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The Evolving Adult Immunization Platform

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The Evolving Adult Immunization Platform William Schaffner, MD Vanderbilt University School of Medicine Nashville, TN Invigoration of Adult Immunization Build on ... – PowerPoint PPT presentation

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Title: The Evolving Adult Immunization Platform


1
The Evolving AdultImmunization Platform
  • William Schaffner, MD
  • Vanderbilt University School of Medicine
  • Nashville, TN

2
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)

3
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
4
Invigoration of Adult Immunization
  • Build on success of infant/childhood, adolescent
    program
  • New vaccines targeted at adults
  • Recognition of the burden of adult
    vaccine-preventable disease

5
Burden of Adult 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

6
Reported Pertussis Cases
19 yrs
1118 yrs
lt 11 yrs
Reported Pertussis Cases
  • 2004 provisional data

7
Tdap VaccineTetanus-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)

8
Human Papillomavirus Vaccine(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

9
Natural History of HPV Infection and Potential
Progression to Cervical Cancer1
01 Year
05 Years
120 Years
Invasive Cervical Cancer
InitialHPV Infection
ContinuingInfection
CIN 2/3
CIN 1
Cleared HPV Infection (80)
1. Pinto AP, Crum CP. Clin Obstet Gynecol.
200043352362.
10
HPV Vaccine Trial
  • Randomized, placebo-controlled, double blind
  • 27,000 volunteers
  • 100 effective vs. CIN 2/3

11
Human Papillomavirus Vaccine
  • CDCs 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

12
Herpes Zoster (shingles) Vaccine
  • 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

13
Shingles Prevention Study - 1
  • Randomized, placebo-controlled, double blind
    vaccine trial
  • 38,546 volunteers at 22 sites adults 60

14
Shingles Prevention Study - 2
  • 95 of volunteers completed study
  • Follow-up lt1 - 4.9 years average 3 years
  • Shingles reduced 51
  • 60-69 years 64
  • 70-79 years 41
  • 80 18
  • Post-shingles pain 67

15
Reported Acute Hepatitis B Incidence By Age
Group United States, 1990-2004
20 years
71 decline
94 decline
12-19 years
Cases per 100,000
lt12 years
Year
16
Reported Acute Hepatitis B Incidence By Age and
Sex United States, 2004
0.1
0.1
lt5
Female
Male
0.1
0.0
5-9
0.1
0.1
10-14
0.4
1.1
15-19
3.1
3.1
20-24
5.2
4.2
25-29
4.9
4.0
30-34
Age Group (Yrs)
5.4
4.4
35-39
4.9
3.6
40-44
4.0
2.7
45-49
3.2
2.0
50-54
2.9
1.3
55-59
1.4
0.8
60
Rate per 100,000
17
Hepatitis B Vaccine ACIP Recommendations
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

18
Adult Immunization
  • Influenza Tdap
  • Pneumococcal HPV (cervical cancer)
  • Hepatitis B Shingles
  • Special circumstances, e.g. Travel, Health Care
    Worker

19
Adult 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
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