Introduction to Immunization Best Practice

Introduction

The Centers for Disease Control and Prevention (CDC) recommends routine vaccination to prevent 17 vaccine-preventable diseases that occur in infants, children, adolescents, or adults. This report provides information for clinicians and other health care providers about concerns that commonly arise when vaccinating persons of various ages. Providers and patients must navigate numerous issues, such as the timing of each dose, screening for contraindications and precautions, the number of vaccines to be administered, the educational needs of patients and parents, and interpreting and responding to adverse events. Vaccination providers help patients understand the substantial body of (occasionally conflicting) information about vaccination.

This vaccination best practice guidance is intended for clinicians and other health care providers who vaccinate patients in varied settings, including hospitals, provider offices, pharmacies, schools, community health centers, and public health clinics. The updated guidelines include 1) new information on simultaneous vaccination and febrile seizures; 2) enhancement of the definition of a "precaution" to include any condition that might confuse diagnostic accuracy; 3) confirmation that if a patient is not acutely moderately or severely ill, vaccination during hospitalization is a best practice; 4) more descriptive characterization of anaphylactic allergy; 5) incorporation of protocols for management of anaphylactic allergy; 6) allowances for alternate route (subcutaneous instead of intramuscular) for hepatitis A vaccination; 7) an age cutoff of 12 years through 17 years of age for validating a dose of intradermal influenza vaccine; 8) deletion of much of the content from storage and handling, including storage units, temperature monitoring, and expiration dates (because this content is now codified and continually updated in the CDC's Vaccine Storage and Handling Toolkit.); 9) incorporation of Infectious Diseases Society of America guidance on vaccination of persons with altered immunocompetence; 10) timing of intramuscular administration in patients with bleeding disorders; 11) updated data on vaccination record policy; 12) additional impacts of the Affordable Care Act12 on adult vaccination; and 13) updated programmatic contact information on source material for vaccine information.

The guidance is organized in the following 10 documents: 1) Timing and Spacing of Immunobiologics; 2) Contraindications and Precautions; 3) Preventing and Managing Adverse Reactions; 4) Vaccine Administration; 5) Storage and Handling of Immunobiologics; 6) Altered Immunocompetence; 7) Special Situations; 8) Vaccination Records; 9) Vaccination Programs; and 10) Vaccine Information Sources. A glossary follows (see Appendix 1: Glossary).

This report will help vaccination providers to assess vaccine benefits and risks, use recommended administration practices, understand the most effective strategies for ensuring that vaccination coverage in the population remains high, and communicate the importance of vaccination to reduce the effects of vaccine-preventable disease. These best practice guidelines are intended for use in the United States; vaccine availability, use, and epidemiologic circumstances might differ in other countries and might warrant different guidance.