PHARMACIST-ADMINISTERED PEDIATRIC INFLUENZA VACCINATION IN THE UNITED STATES

Abstract

One of the ten greatest public health achievements of the 20th century is the control of infectious diseases from vaccination according to the Centers for Disease Control and prevention (CDC). It is recommended by the CDC and the Advisory Committee on Immunization Practices (ACIP) that everyone 6 months and older should receive an annual influenza vaccination. The influenza vaccine is a safe and effective way to prevent the influenza infection and subsequent complications, which is particularly important in children because it has been shown to reduce influenza illness in older adults. Currently, the United States utilizes the National Immunization Survey (NIS-Flu) to provide estimates of annual vaccination rates of children, which are subject to limitations of survey data such as low response and recall bias. As of 2009, pharmacists were considered approved influenza vaccinators in all states. Pharmacist-administered vaccination improves access to care through increased convenience with proximity, longer hours, and without the need for an appointment. Pharmacists have the authority to vaccinate children against influenza and other vaccine preventable diseases based on different authorization models; protocols, minimum age restrictions, and/or prescription requirements by state. The utilization of pharmacists as pediatric vaccinators, as well as the implications of the restrictions, is not well understood. Particularly relevant during the current coronavirus disease 2019 (COVID-19) pandemic, pharmacists will have a more substantial role in the vaccination of children. In August 2020, the United States Health and Human Services Department (HHS) granted pharmacists the authority to administer any Food and Drug Administration (FDA) authorized vaccine to children 3 years of age and older under the “Third Amendment to Declaration Under the Public Readiness and Emergency Preparedness Act for Medical Countermeasures Against COVID–19” (PREP Act), which overrides state-level regulatory mandates. Pharmacists are being recognized as well-positioned to expand access to all childhood vaccinations in an effort to combat the alarming decline in all routine pediatric vaccines observed during the onset of the pandemic due to decreased pediatric physician visits and changes in access to healthcare. This dissertation provides information that can help to understand the trends in utilization of pharmacist-administered pediatric influenza vaccine prior to the PREP Act, as well as determine demographic and clinical characteristics predictive of utilization of a pharmacy setting for receiving influenza immunizations and determine if state-level pediatric vaccination rates by a pharmacist impact state level-influenza diagnoses. For all studies, Optum’s de-identified Clinformatics ® Data Mart Database, a claims data