Vaccinations 2021

The 2021 vaccination season is upon us with many pharmacies administering the 2021 influenza vaccine. As the COVID-19 vaccination roll out begins, pharmacists and pharmacy owners must ensure appropriate vaccination  training,  qualifications and procedures are reviewed and updated. Excellent and consistent processes are imperative to ensure all vaccines are administered safely.

The PDL Master Policy provides indemnity cover for the administration of a vaccine, including COVID-19 vaccines. The definition of administration in the policy includes manufacture, storage, receipt, handling, preparation, reconstitution, alteration, administration, treatment, sale, supply, delivery, or distribution of a vaccine. Pharmacists are obliged to follow relevant legislation, protocols, guidelines, training, and recommendations relating to the vaccines and vaccination process.

To ensure members are prepared for the 2021 vaccination season, PDL suggests you consider the following:

• Complete the COVID-19 vaccine specific training
• Ensure all pharmacists have PRODA access, and are linked to every service provider (i.e., the community pharmacies, hospitals or medical centres) they practise in.
• Make sure all pharmacist vaccinator credentials (including first aid and CPR) are sighted, confirmed as current and valid for the State or Territory, and recorded.
• Ensure adequate numbers of staff are trained in CPR and first aid. Consider simulations to ensure all staff understand their roles in managing and reporting an adverse event.
• A suitable area for vaccination must comply with State legislation and guidelines and include adrenaline with clearly noted expiry dates and reminders for replacement prior to expiry.
• Review your local Health Department websites for further information regarding vaccination standards.
• Ensure vaccination providers understand the ATAGI recommended exclusion periods and timing recommendations for COVID-19 and other vaccines. In summary, anyone in Phase 1a or 1b should get their COVID-19 vaccine first, others should be encouraged to get their influenza vaccine prior to the COVID-19 Phase 2 roll-out commencing.
• The recommendation to separate COVID-19 vaccines by a minimum of 14 days applies to ALL other vaccines, not just influenza vaccine.
• The A.I.R. is checked prior to every vaccine being administered.
• Review your State Health Department’s website for the minimum age limits and range of vaccines permitted for pharmacist vaccination.
• Ensure recording of informed consent and the vaccination service is done in a manner where the records can be accessed if needed for future verification or clarification.
• Understand how any adverse events are recorded for any vaccine.

Please note that State regulators can undertake inspections of pharmacy vaccination services at any time.

The Australian Technical Advisory Group on Immunisation (ATAGI) have released their 2021 statement outlining the age ranges for influenza vaccines in Australia.

Overview of key points and updates for 2021

• Annual influenza vaccination is recommended for all people ≥6 months of age. It is the most important measure to prevent influenza and its complications.
• Influenza vaccinations must be recorded on the Australian Immunisation Register (AIR).
• Administration of an influenza vaccine and a COVID-19 vaccine should be separated by a minimum of 14 days.
• A new cell-based influenza vaccine (Flucelvax Quad®) is available but not funded under the National Immunisation Program (NIP).
• For adults aged ≥65 years, the adjuvanted influenza vaccine, Fluad® Quad, is preferentially recommended over standard influenza vaccine.

Table 1. Seasonal influenza vaccines registered and available for use in Australia in 2021, by age

Ticks indicate age at which a vaccine is registered and available. Shaded boxes indicate the vaccine is funded under the NIP for eligible people • NIP funding only for Aboriginal and Torres Strait Islander people, pregnant women and people who have certain medical conditions. 
Source: ATAGI Clinical Advice, March 2021

Incident reports to PDL involving vaccines 

While vaccine-related incident reports to PDL in 2020 were very small in proportion to the number of vaccines administered, there were a few consistent incident types and the following advice is provided:

Shoulder injury related to vaccine administration (SIRVA)

• Good administration technique is vital as per vaccination training.
• Pharmacist positioning in relation to patient i.e. sitting rather than standing and thorough assessment of the intended site of vaccination can help prevent this complication.
• A patient presenting with persistent pain following vaccination should be advised to seek medical advice. The Immunisation Handbook has a document assisting practitioners to address this issue.

Light-headedness or fainting during or shortly after vaccination

• This may occur when patients attempted to stand or leave the pharmacy too soon after vaccination and experienced unsteadiness resulting in a fall.
• While most are vasovagal episodes, pharmacists and staff need to be able to differentiate between a vasovagal episode and an anaphylactic reaction and be prepared to respond promptly. The Immunisation handbook has a table comparing symptoms between vasovagal and anaphylactic reaction.
• Ensure patients are monitored for 15 minutes after their vaccination.

Age-related issues 

• Children vaccinated when under the minimum age through an oversight or misleading information from the patient or parent.
• Patients over 65 years vaccinated by a pharmacist with an influenza vaccine that was not adjuvanted. The recommendation is for patients 65 years and over to receive the adjuvanted vaccine.
• Limitations in supply or imminent travel may warrant vaccination with another form of influenza vaccine.
• PDL recommends these patients are made aware of the advice from advisory bodies about the preference to vaccinate with the adjuvanted vaccine. Consider contacting the prescriber and discussing the situation. Ensure the patient is fully informed, they consent to a non-adjuvanted vaccine and there is documentation to support this action.

Expired vaccines

• Vaccines have been administered after their expiry date.
• Good procedures are needed to flag batch expiry dates and ensure vaccines with short expiry dates are not allocated for patients requesting a vaccine is reserved for them.

Useful links:

• ATAGI advice on seasonal influenza vaccines in 2021
• COVID-19 vaccines ⁠–⁠ Is it true?

For immediate advice and incident support, call PDL on 1300 854 838 to speak with one of our Professional Officers. We are here to support our pharmacist members 24/7, Australia-wide.