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November 2008
Vol. 18 No. 11
Policy and Advocacy
IM Subspecialists Lend Support to Adult Immunization

The American College of Physicians (ACP), IDSA, and 17 other internal medicine subspecialty societies are asking their members to take a more active role in discussing and reviewing their adult patients’ vaccination status and in administering recommended vaccines.

IDSA played a pivotal role in encouraging ACP and the other societies to adopt a new policy statement outlining their support for adult immunization. The statement was announced earlier this month.

The Centers for Disease Control and Prevention (CDC) estimates that about 95 percent of vaccine-preventable diseases occur in adults. Each year, hundreds of thousands of adults are hospitalized and more than 46,000 adults die because of vaccine-preventable diseases or their complications. Costs associated with treatment run in the billions.

Adult Uptake of New Vaccines

2.1%:

Adults ages 18-64 who received diphtheria-tetanus-pertussis

1.9%:

Adults ages 60 and older who received zoster (shingles)

10%:

Women ages 18-26 who received human papillomavirus

Adult Uptake of Influenza Vaccine, 2007

37%:

High-risk individuals age 18-49

42%:

Individuals age 50-64

69%:

Individuals age 65 and older

Source: Centers for Disease Control and Prevention

While immunization rates among children are high, uptake rates for adults fall significantly short of public health targets. Adult vaccination rates range from 26 to 69 percent, depending on the vaccine and the specific target group. For newer vaccines, the rates are even lower. (See box.)

“Thanks to immunization, most children in this country never suffer from vaccine-preventable diseases. That’s not true for their parents or grandparents,” said William Schaffner, MD, FIDSA, chair of IDSA’s Immunization Work Group. “Every year, thousands of adults get sick, miss work, are hospitalized, and many die because of vaccine-preventable diseases.”

“It is crucial for physicians—internists, family physicians, and subspecialists who provide primary and preventive care services for patients, especially those with chronic diseases—to discuss and review their adult patients’ vaccination status and either vaccinate them or provide a referral for recommended vaccines,” said Jeffrey P. Harris, MD, FACP, president of ACP.

The ACP/IDSA statement also notes that physicians and their staff should be up to date on their own recommended immunizations, particularly their annual flu vaccinations.

ACP and IDSA plan to work with the other subspecialty societies toward facilitating access to tools and resources to help physicians encourage adult immunization--such as simple screening tools (see the Immunization Action Coalition’s patient checklist at www.immunize.org/catg.d/p4036.pdf), software for physicians offices, improved insurance coverage, and better payment for vaccines and their administration.

For its part, IDSA plans to survey its members in the near future about their practices and opinions regarding immunizing adults. “We hope IDSA members will respond to this survey and be very candid in their answers,” said Dr. Schaffner. “We have a huge potential to improve public health, but first we need to fully understand why more adults aren’t being immunized.”

Dr. Schaffner acknowledges that cost is one factor. Many new vaccines are expensive, and more than 40 million individuals in the U.S. do not have health insurance coverage. For those who do, coverage of vaccines is not always adequate.

For more information, see the adult immunization section of the IDSA website. The ACP/IDSA Joint Statement of Medical Societies Regarding Vaccination by Physicians can be found there, as well as IDSA’s 2007 policy principles on adult immunization, , with specific steps to strengthen adult immunization coverage. The American Medical Association recently lent its support to the concepts outlined in IDSA’s 2007 document.

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