See Appendix 1 for the Vaccine Screening and Consent Form, available in regular and large font fillable PDFs.

See Appendix 4 for a PDF of this Guide.

This Guide for Vaccine Screening Tool and Consent Form Questions (the Guide) has been developed by medSask and the Pharmacy Association of Saskatchewan as a support document to the Vaccine Screening Tool and Consent Form (the Form), see Appendix 1.

This guide is intended to provide rationale for the questions included on the Form and direction in the specific situations. This is not a comprehensive vaccine guide. Pharmacists need to consult the Saskatchewan Immunization Manual (SIM) and/or the Canadian Immunization Guide (CIG) for vaccine eligibility/recommendations and specific vaccine information. Also see references in Appendix 2.

Each section in the Guide has the relevant questions from the Form, with answers providing context and intent of the question and how to proceed based on the patient response:

  • Inactivated Influenza Vaccine, to which questions 1-5 are relevant;
  • Other Inactivated Vaccines, to which questions 1-7 are relevant; and
  • All Live Vaccines (including Live Attenuated Influenza Vaccine), to which questions 1-10 are relevant

The information has been organized in this manner because influenza is the vaccine most commonly administered by pharmacists; however, there are some differences and/or other considerations when administering other inactivated and live vaccines.

The accompanying Form meets the record keeping requirements as set out by the Regulatory Bylaws of the Saskatchewan College of Pharmacy Professionals regulating the Administration of Drugs by Injection and Other Routes by a pharmacist. A list of the documentation requirements,  can be found in Appendix 3.

Special thanks to the Saskatchewan College of Pharmacy Professionals for providing feedback into the development of this document.

Acronyms Used in the Guide

BCG = Bacille Calmette-Guerin 
CIG = the Canadian Immunization Guide
IIV = inactivated influenza vaccine
LAIV = live attenuated influenza vaccine (FluMist®)
MMR = measles, mumps, rubella
MMRV = measles, mumps, rubella, varicella
SIM = the Saskatchewan Immunization Manual

Q1. Feel sick today?

There is no evidence that acute illness reduces vaccine efficacy or increases vaccine adverse events. Mild illnesses (such as otitis media, upper respiratory infections, upset stomach, and diarrhea) are NOT contraindications to vaccination, acknowledging that during the COVID-19 pandemic, individuals who do not meet screening criteria will be asked to defer immunizations.

  • A moderate, or severe acute illness, with or without a fever, may be reason to delay immunization. Benefits need to be weighed against risks. Expert opinion is strongly recommended in this situation.
    • Reasons to vaccinate may include:
      • protection in a high risk exposure situation
      • short window of opportunity
    • Reasons to delay vaccination may include:
      • vaccine-related adverse event (particularly fever) could complicate the management of the individual
      • events associated with the acute illness may be misperceived as vaccine-related adverse events

There is no evidence that acute illness reduces vaccine efficacy or increases vaccine adverse events. Mild illnesses (such as otitis media, upper respiratory infections, upset stomach, and diarrhea) are NOT contraindications to vaccination, acknowledging that during the COVID-19 pandemic, individuals who do not meet screening criteria will be asked to defer immunizations.

  • A moderate, or severe acute illness, with or without a fever, may be reason to delay immunization. Benefits need to be weighed against risks. Expert opinion is strongly recommended in this situation.
    • Reasons to vaccinate may include:
      • protection in a high risk exposure situation
      • short window of opportunity
    • Reasons to delay vaccination may include:
      • vaccine-related adverse event (particularly fever) could complicate the management of the individual
      • events associated with the acute illness may be misperceived as vaccine-related adverse events
If significant nasal congestion is present that might interfere with delivery of LAIV to the nasopharyngeal mucosa, IIV can be administered instead; LAIV can be deferred until resolution of the illness but taking the opportunity to vaccinate at time of presentation is preferred.

Q2. Have allergies to medications, food, a vaccine component, or latex?

  • Vaccines should not be administered to individuals who have had an anaphylactic reaction to any of the vaccine components, with the exception of egg (see below). Refer patients who report a severe reaction to other ingredients to their primary care provider or Public Health for further assessment.
Vaccine antigens
  • A vaccine is contraindicated in an individual with a history of anaphylaxis after previous administration of the same vaccine or same antigen. Refer to primary care provider for further investigation.
Nonmedicinal Ingredients 
  • May be present in vaccine products, usually only in trace amounts. Consult individual vaccine monographs for the list of nonmedicinal ingredients contained in each product. The SK Drug Plan and Extended Benefits Branch provides the components of the publicly funded influenza vaccines.
    • Egg proteins (ovalbumin) - Studies show that egg-allergic individuals, even those who report a severe reaction, may be vaccinated with the full dose of most vaccines without prior vaccine skin testing, even if the vaccines contain trace amounts of eggs.
      • Inactivated influenza vaccine and MMR/MMRV may have trace amounts of eggs but have been found to be safe in egg-allergic individuals.
      • **An exception is the rabies vaccine RabAvert®, which generally should not be received by patients reporting anaphylactic reactions to eggs. Eggs are not used in the manufacturing of the rabies vaccine Imovax®. See SIM–Chapter 6 for more details.
    • Thimerosal - minute amount is present in some multi-dose vials as a preservative but not in single dose vials or prefilled syringes or the inhaled vaccine product.
      • Inactivated influenza vaccine - refer patients with documented allergy to thimerosal (or those requesting) to Public Health to receive a thimerosal-free product.
      • Other vaccines - If thimerosal-free products are not available for other vaccines, refer to the primary care provider or Public Health. Note that thimerosal is considered safe in pregnancy.
    • Latex - some tips of syringe plungers, tips of prefilled syringes and vial stoppers contain latex. These products need to be avoided in those reporting anaphylactic allergic reaction to latex. For reactions other than anaphylactic (often contact allergy), latex-containing products may be used.
    • Antibiotics (such as gentamicin, neomycin or kanamycin) – if the reaction reported is not anaphylactic (e.g. is a contact allergy or delayed type immune reaction) the product can be administered.
    • Adjuvants - e.g. aluminum hydroxide, aluminum phosphate, AS01B, AS04, MF59.
    • Other common ingredients: buffers (such as sodium chloride, potassium chloride, disodium hydrogen phosphate heptahydrate, potassium dihydrogen phosphate), gelatin, surfactants (such as α-tocopheryl hydrogen succinate, cetrimonium bromide, polysorbate 80, sodium deoxycholate, Triton X-100) ethanol, formaldehyde and sucrose.

Q3. Ever have a serious reaction after receiving a vaccination?

All Vaccines
  • Vaccines are contraindicated for individuals who have had an anaphylactic reaction to a previous dose. Refer patients who have previously experienced severe lower respiratory symptoms (wheeze, chest tightness, difficulty breathing) within 24 hours of a vaccination, an apparent significant allergic reaction to the vaccine or any other symptoms (e.g. hives, throat constriction, difficulty swallowing) that raise concern regarding the safety of re-immunization. Because of the morbidity and mortality associated with vaccine-preventable diseases, a diagnosis of vaccine allergy should not be made without confirmation from medical experts.
  • GBS is a neurological condition that can cause paralysis.
Inactivated Influenza and Live Attenuated Influenza Vaccines
  • Although the evidence associating influenza and GBS is inadequate to accept or reject a causal relationship, avoiding subsequent influenza vaccination of all individuals known to have had GBS within six weeks of previous influenza vaccination is recommended at this time. However, the potential risk of GBS recurrence associated with influenza vaccination must be balanced against the risk of GBS associated with influenza infection itself. Vaccination may still be warranted - refer patients to their primary care provider for assessment of risk.
Tetanus Toxoid-Containing Vaccine
  • Cases of GBS following toxoid-containing vaccination have been reported, though population studies have not found a causal association. Individuals who develop GBS within 6 weeks of receipt of tetanus toxoid-containing vaccine should not receive a further dose.

Reactions from past vaccines that may be reported but do not warrant withholding future vaccinations:

  • extensive limb swelling
  • syncope
  • febrile seizure
  • cutaneous reactions

Q4. Have any of the following medical conditions

General: 
  • Bleeding disorders are NOT contraindications to injectable vaccine administration. To reduce bleeding risk:
    • A fine gauge needle (23, 25, or 27 G) should be used.
    • Apply direct pressure (without rubbing) to the injection site for 5 to 10 minutes after injection to stop the bleeding.
  • For patients with haemophilia, if there is concern that the injection may stimulate bleeding, schedule the injection shortly after the administration of anti-haemophilia therapy. It is advisable to administer the vaccine approximately 3-4 hours after the anti-haemophilia therapy that decreases the risk of bleeding and haematoma. See SIM - Chapter 7 for more details.
MMR and MMRV Vaccines
  • Always consult with the patient’s physician/specialist prior to MMR immunization if they have had an episode of thrombocytopenia in the past, which may or may not have occurred within 6 weeks of a previous MMR/MMRV vaccine.
Live Attenuated Influenza Vaccine
  • LAIV is not recommended for patients with severe asthma (defined as currently on oral or high dose inhaled glucocorticosteroids or active wheezing) or those who have had to seek medical attention for wheezing in the 7 days prior to vaccination.
  • LAIV can be given to patients with stable, non-severe asthma.
All Vaccines
  • Injection of a vaccine into an area where lymphatic circulation may be impaired (e.g. deltoid injection in an individual with local lymphedema, lymphangioma, axillary lymph node dissection, A-V fistula, upper limb amputation) could theoretically result in an impaired immune response due to impaired vaccine absorption, although there are no data to support this. Consider an alternative injection site if possible.
    • Note that axillary lymph node dissection is most commonly associated with mastectomy and lumpectomy, though not all patients who have undergone these procedures have lymph node dissection so this should be clarified if possible.
    • If lymphatic circulation impairment is unilateral, inject in the opposite arm; if bilateral, the vastus lateralis is a suitable alternate site.
    • As this is a theoretical concern, some patients, in consultation with their healthcare providers, may decide to use the deltoid even if bilateral involvement.
  • See SIM – Chapter 7 and CIG- Immunization of immunocompromised Persons for more details.
  • In general, immunocompromised individuals are more susceptible to vaccine-preventable infections and may have severe infections, making vaccination even more important. The safety and effectiveness of vaccines in immunocompromised individuals are determined by the type of immunodeficiency and degree of immunosuppression.
  • Tip: For the vast majority of patients receiving cancer treatment, influenza immunization is recommended and even more so this year with COVID-19 circulating. However, there are a few exceptions that can be found in the Saskatchewan Cancer Agency’s (SCA) Influenza Immunization Guideline 2020.
    • Inquiring if an individual has/is receiving cancer treatment at the time of first contact regarding the flu shot is helpful in catching these particular individuals who should not receive the flu shot this year.
  • People who are severely immunocompromised or in whom immune status is uncertain should not receive live vaccines because of the risk of disease caused by the vaccine strains, or may not mount an appropriate immune response to inactivated vaccines. Refer these individuals to Travel Health Center/ Specialty Immunization Clinic (Saskatoon, Regina, or Prince Albert). Contact Public Health or Travel Health Centers to be directed in other areas of the province.
  • Also see Question 5B regarding drugs that affect the immune system if applicable.
Inactivated Influenza and Inactivated Vaccines
  • There are few contraindications to the use of inactivated vaccines in these individuals. See section ii (Cancer) below for exceptions.
  • The immune response to inactivated vaccines is suboptimal (depending on level of immunodeficiency).
    • Try to immunize before immunosuppression ensues (if possible); otherwise, try to immunize at time of anticipated maximum immune response (though this is often not established).
  • As these patients are at greater risk of infection, up-to-date immunization, including annual IIV, is important.
Live Attenuated Influenza and Other Live Vaccines
  • Administration of live vaccines may cause uncontrollable replication of the virus or bacterium and result in serious adverse events in immunocompromised patients.
  • If available, use an inactivated form of the antigen (e.g. herpes zoster, influenza, typhoid).
  • If live vaccine is required and no inactivated form is available/suitable, refer to Travel Health Center/ Specialty Immunization Clinic (Saskatoon, Regina, or Prince Albert). Contact Public Health or Travel Health Centers to be directed in other areas of the province.
    • Some live vaccines (e.g. MMR, varicella) are given to some of these patients depending on degree of immunosuppression, susceptibility, age and vaccine history. See SIM-Chapter 7 for details but refer these patients.
General
  • Tip: For the vast majority of patients receiving cancer treatment, influenza immunization is recommended and even more so this year with COVID-19 circulating. However, there are a few exceptions that can be found in SCA’s Influenza Immunization Guideline 2020.
    • Inquiring if an individual has/is receiving cancer treatment at the time of first contact regarding the flu shot is helpful in catching these particular individuals who should not receive the flu shot this year.
  • In general, if a patient is 3 months post-chemotherapy or if immunosuppression has been discontinued for at least 3 months (6 months or more for anti-B cell antibodies), the cancer is in remission and T cell function is normal, the individual is no longer considered immunocompromised.
  • See information in Question 4D regarding lymphatic circulation for those who have undergone mastectomy or lumpectomy and/or are experiencing lymphedema.
Inactivated Influenza Vaccine 
  • Inactivated influenza vaccine is strongly recommended for individuals with cancer unless medically contraindicated. Refer to the Saskatchewan Cancer Agency’s (SCA) Influenza Immunization Guideline 2020 for all individuals with cancer. This document addresses:
    • medical contraindications to IIV
    • timing of IIV in relation to anticancer treatments
    • recommendations for candidates, donors and recipients of stem cell transplants (SCT)
    • how to determine specific anticancer treatments of individuals
    • encouragement to immunize close contacts with IIV
Other Inactivated Vaccines
  • Inactivated vaccines can be safely administered at any time before, during or after immunosuppression; however, response may be suboptimal depending on degree of immunosuppression during anticancer treatment.
  • Refer to SCA’s Influenza Immunization Guideline 2020, which provides durations to wait before administering IIV.
    • The durations in this document would be minimum durations for other inactivated vaccines.
    • Depending on the vaccine and risk of infection, the decision may be made to defer vaccination until immune function has been restored (or improved).
    • Consult with SCA regarding suitability and timing of other inactivated vaccines.
    • Timing and vaccine requirements vary among those who have received SCT. Refer to or consult with SCA to ensure appropriate vaccination and timing.
    • SCT donors should receive inactivated vaccines at least 2 weeks prior to stem cell collection.
Hepatitis B Vaccine
  • Should be given at double the dose and using a 3- or 4-dose schedule.
Human Papillomavirus Vaccine
  • Should be given following routine age indications but using a 3-dose schedule, regardless of age.
Live Attenuated Influenza Vaccine and Other Live Attenuated Vaccines
  • These vaccines should not be administered during anticancer treatment and for at least:
    • 3 months after completion of chemotherapy and/or radiotherapy, if cancer is in remission and T cell function is normal.
    • 6 months or more after completion of anti-B cell antibodies (e.g. rituximab, obinutuzumab, alemtuzumab), if cancer is in remission and T cell function is normal.
    • 24 months post SCT. Consultation with SCA or Travel Health Center/ Specialty Immunization Clinic is required prior to immunization with live vaccines.
  • Live vaccines should not be given within 4 weeks of the start of immunosuppressive therapy.
  • If available, use an inactivated form of the antigen (e.g. herpes zoster, influenza, typhoid).
  • Consult SCA if immune status unknown and live vaccine is only option.
Inactivated Influenza Vaccine
  • Recommended annually for those 6 months and older.
Other Inactivated Vaccines
  • HIV infection is not a contraindication to inactivated vaccines.
  • Inactivated vaccines can be administered at any point in course of infection.
    • If immune suppression is severe in an untreated or newly treated individual and likelihood of exposure to the vaccine-preventable disease is low, may consider deferring vaccination pending immune recovery after effective antiretroviral therapy. These individuals should be referred to Travel Health Center/ Specialty Immunization Clinic (Saskatoon, Regina, or Prince Albert). Contact Public Health or Travel Health Centers to be directed in other areas of the province.
Hepatitis B Vaccine
  • Hepatitis B vaccine should be given at double the routine dose and using a 3 or 4 dose schedule.
  • Post-immunization titres should be done one month after completing a primary hepatitis B vaccine series.
Human Papillomavirus Vaccine
  • Should be given following routine age indications but using a 3-dose schedule, regardless of age.
Rabies Vaccine
  • Post-immunization titres should be done one month after completing a rabies vaccine series.
Live Attenuated Influenza Vaccine
  • Children: As of 2020-21, NACI recommends IIV to be used in children but if IM injection is unacceptable by parent or substitute decision maker, LAIV can be administered to children with HIV who meet the following criteria:
    • age 2–17 years; and
    • have been receiving HAART for ≥4 months; and
    • have a CD4 count ≥500/µL if 2–5 years of age, or ≥200/µL if 6–17 years of age (measured within 100 days before administration of LAIV); and
    • have HIV plasma ribonucleic acid (RNA) <10,000 copies/mL (measured within 100 days before administration of LAIV).
  • Adults: LAIV is contraindicated in adults with HIV infection due to the lack of evidence for its immunogenicity and safety in this population, and given that LAIV may be less effective than inactivated influenza vaccine in adults.
Other Live Vaccines
  • If available, use an inactivated form of the antigen (e.g. herpes zoster, typhoid).
  • Refer to Travel Health Center/ Specialty Immunization Clinic (Saskatoon, Regina, or Prince Albert). Contact Public Health or Travel Health Centers to be directed in other areas of the province. While some live vaccines may be appropriate, the risks and benefits need to be carefully considered in consultation with an infectious disease specialist/immunologist.

Q5. Taking any of the following medications

General
  • Use of anticoagulants/antiplatelets are NOT contraindications to injectable vaccine administration. To reduce bleeding risk:
    • A fine gauge needle (23, 25, or 27 G) should be used.
    • Apply direct pressure (without rubbing) to the injection site for 5 to 10 minutes after injection to stop the bleeding.
Live Attenuated Influenza Vaccine
  • LAIV is contraindicated for children and adolescents, 2 to 17 years of age, currently receiving salicylate therapy because of the association of Reye's syndrome with ASA and wild-type influenza infection. They should receive IIV instead. It is recommended that initiation of salicylate-containing products be delayed for four weeks after receipt of LAIV in children less than 18 years of age.
MMRV and Varicella Vaccines
  • An association exists among use of salicylates in children and adolescents, wild-type varicella virus and Reye’s syndrome.
  • Ideally, children and adolescents requiring chronic salicylate therapy should receive varicella vaccination prior to initiating the chronic salicylate therapy.
  • Refer children and adolescents taking chronic salicylate therapy to Public Health so that theoretical risks associated with varicella vaccine can be weighed against the known risks associated with wild-type varicella infection and for close monitoring if varicella vaccine is administered.
  • Drugs include, but are not limited to, prednisone, other steroids, anticancer drugs, monoclonal antibodies, other biologics, and others – often for treatment of inflammatory conditions (e.g. rheumatoid arthritis, Crohn’s disease, psoriasis), other conditions or for transplant recipients.
General 
  • In general, immunocompromised individuals are more susceptible to vaccine-preventable infections and may have severe infections, making appropriate vaccination even more important. The safety and effectiveness of vaccines in immunocompromised individuals are determined by the type of immunodeficiency and degree of immunosuppression.
  • Also see Question 4D for conditions causing immunosuppression, if applicable.
  • Certain drugs (e.g. calcineurin inhibitors, monoclonal antibodies, other biologics, cytotoxic drugs) used post-transplant or to treat conditions such as cancer, and inflammatory conditions such as rheumatoid arthritis, Crohn’s disease, psoriasis, etc. may have a significant effect on the immune system.
  • People who are severely immunocompromised or in whom immune status is uncertain should not receive live vaccines because of the risk of disease caused by the vaccine strains, or may not mount an appropriate immune response to inactivated vaccines. Refer these individuals to Travel Health Center/ Specialty Immunization Clinic (Saskatoon, Regina, or Prince Albert). Contact Public Health or Travel Health Centers to be directed in other areas of the province.
  • Corticosteroid therapy is not a contraindication to inactivated or live vaccine administration when:
    • steroid therapy is short-term (i.e., less than 14 days)
      • e.g. 1250 mg prednisone once daily x 5 days
    • a low to moderate dose (i.e. < 2 mg/kg/day for a child or < 20 mg/day for an adult of prednisone or its equivalent)
      • e.g. 15 mg prednisone (adult) once daily x 4 months
    • long-term, alternate-day treatment with short-acting preparations
      • e.g. 7.5 mg prednisone (adult) every other day
    • maintenance physiologic replacement therapy
    • administered topically, inhaled, or locally injected (e.g. joint injection).
  • There should be an interval of at least 4 weeks after discontinuation of high-dose systemic steroids before vaccines are administered.
    • high dose: ≥2 mg/kg day (child),  ≥20 mg/kg/day (adult) prednisone or equivalent for ≥ 14 days
Inactivated Influenza Vaccine 
  • As these patients are at greater risk of infection, up-to-date immunization, including annual IIV, is important, even if a lower immune response is expected.
  • See Other Inactivated Vaccines below for more general information.
  • For those with cancer, refer to the Saskatchewan Cancer Agency's (SCA) Influenza Immunization Guideline 2020 for durations to wait before administering IIV according to anticancer treatment.
Other Inactivated Vaccines
  • The immunocompromised state is not a contraindication to the use of inactivated vaccines. However, the immune response to inactivated vaccines is suboptimal (depending on level of immunodeficiency) and a delay may be required between completion of immunosuppressive therapy and vaccination.
    • Ideally, inactivated vaccines should be given prior to initiation of agents causing immunosuppression (≥ 14 days) or at least 3 months (6 months if anti-B cell antibodies, e.g., rituximab) after therapy is discontinued to ensure immunogenicity.
    • A period of at least three months should elapse post-transplant before administering inactivated vaccines.
    • If immunosuppressive agent has already been started and is chronic therapy, try to immunize at time of anticipated maximum immune response (which often has not been determined).
  • If risk of exposure is low, consideration may be given to deferring inactivated vaccines until the individual is the least immunosuppressed. 
  • Doses may need to be repeated when the individual is no longer immunosuppressed unless antibody response can be demonstrated.
  • For those receiving anticancer treatment, refer to SCA’s Influenza Immunization Guideline 2020, which provides durations to wait before administering IIV.
    • The durations in this document would be minimum durations for other inactivated vaccines.
    • Depending on the vaccine and risk of infection, the decision may be made to defer vaccination until immune function has been restored (or improved).
    • Consult with SCA regarding suitability and timing of other inactivated vaccines.
Hepatitis B Vaccine
  • HBV should be given at double the dose and using a 3- or 4-dose schedule.
Human Papillomavirus Vaccine
  • Should be given following routine age indications but using a 3-dose schedule, regardless of age.
Live Attenuated Influenza Vaccine and Other Live Attenuated Vaccines
  • Administration of live vaccines may cause uncontrollable replication of the virus or bacterium and result in serious adverse events in immunocompromised patients and is contraindicated in most cases.
  • Live vaccines should be given prior to initiation of agents causing immunosuppression (≥ 4 weeks) or at least 3 months (6 months if anti-B cell antibodies, e.g. rituximab) after therapy is discontinued to reduce the risk of disease caused by the vaccine strain.
  • If available, use an inactivated form of the antigen (e.g. herpes zoster, influenza, typhoid).
  • If live vaccine is required and no inactivated form is available/suitable, refer to Travel Health Center/ Specialty Immunization Clinic (Saskatoon, Regina, or Prince Albert). Contact Public Health or Travel Health Centers to be directed in other areas of the province.
    • Some live vaccines (e.g. MMR, varicella) are given to some of these patients depending on degree of immunosuppression, susceptibility, age and vaccine history. See SIM – Chapter 7 for details but refer these patients.
  • The safety and efficacy of live vaccines during low dose intermittent or maintenance therapy with non-corticosteroid immunosuppressive drugs are generally unknown (see herpes zoster below for exceptions).
  • A careful risk benefit assessment should be done if other live attenuated vaccines are to be considered in patients on low dose immunosuppression - see varicella and live herpes zoster vaccines below for definition.
Varicella and Live Herpes Zoster Vaccines
  • For herpes zoster, use recombinant herpes zoster vaccine (Shingrix®) unless unavailable or contraindicated.
  • These live vaccines can be considered in those taking low-dose immunosuppression defined as:
    • low dose methotrexate (≤ 0.4 mg/kg/week)
    • azathioprine (≤ 3 mg/kg/day)
    • 6-mercaptopurine (≤ 1.5 mg/kg/day)
    • < 2 mg/kg/day for a child or < 20 mg/day for an adult of prednisone or its equivalent
  • If combination low dose immunosuppression is being used, consult or refer to Travel Health Center/ Specialty Immunization Clinic (Saskatoon, Regina, or Prince Albert). Contact Public Health or Travel Health Centers to be directed in other areas of the province.
Inactivated Influenza and Other Inactivated Vaccines
  • There is no reason to withhold inactivated vaccines for patients taking antivirals (including those active against influenza and varicella) or antibacterials.
Live Attenuated Influenza Vaccine
  • LAIV should not be administered for at least 48 hours after antiviral agents active against influenza (oseltamivir, zanamivir) are stopped, and these antiviral agents, unless medically indicated, should not be administered until two weeks after receipt of LAIV so that the antiviral agents do not kill the replicating virus.
  • If these antiviral agents are administered within this time frame (i.e., between 48 hours before and two weeks after LAIV is given), revaccination should take place at least 48 hours after the antivirals are stopped.
MMRV, Varicella and Live Attenuated Herpes Zoster Vaccines
  • Systemic antiviral therapy active against varicella zoster virus (e.g. acyclovir, valacyclovir, famciclovir) should be avoided for at least 24 hours before vaccine administration as it may affect the reproduction of and reduce the efficacy of a varicella-containing vaccine or a live zoster vaccine.
    • If taking these antivirials and herpes zoster vaccination is required, use the recombinant herpes zoster vaccine.
  • Systemic antiviral therapy active against varicella zoster virus (e.g. acyclovir, valacyclovir, famciclovir) should not be started until at least 14 days following administration of a varicella-containing vaccine or a live zoster vaccine as the antivirals to prevent the antiviral from killing the replicating virus.
  • On the basis of expert opinion, it is recommended that individuals taking long-term antiviral therapy should discontinue these drugs, if possible, from at least 24 hours before administration of a varicella-containing vaccine or a live zoster vaccine, and should not restart antiviral therapy until 14 days after vaccine administration.
Live Oral Typhoid Vaccine
  • Live oral typhoid vaccine should be delayed 48 to 72 hours after completing treatment with antibiotics active against Salmonella typhi.
  • Antibiotics active against Salmonella typhi should not be initiated until at least 72 hours following the last dose of the oral typhoid vaccine series.
  • Examples of antibiotics active against S. typhi (not an exhaustive list) include: azithromycin, 3rd-generation cephalosporins, carbapenems, sulfonamides and fluoroquinolones.

Q6. Are you pregnant or breastfeeding or is there a chance you could become pregnant during the next month?

Inactivated Influenza Vaccine
  • Encourage vaccination as pregnant women are at high risk of influenza-related complications or hospitalization.
  • Women who are breastfeeding should receive this vaccine if not received while pregnant.
Other Inactivated Vaccines
  • No precautions or concerns with most inactivated vaccines in pregnancy (see exceptions below) and breastfeeding.
  • Vaccination during pregnancy protects the mother from vaccine-preventable diseases that may otherwise be acquired and be transmitted to the fetus or infant.
  • Several vaccines are recommended during pregnancy. See CIG- Immunization in Pregnancy and Breastfeeding for details.
     Inactivated Vaccines to Avoid in Pregnancy:

    Human Papillomavirus Vaccine

  • Not recommended during pregnancy due to limited safety and effectiveness data.
  • If a vaccine dose has inadvertently been administered during pregnancy, no intervention is indicated, but completion of the series should be delayed until after pregnancy.

     Recombinant Herpes Zoster Vaccine

  • Should be used with caution in pregnant woman due to no data in this population (though is unlikely to be indicated).
Live Attenuated Influenza Vaccine
  • Due to a lack of safety data at this time, LAIV should not be administered to pregnant women due to the theoretical risk to the fetus from administering a live virus vaccine.
  • LAIV can be administered to breastfeeding women.
Other Live Vaccines
Pregnancy
  • In general, live vaccines are contraindicated in pregnancy, as there is a theoretical risk to the fetus.
    • There may be some individual cases in which the benefits outweigh the theoretical risk (e.g. rubella outbreak).
Breastfeeding
  • MMR and varicella vaccine should be administered to breastfeeding women if indicated.
  • If herpes zoster (unlikely to be indicated in a breastfeeding woman) or typhoid vaccinations are required, inactivated should be used.
  • Safety data are not well established for yellow fever, smallpox and BCG, which are unlikely to be administered in a pharmacy. See CIG - Immunization in pregnancy and breastfeeding for details.

Q7. Have a history of any vaccinations in the past 4 weeks? Have plans for travel in the upcoming 4 weeks?

These questions are asked so that timing of vaccines can be coordinated for those:

  • who have received vaccines in the last 4 weeks; and/or
  • who may be receiving vaccines in the upcoming 4 weeks for travel (which may or not be known depending if travel assessment has been undertaken)
  •  
  • No precautions or concerns with inactivated vaccines in relation to timing of other vaccines.
    • Inactivated vaccines can be administered concomitantly or at any time before or after the administration of any other live attenuated or inactivated vaccine using different injection sites and separate needles and syringes.
            Exception
    • Different formulations of vaccine that protect against the same disease (e.g. pneumococcal vaccine, meningococcal vaccine) should not be administered concomitantly.
  • Given the lack of data for immune interference, and that LAIV is not a parenteral vaccine, LAIV can be administered concomitantly or at any time before or after the administration of any other live attenuated or inactivated vaccine.
  • Live vaccines given by the parenteral route may be administered concomitantly with all other vaccines during the same visit, using different injection sites and separate needles and syringes.
  • In general, if two live parenteral vaccines are not administered concomitantly, there should be a period of at least 4 weeks before the second live parenteral vaccine is given. See exceptions below.
  • If live parenteral vaccines are given too close together, the immune response to the second dose may be affected by the first dose and is considered invalid; the second dose should be repeated at the recommended interval.
  • Minimum intervals for vaccine series (e.g. varicella-containing vaccines) still apply such that often > 4 weeks is required between doses.

             Exception
    • Live varicella-containing vaccine should be not administered at the same time as smallpox vaccine; separate immunizations by at least 4 weeks.
  • Live vaccines given by the oral route may be administered concomitantly with all other vaccines during the same visit or at any time before or after of the administration of any other live attenuated (parenteral, oral, or intranasal) or inactivated vaccine.
            Exception
    • Administration of live oral typhoid vaccine and live oral cholera vaccine needs to be separated by at least 8 hours.

Q8. Require a TB skin test within next 4 weeks? Have a history of a positive TB skin test?

  • No contraindications or precautions exist in those who require a TB skin test in the next 4 weeks.
  • No contraindications or precautions exist in those who have a history of a positive TB skin test.
  • A false negative skin test can occur if a live vaccine such as LAIV is given BEFORE the TB skin test. If a live vaccine is given, wait at least 4 weeks before doing the TB skin test.  All vaccines, live or inactivated, can be given on the same day or at any time AFTER a TB skin test.
  • A positive TB test (at any time) is NOT a contraindication to LAIV.
  • A positive test indicative of active, untreated TB is a contraindication for MMR (measles, mumps, and rubella), MMRV (measles, mumps, rubella and varicella), univalent varicella, live herpes zoster, and BCG (Bacille Calmette-Guerin) vaccines as a precautionary measure.

Q9. Have close contact with anyone with a weakened immune system

  • No precautions or concerns.
  • Inactivated Influenza vaccination and maintaining up-to-date routine immunizations should be encouraged for all close contacts of anyone with a weakened immune system.
  • Inactivated Influenza Vaccine is preferred.
  • LAIV recipients should avoid close association with individuals with severe immune compromising conditions (e.g. bone marrow transplant recipients requiring isolation) for at least two weeks following vaccination, because of the theoretical risk for transmission.
  • For herpes zoster vaccination, preferably use the recombinant vaccine.
  • If a vaccine recipient develops a varicella-like rash within 42 days of vaccine administration, the rash should be covered and the vaccinee should avoid direct contact with the immunocompromised individual for the duration of the rash.

Q10. During the past year, have a history of receiving a transfusion of blood or blood products, or immune globulin (Ig)?

  • Blood products and Ig preparations have minimal or no interaction with these vaccines.

Appendices

Vaccine Screening Tool and Consent Form fillable PDF in regular font and large font.

Last updated: 13 Nov 2020

Saskatchewan Immunization Manual, especially:

 Canadian Immunization Guide, especially:

Saskatchewan College of Pharmacy Professionals

  • Sep 2020 MicroSCOPe – Special Edition: Preparing for Flu Season


Drug Plan and Extended Benefits Branch


Pharmacy Association of Saskatchewan

As set out in PART L – Pharmacist Authority: Administration of Drugs by Injection and Other Routes of The Regulatory Bylaws of the Saskatchewan College of Pharmacy Professionals

Reporting

  1. A licensed pharmacist who administers a drug to a patient must report the details of the administration (which may include personal health information as that term is defined in The Health Information Protection Act) as follows:
  1. report all Schedule II drug administration to the patient’s primary care provider in accordance with Council policy; and
  2. report all vaccinations to the immunization reporting or record keeping system, electronic or otherwise, designated by the minister of Health for vaccines. The report must be in the form and be provided in the timeframe that the minister requires.

 Record Keeping

A licensed pharmacist who administers a drug to a patient must make and retain a record in the pharmacy of the following:

  1. the patient’s name and address;
  2. the name of the drug and total dose administered
  3. for an advanced method or vaccination by any method, identification of the manufacturer, lot number and expiry date of the drug;
  4. for an advanced method, the route of administration, dosage and the location on the body where the drug was administered;
  5. the name of the licensed pharmacist administering the drug;
  6. the date and the time of administration;
  7. any adverse events; and
  8. the price, if there is a charge for administration.

 See Appendix 1 for a form that meets these requirements.

 Notification for Children Five to Eight Years of Age

  • A Notification of Administration of Influenza Vaccine form for each child five to eight years of age must be completed and sent to the Drug Plan and Extended Benefits Branch within three business days of vaccine administration. The form can be found at the Seasonal Influenza Immunization Program.
The content of this guide in PDF.

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Last updated: 13 Nov 2020