adult immunization

CDC: Vaccination rates among kindergartners remain stable

kkrisberg — Tue, 17 Oct 2017 20:05:49 +0000

CDC: Vaccination rates among kindergartners remain stable

In more encouraging public health news, the Centers for Disease Control and Prevention reports that vaccination rates among kindergarteners have remained stable, with the median vaccine exemption rate at 2 percent. Some states even reported an increase in immunization rates.

In a study published last week in CDC’s Morbidity and Mortality Weekly Report, researchers examined 2016-2017 data from 49 states regarding coverage of three vaccines: measles, mumps and rubella (MMR); diphtheria, tetanus and acellular pertussis (DTaP); and varicella, more commonly known as chickenpox. Researchers also examined exemption numbers from all 50 states as well as data on kindergartners in 27 states who were provisionally enrolled in school or were within a vaccine grace period. They found median vaccination coverage was at 94.5 percent for state-required doses of DTaP; at 94 percent for two doses of MMR, which is what the Advisory Committee on Immunization Practices recommends; and at 93.8 percent for two doses of varicella, also what the committee recommends.

Overall, it means rates of vaccine coverage and vaccine exemption have been “relatively consistent” since 2011-2012. According to researchers: “Vaccination coverage remains consistently high and exemptions low at state and national levels.”

Getting into the particulars, the study reported that MMR vaccine coverage ranged from more than 85 percent in Washington, D.C., to more than 99 percent in Mississippi, with 20 states reporting coverage at 95 percent or higher. Among the 48 states that reported DTaP data, coverage ranged from about 82 percent in Washington, D.C., to nearly 100 percent in Maryland, with 23 states at 95 percent or higher. On chickenpox, 42 states reported coverage ranging from more than 84 percent in D.C. to more than 99 percent in Mississippi, with 15 states reporting coverage rates of 95 percent or above.

Among 46 states reporting data, the median percentage of kindergartners exempted from one or more vaccines was 2 percent. That rate ranged from less than 1 percent in Mississippi to nearly 7 percent in Alaska. Exemption rates were lower than 1 percent in four states: Alabama, Louisiana, Mississippi and West Virginia. Between the 2015-2016 and 2016-2017 school years, the exemption rate decreased in California and Vermont and slightly increased in Alaska, Georgia, Nevada, New Hampshire, New Mexico, North Carolina and Wisconsin. The median percentage of kindergartners in school with a provisional enrollment or during a grace period was at 2 percent.

The study found that four states — California, New York, North Dakota and Tennessee — reported increased coverage rates for all three vaccines. Researchers said the increases could be due to policy changes as well as efforts to educate school personnel on vaccine requirements. For example, California eliminated nonmedical exemptions for kindergartners at public and private schools. And in North Dakota, educating school superintendents on the importance of vaccines prompted most school districts to more strictly enforce vaccine requirements, which led to coverage increases of more than 3 percentage points for each of the three vaccines.

Researchers concluded the study by pointing to the importance of local data in guiding public health immunization efforts. Co-authors Ranee Seither, Kayla Calhoun, Erica Street, Jenelle Mellerson, Cynthia Knighton, Ashley Tippins and J. Michael Underwood write:

However, clusters of low vaccination coverage continue to serve as opportunities for outbreaks of vaccine-preventable diseases. Because vaccination coverage and exemption levels are clustered locally, availability of local-level vaccination data can help immunization programs identify schools that might be vulnerable in an outbreak. CDC is working with programs to improve collection and use of grace period and provisional enrollment data to understand contributing factors for reported under-vaccination and identify programmatic actions that might increase vaccination coverage among kindergartners.

Proposals at the federal level could impact vaccine rates as well. For example, lawmakers are looking to raid billions from the Affordable Care Act’s Prevention and Public Health Fund (PPHF) to keep the Children’s Health Insurance Program running — leaders in Congress let funds for the vital safety net program expire in September. However, monies from the PPHF already go to support other essential health programs, such as CDC’s Section 317 Immunization Program, which provides vaccines to underinsured children and uninsured adults. Fifty-three percent of the 317 funding now comes from the PPHF.

Advocates are calling on Congress to pass a “clean” bill that extends CHIP funding without pitting critical health programs against each other.

For a copy of the new vaccine study, visit MMWR.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Tue, 10/17/2017 - 16:05

When adults forgo their immunizations, it costs the nation billions in care

kkrisberg — Fri, 14 Oct 2016 15:54:40 +0000

When adults forgo their immunizations, it costs the nation billions in care

Another day, another study on the benefit of vaccines. This time, it’s a study on the economic cost of vaccine-preventable diseases among U.S. adults — a cost that likely surpasses your wildest guesses.

Published this week in Health Affairs, the study found that vaccine-preventable diseases affecting adults cost the American economy $8.95 billion in 2015, with unvaccinated adults accounting for $7.1 billion of that total. To conduct the study, researchers examined the economic burden associated with 10 vaccines that protect against hepatitis A; hepatitis B; shingles (or herpes zoster); human papillomavirus (HPV); influenza; measles, mumps and rubella (MMR); meningococcal disease; pneumococcal disease; tetanus, diphtheria and pertussis (Tdap); and chickenpox.

They found that the majority of that economic burden, about 95 percent, was due to direct medical costs, including $5.9 billion for inpatient treatment and $2.4 billion for outpatient treatment. The remaining 5 percent of the total tab was attributed to productivity losses, i.e. wages lost while receiving medical care. The costliest vaccine-preventable disease was the flu, which accounted for 65 percent, or $5.8 billion, of the economic burden. Another 21 percent, or $1.9 billion of the calculated 2015 burden, was due to pneumococcal disease, and 9 percent, or $782 million, was due to shingles. Study authors Sachiko Ozawa, Allison Portnoy, Hiwote Getaneh, Samantha Clark, Maria Knoll, David Bishai, H. Keri Yang and Pallavi Patwardhan write:

Estimating the economic burden of vaccine-preventable diseases among adults is a first step toward understanding the benefits of increasing adult vaccine uptake in the United States. It highlights the need for US adults to better appreciate the value of vaccines to prevent economic burden. By highlighting the tremendous financial burden that unvaccinated individuals place on the economy and the health system, we hope that our estimates will spur creative policy solutions to reduce the negative externality or spillover effect, while preserving the autonomy of patients to make more informed choices.

The study found that economic costs varied by age groups as well. For example, among people ages 19 to 49, influenza represented the greatest economic burden, at 85 percent, followed by HPV, at 12 percent. For people ages 50 to 64, influenza again took the top spot, followed by shingles. And for adults 65 and older, flu was again in first place, followed by pneumococcal disease. According to the Centers for Disease Control and Prevention, only about 43 percent of U.S. adults got vaccinated against influenza during the 2014-2015 flu season.

About 76 percent, or 14.1 million, of vaccine-preventable disease cases examined in the study occurred among unvaccinated adults, with the economic burden attributable to unvaccinated adults totaling $7.1 billion in 2015.

“The positive health impacts of vaccination, including reduced mortality and morbidity, are recognized more often than the economic burden from people not getting vaccinated,” the study stated. “Estimating and considering the economic burden of adult vaccine-preventable diseases is necessary for public health spending decisions and for increasing adult uptake of vaccines in the United States.”

To request a full copy of the vaccine study, visit Health Affairs. To learn more about expanding access to adult vaccinations, visit the Adult Vaccine Access Coalition.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.

kkrisberg Fri, 10/14/2016 - 11:54

Adult Vaccine Access Coalition launches to rally efforts to increase adult immunization rates

kkrisberg — Fri, 30 Oct 2015 15:31:57 +0000

Adult Vaccine Access Coalition launches to rally efforts to increase adult immunization rates

When it comes to immunization rates in the United States, the story is a mixed one. Among children, we’ve absolutely excelled. In fact, the Centers for Disease Control and Prevention considers the nation’s childhood vaccination rate as one of the greatest public health achievements of the 20^th century. But when it comes to American adults — 50,000 of whom die every year from vaccine-preventable diseases — it’s a very different story.

Earlier this year, CDC’s Morbidity and Mortality Weekly Report reported that uptake of recommended adult immunizations remains low and is far below Healthy People 2020 targets. (Healthy People 2020 sets the nation’s health objectives for the current decade.) In analyzing data from the 2013 National Health Interview Survey, researchers found that just more than 17 percent of adults received a tetanus-diphtheria-pertussis (Tdap) vaccine; 24.2 percent received a vaccine against shingles; just 5.9 percent of young men received a human papillomavirus vaccine; and about 21 percent of adults at high risk received a pneumococcal vaccine. During the 2014-2015 influenza season, adult flu immunization rates did go up by 1.4 percent, but the overall rate was still below 50 percent.

The low rates not only mean many adults remain susceptible to preventable diseases, but that they risk transmitting often dangerous diseases to particularly vulnerable populations, such as very young children, the elderly and those with impaired immune systems. And consider this: The flu alone costs the U.S. billions of dollars in medical care and lost productivity.

These less-than-ideal adult vaccination rates have attracted the attention and action of health professionals for quite some time. However, in September at a briefing in the U.S. Capitol in Washington, D.C., a new coalition of stakeholders from across the health care system officially declared its intention to take up the issue of adult immunizations in earnest and facilitate new solutions to strengthen and enhance access to adult vaccines. Known as the Adult Vaccine Access Coalition (AVAC), the group’s diverse members include health care providers, pharmacists, public health organizations, vaccine makers, and patient and consumer groups. Among its many member groups are the American Public Health Association, American Pharmacists Association, American Academy of Family Physicians, and the Pharmaceutical Research and Manufacturers of America.

The coalition’s policy priorities are three-fold: improving adult immunization data collection; establishing new benchmarks to measure and encourage progress; and advocating for initiatives that boost adult vaccine rates among the most vulnerable and begin to close racial and ethnic disparities in vaccine uptake. Laura Hanen, co-chair of the new coalition and chief of government affairs at the National Association of County and City Health Officials, said the coalition is an opportunity to bring all the stakeholders together and channel relevant resources and skills toward one overriding goal.

“We’ve all been working on this issue in our individual lanes, whether it’s public health groups, health care providers, pharmacists,” Hanen told me. “Now we’re coming together to create collective leverage and build more understanding and awareness around the barriers to adult immunization and try to address it in the post-Affordable Care Act era.”

So why are adult vaccine rates so low? Especially when the U.S. has made such great strides in childhood vaccination coverage. As with most public health conundrums, there are many contributors, but Hanen pointed to a few big ones. Among them are provider and patient awareness. Recommended adult vaccination schedules are not necessarily easy to understand — different vaccines are recommended for different age groups and for people with particular health issues and susceptibilities. It can be “incredibly complicated,” Hanen noted.

Cost and financial reimbursement for adult immunizations have also traditionally been barriers, she said, though new ACA provisions will likely reduce those hurdles. (Under the health reform law, adults who purchase insurance through the new insurance marketplace are entitled to Advisory Committee on Immunization Practices-recommended vaccines with no cost-sharing.) Hanen also added that geographic challenges play a role, noting that not all providers carry the full spectrum of recommended adult vaccines.

Another big contributor, she told me, is that unlike childhood vaccines, there’s no nationwide infrastructure and support system in place devoted to increasing adult vaccine rates. For children, there’s the national Vaccines for Children program, which provides vaccines at no cost to children whose families may not otherwise be able to afford the life-saving drugs. There’s the Section 317 Immunization Program, a federally funded initiative that provides vaccines to uninsured and underinsured kids and adults; there’s school vaccine requirements; and there’s comprehensive reporting of child immunizations to public health agencies so officials can identify gaps and areas of need. In other words, there’s an entire system built to ensure children are protected against vaccine-preventable diseases — and that system has worked incredibly well. Sadly, that’s simply not the case with adults.

Fortunately, AVAC wants to change that. Building on current vaccine systems to improve adult rates is a priority focus for the coalition. For example, Hanen noted that while every state has an immunization registry, their focus has primarily been on engaging with pediatricians and collecting data on childhood immunization coverage. However, the same system could be used to beef up adult vaccine rates too — health departments just need the resources to engage more diverse providers in the registry process, she said. Ideally, all vaccine providers, whether physicians or pharmacists, would be able to access the registry to view an adult’s immunization record, which would give the provider a chance to offer their adult patients seasonal or newly recommended immunizations. In addition, more providers would report adult vaccine data to the registries, providing public health practitioners with the valuable data needed to inform education campaigns, identify coverage gaps and pinpoint particularly vulnerable communities.

“The challenge is that immunization registries need more resources to be more robust,” Hanen said. “With health information technology, we have the opportunity to improve reporting and access and increase cooperability with health systems and records, but we’re not quite there yet.”

Strengthening state registries is just one piece of the coalition’s goals. Overall, AVAC is dedicated to finding systemic and evidence-based answers to the adult vaccine problem. Already, the coalition is speaking out on a number of federal measures that affect adult vaccine access and offering solutions. But as with any problem that has as many contributors and stakeholders as the adult vaccine puzzle, there’s “no magic bullet,” Hanen told me.

“That’s the big challenge,” she said. “It’s all connected, but there’s not one solution.”

To learn more about AVAC and the importance of adult immunizations, visit www.adultvaccinesnow.org.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

kkrisberg Fri, 10/30/2015 - 11:31

This is excellent news! I try hard to stay up-to-date on my vaccinations, but even as a knowledgeable student of public health I don't always know what I should be getting or when.

Not to mention things like when my workplace promises flu shots, but keeps saying that the nurse will come "soon". It's the end of October! We need them now, before the flu season gets bad!
(Or I could stop being lazy and spend the $10 and 30 minutes to get one at the grocery store.)