First Do No Harm: M
andatory Influenza Vaccination Policies for
Healthcare Personnel Help Protect Patients
view the complete list:
www.immunize.org/honor-roll/
influenza-mandates
Refer to the position statements of the leading medical organizations listed below to help
you develop and implement a mandatory influenza vaccination policy at your healthcare
institution or medical setting. Policy titles, publication dates, links, and excerpts follow.
American Academy of Family Physicians (AAFP)
American Public Health Association (APHA)
AAFP Mandatory Influenza Vaccination of Health Care Personnel (6/11)
Annual Influenza Vaccination Requirements for Health Workers (11/9/10)
▶ www.aafp.org/news-now/health-of-the-public/20110613
▶ www.apha.org/policies-and-advocacy/public-health-policy-statements/
mandatoryfluvacc.html
policy-database/2014/07/11/14/36/annual-influenza-vaccinationrequirements-for-health-workers
“The AAFP supports annual mandatory influenza immunization for health care
“Encourages institutional, employer, and public health policy to require influenza
personnel (HCP) except for religious or medical reasons (not personal preferences). If HCP are not vaccinated, policies to adjust practice activities during flu vaccination of all health workers as a precondition of employment and thereafter on an annual basis, unless a medical contraindication recognized in national
season are appropriate (e.g. wear masks, refrain from direct patient care).”
guidelines is documented in the worker’s health record.”
American Academy of Pediatrics (AAP)
Influenza Immunization for All Health Care Personnel: Keep It Mandatory,
a reaffirmation of AAP’s policy on mandatory influenza immunization of
health care personnel (Oct. 2015)
▶ http://pediatrics.aappublications.org/content/136/4/809
“Mandating influenza vaccine for all HCP nationwide is ethical, just, and necessary. For the prevention and control of influenza, we must continue to put the
health and safety of the patient first.”
American College of Physicians (ACP)
ACP calls for immunization for all health care providers (1/14/2013)
▶ www.acponline.org/newsroom/hcp_vaccinations.htm
“Proper immunization safely and effectively prevents a significant number of
infections, hospitalizations, and deaths among patients as well as preventing
workplace disruption and medical errors by absent workers due to illness.”
American Hospital Association (AHA)
AHA Endorses Patient Safety Policies Requiring Influenza Vaccination of
Health Care Workers (7/22/11)
▶ www.aha.org/advocacy-issues/tools-resources/advisory/2011/110722quality-adv.pdf
“To protect the lives and welfare of patients and employees, AHA supports
mandatory patient safety policies that require either influenza vaccination or
wearing a mask in the presence of patients across healthcare settings during
flu season. The aim is to achieve the highest possible level of protection.”
American Medical Directors Association (AMDA)
Mandatory Immunization for Long Term Care Workers (3/11)
▶ www.amda.com/governance/resolutions/J11.cfm
“Therefore be it resolved, AMDA – Dedicated to Long-Term Care Medicine –
supports a mandatory annual influenza vaccination for every long-term health
care worker who has direct patient contact unless a medical contrain­dication
or religious objection exists.”
American Pharmacists Association (APhA)
Requiring Influenza Vaccination for All Pharmacy Personnel (4/11)
▶ www.pharmacist.com/sites/default/files/files/2011
ActionsoftheAPhAHoD-Public.pdf
“APhA supports an annual influenza vaccination as a condition of employment,
training, or volunteering, within an organization that provides pharmacy services
or operates a pharmacy or pharmacy department (unless a valid medical or
religious reason precludes vaccination).”
Association for Professionals in Infection Control and
Epidemiology (APIC)
I nfluenza Vaccination Should Be a Condition of Employment for Healthcare
Personnel, Unless Medically Contraindicated (2/1/11)
▶ www.apic.org/resource_/tinymcefilemanager/advocacy-pdfs/apic_
influenza_immunization_of_hcp_12711.pdf
“As a profession that relies on evidence to guide our decisions and actions, we
can no longer afford to ignore the compelling evidence that supports requiring
influenza vaccine for HCP. This is not only a patient safety imperative, but is
a moral and ethical obligation to those who place their trust in our care.”
Infectious Diseases Society of America (IDSA)
andatory Immunization of Health Care Personnel Against Influenza and
M
Other Infectious Diseases (rev. 12/10/13)
▶ www.idsociety.org/HCW_Policy
“Preventing healthcare-associated transmission of influenza and other infectious
diseases can protect patients, HCP, and local communities. For this reason,
IDSA supports mandatory immunization of HCP according to recommendations
of the Advisory Committee for Immunization Practices (ACIP) of the Centers
for Disease Control and Prevention (CDC).”
National Business Group on Health (NBGH)
Hospitals Should Require Flu Vaccination for all Personnel to Protect
Patients’ Health and Their Own Health (10/18/11)
▶ www.businessgrouphealth.org/pub/f314b0a7-2354-d714-511f57f12807ba2c
“Hospitals should require flu vaccination for all personnel to protect patients’
health and their own health.”
National Patient Safety Foundation (NPSF)
NPSF Supports Mandatory Flu Vaccinations for Healthcare Workers
(11/11/15)
▶ www.npsf.org/news/259784/National-Patient-Safety-FoundationSupports-Mandatory-Flu-Vaccine-for-Health-Care-Workers.htm
“NPSF recognizes vaccine-preventable diseases as a matter of patient safety and
supports mandatory influenza vaccination of health care workers to protect the
health of patients, health care workers, and the community.”
Society for Healthcare Epidemiology of America (SHEA)
Influenza Vaccination of Healthcare Personnel (rev. 8/31/10)
▶ www.journals.uchicago.edu/doi/full/10.1086/656558
“SHEA views influenza vaccination of HCP as a core patient and HCP safety
practice with which noncompliance should not be tolerated.”
Immunization Action Coalition Saint Paul, Minnesota • 651- 647- 9009 • www.immunize.org • www.vaccineinformation.org
www.immunize.org/catg.d/p2014.pdf • Item #P2014 (12/15)
First Do No Harm (continued)
page 2 of 2
Practical resources for vaccinating healthcare personnel against influenza
U.S. Department of Health and Human
Services (HHS)
Immunization Action Coalition (IAC)
Influenza Vaccination of Healthcare Personnel,
part of HHS’ National Action Plan to Prevent
Healthcare-Associated Infections: Roadmap to
Elimination
▶ www.hhs.gov/ash/initiatives/hai/hcpflu.html
Centers for Disease Control
and Prevention (CDC)
Read the joint HICPAC/ACIP Recommendations
Influenza Vaccination of Health-Care Personnel
(MMWR, 2/24/06)
▶ www.cdc.gov/mmwr/PDF/rr/rr5502.pdf
For more recent guidance from CDC, see Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization
Practices (MMWR, 11/25/11)
▶ www.cdc.gov/mmwr/pdf/rr/rr6007.pdf
Visit CDC’s Influenza web section
▶ www.cdc.gov/flu
Visit the IAC’s Influenza Vaccination Honor Roll
to view stellar examples of influenza vaccination
mandates in healthcare settings:
www.immunize.org/honor-roll/influenza-mandates
Visit IAC’s Influenza web section: www.immunize.org/influenza
Get these IAC print materials online:
• Healthcare Personnel Vaccination Recommendations: www.immunize.org/catg.d/
p2017.pdf
•A
ccess Influenza Vaccine Information Statements (VISs) in more than 35 languages:
www.immunize.org/vis
copy this for your patients
Standing Orders for Administering Influenza Vaccine to Adults
Seek emergency medical care if you or
a family member shows the signs
below – a life could
beyouratpatients
risk!
copy this for
Purpose: To reduce morbidity and mortality from influenza by vaccinating all adults who meet the criteria
established by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
Policy: Under these standing orders, eligible nurses and other healthcare professionals (e.g., pharmacists), where
allowed by state law, may vaccinate patients who meet any of the criteria below.
It’s a fact – everyDon’t
year, people
all ages in
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Colorado Hospital Association
Guidance for Developing a Mandatory Influenza
Vaccination Program. This document is intended
to provide guidance and information for developing a mandatory influenza vaccination program
within individual hospitals:
▶ www.immunize.org/honor-roll/cha_guidance
_mandatory_influenza_policy_hcp.pdf
Immunization Action Coalition
of Washington Tool Kit
Make the Case toolkit promotes influenza and
Tdap immunization among healthcare providers
▶ www.withinreachwa.org/what-we-do/
healthy-communities/immunizations/forproviders/
health-care-workers-toolkit/
National Adult and Influenza
Immunization Summit (NAIIS)
Co-sponsored by the National Vaccine Program
Office, CDC, and the Immunization Action
Coalition. Visit the Summit website:
▶ www.izsummitpartners.org/vaccinatinghealthcare-personnel
Standing Orders for Administering Influenza Vaccines to Children and Adolescents
Many Vaccine Information Statements are
available in Spanish and other languages.
See www.immunize.org/vis
Purpose: To reduce morbidity and mortality from influenza by vaccinating all children and adolescents who meet the
criteria established by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.
Hojas de información sobre vacunas están
disponibles en español y en muchos otros
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Bring Immunity to Every Community webpage provides a listing of links for staff and patient educational materials, posters, and recommendations.
▶ www.anaimmunize.org/Main-Menu-Category/
Vaccines-for-nurses/Influenza/default.aspx
Nurse-to-Nurse Influenza Vaccination video uses
principles of risk communication to address the
concerns of a nurse hesitant to receive influenza
vaccine
▶ www.anaimmunize.org/flu-video
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www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf. Do not give live
family’s health – make sure you all
get vaccinated against influenza
INFORMATION STATEMENT
Any child or teen who shows the followingVACCINE
emergency
Emergency warning signs
every year!
warning signs needs urgent medical attention – take them
for children or teens with
Influenza (Flu) Vaccine
to an emergency room or call 9 -1-1.
influenza
(Inactivated or Recombinant):
Emergency warning signs
for adults with influenza
American Nurses Association (ANA)
Patient name:
Procedure:
1. Identify adults with no history of influenza vaccination for the current influenza season.
Date oftobirth:
2. Screen all patients for contraindications and precautions
influenza vaccine:
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after a dose of flu vaccine, or
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conditions
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or yearly
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nose
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serious or a weakened
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vaccination
in protecting the people you love
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• If you are not feeling well.
• keep you from getting flu,
get an injected flu vaccine instead. Your healthcare
Flu is more dangerous for some people. Infants and
It is usually okay to get flu vaccine when you have
provider can help you decide.
young children, people 65 years of age and older,
a mild illness, but you might be asked to come back
• keep you from spreading
flu to your family and• Item #P4073 (8/10)
www.immunize.org/catg.d/p4073.pdf
Tell the provider if you or the person being vaccinated:
• have any allergies, including an allergy to eggs, or
have ever had an allergic reaction to an influenza
vaccine.
flu vaccines Each year thousands of people in the United States die
• have ever had Guillain-Barré Syndrome (also called
from flu, and many more are hospitalized.
Technical
content
reviewed
by
the
Centers
for
Disease
Control
and
Prevention,
November
2010.
A dose of flu vaccine is recommended every flu season.
GBS).
Flu
can:
• St. 8
• 651
Immunization Action Coalition
Selby Avenue
Paul,
MNvaccine
55104
647-9009
www.vaccineinformation.org • www.immunize.org
Children 61573
months
through
years
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may
need• two
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• keep
you from
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doses during the same flu season.
Everyone
elsegetting
needswww.immunize.org/catg.d/p4069.pdf
• Item #P4069 (11/10)
nervous system problems.
only one dose each flu season.• make flu less severe if you do get it, and
• have asthma or breathing problems, or are a child who
• keep you from spreading flu to your family and
Some inactivated flu vaccines contain
a very small
has had wheezing episodes.
other people.
amount of a mercury-based preservative called
• are pregnant.
U.S.•Department
of
thimerosal. Studies have not shown thimerosal in
are a child
or adolescent who is receiving aspirin or
Health and Human Services
Live, attenuated flu
Centers for Disease
vaccines to be harmful, but flu vaccines that do not
products.
Control aspirin-containing
and Prevention
vaccine — LAIV, Nasal Spray
contain thimerosal are available.
• have a weakened immune system.
• will be visiting or taking care of someone, within the
A dose of flu vaccine is recommended every flu season.
next 7 days, who requires a protected environment (for
Children younger than 9 years of age may need two
example, following a bone marrow transplant)
doses during the same flu season. Everyone else needs
only one dose each flu season.
Adapted from the Centers for Disease Control and Prevention
Technical content reviewed by the Centers for Disease Control and Prevention, August 2010.
• 651 647-9009
• www.immunize.org
Immunization Action Coalition 1573 Selby Avenue • St. Paul,
MN 55104
• make
flu less
severe if• www.vaccineinformation.org
you do get it, and
pregnant
women, and vaccinated!
people with certain health
Get vaccinated every
year! Get your
children
when you feel better.
other people.
conditions or a weakened immune system are at
greatest
risk.
Be sureand
your
parents get vaccinated, too!
Inactivated
recombinant
2
2
The live, attenuated influenza vaccine (called LAIV)
may be given to healthy, non-pregnant people 2 through
49 years of age. It may safely be given at the same time
as other vaccines.
Policy: Under these standing orders, eligible nurses and other healthcare professionals (e.g., pharmacists), where allowed by
state law, may vaccinate children and adolescents who meet any of the criteria below.
Procedure:
1. Identify children and adolescents ages 6 months and older who have not completed their influenza vaccination(s) for the
current influenza season.
2. Screen all patients for contraindications and precautions to influenza vaccine:
a. Contraindications: a serious systemic or anaphylactic reaction after ingesting eggs, after receiving a previous dose
of influenza vaccine, or to an influenza vaccine component. For a list of vaccine components, go to www.cdc.gov/
vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf. Do not give live attenuated influenza vaccine (LAIV; nasal spray) to people with a history of hypersensitivity to eggs, either anaphylactic or non-anaphylactic; pregnant adolescents; children younger than age 2 yrs; children age 2 through 4 yrs who have experienced wheezing or asthma within the past 12 mos, based on a healthcare provider’s statement; or children or adolescents with
chronic pulmonary (including asthma), cardiovascular (excluding hypertension), renal, hepatic, neurologic/neuromusMercury
cular,
hematologic,
(e.g., diabetes) disorders; immunosuppression,
including that caused by medications
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in the 2010–2011 vaccination season.
5.0 mL (multi-dose vial)
25
6 through 35 months 90687
90687
5. Document each patient’s vaccine5.0administration
information and follow up in25the following
places:
mL (multi-dose vial)
3 years
& older
90688
90688
a. Medical chart: Record the date the vaccine was administered, the manufacturer and lot number, the vaccination site
Fluzone High-Dose (IIV3)
0.5 mL (single-dose syringe)
0
65 years & older
90662
90662
and route, and the name and title of the person administering the vaccine. If vaccine was not given, record the
Fluzone Intradermal
(IIV4) of the
0.1vaccine
mL (single-dose
microinjection
system)
0 refusal). 18 through 64 years 90630
90630
reason(s)
for non-receipt
(e.g., medical
contraindication,
patient
b. Personal immunization record card: Record the date of vaccination and the name/location of the administering clinic.
Footnotes
An the
administration
code should always
be reportedby
in addition
to the
product
code. Note: Third party payers may
1. IIV3 = egg-based and cell culture-based
trivalent inactivated
influenza vaccine (injectable);
where necessary
to refer to
6. Be prepared
for management
of a medical
emergency
related3. to
administration
of vaccine
having
a vaccine
written
emerhave specific policies and guidelines that might require providing additional information on their claim forms.
cell culture-based vaccine, the prefix “cc” is used (e.g., ccIIV3). IIV4 = egg-based quadrivalent inactivated influenza
gency medical protocol available, as well as equipment and medications.
vaccine (injectable); LAIV4 = egg-based quadrivalent live attenuated influenza vaccine (nasal spray); RIV3 = trivalent
4 . In 2010, ACIP recommended that Afluria not be used in children younger than age 9 years. If no other age-appropriate IIV
recombinant hemagglutinin7.
influenza
vaccine
Report
all(injectable).
adverse reactions to influenza vaccine to the federalisVaccine
Adverse
Event for
Reporting
System
(VAERS)
available, Afluria
may be considered
a child age 5 through
8 years
at high risk forat
influenza complications, after risks
2. Effective for claims with dates of www.vaers.hhs.gov
service on or after 1/1/2011, CPT
Terminology)
code 90658
is no forms are
and benefits
have been
with the parent or guardian. Afluria should not be used in children younger than age 5
or(Current
(800)Procedural
822-7967.
VAERS
report
available
at discussed
www.vaers.hhs.gov.
Influenza Vaccine Products for the 2015–2016 Influenza Season
longer payable for Medicare; rather, HCPCS (Healthcare Common Procedure Coding System) Q codes, as indicated
years. This recommendation continues for the 2015–2016 influenza season.
policy
and procedure shall remain in effect for all patients5.ofAfluria
the is approved by the Food and Drug Administration for intramuscular
until administration with the PharmaJet Stratis
above, should be submitted This
for payment
purposes.
(name of practice or clinic)
rescinded or until
(date).
Needle-Free Injection System for persons age 18 through 64 years.
Medical Director’s signature:
www.immunize.org/catg.d/p3074a.pdf • Item #P3074a (8/11)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Technical content reviewed by the Centers for Disease Control and Prevention
Saint Paul, Minnesota
•
651-647-9009
•
www.immunize.org
•
(LAIV; nasal spray) to an adult with a history
attenuated
influenza vaccine
Screeninganaphylatic
Checklist
for Contraindications
to of hypersensitivity to eggs, either
or non-anaphylactic; who is pregnant, is age 50 years or older, or who has chronic pulmonary (including asthma), cardiovascular (excluding hypertension), renal, hepatic, neurologic/neuromuscular, hematologic, or
Inactivated
Injectable
Vaccination
ofInfluenza
birth:
metabolic
(includingDate
diabetes)
disorders; immunosuppression,
including that caused by medications or HIV.
(mo.) (day)
(yr.)
b. Precautions: moderate or severe acute
illness with
or without fever; history of Guillain Barré syndrome within
6 weeks
of a previous
influenza
for TIV
allergic
reaction to eggs consisting of hives only (obFor adult patients as well
as parents
of children
tovaccination;
be vaccinated:
Theonly,
following
questions
serveispatient
for atwe
least
30 minutes
following
vaccination);
for LAIV
only, close contact with an immunosupwill help us determine if there
any reason
should
not give
you or your
child inactivated
injectable
requiresitprotective
isolation, receipt
influenza
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answerwhen
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to person
any question,
does not necessarily
meanofyou
(or
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or oseltamivir)
the previous
hoursIfora possibility
your child) should not be vaccinated.
It just means
additionalwithin
questions
must be48asked.
question isof use within 14 days after vaccination
Adapted
from
Summary*
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all patients
withtoaexplain
copy ofit.the most current federal Vaccine Information
Statement (VIS). You must docunot clear, please
ask3.
your
healthcare
provider
Don’t
For use with people ages 2 through 49
years:
The
following
help us
determine
if there
tions:
PreventionandControlofInfluYes dateNo
ment
in the questions
patient’s will
medical
record
or office
log,isthe publication
of the Know
VIS and the date it was given to the
any reason we should not give you or yourenza
childwith
live attenuated
intranasalnon-English
influenza vaccine
(FluMist)
today.with
If you
Vaccines:
Recommendations
patient. Provide
speaking
patients
a copy of the VIS in their native language, if available and
answer “yes” to any question, it does not necessarily
mean
you2013–14
(orthese
youratcan
child)
vaccinated. It just
of the ACIP–U.S.,
www.cdc.
preferred;
beshould
foundnot
at be
www.immunize.org/vis.
1. Is the person to be vaccinated
sick today?



means additional questions must be asked.gov/flu/professionals/acip/2013-sumIf a question is not clear, please ask your
Don’t of all ages, give 0.5 mL of injectable trivalent inactivated in4. Administer influenza vaccine as follows: a) For adults
mary-recommendations.htm.
provider
1. Persons with a history of egg allergy who healthcare
have experienced
only to explain it.
Yes
No
Know
vaccine
(22–25g, 1–1½" needle) in the deltoid muscle. (Note: A e" needle may
2. Does the person to befluenza
vaccinated
have (TIV-IM)
an allergy tointramuscularly
eggs or
hivesafterexposuretoeggshouldreceiveinfluenzavaccine.
in the
deltoidmuscle only if the skin is stretched
used for adults weighing less than 130 lbs (<60 kg) for injection
Because relatively little data are available
use person
of LAIV in
to atoday?
component of thebevaccine?
1. for
Is the
tothis
be vaccinated sick



tight,
subcutaneous
tissue
setting, IIV or RIV should be used. RIV is egg-free and may be
Recommendations regarding
influenza
vaccination
of is not bunched, and the injection is made at a 90 degree angle; or b) For healthy adults
used for persons aged 18–49 years who have no other contrainyounger
than
age
50 years,
give 0.2 mL of intranasal LAIV; 0.1 mL is sprayed into each nostril while the patient
persons
who
allergy
to
eggs:
United
States,
2. Does the person to be vaccinated
have
an
allergy
or toACIP,
a ever
component
of
3. Has
thereport
person
to to
beeggs
vaccinated
had a serious
reaction to
dications. However, IIV (egg- or cell-culture based) may also be
 give
 0.1 mlTIV-ID intradermally by inserting
2013–14 influenza season. is in an upright position; or c) Foradults 
ages 18
through 64 years,
the influenza vaccine?
influenza vaccine in the past?
used,withthefollowingadditionalsafetymeasures(seefigure
the needle of the microinjection system at a 90 degree angle in the deltoid muscle; or d) For adults ages 65 years and
in column to right)
older,
give
0.5 mL of high-dose TIV-IM intramuscularly (22–25g, 1–1½" needle) in the deltoid muscle.
yes
Can theever
person
eatalightly
3. Has the person to be vaccinated
serious
to intranasal
Administer
vaccine
per
4. Has
thehad
person
to bereaction
vaccinated
ever had
Guillain-Barré
syndrome?



a) Vaccine should be administered by a healthcare provider who is



cooked
egg (e.g., scrambled
influenza vaccine (FluMist) in
the past?
5. Document
each patient’s vaccine administration information and follow up in the following places:
usual protocol.
familiar with the potential manifestations of egg allergy; and
egg) without reaction?*†
a. Medical chart: Record the date the vaccine was administered, the manufacturer and lot number, the vaccinab) Vaccine recipients should be observed
at leastthe
30 person
minutes for
4. forDoes
to be vaccinated have
problem
with
heartand the name and title of the person administering the vaccine. If vaccine was not given,
tion
site and
route,
no a long-term health
signs of a reaction after administration of each vaccine dose.1
 of


disease, lung disease, asthma, kidney
neurologic
or neuromuscular
disease,
record
the reasons(s)
for non-receipt
the vaccine
(e.g.,______________
medical contraindication, patient refusal).
Formdisease,
completed
by: ____________________________________________
Date:
Administer
RIV3 (if patient
2. Persons who report having had reactions to
eggdisease,
involvingmetabolic
such
liver
disease (e.g., diabetes), or anemia
oraged
another
blood49disorder?
18 through
years); record card: Record the date of vaccination and the name/location of the administerb. Personal
immunization
After eating eggs or
yes
symptoms as angioedema, respiratory distress, lightheadedness,
or
administer
IIV
to
any
egg-containing
foods,
does
Form reviewed by: _____________________________________________
Date: ______________
ing clinic.
or recurrent emesis; or who required 5.
epinephrine
or another
patient
whom
is
the person
experience
If the person
to be vaccinated
is a child
age 2 through 4 years,
in theforpast
12IIVmonths,
indicatedfor
andmanagement
observe for

 related to the administration of vaccine by having a written
emergency medical intervention may receive
if aged 18provider ever
onlytold
hives?
of a
medical
emergency
hasRIV3,
a healthcare
you that he or 6.
sheBe
hadprepared
wheezing
or asthma?
reaction for at least 30 minthrough 49 years and there are no other contraindications. If
emergency
medical
protocol
available,
as
well
as
equipment
and
medications.
no
utes after vaccination.
RIV3 is not available or the recipient is not within the indicated
6. Does the person to be vaccinated have cancer, leukemia,
HIV/AIDS,
or any
other to influenza vaccine to the federal Vaccine Adverse Event Reporting System
7. Report
all adverse
reactions
age range, such persons should be referred to a physician with

 VAERS report forms are available at www.vaers.hhs.gov.
immunefor
system
in the
theperson
past 3experience
months, have
they taken
medications that
(VAERS)
at www.vaers.hhs.gov
or (800)822-7967.
expertise in the management of allergic conditions
furtherproblem; or,
Does
weaken the immune system,
such
as cortisone,
other
symptoms
such as prednisone, other steroids, or
riskassessmentbeforereceiptofvaccine(seefigureincolumnto
This policy and procedure shall remain in effect for all patients of the
until
anticancer drugs; or have they
had radiation
treatments?
right).
• Cardiovascular
changes
(name of practice or clinic)
rescindedAdminister
or until RIV3 (if patient
(date).
(e.g., hypotension)?
3. All vaccines should be administered in settings in which personnel
aged 18 through 49 years)
• Respiratory
yes
7. Is the person to be vaccinated
receivingdistress
antiviral medications?



or refer to a physician with
and equipment for rapid recognition and treatment of anaphy(e.g., wheezing)?
Medical Director’s
signature:
Effective date:
expertise in management
Screening Checklist for Contraindications to
Live Attenuated Intranasal Influenza Vaccination
Influenza Vaccination of People
with a History of Egg Allergy
laxis are available.
• Gastrointestinal
of allergic conditions for
(e.g., nausea/vomiting)?
receiving aspirin therapy or
aspirin-containing therapy? 
8. Is the child or teen to be vaccinated


further evaluation.
4. Some persons who report allergy to egg might not be egg-allergic.
• Reaction requiring
www.immunize.org/catg.d/p3074.pdf • Item #P3074 (8/11)
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Those who are able to eat lightly cooked egg (e.g., scrambled
epinephrine?
9. allergic.
Is theEgg-allergic
person to perbe vaccinated
pregnant
or could
become pregnant
within •1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
• Reaction
requiring
emer-sheImmunization
Action Coalition
egg) without reaction are unlikely to be
  
gency medical attention?
next
month?
sons might tolerate egg in baked productsthe
(e.g.,
bread
or cake).
Tolerance to egg-containing foods does not exclude the possibilwith had
egg allergy
might toleratesyndrome?
egg in baked products (e.g.,
ity of egg allergy.2Eggallergycanbeconfirmedbyaconsistent
* Individuals
10. Has the person to be vaccinated
ever
Guillain-Barré



bread
cake).
Tolerance
toforegg-containing
foods does not exclude the poswww.immunize.org/catg.d/p4066.pdf • Item#P4066 (10/12)
Technical or
content
reviewed
by the Centers
Disease Control and Prevention
medical history of adverse reactions to eggs and egg-containing
sibility of egg allergy.
foods, plus skin and/or blood testing for immunoglobulin E anti11. Does the person to be vaccinated
livewho
with
ornoexpect
to have
close to
contact
† For individuals
have
known history
of exposure
egg, butwith
who are
bodies to egg proteins.
  
suspectedisofseverely
being egg-allergic
on the basis and
of previously
performed
allergy
a person whose immune system
compromised
who must
be in
testing, consultation with a physician with expertise in the management of
5. For individuals who have no known historyprotective
of exposureisolation
to egg, (e.g., an
isolation
room
of be
a bone
marrow
transplant unit)?
allergic
conditions
should
obtained
priorSelby
to vaccination.
Immunization
Action
Coalition
• 1573
Ave. • St.Alternatively,
Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
but who are suspected of being egg-allergic on the basis of preRIV3 may be administered if the recipient is aged 18 through 49 years.
viously performed allergy testing, consultation
a physician
12. Has with
the person
to be vaccinated received any other vaccinations in the past 4 weeks?



with expertise in the management of allergic conditions should
beobtainedpriortovaccination(seefigureincolumntoright). Alternatively, RIV3 may be administered
if the
recipient isby:
aged
Form
completed
__________________________________________________ Date:_________________________
18 through 49 years.
Form reviewed by: ___________________________________________________ Date: ________________________
Effective date:
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Immunization Action Coalition
Patient name:
www.vaccineinformation.org
www.immunize.org/catg.d/p4072.pdf • Item #P4072 (9/15)
6.Aprevioussevereallergicreactiontoinfluenzavaccine,regardless
www.immunize.org/catg.d/p4067.pdf • Item #P4067 (10/12)
Technical content reviewed by the Centers for Disease Control and Prevention
of the component suspected to be responsible for the reaction, is
a contraindication to future receipt of the
vaccine. Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Immunization
abbreviations
LAIV=Liveattenutatedinfluenzavaccine
IIV=InactivatedInfluenzaVaccine
RIV3=RecombinantInfluenzaVaccine,Trivalent
references
1. Kelso JM, Greenhawt MJ, Li JT, Niclas RA, Bernstein DI, Blessing-Moore J, et al.
Adverse reactions to vaccines practice parameter 2012 update. J Clin All Immunol.
2012 Jul;130(1):25–43.
2. Erlewyn-Lajeunesse M, Brathwaite N, Lucas JS, Warner JO. Recommendations for the
administrationofinfluenzavaccineinchildrenallergictoegg.BMJ.2009;339:b3680.
Technical content reviewed by the Centers for Disease Control and Prevention
U.S. Department of
Health and Human Services
Centers for Disease
Control and Prevention
Immunization Action Coalition 1573 Selby Avenue • St. Paul, MN 55104 • 651-647-9009 • www.immunize.org • www.vaccineinformation.org
www.immunize.org/catg.d/p3094.pdf • Item #P3094 (9/13)
•H
ow to Administer Intramuscular, Intradermal, and Intranasal Influ­enza Vaccines:
www.immunize.org/catg.d/p2024.pdf
• I nfluenza Vaccine Products for the 2015–16 Influenza Season: www.immunize.org/catg.d/
p4072.pdf
•S
tanding Orders for Administering Influenza Vaccine to Adults: www.immunize.org/catg.d/
p3074.pdf
•S
creening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination:
www.immunize.org/catg.d/p4066.pdf
•S
creening Checklist for Contraindications to Live Attenuated Intra­nasal Influenza Vaccination:
www.immunize.org/catg.d/p4067.pdf
• I nfluenza Vaccination of People with a History of Egg Allergy: www.immunize.org/catg.d/
p3094.pdf
•D
eclination of Influenza Vaccination (for healthcare worker refusal: www.immunize.org/
catg.d/p4068.pdf
The Joint Commission
Commentary by Arthur L. Caplan, PhD
Titled Influenza Information, this web section
provides resources for healthcare institutions,
including a free monograph, Providing a Safer
Environment for Health Care Personnel and
Patients through Influenza Vaccination: Strategies
from Research and Practice
▶ www.jointcommission.org/topics/
hai_influenza.aspx
Managing the Human Toll Caused by Seasonal
Influenza – New York State’s Mandate to Vaccinate or Mask (JAMA, 10/1/2013)
▶ http://jama.jamanetwork.com/article.
aspx?articleid=1746248
Why Hospital Workers Should Be Forced to Get
Flu Shots
▶ www.medscape.com/viewarticle/770383
(log-in required)
Immunization Action Coalition • Saint Paul, Minnesota • 651- 647- 9009 • www.immunize.org • www.vaccineinformation.org
www.immunize.org/catg.d/p2014.pdf • Item #P2014 (12/15)