Target Audience (click to view)
This activity is designed to meet the needs of physicians
Learning Objectives(click to view)
Upon completion of the educational activity, participants should be able to:
- Review the 2015 schedule of recommended adult immunizations for use in the United States, released by the CDC’s Advisory Committee on Immunization Practices.
- Explain the issue of poor immunization coverage among U.S. adults and how clinicians can help promote vaccination.
Method of Participation(click to view)
Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation. A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwaugust4. You must participate in the entire activity to receive credit. If you have questions about this CME/CE activity, please contact AKH Inc. at firstname.lastname@example.org.
Credit Available(click to view)
CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s. AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Commercial Support(click to view)
There is no commercial support for this activity.
Disclosures(click to view)
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.
Disclosure of Unlabeled Use & Investigational Product(click to view)
This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer(click to view)
This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.
Faculty & Credentials(click to view)
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH planners and reviewers have no relevant financial relationships to disclose.
Take CME(click to view)
Based on three changes in the area of adult immunizations that occurred recently, the CDC’s Advisory Committee on Immunization Practices (ACIP) has approved an updated schedule of recommended adult immunizations for use in the United States. The schedule reflects the recommendation that all adults aged 65 or older receive the 13-valent pneumococcal conjugate vaccine (PCV13), a recent FDA approval to expand the patient age range for receipt of the recombinant influenza vaccine to now include all adults aged 18 and older, and a revision on contraindications and precautions for the live attenuated influenza vaccine. The revision changed the statement “influenza antiviral use within the last 48 hours” from a precaution to a contraindication. It also changed asthma and chronic lung diseases; cardiovascular, renal, and hepatic diseases; and diabetes and other conditions from contraindications to precautions.
“The biggest change in the 2015 schedule is the inclusion of the ACIP recommendation for routine administration of PCV13 in series with the 23-valent pneumococcal polysaccharide vaccine for all adults aged 65 and older,” says David K. Kim, MD, lead author of the schedule, which was published in Annals of Internal Medicine. “Previously, PCV13 was recommended only for adults aged 19 to 64 with certain health conditions that put them at increased risk for pneumococcal disease. The significant morbidity and mortality associated with pneumococcal disease—from pneumonia to blood-borne infections and meningitis—disproportionately affects adults, particularly older adults.”
Of the 40,000 cases of invasive pneumococcal disease (IPD) that occur annually in the U.S., 13,500 occur among adults aged 65 and older. Also, approximately 20% to 25% of IPD cases and 10% of community-acquired pneumonia cases are caused by PCV13 serotypes and could be prevented by using PCV13. “The vaccine can prevent much of the morbidity associated with IPD and, in doing so, prevent death,” adds Dr. Kim. Unfortunately, the 2013 pneumococcal vaccination coverage rate for adults aged 65 and older was less than 60%, and the rate was only about 20% for those aged 19 to 64 who have medical conditions that place them at high risk for pneumococcal disease.
Low Immunization Rates
The poor immunization coverage among U.S. adults expands beyond pneumococcal disease. “For example, in 2013 less than two-thirds of all adults were not current on their tetanus vaccine,” explains Dr. Kim. “Only about one-quarter of adults aged 60 and older receive the zoster vaccine. These examples show that physicians need to promote vaccination for their adult patients.”
Dr. Kim notes that consumer research indicates that patients tend to heed the advice of healthcare providers who recommend vaccines to them. “Clinicians can also promote vaccination by following the Standards for Adult Immunization Practice,” he says. The standards include a four-step process:
♦ Assess immunization of all patients at every clinical encounter.
♦ Strongly recommend to patients the vaccines that they need.
♦ Administer recommended vaccines or refer patients to a vaccination provider.
♦ Document vaccines that have been administered, including those administered by another provider.
“Documentation of administered vaccines should be in the provider’s state vaccine registry, which almost all states possess,” Dr. Kim notes. “These four steps help providers engage their adult patients on vaccines and ensure that their vaccination records can be accessed by any provider.”
Initiating the conversation about vaccination with adult patients can be guided by the information provided in Figure 1, based on patient age, and in Figure 2, depending on patients’ health conditions and other indications. “When reviewing the schedule as depicted in these figures, healthcare providers need to review the footnotes,” explains Dr. Kim. “The footnotes contain the details that clinicians need in order to successfully vaccinate their adult patients, including contraindications, precautions, the order of vaccine intervals, and other nuances. The schedule is a visual tool to assist physicians in delivering the vaccines needed by their patients.”
Physicians believe that vaccines are an important component of overall healthcare, says Dr. Kim. “Therefore, physicians are in a position to have a significant impact on increasing the adult immunization coverage rates, and they have a responsibility to make that happen,” he says. “The 2015 Recommended Adult Immunization Schedule provides recommendations to help clinicians with this task, but they are meaningless unless physicians start the dialog with their adult patients about vaccines.”
Readings & Resources (click to view)
Kim D, Bridges C, Harriman K. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older: United States, 2015. Ann Intern Med. 2015;162:214-223. Available at http://annals.org/data/Journals/AIM/932718/0000605-201502030-00009.pdf.
Tomcsyk S, Bennett N, Stoecker C, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2014;63;822-825.
Grohskopf L, Olsen S, Sokolow L, et al; Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014-15 influenza season. MMWR. 2014;63:691-697.
Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR. 2010;59:1102-1106.