Throughout the month of August, NACCHO’s National Immunization Awareness Month (NIAM) Blog Series highlights the importance of immunizations across the lifespan. In this Q&A, Linda Baker, RN, Public Health Nurse at the Orange County (NY) Health Department, discusses how her local health department is working to improve immunization rates in their adult population.

As a public health nurse, how are you and your local health department involved in increasing immunization rates in Orange County’s (NY) adult populations?

We mainly go out to community events throughout Orange County to provide written information and engage community members about the importance of immunization in the adult population. In these conversations, we focus on discussing if they have any health issues that make specific immunizations particularly important for their subgroup. For example, we encourage people living with diabetes to receive the hepatitis B vaccine, and engage those in their early twenties to discuss the importance of completing the HPV vaccine series if they haven’t already. We also go out to senior sites to do presentations for those aged sixty-five and older and talk to them about getting the pneumococcal and shingles vaccines, as well as the flu vaccine, which we promote for all adults. We also discuss Tdap for grandparents, to promote cocooning. In addition, the health department advocates for patients to talk to their primary care physician about inputting all of these vaccination records into the New York State Immunization Information System (NYSIIS) registry.

Immunization information systems (IIS) can be used for a range of purposes, from assessing immunization coverage rates to looking up patient-level immunization history. How are you specifically using NYSIIS to improve vaccination rates in your adult population?

We use IIS when we do our AFIX (Assessment, Feedback, Incentives, and eXchange) program visits; that’s where we draw our information from. Primarily, we use it for childhood immunizations because it’s mandatory for children’s records to be added to the registry. That same mandate doesn’t apply to adults though, which makes participation at that level more challenging. Still, we use it at our county travel clinic and have found that pharmacists tend to be pretty good about using the system. Primary care physicians don’t consistently utilize it as well as they could, but we have encouraged a couple practices in the area to more regularly input records. It’s important for patients to advocate for their physicians to keep track of their records, so we encourage the adult population to have their providers use it more consistently so that the health department can more easily track the vaccination status of adults in our county. Having this information in the system means that patients won’t be asked to get their flu vaccine if they’ve already had it, and there will be documentation for which of the two pneumococcal vaccines they’ve received, even when they change physicians.

You briefly mentioned Orange County’s Adult Travel Clinic. Can you tell us more about the clinic and how it helps to promote the importance of non-routine vaccines, especially during high travel months in the summer?

We host a travel clinic in Orange County twice a month and it’s quite popular. We often receive calls looking for information on what vaccines are required to visit certain destinations outside the country. We primarily use the CDC travel website and always reference people to this so that they can look further in-depth. At the clinic, we offer both typhoid and yellow fever vaccines, which are non-traditional vaccines in the United States. We also encourage the hepatitis A vaccine for anyone traveling outside of the country, and we ensure that individuals have had their hepatitis B and MMR vaccines, which we also offer at this clinic. Again, we promote the use of NYSIIS by asking patients to bring in any records that they’ve had from the past and getting those added into the system so we have a clearer picture of their vaccination history.

What challenges are associated with vaccinating this population?

There is a lack of awareness of recommended vaccines for adults. Often times, we have travelers that come into the clinic to receive their travel vaccines but are unaware of routinely recommended adult vaccines; they’ll come in to get hepatitis A and typhoid vaccines, but not realize that Tdap and hepatitis B vaccines should be on their radar. Many people also don’t realize that there are two vaccines for pneumococcal now.

Every year, we struggle with flu vaccine myths. People still think that they’re going to get sick from the flu vaccine or that the vaccine itself gave them the flu. It’s challenging to convince them otherwise, even though we share with them that it’s an inactivated vaccine. Around February, we offer flu vaccines at food pantries and soup kitchens in the community for those who haven’t had the opportunity to receive the vaccine. Despite the provided vaccine being free of charge, there’s still a lot of hesitation over the thought that the flu vaccine is going to cause the flu.

The shingles vaccine also has a lot of pushback, but those over the age of seventy are more apt to get the vaccine because they often know somebody who has had shingles and see how painful it was for them. Cost is also a factor. Even though the vaccine is licensed for anyone over fifty years old and a number of cases are occurring even before then, insurance doesn’t cover it unless you’re over sixty years old. Having to pay out of pocket is often the deciding factor for not receiving the vaccine.

How have the resources and relationships you’ve gleaned from NACCHO helped to enhance adult immunization services in your communities?

While serving as an HPV Demonstration Site, we were afforded the opportunity to collaborate with stakeholders in the community, especially large providers that cover both adult and pediatric populations. We spoke to two of these larger sites about the importance of utilizing NYSIIS to report adult immunization records. This proved to be beneficial and opened doors for those looking for quality improvement and how to provide better care across the lifespan. This was also an excellent networking opportunity; even if a stakeholder was focused on pediatric immunizations, there was the opportunity to network and connect with other stakeholders focused on adult immunizations.

NACCHO is pleased to support local health departments in their participation of NIAM. Click here to find resources that can be utilized by your local health department, and be sure to check out our previous posts in the NIAM Blog Series:

• Breaking Down Barriers to Access to Increase Immunization Rates
• Leveraging Partnerships to Increase Maternal Immunization
• Turning the Tide on HPV Vaccination Rates
• Increasing Immunization through School-Located Clinics

For more information about vaccines for adults, check out resources from the Centers for Disease Control and Prevention and the Gerontological Society of America.

• Join CDC’s webinar on Peer to Peer: Proven Practices for Increasing Vaccination Rates in Adults and Pregnant Women
• Share CDC’s Adult Vaccine Quiz.
• Implement CDC’s Standards for Adult Immunization and download adult vaccine resources.
• Remind adults with chronic health conditions to get vaccinated.