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Clearing up some flu confusion

November 18, 2014

Can pharmacists administer FluMist® to children younger than 9 years of age? When do pharmacists have to refer a patient to public health?

What are the age limits for receiving FluMist?

To determine FluMist administration restrictions, follow this three-step process.

  1. Check the Standards

Standard 17.5 of the Standards of Practice for Pharmacists and Pharmacy Technicians states:

A pharmacist authorized to administer drugs by injection must not administer an injection to a child younger than five years old.

  1. Check the FluMist monograph

ACP standards do not set an age limit for the administration of non-injectibles. However, the FluMist product monograph specifies that the product is not indicated for individuals younger than two years old.

  1. Check the Alberta Health Influenza Immunization Policy

Page 18 of the policy states that:

Pharmacists shall not bill Alberta Blue Cross for administering influenza vaccine (injectable and non-injectable) to children less than nine years of age.

Therefore, pharmacists may administer FluMist to anyone two years of age or older, but may only bill Alberta Blue Cross for administrations of provincially funded vaccine to individuals nine years of age or older.

In their Oct. 20 update, AHS pointed out that FluMist is intended for younger people and, ideally, should only be administered to those adults (18-59 years old) who refuse injectable vaccine.

When do pharmacists need to refer?

The Alberta Health Influenza Immunization Policy directs that, “In any case where a pharmacist is unsure whether a specific client should receive influenza vaccine either due to a clinical concern or whether they are otherwise ineligible, the pharmacist must refer the client to the local AHS public health office for assessment.”

Publicly funded vs. private stock

Pharmacists have a responsibility to make patients and their families aware of the universal publically funded influenza immunization program before offering any alternative that is not included in the public program.

As instructed in the Code of Ethics, all pharmacists must provide each patient with any information that the patient needs to make informed decisions about their health and health care and discuss that information with the patient (Principle 2, Statement 3).

Originally published in the November 18, 2014 issue of The Link