Immunization screening and provisions in the pharmacy setting often focus on initiatives for adults over 65 years of age. Yet the majority of the US population is between the ages of 18 and 64, with many of these individuals suffering from a chronic condition: The CDC estimates that 6 in 10 US adults have a chronic disease, and 4 in 10 have 2 or more.1 The most common chronic conditions, and the biggest drivers in annual health care costs for US adults, include heart disease, cancer, chronic lung disease, diabetes, and chronic kidney disease.1 Chronic health conditions with specific adult vaccination recommendations include those above, as well as HIV, chronic liver disease, iatrogenic immunosuppression, sickle cell anemia, and asplenia.

To better serve adults aged 19 to 64 years with chronic conditions, an easy-to-use vaccine guide, based on the CDC’s recommendations, is included below (see table).2 Additional resources to improve immunization screening practices for this patient population are also provided.





Current guidelines recommend that all adult patients aged 19 to 64 years—except those with allergies to components of the vaccine or contraindications— get an annual flu vaccine, a tetanus (or tetanus, diphtheria, and pertussis) booster every 10 years (assuming prior vaccination history), and the shingles vaccination series at 50 years or older.2

Improving screening procedures for recommended vaccinations can be as simple as providing a vaccine screening questionnaire to patients to better identify chronic health conditions. The CDC offers an excellent questionnaire at cdc.gov/vaccines/hcp/adults/downloads/patient-intake-form.pdf.3 This form can help explain to patients the importance of preventive health. After the patient fills out the form, the pharmacist can scan it into the computer charting system, analyze it, bill the patient’s insurance, and give recommended immunizations at the required intervals.

Resources for vaccine series follow-up are important yet often not discussed. Pharmacy staff can try to help patients set smartphone reminders at the end of their appointment to inform them when their next vaccine is due. Pharmacy staff can also provide appointment cards to remind patients when their next vaccine(s) are due and use technology means, such as text message reminders, to follow up with patients at appropriate intervals.

Using the aforementioned tools, pharmacists can better serve their adult patients with chronic condition immunization needs. 
 
LINCOLN ALEXANDER, PHARMD, is a residency program director and student experiential coordinator at Albertsons Companies in Portland, Oregon. He is an alumnus of the Oregon State University College of Pharmacy.

REFERENCES
  1. National Center for Chronic Disease Prevention and Health Promotion. Chronic diseases in America. CDC website. cdc.gov/chronicdisease/resources/infographic/ chronic-diseases.htm. Updated March 18, 2019. Accessed April 14, 2019.
  2. Immunization schedules. CDC website. cdc.gov/vaccines/schedules/hcp/imz/ adult.html. Updated February 5, 2019. Accessed April 14, 2019.
  3. Engerix-B [prescribing information]. Research Triangle Park, NC: GlaxoSmith- Kline; 2018. gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_ Information/Engerix-B/pdf/ENGERIX-B.PDF. Accessed April 14, 2019.
  4. Twinrix [prescribing information]. Research Triangle Park, NC: GlaxoSmith- Kline; 2018. gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/ Prescribing_Information/Twinrix/pdf/TWINRIX.PDF. Accessed April 14, 2019.
  5. FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old [news release]. Baltimore, MD: FDA; October 5, 2018. www.fda.gov/NewsEvents/ Newsroom/PressAnnouncements/ucm622715.htm. Accessed April 14, 2019.
  6. Standards for practice: vaccine needs assessment. CDC website. cdc.gov/ vaccines/hcp/adults/for-practice/standards/assessment.html. Updated May 2, 2016. Accessed April 14, 2019.