the state of adult immunizations...crs 152 0 100% h. flu (

The “State” of

Adult Immunizations

Maria C. Lanzi, ANP, MPH

Impact of Vaccines in the

20th and 21st Centuries

Disease 20th C Annual

Morbidity

2010 Reported

Cases

% Decrease

Smallpox 29,005 0 100%

Diptheria 21,053 0 100%

Pertusus 200,752 21,291 89%

Tetanus 580 8 99%




Morbidity

2010 Reported

Cases

% Decrease

Polio

(paralytic)

16,316 0 100%

Measles 530,217 61 >99%

Mumps 162,344 2,528 98%

Rubella

47,745 6 >99%




Morbidity

2010 Reported

Cases

% Decrease

CRS 152 0 100%

H. Flu (<5

years of age)

20,000 (est) 270 99%

Pre-Vaccine versus Current Estimated

Annual Morbidity

Disease Pre-Vaccine Era

2008 Estimates

% Decrease

Hepatitis A 117,333 11,049 91%

Hepatitis B (acute)

66,232 11,269 83%

Varicella 4,085,120 449,363 89%

Pre-Vaccine versus Current Estimated

Annual Morbidity

Disease Pre-Vaccine Era

2008 Estimates

% Decrease

Pneumococcus

(invasive), All

ages

60,067 44,000 30%

Pneumococcus

(invasive), < 5yo

16,069 4,167 74%

Rotovirus

(hospitalizations

< 5 yo)

62,500 7,500 88%

Immunizations are recommended throughout life to prevent infectious diseases and their sequalae

Adult vaccines target different populations based on age, medical conditions, behavioral risk factors, occupation and travel.

Between 40,000 and 50,000 adults die in the United States annually from Vaccine Preventable Diseases

Direct health care burden of VPD, annually, $10 Billion

Kill more Americans each year than traffic accidents, breast cancer or HIV/AIDs

Adult Immunizations

• Each year, on average: – 36,000 Americans die of seasonal flu and it’s complications;

most are 65 or older • More than 200,000 hospitalizations

– 5,000 Americans die from invasive pneumonia (more than 50% of those are age 65 and over)

• Together, Influenza and Pneumonia are the 5th leading cause of adult deaths

Impact of VPD

– Approximately 20 million Americans 15-49 yo are currently infected with HPV • 6.2 million new cases year year

– More than 1 million adults get shingles each year • 1 in 3 Americans will get shingles in their lifetime

– More than 1 million Americans have chronic HBV infection • HBV related liver disease kills about 5,000 annually and costs

about $700 million annually in health care and productivity related costs

Impact of VPD

Incomplete Vaccination

Never completed series

New Vaccines that didn’t exist when child

Waning Immunity

Travel

Immigrants, including international adoptions

Refugees

Short Term Transit, including students (MMR)

Incidence Contributing Factors

Influenza Measles/Mumps/Rubella Hepatitis A Pneumococcal Hepatitis B

Tetanus/Diphtheria/Pertussis HPV Varicella Meningococcal Zoster

Adult Immunizations current CDC recommendations

Influenza 18-64yo; pregnant women 80%

18-64yo high risk; >=65 90%

HCP 90%

Pneumococcal persons >=65yo 90%

High risk persons 18-64yo 60%

Herpes Zoster 30%

HBV (for HCP) 90%

Healthy People 2020 Targets reduce incidence of VPD

Influenza “Old Man’s Friend”

•Overall 38.8% •HCP 66.9%

• Physicians: 85.6% • Nurses: 77.9% • All other: 62.8%

•Pregnant Women: 47% •New Jersey: 42.8%

Adult Vaccination Coverage 2011

“Captain of the Men of Death”

Pneumococcal: • High risk 19-64 year old: 20.1% overall

1.6% increase from 2010

• Adults aged >=65 year old: 62.3% overall 2.6% increase from 2010

New Jersey >=65 year old: 63.5%


Hepatitis B (2011: DM <60yo)

High risk adults’ data was not collected

Adults aged 19-49 not at high risk: 35.9%

Diabetics aged 19-59: 26.9%

Diabetics >=60 years: 12.4%

HCP overall: 63.8%


Herpes Zoster

Age >=60 years: 15.8%

Just under 2% of those 60 and older have had shingles

vaccine


• Tetanus (any tetanus toxoid –Td or Tdap) • Adults aged 19-64: 64.5% overall

• Age 50-64: 69.3%

• Age >=65: 54.4%

• Tdap specific: • Adults aged 19-64: 12.5%

• HCP 26.8% 2.1% of eligible adults had a Tdap in previous 2 years

HCP regardless of age, should receive a single dose Tdap if not previously had one

Adult Immunization Coverage 2011

Hepatitis A

Age 19-49: 12.5%

International Travel:

high endemic areas: 20.1%

low endemic areas: 8.4%

Chronic Liver Conditions: 17.1%


• HPV

• Women aged 19-26 >=1 dose: 29.5%

• Men aged 19-26 >=1 dose: 2.1%

• Only 10% of eligible adult women (18-26) had HPV vaccine


Difference between 2010 and 2011 overall

Non influenza adult vaccination coverage was similar to

2010 except for modest increase in Tdap vaccination

overall and HPV vaccination among women

Adult Vaccination Coverage

• MMR • Documented titers

• Meningococcal • Asplenia, persistent complement component deficiencies,

HIV, high risk exposure

• Varicella

• Written documentation of 2 doses

• most common VPD reported on cruise ships

Adult Vaccines

Special Populations - HCP

• MMR • Measles: Western Europe, Asia, Southeast Asia, the

South Pacific and Africa

• In 2011 40% of US measles cases resulted from international

travel

• Meningococcal • African meningitis belt

• Saudi Arabia: Hajj

• Poliomyelitis

• Nigeria, Pakistan, Afghanistan,

Adult Vaccines

Special Populations - Travel

Japanese Encephalitis

Rabies

Tick Borne Encephalitis (non US)

Typhoid

Yellow Fever

Adult Vaccines

Special Populations - Travel

Limited Access Adult Vaccines are not required (outside of institutions)

HCP: Influenza, Hepatitis B, Measles/Mumps/ Rubella, Tetanus/Diphtheria/Pertussis, Varicella

Limited Care Lack of stress on prevention/primary care/“well adult visits”

Limited Financing Insurance coverage

Medicare: Influenza, Pneumococcal, HBV (high risk)

Barriers to Increasing Immunization

Education Awareness

Reluctance to discuss Risk Behaviors and STD

Misinformation on safety and effectiveness

Cultural and unsubstantiated biases HCP, disparity between racial groups

Waning Immunity

Notification and Tracking Registry-like information

Information sharing across different providers

Barriers to Increasing Immunization

Patient Education Community Education

Standing Orders Hospital discharge Home visits

Reminders Computerized, phone, chart, mail

Expanding Access Increasing convenience, non traditional delivery

Personal Health Records

Strategies to Increase Rates

CDC: MMWR: Adult Vaccination Coverage – US, 2010; 2/3/2012 CDC: MMWR: Non-influenza Vaccination Coverage Among Adults – US 2011; 1/29/2013 CDC:MMWR: Influenza Vaccination Coverage Among Pregnant Women — 2011–12 Influenza Season, US; 11/28/12 CDC Health Information for International Travel 2012 CDC Adult Vaccination Resources for Healthcare Providers CDC Strategies for Increasing Vaccination Rates Adult Immunization: Shots to Save Lives 2010

Citations

New Jersey Behavioral Risk Factor Survey: Summary Report

“USE OF CLINICAL PREVENTIVE SERVICESIN NEW

JERSEY (2): IMMUNIZATION AND HORMONE

REPLACEMENT STATUS OF OLDER ADULTS. September

2000 Volume 4

Centers for Medicare and Medicaid Services: Immunizations

JAMA. 2007; 298(18):2155-2163

Forbes.com 2/19/2013: How Vaccines Have Changed Our

World In one Graphic

Citations

Thank you

Maria Lanzi, ANP, MPH

[email protected]

Super Storm Sandy:

Immunization Recovery

Suzanne Courtwright, MS, APRN-C

Director, New Jersey Immunization Network

Hurricane Sandy hits NJ Oct. 29,2012

www.abcnews.com

Trenton, NJ – Governor Chris Christie today announced a total assessment of the damage sustained from Hurricane Sandy to the State of New Jersey, which places the total cost at $36.9 billion.

Christie Administration Releases Total

Hurricane Sandy Damage Assessment

of $36.9 Billion

Wednesday, November 28, 2012

Health Care Costs: $291.8 million Businesses: $8.3 billion

American Academy of Pediatrics

New Jersey Chapter---

Membership Survey: “Sandy Recovery”

Goal:

• Assess affect on vaccine supply and loss

• Identify strategies used in 2012 to avoid vaccine loss

• Understand need for future comprehensive vaccine protection plan

• Identify best practices for vaccine

protection

Funded by the AAP Friends of Children Fund

American Academy of Pediatrics

New Jersey Chapter---

Membership Survey: “Sandy Recovery”

• 1,700 + members surveyed

• Survey Monkey

• 177 members responded

Survey Results:

Loss of childhood vaccines

• Nearly 20% practices who responded reported loss of vaccines 34/177 (19.2%)

• 7.4% practices who responded reported 100% loss of all vaccines (13/177)

Survey Results: Financial Hardship on Pediatric Practices

• 1 in 2 practices experienced financial hardship as a direct result of Hurricane Sandy (54.4%)

• Only 1 in 5 reported recovering financial losses as a result of adequate insurance (19.6%)

• 14 practices reported an actual dollar amount of estimated loss (totaling $409,600, approximately $30K on average)

Survey Results:

Disaster Preparedness in 2012

Plan # Practices % Practices

Vaccine Disaster Preparedness Plan 55 31

Generator 14 7.9

Off -Site Storage 17 9.6

Off-Site Storage (Professional) 9 5

Off-Site Storage (Home/Employee/Friend) 5 2.8

No Plan 3 1.6

Good Luck/Good Fortune 4 2.3

Survey Results:

Disaster Preparedness: Future

#Practices %Practices

Formal Vaccine Preparedness Plan 19 10.7

Generator in Office 55 31

Move Vaccines Off-Site 15 8.5

Not Sure 2 1.1

Nothing Different 20 11.2

Medical Building: Town should make it a priority to supply a generator

3 1.7

Demonstrated need for

Emergency Vaccine Management Plan

Vaccine Storage & Handling Toolkit

http://www.cdc.gov/vaccines/recs/storage/toolkit/storage-handling-toolkit.pdf

November 2012







Vaccine Storage & Handling Toolkit







CDC Recommended Best Practices:

Emergency Vaccine Retrieval &

Storage Plan

• Every site should have a written plan

• Provides up-to-date information on procedures to follow for vaccine protection

• Post near vaccines

• Ensure staff familiarity with it

• Review with staff quarterly

• Review the plan for updates at least annually

• Implement in advance of the event









Storage Plan Outlines:

• Personnel

• Equipment

• Information

• Protocols









Storage Plan 1. Designated primary & alternate vaccine

coordinators with emergency contact info 2. Emergency staff contact list in order of contact

preference 3. Vaccine storage unit specifications 4. Alternate vaccine storage facility(ies) 5. Written protocols, vehicles, & drivers for

transporting vaccines to and from alternate facility









Storage Plan

6. Written instructions for entering facility & vaccine storage spaces in an emergency if building is closed.

7. Appropriate packing materials to safely transport or temporarily store vaccines.

8. Written protocol for vaccine packing.







Thank you!

the state of adult immunizations...crs 152 0 100% h. flu (

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