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    Immunizations Across the Adult Lifespan

    Vaccinations in adulthood play an important role in public health and in reducing the morbidity and mortality associated with infections.

    Abstract: Many adult patients have not received recommended vaccines. The pharmacist is in a unique position to participate fully in the Standards for Adult Immunization Practice’s standards of assessment, recommendation, administration, and documentation of adult vaccines. This article reviews the Standards for Adult Immunization Practice and the Centers for Disease Control and Prevention’s 2017 Adult Immunization Recommendations to help pharmacists play an active role in improving immunization rates in their community.

    Introduction

    Adult vaccinations are one method of decreasing infections and their associated morbidity and mortality. The United States has created goals for specific health characteristics, including vaccine-preventable illnesses and immunizations. HealthyPeople 2020 was established in 2008 with specific standards it hopes to achieve by 2020.1 Many of the goals have not yet been achieved. 

    Related article: New Map Highlights Children's Vaccine Rates, Disease Outbreaks by State

    One important HealthyPeople goal is to decrease the incidence of invasive pneumococcal disease (IPD) in the elderly and high-risk populations. Consider, for example, the noninstitutionalized elderly. In this population, although the goal of decreasing IPD to 31 per 100,000 overall has been met, the target of 9 per 100,000 for antibiotic-resistant IPD remains elusive (12.2 per 100,000 in 2008 to 10.2 per 100,000 in 2013).1 This lack of significant improvement in antibiotic-resistant IPD is likely at least partially due to the very low pneumococcal vaccination rates in the elderly. Specifically, although goal vaccination is 90%, only 60% of this population is vaccinated, and no significant improvements have been made in recent years.1,2 Pneumococcal vaccination also lags for high-risk patients 18 to 64 years of age (goal: 60%). Despite small gains, only 20% of this group was vaccinated in 2014.1,2

    QuotationMost recent estimates suggest that the annual incidence of IPD is down to a low of about 30,000, with 3,000 related deaths.3 It is believed that the improvements in IPD and pneumococcal mortality are likely multifactorial. First, pediatric 13-valent pneumococcal conjugate vaccine (PCV13) uptake is high, and this may reduce the carriage of vaccine-associated strains resulting in disease among nonvaccinated patients. Second, the Advisory Committee on Immunization Practices (ACIP) has recently recommended both the PCV13 and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for high-risk patients, as well as for all patients 65 years and older. This addition of PCV13 to the recommendations may have provided some modest improvements seen in vaccination rates in these age groups.4 Finally, the impact of pharmacists on vaccinations and the recent expansion in their ability to provide broad immunizations in many states will likely demonstrate significant impact in the coming years.5,6

    Related article: CDC Anticipates Yellow Fever Vaccine Shortage

    Unfortunately, this phenomenon is not limited to pneumococcal vaccination. Adults are often behind in many vaccinations. Common examples include: influenza and tetanus vaccine in the general population, zoster vaccine in the elderly, and pertussis vaccine in expectant mothers.1,2,7 Influenza vaccination goals for general adults, expectant mothers, and elderly are 70%, 80%, and 90%, respectively. Most recent reports suggest that only 32% of young adults, 48% of middle-aged adults, 28% of expectant mothers, and 67% of elderly have received an influenza vaccination.1,2

    Up next: Improving vaccination in the community

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