The Evolving Landscape of Influenza Immunizations - Episode 8

Influenza Vaccine Administration Considerations for Senior Patients

Influenza vaccine administration timing and considerations for senior patients are explored by key opinion leaders.

Mitchel Rothholz, RPh, MBA: We’ve got this new senior recommendation. How does it play out? If a patient comes in early in the season in July, August, or September, and they want to get their flu vaccine, how do pharmacists handle that request? How does that play out in terms of which vaccine you give the patient?

John Beckner, RPh: Pharmacists over the years have been ingrained with the thought that if someone comes in and requests a vaccine, you shouldn’t let them leave the store without it. That may be in conflict with whether it’s too early. Should you wait until the sweet spot of October or November to provide the vaccine? It’s an important conversation for pharmacists to have with patients. Each situation is a little different, so it may depend on the situation and the pharmacist’s professional judgement on whether that patient might be better off waiting and will come back.

Mitchel Rothholz, RPh, MBA: Jeff?

Jeff Goad, PharmD, MPH: There are 2 situations where you might want to use the vaccine as soon as it’s available. One is if you’re traveling to the southern hemisphere or to equatorial regions. I always advise people to say you’re traveling if you’re trying to get the vaccine in July or early August. People who are frail or older and need more immediate protection are fine to do, especially now that we’re using high-dose adjuvanted. We’re not sure whether it lasts longer because we’re worried about waning immunity. But now we’re giving 4 times the dose in the high-dose populations and we’re learning more about adjuvant’s durability. There might be a case to be made, at least for those high-risk individuals, to potentially vaccinate as soon as it’s available.

I agree 100% with John about trying to get people to focus on September and October for what we call the campaign season when they know it’s available at the pharmacy and to tell them, “I’ve got it, but your best chance is to get it in September or October.” Some of the data are suggesting that our swing back to February peak season is likely to start occurring again and might entice them to wait.

Mitchel Rothholz, RPh, MBA: The official language that has come out and is getting published by the ACIP [Advisory Committee on Immunization Practices] is to delay until September or October, especially with older patients, because of the waning. But if you don’t think the patient is going to come back, don’t miss the opportunity. If the patient comes in, especially a senior, and you don’t have a high-dose or adjuvant vaccine available, what do you do?

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: I’m all about informing the consumer. I’m going to tell you that first. I’ll say what the guidelines suggest would be a better vaccine for them, which would be the high dose or the adjuvanted, but I’d also ask whether they have access to get a vaccine at another time where they might be able to get that. If not, we have the other vaccine that will still give them protection. It just might not give them the same titers that a high dose would give them. Has that happened? Yes, it has in our practices, but we make sure the patient is fully informed to make that decision with us giving the information that hopefully makes them feel better about making a decision.

Mitchel Rothholz, RPh, MBA: John?

John Beckner, RPh: I agree with Randy. It’s important to let them know. You may decide together that based on that particular circumstance, it’s best to go ahead and get the regular vaccine, with full disclosure in letting the patient know that there’s a vaccine recommended for their age group. They need to know. If you don’t have it, you should try to get some as soon as possible.

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: It changed this whole discussion when the ACIP came out and the CDC accepted that recommendation, because that’s stronger than it has been in the past. We haven’t had that situation happen in more recent years, but we’ll make sure our patients are fully informed that with the high-dose or adjuvanted vaccines, especially if they’re older, it would be better for them if they can wait until September or October. We also know that a lot of patients get very anxious, and you’re afraid they may not come back. It’s a lot of professional judgement you have to make. At the end of the day, I want to make sure I’m going to do what’s right by the patient and make sure the patient fully understands what’s happening and is informed.

Transcript edited for clarity.