1. 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

2. 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

3. Presentation Outline Adult Immunization Healthy People 2010 Objectives NVAC reports and recommendations on adult immunization Proposed role for NVAC

4. 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)

5. 14-28: Increase Hepatitis B vaccine coverage among high-risk groups ObjectiveIncrease Hep B Coverage in High Risk Groups 1995 Baseline 2010 Target Percent 14-28aLong-term hemodialysis patients 3590 14-28bMen who have sex with men 960 14-28cOccupationally exposed workers 6793

6. 14-29: Increase proportion of adults vaccinated against influenza and pneumococcal disease ObjectiveIncrease in adults vaccinated1998 Baseline 2010 Target Percent Noninstitutionalized adults aged 65 years and older 14-29aInfluenza vaccine6490 14-29bPneumococcal vaccine4690 Noninstitutionalized high-risk adults aged 18 to 64 years 14-29cInfluenza vaccine2660 14-29dPneumococcal vaccine1360

7. 14-29: Increase proportion of adults vaccinated against influenza and pneumococcal disease ObjectiveIncrease in adults vaccinated1998 Baseline 2010 Target Percent Institutionalized adults (persons aged 18 years and older in long- term or nursing homes) 14-29eInfluenza vaccine59 (1997)90 14-29fPneumococcal vaccine25 (1997)90 Noninstitutionalized adults aged 18 to 64 years 14-29gInfluenza vaccine for health care workers 37 (2000)60

8. 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

9. 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

10. 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

11. 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

12. 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)