Scroll through this compact slide show for review of gaps in US adult vaccination practice and how primary care can help fill them.
A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.âWinston S. Churchill
More Illness but Less Vaccination.
VPDs cause long-term illness and death, but rates of recommended vaccination for US adults are low. Fewer than one-fourth of persons who should receive vaccination against hepatitis B or herpes zoster are inoculated routinely. For human papillomavirus vaccine, only 6% to 37% of men and women aged 19 to 26 years receive even 1 dose in the series.
True or False: Less than 20% of persons aged â¥19 years have ever received a dose of Tdap. Answer : True.
Hep B Vaccination in Diabetes: The Sooner the Better.
Infections in patients with diabetes can lead to poor glucose control, ketoacidosis, hyperosmolar syndrome, hospitalization, and more. Among viral infections, diabetes patients are especially prone to hepatitis B, thus the sooner after the diagnosis of diabetes a patient is vaccinated against hepatitis B the better.
In a study of 29 hepatitis B outbreaks in patients with diabetes, how many were a consequence of contaminated blood glucose monitors? Answer: 25 outbreaks.
Pneumococcal Disease Thrives in Diabetes.
Pneumococcal infection, including invasive pneumococcal disease (IPD) and community acquired pneumonia, can be particularly virulent in adults with diabetes and other chronic disease. Patients with chronic disease are at risk for infection with IPD all year round, not just in winter, and so are candidates for vaccination at “the earliest opportunity at any time of the year.”
True or False: Before age 65 years, both PPSV-23 and PCV-13 vaccines are recommended in diabetes patients. False. Only PPSV23 is recommended.
Pneumococcus and Zoster Hit Older Adults Hard.
The Baby Boomers are living longer and many are staying healthier, but there is no ultimate protection against waning immunity. Shingles, for example, is seen more often in older adults and postherpetic neuralgia can be a devastating consequence. Pneumococcal vaccination for those age â¥65 years is today essential against the infection that was once a death sentence.
True or False: The incidence of postherpetic neuralgia decreases less than 50% after zoster vaccination. False: Incidence decreases as much as 67%.
Vaccine to Reduce Meningococcal Infection Risk.
College students in close quarters are only one group at risk for meningococcal infection. Persons born with complement deficiency are at 10,000 times greater risk than the general population. Others at serious risk who should be inoculated include persons who had their spleen removed, those with sickle cell disease, and those who work with or are inadvertently exposed to
How soon after exposure to a person infected with meningococcus may a close contact become ill? Answer: 72 hours.
Fight Cancer with HPV Vaccine.
The human papillomavirus causes invasive cervical cancer in women; penile cancer in men; and anal, oropharyngeal, and head and neck cancers in women and men. Guideline- recommended vaccine administration could prevent 28,500 cases of cancer caused by HPV. All 3 available vaccines-quadrivalent, 9-valent, and bivalent-prevent cervical disease in women.
Are anogenital warts caused by the same HPV serotypes (16 and 18) that cause HPV-related cancers? Answer: No; serotypes 6 and 11 cause anogenital warts.
Renal Disease Immunization Underutilized.
Special populations predisposed to VPDs include patients on dialysis, persons with cirrhosis, those without a spleen, and pregnant women. Infection is a leading cause of death in patients with end stage renal disease, second only to cardiovascular causes, but immunization is underutilized. A suboptimal response to routine vaccines compounds the morbidity related to poor coverage.
True or False: Pneumonia-related mortality in ESRD patients is >10 times higher than in those not dependent upon dialysis. Answer: True.
Primary care practice is the hub for prevention of vaccine-preventable diseases (VPDs) in adults, says Gregory W. Rutecki, MD, Cleveland Clinic, author of the Patient Care Special Report on Adult Vaccination. The battle to protect patients against deadly infectious diseases is far from won, he notes, but primary care physicians can expand their clinical knowledge of the specific vaccination needs of diverse and vulnerable patient populations and help ease the burden of VPDs.The slides above highlight key points from Dr Rutecki's report, about VPDs in a range of patient groups; many of these patients may see specialists for care of specific diseases but still rely on primary care for first-line preventive medicine. The full report, inlcuding quizzes on each topic, is available in the Patient Care section, Special Report.Â For specific topics: Patient Care Special Report on Adult Vaccinationhttp://www.patientcareonline.com/special-report/special-report-adult-vaccinationMore Illness But Less Vaccinationhttp://www.patientcareonline.com/special-report/special-report-adult-vaccinationHep B Vaccination in Diabetes: The Sooner the Betterhttp://www.patientcareonline.com/special-report/adult-vaccination-part-1-patients-diabetes-mellitusPneumococcal Disease Thrives in Diabeteshttp://www.patientcareonline.com/special-report/adult-vaccination-part-1-patients-diabetes-mellitusPneumococcus and Zoster Hit Older Adults Hardhttp://www.patientcareonline.com/special-report/adult-vaccination-part-ii-older-adultsVaccine to Reduce Meningococcal Infection Riskhttp://www.patientcareonline.com/special-report/part-iii-meningococcal-and-hpv-infections-whos-riskFight Cancer With HPV Vaccine http://www.patientcareonline.com/special-report/part-iii-meningococcal-and-hpv-infections-whos-riskRenal Disease Immunization Underutilizedhttp://www.patientcareonline.com/special-report/part-iv-vaccination-special-populationsÂ