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JULY 2009

August is National Immunization Awareness Month


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Florida Pharmacy TodaY

florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 20 Buyer’s Guide

VOL. 72 | NO. 7 JULY 2009 the official publication of the florida pharmacy association


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August is National Immunization Awareness Month Pharmacy Time Capsule 2009

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FPA Calendar 2009



FPA Legislative Committee Meeting (Tentative) Orlando

30-8/2 FSHP Annual meeting 31

Legislative Committee Meeting Marriott Orlando Downtown Orlando August



Florida Conference University of South Florida Tampa, Florida

9-12 Southeastern Education Gatherin The Grand Complex of Village at Baytowne Wharf 11-12 Board of Pharmacy Meeting Orlando 14-16 Southeastern Officer's Conference Sandestin, Florida


Labor Day, FPA Office closed

Mission Statements: of the Florida Pharmacy Today Journal The Florida Pharmacy Today Journal is

12-13 Law and Regulatory Conference Hyatt Regency Bonaventure, Weston, Florida

a peer reviewed journal which serves as a

20 - 27 Florida Pharmacy Association CE at SEA Port of Canaveral, Florida

the profession on advances in the sciences of

OCTOber 10-11 FPA Midyear Clinical Conference Nuclear Recertification Conference Sheraton Orlando North Orlando 13-14 Board of Pharmacy Meeting Tallahassee 17-21 NCPA Annual Meeting New Orleans, LA

29-30 FPA Committee and Council Meetings Orlando

medium through which the Florida Pharmacy Association can communicate with pharmacy, socio-economic issues bearing on pharmacy and newsworthy items of interest to the profession. As a self-supported journal, it solicits and accepts advertising congruent with its expressed mission.

of the Florida Pharmacy Today Board of Directors The mission of the Florida Pharmacy Today Board of Directors is to serve in an advisory capacity to the managing editor and executive editor of the Florida Pharmacy Today

Journal in the establishment and interpretation of the Journal’s policies and the management of the Journal’s fiscal responsibilities. The Board of Directors also serves to motivate the Florida Pharmacy Association members

For a complete calendar of events go to CE CREDITS (CE cycle) The Florida Board of Pharmacy requires 10 hours LIVE Continuing Education as part of the required 30 hours general education needed every license renewal period. Pharmacists should have satisfied all continuing education requirements for this biennial period by September 30, 2009 or prior to licensure renewal. *For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact Ranada Simmons in the FPA office. For More Information on CE Programs or Events: Contact the Florida Pharmacy Association at (850) 222-2400 or visit our Web site at CONTACTS FPA — Michael Jackson (850) 222-2400 FSHP — Michael McQuone (850) 906-9333 U/F — Dan Robinson (352) 273-6240 FAMU — Leola Cleveland (850) 599-3301 NSU — Carsten Evans (954) 262-1300 DISCLAIMER Articles in this publication are designed to provide accurate and authoritative information with respect to the subject matter covered. This information is provided with the understanding that neither Florida Pharmacy Today nor the Florida Pharmacy Association are engaged in rendering legal or other professional services through this publication. If expert assistance or legal advice is required, the services of a competent professional should be sought. The use of all medications or other pharmaceutical products should be used according to the recommendations of the manufacturers. Information provided by the maker of the product should always be consulted before use.

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to secure appropriate advertising to assist the

Journal in its goal of self-support.

Advertisers HAYSLIP & ZOST............................................. 12 Healthcare consultants..................... 3 heart of florida...................................... 18 Kahan ◆ SHIR, P.L......................................... 16 Mckesson......................................................... 2 meadowbrook.............................................. 9 MEDICAL STAFFING...................................... 18 Pharmacy for sale.................................. 12 PHARMACY PROVIDER SERVICES (PPSC)........................................ 16 Rx RElief.......................................................... 16

E-mail your suggestions/ideas to

The President’s Viewpoint Norm Tomaka, FPA President

FPA Grows with Change


ince established in 1887, our FPA has empowered pharmacists to embrace the profession and bend like a palm tree in a hurricane. Using the storm of change as a new source of power, pharmacists and technicians connect to the FPA to strengthen their careers and prepare for new challenges in our healthcare delivery routine. During the past year, FPA members exemplified our capability to grow with change. Enduring unprecedented financial challenges, FPA shared in the nation’s experience. With government budgets in disarray, two popular and productive services developed by your Association formally ended. Despite documented positive outcomes, the FL Medicaid DUR contract and Pinellas County’s Diabetes Ten Cities Challenge ended affiliation with FPA. With the conviction needed to strengthen our financial muscle, this Association redesigned its organizational structure in order to continue a tradition of excellent service to the membership. With a smaller staff and Board of Directors, FPA operates within a budget that meets the projected revenue of the Association. Without reducing lucrative membership benefits, EVP/CEO Michael Jackson stretched the capacity of FPA staff and delivered the goods that Association members have come to expect. With the full support of the volunteer leadership, the Association positioned itself to grow new membership by at least 10 percent annually while adding no additional payroll! Few organizations have been able to make such progress in the challenging fiscal environment of 20082009. I thank Organizational Affairs Chairs Fritz Hayes and Kim Murray for leading the Association to embrace

a streamlined structure while continuing to provide an array of tangible benefits to the membership. The Florida Pharmacy Association developed unique services in a costeffective manner as FPA discovered new quality patient-care initiatives that will serve the membership’s education needs well into the future. Seminars have featured concepts that combine medication therapy management with a managed care process governed by pharmacists. Those members who become familiar with “Uncoordinated Care Analysis” will have yet another tool to integrate into their practice and expand opportunities otherwise unrealized in times of economic stress. As healthcare reform models are introduced, the FPA pharmacist will become empowered with a new armament of cost-effective patient services. Independent pharmacist practitioners have an emerging opportunity despite the instability of professional compensation. Our dedication to promoting “Professional Independence” has been unwavering. With Florida’s DeAnn Mullins soon to serve as president of the National Community Pharmacists Association, our Association will remain immersed in national political advocacy that promotes the Community Pharmacist. Further proof for continued optimism is seen in past FPA President Ed Hamilton’s inspirational national leadership. As this year’s president of the American Pharmacists Association, Dr. Hamilton has moved Florida into a prominent position of professional influence. More than ever before, the FPA membership is in the best position to benefit from major national initiatives that will affect the practice of pharmacy throughout Florida. Through the stellar work of Educational Affairs Council led by Chairman

Norman Tomaka, 2008-09 FPA President

Carmen Aceves, FPA will continue to provide seminars that fuse clinical pharmacy with the reality of today’s healthcare marketplace. As our membership continues to embrace clinicalbased outcomes as fuel for growing new practice opportunities, the Association has constructed an ambitious and innovative agenda for continuing education programming through 2010. While education continues to propel FPA members, statewide political advocacy remained a principal activity of your Association. The past year provided ample work for the Legislative Committee and Chairman Alex Pytlarz. Together with Ayala Fishel and the Public Affairs Council, FPA was able to maneuver in rough political waters. By orchestrating well-attended Pharmacist Health Fairs in Miami and Tallahassee, your Association integrated political advocacy with a demonstration of costeffective medication therapy and disease-state management techniques. As promised early in 2008, Pharmacists made our first appearance at J U LY 2 0 0 9



2009/2010 FPA Board of Directors The Florida Pharmacy Association gratefully acknowledges the hard work and dedication of the following members of the FPA leadership who work deligently all year long on behalf of our members.

Norman Tomaka.....................................Chairman of the Board of Directors Karen Whalen...............................................................................................FPA President Don Bergemann.....................................................................................................Treasurer Alexander Pytlarz..................................Speaker of the House of Delegates Dean William Riffee...................Vice Speaker of the House of Delegates Alexander Pytlarz......................................................................................Speaker Elect Preston McDonald, Director............................................................................ Region 1 Marcus Dodd-o, Director .................................................................................Region 2 Al Tower, Director ..................................................................................................Region 3 Raul N. Correa, Interim Director ................................................................Region 4 John Noriega, Director ......................................................................................Region 5 Chris Lent, Director...............................................................................................Region 6 Kim Murray, Director............................................................................................ Region 7 Joy Marcus, Director...........................................................................................Region 8 Ayala Fishel, Director...........................................................................................Region 9 Richard Montgomery.......................................................................... President FSHP Michael Jackson........................................Executive Vice President and CEO

Florida Pharmacy Today Journal Board Chairman............................................................ Dick Witas, Treasurer....................Stephen Grabowski, Secretary...................................................................Stuart Ulrich, Member.......................................................... Betty Harris, Member.................................................Joseph Koptowsky, Member...............................................Jennifer Pytlarz, Executive Editor................Michael Jackson, Managing Editor...................Dave Fiore,

the Miami-Dade Community College Health Fair in February 2009. The tradition of the Capitol Health Fair continued in Tallahassee on March 18. Health Fair Chairs Bert Martinez and Karen Bills lead the FPA team to deliver outstanding patient care in an array of pharmacist-provided services. At each event, student pharmacists from all colleges in Florida showcased the value of professional education. Pharmacist advocacy was successful. Despite preoccupation with budget concerns, the profession continued to evolve to implement practices that improve patient safety. With the new rules for pharmacist technician registration at the Board of Pharmacy, FPA again represented the interests of practicing pharmacists and technicians. The Professional Affairs Council, led by Chairman Todd Rosen, analyzed the proposed technician rules along with numerous professional issues encompassing pharmacy workload and permit management. From the annual meeting to the next convention, membership concerns were routinely reviewed through the FPA Councils and Committees. We are well served by a talented array of pharmacists from across the state, including our good friends at FSHP. The combined talents of pharmacists Mike McQuone, Rich Montgomery, Peter Iafrate and the FSHP leadership, empower the profession to display strength that only unity provides. With the unpredictability of state government priorities, pharmacists need a proactive instrument capable of assisting the membership with representation in statewide campaigns. One of the concerns the membership expressed throughout the year centered on the viability of the Florida Pharmacy Political Action Committee of Continuous Existence (PACCE). Past FPA Presidents Joy Marcus and Mark Hobbs and the PACCE board have implemented a plan for ongoing fiscal replenishment. The PACCE is pharmacy’s tool to strengthen our preparation for future political endeavors. I encourage all members to use the PACCE’s new online process for monthly contributions. Now a permanent part of the FPA Web See “Viewpoint”, continued on page 8

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Executive Insight By Michael Jackson, FPA Executive by michael jackson, Vice RPh President/CEO

Time to Pick your Politician


ou may not believe this, but we are entering into a new election season. This one, however, is quite different from the ones you are used to. There are a large number of seats that have opened in both the Florida House and Senate. We also are preparing to elect a new senator to represent us in Washington, and a majority of the state cabinet posts are up for reelection. Keep in mind that Congress is examining health care with reform in the back of its mind. Remember when Florida tinkered with this a few years ago? Has it made life better for you and for your patients? From what I have been reading in the press and hearing from the chatter in Tallahassee, Florida health care reform has its challenges. This could be because the reform plan was a top-down initiative and did not include a lot of input from stakeholders. Our friends in Washington, however, seem to be doing a lot of outreach into the communities to understand the good, the bad and the ugly of American health care services from the provider, the payor and the recipient. Healthcare is not something that you hand off to a payor and say, “Fix this.” Reform means you have to do something different than what was tried and failed. When you use the word “reform,” your thesaurus will give you words such as improve, reorganize, restructure, modify, transformation, alteration, change and development. I do not see words like “do over” or cut provider reimbursement as a tool to reform health care. I have not seen that work in 13 years of advocacy and do not anticipate it working next year. True reform means looking at a broken health care system and making dramatic and life-altering policy changes to correct a

failed system. To do anything in health care reform and be successful there needs to be a champion in the halls of health care policy development. This means that this year, pharmacy has a unique opportunity to pick policymakers who can make a difference. With all the open seats out there, our members need to set the oven to broil, turn on the blender to frappe and throttle our engines to the firewall and get involved in the

We also are preparing to elect a new senator to represent us in Washington, and a majority of the state cabinet posts are up for reelection. democratic process created by our nation’s founding fathers. We cannot afford to continue to allow lobbying dollars from well-financed organizations that are not stakeholders in the profession of pharmacy to pave the roads of our future. This year needs to be different. Every political candidate in the election this year should have a relationship with a pharmacist. They will be visiting in your churches, attending your social gatherings and calling you on the phone asking for your support. You should use these opportunities to shake hands with them and talk to them about REAL health care reform. Let them know that their neighborhood

Michael Jackson

pharmacist is the resource they should rely upon when facing any questions related to prescription drug therapy management and health and wellness. Now is not the time to be shy. There will be a fundamental shift in health care, and we all need to be at the table to ensure the viability and sustainability of health care services by pharmacists. You do this by following these simple steps: 1. Become familiar with health care issues; 2. Know how health care is funded and where the real costs are; 3. Know who represents you in Washington, D.C., and in Tallahassee; 4. Make sure those who represent you in Washington, D.C., and in Tallahassee know who you are; 5. Maintain your membership in your state and national professional organizations; 6. Contribute generously to your pharmacy political action committee; 7. Know the political candidates seeking your support and get active in See “Insight”, continued on page 9 J U LY 2 0 0 9



FPA Staff Executive Vice President/CEO Michael Jackson (850) 222-2400, ext. 200 Director of Continuing Education Tian Merren-Owens, ext. 120 Controller Wanda Hall , ext. 211 Membership Coordinator Ranada Simmons , ext. 110 Educational Services Office Assistant Stacey Brooks , ext. 210 Florida Pharmacy Today Board Chairman................................................... Dick Witas, Odessa Treasurer...............................Stephen Grabowski, Tampa Secretary.........................Stuart Ulrich, Boynton Beach Member...........................Betty Harris, Lighthouse Point Member..................................... Joseph Koptowsky, Miami Member...................................... Jennifer Pytlarz, Brandon Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee

This is a peer reviewed publication. ©2009, FLORIDA PHARMACY JOURNAL, INC. ARTICLE ACCEPTANCE: The Florida Pharmacy Today is a publication that welcomes articles that have a direct pertinence to the current practice of pharmacy. All articles are subject to review by the Publication Review Committee, editors and other outside referees. Submitted articles are received with the understanding that they are not being considered by another publication. All articles become the property of the Florida Pharmacy Today and may not be published without written permission from both the author and the Florida Pharmacy Today. The Florida Pharmacy Association assumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today. The Journal of the Florida Pharmacy Association does not accept for publication articles or letters concerning religion, politics or any other subject the editors/ publishers deem unsuitable for the readership of this journal. In addition, The Journal does not accept advertising material from persons who are running for office in the association. The editors reserve the right to edit all materials submitted for publication. Letters and materials submitted for consideration for publication may be subject to review by the Editorial Review Board. FLORIDA PHARMACY TODAY, Annual subscription - United States and foreign, Individual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax. Florida Pharmacy Association

610 N. Adams St. • Tallahassee, FL 32301 850/222-2400 • FAX 850/561-6758 Web Address: 8 |

Florida Pharmacy TodaY

"Viewpoint" continued from page 7

site “shopping” menu, pharmacists and technicians can easily become a part of the solution for professional political advocacy. Please get involved! Check it out! Along with advocacy, FPA continues to boast a commitment to professional philanthropy. Our health fair efforts in Miami centered on patients without active medical insurance. Our Association also remains dedicated to the educational expenses endured by student pharmacists. The Florida Pharmacy Foundation awards 17 scholarships annually. In order to enhance scholarship activity, the Foundation has initiated a “Brick Paver Walkway” allowing members and friends to purchase a piece of the newly planned FPA office walkway. With the historic office building located next to the Governor’s Mansion, the walkway is certain to add perpetuity to names prominently displayed on each brick. Hopefully, you are included. Check it out! FPA membership is charitable and active in many ways. Join me in extending accolades to Foundation EVP Ken Norfleet, Mrs. Pat Powers and all the trustees for their work. Association leadership activity continues to center on membership recruitment and retention. Along with Membership Committee Chairman Alton Tower, student pharmacists, faculty and practitioners join the effort to plan for new recruitment activities. Initiated with student pharmacists Megan Kloet amd Victoria Montoya, FPA embraces communication technology in order to stimulate new membership activity. With FPA sites on Facebook™, and several personal appearances on campus, FPA student membership is reaching an all-time high. The membership committee announced plans to implement a new program that encourages pharmacists to become members of FPA. Stay tuned! It remains every member’s responsibility to invite a colleague to experience the privilege of FPA membership. We can sustain our Association’s capacity to effectively deliver more services and advocacy. Extending the privilege of membership to all our colleagues is a pathway for future success. As promised in Orlando at the 118th convention on July 13,

2008, your Association leadership has conducted “Town Hall Meetings” rallying pharmacists to join FPA and become involved in improving our profession. Events were combined with CE programs offered in Bradenton, Fort Lauderdale, Fort Myers, Gainesville, Maitland, Melbourne, Miami, Orlando, Palm Beach, Pensacola and Tampa. Our Association’s vision remains clear. FPA is poised to be the premier state pharmacy organization! Our Association is empowered by the finest colleges of pharmacy in the U.S. We continue to build upon a strong state network of pharmacy practitioners to represent a unified voice on behalf of effective, safe and patient-driven health care. The Association membership is motivated as we “upgrade” the leadership. Like so many others, I am invigorated by the “future” success represented by incoming FPA President Karen Whalen. Along with President-Elect Bert Martinez, incoming Treasurer Don Bergemann and a dedicated Board of Directors, Dr. Whalen will embrace the challenges of change to promote quality health care while empowering pharmacists to new heights of success. FPA is a strong and vibrant professional organization that will meet expectations of the membership. We continue to deliver an expanding array of benefits with a leaner organizational structure and staff. With a membership-based recruitment campaign and a newfound financial commitment to political advocacy, your Association will empower pharmacy practitioners and technicians for decades to come. As outgoing president of the Florida Pharmacy Association, I recognize that each member has an important role in promoting the Association. I am thankful for the opportunity to serve as FPA president and grateful for the many new friends met at meetings around our awesome state. The challenges presented by economic forces will only strengthen our conviction to succeed. Please buy a brick, give to the PACCE and recruit a new member! Today, FPA is more empowered than ever before! Thank you for a great year. n Sincerely, Norm Tomaka

"Insight" continued from page 7

their campaigns; 8. Invite your state representative, senator or congressman into your pharmacy and talk to them about the value pharmacy services; 9. Share information about your relationship with policymakers with the Florida Pharmacy Association; 10. Plan to participate in FPA Legislative Days at the Florida Capitol next spring; and 11. Invite your patients to talk to policymakers about the value of services you provide. They will be your best champion. Decisions about health care will be made by most folks who have no clue what a pharmacist may do to contribute to quality health. Very few politicians are pharmacists, and as such, we must rely upon our grassroots membership and FPA leadership to educate and inform. We can be successful if each of us would be willing to do our part. The opportunity to make a difference is upon us. Let’s not allow it to pass us by. n

JOIN TODAY! Florida Pharmacy Association

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August is National Immunization Awareness Month

Source: Centers for Disease Control and Prevention forts, people in the U.S. still die from these and other vaccine-preventable diseases. Vaccines offer safe and effective protection from infectious diseases. By staying up-to-date on the recommended vaccines, individuals can protect themselves, their families and friends and their communities from serious, lifethreatening infections.

August is recognized as National Immunization Awareness Month (NIAM). The goal of NIAM is to increase awareness about immunizations across the life span, from infants to the elderly. August is the perfect time to remind family, friends, co-workers, and those in the community to catch up on their vaccinations. Parents are enrolling their children in school, students are entering college, and healthcare workers are preparing for the upcoming flu season. Why are immunizations important? Immunization is one of the most significant public health achievements of the 20th century. Vaccines have eradicated smallpox, eliminated wild poliovirus in the United States. and significantly reduced the number of cases of measles, diphtheria, rubella, pertussis and other diseases. But despite these ef10


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Who should be immunized? Get t i ng i m munized is a lifelong, lifeprotecting community effort regardless of age, sex, race, ethnic background or country of origin. Recommended vaccinations begin soon after birth and continue throughout life. Being aware of the vaccines that are recommended for infants, children, adolescents, adults of all ages and seniors, and making sure that we receive these immunizations, are critical to protecting ourselves and our communities from disease. When are immunizations given? Because children are particularly vulnerable to infection, most vaccines are given during the first five to six years of life. Other immunizations are recommended during adolescent or adult years and, for certain vaccines, booster immunization are recommended throughout life. Vaccines against certain diseases that may be encountered when traveling outside of the U.S. are recommended for travelers to specific regions of the world.

Possible Novel H1N1 Flu Screening for International Travelers Due to the outbreak of novel H1N1 flu occurring in the United States and many other countries, airport staff in some countries may check the health of arriving passengers. Many countries, including Japan and China, are screening arriving passengers for illness due to novel H1N1 flu. These health screenings are being used to reduce the spread of novel H1N1 flu. If you are sick with symptoms of influenza-like illness, you should not travel. These symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Since the novel H1N1 flu outbreak is occurring in the United States, flights from the United States arriving in other countries may be specifically targeted for screening. Travelers coming from the United States may be checked for fever and other symptoms of novel H1N1 flu, and their travel may be delayed. Consult the embassy of the country, or countries, in your travel itinerary for information about entry screening procedures (see Websites of U.S. Embassies, Consulates, and Diplomatic Missions for contact information). If you travel internationally from the United States, you may be asked to: ■■ Pass through a scanning device that checks your temperature. (The device may look like an airport metal detector, a camera, or a handheld device.) ■■ Have your temperature taken with an oral or ear thermometer ■■ Fill out a sheet of questions about your health ■■ Review information about the symptoms of novel H1N1 flu ■■ Give your address, phone number,



and other contact information Be quarantined for a period of time if a passenger on your flight is found to have symptoms of novel H1N1 flu Contact health authorities in the country you are visiting to let them know if you become ill

If you have a fever or respiratory symptoms or are suspected to have novel H1N1 flu based on screening, you may be asked to: ■■ Be isolated from other people until you are well ■■ Have a medical examination ■■ Take a rapid flu test (which consists of a nasal swab sample) ■■ Be hospitalized and given medical treatment, if you test positive for novel H1N1 flu Please note that the U.S. Department of State usually cannot interfere with the rights of other countries to screen airline passengers entering or

exiting their countries, nor can it influence the number of days in quarantine. Because these outbreak-related delays, which could include several days of quarantine, may affect planned activities and lead to unexpected costs, CDC strongly recommends that travelers consider purchasing travel insurance. To find a list of possible travel health and medical evacuation insurance companies, visit Medical Information for Americans Abroad (U.S. Department of State). Why Immunize? (For Parents) Why immunize our children? Sometimes we are confused by the messages in the media. First we are assured that, thanks to vaccines, some diseases are almost gone from the U.S. But we are also warned to immunize our children, ourselves as adults, and the elderly. Diseases are becoming rare due to vaccinations. It’s true, some diseases (like polio

and diphtheria) are becoming very rare in the U.S. Of course, they are becoming rare largely because we have been vaccinating against them. But it is still reasonable to ask whether it’s really worthwhile to keep vaccinating. It’s much like bailing out a boat with a slow leak. When we started bailing, the boat was filled with water. But we have been bailing fast and hard, and now it is almost dry. We could say, “Good. The boat is dry now, so we can throw away the bucket and relax.” But the leak hasn’t stopped. Before long we’d notice a little water seeping in, and soon it might be back up to the same level as when we started. Keep immunizing until disease is eliminated. Unless we can “stop the leak” (eliminate the disease), it is important to keep immunizing. Even if there are only a few cases of disease today, if we take away the protection given by vaccination, more and more people will be in-

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fected and will spread disease to others. Soon we will undo the progress we have made over the years. Japan reduced pertussis vaccinations, and an epidemic occurred. In 1974, Japan had a successful pertussis (whooping cough) vaccination program, with nearly 80% of Japanese children vaccinated. That year only 393 cases of pertussis were reported in the entire country, and there were no deaths from pertussis. But then rumors began to spread that pertussis vaccination was no longer needed and that the vaccine was not safe, and by 1976 only 10% of infants were getting vaccinated. In 1979 Japan suffered a major pertussis epidemic, with more than 13,000 cases

of whooping cough and 41 deaths. In 1981 the government began vaccinating with acellular pertussis vaccine, and the number of pertussis cases dropped again. What if we stopped vaccinating? So what would happen if we stopped vaccinating here? Diseases that are almost unknown would stage a comeback. Before long we would see epidemics of diseases that are nearly under control today. More children would get sick and more would die. We vaccinate to protect our future. We don’t vaccinate just to protect our children. We also vaccinate to protect

our grandchildren and their grandchildren. With one disease, smallpox, we “stopped the leak” in the boat by eradicating the disease. Our children don’t have to get smallpox shots any more because the disease no longer exists. If we keep vaccinating now, parents in the future may be able to trust that diseases like polio and meningitis won’t infect, cripple, or kill children. Vaccinations are one of the best ways to put an end to the serious effects of certain diseases. Editor's Note: The Florida Pharmacy Association is collaborating with the American Pharmacist Association to present a pharmacist immunization certificate training program on September 11, 2009, at the Miami Marriott Airport. Please visit our web site for details.

Recommended Adult Immunization Schedule UNITED STATES · 2009

Note: These recommendations must be read with the footnotes that follow containing number of doses, intervals between doses, and other important information.

Figure 1. Recommended adult immunization schedule, by vaccine and age group VACCINE


19–26 years

27–49 years

50–59 years

60–64 years

>65 years

Tetanus, diphtheria, pertussis (Td/Tdap)1,*

Substitute 1-time dose of Tdap for Td booster; then boost with Td every 10 yrs

Human papillomavirus (HPV)2,*

3 doses (females)


2 doses 1 dose

Zoster4 Measles, mumps, rubella (MMR)5,* Influenza6,* Pneumococcal (polysaccharide)7,8

1 or 2 doses

1 dose 1


annually 1 dose

1 or 2 doses

Hepatitis A9,*

2 doses

Hepatitis B10,*

3 doses 1 or more doses

Meningococcal11,* *Covered by the Vaccine Injury Compensation Program.

Td booster every 10 yrs

For all persons in this category who meet the age requirements and who lack evidence of immunity (e.g., lack documentation of vaccination or have no evidence of prior infection)

Recommended if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications)

No recommendation

Report all clinically significant postvaccination reactions to the Vaccine Adverse Event Reporting System (VAERS). Reporting forms and instructions on filing a VAERS report are available at or by telephone, 800-822-7967. Information on how to file a Vaccine Injury Compensation Program claim is available at or by telephone, 800-338-2382. To file a claim for vaccine injury, contact the U.S. Court of Federal Claims, 717 Madison Place, N.W., Washington, D.C. 20005; telephone, 202-357-6400. Additional information about the vaccines in this schedule, extent of available data, and contraindications for vaccination is also available at or from the CDC-INFO Contact Center at 800-CDC-INFO (800-232-4636) in English and Spanish, 24 hours a day, 7 days a week. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.



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Figure 2. Vaccines that might be indicated for adults based on medical and other indications INDICATION


VACCINE Tetanus, diphtheria, pertussis (Td/Tdap)1,*

Immuno3,12,13 compromising HIV infection conditions (excluding human CD4+ T lymphocyte count immunodeficiency virus [HIV]) 13 <200 >200 cells/µL cells/µL


Diabetes, heart disease, chronic lung disease, chronic alcoholism

Chronic liver disease

Kidney failure, end-stage renal disease, receipt of hemodialysis

Health-care personnel

Substitute 1-time dose of Tdap for Td booster; then boost with Td every 10 yrs

Human papillomavirus (HPV)2,*

3 doses for females through age 26 yrs





1 dose

Measles, mumps, rubella (MMR)5,*


1 or 2 doses


2 doses

1 dose TIV or LAIV annually

1 dose TIV annually

Pneumococcal (polysaccharide)7,8

1 or 2 doses

Hepatitis A9,*

2 doses

Hepatitis B10,*

3 doses


1 or more doses

*Covered by the Vaccine Injury Compensation Program.


Asplenia 12 (including elective splenectomy and terminal complement component deficiencies)

For all persons in this category who meet the age requirements and who lack evidence of immunity (e.g., lack documentation of vaccination or have no evidence of prior infection)

Recommended if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications)

No recommendation

These schedules indicate the recommended age groups and medical indications for which administration of currently licensed vaccines is commonly indicated for adults ages 19 years and older, as of January 1, 2009. Licensed combination vaccines may be used whenever any components of the combination are indicated and when the vaccine’s other components are not contraindicated. For detailed recommendations on all vaccines, including those used primarily for travelers or that are issued during the year, consult the manufacturers’ package inserts and the complete statements from the Advisory Committee on Immunization Practices (

The recommendations in this schedule were approved by the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists (ACOG), and the American College of Physicians (ACP).

Department of Health and Human Services Centers for Disease Control and Prevention


Recommended Adult Immunization Schedule—UNITED STATES · 2009

For complete statements by the Advisory Committee on Immunization Practices (ACIP), visit 1. Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination Tdap should replace a single dose of Td for adults aged 19 through 64 years who have not received a dose of Tdap previously. Adults with uncertain or incomplete history of primary vaccination series with tetanus and diphtheria toxoid-containing vaccines should begin or complete a primary vaccination series. A primary series for adults is 3 doses of tetanus and diphtheria toxoid-containing vaccines; administer the first 2 doses at least 4 weeks apart and the third dose 6–12 months after the second. However, Tdap can substitute for any one of the doses of Td in the 3-dose primary series. The booster dose of tetanus and diphtheria toxoid-containing vaccine should be administered to adults who have completed a primary series and if the last vaccination was received 10 or more years previously. Tdap or Td vaccine may be used, as indicated. If a woman is pregnant and received the last Td vaccination 10 or more years previously, administer Td during the second or third trimester. If the woman received the last Td vaccination less than 10 years previously, administer Tdap during the immediate postpartum period. A dose of Tdap is recommended for postpartum women, close contacts of infants aged less than 12 months, and all health-care personnel with direct patient contact if they have not previously received Tdap. An interval as short as 2 years from the last Td is suggested; shorter intervals can be used. Td may be deferred during pregnancy and Tdap substituted in the immediate postpartum period, or Tdap may be administered instead of Td to a pregnant woman after an informed discussion with the woman. Consult the ACIP statement for recommendations for administering Td as prophylaxis in wound management.

2. Human papillomavirus (HPV) vaccination HPV vaccination is recommended for all females aged 11 through 26 years (and may begin at 9 years) who have not completed the vaccine series. History of genital warts, abnormal Papanicolaou test, or positive HPV DNA test is not evidence of prior infection with all vaccine HPV types; HPV vaccination is recommended for persons with such histories. Ideally, vaccine should be administered before potential exposure to HPV through sexual activity; however, females who are sexually active should still be vaccinated consistent with age-based recommendations. Sexually active females who have not been infected with any of the four HPV vaccine types receive the full benefit of the vaccination. Vaccination is less beneficial for females who have already been infected with one or more of the HPV vaccine types. A complete series consists of 3 doses. The second dose should be administered 2 months after the first dose; the third dose should be administered 6 months after the first dose. HPV vaccination is not specifically recommended for females with the medical indications described in Figure 2, "Vaccines that might be indicated for adults based on medical and other indications." Because HPV vaccine is not a live-virus vaccine, it may be administered to persons with the medical indications described in Figure 2. However, the immune response and vaccine efficacy might be less for persons with the medical indications described in Figure 2 than in persons who do not have the medical indications described or who are immunocompetent. Health-care personnel are not at increased risk because of occupational exposure, and should be vaccinated consistent with age-based recommendations.

3. Varicella vaccination All adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine if not previously vaccinated or the second dose if they have received only one dose unless they have a medical contraindication. Special consideration should be given to those who 1) have close contact with persons at high risk for severe disease (e.g., health-care personnel and family contacts of persons with immunocompromising conditions) or 2) are at high risk for exposure or transmission (e.g., teachers; child care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers). Evidence of immunity to varicella in adults includes any of the following: 1) documentation of 2 doses of varicella vaccine at least 4 weeks apart; 2) U.S.-born before 1980 (although for health-care personnel and pregnant women, birth before 1980 should not be considered evidence of immunity); 3) history of varicella based on diagnosis or verification of varicella by a health-care provider (for a patient reporting a history of or J U LY 2 0 0 9 | presenting with an atypical case, a mild case, or both, health-care providers should seek either an epidemiologic link with a typical varicella case or to a laboratory-confirmed case or evidence of laboratory confirmation, if it was performed at the time of acute disease); 4) history of herpes zoster based on health-care provider diagnosis or verification of herpes zoster by a health-care provider; or 5) laboratory evidence of immunity or


3. Varicella vaccination All adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine if not previously vaccinated or the second dose if they have received only one dose unless they have a medical contraindication. Special consideration should be given to those who 1) have close contact with persons at high risk for severe disease (e.g., health-care personnel and family contacts of persons with immunocompromising conditions) or 2) are at high risk for exposure or transmission (e.g., teachers; child care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers). Evidence of immunity to varicella in adults includes any of the following: 1) documentation of 2 doses of varicella vaccine at least 4 weeks apart; 2) U.S.-born before 1980 (although for health-care personnel and pregnant women, birth before 1980 should not be considered evidence of immunity); 3) history of varicella based on diagnosis or verification of varicella by a health-care provider (for a patient reporting a history of or presenting with an atypical case, a mild case, or both, health-care providers should seek either an epidemiologic link with a typical varicella case or to a laboratory-confirmed case or evidence of laboratory confirmation, if it was performed at the time of acute disease); 4) history of herpes zoster based on health-care provider diagnosis or verification of herpes zoster by a health-care provider; or 5) laboratory evidence of immunity or laboratory confirmation of disease. Pregnant women should be assessed for evidence of varicella immunity. Women who do not have evidence of immunity should receive the first dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the health-care facility. The second dose should be administered 4–8 weeks after the first dose.

4. Herpes zoster vaccination A single dose of zoster vaccine is recommended for adults aged 60 years and older regardless of whether they report a prior episode of herpes zoster. Persons with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication.

5. Measles, mumps, rubella (MMR) vaccination Measles component: Adults born before 1957 generally are considered immune to measles. Adults born during or after 1957 should receive 1 or more doses of MMR unless they have a medical contraindication, documentation of 1 or more doses, history of measles based on health-care provider diagnosis, or laboratory evidence of immunity. A second dose of MMR is recommended for adults who 1) have been recently exposed to measles or are in an outbreak setting; 2) have been vaccinated previously with killed measles vaccine; 3) have been vaccinated with an unknown type of measles vaccine during 1963–1967; 4) are students in postsecondary educational institutions; 5) work in a health-care facility; or 6) plan to travel internationally. Mumps component: Adults born before 1957 generally are considered immune to mumps. Adults born during or after 1957 should receive 1 dose of MMR unless they have a medical contraindication, history of mumps based on health-care provider diagnosis, or laboratory evidence of immunity. A second dose of MMR is recommended for adults who 1) live in a community experiencing a mumps outbreak and are in an affected age group; 2) are students in postsecondary educational institutions; 3) work in a health-care facility; or 4) plan to travel internationally. For unvaccinated health-care personnel born before 1957 who do not have other evidence of mumps immunity, administering 1 dose on a routine basis should be considered and administering a second dose during an outbreak should be strongly considered. Rubella component: 1 dose of MMR vaccine is recommended for women whose rubella vaccination history is unreliable or who lack laboratory evidence of immunity. For women of childbearing age, regardless of birth year, rubella immunity should be determined and women should be counseled regarding congenital rubella syndrome. Women who do not have evidence of immunity should receive MMR upon completion or termination of pregnancy and before discharge from the health-care facility.

6. Influenza vaccination Medical indications: Chronic disorders of the cardiovascular or pulmonary systems, including asthma; chronic metabolic diseases, including diabetes mellitus, renal or hepatic dysfunction, hemoglobinopathies, or immunocompromising conditions (including immunocompromising conditions caused by medications or human immunodeficiency virus [HIV]); any condition that compromises respiratory function or the handling of respiratory secretions or that can increase the risk of aspiration (e.g., cognitive dysfunction, spinal cord injury, or seizure disorder or other neuromuscular disorder); and pregnancy during the influenza season. No data exist on the risk for severe or complicated influenza disease among persons with asplenia; however, influenza is a risk factor for secondary bacterial infections that can cause severe disease among persons with asplenia. Occupational indications: All health-care personnel, including those employed by long-term care and assisted-living facilities, and caregivers of children less than 5 years old. Other indications: Residents of nursing homes and other long-term care and assisted-living facilities; persons likely to transmit influenza to persons at high risk (e.g., in-home household contacts and caregivers of children aged less than 5 years old, persons 65 years old and older and persons of all ages with high-risk condition[s]); and anyone who would like to decrease their risk of getting influenza. Healthy, nonpregnant adults aged less than 50 years without high-risk medical conditions who are not contacts of severely immunocompromised persons in special care units can receive either intranasally administered live, attenuated influenza vaccine (FluMist®) or inactivated vaccine. Other persons should receive the inactivated vaccine.

7. Pneumococcal polysaccharide (PPSV) vaccination Medical indications: Chronic lung disease (including asthma); chronic cardiovascular diseases; diabetes mellitus; chronic liver diseases, cirrhosis; chronic alcoholism, chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]); immunocompromising conditions; and cochlear implants and cerebrospinal fluid leaks. Vaccinate as close to HIV diagnosis as possible. Other indications: Residents of nursing homes or long-term care facilities and persons who smoke cigarettes. Routine use of PPSV is not recommended for Alaska Native or American Indian persons younger than 65 years unless they have underlying medical conditions that are PPSV indications. However, public health authorities may consider recommending PPSV for Alaska Natives and American Indians aged 50 through 64 years who are living in areas in which the risk of invasive pneumococcal disease is increased.

8. Revaccination with PPSV One-time revaccination after 5 years for persons with chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy); and for persons with immunocompromising conditions. For persons aged 65 years and older, one-time revaccination if they were vaccinated 5 or more years previously and were aged less than 65 years at the time of primary vaccination.

9. Hepatitis A vaccination Medical indications: Persons with chronic liver disease and persons who receive clotting factor concentrates. Behavioral indications: Men who have sex with men and persons who use illegal drugs. Occupational indications: Persons working with hepatitis A virus (HAV)-infected primates or with HAV in a research laboratory setting. Other indications: Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A (a list of countries is available at and any person seeking protection from HAV infection. Single-antigen vaccine formulations should be administered in a 2-dose schedule at either 0 and 6–12 months (Havrix®), or 0 and 6–18 months (Vaqta®). If the combined hepatitis A and hepatitis B vaccine (Twinrix®) is used, administer 3 doses at 0, 1, and 6 months; alternatively, a 4-dose schedule, administered on days 0, 7 and 21 to 30 followed by a booster dose at month 12 may be used.

10. Hepatitis B vaccination Medical indications: Persons with end-stage renal disease, including patients receiving hemodialysis; persons with HIV infection; and persons with chronic liver disease. Occupational indications: Health-care personnel and public-safety workers who are exposed to blood or other potentially infectious body fluids. Behavioral indications: Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than 1 sex partner during the previous 6 months); persons seeking evaluation or treatment for a sexually transmitted disease (STD); current or recent injection-drug users; and men who have sex with men. Other indications: Household contacts and sex partners of persons with chronic hepatitis B virus (HBV) infection; clients and staff members of institutions for persons with developmental disabilities; international travelers to countries with high or intermediate prevalence of chronic HBV infection (a list of countries is available at; and any adult seeking protection from HBV infection. Hepatitis B vaccination is recommended for all adults in the following settings: STD treatment facilities; HIV testing and treatment facilities; facilities providing drug-abuse treatment and prevention services; health-care settings targeting services to injection-drug users or men who have sex with men; correctional facilities; end-stage renal disease programs and facilities for chronic hemodialysis patients; and institutions and nonresidential daycare facilities for persons with developmental disabilities. If the combined hepatitis A and hepatitis B vaccine (Twinrix®) is used, administer 3 doses at 0, 1, and 6 months; alternatively, a 4-dose schedule, administered on days 0, 7 and 21 to 30 followed by a booster dose at month 12 may be used. Special formulation indications: For adult patients receiving hemodialysis or with other immunocompromising conditions, 1 dose of 40 µg/mL (Recombivax HB®) administered on a 3-dose schedule or 2 doses of 20 µg/mL (Engerix-B®) administered simultaneously on a 4-dose schedule at 0, 1, 2 and 6 months.

11. Meningococcal vaccination Medical indications: Adults with anatomic or functional asplenia, or terminal complement component deficiencies. Other indications: First-year college students living in dormitories; microbiologists who are routinely exposed to isolates of Neisseria meningitidis; military recruits; and persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic (e.g., the “meningitis belt” of sub-Saharan Africa during the dry season [December–June]), particularly if their contact with local populations will be prolonged. Vaccination is required by the government of Saudi Arabia for all travelers to Mecca during the annual Hajj. Meningococcal conjugate (MCV) vaccine is preferred for adults with any of the preceding indications who are aged 55 years or younger, although meningococcal polysaccharide vaccine (MPSV) is an acceptable alternative. Revaccination with MCV after 5 years might be indicated for adults previously vaccinated with MPSV who remain at increased risk for infection (e.g., persons residing in areas in which disease is epidemic).

12. Selected conditions for which Haemophilus influenzae type b (Hib) vaccine may be used Hib vaccine generally is not recommended for persons aged 5 years and older. No efficacy data are available on which to base a recommendation concerning use of Hib vaccine for older children and adults. However, studies suggest good immunogenicity in persons who have sickle cell disease, leukemia, or HIV infection or who have had a splenectomy; administering 1 dose of vaccine to these persons is not contraindicated.

13. Immunocompromising conditions Inactivated vaccines generally are acceptable (e.g., pneumococcal, meningococcal, and influenza [trivalent inactivated influenza vaccine]), and live vaccines generally are avoided in persons with immune deficiencies or immunocompromising conditions. Information on specific conditions is available at



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Have you been searching for just the right gift or thought of placing your name in perpetuity? If so, then consider purchasing an engraved brick for you or someone else. The main sidewalk at the Florida Pharmacy Association needs replacing. The Florida Pharmacy Foundation has undertaken the project to repair and beautify the sidewalk with engraved personal bricks purchased by pharmacists or friends of pharmacy. Engraved 4x8 bricks can be purchased for $250.00 each with the donor’s name engraved (3 lines available) or you could also purchase an engraved brick for someone you feel should be honored or remembered. The monies earned from this project will be used to fulfill the goals and future of the Foundation. There are a limited number of bricks available – so, it is first come first served.


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Pharmacy Time Capsule 2009 ■■ ■■

■■ ■■



Twenty-five years ago:

Seventy-five year ago

National Patient Counseling Competition for student pharmacists inaugurated. George C. Glenner discovered that a principal component of the plaque in the brains of Alzheimer patients was a peptide, now termed beta-amyloid peptide.



Arizona, Delaware, Massachusetts, Nevada, New Mexico, Tennessee, and Vermont did not require graduate forma college of pharmacy as a prerequisite to take the board of pharmacy licensing exam Annual dues for membership in the Conference of Pharmaceutical Association Secretaries was $5.00



Fifty years ago

One hundred years ago

The independent Southern School of Pharmacy merged with Mercer University. All state boards but one require an applicant for registration to have completed one year of practical experience.

■■ ■■

Most states pay pharmacy board members $5 per day plus actual expenses Centennial of the birth of Charles Darwin.

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Recovering Pharmacists Network of Florida (407) 257-6606 “Pharmacists Helping Pharmacists”

July 2009 Florida Pharmacy Journal  

July 2009 Issue

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