Protecting the Circle of Life: Adult Immunizations by Amy Groom , MPH and CDR Ann Gorman , PharmD, BCPS, NCPS, NCPS-I IHS Clinical Rounds January 10, 2013 hosted by Susan Karol, MD IHS Chief Medical Officer
Objectives: 1. Understand the rationale and current recommendations for adult immunizations 2. Be familiar with tools and strategies they can implement in their facilities to help improve adult immunization coverage. 3. Understand the rationale for and how to set up a pharmacy based immunization clinic.
Accreditation • The Indian Health Service (IHS) Clinical Support Center is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The IHS Clinical Support Center designates this live educational activity for a maximum of 1 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. • The Indian Health Service Clinical Support Center is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. • This activity is designated 1.0 contact hours for nurses.
Disclaimer Accreditation applies solely to this educational activity and does not imply approval or endorsement of any commercial product, services or processes by the CSC, IHS, the federal government, or the accrediting bodies.
Upcoming Clinical Rounds • IHS TBHCE Training Calendar • January 17 th – • Northwest Portland Area IndianHealth Board’s WeRNative website presentation • February 14 th – Management of Chronic Pain in Primary Care
Faculty Disclosure Statement As a provider accredited by ACCME, ANCC, and ACPE, the IHS Clinical Support Center must ensure balance, independence, objectivity, and scientific rigor in its educational activities. Course directors/coordinators, planning committee members, faculty, and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial relationships with any commercial interest related to the subject matter of the educational activity. Safeguards against commercial bias have been put in place. Faculty will also disclose any off-label and/or investigational use of pharmaceuticals or instruments discussed in their presentation. Disclosure of this information will be included in course materials so those participating in the activity may formulate their own judgments regarding the presentations. The course directors/coordinators, planning committee members, and faculty for this activity have completed the disclosure process and have indicated that they do not have any significant financial relationships or affiliations with any manufacturers or commercial products to disclose.
Meet the Presenters: Amy Groom, MPH • Amy Groom is a CDC assignee to IHS, and has served as the IHS immunization Program Manager since 2001. • She oversees the development of the RPMS immunization software and serves as a liaison between IHS, CDC and state immunization programs on issues affecting the American Indian and Alaska Native population. • She has a Master in Public Health from Boston University.
Meet the Presenters: CDR Ann Gorman, PharmD • CDR Ann Gorman was co-director of Phoenix Indian Medical Center's Pharmacy Immunization Services from 2006-2012. • With 2 providers her first year and 30 providers her final year, the pharmacy was able to offer an array of immunization services in the outpatient and inpatient settings. • CDR Gorman has transferred to Santa Clara Health Clinic in Espanola, NM for a new adventure.
Guidelines for Receiving Continuing Education Credit • To receive a certificate of continuing education or certificate of attendance, you must attend the educational event in its entirety and successfully complete an on-line evaluation of the seminar within 15 days of the activity. At the end of the evaluation, click on the appropriate line to obtain your certificate, fill in your name and print the certificate. • If you need assistance, please contact Dr. Chris Fore (chris.fore@ ihs.gov) or Mollie Ayala (mollie.ayala@ihs.gov).
Protecting the Circle Of Life: Adult Immunizations Amy Groom, MPH IHS Immunization Program Manager
Overview of the Presentation • Provide rationale for emphasis on adult vaccination • Review current adult vaccine recommendations • Review current adult vaccine coverage estimates • Describe strategies and best practices to increase adult vaccine coverage • Describe the process for implementing a pharmacy-based immunization clinic
Background High burden of illness from infectious diseases among adults in the United States for which vaccines are available • From 3,000 to about 49,000 influenza-related deaths per year – ~90% among adults 65 years and older • 9,419 cases of acute hepatitis B in 2009 • 43,500 cases invasive pneumococcal disease (IPD) in 2009, including ~5,000 deaths – 85% of IPD and nearly all IPD deaths among adults • Over 27,000 reported cases of pertussis in US in 2010 – 6,640 among adults, 4% of which are hospitalized • About 1 million cases of zoster annually U.S 1.CDC. Active Bacterial Core Surveillance. http://www.cdc.gov/abcs/reports-findings/survreports/spneu09.pdf 2.Huang et al . Vaccine 2011 3.2009 NNDSS 4.Thompson AJPH 2009 5.CDC. Prevention of Herpes Zoster. MMWR 2008. 57(RR-5): p. 1-30 Slide courtesy of Dr. Carolyn Bridges, presented at the 2012 National Adult Immunization Summit
VACCINE RECOMMENDATIONS
Vaccine Recommendations CDC 2012 Recommended Adult Vaccine Schedule
Vaccine Recommendations CDC 2012 Recommended Adult Vaccine Schedule
Changes/New Recommendations • Hepatitis B vaccine for all unvaccinated diabetics 19 – 59 years (Dec. 2011) – Can be considered for those 60 yrs and older • Routine Tdap for all adults, including those 65 years and older (June 2012) • Tdap during EVERY pregnancy (Dec. 2012) – To protect the infant through passive antibody transfer – Optimal window is 27 – 36 weeks gestation • 13-valent Pneumococcal Conjugate vaccine (PCV13) for adults with immunocompromising conditions (Oct. 2012) Source: CDC/ACIP Vaccine Recommendations: http://www.cdc.gov/vaccines/pubs/ACIP-list.htm
PCV13 Recommendation for Immunocompromised Adults • Pneumococcal Naïve persons: – PCV13 first, followed by a dose of 23-valent Pneumococcal Polysaccharide Vaccine (PPSV23) at least 8 weeks later. – Re-vaccination with PPSV23 5 years after PPSV23 dose if indicated • Previous vaccination with PPSV23: – PCV13 dose ≥1 year after the last PPSV23 dose was received . – For those who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23. Source: Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
TABLE. Medical conditions or other indications for administration of 13-valent pneumococcal conjugate vaccine (PCV13), and indications for 23- valent pneumococcal polysaccharide vaccine (PPSV23) administration and revaccination for adults aged ≥19 year s,* by risk group - Advisory Committee on Immunization Practices, United States, 2012 Revaccination 5 yrs after1 st dose Risk group Underlying medical condition PCV13 PPSV23 Recommended Recommended ✔ Immunocompetent persons Chronic heart disease† ✔ Immunocompetent persons Chronic lung disease§ ✔ Immunocompetent persons Diabetes mellitus ✔ ✔ Immunocompetent persons Cerebrospinal fluid leak ✔ ✔ Immunocompetent persons Cochlear implant ✔ Immunocompetent persons Alcoholism ✔ Immunocompetent persons Chronic liver disease, cirrhosis ✔ Immunocompetent persons Cigarette smoking ✔ ✔ ✔ Persons with functional or anatomic asplenia Sickle cell disease/other hemaglobinopathy ✔ ✔ ✔ Persons with functional or anatomic asplenia Congenital or acquired asplenia ✔ ✔ ✔ Immunocompromised persons Congenital or acquired immunodeficiency¶ ✔ ✔ ✔ Immunocompromised persons Human immunodeficiency virus infection ✔ ✔ ✔ Immunocompromised persons Chronic renal failure ✔ ✔ ✔ Immunocompromised persons Nephrotic syndrome ✔ ✔ ✔ Immunocompromised persons Leukemia ✔ ✔ ✔ Immunocompromised persons Lymphoma ✔ ✔ ✔ Immunocompromised persons Hodgkin disease ✔ ✔ ✔ Immunocompromised persons Generalized malignancy ✔ ✔ ✔ Immunocompromised persons Iatrogenic immunosuppression** ✔ ✔ ✔ Immunocompromised persons Solid organ transplant ✔ ✔ ✔ Immunocompromised persons Multiple myeloma * All adults aged ≥65 years should receive a dose of PPSV23, regardless of previous history of vaccination with pneumococcal vaccine. † Including congestive heart failure and cardiomyopathies, excluding hypertension. § Including chronic obstructive pulmonary disease, emphysema, and asthma. ¶ Includes B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (excluding chronic granulomatous disease). ** Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and radiation therapy.
ADULT VACCINE COVERAGE
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