Preparation, distraction techniques and treating younger patients like adults will ensure the Spikevax vaccination process runs smoothly.
Children aged 12 to 15 have only been eligible for COVID-19 vaccination for just over 2 weeks in most states, but more than 30% have already received a first dose. This jumps to 44.5% in New South Wales, 41.8% in the ACT and 37.1% in Victoria.
With many adolescents presenting to their local pharmacy for a dose of Spikevax, including the teens behind the CovidBase AU data tracking website, pharmacists may need a few new tricks in their arsenal.
BOOM! 12-15s can get the💉
Today the three of us who run @covidbaseau, Jack, Wesley and Darcy, had our first dose of the Moderna vaccine.🎉
Thought this would be a good time to share who we really are.😄
Thrilled that we will finally be included in our data! pic.twitter.com/SeIQFXPjGW
— CovidBaseAU 🦠📊🇦🇺 (@covidbaseau) September 23, 2021
Luckily, PSA CEO and registered nurse Mark Kinsela shared some expert tips on PSA’s Early Career Pharmacist Facebook page recently.
Keeping nerves at bay
First, preparation is essential. The needle, cotton bud and tape should be ready to go in a dedicated area before the patient arrives.
‘You don’t want to be drawing things up in front of them,’ Mr Kinsela wrote.
If possible, try to avoid interruptions by staff during the process and the teen witnessing a vaccination prior to their own.
To quell any nerves, try to distract the patient. You could encourage them to watch a video on their phone, or ask them about their day or their plans after lockdown lifts.
Remember to stay calm and confident and ensure the patient doesn’t wait too long, which can lead them to ‘work themselves up’, particularly if they are in a group.
Mr Kinsela suggests breaking the ice, for example saying, ‘I’ve vaccinated thousands of people and I always get great reviews on Yelp’.
‘Don’t be afraid to send them away to get a coffee or come back another day if they are too anxious,’ he added.
The finer details
In younger patients, vasovagal syncope is common. Before administering the vaccine, Mr Kinsela advises checking with patients if they have a previous history of fainting around needles. If so, the vaccine should be administered in a treatment bed when available, or otherwise sitting on the floor.
If the patient does faint, however, Mr Kinsela advises pharmacists not to panic. Staying calm will help the patient recover faster.
‘Keep an eye on the patient’s colour,’ he said. ‘If they become pale and lethargic, ask them to lie down on the floor and pop their legs up on a chair above their body.’
For pharmacists concerned about anaphylaxis, preparation is the best antidote.
Mr Kinsela suggests practicing drawing up and administering adrenaline, and delegating staff members to call 000, meet the ambulance and take charge of crowd control.
Checking in with your team post-episode is also key.
‘It helps with your team’s mental wellbeing to decompress, and you can also discuss ways to improve for next time,’ Mr Kinsela said. For further advice, PSA members can also access the Pharmacist to Pharmacist Advice Line.
Lastly, younger patients typically have smaller deltoid muscles, so it’s wise to use a finer needle or refrain from going in deep.
‘Occasionally you can hit the bone with these patients,’ Mr Kinsela said. ‘Just back out a little bit and continue with the vaccination.’
Talking to teens
Early career pharmacist Erin Cooper MPS, based in Canberra, began vaccinating patients with Spikevax on 23 September, with the majority of recipients under the age of 18.
So excited to be a part of the next stage of the vaccine rollout with Moderna arriving in the pharmacy! I was also very lucky to see some of my ballet girls who were very excited to get the vaccine and told me “Miss Erin I’m surprised you’re actually a great pharmacist” 😂🤦🏼♀️🦠💉 pic.twitter.com/1iUe42HbZ8
— Erin Cooper (@misserin_c) September 23, 2021
While most of the teens who have come through her pharmacy so far have been keen to get vaccinated, PSA’s 2021 Intern of the Year found she spends more time reassuring their accompanying parents.
‘The parents are not normally concerned about the process of the vaccine, but they’re nervous that kids are nervous,’ Ms Cooper told Australian Pharmacist.
‘When I start having a conversation with the child themselves, and [the parent] notices they’re not as distressed as they believe them to be, they calm down a bit.’
Before administering the vaccine, Ms Cooper talks them through what to expect and what may happen after the procedure – addressing the child rather than the parent.
‘Obviously I juggle eye contact between both,’ she said. ‘But I make sure the focus is on the child, and that they have some responsibility for their own health.’
Ms Cooper asks the patient if they have any questions and addresses them as she would an adult.
‘They feel quite proud [of] what they’re doing, not only for themselves but for the rest of the community,’ she said.
‘Making them feel like they’re a bit more grown up takes that stress away from them.’
A final tip from Ms Cooper: have sweets on hand. ‘They all love the lollipop,’ she said.
Pregnant women urged to get vaccinated
Meanwhile, new research published in the American Journal of Obstetrics & Gynecology – Maternal-Fetal Medicine revealed that pregnant women who receive an mRNA COVID-19 vaccine pass high levels of antibodies onto their babies. Antibodies are also passed onto infants through breast milk.
A further dose of the mother's antibodies is also delivered in the colostrum, the first milk produced for breast feeding. If the mother has had any of the vaccines, including Pfizer or Moderna, the baby will also get that protection. https://t.co/zhOxdsDnyc
— Prof. Peter Doherty (@ProfPCDoherty) September 24, 2021
In the US, the Centers for Disease Control and Prevention has already advised pregnant women to receive COVID-19 vaccine booster doses. Australian obstetricians, including Dr Gauthami Bhagwanani, Birthing Unit Director at Liverpool Hospital, have also urged pregnant women, those who are planning a pregnancy, or those who are breastfeeding to come forward to get vaccinated.
Dr Bhagwanani has seen firsthand the impact COVID-19 can have on pregnant mothers and their babies, with most women admitted to Liverpool Hospital unvaccinated.
‘Having COVID-19 [while] you’re pregnant means you are at double the risk of needing an ICU admission, you have an increased risk of needing invasive ventilation [and] requiring a preterm delivery,’ she said. ‘It also doubles your risk of stillbirth.’
Pregnant women can receive the Pfizer COVID-19 vaccine or book into their local pharmacy for a Spikevax dose.
Where the Moderna vaccine is unavailable, pharmacists can discuss the AstraZeneca with patients who are breastfeeding or planning a pregnancy.
Similar to the pertussis vaccine, birth support partners and other family members should also be vaccinated against COVID-19 to protect mother and child.