Pharmacist-Administered Immunization Movement Propels Profession Forward

Pharmacists have been involved in vaccines since the distribution of the smallpox vaccine in the mid 1800s.

The Washington State Pharmacy Association designed the first formalized training program for pharmacist-administered vaccines in 1994. In 1996, the American Pharmaceutical (now Pharmacists) Association launched its nationally recognized training program.¹

Fast-forward to 2021 and all 50 states, as well as the District of Columbia and Puerto Rico, have given pharmacists the authority to administer vaccines, although this authority differs from state to state. Some state-specific restrictions include age of patient, requirement of a prescription, and type of vaccine. The profession has made great strides in the vaccination arena, but pharmacists can still advocate for nationwide standards as opposed to different regulations and rules for every state.

Although most people live close to a pharmacy, vaccination rates are still suboptimal. The CDC estimates that influenza-related hospitalizations in the United States have ranged from 140,000 to 710,000 since 2010. Influenza-related deaths ranged from 12,000 to 56,000 over the same period.²

Approximately 320,000 people contract pneumococcal pneumonia every year, leading to more than 5000 deaths and 150,000 hospitalizations.² Between 700,000 and 1.4 million people have chronic hepatitis B, which can cause complications, such as liver cancer.²

Human papillomavirus (HPV) causes more than 27,000 cancers in both men and women each year. Approximately 4000 women die every year from cervical cancer.²

Common vaccine-preventable diseases include:

Chickenpox (varicella): Causes symptoms including headache, fever, an itchy rash with blisters, and tiredness. Chickenpox is typically mild but can lead to encephalitis, pneumonia, severe skin infections, and even death.²

Diphtheria: Produces a toxin in the body that can cause low-grade fever, sore throat, swollen neck glands, and weakness. The effects of this toxin can also lead to swelling of the heart muscle and heart failure. Severe cases can result in coma, paralysis, and death.²

Influenza: Causes chills, dry cough, headache, joint and muscle pain, runny nose, sore throat, and sudden high fever. Extreme fatigue can last from days to weeks. The disease can lead to hospitalization or even death.²

Hepatitis A: Often spreads through contaminated food. Hepatitis A can cause abdominal discomfort, dark urine, fever, jaundice, loss of appetite, nausea, and tiredness. People who are infected with this disease may have no symptoms, mild symptoms, or severe illness.²

Hepatitis B: A blood-borne disease that causes influenza-like symptoms such as jaundice, joint pain, loss of appetite, nausea, rashes, and vomiting. This virus can stay in the liver of some individuals for the rest of their lives, causing severe liver diseases, including fatal cancer.²

HPV: Especially prevalent among individuals in their teens and early 20s. HPV is a major cause of anal cancer or genital warts in both men and women and of cervical cancer in women. Some other types can cause cancers of oropharynx and penis.²

Measles: A respiratory disease often brought to the United States by international travelers. This virus can cause cough, rash, and persistent fever. It can also cause brain damage, pneumonia, seizures, or
in some cases death.²

Meningococcal disease: A bacteria-caused illness that is the leading cause of bacterial meningitis. It can cause confusion, nausea, photosensitivity, sleepiness, and vomiting. It also causes blood infections. Meningitis has about a 10% mortality rate, and survivors may become deaf or developmentally disabled, develop nervous symptom difficulties, lose limbs, or experience seizures or strokes.²

Mumps: Causes fever, headaches, loss of appetite, muscle aches, and swelling of salivary glands. Severe complications can include encephalitis, meningitis, permanent hearing loss, and swelling of the testes, leading to sterility.²

Pneumococcal disease: A bacterial illness that can spread from the nose and throat to ears or sinuses and generally causes mild infections. Serious health problems typically occur when the bacteria spread into other parts of the body, such as the blood (bacteremia), the lining of the brain and spinal cord (meningitis), and the lungs (pneumonia). Severe disease may result in brain damage, hearing loss, limb loss, or even death.²

Rubella: A viral disease, often called German measles. It usually causes mild illness with fever, a rash, and swollen glands. Severe disease can lead to encephalitis in adults. If a pregnant woman becomes infected, it can result in miscarriage or serious birth defects, such as blindness, deafness, heart defects, and intellectual disability.²

Shingles (herpes zoster): Varicella zoster virus that causes chickenpox, shingles causes a painful rash that blisters, then typically scabs over and clears up. Other symptoms can include chills, fever, headache, and an upset stomach. If shingles affects the eye, it can cause loss of vision.²

Tetanus: A serious bacterial disease that causes painful, serious tightening of the muscles, leading to spasms and stiffening of all the muscles in the body. This can lead to lockjaw to the point of being unable to breathe, open the mouth, or swallow. Tetanus has approximately a 30% mortality rate.²

Whooping cough (pertussis): A highly contagious, bacterial respiratory infection that causes prolonged cold symptoms leading, to choking and violent coughing. It is most severe for babies, even leading to hospitalization or death. Babies typically contract this disease from a caregiver, parent, or relative.²

Travel Vaccines

In some states, pharmacists are also authorized to administer travel vaccines. Examples of diseases covered by such vaccines include cholera, Japanese encephalitis, rabies, typhoid, and yellow fever. The CDC has a complete list of recommended and required vaccinations based on age, destination, season, and vacation duration.

Pharmacist involvement in immunization, whether as administrators, educators, or facilitators, results in an increased uptake of immunizations. This, in turn, results in a healthier, more prosperous society.

Kathleen Kenny, PharmD, RPh, has more than 25 years of experience as a community pharmacist and is a freelance clinical medical writer based in Colorado Springs, Colorado.

REFERENCES

1. Hogue MD, Grabenstein JD, Foster SL, Rothholz MC. Pharmacist involvement with immunizations: a decade of professional advancement. J Am Pharm Assoc (2003). 2006;46(2):168-179. doi:10.1331/154434506776180621
2. Vaccine-preventable adult diseases. CDC. Updated February 3, 2021. Accessed August 15, 2021. https://www.cdc.gov/vaccines/ adults/vpd.html