• Academy, STFM Launch Shots by AAFP/STFM

    April 02, 2018, 08:51 am Chris Crawford – The Academy and the Society of Teachers of Family Medicine (STFM) are excited to announce that the new Shots by AAFP/STFM applet has been added to the AAFP mobile app and is available in a stand-alone version, as well.

    hand touching smartphone with shots app on screen

    Both are available for Android and iOS devices and combine elements from the original Shots app from the STFM and the Immunizations applet from the AAFP.

    Shots by AAFP/STFM includes the latest guidance from the CDC Advisory Committee on Immunization Practices' (ACIP's) 2018 adult and childhood immunization schedules, including children's catch-up schedules.

    The new tool also offers schedules for combination vaccines and can tailor vaccine recommendations according to specific medical conditions or other circumstances. Individual dosing schedules, potential adverse reactions, contraindications, brand names and CPT codes, and resident education are listed for each specific vaccine.

    Story Highlights

    Background on App Development

    Donald Middleton, M.D., and Richard Zimmerman, M.D., M.P.H., both professors of family medicine at the University of Pittsburgh (Pa.) School of Medicine, had overseen the original Shots app since its inception in 2004 as solely an STFM product.

    The team that developed the content for the new Shots by AAFP/STFM product was composed of vaccine experts from across the United States, including Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division. Each expert reviewed a vaccine or two each year for inclusion, Middleton told AAFP News.

    "Clearly, knowledge about and proper utilization of vaccinations are part of the skilled family physician's armamentarium," Middleton said. "Both the AAFP and STFM leadership understand the importance of maintaining our expertise."

    However, he said, information on vaccination is constantly changing and, indeed, growing exponentially from year to year.

    "To keep all who use the STFM and AAFP apps up-to-date, the leadership of the AAFP and STFM determined that an enhancement of the current AAFP app would be beneficial. Hence the incorporation of Shots into that app," Middleton said.

    Shots by AAFP/STFM Explained

    Under the main Schedules heading in Shots by AAFP/STFM, users can choose from childhood, adult, catch-up and combination vaccine options.

    Under the Guide heading, the By Profile function lets users enter a patient's information, medical conditions and special circumstances (e.g., employment as a health care worker) to determine which vaccines are indicated for that individual.

    This function, in particular, augments the ACIP's medical conditions schedules, Middleton said.

    "One could, for example, enter an age of 50-59 years and IV drug use to get a list of vaccines that are advised," he said. "In this case, the patient should be given hepatitis A, hepatitis B, zoster, seasonal influenza and Td/Tdap vaccines, if not already done."

    The By Condition function draws on the ACIP schedules for medical conditions and other indications, which are listed for both children and adults.

    For example, family physicians and family medicine residents can use the By Condition section to figure out which vaccines are appropriate for patients with immunocompromising conditions such as cancer chemotherapy or who exhibit behaviors such as smoking, Middleton said.

    The By Type function provides specific indications for and information about each vaccine, such as vaccine basics (the routine schedule and the vaccine products available to comply with that schedule), high-risk indications, adverse reactions, contraindications and precautions, catch-up schedules, administration details, risk communication, epidemiology of the vaccine-preventable disease for which the vaccine is indicated, brand names and associated CPT codes, excipients and additives, resident education and, where available, pictures.

    "The risk communication and epidemiology areas are particularly helpful to provide education for individuals who have any hesitancy about vaccinations," Middleton said. "The excipients and additives area can be used to reassure vaccine recipients that chemicals such as thimerosal are not included in a specific product."

    Family Physician Expert's Perspective

    As an adviser to the original Shots app, Middleton acknowledged that he may depend on it more strongly than others, but said he uses the product almost every day.

    "Through Google monitoring, we see that many other vaccinators do so, as well," he noted.

    Middleton said using an immunization app such as Shots by AAFP/STFM has been very useful in his practice for answering questions about the timing of vaccinations and management of specific vaccine products. He also pointed out that Shots by AAFP/STFM provides more details about vaccine products than the traditional ACIP schedules do.

    "For example, let's say a physician wishes to vaccinate a young adult against both hepatitis A and B," Middleton said. "To do so, the physician will need two shots of hepatitis A vaccine and two or three shots of hepatitis B vaccine, depending upon the vaccine product used."

    Again, depending on the product(s) being used, the appropriate timing of injections can be an issue.

    "When practitioners look at the adult schedule in Shots by AAFP/STFM, clicking on either Hep A or Hep B leads them to Basics and Dosing Schedule, which contains a list of vaccine products," he said.

    One product, Twinrix, is a vaccine for both hepatitis A and B that allows physicians to reduce the number of injections to three overall.

    "However, Twinrix must be used for all three shots to satisfy the requirements for hepatitis A immunity," Middleton said. "Shots provides clear guidance in this situation and gives clear timing of the vaccine doses."

    Additional Details

    For most of its history, iterations of the Shots app have been free, Middleton said, thanks to external funding.

    At the height of its use, Shots was downloaded annually by 60,000 to 90,000 users, he said. From 2014-2018, the AAFP Immunizations applet was used by 79,000 members.

    As for recognition that previous versions of Shots garnered from outside sources, Middleton said it's been lauded as one of the top medical apps in several publications, including Clinical Infectious Diseases.

    The Immunization Action Coalition also currently lists Shots as one of its preferred vaccination apps.

    Finally, Middleton said, "All of the developers at the AAFP and STFM encourage our members to utilize Shots by AAFP/STFM to the fullest extent and to provide us with enhancing suggestions."

    Related AAFP News Coverage
    ACIP: LAIV OK to Use During 2018-19 Flu Season
    Group Also Addresses Hepatitis A, B Vaccines


    CDC, AAFP Release 2018 Immunization Schedules
    Updates Include Preferential Shingrix Recommendation, Third MMR Dose for Some