Vaccine distribution for this season has already begun. Vaccinate all of your eligible patients for influenza and continue through the spring until the vaccine expires.
Obtaining vaccine: Although generally prebooked in the spring, influenza vaccine can still be purchased. Go to www.nyc.gov/html/doh/downloads/pdf/imm/flu-imm-order-info.pdf for a list of manufacturers and www.flusupplynews.com for a list of distributors. If you are enrolled in the Vaccines for Children (VFC) program, order vaccine for all eligible children and adolescents online at www.nyc.gov/health/cir. Be sure to order an adequate supply of preservative-free vaccine to administer to young children and pregnant women.
Storing vaccine: Store vaccines correctly to ensure full potency (see www.immunize.org/catg.d/p3035.pdf for a sample safety and storage checklist). Store vaccine in a standard household-size refrigerator with a separate freezer compartment; do not use a dormitory-style unit or store food, beverages, or clinical specimens along with vaccines. Refrigerator temperature should be maintained at 35º to 46º Fahrenheit (2º to 8º Celsius) and be logged twice per day with a certified and calibrated thermometer. Place “Do Not Unplug” signs next to electrical outlets for the refrigerator and freezer and display emergency contact information in the event of a power failure. Do not use expired vaccines as they may be ineffective. If vaccines are exposed to temperatures outside of the recommended range, please call the vaccine manufacturer to determine if they may still be used.
Vaccination forms: Give patients and parents the Vaccine Information Statement (VIS) to read before vaccination as required by federal law. Separate statements are available for TIV and LAIV in multiple languages (www.immunize.org/VIS). Have those refusing vaccination sign a Vaccine refusal Form, available at www.immunize.org/catg.d/p4068.pdf.
Administering vaccine: Trivalent influenza vaccine is administered as either an intramuscular or intradermal injection into the deltoid area of the upper arm at a 90º angle. For intramuscular vaccine, choose needle size based on the patient’s weight: heavier patients require a longer needle (see Figure). the needle should be long enough to penetrate the muscle mass and prevent vaccine from seeping into subcutaneous tissue, but not long enough to reach the underlying bone (44). Live attenuated influenza vaccine is administered intranasally. Intradermal vaccine is administered using the prefilled microinjection syringe system described earlier.
Recordkeeping: Document all vaccinations administered in the patient’s electronic or paper medical record and include the VIS edition date and the date the VIS was given to the patient or parent/guardian. If the patient has signed a Vaccine Refusal Form, include the form in the medical record. Be sure to record vaccinations given outside of your medical facility as well. Many electronic medical records, including those used by the Primary Care Information Project, have a feature for this. Facilities without electronic health records may use the Vaccine Administration Record for Adults (www.nyc.gov/html/doh/downloads/pdf/csi/flu03kit-clin-adminrec.pdf) or a preventive services flow sheet.
| FIGURE. ANATOMIC SITES FOR INTERMUSCULAR IMMUNIZATION
Recommended needle lengths
- Adults and older children: Deltoid muscle.
- Infants and children aged 6 through 35 months:
Preferred site is the anterolateral aspect of the thigh.
- Adults and older children: ≥1 in. (>25 mm)
(longer needles may be needed, depending
on the patient's size).
- Children with adequate deltoid muscle mass:
7/8 in. to 1.25 in.
- Children aged <12 months: 7/8 in. to 1 in.
| Sources: ACIP recommendations and product prescribing information.
Figure used with permission of the California Department of
Public Health Immunization Branch.