Pharmacy team members are an integral part of vaccination efforts in the United States. More than 248 million doses of COVID-19 vaccines were administered at pharmacies across the United States as of May 11, 2022, according to the CDC.1 This includes more than 8 million doses administered by pharmacists in long-term care facilities to some of the most vulnerable patients in the country by 2021. However, pharmacists, trainee pharmacists and pharmacy assistants have given significantly more immunizations than those documented by the CDC for COVID-19 vaccines. They also administer seasonal flu (flu) vaccines and routine vaccines for adults and children. Even before the pandemic, pharmacy team members played an important role in vaccinations. During the 2020-2021 flu season, more than 47 million doses of flu vaccine were administered to adults in U.S. pharmacies, compared with 32 million doses administered in doctors’ offices.2
The Third Amendment to Public and Emergency Preparedness
The law was enacted in August 2020 to counter declining routine childhood vaccination rates during the pandemic.3 It authorizes pharmacists in all US states to routinely administer pediatric vaccines to children as young as 3 years of age. Pharmacy team members can now administer more types of vaccines to more patients than at any time in history. However, this also means that it is more important than ever to stay informed about vaccine advancements, changes and updates. This article updates the vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) prepared and approved for 2022.
How are decisions made about updates to vaccine recommendations?
Each year, a new vaccination schedule is recommended by the ACIP, a committee within the CDC, after a thorough review of vaccine-related data. The ACIP is made up of 15 voting members whose medical and public health expertise includes vaccinology, immunology, pediatrics, internal medicine, nursing, family medicine, virology, public health, infectious disease and preventive medicine. When making vaccine recommendations, the ACIP takes into account data that includes the epidemiology and societal impact of disease and the effectiveness and safety of the vaccines. Historically, the ACIP meets three times a year to review new information and vote on vaccine recommendations, although more frequent meetings were needed during the pandemic. ACIP recommendations are reviewed and approved by the CDC, the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American College of Nurse-Midwives, the American Academy of Physician Associates, and the Society for Healthcare Epidemiology of America. Official vaccine recommendations are published in the CDC’s Morbidity and Mortality Weekly Report (MMWR).4
Anyone interested in the new vaccine recommendations in the United States should consider watching the upcoming ACIP meetings, which will be streamed live for free to the public.5 In addition, the CDC allows written public comments and requests for oral public comments at upcoming meetings. Dates for upcoming meetings, agendas, registration information, and directions for submitting a public comment are available under the Meeting Information section on the ACIP website. Presentation slides and videos are available online after each meeting.
Changes to the recommended adult immunization schedule for ages 19 and older
The recommended vaccination schedule for adults 19 years and older is available in a variety of formats, and pharmacy team members should be aware of the options.6 A version of the schedule is classified by age group. This version can be useful to help a new or existing patient identify which vaccines may be needed, which can be determined simply by asking their age. Another version of the schedule is classified by medical condition or indication. This version can be useful when a patient is newly diagnosed or has another indication that requires additional vaccinations.
When reading the vaccination schedule it is important to be familiar with the color coding and meaning of each color.6 On the schedule, categorized by age, yellow indicates that the vaccination is recommended for adults who have not been vaccinated and who meet the stated age requirement, have no documentation of previous vaccination, or have no evidence of previous infection. For example, the chart is arranged by age, in the column for adults 65 years and older, the row for pneumococci is yellow, indicating that vaccination against pneumococci is recommended for that age group. Purple indicates that the vaccination is recommended for adults in an age group who have an additional risk factor or indication. When a patient meets the criteria in the purple section, check the Notes section of the schedule for more details. If the schedule line is blue, shared clinical decision-making about vaccination is recommended.
In addition to the yellow, purple, and blue color coding, the adult chart, listed by drug condition or indication, includes red, which indicates that the vaccination is contraindicated and should not be administered, and orange, which indicates that the vaccination may be indicated if the benefits of protection outweigh the risk of side effects.
The ACIP approved the recommended adult vaccination schedule for adults at least 19 years of age at its November 2021 meeting.7 The 2022 schedule also includes several updates and changes from the 2021 schedule
to an appendix with contraindications and precautions for all vaccines in the schedule. Changes to the adult immunization schedule for 2022 include revised recommendations for the hepatitis B, flu, pneumococcal, zoster and COVID-19 vaccines. Also the language for recommendations related to measles, mumps, rubella; meningococci; and varicella vaccines was revised to improve clarity. An overview of the changes is shown in table 1†6.7
Changes to the recommended immunization schedule for children and adolescents aged 18 years or younger
Like the adult schedule, the recommended immunization schedule for children and adolescents is available in several formats.8 The recommended immunization schedule for children and adolescents aged 18 years and under consists of 3 tables: (1) by age group; (2) on a catch-up schedule; and (3) by medical condition or indication. The catch-up schedule is useful for pediatric patients who are behind schedule on their routine immunizations or who have missed a dose.
A difference between the vaccination schedule for adults and the schedule for children and adolescents is the addition of a variegated color code, yellow with brown checks.8 In the table, arranged by medical indication, this color code is used to indicate that vaccination is recommended and additional doses may be required. In the age-ranked chart, yellow with brown ticks indicate that the recommended vaccination can begin in a particular age group. When a pharmacy team member identifies a child or adolescent with characteristics that match the yellow and brown checkmark coding, the Comments section should be consulted for additional information. table 2 shows a summary of the recommended changes to the immunization schedule for children and adolescents for 2022.8.9 In addition, the definition of severe immunosuppression due to HIV infection was changed to “< 15% or total CD4 cell count of < 200/mm3" for consistency with the ACIP's General Best Practice Guidelines for Immunization.
conclusions
One of the most important things immunizing pharmacy team members can do is stay current with the latest immunization recommendations. By using recommended vaccination schedules to identify those who need to be vaccinated, we protect ourselves and our patients and provide an important public health service.
About the author
Kimberly C. McKeirnan, PharmD, BCACP, is an associate professor in the Department of Pharmacotherapy and director of the Center of Pharmacy Practice Research at Washington State University College of Pharmacy and Pharmaceutical Sciences in Spokane.
References
1. The Federal Retail Pharmacy Program for COVID-19 Vaccination. Center for Disease Control and Prevention. May 17, 2022. Accessed May 25, 2022. https://www.cdc.gov/vaccines/covid-19/retail-pharmacy-program/index. html
2. Influenza vaccinations administered in pharmacies and doctors’ offices, adults, United States. Center for Disease Control and Prevention. Feb 23, 2022. Accessed Apr 14, 2022. https://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-administered.html
3. Third Amendment of Statement under the Public Preparedness and Preparedness for Medical Countermeasures Against COVID-19 Act. Federal registry. August 24, 2020. Accessed April 29, 2022. https://www.federalregister.gov/documents/2020/08/24/2020-18542/third-amendment-todeclaration-under-the-public-readiness-and-emergency – preparedness-act-for-medical
4. Role of the Immunization Practices Advisory Committee in the CDC’s Vaccine Recommendations. Center for Disease Control and Prevention. January 12, 2022. Accessed April 13, 2022. https://www.cdc.gov/vaccines/acip/committee/role-vaccine-recommendations.html
5. ACIP meeting information. Center for Disease Control and Prevention. April 8, 2022. Accessed April 14, 2022. https://www.cdc.gov/vaccines/acip/meetings/index.html
6. Adult vaccination schedule. Center for Disease Control and Prevention. February 17, 2022. Accessed April 10, 2022. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html.
7. Murthy N, Wodi AP, Bernstein H, McNally V, Cineas S, Ault K. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults 19 Years of Age or Older – United States, 2022. MMWR Morb Mortal Wkly Rep† 2022;71(7):229-233. doi:10.15585/mmwr.mm7107a1
8. Vaccination schedule for children and adolescents. Center for Disease Control and Prevention. February 17, 2022. Accessed April 10, 2022. https://www. cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
9. Wodi AP, Murthy N, Bernstein H, McNally V, Cineas S, Ault K. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents 18 Years of Age or Under – United States, 2022. MMWR Morb Mortal Wkly Rep† 2022;71(7):234-237. doi:10.15585/ mmwr.mm7107a2