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The Evolving Adult Immunization Platform William Schaffner, MD Vanderbilt University School of Medicine Nashville, TN.

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Presentation on theme: "The Evolving Adult Immunization Platform William Schaffner, MD Vanderbilt University School of Medicine Nashville, TN."— Presentation transcript:

1 The Evolving Adult Immunization 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 ( )

3 Infant/Childhood immunization – one of the top public health success stories of the 20 th 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 Build on success of infant/childhood, adolescent program New vaccines targeted at adults New vaccines targeted at adults Recognition of the burden of adult vaccine- preventable disease 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 200,000 hospitalizations 36,000 deaths (average) 36,000 deaths (average) Pneumococcal: 2, meningitis 40,000+ bloodstream infections 40,000+ bloodstream infections 150, ,000 pneumonia 150, ,000 pneumonia Pertussis: 1 million Cervical cancer: 10,000 Shingles: 1 million Adult deaths from vaccine-preventable diseases: 43,000

6 Reported Pertussis Cases 2004 provisional data 19 yrs 11–18 yrs < 11 yrs Reported Pertussis Cases

7 Tdap Vaccine Tetanus-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 Individual protection against pertussis, tetanus, diphtheria Reduce community outbreaks Reduce community outbreaks Interrupt transmission to vulnerable infants by vaccinating adults (cocoon) 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 Licensed vaccine against 4 virus types (6, 11, 16, 18) for females 9-26 years Papillomavirus infection is precursor to cervical cancer Papillomavirus infection is precursor to cervical cancer Types 16, 18 account for 70% of cervical cancers Types 16, 18 account for 70% of cervical cancers Virus is transmitted by sexual contact Virus is transmitted by sexual contact Over half of women are infected during their lifetime Over half of women are infected during their lifetime Three-dose series Three-dose series

9 0–1 Year0–5 Years1–20 Years Invasive Cervical Cancer Cleared HPV Infection (~80%) 1. Pinto AP, Crum CP. Clin Obstet Gynecol. 2000;43:352–362. CIN 1 Initial HPV Infection Continuing Infection CIN 2/3 Natural History of HPV Infection and Potential Progression to Cervical Cancer 1

10 HPV Vaccine Trial Randomized, placebo-controlled, double blind Randomized, placebo-controlled, double blind 27,000 volunteers 27,000 volunteers 100% effective vs. CIN 2/3 100% 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 years Routine immunization of females at years May be started as young as 9 years at discretion of provider/parent May be started as young as 9 years at discretion of provider/parent Vaccination of females up to age 26 Vaccination of females up to age 26

12 Herpes Zoster (shingles) Vaccine Licensed for persons 60+ years of age Licensed for persons 60+ years of age Shingles – localized rash due to reactivation of latent chickenpox (varicella) virus Shingles – localized rash due to reactivation of latent chickenpox (varicella) virus Post-Shingles pain – extreme, debilitating pain lasting for months Post-Shingles pain – extreme, debilitating pain lasting for months Vaccine licensed for persons 60+ years of age Vaccine licensed for persons 60+ years of age High potency live, attenuated varicella vaccine High potency live, attenuated varicella vaccine Boosts immunity Boosts immunity

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

14 Shingles Prevention Study % of volunteers completed study 95% of volunteers completed study Follow-up < years; average 3 years Follow-up < years; average 3 years Shingles reduced 51% Shingles reduced 51% years 64% years 64% years 41% years 41% % % Post-shingles pain: 67% Post-shingles pain: 67%

15 Reported Acute Hepatitis B Incidence By Age Group: United States, years years <12 years 71% decline94% decline Year Cases per 100,000

16 Reported Acute Hepatitis B Incidence By Age and Sex: United States, 2004 Female Male < Age Group (Yrs) Rate per 100,

17 Hepatitis B Vaccine: ACIP Recommendations Sexual Transmission All sexually active persons not in a mutually monogamous relationship All sexually active persons not in a mutually monogamous relationship Persons evaluated or treated for STDs Persons evaluated or treated for STDs Men who have sex with men Men who have sex with men Sex partners of HBsAg-positive persons Sex partners of HBsAg-positive persons Expanded Risk Groups

18 Adult Immunization InfluenzaTdap PneumococcalHPV (cervical cancer) Hepatitis BShingles 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 Inadequate payment for vaccines and administration in both public programs and private medical insurance Lack of knowledge – both patients and providers Lack of knowledge – both patients and providers Poor public health and private infrastructure for vaccine delivery Poor public health and private infrastructure for vaccine delivery


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