Administering vaccines

In many states, medical assistants administer vaccines, especially in primary care departments. A medical assistant must understand the types of vaccines and the special procedures involved when administering vaccines. The following sections discuss the types of vaccines and the importance of the Vaccine Information Statements.

Types of vaccines

There are several types of vaccines:

• Inactivated vaccines: The microorganism is dead. Examples of inactivated vaccines include hepatitis A, (injectable) influenza, (injectable) polio, and rabies.
• Live-attenuated vaccines: The microorganism is alive but attenuated (weakened) in the laboratory. Examples of live virus vaccines include MMR (measles-mumps-rubella), smallpox, varicella (chickenpox), and yellow fever. Live virus vaccines need to be kept cool. Patients may not receive a live-virus vaccine in the following circumstances:
• They were vaccinated with another live-virus vaccine less than 28 days earlier.
• They are pregnant or may become pregnant in the next month.
• They are immunocompromised (e.g., cancer, leukemia, human immunodeficiency virus [HIV] infection).
• They are receiving chemotherapy or high-dose steroid therapy.
• They recently received a blood transfusion, immune (gamma) globulin, or antiviral medication.
• Messenger RNA (mRNA) vaccines: According to the Centers for Disease Control and Prevention (CDC), the mRNA vaccines cause the cells to make a protein that triggers the immune response, which then causes antibodies to be produced. These antibodies protect the body when it is exposed to the disease. The mRNA COVID-19 vaccines are examples of this type of vaccine.
• Subunit, recombinant, polysaccharide, and conjugate vaccines: Use specific pieces of the microorganism, which creates a very strong immune response. Examples of these types of vaccines include Hib (Haemophilus influenzae type b), hepatitis B, HPV (human papillomavirus), pertussis, pneumococcal, meningococcal, and shingles (Shingrix). These vaccines can be used by people with weakened immune systems. HPV is contraindicated with pregnancy.
• Toxoid vaccines: Use the toxin made by the microorganism. Examples of toxoid vaccines include diphtheria and tetanus.
• Viral vector vaccines: Use a modified version of a different virus as a vector to deliver protection. The COVID-19 vaccine is an example of this type of vaccine.

Vaccines to prevent COVID-19

In December 2020, the US Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) to permit the emergency use of two unapproved messenger RNA (mRNA) vaccines to prevent COVID-19. In 2021, the FDA issued an EUA for the Janssen vaccine. Since then, the mRNA vaccines have received the FDA approval.

• Pfizer-BioNTech COVID-19 Vaccine (COMIRNATY): The primary series for this mRNA vaccine consists of 2 intramuscular (IM) doses in the deltoid, spaced 3 to 8 weeks apart. Boosters may be recommended. The vials should be protected from direct sunlight and ultraviolet light. The vaccine will be an off-white suspension.
• Moderna COVID-19 Vaccine (Spikevax): The primary series for this mRNA vaccine consists of 2 IM doses in the deltoid, spaced 4 to 8 weeks apart. Boosters may be recommended. The suspension is whitish in color.
• Janssen COVID-19 Vaccine: The vaccine is available in some situations per the CDC. This viral vector vaccine is given as a single intramuscular dose. Protect the vials from light. The vaccine is clear, colorless to slightly yellow.

Do not use if the vaccine is discolored or contains particulate matter. According to the CDC, there is a rare risk of myocarditis and pericarditis associated with mRNA COVID-19 vaccination and thrombosis with thrombocytopenia syndrome with the Janssen vaccine. See package inserts for more information on storage, administration, dosage, contraindications, and adverse effects of the vaccine. Clinical research continues with these vaccines. For the latest developments, see the COVID vaccine information on the CDC (https://www.cdc.gov) and the FDA (https://www.fda.gov) websites.

Types of diphtheria, tetanus, and pertussis vaccines

There are many types of diphtheria, tetanus, and pertussis (also called whooping cough) vaccines. Diphtheria is abbreviated with a D, tetanus with a T, and acellular pertussis (aP). Types of vaccines include the following:

• DT: Generic vaccine available
• Td: Tenivac and generic vaccines available
• DTaP: Daptacel, Infanrix, Kinrix, Pediarix, Pentacel, Quadracel, and Vaxelis are trade names of the available vaccines
• Tdap: Adacel and Boostrix are available vaccines

The uppercase letter indicates that the vaccine contains a full-strength dose of that vaccine. A lowercase letter indicates a smaller dose of that vaccine. For example, Td contains a full-strength dose of the tetanus vaccine and a smaller dose of the diphtheria vaccine. It is important how you write or type the name of the medication in the patient’s health record.

Timing of vaccines

Timing for vaccines may not be written on the provider’s order, but the medical assistant should ensure that it is the correct time for a vaccine to be given. The timing of a vaccine is based on the patient’s vaccination history and the person’s age. Using immunization schedules or the immunization tables in EHRs, the medical assistant can determine what vaccines are due. The immunization schedule indicates the person’s age and the timing between doses. If a vaccination is administered too early or before the patient reaches a specific age, the patient may need to be revaccinated.

The provider will postpone vaccinations when patients have a moderate or severe acute illness. Specific vaccines are not given if a person has had a severe allergic reaction to a vaccine component, to latex, or to a prior dose.

Consult the CDC website for information on vaccine schedules and catch-up schedules (Vaccines and Immunizations). The CDC also offers a free app that provides vaccine information.

Vaccine information statements

The VIS can be displayed on a computer screen or as a laminated copy that the patient can read prior to the administration of the vaccine. Copies of the VIS can be given to the patient or parent/guardian to take home. The provider must offer the information; however, the patient or parent/guardian has the right to decline to take the document. If the patient cannot read, the medical assistant should review the VIS with the patient. VISs can be downloaded in about 40 different languages for patients who do not speak English.

Besides giving the patient or parent/guardian the VIS prior to the vaccination, the medical assistant must document the vaccine name, dose, route, and site along with the following in the patient’s health record:

• The edition date of the VIS. This is found on the back of the document in the bottom right corner. Make sure to have the latest edition of the VIS.
• The date the VIS was provided and the date the vaccine was administered (usually, the two are done on the same day).
• The office address, name, and title of the person who administered the vaccine.
• The vaccine’s manufacturer and lot number.