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Improvement needed in vaccine coverage rates

NEW YORK — Improvement of routine immunization rates is important and should begin with pediatricians and office staff.

Mark H. Sawyer, MD, professor of clinical pediatrics and pediatric infectious disease specialist at the University of California, San Diego School of Medicine and Rady Children’s Hospital, spoke at the 25th Annual Infectious Diseases in Children Symposium and said pediatricians should be up-to-date on their immunizations, along with the office staff, and pediatricians should also know the coverage rates for their patient population.

“Set a good example by making sure you and your staff are all immunized,” Sawyer said. “Do a missed opportunity assessment so you know how many of your patients could have received immunizations.”

Ways to improve coverage rates

Other ways to improve rates include use of standing orders for immunizations, reminder/recall systems and immunization registries. Evidence from hospitals show that standing orders are effective, and veterinarians have been using remind/recall successfully for years. Besides positive effect of immunization registries, Sawyer said the CMS will now provide monies for participation in electronic health records (EHRs) under the Meaningful Use Guidelines.

This payment is part of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which authorized incentive payments through Medicare and Medicaid to clinicians and hospitals that use EHRs in a meaningful way that significantly improves clinical care.

The latest available data on pertussis vaccine coverage rates indicate that DTaP rates among children aged 19 to 35 months is 84% vs. nearly 69% Tdap coverage among adolescents aged 13 to 17 years. Tdap immunization rates among adults is just 8%, despite ACIP recommendations that call for one dose of Tdap for everyone aged 11 years or older, especially those who are in close contact with an infant aged younger than 12 months.

Health care workers

Rates among health care workers also remain poor, with pertussis rates of 17%, followed by influenza at 53% (ages 18 to 64 years), and hepatitis B vaccine at 68%.

Additional vaccines that should be more utilized include rotavirus vaccine (current coverage rate of 67%); hepatitis A (52%); meningococcal (71%); HPV (36% among girls; 5% among boys); and influenza (51%).

“Vaccines are one of the most cost-effective prevention strategies we have,” Sawyer said, borrowing a quote from David Satcher, MD, former US Surgeon General.