Vaccine Safety Updates

Background: Immunizations are one of the greatest public health achievements in history, and the field of vaccinology continues to evolve with the introduction of new vaccines made with novel technologies, updates in vaccine recommendations, and innovations in safety monitoring. It is essential that nurses who work with immunizations stay informed about vaccine science, vaccination policy, and vaccine safety.

Methods: We reviewed recent presentations from CDC’s advisory committee on immunization practices (ACIP) meetings and revisions to ACIP vaccine recommendations and guidelines. We also reviewed selected recent additions to the vaccine safety literature to determine which current updates on vaccine safety are important for nurses to know.

Results: Recent vaccination information and updates relevant for nurses include:
1) Newly licensed adjuvanted vaccines Fluad (MF59 adjuvant), Shingrix (ASO1B adjuvant), and Heplisav-B (CpG 1018) are available and recommended for use by ACIP. The purpose of adjuvants is to increase the vaccine recipient’s immune response to the vaccine so that the vaccine can better protect the recipient from disease. Like all vaccines, those containing adjuvants are tested for safety and effectiveness prior to licensure and are continuously monitored after licensure to ensure their safety.
2) Shingrix, an adjuvanted recombinant vaccine, is the newly licensed (October 2017) vaccine against herpes zoster (shingles). Shingrix differs substantially from the older live-attenuated zoster vaccine, Zostavax. Shingrix has different storage requirements, administration procedures, and a different dosing schedule. Important differences are that Shingrix is stored in the refrigerator between 2° and 8°C (36° and 46°F), requires two doses, and is recommended to be given by the intramuscular route, whereas Zostavax is stored frozen, requires one dose, and is recommended to be given by the subcutaneous route. Shingrix is preferentially recommended over Zostavax by ACIP.
3) Shoulder injury related to vaccine administration is an uncommon outcome that can occur after a vaccine intended for intramuscular administration is given in the arm. The most commonly reported possible contributing factor is vaccine being given too high on the shoulder. Knowledge of proper administration technique for intramuscular administration of vaccines is important in helping to prevent this condition.
4) The ACIP recommends inactivated influenza vaccine (IIV) and tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during each pregnancy to protect both mother and baby. Flu tends to cause more severe illness in pregnant women, and IIV given during pregnancy can protect both the mother and the newborn from flu (flu vaccines are not approved in children under 6 months of age). Tdap vaccine given to pregnant women helps to protect a baby from pertussis during the first few months of life before a baby completes the initial series of DTaP vaccinations.

Conclusion and discussion: Nurses who routinely administer vaccines should stay current with vaccine science, vaccine recommendations and vaccine safety. Their knowledge will ensure that patients are informed of the benefits and risks of vaccination and will help improve vaccine confidence with patients and parents.