The evolving adult immunization platform
Download
1 / 19

The Evolving Adult Immunization Platform - PowerPoint PPT Presentation


  • 110 Views
  • Uploaded on

The Evolving Adult Immunization Platform. William Schaffner, MD Vanderbilt University School of Medicine Nashville, TN. When meditating over a disease, I never think of finding a remedy for it, but, instead, a means of preventing it. Louis Pasteur

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'The Evolving Adult Immunization Platform' - metea


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
The evolving adult immunization platform

The Evolving AdultImmunization Platform

William Schaffner, MD

Vanderbilt University School of Medicine

Nashville, TN


When meditating over a disease,

I never think of finding a remedy for it,

but, instead, a means of preventing it.

Louis Pasteur

(1822-1895)


Infant/Childhood immunization – one of the top public health success stories of the 20th century

Diphtheria, tetanus, measles, mumps, rubella, polio, H. influenzae B, hepatitis B reduced by over 99%

Pertussis, hepatitis A, select pneumococcal, varicella, rotavirus, influenza being reduced


Invigoration of adult immunization
Invigoration of health success stories of the 20Adult Immunization

  • Build on success of infant/childhood, adolescent program

  • New vaccines targeted at adults

  • Recognition of the burden of adult vaccine-preventable disease


Burden of adult vaccine preventable disease
Burden of health success stories of the 20Adult Vaccine-Preventable Disease

Influenza: 10-20% of US population affected annually

200,000 hospitalizations

36,000 deaths (average)

Pneumococcal: 2,000-5000 meningitis

40,000+ bloodstream infections

150,000-300,000 pneumonia

Pertussis: 1 million

Cervical cancer: 10,000

Shingles: 1 million

Adult deaths from vaccine-preventable diseases: 43,000


Reported pertussis cases
Reported Pertussis Cases health success stories of the 20

≥ 19 yrs

11–18 yrs

< 11 yrs

Reported Pertussis Cases

  • 2004 provisional data


Tdap vaccine tetanus diphtheria acellular pertussis
Tdap Vaccine health success stories of the 20Tetanus-Diphtheria – acellular Pertussis

Licensed as one-time booster dose through age 64

Use Tdap at time of regular 10-year booster

  • Individual protection against pertussis, tetanus, diphtheria

  • Reduce community outbreaks

  • Interrupt transmission to vulnerable infants by vaccinating adults (cocoon)


Human papillomavirus vaccine cervical cancer
Human Papillomavirus Vaccine health success stories of the 20(Cervical Cancer)

  • Licensed vaccine against 4 virus types (6, 11, 16, 18) for females 9-26 years

  • Papillomavirus infection is precursor to cervical cancer

    • Types 16, 18 account for 70% of cervical cancers

  • Virus is transmitted by sexual contact

    • Over half of women are infected during their lifetime

  • Three-dose series


Natural history of hpv infection and potential progression to cervical cancer 1
Natural History of HPV Infection and health success stories of the 20Potential Progression to Cervical Cancer1

0–1 Year

0–5 Years

1–20 Years

Invasive Cervical Cancer

InitialHPV Infection

ContinuingInfection

CIN 2/3

CIN 1

Cleared HPV Infection (~80%)

1. Pinto AP, Crum CP. Clin Obstet Gynecol. 2000;43:352–362.


Hpv vaccine trial
HPV Vaccine Trial health success stories of the 20

  • Randomized, placebo-controlled, double blind

  • 27,000 volunteers

  • 100% effective vs. CIN 2/3


Human papillomavirus vaccine
Human Papillomavirus Vaccine health success stories of the 20

CDC’s Advisory Committee on Immunization Practices (ACIP) June 29, 2006

Recommendations:

  • Routine immunization of females at 11-12 years

  • May be started as young as 9 years at discretion of provider/parent

  • Vaccination of females up to age 26


Herpes zoster shingles vaccine
Herpes Zoster (shingles) Vaccine health success stories of the 20

  • Licensed for persons 60+ years of age

  • Shingles – localized rash due to reactivation of latent chickenpox (varicella) virus

  • Post-Shingles pain – extreme, debilitating pain lasting for months

  • Vaccine licensed for persons 60+ years of age

    • High potency live, attenuated varicella vaccine

    • Boosts immunity


Shingles prevention study 1
Shingles Prevention Study - 1 health success stories of the 20

  • Randomized, placebo-controlled, double blind vaccine trial

  • 38,546 volunteers at 22 sites; adults 60+


Shingles prevention study 2
Shingles Prevention Study - 2 health success stories of the 20

  • 95% of volunteers completed study

  • Follow-up <1 - 4.9 years; average 3 years

  • Shingles reduced 51%

    • 60-69 years 64%

    • 70-79 years 41%

    • 80+ 18%

  • Post-shingles pain: 67%


Reported acute hepatitis b incidence by age group united states 1990 2004
Reported Acute Hepatitis B Incidence health success stories of the 20By Age Group: United States, 1990-2004

≥20 years

94% decline

71% decline

12-19 years

Cases per 100,000

<12 years

Year


Reported acute hepatitis b incidence by age and sex united states 2004
Reported Acute Hepatitis B Incidence health success stories of the 20By Age and Sex: United States, 2004

0.1

0.1

<5

Female

Male

0.0

0.1

5-9

0.1

0.1

10-14

1.1

0.4

15-19

3.1

3.1

20-24

5.2

4.2

25-29

4.9

4.0

30-34

Age Group (Yrs)

4.4

5.4

35-39

3.6

4.9

40-44

2.7

4.0

45-49

2.0

3.2

50-54

1.3

2.9

55-59

0.8

1.4

60+

Rate per 100,000


Hepatitis b vaccine acip recommendations
Hepatitis B Vaccine: ACIP Recommendations health success stories of the 20

Expanded Risk Groups

Sexual Transmission

  • All sexually active persons not in a mutually monogamous relationship

  • Persons evaluated or treated for STDs

  • Men who have sex with men

  • Sex partners of HBsAg-positive persons


Adult immunization
Adult health success stories of the 20 Immunization

Influenza Tdap

Pneumococcal HPV (cervical cancer)

Hepatitis BShingles

Special circumstances, e.g. Travel, Health Care Worker


Adult immunization challenges
Adult health success stories of the 20 Immunization Challenges

  • Inadequate payment for vaccines and administration in both public programs and private medical insurance

  • Lack of knowledge – both patients and providers

  • Poor public health and private infrastructure for vaccine delivery


ad