Outline. Why Adult Immunization Matters. Recommended Adult Vaccines: Age Based. Why Do We Vaccinate? Footnotes. Risk Based
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1 Why Adult Immunization Matters Outline CDC Recommended Adult Vaccines Burden of U.S. adult vaccine preventable disease Vaccine effectiveness in adults Adult immunization coverage rates Ramifications of failing to vaccinate Resources Q&As March 18 Item #S871 2 Why Do We Vaccinate? Important for optimizing health, protecting persons vaccinated, and others Example: Vaccination against influenza and pertussis reduces the risk for the person vaccinated and also prevents the person from spreading these diseases Recommended Adult Vaccines: Age Based Recommended Adult Vaccines: Footnotes Recommended Adult Vaccines: Risk Based
2 Diseases Among U.S. Adults Diseases among U.S. Adults Influenza 3, to 49, total influenza related deaths per year 71% 85% of deaths among adults 65 years and older 226, (mean) influenza associated hospitalizations recs/vacc specific/downloads/acip recs bkgd.pdf 7 8 Influenza Costs Lives and Money Direct medical costs in U.S.: ~$1.4 billion Add in loss of work and life: ~$87 billion Vaccination (41% in ) prevented: 7 million+ illnesses 3 million+ medically attended illnesses 9,+ hospitalizations Invasive pneumococcal disease (IPD) 29,5 total cases/ 3,35 total deaths (in ) 9% of IPD and nearly all IPD deaths among adults 65 years and older Molinari, et al. The annual impact of seasonal influenza in the US: Measuring disease burden and costs. Vaccine 7;25 : Reed, et al. Estimated Influenza Illnesses and Hospitalizations Averted by Vaccination United States, 14 Influenza Season MMWR :63(49); CDC.. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Streptococcus pneumoniae, 9 1 Pertussis in,762 cases >4,65 among adults years of age and older Hepatitis B 2,791 acute cases reported in ~18,1 estimated new infections in CDC.. Final pertussis surveillance report. surv report.pdf commentary.htm#hepatitisb
3 Zoster ~1 million cases annually in U.S. CDC. Prevention of Herpes Zoster. MMWR 8. 57(RR 5):1 3 Cost Burden of 4 Adult Vaccine preventable Diseases to the U.S (65 yrs and older), Vaccine-Preventable Disease Estimated # of CASES Estimated COSTS (Medical & Indirect) (in millions) Influenza 4,19,759 8,312.8 Pneumococcal 44,187 3,787.1 Zoster 555,989 3,17.4 Pertussis 7, TOTAL 5,223,176 $15,329.8 ~$11 billion more annually if population 5 64 yrs of age included McLaughlin, JM., Tan, L., et al. J Prim Prev. Aug;36(4): Recent Burden of Other Diseases Among U.S. Adults Ebola 4 cases Avian Influenza none E. coli H7:157 from eating at Chipotle: <1 cases Zika virus ( 17): 5,19 cases (travel associated) The Vaccines Are Effective Vaccine Effectiveness in Adults Effectiveness Influenza vaccine Vaccine effectiveness (VE) varies by vaccine type, the disease outcome, and the age or health of the person vaccinated What outcome are you measuring? Prevention of: Death Hospitalization Visits to the doctor or emergency room Disease symptoms What population are you studying? Most vaccines work less well in the very old or very young Young adults Age
4 Effectiveness PCV13 1 Effectiveness Hepatitis B Pneumonia Invasive Disease Overall < Diabetic (age group, yr) Effectiveness Zoster Pregnant Women Two for one vaccination! Effectiveness in infants Shingles PHN Severe PHN Pertussis Influenza Pregnant Women Two for one vaccination! Influenza vaccination of pregnant women Reduce risk of influenza illness in pregnant women Reduce risk of influenza illness, fevers and influenza hospitalizations in infants during first 6 months of life Vaccinate with inactivated flu vaccine (not live vaccine) during pregnancy Adult Immunization Coverage Rates WE ARE FAILING TO VACCINATE OUR ADULT POPULATION!!!
5 National Health Interview Surveys, National Health Interview Surveys, = HP Goal = HP Goal 25 CDC. MMWR Surveillance Summary. 17;66(11):1 28. ; CDC. MMWR Surveillance Summary. 16;65(1):1 36. CDC. MMWR. ;64(4):95 12.; CDC. MMWR. ;63(5): CDC. MMWR. ;62(4): objectives/topic/immunization and infectious diseases/objectives 26 CDC. MMWR Surveillance Summary. 17;66(11):1 28. ; CDC. MMWR Surveillance Summary. 16;65(1):1 36. CDC. MMWR. ;64(4):95 12.; CDC. MMWR. ;63(5): CDC. MMWR. ;62(4): objectives/topic/immunization and infectious diseases/objectives National Health Interview Surveys, National Health Interview Surveys, = HP Goal = HP Goal 27 CDC. MMWR Surveillance Summary. 17;66(11):1 28. ; CDC. MMWR Surveillance Summary. 16;65(1):1 36. CDC. MMWR. ;64(4):95 12.; CDC. MMWR. ;63(5): CDC. MMWR. ;62(4): objectives/topic/immunization and infectious diseases/objectives 28 CDC. MMWR Surveillance Summary. 17;66(11):1 28. ; CDC. MMWR Surveillance Summary. 16;65(1):1 36. CDC. MMWR. ;64(4):95 12.; CDC. MMWR. ;63(5): CDC. MMWR. ;62(4): objectives/topic/immunization and infectious diseases/objectives National Health Interview Surveys, National Health Interview Surveys, = HP Goal = HP Goal 29 CDC. MMWR Surveillance Summary. 17;66(11):1 28. ; CDC. MMWR Surveillance Summary. 16;65(1):1 36. CDC. MMWR. ;64(4):95 12.; CDC. MMWR. ;63(5): CDC. MMWR. ;62(4): objectives/topic/immunization and infectious diseases/objectives CDC. MMWR Surveillance Summary. 17;66(11):1 28. ; CDC. MMWR Surveillance Summary. 16;65(1):1 36. CDC. MMWR. ;64(4):95 12.; CDC. MMWR. ;63(5): CDC. MMWR. ;62(4): objectives/topic/immunization and infectious diseases/objectives 5
6 31 Adults with Diabetes Who Received 3 Doses Hepatitis B Vaccine, by Age, National Health Interview Surveys, 6 yrs yrs CDC. MMWR Surveillance Summary. 17;66(11):1 28. CDC. MMWR Surveillance Summary. 16;65(1):1 36. CDC. MMWR. ;64(4): CDC. MMWR. ;63(5): CDC. MMWR. ;62(4): Influenza Vaccination Coverage Among U.S. Adults, Past Four Seasons Group * Statistically significant declines/increases from the previous season Persons > 18 yrs * 43.3 ±.6* Persons yrs, all ±.8 Persons yrs, high risk ± 1.8 Persons 5-64 yrs * 45.4 ± 1.* Persons 65 yrs * 65.3 ± 1.* Ramifications Exist When We Fail to Vaccinate Adults Beyond the impact to the health of the public, our ineffectiveness in immunizing adults: Creates disincentive for manufacturers to enter the market Leave the chronically ill vulnerable Creates disparities in access to care Absence of commitment exacerbates existing barriers to immunization for those in the lower socio economic strata and for racial and ethnic minorities Other Ramifications Exist By failing to prepare, we are preparing to fail Benjamin Franklin Leaves us vulnerable during times of crisis when the ability to reach 25 million adults with vaccines/medications is crucial Pandemic influenza Our failure to successfully immunize adults in healthy times predicts our failure to immunize them in times of crisis Conclusion Substantial burden of disease in adults for which vaccines are available Vaccines are effective in the adult population. Effectiveness varies by: Vaccine type Disease outcome Age or health of person vaccinated Vaccination rates low among adults in U.S. Ramifications for failing to vaccinate IAC Resources Immunization Action Coalition IAC Express: free weekly e newsletter IAC s Adult Patient Handouts & Staff Education Materials (all CDC reviewed) vaccination.asp
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Medical Coverage Guidelines are subject to change as new information becomes available.
IMMUNIZATIONS Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage Guideline must
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REACHING OUR GOALS: IMMUNIZATION PROVIDER EDUCATION 1 DISCLOSURES I have no relevant financial relationships with the manufacturers of any commercial products and/or providers of commercial services discussed
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Kansas Spotlight: Prevention This report describes prevention in three distinct categories: Access to Health Care, Immunizations (coverage), and Chronic Disease Prevention. Access Dedicated Health Care