Pharmacists Can Take Shots at Vaccine-Preventable Diseases

Vaccines are seeing a resurgence in the United States. No polio cases caused by wild poliovirus (Poliovirus) have originated in the United States since 1979, and measles (Measles virus) was declared eliminated from the nation in 2000. However, cases of both preventable diseases are again on the rise.^1,2 According to the CDC, 1274 cases of measles virus were reported in 31 states in 2019—the highest number since 1992.³ In 2022, the United States was added to a list of 30 countries with circulating vaccine-derived poliovirus when a case was detected in an unvaccinated adult in Rockland County, New York, and the virus was also found in samples of nearby wastewater.⁴

Although measles virus cases have decreased since 2019 and poliovirus remains rare, declining childhood vaccination rates are worrisome. Pharmacists can play an important role in combating measles virus and poliovirus through vaccine promotion and administration, patient education, and health care provider collaboration.

Cases on the Rise

According to the CDC, measles virus is one of the most contagious respiratory viruses.¹ Infants, children younger than 5 years, adults older than 20 years, pregnant women, and immunocompromised individuals are at higher risk for experiencing complications such as encephalitis, pneumonia, and death.¹

Poliovirus can cause paralysis and—in severe cases—death. Current cases in the United States are vaccine derived in and originate from other countries, as the United States no longer uses the oral vaccine known to indirectly cause disease.³ Poliovirus is usually found in young children and transmits orally; it then replicates in the oropharynx and gastrointestinal tract.² Most infected individuals have no symptoms; 25% of infected patients have flulike symptoms lasting 2 to 5 days that resolve on their own, according to the CDC. Approximately 1% of patients experience paralysis or weakness in their limbs, although paralysis can affect other parts of the body and lead to permanent disability or death.²

Noninfectious postpolio syndrome is a complication of the disease and can occur 15 to 40 years after paralytic poliomyelitis. Between 25% and 40% of survivors experience this complication that causes slow and increasing weakness in the muscle groups affected by the initial infection.²

Promoting and Administering Vaccines

Laws vary by state on which vaccinations pharmacists may administer. The National Alliance of State Pharmacy Associations has published guidance on a state-by-state basis.⁵ Some states do not permit certain vaccinations to be administered in the pharmacy, whereas others require a prescription or have age limitations. It is essential to know the rules and regulations on vaccine administration that are appropriate for the state of practice.

Vaccination Against Measles Virus

Pharmacists may administer the measles vaccine to eligible patients in most states, including adults who may not have received it as children. The CDC advises that pharmacists highly encourage routine childhood measles-mumps-rubella vaccination. The first dose should be given to children aged 12 to 15 months⁶; the second dose should be administered to children aged 4 to 6 years, or at least 28 days after the first dose. Adults without evidence of immunity should have at least 1 dose,⁶ and unvaccinated individuals—both children and adults—should be vaccinated before any international travel.

Vaccination Against Poliovirus

Inactivated polio vaccine is a shot given in the leg or arm depending on the age of the patient.⁷ Children should receive routine vaccination with 4 doses at 2 months, 4 months, 6 to 18 months, and between 4 and 6 years.⁷ Unvaccinated children and adults, or those who did not complete the vaccine series, should be revaccinated with the full series.

Patient Education

Pharmacists can offer education and support to patients on the importance of vaccination against measles virus and poliovirus, and can explain how vaccines work in a way patients can understand.⁸ They can also discuss the risks of contracting measles virus and poliovirus and how vaccination protects patients and others, answering questions about adverse effects.⁸ Common myths and misconceptions about vaccines, such as the false claim that vaccines can cause autism, can also be addressed.

Authors of a commentary published in The Journal of Pediatric Pharmacology and Therapeutics⁸ noted that “across settings, developingrapport with their patients is necessary as all pharmacists recommend proper immunization schedules and provide support during outbreaks. Trust between patients and health care professionals and lobbying for patient advocacy help to build relationships and to enhance the communication between provider and patient.” In addition, pharmacists can provide resources for patients to learn more about these vaccines, such as websites or printed materials.

Collaboration With Health Care Providers

Coordination with other health care providers is essential to combat measles virus and poliovirus from the pharmacy. Some states require provider prescriptions for vaccinations against both diseases. Effective collaboration among health care providers can also help identify vaccination coverage gaps and develop strategies for increasing vaccination rates. If a community is experiencing an outbreak of measles virus or poliovirus, pharmacists can work with public health officials and other health care providers to develop targeted vaccination campaigns to help the most vulnerable.⁸ By sharing information, health care providers can also address vaccination barriers, such as misinformation or logistical challenges. Close collaboration between other health care providers and pharmacists ensures that patients are protected from these preventable diseases.⁸

Anna Legreid Dopp, PharmD, senior director, clinical guidelines and quality improvement, of the American Society of Health-System Pharmacists, spoke with Drug Topics about how pharmacists can combat these diseases from the pharmacy. Millions of vaccine doses were missed due to the COVID-19 pandemic, Legreid Dopp explained. “This is a setback to progress made

in improving vaccination rates for routine vaccinations, largely thanks to increasing patient access to vaccines through pharmacist services. We have catching up to do to ensure patients receive all recommended vaccines and to prevent future vaccine-preventable disease outbreaks.”

She added that, as the most accessible health care provider, pharmacists and pharmacy technicians can start by screening patients to see if they are up-to-date on their vaccines. Then, as a trusted member of the health care team, pharmacists can inform patients, identify opportunities for vaccination, and administer needed vaccines.

“Vaccine confidence continues to be a significant barrier to increasing vaccination rates; everyone in health care can have an impact on providing accurate information and combating misinformation on vaccines,” Legreid Dopp said.

References

1. Measles (rubeola) for healthcare providers. CDC. Updated November 5, 2020. Accessed March 23, 2023. https://www.cdc.gov/measles/hcp/index.html

2. Poliomyelitis: for healthcare providers. CDC. Updated August 10, 2022. Accessed March 23, 2023. https://www.cdc.gov/polio/what-is-polio/hcp.html

3. Measles cases and outbreaks. CDC. Updated April 4, 2023. Accessed March 23, 2023. https://www.cdc.gov/measles/cases-outbreaks.html

4. United States confirmed as country with circulating vaccine-derived poliovirus. News release. CDC. September 13, 2022. Accessed March 23, 2023. https://www.cdc.gov/media/releases/2022/s0913-polio.html

5. Pharmacist immunization authority. National Alliance of State Pharmacy Associations. Accessed April 11, 2023. https://naspa.us/resource/pharmacist-authority-to-immunize/

6. Pharmacists play crucial part in measles prevention. CDC. October 2020. Accessed March 23, 2023. https://www.cdc.gov/measles/downloads/matte-measles-pharmacists.pdf

7. Polio vaccination: information for healthcare professionals. CDC. Reviewed October 12, 2022. Accessed March 23, 2023. https://www.cdc.gov/vaccines/vpd/polio/hcp/index.html

8. Guerci J, Campbell CT, Curtis SD. The pharmacists’ role in disease outbreaks: navigating the dynamics of uncertainty before, during, and after disease outbreaks. J Pediatr Pharmacol Ther. 2020;25(5):384-389. doi:10.5863/1551-6776-25.5.384