Adult vaccination rates increase but are insufficient

The CDC said vaccinations were one of the top 10 public health success stories of the 20th century.^1-3

The incidence, morbidity, mortality and prevalence of vaccine-preventable diseases have significantly decreased since vaccination. Yet despite the effectiveness and safety of vaccines, it is estimated that between 40,000 and 50,000 American adults die each year from vaccine-preventable diseases.^4.5 Vaccines are considered a cost effective, effective and safe way to prevent death, disability and diseases related to certain infectious diseases.^6.7

In the adult patient population, vaccination rates increased slightly in 2015 for hepatitis B; shingles; influenza; pneumococcus; and tetanus, diphtheria and pertussis (Tdap) vaccines compared to 2014 rates, according to the most recent data from the National Health Interview Survey (NHIS).^8.9

However, adult vaccination rates remain suboptimal, many well below the federal targets for healthy people in 2020.^8.9 According to a published comparison of vaccination rates with these goals, only the rate of vaccination against shingles of 30.6% in people 60 years and older exceeded the set target of 30.0% .^8.9 All other immunization rates fell well below targets. For example, less than 45% of adults received the annual influenza vaccine, but the target "Healthy Population for 2020" was 70%.^8.9 Influenza immunization rates for health care providers were also lower than the recommended target of 90.0%, or 68.6% overall.^8.9

The Advisory Committee on Immunization Practices (ACIP) recommends the administration of a single dose of herpes zoster vaccine to all adults 60 years of age and older, who have or not reported an earlier episode of herpes zoster.^8.9 Herpes zoster vaccination coverage in 2015 was Healthy people 2020 goal of 30%.^8-10 Recent NHIS data also showed that there were ethnic and racial differences in vaccination rates, with Caucasians generally having higher vaccination rates.^8.9 In addition, the results of the NHIS report showed that overall vaccination rates are generally lower in adults without health insurance and higher in those with private insurance compared to public insurance.^8.9 The data showed that adults receiving routine health care are more likely to receive the recommended vaccines.^8.9

Pharmacists are well positioned to improve immunization rates and can play the role of advocates, educators, identifiers and immunizers. The CDC encourages all health care providers to educate patients about vaccine-preventable diseases and strongly recommends vaccines, as the data has shown that the provider's recommendation is one of the major drivers of immunization.^9.10

Vaccine preventable diseases

However, efforts are underway to promote effective vaccination. According to the National Infectious Disease Foundation, vaccine-preventable diseases claim more lives every year than bad cancer, HIV / AIDS and road accidents.¹¹ Each year, ACIP continuously reviews and updates recommended vaccines, vaccination standards, and vaccination schedules in the United States. The National Adult Immunization and Influenza 2019 Summit is scheduled for May 14-16, 2019. In February 2018, the CDC released its recommended vaccination schedule for adults 19 years of age or older United, 2018, as recommended by the ACIP. . The new recommendations for vaccination are based primarily on factors such as age, health status, vaccination history, lifestyle, occupation and whether a person is immunocompromised or about to travel.^1.12 In the absence of contraindications, ACIP recommends that all adults be vaccinated against influenza every year and that they receive the Tdap booster every 10 years.^12,13 ACIP also recommends that, in addition to these vaccines, pneumococcal and shingles vaccines be administered to persons 65 years of age and older.^12,13 The most recent ACIP recommendations and the adult vaccination schedule are available at cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf. Some vaccines may be recommended to adults because of special requirements related to work or school, health problems, lifestyles and other factors.^13,14 A complete list of all vaccine preventable diseases is available at cdc.gov/vaccines/vpd-vac/vpd-list.htm. In addition, those visiting certain countries may need specific vaccines before their visit. For more information on vaccines, visit the CDC website.

Vaccines in the news

In October 2018, the FDA expanded the approval of Gardasil 9, the human papillomavirus vaccine, to adults between 27 and 45 years old.¹⁵ At the same time, the results of a new study confirm that influenza vaccine reduces the risk of hospitalization related to influenza in pregnant women.¹⁶

The role of the pharmacist

Although vaccination remains a patient choice, as the most accessible health professional, pharmacists can play a key role in providing patients with relevant information to help them make informed choices about immunization, explaining their benefits as well as their risks. Pharmacists are also in a unique position to identify patients who are part of target groups for certain vaccinations. They may also be able to alleviate the fears of many patients by providing them with facts such as clinical data and dispelling common misconceptions and myths about immunization; they can also highlight the significant risks badociated with not being vaccinated. In addition, pharmacists can share resources to educate patients (see Table).

Yvette C. Terrie, BSPharm, RPh, is a consulting pharmacist and medical writer in Haymarket, Virginia.

References

1. Oldfield BJ, Stewart RW. Misconceptions, advances and current updates in the administration of pediatric vaccines. South Med J. 2016 109 (1): 38-41. Doi: 10.14423 / SMJ.0000000000000000399.
2. Ventola CL. Vaccination in the United States: Recommendations, Barriers and Measures to Improve Compliance: Part 2: Adult Immunizations. P T. 2016 41 (8): 492-506.
3. Temoka E. Becoming a vaccine champion: Evidence-based interventions to address the challenges of immunization. S D Med. 2013; (thematic number): 68-72.
4. Bach AT, Goad JA. The Role of Community Pharmacy Vaccination in the United States: Current and Future Practices. Integr Pharm Res Pract. 2015; 4: 67-77. doi: 10.2147 / IPRP.S63822.
5. Poland GA, Schaffner W, Hopkins RH Jr, US Department of Health and Human Services. Vaccination Guidelines in the United States: New Vaccines and New Recommendations for Children, Adolescents and Adults. Vaccine. 2013; 31 (42): 4689-4693. doi: 10.1016 / j.vaccine.2013.03.031.
6. Esposito S, Durando P, Bosis S, Ansaldi F, Tagliabue C, Icardi G; ESCMID Vaccine Study Group (EVASG). Vaccine preventable diseases: targets for children or adults. Eur J Intern Med. 2014; 25 (3): 203-212. doi: 10.1016 / j.ejim.2013.12.004.
7. Remy V, Y Zöllner, Heckmann U. Immunization: the cornerstone of an effective health system. J Mark Access Health Policy. 2015; 3 (1). doi: 10.3402 / jmahp.v3.27041.
8. Williams WW, Lu PJ, O'Halloran A, et al. Surveillance of immunization coverage among adults – United States, 2015. MMWR Surveill Summ. 2017 66 (11): 1-28. doi: 10.15585 / mmwr.ss6611a1.
9. Tanzi MG. Adult vaccination rates show modest but far from optimal gains. Pharm today. 2017 23 (8): 43. pharmacytoday.org/article/S1042-0991(17)31108-8/fulltext?rss=yes. Accessed October 17, 2018.
10. Surveillance of vaccination coverage in adults. Website of the American Pharmacists Association. pharmacist.com/article/surveillance-vaccination-coverage-among-adult-populations. Posted on May 8, 2017. Accessed October 18, 2018.
11. Main reasons for getting vaccinated. Website of the National Foundation for Infectious Diseases. nfid.org/about-vaccines/reasons. Accessed October 17, 2018.
12. Adult immunization resources. CDC website. cdc.gov/vaccines/hcp/adults/index.html. Updated June 7, 2018. Accessed October 18, 2018.
13. Vaccination schedules. CDC website. cdc.gov/vaccines/schedules/hcp/imz/adult.html. Updated March 5, 2018. Accessed October 18, 2018.
14. Vaccines and preventable diseases. CDC website. cdc.gov/vaccines/vpd/vaccines-age.html. Updated May 1, 2018. Accessed October 17, 2018.
15. Ingram I. The FDA approves the HPV vaccine for adults up to 45 years old. MedPage today. October 7, 2018. medpagetoday.com/obgyn/cervicalcancer/75551. Accessed October 17, 2018.
16. Influenza Vaccine Reduces Risk of Hospitalization for Influenza in Pregnant Women [news release]. Atlanta, GA: CDC; October 11, 2018. cdc.gov/media/releases/2018/p1011-flu-vaccine-reduces-risk-pregnant-women.html. Accessed October 17, 2018.