New infectious diseases blueprint for action

Jun 19 2007

New vaccines are available to make significant gains against cervical cancer deaths and debilitating pain from shingles, but infectious diseases experts warn that their full potential will not be realized without changes in the way vaccines for adults and adolescents are promoted, financed, and delivered in the United States.

The Infectious Diseases Society of America (IDSA) has released a new blueprint for action to prevent tens of thousands of deaths and illnesses caused by these and other diseases that can be avoided with a few simple shots. The blueprint is published in the June 15 issue of Clinical Infectious Diseases.

"We have done a great job in this country delivering vaccines to children, but we have done an awful job delivering vaccines to adults," said Neal A. Halsey, MD, professor at the Johns Hopkins University Bloomberg School of Public Health and chair of the IDSA Immunization Work Group that developed the policy blueprint.

For example, he points out that more than 90 percent of U.S. children are immunized against measles, mumps, whooping cough, hepatitis B, and other diseases. Rates of these diseases are at or near historic lows. In contrast, an estimated 175,000 adults are hospitalized and 6,000 die each year from pneumococcal pneumonia, but one in three adults over 65 has not been vaccinated against it. The Centers for Disease Control and Prevention (CDC) estimates that the cost of treating diseases that vaccines could prevent exceeds $10 billion annually.

Cost is one factor in why adults do not get vaccinated, particularly the uninsured. "CDC has very effective systems for delivering vaccines to underserved children," said IDSA work group member Walter A. Orenstein, MD, associate director of the Emory Vaccine Center and former head of CDC's immunization program. "One of them is Section 317 of the Public Health Service Act, which helps state and local health departments provide vaccines to uninsured or underinsured patients, largely children, for free. Section 317 must now be expanded to catch underserved adults at highest risk."

While the program is cost-effective, expanding Section 317 will require a significant infusion of cash. Section 317's current $520 million budget will need an additional $170 million per year in order to cover all vaccines for uninsured adults, according to a recent CDC estimate. "It is essential that we provide adults access to these vaccines that save lives and prevent illnesses," Dr. Orenstein said,but immunizing adults must not be done at the expense of children."

IDSA also is calling for all plans to cover all adult and adolescent vaccines recommended by CDC's Advisory Committee on Immunization Practices and to pay physicians adequately for office costs associated with immunization. Further, managed care plans should be measured in part on how well they immunize patients. Another principle supports exploring where immunization can appropriately take place outside the traditional office setting. Funding to support research into vaccines and vaccine delivery must be increased, and resources must be available to gather data on safety, efficacy, and usage.

Physicians and patients also must be part of the solution, according to the IDSA blueprint. "Part of the problem lies with physicians, who are not accustomed to offering vaccines during routine visits with adult patients; and with patients, who are unaware the vaccines exist," said IDSA work group member William Schaffner, MD, chair of the Department of Preventive Health at Vanderbilt University. Doctors who serve adults must begin assessing adult immunization needs during routine preventive health care visits. Also, CDC should launch an education campaign to help improve awareness about vaccines and the illnesses they can prevent in adults.

"As health care workers, we set an example for our patients," Dr. Schaffner added. "We all must be fully immunized."

"We have the tools to make dramatic improvements in adult and adolescent health, as we have for children," said Andrew T. Pavia, MD, chair of IDSA's National and Global Public Health Committee, Chief of Pediatric Infectious Diseases at the University of Utah, and a member of the National Vaccine Advisory Committee. "IDSA's blueprint outlines the steps we must take to use these tools effectively. Now all we need is the will to take those steps."