Nettleman Mary D, Garcia-Chen Vanessa
Sanford School of Medicine of the University of South Dakota, USA.
S D Med. 2013;Spec no:73-9.
Vaccination strategies for adults have recently been updated to include newer vaccine products and to reflect the changing epidemiology of vaccine-preventable diseases in adults. New products include vaccines against shingles and the human papillomavirus, and a combination vaccine which contains an acellular pertussis component (Tdap). In some cases, existing vaccines have been re-formulated to provide alternate routes of delivery, as is the case with the influenza vaccine, or more effective formulations, as is the case with the meningococcal vaccine. Vaccine strategies for adults are designed to respond to existing, emerging, or re-emerging infectious diseases in populations at risk. This includes the resurgence of pertussis and recent evidence showing that diabetics are at increased risk for hepatitis B. Unfortunately, large portions of the adult population do not receive recommended vaccinations. As a result, more adults die from vaccine-preventable diseases than die from motor vehicle accidents. Strategies to improve vaccine coverage include public education campaigns and making some vaccines available in nontraditional settings such as retail stores or workplaces. Within health care settings, successful strategies have included the use of standing orders, automatic reminders for physicians using the electronic health record and recall/reminder letters for patients. Appropriate use of adult vaccines plays a key role in prevention of disease and the provision of high-quality care.
成人疫苗接种策略最近已更新，纳入了更新的疫苗产品，并反映了成人中疫苗可预防疾病流行病学的变化。新产品包括带状疱疹疫苗、人乳头瘤病毒疫苗，以及一种含有无细胞百日咳成分的联合疫苗（Tdap）。在某些情况下，现有疫苗已重新配方，以提供替代给药途径，如流感疫苗；或更有效的配方，如脑膜炎球菌疫苗。成人疫苗策略旨在应对高危人群中现有的、新出现的或再次出现的传染病。这包括百日咳的卷土重来，以及最近有证据表明糖尿病患者感染乙型肝炎的风险增加。不幸的是，很大一部分成年人口未接种推荐疫苗。因此，死于疫苗可预防疾病的成年人比死于机动车事故的成年人更多。提高疫苗接种覆盖率的策略包括开展公众教育活动，以及在零售商店或工作场所等非传统场所提供一些疫苗。在医疗保健机构中，成功的策略包括使用长期医嘱、利用电子健康记录自动提醒医生，以及向患者发送召回/提醒信函。合理使用成人疫苗在疾病预防和提供高质量医疗服务方面发挥着关键作用。
