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October 12, 1994, Vol 272, No. 14 >
ARTICLE | October 12, 1994

Adult Immunization: Title and subTitle BreakSummary of the National Vaccine Advisory Committee Report FREE

David S. Fedson, MD; Vincent A. Fulginiti, MD; Barry R. Bloom, PhD; Judy Braiman; Betty F. Bumpers; Robert B. Couch, MD; R. Gordon Douglas, Jr, MD; David S. Fedson, MD; Charles M. Helms, MD, PhD; Paul P. Hung, PhD; Kay Johnson; David T. Karzon, MD; Susan M. Lett, MD, MPH; Robert K. Ross, MD; Daniel W. Shea, MD; Sylvia F. Villarreal, MD
[+] Author Affiliations

A complete list of committee members appears at the end of this article.

Reprint requests to National Vaccine Program Office, Rockwall II Bldg, Suite 1075, 5600 Fishers Ln, Rockville, MD 20852.


JAMA. 1994;272(14):1133-1137. doi:10.1001/jama.1994.03520140063039
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References

In January 1994 the National Vaccine Advisory Committee adopted a report that reviewed the status of adult immunization in the United States. Vaccine-preventable infections of adults represent a continuing cause of morbidity and mortality. Their major impact is among older persons. Effective and safe vaccines against these diseases are available, but they are poorly used. Several reasons account for low immunization levels among adults, including inadequate awareness by health care providers and the public of the importance and benefits of vaccination. Health care providers often fail to take advantage of opportunities to immunize adults during office, clinic, and hospital contacts and fail to organize programs in medical settings that ensure adults are offered the vaccines they need. Inadequate reimbursement for adult immunization by public and private health insurers and a lack of federal programs to support vaccine delivery are also major problems. The National Vaccine Advisory Committee's report includes five goals and 18 recommendations for improving adult immunization. To reach the Public Health Service adult immunization goals for the year 2000, the Committee recommends (1) improvements in public and provider education; (2) major changes in clinical practice; (3) increased financial support by public and private health insurers; (4) improved surveillance of vaccine-preventable diseases and vaccine production and delivery; and (5) support for research on vaccine-preventable diseases, new and improved vaccines, immunization practices, and international programs for adult immunization.

(JAMA. 1994;272:1133-1137)

REFERENCES

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Peter G.  Childhood immunizations. N Engl J Med . 1992;;327:1794-1800.
2 +
Centers for Disease Control and Prevention.  General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep . 1994;;43(No. (RR-1) ):1-38.
3 +
Centers for Disease Control.  Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other measures: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Morbid Mortal Wkly Rep . 1991;; 40(No. (RR-10) ):1-28.
4 +
de Quadros CA, Andrus JK, Olive J, et al.  Eradication of poliomyelitis: progress in the Americas. Pediatr Infect Dis J . 1991;;10:222-229.
5 +
Atkinson WL, Orenstein WA, Krugman S.  The resurgence of measles in the United States, 1989-1991. Annu Rev Med . 1992;;43:451-463.
6 +
Lee SH, Ewert DP, Frederick PD, Mascola L.  Resurgence of congenital rubella syndrome in the 1990s. JAMA . 1992;;267:2616-2620.
7 +
Sosin DM, Cochi SL, Gunn RA, et al.  Changing epidemiology of mumps and its impact on university campuses. Pediatrics . 1989;;84:779-784.
8 +
Centers for Disease Control and Prevention.  Progress toward elimination of Haemophilus influenzae type b disease among infants and children: United States, 1987-1993. MMWR Morbid Mortal Wkly Rep . 1994;;43:144-148.
9 +
Howson CP, Fineberg HV.  Adverse events following pertussis and rubella vaccines: summary of a report of the Institute of Medicine. JAMA . 1992;; 267:392-396.
10 +
Centers for Disease Control and Prevention.  Reportable vaccine-preventable diseases: United States, 1993, and the Childhood Immunization Initiative. MMWR Morbid Mortal Wkly Rep . 1994;; 43:57-60.
11 +
Gardner P, Schaffner W.  Immunization of adults. N Engl J Med . 1993;;328:1252-1258.
12 +
Atkinson WL, Markowitz LE, Adams NC, Seastrom GR.  Transmission of measles in medical settings: United States, 1985-1989. Am J Med . 1991;; 91( (suppl 3B) ):320S-324S.
13 +
Goodman AK, Friedman SM, Beatrice ST, Bart SW.  Rubella in the workplace: the need for employee immunization. Am J Public Health . 1987;; 77:725-726.
14 +
Wharton M, Cochi SL, Hutcheson RH, Schaffner W.  Mumps transmission in hospitals. Arch Intern Med . 1990;;150:47-49.
15 +
McBean AM, Babish JD, Warren JL.  The impact and cost of influenza in the elderly. Arch Intern Med . 1993;;153:2105-2111.
16 +
Centers for Disease Control.  Update on adult immunization. MMWR Morbid Mortal Wkly Rep . 1991;;40(No. (RR-12) ):i-vi, 1-94.
17 +
Centers for Disease Control.  The public health burden of vaccine preventable diseases among adults: standards for adult immunization practice. MMWR Morbid Mortal Wkly Rep . 1990;;39:725-729.
18 +
American College of Physicians Task Force on Adult Immunization and Infectious Diseases Society of America. Guide for Adult Immunization . 3rd ed. Philadelphia, Pa: American College of Physicians; 1994;.
19 +
US Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions . Baltimore, Md: Williams & Wilkins; 1989;.
20 +
Centers for Disease Control and Prevention.  Final results: Medicare influenza vaccine demonstration: selected states, 1988-1992. MMWR Morbid Mortal Wkly Rep . 1993;;42:601-604.
21 +
National Vaccine Advisory Committee. Adult Immunization . Washington, DC: National Vaccine Program, US Dept of Health and Human Services; January 1994;.
22 +
Healthy People 2000: National Health Promotion and Disease Prevention Objectives: Full Report with Commentary . Washington, DC: US Dept of Health and Human Services; 1991;. DHHS publication PHS 91-50212.
23 +
Fedson DS.  Clinical practice and public policy for influenza and pneumococcal vaccination of the elderly. Clin Geriatr Med . 1992;;8:183-199.
24 +
Anderson K, Teske R, Dini E, Strikas R.  Improving influenza vaccination coverage in the Medicare population.  In: Hannoun C, Kendal AP, Klenk HD, Ruben FL, eds. Options for the Control of Influenza, II . Amsterdam, the Netherlands: Elsevier; 1993;:109-113.
25 +
Williams WW, Hickson MA, Kane MA, et al.  Immunization policies and vaccine coverage among adults: the risk for missed opportunities. Ann Intern Med . 1988;;108:616-625.
26 +
Barton MB, Schoenbaum SC.  Improving influenza vaccination performance in an HMO setting: the use of computer-generated reminders and peer comparison feedback. Am J Public Health . 1990;; 80:534-536.
27 +
Centers for Disease Control and Prevention.  Prevention and control of influenza: part I, vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep . 1994;;43(No. (RR-9) ):1-13.
28 +
Alter MJ, Hadler SC, Margolis HS, et al.  The changing epidemiology of hepatitis B in the United States: need for alternative vaccination strategies. JAMA . 1990;;263:1218-1222.
29 +
Butler JC, Breiman RF, Campbell JF, Lipman HB, Broome CV, Facklam RR.  Pneumococcal polysaccharide vaccine efficacy: an evaluation of current recommendations. JAMA . 1993;;270:1826-1831.
30 +
Neustadt RE, Fineberg HV. The Swine Flu Affair: Decision-Making on a Slippery Disease . Washington, DC: US Dept of Health, Education, and Welfare; 1978;:48-56, 79-81.
31 +
Hinman AR.  DTP vaccine litigation. AJDC . 1986;;140:528-530.
32 +
Mariner WK.  The National Vaccine Injury Compensation Program. Health Aff (Millwood) . 1992;; 11( (1) ):255-265.
33 +
Centers for Disease Control and Prevention.  Comprehensive delivery of adult vaccination: Minnesota, 1986-1992. MMWR Morbid Mortal Wkly Rep . 1993;;42:768-770.
34 +
National Institute of Allergy and Infectious Diseases. The Jordan Report: Accelerated Development of Vaccines, 1993 . Bethesda, Md: National Institutes of Health; 1993;.
35 +
Centers for Disease Control and Prevention.  Diphtheria outbreak: Russian Federation, 1990-1993. MMWR Morbid Mortal Wkly Rep . 1993;;42: 840-841, 847.
36 +
Centers for Disease Control and Prevention.  Imported cholera associated with a newly described toxigenic Vibrio cholerae 0139 strain: California, 1993. MMWR Morbid Mortal Wkly Rep . 1993;;42: 501-503.
37 +
Breiman RF, Butler JC, Tenover FC, Elliott JA, Facklam RR.  Emergence of drug-resistant pneumococcal infections in the United States. JAMA . 1994;;271:1831-1835.
38 +
Mitchell VS, Philipose NM, Sanford JP, eds. The Children's Vaccine Initiative: Achieving the Vision . Washington, DC: National Academy Press; 1993;.

Figures

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Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Peter G.  Childhood immunizations. N Engl J Med . 1992;;327:1794-1800.
2 +
Centers for Disease Control and Prevention.  General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep . 1994;;43(No. (RR-1) ):1-38.
3 +
Centers for Disease Control.  Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other measures: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Morbid Mortal Wkly Rep . 1991;; 40(No. (RR-10) ):1-28.
4 +
de Quadros CA, Andrus JK, Olive J, et al.  Eradication of poliomyelitis: progress in the Americas. Pediatr Infect Dis J . 1991;;10:222-229.
5 +
Atkinson WL, Orenstein WA, Krugman S.  The resurgence of measles in the United States, 1989-1991. Annu Rev Med . 1992;;43:451-463.
6 +
Lee SH, Ewert DP, Frederick PD, Mascola L.  Resurgence of congenital rubella syndrome in the 1990s. JAMA . 1992;;267:2616-2620.
7 +
Sosin DM, Cochi SL, Gunn RA, et al.  Changing epidemiology of mumps and its impact on university campuses. Pediatrics . 1989;;84:779-784.
8 +
Centers for Disease Control and Prevention.  Progress toward elimination of Haemophilus influenzae type b disease among infants and children: United States, 1987-1993. MMWR Morbid Mortal Wkly Rep . 1994;;43:144-148.
9 +
Howson CP, Fineberg HV.  Adverse events following pertussis and rubella vaccines: summary of a report of the Institute of Medicine. JAMA . 1992;; 267:392-396.
10 +
Centers for Disease Control and Prevention.  Reportable vaccine-preventable diseases: United States, 1993, and the Childhood Immunization Initiative. MMWR Morbid Mortal Wkly Rep . 1994;; 43:57-60.
11 +
Gardner P, Schaffner W.  Immunization of adults. N Engl J Med . 1993;;328:1252-1258.
12 +
Atkinson WL, Markowitz LE, Adams NC, Seastrom GR.  Transmission of measles in medical settings: United States, 1985-1989. Am J Med . 1991;; 91( (suppl 3B) ):320S-324S.
13 +
Goodman AK, Friedman SM, Beatrice ST, Bart SW.  Rubella in the workplace: the need for employee immunization. Am J Public Health . 1987;; 77:725-726.
14 +
Wharton M, Cochi SL, Hutcheson RH, Schaffner W.  Mumps transmission in hospitals. Arch Intern Med . 1990;;150:47-49.
15 +
McBean AM, Babish JD, Warren JL.  The impact and cost of influenza in the elderly. Arch Intern Med . 1993;;153:2105-2111.
16 +
Centers for Disease Control.  Update on adult immunization. MMWR Morbid Mortal Wkly Rep . 1991;;40(No. (RR-12) ):i-vi, 1-94.
17 +
Centers for Disease Control.  The public health burden of vaccine preventable diseases among adults: standards for adult immunization practice. MMWR Morbid Mortal Wkly Rep . 1990;;39:725-729.
18 +
American College of Physicians Task Force on Adult Immunization and Infectious Diseases Society of America. Guide for Adult Immunization . 3rd ed. Philadelphia, Pa: American College of Physicians; 1994;.
19 +
US Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions . Baltimore, Md: Williams & Wilkins; 1989;.
20 +
Centers for Disease Control and Prevention.  Final results: Medicare influenza vaccine demonstration: selected states, 1988-1992. MMWR Morbid Mortal Wkly Rep . 1993;;42:601-604.
21 +
National Vaccine Advisory Committee. Adult Immunization . Washington, DC: National Vaccine Program, US Dept of Health and Human Services; January 1994;.
22 +
Healthy People 2000: National Health Promotion and Disease Prevention Objectives: Full Report with Commentary . Washington, DC: US Dept of Health and Human Services; 1991;. DHHS publication PHS 91-50212.
23 +
Fedson DS.  Clinical practice and public policy for influenza and pneumococcal vaccination of the elderly. Clin Geriatr Med . 1992;;8:183-199.
24 +
Anderson K, Teske R, Dini E, Strikas R.  Improving influenza vaccination coverage in the Medicare population.  In: Hannoun C, Kendal AP, Klenk HD, Ruben FL, eds. Options for the Control of Influenza, II . Amsterdam, the Netherlands: Elsevier; 1993;:109-113.
25 +
Williams WW, Hickson MA, Kane MA, et al.  Immunization policies and vaccine coverage among adults: the risk for missed opportunities. Ann Intern Med . 1988;;108:616-625.
26 +
Barton MB, Schoenbaum SC.  Improving influenza vaccination performance in an HMO setting: the use of computer-generated reminders and peer comparison feedback. Am J Public Health . 1990;; 80:534-536.
27 +
Centers for Disease Control and Prevention.  Prevention and control of influenza: part I, vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep . 1994;;43(No. (RR-9) ):1-13.
28 +
Alter MJ, Hadler SC, Margolis HS, et al.  The changing epidemiology of hepatitis B in the United States: need for alternative vaccination strategies. JAMA . 1990;;263:1218-1222.
29 +
Butler JC, Breiman RF, Campbell JF, Lipman HB, Broome CV, Facklam RR.  Pneumococcal polysaccharide vaccine efficacy: an evaluation of current recommendations. JAMA . 1993;;270:1826-1831.
30 +
Neustadt RE, Fineberg HV. The Swine Flu Affair: Decision-Making on a Slippery Disease . Washington, DC: US Dept of Health, Education, and Welfare; 1978;:48-56, 79-81.
31 +
Hinman AR.  DTP vaccine litigation. AJDC . 1986;;140:528-530.
32 +
Mariner WK.  The National Vaccine Injury Compensation Program. Health Aff (Millwood) . 1992;; 11( (1) ):255-265.
33 +
Centers for Disease Control and Prevention.  Comprehensive delivery of adult vaccination: Minnesota, 1986-1992. MMWR Morbid Mortal Wkly Rep . 1993;;42:768-770.
34 +
National Institute of Allergy and Infectious Diseases. The Jordan Report: Accelerated Development of Vaccines, 1993 . Bethesda, Md: National Institutes of Health; 1993;.
35 +
Centers for Disease Control and Prevention.  Diphtheria outbreak: Russian Federation, 1990-1993. MMWR Morbid Mortal Wkly Rep . 1993;;42: 840-841, 847.
36 +
Centers for Disease Control and Prevention.  Imported cholera associated with a newly described toxigenic Vibrio cholerae 0139 strain: California, 1993. MMWR Morbid Mortal Wkly Rep . 1993;;42: 501-503.
37 +
Breiman RF, Butler JC, Tenover FC, Elliott JA, Facklam RR.  Emergence of drug-resistant pneumococcal infections in the United States. JAMA . 1994;;271:1831-1835.
38 +
Mitchell VS, Philipose NM, Sanford JP, eds. The Children's Vaccine Initiative: Achieving the Vision . Washington, DC: National Academy Press; 1993;.

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