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Brief Summary

GUIDELINE TITLE

Improving influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among adults aged <65 years at high risk. A report on recommendations of the Task Force on Community Preventive Services.

BIBLIOGRAPHIC SOURCE(S)

GUIDELINE STATUS

This is the current release of the guideline.

BRIEF SUMMARY CONTENT

 
RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

The relationship between the strength of evidence of effectiveness and the strength of the recommendation is defined at the end of the "Major Recommendations" field.

Overview

The Task Force on Community Preventive Services conducted systematic reviews to evaluate the effectiveness of interventions to improve targeted vaccination coverage (i.e., coverage with vaccines recommended for some but not all persons in an age range on the basis of risk for exposure or disease) among adults aged <65 years at high risk when implemented alone (single-component interventions) and in combination with other interventions (multicomponent interventions). Three targeted vaccinations recommended for populations at risk are addressed in this review: influenza, pneumococcal polysaccharide, and hepatitis B. The Task Force identified evidence that certain combinations of interventions have improved vaccination coverage.

Recommendations

  • To increase targeted vaccination coverage, the Task Force recommends provider reminders, when implemented alone, to improve targeted vaccination coverage.
  • The Task Force also recommends a combination of interventions that include selected interventions from two or three categories of interventions (i.e., increasing community demand for vaccinations, enhancing access to vaccination services, and provider- or system-based interventions - see Table below).

Table: Menu format of intervention combinations recommended by the Task Force on Community Preventive Services to increase targeted vaccinations

One or both of these interventions to enhance access to vaccination services:

  • Expanded access in health-care settings
  • Reducing client out-of-pocket costs

Plus

One or more of these provider- or system-based interventions:

  • Standing orders
  • Provider reminder systems
  • Provider assessment and feedback

And/or

One or both of these interventions to increase client demand for vaccination services:

  • Client reminder systems
  • Client education

Definitions:

The strength of the body of evidence of effectiveness was characterized as strong, sufficient, or insufficient on the basis of the number of available studies, the suitability of study designs for evaluating effectiveness, the quality of execution of the studies, the consistency of the results, and a determination of median effect size sufficient for the purpose of public health benefit.

Strength of Evidence of Effectiveness = Strength of Recommendation

The strength of each recommendation is based on the evidence of effectiveness (i.e., an intervention is recommended on the basis of either strong or sufficient evidence of effectiveness).

If insufficient evidence to determine effectiveness is found, this means that it was not possible to determine whether or not the intervention works based on the available evidence.

CLINICAL ALGORITHM(S)

None provided

EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The recommendations are based on 35 qualifying studies, all of which had good or fair execution quality. In general, the strength of evidence of effectiveness corresponds directly to the strength of recommendations (see the "Major Recommendations" field).

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

2005 Apr 1

GUIDELINE DEVELOPER(S)

Task Force on Community Preventive Services - Independent Expert Panel

SOURCE(S) OF FUNDING

U.S. Department of Health and Human Services; Centers for Disease Control and Prevention (CDC)

GUIDELINE COMMITTEE

Task Force on Community Preventive Services

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Report Prepared By: Bayo C. Willis, MPH, Immunization Services Division, National Immunization Program; Serigne M. Ndiaye, PhD, Global Aids Program/Office of the Director, National Center for HIV, STD, and TB Prevention; David P. Hopkins, MD, Division of Prevention Research and Analytic Methods, Epidemiology Program Office; Abigail Shefer, MD, Immunization Services Division, National Immunization Program

Task Force Chair: Jonathan E. Fielding, MD, Los Angeles Department of Health Services, Los Angeles, California

Task Force Members: Noreen Morrison Clark, PhD, University of Michigan School of Public Health, Ann Arbor, Michigan; John Clymer, Partnership for Prevention, Washington, DC; Kay Dickersin, PhD, Center for Clinical Trials and Evidence-based Healthcare, Brown University, Providence, Rhode Island; Alan R. Hinman, MD, Task Force for Child Survival and Development, Atlanta, Georgia; Robert L. Johnson, MD, New Jersey Medical School, Department of Pediatrics, Newark, New Jersey; Garland H. Land, MPH, Center for Health Information Management and Epidemiology, Missouri Department of Health, Jefferson City, Missouri; Patricia A. Nolan, MD, Rhode Island Department of Health, Providence, Rhode Island; Alonzo L. Plough, PhD, Public Health, Seattle and King County, Seattle, Washington; Nicolaas P. Pronk, PhD, HealthPartners Center for Health Promotion, Minneapolis, Minnesota; Dennis L. Richling, MD, Midwest Business Group on Health, Chicago, Illinois; Barbara K. Rimer, DrPH; School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Steven M. Teutsch, MD, Merck & Company, Inc., West Point, Pennsylvania

Consultants: Robert S. Lawrence, MD, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; J. Michael McGinnis, MD, Robert Wood Johnson Foundation, Princeton, New Jersey; Lloyd F. Novick, MD, Onondaga County Department of Health, Syracuse, New York

Patricia A. Buffler, PhD, University of California, Berkeley; Ross Brownson, PhD, St. Louis University School of Public Health, St. Louis, Missouri; Mary Jane England, MD, Regis College, Weston, Massachusetts; Caswell A. Evans, Jr., DDS, National Oral Health Initiative, Office of the U.S. Surgeon General, Rockville, Maryland; David W. Fleming, MD, CDC, Atlanta, Georgia; Mindy Thompson Fullilove, MD, New York State Psychiatric Institute and Columbia University, New York, New York; Fernando A. Guerra, MD, San Antonio Metropolitan Health District, San Antonio, Texas; George J. Isham, MD, HealthPartners, Minneapolis, Minnesota; Charles S. Mahan, MD, College of Public Health, University of South Florida, Tampa, Florida; Patricia Dolan Mullen, DrPH, University of Texas--Houston School of Public Health, Houston, Texas; Susan C. Scrimshaw, PhD, University of Illinois School of Public Health, Chicago, Illinois; and Robert S. Thompson, MD, Department of Preventive Care, Group Health Cooperative of Puget Sound, Seattle, Washington, also served on the Task Force while the recommendations were being developed.

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

GUIDELINE STATUS

This is the current release of the guideline.

GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the Centers for Disease Control and Prevention (CDC) Web site.

Print copies: Available from the Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS E-30, Atlanta, GA, 30333.

AVAILABILITY OF COMPANION DOCUMENTS

None available

PATIENT RESOURCES

None available

NGC STATUS

This NGC summary was completed by ECRI on July 8, 2005. The information was verified by the guideline developer on July 19, 2005.

COPYRIGHT STATEMENT

No copyright restrictions apply.

DISCLAIMER

NGC DISCLAIMER

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Readers with questions regarding guideline content are directed to contact the guideline developer.


 

 

   
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