Vaccination of Adults in General Medical Practice

Abstract

In vaccinating adults, clinicians face 2 types of challenges: (1) staying current on recommendations for influenza, pneumococcal, hepatitis A and B, zoster, and other vaccines and (2) addressing systemic barriers to implementing practices that increase vaccination rates. Although adult immunization rates remain suboptimal, there has been much good news in adult vaccination recently. New high-dose and adjuvanted influenza vaccines help improve immune response and may reduce influenza complications in older adults. The new recombinant zoster vaccine offers significantly more efficacy against zoster outbreaks and postherpetic neuralgia than zoster vaccine live. Pertussis vaccine given during the third trimester of pregnancy may prevent between 50% and 90% of pertussis infections in infants. Shorter time for completion (1 vs 6 months) of new, adjuvanted hepatitis B vaccine may increase adherence. Clinicians can address systemic barriers to increasing vaccination rates in their clinics and health care systems by following the Centers for Disease Control and Prevention's Standards for Adult Immunization Practice. Clinicians can help increase vaccination rates by writing standing orders and by advocating for nurses or medical assistants to receive training and protected time for assessing and documenting vaccination histories and administration. Strong recommendations that presume acceptance of vaccination are effective with most patients. Communication techniques similar to motivational interviewing can help with vaccine-hesitant patients. Clinicians, as experts on providing preventive services, can educate community leaders about the benefits of immunization and can inform vaccine experts about challenges of implementing vaccination recommendations in clinical practice and strategies that can work to raise vaccination rates.

Patterns of recommended vaccine receipt among women ages 24–45 years: a cross-sectional analysis

“…It is not surprising that these women were less likely to have received the HPV vaccine, given that some women in this population would not have been age-eligible for vaccination prior to the recent expansion to include women 27–45 years old for shared clinical decision making [ 4 ]. Influenza vaccine coverage tends to be higher among older adults [ 2 , 13 ], presumably due to increased interaction with the healthcare system or increased recommendation of the vaccine based on comorbidities. However, it is unclear from our data why vaccine receipt would be higher among adults aged 36–45 years in this population, even after controlling for recent interactions with the healthcare system.…”

Management of Immunity Alteration-Induced Chronic Pain During the Coronavirus Disease-2019 (COVID-19) Pandemic

“…PHN is defined as skin-distributed pain that persists for at least 3 months after acute HZ (Salvetti et al, 2019 ). The treatment for PHN focuses on symptom control, including the use of topical lidocaine or capsaicin and oral gabapentin, pregabalin, or tricyclic antidepressants (Hempstead et al, 2020 ; Kopel and Brower, 2020 ), as well as the improvement of immunity and antiviral treatments (Huning et al, 2019 ; Hunter et al, 2020 ). The analgesic effects of traditional treatments have not been reported to have good efficacy among PHN patients with older age, serious skin lesions, or long disease courses.…”

Vaccines for International Travel

“…Full details of routine adult immunization are found elsewhere in this Mayo Clinic Proceedings vaccine thematic series. 94 Verification and update of these routine vaccines, regardless of itinerary, is part of the pretravel consultation. However, for many VPDs, the risk of disease is also increased in developing countries.…”

“…Asymptomatic adults with HIV and reconstituted CD4 cell counts of more than 200/mL are considered to have limited immune deficits and should receive additional vaccines according to the usual guidelines found elsewhere in this Mayo Clinic Proceedings vaccine thematic series. 94 The HB vaccine high-dose regimen is recommended for all immunocompromised persons and adult hemodialysis patients. 58 Titers should be determined for HB surface antibody response after vaccination; patients should be revaccinated if response is absent.…”