October 2007 NVAC Meeting Minutes
The first adult immunization objective of Healthy People 2010 (14-28) is to increase hepatitis B vaccination coverage among three high-risk groups—long-term hemodialysis patients, men who have sex with men (MSM), and occupationally exposed workers. The objective requires that occupationally exposed workers be offered hepatitis B vaccine at no cost. This was mandated by the Occupational Safety and Health Administration in 1990 and explains why coverage rates are higher with occupationally exposed workers than with the other two high-risk groups.
The next adult immunization objective of Healthy People 2010 (14-29) is to increase the proportion of adults vaccinated against influenza and pneumococcal disease. During the midcourse review of the Healthy People 2010 objectives, part G of objective 14-29 was added to increase the proportion of healthcare workers who receive the influenza vaccine. However, statistics regarding influenza vaccination in healthcare workers have not improved much since 2000.
Dr. Strikas reviewed NVAC’s efforts to address issues of coverage in reports from 1990 to 2005. He believes NVAC should review the status of adult vaccination coverage and attitudes about—and barriers to—adult immunization. He also suggested NVAC consider forming an Adult Immunization Working Group and that the Committee review financial barriers to vaccination and programmatic approaches for improving vaccine update during their February meeting.
In response to a question about how to address the issues identified in the 1990 and 1994 reports, Dr. Strikas proposed that the Subcommittee on Immunization Coverage examine current strategies that could be incorporated into public and private healthcare settings, with no, or limited, extra resources, to improve vaccination coverage. Dr. Andrew Pavia suggested the Subcommittee create a report card of the original recommendations to see which ones failed and which ones had not been implemented and to identify the barriers to implementation in order to come up with new recommendations.
Since the release of the 1990 and 1994 NVAC statements, there have been several big changes related to adult immunizations. Therefore, Dr. Anne Schuchat believed all strategies to improve vaccination coverage should be reexamined. Since the initial reports were published, three new vaccines became available for adults: The Tdap (tetanus, diphtheria, and pertussis) vaccine, the herpes zoster (shingles) vaccine, and the human papillomavirus (HPV) vaccine (for women). The annual supply of influenza vaccine has increased substantially. And thirdly, the impact of indirect protection of adults through childhood vaccination has been demonstrated through the huge decrease in the number of cases of pneumococcal disease in adults since administration of pneumococcal conjugate vaccine (PCV) in children began in 2000.
Dr. Geoffrey Evans ended the discussion by clarifying that Zostavax, the herpes zoster vaccine, is not covered under the National Vaccine Injury Compensation Program (VICP) because it is not routinely used in children. The same holds true for the pneumococcal polysaccharide vaccine, the other vaccine given routinely to adults.
Adult Immunization at CDC—Dr. Gina T. Mootrey
Dr. Gina T. Mootrey began her presentation by explaining that the Immunization Services Division (ISD), which is housed within the National Center for Immunization and Respiratory Diseases (NCIRD) at CDC, is the division within CDC that primarily coordinates adult immunization activities. ISD works closely with the Advisory Committee on Immunization Practices (ACIP).