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Examining Low HPV Vaccination Rates

Examining Low HPV Vaccination Rates

Human papillomavirus (HPV) vaccination among adolescents aged 11 or 12 has been shown to be effective and is recommended as a routine primary prevention strategy to reduce many HPV-related cancers. However, data indicate that HPV vaccination coverage is low for adolescents. Examining Coverage To better understand HPV vaccination coverage rates in the United States, the CDC partnered with the National Committee on Quality Assurance (NCQA) to evaluate the rate of vaccination among more than 626,000 girls at age 13 who were enrolled in commercial health insurance plans or Medicaid in. “NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) houses data on performance measures for important healthcare issues that are reported by health insurance plans,” explains Shannon Stokley, MPH. “The HEDIS HPV Vaccine for Female Adolescents performance measure evaluates how many members of a given health plan have received the complete, three-dose HPV vaccination series by the age of 13.” Stokley and colleagues found that although health plan performance on HPV coverage varied by plan type, overall performance was low. Commercial plans provided all three doses of the HPV vaccine to a median of 12% of adolescent girls by age 13, with rates ranging from 0% to 34%. The authors observed little difference in performance by plan size, and the highest-performing plans were health maintenance organizations. Although Medicaid plans reported a significantly higher rate of coverage, these plans provide all three doses of the vaccine to only 19% of girls by age 13, with coverage ranging from 5% to 52% among the various plans. Next Steps “Other reports have shown that vaccination coverage rates for the tetanus, diphtheria, and pertussis...
Making the Case for Meningococcal Disease Prevention

Making the Case for Meningococcal Disease Prevention

While relatively rare, meningococcal disease is a serious cause of morbidity and mortality, even when it is managed with state-of-the-art therapy. Meningococcal disease is often hard to diagnose in its early stages because it typically presents with only fever and malaise. However, the disease can progress very rapidly, with death occurring within 24 hours of symptom onset in some cases. In an outbreak of disease, emergency room physicians or family practice specialists often find themselves on the front lines of caring for meningococcal disease. Unfortunately, they may not have any prior hands-on experience in identifying or treating it. The Development of Vaccines Because of the pattern of insidious onset and a high risk of severe sequelae and mortality, prevention of meningococcal disease is viewed as the best option. Vaccines have been developed to address this critical public health need and protect those at risk. Vaccines that offer protection against four of the five serogroups of meningococcal disease—A, C, W, and Y—are currently available in the United States and are recommended for routine use in adolescents as well as other vulnerable populations. While these established vaccination programs have reduced the incidence of meningococcal disease in the U.S., serogroup B still causes approximately one-third of all cases overall. Currently, there is no licensed vaccine for serogroup B meningococcal disease, and vaccine development for this serogroup has been challenging. Examining Recent Efforts Meningococcal disease tends to occur in outbreaks. For example, in 2013, outbreaks of serogroup B disease occurred at both Princeton University and the University of California, Santa Barbara. To help thwart the spread of disease, the FDA allowed a broad...
Updated Guidelines for HIV Care

Updated Guidelines for HIV Care

According to the CDC, nearly 1.2 million Ameri-cans are living with HIV and about 50,000 people in the United States are infected with the virus each year. Studies have estimated that as many as 80% of patients with HIV have their virus under control and live long, full lives. “With HIV continuing to become a manageable but complex chronic disease, HIV specialists and primary care physicians (PCPs) now need to provide the full spectrum of healthcare to these patients,” says Michael A. Horberg, MD, MAS, FACP, FIDSA. “PCPs and other healthcare providers need a better grasp of the impact that HIV care has on routine healthcare.” A Helpful Update In 2009, an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America (IDSA) released evidence-based guidelines for the management of people infected with HIV. Recently, these guidelines were updated to replace the 2009 recommendations and published in Clinical Infectious Diseases. Since 2009, new antiretroviral drugs and classes have become available, and the prognosis of people with HIV infection continues to improve. The guideline update also incorporates new information based on publications from 2009 to 2013. “The updated IDSA guidelines are intended for use by healthcare providers who care for HIV-infected patients,” says Dr. Horberg, who was on the expert panel that developed the update. “These new recommendations reflect the fact that people with HIV are now living much more normal life spans. As such, there is a greater need to focus on preventive care, including screening for high cholesterol, diabetes, osteoporosis, depression, and substance abuse, among other health conditions.” Although there are better survival rates,...

Highlights from the 2013 Adult Immunization Schedule

The Advisory committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention has issued the 2013 adult immunization schedule, posted online this week in the Annals of Internal Medicine. Because current levels of vaccine uptake for adult vaccines are low, the recommendations stress the importance of providers routinely assessing patients’ vaccination histories and providing routinely recommended vaccines. A strong recommendation from physicians offering vaccination has been associated with increased uptake of vaccines. Physicians are also encouraged to implement reminder/recall systems and standing orders. View figure of the Recommended Adult Immunization Schedule, or click here to download. Changes in the 2013 vaccination schedule include the following: PCV13. Updates have been added for the first time on the use of 13-valen pneumococcal conjugate vaccine (PCV13) and the timing of administration of PCV13 relative to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adults. PC13 is recommended for immunocompromised adults aged 19 and older. The schedule also clarifies which adults would need 1 or 2 doses of PPSV23 before age 65. Tdap. Recommendations have been expanded to include routine administration of Tdap vaccination to adults age 65 and older as well as pregnant women. Pregnant women should receive the Tdap vaccine during each pregnancy, ideally between 27 and 36 weeks’ gestation to increase the likelihood of optimal protection for the woman, the fetus during pregnancy, and the first few months of the infant’s life. Influenza. The guidelines continue to recommend influenza vaccination for patients 6 months and older. Mild allergy to eggs is no longer a contraindication for the influenza vaccination – but patients with this allergy should receive the...

Protecting Older, Vulnerable Patients From the Flu

People aged 65 and older account for more than 60% of the estimated 226,000 flu-related hospitalizations and 90% of the 3,000 to 49,000 flu-related deaths in the United States each year. This age group is at highest risk for contracting influenza and developing its potentially serious complications, including pneumonia, bronchitis, sinus and ear infections, and coronary problems. Flu symptoms can even exacerbate other comorbid conditions. This puts patients at greater risk for complications and reduces quality of life. Collectively, these health issues can result in hospitalization and even death in older patients. Be Vigilant of Those at Higher Risk for Flu As the 2012-2013 influenza season continues and we look ahead to the next, it’s important to improve community-wide vaccination rates so that we can protect public health, especially when treating adults aged 65 and up. Seniors are at higher risk for influenza because the immune system weakens with age. In turn, the body’s ability to produce a sufficient amount of protective antibodies is reduced. When considering influenza vaccine resources for the season, it’s important to offer a variety of vaccine options and newer delivery systems. Merle C. Turner, DO A few years ago, the healthcare world received good news when a higher dose of the influenza vaccine was approved by the FDA for older patients. Designed for those aged 65 and older, the vaccine generates a stronger immune response because it contains four times the amount of antigen as the standard dose. While the high-dose vaccine has shown a higher risk for side effects at the injection site, there is no greater risk of a systemic reaction than...
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