Optimizing Immunization Efforts During Respiratory Virus Season

In this discussion, Crystal Hodge, PharmD, BCIDP, BCPS, emphasizes the importance of a holistic approach to vaccination during respiratory virus season. With multiple vaccines to consider—including influenza, RSV, COVID-19, and routine immunizations such as MMR—pharmacists play a critical role in ensuring patients are both protected and informed. Hodge highlights the CDC’s measles toolkit and educational flyers as valuable resources that can be incorporated into pharmacy settings to enhance patient understanding and engagement.

She explains that an effective strategy relies on a three-pronged approach: isolate, vaccinate, and educate. For suspected measles cases, isolation remains essential, while prevention efforts focus on ensuring vaccinations are up to date and risk factors are considered when timing doses. Hodge notes that although influenza, RSV, and COVID-19 follow more defined seasonal patterns, measles can be harder to detect until after exposures occur, underscoring the need for proactive patient education and comprehensive vaccine management.

Pharmacy Times: What evidence-based strategies can pharmacists use to address vaccine hesitancy and misinformation about the MMR vaccine?

Crystal Hodge, PharmD, BCIDP, BCPS: This is a really good question, because it's something we've been encountering a lot. We saw this with MMR before COVID, and then COVID really highlighted a lot of vaccine hesitancy and misinformation. We’re still encountering this quite a bit in the medical field.

One of the biggest things I would suggest to help with these conversations is to try not to make assumptions about why people are vaccine hesitant or about their willingness to engage in education efforts. Try to use motivational interviewing strategies as much as possible to better understand what their barriers are, what misinformation might be present, and what the best strategy is to adapt to that person in front of you.

For example, before COVID, in medical education we often used appeals to authority—saying that vaccines are generally safe and effective or that they’re recommended by the CDC. That worked for a lot of people, but there is a pocket of the population for whom those appeals don’t mean what they used to and may actually make them more skeptical. That’s why it’s so important to find out who you’re talking to, what their barriers are, and to adapt your approach. Avoiding trigger words or buzzwords whenever possible helps create space for a more informed conversation.

I would also suggest avoiding terms like “generally safe and effective” unless you’ve established that the person is willing to accept that, because many people are now skeptical of that phrase. It no longer carries the same weight it once did. Instead, be honest and focus on informed consent. For example, explaining, “Here are some of the side effects; here’s what to expect.” That way, when side effects occur, they can say, “My pharmacist gave me a heads-up about this—this is what I was expecting,” rather than, “They told me this was safe and effective, so why is my arm so sore?”

So, making sure we’re having more adaptable conversations, really focusing on the evidence, and meeting people where they are is key. Not everything is just misinformation. Sometimes there’s a nugget of truth that’s been spun in certain ways. If we can get to that nugget, come to an agreement, and expand from there, the conversation becomes much more productive.

Pharmacy Times: How should pharmacists approach catch-up vaccination for patients who are behind on their MMR schedule, including consideration for adults or special populations?

Hodge: So, since the MMR vaccine is a live vaccine, it is not appropriate for everyone. It is recommended for most people, which is why we want vaccination rates to be around 95%. We understand that for some individuals it isn’t appropriate as part of the general vaccine schedule.

For children, the schedule is to vaccinate at 12 to 15 months of age and then give the second dose at 4 to 6 years of age, since it’s a two-dose series. So essentially, you get one around a year old and the second between four and six years old. If someone doesn’t get vaccinated during that time frame, they can still do a catch-up vaccination. For the MMR vaccine, the doses just need to be separated by at least 28 days.

The caveat is that in pediatrics, there’s also the MMRV, which combines MMR with varicella. If that co-formulation is used, then the doses need to be separated by three months. So you want to think about the regular pediatric schedule—12 to 15 months, then 4 to 6 years—while also considering catch-up schedules.

And again, because it’s a live vaccine, there are populations where it shouldn’t be given—for example, immunocompromised patients or those who are pregnant. You also want to be mindful of which product is being used.

Pharmacy Times: How can pharmacists collaborate with local public health departments and other health care providers to track, report, and respond to measles cases effectively?

Hodge: Another great question. Measles is a reportable condition, so if you suspect it, you want to make sure that testing is done. Again, it’s important to call ahead and make sure the infrastructure is in place for the right testing. That means either contacting the health department if you think there’s a potential exposure at your pharmacy or, if you’re referring patients to their primary care provider or urgent care, letting them know as well.

Anytime there’s a positive test result, it does need to be reported. Usually, it’s the lab that reports, but not always—sometimes it’s the health system. For example, if it’s a hospital, then the hospital would be responsible for reporting.

In terms of tracking, you’ll want to check with your health department or local health department’s website and work with them as much as possible. During outbreaks, a lot of health departments have developed great toolkits and communication resources, which can be very helpful when communicating with the community at large.

Pharmacy Times: Given the overlap with other respiratory illnesses like influenza, RSV, and COVID-19, how can pharmacists prioritize patient education and vaccination to reduce overall disease burden this season?

Hodge: So, for the respiratory virus season, you’re going to have multiple vaccines to talk to people about—RSV, COVID, and flu—and you mentioned measles as another one to include. It’s important to think not just about seasonal vaccines but also about routine vaccines and making sure all of those are up to date, including the MMR vaccine.

The CDC has a measles toolkit that can be helpful to navigate, and they also provide flyers and other educational materials you can post in pharmacies or clinics. Having visible resources available while people are waiting can reinforce education efforts. Along with that, it’s important to tell patients about side effects, which vaccines they’re indicated for and when, and to consider timing based on their risk factors. That’s often the most helpful way to guide decision-making.

I try to take a three-pronged approach: isolate, vaccinate, and educate as much as possible. If you suspect measles, isolate. If you don’t suspect it and are focused on prevention or reducing exposures, then vaccinate and provide education.

When it comes to flu, RSV, and COVID, those viruses tend to follow very distinct seasonal patterns. Measles doesn’t follow the same clear seasonal trend, and it can be harder to differentiate until it’s almost too late—meaning exposure may already have occurred. That’s why it’s important to keep a holistic approach to people’s vaccine schedules.