The Vaccine Fundamentals module topics include types of vaccines (e.g., live vs. inactive), vaccine components (e.g., antigens, adjuvants), and the current vaccine schedules.

Length: 30min-1hr

Objectives:

• Distinguish the difference between innate and adaptive immunity.
• Explain the necessity for prime and booster vaccinations.
• Interpret the annual CDC vaccine schedules to tailor individual vaccine recommendations based on a patient’s age, vaccination history, and health status (e.g., healthy, asplenic, or pregnant).
• Locate trusted sources of vaccine information for healthcare providers and their patients and families.

Key takeaways:

• The adaptive immune system learns by being exposed to antigens, e.g., naturally by an infection or through immunization.
• Vaccines stimulate B and T cells (adaptive immunity) to produce long-lasting immunity.
• By using an adjuvant in a vaccine, you can use less of the antigen, or give fewer vaccine doses, to achieve the same effect.
• Thimerosal is typically found in multi-dose vials of a vaccine in order to prevent contamination by bacteria growth.
• Vaccines contain 0.37% of the amount of formaldehyde found in cauliflower.
• Shared clinical decision-making (new in 2020) recommendations are individually based and informed by a decision process between the health care provider and the patient or parent/guardian.

The Vaccine Safety module gives a brief introduction to vaccine safety in the U.S. This module should increase your confidence in vaccine recommendations in order to accurately answer questions from patients and families.

Length: 30min-1hr

Objectives:

• Describe how vaccines are developed, licensed, and recommended for use in the immunization schedule.
• Describe the U.S. vaccine safety monitoring system.
• Differentiate contraindications and precautions for specific vaccines.
• Identify parents’ and patients’ most common concerns about vaccines and relevant facts related to these concerns.

Key takeaways:

• Vaccines go through a long testing process and much collaboration before being made available to the public.
• Several factors are considered in the decision to recommend a vaccine to the public, and safety trials are ongoing even after the recommendation is made.
• The National Vaccine Injury Compensation Program is available to make financial claims in the rare event a person experiences an injury due to a vaccine.
• There are multiple U.S. Safety Monitoring Programs in place for continuous monitoring of adverse events that may or may not be linked to various vaccines.
• The CDC produces Vaccine Information Statements for all licensed vaccines, which includes information regarding rare adverse events that may occur after receipt of the vaccine.
• Many of the adverse events listed on vaccine package inserts are not related to the vaccine, but must be listed as they occurred during the clinical trials (even in the placebo arm).

The Vaccine Preventable Diseases (VPDs) module focuses on the clinical manifestations of VPDs and will introduce you to the concepts of vaccine efficacy and vaccine effectiveness. This module uses clinical vignettes to enhance your understanding of select VPDs.

Length: 30 min-1hr

Objectives:

• Recognize the most common clinical manifestations of a few notable VPDs like measles and hepatitis A.
• Explain the rationale for administering several specific vaccines including MMR.
• Contrast the concepts of vaccine efficacy and effectiveness.

Key takeaways:

• Vaccines are available to prevent 26 different diseases, many of which have multiple serotypes or groups, and present in many guises.
• Vaccination has eliminated worldwide occurrence of 3 VPDs: smallpox, polio type 2, and polio type 3.
• In 2016 only 60% of children and 10% of U.S. adults were vaccinated against HAV.
• Hepatitis B infection can be asymptomatic in both the acute and chronic phases.
• Measles is a highly contagious virus, infecting 90% of susceptible contacts, and can live 2 hours or longer in the air after an infected person coughs or sneezes.
• Human papillomavirus is the most common STI. Nearly 80% of sexually active people get the virus at some point in their lives.

The Vaccine Communication module provides communication methods and tips for communicating about vaccines in ways that lead to more effective conversations with patients and parents.  This module emphasizes methods for developing a skills and knowledge repertoire essential for dealing with preventing and addressing vaccine hesitancy.

Length: 30 min-1hr

Objectives:

• Assess attitudinal barriers to various vaccines among vaccine-hesitant individuals.
• Create a plan for approaching families in each level of vaccine hesitancy.
• Model the “presumptive” approach to vaccination.
• Based on moral, legal, and clinical considerations, propose a clinic policy regarding dismissal of families or patients that choose to refuse vaccination.

Key takeaways:

• Herd immunity does not apply to VPDs spread by routes other than person-to-person contact, for example, tetanus, which is spread by spores in soil.
• Approximately 94% of the community must be immune to measles (by way of immunization or natural disease) in order to achieve herd immunity.
• A person with influenza is likely to infect 2 to 3 other people, but a person with measles can infect 12 to 18 other people.
• Healthcare providers should always start with the presumptive approach when speaking with patients and families and be firm in their recommendations.
• Patients and families depend on their health care providers to provide a strong, open, and direct recommendation.
• Practicing difficult vaccine conversations will help in discussing vaccine concerns with patients and families.

The Decreasing US Rates of Hepatitis B module will review clinical background information and hepatitis B vaccination recommendations to decrease the rate of hepatitis B disease in the United States.

Length: 20-30 minutes

Objectives:

• Outline key clinical background facts that explain the rationale for the recent ACIP hepatitis B vaccination recommendations.
• Integrate the most recent ACIP recommendations into your practice.
• Choose 2-3 reliable resources to which you can turn for answers to hepatitis B questions in the future.

The Improving the Vaccination Experience: Pain Mitigation module will provide techniques that may reduce the pain of vaccination and ultimately help parents to accept vaccination for their children.

Length: 15-20 minutes

Objectives:

• Reduce the pain of vaccination through techniques that can be adapted to varying situations.
• Reduce the stress of the immunization experience using low-cost techniques.

The HPV module reviews key facts about diseases caused by HPV and how use of the HPV vaccine can prevent infection. It also reviews current HPV vaccine recommendations in the U.S.

Length: 20-30 minutes

Objectives:

• Describe the HPV virus and potential sequelae of infection with the HPV virus.
• Identify the recommended vaccine schedules and spacing between HPV doses based on a patient’s age and health status (e.g., immunocompromised or immunocompetent).
• Demonstrate the clinical skills, techniques, and procedures for an effective introduction to vaccination using the “same way, same day” approach.
• Respond accurately, in plain language to patients’ and parents’ common questions about HPV vaccination.

Key Takeaways:

• In the U.S., 8 out of 10 women and 9 out of 10 men will be infected with genital HPV at some time in their lives.
• During 2012-2016 in the U.S., 34,800 cancers reported annually were attributable to HPV. Of these, 32,100 (92%) cancers were attributable to HPV types targeted by the 9-valent HPV vaccine.
• HPV is thought to cause 70% of oropharyngeal cancers in the United States (not all of these are vaccine-type HPV).
• About 37% of cervical cancers occur in women between the ages of 20 and 44 years, i.e., child-bearing years.
• Available evidence indicates protection for at least 12 years with a complete HPV vaccine series.
• A 2-dose HPV vaccine schedule is recommended for people who get the 1st dose before their 15th birthday. A 3-dose HPV vaccine schedule is recommended for people who get the 1st does on or after their 15th birthday, and for people with an immunocompromised status.

The Influenza module covers the basics about influenza and influenza vaccines. It will help learners understand CDC’s influenza vaccine recommendations and answer frequently asked questions.

Length: 20-30 minutes

Objectives:

• Distinguish the difference between the types of influenza virus and their properties.
• Demonstrate knowledge of the clinical features and complications of influenza.
• Identify the different types of influenza vaccines available in the United States.
• Use current ACIP recommendations for influenza vaccination.

Key Takeaways:

• Because influenza virus constantly adapts through mutations, it is difficult for us to develop vaccines and therapeutic agents that remain effective over time.
• Two primary influenza types cause human disease: Type A and Type B.
• Type A influenza viruses are the cause of most influenza-related fatalities. Type B infection is often more severe in children and young adults.
• In the 2017-2018 influenza season, there was an estimated 61,000 influenza-related deaths.
• Influenza is extremely common and comes in waves every year (except 2020-2021 during the COVID-19 pandemic).
• Everyone 6 months of age or older should be vaccinated because everyone can suffer from influenza.

The COVID-19 Vaccines module will review the basics of the SARS-COV-2 virus, COVID-19 vaccines, and the FDA’s Emergency Use Authorization and the latest ACIP recommendations. The module also provides key resources regarding COVID-19 disease trackers, vaccine availability resources, and vaccine monitoring and reminders.

Length: 20-30 minutes

Objectives:

• Summarize how COVID-19 vaccines are designed to trigger development of antibodies against the SARS-CoV-2 virus spike protein.
• Illustrate three primary methods used to make COVID-19 vaccines.
• Apply the Advisory Committee on Immunization Practices’ (ACIP) recommendations for COVID-19 vaccines in a clinical setting.

Key Takeaways:

• An epidemic is the rapid spread of disease to a large number of people in a given population within a short time. A pandemic is a worldwide epidemic.
• The basic reproduction number, or R0, of a disease is affected by many factors and can be a complex number to arrive at. The SARS-CoV-2 virus is thought to have an R0 of anywhere between 1.6 and 7.
• As of June 2021, there are three COVID-19 vaccines authorized by the FDA for Emergency Use Authorization in the United States.
• The target of COVID-19 vaccines is the spike protein, found on the outer shell of the SARS-CoV-2 virus.
• There are three main types of COVID-19 vaccines: Nucleic Acid/mRNA, Protein Subunit, and Viral Vector.
• COVID-19 vaccine clinical trials are ongoing to obtain enough safety and effectiveness data to ultimately apply for full approval (licensure).

The Bacterial Meningitis module focuses on the clinical presentation of meningitis and emphasizes the three bacterial agents for which a vaccine is available. It will also review the current recommendations for the available meningitis vaccines.

Length: 20-30 minutes

Objectives:

• Identify patients who have risk factors for bacterial meningitis
• Evaluate the common clinical manifestations of bacterial meningitis through a history and physical exam of a patient
• Apply CDC vaccination recommendations to clinical practice, especially as they relate to:
  • Indication (i.e., to whom the vaccines should be given) and
  • Vaccination timing (i.e., when the vaccines should be given)
• Explain the rationale for administering meningitis vaccines to patients and their families.

Key Takeaways:

• Worldwide and in the U.S., bacterial meningitis is a major cause of acute illness, chronic morbidity (including hearing loss, limb loss, and intellectual damage), and mortality.
• Bacterial meningitis occurs both sporadically and in outbreaks, but vaccination has dramatically reduced the incidence.
• In the U.S., in the pre-vaccine era, Haemophilus influenzae type b (Hib) accounted for ~50-65% of meningitis cases.
• 1 in 5 meningococcal disease survivors will have long-term disability such as deafness, neuro-cognitive deficits, and/or loss of limbs.
• The mortality rate from any meningococcal disease, even with appropriate antibiotic treatment is 10-15 in every 100 cases.
• There are two vaccines to prevent Streptococcus pneumoniae (which may lead to pneumococcal meningitis): PCV13 and PPSV23.

The Travel Vaccines module will introduce travel vaccines and vaccine preventable diseases that are relevant for people leaving the U.S. It will review travel vaccine recommendations, as well as suggest other key considerations when discussing international travel with your patients.

Length: 30-45 minutes

Objectives:

• For at least four vaccine preventable diseases associated with international travel, describe a major clinical sign/symptom of infection.
• List other diseases for which there are prophylactic medications or environmental precautions that should be discussed prior to travel to certain countries.
• Utilize the CDC Yellow Book to select appropriate vaccines for travel internationally.

Key Takeaways:

• The number of U.S. citizens traveling out of the United States in 2019 amounted to approximately 44.81 million.
• Only 1 out of every 200 people with Japanese encephalitis virus develop symptomatic disease, however for the <1% of symptomatic disease, the fatality rate is 20-30%.
• Worldwide, 99% of rabies cases are dog-mediated; in the US, 70% of Americans who die from rabies were infected by bats.
• A person can only spread Ebola to other people after they develop signs and symptoms.
• Routine vaccination for travel remains important; nearly 30% of measles outbreaks in the US are associated with young travelers.
• Malaria and dengue fever do not yet have associated vaccines to protect against disease, but travelers should be aware of ways in which to prevent it.

The Common Vaccines Module is module reviews commonly reported vaccination concerns of parents and patients.

Length: 20-30 minutes

Objectives:

• Demonstrate the ability to succinctly and accurately answer a patient’s vaccine concern during a well care visit.
• Using plain language, summarize why it is better to develop immunity to vaccine preventable diseases through vaccination than through “natural infection.”
• Write a tweet targeted to parents that outlines the safety of a vaccine adjuvant (e.g., aluminum, thimerosal).

Key Takeaways:

• Although some vaccine preventable diseases are no longer endemic in the U.S., they are only a plane ride away, and some diseases will never be eradicated (tetanus!), thus, vaccination is still necessary.
• For many diseases, natural infection does provide robust and long-lasting protection against the disease., such as rotavirus.
• The U.S. has a tremendous vaccine safety monitoring program that looks for long-term and short-term adverse effects of vaccines; no long-term, serious adverse effects have been identified for currently licensed vaccines.
• Vapocoolants have been shown to be effective for both children and adults in reducing vaccination injection pain.
• Many of the vaccine adverse events listed on package inserts are not related to the vaccine but must be listed as they occurred during the clinical trials (even in the placebo arm).
• A strong provider vaccine recommendation continues to be of the utmost importance in combatting vaccine hesitancy.

The Vaccination During Pregnancy module reviews vaccine recommendations for women who are pregnant or planning to become pregnant. It also provides sample responses to common questions patients may have about vaccination during pregnancy.

Length: 20-30 minutes

Objectives:

• Confidently explain the importance of vaccines during pregnancy:
  • Influenza
  • Pertussis
  • COVID-19
• Apply evidence-based communication techniques to communicate the value of vaccination for both the mother and fetus.

Key Takeaways:

• Flu infection during pregnancy was associated with an increased risk of fetal death. Vaccination during pregnancy reduced the risk of an influenza diagnosis.
• Within 2 weeks of a flu shot, mother’s antibodies against flu pass to the fetus through the placenta.
• In the U.S., from 2010-2017, 69% of people who died from pertussis were less than 2 months old.
• One of the best ways to prevent pertussis in a young infant is by vaccinating the mother with Tdap vaccine during pregnancy.
• Pregnant and recently pregnant women (for at least 42 days following end of pregnancy) are at an increased risk for severe illness from COVID-19 when compared to non-pregnant women.
• The benefits of receiving a COVID-19 vaccine outweigh any known or potential risks of vaccination during pregnancy.

The Rotavirus module covers the basics of rotavirus diseases and rotavirus vaccine recommendations.

Length: 20 minutes

Objectives:

• Utilize Centers for Disease Control and Prevention (CDC) rotavirus vaccination recommendations regarding:
  • Indication (i.e., to whom the vaccines should be given)
  • Vaccination timing (i.e., when the vaccines should be given)
• Explain the rationale for administering rotavirus vaccine in plain language.

Key Takeaways:

• Rotavirus was discovered in 1973 and by 1980, rotavirus was recognized as the most common cause of severe gastroenteritis in infants and young children in the United States.
• In the pre-rotavirus vaccine era, 95% of all children were infected by age 5 years.
• The first rotavirus infection after age 3 months is generally the most severe.
• Recovery from a first rotavirus infection usually doesn’t lead to permanent immunity.
• There are two rotavirus vaccines in use in the U.S.
• Rotavirus vaccine is 74%-87% effective against any rotavirus gastroenteritis and 85%-98% effective against severe gastroenteritis.

The Vaccines & Social Media module discusses the social media crisis of misinformation as it relates to vaccines and the diseases they prevent. In addition, it gives ways that providers can combat this problem.

Length: 20 minutes

Objectives:

• Describe two ways in which social media is used to spread misinformation.
• Develop an example response to a vaccine concern using the key elements of an effective message.

Key Takeaways:

• Social media made its debut in 1997.
• In the U.S., about 72% of the public uses a social media platform of some kind, with the highest use in the 18-29-year-old category.
• Social media is often a breeding ground for misinformation, which has increased and intensified vaccine hesitancy.
• Data suggest it only takes a few minutes on an anti-vaccination site to increase perceptions of vaccination risks, decrease perceptions of consequences of vaccine omission, and lessen intention to vaccinate.
• Some research suggests just 12 people are responsible for 65% of the “shares” of anti-vaccine misinformation on social media.
• Social media ‘listening’ is a strategy that can be used to help identify trending inaccurate information.

The Rash or Vaccine Preventable Disease?: Clinical Scenarios module provides education on a variety of rashes, many of which are associated with vaccine preventable diseases (VPDs).

Length: 20-30 minutes

Objectives:

• Identify the characteristic rashes associated with VPDs including:
  • Pattern of spread
  • Associated symptoms, e.g., pruritis, blistering, mucosal involvement
  • Rash timing in relation to other clinical symptoms of disease
• Distinguish rashes associated with VPDs from other common rashes.
• Recognize rashes that necessitate medical care.

Key Takeaways:

• Rash identification is important because rashes characteristic of a certain VPD help you make a timely diagnosis, which, in turn, can prevent disease spread.
• Vaccines have substantially decreased the incidence of VPDs, but not completed eliminated them.

The Vaccination of Special Populations: Adults module provides vaccine recommendations for adults with certain medical conditions.

Length: 30-45 minutes

Objectives:

• Apply the ACIP immunization schedule recommendations for adult patients with special healthcare needs.
• Develop a plan for meningococcal and pneumococcal vaccinations based on an adult patient’s age, underlying illness, and vaccination history.
• Identify the routinely recommended vaccines that are and are not contraindicated based on an adult patient’s age and underlying illness.

The Vaccination of Special Populations: Pediatric module provides vaccine recommendations for children and adolescents with certain medical conditions.

Length: 20-30 minutes

Objectives:

• Apply the ACIP immunization schedule recommendations for pediatric patients with special healthcare needs.
• Develop a plan for Hib, meningococcal, and pneumococcal vaccinations based on a pediatric patient’s age, underlying illness, and vaccination history.
• Identify the routinely recommended vaccines that are and are not contraindicated based on a pediatric patient’s age and underlying illness.

The Dengue module introduces dengue and its vaccine recommendations.

Length: 15-20 minutes

Objectives:

• Describe at least 3 warning signs of severe dengue disease.
• Identify at least 2 strategies for dengue infection prevention.
• Summarize the age, location, and past medical history issues of people in the U.S. for whom dengue vaccine is indicated.