William Schaffner, MD, is professor of preventive medicine and medicine (infectious diseases) at Vanderbilt University School of Medicine in Nashville, Tenn. Additionally, he serves as a hospital epidemiologist at Vanderbilt University Hospital and is immediate past-president of the National Foundation for Infectious Diseases.

Eliminate missed vaccination opportunities

Despite well-documented evidence regarding effectiveness and safety, overall adult vaccination rates in the United States fall short of national public health goals. Efforts to increase vaccine uptake have largely focused on reducing the number of so-called missed opportunities (eg, patients who visit health care providers without being vaccinated). All health care professionals, whether in public or private practice, should take advantage of every patient visit to ask about immunization history and provide patients with the recommended vaccines they need or refer them to providers who can offer the vaccines. While this may occur in some practices, I see missed opportunities all the time, particularly in specialty practices.

Whether it is the cardiologist who fails to recommend pneumococcal vaccination for their patient with cardiac disease or a physician in a tuberculosis clinic that doesn’t offer influenza vaccine —opportunities to make sure adults are immunized against vaccine-preventable diseases are being missed.

Paul Etkind, MPH, senior analyst for immunizations at the National Association of County and City Health Officials (NACCHO), said, “[While] it is not unusual for STD clinics to be offering HPV, Hepatitis B and Hepatitis A immunizations to their patients, it is more unusual for TB clinics to routinely offer flu and/or pneumonia vaccinations to their patients.” However, NACCHO supports the concept that rather than having TB clinics administer vaccines themselves, another possibility would be for TB clinic staff to routinely ask patients about their flu and pneumonia immunization histories and prompt the under- or unvaccinated patient to see their primary care provider or local health department to receive the appropriate immunization(s).

The ultimate goal is to have every patient fully immunized, and that includes the entire array of vaccines recommended for adults by the CDC’s Advisory Committee on Immunization Practices: influenza, pneumococcal, Tdap, shingles, hepatitis B, hepatitis A and HPV. Achieving this goal will require the involvement of all health care professionals in both private and public health venues. And I challenge you to help meet this public health goal by leaving no opportunity behind.