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Immunization: Adult Immunization
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Gregory A. Poland, M.D., Chairman of the National Coalition for Adult Immunization (NCAI) and head of vaccine research at the Mayo Clinic, gives the U.S. healthcare system "about a C" for adult immunizations. Flu shots have become more common, yet many doctors still neglect to offer pneumococcal vaccines. Hospitals and long-term care facilities, where outbreaks are potentially deadly, have been slow to institute standing orders that mandate routine administration of flu and pneumococcal vaccines.
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The cornerstone of the College's campaign will be publication of the fourth edition of its handbook, Guide for Adult Immunization. Since 1985, when the first edition of the Guide was published, internists, health departments, college health centers and others managing adult health have turned to the book for guidance on vaccines for young and older adults. The College will ... direct the new edition to health professionals working in managed care settings, the places where many Americans now receive health care.
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There are immunization success stories. Even though Haemophilus Influenzae type b bacteria is still causing disease in the adult population, because of immunization, it is almost never seen anymore in children. A newer vaccine, called Prevnar, is seeing similar results for meningitis caused by strep pneumonia, with some studies showing decreases in disease incidence by as much as 69 percent in the last three years. This is good because these bacteria have the capability to resist to many antibiotics.
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Tetanus is completely preventable by active immunization. Tetanus toxoid has proven to be safe since its introduction during the 1920s. Tetanus toxoid consists of inactivated tetanus toxin treated with chemicals or heat to decrease the toxic effect, but to retain its antigenic power. For practical purposes, tetanus should be considered a disease against which there is no naturally acquired immunity. Tetanus toxoid is available by itself, or frequently as one of three components in a vaccine. It can be combined with diphtheria toxoid and pertussis vaccine (DTP) for primary immunization of children, and with reduced diphtheria toxoid (Td) for immunization of older adults and children.
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One adult vaccine with low immunization rates ( < 2 percent) prevents herpes zoster or shingles, a severely painful and debilitating infectious disease. "There are more than 1 million new cases of shingles in the U.S. every year; over half in people 60 and older," said Michael N. Oxman, MD, Professor, University of California, San Diego; Staff Physician at the San Diego VA Medical Center; and Chairman of the Shingles Prevention Study, the VA Cooperative Study that demonstrated the efficacy of the shingles vaccine. "The vaccine not only helps reduce the risk of getting shingles, but it reduces the incidence of postherpetic neuralgia (PHN), a long-lasting shingles pain syndrome that constitutes the most common serious and debilitating complication of shingles." PHN pain can last for years after the initial shingles outbreak and is often resistant to treatment.
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The Adult Immunization section provides information and resources related to the coverage, billing, delivery, and promotion of influenza, pneumococcal, and hepatitis B vaccinations. Medicare covers both the costs of these vaccines and their administration by recognized providers. The following sections address influenza and pneumococcal vaccinations together because of the similarities in their coverage and billing policies. Hepatitis B vaccination is addressed separately.
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Adult Immunization