Some Perspectives on Vaccination of Adults

1. Some Perspectives on Vaccination of Adults Dennis J. O’Mara Associate Director for Adult Immunization Immunization Services DivisionNational Immunization Program Centers for Disease Control and Prevention Department of Health and Human Services National Hepatitis Coordinators’ Conference San Antonio, Texas January 28, 2003

2. AnnualAdult Vaccine-PreventableDisease Burden Is High • 36,000 deaths from influenza • 6,600 deaths from pneumococcal disease • 5,000 deaths from hepatitis B • 5 deaths from tetanus

3. Adult VaccinationCoverage Levels are Low • High-risk for influenza complications: ~50% • ≥65 for pneumococcal disease: ~55.7% • Hemodialysis patients for hepatitis B: ~35% • ≥50 for tetanus-diphtheria: ~50%

4. Core Adult Vaccines • Influenza Vaccine (1 dose annually) • Pneumococcal Polysaccharide Vaccine (1 dose; boosters under certain circumstances) • Hepatitis B and A Vaccines (series for those at risk) • Tetanus/Diphtheria Toxoids (series plus 10-year boosters)

5. Comparison of Childhood and Adult Vaccination Programs

6. My Recommendations to NIP Grantees • Develop comprehensive plans • Develop public/private partnerships • Seek additional resources • Use the available tools • Implement interventions that work

7. Strategic Planning • Mission, Vision, Goal(s) • Objectives • Critical Success Factors/Barriers • Strategies • Activities • Resources Needed

8. Public/Private Partnership • Bring stakeholders/partners together • Discuss issues/identify problems • Propose recommendations/solutions • Organize to takeACTION

9. National Influenza Vaccine Summit • Co-sponsored by the AMA • Over 60 organizations represented • 5 working groups formed in advance of the summit to explore issues and make recommendations • 50 recommendations proposed • 9 working groups, NIP branches, organizations, to address recommendations • Progress to be tracked and reported

10. National Influenza Vaccine Summit: The Players • Vaccine manufacturers • Vaccine distributors • Selected federal agencies • Professional medical organizations • Community vaccinators • Public health organizations • Hospitals

11. National Influenza Vaccine Summit: The Players, cont. • Businesses • Occupational health • Private insurance/managed care • Nursing homes • Quality improvement organizations • Consumer organizations • Disease-specific organizations

12. Partners/Stakeholders in Hepatitis B Prevention Efforts • STD prevention programs • HIV counseling/testing programs • Prison and jail systems • Prisoner advocacy organizations • Drug treatment facilities

13. Funding of Adult Vaccination Infrastructure? • 317 grant funds? (Guidance is permissive) • State or local funds? • Other sources? • A “carve-out”?

14. Potential Resources toOffset the Cost of Adult Vaccines • Medicare • Medicaid • VFC for those ≤18 • Private insurance • Occupational Health Programs • Some 317 funding?(Guidance is permissive) • State or local funding? • Billing?

15. Tools Available to SupportAdult Vaccination Efforts • Guide to Community Preventive Services, MMWR, June 18, 1999, Vol. 48/No. RR-8http://web.health.gov/communityguide • Guide to Clinical Preventive Services, 2nd edition, William & Wilkins, Baltimore, MD, 1996 • HEDIS measures – www.NCQA.org • Influenza vaccine coverage: ≥65 • Influenza vaccine coverage: 50-64 • Pneumococcal polysaccharide vaccine coverage: ≥65

16. Tools Available to SupportAdult Vaccination Efforts, cont. • Healthy People 2010 www.health.gov/healthypeople/ • The “What Works” CDWhatWorks@atpm.org • Background, recommendations and resources • Model practices and strategies • Built-in test on adult immunization • Template for developing a practice-based adult immunization plan • Continuing education credits

17. Tools Available to Support Adult Vaccination Efforts, cont. • Updated Adult Immunization Standards • Adult CASA • Harmonized Adult Vaccination Schedule

18. Adult Vaccination Program Guidance Being Developed • Based on Guide to Community Preventive Services • Combinations of interventions for maximum impact • Combinations based on setting and target population

19. Recommended Adult Vaccination Interventions • Provider assessment/feedback • Provider reminder systems • Standing orders • Expanding access to vaccination • Reducing out-of-pocket costs • Patient reminder systems • Multi-component patient education

20. What should adult vaccination coordinators be doing now? • Planning • Developing public/private partnerships • Statewide • Locally • Seeking resources • Using the tools and implementing the interventions known to raise vaccine coverage

21. Dennis J. O’MaraAssoc. Director Adult Immunization ISD / NIP / CDC 1600 Clifton Road NE · MS E-52 Atlanta, GA 30333 Telephone: 404-639-8820 Fax: 404-639-8615 E-mail: djo1@cdc.gov Web Site: www.cdc.gov/nip