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1072
Utilization of pre-travel clinic for administration of routine vaccinations in adults: a lost opportunity?

Session: Poster Abstract Session: Vaccines: Knowledge, Attitudes, Coverage, Outcomes, Safety
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background:

The pre-travel counseling visit represents an ideal opportunity for updating routine and destination specific immunizations. The American College of Immunization Practices (ACIP) recommends pneumococcal vaccination (PPSV) for adults ≥ 65 years and Zostavax in those ≥ 60 years.  Recent updates also recommend Hepatitis B vaccination for diabetics. To examine coverage and factors associated with the failure to address routine adult vaccinations listed above, we analyzed data collected in the TravMil study at the pre-travel visit. 

Methods: The TravMil cohort is comprised of DoD beneficiaries evaluated pre-travel at 3 military travel clinics (Walter Reed National Military Medical Center (WRNMMC), National Naval Medical Center San-Diego (NMCSD), and Naval Medical Center Portsmouth (NMCP)). Vaccination status and vaccine prescriptions were evaluated. Multivariate Poisson regression with robust error variance was used to examine factors associated with failure to immunize adults who met criteria for immunization with PPSV, Zostavax, and Hepatitis B.

Results:

Vaccine Status

Overall

WRNMMC

NMCP

NMCSD

Hepatitis B in Diabetics

n=86

n=8

n=29

n=49

Up to date

26(30.2)

5(62.5)

5(17.2)

16(32.7)

Administered at pre-travel visit

14(16.3)

1(7.1)

9(31.0)

4(8.2)

 

 

 

 

 

PPSV in adults ≥65

n=352

n=39

n=97

n=216

Up to date

241(68.5)

29(74.4)

59(60.8)

153(70.8)

Administered at pre-travel visit

72(20.5)

9(23.1)

22(22.7)

41(19.0)

 

 

 

 

 

Zostavax in adults ≥60

n=477

n=54

n=139

n=284

Up to date

301(63.1)

39(72.2)

72(51.8)

190(66.9)

Administered at pre-travel visit

41(8.6)

5(9.3)

3(2.2)

33(11.6)

Non-white race [RR: 1.42 (1.04-1.92)] was associated with a failure to vaccinate with Zostavax and/or PPSV, as was evaluation at NMCP [Ref WRNMMC; RR 2.46 (1.43-4.24)]. Female diabetics were less likely to receive Hepatitis B vaccination [RR: 1.60 (1.08-2.39)].

Conclusion: Even in a setting with free access to care and vaccinations, significant variability in coverage of recommended vaccines was noted by race, gender and clinic site. Factors associated with these differences need to be studied further.

Kristina J. St. Clair, DO, MTM&H1, Tahaniyat Lalani, MBBS, MHS1, Edward Grant, MPH2, Mark D. Johnson, MD3, David R. Tribble, MD, DrPH4, Jason Maguire, MD MPH1, Jamie Fraser, MPH2, Timothy Burgess, MD, MPH5, Mark Riddle, MD, DrPH6, Ryan Maves, MD7, Robert Deiss, MD2, Timothy Whitman, DO8, Philip Coyne, MD, MSPH9 and Anuradha Ganesan, MD10, (1)Naval Medical Center Portsmouth, Portsmouth, VA, (2)Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, (3)Naval Medical Center Sandiego, San Diego, CA, (4)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (5)Walter Reed National Military Medical Center, Bethesda, MD, (6)NMRC, Silver Spring, MD, (7)Infectious Diseases, Naval Medical Center San Diego, San Diego, CA, (8)National Naval Medical Center, Bethesda, MD, (9)Uniformed Services University of the Health Sciences, Bethesda, MD, (10)Infectious Disease Clinical Research Program, USUHS, Rockville, MD

Disclosures:

K. J. St. Clair, None

T. Lalani, None

E. Grant, None

M. D. Johnson, None

D. R. Tribble, None

J. Maguire, None

J. Fraser, None

T. Burgess, None

M. Riddle, None

R. Maves, None

R. Deiss, None

T. Whitman, None

P. Coyne, None

A. Ganesan, None

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