Jill Sederstrom

Results of a recent study showed that the Bacille Calmette-Guérin (BCG) vaccine can protect elderly adults against various respiratory infections—but it’s unclear what effect it could have on the coronavirus disease 2019 (COVID-19).

BCG is a vaccine for tuberculosis (TB). Although not widely used in the United States, the vaccine is often given to infants and small children in other countries where TB is common.

For the double-blind randomized clinical trial, which was a joint collaboration between Radboud University Medical Center and the National and Kapodistrian University of Athens, investigators examined the effect that the BCG vaccine had on elderly adults after they were discharged from the hospital.

The investigators assigned the 198 study participants to either receive a placebo or BCG vaccine as they were being discharged from the hospital and then followed the participants for 12 months to determine whether there were any new infections, according to the results of the ACTIVATE study published in 

Evangelos J. Giamarellos-Bourboulis, MD, PhD, co-coordinator of the study at the 4th Department of Internal Medicine at ATTIKON University Hospital, told 

® that the investigators discovered a “decrease of overall risk of new infection with the BCG vaccination” among those who received the vaccine.

According to the results, 42.3% of the elderly participants developed an infection in the placebo group, whereas only 25% developed an infection in the BCG group, according to 

 announcing the findings. Those in the treatment arm also took longer to develop their first infection—with an average of 16 weeks after vaccination—compared with 11 weeks in the placebo group.

“In addition to the clear effect of BCG vaccination on infections in general, the most important observation was that BCG could mainly protect against respiratory infections: BCG-vaccinated elderly people had 75% fewer respiratory infections than the elderly who received placebo,” Giamarellos-Bourboulis said in the release.

® that the types of respiratory infections included respiratory viruses and pneumonia.

Investigators reported no differences in adverse effects between the groups and determined the BCG vaccine was safe for elderly patients.

It’s also possible the vaccine could help protect the elderly against COVID-19, but that has not been fully studied. The study began before the coronavirus pandemic began and a low prevalence of COVID-19 among those in the study prevented the investigators from being able to draw any conclusions.

Giamarellos-Bourboulis said the next step in the research will be to “run trials with BCG vaccination to protect the elderly from COVID-19.”

Several studies are already underway to examine whether the BCG vaccine could also have a protective effect against COVID-19.

Giamarellos-Bourboulis EJ, Tsilika M, Moorlag S, et al. Activate: Randomized clinical trial of BCG vaccination against infection in the elderly. 

https://doi.org/10.1016/j.cell.2020.08.051

Elderly people protected against respiratory infections by BCG vaccine. News release. Radboud UMC; September 1, 2020. Accessed October 6, 2020. https://www.radboudumc.nl/en/nieuws/2020/elderly-people-protected-against-respiratory-infections-by-bcg-vaccine

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The BCG vaccine decreased the overall risk of new respiratory infections in elderly adults, according to the study results. 

Study: BCG Vaccine Protects Elderly Against Respiratory Infections

Health care providers are getting creative and taking their immunization efforts on the road this year in an effort to increase influenza vaccinations.

Giant Food, a regional grocery chain in the greater Washington DC area, announced its pharmacy would be operating mobile clinics, manned by specially trained pharmacists, to make stops throughout the region in October, according to 

Pharmacists will use an Airstream vehicle to stop in key locations to provide influenza vaccines to interested families and individuals. Company officials said the grocery chain opted to take their immunization efforts on the road because of the high demand for the vaccine in light of coronavirus disease 2019 (COVID-19) pandemic.

“As we prepare for the possibility of the unprecedented convergence of COVID-19 and flu, getting your annual flu shot is more important than ever to help you, your family and your community stay healthy," said Paul Zvaleny, director of pharmacy operations at Giant Food.

As part of the effort, Giant also partnered with Gym Jonez, a popular certified fitness trainer in the area, to bring the mobile flu clinic to his outdoor workout classes to offer participants the flu vaccine.

“We are eager to make flu shots as accessible as possible for members of our communities and are hoping to continue to expand this program to more parts of the region to service people and communities who might not have easy access to a pharmacy,” Zvaleny said.

 “As pharmacists being the most accessible health care professionals, we need to ensure we expand that access to people and communities in need.”

Giant Food isn’t the only organization to bring the vaccines to its client base. In Virginia, the Carilion Clinic fixed up a new van to offer mobile health services.

“It was perfect timing for the vaccine season because our strategy this year was to be neighborhood-based,” community health workforce supervisor Cris Sheffield told 

 “We wanted to make it easy for people and go where people already are.”

In September, the van made a stop at a community center and offered free flu vaccinations to anyone over the age of 18. The health care clinic is planning to host free flu vaccination events 4 times a week through the end of October.

“My biggest hope for flu season is that [with] a lot of the precautions and the things we’ve been putting into place that people are listening," Sheffield told the outlet.

 "And that we will be able to keep it down and keep it pretty good so that we don’t complicate it with COVID and the pandemic we’re already dealing with.”

In Canada, Hamilton EMS Chief Mike Sanderson said Hamilton’s paramedic service hopes to vaccinate about 2400 people through mobile flu vaccine clinics this fall, according to 

. Sanderson said the immunization services are being offered at homeless shelters, social housing buildings, and senior centers throughout the city.

“With the risk of simultaneous cold and flu season, it’s even more important now to get people immunized against the flu as early as possible,” he said.

 everyone over 6 months old should get the flu vaccine, with some rare exceptions.

1. Giant Food Pharmacy Takes Flu Vaccinations On-The-Road with New Mobile Flu Clinics. News release. Giant Food; September 22, 2020. Accessed October 6, 2020. 

https://www.prnewswire.com/news-releases/giant-food-pharmacy-takes-flu-vaccinations-on-the-road-with-new-mobile-flu-clinics-301135518.html

2. Roshetko K. Free flu shot clinic launches Carilion mobile health outreach initiative. WDBJ. Published September 25, 2020. Accessed October 6, 2020. 

https://www.wdbj7.com/2020/09/25/free-flu-shot-clinic-launches-carilion-mobile-health-outreach-initiative/

3. Mann K. Paramedics hope to reach 6 times as many at-risk residents through mobile flu shot clinics. Global News. Published September 25, 2020. Accessed October 6, 2020. 

https://globalnews.ca/news/7359321/hamilton-mobile-flu-shot-clinics/

Some health care providers are taking their flu immunization efforts to the road this year. 

Health Care Providers Hope To Expand Patient Reach With Mobile Flu Clinics

The number of adults getting the shingles vaccine is on the rise, but there is still significant room for improvement, according to 

A brief from the National Center for Health Statistics showed that the percentage of adults over the age of 60 years old who received the shingles vaccine has jumped from 6.7% in 2008 to 34.5% in 2018, suggesting positive progress in recent years to improve vaccination rates.

But although the figures have continued to rise, the majority of older adults still haven’t been vaccinated.

“I definitely think there is room for improvement,” Mitchel C. Rothholz, RPh, MBA, chief of governance and state affiliates of the American Pharmacists Association (APhA) and executive director for the APhA Foundation told 

Rothholz said one of the biggest obstacles in recent years has been the accessibility of the vaccine for many pharmacies and patients.

Although Merck offered the first shingles vaccine, Zostavax, in the United States beginning in 2006, it stopped selling its product in July after the more effective vaccine Shingrix began to take hold of the market, according to 

Shingrix, which was approved in late 2017, has been found to be 97% effective in adults ages 50 to 69, but it has also been in short supply.

“I think the rate would have probably been higher if there wasn’t a supply issue that manufacturers have just really come out of,” Rothholz said. “I don’t think we’ve seen the maximum potential with the vaccine delivery there.”

Another barrier, he said, has been payment policy. Under Medicare, the vaccine is covered under Medicare Part D but prescription drug plans “have different copays that people are having to pay to get that and some of those are high copays and become a barrier, especially as things in the economy change,” he said.

According to the data from the National Center for Health Statistics brief, there are still significant differences in immunization rates based on race, education level, and socioeconomic status.

The data, which was taken from the National Health Interview Survey, found that non-Hispanic white adults were much more likely to get the vaccine and had a rate of 38.6% compared with non-Hispanic Black adults (18.8%) and Hispanic adults (19.5%).

Adults were also more likely to get the vaccine if they had a high school diploma or GED compared with those adults with less education (39.9% vs 21.1%, respectively).Those adults who were considered poor based on their family income level were also less likely to receive the vaccine (20.4%) compared with those who were above the income category (38.4%). Men and women were equally likely to have gotten the vaccine (33.5% and 35.4%, respectively).

According to Rothholz, pharmacies have been the “primary provider” administering the vaccine and their role is only expected to grow now that the vaccine has become more accessible.

“They’ve been managing the best they can with the limited resources that we have,” he said of pharmacies.

Now that more vaccines are expected to be available, Rothholz said it is important that pharmacists talk with patients about any potential reactions associated with the vaccine, particularly now that people are more in-tune with their health because of the coronavirus pandemic.

It’s important they know which symptoms could be attributed to the vaccine and which symptoms might suggest a more serious health concern, he said.

“This is one of the tools in our immunization tool kit to protect the public and even in this time of COVID people need to be protected,” he said.

1. CDC. National Center for Health Statistics. Shingles Vaccination Among Adults Aged 60 and Over: United States, 2018. July 2020. 

https://www.cdc.gov/nchs/products/databriefs/db370.htm

2. Galewitz P. Shingles Vaccination Rate Soars But Leaves Many Behind. 

. Published July 9, 2020. Accessed August 31, 2020. https://khn.org/news/shingles-vaccination-rate-soars-but-leaves-many-behind/.

New data show that the percentage of adults over the age of 60 years old who received the shingles vaccine has jumped from 6.7% in 2008 to 34.5% in 2018. 

US Shingles Vaccination Rate Jumps, But There Is Still Room for Improvement

Results of a new study on immunization rates and current barriers at Wisconsin pharmacies demonstrated that collaborating with physicians could provide significant benefits to patients.

, reported the most common vaccines administered in pharmacy settings, identified the biggest barriers to increasing vaccination rates in the pharmacy setting, and stressed the importance of collaboration with other medical providers.

“Having physicians and colleagues as allies is essential,” lead author Philip C. Berce, PharmD, told 

Investigators used data from the Wisconsin Immunization Registry to determine the number of vaccinations provided to patients who were over the age of 6 years old from July 2017 to July 2018.

According to the study, 39% of zoster vaccines and 20% of influenza vaccines were administered in pharmacy settings across the state. Pharmacies were responsible for the lowest proportion of vaccine doses—at just 0.2%--for the human papillomavirus (HPV) vaccine.

Although the majority of pharmacies (84%) reported stocking influenza vaccines, just 21% reported having the HPV vaccine in stock.

The study also used survey data from 236 Wisconsin pharmacists who were asked about their attitudes on vaccination and the biggest barriers they face. 

Berce said the biggest barriers most pharmacists reported were related to billing and reimbursements.

“Despite the barriers, community pharmacies have significant potential to address vaccination gaps,” the study’s authors wrote. “Physicians, patient and legislative bodies are generally well-accepting of pharmacists as immunizers. Pharmacists, in order to be fully utilized as immunizers, must engage in active communication with patients and be willing to collaborate with physicians.”

Berce said pharmacists can work to overcome existing barriers by working with patients to advocate to their insurer and adopting patient-centric approaches, where patients are able to choose where and when they want vaccinations rather than being provider-centric.

“Our team is a collaboration between a school of pharmacy, endowment through a medical school, and a state pharmacy association—given what we are seeing at the national level, I’m thankful for our collaborative ‘immunization neighborhood’ approach in Wisconsin,” he said, adding that everyone needs to work together to improve immunization rates.

Pharmacists are often the most accessible health care provider and have the potential to make a valuable impact on improving vaccination rates, he said.

To best address patient needs, Berce said some pharmacies may need to reimagine workflow to allow for more time with patients who may be interested in vaccinations.

Although the individual roles of pharmacists and physicians may differ, Berce said they “share the same goals” and are each “well-suited to address immunization issues.”

Berce PC, Bernstein RS, MacKinnon GE. Immunizations at Wisconsin pharmacies: results of a statewide vaccine registry analysis and pharmacist survey. 

https://doi.org/10.1016/j.vaccine.2020.04.043