Pharmacist-Administered Influenza Vaccination in Children and Corresponding Regulations

Abstract

In our retrospective cohort study, we evaluated trends in pharmacist-administered pediatric influenza vaccination rates in the United States and corresponding state-level pharmacist pediatric vaccination authorization models, including minimum age requirements, vaccination protocols, and/or prescription requirements. An administrative health claims database was used to capture influenza vaccinations in children less than 18 years old with 1 year of continuous enrollment and joinpoint regression was used to assess trends. Of the 3,937,376 pediatric influenza vaccinations identified over the study period, only 3.2% were pharmacist-administered (87.7% pediatrician offices, 2.3% convenience care clinics, 0.8% emergency care, and 6.0% other locations). Pharmacist-administered pediatric influenza vaccination was more commonly observed in older children (mean age 12.65 ± 3.26 years) and increased significantly by 19.2% annually over the study period (95% confidence interval 9.2%-30.2%, p < 0.05). The Northeast, with more restrictive authorization models, represented only 2.2% (n = 2816) of all pharmacist-administered pediatric influenza vaccinations. Utilization of pharmacist-administered pediatric influenza vaccination remains low. Providing children with greater access to vaccination with less restrictions may increase overall vaccination rates. Due to the COVID-19 pandemic and the Public Readiness and Emergency Preparedness Act, pharmacists will play a major role in vaccinating children.

Demographic and Clinical Predictors of Pharmacist-Administered Pediatric Influenza Immunization

“…For example, in Oregon, children 7 and younger can receive an influneza vaccine from a pharmacist under pharmacist independent authority and children of any age can receive an influneza vaccine from a pharmacist with a prescription from the child’s physican. 7,10 This form of expanded access for additional age groups increased the likelihood of pharmacist-administered pediatric influenza vaccination. In both the 5 to 12-year-old age group and the 13- to 17-year-old age group, allowing pharmacists to vaccinate children against influenza via physician prescription increased the likelihood of pharmacist-administered vaccination by 500%.…”

“…Prior to the Coronavirus Disease 2019 (COVID-19) pandemic and during the timeframe of our study (July 1, 2016 – June 30, 2017), individual states governed regulatory mandates for pharmacist-administered vaccinations 7,10 and utilization of pharmacists as immunizers was low, especially in states with more restrictive minimum age requirements. More recently, pharmacists were granted expanded vaccination authority to administer any FDA authorized vaccine to children aged 3 to 18 under the “Third Amendment to Declaration Under the Public Readiness and Emergency Preparedness Act for Medical Countermeasures Against COVID–19” (PREP Act) released in August 2020 27 for the duration of the COVID-19 pandemic.…”

“…A common regulation is a minimum age restriction for pharmacist administration of influenza vaccination in children, which varies by state, ranging from no age restrictions to restrictions on all pediatric vaccination by pharmacists (ie only allowed for 18 years of age and older). [7][8][9][10] Positive experiences with pharmacies are common, 11 and 93% of the population live within five miles of a pharmacy. 12 In addition, pharmacies are found to be more accessible with more widespread locations, have more convenient hours, and require less time than a pediatrician's office visit.…”

“…While all but six states allow pharmacists to administer influenza vaccines to children of various ages, 7,10 in our review of the literature, we did not identify drivers or barriers of pediatric vaccination by a pharmacist compared with children vaccinated in a pediatrician's office. Therefore, the purpose of our study was to determine demographic and clinical characteristics predictive of pharmacist-administered influenza vaccination among children when compared with influenza vaccination in pediatrician's offices.…”