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Formulary managers can help improve vaccination rates


Managed care and hospital decision-makers are in a key position to “move the needle” at the system level on improving adult immunization coverage rates in the United States.

Vaccine-preventable diseases have been top-of-mind from a public health perspective and politicized due to the recent measles outbreak that began in California and spread to Illinois.

Measles is a highly contagious, airborne respiratory disease spread through coughing and sneezing. The Centers for Disease Control and Prevention (CDC) says that 102 people in 14 states were reported to have measles in January of 2015. Most, but not all, cases have been linked to several dozen unvaccinated individuals who were exposed to the disease at Disneyland in Anaheim, California.

The current vaccination rate stands at 92%, a number that has been waning in recent years.

“We do not have a sufficient number of people vaccinated,” said John Swartzberg, MD, FACP, emeritus clinical professor at the University of California at Berkley’s School of Public Health.

Swartzberg said that not enough is being done to educate the public about the need for the vaccine, and he adds that the U.S.’s laws are also too lax in allowing people to opt-out of vaccination.

In the case of the measles vaccine, Swartzberg said formulary managers “have to assure that the vaccine is available and that that they are well educated on their safety and efficacy and prepared to debunk misinformation.”

Related: How to avoid vaccine administration errors

Moving the needle on adult immunizations

Managed care and hospital decision-makers are in a key position to “move the needle” at the system level on improving adult immunization coverage rates in the United States, according to David Kim, MD, MA, CAPT, U.S. Public Health Service, Immunization Services Division, National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention

“Formulary managers can link up with state vaccine registries and instituting practices that utilize vaccine registry capabilities that have been proven to be effective in improving vaccination rates such as reminder recalls,” said Dr Kim. These state vaccine registries accept and share records of vaccines administered to adults among providers.



“For managed care and hospital decision-makers, we particularly want to promote the implementation of the adult immunization practice standards,” he added.

Here's how:

1/ Assess immunization status for your adult patients on every visit

2/ Strongly recommend vaccines they need

3/ Administer the vaccines or refer the patients to a provider who does (eg, pharmacist)

4/ Document the vaccines administered in your state registry


“Documenting vaccines that patients receive in states’ vaccine registries is important so that other providers can access them, thus improving communication between providers, including pharmacists who also administer vaccines; reducing redundant vaccination; and optimizing patients’ vaccination recordkeeping,” says Kim.

All states have vaccine registries for children that are used widely and almost all states have ‘lifetime’ vaccine registries, [ie, the registries accept and share records of vaccines administered to adults], according to Kim.

Related: U.S. women not getting vaccinations

“These adult vaccine registries should be used more widely,” he noted. “Your state’s vaccine registry can be a valuable tool for you to routinely assess your patients’ immunization status.”

Kim said the U.S. has “a lot of work to do to improve adult immunization coverage

“Vaccines are recommended for adults throughout their lifetime," he said. "Which vaccines adults need depend on their age, prior vaccinations, health conditions, travel, occupation, and other factors.”

CDC updates adult immunization schedule annually. The 2015 immunization schedule for adults aged 19 years or older is now available.

There are 2 major changes from the 2014 schedule: (1) the 13-valent pneumococcal conjugate vaccine (PCV13) is now recommended for all adults who are 65 years old or older in series with the pneumococcal polysaccharide vaccine (PPSV23) and (2) the age group for which the recombinant influenza vaccine (RIV), which is egg-free, has been expanded from persons aged 18–49 to persons to 18 years and older. All adults are recommended to receive the influenza vaccine yearly, at least 1 dose of Tdap (tetanus, diphtheria, acellular pertussis) vaccine, shingles vaccine at aged 60 years, and 2 different pneumococcal vaccines at aged 65 (sometimes earlier depending on medical conditions). Other vaccines may also be needed based on an adult’s medical conditions and prior vaccinations or travel.

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