Fedson D S
National Vaccine Program Office, Rockville, MD 20852.
JAMA. 1994 Oct 12;272(14):1133-7. doi: 10.1001/jama.272.14.1133.
In January 1994 the National Vaccine Advisory Committee adopted a report that reviewed the status of adult immunization in the United States. Vaccine-preventable infections of adults represent a continuing cause of morbidity and mortality. Their major impact is among older persons. Effective and safe vaccines against these diseases are available, but they are poorly used. Several reasons account for low immunization levels among adults, including inadequate awareness by health care providers and the public of the importance and benefits of vaccination. Health care providers often fail to take advantage of opportunities to immunize adults during office, clinic, and hospital contacts and fail to organize programs in medical settings that ensure adults are offered the vaccines they need. Inadequate reimbursement for adult immunization by public and private health insurers and a lack of federal programs to support vaccine delivery are also major problems. The National Vaccine Advisory Committee's report includes five goals and 18 recommendations for improving adult immunization. To reach the Public Health Service adult immunization goals for the year 2000, the Committee recommends (1) improvements in public and provider education; (2) major changes in clinical practice; (3) increased financial support by public and private health insurers; (4) improved surveillance of vaccine-preventable diseases and vaccine production and delivery; and (5) support for research on vaccine-preventable diseases, new and improved vaccines, immunization practices, and international programs for adult immunization.
1994年1月，国家疫苗咨询委员会通过了一份报告，该报告回顾了美国成人免疫接种的状况。成人可通过疫苗预防的感染仍是发病和死亡的一个持续原因。其主要影响人群是老年人。针对这些疾病的有效且安全的疫苗已经存在，但使用情况不佳。成人免疫接种水平低有几个原因，包括医疗保健提供者和公众对疫苗接种的重要性和益处认识不足。医疗保健提供者常常未能利用在门诊、诊所和医院接触成人时的机会为其接种疫苗，也未能在医疗机构组织确保为成人提供所需疫苗的项目。公共和私人健康保险公司对成人免疫接种的报销不足，以及缺乏支持疫苗供应的联邦项目也是主要问题。国家疫苗咨询委员会的报告包括改善成人免疫接种的五个目标和18项建议。为实现公共卫生服务部门2000年的成人免疫接种目标，委员会建议：（1）改善公众和医疗保健提供者教育；（2）临床实践的重大变革；（3）公共和私人健康保险公司增加财政支持；（4）加强对可通过疫苗预防疾病以及疫苗生产和供应的监测；（5）支持对可通过疫苗预防疾病、新型和改进疫苗、免疫接种实践以及成人免疫接种国际项目的研究。
