VACCINATION: A CONCERN IN ADULTS.

Prof. (Dr.) A K Prasad.

Chairman, Influenza Foundation (India)

Agra; the 22 November 2015

VACCINATION A CONCERN IN ADULTS?

The misnomer of the past years, as accepting vaccination a child hood domain, ‘Preventive Vaccination’ has suffered much in all other age groups.

GSI in the past decade has done a very commendable job and brought the arena of vaccine in active consideration, a thing for all ages.

Strongly supported by IFI and Vaccine Advocacy Forum (VAF) a need for all age groups, thinking has changed in favor Vaccine for all other age groups.

IFI advocates very strongly against the ignored & the callus approach towards Influenza , has opened a new vista of thoughts in prevention.

DRAW BACKS IN ADULT IMMUNIZATION

The Lack of awareness. This could be solved by mass education & help from Print/ Electronic media.

What is Vaccine? elA time tested preventive method for

artificially acquired active immunity to protect from a specific infection. This is effective against many viral & bacterial diseases.

to the health care providers by the government and the scientific bodies

PREVENTION IN OLD ADULTS

Vaccination remains the primary preventive strategy in the elderly against Streptococcus pneumoniae and influenza infections.

The effectiveness of this strategy in preventing pneumonia has been in doubt despite the increase in vaccination coverage among older adults. Randomized controlled trials (RCTs) and observational studies aimed at determining clinical outcomes and immune response following pneumococcal vaccination have yielded conflicting results. The protective efficacy of pneumococcal vaccination against pneumonia in older adults has not been firmly established due to a lack of RCTs specifically examining patients ≥ 65 years of age. Similarly, the reported benefits of influenza vaccination have been derived from observational data. (There are various reasons for this and debatable).

PREVENTION IN OLD ADULTS

Pneumococcal vaccine Based on the most recent recommendations, the Advisory Committee on

Immunization Practices (ACIP) advocates a single dose of 23-valent pneumococcal capsular polysaccharide vaccine (PPSV23) for all persons aged 65 years and older.

In addition, for adults aged 19–64 years, PPSV23 should be administered to those who are immunocompromised (including chronic renal failure or nephrotic syndrome); those with functional or anatomic asplenia; those who are immunocompetent and have chronic conditions such as alcoholism, diabetes mellitus, or chronic lung disease; those who are smokers; and those with cochlear implants or cerebrospinal fluid leaks.

A repeat vaccination is recommended for persons ≥ 65 years of age who received their first vaccine at <65 years of age.

Revaccination is not recommended for persons who received their first vaccination at ≥65 years of age unless the patient is immunocompromised or asplenia.

Furthermore, a one-time revaccination after 5 years is recommended for older adults with chronic renal failure, nephritic syndrome, or immunosuppressive conditions. Although not yet recommended by the ACIP, 13-valent pneumococcal conjugate vaccine (PCV13) is available for use among adults aged 50 years and older in accordance with the package insert.

INFLUENZA VACCINE.

The first population-scale use of an inactivated influenza vaccine was in US military personnel in 1945. It was not until the 1960s that the US health agencies pursued a policy of widespread influenza vaccination targeting the high-risk segment of the population, including patients with chronic conditions and elderly people.54 This came in response to the substantial morbidity and mortality during the 1957–58 pandemic.55The recommendation was made on the basis of studies showing efficacy in young healthy recruits with clinical illness or sero-conversion as primary measures of infection. In 1964, the ACIP reaffirmed this recommendation, but noted the absence of efficacy data.56

EFFECTIVENESS OF INFLUENZA VACCINATION IN INSTITUTIONALIZED OLDER ADULTS: A SYSTEMATIC REVIEW.CHAN TC1, FAN-NGAI HUNG I2, KA-HAY LUK J3, CHU LW4, HON-WAI CHAN F3.

Influenza infection is common among institutionalized older adults. Many nonrandomized observational studies on influenza vaccination suggested that it could reduce influenza-related hospitalizations and mortality in institutionalized older adults. Criticism regarding the effectiveness of influenza vaccine estimated by nonrandomized observational studies include the frailty selection bias and use of nonspecific outcome, such as all-cause mortality.

INFLUENZA

A review of influenza: implications for the geriatric population.

Dambaugh LA1. 1Progressive Pulmonary Care Unit, Rochester General Hospital,

Department of Nursing, 1425 Portland Avenue, Rochester, NY 14617, USA. lori.dambaugh@rochestergeneral.org

Abstract The influenza virus is a significant cause of morbidity and

mortality each year in the United States, and is a major public health problem. Individuals aged 65 years and older comprise a sizeable population subgroup at high risk of infection and subsequent complications. Although influenza may cause substantial morbidity and mortality across the age spectrum, it becomes particularly problematic for those older than 65. This article presents an overview of influenza, with a focus on how the influenza virus has particular implications for the geriatric population.

BASIC FACTS FOR VACCINE PREVENTION IN OLD ADULTS.

As the population of older adults and the prevalence of underlying medical conditions that complicate the course of pneumonia increases, hospitalizations for pneumonia are likely to continue to rise unless effective intervention strategies are implemented.

Current US strategies to prevent pneumonia among older adults include recommending immunization with PPV and annual influenza vaccinations.

However, the effectiveness of these vaccines decreases with increasing age and among individuals with co-morbid conditions.

INFLUENZA FOUNDATION (INDIA)

IFI feels happy for IFI association with GSI started on the right understanding three years back (2012), on preventive vaccination in Old Adults.

We need to dispel the wrong believe, misnomers & understanding that Preventive Immunization is for children alone.

We all, at any age group needs protective vaccination.

The IFI-GSI realize this, and accepted to adopt at least Influenza, pneumococcal and tetanus prevention as a must for Old Adult. This has been accepted by many countries in S E Asia.

WHAT IS VACCINE ADVOCACY?AND WHY WE WISH TO ADVOCATE:-

Prevention is better than cure & this is very true.

No country can provide total health care for the total countries population.

Preventive vaccine not only protects but prevents disease in risk groups. This the best and cheapest method in reducing the “Countries Health Burden’ and strain on the country’s economy.

INFLUENZA IS NOT THE ONLY INFECTIOUS DISEASE NEEDS PROTECTION.

As a person in the field of Influenza, I have been talking about ‘Influenza Prevention by Influenza Vaccine’ in the past and felt the seriousness & the essential need for “Preventive Vaccine for other diseases”.

PREVENTIVE VACCINES

Any country health programme aims to protect and prevent the preventable disease

vaccine advocacy appears the easiest, quickest in reducing the health disease burden and in reducing load on the health economy.

No country can provide total and a disease free population but, the preventable diseases by the preventives in risk population will certainly have the desired reduced disease impact.

Starting from 1947, the longevity has risen from 32 to 67 years. Small pox is wiped off and Polio is on exist.

There are various reason and important are: Better food nutrient, improved health care, reduced child mortality by early life preventive vaccines and more to the list.

Age itself is a disease and with advancement more and more chronic diseases make home and become the reason for the morbidity & mortality. With preventive vaccine this suffering gets reduced.

LOGIC FOR VACCINE

Birth & death are inevitable but to make the days, months and years more happy one needs the preventable. why not use this?

I will not get into the merits of each disease but just to quote one simple example.

Each day men are bitten by rabid dog(s) in each cities and without any reservation all dog bite cases are covered by ARS & ARV. Why? (Delhi figures alone almost 500 dog-bites each day ( MailToday:16 Nov.15;P-2).

But you know only 1 out of 10 bites will result into case of Rabies and all dog bite cases are covered by Anti Rabid treatment as once the symptom appears, the patient is in no return situation for recovery.

VACCINE ADVOCACY

There are three important goals for Vaccine Advocacy, for any disease under consideration:

(1) Increased knowledge & understanding. (2) Enhanced trust & credibility, and (3) Enhanced dialogue to resolve disarrangements.

INFLUENZA

A review of influenza: implications for the geriatric population.

Dambaugh LA1. 1Progressive Pulmonary Care Unit, Rochester General Hospital,

Department of Nursing, 1425 Portland Avenue, Rochester, NY 14617, USA. lori.dambaugh@rochestergeneral.org

Abstract The influenza virus is a significant cause of morbidity and

mortality each year in the United States, and is a major public health problem. Individuals aged 65 years and older comprise a sizeable population subgroup at high risk of infection and subsequent complications. Although influenza may cause substantial morbidity and mortality across the age spectrum, it becomes particularly problematic for those older than 65. This article presents an overview of influenza, with a focus on how the influenza virus has particular implications for the geriatric population.

BASIC FACTS FOR VACCINE PREVENTION IN OLD ADULTS.

As the population of older adults and the prevalence of underlying medical conditions that complicate the course of pneumonia increases, hospitalizations for pneumonia are likely to continue to rise unless effective intervention strategies are implemented.

Current US strategies to prevent pneumonia among older adults include recommending immunization with PPV and annual influenza vaccinations.

However, the effectiveness of these vaccines decreases with increasing age and among individuals with co-morbid conditions.

VACCINE ADVOCACY

The key word to Vaccine Advocacy is: Advocacy and Communication. Education and Information. Share your valuable observation.

BASIC FACTS ABOUT INFLUENZA

Influenza or, Seasonal Influenza is an important disease . There are 250,000-500,000 annual deaths globally. Out of

this Children < 5 Y alone account deaths for 28,000-111,5000 predominantly in developing countries. (WHO: Vaccines against influenza Position Paper. Wkly Epidemiol Rec 2012; 47: 461-476).

Adults aged 65 years or, older , pregnant women & people of any age underlying medical conditions, are at high risk of severe disease or, complications. (WHO : Influenza Seasonal Fact Sheet 211; 2014).

Global target for vaccine coverage in high risk groups are at least 75% in adults < 65years age.

The use of vaccine world wise availability has increased and today the SEA countries accounts for >25,00,00,000 (250M) which is little over half of the what is for developed countries. Palache et al (2015) Vaccine 33 (42); 5598-5605.

(Still the figure in SEA covers only >1/1000 population count as against >500 in USA).

Facts about ADULT IMMUNIZATION IN INDIA

• Barriers & Challenges

• Lack of recognition of the importance of adult immunization.

• Education of potential vaccine recipients. • publicity to promote

vaccination.• Radio and TV can be used

to promote vaccines in the adult.

• Possible Solutions

Barriers and Challenges Possible solutions

• Lack of recommendation from health care providers

• Definitive guide lines for adult and elderly vaccination to be provided to the health care providers by the government and the scientific bodies.• development of a

comprehensive and sustainable adult immunization program.

• Lack of health care provider knowledge about adult immunization and recommended vaccines.

• To provide knowledge about the vaccine to HCP by regular CME’S, symposia and workshops.

Barriers and Challenges Possible solutions

• Misrepresentation/misunderstanding of the risks of vaccine and benefits of disease prevention in adults

• The detailed knowledge about the safety of vaccine to be imparted to the HCP so that their concepts are clear and they can further transmit this to the beneficiaries.

Barriers and Challenges Possible solutions

• Lack of understanding of vaccine safety and efficacy.

• The detailed knowledge about the safety of vaccine to be imparted to the HCP so that their concepts are clear and they can further transmit this to the beneficiaries.

Barriers and Challenges Possible solutions

Barriers and Challenges Possible solutions

• Missed opportunities for vaccination in health care providers’ offices, hospitals, and nursing homes.

• It should be made mandatory/compulsory for health care providers’ offices, hospitals and nursing homes staff.

• Lack of publicly-funded vaccine and reimbursement to vaccine providers.

• The government, NGO’S and charitable institutions should come forward to financially support and reimburse the cost of vaccine to the vaccine provider. • Free standing

immunization clinics.

Barriers and Challenges Possible solutions

• Lack of coordinated immunization programs for adults.

• There should be immunization programs for adults verified and recommended by WHO and other health authorities. • Dedicated nurse to

administer the vaccine.

Barriers and Challenges Possible solutions

• Lack of regulatory or legal requirements.

• The government can start the regulatory requirements and legality involved in it.

Barriers and Challenges Possible solutions

• Fear of injections. • HCP should publically transmit and advertise the procedure of administration of vaccine so that the fear of injection is taken away.• Have flyers and posters

displaying information about vaccines in the waiting area.

Barriers and Challenges Possible solutions

• Lack of availability of up-to-date records and recording systems.

• Computerised up-to-date record of the beneficiaries should be kept and it should be linked to any document of identification viz Aadhar card etc.

Barriers and Challenges Possible solutions

• Busy schedules and competing demands.

• All busy persons should be educated about the importance of disease prevention so that they understand the importance of vaccinations.

Barriers and Challenges Possible solutions

• Medical assistant/Clinician(HCP) did not accept influenza immunization for himself/herself.

• Guidelines should be made and it should made compulsory for all HCP’S to get them self vaccinated against the diseases as per the criterion.

Barriers and Challenges Possible solutions

• Infrastructure/Logistics:• Poor/inconvenient vaccine

availability • Refrigerator located in the

basement • Vaccine refrigerator 18ft from

nearest exam room• No vaccine stocks on site have to

request from central pharmacy and recall patient when arrives on a subsequent day

• Vaccines recorded in a central log, not in individual charts

• No reminder system for vaccines • Lack of routine screening by staff of

immunization status

• Vaccine should made available easily and conveniently.

• Proper storage facility should be provided at a convenient distance.

• Vaccine should be available round the clock.

• Vaccines should be recorded indusial in patient chart.

• Proper reminder system should be developed for all the persons attending the clinics.

• And a routine screening should be done by the staff.

Barriers and Challenges Possible solutions

• Obstetrics & Gynaecology• Ignorance and apathy

about vaccine preventable diseases among Obstetrics and Gynaecologists• Adult immunization is

not a significant part of the training or culture in obstetrics/gynaecology

Persistence efforts will yield positive result

Barriers and Challenges Possible solutions

• Continuing questions about efficacy and safety of vaccines.

• Persistence is the Key word for success.

Barriers and Challenges Possible solutions

http://www.fotosearch.com/

Influenza Affects All Ages & so are other diseases.

THANK YOU

Thank you & best wishes from Influenza Foundation of India.

A K Prasad,Chairman, IFI.