Dr. Schlesselman is an assistant clinical professor at the University of Connecticut School of Pharmacy.
At For Your Health Pharmacy, a man approaches the counter with a new prescription. The technician notices that the prescription is for diphtheria, tetanus, and acellular pertussis (Tdap) vaccine. The man comments that his physician said that the Centers for Disease Control and Prevention (CDC) guidelines recommend the use of a single dose of this vaccine for adults aged 19 to 64.
The technician enters the prescription as Daptacel (Dtap) and attempts adjudication with the insurance company. which rejects the claim. The man says that he will pay for it himself.
When the prescription, label, and product reach the front of the line, another technician calls the man's name and asks him to follow her into the immunization area. When they enter, the pharmacist who is waiting to give the injection asks where the child is who needs the vaccine. The technician and the man are confused by the question. The man confirms that he is the patient who needs the vaccine.
Why does the pharmacist expect a child?
At For Your Health Pharmacy, a mother approaches the counter with her 4-yearold son and hands the technician a prescription for him. The technician notices that the prescription is written for Zostavax. After entering the prescription into the computer, the technician receives notification from the insurance company that the claim is denied because the patient is too young. When the technician explains this to the mother, she says that her son is required to receive the varicella vaccine before enrolling in kindergarten. Rather than waiting until he is 5, she and the pediatrician opted to give the vaccine this year. She agrees to pay for the prescription rather than wait another year.
When the prescription, label, and product reach the front of the line, another technician calls the little boy's name and asks him and his mother to follow her into the immunization area. When they enter, the pharmacist who is waiting to give the injection is confused by the presence of a small child and young mother. After confirming that the prescription is actually written for this boy, he explains that he will need to call the pediatrician's office to clarify the prescription.
When he calls the office, the nurse is adamant that the child needs the Zostavax before he can enter kindergarten. When the pharmacist explains that the child is too young for it, the nurse recommends diluting the vaccine and giving him only half a dose.
Should the pharmacist consider diluting the Zostavax vaccine and giving half a dose an appropriate option for a child who needs a varicella vaccine?
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CASE ONE: Although the CDC's Advisory Committee on Immunization Practices does recommend the routine use of a single dose of a newly available tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in adults aged 19 to 64, this is not the same vaccine as the one administered to children. The adult version contains less diphtheria and pertussis. The adult version is marketed under the brand name Adacel (Tdap), and the pediatric version is Daptacel (Dtap).
CASE TWO: The pharmacist should not consider diluting the Zostavax as an option. Zostavax is the zoster live attenuated vaccine approved for the prevention of shingles in individuals aged 60 and older. The vaccine that is administered to children to prevent chickenpox is Varivax, the varicella live attenuated vaccine. This vaccine can be administered to children aged 12 months and older. These vaccines should not be confused and are not substitutable.