VACCINES FOR ADULTS Developing an Underutilised Health Resource 13 November 2007
OUTLINE background to adult immunisation in Canada roles and recommendations of immunisation advisory committees in Canada enhancing adult immunisation programmes in Canada getting adult immunisation on the health agenda
IMMUNE MEMORY AND THE NEED FOR BOOSTERS Some vaccines need only one dose for lasting protection Conjugated meningococcal vaccine in adults Most vaccines need more than one dose to be fully effective and to be long-lasting Some vaccines need regular boosting throughout life Toxoids: tetanus & diphtheria adults need to have some of their routine immunisations boosted I. M. GEMMILL, MD, CCFP, FRCP(C)
WHY WORRY ABOUT IMMUNISATION OF ADULTS serosurveys among adult Canadians indicate that 20% do not have protective antibody to diphtheria¹ the unprotected proportion increases with age the potential for outbreaks in susceptible populations has been observed waning diphtheria immunity puts adult Canadians at risk 1. Canadian Immunisation Guide
WHY WORRY ABOUT IMMUNISATION OF ADULTS serosurveys suggest that a substantial proportion of Canadians do not have protective antibody to tetanus ¹ the unprotected proportion increases with age factors for susceptibility include age, birth outside of Canada and missing immunisation records 1. Canadian Immunisation Guide
HUMAN PAPILLOMA VIRUS & CERVICAL CANCER Cervical Cancer: Incidence and Mortality per 100,000 Females, Canada, 1990-1995 Prepared by: Division of STD Prevention and Control, Bureau of HIV/AIDS and STD, LCDC, Health Canada, 1997 DR. I. M. GEMMILL, MD, CCFP, FRCPC
WHY IMMUNISATION OF ADULTS IS IGNORED vaccines are just for children diseases against which adults have been immunised have disappeared there are myths about adult immunisation that must be dispelled
IMMUNISATION ADVISORY COMMITTEES & THEIR ROLES NACI: provides scientific advice about safety, efficacy and appropriate use of specific vaccines CIC: 1). develops common approaches to vaccine use in publicly funded programmes in Canada e.g. HPV vaccine 2). attempts to move toward harmonisation across the various jurisdictions
IMMUNISATION ADVISORY COMMITTEES & THEIR ROLES Provincial Immunisation Advisory Committees: established in many of the provinces & territories roles are similar: making recommendations on vaccine use in publicly funded programmes levels of sophistication vary from province to province
From approval of a vaccine to its inclusion in a public health program Approval BGTD once submitted by manufacturer Recommendations NACI CIC Provincial committees Decision Taken by provincial authorities Slide courtesy of Dr. Bernard Duval
The decision to include a vaccine in provincial programs Provincial advisory committees Financial implications are very important for provincial governments the cost of a vaccine and of its administration, both initial and recurring costs Vaccines compete with all other public health programmes, curative interventions and with other sectors The decision concerning a vaccine follows the usual rules for political decisions: a mix of science, opportunity and public pressure Slide courtesy of Dr. Bernard Duval
Is the Vaccine a Candidate for a Public Programme Erickson-De Wals criteria: burden of disease vaccine characteristics choosing the right strategy cost-effectiveness acceptability feasibility ability to evaluate DR. I. M. GEMMILL, MD, CCFP, FRCPC
Is the Vaccine a Candidate for a Public Programme Erickson-De Wals criteria: research questions equity ethical considerations legal considerations conformity of programmes political considerations DR. I. M. GEMMILL, MD, CCFP, FRCPC
Is the Vaccine a Candidate for a Public Programme Other considerations: competing public health priorities competing health expenditures vaccine cost varying opinions about vaccine value political actions (UIIP in Ontario, HPV funding) DR. I. M. GEMMILL, MD, CCFP, FRCPC
HOW VACCINES ARE USED Reasons for use are based on epidemiological risk May be for universal use e.g. pertussis May be for targeted populations e.g. travel, lifestyle May be used before pre-exposure (routine use) May be used after exposure (outbreak control: e.g. hepatitis A) I. M. GEMMILL, MD, CCFP, FRCP(C)
NACI RECOMMENDED VACCINES FOR ADULTS: PUBLICLY FUNDED Routine vaccines for all adults: diphtheria tetanus polio is no longer needed Hib risk is very low after age 3 & therefore not used over this age
NACI RECOMMENDED VACCINES FOR ADULTS: PUBLICLY FUNDED Routine vaccines for some adults: measles: susceptible and born after 1970 mumps: susceptible and born after 1970 rubella: susceptible HCW & women of child-bearing age
NACI RECOMMENDED VACCINES FOR ADULTS: PUBLICLY FUNDED Routine vaccines for some adults: influenza: pneumococcal: > 65 years of age medically compromised care providers emergency service workers all residents in Ontario > 65 years of age medically compromised
NACI RECOMMENDED VACCINES FOR ADULTS: PUBLICLY FUNDED Vaccines for adults with special risks: hepatitis A: hepatitis B: rabies: gay men, contacts of cases gay men, sexually active, dialysis patients people with possible exposures
VACCINES RECOMMENDED BY NACI FOR ADULTS: NOT PUBLICLY FUNDED whooping cough chickenpox influenza (except Ontario) HPV
POTENTIAL BENEFITS OF A UNIVERSAL INFLUENZA PROGRAMME FOR ADULTS fewer days lost from work less disruption with personal activities and responsibilities lower transmission in the population lower health costs
POTENTIAL BENEFITS OF A UNIVERSAL PERTUSSIS PROGRAMME FOR ADULTS fewer cases of fatiguing respiratory illness lower risk of transmission to susceptible infants lower transmission in the population lower health costs
POTENTIAL BENEFITS OF A UNIVERSAL HPV PROGRAMME FOR ADULTS fewer abnormal Pap tests less consequent worry fewer colposcopies and associated costs lower transmission in the population fewer cases of cervical cancer, lower health costs, fewer deaths
BENEFITS OF IMMUNISATION IN THE WORKPLACE Healthier, valued workforce Fewer sick days and lost time owing to illness & treatments Decreased risk of outbreak and reduced workforce Less medical benefit costs Fewer lost days caring for ill children
BENEFITS OF IMMUNISATION IN THE HEALTH WORKPLACE Vulnerable sick populations are at lower risk of infection There is a secure health workforce There is less disruption and less expense to control outbreaks in the health setting
A VISION FOR ADULT IMMUNISATION PROGRAMMES Adult immunisation is given as much importance as other preventive programmes New vaccines for adults are given priority, like childhood vaccines Safe & effective vaccines that are recommended for adults are made available in all provinces & territories
A VISION FOR ADULT IMMUNISATION PROGRAMMES There is good promotion of adult vaccines There is good uptake and coverage of adult immunisations, including both boosters and new vaccines
VACCINES FOR ADULTS THANK YOU! QUESTIONS?