Five Things Regarding Vaccine Administration

1.      If a Patient has not Completed a Vaccine Series, You Don’t Restart

  • In general, interruption of a vaccine series does not require restarting the series, regardless of the time between doses.
    • Exceptions include the oral ETEC diarrhea vaccine. The vaccine dose should be repeated if more than 6 weeks elapses between the first and the second dose of the primary 2-dose series or if more than 5 years have passed since the primary 2-dose series or the last booster dose.
  • As a general rule for any immunization series, it is better to be late than to be too early for subsequent doses. Although it is ideal for the patients to follow the recommended schedule as much as possible

2.      You can Give Multiple Vaccines on the Same Date

  • Most vaccines can be safely and effectively administered at the same visit
  • In general, all vaccine doses for which a recipient is eligible should be administered at a single visit to increase the chance that the person will be fully immunized
  • Simultaneous administration of vaccines is particularly important for persons preparing for travel or if it is uncertain that the person will return for additional immunization
  • Separate limbs should be used if two IM injections are required. If more than two injections are required, two injections may be administered into the same muscle separated by at least 2.5 cm (1″)
  • Vaccines that are known to cause more stinging or pain should be given last

3.      DON’T give ANY Live Vaccines if the Patient is Going to Need a Yellow Fever Vaccine

  • Live vaccines given by the parenteral route may be administered concomitantly with all other vaccines during the same visit, using different injection sites and separate needles and syringes.
  • In general, if two live parenteral vaccines are not administered concomitantly, there should be a period of at least 4 weeks before the second live parenteral vaccine is given.
  • If live parenteral vaccines are given too close together, the immune response to the second dose may be affected by the first dose and is considered invalid; it should be repeated at the recommended interval.
  • Live oral vaccines or live intranasal vaccine can be given concomitantly with, or any time before or after any other live or inactivated vaccine, regardless of the route of administration of the other vaccine. Exceptions include oral ETEC diarrhea vaccine (inactivated) and oral typhoid vaccine (live), which should be administered at least 8 hours apart.
  • The main one for pharmacists is to not administer a live attenuated herpes zoster vaccine and then send them to a travel clinic for a yellow fever vaccine

4.      Pharmacist Follow-Up for Boosters

  • There are many travellers who start a vaccine series and don’t complete it
  • Pharmacists should consider setting up call backs to ensure patients finish their full vaccine series

5.      Travel is a Good Time to Assess if a Traveller Needs Routine Vaccines

  • Consider assessing if the patient needs any of the following vaccines:
    • Tetanus/diphtheria – once every 10 years
    • Acellular pertussis – once in adulthood
    • Pneumococcal – most patients ≥ 18 with chronic conditions and all those at 65 years
    • Herpes zoster – Can be considered in anyone ≥ 50 years
    • HPV– Can be considered for any sexually active male or female

4 thoughts on “Five Things Regarding Vaccine Administration”

  1. If patient has finished all doses of Twinrix(HABV) 15 years ago then do they need new doses if travelling in risk area Again?

    1. Thanks for reading Hetal. According the Canadian Immunization Guide (CIG) most travellers will not need any further dosing. The only time I would consider titres is a patient at High risk (severe renal disease, or immunocompromised). The thought is if they completed the schedule the protection is lifelong even if the titres drop.

      Currently, no boosters are required if a traveller completed his/her Hep A/B series. This may changed but it has been this way for years.

      Thanks for reading

    1. Hi Saeed,

      In Canada, it depends on the province of practice. In some provinces, such as Ontario, pharmacists need a prescription from a MD or NP prior to injecting. Many will call the physician if a patient is a candidate. In other products, pharmacists don’t require a prescription. They can recommend and if the patient is interested, inject the same day.

      Thanks for reading

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