Jacklyn Chandler, M.S., Outreach Coordinator, MDHHS Division of Immunization

Making sure your adult patients are up-to-date on vaccines recommended by the Centers for Disease Control and Prevention (CDC) and the Michigan Department of Health and Human Services (MDHHS) gives them the best protection available from several serious diseases and related complications. The National Vaccine Advisory Committee (NVAC) recently revised and updated the Standards for Adult Immunization Practice to reflect the important role that all healthcare professionals play in ensuring adults are getting the vaccines they need.

These new standards were drafted by the National Adult Immunization and Influenza Summit (NAIIS) of over 200 partners, including medical associations, state and local health departments, pharmacists associations, federal agencies, and other immunization stakeholders¹. What makes adult immunization a priority for leaders in medicine and public health?

Every year, tens of thousands of adult Americans suffer serious health problems, are hospitalized, and even die from diseases that could be prevented by vaccines². These diseases include shingles, influenza, pneumococcal disease, hepatitis A, hepatitis B-related chronic liver disease and liver cancer, HPV-related cancers and genital warts, pertussis ("whooping cough"), tetanus and more. Adult vaccination rates are extremely low. For example, coverage rates for Tdap and zoster vaccination are less than 30% for adults who are recommended to receive them³. In Michigan, even high risk groups are not getting the vaccines they need -- only 30.6% of adults younger than 65 years old who are high risk for complications from pneumococcal disease are vaccinated⁴.

Make it clear to your patients that vaccination is important because it not only protects the person receiving the vaccine, but also helps prevent the spread of certain diseases, especially to those that are most vulnerable to serious complications, such as infants and young children, elderly, and those with weakened immune systems. Immunizing adults creates healthier communities and protects the places in which we live, work, and play.

Adults trust their healthcare provider to advise them about important preventive measures. Most health insurance plans provide coverage for recommended adult vaccines. Furthermore, research indicates that most patients are willing to get vaccinated if recommended by their provider^{5, 6}. However, many patients report their healthcare providers are not talking with them about vaccines, missing critical opportunities to immunize⁷.

MDHHS is calling on all healthcare professionals to make adult immunizations a standard of routine patient care in their practice by integrating four key steps⁸:

1. ASSESS immunization status of all your patients at every clinical encounter. This involves staying informed about the latest CDC recommendations for immunization of adults and implementing protocols to ensure that patients' vaccination needs are routinely reviewed.
2. Strongly RECOMMEND vaccines that patients need. Key components of this include tailoring the recommendation for the patient, explaining the benefits of vaccination and potential costs of getting the diseases they protect against, and addressing patient questions and concerns in clear and understandable language.
3. ADMINISTER needed vaccines or REFER your patients to a provider who can immunize them. It may not be possible to stock all vaccines in your office, so refer your patients to other known immunization providers in the area to ensure that they get the vaccines they need to protect their health. Coordinating a strong immunization referral network will reduce a substantial burden on your adult patients and your practice. If your adult patients do not have insurance, or if their insurance does not cover any of the cost of an immunization, check with your local health department to see if your patient qualifies for the following public vaccines: Td, Tdap, MMR, Hep A, Hep B or Zoster.
4. DOCUMENT vaccines received by your patients. Help your office, your patients, and your patients' other providers know which vaccines they have had by documenting in the Michigan Care Improvement Registry (MCIR). And for the vaccines you do not stock, follow up to confirm that patients received recommended vaccines.

Additional educational resources are available to provider offices, including free immunization education sessions through the MDHHS Immunization Nurse Education program and the Physician Peer Education Project on Immunization. The education sessions through both education programs are approved for continuing medical education credit. Visit www.aimtoolkit.org -- click "Information for Health Care Professionals" and "Education & Training" for more complete information⁹.

Informational brochures about immunization topics are available free of charge from MDHHS. A variety of materials is available, and can be ordered online at www.healthymichigan.com -- click "Enter Site" and "Immunizations" to begin adding resources to your cart. In spring 2016, the "AIM Packet - Adult" was added: the contents focus on adults and include the immunization schedule, brochures, posters, and other educational flyers and resources for your practice.
 

 
References:

1. National Adult and Influenza Immunization Summit (NAIIS). Organizations Supporting the NVAC Adult Standards. Accessed May 17, 2016.
2. Centers for Disease Control and Prevention (CDC). Reasons to Vaccinate. Accessed May 17, 2016.
3. Williams WW et al. Surveillance of Vaccination Coverage Among Adult Populations -- United States, 2014. MMWR Surveill Summ 2016; 65(No. SS-1):1-36.
4. Centers for Disease Control and Prevention (CDC). Pneumococcal vaccination coverage among adults 18-64 years at increased risk and ≥65 years by State, HHS Region, and the United States, BRFSS, 2008 through 2014. Accessed May 17, 2016.
5. Ding H et al. Influenza Vaccination Coverage Among Pregnant Women -- United States, 2014-15 Influenza Season. MMWR Morb Mortal Wkly Rep 2015; 64(36):1000-1005.
6. Malosh R et al. Factors Associated with Influenza Vaccine Receipt in Community Dwelling Adults and Their Children. Vaccine 2014; 32(16): 1841-1847.
7. Ylitalo KR et al. Health Care Provider Recommendation, Human Papillomavirus Vaccination, and Race/Ethnicity in the US National Immunization Survey. Am J Public Health 2013; 103(1): 164-169.
8. Centers for Disease Control and Prevention (CDC). Standards for Adult Immunization Practice. Accessed May 17, 2016.
9. Alliance for Immunization in Michigan (AIM). Education & Training. Accessed May 17, 2016.