INCREASING IMMUNIZATION RATES AMONG AFRICAN-AMERICAN ADULTS: C.Vaccine Effectiveness and Cost-Effectiveness
Influenza Vaccine
The Influenza vaccine has reduced death, hospitalization, and clinical illness in years when vaccine and epidemic strains are similar. Influenza vaccine is up to 90 percent effective in preventing illness in young, healthy adults. Among institutionalized, high-risk older persons, those vaccinated experience a 30 percent to 40 percent reduction in incidence of illness; a 50 percent-60 percent reduction in hospitalization; and up to 80 percent reduction in death.
The Office of Technology Assessment concluded that vaccination of persons aged 65 years or older would save money and improve health. Optimizing vaccination programs in nursing homes could prevent about 70,000 cases of influenza in a typical epidemic, saving more than $50 million in direct costs. More recently, it has been estimated that vaccination of older adults saved an estimated $30 to $60 in hospitalization costs per $1 spent on vaccination. cheap viagra uk
Pneumococcal Polysaccharide Vaccine
Estimated effectiveness of pneumococcal vaccine against invasive pneumococcal disease caused by serotypes in the vaccine has ranged from 56 percent to 84 percent. Effectiveness was demonstrated in specific patient groups at higher risk for pneumococcal disease, including persons with diabetes, coronary heart disease, congestive heart failure, chronic pulmonary disease, and anatomic asplenia.
Data on effectiveness against invasive pneumococcal disease are not compelling for certain groups of immunocompromised patients, such as those with sickle cell disease or chronic renal failure. However, these studies are limited by the small numbers of unvaccinated persons with these illnesses.
Vaccination against pneumococcal bacteremia can improve the health of elderly persons at a reasonable cost and would save money if the vaccine were administered under a public program (saving $8.27 per person vaccinated). Vaccination of persons aged (65 years can result in reduced medical expenses; additional years of healthy life; and save society millions of dollars. Pneumococcal vaccination is likely to result in even more cost saving for African Americans because of the higher rates of pneumococcal bacteremia and lower pneumococcal vaccination levels compared to the majority population. canadian antibiotics
Hepatitis В Vaccine
The overall effectiveness of vaccine in preventing viremic hepatitis В infection is 85 percent to 95 percent among susceptible adults. If a protective antibody response develops after vaccination, vaccine recipients are virtually 100 percent protected against clinical illness. Long-term studies of healthy adults and children indicate that immunologic memory remains intact for at least 10 years, and offers protection against chronic hepatitis В infection, even though anti-HBs levels may become low or decline below detectable levels. For children and adults whose immune status is normal, booster doses of the vaccine are not recommended. The possible need for booster doses will be assessed as additional information becomes available.
Analysis indicates vaccinating susceptible persons would be cost-saving for populations with annual attack rates above 5 percent and would be cost-effective (or cost saving when indirect costs are included) for populations with attack rates as low as 1 percent to 2 percent. Annual attack rates for high-risk groups are likely to be well above these thresholds.
D. Disparities in Vaccination Levels
Influenza and Pneumococcal Vaccination of Persons Aged >=65 Years To reduce morbidity and mortality caused by influenza and pneumococcal disease, Healthy People 2000 objective 20. called for at least 60 percent vaccination against these diseases among persons at high risk for complications, including all persons aged >=65 years. From 1989 through 1997, influenza and pneumococcal vaccination levels among non-institutionalized persons aged 65 years or older increased steadily in each racial and ethnic group, but remained significantly lower in each year for African Americans and Hispanics compared to non-Hispanic Whites 28-29 jn 19975 the influenza vaccination level was 67.2 percent among Whites compared to 50.2 percent among African Americans, with pneumococcal vaccination levels lower in both groups (47.3 percent for Whites and 29.7 percent for African Americans). Proposed objectives for Healthy People 2010 include a 90 percent coverage target for influenza and pneumococcal vaccination among persons aged 65 years and older. online pharmacy without a prescription
Using data from the 1995 National Health Interview Survey, these disparities between African Americans and non-Hispanic Whites persisted when stratified by poverty status, level of education, frequency of contact with physicians, sex, and age. In most states where sample sizes were sufficient for reliable estimation after combining 1995 and 1997 data from the Behavioral Risk Factor Surveillance System (26 for influenza and 22 for pneumococcal), non-Hispanic Whites were more likely than non-Hispanic African Americans to report receiving influenza and pneumococcal vaccinations.
The Healthy People 2000 objective 20. also called for at least 80 percent influenza and pneumococcal vaccination of chronically ill or older persons in adult long-term care facilities.27 Using data from the 1995 National Nursing Home Survey, estimated coverage was at least 61 percent for influenza vaccination and at least 22 percent for pneumococcal vaccination. Coverage did not differ by racial/ethnic group.
Influenza and Pneumococcal Vaccination of High-risk Persons aged 18-64 Years
In 1995, vaccination levels among adults under age 65 years with one or more high-risk medical conditions were lower than vaccination levels of persons aged 65 years and older. Among persons aged 50-64 years with one or more vaccine-indicated chronic conditions, non-Hispanic African Americans were significantly less likely than non-Hispanic Whites to report receipt of influenza vaccination (24.5 percent vs. 40.4 percent) or pneumococcal vaccination (11.7 percent vs. 21.5 percent). In younger adults with high-risk conditions, there were no differences by racial/ethnic group. viagra soft
Hepatitis В Vaccination of High-risk Adults
Healthy People 2000 objective 20 called for hepatitis В immunization among selected high risk populations, including at least 90 percent among occupationally exposed workers, and at least 50 percent among injecting drug users in drug treatment programs and men who have sex with men. National data does not exist to estimate hepatitis В vaccination in these and other high-risk groups. At least 70 percent of adults with occupational exposure to hepatitis В virus are estimated to have been vaccinated. However, surveys of young men who have sex with men show high rates of hepatitis В infection and low and only a small proportion of STD clinics, drug treatment programs, and correctional facilities routinely offer hepatitis В vaccination.
Tetanus Toxoid Use in Persons Aged >=18 Years The Healthy People 2000 objective 21 called for 62 percent of adults to be up-to-date for the 10-year tetanus booster. The proportion of non-Hispanic African Americans in 1995 who reported receiving tetanus toxoid (with or without diphtheria toxoid) during the past ten years decreased significantly with age, from 60.5 percent among those aged 18-49 to 43.9 percent among those aged 50-64 and 36.9 percent among those aged >=65 years. Tetanus coverage levels were significantly higher for non-Hispanic Whites aged 18-49 years (68.9 percent) and aged 50-64 (56.0 percent). pharmacy united kingdom
