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Witness Testimony of Hon. Cliff Stearns, a Representative in Congress from the State of Florida

Thank you Chairman Michaud and Ranking Member Brown.

I have two bills before the committee today.  H.R. 5516—Access to Appropriate Immunizations for Veterans and H.R. 5996—a bill to help veterans with chronic obstructive pulmonary disease (COPD).

H.R. 5996 is a bipartisan bill that I’m proud to have introduced as the co-founder of the COPD caucus.  COPD is the 4th leading cause of death in the US, and is predicated to be the 3rd leading cause of death by 2020, beating both diabetes and stroke.  126,000 Americans die each year from this disease—that’s about 1 death every 4 minutes.

My bill would increase the VA’s ability to diagnose, treat and manage COPD.  COPD is a chronic condition that does not have a cure. Early detection and treatment is important to slow or arrest the progression of the disease.  It is estimated that more than 12 million people are diagnosed with COPD and yet this number is believed to be too small as COPD is often under-diagnosed.  The Centers for Disease Control and Prevention (CDC) estimates that over 24 million Americans have symptoms of COPD.

Despite all this, there is a lack of COPD awareness by patients and doctors. 

Because this is a progressive disease, early detection is important. 

Because there is no cure, early treatment is vital. 

Because the COPD rate is 3 times higher in the veteran population than the civilian population, how can the VA not be providing this type of specialized care?  COPD is the fourth most common diagnosis amongst hospitalized veterans aged 65-74.

H.R. 5996 would have the VA develop treatment protocols and related tools for the diagnosis, treatment and management of chronic obstructive pulmonary disease.  It would also have the VA establish a pilot smoking cessation program targeted towards individuals who have COPD.  While there are many ways that someone can develop COPD, the most common is from smoking.  However, it should also be noted that COPD has underlying genetic risk factors and healthy non-smokers can develop COPD.

I think it’s important to note that this is not giving VA any new authority.  VA already has the authority to do what I’m asking for, but for whatever reason, they have not aggressively moved to develop these treatment protocols for the 4th leading cause of death in the United States.  My bill would have the VA begin to develop these treatments for our veterans.

H.R. 5996 has the support of the US COPD Coalition, the COPD Foundation, the American Thoracic Society, the American Association for Respiratory Care, the Alpha-1 Foundation and the Alpha-1 Association.  I’d like to submit their letters of support for the record.

My other bill is the Access to Appropriate Immunizations for Veterans, H.R. 5516.  The VA already has the authority to provide vaccines to veterans to immunize them against preventable diseases.  However, the VA has only established performance measures for two vaccines.  For these two vaccines against the flu and pneumonia, the vaccination rate increased from about 27% to almost 80% and hospitalization rates dropped in half.

My bill would extend all the Centers for Disease Control & Prevention’s recommended vaccines to the performance measures.  It is important to note that vaccines are not just for children.  In fact, just last week the NY Times ran an article on how important it is for adults to receive vaccines and booster shots.

I’d like to read a part of this article:

“Adult immunizations are not just an important way to prevent the spread of disease.  Immunizations are also a phenomenally cost-effective way to preserve health. 

“‘When you compare the cost of getting sick with these diseases to the cost of a vaccine, it’s a modest investment,’ said Dr. Robert H. Hopkins, a professor of internal medicine and pediatrics at the University of Arkansas for Medical Sciences.”

According to the CDC, each year approximately 70,000 adult Americans die from vaccine-preventable diseases.  Influenza along is responsible for over one million ambulatory care visits…200,000 hospitalizations…and 30,000 deaths.  Only 7% of Americans over the age of 60 have received the vaccine to protect them from shingles, a painful nerve infection.  Just 11% of young women have received the vaccine against HPV that cause 70% of all cervical cancers.

Many of our veterans who are in the “high-risk” category of contracting vaccine-preventable diseases—include those with HIV, Hepatitis C and substance abuse disorder—are enrolled in the VA health care system and could benefit from receiving vaccinations.

I want the VA to provide superior quality health care to our veterans.  Adding vaccination to the performance measure is a simple common-sense idea that will increase the level of care available and save money by stopping preventable diseases.  The bill would also require the VA to report back to Congress on their progress of supporting vaccinations within the veteran population.

And I’d like to enter this NY Times article into the record and the CDC’s recommended vaccination schedule for adults.


Alpha-1 Association
Miami, FL.
September 28, 2010

The Honorable Cliff Stearns
2370 Rayburn House Office Building
Washington, DC 20515

Dear Representative Stearns,

On behalf of the Alpha-1 Association’s Board of Directors, I wish to express our heartfelt appreciation for your leadership in Chronic Obstructive Pulmonary Disease (COPD) in the veterans’ community and to express our support for the passage of H.R. 5996.

The Alpha-1 Association is a patient-focused and patient-driven organization dedicated to identifying individuals affected by Alpha-1 and improving the quality of their lives through support, education, advocacy and to encourage participation in research. As a 501(c) (3) not-for-profit membership organization, the Association has been providing services to Alphas and their families since 1991.

This bill affects our patient community. According to the National Heart, Lung & Blood Institute, 3 percent of the 12 million people that have been diagnosed with COPD in the United States have Alpha-1.

Alpha-1 is a genetic condition that may result in serious, chronic lung and/or liver disease at various ages in life (children and adults). It is often misdiagnosed as asthma or smoking-related Chronic Obstructive Pulmonary Disease (COPD).

Individuals with Alpha-1 may develop emphysema even if they have never smoked. Despite treatments, including protein replacement, adults may require a lung transplant due to severe emphysema.

As the foremost provider of health care services to over 8 million veterans, the Department of Veterans Affairs has a unique opportunity to become a leader in the fight against Alpha-1 (Genetic COPD). H.R. 5996 will allow the VA to take a comprehensive approach in reducing the burden of Alpha-1 through innovative prevention, education and treatment strategies. It will also provide for the critically needed research into best practices that will help to simultaneously reduce costs and improve quality of life.

Our Association and the COPD community care deeply about the need to address COPD in America’s veteran population. The VA system has been a leader in health systems research and H.R. 5996 will build on a record of using innovative methods to improve the health of the veterans it serves. We encourage your colleagues to join you in support of H.R. 5996. Congress’ actions will mark a great step towards addressing the burden that COPD places on veterans, their families and the health care delivery system.

We are happy to support your efforts in any way that will aid you in obtaining passage of H.R. 5996.

Sincerely,

Marlene Erven
Executive Director


 

American Association for Respiratory Care
Irving, TX.
August 15, 2010

The Honorable Cliff Stearns
2370 Rayburn House Office Building
Washington, DC 20515

Dear Representative Stearns:

The American Association for Respiratory Care (AARC) a 50,000 member professional association for respiratory therapists endorses and fully supports H.R. 5996. This legislation will direct the Secretary of Veterans Affairs to improve the prevention, diagnosis, and treatment of veterans with chronic obstructive pulmonary disease (COPD).

Respiratory therapists provide clinical care and services to pulmonary patients across the continuum of care ranging from the hospital settings, to rehabilitation centers, to skilled nursing facilities, to home care and in physician offices.

Among the important provisions of H.R. 5996 is a special emphasis on assisting our nations veterans with smoking cessation efforts- a leading contributor to COPD. Respiratory therapists are on the front lines as health care professionals who assist the public with smoking prevention and cessation efforts.

There are over 1,700 respiratory therapists currently employed in the Veterans Health Care System. With the enactment of H.R. 5996, there will be a cadre of respiratory therapists already in place to help implement the directives mandated by this important legislation.

Thank you again for your foresight and commitment to our nations veterans and their health care.

Sincerely,

Tim Myers, BS, RRT-NPS
President

 


American Lung Association
Washington, DC.
October 4, 2010

The Honorable Cliff Stearns
U.S. House of Representatives
Washington, DC 20515

Dear Representative Stearns:

The American Lung Association is pleased to support H.R. 5596, legislation to improve the prevention, diagnosis, and treatment of veterans with chronic obstructive pulmonary disease (COPD). Chronic obstructive pulmonary disease takes a tremendous human and financial toll on the Department of Veterans Affairs. An estimated 8 percent of veterans in the Department of Veterans Affairs (VA) Health Care System have been diagnosed with COPD. COPD ranks as the fourth most common reason for hospitalization in the VA patient population. It is the fourth most common cause of death in the United States, and it is projected to become the third leading cause of mortality by 2020.

H.R. 5996 will require the development of treatment protocols and related tools for the prevention, diagnosis, treatment, and management of chronic obstructive pulmonary disease. The legislation also will bolster biomedical and prosthetic research programs regarding this disease. These steps are urgently needed to help improve patient outcomes.

Between 80 and 90 percent of all COPD cases are caused by smoking. The best way to prevent COPD and many diseases the VA healthcare system manages is to quit smoking or not to smoke in the first place. H.R. 5996 will help address this by directing the VA, in conjunction with Centers for Disease Control and Prevention, to develop improved techniques and best practices for assisting veterans with chronic obstructive pulmonary disease in successfully quitting smoking.

According to the 2008 Study of Veteran Enrollees’ Health and Reliance Upon VA, over 70 percent of VA enrollees report that they have smoked at one time in their lives. Currently 19.7 percent smoke. This is down from 22.2 percent in 2005 and 21.5 percent in 2007 and shows some important momentum in the right direction. Among the 70 percent of the VA population who has ever smoked, over twenty five percent (25.5) say they’ve recently quit smoking, again, a step in the right direction.

Sadly, the VA will continue to battle this problem for some time to come.  The current smoking rate for active duty military is 30.4 percent, with smoking rates highest among personnel ages 18 to 25--especially among soliders and Marines.  The Department of Veterans Affairs estimates taht more than 50 percent of all active duty personnel stationed in Iraq smoke.

H.R. 5596 is an important step to address COPD and th etoll of tobacco on our nation's veterans.  We look forward to working with you to pass this lifesaving legislation.

Sincerely,

Charles D. Connor
President and Chief Executive Officer

cc:  The Honorable John Lewis


COPD Foundation
Washington, DC.
August 10, 2010

The Honorable Cliff Stearns
2370 Rayburn House Office Building
Washington, DC 20515

Dear Representative Stearns,

On behalf of the COPD Foundation’s Board of Directors, I wish to express our heartfelt appreciation for your leadership in Chronic Obstructive Pulmonary Disease (COPD) in the veterans’ community and to express our support for the passage of H.R. 5996.

The COPD Foundation is the national not-for-profit organization solely dedicated to representing individuals with COPD in the United States. As you know, COPD, or Chronic Obstructive Pulmonary Disease, is an umbrella term used to describe progressive lung diseases, encompassing emphysema, chronic bronchitis, refractory asthma, and severe bronchiectasis.

The NIH estimates that 12 million adults have COPD and another 12 million are undiagnosed or developing COPD. COPD is currently the fourth leading cause of death in the US and it is estimated to become the third leading cause of death by 2020. The impacts on the economy are severe, with national costs projected to be $49.9 billion in 2010, in part due to COPD’s status as the second leading cause of disability.

As the foremost provider of health care services to over 8 million veterans, the Department of Veterans Affairs has a unique opportunity to become a leader in the fight against COPD. H.R. 5996 will allow the VA to take a comprehensive approach to reducing the burden of COPD through innovative prevention, education and treatment strategies. It also provides for critically needed research into best practices that will help to simultaneously reduce costs and improve quality of life.

Our organization and the COPD community care deeply about the need to address COPD in America’s veteran population. A 2003 study revealed that COPD was the fourth most common diagnosis amongst hospitalized veterans and a strong predictor for patient readmission following a hospital stay. The VA system has been a leader in health systems research and H.R. 5996 will build on a record of using innovative methods to improve the health of the veterans it serves. We encourage your colleagues to join you in support of H.R. 5996. Congress’ actions will mark a great step towards addressing the burden that COPD places on veterans, their families and the health care delivery system.

We were excited to learn that the House Committee on Veterans’ Affairs will hold a hearing on September 29, 2010 that will include a discussion of H.R. 5996. If there is an opportunity to provide a witness at this hearing we would be pleased to identify a patient, physician or researcher who could lend substance to the discussion of COPD in the Veterans’ population. We are happy to support your efforts in any way that will aid you in obtaining passage of H.R. 5996.

Sincerely,

John W. Walsh
President


EFFORTS
Kansas City, MO.
October 1, 2010

Dear Representative Stearns,

On behalf of EFFORTS, www.emphysema.net, an online COPD, support, advocacy organization we wish to thank you for your leadership with regard to COPD and our Veterans and to offer our full support for the passage of H.R. 5996.

Currently, COPD ranks as the fourth leading cause of death in the U.S. behind heart disease, cancer, and cardiovascular disease, and it is the only major disease that continues to show increased mortality rates each year. In contrast, seven of the other ten leading causes of death actually showed decreases in mortality.

In Healthy People 2010, a publication of The Centers for Disease Control (CDC) and the National Institutes of Health (NIH), one central recommendation was that developing better methods for early detection of COPD is of utmost importance. It is often stated that COPD is diagnosed after age 65. However, in a recent survey of 338 members of our EFFORTS organization, we found that the age of diagnosis averaged 47 years for females and 56 years for males. It was also noted that many were experiencing symptoms of their disease long before they were actually diagnosed. Unfortunately, it is not at all uncommon for someone to have lost 50% or more of his/her lung function before they are diagnosed.

COPD is an enormous economic burden to society. It strikes during the height of the productive years, significantly interferes with the ability to earn a living, forces many to go on Medicare disability or take early retirement at an early age, and often disrupts the lives of the individual and family for many years before death occurs. According to data from the NHLBI, the direct costs of health care services and indirect costs related to loss of productivity for COPD were $26 billion in 1998 and $30.4 billion in 2000. Medical expenses for COPD patients are extremely high because of frequent visits to the emergency room, extended hospital stays, and expensive medications. In 1997, there were an estimated 13.4 million physician office visits and more than 600,000 hospitalizations for COPD (NHLBI, 2001). Data from the Centers for Disease Control indicate that diseases of the respiratory system rank #3 in the number of emergency room visits. It is expected that all of the costs associated with COPD will continue to spiral upward because the prevalence of COPD is continuing to rise each year.

There are only a few treatment options available to the millions of patients who suffer from this killer disease. None provides a cure and only treat the symptoms. Physicians can experiment with medications developed for asthma, consider surgery, prescribe oxygen, and/or refer the patient for pulmonary rehabilitation. Unfortunately, Lung Volume Reduction Surgery (LVRS), a procedure shown to be helpful to some but not all patients, is not covered by Medicare and many insurance companies because it is considered to be an experimental procedure. Lung transplantation is a viable option, but the strict medical requirements and critical shortage of organ donors make it available to a relatively small number of patients. Pulmonary rehabilitation, universally recognized as extremely important for optimizing patients' overall physical conditioning, is not universally available to everyone in need because it is not covered by Medicare in most states.

One medicine was developed specifically for COPD a few years ago. Another “blockbuster” drug with great promise has been tested and approved in several countries outside the US, but has not yet been approved by the FDA. At a recent hearing at the FDA (9/02), it was determined that although this important drug was safe and shown to bring significant improvement in measures of lung function, the FDA still wanted additional testing. This ruling will cause a significant delay in the availability of this important drug to people with COPD.

We believe that the continuing rise in death and disability due to COPD in this country is distinct public health emergency. Millions of children under the age of 18 begin smoking every day. Approximately 15 percent to 20 percent of those who smoke will eventually develop severely disabling COPD, and there are growing concerns about the harmful effects of our environment on lung function.

Many patients with COPD are totally reliant on the Veterans Administration for their medical care. As an organization, EFFORTS is excited to learn that the House Committee on Veterans Affairs will be holding a hearing that will include a discussion of COPD and will support your efforts in any way that will aid the passage of H.R. 5996.

Sincerely,

EFFORTS Executive Board
Joan Esposito V.P. N.J.
Ann Lornie V.P. UK
Maggie Borger IL
Edna Fiore CO.
Jean Rommes IA.
Michael MacDonald MA. &
Linda Watson N.Y. President  


NTM Info and Research, Inc.
Coral Gables, FL.
October 1, 2010

The Honorable Cliff Stearns
2370 House Office Building
Washington, DC 20515

Dear Representative Stearns,

On behalf of NTM Info & Research (NTMir), I wish to express our appreciation for your leadership in Chronic Obstructive Pulmonary Disease (COPD) in the veterans' community and to express our support for the passage of H.R. 5996.

NTMir is the national not-for-profit organization dedicated to pulmonary nontuberculous mycobacterial (NTM) disease. COPD, or Chronic Obstructive Pulmonary Disease, is an umbrella term used to describe progressive lung diseases, encompassing emphysema, chronic bronchitis, refractory asthma, severe bronchiectasis, and NTM lung disease.

The NIH estimates that 12 million adults have COPD and another 12 million are undiagnosed or developing COPD. COPD is currently the fourth leading cause of death in the US and is estimated to become the third leading cause of death by 2020. The impacts on the economy are severe, with national costs projected to be $49.9 billion in 2010, in part due to COPD's status as the second leading cause of disability.

As the foremost provider of health care services to over 8 million veterans, the Department of Veterans Affairs has a unique opportunity to become a leader in the fight against COPD. H.R. 5996 will allow the VA to take a comprehensive approach to reducing the burden of COPD through innovative prevention, education and treatment strategies. It also provides for critically needed research into best practices that will help to simultaneously reduce costs and improve quality of life.

NTMir and the COPD community care deeply about the need to address COPD in America's veteran population. A 2003 study revealed that COPD was the fourth most common diagnosis among hospitalized veterans and a strong predictor for patient readmission following a hospital stay. The VA system has been a leader in health systems research and H.R. 5996 will build on a record of using innovative methods to improve the health of the veterans it serves. We encourage your colleagues to join you in support of H.R. 5996. Congress' actions will mark a great step toward addressing the burden that COPD places on veterans, their families and the health care delivery system.

Sincerely,

Philip Leitman
President


 

Respiratory Health Association of Metropolitan Chicago
Chicago, IL. 
October 4, 2010

Honorable Cliff Stearns
U.S. Representative
2370 Rayburn House Office Bldg
Washington, DC 20515

Dear Congressman Stearns,

Respiratory Health Association of Metropolitan Chicago (RHAMC) urges support of H.R. 5996 which seeks to improve the prevention, diagnosis, and treatment of veterans with COPD. The legislation directs the Veterans Administration Secretary to focus attention and resources toward addressing COPD within the population they serve.

RHAMC has been dedicated to community lung health since 1906. Our mission is to promote healthy lungs and fight lung disease through research, advocacy and education. RHAMC launched the COPD Initiative in response to the growing impact of COPD upon our communities. The goals are to increase COPD awareness, educate the public and health care community, advance COPD policies, advocate for people living with COPD.
There is a growing, active and engaged COPD patient community that is advocating for improved programming and coverage addressing COPD. The patients and caregivers in our communities seek more resources dedicated to addressing COPD.

COPD is the fourth leading cause of death in Illinois. An estimated 500,000 adults in Illinois alone suffer from COPD. Smoking is the primary cause, but exposure to lung irritants like vapors and dusts in occupational settings as well as secondhand smoke contribute to COPD. In the past five years, more women died of COPD than men in the United States. In Illinois, more women than men are hospitalized every year for COPD.
Veterans Administration needs to take a comprehensive approach to reducing the burden of COPD through innovative prevention, education and treatment strategies. This legislation also provides for critically needed research into best practices that will help to simultaneously reduce costs and improve quality of life.

We applaud the House Committee on Veterans’ Affairs for addressing this issue and we support passage if H.R. 5996.

Sincerely,

Joel J. Africk
President and Chief Executive Officer


New York Times
September 24, 2010

Cost and Lack of Awareness Hamper Adult Vaccination Efforts

By LESLEY ALDERMAN

VACCINES are not just for children.

About 11,500 cases of whooping cough, or pertussis, have been reported nationwide so far this year. In California, where the infections are nearing a record high, nine infants have died.

It is likely that some of those children had not received all their shots, experts say. But some of those deaths might have been prevented if more adults, too, had been immunized.

Though public health authorities have long recommended that adults get a pertussis booster shot, just half have done so. Without it, they risk passing this illness to vulnerable children.

“Almost everyone understands how important it is for children to be immunized,” said Dr. Melinda Wharton, deputy director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, “but adults need vaccines too.”

Far too few get them. The C.D.C. recommends that people 19 and older receive immunizations against as many as 14 infectious diseases. (Not all adults require every vaccine.) Yet most adults rarely think about getting the shots—until they step on a rusty nail or begin planning travel to a developing country.

Only 7 percent of Americans over age 60, for instance, have received the herpes zoster vaccine, which prevents shingles, a painful nerve infection. Just 11 percent of young women have received the vaccine against the two types of human papilloma virus that cause 70 percent of all cervical cancers.

Why are adults so behind on vaccinations? For one thing, the shots can be expensive (from $20 to $200 a dose for some, and some require three doses). But a bigger part of the problem is a lack of awareness. Doctors often fail to remind patients that they require booster shots, and consumers are not well informed about the need.

In a 2007 survey by the National Foundation for Infectious Diseases, 40 percent of respondents incorrectly stated that, if they had received vaccines as a child, they did not need them again; 18 percent said vaccines were not necessary for adults.

The new health care law should help get more adults to roll up their sleeves. Under the law, group and individual health plans, as well as Medicare, must provide preventive health services, including immunizations recommended by the C.D.C., free of charge. That means no co-payments, co-insurance or deductibles.

The hope is that since vaccines will be free, more doctors will suggest them and more patients will ask for them, said Jeffrey Levi, executive director of Trust for America’s Health, a nonprofit group that works to prevent epidemics.

Here’s the catch. If you are in a group or individual health plan, your plan must be new, or it must have undergone substantial changes, in order for the new requirements to apply. In addition, certain recent vaccine recommendations will not be covered right away. If you are uncertain, call your insurer.

Adult immunizations are not just an important way to prevent the spread of disease. Immunizations are also a phenomenally cost-effective way to preserve health.

“When you compare the cost of getting sick with these diseases to the cost of a vaccine, it’s a modest investment,” said Dr. Robert H. Hopkins, a professor of internal medicine and pediatrics at the University of Arkansas for Medical Sciences.

If you end up in the emergency room with a bad case of the flu or pneumonia, your bill could be thousands of dollars. A flu shot is just $20, or often free; the pneumonia vaccine is about $77.

Here is how to get up-to-date on your shots—whether you have a new insurance plan, an old plan or no plan at all.

THE VACCINES YOU NEED Tear out the immunization chart accompanying this article or print it out online. Note the vaccines you should be getting, based on your age and health status.

This year, for the first time, the C.D.C. recommends that everyone, regardless of age or health, get an influenza shot. Most people need only one. This year the flu shot provides protection against the H1N1 virus and two seasonal viruses.

Most other vaccines are intended for specific age groups or for those with particular risk factors. The zoster vaccine, for example, has been tested only in older people. There is little evidence that it could benefit younger people, whose immune systems are still strong.

Next, figure out which vaccines you have already received. Your doctor should be able to help. But if you have switched physicians a number of times, you may have to reconstruct your history on your own.

“When in doubt, get vaccinated,” said Dr. Hopkins. “There’s very little risk with getting a second dose of a vaccine.”

IF YOU HAVE INSURANCE Call your primary care physician and explain that you would like to get your vaccinations updated.

Some offices do not stock vaccines, so it is wise to tell the staff in advance what you will need. You may find that certain vaccines are not available right away; your doctor can tell you where to find them, or how long the wait will be.

Next, call your insurer and ask if they will cover vaccines free of charge. If not, ask how much they charge. If the fees are high, see below for alternate options.

IF YOU LACK COVERAGE You can still pay out-of-pocket for immunizations at the doctor’s office, of course. But the shots may be less expensive at other places.

YOUR HEALTH DEPARTMENT If money is tight, find out if your state or community health department provides vaccinations for adults. Unfortunately, there is no federally funded program for adult immunizations, only for children.

The C.D.C. Web site provides an interactive map to help locate the health department or immunization clinic in your area.

YOUR LOCAL PHARMACY Many retail clinics administer vaccines, including CVS MinuteClinics and Walgreens Take Care Clinics. MinuteClinics offer 10 vaccines for adults, including shots for hepatitis A ($117) and B ($102), meningitis ($147), pneumococcal disease ($77) and DTaP, which protects you from diphtheria, tetanus and pertussis ($82).

There are 500 CVS clinics across the country, and all are open seven days a week. No appointments or prescriptions are necessary. Walgreens clinics offer travel vaccines, like the one for typhoid fever, as well.

Even if your local pharmacy does not have a clinic, you may be able to get some of the shots you need there. In all states, pharmacists are licensed to give flu shots; in some states, they can administer other vaccines as well, like the one to protect against pneumonia.

Check with a local pharmacy and find out what shots they are licensed to provide and at what cost.

YOUR EMPLOYER Inquire at your company’s human resources or wellness office. Some companies provide free flu shots for employees, as well as their families. Few companies provide other vaccines, but it can’t hurt to ask.

Remember that when you get immunized, you are not only ensuring your own good health but the health of those around you.


Chart from CDC Showing the Recommended Adult Immunization Schedule Page 1

Chart Showing Vaccines that might be indicated for adults baswed on medical and other indications

Footnotes

Recommended Adult Immunization Schedule—UNITED STATES · 2010

For complete statements by the Advisory Committee on Immunization Practices (ACIP), visit www.cdc.gov/vaccines/pubs/ACIP-list.htm.

1.Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination

Tdap should replace a single dose of Td for adults aged 19 through 64 years who have not received a dose of Tdap previously.

Adults with uncertain or incomplete history of primary vaccination series with tetanus and diphtheria toxoid-containing vaccines should begin or complete a primary vaccination series. A primary series for adults is 3 doses of tetanus and diphtheria toxoid-containing vaccines; administer the first 2 doses at least 4 weeks apart and the third dose 6–12 months after the second; Tdap can substitute for any one of the doses of Td in the 3-dose primary series. The booster dose of tetanus and diphtheria toxoid-containing vaccine should be administered to adults who have completed a primary series and if the last vaccination was received ≥10 years previously. Tdap or Td vaccine may be used, as indicated.

If a woman is pregnant and received the last Td vaccination ≥10 years previously, administer Td during the second or third trimester. If the woman received the last Td vaccination <10 years previously, administer Tdap during the immediate postpartum period. A dose of Tdap is recommended for postpartum women, close contacts of infants aged <12 months, and all health-care personnel with direct patient contact if they have not previously received Tdap. An interval as short as 2 years from the last Td is suggested; shorter intervals can be used. Td may be deferred during pregnancy and Tdap substituted in the immediate postpartum period, or Tdap can be administered instead of Td to a pregnant woman.

Consult the ACIP statement for recommendations for giving Td as prophylaxis in wound management.

2. Human papillomavirus (HPV) vaccination

HPV vaccination is recommended at age 11 or 12 years with catch-up vaccination at ages 13 through 26 years.

Ideally, vaccine should be administered before potential exposure to HPV through sexual activity; however, females who are sexually active should still be vaccinated consistent with age-based recommendations. Sexually active females who have not been infected with any of the four HPV vaccine types (types 6, 11, 16, 18 all of which HPV4 prevents) or any of the two HPV vaccine types (types 16 and 18 both of which HPV2 prevents) receive the full benefit of the vaccination. Vaccination is less beneficial for females who have already been infected with one or more of the HPV vaccine types. HPV4 or HPV2 can be administered to persons with a history of genital warts, abnormal Papanicolaou test, or positive HPV DNA test, because these conditions are not evidence of prior infection with all vaccine HPV types.

HPV4 may be administered to males aged 9 through 26 years to reduce their likelihood of acquiring genital warts.  HPV4 would be most effective when administered before exposure to HPV through sexual contact.

A complete series for either HPV4 or HPV2 consists of 3 doses. The second dose should be administered 1–2 months after the first dose; the third dose should be administered 6 months after the first dose.

Although HPV vaccination is not specifically recommended for persons with the medical indications described in Figure 2, “Vaccines that might be indicated for adults based on medical and other indications,” it may be administered to these persons because the HPV vaccine is not a live-virus vaccine. However, the immune response and vaccine efficacy might be less for persons with the medical indications described in Figure 2 than in persons who do not have the medical indications described or who are immunocompetent. Health-care personnel are not at increased risk because of occupational exposure, and should be vaccinated consistent with age-based recommendations.

3. Varicella vaccination

All adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine if not previously vaccinated or the second dose if they have received only 1 dose, unless they have a medical contraindication. Special consideration should be given to those who 1) have close contact with persons at high risk for severe disease (e.g., health-care personnel and family contacts of persons with immunocompromising conditions) or 2) are at high risk for exposure or transmission (e.g., teachers; child-care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers).

Evidence of immunity to varicella in adults includes any of the following: 1) documentation of 2 doses of varicella vaccine at least 4 weeks apart; 2) U.S.-born before 1980 (although for health-care personnel and pregnant women, birth before 1980 should not be considered evidence of immunity); 3) history of varicella based on diagnosis or verification of varicella by a health-care provider (for a patient reporting a history of or presenting with an atypical case, a mild case, or both, health-care providers should seek either an epidemiologic link with a typical varicella case or to a laboratory-confirmed case or evidence of laboratory confirmation, if it was performed at the time of acute disease); 4) history of herpes zoster based on diagnosis or verification of herpes zoster by a health-care provider; or 5) laboratory evidence of immunity or laboratory confirmation of disease.

Pregnant women should be assessed for evidence of varicella immunity. Women who do not have evidence of immunity should receive the first dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the health-care facility. The second dose should be administered 4–8 weeks after the first dose.

4. Herpes zoster vaccination

A single dose of zoster vaccine is recommended for adults aged ≥60 years regardless of whether they report a prior episode of herpes zoster. Persons with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication.

5. Measles, mumps, rubella (MMR) vaccination

Adults born before 1957 generally are considered immune to measles and mumps.

Measles component: Adults born during or after 1957 should receive 1 or more doses of MMR vaccine unless they have 1) a medical contraindication; 2) documentation of vaccination with 1 or more doses of MMR vaccine; 3) laboratory evidence of immunity; or 4) documentation of physician-diagnosed measles.

A second dose of MMR vaccine, administered 4 weeks after the first dose, is recommended for adults who 1) have been recently exposed to measles or are in an outbreak setting; 2) have been vaccinated previously with killed measles vaccine; 3) have been vaccinated with an unknown type of measles vaccine during 1963–1967; 4) are students in postsecondary educational institutions; 5) work in a health-care facility; or 6) plan to travel internationally.

Mumps component: Adults born during or after 1957 should receive 1 dose of MMR vaccine unless they have 1) a medical contraindication; 2) documentation of vaccination with 1 or more doses of MMR vaccine; 3) laboratory evidence of immunity; or 4) documentation of physician-diagnosed mumps.

A second dose of MMR vaccine, administered 4 weeks after the first dose, is recommended for adults who 1) live in a community experiencing a mumps outbreak and are in an affected age group; 2) are students in postsecondary educational institutions; 3) work in a health-care facility; or 4) plan to travel internationally.

Rubella component: 1 dose of MMR vaccine is recommended for women who do not have documentation of rubella vaccination, or who lack laboratory evidence of immunity. For women of childbearing age, regardless of birth year, rubella immunity should be determined and women should be counseled regarding congenital rubella syndrome. Women who do not have evidence of immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge from the health-care facility.

Health-care personnel born before 1957: For unvaccinated health-care personnel born before 1957 who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease, health-care facilities should consider vaccinating personnel with 2 doses of MMR vaccine at the appropriate interval (for measles and mumps) and 1 dose of MMR vaccine (for rubella), respectively.

During outbreaks, health-care facilities should recommend that unvaccinated health-care personnel born before 1957, who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease, receive 2 doses of MMR vaccine during an outbreak of measles or mumps, and 1 dose during an outbreak of rubella.

Complete information about evidence of immunity is available at www.cdc.gov/vaccines/recs/provisional/default.htm.

6. Seasonal Influenza vaccination

Vaccinate all persons aged ≥50 years and any younger persons who would like to decrease their risk of getting influenza. Vaccinate persons aged 19 through 49 years with any of the following indications.

Medical: Chronic disorders of the cardiovascular or pulmonary systems, including asthma; chronic metabolic diseases, including diabetes mellitus; renal or hepatic dysfunction, hemoglobinopathies, or immunocompromising conditions (including immunocompromising conditions caused by medications or HIV); cognitive, neurologic or neuromuscular disorders; and pregnancy during the influenza season. No data exist on the risk for severe or complicated influenza disease among persons with asplenia; however, influenza is a risk factor for secondary bacterial infections that can cause severe disease among persons with asplenia.

Occupational: All health-care personnel, including those employed by long-term care and assisted-living facilities, and caregivers of children aged <5 years.

Other: Residents of nursing homes and other long-term care and assisted-living facilities; persons likely to transmit influenza to persons at high risk (e.g., in-home household contacts and caregivers of children aged <5 years, persons aged ≥50 years, and persons of all ages with high-risk conditions).

Healthy, nonpregnant adults aged <50 years without high-risk medical conditions who are not contacts of severely immunocompromised persons in special-care units may receive either intranasally administered live, attenuated influenza vaccine (FluMist) or inactivated vaccine. Other persons should receive the inactivated vaccine.

7.  Pneumococcal polysaccharide (PPSV) vaccination

Vaccinate all persons with the following indications.

Medical: Chronic lung disease (including asthma); chronic cardiovascular diseases; diabetes mellitus; chronic liver diseases, cirrhosis; chronic alcoholism; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]); immunocompromising conditions including chronic renal failure or nephrotic syndrome; and cochlear implants and cerebrospinal fluid leaks. Vaccinate as close to HIV diagnosis as possible.

Other: Residents of nursing homes or long-term care facilities and persons who smoke cigarettes. Routine use of PPSV is not recommended for American Indians/Alaska Natives or persons aged <65 years unless they have underlying medical conditions that are PPSV indications. However, public health authorities may consider recommending PPSV for American Indians/Alaska Natives and persons aged 50 through 64 years who are living in areas where the risk for invasive pneumococcal disease is increased.

8. Revaccination with PPSV

One-time revaccination after 5 years is recommended for persons with chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy); and for persons with immunocompromising conditions. For persons aged ≥65 years, one-time revaccination is recommended if they were vaccinated ≥5 years previously and were younger than aged <65 years at the time of primary vaccination.

9. Hepatitis A vaccination

Vaccinate persons with any of the following indications and any person seeking protection from hepatitis A virus (HAV) infection.

Behavioral: Men who have sex with men and persons who use injection drugs.

Occupational: Persons working with HAV–infected primates or with HAV in a research laboratory setting.

Medical: Persons with chronic liver disease and persons who receive clotting factor concentrates.

Other: Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A (a list of countries is available at wwwn.cdc.gov/travel/contentdiseases.aspx).

Unvaccinated persons who anticipate close personal contact (e.g., household contact or regular babysitting) with an international adoptee from a country of high or intermediate endemicity during the first 60 days after arrival of the adoptee in the United States should consider vaccination. The first dose of the 2-dose hepatitis A vaccine series should be administered as soon as adoption is planned, ideally ≥2 weeks before the arrival of the adoptee.

Single-antigen vaccine formulations should be administered in a 2-dose schedule at either 0 and 6–12 months (Havrix), or 0 and 6–18 months (Vaqta). If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6 months; alternatively, a 4-dose schedule, administered on days 0, 7, and 21–30 followed by a booster dose at month 12 may be used.

10. Hepatitis B vaccination

Vaccinate persons with any of the following indications and any person seeking protection from hepatitis B virus (HBV) infection.

Behavioral: Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than one sex partner during the previous 6 months); persons seeking evaluation or treatment for a sexually transmitted disease (STD); current or recent injection-drug users; and men who have sex with men.

Occupational: Health-care personnel and public-safety workers who are exposed to blood or other potentially infectious body fluids.

Medical: Persons with end-stage renal disease, including patients receiving hemodialysis; persons with HIV infection; and persons with chronic liver disease.

Other: Household contacts and sex partners of persons with chronic HBV infection; clients and staff members of institutions for persons with developmental disabilities; and international travelers to countries with high or intermediate prevalence of chronic HBV infection (a list of countries is available at wwwn.cdc.gov/travel/contentdiseases.aspx).

Hepatitis B vaccination is recommended for all adults in the following settings: STD treatment facilities; HIV testing and treatment facilities; facilities providing drug-abuse treatment and prevention services; health-care settings targeting services to injection-drug users or men who have sex with men; correctional facilities; end-stage renal disease programs and facilities for chronic hemodialysis patients; and institutions and nonresidential daycare facilities for persons with developmental disabilities.

Administer or complete a 3-dose series of HepB to those persons not previously vaccinated. The second dose should be administered 1 month after the first dose; the third dose should be administered at least 2 months after the second dose (and at least 4 months after the first dose). If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6 months; alternatively, a 4-dose schedule, administered on days 0, 7, and 21–30 followed by a booster dose at month 12 may be used.

Adult patients receiving hemodialysis or with other immunocompromising conditions should receive 1 dose of 40 µg/mL (Recombivax HB) administered on a 3-dose schedule or 2 doses of 20 µg/mL (Engerix-B) administered simultaneously on a 4-dose schedule at 0, 1, 2 and 6 months.

11. Meningococcal vaccination Meningococcal vaccine should be administered to persons with the following indications.

Medical: Adults with anatomic or functional asplenia, or persistent complement component deficiencies.

Other: First-year college students living in dormitories; microbiologists routinely exposed to isolates of Neisseria meningitidis; military recruits; and persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic (e.g., the “meningitis belt” of sub-Saharan Africa during the dry season [December through June]), particularly if their contact with local populations will be prolonged. Vaccination is required by the government of Saudi Arabia for all travelers to Mecca during the annual Hajj.

Meningococcal conjugate vaccine (MCV4) is preferred for adults with any of the preceding indications who are aged ≤55 years; meningococcal polysaccharide vaccine (MPSV4) is preferred for adults aged ≥56 years. Revaccination with MCV4 after 5 years is recommended for adults previously vaccinated with MCV4 or MPSV4 who remain at increased risk for infection (e.g., adults with anatomic or functional asplenia). Persons whose only risk factor is living in on-campus housing are not recommended to receive an additional dose.

12. Selected conditions for which Haemophilus influenzae type b (Hib) vaccine may be used

Hib vaccine generally is not recommended for persons aged ≥5 years. No efficacy data are available on which to base a recommendation concerning use of Hib vaccine for older children and adults. However, studies suggest good immunogenicity in patients who have sickle cell disease, leukemia, or HIV infection or who have had a splenectomy. Administering 1 dose of Hib vaccine to these high-risk persons who have not previously received Hib vaccine is not contraindicated.

13. Immunocompromising conditions

 Inactivated vaccines generally are acceptable (e.g., pneumococcal, meningococcal, influenza [inactivated influenza vaccine]) and live vaccines generally are avoided in persons with immune deficiencies or immunocompromising conditions. Information on specific conditions is available at www.cdc.gov/vaccines/pubs/acip-list.htm.