6.5 Vaccine Prescribing & Administration: Age Floors, Protocols, Training & ALERT IIS

Why this matters

Vaccine questions are common and change often. Oregon's statute sets age floors. The Board's rules set training and record duties. Since 2025, the Board's protocols have tied pharmacist vaccination to specific dated ACIP recommendations and to West Coast Health Alliance (WCHA) guidance for respiratory vaccines. Many older study aids use repealed age thresholds.

Who may be vaccinated (ORS 689.645(1)(a))

A pharmacist, or a pharmacy technician under a pharmacist's supervision, may administer vaccines:

The Board repealed its standard vaccination protocols for ages 3–6 and 6 months–2 years in January 2026. Outside the influenza exception and emergency authorizations, a non-influenza vaccine for a child under 7 needs another lawful authority, such as a patient-specific order from a prescriber, which a pharmacist may administer under ORS 689.655.

The current Board protocols (OAR 855-115-0345)

• Standard Vaccination Protocol for Adults 18 and Older and for Persons 7 through 17 (v. 09/2026). The pharmacist may prescribe, dispense and administer listed vaccines according to ACIP recommendations adopted by reference as of specific dates, the CDC Pink Book and Yellow Book, and Board rules. Examples include Tdap, HPV, hepatitis A and B, MMR, meningococcal, pneumococcal, polio, varicella, and travel vaccines such as typhoid, Japanese encephalitis, rabies and yellow fever.
• Separate protocols for COVID-19, influenza and RSV, which reflect WCHA recommendations (influenza v. 09/2026). For example, the influenza protocol covers persons 6 months and older IM, live attenuated (intranasal) vaccine for ages 2 and older, and two doses at least 28 days apart for children under 9 receiving influenza vaccine for the first time.
• Protocol for Managing Adverse Reactions, which every immunizing site must have along with the required equipment and supplies.

Training and readiness (OAR 855-115-0305)

Before administering, the pharmacist must:

1. Complete practical training in the injection site and technique used.
2. Complete training in hands-on injection technique, clinical evaluation of indications and contraindications, and recognition and treatment of emergency reactions.
3. Hold current CPR certification for health care providers, from the American Heart Association, the American Red Cross or an equivalent. It must include a hands-on component, be specific to the age of the population being vaccinated, and be valid for no more than three years.
4. Ensure the vaccine was stored under OAR 855-041-1036.

The Board may issue certificates of special competency in vaccine prescribing or administration (ORS 689.645(3)). Training records are kept six years or uploaded to eGov (OAR 855-104-0055).

Who does what in the encounter

• The pharmacist, or a trained intern past the first academic year, reviews ALERT IIS, makes the recommendation and selects the vaccine (OAR 855-115-0305(3)).
• A trained technician may perform only the physical act of administration, for patients 7 and older (OAR 855-125-0305).
• The Vaccine Information Statement (VIS) must be given before each dose (42 U.S.C. 300aa-26).

Records and reporting

The administering licensee records:

• The patient identifier and the administering licensee identifier.
• The vaccine, dose, lot number and expiration date.
• The route and site.
• The date and time.

The pharmacist must ensure reporting to ALERT IIS (OAR 855-115-0125(9)(a)). OHA's IIS rule sets a 14-calendar-day reporting window for participating providers (OAR 333-049-0050). Clinically significant adverse events and errors are reported to VAERS. Under ORS 689.645(4), the Board's rules address reporting to the patient's primary care provider and to OHA.

Managing anaphylaxis

The Board's adverse-reaction protocol follows standard emergency care:

1. Give intramuscular epinephrine (1 mg/mL) into the anterolateral thigh at the weight-based dose, up to 0.5 mg in adults (often 0.3 mg by auto-injector).
2. Call 911.
3. Position the patient appropriately.
4. Repeat epinephrine every 5–15 minutes if needed.
5. Give antihistamines only as adjuncts.

Patients are typically observed for 15 minutes after vaccination, or 30 minutes with a history of immediate reactions.

Exam scenario

A parent brings a 5-year-old for a seasonal flu shot and a varicella booster, with no prescription and no emergency declaration in effect. The pharmacist may give the influenza vaccine under the influenza protocol (6 months and older). They may not give varicella under a protocol, because the child is under 7, and the 3-year emergency authority isn't active. A licensed technician may not administer either dose to this child, because technician administration is limited to ages 7 and up.