Immunizations

continuing education
Overview of Pediatric, Adult,

and Travel Immunizations
By Gretchen M. Kreckel, PharmD
U pon completing this article the

pharmacist should be able to:
1. Understand basic principles of
passive and acquired immunity.
2. List target population, administra-
tion site, storage requirements,
administration schedule and special con-
siderations of immunizations available for
pharmacist administration.
for phagocytosis. This is adaptive immunity. Passive
immunity is most often known when it occurs between a
mother and her child. During pregnancy IgG is passed to
the baby. After delivery, IgA is passed to the baby through
breast milk. Passive immunity also occurs through immu-
nizations when certain antibodies are injected to provide
protection against specific pathogens or toxins. Many
vaccines require several doses for full protection. After
an initial vaccine, T-cells respond and then stimulate the
3. Understand elements of adding immuniza- production of memory B-cells. Multiple doses are needed
tions to the pharmacy business model. to ensure long-term protection. For many of the vaccines
4. Explain immunization by protocol, collabora- that require several doses, at least four weeks is needed
tive practice, prescription and elements of an between each dose. If it is necessary for a patient to
emergency protocol. “catch up,” the minimal acceptable time between vac-
cines should be followed using the “catch-up” dosing
One of the leading health indicators from schedule. If a dose is given before the minimal accept-
Healthy People 2010 is immunization. This is able time has elapsed, the dose doesn’t count and the
an area that was focused on to be increased vaccine would need to be given again. The only vaccine
by the year 2010. It will be interesting to see as series that would need to be restarted because of too
we have now entered 2010 if there has been an much time between doses is the oral typhoid vaccine.
increase in those who are up to date with the When administering vaccines, more than one type
recommended immunizations. Pharmacists play can be given at the visit, but the injection sites need to
an important role in immunizing patients. Many be separated by at least one inch. For inactive vaccines
patients who do not have a primary care physi- that are not given at the same visit there is no minimum
cian are able to get their vaccines from their time between when another inactive or live vaccine can
pharmacist. Pharmacists are the most acces- be administered with regard to the first vaccine. If two live
sible health care practitioners, so we have many vaccines are not given at the same visit, they should be
opportunities throughout our workdays to im- separated by at least a month. A purified protein deriva-
prove the health and wellbeing of our patients. tive (PPD for tuberculosis) test should also be separated
A basic understanding of the immunology from live vaccines by one month.
behind vaccines is necessary to understand Finding the most up-to-date information is imperative
how they work. Immunoglobulins are the an- when recommending what vaccinations a patient may
tigen binding molecules, and in the secreted need. The Centers for Disease Control (CDC) Web site
form are known as antibodies that are made (www.cdc.gov) is a useful resource. From its site you are
by B-cells. Antibodies circulate in the body able to print the most current vaccine information state-
fluids and target bacterial cells and particles ments to provide to your patients. Vaccination schedules,
www.americaspharmacist.net March 2010 | america’s Pharmacist 35

Recommended Immunization Schedule for Persons Aged 0 Through 6 Years—6OJUFE4UBUFTt
'PSUIPTFXIPGBMMCFIJOEPSTUBSUMBUF TFFUIFDBUDIVQTDIFEVMF
1 2 4 6 12 15 18 19–23 2–3 4–6

Vaccine ▼ Age ► Birth month months months months months months months months years years
)FQBUJUJT#1 HepB HepB HepB
Rotavirus2 RV RV RV 2 Range of
recommended
see
Diphtheria, Tetanus, Pertussis DTaP DTaP DTaP footnote 3 DTaP DTaP ages for all
DIJMESFOFYDFQU
Haemophilus influenzae type b4 Hib Hib Hib4 Hib DFSUBJOIJHISJTL
groups
Pneumococcal 5 PCV PCV PCV PCV PPSV
Inactivated Poliovirus6 IPV IPV IPV IPV

Range of
Influenza7 Influenza (Yearly) recommended
ages for certain
Measles, Mumps, Rubella MMR see footnote 8 MMR IJHISJTLHSPVQT
Varicella9 Varicella see footnote 9 Varicella
)FQBUJUJT"10 HepA (2 doses) HepA Series
Meningococcal11 MCV
This schedule includes recommendations in effect as of December 15, 2009. Committee on Immunization Practices statement for detailed recommendations:
Any dose not administered at the recommended age should be administered at a http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse
along with “catch-up” vaccination schedules, are also
subsequent visit, when indicated and feasible. The use of a combination vaccine by bacteria and usually affects children under 5
events that follow immunization should be reported to the Vaccine Adverse Event
generally is preferred over separate injections of its equivalent component vaccines. Reporting System (VAERS) at http://www.vaers.hhs.gov or by telephone,
available through the CDC site. Through the site you are
Considerations should include provider assessment, patient preference, and years old. Before the availability of the vaccine
800-822-7967.
the potential for adverse events. Providers should consult the relevant Advisory
also able to determine what vaccinations are both recom- it was the leading cause of bacterial meningitis
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Chicken Pox
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trunk, face, and
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into
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the child’s
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which is available
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live attenuated vaccine and is administered subcutane- TFDPOEEPTFNBZCFBENJOJTUFSFECFGPSFBHF
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ouslyrin the upper arm. Children who have never had 9. Varicella
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15 months, and the second dose should
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between ages of 4 and 6 years old. The second dose can Administer
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children aged 12 months through 4 years. or for whom immunity against hepatitis A is desired.
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vaccine. be stored frozen and reconstituted the timevaccine.
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with the diluent immediately before administration.
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ment component deficiency, anatomic or functional asplenia, and certain other
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vaccine, years or older with certain underlying medical conditions, including a cochlear
neomycin,
implant. or gelatin
See MMWR /P33 should
not receive this vac- Hepatitis
m
A
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cine. Persons who are pregnant, have an acute illness, Hepatitis A disease is a serious liver disease
$4"
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are (http://www.cdc.gov/vaccines/recs/acip),
taking immunosuppressive therapy,
the American or are
Academy receiving
of Pediatrics (http://www.aap.org that is caused by the hepatitis Ahttp://www.aafp.org).
BOEUIF"NFSJDBO"DBEFNZPG'BNJMZ1IZTJDJBOT virus found
%FQBSUNFOUPG)FBMUIBOE)VNBO4FSWJDFTr$FOUFSTGPS%JTFBTF$POUSPMBOE1SFWFOUJPO
immune globulin or other blood products during the past in the stool of an infected person. It is spread
five months should not receive this vaccine. through close personal contact or through
09_207330-A_Atkinson_2010ChildImmSched_122809.indd 1 12/28/2009 1:03:47 PM
food or drinking water that has been contami-
Haemophilus influenzae type B nated. Infection with this virus can present as
Haemophilus influenzae type B (Hib) disease is caused a mild “flu-like” illness, jaundice, or with severe
36 america’s Pharmacist | March 2010 www.americaspharmacist.net

stomach pains and diarrhea. Those who should include loss of appetite, diarrhea and vomiting, fatigue,
get vaccinated include all children 1 year old, jaundice, or pain in muscles, joints, and stomach. It can
those who are 1 and older traveling to a country lead to chronic infection which leads to cirrhosis, liver
where hepatitis is highly prevalent, children up cancer, and even death. All children should get their first
to 18 who live in communities where vaccination dose at birth, should receive the second dose at 1 to 2
has been implemented because of high dis- months of age and receive the final dose between the
ease prevalence, men who have sex with men, ages of 6 and 18 months. Children and adults who are not
those who use illegal drugs, those with chronic vaccinated should receive an initial dose, a second dose
liver disease, those who are treated with clotting a month later, and the final dose six months after the first
factors, and those who work with hepatitis A dose is administered. It is administered intramuscularly
infected primates or work in hepatitis A research into a child’s upper thigh or, if older than 3 years, into the
laboratories. It is administered intramuscularly deltoid muscle. This vaccine is stored in the refrigerator.
into a child’s upper thigh or, if older than, into Persons who have ever had a serious allergic reaction to
the deltoid muscle. a previous dose of this vaccine or to baker’s yeast, and
The first dose should be given after 1 year anyone who is moderately to severely ill at the time that the
of age, and the second dose should be given shot is scheduled should not receive the vaccine.
at least six months following the first dose. This vaccine is an inactivated vaccine that is available
This vaccine must be refrigerated. People who as Engerix-B (GSK) and Recombivax HB (Merck) both as
have ever had a serious allergic reaction to a pediatric and adult formulations.
previous dose of this vaccine and anyone who
is moderately to severely ill at the time that Human Papillomavirus (HPV)
the shot is scheduled should not receive the Human Papillomavirus (HPV) is the most commonly
vaccine. This vaccine is an inactivated vaccine transmitted sexually transmitted disease in the United
that is available under the trade names Vaqta States. Currently more than 100 types of HPV have
(Merck) and Havrix (GlaxoSmithKline). been identified, with 35 types infecting the genital tract.
HPV Type-16 and Type-18 cause 70 percent of cervical
Hepatitis B cancers. HPV Type-6 and Type-11 cause approximately
Hepatitis B is another serious disease that af- 95 percent of anogential warts. It can cause genital warts
fects the liver and is caused by the hepatitis B and can also cause cervical cancer in women. The HPV
virus that is spread through the blood or bodily vaccine protects against the four major types of HPV.
fluids of an infected person. An acute illness can The vaccine is indicated for females between the ages
Recommended Immunization Schedule for Persons Aged 7 Through 18 Years— 6OJUFE4UBUFTr

For those who fall behind or start late, see the schedule below and the catch-up schedule
Vaccine ▼ Age ► 7–10 years 11–12 years 13–18 years

1 Tdap Tdap
Tetanus, Diphtheria, Pertussis
Range of
Human Papillomavirus2 see footnote 2 HPV (3 doses) HPV series recommended
ages for all
children except
Meningococcal MCV MCV MCV
DFSUBJOIJHISJTL
groups
Influenza Influenza (Yearly)
Pneumococcal5 PPSV
Range of
recommended
Hepatitis A6 HepA Series
ages for
catch-up
Hepatitis B7 Hep B Series immunization
8
Inactivated Poliovirus IPV Series
9 Range of
Measles, Mumps, Rubella MMR Series
recommended
10
ages for certain
Varicella Varicella Series IJHISJTLHSPVQT
This schedule includes recommendations in effect as of December 15, 2009. Committee on Immunization Practices statement for detailed recommendations:
Any dose not administered at the recommended age should be administered at a http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse
subsequent visit, when indicated and feasible. The use of a combination vaccine events that follow immunization should be reported to the Vaccine Adverse Event
www.americaspharmacist.net
generally is preferred over separate injections of its equivalent component vaccines. March 2010 | america’s
Reporting System (VAERS) at http://www.vaers.hhs.gov Pharmacist
or by telephone, 37
Considerations should include provider assessment, patient preference, and 800-822-7967.
the potential for adverse events. Providers should consult the relevant Advisory
1. Tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap). 4. Influenza vaccine (seasonal).
(Minimum age: 10 years for Boostrix and 11 years for Adacel) r "ENJOJTUFSBOOVBMMZUPDIJMESFOBHFENPOUITUISPVHIZFBST
www.americaspharmacist.net
Catch-up Immunization Schedule for Persons Aged 4 Months Through 18 Years Who Start Late or Who Are More Than 1 Month Behind—United States t 2010
The table below provides catch-up schedules and minimum intervals between doses for children whose vaccinations have been delayed. A vaccine
series does not need to be restarted, regardless of the time that has elapsed between doses. Use the section appropriate for the child’s age.
PERSONS AGED 4 MONTHS THROUGH 6 YEARS
Minimum Age Minimum Interval Between Doses
Vaccine
for Dose 1 Dose 1 to Dose 2 Dose 2 to Dose 3 Dose 3 to Dose 4 Dose 4 to Dose 5
8 weeks
)FQBUJUJT# #JSUI 4 weeks
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3PUBWJSVT XLT 4 weeks 4 weeks2
%JQIUIFSJB 5FUBOVT 1FSUVTTJT XLT 4 weeks 4 weeks 6 months 6 months3
4 weeks 4 weeks4
JGàSTUEPTFBENJOJTUFSFEBUZPVOHFSUIBOBHFNPOUIT JGDVSSFOUBHFJTZPVOHFSUIBONPOUIT
8 weeks (as final dose)
8 weeks (as final dose) 8 weeks (as final dose)4 5IJTEPTFPOMZOFDFTTBSZ
JGàSTUEPTFBENJOJTUFSFEBUBHFmNPOUIT JGDVSSFOUBHFJTNPOUITPSPMEFSBOEàSTUEPTF GPSDIJMESFOBHFENPOUIT
Haemophilus influenzae UZQFC XLT
BENJOJTUFSFEBUZPVOHFSUIBOBHFNPOUITBOE UISPVHINPOUITXIP
No further doses needed
TFDPOEEPTFBENJOJTUFSFEBUZPVOHFSUIBONPOUIT SFDFJWFEEPTFTCFGPSF
JGàSTUEPTFBENJOJTUFSFEBUBHFNPOUITPSPMEFS
BHFNPOUIT
No further doses needed
JGQSFWJPVTEPTFBENJOJTUFSFEBUBHFNPOUITPSPMEFS
4 weeks 4 weeks
JGDVSSFOUBHFJTZPVOHFSUIBONPOUIT 8 weeks (as final dose)
JGàSTUEPTFBENJOJTUFSFEBUZPVOHFSUIBOBHFNPOUIT
5IJTEPTFPOMZOFDFTTBSZ
8 weeks (as final dose for healthy children) 8 weeks GPSDIJMESFOBHFENPOUIT
JGàSTUEPTFBENJOJTUFSFEBUBHFNPOUITPSPMEFS (as final dose for healthy children) UISPVHINPOUITXIP
1OFVNPDPDDBM XLT
PSDVSSFOUBHFUISPVHINPOUIT JGDVSSFOUBHFJTNPOUITPSPMEFS SFDFJWFEEPTFTCFGPSF
BHFNPOUITPSGPSIJHI
No further doses needed No further doses needed SJTLDIJMESFOXIPSFDFJWFE
GPSIFBMUIZDIJMESFOJGàSTUEPTF GPSIFBMUIZDIJMESFOJGQSFWJPVTEPTFBENJOJTUFSFEBUBHF EPTFTBUBOZBHF
BENJOJTUFSFEBUBHFNPOUITPSPMEFS NPOUITPSPMEFS
*OBDUJWBUFE1PMJPWJSVT XLT 4 weeks 4 weeks 6 months
.FBTMFT .VNQT 3VCFMMB NPT 4 weeks
7BSJDFMMB NPT 3 months
)FQBUJUJT" NPT 6 months
PERSONS AGED 7 THROUGH 18 YEARS
4 weeks
JGàSTUEPTFBENJOJTUFSFEBUZPVOHFSUIBOBHFNPOUIT 6 months
5FUBOVT %JQIUIFSJB
Pharmacist | March 2010

ZST 4 weeks JGàSTUEPTFBENJOJTUFSFEBU
5FUBOVT %JQIUIFSJB 1FSUVTTJT 6 months ZPVOHFSUIBOBHFNPOUIT
JGàSTUEPTFBENJOJTUFSFEBUNPOUITPSPMEFS
)VNBO1BQJMMPNBWJSVT ZST Routine dosing intervals are recommended11
)FQBUJUJT" NPT 6 months
8 weeks
)FQBUJUJT# #JSUI 4 weeks
BOEBUMFBTUXFFLTBGUFSàSTUEPTF
*OBDUJWBUFE1PMJPWJSVT XLT 4 weeks 4 weeks 6 months
.FBTMFT .VNQT 3VCFMMB NPT 4 weeks
america’s
3 months
JGQFSTPOJTZPVOHFSUIBOBHFZFBST
7BSJDFMMB NPT
4 weeks
JGQFSTPOJTBHFEZFBSTPSPMEFS
38
1. Hepatitis B vaccine (HepB). r "GPVSUIEPTFJTOPUOFDFTTBSZJGUIFUIJSEEPTFXBTBENJOJTUFSFEBUBHFZFBST
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r "EPTFTFSJFT TFQBSBUFECZBUMFBTUNPOUIT PGBEVMUGPSNVMBUJPO3FDPNCJWBY r *OUIFàSTUNPOUITPGMJGF NJOJNVNBHFBOENJOJNVNJOUFSWBMTBSFPOMZSFDPN
)#JTMJDFOTFEGPSDIJMESFOBHFEUISPVHIZFBST NFOEFEJGUIFQFSTPOJTBUSJTLGPSJNNJOFOUFYQPTVSFUPDJSDVMBUJOHQPMJPWJSVT JF
2. Rotavirus vaccine (RV). USBWFMUPBQPMJPFOEFNJDSFHJPOPSEVSJOHBOPVUCSFBL
r 5IFNBYJNVNBHFGPSUIFàSTUEPTFJTXFFLTEBZT7BDDJOBUJPOTIPVMEOPUCF 7. Measles, mumps, and rubella vaccine (MMR).
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of 9 and 26 years old. It consists of a three the time that the shot is scheduled should not receive the
shot series where a first dose is administered vaccine. Those with a history of Guillain-Barre Syndrome
(day-0), with a second dose administered two should talk with their physician before receiving the vac-
months later, and the final dose administered cine. Most people need only one dose of the influenza
six months after the first dose. This vaccine is vaccine each year, but children younger than 9 years who
administered intramuscularly into the deltoid are receiving the vaccine for the first time should receive
muscle. This vaccine available as Gardasil two doses that are spaced at least four weeks apart. In
(Merck), and requires refrigeration. It is an spite of their repeated exposure to the flu virus, approxi-
inactivated vaccine. People who have ever had mately 40 percent of U.S. health care workers do not
a serious allergic reaction to a previous dose receive the annual flu vaccine.
of this vaccine or to yeast, pregnant women,
and anyone who is moderately to severely ill at Japanese Encephalitis
the time that the shot is scheduled should not Japanese encephalitis (JE), a mosquito-borne arboviral
receive the vaccine. Flavivirus infection, is the leading cause of viral encepha-
litis in Asia. It is spread through infected mosquitoes and
Influenza causes fever and headache and in severe cases results
Influenza can be spread through coughing, in swelling of the brain. People who are traveling to af-
sneezing, or through nasal secretions causing fected areas should protect themselves by using insect
fever, cough, sore throat, headache, fatigue, repellant and wearing clothing to cover most of the body
chills, and muscle aches. The influenza vaccine as well as by getting the vaccine. The vaccine is given
protects against the seasonal flu and needs to in three doses, with the second dose given seven days
be given yearly. There are two types of the influ- after the first dose, and the third dose given 30 days after
enza vaccine; the live, attenuated vaccine avail- the first. The final dose should be given at least 10 days
able as a nasal spray (Flumist Medimmune) before traveling. A booster dose may be needed after two
and the inactivated influenza vaccine, which is years. This vaccine is inactivated and is administered in-
given by injection (Fluzone Sanofi). tramuscularly into the deltoid muscle. It is available under
The live, attenuated vaccine can be given the trade name JE-VAX, manufactured by The Research
to healthy persons between the ages of 2 and Foundation for Microbial Diseases of Osaka University
49 who are not pregnant. It is administered (BIKEN). The vaccine should be stored under refrigera-
intranasally, with half of the dose administered tion. Those who have had a life-threatening reaction to
in each nostril. It requires refrigeration. The “flu mouse protein, thimerosal, or to a previous dose of this
shot” should be given to all children 6 months vaccine should not be vaccinated.
of age and older, women who are pregnant, There are currently two JE vaccines available in the
those with long-term health problems, health United States, under the trade names JE-VAX (Sanofi
care providers, caregivers of children who are Pasteur) and IXIARO (Novartis Vaccines). This vaccine
younger than 5 years of age, or those who live is inactivated and is administered intramuscularly into
in crowded conditions, such as dormitories, the deltoid muscle. IXIARO was approved by the FDA
nursing homes, or correctional facilities. Vacci- in March 2009 and is currently only indicated in patients
nation for influenza occurs from late September ≥17 years of age. The immunization schedule consists of
through January. It is administered intramuscu- two doses administered 28 days apart, and it is recom-
larly into a child’s upper thigh or, if older than mended that the series be completed at least one week
3 years, into the deltoid muscle. This vaccine prior to potential exposure. Because IXIARO is currently
is stored in the refrigerator. Persons who have approved only for use in persons, JE-VAX remains the
ever had a serious allergic reaction to a previ- only JE vaccine that is approved for use in children in the
ous dose of this vaccine or are allergic to eggs, United States. Supply is limited and remaining quantities
and anyone who is moderately to severely ill at are reserved for use in children only.

Meningococcal to receive the vaccine and women should avoid
Meningococcal disease is a bacterial illness that is the getting pregnant for four weeks after vaccina-
leading cause of bacterial meningitis in children between tion. Anyone who is moderately to severely ill at
the ages of 2 and 18 years old. There are two forms of the time that the shot is scheduled should not
meningococcal vaccines available in the United States. receive the vaccine. Those who are immuno-
The meningococcal conjugate vaccine (MCV4) is for compromised, have cancer, are being treated
those from the ages of 2 and 55 (Manactra Sanofi) and with steroids, had a low platelet count, or had a
meningococcal polysaccharide vaccine (MPSV4) (Meno- recent transfusion should check with their physi-
mune Sanofi) that is used when MCV4 is not available cian before getting vaccinated. This combina-
and in those older than 55. Both versions of the vaccine tion product is available as MMR by Merck.
are inactivated. This vaccine is recommended for those
between 11 and 18 years old. It is recommended for Pneumococcal
college freshman living in dormitories, those who work Pneumococcal disease is caused by Strepto-
in laboratories and are exposed to the bacteria, military coccus pneumoniae bacteria and can lead to
recruits, those traveling to or living in countries where the serious infections of the lungs, blood, or to men-
disease is common, those with a damaged or removed ingitis. It is recommended that all adults over the
spleen, those with terminal complement component age of 65, anyone between the ages of 2 and
deficiency, and those who may have been exposed to an 64 years old with a long-term health problem or
outbreak. Those persons 2 years old and older should condition that lowers the body’s resistance to
receive one dose and, in special circumstances, for chil- infection, as well as any adults who are between
dren from 3 months of age to 2 years who need the vac- 19 and 64 years old with asthma or are smokers
cine, two doses should be given three months apart. This should receive the pneumococcal polysaccha-
vaccine is administered intramuscularly into the deltoid ride vaccine. This vaccine is a mixture of the 23
muscle. This vaccine is stored in the refrigerator. People of the most prevalent or invasive pneumococcal
who have ever had a serious allergic reaction to a previ- types of Streptococcus pneumoniae. There are
ous dose of this vaccine and anyone who is moderately 90 known types. The 23 valent vaccine accounts
to severely ill at the time that the shot is scheduled should for at least 90 percent of the pneumococcal
not receive the vaccine. Those with a history of Guillain- blood isolates. Pneumovax23 (Merck), an inacti-
Barre Syndrome should talk with their physician before vated vaccine consists of highly purified capsu-
receiving the vaccine. lar polysaccharides.
Usually only one dose of the vaccine is
Measles, Mumps, and Rubella needed, but a second dose of the vaccine is
Measles, mumps, and rubella are serious diseases that recommended for people over 65 who received
can be spread from person to person through the air. the first dose of the vaccine when they were
Children should get two doses of the MMR vaccine with younger than 65 and at least five years has
the first dose administered between the ages of 12 and elapsed since the first dose. Those between 2
15 months, at ages 4 to 6 years. People who were born and 64 years old with certain health conditions,
after 1956 should get at least one dose of the vaccine such as a damaged or no spleen, sickle-cell
unless they have been previously vaccinated or had the disease, HIV infection or AIDS, cancer, nephritic
diseases. This vaccine is administered subcutaneously in syndrome, organ or bone marrow transplant, or
the upper arm. It is a live attenuated vaccine and needs to are taking medications that lower their immunity
be stored in the refrigerator and reconstituted immediately should also receive a second dose. Second
before administration. Persons who have ever had a seri- doses should always be given five years after the
ous allergic reaction to a previous dose of this vaccine, first dose. It is administered intramuscularly into
to gelatin, or to neomycin should not receive the vaccine. a child’s upper thigh, or if older than 3 years, into
Pregnant women should wait until they have given birth the deltoid muscle. This vaccine requires refrig-

Recommended Adult Immunization Schedule
UNITED STATES · 2010
Note: These recommendations must be read with the footnotes that follow
containing number of doses, intervals between doses, and other important information.
Figure 1. Recommended adult immunization schedule, by vaccine and age group
AGE GROUP 19–26 years 27–49 years 50–59 years 60–64 years >65 years
VACCINE
Tetanus, diphtheria, pertussis Td booster

Substitute 1-time dose of Tdap for Td booster; then boost with Td every 10 yrs every 10 yrs
(Td/Tdap)1,*
Human papillomavirus (HPV)2,* 3 doses (females)
Varicella3,* 2 doses
Zoster4 1 dose
Measles, mumps, rubella (MMR)5,* 1 or 2 doses 1 dose
Influenza6,* 1 dose annually
Pneumococcal (polysaccharide)7,8 1 or 2 doses 1 dose
Hepatitis A9,* 2 doses
Hepatitis B10,* 3 doses
Meningococcal11,* 1 or more doses
*Covered by the Vaccine Injury Compensation Program.

For all persons in this category who meet the age Recommended if some other risk factor is No recommendation
requirements and who lack evidence of immunity present (e.g., on the basis of medical,
(e.g., lack documentation of vaccination or have occupational, lifestyle, or other indications)
no evidence of prior infection)
Report all clinically significant postvaccination reactions to the Vaccine Adverse Event Reporting System (VAERS). Reporting forms and instructions on filing a VAERS report are available at www.vaers.hhs.gov or by
telephone, 800-822-7967.
Information on how to file a Vaccine Injury Compensation Program claim is available at www.hrsa.gov/vaccinecompensation or by telephone, 800-338-2382. To file a claim for vaccine injury, contact the U.S. Court of
Federal Claims, 717 Madison Place, N.W., Washington, D.C. 20005; telephone, 202-357-6400.
Additional information about the vaccines in this schedule, extent of available data, and contraindications for vaccination is also available at www.cdc.gov/vaccines or from the CDC-INFO Contact Center at
800-CDC-INFO (800-232-4636) in English and Spanish, 24 hours a day, 7 days a week.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
eration. People who have ever had a serious al- been bitten by an animal and has not previously been
lergic reaction to a previous dose of this vaccine vaccinated should get five doses of the rabies vaccine,
and anyone who is moderately to severely ill at the first dose immediately and additional doses on the
the time that the shot is scheduled should not re- third, 14th, and 28th days. This vaccine, RabAvert, is an
ceive the vaccine. Women should be vaccinated inactivated vaccine. They also should receive rabies im-
before becoming pregnant if possible. mune globulin, with the first dose to provide immediate
protection. The first dose is often given at physician’s of-
Rabies fice or in the emergency room, and the subsequent doses
Rabies is a serious disease caused by a virus. are often given at the pharmacy. If a person has been
Humans get rabies when they are bitten by an previously vaccinated they should get two doses of the
infected animal. The vaccine is given to pro- vaccine after an exposure. The first dose is given immedi-
tect people who are at high risk of exposure to ately and a second dose is administered on the third day.
rabies and can also be given to those who have In this instance rabies immune globulin is not needed.
been exposed. It is recommended that those It is administered intramuscularly into the deltoid
who are at high risk for exposure be vaccinated. muscle. This vaccine is stored in the refrigerator. People
The schedule for pre-exposure consists of three who have ever had a serious allergic reaction to a previ-
doses. Dose one is given, then dose two is ous dose of this vaccine and anyone who is moderately
given seven days later, and dose three is given to severely ill at the time that the shot is scheduled should
21 or 28 days after dose one. Anyone who has not receive the vaccine. If a person has been exposed to

rabies, they should receive the vaccine regardless of any are caused by bacteria. Diphtheria and pertus-
other illnesses that they have. sis are spread from person to person, whereas
tetanus is spread through cuts or wounds. The
Herpes Zoster three are given in a series starting at 6 weeks
Herpes Zoster, commonly known as shingles, is a painful of age and older. The first dose is given at that
skin rash that usually appears on one side of the face or time, the second dose is given at 4 months
body. Shingles is caused by the Varicella Zoster virus, of age, the third dose at 6 months of age, the
which is the same virus that causes chickenpox. A single fourth dose is administered six months after
dose of the vaccine is recommended for those 60 and the third dose, and the final dose is adminis-
older. It is administered subcutaneously in the upper arm. tered between the ages of 4 and 6 years. Upon
This live attenuated vaccine, known as Zostavax needs completion of the series a booster dose of diph-
to be stored frozen and reconstituted with the diluent im- theria, tetanus, and pertussis is administered
mediately before administration. between 11 and 12 years of age. Adults need a
booster of tetanus and diphtheria (Td) vaccine
Zoster vaccine should not be administered to: every 10 years. Due to the recent increase in
• People with leukemia, lymphomas, or other malignant neo- pertussis cases, it is now recommended to
plasms affecting the bone marrow or lymphatic system. substitute one dose of Tdap for Td on the adult
• People on immunosuppressive therapy, including immunization schedule. It is an inactivated
high-dose corticosteroids (>20 mg/day of prednisone vaccine that is administered intramuscularly
or equivalent) lasting two or more weeks. Vaccination into the deltoid muscle. This vaccine is stored
should be deferred for at least one month after discon- in the refrigerator. Persons who have ever had
tinuation of such therapy. a serious allergic reaction to a previous dose of
• People with clinical or laboratory evidence of other this vaccine and anyone who is moderately to
unspecified cellular immunodeficiency. severely ill at the time that the shot is scheduled
• People receiving recombinant human immune media- should not receive the vaccine.
tors and immune modulators, especially the antitumor
necrosis factor agents adalimumab, infliximab, and Typhoid
etanercept. If it is not possible to administer zoster vac- Typhoid is a disease that is caused by the
cine to patients before initiation of therapy, assess the bacteria Salmonella Typhi that can cause a high
immune status of the recipient on a case-by-case basis fever, weakness, stomach pains, loss of appetite,
to determine the relevant risks and benefits. Otherwise, and maybe a rash. If left untreated it could lead
defer vaccination for at least one month after discon- to death. It is often contracted through contami-
tinuation of such therapy. nated food or water, but can also be spread from
• Persons taking chronic acyclovir, famciclovir, or vala- human to human. There are two vaccination op-
cyclovir should discontinue these medications at least tions to prevent typhoid. The inactivated vaccine
24 hours before administration of zoster vaccine, if is given as a shot and the live vaccine is avail-
possible. These medications should not be used for at able as oral capsules. It is recommended that
least 14 days after vaccination, by which time the im- people who are traveling to areas where typhoid
munologic effect should be established. is common, those who are in contact with travel-
• People who have ever had a serious allergic reaction ers exposed to typhoid, and those who work in
to neomycin or gelatin, those with a weakened immune laboratories that handle these bacteria should
system, and those with untreated tuberculosis should be vaccinated. The shot can be given to those
not receive this vaccine. over 2 years old at least two weeks before travel.
A booster would be needed every two years
Tetanus, Diphtheria, and Pertussis for those who remain at risk. The oral vaccine
Tetanus, diphtheria, and pertussis are three diseases that can be given to those over 6 years of age. Four

Figure 2. Vaccines that might be indicated for adults based on medical and
other indications
Asplenia 12
Immuno- HIV Diabetes, (including
infection 3–5,12,13 Kidney failure,
compromising heart disease, elective
end-stage renal Health-care
conditions chronic splenectomy Chronic liver
INDICATION Pregnancy
(excluding human CD4+ T lympho- lung disease, and persistent disease
disease, personnel
cyte count receipt of
immunodeficiency chronic complement
hemodialysis
virus [HIV]) 3–5,13 alcoholism component
<200 >200
VACCINE cells/µL cells/µL
deficiencies)
Tetanus, diphtheria, pertussis

Td Substitute 1-time dose of Tdap for Td booster; then boost with Td every 10 yrs
(Td/Tdap)1,*
Human papillomavirus (HPV)2,* 3 doses for females through age 26 yrs
Varicella3,* Contraindicated 2 doses
Zoster4 Contraindicated 1 dose
Measles, mumps, rubella (MMR)5,* Contraindicated 1 or 2 doses
1 dose TIV
Influenza6,* 1 dose TIV annually or LAIV
annually
Pneumococcal (polysaccharide)7,8 1 or 2 doses
Hepatitis A9,* 2 doses
Hepatitis B10,* 3 doses
Meningococcal11,* 1 or more doses

*Covered by the Vaccine Injury Compensation Program.
For all persons in this category who meet the age Recommended if some other risk factor is No recommendation
requirements and who lack evidence of immunity present (e.g., on the basis of medical,
(e.g., lack documentation of vaccination or have occupational, lifestyle, or other indications)
no evidence of prior infection)
These schedules indicate the recommended age groups and medical indications for which administration of currently licensed vaccines is commonly indicated for adults ages 19 years and older, as of January 1, 2010.
Licensed combination vaccines may be used whenever any components of the combination are indicated and when the vaccine’s other components are not contraindicated. For detailed recommendations on all vaccines,
including those used primarily for travelers or that are issued during the year, consult the manufacturers’ package inserts and the complete statements from the Advisory Committee on Immunization Practices
(www.cdc.gov/vaccines/pubs/acip-list.htm).
The recommendations in this schedule were approved by the Centers for Disease Control and Prevention’s (CDC) Advisory
CS209938-A
Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), the American College of Department of Health and Human Services
Obstetricians and Gynecologists (ACOG), and the American College of Physicians (ACP). Centers for Disease Control and Prevention
doses given two days apart are needed for pro- rhea in babies and young children. It can also be accom-
tection with the last dose given at least one week panied by vomiting and a fever. Depending on the brand
before travel. This product, Vivotif Berna (Berna of vaccine that is used a child will need either two or three
Biotech LTD) must be refrigerated. A booster doses. The first dose is given at 2 months of age; the
would be needed every five years for those who second dose is given at 4 months, and if needed a final
remain at risk. The shot is administered intra- dose is given at 6 months. The vaccination series needs
muscularly into the deltoid muscle. Persons who to be started by 14 weeks and 6 days of age and the
have ever had a serious allergic reaction to a series needs to be completed by 8 months of age. Rota-
previous dose of this vaccine should not receive virus is a live oral vaccine. It is stored under refrigeration.
the vaccine. The live vaccine should also not be Children who have ever had a serious allergic reaction to
administered to those with weakened immune a previous dose of this vaccine or who are moderately to
systems or within 24 hours of antibiotics (penicil- severely ill at the time that the shot is scheduled should
lin), corticosteroids (prednisone), immunosup- not receive the vaccine. If the child’s immune system
pressants (such as certain cancer medicines, is weakened the physician should be consulted before
cyclosporine), or sulfonamides because they administering the vaccine.
may decrease Vivotif Berna’s effectiveness.
Polio
Rotavirus Polio is a disease that is caused by a virus that enters
Rotavirus is a virus that causes a severe diar- through the person’s mouth and can cause paralysis.

Although there have been no cases of wild polio in the pharmacy, and you could choose to offer only
United States for more than 20 years, vaccination is still routine vaccines or choose to offer travel vac-
important until it is eradicated throughout the world. The cines as well. How immunizations fit into the
inactivated polio vaccine is given to children in a four-shot workflow depends on the practice location.
series. Children get the first dose at 2 months of age, the Many of the large chain pharmacies run im-
second dose at 4 months, the third at between 6 and 18 munizations through the workflow as normal
months, and a booster dose at 4 to 6 years old. Adults prescriptions, and then administer vaccines
would only need the vaccine if they are at a higher risk by upon receiving payment. Buford Road Phar-
traveling, working in a laboratory, or by treating patients macy is an independent pharmacy located in
with polio. Adults who have had the complete vaccination Richmond, Virginia. At this pharmacy, they also
series can receive one booster shot. It is administered fit immunizations into the daily prescription
intramuscularly into a child’s upper thigh, or if older than workflow. The patients receive their vaccines
3 years, into the deltoid muscle. This vaccine must be in the Healthy Living Center, where a pharma-
refrigerated. People who have ever had a serious allergic cist or trained pharmacy student administers
reaction to a previous dose of this vaccine, to neomycin, the vaccines. Some pharmacies have patients
streptomycin, or polymyxin B should not receive the vac- make appointments to receive vaccines and will
cine. Those who are moderately to severely ill at the time only administer vaccines at scheduled times.
that vaccine is scheduled should wait to receive it. The laws and regulations may dictate which
model a pharmacy follows because in many
Yellow Fever states pharmacists are the only ones authorized
Yellow fever is a serious disease caused by the yellow to immunize, whereas in other states trained
fever virus, which is transmitted through the bite of an in- pharmacy students are also able to immunize,
fected mosquito. This virus is found in parts of Africa and thus relieving the workload of the pharmacist.
South America. People who develop yellow fever disease Pharmacists may also participate in off-site
can have flu-like symptoms, jaundice, organ system fail- clinics where they administer vaccines. This
ure, can vomit blood, or even die. To be able to administer is often seen during the influenza vaccina-
this vaccine, the site needs to be an approved vaccination tion season. To reach out to the public, many
center. After being vaccinated, patients receive a vaccina- pharmacies choose to participate in health
tion card that is valid 10 days after receiving the vaccine, fairs, or set up their own clinics at local busi-
and it lasts for 10 years. It is recommended that persons nesses or organizations. For some businesses,
9 months of age and older who are traveling through or to the companies pay for their employees’ vac-
a country that require yellow fever vaccination receive the cines in whole, or by covering the copayment.
vaccine. A booster dose is then required every 10 years if Many pharmacies, especially those that service
the person will be in the endemic area. It is a live attenuat- long-term care facilities provide vaccinations for
ed vaccine that is administered subcutaneously in the up- the residents and the staff. These vaccines can
per arm. This vaccine, known as YF-VAX, is stored in the be billed before going to the facility or after the
refrigerator and should be reconstituted with the provided clinic. If any of the residents or staff has a co-
diluent immediately before administration. People who payment, they can then be billed. This opportu-
have ever had a serious allergic reaction to a previous nity also produces challenges in terms of taking
dose of this vaccine, eggs, chicken, or gelatin should not enough of the necessary supplies and many
receive this vaccine. Patients with certain diseases may challenges with billing. Because of the billing
not be eligible to receive the vaccine and should obtain a challenges, many of these clinics charge a cash
waiver letter from their physician before traveling. price. When traveling off site to give vaccines,
it is important to have a well-insulated cooler to
Pharmacy Business Model keep the vaccines at the optimum temperature.
There are many vaccines that can be offered in the If the pharmacy decides to do many off-site

clinics, it would be advised to have a travel kit ing a letter to fax or mail to local physician offices. You may
ready to go that is stocked with gloves, Band- also choose to call local physicians or stop at their office to
Aids, cotton balls, alcohol swabs, hand sani- inform them of the new vaccination service. Finally, services
tizer, needles, Epi pens, and a sharps container. need to be marketed to patients through bag stuffers, in-
The same supplies are also needed for when store advertisements, or by advertising in local newspapers
vaccines are given in the pharmacy. Many and through contacting local health departments.
states have it written into their laws as to what is
required to be kept on hand in order to adminis- The Pharmacist Immunizer
ter immunizations. Pharmacists are able to establish an immunization prac-
tice through using a protocol with local physicians, by
Handling Tips for Vaccines: accepting prescriptions from physicians, or through a col-
• Rotate stock so that the shortest-dated vac- laborative practice agreement.
cine is used first.
• Ensure that the refrigerator is plugged into an Protocol
outlet in a protected area where it cannot be The first option is for a pharmacist to develop a protocol
disconnected accidentally. with local physicians as to which vaccines can be admin-
• Record refrigerator and freezer temperatures istered to his or her patients and will include what will be
twice a day in a temperature log. done in the event of an emergency. Each physician then
• All vaccines must be discarded after the expira- reviews the protocol, and will sign it so that the pharma-
tion date; expired or damaged vaccines for cist will be able to immunize his or her patients. Many
children (VFC) must be returned to your state states require that these protocols be on file through the
immunization program. VFC is a program that department that regulates the administration of immu-
provides vaccines at no cost to children who nizations. For example, in Virginia the signed protocol
otherwise would not be able to afford to be vac- needs to be submitted to the board of nursing. After the
cinated. Children are eligible to receive pediatric board of nursing reviews and accepts it the protocol can
vaccines that are recommended by the Advi- go into effect.
sory Committee on Immunization Practices.
Prescription
There are many things to think about before Many pharmacies administer vaccines only by prescrip-
you decide to start offering vaccines-a refrig- tion. A patient will receive a prescription from their physi-
erator needs to be on a grounded outlet on a cian and the pharmacy will fill it as a regular prescription
dedicated circuit to ensure that it can maintain and then administer the vaccine. Pharmacists may also
a constant temperature. The refrigerator needs receive telephoned prescriptions for vaccines and may
to have ample storage room (for flu bulk ship- then administer the vaccine.
ment), and you will need temperature logs or
a chart recorder, and cold packs to insulate Collaborative Practice
against temperature fluctuation. It is also impor- The option that gives the pharmacist the most freedom
tant to develop a marketing plan. with administering vaccines is through a collaborative
As the vaccination service is being started practice agreement with a single prescriber. Many phar-
at a pharmacy, staffing may not need to be in- macists have a local physician with whom they have built
creased initially, but as the service grows it may a rapport. Standing orders are developed for vaccines
be necessary to have an additional pharmacist and the pharmacist is then able to use their professional
to help administer vaccines. judgment to determine which patients need vaccines,
To market your vaccine service it is important and which vaccines they need. The collaborative practice
to let others know what vaccines your pharmacy agreement includes which vaccines will be given and to
will be providing. This could be as simple as typ- whom they will be administered, as well as including what

Continuing Education Quiz
will be done in the event of an emergency. The pharma- Select the correct answer.
cist and collaborating physician review the agreement
and sign it. As with a protocol, many states require that 1. Which of the following vaccines is indicated
this information be on file with the department that regu- for the prevention of herpes zoster?
lates the administration of vaccines. a. Herpavax
b. Varivax
Emergency Protocol c. Zostavax
An emergency protocol needs to be in place should a d. Shingavax
patient have an adverse reaction to a vaccine. Pharma-
cies should have an emergency kit and all staff members 2. All of the following vaccines may be
should know where it is located. The most important thing to administered to a 70 year old female (assuming
remember in the event of an emergency is to remain calm. suitable risk factors) EXCEPT:
If an adverse reaction is experienced, it should be reported a. HPV
through the Vaccine Adverse Event Reporting System b. Hepatitis A
(VAERS), which is a safety surveillance program sponsored c. Meningococcal
through the Centers for Disease Control and Prevention and d. Tetanus/diphtheria
the Food and Drug Administration. These adverse reactions
to vaccines are most often reported by health care profes- 3. Which of the following is an example of an
sionals and by vaccine manufacturers. By reporting these inactivated vaccine?
events it can help to determine what reactions are most often a. MMR
seen from certain vaccines. One of the major limitations of b. Varicella zoster
this program is underreporting. The adverse events that are c. Intranasal flu vaccine (Flumist)
reported through VAERS can range from as mild as a fever d. Hepatitis B
or localized reaction to as serious as a life-threatening condi-
tion, permanent disability or death. 4. Which is the earliest age that the
Keeping accurate records is important as an immu- meningococcal vaccine (MCV) may be
nizing pharmacist. It is recommended to contact your administered to a pediatric patient?
state licensing board to see what documentation require- a. At birth
ments must be met. b. One year
Through vaccination efforts at pharmacies, a greater c. Two years
number of those who remain unvaccinated can be d. Five years
reached. By having an understanding of what procedures
need to be in place, an understanding of vaccines, and 5. Jim Johnson is a 52-year-old patient who
the vaccination schedules a successful vaccination pro- comes to a pharmacy that offers immunizations.
gram can be established. He has had all of the childhood diseases and
immunizations, but has not needed medical care
for 14 years, since he was in an auto accident.
Gretchen M. Kreckel, PharmD, is a community pharmacy practice resi-
Which of the following immunizations should be
dent at Buford Road Pharmacy in Richmond, Virginia. The residency
administered today?
is coordinated through the Virginia Commonwealth University School
a. Tdap (tetanus, diphtheria & acellular
of Pharmacy. Kreckel is an April 2009 graduate of the University of
pertussis)
Pittsburgh School of Pharmacy.
b. MMR (mumps measles and rubella)
c. OPV (oral polio vaccine)
Editor’s Note: To obtain the complete list of references used in d. Zostavax (herpes zoster vaccine)
the article, contact Chris Linville at NCPA (703-838-2680) or at
chris.linville@ncpanet.org.

6. Which of the following vaccines is administered 11. Which of the following vaccines must be administered at
subcutaneously? a specially approved vaccination center?
a. Typhoid a. Typhoid
b. Influenza b. Hepatitis B
c. Varicella zoster c. MMR
d. Rabies d. Yellow fever
7. Which of the following vaccine series would 12. Which of the following vaccinations is given at birth?
need to be restarted if too much time has elapsed a. Hepatitis A
between doses? b. Varicella
a. Hepatitis B c. Hepatitis B
b. Herpes zoster d. MMR
c. Oral typhoid
d. HPV 13. Which of the following dosing schedules is correct for
the Rabies vaccine post exposure?
8. Thelma Smith is a 66-year-old female who has a. First dose immediately and additional doses on the fifth,
come to the pharmacy for her annual flu shot. She ninth, 14th, and 28th days
has received the flu shot every year for the past b. First dose immediately and additional doses on the
seven years, but no other vaccines since. When seventh and 28th days
her vaccination record was checked seven years c. First dose immediately and additional doses on the third,
ago she was up to date with the recommended seventh, 14th, and 28th days
vaccinations. Which of the following vaccines d. First dose immediately and additional doses on the third,
would Thelma NOT need at this point? seventh, 14th, 21st, and 28th days
a. Herpes zoster
b. Pneumococcal 14. Which of the following vaccines would not be
c. Hepatitis B administered routinely?
d. Influenza a. Japanese encephalitis
b. MMR
9. At what age should the Rotavirus series be c. Varicella
completed by? d. Hepatitis B
a. 2 months
b. 4 months 15. If two live injectable vaccines are not given together,
c. 8 months how long should the interval of administration between the
d. 24 months two vaccines be?
a. Three days
10. Megan Harrison is a 25-year-old female who b. One week
will be traveling out of the country and wants to c. Two weeks
complete her hepatitis B series before leaving. d. Four weeks
What is the minimum time that she must allow
to complete the series if she uses the catch-up
schedule?
a. Three months
b. Four months
c. Five months
d. Six months

16. Mark Martin is a 12-year-old male who came Overview of Pediatric, Adult
to the pharmacy clinic to receive any vaccinations and Travel Immunizations
that he was due for at that time. He received all Mar. 1, 2010 (expires Mar. 1, 2013)
of his childhood immunizations. Which of the

FREE ONLINE C.E. Pharmacists now have online access to NCPA’s
following vaccines would he need at this time? C.E. programs through Powered by CECity. By taking this test on-
line—go to the Continuing Education section of the NCPA Web site
a. Hepatitis B (www.ncpanet.org) by clicking on “Professional Development” under
b. Tdap (tetanus, diphtheria & acellular pertussis) the Education heading you will receive immediate online test results
and certificates of completion at no charge.
c. HPV
d. Varicella To earn continuing education credit: ACPE Program 207-000-10-003-H01-P
A score of 70 percent is required to successfully complete the C.E. quiz.
17. Which of the options gives a pharmacist If a passing score is not achieved, one free reexamination is permitted.
the most freedom with decision making when Statements of credit for mail-in exams will be available online for you
to print out approximately three weeks after the date of the program
administering vaccinations? (transcript Web site: www.cecerts.ORG). If you do not have access to a
a. Collaborative practice agreement computer, check this box and we will make other arrangements to send
b. Prescriptions for each vaccine you a statement of credit: q
c. Protocol with individual physicians Record your quiz answers and the following information on this form.
d. Emergency protocol q NCPA Member License
NCPA Member No. ____________________ State __________ No. _____________________
q Nonmember State __________ No. _____________________
18. Which of the following vaccines needs to be

All fields below are required. Mail this form and $7 for manual processing to:
stored frozen? NCPA C.E. Processing Ctr.; 405 Glenn Drive, Suite 4; Sterling, VA. 20164
a. Flumist _____________________________________________________________________________________
Last 4 digits of SSN MM-DD of birth
b. YF-VAX _____________________________________________________________________________________
Name
c. Varivax _____________________________________________________________________________________
d. Menactra Pharmacy name
_____________________________________________________________________________________
Address
_____________________________________________________________________________________
19. Which of the following patients should receive City State ZIP
_____________________________________________________________________________________
two doses of the annual influenza vaccine? Phone number (store or home)
a. Shirley, a 65-year-old female with diabetes and _____________________________________________________________________________________

Store e-mail (if avail.) Date quiz taken
COPD Quiz: Shade in your choice

b. Madison, a 7-month-old female a b c d e a b c d e
c. Charlie, a 15-year-old male with asthma 1. q q q q q 11. q q q q q
2. q q q q q 12. q q q q q
d. Bella, a 3-year-old female who receive the 3. q q q q q 13. q q q q q
vaccine last year 4. q q q q q 14. q q q q q
5. q q q q q 15. q q q q q
20. All of the following are contraindications for 6. q q q q q 16. q q q q q
administration of Zostavax, EXCEPT: 7. q q q q q 17. q q q q q
a. Completed a Methylprednisolone 4 mg taper 8. q q q q q 18. q q q q q
9. q q q q q 19. q q q q q
pack for bee sting 10. q q q q q 20. q q q q q
b. Currently taking Valtrex (valcyclovir) for
Quiz: Circle your choice
suppressive therapy for herpes simplex
21. Is this program used to meet your mandatory C.E. requirements?
c. Currently taking Humira (adalimumab) for a. yes b. no
rheumatoid arthritis 22. Type of pharmacist: a. owner b. manager c. employee
d. Currently receiving chemotherapy for breast 23. Age group: a. 21–30 b. 31–40 c. 41–50 d. 51–60 e. Over 60
24. Did this article achieve its stated objectives? a. yes b. no
cancer
25. How much of this program can you apply in practice?
a. all b. some c. very little d. none
How long did it take you to complete both the reading and the quiz? ______ minutes
NCPA® is accredited by the Accreditation Council for Pharmacy Education as a provider

of continuing pharmacy education. NCPA has assigned two contact hours (0.2 CEU)
of continuing education credit to this article. Eligibility to receive continuing education
48 america’s Pharmacist | March 2010 credit for this article expires three years from thewww.americaspharmacist.net
month published.

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continuing education

Overview of Pediatric, Adult,

U pon completing this article the

www.americaspharmacist.net March 2010 | america’s Pharmacist 35

1 2 4 6 12 15 18 19–23 2–3 4–6

Inactivated Poliovirus6 IPV IPV IPV IPV

Varicella9 Varicella see footnote 9 Varicella

)FQBUJUJT"10 HepA (2 doses) HepA Series

36 america’s Pharmacist | March 2010 www.americaspharmacist.net

Recommended Immunization Schedule for Persons Aged 7 Through 18 Years— 6OJUFE4UBUFTr

Vaccine ▼ Age ► 7–10 years 11–12 years 13–18 years

Pharmacist | March 2010

www.americaspharmacist.net March 2010 | america’s Pharmacist 39

40 america’s Pharmacist | March 2010 www.americaspharmacist.net

Tetanus, diphtheria, pertussis Td booster

Human papillomavirus (HPV)2,* 3 doses (females)

Measles, mumps, rubella (MMR)5,* 1 or 2 doses 1 dose

Influenza6,* 1 dose annually

Pneumococcal (polysaccharide)7,8 1 or 2 doses 1 dose

Hepatitis A9,* 2 doses

Hepatitis B10,* 3 doses

Meningococcal11,* 1 or more doses

*Covered by the Vaccine Injury Compensation Program.

www.americaspharmacist.net March 2010 | america’s Pharmacist 41

42 america’s Pharmacist | March 2010 www.americaspharmacist.net

Tetanus, diphtheria, pertussis

Human papillomavirus (HPV)2,* 3 doses for females through age 26 yrs

Varicella3,* Contraindicated 2 doses

Zoster4 Contraindicated 1 dose

Measles, mumps, rubella (MMR)5,* Contraindicated 1 or 2 doses

Pneumococcal (polysaccharide)7,8 1 or 2 doses

Hepatitis A9,* 2 doses

Hepatitis B10,* 3 doses

Meningococcal11,* 1 or more doses

www.americaspharmacist.net March 2010 | america’s Pharmacist 43

44 america’s Pharmacist | March 2010 www.americaspharmacist.net

www.americaspharmacist.net March 2010 | america’s Pharmacist 45

46 america’s Pharmacist | March 2010 www.americaspharmacist.net

www.americaspharmacist.net March 2010 | america’s Pharmacist 47

of his childhood immunizations. Which of the

18. Which of the following vaccines needs to be

a. Shirley, a 65-year-old female with diabetes and _____________________________________________________________________________________

COPD Quiz: Shade in your choice

NCPA® is accredited by the Accreditation Council for Pharmacy Education as a provider

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Recommended Immunization Schedule for Persons Aged 7 Through 18 Years— 6OJUFE4UBUFTr

a. Shirley, a 65-year-old female with diabetes and _____________________________________________________________________________________