May 31 2019

Lessons from the Measles Outbreak – Using your Pharmacy Pulpit to Promote Immunizations

Although news of the measles outbreak no longer garners front-page attention, the Centers for Disease Control (CDC) reported that as of early June 2019, more than 980 cases had been reported across 26 states.  This was an increase of almost 300 cases over just a month earlier.

While much discussion focused on pockets of outbreaks in New York and Michigan, and the incidence of children in those neighborhoods who had not been vaccinated because of religious beliefs, public health professionals continue to be alarmed by the speed at which the virus spread across the country.

As reported by DrugTopics, the Washington State Department of Health reported a 500 percent increase in Mumps-Measles-Rubella (MMR) vaccinations for Clark County, which reported more than 70 measles cases as of early June.  And one Seattle pharmacy owner reported having administered more than 50 MMR doses during just the first six weeks of 2019, versus a normal rate of 50 doses for an entire year.

Not surprisingly, pharmacists nationwide faced a surge in questions from patients about everything from uncertainty over whether they had been vaccinated, if a booster shot was needed, the safety of the vaccination, and about the disease in general.

In March, the CDC issued an appeal to pharmacists, requesting their help in ensuring patients were up to date on the MMR vaccine.  “Pharmacists are a crucial community source of information on vaccinations for potentially-life threatening diseases, like measles,” the CDC posted on its website.

As pharmacists rose to this challenge, many did so by counseling patients about the safety and effectiveness of the MMR vaccine, by referring patients to providers who could administer the shot, or by administering the immunization themselves.  In doing so, pharmacists validated the strong level of trust that patients have in them, as evidenced by pharmacists consistently high ranking as a “most trusted” profession.

 But the measles outbreak presents a good opportunity for pharmacists to review protocols that are relevant to all immunization situations.  Specifically, the American Pharmacists Association (APhA) has approved a set of guidelines for “Pharmacy-Based Immunization Advocacy,” which covers five main categories:

Guideline 1 – Prevention
Pharmacists should protect their patients’ health by being vaccine advocates.

  • Pharmacists should protect their patients’ health by being vaccine advocates.
  • Pharmacists should adopt one of three levels of involvement in vaccine advocacy:
    • Pharmacist as educator
    • Pharmacist as facilitator
    • Pharmacist as immunizer
  • Pharmacists should focus their immunization efforts on diseases that are the most significant sources of preventable mortality among the American people.
  • Pharmacists should routinely determine the immunization status of patients, then refer patients to another appropriate provider for immunization.
  • Pharmacists should identify high-risk patients in need of targeted vaccines and develop an appropriate immunization schedule.
  • Pharmacists should protect themselves and prevent infection of their patients by being appropriately immunized themselves.          

Guideline 2 – Partnership
Pharmacists who administer vaccines do so in partnership with their community

  • Pharmacists should support the immunization advocacy goals and other educational programs of health departments in their city, county, and state.
  • Pharmacists should collaborate with community prescribers and health departments.
  • Pharmacists should assist their patients in maintaining a medical home, including care such as immunization delivery.
  • Pharmacists should consult with and report immunization delivery, as appropriate, to primary-care providers, state immunization registries, and other relevant parties.
  • Pharmacists should identify high-risk patients in hospitals and other institutions and assure that appropriate vaccination is considered either before discharge or in discharge planning.
  • Pharmacists should identify high-risk patients in nursing homes and other facilities and assure that needed vaccinations are considered either upon admission or in drug regimen reviews.

Guideline 3 – Quality
Pharmacists must achieve and maintain competence to administer immunizations.

  • Pharmacists should administer vaccines only after being properly trained and evaluated in disease epidemiology, vaccine characteristics, injection technique, and related topics.
  • Pharmacists should administer vaccines only after being properly trained in emergency responses to adverse events and should provide this service only in settings equipped with epinephrine and related supplies
  • Before immunization, pharmacists should question patients and/or their families about contraindications and inform them in specific terms about the risks and benefits of immunization.
  • Pharmacists should receive additional education and training on current immunization recommendations, schedules, and techniques at least annually. 

Guideline 4 – Documentation
Pharmacists should document immunizations fully and report clinically significant events appropriately.

  • Pharmacists should maintain perpetual immunization records and offer a personal immunization record to each patient and his or her primary care provider whenever possible.
  • Pharmacists should report adverse events following immunization to any appropriate primary-care providers and to the Vaccine Adverse Event Reporting System (VAERS).

Guideline 5 – Empowerment
Pharmacists should educate patients about immunizations and respect the patient’s rights.

  • Pharmacists should encourage appropriate vaccine use through information campaigns for health care practitioners, employers, and the public about the benefits of immunizations.
  • Pharmacists should educate patients and their families about immunizations in readily available terms
  • Before immunizing, pharmacists should document any patient education provided and informed consent obtained, consistent with the law.

While each pharmacist will choose the level of immunization advocacy the best fits their specific situation, it’s important to note that many of the APhA guidelines – documentation, notification, records management, reporting --  can be easily addressed through a comprehensive pharmacy technology solution. 

As the current measles outbreak hopefully recedes soon, a technology system can help a pharmacist be fully prepared for when – not if – the next spike in immunization-avoidable disease outbreak occurs.