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Decreasing vaccine preventable diseases in adults Joint Regional Meeting For the Americas and Europe Madrid, Spain February 1, 2017 Bruce Gellin, MD, MPH Deputy Assistant Secretary for Health Director, National Vaccine Program Office US Department of Health and Human Services https://www.hhs.gov/nvpo The vision for the Decade of Vaccines (2011–2020) is of a world in which all individuals and communities enjoy lives free from vaccine-preventable diseases. The mission of the Decade of Vaccines is to extend, by 2020 and beyond, the full benefit of immunization to all people, regardless of where they are born, who they are or where they live. 13. CONSIDERS that an evidence-based, cost-effective, safe and efficient immunization system is an integral part of a well-functioning health system. December 2014 14. POINTS OUT that, given the changes in the demographic structure of the European population, there must be a greater focus on preventing infectious diseases by means of vaccination of all age groups where this improves the epidemiological control of the disease. December 2014 SEASONAL INFLUENZA VACCINE DOSES DISTRIBUTED 2004-2013 (PER 1,000) Palache 2015 SEASONAL INFLUENZA VACCINE DOSES DISTRIBUTED 2004-2013 (PER 1,000) Palache 2015 SEASONAL INFLUENZA VACCINE DOSES DISTRIBUTED 2004-2013 (PER 1,000) Palache 2015 SEASONAL INFLUENZA VACCINE DOSES DISTRIBUTED 2004-2013 (PER 1,000) Palache 2015 SEASONAL INFLUENZA VACCINE DOSES DISTRIBUTED 2004-2013 (PER 1,000) ? Palache 2015 POLICIES THAT ENABLE SEASONAL INFLUENZA VACCINE UPTAKE • • • • • Vaccine advocacy and education Building public trust Real-time management of the vaccination program Political commitment Improving access to vaccination Palache 2015 POLICIES THAT ENABLE SEASONAL INFLUENZA VACCINE UPTAKE • Vaccine advocacy and education – For general public, high risk groups, vaccinators • Building public trust – – – – Adverse event monitoring Disease surveillance Program impact assessment Communication • Real-time management of the vaccination program – Monitor coverage in real time – Continuous quality improvement • Political commitment – Prioritize influenza within health portfolio • Improving access to vaccination – – – – Reduce restrictions to access Reduce financial disincentives Reconsider age limits of older populations Provide monetary incentives to vaccinators Palache 2015 Member States Recommending Seasonal Influenza Vaccination for Adults Recommended Adult Immunization Schedule United States - 2016 Evolution of Seasonal Influenza Vaccination Recommendations – United States HR Adults 19-49 300 Adults > = 50 years 250 Children 6mo-18 yrs 24-59 mos. of age Millions 200 6-23 mos. of age 150 50-64 year healthy individuals Household contacts 100 Health care workers 50 Nursing home residents Pregnant women 0 1964 1974 1984 1994 2004 2006 2008 Year 2010: Flu vaccine recommended for all > 6 months of age <65 years with a high risk condition > =65 years Impact of Policies (and their adoption) Seasonal Influenza Vaccine Production, Distribution: United States 1979-2010 (millions of doses) Outreach and Reminder Recall “We ask that you confirm your risk category for flu….” Recommended Adult Immunization Schedule United States - 2016 February 5, 2016 Surveillance of Vaccination Coverage Among Adult Populations — United States, 2010-2014 Percentage PPV coverage –ever vaccinated, by age group, England, 2005/06 to 2014/15 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/448 406/hpr2615_ppv.pdf Cumulative shingles vaccine coverage in England by age cohort, September 2014 to May 2015 (year 2), and September 2013 to August 2014 (year 1) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/448407/hpr2615_shngls.pdf United States • • • • Assess Recommend Administer or Refer Document Assess Recommend Administer or Refer Document Adult Vaccination Finder Available at http://www.vaccines.gov/ National Immunization Awareness Month • In August; third week focuses on adults • Highlights value of vaccines across the lifespan Toolkit available at: www.nphic.org/niam http://www.izsummitpartners.org/ Maternal Immunization Sobanjo-ter Mullen (VRBPAC, 2015) Global Impact of AMR by 2050 300 million people are expected to die prematurely because of drug resistance GDP will shrink by 2 to 3.5% Global economy will lose between 60 and 100 trillion USD worth of economic output http://amr-review.org/ Vaccines prevent infections and so reduce the need to use antibiotics This is true for vaccines that prevent bacterial infections, and it is also true for vaccines that prevent viral infections, such as the flu, which should not be treated with antibiotics but often are anyway. This may be for lack of rapid diagnostic tests to inform prescription or because patients buy them over the counter. Vaccines also have the potential to reduce the use of antibiotics in agriculture February 2016 Recommendations • Use existing products more widely in humans and animals • Renew impetus for early research • Sustain a viable market for needed products February 2016 Four Overarching Goals THE NATIONAL VACCINE PROGRAM OFFICE Epilogue…. …and Prelude Vaccine hesitancy, acceptance and demand 16. RECOGNISES the importance of the general public understanding the value of vaccinations and NOTES that the occasional lack of awareness of the benefits of some vaccines and the increasing refusal of vaccination in some Member States may lead to under-vaccination in some populations resulting in public health problems and costly outbreaks. December 2014 Howard takes all of the flu shots that other employees refuse to take