Adult Immunization: The Big 5 Making the Case (Patient, Team, Community) Adult Immunization: The Big 5 Making the Case (Patient, Team, Community) Sandra Adamson Fryhofer, MD, MACP Practicing General Internist, Atlanta, GA Adjunct Associate Professor of Medicine, Emory University School of Medicine Emory University School of Medicine Past President, American College of Physicians ACP Liaison to ACIP

Adult Immunization The Big 5  Influenza  Tdap  Hepatitis B  Pneumococcal PCV 13 PCV 13 PPSV 23 PPSV 23  Shingles

Big 5 Itinerary: ACIP Adult Immunization Schedule

Adult Immunization : Make the Case – Make It Happen  Practice Assessment  Team Education  Patient Education  Billing / Reimbursement  Documentation

Incorporating Adult immunization in Your Practice : Start with the ACIP Adult Schedule  Practice Assessment Which vaccines to stock? Which vaccines to stock? Age range and medical conditions of your patients Age range and medical conditions of your patients Vaccine Storage: separate freezer (shingles vax) / dedicated refrigerator Vaccine Storage: separate freezer (shingles vax) / dedicated refrigerator  Ready, set: Order (and bill) Ordering vaccines: point person Ordering vaccines: point person Billing (know your ICD’s and CPT’s and don’t forget administration fees) Billing (know your ICD’s and CPT’s and don’t forget administration fees)

Media Hooks  Use them to start the conversation

Make it happen: The Hook How the Media can help you Examples:  Measles at Disneyland  Mumps in the National Hockey League  Pertussis epidemics  Flu: trends/ outbreaks  Last year’s low flu vaccine effectiveness is opportunity for discussion: this year’s vaccine has had a makeover (strains covered are different)

Make it Happen  Show that you are a believer  Practice what you preach  Flu vaccination clinic for staff Use vaccine effectiveness to show how everyone needs vaccination (not 100%) Use vaccine effectiveness to show how everyone needs vaccination (not 100%) Even if you don’t get real sick, you could give it to elderly relative Even if you don’t get real sick, you could give it to elderly relative  Tdap-Use family discussions with patients (grandchild --niece--nephew on the way)

Social Media: Tweet/ Facebook Photo from Office Flu Clinic with Reminder that Flu Shots are in!

Flu Vaccine Makeover: Flu Vaccination : Standard Shot (IIV3 and IIV 4)  IIV 3: Trivalent vaccines will contain: an A/California/7/2009 (H1N1)pdm09-like virus; (same as ) an A/California/7/2009 (H1N1)pdm09-like virus; (same as ) an A/Switzerland/ /2013 (H3N2)-like virus; (NEW) an A/Switzerland/ /2013 (H3N2)-like virus; (NEW) a B/Phuket/3073/2013-like virus. (NEW) a B/Phuket/3073/2013-like virus. (NEW)  IIV 4: Quadrivalent vaccines: the above + a B/Brisbane/60/2008-like virus (same as ) a B/Brisbane/60/2008-like virus (same as )

Free Posters, etc. from CDC

Free Templates for Stickers

Vaccine Information Statements (VIS)

VIS Notebook (Vaccine Information Statements)

ACIP Recommendations

If you don’t stock it, write Rx for it!

Pneumococcal Vaccination Confusion: Dispelling the Myths  Confusion about which vaccine is needed  Confusion about which vaccine to get first  Confusion about coverage by Medicare  Confusion by pharmacies as to what to give (anecdote: gave patient Rx to get PCV 13; pharmacy gave them PPSV23 and patient had received that already!)

PCV 13 and PPSV 23 can NOT be given at the same time! ACIP recs:  The minimum acceptable interval between the PCV13 and then PPSV23: 8 weeks  Recommended interval between the PCV13 and then PPSV23 : 6-12 months  Adults 65 years of age or older who have previously received PPSV23 should receive the PCV 13 at least 1 year after their most recent dose of PPSV23.  Medicare coverage parameters are different

Pneumococcal vaccination is covered under Medicare Part B Source:  Medicare Part B (Medical Insurance) covers a pneumococcal shot to prevent pneumococcal infections (like certain types of pneumonia). Medicare Part B (Medical Insurance) Medicare Part B (Medical Insurance)  Part B also covers a different second shot 11 months after the exam where you got the first shot.

Adult I mmunization: The Inside Story Vaccines for Adults (price per dose) *means company website  Flu- Inactivated shot ($12-19) Egg-free FluBlok ($32) Nasal vaccine (live) ($24) Intradermal* ($17.50) High dose* ($30)  Hep A ($63-65)- need 2  Hep B ($52-59)- need 3  HPV- Series 3 doses HPV2, HPV4, HPV9* $128 / $147 / $163  Hib* haemophilus influenza type b ($27)  Meningococcal ACWY ($71-75) B*: Bexsero $160 (need 2) Trumenba $135 (need 3)  MMR (live) ($59)- need 2  Pneumococcal PPSV 23- ($72) PCV 13-($152)  Shingles ($187)  Td/ Tdap ($24 / $37)  Varicella ($100) need 2

Happy Vaccinating!