020. MMWR Morb Mortal Wkly Rep 2020;69:591—593. DOI: http://dx.doi.org/10.15585/mmwr.mm6919e2external icon
• Guidance for pharmacies. Centers for Disease Control and Prevention. Updated May 28, 2020. Accessed June 10, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/pharmacies.html.
• Framework for healthcare systems providing non-COVID-19 clinical care during the COVID-19 pandemic. Centers for Disease Control and Prevention. Updated May 12, 2020. Accessed June 10, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/framework-non-COVID-care.html
• COVID-19 guidance for provision of curbside immunization services. Tennessee Department of Health. Updated April 25, 2020. Accessed June 10, 2020. https://www.tn.gov/content/dam/tn/health/documents/cedep/novel-coronavirus/GuidanceForCurbsideImmunizations.pdf.

About the Author

Bedrija Nikocevic, PharmD, BCACP, is assistant professor of Clinical Sciences, director of Professional Laboratories, Roosevelt University College of Pharmacy.