1 . In the United States, what group is responsible for regulating vaccines?
| A) | | Centers for Disease Control and Prevention |
| B) | | Advisory Committee on Immunization Practices |
| C) | | FDA Center for Biologics Evaluation and Research |
| D) | | FDA Vaccines and Related Biological Products Advisory Committee |
AN OVERVIEW OF IMMUNIZATION SCHEDULES
It is helpful to understand how vaccines are approved and then
recommended as part of a schedule. The U.S. Food and Drug Administration's (FDA) Center for
Biologics Evaluation and Research (CBER) is responsible for regulating vaccines in the United
States. Vaccine clinical development follows the same general pathway as drugs and other
biologics. A sponsor who wishes to begin clinical trials with a vaccine must submit an
investigational new drug application (IND) to the FDA. The IND describes the vaccine, its
method of manufacture, and the types of quality control testing done prior to administering
the vaccine to humans. Also included is information about the vaccine's safety and ability to
elicit an immune response in animal testing. In addition, the IND contains the proposed
clinical protocol.
2 . According to the 2024 immunization schedule, what are the recommended vaccine doses for a healthy, 2-month-old infant born in June with no special risks or contraindications who is up-to-date on vaccinations so far?
| A) | | DTaP, Hib, IPV, and HepB if needed |
| B) | | DTaP, Hib, PCV, IPV, and HepB if needed |
| C) | | Rotavirus, DTaP, Hib, IPV, and HepB if needed |
| D) | | Rotavirus, DTaP, Hib, PCV13, IPV, and HepB if needed |
AN OVERVIEW OF IMMUNIZATION SCHEDULES
RECOMMENDED IMMUNIZATION SCHEDULE FOR PERSONS 0 THROUGH 18 YEARS OF AGE, 2024
3 . Assuming no special risk groups or contraindications and assuming that the ACIP recommendations are followed, what vaccines would a male patient, 50 years of age, be likely to receive?
| A) | | Tdap or Td only |
| B) | | Tdap or Td, IIV, and zoster |
| C) | | Tdap or Td, IIV, and PPSV23 |
| D) | | Tdap or Td, IIV, zoster, and PPSV23 |
AN OVERVIEW OF IMMUNIZATION SCHEDULES
RECOMMENDED ADULT IMMUNIZATION SCHEDULE BY VACCINE AND AGE GROUP, 2024
| Vaccine | 19–23 years | 24–26 years | 27–49 years | 50–64 years | 65 years and older |
|---|
| COVID-19 | 1 or more doses of updated
vaccine |
| Influenza (IIV4, RIV4, or LAIV4) | 1 dose (IIV4, RIV4, or LAIV4)
annuallya | 1 dose (IIV4 or RIV4)
annuallya |
| Respiratory syncytial virus | Seasonal RSV during pregnancy
only | — | RSVc | RSVa |
| Tetanus, diphtheria, pertussis (Td or Tdap) | One dose of Tdap, then boost with
Tdap or Td every 10 years |
| One dose Tdap during each
pregnancy; one dose Td for wound prophylaxisa |
| Varicella | 2 doses (if born in 1980 or
later)a | 2 dosesb |
| Human papillomavirus | 2 or 3 dosesa | 2 or 3 dosesc | — | — |
| Zoster (RZV) | 2 doses (if
immunocompromised)b | 2 doses |
| Measles, mumps, rubella | 1 or 2 doses (if born 1957 or
later)a | — |
| Pneumococcal 13-valent conjugate (PCV15, PCV20, PPSV23) | 1 dose PCV20 OR 1 dose PCV15
followed by PPSV23b | 1 dose PCV20 OR 1 dose PCV15
followed by PPSV23a |
| Hepatitis A | 2,3, or 4 dosesb |
| Hepatitis B | 2, 3, or 4 doses | 2, 3 or 4 dosesb |
| Meningococcal ACWY | 1 or 2 doses, then boosterb every 5
years |
| Meningococcal B (MenB) | 2 or 3 dosesc | 2 or 3 dosesb |
| Haemophilus influenzae type b (Hib) | 1 or 3 dosesb |
| Mpox | 2 dosesb |
| aFor all patients in this category who lack evidence of immunity. | | bRecommended if other risk factor is present. | | cRecommended based on clinical decision-making. |
|
4 . The ACIP rationale for expanding the recommendation for influenza vaccination to include all children from 6 months to 18 years of age includes
| A) | | adolescents typically have high rates of physician visits. |
| B) | | universal childhood vaccination is expected to help increase coverage for at-risk groups. |
| C) | | missed school days due to influenza have been low but proven to adversely affect children's grades. |
| D) | | a large new clinical trial reinforced confidence in the safety and efficacy of influenza vaccination in school-age children. |
VACCINES AND RECOMMENDATIONS
The expansion of the recommended ages for the vaccination of
children and adults against influenza is one of the most significant changes to the schedule
in recent years. It requires an annual visit to a healthcare provider, including among older
children and young adults who typically have low rates of physician visits.
The ACIP considered multiple factors in making this
recommendation. First, according to accumulated evidence, the influenza vaccine appears to
be both safe and effective, with the benefits of vaccination outweighing the small risk of
adverse effects [21]. Widespread vaccination
is also intended to lower the social and economic impact of influenza. The number of missed
days of school for children and missed days of work for parents is substantial. Physician
visits for the flu may lead to a prescription for antibiotics—treatment that is unnecessary
and potentially dangerous.
The recommendation is also intended to simplify the decision
to advise vaccination for children [21]. In
previous years, vaccination was recommended for a number of groups with specific risk
factors. These included older children with certain medical conditions and children who were
close contacts of people who should be immunized. Making vaccination routine for all
children is expected to lead to a 50% increase in coverage for those children who have a
specific risk-based or contact-based indication.
5 . According to the ACIP recommendations, and considering healthy patients without special risk factors or contraindications, who should receive the HPV vaccine?
| A) | | Girls 11 to 12 years of age, plus adult women at high risk of contracting HPV |
| B) | | Girls 15 years of age or older, plus adult women at high risk of contracting HPV |
| C) | | Girls younger than 18 years of age who are sexually active, plus adult women through age 26 who have not been vaccinated |
| D) | | All individuals 11 to 26 years of age who have not been vaccinated |
VACCINES AND RECOMMENDATIONS
Recommendation for Adolescents: HPV
vaccine is recommended for girls and boys 11 to 12 years of age and for older adolescents
who have not yet been vaccinated. Children 9 to 10 years of age may also be
vaccinated.
Recommendation for Adults: HPV
vaccine is recommended for adults up to 26 years of age who have not completed the vaccine
series. HPV vaccine is also recommended for those 27 to 45 years of age if desired or if a
risk factor is present.
6 . The ACIP rationale for recommending HPV vaccination to preteens includes all of the following, EXCEPT:
| A) | | HPV infection is particularly common in teenagers and young adults. |
| B) | | Vaccination before the age of sexual debut is likely to offer the most benefit. |
| C) | | Infection with HPV often occurs within the first few years after sexual debut. |
| D) | | After an individual has been infected with any type of HPV, the vaccine is no longer of benefit. |
VACCINES AND RECOMMENDATIONS
Epidemiologic data on HPV incidence and age of sexual debut
suggest that the pre-teen years are an appropriate time to begin HPV protection [32]. Genital HPV is the most common sexually
transmitted infection in the United States, with 13 million new infections among people ≥15
years of age each year [95]. Teens and young
adults are particularly at risk; about half of those infections occur in individuals 15 to
24 years of age [32]. One multisite,
clinic-based study of sexually active females found the highest prevalence of HPV in girls
14 to 19 years of age. In another study, using a representative, population-based sample,
HPV prevalence was 26.9% among sexually active women 18 to 25 years of age [33]. The prevalence of types 16 or 18 was 7.8%.
Another study, also intended to be representative of the general population, found that the
prevalence of HPV was 26.8% for women 14 to 59 years of age and nearly 45% among women 20 to
24 years of age [34]. In the overall study
population, the prevalence of type 16 was 1.5%, and type 18 was 0.8%.
An important consideration in protecting adolescents who are
not yet sexually active is that HPV infection is common within the first few years after
sexual debut [32]. In addition, studies have
shown high antibody titers with vaccination at age 11 to 12 years. The projected impact of
vaccinating girls at 12 years of age is a 20% to 66% reduction in lifetime cervical cancer
risk, depending on the effectiveness of the vaccine and the duration of protection.
Vaccination could also lead to a 21% reduction in low-grade abnormalities on Pap tests over
the life of a cohort of vaccinated females. A comparison of HPV prevalence data from the
vaccine era (2009–2012) and the prevaccine era (2003–2006) found that the prevalence of the
HPV types included in the quadrivalent vaccine decreased by 64% (from 11.5% to 4.3%) among
girls 14 to 19 years of age [17].
Considering the modest uptake of this vaccine, the potential impact is significant.
The recommendation to vaccinate young adults takes into
account the fact that many will already be sexually active and may have been exposed to one
or more types of HPV. Young adults who are not yet sexually active can receive the full
benefit of vaccination. In addition, it is likely that many individuals who are infected
have not yet encountered each of the vaccine-covered types, so they can receive at least
partial benefit [35,36]. The recommendation to vaccinate adults to
the age of 26 years reflects the safety and efficacy testing on which the initial vaccines'
approvals were based [30,31,37]. Use in older individuals is also effective, and many patients will
benefit from vaccination at 27 to 45 years of age. Medical professionals can inform patients
of the option to receive the vaccine series or to complete the series, help assess the
benefits and individual risk factors, and facilitate decision-making. As noted, the HPV
vaccine remains significantly underutilized as of 2024.
7 . What change was made to the recommendations regarding vaccination against rotavirus in 2009?
| A) | | Three rotavirus vaccines are now available. |
| B) | | Ages for dosing were harmonized for the two available vaccines. |
| C) | | The number of doses was standardized, with both vaccines now requiring 2 doses. |
| D) | | The age to initiate rotavirus vaccination was expanded to include infants up to 1 year of age. |
VACCINES AND RECOMMENDATIONS
In 2009, the age parameters for vaccine administration were
adjusted to harmonize the schedules of the two approved rotavirus vaccines [40]. One is a pentavalent reassortant vaccine
based on a bovine rotavirus, often abbreviated as RV5. The other is a live, attenuated human
rotavirus vaccine, often abbreviated as RV1. RV5 has a three-dose schedule, while RV1
requires two doses [41]. The maximum ages
for these vaccines are somewhat different, according to their prescribing information, but
an ACIP workgroup has concluded that safety and efficacy are unlikely to be affected if the
same age limits are used for both [40].
8 . Why is MCV included as a routine vaccination for healthy children?
| A) | | Unlike MPSV, MCV covers all of the most common meningococcal serotypes. |
| B) | | The high number of cases, about 45,000 in the United States each year, makes vaccination essential. |
| C) | | Vaccinating children protects them against meningococcal disease in middle age, when incidence becomes highest. |
| D) | | In addition to the high case-fatality rate, each case of meningococcal disease requires substantial resources to identify additional cases and prevent disease spread. |
VACCINES AND RECOMMENDATIONS
Historically, before widespread vaccination, there were about
1,400 to 2,800 cases of meningococcal disease in the United States each year [42]. Although not a common illness,
meningococcal disease has a rapid course and a high degree of mortality, with a
case-fatality ratio of about 10% to 14%. Among survivors, 11% to 19% will experience serious
sequelae, such as neurologic deficit, deafness, or loss of a limb [43]. The degree of severity means that, in
addition to putting the patient's life at risk, each case requires a substantial public
health effort to identify additional cases quickly and prevent the disease from spreading
[44].
9 . The zoster vaccine is included on the adult immunization schedule. The recommendation for this vaccine includes
| A) | | adults 50 years of age and older. |
| B) | | adults 65 years of age and older. |
| C) | | only adults with certain medical risk factors. |
| D) | | only adults who have never had chickenpox. |
VACCINES AND RECOMMENDATIONS
Recommendation for Adults: RZV is
recommended for individuals 50 years of age and older with no vaccination history and for
individuals who previously received the ZVL vaccine. RZV is also recommended for
individuals 19 years of age or older who are immunocompromised or who will be
immunodeficient/immunosuppressed due to disease or therapy.
10 . Before vaccination was available, what proportion of the population experienced herpes zoster at some point in their lives?
| A) | | About one-tenth |
| B) | | About one-third |
| C) | | About one-half |
| D) | | About two-thirds |
VACCINES AND RECOMMENDATIONS
There are an estimated 1 million cases of herpes zoster each
year, and incidence increases with age [49].
Without vaccination, about one-third of Americans will experience shingles at some point in
their lives [49]. In addition to discomfort
and inconvenience for the patient, there is also a risk of viral transmission leading to
primary varicella in at-risk contacts. Postherpetic neuralgia (PHN) is an unfortunate but
fairly common complication. A community-based study in Minnesota looked at the incidence of
PHN as defined by various durations of pain [50]. Eighteen percent of patients experienced PHN-type pain for at least 30
days, 13% for at least 60 days, and 10% for at least 90 days [50]. The ACIP added the zoster vaccine to the
adult immunization schedule to take advantage of the opportunity to decrease both the burden
of disease and the risk of complications. In 2018, the recombinant zoster vaccine (RZV) was
added as the preferred vaccine, and in 2020, the ZVL vaccine was discontinued [19]. RZV has better proven efficacy in
preventing herpes zoster compared with ZVL, and breakthrough cases are associated with less
severe herpes zoster-related pain and less interference on activities of daily living [56].
11 . If a patient has a severe (anaphylactic) latex allergy, how would this affect the vaccinations he or she could receive?
| A) | | No vaccinations should be given. |
| B) | | Some vaccines would be contraindicated. |
| C) | | All vaccines can be used, but 15 minutes of observation is recommended. |
| D) | | There would be no change, because latex is not used in manufacturing vaccines. |
VACCINE CONTRAINDICATIONS
HYPERSENSITIVIES AND VACCINE RECOMMENDATIONS
| Hypersensitivity | Vaccine | CDC Recommendation |
|---|
| Yeast |
| Do not use |
| Latex | Rotavirus (RV1), MenB | Check packaging to see if latex is used and for guidance |
| Gelatin |
| Use extreme caution if administering |
| Neomycin |
| IPV | | MMR | | Varicella | | HepA | | Some influenza vaccines |
| Do not use |
| Streptomycin | IPV | Do not use |
| Polymyxin B |
| IPV | | Some influenza vaccines |
| Do not use |
| Thimerosal | Some brands/formulations, including certain DTaP, influenza (IIV), Td,
DT | Check package insert |
12 . A father brings his 5-year-old son, Patient S, in for a checkup one morning in November. He states that Patient S has had "the sniffles" for the past two days and that he has been "running a bit of a fever." On exam, Patient S appears well except for nasal congestion. His temperature is 99.0°F. Patient S's medical history is unremarkable, he has no known allergies, and he tolerated his previous vaccinations well. He was up-to-date on all recommended vaccinations through 2 years of age, but has not received any vaccinations since then. At today's visit, which of the following vaccines should probably be deferred?
| A) | | IPV |
| B) | | DTaP |
| C) | | MMR |
| D) | | LAIV |
VACCINE CONTRAINDICATIONS
The ACIP recommends that LAIV not be used in patients with
asthma or other conditions predisposing to flu complications [12,21]. In most cases, IIV or another type can be used instead. LAIV should
also be avoided in children and adolescents who are receiving aspirin or salicylate
therapy. Acute respiratory illness with nasal congestion, which could interfere with
delivery of the vaccine, is a reason to consider delaying the use of this vaccine until
the congestion has decreased. Children younger than 5 years of age who have recent or
recurrent wheezing should not receive LAIV [12,21].
13 . A mother brings her young daughter to a new pediatrician for the first time. She is changing doctors because her previous pediatrician refuses to see patients whose parents decline to have them vaccinated. She explains, "I know that MMR vaccine can cause autism, and I don't want that to happen to my child." What can you tell her?
| A) | | Large observational studies have failed to find a link between MMR and autism. |
| B) | | Experts do not believe that MMR causes autism, but this issue has not been studied. |
| C) | | An older type of MMR was a cause of autism, but this specific vaccine is no longer used. |
| D) | | Good evidence links MMR and autism, but the benefits of vaccination are considered to outweigh the risks. |
Although measles was considered effectively eliminated in
the United States in 2000, resurgence in the disease and regional outbreaks have resulted
from suboptimal vaccination rates. In 2014, there were 667 cases of measles in the United
States, more than 10 times the number of cases in 2000; another even larger spike occurred
in 2019 (1,282 cases in 31 states) [6]. A
large outbreak in 2014–2015 was linked to unvaccinated children visiting Disneyland, the
source patient probably being infected overseas (likely the Philippines) [6]. The decrease in vaccine coverage is in part
attributed to the false belief that the MMR vaccine may cause autism. Based on multiple
studies, experts generally agree that there is no evidence for a link between the MMR
vaccine and autism, and it is important that clinicians address these misconceptions with
patients. In 2004, the Institute of Medicine (IOM) reported that "the body of
epidemiological evidence favors rejection of a causal relationship between the MMR vaccine
and autism" [83]. The American Academy of
Pediatrics has also concluded that the evidence does not support such a connection. In
addition, autism is not thought to be immune-mediated, and there is no clear mechanism by
which MMR would cause this disorder [84].
Research on the topic includes a Canadian study involving
27,749 children born between 1987 and 1998 [85]. This study found no association between rates of pervasive
developmental disorder and either one or two doses of the MMR vaccine. In a 2015
retrospective cohort study of 95,727 children, MMR vaccine receipt was not found to predict
autism diagnosis, even among children with older siblings with an autism spectrum disorder
[78]. A study of 657,461 children born in
Denmark between 1999 and 2010 found no increased risk of autism in those who received the
MMR vaccine, including in special subgroups (e.g., autism risk factors, other childhood
vaccinations) [115].
14 . Some parents have concerns about the presence of thimerosal in childhood vaccines. Which of the following is correct?
| A) | | Experts believe that thimerosal does not cause autism, but this has not been studied. |
| B) | | Thimerosal remains a component of most childhood vaccines, but observational studies have not found a connection with autism. |
| C) | | Vaccines recommended for children 6 years of age and younger now either contain no thimerosal or contain only trace amounts, because thimerosal was shown to cause autism. |
| D) | | Vaccines recommended for children 6 years of age and younger now either contain no thimerosal or contain only trace amounts, although observational studies have not found a connection between thimerosal and autism. |
Some of the concerns about autism involve the use of
thimerosal, a mercury-containing preservative. The IOM has concluded that, as with concerns
about MMR, the evidence favors rejecting the idea of a causal relationship between
thimerosal-containing vaccines and autism [83]. In addition, the same study that looked at MMR and autism in a large cohort of Canadian
children also looked for any relationship between ethylmercury exposure and autism and
failed to find a connection [85]. Exposure
levels were comparable to levels in the United States during the 1990s. Another study, which
examined the incidence of autism in California children before and after thimerosal was
removed from childhood vaccines, found no decrease in autism following the change [88].
Most vaccines for children 6 years of age or younger that
had contained thimerosal either no longer contain this preservative or contain only trace
amounts—small enough that the FDA considers them "preservative free" [89]. IIV vaccines are now largely in this
category, as "preservative-free" preparations of IIV are widely available. For the 2023–2024
season, 91% of IIV vaccines are thimerosal-free or thimerosal-reduced formulations [118].
15 . A woman, 70 years of age, who is in generally good health, comes in to discuss some knee pain she has been having. While she is in your office, you take advantage of the opportunity to offer vaccination against seasonal influenza. She tells you that one of her friends is recovering from Guillain-Barré syndrome (GBS), and she recalls hearing something about the flu shot and GBS. What can you tell her?
| A) | | There is a proven risk with some of the current influenza vaccines, but not all. |
| B) | | The rumor that incidence of GBS increased with the 1976 swine flu vaccine is untrue. |
| C) | | There is a proven risk with the current influenza vaccines, but it is small, about 1 case per 1 million people. |
| D) | | There is a theoretical risk with the current influenza vaccines, but even if there is a risk it would probably be small, about 1 case per 1 million people. |
GBS was associated with a swine flu vaccine in 1976, with an
estimated 1 case per 100,000 people vaccinated [21]. Some observational studies since then have found a small increase in
GBS cases associated with influenza vaccination, while others have found no link. Whether
there is an association between current influenza vaccines and GBS is not known. According
to the CDC, based on studies in prior seasons, if an association does exist the risk would
likely be low (i.e., one case per 1 million people vaccinated). The IOM conducted a thorough
scientific review of this issue in 2003 and concluded that people who received the 1976
swine influenza vaccine had an increased risk for developing GBS. Scientists have multiple
theories regarding why this increased risk may have occurred, but the exact reason for this
association remains unknown [93].
16 . As of 2024, what is known about HPV and problems following vaccination?
| A) | | The majority of events reported to VAERS have been considered non-serious. |
| B) | | Postmarketing reports rule out any connection between vaccination and syncope. |
| C) | | The only events reported to VAERS have been non-serious, such as fainting, swelling at the injection site, headache, nausea, or fever. |
| D) | | All of the above |
Clinical trials and the post-licensure monitoring data of
three HPV vaccines (two discontinued and one in current use) show that they are safe [107]. Since the licensure of the HPV vaccines,
both the CDC and the FDA have monitored HPV vaccine safety through VAERS, VSD, and CISA
systems. It should be noted that most of the available data is from the quadrivalent
Gardasil formulation, which is no longer available in the United States. A 2009 CDC/FDA
report found that the most common adverse events reported to VAERS following vaccination
with Gardasil were fainting, swelling at the injection site, headache, and nausea. Seven
percent were considered serious. However, no common pattern for serious events has emerged,
making it difficult to form theories about causality. GBS was reported but did not appear to
occur at a rate above background levels. Blood clots were reported in a small number of
patients, most of whom had pre-existing risk factors (e.g., smoking, obesity, use of oral
contraceptives). Over the first three years of its use, more than 28 million doses of
Gardasil 9 were administered, and 7,244 adverse events were reported to VAERS, of which 3%
(217 events) were classified as serious [107].
17 . Research regarding parents' concerns about vaccination suggests that
| A) | | it is unusual for parents to have questions or concerns about vaccines. |
| B) | | the majority of parents have some level of uncertainty about vaccinating their children. |
| C) | | information from healthcare providers is unlikely to influence decisions about vaccination. |
| D) | | information from healthcare providers can have an important impact on parents' decisions to vaccinate. |
OVERCOMING BARRIERS FOR CHILDREN AND ADOLESCENTS
Healthcare providers can have an influence when parents are
concerned or confused about vaccines. For example, in one survey, 28% of parents had some
level of uncertainly about vaccines [97].
For those who ultimately decided to allow timely vaccination, assurances or information
provided by a healthcare provider were important reasons for the decision.
18 . In addition to children who are enrolled in Medicaid, children who are eligible for free vaccines under the Vaccines for Children program include children who
| A) | | are underinsured. |
| B) | | have no health insurance coverage. |
| C) | | are American Indian or Alaska Native. |
| D) | | All of the above |
OVERCOMING BARRIERS FOR CHILDREN AND ADOLESCENTS
The Vaccines for Children (VFC) program is designed to help
overcome cost as a barrier to childhood vaccination. All of the ACIP-recommended vaccines
are available for children enrolled in Medicaid, with VFC covering children through 18 years
of age [101]. Children who have no health
insurance coverage, children who are underinsured, and children who are American Indian or
Alaska Native are also eligible for vaccines through VFC.
19 . You have found that there is room for improvement in pediatric vaccination rates. One of the nurses suggests sending letters to remind both adult patients and the parents of pediatric patients when vaccinations are needed. However, your office manager reminds you that the budget is tight this year. Sending letters would be an extra expense. Based on evidence and current recommendations, what should you do?
| A) | | Either send the letters or institute a system of reminder phone calls. |
| B) | | Send letters only for pediatric patients, because reminders work for children but not adults. |
| C) | | Do not use letters or phone calls, because reminder systems for patients do not work. |
| D) | | Institute a system of reminder phone calls instead of letters, because calls have been proven to have greater effect. |
OVERCOMING BARRIERS FOR CHILDREN AND ADOLESCENTS
Reminding parents to bring their children in for
vaccinations is a proven way to increase coverage and is recommended in standards developed
by the National Vaccine Advisory Committee and supported by other organizations [102,103]. Reminders need not take up extensive staff time. Mailed reminders have
been shown to increase child vaccination rates and so have telephone calls, which may be
computer-generated to save work by the office staff [104,105,106]. Outreach should be more intensive for
families at high risk of missing appointments [102].
20 . Your group practice recently conducted a chart audit and discovered many "missed opportunities" for adult vaccination. You would like to institute a reminder system for yourself and your colleagues, but the others ask if there is any evidence it will work. Based on the evidence, what can you tell them?
| A) | | A review of studies was inconclusive, but a reminder system will do no harm and might help. |
| B) | | The office should only use an electronic medical records system, because placing reminders in paper charts has been proven not to work. |
| C) | | A review of studies found that physician reminder systems, such as chart notations, stickers, and patient lists, can improve vaccination coverage. |
| D) | | Reminder systems for patients work, so even though reminder systems for physicians have not been studied, they can also be expected to increase vaccination rates. |
OVERCOMING BARRIERS FOR ADULTS
There is evidence that when physicians recommend preventive
services, patients are interested in receiving them. For example, 95.1% of patients in a
national survey stated that they would accept the herpes zoster vaccination if their doctor
recommended it [111]. Standards provided by
the National Vaccine Advisory Committee, in cooperation with more than 60 organizations,
offer evidence-based methods to help reduce missed opportunities for adults [110]. Providers should assess the vaccination
status of all new patients and review vaccination status annually. Pneumococcal vaccination
status should be reviewed when patients present for influenza vaccination.
Standing orders for vaccination should be used, based on
evidence that they improve adult vaccination coverage in many different settings [110]. Reminder systems for staff can also
improve vaccination rates. In one review of studies, use of physician reminder systems, such
as chart notations, stickers, and patient lists, improved coverage by a median of 22% [112]. Assessing a practice's success at
vaccinating patients who are eligible and reporting the results to staff can also help to
improve coverage [110].
