Adult Immunizations & the Workplace Samuel B. Graitcer, MD Office of Associate Director for Adult Immunizations Immunization Services Division National Center for Immunization & Respiratory Diseases Immunization Services Division
Outline Burden of common vaccine preventable diseases Review current adult immunization rates Factors associated with low immunization rates among adults Workplace vaccination and its benefits
Burden of Influenza Influenza causes yearly seasonal epidemics and can cause sporadic pandemics Four pandemics in 100 years 226,000 hospitalizations and 3,000-49,000 annual influenza-related deaths ~ h a lfo fa llh o sp ita liza tio n sa m o n gp a tie n ts 6 5ye a rso fa g e ~90% of deaths among patients 65 years of age Among other adults: 2%-10% get influenza each year Resulting in approximately 0.6-2.5 days lost per illness Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2010.
Burden of Influenza Severe influenza illness occurs among all adults with co-morbid conditions, not just elderly or children Adults with asthma, diabetes, heart disease, neurologic conditions, kidney and liver disease, immune compromised conditions get severe disease too Among adults with influenza infections serious enough to require hospitalization during 2010-11: 87% had at least one co-morbidity 1 43% had asthma or chronic lung disease 36% had diabetes or other endocrine disorder 37% had cardiovascular disease 5% were pregnant women 1. Emerging Infections Program, FluView 2010-11: http://www.cdc.gov/flu/weekly/weeklyarchives2010-2011/10-11summary.htm
Burden of Influenza by Race/Ethnicity Significant disparity persists among severity of illness among racial and ethnic groups: Influenza-like illness (ILI): ~3 times higher among Alaska Natives/American Indians than other groups 1 Hospitalization rates: Almost 3 times higher for minority groups compared to whites 1 In Chicago study: hospitalization among blacks and hispanics were four times higher than white counterparts 1. Dee et al. Ann Epidemiol. 2011
Societal and Economic Burden of Influenza 3.1 million hospital days 31.4 million outpatient visits (e.g. ER, nurse or doctor s office) ~$10.4 billion direct medical costs ~$16.3 billion indirect cost from lost earnings due to illness and loss of life Total economic burden ~$87 billion per year Molinari et al. Vaccine. 2007
Burden of S. pneumonia Infections 4 million illness episodes Pneumonia, ear infection, blood infection, meningitis, death 5 million outpatients visits 774,000 ER visits 445,000 hospitalizations 22,000 deaths ~$3.5 billion direct medical costs ~ $ 1.8b illio nd ire ctco sta m o n g 6 5ye a rso ld Accounting for lost work and productivity, cost due to pneumonia infection among 18-50 years old, similar to costs among >65 years old Huan et al. Vaccine. 2011.
Burden of Pertussis: Whooping cough Multiple large state outbreaks associated increased morbidity and even death among infants Incidence of pertussis of infants has tripled since 1980 s In 2010 alone, >27,000 cases were reported to CDC True number of cases could be nearly 3.3million Whooping cough can cause severe disease for infants 92% of cases were infants < 4 months of age 63% of infants < 12 months of age needed hospitalization Asymptomatic adults can spread pertussis to children too young to be fully immunized Even if adult was vaccinated as a child, they can spread pertussis since protection from the vaccine wanes throughout life Adults need booster Tdap vaccine Lee. Pediatrics. 2007.; Recommendations of ACIP. MMWR 2006; Wendleboe et al. Pedriatric Infect Dis J. 2007; Cherry et al. Pediatrics. 2007
Low Adult Vaccination Rates Vaccination offers best protection against disease: Directly protects those vaccinated by preventing infection Indirectly protects other by decreasing spread of disease Influenza and pneumococcal disease spread by air, therefore hand washing offers little protection Important adult vaccines include: Influenza vaccination needed yearly for every adult Pneumococcal vaccination needed for select groups with high-risk conditions and for all >64 years of age Tdap or pertussis booster vaccination recommended at least once in series of tetanus shots, especially for pregnant women and those with children <12 months Advisory Committee on Immunization Practices
2010-11Seasonal Influenza Vaccination Coverage Group 2010-11(%) 1 Persons > 18 yrs 41% Persons 18-49 yrs, all 31% Persons 18-64 yrs, high risk 47% Persons 65 yrs 67% 1. BRFSS and NIS estimates, 2010-11. Online at: http://www.cdc.gov/flu/professionals/vaccination/coverage_1011estimates.htm
Seasonal Influenza Vaccination Coverage by Race/Ethnicity: 2010-11 Seasons Group 2010-11 (%) 1 Race/ethnicity (adults) White, non-hispanic 43% Black, n o n -Hispanic 34% Hispanic 32% * Statistically significant difference in 2010-11 coverage compared to non-hispanic whites 1. BRFSS and NIS estimates, 2010-11. Online at: http://www.cdc.gov/flu/professionals/vaccination/coverage_1011estimates.htm
Vaccinations Rates of Other Adult Vaccines Vaccine By Group 2010 1 Pneumococcal, adults 65+ 60% Pneumococcal, high-risk adults 18-64 19% Shingles (zoster), adults 60+ 14% Hepatitis B, adults with diabetes (3 doses), 18-64 23% *Data source: 2010 National Health Interview Survey
Barriers to Adult Vaccination Provider factors Competing demands away from preventative services Vaccine not available System factors No federal program to provide vaccines to uninsured adults Persistent barriers to reimbursement for other types of providers who may be able to expand opportunity for adult immunizations Patient factors Less likely to have regular health care provider than children Many uninsured or underinsured adult Inconvenient access, competing demands (e.g. work)
Place of Influenza Vaccination Among Adults United States, 2010-11 Season Doctor's office/hmo Hospital/ED Other clinic/health center Health Department Store* Workpla ce Senior rec/comm center School Other non-medical * e.g. supermarket or drug store MMWR June 17, 2011;60(23):781-785 18+ yrs 18-49 50-64 65+ 0 10 20 30 40 50 60 % of vaccinated by place BRFSS, January-March 2011 data from 46 states and District of Columbia
Adult Immunizations WORKPLACES & BENEFITS OF VACCINATIONS
Benefits of Workplace Vaccination Benefits to Employee: Reduced absences due to sickness, doctor visits, antibiotic use Improved health Convenience Improved morale Benefits to Employers: Reduces costs by decreasing time spend from work to get vaccinated Reduces costs by reducing absences due to illness, resulting in improved productivity Vaccination often already covered under employee health plans Benefits will vary based on investment by employers in championing vaccinations and number vaccinated
Cost Benefit of Influenza Vaccination and Working Adults US manufacturing company over 2 seasons with >1100 employees Workers aged 18-64 years randomized to receive influenza vaccination or placebo Among vaccinated workers, well-matched/ highly effective vaccine reduced: Influenza-like illness by 34% Physician visits by 42% Lost workdays by 32% Net cost to society $11.17 Societal cost include vaccine cost and administration cost + physician visits, hospitalizations, prescriptions Bridges et al. JAMA. 2000.
Workplace and Influenza Vaccination Among airline crews in Brazil 1 : Vaccinated employee had 39.5% fewer influenza-like illness episodes 26% fewer days of work lost Pharmaceutical company in Brazil 2 : Company saved $35 per employee due to decreased illness related absences Tobacco process company in North Carolina 3 : For every dollar spent on vaccination, saved $2.58 Adult 50-64 year at major university 4 : 25% fewer upper respiratory infections (URIs) 43% fewer sick leave days due to URI 1. Mixeu et al. Aviat Environ Med. 2002; 2. Burckel et al. Pharmacoeconomics. 1999.; 3. Campbell et al. J. Occup Environ Med. 1997; 4. Nichol et al. NEJM. 1995
Summary Vaccine preventable diseases associated with large health and economic burden to people of all ages Vaccine are needed throughout life Vaccination rates are low among adults By encouraging workplace vaccination, employers can help workers improve: Health Morale Reduce absenteeism due to illness and other associated cost to employees
Thank you! For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov National Center for Immunizations and Respiratory Diseases Immunization Services Division