Primary care is the hub for the prevention of so-called vaccine-preventable diseases (VPD) in adults. Every patient encounter is an opportunity to make sure the complex population of people you see in your practice remains protected from the deadly diseases we have conquered with vaccines and that not one will pass along infection to those who for whatever reason cannot resist a specific VPD.
So just how well are we performing in this front-line practice setting? I wish I could say things were better.
Rates of recommended vaccination for adults in the United States are low: less than one quarter of those who should receive vaccination against hepatitis B or herpes zoster are routinely inoculated; uptake of the human papillomavirus (HPV) vaccine has been disappointing with only 6% to 37% of men and women aged 19 to 26 years receiving even one dose in the series.1 In 2013, there were more than 26,000 cases of pertussis and approximately 17,000 individuals were infected with pneumococcus; there were more than 3000 cases of hepatitis B and nearly 250 cases of meningococcal disease (strains ACYW or B).2 Td and Tdap coverage in 2013 was limited to 57.5% and ~29% of the population, respectively.3
A few more facts:
► Less than 20% of persons aged ≥19 years have ever received a dose of Tdap.1
► Only 60% of patients aged ≥65 have received any pneumococcal vaccine.1
► Only 29% of adolescents have completed meningococcal vaccination (MenAC-WY); 40% have completed the HPV series; 88% have received a single dose of Tdap.2
The bottom line: we have work to do.
This Patient Care Special Report on Adult Vaccination doesn’t offer a step-by-step review of the Advisory Committee on Immunization Practices (ACIP) annually updated schedule of vaccine recommendations. That’s available any time on the CDC's website.
Instead you will be challenged in a series of multiple choice quizzes to engage your clinical knowledge of the specific vaccination needs of a variety of populations – some of these you may know by rote, but others we hope will make you stop and think. For example:
► What vaccines are critical for your patients with type 2 diabetes? What are the particular vulnerabilities in this population?
► What is the most effective approach to herpes zoster vaccination in older adults to avoid post herpetic neuralgia? In what order should the 23- and 13-valent pneumococcal vaccines be given in the over-65 years population?
► What is currently true and what false about meningococcal vaccination for young adults aged 19-21? Who should and who shouldn’t receive the HPV vaccine?
► What do you know about immunization in special populations, eg, pregnant women, immunocompromised patients, patients with advanced renal disease?
The less-than-robust statistics regarding vaccinations should give all of us resolve to do much, much better. We hope, as you work through the challenges in this Special Report, that your awareness will be raised, your curiosity piqued, and your resolve to double-down on updating all your current patients’vaccine status will be renewed.
This is the time to do better with a simple and long-lived medical practice that provides substantial long-term benefits.
1. Meningococcus ©Royaltystockphoto/Shutterstock.com
2. Inflluenza ©mathagraphics/Shutterstock.com
3. Human immunodeficiency virus ©xrender/Shutterstock.com
4. Human papillomavirus 16 ©Katyrena Kan/Shutterstock.com
Introduction: Adult Vaccination
1. Williams WW, Lu PJ, O’Halloran A, et al; Centers for Disease Control and Prevention (CDC). Vaccination coverage among adults, excluding influenza vaccination – United States, 2013. MMWR Morb Mortal Wkly Rep. 2015;64:95-102. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6404a6.htm
2. Adams D, Fullerton K, Jajorsky R, et al. Summary of notifiable infectious diseases and conditions –United States, 2013. MMWR Morb Mortal Wkly Rep. 2015;62:1-122. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6253a1.htm
3. Lu P-J, O’Halloran A, Ding H, et al. National and state-specific Td and Tdap vaccination of adult populations. Am J Prev Med. 2016; 50:616-626. http://www.ncbi.nlm.nih.gov/pubmed/?term=Am+J+Prev+Med.+2016%3B+50%3A616-626.
1. Centers for Disease Control and Prevention (CDC).Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2011 Dec 23;60:1709-11.
2. Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin. Inf. Dis. 2014; 58:e44. http://cid.oxfordjournals.org/content/58/3/e44.long
3. CDC. Vaccine information for adults. HIV Infection and Adult Vaccination. http://www.cdc.gov/vaccines/adults/rec-vac/health-conditions/hiv.html
4. Rubin LG, Schaffner W. Clinical practice: Care of the asplenic patient. N Engl J Med. 2014; 371:349-356. http://www.nejm.org/doi/full/10.1056/NEJMcp1314291
5. Soni R, Horowitz B, Unruh M. Immunization in end-stage renal disease: opportunity to improve outcomes. Semin Dial. 2013;26:416-426. http://onlinelibrary.wiley.com/doi/10.1111/sdi.12101/abstract;jsessionid=6BEAD64A884CB7B5B807E2409778A01B.f03t03