Deborah L. Wexler, MD, Executive Director, Immunization Action Coalition
Missed opportunities to vaccinate contribute to lower immunization rates in medical practices and healthcare systems across the nation. Here are some simple tips to help your practice facilitate vaccination during all patient visits.
Tip #1: Remember that vaccines can be given at any clinic visit — not just during well-child or adult physical exam visits.
All medical visits (including acute care and follow-up visits) offer the opportunity to assess your patients’ immunization status and provide them with needed vaccinations. In particular, patients with chronic illnesses, many of whom visit a provider only during an acute episode, may be the individuals who are most at risk for complications from vaccine-preventable illnesses. Don’t miss any opportunity to provide protection for your patients. Consider facilitating patient access to vaccines by establishing systems that allow them to walk in during regular office hours or to call ahead for a “nurse only” visit.
Tip #2: You don't need to routinely check temperatures on all patients before vaccinating them.
Routinely measuring temperatures is not a prerequisite for vaccinating patients who appear to be healthy. As part of your routine pre-vaccination screening for contraindications and precautions, simply ask the parent or patient about the patient's current state of health. Here are two handy checklists to help you screen:
Mild acute illness (e.g., diarrhea or mild upper-respiratory tract infection) with or without fever is not a reason to postpone vaccination. If an illness is reported that is moderate or severe, vaccination is considered to be a precaution, not a contraindication; but, in general, it probably should be postponed.
Tip #3: You don't need to routinely test for pregnancy in girls and women of childbearing age before administering a live virus vaccine.
Routine pregnancy testing of girls and women of childbearing age before administering a live virus vaccine is not recommended, according to CDC's General Recommendations on Immunization (see page 27). However, females of childbearing age should be asked about the possibility of their being pregnant or their intention to become pregnant during the next four weeks prior to being given any vaccine for which pregnancy is a contraindication or precaution. (See CDC’s Guidelines for Vaccinating Pregnant Women, page 8). The patient's answer should be documented in the medical record. If the patient is uncertain if she is pregnant, a pregnancy test should be performed before administering live virus vaccines.
Tip #4: Implementing standing orders for vaccination allows appropriate medical personnel to administer vaccines even if a physician is not on site.
Vaccines can be administered only with an order from a physician or a healthcare provider who is authorized by the state to prescribe them. However, a physician may not necessarily need to be present to administer vaccines if standing orders are used. Several studies have shown that the use of standing orders can improve vaccination rates, and the Task Force on Community Preventive Services strongly recommends the use of standing orders programs among children, adolescent and adult vaccination programs (see Table 15 on page 50). A comprehensive set of Sample Standing Orders for Child and Teen Vaccination and Adult Vaccination is available from IAC. These sample orders may be modified to suit your work setting.
At the beginning of each year, the Centers for Disease Control and Prevention (CDC), in collaboration with professional societies, releases updated versions of the recommended U.S. immunization schedules for children and teens as well as for adults. These updated schedules reflect changes that were made in vaccination recommendations during the previous year.
Recommended Immunization Schedules for Persons Aged 0 Through 18 Years, U.S., 2014. This six-page schedule, which was published on the CDC website on January 31, 2014 includes the age-based routine vaccination schedule for children and teens and the approved catch-up immunization schedule for people age 4 months through 18 years who start vaccination late or who are more than one month behind. The schedule also includes three pages of essential explanatory footnotes. An article in the February 7 MMWR provides a summary of these changes.
Recommended Immunization Schedule for Adults Aged 19 Years and Older, U.S., 2014. Released by CDC on February 3, this five-page schedule for adult vaccination provides recommendations by age group as well as by medical condition, two pages of essential footnotes, and a final page summarizing the contraindications and precautions for adult vaccine use. An article in the February 7 MMWR summarizes the changes to the adult guidance.
Several additional formats of the schedules, including patient-friendly versions, are available on the CDC website.
To make your job easier, the Immunization Action Coalition (IAC) has designed two user-friendly documents that summarize the guidance contained in the current CDC/ACIP recommendations.
These summaries distill the ACIP recommendations for child, teen and adult immunization into two easy-to-use documents. Each summary includes the routine schedule, spacing between doses, schedules for catch-up vaccination, routes of administration, and contraindications and precautions for all routinely recommended vaccines in the United States.
These summaries of the recommendations have long proved their value — for almost two decades, they have been top downloads from IAC's website for busy healthcare professionals. They have been reprinted in textbooks and state health department newsletters and distributed at countless medical, nursing and public health conferences. Print the summaries on card stock and place them in every exam room for easy reference — you'll be glad you did!
In addition, IAC has developed the following specialized recommendation summaries for situations that providers often find confusing:
You can access these and more than 250 other ready-to-copy IAC materials
for healthcare professionals and patients on the IAC website.
Let’s start with the good news. Since human papillomavirus (HPV) vaccine was licensed for use in the U.S. in 2006, vaccine-type HPV prevalence has declined 56 percent among females 14 through 19 years of age.
Now for the bad news. According to the United States Centers for Disease Control and Prevention’s (CDC) most recent National Immunization Survey for teens, HPV vaccination rates did not increase at all from 2011 to 2012 in 13- to 17-year-old girls. Only half of these teens received the first dose of this anticancer vaccine, and only one-third received the full three-dose series.
Tdap and meningococcal vaccines were added to the vaccination schedule for preteens at about the same time, yet their coverage rates are much higher, 85 percent and 74 percent, respectively.
These survey results demonstrate that we are missing opportunities to vaccinate preteens against HPV. We need to do better.
Research consistently shows that a provider’s recommendation to vaccinate is the single most influential factor in convincing parents to vaccinate their children. Here are some important points to remember and statements you can make to parents when recommending HPV vaccine:
Your approach to discussing HPV vaccination with a parent strongly influences whether they have their child vaccinated. When you only ask parents if they’d like to vaccinate their child, rather than recommending it, vaccine acceptance drops significantly. Your strong recommendation is what is needed to protect our nation’s children from HPV.
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