Immunization remains the best means of preventing many of infections diseases. In the United States, childhood immunization has resulted in near elimination of measles. mumps, rubella, poliomyelitis, diphtheria, pertussis, and tetanus. Hemophiliacs influenza type b invasive disease has been reduced by more than 95% since the introduction of the first conjugate vaccines.
However, substantial vaccine-preventable morbidity and mortality continue to occur among adults from vaccine-preventable diseases, such as hepatitis A, hepatitis B, influenza, and pneumococcal infections. For example, in adults in the United States, there are an estimated 50,000-70,000 deaths annually from influenza, hepatitis B, and invasive pneumo-coccal disease.
Influenza vaccination is recommended for adults age 50 and older, and it has been documented that annual influenza immunization with inactivated vaccine (administered intramuscularly) prevents cardiovascular morbidity and all-cause mortality in persons with coronary and other atherosclerotic vascular disease. Rates of influenza vaccination have increased. Self reported rates of influenza vaccine coverage in adults older than 65 years increased from 30% in 1989 to 71% in 2008. However, vaccination rates were higher for non-Hispanic whites compared with other ethnic minority groups.
The Advisory Committe on Immunization Practices (ACIP) recommends that clinicians should review each adult's immunization status at age 50; asses risk factors that would indicate a need for pneumoccal vaccination and annual influenza immunizations; re immunize at age 65 those who received an immunization against pneumococcus more than 5 years before; ensure that all adults have completed a primary diptheria-tetanus immunization series, and administer a single booster at age 50; and asses the post vaccination serologic response to hepatitis B vaccination in all recipients who have ongoing risks of exposure to blood or body fluids (eg. Sharp injuries, Blood Splashes).
Strategies have also been proposed to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination. Strategies to enhance vaccination in general include increasing community demand for vaccination; enhancing acces to vaccination services; and providier- or system based interventions, such as reminder systems, increasing reports of pertussis among US adolescents, adults, and their infant contacts have stimulated vaccine development for older age groups. A Safe and effective tetanus-diphtheria 5-component acellular pertussis vaccine (Tdap) is available for use in adolescents and in adults younger than 65.
A Recombinant protein in hepatitis E vaccine has been developed that has proven safe and efficacious in preventing hepatitis' E among high risk populations ( such as those in Nepal). both hepatitis A vaccine and immune globulin provide protection against hepatitis A; however, administration of immune globulin may provide a modest benefit over vaccination in some settings.
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