Guideline source: Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices
Literature search described? No
Evidence rating system used? No
Published source: Morbidity and Mortality Weekly Report, October 19, 2007
The annual update of the harmonized adult immunization schedule was recently published in Morbidity and Mortality Weekly Report1 and is reproduced in this issue of American Family Physician (Figures 1 and 2). It represents the work of vaccine experts at the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP), as well as the collaboration of several partner organizations, including the American Academy of Family Physicians. The adult and child immunization schedules are updated each year to reflect the development, licensure, and ACIP recommendations on new vaccine products and expanded recommendations on preexisting ones. Adherence to all three schedules helps to ensure that individuals and communities can gain maximum benefits from one of the most effective public health interventions: vaccines.
Changes in this year's adult schedule are few. They include the addition of quadrivalent human papillomavirus vaccine (Gardasil) for women up to 26 years of age, and herpes zoster virus vaccine (Zostavax) for adults 60 years and older; both vaccines were approved by the U.S. Food and Drug Administration since the last adult schedule was released.2 In addition, the schedule reflects the new recommendation of a second dose of varicella vaccine for young adults who have received only one dose.
The publication of the harmonized schedule should serve as a reminder that rates of adult immunization with recommended vaccines remain suboptimal, far below rates achieved in children. The immunization goals set for 2010 include having 90 percent of adults 65 years and older and 60 percent of adults with asthma or diabetes immunized against influenza annually and against pneumococcal pneumonia.3 As a nation, we are far below these goals.4 The CDC recommends that all health care workers receive influenza vaccine in addition to vaccines against other infectious agents that can be spread in the health care setting.4,5 Again, the evidence is that we perform poorly in this area.4
There are several reasons why our adult immunization rates are so poor. Payment for adult vaccines is much more problematic than it is for children because there is no adult equivalent of the Vaccines for Children Program, which guarantees funding for vaccines for eligible children. Federal funding for adult vaccine programs is woefully inadequate; it does not keep pace with the increasing number of vaccines and the number of adults who lack insurance coverage for immunizations. Unlike vaccines for children and adolescents, many vaccines for adults are indicated based on the presence of risk factors and not age, which adds the variables of physician and patient memory to the compliance formula. Historically, universal vaccine recommendations have resulted in much higher adherence rates than risk-specific ones.
What can physicians do to improve the rate of immunizations among our staff and adult patients? After reviewing the evidence on immunizations, the Task Force on Community Preventive Services recommended the following interventions for physicians to increase vaccination rates: patient recall and reminder systems; patient education as part of a multicomponent intervention; expanded clinic hours for immunizations; measurement of performance and provision of feedback to physicians; and the use of standing orders to allow staff to vaccinate patients.6
Physicians also must ensure that their clinical setting and staff are not sources of infectious diseases that spread to patients and the community. Good office infection-control practices are essential; this includes ensuring that we and our staff are fully immunized. The CDC now recommends that staff adherence to influenza vaccination should be used as a quality measure.4
Family physicians are an important component of the nation's immunization system. To fulfill this role, we must do all we can to ensure the highest possible level of adherence to immunization recommendations by patients, staff, and ourselves.