Immunization adherence is now critically important, especially because the antivaccination movement stands to jeopardize public health. In fact, the World Health Organization has named vaccine hesitancy one of the 10 global threats of 2019.1 The measles outbreak has reached record-high levels, with 1246 cases confirmed across 31 states in 2019 as of October 3, 2019.2 That is the greatest number of cases reported in the United States since 1992 and since measles was declared eradicated in 2000.2 Pharmacists can play an important role in protecting public health and raising awareness of vaccine-preventable diseases by urging patients to follow immunization recommendations. During encounters with parents, pharmacists must stress the importance of staying up-to-date on children’s vaccines, as they protect against 14 diseases by age 2 years (figure).3



MEASLES AND COUNTERING THE ANTIVACCINATION MOVEMENT
Pharmacists must continue to debunk the myth that the measles, mumps, and rubella (MMR) vaccine causes autism. The Wakefield study published in the Lancet sparked fear among the public that the MMR vaccine caused autism, when in fact it was completely fabricated. The study was retracted, and Wakefield lost his medical license. Unfortunately, many who oppose vaccination still believe the claim. Pharmacists must continue to discuss the literature, which consistently demonstrates that the MMR vaccine does not cause autism. Results of one recent large-scale study of 657,461 Danish children over a 10-year period showed no link between autism and the MMR vaccine.4 However, debunking myths may not be effective when it comes to countering vaccine hesitancy. One controlled, ongoing randomized trial by Kaiser Permanente Colorado is evaluating 3 treatment arms, which involve testing the efficacy of the web-based Vaccines and Your Baby tailored messaging intervention versus an untailored version, compared with usual care for improving receipt of recommended childhood vaccines.5 The primary outcome is vaccination status by 6 months of age, and the study may shed light on the use of technology to counter vaccine hesitancy.

Pharmacists should focus discussions on the negative health consequences of not vaccinating adults and children, especially regarding the MMR vaccine. Remind parents of just how serious measles can be, with complications such as encephalitis, hospitalization, permanent hearing loss, pneumonia, and death. Also stress that refusal of the MMR vaccine increases risk for others who are too young to receive the vaccine as well as immunocompromised individuals. Social media platforms such as Facebook are taking steps to counter vaccine misinformation. However, inaccurate information is still spreading globally. As trusted health care professionals, pharmacists should use the various social media platforms to educate the public about the importance of vaccines. Community outreach programs and health fairs also afford opportunities to spread the word. Finally, pharmacists can advocate for stricter vaccine state laws that eliminate philosophical and religious exemptions.

INFLUENZA VACCINE AND THE UPCOMING FLU SEASON
Flu season is just around the corner, and pharmacists should emphasize the importance of early vaccination by October, before the season begins, as pharmacies usually receive influenza vaccines in August. Both the CDC’s Advisory Committee on Immunization Practices and the American Academy of Pediatrics will not have a preference regarding the inactivated influenza vaccine or the live attenuated influenza vaccine (LAIV) for the upcoming season.6 However, the LAIV FluMist nasal spray will be limited during the 2019-2020 season because of manufacturing constraints. Children aged 6 months to 8 years who did not receive at least 2 doses of the influenza vaccine before July 1, 2018, should receive 2 doses separated by at least 4 weeks.6 Children should receive the influenza vaccine as soon as it becomes available, especially those receiving it for the first time and who need 2 doses. Patients are sometimes hesitant to receive the flu vaccine because the efficacy can vary each season, so pharmacists must advise patients that getting the immunization is the best way to protect against influenza. During the 2018-2019 flu season, the CDC received 126 reports of influenza-associated pediatric deaths.7 Results from studies also demonstrate that the influenza vaccine protects against serious complications and death in those who receive the immunization.8
 
Jennifer Gershman, PharmD, CPh, is a drug information pharmacist and Pharmacy Times® contributor who resides in South Florida.

REFERENCES
  1. Ten threats to global health in 2019. World Health Organization website. who.int/emergencies/ten-threats-to-global-health-in-2019. Accessed July 26, 2019.
  2. Measles cases and outbreaks. CDC website. cdc.gov/measles/cases-outbreaks.html. Updated September[PS1]  16 2019. Accessed September 16, 2019. 
  3. 14 diseases you almost forgot about (thanks to vaccines). CDC website. cdc.gov/vaccines/parents/diseases/child/14-diseases.html. Updated August 2, 2019. Accessed September 16, 2019.
  4. Hviid A, Hansen JV, Frisch M, Melbye M. Measles, mumps, rubella vaccination and autism: a nationwide cohort study. Ann Intern Med. 2019;170(8):513-520. doi: 10.7326/M18-2101.
  5. Dempsey AF, Wagner N, Narwaney K, et al. ‘Reducing Delays in Vaccination’ (REDIVAC) trial: a protocol for a randomised controlled trial of a web-based, individually tailored, educational intervention to improve timeliness of infant vaccination. BMJ Open. 2019;9(5):e027968. doi: 10.1136/bmjopen-2018-027968.
  6. Jenco M. ACIP approves recommendations on MenB, HepA, flu vaccines. AAP News website. aappublications.org/news/2019/06/28/acip062819. Published June 28, 2019. Accessed July 31, 2019.
  7. Weekly U.S. influenza surveillance report. CDC website. cdc.gov/flu/weekly/index.htm. Updated July 5, 2019. Accessed July 31, 2019.
  8. Flannery B, Reynolds SB, Blanton L, et al. Influenza vaccine effectiveness against pediatric deaths: 2010-2014. Pediatrics. 2017;139(5):e20164244. doi: 10.1542/peds.2016-4244.