IDSA Working Principles Actions Needed to Strengthen Adult and Adolescent Immunization Coverage in...

IDSA Working Principles

Actions Needed to Strengthen Adult and Adolescent Immunization

Coverage in the U.S.

Immunization Working GroupNeal A. Halsey, Chair

IDSA represents more than 8,400 physicians and scientists who work in various areas of the field of infectious diseases medicine, including patient care, basic and clinical research, public health, and academia.

IDSA Advocates for the ID Profession, Our Patients, and Public Health

• ID Product R&D (antimicrobials, vaccines, diagnostics)

• Preparedness for Pandemic Influenza and Other Bioemergencies

• Immunization (Adults and Children)• HIV/AIDS, Ryan White CARE Act• Bring a voice advocating for patients and the

best science to deal with infectious threats

IDSA Immunization Work Group

• Neal A. Halsey, MD, FIDSA, Chair• Donna Ambrosino, MD• Edward A. Belongia, MD• Gail A. Bolan, MD• Walter A. Orenstein, MD,FIDSA• Andrew T. Pavia, MD• William Schaffner, MD, FIDSA• Bonnie M. Word, MD

CDC Estimates of Annual Burden of Adult Vaccine Preventable Disease in

the U.S.

• Premature deaths: > 45,000

• Cost > $10 billion

• Hospitalizations ?

Source: MMWR, March 24, 2000/ Vol. 49 / No. RR-1

Self-reported Tetanus Toxoid Coveragein past 10 years by age group

US 1999+

0

20

40

60

80

100

18-49 50-64 >65

Perc

ent

Source: CDC www.cdc.gov/nip/coverage/NHIS/tables/general-99.pdf

Self-reported Tetanus Toxoid Coverageby ethnic group

US 1999+

0

20

40

60

80

100

Wnh Bnh H API Wnh Bnh H API Wnh Bnh H API

Perc

ent

Source: CDC www.cdc.gov/nip/coverage/NHIS/tables/general-99.pdf

>65 yrs18-49 50-64

Self-reported Pneumococcal Vaccination Coverage

for High Risk Adults by age groupUS 1997-2005

0

20

40

60

80

100

1997 1998 1999 2000 2001 2002 2003 2004 2005

Perc

ent >65

18-49 hi risk50-64 hi risk

Source: CDC www.cdc.gov/flu/professionals/vaccination/pdf/pneumococcal-vaccinetrend.pdf

Percentage >65 yrs who had ever received a pneumococcal vaccination

by ethnic groupJanuary - June 2006

Source: CDC www.cdc.gov/nchs/data/nhis/earlyrelease/200612_05.pdf

Why Did IDSA Issue the Principles?

1. Lessons learned from the successes in the pediatric immunization program can be applied to the AAI problem

2. To guide IDSA staff in supporting legislation and other actions

3. To help focus the efforts of the IWG and NGPHC on activities that might improve protection against disease

New Vaccines Have Created New Opportunities to Prevent Disease in

Adolescents and Adults1. Meningococcal conjugate

2. Tdap

3. HPV

4. Zoster

AAI Working Principles

I. Increase demand

II. Strengthen capacity to deliver

III. Expand provision of vaccines in insurance

IV. Promote as a measure of health care quality

V. Monitor and improve performance of the vaccine delivery and safety monitoring systems

VI. Assure adequate support for research

I. Increase demand

a. All medical providers should be encouraged to offer immunization at all encounters whenever possible.

b. Societies and subspecialties increase education; consider standards, incentives and performance benchmarks

c. Medical and nursing schools and post-graduate educational programs should support and expand curricula on VPD

I. Increase demand (2)

d. Encourage tracking and reminder systems for providers and patients

e. Emphasize 11-12, 14-15, and 17-18 year visits

f. All healthcare workers should be fully immunized

I. Increase demand (3)

g. Availability and the importance of AAI

h. Target specific vaccines and high risk:

• minority populations, adolescents and parents

Public awareness:

II. Strengthen the health care system’s capacity to deliver vaccines

a. Enhance 317 program: CDC and HHS should develop and implement a plan to finance and deliver AAI vaccines

• Follow recommendations in reports by NVAC (1994, 2004), IOM (2000) and others (Poland, 2000).

II. a. 317 program

i. vigorous adult immunization program:• sustainable and dependable funding • infrastructure and purchase. • cover all vaccines recommended by ACIP

ii. distributed equitably among the states and territories based on need

II. a. 317 program (2)

iii. Separate annual funds for adult vaccine purchase and infrastructure

• ASTHO est. for 2007: $88m and $45m • new monies: not taken from childhood

immunization resourcesiv. appropriations for Section 317 should

be increased each time ACIP approves a new vaccine

II. a. 317 program (3)

v. full-time adult immunization coordinator for each of the 64 immunization programs

vi. strengthened AAI Unit at CDC • dedicated funds to strengthen state and regional IIS • adequate personnel including regional public health

advisors • national education/promotion program • increased capacity to measure coverage.

II. b. Adolescent coverage must be strengthened

i. increase VFC providers serving adolescents: OB/gyns and internists

• finance immunization in non-traditional settings:

• school-based clinics • OB/gyn offices and clinics.

II. b. Adolescent coverage must be strengthened (2)

ii. Consideration by national and state authorities and professional societies:

• broaden minors’ consent for health care to include immunizations for STIs.

II. c. State and local public health agencies must strengthen financial

and programmatic investments in AAI

i. State budgets should strengthen support for vaccines and programs.

ii. Patient and physician reminder systemsiii. Standing order policies that allow non-

physicians to administer vaccines: • schools, pharmacies, and walk-in clinics

iv. Enhance support for AAI Coalitions

II. d. Hospitals must increase attention

• policy mandates to vaccinate eligible in-patients and out-patients

• builds on existing mandates for in-patients at nursing homes and limited CMS and JCAHO standards.

• adequate financial incentives • payment for vaccine acquisition, storage,

and administration.

II. e. Strengthen IIS for AAI

i. promote state based IIS through legislative mandates

ii. nontraditional locations iii. Increase outreach to providers,

nursing homes and other adult facilities.

II. f. Assure VICP coverage for all AAI vaccines

II. g. Address financial and administrative obstacles to AAI at non-

traditional points of care

• e.g. Tdap or influenza vaccine to the parent who brings a child

III. Expand AAI vaccine coverage in public and private health insurance

a. States should require payers to cover all AAI vaccines recommended by ACIP

b. Include payment for administration and carrying costs.

c. CMS should provide adequate payment under Medicare and Medicaid for all recommended adult vaccines

d. CMS should review codes and encourage all insurers to provide coverage

e. Other measures to encourage coverage

IV. Promote AAI as a measure of health care quality in health care organizations

a. revise HEDIS measures to include recommended adolescent vaccines (meningococcal, Tdap, and HPV vaccines not covered).

b. establish a measure on pneumococcal vaccine for older adults

c. eventual inclusion of all ACIP-recommended AAI vaccines

d. establish criteria for assessing influenza, pertussis and hepatitis B immunization rates in HCWs

NCQA

JCAHO

V. Monitor and improve the performance of the nation’s vaccine delivery and

safety monitoring systems

a. comprehensive data-collection initiative for morbidity and mortality from vaccine-preventable diseases among A and A

b. Improve surveillance of coverage and practices (don’t steal from peds)

c. coverage in high-risk patients: pregnant women, renal failure, diabetes, cardiac disease, chronic lung disease, cancer, and other disorders associated with immune deficiency.

V. Monitor and improve the performance of the nation’s vaccine delivery and

safety monitoring systems (2)

d. Ensure continued financial support for monitoring post-licensure vaccine-safety surveillance

e. Advocate with state-based collaboratives to include performance measures

f. Supplemental funding needed to support surveillance activities so that support for pediatric activities is not compromised.

VI. Assure adequate support for research regarding AAI diseases and

vaccines a. NIH, CDC, FDA and other agencies must be

adequately funded for:• effectiveness, efficacy and safety• cost-benefit research.

b. Health services research: • public and provider acceptance• elimination of racial and ethnic disparities. • vaccine delivery • factors contributing to delays or refusals

Summary

1. There are numerous specific actions that IDSA members can do or advocate for that will improve AAI

2. New financial support and commitment from federal, state, and other sources is essential to make these changes

3. Avoid taking from pediatric programs

Contact:Julie Hantman, MPH

703-299-0015jhantman@idsociety.orghttp://www.idsociety.org