Improving Adult Immunizations Through Implementing the Standards

for Adult Immunization Practice

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

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: 1333-13402. 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.

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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.

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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.]

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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

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www.cdc.gov/vaccines/schedules/hcp/adult.html7

Recommended Adult Vaccines

www.cdc.gov/vaccines/schedules/hcp/adult.html8

Recommended Adult Vaccines

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

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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.

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.

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Vaccination Coverage Rates

Adult Immunization Coverage Rates 2010 - 2013

Zoster, age ≥60

Pneumococcal, age 19-64 at high risk

Pneumococcal, age ≥65

Tetanus past 10y, age 19-64

Tetanus past 10y, age ≥65

0 10 20 30 40 50 60 70 80 90 100

2013201220112010

Source: National Health Interview Surveys : Healthy People 2020 target

Coverage rate (%)

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Hepatitis B Vaccination for Adults Living with Diabetes

19-59 yrs ≥60 yrs0

10

20

30

40

50

60

70

80

90

100

20112010 2012 2013 20112010 2012 2013

Adults with diabetes who received ≥3 doses hepatitis B vaccine by age, National Health Interview Surveys, 2010-2013

Cove

rage

rate

(%)

Age

Source: National Health Interview Surveys

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Improvements in Some Adult Immunizations

Tdap, HCP 19-64 yrs

HPV (≥1 dose), Women 19-26 yrs

0 10 20 30 40 50 60 70 80 90 100

Coverage for zoster vaccine also increased 2011-2013 (16%24%), though still below Healthy People 2020 target of 30%

201320122011

Source: National Health Interview Surveys

201320122011

Coverage rate (%)

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Adult Immunization Rates Still Low

Hep B ≥3 doses, HCP ≥19 yrs

Tdap, HCP 19-64 yrs

HPV (≥1 dose), Men 19-26 yrs

HPV (≥1 dose), Women 19-26 yrs

0 10 20 30 40 50 60 70 80 90 100

201320122011

Improving but still only 37%

Increased in 2013 but long way to go

Improving but still only 38%

Source: National Health Interview Surveys : Healthy People 2020 target

201320122011

201320122011

Not improving andfar below target

Coverage rate (%)

201320122011

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Group 2011-12 (%)

2012-13 (%)

2013-14 (%)*

Difference (%)

Persons > 18 yrs 38.8 41.5 42.4 3.6

Persons 18-49 yrs, all 28.6 31.1 32.3 3.7

Persons 18-49 yrs, high risk 36.8 39.8 38.7 1.9

Persons 50-64 yrs 42.7 45.1 45.3 2.6

Persons ≥ 65 yrs 64.9 66.2 65.0 0.1

Influenza Vaccination Coverage Among U.S. Adults2011-12, 2012-13, and 2013-14 Seasons

http://www.cdc.gov/flu/fluvaxview/index.htm

* Estimates of the percentage of people vaccinated are based on interviews conducted beginning September (BRFSS) or October (NIS) 2013 through June 2014 and reported vaccinations from July 2013 through May 2014. For California, BRFSS interview data were only available for September-December 2013 and thus estimates for persons ≥18 years only reflect vaccinations during July-November 2013. For Mississippi, sample size was insufficient from interviews conducted April-June 2014 to estimate vaccinations past the end of February, 2014 for persons ≥18 years.

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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

171. Lu, P-J, et al. Am J Prev Med 2015 (in press)

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

Vaccination Coverage of Pregnant Womenby 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.

n =

1,70

2

n =

895

n =

270

n =

455

Overall Reported a provider rec-ommendation and offer

Reported a provider rec-ommendation but no offer

Reported no provider rec-ommendation

0

10

20

30

40

50

60

70

80

90

100

50.5

70.5

46.3

16.1

Influenza vaccination before and during pregnancy by provider recommendation and offer* be-tween October 2012 -January 2013, Internet Panel Survey

Cove

rage

esti

mat

es (%

) Your recommendation is critical to ensure

your patients are up to date on their vaccines.

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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

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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

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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/

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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

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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

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Examples of Assessment Tools

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CDC forms at www.cdc.gov/vaccines/adults. • Online quiz for patients• In-office 2- page intake form

Examples of Assessment Tools

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Patient vaccine needs- assessment form from Immunization Action Coalition at immunize.org. Consider Health, Age, Lifestyle and Occupation/Other Factors

H-A-L-O

Examples of Assessment Tools

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Adult patient vaccine needs- assessment form from National

Foundation for Infectious Diseases at NFID.org

Question

Considering the information you have just heard, what could your practice do to raise

vaccination rates among your patients?

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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

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.

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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

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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.

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http://www.izsummitpartners.org/immunization-excellence-awards/awards-2014/

Results with Implementation of StandardsIndian 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

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Indian Health ServiceLeveraging 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

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Indian Health Service Leveraging Technology Data

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

81.5%74.1%

49.5%

31.8% 27.4%

8.6%

38.8%

74.9%

87.1%

IHS Adult Vaccination Coverage*FY 2014 Q1 Reports

FY 2014 Q1

* Based on Active Clinical Users (2 visits in 3 years), N = 558,566

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Results with Implementation of StandardsOutpatient 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.

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Results with Implementation of StandardsHospital 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.

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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

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Resources For Implementing New Standards

CDC handouts for providers about how to implement the Standardswww.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 Diseaseswww.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.

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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.

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Series for Healthcare Providers on Implementing Standards

www.cdc.gov/vaccines/AdultStandards41

Patient Education Materials - Handouts

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Patient Education Materials - Posters

www.cdc.gov/vaccines/hcp/patient-ed/adults/for-patients/adults-all.html43

For Providers That Need to Refer Patients for Vaccinations

Providers and patients can find vaccine providers in their area at http://vaccine.healthmap.org.

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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

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Thank you! [Speaker – add your contact information]

46

AppendixAdditional slides – may be useful for some audiences

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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

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Adult Immunization Practice StandardsFramework

• 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

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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.

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Influenza Vaccination Rates by Age Group and Risk Group, BRFSS 2011-14

2011-12 2012-13 2013-14 0

10

20

30

40

50

60

70

80

90

100

18-49 yrs, all18-49 yrs, high risk50-64 yrs ≥ 65 yrs

Healthy People 2020 GoalAdults 18 and older

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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

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Courtesy MN Oxman San Diego VAMC

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.”

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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.”

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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 .”

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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 2012– Modest increases for HPV (men, 19-26), 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

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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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• BLANK – template for speakers to use if need extra slides

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