Adult Immunization: It’s Your Best Shot! A Clinician to Clinician Educational Program

Southern Nevada Health District © CAIC 9/2007

Vaccine Preventable Diseases in Adults VPD's kill hundreds of times more adults than children every year! • Burden of Illness on Hospitals – 114,000 – 15,000

Influenza admissions Hepatitis admissions

• More than 40,000 deaths per year: – 20-40,000 from pneumonia and influenza – 5,000 from hepatitis B

• Adult IZ Coverage levels generally low Strengthening Adult Immunization: A Call to Action, Partnership for Prevention, 2005

© CAIC 9/2007

Healthy People 2010 Goals and Current Coverage Healthy People 2010 Goal 100%

90%

98%

90%

90% 80% 60%

70%

60%

60%

75%

70%

60% 50%

56%

40% 30%

24%

20%

13%

10%

9%

0% PPV23 65+

PPV23 18-49 High Risk

www.healthypeople.gov National Health Interview Survey (CDC, NCHS)

Flu 65+

Flu 18-49 High Risk

Hep B MSM

Hep B HCW

© CAIC 9/2007

Recommended Adult Immunization Schedule October 2006–September 2007

For everyone

Risk factors other than age

© CAIC 9/2007

Select Changes to the Adult Immunization Schedule •

Human papillomavirus (HPV) vaccine was added to the agebased schedule for women 99% protection

• Administration – DECAVAC (Td), Boostrix (licensed for 10-18 year olds) or Adacel (Tdap) – 0.5 ml IM only

• Comments – Tdap is the recommended booster for adults, 19-64 years, including pregnant women © CAIC 9/2007

Influenza Spanish Influenza Pandemic, 1918 Influenza Ward, U.S. Army Field Hospital No. 29, Hollerich, Luxembourg

Influenza germs spread through the air through a cough

© CAIC 9/2007

Hepatitis B

Woman suffering from liver cancer caused by hepatitis B

© CAIC 9/2007

Hepatitis B Vaccine •

Composition – Inactivated – Recombinant HBsAg (yeast)

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Duration and Level of Protection – >15 years – After 3 doses, >90% protection

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Administration – Recombivax HB and Engerix-B – 1 ml IM only of the adult formulation

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Comments – Brands are interchangeable – Can accelerate the series © CAIC 9/2007

Hepatitis A Man with jaundice caused by hepatitis A

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Hepatitis A Vaccine •

Composition – Inactivated

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Duration and Level of Protection – Predicted 20+ years after 2 doses – 99%+ protected after 1 month and 1 dose

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Administration – Havrix and VAQTA – 1 ml IM only of the adult formulation

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Comments – VAQTA is preservative free – Use IGIM if traveling in less than 2 weeks © CAIC 9/2007

Measles, Mumps, Rubella • Composition – Live attenuated virus vaccine

• Duration and Level of Protection – Lifelong protection – 99%+ are protected after 2 doses

• Administration – MMR II – 0.5 ml SC (use for adults and pediatrics)

• Comments – Immunity may be assumed by: – Antibody titers – Born before 1957 – Immunization record with record of > 1 dose

– Titers often required for healthcare workers – Store frozen © CAIC 9/2007

Measles Koplik spots on the inside of the mouth that occur 24-48 hours before the measles rash stage

Measles rash

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Varicella or “Chickenpox” Woman with chickenpox

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Varicella or “Chickenpox” Vaccine • Composition – Live attenuated virus vaccine – Keep frozen at +5°F (-15°C)

• Duration and Level of Protection – Should have lifelong protection – 99%+ after 2 doses

• Administration – Varivax – 0.5 ml SC (use for adults and pediatrics)

• Comments – Serologic testing in adults is recommended – Effect on epidemiology of shingles is unknown © CAIC 9/2007

Breaking Down Barriers to Immunization

© CAIC 9/2007

Patient Barriers • Lack of recommendation from health care provider • Changing ACIP recommendations • Myths about vaccines • Access to vaccine • Cost of vaccines • Needle Phobia • Negative media stories © CAIC 9/2007

Key Messages: The Problem •

Adult vaccination rates fall far below Healthy People 2010 leaving thousands of adults at risk for vaccine preventable diseases.

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Many barriers contribute to low immunization rates.

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Many adults are not aware of their need to receive immunizations as a preventive care measure.

© CAIC 9/2007

Key Messages: Solutions • The ACIP and CDC provide clear age and risk-based recommendations for adult vaccinations.

• Clinicians have a key role in communicating preventive care messages to their patients.

• A range of strategies including system changes have been found to be highly effective in increasing adult immunization rates. © CAIC 9/2007

Questions?

© CAIC 9/2007