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Influenza and Pneumococcal Vaccination Inclusion/Exclusion Screening Criteria

Influenza and Pneumococcal Vaccination Inclusion/Exclusion Screening Criteria - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Infection and Isolation, Related


1
Influenza and Pneumococcal Vaccination –
Adult/Pediatric – Inpatient/Ambulatory/Primary Care/Home Health – Clinical
Practice Guideline
Appendix A. Influenza Vaccination Screening for Immunization Delegation
Protocol [60]
Inclusion Criteria
• 6 months of age or older
Exclusion Criteria
• is aged 9 years or older has already received one dose of influenza vaccine during the
current influenza season
• caregiver or patient offered and declined the influenza vaccination
• has a hypersensitivity to eggs* of other components of the vaccine
• is hospitalized with an episode of acute inflammatory demyelinating polyneuropathy
(AIDP) or Guillain-Barré Syndrome (GBS) or has a history of AIDP or GBS (Neurologist
should determine when patient may again be eligible for vaccination)
• has a history of anaphylactic latex allergy
• is having a solid organ transplant (e.g. heart, lung, pancreas, kidney, liver, intestine)
during the current hospitalization
• has undergone a solid organ transplant (e.g. heart, lung, pancreas, kidney, liver,
intestine) in the past 6 months
• is having a bone marrow/stem cell transplant during the current hospitalization
• has undergone a bone marrow/stem cell transplant in the past 6 months
• is receiving palliative care
• has planned discharge to hospice care
• is enrolled in research protocol(s)
Additional exclusion criteria for patients aged 6 months to 8 years
• has received at least two doses of influenza vaccine during the current influenza season
• has received two or more doses of seasonal vaccine before July 1, 2017 and has
already received one dose of influenza vaccine during the current influenza season
• has received an influenza vaccine dose within the last 4 weeks
* Reported egg allergy excludes patients from the inpatient pharmacist-driven immunization
delegation protocol, but should not preclude patients from receiving influenza vaccine. Patients
with reported egg allergy should be evaluated by a physician for influenza vaccine screening.
See Appendix C.
Last approved by the UW P&T Committee, 9/2017
For content changes or questions contact Philip Trapskin ptrapskin@uwhealth.org
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

2


Influenza and Pneumococcal Vaccination – Adult/Pediatric –
Inpatient/Ambulatory/Primary Care/Home Health –
Clinical Practice Guideline

Appendix B. Influenza Vaccination Screening (6 months-8 years)

Influenza vaccine dosing algorithm for children aged 6 months through 8 years —
Advisory Committee on Immunization Practices, United States, 2017–18 influenza season





Last approved by the UW P&T Committee, 9/2017
For content changes or questions contact Philip Trapskin ptrapskin@uwhealth.org

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

3


Influenza and Pneumococcal Vaccination –
Adult/Pediatric – Inpatient/Ambulatory/Primary Care/Home Health – Clinical
Practice Guideline

Appendix C. Influenza Vaccine and People with Egg Allergies

Recommendations regarding influenza vaccination of persons who report allergy
to eggs: Advisory Committee on Immunization Practices, United States, 2017-18
Influenza Season

• Persons with a history of egg allergy who have experienced only urticaria (hives) after
exposure to egg should receive influenza vaccine. Any licensed and recommended
influenza vaccine (i.e., any IIV or RIV) that is otherwise appropriate for the recipient’s
age and health status may be used.
• Persons who report having had reactions to egg involving symptoms other than urticaria
(hives), such as angioedema, respiratory distress, lightheadedness, or recurrent emesis;
or who required epinephrine or another emergency medical intervention, may similarly
receive any licensed and recommended influenza vaccine (i.e., any IIV or RIV) that is
otherwise appropriate for the recipient’s age and health status. The selected vaccine
should be administered in an inpatient or outpatient medical setting (including, but not
necessarily limited to, hospitals, clinics, health departments, and physician offices).
Vaccine administration should be supervised by a health care provider who is able to
recognize and manage severe allergic conditions.
• A previous severe allergic reaction to influenza vaccine, regardless of the component
suspected of being responsible for the reaction, is a contraindication to future receipt of
the vaccine.
Last approved by the UW P&T Committee, 9/2017
For content changes or questions contact Philip Trapskin ptrapskin@uwhealth.org

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

4

Influenza and Pneumococcal Vaccination – Adult/Pediatric –
Inpatient/Ambulatory/Primary Care/Home Health – Clinical
Practice Guideline
Appendix D. Pneumococcal Vaccination Exclusion Criteria for Immunization
Delegation Protocol [60]

Exclusion criteria for all patients
• caregiver or patient offered and declined pneumococcal vaccination
• hypersensitivity to component(s) of the vaccine
• pregnant
• is hospitalized with an episode of acute inflammatory demyelinating polyneuropathy
(AIDP) or Guillain-Barré Syndrome (GBS) or has a history of AIDP or GBS (Neurologist
should determine when patient may again be eligible for vaccination)
• enrolled in a research protocol
• 19 years or older and received PCV13 or PPSV23 in the previous 12 months; patient
should follow-up for additional pneumococcal screening to be evaluated by primary care
provider
• 19 years or older and previously received pneumococcal vaccine but unable to confirm
PCV13 or PPSV23; patient should follow-up with primary care provider following
discharge
• younger than 19 years of age and received PCV13 or PPSV23 in the previous 8 weeks
• has undergone a solid organ transplant (e.g. heart, lung, pancreas, kidney, liver,
intestine) in the past 6 months
• has undergone a bone marrow/stem cell transplant in the past 12 months
• has received chemotherapy or radiation in the last 2 weeks
• has received the shingles vaccine (Zostavax) within the past 4 weeks

Additional exclusion criteria for inpatients:
• planned discharge to hospice care
• having a solid organ transplant (e.g. heart, lung, pancreas, kidney, liver, intestine) during
the current hospitalization
• is having a bone marrow/stem cell transplant during the current hospitalization
• is receiving comfort measures only

Last approved by the UW P&T Committee, 9/2017
For content changes or questions contact Philip Trapskin ptrapskin@uwhealth.org

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

5

Influenza and Pneumococcal Vaccination – Adult/Pediatric –
Inpatient/Ambulatory/Primary Care/Home Health – Clinical Practice Guideline

Appendix E. Pneumococcal Vaccination Screening (24-71 months)

Table 1. Recommended schedule for administering doses of 13-valent pneumococcal conjugate vaccine (PCV13) to
children aged 24-71 months by PCV vaccination history and age
Age at this visit (months)
Vaccination history: total number of
PCV7 and/or PCV13 doses received
previously before age 24 months
Recommended PCV13 regimen
(Minimum interval between doses is 8
weeks)
24-59 months in healthy children
Unvaccinated or any incomplete
schedule
1 dose, ≥ 8 weeks after the most recent
dose
4 doses of PCV7 or other age-
appropriate, complete PCV7 schedule
1 supplemental dose, ≥8 weeks after the
most recent dose
24-71 months in children with
underlying medical conditions (see
Table 2 and Appendix F)

Unvaccinated or any incomplete
schedule of <3 doses
2 doses, the first dose ≥8 weeks after the
most recent dose and a second dose ≥ 8
weeks later
Any incomplete schedule of 3 doses
1 dose, ≥ 8 weeks after the most recent
dose
4 doses of PCV7 or other age-
appropriate complete PCV7 schedule
1 supplemental dose, ≥8 weeks after the
most recent dose
PCV7 = 7-valent pneumococcal polysaccharide-protein conjugate vaccine.


Table 2. Underlying medical conditions that are indications for pneumococcal vaccination among children by risk group
Risk group Condition
Immunocompetent children
Chronic heart disease
A
Chronic lung disease
B
Diabetes mellitus
Cerebrospinal fluid leaks
Cochlear implant
Children with functional or
anatomic asplenia
Sickle cell disease and other hemoglobinopathies
Congenital or acquired asplenia, or splenic dysfunction
Children with
immunocompromising
conditions
HIV infection
Chronic renal failure and nephrotic syndrome
Diseases associated with treatment with immunosuppressive drugs or radiation therapy,
including malignant neoplasms, leukemias, lymphomas and Hodgkin disease; or solid organ
transplantation
Congenital immunodeficiency
C

A
Particularly cyanotic congenital heart disease and cardiac failure
B
Including asthma if treated with high-dose oral corticosteroid therapy
C
Includes B- (humoral) or T-lymphocyte deficiency; complement deficiencies, particularly C1, C2, C3, and C4
deficiency; and phagocytic disorders (excluding chronic granulomatous disease).
Last approved by the UW P&T Committee, 9/2017
For content changes or questions contact Philip Trapskin ptrapskin@uwhealth.org






Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

6

Influenza and Pneumococcal Vaccination – Adult/Pediatric –
Inpatient/Ambulatory/Primary Care/Home Health – Clinical Practice Guideline

Appendix F. Pneumococcal Vaccination Screening (2-18 years with underlying medical
conditions)

Table 1. Schedule for vaccination using 23-valent polysaccharide vaccine (PPSV23) after 13-valent pneumococcal
conjugate vaccine (PCV13) for children aged ≥2 years with underlying medical conditions
Group Schedule for PPSV23 Revaccination with PPSV23
Children who are
immunocompromised, have sickle
cell disease, or functional or
anatomic asplenia
A
1 dose of PPSV23 administered at
age ≥2 yrs and ≥8 weeks after last
indicated dose of PCV13
B
1 dose 5 years after the first dose of
PPSV23
B
Immunocompetent children with
chronic illness
A
1 dose of PPSV23 administered at
age ≥2 yrs and ≥8 weeks after last
indicated dose of PCV13
B
Not recommended
B
A
See Table 2 below
B
See Appendix F

Table 2. Underlying medical conditions that are indications for pneumococcal vaccination among children by risk group
Risk group Condition
Immunocompetent children
Chronic heart disease
A
Chronic lung disease
B
Diabetes mellitus
Cerebrospinal fluid leaks
Cochlear implant
Children with functional or
anatomic asplenia
Sickle cell disease and other hemoglobinopathies
Congenital or acquired asplenia, or splenic dysfunction
Children with
immunocompromising
conditions
HIV infection
Chronic renal failure and nephrotic syndrome
Diseases associated with treatment with immunosuppressive drugs or radiation therapy,
including malignant neoplasms, leukemias, lymphomas and Hodgkin disease; or solid organ
transplantation
Congenital immunodeficiency
C

A
Particularly cyanotic congenital heart disease and cardiac failure
B
Including asthma if treated with high-dose oral corticosteroid therapy
C
Includes B- (humoral) or T-lymphocyte deficiency; complement deficiencies, particularly C1, C2, C3, and C4
deficiency; and phagocytic disorders (excluding chronic granulomatous disease).
Last approved by the UW P&T Committee, 9/2017
For content changes or questions contact Philip Trapskin ptrapskin@uwhealth.org






Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

7

Influenza and Pneumococcal Vaccination – Adult/Pediatric –
Inpatient/Ambulatory/Primary Care/Home Health – Clinical Practice Guideline

Appendix G. Pneumococcal Vaccination Screening (6-18 years)
Risk group
Underlying medical
condition
PCV13 PPSV23
Recommended Recommended
Revaccination
5 years after first
dose
Immunocompetent persons
Chronic heart disease
A


X

Chronic lung disease
B

X

Diabetes mellitus

X

Cerebrospinal fluid leaks X X

Cochlear implants X X

Alcoholism

X

Chronic liver disease

X

Cigarette smoking

X

Persons with functional or anatomic
asplenia
Sickle cell disease/other
hemaglobinopathies
X X X
Congenital or acquired
asplenia
X X X
Immunocompromised persons
Congenital or acquired
immunodeficiencies
C

X X X
Human immunodeficiency
virus infection
X X X
Chronic renal failure X X X
Nephrotic syndrome X X X
Leukemia X X X
Lymphoma X X X
Hodgkin disease X X X
Generalized malignancy X X X
Iatrogenic
immunosuppression
D
X X X
Solid organ transplant X X X
Multiple myeloma X X X
A
Including congestive heart failure and cardiomyopathies.
B
Including chronic obstructive pulmonary disease, emphysema, and asthma.
C
Includes B-(humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4
deficiencies), and phagocytic disorders (excluding chronic granulomatous disease)
D
Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and
radiation therapy

Last approved by the UW P&T Committee, 9/2017
For content changes or questions contact Philip Trapskin ptrapskin@uwhealth.org

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

8

Influenza and Pneumococcal Vaccination – Adult/Pediatric –
Inpatient/Ambulatory/Primary Care/Home Health – Clinical Practice Guideline

Appendix H. Pneumococcal Vaccination Screening (>19 years)
Risk group Underlying medical condition
PCV13 PPSV23
Recommended Recommended
Revaccination
5-yrs after first
dose
65 years of age or older X X
Immunocompetent
persons
Chronic heart disease
A

X

Chronic lung disease
B


X

Diabetes mellitus

X

Cerebrospinal fluid leaks X X

Cochlear implants X X

Alcoholism

X

Chronic liver disease

X

Cigarette smoking

X

Persons with functional
or anatomic asplenia
Sickle cell disease/other
hemaglobinopathies
X X X
Congenital or acquired asplenia X X X
Immunocompromised
persons
Congenital or acquired
immunodeficiencies
C
X X X
Human immunodeficiency virus infection X X X
Chronic renal failure X X X
Nephrotic syndrome X X X
Leukemia X X X
Lymphoma X X X
Hodgkin disease X X X
Generalized malignancy X X X
Iatrogenic immunosuppression
D
X X X
Solid organ transplant X X X
Multiple myeloma X X X
A
Including congestive heart failure and cardiomyopathies.
B
Including chronic obstructive pulmonary disease, emphysema, and asthma.
C
Includes B-(humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4
deficiencies), and phagocytic disorders (excluding chronic granulomatous disease)
D
Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and
radiation therapy
Last approved by the UW P&T Committee, 9/2017
For content changes or questions contact Philip Trapskin ptrapskin@uwhealth.org

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

9

Influenza and Pneumococcal Vaccination – Adult/Pediatric –
Inpatient/Ambulatory/Primary Care/Home Health –Clinical Practice Guideline

Appendix I. Recommended Intervals for sequential use of PCV-13 and PPSV-23
for Immunocompetent adults aged ≥65 years
A,B



A
In pneumococcal-naïve patients, administer PCV-13 first
B
For adults aged ≥65 years with immunocompromising conditions, functional or anatomic asplenia,
cerebrospinal fluid leaks, or cochlear implants, the recommended interval between PCV13 followed by
PPSV23 is ≥8 weeks. For those for who previously received PPSV23 when aged <65 years and for
whom an additional dose of PPSV23 is indicated when aged ≥65 years, this subsequent PPSV23 dose
should be given ≥1 year after PCV13 and ≥5 years after the most recent dose of PPSV23.



Last approved by the UW P&T Committee, 9/2017
For content changes or questions contact Philip Trapskin ptrapskin@uwhealth.org

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org

10

Influenza and Pneumococcal Vaccination – Adult/Pediatric –Inpatient/Ambulatory/Primary Care/Home Health –
Clinical Practice Guideline
Appendix J. Medical conditions or other indications for administration of PCV-13 and PPSV-23 for adults

Last approved by the UW P&T Committee, 9/2017
For content changes or questions contact Philip Trapskin ptrapskin@uwhealth.org

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2018CCKM@uwhealth.org