imunizari la adult

7/28/2019 Imunizari La Adult

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CAIC 9/2007

Adult Immunization:Its Your Best Shot!

A Clinician to Clinician Educational Program

California Adult Immunization Coalition


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CAIC 9/2007

Vaccine Preventable

Diseases in Adults

VPD's ki l l hundreds o f t imes more adu l tsthan chi ld ren every year!

Burden of Illness on Hospitals 114,000 Influenza admissions

15,000 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


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CAIC 9/2007

Healthy People 2010 Goals and

Current CoverageHealthy People 2010 Goal

56%

13%

70%

24%

9%

75%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PPV 23 65+ PPV 23 18-49 High

Risk

Flu 65+ Flu 18-49 High Risk Hep B MSM Hep B HCW

90%

60%

90%

60% 60%

98%

www.healthypeople.gov

National Health Interview Survey (CDC, NCHS)


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CAIC 9/2007

Recommended Adult Immunization Schedule

October 2006September 2007

For everyone Risk factors other than age


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CAIC 9/2007

Select Changes to the

Adult Immunization Schedule

Human papillomavirus (HPV) vaccine was added to the age-based schedule for women


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CAIC 9/2007


Adult Immunization Schedule(CONTINUED)

The varicella schedule reflects new ACIP recommendations foradministering a routine second dose for all adults without evidenceof immunity and a new definition of evidence of immunity: documentation of 2 doses of varicella vaccine > 4 weeks apart

born before 1980 (for HCWs & pregnant women, birth before 1980 shouldnot be considered evidence of immunity)

history of varicella based on diagnosis or verification by a HCP history of herpes zoster based on HCP diagnosis OR

laboratory evidence of immunity or laboratory confirmation of disease.

ACIP recommendations have also been updated to reflect arecommendation for: prenatal assessment and postpartumvaccination; expanding the use of the varicella vaccine for certainHIV-infected children, and establishing middle school, high school,and college entry vaccination requirements.

Centers for Disease Control and Prevention:

http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm


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CAIC 9/2007


Adult Immunization Schedule(CONTINUED)

The influenza footnote has been revisedto reflect ACIP recommendations tovaccinate close contacts of children aged059 months rather than 023 months.

The hepatitis B footnote has been revisedto reflect recommendations to vaccinate

any adult seeking protection from hepatitisB virus infection and vaccinate adults inspecific settings.

Centers for Disease Control and Prevention:

http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm


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CAIC 9/2007

If Your Patient (> 18 years old)HasThey Need:

Pneumo23and

Flu (TIV)

Pneumo23

Meningococcal

DM CVD

COPD Immunodeficiency Chronic Alcoholism Kidney Failure

Asplenia

VACCINES


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CAIC 9/2007

If Your Patient isThey Need:

65 years Flu Pneumo23

A Health Care Worker Flu MMR

Hepatitis B Td/Tdap Varicella (if there is no confirmed evidence of immunity)

An IVDA/MSM Hepatitis A Hepatitis B

Pregnant Flu (TIV) Td/Tdap

A College Freshman Meningococcal MMR


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CAIC 9/2007

Tetanus Diphtheria- AcellularPertussis Vaccine

Composition of Tdap Inactivated

Tetanus and diphtheria toxoids + pertussis antigens

Duration and Level of Protection 10 years (for Td); unknown for Tdap >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


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CAIC 9/2007

Influenza

Spanish InfluenzaPandemic, 1918

Influenza Ward, U.S. Army Field

Hospital No. 29, Hollerich,

Luxembourg

Influenza germs spreadthrough the air through a

cough


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CAIC 9/2007

Influenza Vaccine:Trivalent Inactivated

Composition Inactivated

Type A (H3N2 & H1N1) and B strains included

Duration and Level of Protection

Revaccinate yearly Highly protective Protects individuals

Limits the spread of influenza

Administration

Fluarix, Fluzone, Fluvirin, FluLaval 0.5 ml IM only

Comments Do not use in people with egg allergy

Start vaccinating in September-October and continue

through March


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CAIC 9/2007

Influenza Vaccine:Live Attenuated Influenza (LAIV)

Composition Cold adapted intranasal vaccine-trivalent

Type A (H3N2 & H1N1) and B strains included


Revaccinate yearly Similar efficacy to TIV

Administration Flumist

0.2 ml intranasal (0.1 ml per nostril)

Comments Do not use in people with egg allergy

Store at 35F-- 46F

Start vaccinating in September-October and continuethrough March


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CAIC 9/2007

Shortage StrategyTIV Influenza Vaccine

http://www.cdc.gov/flu/professionals/vaccination/vax_priority.htmONLY if a shortage is declared!

During periods of inactivated flu vaccine shortages, vaccination is prioritized based on the

risk of serious flu-related complications. In the event of a shortage, the California and localpublic health departments will provide guidance regarding distribution using these tiers.

Tier Priority Group

1A Persons aged >65 years with comorbid conditions

Residents of long-term care facilities

1B Persons aged 2-64 years with comorbid conditions

Persons aged >65 years without comorbid conditions

Children aged 6-23 months

Pregnant women

1C Children aged 24-59 months

Health-care personnel

Household contacts and out-of-home caregivers of children


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CAIC 9/2007

Pneumococcal Vaccine

Composition Inactivated pure polysaccharide

23 strains ofS. pneumon iae

Duration and Level of Protection 3-5 years (maximum 2 doses) 60-70% effective against Invasive

Pneumococcal Disease

Administration Pneumovax 23 0.5 ml IM or SC

Comments Not effective in children < 2 years old


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CAIC 9/2007

Hepatitis B

Woman sufferingfrom liver cancer

caused by hepatitis B


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CAIC 9/2007

Hepatitis B Vaccine


Recombinant HBsAg (yeast)

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

Administration Recombivax HB and Engerix-B

1 ml IM only of the adult formulation

Comments Brands are interchangeable

Can accelerate the series


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CAIC 9/2007

Hepatitis A

Man with jaundice caused by hepatitis A


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CAIC 9/2007

Hepatitis A Vaccine


Duration and Level of Protection Predicted 20+ years after 2 doses

99%+ protected after 1 month and 1 dose

Administration Havrix and VAQTA

1 ml IM only of the adult formulation

Comments VAQTA is preservative free

Use IGIM if traveling in less than 2 weeks


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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> 1dose

Titers often required for healthcare workers

Store frozen


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CAIC 9/2007

Measles

Koplik spots on theinside of the mouth that

occur 24-48 hours before

the measles rash stage

Measles rash


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CAIC 9/2007

Varicella or Chickenpox Vaccine

Composition Live attenuated virus vaccine

Keep frozen at +5F (-15C) 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


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CAIC 9/2007

Meningococcal Vaccine

Composition Inactivated, tetravalent (A,C,Y,W-135)

Pure polysaccharide (MPSP4) and conjugate (MCV4)


3-5 yrs for MPSP4 and >5 yrs for MCV4 >85% against A and C strains

Administration Menomune (MPSP4) and Menactra (MCV4)

0.5 ml SC (MPSP4) and 0.5 ml IM (MCV4)

Comments MCV4 only indicated for 11-55 yrs

Substitute MCV4 for MPSP4 whenever possible

High diphtheria toxoid content of MCV4 does not changespacing recommendations with other vaccines


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CAIC 9/2007

HPV Vaccine (Quadrivalent)

Indication (Gardasil) Prevention of HPV related cancers due to HPV 16 and 18

Prevention of genital warts due to HPV 6 and 11

Composition Derived from non - infectious HPV - like particles (VLP), composed of

the L1 major capsid protein

Duration and Level of Protection The length of vaccine protection unknown, but studies indicate

protection for at least five years.

Administration 0.5 mL, IM route

3 dose series (0, 2, 6 months)

Comments Quadrivalent HPV is not recommended for use in pregnancy

Vaccine is contraindicated for people with a history of immediatehypersensitivity to yeast or to any vaccine component

At present, cervical cancer screening recommendations have notchanged for females who receive quadrivalent HPV vaccine


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CAIC 9/2007

Breaking DownBarriers to Immunization


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CAIC 9/2007

System Barriers

Distribution

Communication

Redistribution

Documentation in medical record


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CAIC 9/2007

Provider Barriers

Uncertainty about who should bevaccinated

Missed opportunities

Written consent

Cost and reimbursement issues


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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

St t i t I Ad lt


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CAIC 9/2007

Strategies to Improve AdultImmunization Rates Short Term

Effective Evidence-Based Strategies

Reminders Provider and Patient

Education Staff, Provider and Patient

Offer alternative sites for vaccineadministration

NFID. A Call To Action: Improving Influenza And Pneumococcal ImmunizationRates Among High-risk Adults


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Si l St Y C


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CAIC 9/2007

Simple Steps You CanTake to Improve Rates

Dont underestimate the impact of a providerrecommendation to get vaccinated!

Educate staff in your office or facility & enlisteveryone from the front desk to the exam room toencourage patients to get vaccinated.

Work toward a specific vaccination goal for yourpractice or facility.

Simple Steps You Can


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CAIC 9/2007

Simple Steps You Can

Take to Improve Rates (CONTINUED)

Use every encounter with a patient as anopportunity to immunize or educate! Offer walk-ins and evening or weekend shot clinics. Use a simple reminder system.

Make reminder calls or send reminder letters.

Use a colorful poster (Ask us if you are due for any shots

today!) to prompt patients.

Record a reminder message on your hold message.

Include a reminder message in materials mailed to your

patients.

Use chart stickers or preventive flow sheets to remind clinicians

& staff when shots are due.


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CAIC 9/2007

Key Messages: The Problem

Adult vaccination rates fall far below HealthyPeople 2010 leaving thousands of adults at

risk for vaccine preventable diseases.

Many barriers contribute to lowimmunization rates.

Many adults are not aware of their need toreceive immunizations as a preventive care

measure.


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CAIC 9/2007

Key Messages: Solutions

The ACIP and CDC provide clear ageand risk-based recommendations foradult vaccinations.

Clinicians have a key role incommunicating preventive caremessages to their patients.

A range of strategies including systemchanges have been found to be highlyeffective in increasing adult

immunization rates.


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CAIC 9/2007

Questions?

A Statewide Campaign to promote


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CAIC 9/2007

A Statewide Campaign to promote

National Adult Immunization Awareness Week

September 23 29, 2007

Thank you for your efforts toimprove adult immunization systemsand coverage levels.

This project is sponsored by the CAIC.

For additional materials and information,

please visit our website at

www.immunizecaadults.org!
http://www.immunizecaadults.org/http://www.immunizecaadults.org/

imunizari la adult

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