ACIP Broadens Adult Immunization Recommendations

 

Photo Credit PHIL

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ACIP, the CDC's Advisory Committee on Immunization Practices, has published their revised recommendations for adult immunizations today in the February 1st edition of the Annals of Internal Medicine.

 

Among the changes, ACIP now recommends routine HPV vaccination for males aged 11 to 12 years, and has broadened their recommendations for administering the Hepatitis B vaccine.

 

The entire recommendation can be read at:

 

Recommended Adult Immunization Schedule: United States, 2012*

1. Advisory Committee on Immunization Practices†

 

But for the short version, we have this press release from the American College of Physicians.

 

2012 adult immunization schedule broadens recommendations for HPV and hepatitis B vaccinations

Annals of Internal Medicine early release article for Feb. 1, 2012

Philadelphia, February 1, 2012 – The CDC's Advisory Committee on Immunization Practices (ACIP) now recommends routine HPV vaccination for males aged 11 to 12 years and catch-up vaccination for males aged 13 to 21. These are just two of the changes to the 2012 Recommended Adult Immunization Schedule being published February 1 in Annals of Internal Medicine (www.annals.org), the flagship journal of the American College of Physicians (ACP).

 

In addition to the changes in the HPV vaccine, the ACIP now recommends vaccination against Hepatitis B for adults younger than age 60 who have diabetes, as soon as possible after diabetes is diagnosed. Hepatitis B vaccinations should also be given to adults with diabetes aged 60 years or older based on a patient's need for assisted blood glucose monitoring, likelihood of acquiring hepatitis B, and likelihood of immune response to vaccination.

 

The ACIP is comprised of the ACP and 16 other medical societies representing various medical practice areas. Each year, the ACIP reviews the CDC's Recommended Adult Immunization Schedule to ensure the schedule reflects current clinical recommendations for licensed vaccines. The recommendations are intended to guide physicians and other clinicians about the appropriate vaccines for their adult patients. In October 2010, the ACIP adopted an evidence-based process that considers quality of evidence, benefits and harms, values and preferences of affected populations, and economic impact. Voting to expand routine HPV vaccination to males and hepatitis B vaccinations to young adult diabetics was the first exercise of this approach.

 

Changes were also made to when mothers should receive the tetanus, diphtheria, and acellular pertussis (Tdap) booster that is designed to protect infants from pertusiss. According to the 2012 schedule, women should receive the vaccine during pregnancy, preferably after 20 weeks of gestation. Protective maternal antibodies will pass to the fetus.

 

Adult patients should continue to be vaccinated against influenza. Egg allergy is no longer a contraindication, but patients with an egg allergy should get the inactivated flu shot because that is what has been studied.

 

A footnote was added to the schedule directing readers to links for the full ACIP vaccine recommendations. Specific vaccine recommendations for travelers also were added. In another new addition, the schedule now includes a table summarizing precautions and contraindications for vaccines.

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The full 2012 Recommended Adult Immunization Schedule can be viewed at www.annals.org.

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Study: An Economic Appraisal Of Universal Flu Vaccination

 

 

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Influenza epidemics each year inflict a heavy toll around the world, in terms of lives lost and human suffering, and in purely economic terms as well.   

 

The numbers are estimates of course, but as many as 500,000 lives are believed lost in a `normal’ influenza year.   Millions more are hospitalized, and so the economic burden of the disease is heavy.

 

Ontario, Canada (pop. 13 million) was the first region in the world to begin offering `universal’ flu vaccinations, beginning back in 2000.

 

Not everyone avails themselves of the shot, of course.  But unlike the rest of the world, all those under the age of 65 have been encouraged to get the shot.

 

After ten years, we now have some comparative data showing the impact, and relative costs, of Universal Influenza Immunization Programs (UIIPs) vs. Targeted Influenza Immunizations Programs (TIIPs).

 

These numbers are, by necessity, estimates. There is simply no practical way to count every influenza case, or identify every influenza-related death. 

 

Still . . . with years of data to examine, the trends reported in this study appear to support the notion of offering universal flu vaccinations.

 

First, some excerpts from the press release then a look at the PLoS study’s abstract.

 

 Public release date: 6-Apr-2010

Ontario's universal flu vaccination plan

The millions of dollars invested by the province of Ontario in its universal flu vaccine campaign saves lives and is a sensible investment, according to an economic analysis by a researcher at the University of Toronto and the University Health Network.

 

Even though the estimated $40 million annual cost of Ontario's flu vaccine campaign is double the price tag of a vaccination campaign targeted to specific populations, the universal campaign remains "economically attractive," said Beate Sander, a doctoral student at the University of Toronto Faculty of Medicine's Department of Health Policy, Management & Evaluation and a researcher at the University Health Network's Division of Clinical Decision-Making and Health Care Research.

 

"Compared to a targeted influenza immunization program, the universal program reduces influenza illness attack rates, morbidity and mortality at reasonable cost to the taxpayer," said Sander, also of the Toronto Health Economics and Technology Assessment Collaborative. The study by Sanders and her colleagues was published today in the journal PloS Medicine.

<SNIP>

Among the findings of Sander and her colleagues:

• Estimated number of influenza cases prevented each season: 34,541 (61% of all cases each season)
• Estimated number of influenza deaths prevented each season: 111 (28% reduction in mortality)
• Estimated number of influenza-related hospitalizations prevented each season: 786 (46% reduction)
• Estimated number of Emergency Department visits prevented each season: 7,745 (61% reduction)
• Estimated number of doctor office visits prevented each season: 30,306 (61% reduction)

(Continue . . . )

 

As this is a PLoS Medicine study, it is freely available online. I’ve reparagraphed the Method and Findings section for easier readability.

 

Follow the link to read it in its entirety.

 

 

Economic Appraisal of Ontario's Universal Influenza Immunization Program: A Cost-Utility Analysis

Citation: Sander B, Kwong JC, Bauch CT, Maetzel A, McGeer A, et al. (2010) Economic Appraisal of Ontario's Universal Influenza Immunization Program: A Cost-Utility Analysis. PLoS Med 7(4): e1000256. doi:10.1371/journal.pmed.1000256

Abstract

Background

In July 2000, the province of Ontario, Canada, initiated a universal influenza immunization program (UIIP) to provide free seasonal influenza vaccines for the entire population. This is the first large-scale program of its kind worldwide. The objective of this study was to conduct an economic appraisal of Ontario's UIIP compared to a targeted influenza immunization program (TIIP).

Methods and Findings

A cost-utility analysis using Ontario health administrative data was performed. The study was informed by a companion ecological study comparing physician visits, emergency department visits, hospitalizations, and deaths between 1997 and 2004 in Ontario and nine other Canadian provinces offering targeted immunization programs.

 

The relative change estimates from pre-2000 to post-2000 as observed in other provinces were applied to pre-UIIP Ontario event rates to calculate the expected number of events had Ontario continued to offer targeted immunization.

 

Main outcome measures were quality-adjusted life years (QALYs), costs in 2006 Canadian dollars, and incremental cost-utility ratios (incremental cost per QALY gained). Program and other costs were drawn from Ontario sources. Utility weights were obtained from the literature. The incremental cost of the program per QALY gained was calculated from the health care payer perspective.

 

Ontario's UIIP costs approximately twice as much as a targeted program but reduces influenza cases by 61% and mortality by 28%, saving an estimated 1,134 QALYs per season overall. Reducing influenza cases decreases health care services cost by 52%.

 

Most cost savings can be attributed to hospitalizations avoided. The incremental cost-effectiveness ratio is Can$10,797/QALY gained. Results are most sensitive to immunization cost and number of deaths averted.

Conclusions

Universal immunization against seasonal influenza was estimated to be an economically attractive intervention.

Please see later in the article for the Editors' Summary

(Continue . . . )

 

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