With a resurgence in vaccine-preventable diseases, it is incumbent upon pharmacists to take a lead role in providing education on the importance of vaccines in protecting public health, according to a session titled “Unique Strategies to Reduce Vaccine-Preventable Diseases,” at the American Society of Health-System Pharmacists (ASHP) 54th Midyear Clinical Meeting & Exhibition.

Presenters Jaime R. Hornecker, PharmD, BCPS, CDE, DPLA, a clinical professor of Pharmacy Practice at the University of Wyoming School of Pharmacy, and Shanna O’Connor, PharmD, assistant professor at the Idaho State University School of Pharmacy, outlined some of the barriers to immunization and strategies to overcome these challenges during their presentation the ASHP meeting.

“[Vaccines] are arguably the most important public health intervention of our time,” Hornecker said. “Immunizations have definitely played an important role in public health in our country.”

However, Hornecker noted that vaccine-preventable illnesses are making a resurgence due to myriad factors, such as a refusal to be immunized, under-vaccination, and waning immunity to diseases such as pertussis.

“One great example of this is measles,” she said during the presentation. “Within the last week, there have been 1276 cases reported to the CDC in this country. Now that’s largely due to patients who are unvaccinated; however, we also need to recognize that anyone who goes unvaccinated for a vaccine-preventable disease is at risk for morbidity and mortality.”

Hornecker noted that barriers such as concerns about adverse effects from vaccines, the number of immunizations administered to infants, and systemic and operational obstacles have also contributed to the resurgence of vaccine-preventable diseases.

“We also think of cost as a big concern. It’s not only cost related to the immunization and administration of the immunization itself, but it’s also the cost associated with receiving that immunization, such as transportation to the clinic,” she said.

Hornecker said that pharmacists may actually have unintentionally contributed to the rise of vaccine-preventable diseases because many of these diseases have been all but eradicated in the United States.

“We have a new generation of parents, perhaps, who maybe didn’t see the threat of those vaccine-preventable diseases, and so they may be making the choice to not immunize recognizing that it’s less important to do so, when in reality we know that’s not the case,” Hornecker said.

She discussed the success that the Educational Health Center of Central Wyoming had in initiating a program that improved vaccination rates for human papillomavirus (HPV) at the clinic. The initiative included educating health care providers and staff on the benefits of HPV vaccination, as well as patients on the facts and myths of HPV vaccination and its importance in preventing cancer.

The clinic also implemented improvements in their system, which addressed issues such as standing vaccine orders, remind/recall workflows, and the identification of strategies to improve compliance.

As a result, Hornecker said that HPV series and completion among adolescents at the clinic nearly doubled and missed opportunities decreased.

During her portion of the presentation, O’Connor discussed a vaccine series completion service run by Idaho State’s Bengal Pharmacy to improve vaccination for hepatitis A and B, which also addressed when patients dropped out from completing the series. The service initiated a vaccine calendar to contact patients 5 days prior to the due date for their next vaccine in the series, with a call placed to the prescriber, if needed. The clinic was then informed when the series was completed.

The service also took advantage of a state law in Idaho that allows pharmacy technicians who complete an extensive training program to administer vaccines to patients 6 years of age and older, which frees up pharmacists to operate at the top of their clinical capacity, according to O’Connor.

The program resulted in a 50% success rate per vaccine and $7200 net revenue over a 12-month period.

“There’s obviously a benefit for public health from the standpoint of decreasing the likelihood of communicable disease transmission in a high-risk population,” O’Connor said.

Reference
Hornecker J, O’Connor S. Unique Strategies to Reduce Vaccine-Preventable Diseases. Presented at: ASHP (American Society of Health-System Pharmacists) 54th Midyear Clinical Meeting & Exhibition; Las Vegas, NV: December 8, 2019.