Recommend Back-to-School Immunizations

August is National Immunization Awareness Month and a great time to talk to parents about vaccinations for their children before school.

Most vaccine-preventable illnesses are spread in the air and by direct contact. At school, children are in close contact and often share desks and supplies, creating an ideal environment for germs and viruses to spread to a large group in a short period. Importantly, parents should ensure children are vaccinated before they are exposed so their immune systems are prepared to fight off infection. Vaccinations help protect not only those being vaccinated but also others in the community from serious, sometimes life-threatening diseases.^1,2

The United States has very low rates of vaccine-preventable diseases, but this is not the case in other parts of the world. International travelers can easily introduce a disease to a community with low vaccination rates and cause an outbreak. Measles, for example, is common in areas of Africa, Asia, Europe, and the Pacific. About 10 million measles cases are reported around the world each year, with about 110,000 resulting in death. This is why vaccinations are so important.

This year, the United States has seen the greatest number of measles cases reported since 1994 and since measles was declared eliminated in 2000, according to the CDC. Most of these cases were linked to international travel.^3,4

PARENTS PLAY A KEY ROLE

Parents can protect their children by making sure they are up-to-date with all their vaccinations before school starts. Immunization records are often required for child care, participation on athletic teams, and school registration. State laws establish vaccination requirements for schoolchildren in both private and public settings as well as day care facilities. All states provide medical exemptions, and some also offer exemptions for philosophical and/or religious reasons.^5,6 All 50 states and the District of Columbia have childhood immunization mandates for varicella (chickenpox); diphtheria, tetanus, and acellular pertussis (DTaP); Haemophilus influenzae type b (Hib); measles, mumps, and rubella (MMR); and poliovirus. Some states have additional mandates for hepatitis A (Hep A), hepatitis B (Hep B), human papillomavirus (HPV), and/or meningococcal conjugate (MenACWY).² Information about immunization exemptions and requirements is available on the CDC website and each state’s department of health website.

For the best protection, patients should follow the CDC’s recommended immunization schedules. Below is a summary of immunizations by school age.^7,8 (Refer to the recommended immunization schedules for complete details and footnotes.)

Kindergarten/elementary school: From birth to age 6, children should receive 3 doses of Hep B, 2 or 3 doses of rotavirus (depending on the product administered), 5 doses of DTaP, 4 doses of Hib, 4 doses of pneumococcal (PCV13), 4 doses of inactivated poliovirus, 2 doses of MMR, 2 doses of chickenpox, and 2 doses of hep A. The CDC recommends a yearly influenza vaccine starting at age 6 months. Remember that 2 doses of the influenza vaccine are administered at least 4 weeks apart for children 6 months to 8 years who are getting the immunization for the first time.

Middle school: All children should receive a yearly flu vaccine. Those 11 to 12 years should receive 1 dose of Tdap, a 2-dose series of HPV, and a single dose of MenACWY.

High school: All teens should receive a yearly flu vaccine. For those age 16, the CDC recommends a MenACWY booster. Individuals 16 to 18 years through 23 years may also receive a sero-group B meningococcal vaccine.

For children whose vaccinations were missed or delayed, the CDC provides catch-up schedules and interval guidance for health care professionals to bring patients up-to-date.

PHARMACISTS PLAY A KEY ROLE

Pharmacists play a vital role in disease prevention through vaccination. Education and counseling will help parents better understand the importance of vaccination and how it can protect their children and communities. Pharmacists can also provide helpful written information from authoritative sources, such as the CDC, that parents can take home for further review and assistance with decision making. As the new school year approaches, keep these talking points in mind for your immunization discussions.^1,9

Infants and children receive multiple vaccines, many administered on the same day. These vaccines do not overwhelm the child’s immune system. Remember that a healthy child’s immune system successfully battles thousands of antigens each day. Vaccines contain only a small number of antigens compared with what children are exposed to on a daily basis.

The FDA has ensured vaccine safety and effectiveness through extensive clinical studies. Once a vaccine is licensed, the CDC and the FDA continue to monitor its safety and efficacy through the Vaccine Adverse Event Reporting System (VAERS). Parents, patients, health care providers, and anyone who experiences problems after vaccination should report to VAERS at vaers.hhs.gov or (800) 822-7967.

Most adverse effects reported with vaccines are mild and short-lived. Fever and soreness at the injection site are commonly reported. Fainting after vaccination is possible, so patients may want to sit down for about 15 minutes after the injection is administered. Although serious adverse effects are much less common, they are possible. Severe allergic reactions and seizures have been reported.

Thimerosal, a mercury-based preservative, was used to prevent contamination in vaccines. It was thought to be linked to autism, causing many parents to stop vaccinating their children. Although a link between thimerosal in vaccines and autism was never scientifically proved, the Public Health Service agencies, the American Academy of Pediatrics, and vaccine manufacturers agreed that thimerosal should be reduced or eliminated in vaccines as a precautionary measure. Thimerosal is present in only multidose flu vaccine vials. Single-dose vials of flu vaccines do not contain thimerosal.

Adjuvants, such as aluminum salts, are ingredients added to vaccines to help the body build a stronger immune response to the disease. They are present in very small amounts and are not readily absorbed by the body.

The flu strain is different each flu season, as is the flu vaccine. The CDC recommends a yearly flu vaccine for all individuals 6 months and older, preferably by the end of October. Vaccination is the best way to prevent seasonal flu and a considerable number of flu-related illnesses, hospitalizations, and deaths each year.

CONCLUSION

Pharmacists have many opportunities to promote public health. As your patients prepare their children for the start of the new school year, complete their back-to-school checklist with a discussion about immunizations. Make sure they are up-to-date and protect- ed. A positive and informative conversation can have a significant impact on patient health and the safety of communities.

Athena Baglio, MBA, RPh, and Susan Mamula, PharmD, are clinical pharmacists at Rite Aid in Moon Township, Pennsylvania.

REFERENCES

• State vaccination requirements. CDC website. cdc.gov/vaccines/imz-managers/laws/state-reqs.html. Updated November 15, 2016. Accessed July 15, 2019.
• Turner T. Back-to-school vaccine guide. Drugwatch website. drugwatch.com/news/2018/08/09/back-to-school-vaccine-guide/. Updated May 17, 2019. Accessed July 15, 2019.
• About measles. CDC website. cdc.gov/measles/about/index.html. Updated June 13, 2019. Accessed July 15, 2019.
• Influenza-related questions & answers by topic. CDC website. cdc.gov/flu/about/flu-faq.htm. Updated August 23, 2018. Accessed July 15, 2019.
• Plan for travel. CDC website. cdc.gov/measles/travelers.html. Updated June 18, 2019. Accessed July 15, 2019.
• 2019 recommended immunizations for infants and children (birth through 6 years) in easy-to-read format. CDC website. cdc.gov/vaccines/schedules/easy-to-read/child-easyread-compliant.html. Updated February 5, 2019. Accessed July 15, 2019.
• 2019 recommended vaccinations for children 7-18 years old. CDC website. cdc.gov/vaccines/schedules/easy-to-read/adolescent-easyread-compliant.html. Updated February 5, 2019. Accessed July 15, 2019.
• Finding and updating vaccine records. CDC website. cdc.gov/vaccines/parents/records-requirements.html. Updated May 17, 2019. Accessed July 15, 2019.
• Making the vaccine decision. CDC website. cdc.gov/vaccines/parents/vaccine-decision/index.html. Updated March 18, 2019. Accessed July 15, 2019.