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Adult Immunization

SyringeOnce assessment and planning have been completed, including analysis of the collected data, the next step is implementing the strategies and interventions that will comprise the workplace health program. The intervention descriptions on this page include the public health evidence-baseThe development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models. for each intervention, details on designing interventions for adult immunization, and links to examples and resources.

Before implementing any interventions, the evaluation plan should also be developed. Potential baseline, process, health outcomes, and organizational change measures for these programs are listed under evaluation of adult immunization programs.

Vaccine-preventable diseases are infectious diseases that can be prevented by immunization (vaccination). Traditionally, vaccines have been associated with protecting young children, but far too many adults become ill, are disabled, and die each year from diseases that could easily have been prevented by vaccines. Vaccines not only prevent disease in the people who receive them but often create “herd immunity,” meaning that even unvaccinated individuals are at lower risk of disease if most of their community is immunized. Everyone from young adults to older adults can benefit from immunizations.

Among vaccine-preventable diseases in adults, influenza has the greatest impact in the U.S. population.

  • An average of 36,000 deaths and over 200,000 hospitalizations associated with influenza occur each year in the United States1-2 
  • The combination of influenza and pneumonia was the eighth leading cause of death among all persons in the United States in 2005, accounting for 63,000 deaths3 
  • The overall national economic burden of influenza-attributable illness for adults, age 18 years and above is $83.3 billion. Direct medical costs for influenza in adults totaled $8.7 billion including $4.5 billion for adult hospitalizations resulting from influenza-attributable illness4 
  • Influenza is also responsible for substantial indirect costs ($6.2 billion annually), mainly from lost productivity. Each year, among adults age 18 to 64 years, 17 million workdays are lost to influenza-related illness5  

In Rankings of Preventative Services for the U.S. Population, the Partnership for Prevention provides an approach to ranking preventive services according to their clinically preventable burden (CPB) and cost effectiveness (CE). CPB is the disease, injury and premature death that would be prevented if the service were delivered to all people in the target population. With this approach, influenza vaccination for adults age 50 years and above received a ranking of 8 on a scale of 1-10, with 10 being the highest ranking.

The National Advisory Committee on Immunization Practices (ACIP) consists of a 15 member expert panel convened by the U.S. Department of Health and Human Services (DHHS) to provide advice and guidance to DHHS and the Centers for Disease Control and Prevention (CDC) on the control of vaccine-preventable diseases. The ACIP produces a recommended schedule of adult immunizations by vaccine-preventable disease, age group, and indications based on several medical conditions such as pregnancy or chronic disease.

  • The ACIP recommends that healthy adults who want to reduce the risk of becoming ill with flu or transmitting it to others, receive an influenza (flu) vaccine each year. Yearly vaccination should begin in September or as soon as vaccine is available. Adults can be vaccinated throughout the influenza season into December, January, and beyond
  • The ACIP also recommends several other vaccinations for adults based on their age, medical conditions and/or other circumstances as determind by their physicians
  • As of July 2006, the average lifetime, private-sector cost to vaccinate healthy adults through age 74 with universally recommended vaccines is approximately $380 to $480, depending on the brand of vaccine given5 

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Health-related adult immunization programs6-7      

Employee programs refer to activities that include active employee involvement, such as classes, seminars or competitions. Employee programs are frequently provided on-site at the workplace.

Employee health surveys in the workplace provide assessment and implementation opportunities
  • Information from employee health surveys can be used not only in obtaining baseline group data on employee immunization levels but also to educate individual employees to their needs for follow up for specific health concerns
Multicomponent interventions that include education are effective in improving immunization rates
  • The Task Force on Community Preventive Services recommends multicomponent interventions that include combinations of:
    • Vaccine education through mailings, newspaper, media, and other sources
    • Provider and client reminders for recommended vaccines
    • Education of vaccine providers along with clinical components such as expanded hours or access
    • Reduced out-of-pocket costs for clients
  • Multicomponent interventions that include education increase community awareness of the availability, usefulness, and relevance of vaccination services, as well as providing the information necessary to use these services
Education can emphasize the importance of vaccines, especially flu vaccines, in maintaining worker productivity
  • Studies have shown that healthy working adults who received an influenza vaccine (in a year when the vaccine was well matched to circulating influenza viruses) experienced significantly fewer days of influenza-like illness, made fewer doctor visits for such illnesses, and took fewer days off from work than did workers who were not vaccinated
  • To reduce rates of seasonal influenza among employees, The National Business Group on Health [PDF - 161KB] recommends that employers:
    • Encourage employees to get vaccinated
    • Consider offering onsite flu vaccination clinics
    • Encourage employees to practice good hygiene by posting handwashing signs in rest rooms and providing hand sanitation stations
    • Encourage sick employees to stay home

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Health-related policies for adult immunization8 

Workplace policies promote a corporate “culture of good healthThe creation of a working environment where employee health and safety is valued, supported and promoted through workplace health programs, policies, benefits, and environmental supports. Building a Culture of Health involves all levels of the organization and establishes the workplace health program as a routine part of business operations aligned with overall business goals. The results of this culture change include engaged and empowered employees, an impact on health care costs, and improved worker productivity..”

Encourage sick employees to stay home
  • Employers can structure time and attendance policies to encourage sick employees to stay home limiting their exposure to other employees so that healthy employees are less likely to become sick
Health care personnel are at elevated risk for contracting and transmitting influenza
Establish a corporate plan for operations during an influenza pandemic
  • A pandemic is a population-wide outbreak of disease that affects large numbers of people. Absentee rates and worker productivity will be severely affected during an influenza pandemic. The U.S. Department of Health and Human Services (DHHS) recommends that each business establish an emergency plan for operations during a pandemic

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Health benefits for adult immunization9-10 

Employee health benefits are part of an overall compensation package and affect an employee’s willingness to seek preventive services and clinical care.

Provide coverage for clinical preventive services such as immunization for vaccine-preventable diseases
  • The recommendations of The Advisory Committee on Immunization Practices (ACIP) are the most commonly accepted national guidelines for pediatric, adolescent, and adult immunizations. The ACIP is supported by liaison members such as the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP), and the American Medical Association (AMA) who are critical partners to carry out the recommendations of the committee. The ACIP produces a recommended schedule of adult immunizations by vaccine-preventable disease, age group, and indications based on several medical conditions such as pregnancy or chronic disease
  • Employer should provide coverage for the following ACIP recommended adult vaccines:
    • Diphtheria and tetanus (Td) booster every 10 years for persons younger than 65 years. One of the Td boosters should be replaced with tetantus/diptheria/acellular pertussis (Tdap) to provide protection against pertussis (whooping cough)
    • Influenza (annually for adults age 50 years and older)
    • Human papillomavirus for women ≤ 26 years of age
    • Varicella (chickenpox) immunization (2 doses) for people with no evidence of immunity such as a history of varicella infection. Very few adults actually need the varicella vaccine because most adults had chickenpox as children
    • Zoster (shingles) for adults age 60 years and older
    • Pneumococcal (for adults age 65 years and older)
  • Other immunizations, such as hepatitis A and B; pneumococcal (for persons younger than 65 years based on high risk conditions such as diabetes); measles, mumps, and rubella (1-2 doses for persons born after 1957); and meningococcal vaccines
  • All vaccines may be recommended for individuals based on their age, medical conditions and/or other circumstances as determined by their physicians
  • Health care personnel may need a more comprehensive group of immunizations even if their overall health is good
Reducing the out-of-pocket costs for immunization will increase vaccination coverage among employees
  • Investigations have shown that reducing the out-of-pocket cost of the intervention service for the client increases demand for and use of immunization services. Employers can reduce the costs for vaccinations by paying for the immunization or their administrative costs, by providing insurance coverage, or by reducing co-payments for these services
  • The Task Force on Community Preventative Services has determined that reducing out-of-pocket costs is effective in increasing vaccine coverage
  • Bringing immunization services on-site such as through an occupational health clinic is often an effective strategy to reduce out-of-pocket expenses. On-site interventions reduce the cost barriers that prevent employees from receiving preventive services such as transportation to a clinic facility and the need for child care
Require health plans to send reminders to employees and providers about recommended vaccines
  • Task Force on Community Preventative Services has determined that client and provider reminder/recall is effective in increasing vaccine coverage
  • Employee reminders tell people that it is time to schedule an appointment for a recommended vaccine or that they are late (recall) for a recommended vaccine
  • Provider reminders may be placed in patient records or entered into a reminder system to encourage clinicians to contact patients who are due for immunizations
  • Employee reminders can be mailed as a letter or postcard or communicated as part of a telephone call
  • Additional information about the health benefits of immunization can also be included as part of the reminder

Tools and Resources (more)

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Environmental support for adult immunization

Environmental support provides a worksite physically designed to encourage good health.

Provide handwashing stations for employees and encourage their use
  • It is estimated that up to 80% of all infections are transmitted by hands making good hygiene practices among all employees a must. Employees who regularly wash their hands are less likely to get sick and miss work
  • Provide hand sanitizers and gels containing 60%-90% ethanol or isopropanol when sinks and soap are not available
  • Employers can also remind employees about good hygiene by placing handwashing signs and reminders in bathrooms, kitchens, break rooms, or other communal areas with sinks

Tools and Resources


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