Immunization Update 2014: A Focus on Medical Indications for Vaccines in Adults- Pharmacist
The Healthy People 2020 report, published by the U.S. Department and Health and Human Services, includes targets for reducing vaccine-preventable disease rates and increasing vaccination rates in all age groups. According to the report, the routine childhood vaccination schedule prevents 14 million cases of disease, and reduces direct healthcare costs by $9.9 billion for each group of individuals vaccinated during the year they were born. Despite vaccines being one of the most cost-effective clinical preventive services, approximately 42,000 adults and 300 children in the U.S. die each year from vaccine-preventable diseases. There have been a number of recent measles and pertussis outbreaks in communities with pockets of unvaccinated and under-vaccinated children.
In order to meet the Healthy People 2020 targets, all healthcare providers should remain up-to-date on vaccine recommendations and play an active role in immunizations. The Centers for Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (ACIP) update their recommendations for routine immunizations annually, while vaccine-specific recommendations are typically updated every 3-5 years (except influenza, which is updated yearly). Additionally, the CDC publishes the General Recommendations on Immunization and the Epidemiology and Prevention of Vaccine-Preventable Diseases (otherwise known as “The Pink Book”), which are considered core references for vaccine providers. The updated ACIP-recommended immunization schedule for adults was published in the Annals of Internal Medicine in February 2014; the schedules for children, adolescents, and adults are available online.
Vaccines for adults are recommended on the basis of age, medical conditions, lifestyle, occupation, and travel. This review will focus on specific recommendations and considerations for adults 19 years of age and older who have altered immunocompetence, common chronic medical conditions, and selected health characteristics or concerns. Further information for these and other special groups can be found in the ACIP recommendations. (See Tables 1-3.)