At the completion of the self-study program, the participant will be able to:

The self-study learning activity is designed to ensure that all participants have an understanding of vaccine-preventable diseases and the role of pharmacists as vaccine advocates and administrators.  There are five learning modules that present in-depth information on immunology, practice implementation, and legal and regulatory issues as noted below, with appropriate references to the Centers for Disease Control and Prevention (CDC) resource publication, Epidemiology and Prevention of Vaccine-Preventable Disease.  The self-study program includes a self-assessment test and real-life case studies that are designed to help reinforce and evaluate participants' understanding of key information and concepts.

Module 1. Pharmacists, Vaccines, and Public Health

At the completion of this activity, participants will be able to:

• Describe the effects of immunizations on morbidity and mortality rates of vaccine-preventable diseases in the United States.
• Discuss Healthy People 2020 goals for vaccination rates in the United States.
• Explain the expansion of the role of pharmacists as vaccine providers and describe the status of pharmacists’ authorization to administer vaccines throughout the United States.
• Describe strategies for pharmacists to advocate for pharmacy-based delivery of vaccines.
• Discuss the role of pharmacists as immunizers in emergency preparedness activities.
• Identify resources that are useful for immunization providers and educators.

Module 2. Overview of Immunology and Vaccine Development

At the completion of this activity, participants will be able to:

• Identify the differences between active and passive immunity and describe key elements of each process.
• Explain how vaccines elicit an immune response and provide protection from disease.
• Describe the characteristics of and distinctions among live vaccines, inactivated vaccines, polysaccharide vaccines, and recombinant vaccines.
• Discuss the rationale for timing of vaccine administration and intervals between doses, including vaccine-vaccine spacing and vaccine-antibody spacing.
• Describe principles of herd immunity. 

Module 3. Vaccine-Preventable Diseases

At the completion of this activity, participants will be able to:

• Describe the epidemiology, clinical features, and potential complications of diseases that can be prevented with vaccines.
• Identify vaccines available in the U.S. market for each vaccine-preventable disease and describe their features.
• Identify the contraindications and precautions for the use of vaccines available in the United States.
• Use recommendations from the Advisory Committee on Immunization Practices to identify target groups for receipt of each vaccine.

Module 4. Patient Care Considerations for Immunizing Pharmacists

At the completion of this activity, participants will be able to:

• Explain how to apply the pharmacists’ patient care process to immunization services.
• Identify patients with immunization needs.
• Given a patient case, select appropriate vaccines using an immunization schedule from the Advisory Committee on Immunization Practices, and identify appropriate timing, doses, and routes of administration.
• Discuss the rationale for timing for vaccine administration and intervals between doses, including vaccine-vaccine spacing and vaccine-antibody spacing.
• Recall recommended patient screening questions for vaccination and identify valid contraindications for vaccinations.
• Educate patients about the benefits of vaccines and address common concerns about vaccines.
• Provide accurate information that addresses common myths about vaccines.
• Describe the roles of the Vaccine Adverse Event Reporting System in managing vaccine safety.
• Educate patients about potential adverse reactions following the receipt of a vaccine and how to manage them.
• Explain appropriate techniques for intramuscular, subcutaneous, intradermal, and intranasal administration of vaccines.
• Describe the signs and symptoms of adverse reactions to vaccines and procedures that pharmacists should follow to manage various adverse reactions.
• Describe appropriate documentation and follow-up after vaccine administration. 

Module 5. Operating a Pharmacy-Based Immunization Program

At the completion of this activity, participants will be able to:

• Describe important considerations when deciding which vaccines to offer.
• Describe physical space requirements for a vaccine service.
• Discuss Occupational Safety and Health Administration regulations for the prevention of employee exposure to bloodborne pathogens and needlestick injury at worksites where immunizations are administered.
• Outline principles and procedures for vaccine storage and handling.
• Discuss workflow options for administering vaccines in pharmacy practice.
• Identify marketing strategies that can be used to promote a pharmacy-based immunization service.
• Explain potential options for obtaining reimbursement and compensation for vaccines and vaccine administration.
• Describe liability issues related to vaccine administration, including the Vaccine Injury Compensation Program.

The second component of the APhA’s Pharmacy-Based Immunization Delivery certificate training program (14th Edition) is an active learning seminar focusing on pharmacy practice implementation.  The live training seminar is based on the experience of practitioners involved in immunization advocacy and administration.  The training seminar reinforces and expands on the self-study program and addresses areas such as immunization needs, legal and regulatory issues, and injection-technique training.  Participants will be expected to practice giving intramuscular and subcutaneous injections.

After participating in the Live Seminar, the participant will be able to:

• Describe strategies for increasing immunization rates, including physician collaborations, community level activities, and immunization coalition activities
• Describe pharmacy operations and a process for administering vaccines in various pharmacy practice settings
• Evaluate patient histories and make patient-specific recommendations based on the appropriate immunization schedule
• Demonstrate effective strategies for communicating with patients who have concerns about vaccines
• Describe current evidence regarding vaccine safety
• Recognize the signs and symptoms of adverse reactions that can occur after vaccination
• Describe procedures for management of patients with adverse reactions to vaccination that constitute an emergency
• List the steps for administering currently available intranasal and intradermal vaccines
• Demonstrate appropriate intramuscular and subcutaneous injection techniques for adult immunization

All participants are strongly encouraged to obtain CPR or BCLS certification.  However, certification is not a prerequisite of the program.  A Certificate of Achievement is awarded to participants who successfully complete all program requirements.  The Certificate of Achievement is invalid, however, without written proof of current CPR or BCLS certification.

• Check-in and Continental Breakfast
• Welcome, Introductions and Acknowledgements
• Clinical Review
• Morning Break
• Managing a Pharmacy-Based Immunization Program
• Strategies for Increasing Immunization Rates
• Lunch
• Applying ACIP Immunization Schedules
• Communicating with Patients
• Afternoon Break
• Vaccine Administration Technique
• Transitional/Summary Remarks
• Skills Assessment

• Chair:
  Stephan L. Foster, PharmD, FAPhA
  CAPT (Ret) U.S.P.H.S.
  Professor, University of Tennessee Health Sciences Center
  Memphis, Tennessee
• Lauren B. Angelo, PharmD, MBA
  Assistant Dean, Academic Affairs
  Associate Professor, Pharmacy Practice
  Rosalind Franklin University of Medicine and Science
  North Chicago, Illinois
• Jeff Goad, Pharm.D., MPH, FAPhA, FCPhA, FCSHP
  Professor and Chair, Department of Pharmacy Practice
  Chapman University School of Pharmacy
  Irvine, California
• Jean-Venable “Kelly” R. Goode, PharmD, BCPS, FAPhA, FCCP
  Professor and Director, Community-Based Pharmacy Residency Program
  Virginia Commonwealth University
  Richmond, Virginia
• Vincent A. Hartzell, Pharm.D.
  President
  Hartzell's Pharmacy
  Catasauqua, Pennsylvania
• Carrie Foust Koenigsfeld, Pharm.D, FAPhA
  Professor of Clinical Sciences
  Drake University, College of Pharmacy and Health Sciences
  Des Moines, Iowa
• Adam C. Welch, PharmD, MBA, BCACP, FAPhA
  Associate Dean for Academic Affairs and Assessment
  Bill Gatton College of Pharmacy
  East Tennessee State University
  Johnson City, Tennessee

The following APhA staff members contributed to the development of this program:

• Mitchel C. Rothholz, RPh, MBA, Chief Strategy Officer
• Helen Ali-Sairany, PharmD, Associate Director, Content Development, Education
• Kelly French, Director, Advanced Training
• Misty Knack, Associate Director, Advanced Training
• Bronhed Shaw, Associate Director, Advanced Training.

The original publication was prepared by Judy Crespi Lofton, MS, of JCL Communications, on behalf of APhA.

• Stephan Foster, PharmD, FAPhA, FNAP, has served as a speaker for Merck Vaccines, Pfizer and Seqirus. He has served on advisory boards for Pfizer and Seqirus.
• Jeffrey A. Goad, PharmD, MPH, FCPhA, FCSHP has served as a speaker for Merck Vaccines.
• Carrie Foust Koenigsfeld, PharmD, FAPhA, has served as a speaker for Merck Vaccines and Pfizer.
• Mitchel C. Rothholz, RPh, MBA, declares that his spouse is an employee of Merck and that he has served on advisory boards for Merck and Pfizer.
• All other individuals involved in the development of this material declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.  APhA’s editorial staff declare no conflicts of interest or financial interests in any product or service mentioned in this activity, including grants, employment, gifts, stock holdings, and honoraria. For a complete list of APhA staff disclosures, please visit the APhA website at www.pharmacist.com/apha-disclosures.
• Conflicts of interest have been resolved through content review by Helen Sairany, PharmD, BCACP, Associate Director of Content Development at the American Pharmacists Association. 
• The material presented here does not necessarily reflect the views of the American Pharmacists Association. Every attempt has been made to ensure the accuracy of the information contained herein at the time of writing; however, owing to the nature of pharmacy practice, standards and recommendations change regularly. Pharmacists are advised to verify all information and data before treating patients or employing the practices described in this educational activity.