Effective Date: 
Fri, 10/09/2009
Sun, 08/28/2011
Mon, 08/29/2011

Purpose: To reduce morbidity and mortality from seasonal influenza by vaccinating all adults who meet the criteria established by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

Policy: Under these standing orders, eligible Licensed Vocational Nurses allowed by state law andwho have demonstrated competence in administration of routine immunizations, may vaccinate patients who meet any of the criteria below.


1. Identify adults in need of influenza vaccination based on meeting any of the following criteria:

a. Want to reduce the risk of becoming ill with influenza or of transmitting it to others

b. Age 18 years or older

c. Having any of the following conditions: chronic pulmonary (including asthma), cardiovascular (excluding hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic (including diabetes) disorders; immuno- suppression, including that caused by medications or HIV

d. Being pregnant during the influenza season

e. All healthcare personnel

g. All adults who are household contacts, caregivers, or workplace contacts of persons listed in category 1.c. above or of children age 0–59 months, or of adults age 50 years or older

2. Screen all patients for contraindications and precautions to influenza vaccine:

a. Contraindications: serious reaction (e.g., anaphylaxis) after ingesting eggs or after receiving a previous dose of influenza vaccine or an influenza vaccine component. For a list of vaccine components, go to downloads/appendices/B/excipient-table-2.pdf. Do not give live attenuated influenza vaccine (LAIV; nasal spray) to an adult who is pregnant or who has any of the conditions described in 1.c. or 1.d. above.

b. Precautions: moderate or severe acute illness with or without fever; history of Guillain Barré syndrome within 6 weeks of a previous influenza vaccination; for LAIV only, close contact with an immunosuppressed person when the person requires protective isolation

3. Provide all patients with a copy of the most current federal Vaccine Information Statement (VIS). You must document in the patient’s medical record or office log, the publication date of the VIS and the date it was given to the patient. Provide non- English speaking patients with a copy of the VIS in their native language, if available and preferred; these can be found at

4.  Provide all patients with a vaccine consent form to read and sign.

5. Administer inactivated influenza vaccine IM per manufacturer guidelines.  Alternatively, in healthy adults younger than age 50 years without contraindications may give intranasal live influenza vaccine per manufacturer guidelines.

6. Document each patient’s vaccine administration information and follow up in one the following places:

a. Medical chart: Record the date the vaccine was administered, the manufacturer and lot number, the vaccination site and route, and the name and title of the person administering the vaccine. If vaccine was not given, record the reason(s) for non-receipt of the vaccine (e.g., medical contraindication, patient refusal).

b. Personal immunization record card: Record the date of vaccination and the name/location of the administering clinic.

7.  Maintain a log of Immunizations given per unit guidelines.  All Medical Records including vaccine logs, visit notes, and consents are maintained by the UCSCStudent Health Centerper unit guidelines.

8. Be prepared for management of a medical emergency related to the administration of vaccine by having a written emergency medical protocol available, as well as equipment and medications.

9. Report all adverse reactions to influenza vaccine to the federal Vaccine Adverse Event Reporting System (VAERS) at or (800) 822-7967. VAERS report forms are available at

This policy and procedure shall remain in effect for all patients of the UCSC Student Health Center until rescinded.

Medical Director’s signature:

Electronically signed by Dr. Drew Malloy; original signed hard copies on file in the Assistant to the Executive Directors office.  10/9/09