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Vaccination Strategies for High-Risk Adults

A report published in the June 2005 American Journal of Preventive Medicine entitled “Interventions to Improve Influenza, Pneumococcal Polysaccharide, and Hepatitis B Vaccination Coverage among High-Risk Adults: A Systematic Review,” provides recommendations from the Task Force on Community Preventive Services regarding the use of population-based interventions to improve the coverage of influenza, pneumococcal polysaccharide, and hepatitis B vaccines in a variety of high-risk adult populations (targeted vaccinations).

This report is designed to complement the initial set of systematic reviews of interventions to improve vaccination coverage for universally recommended vaccinations in children, adolescents, and adults. The report was published in a supplement to the American Journal of Preventive Medicine in January 2000.

The recommendations for high-risk adult populations are based on a review of intervention studies conducted among adults aged 18-64 with medical conditions such as diabetes, heart disease, and lung disease; healthcare workers at high risk for occupational exposure; and people with high-risk behaviors for hepatitis B virus infection such as multiple sex partners or injection drug use. The healthcare settings evaluated in the study include academic programs, outpatient clinics, hospitals, long-term care facilities, and the workplace.

Effectiveness of the interventions was measured by changes in vaccination coverage rates for influenza, pneumococcal polysaccharide, and hepatitis B vaccination.

Reviews of qualifying studies identified strong evidence of effectiveness of provider reminder systems, when implemented alone, in increasing targeted vaccination coverage. The Task Force reported finding insufficient evidence to determine the effectiveness of all other interventions when implemented alone.

However, the Task Force identified evidence that certain combinations of interventions have improved vaccination coverage. Therefore, the Task Force recommends a combination of interventions that include selected interventions from two or three categories of interventions (i.e., increasing community demand for vaccinations, enhancing access to vaccination services, and provider- or system-based interventions).

Overall, the report provides evidence that vaccination coverage can be improved in high-risk populations when provider reminder systems are used alone or when several interventions are implemented concurrently.

For complete information regarding the report, please see:
Ndiaye S, Hopkins D, Shefer A, et. al. Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults. American Journal of Preventive Medicine. June 2005;28:5S.

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