Immunization in North Carolina
Happy New Year Everyone! As we celebrate, it is easy to forget that we are still in the middle of flu season! In the United States, flu season starts in October and continues through February. Last February, the state of North Carolina reported, through North Carolina Department of Health and Human Services (NCDHHS), at least 35 deaths from the flu. Many cases go undiagnosed or unreported, so it is likely that the actual number is higher. While the strain of flu is slightly different each year, getting vaccinated is always important to prevent catching and spreading the common sickness. According to the Center for Disease Control, the strain for the flu shot has changed recently.1 The changes are as follows:
Kansas and Brisbane are the locations that the strains were discovered for the 2019-2020 flu season and are predicted to be prevalent. The flu is always mutating, so this prediction may or may not work. Even still, the flu shot usually grants at least some form of protection and is recommended each year.
Pharmacists have a major role in vaccinating communities against the flu. Starting in October 2019, North Carolina law allowed pharmacists to administer the flu vaccine to patients 10 years of age and older without a prescription. The new law also allows pharmacists to vaccinate patients from ages 6 to 10 years old with a doctor’s prescription.2,3 Prior to this legislation, patients had to be at least 14 years old to get their flu vaccine at a pharmacy. Furthermore, pharmacists are now allowed to give the HPV and hepatitis A vaccine to adults. This increases the impact that pharmacists can have on increasing vaccination rates in local communities. Staying current with all vaccinations is especially important as more and more individuals are choosing to forgo immunizations. In 2019, the CDC reported that only 75.2% of patients 24 months old received all seven recommended vaccines (MMR, DTaP, Hep B, 2 doses of Hep A, rotavirus, and influenza).4 Downward trends in vaccination rates have prompted some practices to take action. Blue Ridge Pediatric & Adolescent Medicine in Boone, North Carolina, implemented a “no shots, no service” policy and will not treat patients if they are not vaccinated for non-medical reasons.5 While this may seem harsh, the overall goal is to protect other patients and their families from potential disease exposure. It is important to remember that vaccinations both protect individuals and contribute to the immunity of the whole community.
While students at UNC have been trained on vaccination techniques, laws, and other practices in North Carolina and the United States, students have to take an elective course for international vaccinations for travel purposes. In addition, students don’t really learn much about international vaccination laws and practices. Students should take a chance to research these topics if they can! As previously mentioned, many providers are refusing to take patients who have not received their vaccinations. In Australia, this becomes more of a government and legal issue with legislations titled No Jab, No Pay and No Jab, No Play.6 Both were enacted in 2016 to combat increasing outbreaks of preventable diseases and vaccination misinformation concurrently. Basically, the former legislation says that a child must be fully immunized for parents to receive certain tax benefits. The latter says that a child must be immunized to attend childcare in certain areas. According to the National Centre for Immunisation Research and Surveillance (NCIRS), exemptions do apply but objection is not a valid exemption. Visit the NCIRS website to learn more.
There have been many vaccine myths and bits of misinformation spread by anti vaxxers and health-illiterate persons in the last few decades, some of which involve the US versus international immunization schedules. The most common is that the US gives much more vaccines than any other developed country.7 After taking a look at the vaccination schedules of other countries, one can find out that this myth is either false or exaggerated. While many European countries do not give as many vaccines overall, they do give more vaccines at an earlier age - this includes two doses of MMR and the chicken pox vaccine by the time a child is 15 to 24 months old. Some countries even give vaccines that the US does not give, such as the BCG and MenC vaccines. Another myth is that Japan banned the HPV shot. If a parent refuses the HPV shot for their child on the basis of this myth and its potential harmfulness, let them know that the HPV shot is still widely available in Japan - it is simply not actively recommended. All in all, the schedules are very similar between the US and other countries.
It is important for pharmacy students to be aware of changes in immunization policy. From the local to national, and even on the international scale, legislation is always being updated to reflect the latest science and societal needs. As pharmacists, we have the ability to immunize patients and play a major role in preserving the public health of our communities. Even as students, we can volunteer in flu shot clinics and educate the patient population about current legal changes and the importance of vaccinations. Be sure to keep up with local laws and engage with the community to see the positive change that you can make.
Authors: Linda Allworth and Zane Colon
1. APhA. New NC law lowers age for pharmacy influenza immunization, expands vaccines foradults.https://www.pharmacist.com/article/new-nc-law-lowers-age-pharmacy-influenza-immunization-expands-vaccines-adults. Accessed January 22, 2020.
2. Brown EA. New NC law lowers age for pharmacy flu shots, expands vaccines for adults. Asheville Citizen Times. https://www.citizen-times.com/story/news/local/2019/06/04/nc-law-lowers-age-pharmacy-flu-shots-expands-vaccines-adults-hepatitis-a-hpv/1337142001/. Published June 4, 2019. Accessed January 22, 2020.
3. CDC. Influenza (Flu). https://www.cdc.gov/flu/season/faq-flu-season-2019-2020.htm. Accessed January 22, 2020.
4. Immunization Schedules from Other Countries. Vaxopedia. https://vaxopedia.org/2017/04/23/immunization-schedules-from-other-countries/. Accessed January 22, 2020.
5. NCIRS. No Jab No Play, No Jab No Pay. http://www.ncirs.org.au/public/no-jab-no-play-no-jab-no-pay. Accessed January 26, 2020.
6. Ovaska S. No shots, no service: Pediatricians take tough stands while vaccination rates for young children in N.C. drop. North Carolina Health News. https://www.northcarolinahealthnews.org/2019/05/07/no-shots-no-service-pediatricians-take-tough-stands-while-vaccination-rates-for-young-children-in-n-c-drop/.Accessed January 26, 2020.
7. SUPPLEMENTARY TABLE 3. Estimated vaccination coverage with selected individual vaccines and a combined vaccine series* by age 24 months† among children born 2015-2016,§ by U.S. Department of Health and Human Services (HHS) region, state, selected local area, and territory – National Immunization Survey-Child 2016-2018, United States. 68.