1. Implement a patient intake form to routinely assess vaccination status at every visit and identify which vaccines are needed. 2. Use standing orders and protocols to allow nurses and other staff to administer recommended vaccines. 3. Refer patients to pharmacies or health departments for vaccines not stocked in the practice and document referrals. 3. Enter administered vaccines and referrals into the state immunization registry to track rates and prevent missed opportunities.

1. Improving Adult Immunizations
Through Implementing the
Standards for Adult Immunization
Practice

2.  Provide information on
 Burden of vaccine-preventable disease and illness
 Recommended adult vaccines
 Current adult vaccination rates
 Review “Practice Standards for Adult
Immunization”
 Provide resources for implementing the “Practice
Standards”
2
Goals of Presentation

3. Burden of Disease Among U.S. Adults for
Diseases with Vaccines Available
 Influenza disease burden varies year to year
 Millions of cases and average of 226,000 hospitalizations annually with >75%
among adults1
 3,000-49,000 deaths annually, >90% among adults2
 Invasive pneumococcal disease (IPD)3
 39,750 total cases and 4,000 total deaths in 2010
• 86% of IPD cases and nearly all IPD deaths among adults
 Pertussis (also known as whooping cough)4
 ~28,000 cases per year for 2013 and 2014
• ~9,000 among adults
 Hepatitis B5
 3,350 acute cases reported 2010
• 35,000 estimated cases
 Zoster (also known as shingles)6
 About 1 million cases of zoster annually U.S.
1. Thompson WW, et al. Influenza-Associated Hospitalizations in the United States. JAMA 2004; 292: 1333-1340
2. CDC. Estimates of deaths associated with seasonal influenza – United States, 1976-2007. MMWR. 2010;59(33):1057-1062.
3. CDC. Active Bacterial Core Surveillance. http://www.cdc.gov/abcs/reports-findings/survreports/spneu10.pdf.
4. CDC. Notifiable Diseases and Mortality Tables. MMWR 2013. 61(51&52): ND-719 – ND 732.
5. CDC. Viral Hepatitis Surveillance United States, 2010. National Center for HIV/AIDS, Viral Hepatitis, STD& TB Prevention/Division of Viral Hepatitis.
6. CDC. Prevention of Herpes Zoster. MMWR 2008. 57(RR-5): 1-30.
3

4. Influenza costs lives and money
 Direct medical costs in U.S.: ~$10.4 billion
 Add in loss of work and life: ~$87 billion
 Vaccination (41% in 2013-14) prevented:
• 7+ million illnesses
• 3+ million medically-attended illnesses
• 90,000+ hospitalizations
• Molinari, et al. The annual impact of seasonal influenza in the US: Measuring disease burden and costs. Vaccine 2007;25 :5086–5096.
• Reed, et al. Estimated Influenza Illnesses and Hospitalizations Averted by Vaccination — United States, 2013–14 Influenza Season MMWR
2014:63(49);1151-1154.
4

5. Impact of Vaccine Preventable Diseases in
People
[Speaker – insert personal stories on the
impact of vaccine preventable diseases or
consider using examples among extra
slides at the end of this slide set.]
5

6. Recommended Adult Vaccines
 Vaccines are an important part of optimizing health
of the vaccinated person, and preventing infections
in others
 Example: Vaccination against influenza and
pertussis reduces the risk in the person vaccinated
and also prevent someone from spreading these
diseases
6

7. www.cdc.gov/vaccines/schedules/hcp/adult.html
7
Recommended Adult Vaccines

8. www.cdc.gov/vaccines/schedules/hcp/adult.html
8
Recommended Adult Vaccines

9. Impact of Vaccination
 Vaccine effectiveness varies by vaccine type, the disease
outcome, and the age or health of the person vaccinated
 Zoster (Shingles) vaccine effectiveness: 51% against shingles, 66%
against post-herpetic neuralgia (PHN), and almost 80% against most
prolonged and extreme cases of PHN1
 PCV13 (pneumococcal conjugate vaccine): 45% efficacy against
vaccine-type pneumococcal pneumonia, and 75% efficacy against
vaccine-type invasive pneumococcal disease among adults aged ≥65
years2
 Influenza vaccine: varies annually based on antigenic match and also
age and health of person being vaccinated – about 60‒70% in
younger adults and about 30% in adults 65 years and older against
medically attended influenza when good match3
 Hepatitis B vaccine: 90% effectiveness after completing a 3-dose
series, though lower in persons with diabetes, e.g. 90% with diabetes
and age <40 years, 80% with diabetes and 41‒59 years, 65% if 60‒69
years and <40% if 70 years or older4
9
1. Oxman MN, et al. NEJM 2005;352:2271-84.
2. Bonten MJ, et al. NEJM 2015;372:1114-25.
3. CDC. Prevention and Control of Seasonal Influenza: Recommendations of the ACIP – U.S., 2014-15 Influenza Season. MMWR 2014; 63(32); 691-697.
4. CDC. Use of hepatitis B vaccine for adults with diabetes mellitus. MMWR 2011;60:1709-1711.

10. Vaccination of Pregnant Women: Two-For-One
 Influenza vaccination of pregnant women1
 Reduce risk of influenza illness in pregnant women
 Reduce risk of influenza illness, fevers and influenza hospitalizations in
infants during first 6 months of life
 Vaccinate with inactivated flu vaccine (not live vaccine) during
pregnancy
 Tdap vaccination of pregnant women
 Vaccinate in 3rd trimester to transfer antibody to infant prior to birth
 Prevents pertussis in mom and protects infant
• Tdap vaccination during pregnancy estimated to be 93% effective
in preventing pertussis in infants <4 months old2
 Pregnant women should NOT receive any live vaccines
(e.g. live influenza vaccine, MMR, varicella or shingles
vaccines)
1. CDC. Prevention and Control of Seasonal Influenza: Recommendations of the ACIP – U.S., 2014-15 Influenza Season. MMWR 2014; 63(32); 691-697.
2. Dabrera G, et al. Case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012-
2013. Clin Infect Dis. 2015; 60 (3): 333-337.
10

11. Vaccination Coverage Rates

12. Adult Immunization Coverage Rates 2010 -
2013
0 10 20 30 40 50 60 70 80 90 100
Zoster, age ≥60
Pneumococcal, age 19-64 at high risk
Pneumococcal, age ≥65
Tetanus past 10y, age 19-64
Tetanus past 10y, age ≥65
2013
2012
2011
2010
Source: National Health Interview Surveys : Healthy People 2020 target
Coverage rate (%)
12

13. 0 10 20 30 40 50 60 70 80 90 100
Influenza, ≥19 yrs, HCP
Influenza, ≥19 yrs
% Vaccinated
2013-14
2012-13
2013-14
2012-13
2011-12
Adult Influenza Vaccination Coverage, by Age,
United States
HP2020 Targets: 70% ≥19 years, 90% HCP ≥19 years
Data Source: 2011, 2012, 2013 and 2014 NHIS
2011-12

14. 0 10 20 30 40 50 60 70 80 90 100
Zoster, ≥60 yrs
Pneumococcal, ≥65 yrs
Pneumococcal, HR 19-64yrs
% Vaccinated
2014
2014
2014
2013
2012
2013
2012
2013
2012
Adult Immunization Coverage, Selected Vaccines by
Age and High-risk Status, United States
HP2020 Targets: 90% PPV ≥65 yrs, 60% PPV HR 19-64 yrs, 30% zoster ≥60 yrs
Data Source: 2012, 2013 and 2014 NHIS

15. Adult Vaccination Coverage
Selected Vaccines with Increases from 2011 to 2014
0 10 20 30 40 50 60 70 80 90 100
Tdap, HCP 19-64 yrs
Tdap, 19-64 yrs
HPV (≥1 dose), Women 19-26 yrs
Zoster, ≥60 yrs
2014
2014
2014
2014
Data Source: NHIS 2011-2014
2013
2012
2011
2013
2012
2011
2013
2012
2011
2013
2012
2011

16. Hepatitis B Vaccination for Adults Living
with Diabetes
0
10
20
30
40
50
60
70
80
90
100
19-59 yrs ≥60 yrs
2010 2011 2012 2013 2014
Adults with diabetes who received ≥3 doses hepatitis B vaccine
by age, National Health Interview Surveys, 2010-2014
Coverage
rate
(%)
Age
Source: National Health Interview Surveys
16
2010 2011 2012 2013 2014

17. Disparities In Adult Immunization Rates
 Lower vaccine coverage among1
• Hispanics and African Americans compared to non-
Hispanic Caucasians
• Uninsured
• Lower incomes
 Improve frequency of provider vaccine assessment and
recommendations may help reduce disparities
 For newly insured adults
• Affordable Care Act (ACA) requires non-grandfathered
private plans to include coverage for ACIP-
recommended vaccines
• Especially important to conduct assessment among
newly insured
17
1. Lu, P-J, et al. Am J Prev Med 2015

18.  Challenges
 Vaccine coverage among adults is unacceptably low
 Limited patient awareness about need for vaccines among
adults
 Adult vaccinations less integrated into clinical practice
 Opportunities
 Most patients willing to get vaccinated when
recommended by medical providers
 Primary care providers believe that immunizations are an
important part of the services they provide to patients
 Systematic offering and recommendations from clinicians
result in higher uptake
• Hurley, et al. Annals of Internal Medicine, 2014.
• Guide to community preventive services: www.thecommunityguide.org/vaccines/index.html
• Adult non-influenza vaccine coverage: www.cdc.gov/mmwr/preview/mmwrhtml/mm6305a4.htm. 18
Key Adult Immunization Facts

19. Vaccination Coverage of Pregnant Women
by Provider Recommendation and/or Offer
*Women who didn't visit a provider since August 2012 (n=27) or women who didn't know
whether they received provider recommendation or offer (n=55) were excluded from this analysis.
50.5
70.5
46.3
16.1
0
10
20
30
40
50
60
70
80
90
100
n = 1,702 n = 895 n = 270 n = 455
Overall Reported a provider
recommendation and offer
Reported a provider
recommendation but no offer
Reported no provider
recommendation
Influenza vaccination before and during pregnancy by provider recommendation and offer* between
October 2012 -January 2013, Internet Panel Survey
Coverage
estimates
(%)
Your recommendation
is critical to ensure
your patients are up to
date on their vaccines.
19

20. NEW Adult Immunization Practice Standards
 Stresses that all providers, including those that don’t
provide vaccine services, have a role in ensuring
patients are up-to-date on vaccines
 Acknowledges that:
 Adult patients may see many different healthcare
providers, some of whom do not stock some or all vaccines
 Adults may get vaccinated in a medical home, at work, or
retail setting
 Aim is to avoid missed opportunities and keep adult
patients protected from vaccine-preventable
diseases
20

21. Adult Immunization Practice Standards
 Calls to action for healthcare professionals
 Assess immunization status of all patients in every clinical
encounter.
 Strongly Recommend vaccines that patients need.
 Administer needed vaccines or Refer to a provider who can
immunize.
 Document vaccines received by patients, including entering
immunizations into immunization registries.
http://www.publichealthreports.org
Even if you don’t
vaccinate, you still
need to recommend
vaccines to your
patients
21

22. Adult Immunization Practice Standards
 Formally supported by healthcare organizations:
– American Academy of Pediatrics (AAP)
– American Academy of Physician Assistants (AAPA)
– American Academy of Family Physicians (AAFP)
– American College of Obstetricians and Gynecologists (ACOG)
– American College of Physicians (ACP)
– American Pharmacists Association (APhA)
– Association of Immunization Managers (AIM)
– Association of State & Territorial Health Officials (ASTHO)
– Centers for Disease Control and Prevention (CDC)
– Immunization Action Coalition (IAC)
– Infectious Diseases Society of America (IDSA)
– National Association of County & City Health Officials (NACCHO)
– National Foundation for Infectious Diseases (NFID)
To add your organization to those supporting the standards, go to…
http://www.izsummitpartners.org/support-adult-standards/
22

23. Example of Practice Standards Implementation
 Assessment
 Ask patients about their vaccinations during clinic visits
 E.g. Include a form at check-in and communicate with patients before
seeing the provider about which vaccines might be needed
 Strongly recommend vaccines
 If you provide vaccines, be confident in your recommendation
 Encourage your staff to use the same vaccine messages when caring for
patients
 Share a personal story with hesitant patients, such as your family or staff
are up-to-date with their vaccines
 Community partners, medical associations, and CDC has patient
education materials for your use
www.cdc.gov/vaccines/AdultStandards
23

24. Example of Practice Standards Implementation
 Administer needed vaccines or refer
 Develop standing orders or protocols for vaccine administration
 Ensure practice is up-to-date with vaccine storage and handling
 Develop relationships with pharmacies, health departments, and other
vaccination providers to refer your patients for vaccines you don’t stock
 Document vaccines received by patients
 Document receipt of vaccine in electronic medical records
 Provide patients with vaccine documentation for their personal medical
records, e.g. shot card
 Follow-up with patient or referring provider to document the vaccine
given
 Enter immunization doses to state immunization registries (where
applicable)
www.cdc.gov/vaccines/AdultStandards
24

25. Examples of Assessment Tools
25
 CDC forms:
• Online quiz for patients
• In-office 2- page intake form
http://www.cdc.gov/vaccines/hcp/patient-ed/adults/downloads/patient-intake-form.pdf
http://www2.cdc.gov/nip/adultimmsched/

26. Examples of Assessment Tools
26
Patient vaccine needs- assessment form from Immunization Action Coalition at immunize.org.
Consider Health, Age, Lifestyle and Occupation/Other Factors
H-A-L-O

27. Examples of Assessment Tools
27
Adult patient vaccine needs-
assessment form from National
Foundation for
Infectious Diseases at NFID.org

28. Question
Considering the information you have just
heard, what could your practice do to raise
vaccination rates among your patients?
28

29. Components of Successful Vaccination Programs
 Strategies shown to improve vaccine
uptake in healthcare settings:
 Patient education (e.g. email reminders from
providers plus provider recommendations)
 Use of standing orders
 Use of reminder-recall systems
 Efforts to remove administrative barriers
 Provider and practice assessment of
vaccination and feedback
 Use of immunization registries
http://www.thecommunityguide.org/vaccines/index.html.
29

30. Improving Use of Immunization Information
Systems (IIS – aka Vaccine Registries)
 Increase use important for many reasons, including
 Ensuring patients get the right vaccines at the right time
 Tracking vaccination rates
 Potential for use in quality measures and coverage tracking
• In pediatrics, use of IIS known to improve vaccination
 Meaningful Use part 2 requirement to submit to IIS where available.
 Improves readiness to respond to emergencies like 2009 H1N1
 Challenge: limited use by adult providers (e.g. 8% internists)1
 IIS contacts in each state can be found at:
http://www.cdc.gov/vaccines/programs/iis/contacts-
registry-staff.html.
1. Hurley, et al. Ann Intern Med 2014; 160(3):161.
30

31. Place of Vaccination by age group,
November 2012 NIS and NIFS*
*October 4 – November 17, 2012 National Immunization Survey (NIS) data for children 6 months through 17 years of age
November 2-15, 2012 National Internet Flu Survey (NIFS) data for adults ≥ 18 years of age
31

32. Example of Practice Standards Implementation
 Osterhaus Pharmacy (Maquoketa, IA)
 Eastern Iowa is a large rural area with limited access to health care
services and low vaccination rates
 Osterhaus Pharmacy addressed the problem by identifying 272
patients with diabetes, and flagged them for outreach and
immunization with Tdap, zoster, pneumococcal, hepatitis B, and
influenza vaccines
 Teamed with two local physicians to coordinate immunization
records, educate, screen and vaccinate patients
 Among nearly 200 screened and vaccinated.
 Only three of those screened were up-to-date on their
immunization.
32
http://www.izsummitpartners.org/immunization-excellence-awards/awards-2014/

33. Results with Implementation of Standards
Indian Health Service (IHS)
 IHS is a federal agency charged with providing
healthcare to eligible American Indian/Alaska Native
people
 Member of one of the 566 federally recognized tribes
 Residence in the IHS catchment area
 IHS provides services to approximately 2 million
patients each year
 Network of IHS, Tribal, and Urban Indian health care facilities
in 35 states
33

34. Indian Health Service
Leveraging Technology
 Use of EHR and provider reminder prompts focusing
on the following adult vaccinations:
 Influenza for all ages
 PPSV23 for 65 years+
 PPSV23 for adults with high risk conditions
 Tdap for everyone 19 yrs+
 Td every 10 years
 HPV
 Females 19 – 26 years
 Males 19 – 21 years
 Zoster for 60 yrs +
 Hepatitis A and B for patients who receive first dose
34

35. Indian Health Service
Leveraging Technology Data
81.5%
74.1%
49.5%
31.8% 27.4%
8.6%
38.8%
74.9%
87.1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
IHS Adult Vaccination Coverage*
FY 2014 Q1 Reports
FY 2014 Q1
* Based on Active Clinical Users (2 visits in 3 years), N = 558,566
35

36. Results with Implementation of Standards
Outpatient Medical Practice
 Clinics at University of Iowa wanted to improve pneumococcal
vaccination of their patients
 Placed a two-question form on each chart asking about
 Whether the patient got the pneumococcal vaccination
 And, if no, why not.
 Form also included indications for pneumococcal vaccination
 Form completed for 75% of visits
 Compared to baseline levels, 5-fold increase in pneumococcal
vaccinations
 Returned to baseline levels when form not used
• Tobacman JK. Infect Control Hosp Epidemiol 1992;13:144-46.
36

37. Results with Implementation of Standards
Hospital and Pharmacy Collaboration
 In 2000-2003, pneumococcal vaccine inpatient rates were 15-
31%
 Pharmacy-driven standing orders program (SOP) developed by
multidisciplinary team after reviewing existing system challenges.
 Pharmacists screened patients based on the SOP and, if appropriate,
added the vaccination order to the patient chart
 Nurse reviewed with the patient and family their vaccination history and
allergies, gave the vaccine information statement (VIS), and obtained
verbal consent prior to administering the vaccine
 Results
 During 2005, pneumococcal vaccination increased to 69%
 Influenza vaccination rate of 73%
• Sokos DR, et al. Am J Health-Syst Pharm 2007;46:1096-1102.
37

38.  Patient check-in vaccine questionnaire to be used at
clinics: http://www.cdc.gov/vaccines/hcp/patient-
ed/adults/downloads/patient-intake-form.pdf.
 H-A-L-O – vaccine needs questionnaire based on your
patient’s Health condition, Age, Lifestyle, and Occupation
at http://www.immunize.org/catg.d/p3070.pdf.
 Patient on-line quiz – direct patients to complete the
quiz before coming to their appointment – gives them
and you a starting point for talking about which vaccines
they might need.
http://www2.cdc.gov/nip/adultimmsched/.
 CDC adult vaccine schedule app at
http://www.cdc.gov/vaccines/schedules/hcp/schedule-
app.html.
Resources For Implementing New Standards
38

39. Resources For Implementing New Standards
 CDC handouts for providers about how to implement the Standards
www.cdc.gov/vaccines/adultstandards and information about vaccine
recommendations at www.cdc.gov/vaccines/acip
 National Adult and Influenza Immunization Summit and
Immunization Action Coalition (IAC)
www.izsummitpartners.org has information for providers on each vaccine and
vaccine administration, storage and handling at www.immunize.org.
 National Foundation for Infectious Diseases
www.adultvaccination.org has tools for providers and information to help with
conversations with your patients about vaccines, including the top 10 reasons
to get vaccinated at http://www.adultvaccination.org/10-reasons-to-be-
vaccinated.
39

40. Resources From Professional Provider Organizations
on Adult Immunizations
 American Academy of Family Physicians - http://www.aafp.org/patient-
care/immunizations/schedules.html for information on vaccinations plus CME
opportunities
 American Assocation of Nurse Practitioners -
http://www.aanp.org/education/education-toolkits/immunizations. Includes tool kits
and other information.
 American Academy of Physician Assistants – http://www.aapa.org. has information on
professional recommendations for immunization practice.
 American College of Obstetricians and Gynecologists - www.immunizationforwomen.org
information about vaccines for pregnant and non-pregnant women, vaccine coding and
other business practices
 American College of Physicians - http://immunization.acponline.org/ has information
about adult vaccinations, quality improvement, resources for practical application, and
information on special populations. Download the ACP Immunization Advisor App here:
http://bit.ly/ACPapp
 American Pharmacists Assocation - http://www.pharmacist.com/immunization-
resources. Multiple resources, training and tools for pharmacists on immunizations.
 Infectious Diseases Society of America - http://www.idsociety.org/Immunization/.
Provides multiple resources and also recommendations specifically for immune
compromised persons.
40

41. Series for Healthcare Providers on
Implementing Standards
www.cdc.gov/vaccines/AdultStandards
41

42. Patient Education Materials - Handouts
42

43. Patient Education Materials - Posters
www.cdc.gov/vaccines/hcp/patient-ed/adults/for-patients/adults-all.html
43

44. Medscape Module
Case Presentations and Videos
1. Older Adult
• Zoster
• PCV13
2. Adult with Diabetes
• Hep B
• Influenza
3. Pregnant Woman
• Tdap
• Influenza

45. For Providers That Need to Refer Patients for
Vaccinations
 Providers and patients can find vaccine providers in their
area at http://vaccine.healthmap.org.
45

46. Conclusions
 Substantial burden of disease in adults for which vaccines
available
 Vaccination rates low among adults in U.S.
 Adult Immunization Practice Standards updated and supported by
wide range of provider organizations
 Implementation of standards is key to increasing awareness of
adult immunization, improving vaccine coverage, and reducing
racial and ethnic disparities in vaccine coverage
 Many tools and resources available to:
 Help providers implement practice standards
 Educate patients on the importance of vaccination
46

47. Thank you!
 [Speaker – add your contact information]
47

48. Appendix
Extra slides – may be useful for some
audiences
48

49. Adult Immunization Practice Standards
Framework
• Incorporate IZ needs assessment into every clinical encounter.
• Recommend, administer needed vaccine or refer to a provider who can
immunize.
• Stay up-to-date on immunization recommendations and educate
patients.
• Ensure providers and their staff are up to date on their own vaccines
• Understand how to access registries.
All Providers
•Routinely assess immunization status of patients, recommend
needed vaccines and refer patient to an immunizing provider.
•Establish referral relationships with immunizing providers.
•Follow up to confirm patient receipt of recommended
vaccine(s).
Non-immunizing
Providers
•Observe and adhere to professional competencies regarding
immunizations.
•Assess immunization status in every patient care and counseling
encounter and strongly recommend needed vaccines.
•Ensure receipt of vaccination is documented.
Immunization
Providers
49

50. Adult Immunization Practice Standards
Framework
• Education and training of members, including trainees
• Resources and assistance to implement protocols, immunization
practices, immunization assessment, etc
• Encourage members to be up-to-date on own immunizations
• Assist members in staying up-to-date on IZ info & recommendations
• Partner with others immunization stakeholders to educate the
public
• Seek out collaboration opportunities with other immunization
stakeholders
• Collect and share best practices
• Advocate policies that support adult immunization standards
Professional healthcare
related organizations /
associations/healthcare
systems
•Determine community needs and capacity and community barriers to adult
IZ
•Support activities and policies to increase vaccination rates and reduce
barriers
•Ensure professional competency
•Collect, analyze and disseminate data
•Outreach and education to public and providers
•Work to decrease disparities
•Increase registry access and use
•Develop billing capacities
•Ensure preparedness, communicate vaccine information to providers and to
the public
•Promote adherence to laws and regulations pertaining to immunizations
Public Health
Departments
50

51. Meta-Analysis of Interventions to Increase Use
of Adult Immunization
Intervention Odds Ratio*
Organizational change
(e.g., standing orders, separate clinics devoted to
prevention)
16.0
Provider reminder 3.8
Patient financial incentive 3.4
Provider education 3.2
Patient reminder 2.5
Patient education 1.3
*Compared to usual care or control group, adjusted for all remaining interventions
Stone E. Interventions that increase use of adult immunization and cancer screening services. Ann
Intern Med. 2002; 136:641-51.
51

52. Influenza Vaccination Rates by Age Group and
Risk Group, BRFSS 2011-14
0
10
20
30
40
50
60
70
80
90
100
2011-12 2012-13 2013-14
18-49 yrs, all
18-49 yrs, high risk
50-64 yrs
≥ 65 yrs
Healthy People 2020 Goal
Adults 18 and older
52

53. Impact of Vaccine Preventable Diseases in People
Shingles: "I would rather have ten babies than the pain I've endured
for the past ten years," says 87-year-old Etta Watson Zukerman of
Bethesda, Md., who has lost partial use of her right arm and hand
due to nerve damage from postherpetic neuralgia (PHN).
Hepatitis B: “One day without warning, my brother, who was 18,
woke up with severe pain in his abdomen. When we took him to the
doctor, we were told that he and my mother were hepatitis B carriers.
My brother passed away a year later. One month after his death, my
mother was diagnosed with liver cancer.” Leslie D. Hsu
Testimonials from Immunization Action Coalition and CDC websites
Pertussis: Callie stopped breathing again. Family members watched
helplessly from behind a glass wall as doctors tried for 45 minutes to
revive her. Tragically, Callie could not be saved. She was only 5 weeks
old. "We never dreamed we'd lose her," Katie said. "Callie was a more
loved, more wanted baby than you'd ever find."
CDC website
CDC/ Patricia Walker, M.D., Regions Hospital, MN
53
Courtesy MN Oxman San Diego VAMC

54. Meet Joan:
Special Education Teacher
“The Pain of Shingles”
• Joan developed severe pain in her back
and the doctors could not initially figure
out what was wrong then the rash started
several days later.
• She had contracted shingles, but not the
traditional rash that is common to many at
disease onset.
– In some cases, rash happens after the pain
• The pain was so severe it kept her awake
at night. Joan says that she would have
sought vaccination if she had known it was
recommended.
For Joan’s full story, visit:
http://www.nfid.org/real-stories-real-people/joan-shingles.html
“If I had known that a
vaccine is recommended
for everyone my age, I
would have gotten it.
Believe me, if you could
understand the pain of
shingles, you’d get the
vaccine, too.”
54

55. Jacob Ryan Schmidt:
A competitive martial arts expert
“A Son’s Life Cut Short by Influenza”
• Jacob was strong as a bull and enjoying
life.
• In 2010, at the age of 27, he
succumbed to complications from
H1N1 influenza.
• His lungs collapsed; he developed an
infection. His organs were shutting
down. After about five weeks of
influenza ravaging his body, Jacob died.
For Jacob’s full story, visit:
http://www.nfid.org/real-stories-real-people/jacob-influenza.html#sthash.qbrBJ6AE.dpuf
“Jacob was not someone
you’d expect to fall ill to
influenza. He was healthy
and athletic, and built like
a freight train.”
55

56. Meet Dr. William Cochran:
A Pediatric Gastroenterologist
“A Doctor’s Personal Experience with
Whooping Cough”
• Dr. Cochrane came down with a severe
cough where he could not catch his
breath and would even pass out.
• He coughed so long and hard that he
cracked several ribs.
• He learned that he had pertussis or
“whooping cough”
• It took him three months to recover.
For Dr. Cochrane’s full story, visit:
http://www.nfid.org/real-stories-real-people/cochran-pertussis.html
“Anyone – doctor, parent,
grandparent, caregiver,
who comes into contact
with infants should be
sure they are up to date
on their immunizations to
spare those too young to
be protected through
vaccination .”
56

57.  Overall coverage remains below HP2020 targets
• 90% for 65+ years for pneumococcal vaccine
• 60% for high risk 19-64 years for pneumococcal vaccine
• 30% for 60+ years for Zoster vaccine
• 90% for hepatitis B vaccine for healthcare personnel
 Some improvement from 2013
– Tdap (≥19 year olds), and herpes zoster (≥60 year olds)
vaccines
– No improvements for other vaccines
 Racial and ethnic disparities remain
 Much remains to be done to increase vaccine utilization
among adults and to eliminate disparities
Raising awareness about disparities in adult
immunizations
57

58. *p<0.05 by T test for comparisons between HCP with direct patient care
responsibilities and HCP without direct patient care responsibilities.
Proportion of HCP >19 years of age who received
selected vaccines, by direct patient care
Group %
Influenza (2013-14 season), >19 years, with direct patient care 65
Influenza (2013-14 season), >19 years, without direct patient care 66
Tdap, >19 years, with direct patient care 48
Tdap, >19 years, without direct patient care 32*
HepB (>3 doses), >19 years, with direct patient care 68
HepB (>3 doses), >19 years, without direct patient care 48*
Data Source: 2014 NHIS

59. Partnerships to Raise Awareness and
Immunization Coverage
 Professional medical, nursing, and pharmacist organizations
and their state or local chapters
 Advocacy and education groups:
 Association of Diabetes Educators, American Heart Association, etc.
 Health departments and their clinics for HIV, STD, and TB, etc.
 Community Health Centers
 Corrections
 Large healthcare systems
 Occupational health
 Private sector partners such as community organizations
including faith based partners, and others
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