1. Some Perspectives on Vaccination of Adults
Dennis J. O’Mara
Associate Director for Adult Immunization
Immunization Services Division National 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. Annual Adult Vaccine-Preventable Disease 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 Vaccination Coverage 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
Childhood Vaccination
Adult Vaccination
Substantial Funding
Limited Funding
Substantial Vaccine
Limited Vaccine
Some Public Sector Vaccine Administration
Limited Public Sector Vaccine Administration
Substantial Public Health Infrastructure
Minimal Public Health Infrastructure
Captive Target Pop.
Non-captive Target Pop.
Univer. Target Pop.
Non-univer. Target Pop.
Minimal Disease Burden
Large Disease Burden

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 take ACTION

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 to Offset 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 Support Adult Vaccination Efforts
Guide to Community Preventive Services, MMWR, June 18, 1999, Vol. 48/No. RR-8
Guide to Clinical Preventive Services, 2nd edition, William & Wilkins, Baltimore, MD, 1996
HEDIS measures –
Influenza vaccine coverage: ≥65
Influenza vaccine coverage: 50-64
Pneumococcal polysaccharide vaccine coverage: ≥65

16. Tools Available to Support Adult Vaccination Efforts, cont.
Healthy People
The “What Works” CD
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’Mara Assoc. Director Adult Immunization
ISD / NIP / CDC
1600 Clifton Road NE · MS E-52
Atlanta, GA 30333
Telephone:
Fax:
Web Site: