# Presentation: 658669

## Adult Immunization:  Goals, Challenges, and a role for the National Vaccine Advisory CommitteeOctober 22, 2007

- Raymond A. Strikas, MD
- National Vaccine Program Office
- Department of Health and Human Services

## Adult Immunization Session

- Overview of Issues
- Adult Immunization at CDC
- Adult Immunization at CMS
- Vaccination Coverage among Adults
- Attitudes About & Barriers to Adult Vaccination
- CDC Grantee Immunization Program Guidelines and Activities for Adult Immunization

## Presentation Outline

- Adult Immunization Healthy People 2010 Objectives
- NVAC reports and recommendations on adult immunization
- Proposed role for NVAC

## Immunization and Infectious Diseases Objectives – Healthy People 2010

- Diseases preventable through universal vaccination (14-1 – 14-5)
- Diseases preventable through targeted vaccination (14-6 – 14-8)
- Infectious Diseases and Emerging Antimicrobial Resistance (14-9 – 14-21)
- Vaccination Coverage and Strategies (14-22 – 14-29)
- Vaccine Safety (14-30 – 14-31)

## 14-28:  Increase Hepatitis B vaccine coverage  among high-risk groups

| Objective | Increase Hep B Coverage in High Risk Groups | 1995 
Baseline | 2010 Target |
| --- | --- | --- | --- |
|  |  | Percent |  |
| 14-28a | Long-term hemodialysis patients | 35 | 90 |
| 14-28b | Men who have sex with men | 9 | 60 |
| 14-28c | Occupationally exposed workers | 67 | 93 |

## 14-29:  Increase proportion of adults vaccinated against influenza and pneumococcal disease

| Objective | Increase in adults vaccinated | 1998 Baseline | 2010 Target |
| --- | --- | --- | --- |
|  |  | Percent |  |
|  | Noninstitutionalized adults aged 65 years and older |  |  |
| 14-29a | Influenza vaccine | 64 | 90 |
| 14-29b | Pneumococcal vaccine | 46 | 90 |
|  | Noninstitutionalized  high-risk adults aged 18 to 64 years |  |  |
| 14-29c | Influenza vaccine | 26 | 60 |
| 14-29d | Pneumococcal vaccine | 13 | 60 |

## 14-29:  Increase proportion of adults vaccinated against influenza and pneumococcal disease

| Objective | Increase in adults vaccinated | 1998 Baseline | 2010 Target |
| --- | --- | --- | --- |
|  |  | Percent |  |
|  | Institutionalized adults (persons aged 18 years and older in long-term or nursing homes) |  |  |
| 14-29e | Influenza vaccine | 59 (1997) | 90 |
| 14-29f | Pneumococcal vaccine | 25 (1997) | 90 |
|  | Noninstitutionalized adults aged 18 to 64 years |  |  |
| 14-29g | Influenza vaccine for health care workers | 37 (2000) | 60 |

## NVAC Reports and Recommendations

- 1990 Subcommittee Report (2 pages)  addressed:
- Finances
- Research on barriers
- Public and Provider Education
- Standards of Care
- Liability protection
- Improved vaccines (immunogenicity, safety)
- Supply
- Federal support for programs and partners
- Legislative and regulatory strategies

## NVAC Reports and Recommendations - 2

- 1994 NVAC Report:
- Much more comprehensive review (51 pages)
- 5 goals (similar to 1994 National Vaccine Plan goals), 18 recommendations, 70 strategies
- Formed the basis of HHS Adult Immunization Plan in 1997

## Goals of 1994 NVAC Adult Immunization Report

- Increase the demand for adult vaccination by improving provider and public awareness
- Assure the health care system has an adequate capacity to deliver vaccines to adults
- Assure adequate financing mechanisms to support the expanded delivery of vaccines to adults
- Monitor and improve the performance of the nation’s vaccine delivery system
- Assure adequate support for research on
- vaccine-preventable diseases of adults
- adult vaccines
- adult immunization practices
- new and improved vaccines
- international programs for adult immunization

## Strengthening the Nation's Influenza Vaccination System: An NVAC Assessment (2004*)

- Improve vaccination coverage among recommended groups by facilitating the delivery of influenza vaccines in a range of settings, especially in "medical homes,", other medical sites, workplaces, and community sites where people have not previously had access to vaccination
- Make influenza vaccine purchase less of a burden and financial risk for providers.
- Explore options for a comprehensive vaccination program for adults.
- Increase the rate of influenza vaccination among health care workers.
- Consider expanding influenza vaccination recommendations.
- Implement systems to better understand the burden of influenza illness in the U.S. and to better assess the impact of vaccination programs and vaccine effectiveness
- Conduct a comprehensive review of the influenza research program to identify gaps and areas for additional support.

- *Published in the Am J Prev Medicine, October, 2005

## Proposed Role for NVAC in Adult Immunization

- Review status of coverage and barriers to vaccination of adults (10/22/07)
- Consider forming an adult immunization workgroup to review evidence and formulate strategies
- Review financial barriers and programmatic approaches for improvement of vaccine uptake (February, 2008)