Vaccine Administration and Clinical Guidance

Information for healthcare and public health professionals on communication regarding vaccine decisions and specific guidelines on vaccine administration.

Following the currently recommended immunization schedules for children, adolescents and adults offers the best protection against serious, vaccine-preventable diseases.  The Immunization Action Coalition created several resources as a summary of immunization recommendations, including the Summary of Recommendations for Childhood and Adolescent Immunization, Summary of Recommendations for Adult Immunization, and Healthcare Personnel Vaccination Recommendations

MDPH also outlines the occupational recommendations and requirements in Adult Occupational Immunizations: Massachusetts Recommendations and Requirements.

CDC recommends that all health care personnel who administer vaccines receive comprehensive, competency-based training on vaccine administration policies and procedures BEFORE administering vaccines. Comprehensive, skills-based training should be integrated into existing staff education programs such as new staff orientation and annual education requirements. A free vaccine administration e-Learn is available that offers continuing education for health care personnel, including CME, CNE, CEU, CPE, CPH, and CHES.

Massachusetts providers who are enrolled in the Immunization Program must also comply with the requirements set out in the Guidelines for Compliance with Federal Vaccine Administration Requirements (PDF) l (DOCX). Visit the Vaccine Management page for more information.

Communicate About Vaccine Benefits and Risks

While you can do a number of things to help make vaccines as safe and effective as possible, providing patients or parents/guardians with information about vaccines and immunization is equally important.

Before you administer each dose of certain vaccines, you are required by law to provide a copy of the most current Vaccine Information Statement (VIS) to either the adult vaccinee or to the child’s parent/legal representative. VIS are developed by the CDC and discuss the benefits and risks associated with specific vaccines. You must also record in the patient’s chart the date that the VIS was given and the publication date of the VIS. Current VISs are available on CDC's Vaccine Information Statements page. Translations in over 40 languages are available on the Immunization Action Coalition's Vaccine Information Statements website.

Other materials such as brochures, videos, and resource kits can assist you in communicating with patients or parents about vaccine benefits and risks. These credible resources can assist providers and parents/patients in vaccine conversations and decisions:

• Created by MDPH’s Immunization Division, Communicate with Confidence Talking with Patients about Vaccine l (DOCX)  — is a collection of the best resources on:
  • Communication techniques for providers
  • Articles on vaccine hesitancy
  • Vaccine safety
  • Outreach to specific vaccine-hesitant populations
  • Immunization-related apps for patients and providers
• CDC, AAP, and AAFP created the website, Provider Resources for Vaccine Conversations with Parents, to assisting answering questions about vaccines and provide successful communication strategies related to vaccine confidence.
• The Vaccine Education Center, Children’s Hospital of Philadelphia provides complete, up-to-date and reliable information about vaccines to parents and healthcare professionals.
• The AAP Immunization Training Guide covers all aspects of immunization within a provider office (including vaccine safety and communicating with parents) for physicians, nurses, nurse practitioners, physician assistants, medical assistants and office mangers.
• The Massachusetts Chapter of the AAP updates this resource list reflecting the latest tools to increase vaccine confidence and immunization rates.
• The CDC Vaccine Safety website for providers and parents describes the robust system in place in the U.S. to monitor and assure vaccine safety.
• The Immunization Action Coalition’s Vaccine Safety Resources website maintains a list of links to more trusted sources of information about vaccines
• The Immunization Action Coalition created a What If You Don’t Immunize Your Child factsheet for parents describing the consequences for their own children and how their decisions can also affect others.
• Voices for Vaccines is a parent-driven organization supported by scientists, doctors, and public health officials that provides parents clear, science-based information about vaccines and vaccine-preventable disease, as well as an opportunity to join the national discussion about the importance of on-time vaccination.
• Vaccinate Your Family is a nonprofit organization committed to reducing the burden of vaccine-preventable diseases in families and individuals.
• The American College of Physicians' Guide to Adult Immunization provides important resources as well as vaccine information to help physicians increase adult immunization in their practices.

Screen for Valid Contraindications and Precautions

Contraindications and precautions to vaccination indicate when vaccines should not be given. A contraindication is a condition in a patient that increases the chance of a serious, adverse reaction. In general, a vaccine should not be administered when a contraindication is present. A precaution is a condition in a patient that may increase the chance of a serious side effect or render a vaccine less effective. Normally, vaccination is deferred when a precaution is present. However, situations may arise when the benefits of vaccination outweigh the risk of a side effect, and the provider may decide to vaccinate the patient. Most precautions and some contraindications are temporary and the vaccine may be given at a later time. For details, consult the CDC Guide to Contraindications to Childhood Vaccinations.

One key to preventing serious adverse reactions to vaccines is screening for contraindications and precautions. Every provider who administers vaccines should screen every patient before giving a vaccine dose. Sample screening questionnaires are available from the Immunization Action Coalition site.

Many conditions are often inappropriately regarded as contraindications to vaccination. In most cases, the following are not contraindications:

• Mild acute illness (e.g., diarrhea and minor upper-respiratory tract illnesses, including otitis media) with or without low grade fever
• Mild to moderate local reactions and/or low grade or moderate fever following a prior dose of the vaccine
• Current antimicrobial therapy
• Convalescent phase of illness
• Recent exposure to an infectious disease
• Preterm birth
• Breastfeeding

Vaccine Administration

Proper vaccine administration is critical to ensure that vaccination is safe and effective.

Visit the CDC Vaccine Administration website or the Immunization Action Coalition for information and resources on administering vaccines.

These are specific resources to assist in administering vaccines:

• Administering Vaccines: Dose, Route, Site, and Needle Size
• Administering Vaccines to Adults: Dose, Route, Site, and Needle Size
• Vaccines with Diluents: How to Use Them
• Recommended and Minimum Ages and Intervals Between Doses of Routinely Recommended Vaccines
• Skills Checklist on Administering Vaccines

The Commissioner of the Massachusetts Department of Public Health sent a circular letter entitled Immunization Administration by Medical Assistants (DOC) in August 2017 to inform primary care providers about the approved certifications to enable medical assistants to administer immunizations.

Implementing standing orders in your practice can empower other health care personnel to administer vaccines and increase vaccination rates. For samples of standing orders and more information, please visit the Model Standing Orders page.

Vaccination Clinics

The Guidelines for Vaccination Clinics (PDF) | (DOCX) were developed to assist in the planning and operation of vaccination clinics, including annual flu clinics, school-based clinics, and vaccination clinic in response to small-scale emergencies. This document summarizes key points in running a successful clinic, and provides links to many other useful resources. You can also visit the CDC Guidance for Planning Vaccination Clinics Held at Satellite, Temporary, or Off-Site Locations, which outlines the logistics and considerations needed to plan a high volume vaccination clinic. The National Adult Immunization and Influenza Summit also has many resources on conducting vaccination clinics.

Documenting Vaccines

Health care providers are required by law to record certain information in a patient’s medical record. In Massachusetts, healthcare professionals providing any immunization in the Commonwealth must report to the Massachusetts Immunization Information System (MIIS). Please see the MIIS website for more information.

These MDPH resources can assist providers with documenting vaccines:

• Vaccine Administration Record Form (DOC) 
• Certificate of Immunization (DOC) 
• Immunization Clinic Vaccine Administration Record (DOC) 

The Immunization Action Coalition has many resources to keep patient records and document vaccines. 

Report Suspected Side Effects and Vaccination Errors

Providers who suspect a vaccine adverse event should report to both VAERS and ISMP as detailed below.

Vaccine Adverse Event Reporting System (VAERS)

VAERS provides a nationwide mechanism by which adverse events following immunization can be reported, analyzed and made available to the public. Providers must report adverse events as outlined in the Vaccine Injury Table (PDF). Also included as reportable are events listed in the vaccine manufacturer's package insert as contraindications to receiving additional doses of vaccine and any other serious or unusual event. Providers and the general public can report adverse events by going to the VAERS website and filling out a report online, or by completing a writeable VAERS PDF form and uploading it to the VAERS website. Additional assistance is available via email at [e-mail] or by phone at [phone].

Vaccine Administration Errors

In addition to reporting adverse events, MDPH also recommends reporting vaccine administration errors (e.g., wrong route, wrong dose, and wrong age) to the Institute for Safe Medication Practices (ISMP), via the Vaccine Error Reporting Program (VERP). ISMP is a non-profit organization educating the healthcare community and consumers about safe medication practices. Providers can report these errors utilizing the ISMP website. Vaccine administration errors should also be reported to VAERS (as described above), and MUST be reported if they resulted in an adverse event.