How to Streamline Pediatric Vaccine Coadministration During High-Demand Seasons

As respiratory virus season ramps up, primary care clinics face the dual challenge of ensuring children receive all due vaccines while keeping visits efficient and patient-centered. In this Patient Care® interview, family physician Sarah Sams, MD, offers a practical playbook drawn from her practice: pre‑chart immunizations, coordinate proactively with nursing and medical assistant staff, and maintain a clear, streamlined workflow for vaccine administration.

Dr Sams also shares how she handles concerns about preservatives like thimerosal with clarity and confidence. She notes that thimerosal—a mercury-based preservative—was removed from all routine childhood vaccines nearly two decades ago, except in some multi‑dose flu vials, and that choosing preservative‑free alternatives or explaining the safety of trace amounts can effectively address parental questions. This balanced combination of pre‑visit planning and clear, evidence‑forward communication exemplifies how busy clinicians can deliver comprehensive, patient‑centered immunization care without sacrificing time or trust.

Sarah Sams, MD, is a board-certified family physician who is a member of the board of directors of the American Academy of Family Physicians (AAFP). Dr Sams also an associate director and full-time faculty member at Grant Family Medicine Residency in Columbus, Ohio.

The following transcript has been lightly edited for style and clarity.

Patient Care: How do you handle coadministration in a respiratory virus season when time is tight and multiple shots may be due?

Sarah Sams, MD: Especially with pediatric patients, there are often multiple vaccines due at well-child visits—not just during respiratory season. My approach is to pre-chart before the visit, determine what that patient needs, and enter those orders. We do a pre-huddle with nursing and medical assistant staff, and I tell them what I think the patient needs.

As they room the patient, they ask if they’re okay with those vaccines. If the patient or parent says yes, they start preparing them before I even walk in. If they say no, the staff lets me know they have questions or have declined. That gives me the opportunity to go in, ask again, provide education, and, if they change their mind, I send a secure chat to my medical assistant, sign the order, and they administer it.

Patient Care: How can clinicians effectively counter misinformation about vaccine safety, particularly concerns around aluminum or preservatives, during brief office visits?

Dr Sams: Thimerosal, a mercury-containing preservative, has been removed from all childhood vaccines since about 2001, though some multidose influenza vaccines still contain preservatives. The easiest way to avoid this concern is to purchase single-dose, preservative-free vaccines.

If only multidose vaccines are available, I provide information on the very small amounts of preservative present and explain that, for a single vaccine like the flu shot, those levels are safe.