Role of clinical Pharmacists in Immunization


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Role of clinical Pharmacists in Immunization

  1. 1. Role of Clinical Pharmacists in Immunization ASSIGNMENTTopic: Role of clinical Pharmacist in ImmunizationSubject: Clinical PharmacySubmitted to: Sir Hafiz Muhammad IrfanSubmitted by:Boys Group-2 Pharm-D 2009-14 self support Mohsin shahzad 132 Muhammad Atif 127 Touqeer ahmad 176 Hafiz Muhammad Rizwan 177 Imran akhtar 123 Rana Muhammad Touqeer younis 197 Zameer-ul-hassan 143 Adnan sana Mehdi 182 Nabeel ahmad 131Faculty of Pharmacy,University of SargodhaMohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 1
  2. 2. Role of Clinical Pharmacists in ImmunizationINRODUCTION: Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease. Before vaccines, people became immune only by actually getting a disease and surviving it.The word “immunization” instead of “vaccination” is now in use in but there is a big difference between the two. Immunization means to make someone immune to something. Vaccination, by contrast, according to Dorland’s Medical Dictionary, just means to inject “a suspension of attenuated or killed microorganisms…administered for prevention…or treatment of infectious disease.” Vaccination does not guarantee immunity. Natural immunity happens only after one recovers from the actual disease. During the disease, the microorganism usually has to pass through many of the body’s natural immune defense systems—in the nose, throat, lungs, digestive tract and lymph tissue—before it reaches the bloodstream.History: Edward Jenner formed 1st vaccine. Louis Pasteur then extended Jenner’s invention and formed vaccine of rabies. Pasteur showed that airborne microbes were the cause of disease. Anthrax, fowl cholera, swine erysipelas and rabies. Copemans introduced the role of lymph in immunity. Salmon and Theo bald Smith had shown in 1884 that dead virus can induce immunity against living virus. Metchnikoff explained the humoral and cellular (phagocytic) immunity Von Behring discovered the antitoxins. Ehrlich explained the distinction between active and passive immunizationROLE OF PHARMACIST: The role of pharmacist is the patient counseling, aware people or to give awareness to the people. A pharmacist must have the knowledge of dosage regimen, dose, containers, etc. The general role of pharmacist includes the responsibilities including stocking, dispensing, administering dosage, drug interaction, drug adverse effects etc. A clinical pharmacist specifically deals with the drug interactions, drug adverse effects drug incompatibilities etc. but current situation in Pakistan is not the same. In Pakistan the pharmacists must knowledge of stocking, dispensing and counseling at the same time. In Pakistan no one knows the role of pharmacist even the pharmacist their self do not know their role in society. In all the big hospitals of Punjab specially in Lahore majority of hospitals do not know the role of pharmacist.Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 2
  3. 3. Role of Clinical Pharmacists in Immunization A pharmacist must have the knowledge to compel anyone to vaccination with reason. He should counsel the patient about immunization. He should counsel the patient about the adverse effects if the patients do not give importance to immunization.Services of pharmacists regarding immunization: Pharmacists can get involved in immunization services in three different ways: as advocates, partners, or providers. As advocates, pharmacists can avail opportunity to talk with patients about the importance of immunization. They are uniquely positioned to help target patients at high risk for some vaccine-preventable diseases on the basis of medications used. Partnership roles to support immunization in the community are not unusual. Pharmacy chains have worked with the Visiting Nurses Association to have nurses administer flu vaccines in pharmacies during the flu season. Alternatively, pharmacists can establish partnerships with local health care institutions, such as county health departments or hospitals, to host nurses or physician assistants and offer more convenient times and locations to further the mutual goal of increasing immunization rates. This role is in accordance the National Vaccine Plan goal of "achieving high immunization coverage levels in children and adults through collaboration between health care providers and a variety of groups with access to populations." “In fact, because of the increased awareness within communities, other providers are likely to see an increase in the number of vaccines they provide. Thus, when pharmacists provide vaccines, everybody benefits – the pharmacist, other healthcare providers and most of all, the patients and the community.”Vaccine-Preventable Diseases:Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 3
  4. 4. Role of Clinical Pharmacists in ImmunizationHepatitis AKey facts: Hepatitis A is a viral liver disease that can cause mild to severe illness. Globally, there are an estimated 1.4 million cases of hepatitis A every year. The hepatitis A virus is transmitted through ingestion of contaminated food and water, or through direct contact with an infectious person. Hepatitis A is associated with a lack of safe water and poor sanitation. Epidemics can be explosive in growth and cause significant economic losses. Improved sanitation and the hepatitis A vaccine are the most effective ways to combat the disease.Treatment: There is no specific treatment for hepatitis A. Recovery from symptomsfollowing infection may be slow and take several weeks or months. Therapy is aimed atmaintaining comfort and adequate nutritional balance, including replacement of fluids thatare lost from vomiting and diarrhoea.Hepatitis BKey facts: Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. The virus is transmitted through contact with the blood or other body fluids of an infected person. Two billion people worldwide have been infected with the virus and about 600 000 people die every year due to the consequences of hepatitis B. The hepatitis B virus is 50 to 100 times more infectious than HIV. Hepatitis B is an important occupational hazard for health workers. Hepatitis B is preventable with the currently available safe and effective vaccine. Transmission: In developing countries, common modes of transmission are: perinatal (from mother to baby at birth) early childhood infections (inapparent infection through close interpersonal contact with infected household contacts) unsafe injection practices unsafe blood transfusions unprotected sexual contact. The incubation period of the hepatitis B virus is 90 days on average, but can vary from 30 to 180 days. The virus may be detected 30 to 60 days after infection and persists for variable periods of time.Symptoms: Most people do not experience any symptoms during the acute infection phase.However, some people have acute illness with symptoms that last several weeks, includingMohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 4
  5. 5. Role of Clinical Pharmacists in Immunizationyellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting andabdominal pain.In some people, the hepatitis B virus can also cause a chronic liver infection that can laterdevelop into cirrhosis of the liver or liver cancer.Diagnosis: Laboratory diagnosis of hepatitis B infection centres on the detection of thehepatitis B surface antigen HBsAg. A positive test for the hepatitis B surface antigen(HBsAg) indicates that the person has an active infection (either acute or chronic). WHOrecommends that all blood donations are tested for this marker to avoid transmission torecipients.Treatment: There is no specific treatment for acute hepatitis B. Care is aimed atmaintaining comfort and adequate nutritional balance, including replacement of fluids thatare lost from vomiting and diarrhoea.Some people with chronic hepatitis B can be treated with drugs, including interferon andantiviral agents.Hepatitis EKey facts: Every year there are 20 million hepatitis E infections, over three million acute cases of hepatitis E, and 70 000 hepatitis E-related deaths. Hepatitis E is usually self-limiting but may develop into fulminant hepatitis (acute liver failure). The hepatitis E virus is transmitted via the faecal-oral route, principally via contaminated water. Hepatitis E is found worldwide, but the prevalence is highest in East and South Asia. China has produced and licensed the first vaccine to prevent hepatitis E virus infection, although it is not yet available globally. Hepatitis E is a liver disease caused by the hepatitis E virus: a non-enveloped, positive-sense, single-stranded RNA virus.Transmission: The hepatitis E virus is transmitted mainly through the faecal-oral routedue to faecal contamination of drinking water. Other transmission routes have beenidentified, which include: Foodborne transmission from ingestion of products derived from infected animals; zoonotic transmission from animals to humans; transfusion of infected blood products; Vertical transmission from a pregnant woman to her fetus.Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 5
  6. 6. Role of Clinical Pharmacists in ImmunizationSymptoms: Typical signs and symptoms of hepatitis include: jaundice anorexia (loss of appetite); an enlarged, tender liver (hepatomegaly); abdominal pain and tenderness; nausea and vomiting; fever.Diagnosis: Diagnosis of hepatitis E infection is therefore usually based on the detection ofspecific antibodies to the virus in the blood. Two additional diagnostic tests are: reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis E virus RNA; immune electron microscopy to detect the hepatitis E virus.Treatment: There is no available treatment capable of altering the course of acutehepatitis. Prevention is the most effective approach against the disease.MeaslesKey facts: Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available. In 2011, there were 158 000 measles deaths globally Measles vaccination resulted in a 71% drop in measles deaths between 2000 and 2011 worldwide. In 2011, about 84% of the worlds children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000. Measles is caused by a virus in the paramyxovirus family.Signs and symptoms: Initially high fever, which begins about 10 to 12 days after exposureto the virus, and lasts four to seven days. A runny nose, a cough, red and watery eyes, andsmall white spots inside the cheeks can develop in the initial stage. After several days, arash erupts, usually on the face and upper neck. Over about three days, the rash spreads,eventually reaching the hands and feet. The rash lasts for five to six days, and then fades.On average, the rash occurs 14 days after exposure to the virus.Transmission: The highly contagious virus is spread by coughing and sneezing, closepersonal contact or direct contact with infected nasal or throat secretions.Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 6
  7. 7. Role of Clinical Pharmacists in ImmunizationTreatment: No specific antiviral treatment exists for measles virus.Supportive care that ensures good nutrition, adequate fluid .Antibiotics should beprescribed to treat eye and ear infections, and pneumonia.PneumoniaKey facts: Pneumonia is the leading cause of death in children worldwide. Pneumonia kills an estimated 1.2 million children under the age of five years every year – more than AIDS, malaria and tuberculosis combined. Pneumonia can be caused by viruses, bacteria or fungi. Pneumonia caused by bacteria can be treated with antibiotics, but around 30% of children with pneumonia receive the antibiotics they need.Pneumonia is a form of acute respiratory infection that affects the lungs.Causes: Streptococcus pneumoniae – the most common cause of bacterial pneumonia in children; Haemophilus influenzae type b (Hib) – the second most common cause of bacterial pneumonia; respiratory syncytial virus is the most common viral cause of pneumonia; in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV- infected infants.Transmission: The viruses and bacteria that are commonly found in a childs nose orthroat can infect the lungs if they are inhaled. They may also spread via air-borne dropletsfrom a cough or sneeze. In addition, pneumonia may spread through blood, especiallyduring and shortly after birth.Symptoms: The symptoms of viral and bacterial pneumonia are similar. However, thesymptoms of viral pneumonia may be more numerous than the symptoms of bacterialpneumonia. The symptoms of pneumonia include: rapid or difficult breathing cough fever chills loss of appetite Wheezing (more common in viral infections).Treatment: Pneumonia caused by bacteria can be treated with antibiotics.Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 7
  8. 8. Role of Clinical Pharmacists in ImmunizationPoliomyelitis: Polio (poliomyelitis) mainly affects children under five years of age. In 2012, only three countries (Afghanistan, Nigeria and Pakistan) remain polio- endemic.Polio and its symptoms: Polio is a highly infectious disease caused by a virus. Itinvades the nervous system, and can cause total paralysis in a matter of hours. The virusenters the body through the mouth and multiplies in the intestine. Initial symptoms arefever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs.People most at risk: Polio mainly affects children under five years of age.Waste from health-care activities :Health-care activities, protect and restore health and save lives. But what about the wastesand by-products they generate?Of the total amount of waste generated by health-care activities, about 80% is generalwaste comparable to domestic waste. The remaining 20% is considered hazardousmaterial that may be infectious, toxic or radioactive.Types of waste: infectious waste pathological waste: sharps chemicals pharmaceuticals genotoxic waste radioactive wasteThe major sources of health-care waste are: hospitals and other health-care establishments laboratories and research centres mortuary and autopsy centres animal research and testing laboratories blood banks and collection servicesVaccine waste: In June 2000 six children were diagnosed with a mild form of smallpox(vaccine virus) after having played with glass ampoules containing expired smallpoxvaccine at a garbage dump in Vladivostok (Russia).Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 8
  9. 9. Role of Clinical Pharmacists in ImmunizationYellow fever: Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The "yellow" in the name refers to the jaundice that affects some patients. There are an estimated 200 000 cases of yellow fever, causing 30 000 deaths, worldwide each year. There is no cure for yellow fever. Treatment is symptomatic, aimed at reducing the symptoms for the comfort of the patient. Vaccination is the most important preventive measure against yellow fever. The vaccine is safe, affordable and highly effective, and appears to provide protection for 30–35 years or more. The vaccine provides effective immunity within one week for 95% of persons vaccinated.Signs and symptoms: First, "acute", phase usually causes fever, muscle pain withprominent backache, headache, shivers, loss of appetite, and nausea or vomiting. Mostpatients improve and their symptoms disappear after 3 to 4 days.However, 15% of patients enter a second, more toxic phase within 24 hours of the initialremission. High fever returns and several body systems are affected. The patient rapidlydevelops jaundice and complains of abdominal pain with vomiting. Bleeding can occur fromthe mouth, nose, eyes or stomach. Once this happens, blood appears in the vomit and feces.Available Vaccines: No diphtheria-only vaccine is available. T he diphtheria vaccine is available as: DTaP (Diphtheria, Tetanus, acellular Pertussis vaccine) DTaP in combination with Haemophilus influenzae type b (Hib) vaccine DTaP in combination with hepatitis B and inactivated polio vaccines DTaP in combination with Hib, hepatitis B and inactivated polio vaccines DT or T d (in combination with tetanus vaccine) T dap (Tetanus, reduced diphtheria, acellular Pertussis) Vaccines containing the w hole cell pertussis component (DT P) are no longer recommended for use in theVaccines brands:Examples:1. Diphtheria and tetanus toxoids adsorbed (DT )2. Tripedia® (DTaP)3. Infanrix® (DTaP)4. TriHIBit® (DTaP and Hib conjugate vaccine)5. Daptacel (DTaP)Who Should and Should Not Receive the Vaccine:W ho should receive the vaccine?Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 9
  10. 10. Role of Clinical Pharmacists in ImmunizationMost infants and children younger than seven years of age should receive DTaP beginning at twomonths of age.For children who are younger than 7 years of age for whom there is a reason to not give a pertussiscontaining vaccine, the T D can be administered. Children seven to nine years of age w ho areincompletely immunized, should receive T dap. Previously unimmunized children between the agesof seven and nine, also should receive a dose of T d one to tw o months later and then another doseof T d 6 to 12 months later. Children between 11 and 18 years of age should receive a dose of T dap.T he preferred age for T dap vaccination is 11-12 years.Adverse effects:What are AEFI?Definition:An adverse event following immunization (AEFI) is an unwanted or unexpected event occurringafter the administration of vaccine(s).May be caused by Vaccine or may occur by chance after vaccination (i.e. it would have occurredregardless of vaccination). Most vaccines cause minor adverse events such as low-grade fever, painor redness at the injection site.Common adverse events: Examples: 1. Hepatitis B may cause transient minor adverse events including swelling, redness or soreness at the injection site, and low-grade fever, crying and irritability (in infants). 2. MMR vaccine may be followed 5 to 12 days later by a fever lasting 2 or 3 days, malaise and/or rash. 3. Influenza vaccine may cause soreness at the injection site. Fever, malaise, and myalgia occur less commonly. 4. MenCCV is generally well tolerated. Very common (>10%) adverse events are pain, redness and swelling at the injection site, fever, irritability, anorexia and headache. 5. Varicella vaccine may cause mild local soreness and swelling.Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 10
  11. 11. Role of Clinical Pharmacists in ImmunizationManaging common adverse events:Advice to parents on common adverse events:Vaccine injections may result in soreness, redness, itching, swelling or burning at the injection site.Paracetamol might be required to ease the discomfort.Managing fever after vaccination:Routine use of paracetamol at the time of vaccination is no longer recommended. If an infant orchild has a fever of >38.5ºC following vaccination, paracetamol can be given. The dose ofparacetamol is 15 mg/kg/dose of paracetamol liquid, up to a maximum daily dose of 90 mg/kg perday in 4 to 6 divided doses for up to 48 hours.Preventing AEFI:The key to preventing uncommon or rare adverse events is to screen each person to be vaccinated.The correct injection technique is also important.Uncommon and rare AEFI :Some vaccines have been shown to cause uncommon or rare adverse events, although the rate isalways hundreds to thousands times less frequent than the disease complications. Examples aregiven below.Rare, late events shown to be causally related to some vaccines:Example: The use of oral poliomyelitis vaccine (OPV) in Australia was discontinued in 2005. OPVcan rarely cause vaccine-associated paralytic poliomyelitis (VAPP). The incidence is 1 in 2.4 milliondoses of OPV, which means that Australia would have expected 1 case of VAPP every 3 years whenOPV was in use.Management of an immediate AEFI:Recipients of vaccines should remain under observation for a short interval to ensure that they donot experience an immediate adverse event. It is recommended that recipients remain in thevicinity of the place of vaccination for at least 15 minutes. Severe anaphylactic reactions usuallyhave a rapid onset; most life-threatening adverse events begin within 10 minutes of vaccination.The most serious immediate AEFI is anaphylaxis. However, in adults and older children, the mostcommon immediate adverse event is a vasovagal episode (fainting), either immediately or soonafter vaccination. Adrenaline is drug of choice in the case of anaphylaxis.Adrenaline dose:Adrenaline 1:1000 (one in one thousand) injection is administered Intramuscularly.Doses ofintramuscular 1:1000 (one in one thousand) adrenaline for anaphylaxisMohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 11
  12. 12. Role of Clinical Pharmacists in Immunization Less than 1 year 0.05–0.1 mL 1–2 years (approx. 10 kg) 0.1 mL 2–3 years (approx. 15 kg) 0.15 mL 4–6 years (approx. 20 kg) 0.2 mL 7–10 years (approx. 30 kg) 0.3 mL 11–12 years (approx. 40 kg) 0.4 mL 13 years and over (over 40 kg) 0.5 mLThe dose of 1:1000 (one in one thousand) adrenaline may be repeated every 5 minutes asnecessary until there is clinical improvement.Reporting AEFISurveillance for adverse events following immunization is an integral part of a national vaccinationprogram. Any serious or unexpected adverse event following immunization should be reported.How should AEFI be reported?AEFI are notifiable directly to the relevant health authority .In Tasmania, AEFI should be reportedusing the Adverse Drug Reactions Advisory Committee (ADRAC) blue card.The Adverse Drug Reactions Advisory Committee (ADRAC) receives reports of unexpected andserious adverse events for all medicines, including vaccines. Any person (medical or non-medical)can report an AEFI to ADRAC by telephoning the numbers listed by filling in a blue card orcompleting a web-based report.The Expanded Program on Immunization in Pakistan:Purpose:  Providing immunization for the control and prevention of vaccine preventable diseases is one of the most important and cost effective strategies implemented by any national health program.  Evidence has shown that the benefits of investing in a national program on immunization far exceed investing in treatment for these illnesses.  To reduce death, disease, and disability due to vaccinepreventable diseases (VPDs)  To contribute to the strengthening of national health systems and the attainment of Millennium Development Goal 4 (MDG-4)  In Pakistan, the EPI aims to immunize all children between 0 and 23 months against eight vaccine preventable diseases that include 1) Infant tuberculosis, 2) poliomyelitis, 3) diphtheria,Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 12
  13. 13. Role of Clinical Pharmacists in Immunization 4) pertussis, 5) neonatal tetanus, 6) hepatitis B, 7) Haemophilus influenza type b (Hib), 8) and measles.The proportion of children who are fully immunized is approximately 43 to 62 percent(depending on the survey and year).IMMUNIZATION SCHEDULE:PROBLEMS FACED IN IMMUNIZATION:Natural (earth earthquake , floods) and man-made (terrorism, social barriers)Negligence of health professionals.Insufficient fundsLack of awareness in publicMedia reports:The total number of children died from Measles is 304- WHO (Nawa-e-waqt 9 jan 2013)Polio spread in Quetta division in severity. ( 18 jan 2013, daily express)Polio clearance certificate should also comprises For Pakistanis travelling in any foreigncountry. ( Daily jang, 17 feb, 2013)Recommendations for eradication of problems:The recommendations include:(i) increasing focus on supervision, monitoring and evaluation,(ii) considering performance-based incentives,(iii) exploring partnerships with the private sector,(iv) expediting polio eradication initiatives,(v) improving management,(vi) increasing targeted capacity development,(vii) concentrating on the target age group for immunization,(viii) developing socially acceptable strategies,Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 13
  14. 14. Role of Clinical Pharmacists in Immunization(ix) developing a human resource strategy and implementation plan, and(x) improving planning at the local level.REFORMS BY GOVT. OF PAKISTAN:Amendment 18 to the Constitution of Pakistan was implemented in July 2011, allowingfor a devolution of authority from the federal to the provincial level with the eliminationof the so-called “Concurrent List,” an enumeration of approximately forty areas wherefederal law prevailed, including the health sector, which is now fully devolved to theprovinces.The technical responsibility for the EPI at the federal level has been moved to theMinistry of Inter Provincial coordination (MOIPC).Based on the Pakistan Demographic and Health Survey (PDHS) findings, the coverage rateincrease between 1990 and 2006/07 has been marginal from 35 percent to 47 percent.IMMUNIZATION SERVICES NEEDS TO BE INCREASED:Immunization services should be increased by taking various steps by pharmacists: To aware public about the advantages of immunization To provide accurate information. By warning them the possible effects if not being immunized , I:e; disability By educating them that it will raise their life standards. There will also be a threat always of diseases in their children if they do not get proper immunization. By taking examples of western countries that they are making progress better than us so to have progress we need healthy nation and healthy Pakistanis. If even they caught in any sort of fever etc, it is harmless. This sort of education is very essential as we see a lot of progress in immunization process. As we look after the survey Punjab is on top list, Baluchistan on bottom and is constantly going to decline. There is a need of great efforts in this province.Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 14
  15. 15. Role of Clinical Pharmacists in ImmunizationFunding and Procurement of New Vaccines: New vaccines offer the potential foraverting death and disease for thousands of infants and children each year throughout thecountry. Pakistan has one of the highest infant mortality rates in the world, and over 50percent of deaths in post-neonatal children are attributable to pneumonia, diarrhea, ormeningitis—diseases that can be partially prevented through immunization with newervaccines.Even though new vaccines offer tremendous possibilities in disease control, givenPakistan’s limited resources, the cost of introducing new vaccines may come at theexpense of EPI performance improvement.Role of pharmacist:Immunization Promotion: Pharmacists who do not administer vaccines can promoteimmunization through six types of activities: i. History and screening ii. Patient counseling iii. Documentation iv. Formulary management v. Administrative measures vi. Public education i. History and screening: Pharmacists can promote proper immunization by identifying the patients that need immunization.There are some activities that support a pharmacist to achieve this objective as;  Collection of immunization histories  Encouraging the use of vaccine profiles  Issuing vaccination records to the patientsMohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 15
  16. 16. Role of Clinical Pharmacists in Immunization  Preventing immunologic drug interactionsScreening of patients that need immunization: Pharmacists can play a leading role in followingforms of immunization screening;  Occurrence screening: In this type of screening need of vaccine is identified at some specific events, such as a hospital admission or discharge, emergency rooms visits, mid- decade birthdays ( years of 25, 35 and 45) and any contact with a health care delivery system for patients under 8 years or over 50 years of age.  Periodic mass screening: In this type of screening a comprehensive assessment of immunization adequacy in selected populations at a given time is done. Such screening may be conducted during autumn influenza programs or outbreaks of certain vaccine- preventable illnesses (e.g., measles and meningococcal disease). Mass screening may also be appropriate in areas where no comprehensive immunizationprogram has been conducted recently.  Occupational screening: This screening method focuses on the immunization needs of health care personnel whose responsibilities place them at risk of exposure to certain vaccine-preventable diseases or bring them into contact with high-risk patients (Hemophilia, thalassemia, most types of cancer, sickle cell anemia, chronic alcoholism, cirrhosis and human immunodeficiency virus infection). Depending on their risk of exposure, it may be advisable for members of the pharmacy staff to receive hepatitis B vaccination.  Screening for contraindications and precautions: After candidates for immunization have been identified, they should be screened for contraindications and precautions. ii. Patient Counseling: Patients in need of immunization should be advised of their infection risk and encouraged to accept the immunizations they need. Patient concerns about vaccine safety and efficacy should be discussed and addressed. Health care providers can influence patients’ attitudes regarding immunization. Adhesive reminder labels can also be affixed to prescription containers for drugs used to treatconditions that may indicate the need for vaccination against influenza and pneumococcal. Theselabels would be analogous to labels currently in widespread use. Such labels might read, “You mayneed flu or pneumonia vaccine: Ask your doctor or pharmacist.” Pharmacists should also ensure that informed consent is obtained in a manner that complieswith state laws. iii. Documentation: In USA the National Childhood Vaccine Injury Act of 1986 (NCVIA) requires all health care providers who administer vaccines to maintain permanent vaccination records and to report occurrences of certain adverse events specified in the act.Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 16
  17. 17. Role of Clinical Pharmacists in Immunization The recipient’s permanent medical record must state; The date on which the vaccine was administered. The vaccine’s manufacturer and lot number. The name, address, and title of the person administering the vaccine. Pharmacists in organized health care settings may encourage compliance with this requirementby providing reminder notices each time doses of vaccines are dispensed. Because pharmacists have experience with adverse-drug reaction reporting, they can take thelead in developing and implementing a program to meet this requirement, even if they are notresponsible for administering the vaccine. iv. Formulary management: Formulary systems in organized health care settings should include vaccines, toxoids and immune globulins available for use in preventing diseases in patients and staff. Decisions by the pharmacy and therapeutics committee on immunologic drug choices requireconsideration of relevant immunologic pharmaceutics, immuno- pharmacology and diseaseepidemiology. Because of their expertise and training, pharmacists are well equipped to provide informationand recommendations on which these decisions may be based. Pharmacist should develop and maintain product specifications to aid in the purchase of drugs under the formulary system. The pharmacist should establish and maintain standards to ensure the quality, proper storage, and proper use of all pharmaceuticals dispensed. Pharmacists must choose between single dose or multi-dose containers of vaccines on the basis of efficiency, safety, economic, and regulatory considerations. Pharmacists in institutions should develop guidelines on the routine stocking of immunologic drugs in certain high-use patient care areas. Proper transportation and storage are an important consideration for immunologic drugs, including vaccines, because many require storage at refrigerated or frozen temperatures. Pharmacists have an important responsibility to maintain the “cold chain” in the handling of these drugs. Methods must be established for detecting and properly disposing of outdated and partially administered immunologic agents. Live viral and live bacterial vaccines should be disposed of in the same manner as other infectious bio-hazardous waste. v. Administrative Measures: Some organized health care departments develop policies and protocol regarding; Hepatitis B pre-exposure prophylaxis for health care workers Hepatitis. B post exposure prophylaxis for previously unvaccinated patients. Rabies pre-exposure and post exposure prophylaxis. Wound management guidelines designed to prevent tetanus and diphtheria.Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 17
  18. 18. Role of Clinical Pharmacists in Immunization Valid contraindications to vaccination to ensure patient safety. Employee immunization against measles, rubella, influenza, and other diseases. Emergency measures in the event of vaccine-related adverse reactions.Pharmacists on key committees (e.g., infection control and risk management) in such health caresettings can promote adequate immunization delivery among staff and patients by encouraging thedevelopment of sound organizational policies on immunization. vi. Public education: Pharmacists have greater opportunities to advance the public health through immunization advocacy. Pharmacists can facilitate disease prevention strategies, because many potential victims of influenza and pneumococcal disease visit pharmacies and are seen by pharmacists daily. Working with local public health departments, state or national immunization coalitions, and other groups pharmacists can promote vaccination among high-risk populations. Newsletters, posters, brochures, and seminars may be used to explain the risk of preventable infections to pharmacy staff, other health care personnel, and patients.References: midcourse/html/focusareas/ FA14EmergingIss ues.htm. Accessed May 19, 2008. Accessed May 23, 2008. PublicHealth/tb/8081. Accessed April 24, 2008., February 14, 2011., August 1, ENCYCLOPEDIA OF CLINICAL PHARMACY Pakistan demographic and health survey, 2006Mohsin, Atif, Touqeer, Rizwan, Imran, Touqeer, Zameer, Adnan, Nabeel (MATRITZAN) Page 18