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Recommendations for Adult Immunization

Policy Date: 1/1/1989
Policy Number: 8906

The American Public Health Association,
Recognizing that a substantial number of adults needlessly become victims of vaccine-preventable diseases; 1 and
Recognizing that influenza, pneumococcal and hepatitis B infections account for the majority of adult vaccine-preventable morbidity and death; 1 and
Recognizing that more than 300,000 cases of hepatitis B and more than 5,000 hepatitis B-related deaths occur annually; 1 and
Recognizing that persons age 15 and older accounted for 43 percent and 39 percent, respectively, of the over 16,000 cases of measles and mumps reported in 1987 and about 11 million young women are unprotected against rubella; 1 and
Recognizing that nearly all cases of tetanus in the United States occur in adults; 1 and
Acknowledging that safe, effective vaccines which could reduce disease incidence, morbidity, and death from these illnesses are available but are underutilized; 1 and
Recognizing that significant proportions of poor and low-income populations are not regular users of the health care system but may congregate in such areas as including but not limited to senior centers, shelters, and day care programs; and
Noting that many adults are unprotected against seven diseases which can be prevented by immunization (influenza, pneumococcal, hepatitis B, tetanus, diphtheria, measles, and rubella) and that specific vaccines are recommended according to the importance of specific risk factors in the adult population; 1 and
Noting that health care providers often miss opportunities to provide these vaccines to adults for whom the vaccines are recommended; 1 and
Noting that 40 - 50 percent or more of persons at high risk for or who die from influenza and pneumonia received care in health care institutions during the previous year, and at least 75 percent of these persons saw a care provider but failed to receive influenza vaccine; 1 and
Noting that two-thirds or more of patients with serious pneumococcal disease had been hospitalized at least once within the three to five years before the illness but had not received pneumococcal vaccine; 1 therefore
1. Encourages the promotion of vaccine use through culturally and linguistically appropriate information campaigns for health practitioners, employers, and the public about the benefits of immunization;
2. Recommends that all health providers routinely determine the immunization status of all patients, adults as well as children, that those who are licensed to provide vaccines shall offer vaccines to those for whom they are indicated, and maintain complete immunization records;
3. Recommends that all health providers particularly identify patients in need of influenza vaccine and develop a system to recall these persons for annual immunization each autumn;
4. Recommends that all health providers and institutions particularly identify high-risk adult patients in hospitals and other treatment centers and offer appropriate vaccines to them either prior to discharge or as part of discharge planning;
5. Recommends that all licensing/accrediting agencies require institutions to develop comprehensive immunization programs for staff, inpatients, and outpatients;??
6. Encourages states to establish pre-enrollment immunization requirements for college and university students;
7. Recommends that appropriate strategies be developed and implemented to reach non-regular users of the health care system;
8. Recommends that institutions that train health professionals, deliver health care, or provide laboratory or other medical support services require appropriate immunizations for personnel at risk for contracting or transmitting vaccine-preventable illnesses;
9. Calls upon third-party payors to provide coverage for adult immunization services;
10. Encourages state and local governing bodies to provide funding to state and local health departments for adult immunization services; and
11. Encourages the adoption of a standard personal and institutional immunization record as a cost-efficient means of verifying immunization status.
1. William WW, et al: Immunization policies and vaccine coverage among adults. The risk for missed opportunities. Ann Intern Med 1988;108:616-625.
2. Report of Task Force on Preventive Services, 1989.