HRSA Endorses Recommendations for Adult
Immunizations
November
19, 2008
Dear HRSA Grantee:
Last July, HRSA sent out information
on the U.S. Department of Health and Human
Services (HHS) Initiative to Improve Health
Care Personnel Influenza Vaccination Levels.
We will be following up with selected
Primary Care Associations to determine
whether Health Centers, as major providers
of preventive and primary care, have been
able to increase the extent to which health
care workers and other frontline workers
who deal with the public are receiving
the influenza vaccination as it becomes
available this fall.
We also wish to make you aware of another
initiative within HHS to increase the
extent to which adults receive those immunizations
that are recommended by the Centers for
Disease Control and Prevention (CDC) and
their Advisory Committee on Immunization
Practices (ACIP). The ACIP consists of
15 experts in fields associated with immunization
who have been selected by the Secretary
of HHS to provide advice and guidance
to the Secretary, the Assistant Secretary
for Health, and CDC on the control of
vaccine-preventable diseases.
The Committee develops written recommendations
for the routine administration of vaccines
to children and adults in the civilian
population. Recommendations include age
for vaccine administration, number of
doses and dosing interval, and precautions
and contraindications. The overall goals
of the recommendations are to provide
advice that will lead to a reduction in
the incidence of vaccine preventable diseases
in the United States, and an increase
in the safe use of vaccines and related
biological products.
Recommended Adult vaccinations include:
The complete chart of recommended vaccinations
for adults can be found at: http://www.immunize.org/catg.d/p2011.pdf
The summary of recommendations for adult
immunization covers the following vaccines:
Influenza, Pneumococcal polysaccharide
(PPV), Zoster (shingles), Hepatitis B
(HepB), Hepatitis A (HepA), Td, Tdap (Tetanus,
diphtheria, pertussis) , Polio (IPV),
Varicella (Chickenpox), Meningococcal
Conjugate vaccine (MCV4), MMR (Measles,
mumps, rubella) and Human papilloma virus
(HPV).
Why some adults need vaccines
Some adults incorrectly assume that the
vaccines they received as children will
protect them for the rest of their lives.
Generally this is true, except that:
- Some adults were never vaccinated
as children
- Newer vaccines were not available
when some adults were children
- Immunity can begin to fade over time
- As we age, we become more susceptible
to serious disease caused by common
infections (e.g., flu, pneumococcus).
Updated Recommendations
In 2008 ACIP published updated recommendations
regarding the use of approved vaccinations
to control diseases in the U.S. The ACIP
schedule is updated annually, with the
next update scheduled for January, 2009.
The updates can be found at: http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm#chgs
Some of the differences in the 2008 schedule
from the previous schedule are as follows:
- Varicella (Chickenpox) vaccine is
recommended for all adults without evidence
of immunity to varicella.
- The varicella vaccine may be considered
for persons infected with HIV who have
CD4+ T lymphocyte counts of 200 cells/µL
or more.
- Zoster vaccine is recommended for
persons aged 60 years and older.
- Zoster vaccine is not recommended
for patients with immunocompromising
conditions, including HIV.
- The influenza vaccine for "health-care
personnel" indicates that health-care
personnel can receive either trivalent
inactivated influenza vaccine (TIV)
or live, attenuated influenza vaccine
(LAIV).
HRSA recommends that grantees which provide
a full range of primary and preventive
health services, such as Health Centers
and certain Ryan White grantees, familiarize
themselves with the full set of Recommendations
for Adult Immunization, as well as recent
changes in those recommendations. In addition,
it is recommended that as adults receive
care and preventive services, that a renewed
effort be made to determine individual
patient’s vaccination status, and
that positive actions be taken to bring
such patients up to date with regard to
the recommended schedule. There are also
evidence-based strategies recommended
by the Task Force on Community Preventive
Services that have been demonstrated to
improve adult immunization rates, such
as reminder-recall systems, standing orders,
and expanding access (available clinic
time) for vaccination, which I encourage
you to consider implementing in your clinic
setting. These can be reviewed at http://www.thecommunityguide.org/vaccine/default.htm.
We appreciate your support in this effort.
/S/
Elizabeth M. Duke
Administrator
Health Resources and Services Administration
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