By:  Christina Tarantola, PharmD, PGY-1 Resident at Kings Pharmacy

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The New York State Department of Health issued a health advisory on November 8, 2012 in response to Hurricane Sandy. The document outlined guidelines on recommended immunizations and disaster relief efforts for volunteers and the general public.

Due to an increased risk of exposure to tetanus while cleaning debris from devastated homes, the Tdap (Tetanus, diptheria, acellular pertussis) vaccine was one of the recommended immunizations. Recognizing the need for increased immunizer response, Governor Cuomo issued a temporary standing order for pharmacists to administer the Tdap vaccine. The standing order was signed on November 20, 2012 and expired on December 25, 2012.

Immunizations play a critical role in preventing infectious disease. However, pharmacists in New York were only recently granted immunization privileges in 2008, for influenza and pneumococcal administration. Although vaccination programs have successfully reduced childhood diseases, the same success has not been achieved in adults. According to the Centers for Disease Control, adults account for 95% of vaccine preventable deaths.  The 2009 national health interview survey estimates adult vaccination coverage and reported low immunization rates among adults who were indicated to receive tetanus diphtheria acellular pertussis, hepatitis A, hepatitis B, herpes zoster, and human papilloma virus.

Pharmacists have demonstrated positive and significant immunization rates for the Tdap vaccine. For instance, one study completed at a primary care center located in a metropolitan area looked at adults ranging from the ages of 18 to 79 years who came in for medical appointments.¹ Among the healthcare professionals administering vaccines were physicians, pharmacists, and nurses. They utilized a screening tool to assess the need for patient vaccination using an INA (Immunization Needs Assessment) available from the CDC website. The results of the study provide a benchmark for immunization rates among low-income adults. In this study, pharmacists increased immunization rates on six different vaccines with a statistically significant effect on influenza and Tdap.

The data suggested other healthcare providers may not fully consider or discuss vaccination recommendations with their patients even when provided with an INA. Having a pharmacist dedicated to inform the patient about the INA results and offering administration of needed vaccines proved to be a successful intervention. The role of the pharmacist as an immunizer in this setting appears critical to the success of improving immunization outcomes. The data suggests that using pharmacists as dedicated immunizers plays a critical role in improving vaccination rates, especially in regard to the Tdap vaccine.

Other states allow pharmacists to administer the Tdap vaccine. Vaccination by pharmacists proved to be crucial in the 2010 outbreak of whooping cough that killed 10 babies in California.. Pharmacists and pharmacy students at University of California San Diego offered free vaccines to all household contacts of newborns. In addition, these healthcare providers tried to make the vaccination service easily accessible; there were Saturday and evening hours in a waiting room on the postpartum floor. Eighty four percent of the newborns’ family members received Tdap vaccination before the baby was discharged.² Since newborns can’t receive the whooping cough vaccine themselves, this is one of the best ways to protect them.

In addition to the Tdap vaccine, pharmacy-based immunization clinics have had an enormous success rate while administering the influenza, pneumococcal, and more recently the shingles vaccine.

During the time from allotted for administering the vaccine, the community pharmacy where I work had received several requests for the Tdap vaccine to be administered. Many patients who typically visited doctors at NYU and Bellevue hospital expressed that it was very convenient to receive their vaccines at the local pharmacy. Busy parents with children found it especially valuable.

Since pharmacies have already established policies and procedures for the Tdap protocol, I would like to see an extension for the standing order. Extending the standing order for the Tdap vaccine would offer an enormous benefit in dissolving barriers for patients to receive vaccinations as well as provide an easy, convenient way to combat preventable illnesses such as whooping cough and tetanus. Not only would this action benefit patients, but it would help pharmacists work collaboratively within the healthcare system and advance the profession. Contact your local senator to request an extension of the Tdap vaccine standing order.

For more information, you may contact Dr. Tarantola at (718) 230-3535 x32.

SOURCES:

1. Suzanne Higginbotham S., Stewart A., Pfalzgraf A. Impact of a pharmacist immunizer on adult immunization rates. JAPhA May/June 2012 52:3 367-71.
2. Schaffer, Amanda. “Should You Go to the Drugstore for Your Flu Shots?” Slate.com. N.p., 17 Oct. 2012. Web.