Clinics take a shot at offering more vaccines, including Gardasil

As pharmacies become increasingly involved in flu shots, retail-based clinics are expanding into other areas of vaccination — such as vaccines to help protect against human papillomavirus, meningitis and pneumonia — to further meet the healthcare needs of patients.

“Retail clinics, in general, are an important portal into the healthcare system for our patients. As the national healthcare agenda heads more toward early intervention and prevention, retail clinics are right where they need to be and are poised to play an important part in the national agenda for early intervention and prevention. So, it makes sense that we would be providing these vaccines,” said Susan Cooley, VP clinical services for RediClinic.

Giving patients — some of whom may not even have a primary care physician — convenient access to quality, cost-effective health care is a vital role for retail health clinics. There are currently more than 1,300 clinics in operation, and the industry is expected to see double-digit growth in 2012.

Today’s menu of vaccinations at most retail-based health clinics is expansive and bound to include some of the more recently talked about vaccines to help protect against HPV, pertussis, meningitis, pneumonia and hepatitis. These particular vaccines may be more expensive than a flu shot, but for clinic operators, providing them isn’t about bolstering revenue; it’s about providing greater access for patients.

“One of the most important reasons that we’re providing vaccines — and we have expanded our vaccine offerings in this past year — is really just to provide the access,” said Paulette Thabault, chief nurse practitioner officer for MinuteClinic. “Vaccines are a key prevention strategy for patients, and access to prevention is really important.”

One of the more recent vaccines that MinuteClinic has added to its roster is Gardasil, which helps protect against HPV.

Most other clinics also are offering the Gardasil vaccine, including RediClinic, The Little Clinic and Take Care Clinics.

HPV vaccines are important as certain HPV types cause cancer. According to the Centers for Disease Control and Prevention, HPV is the main cause of cervical cancer in women. There are about 12,000 new cervical cancer cases each year in the United States, and cervical cancer causes about 4,000 deaths in women each year in the United States.

There are about 15,000 HPV-associated cancers in the United States that may be prevented by vaccines each year in women, including cervical, anal, vaginal, vulvar and oropharyngeal (base of the tongue, tonsils and back of throat) cancers, according to the CDC.

There are about 7,000 HPV-associated cancers in the United States that may be prevented by vaccines each year in men, and oropharyngeal cancers are the most common, according to the CDC.

Gardasil also protects against two types of HPV known to cause 90% of genital wart cases in both women and men in the 9- to 26-age range.

Making headlines in recent years is the resurgence of pertussis, or whooping cough. Pertussis is a highly contagious bacterial illness spread by coughs and sneezes. Unimmunized or incompletely immunized young infants are particularly vulnerable. Health officials strongly urge that children be vaccinated against the disease and parents, family members and caregivers of infants get a booster shot.

Clearly, nurse practitioners are in an ideal position to speak with their patients about the vaccination and to field questions about pertussis.

In the United States, DTaP, Tdap and Td vaccines are most commonly used. One of these (DTaP) is given to children younger than 7 years of age, and two (Tdap and Td) are given to older children and adults, the CDC stated. Getting vaccinated with Tdap is especially important for family members with, and caregivers of, new infants.

Many cases of pertussis are not diagnosed and so are not reported. Yet over the past five years, between 10,000 and 27,000 cases have been reported each year. According to the CDC, the last peak year nationally was in 2010 when more than 27,000 cases were reported.

Most retail-based health clinics offer the vaccinations and also are increasingly fielding questions from concerned parents and grandparents about pertussis and the necessary steps for prevention.

“With an adult carrying pertussis, it is just a normal, nasty kind of cold that persists, but obviously when a child picks it up, it really causes restriction in the airways, causes inflammation in the airways and [makes it difficult] for them to breathe. That is where the term ‘whooping cough’ gets into play. They make a very specific high-pitched sound when they cough, but it can be fatal for little infants,” said Sandy Ryan, chief nurse practitioner for Take Care Health Systems.

The meningococcal vaccine for bacterial meningitis also has been in the spotlight recently, in large part because Texas has become the first state in the country to require that all college students, including those at community and junior colleges, receive one dose or booster of the meningococcal vaccine for bacterial meningitis. The new law took effect Jan. 1, 2012. Previously, Texas required only those living in campus dorms to be vaccinated.

Bacterial meningitis is a disease caused by the inflammation of the membranes that cover the brain and spinal cord that can spread rapidly, resulting in serious health consequences. According to the CDC, young adults living and going to class on crowded college campuses and surrounded by individuals from various geographic areas are at the highest risk for the disease.

Those clinic operators with locations in Texas, such as MinuteClinic and RediClinic, quickly responded to help students meet the new state requirement.
MinuteClinic, for example, prepared all of its clinics for the increased demand for the vaccine and launched a marketing campaign in its Texas markets to inform patients of the new Texas law that requires college students to be vaccinated against meningitis prior to the January school start. The result: a 50% increase in vaccinations.

Globally, pneumonia causes more deaths than any other infectious disease, according to the CDC. However, it can often be prevented with vaccines.

There currently are two types of pneumococcal vaccines: pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV). The CDC stated that all adults 65 years of age and older should receive the PPSV vaccine. However, the CDC indicated that the percent of adults 65 years and older who had ever received a pneumococcal vaccination is only 59%.

Those also in need of the PPSV vaccine, according to the CDC, are those ages 2 years through 64 years who have a long-term health problem like lung or heart disease, or such diseases or conditions as leukemia or a damaged spleen that lowers the body’s resistance to infections. Those adults ages 19 years to 64 years who smoke or have asthma also are in need of the vaccine.

“Flu season is the most appropriate time to give that, [so] when patients come in who are getting a flu shot, who meet the criteria, we will also offer them the pneumonia vaccine,” Ryan said.

Hepatitis A and B vaccines also are important and are typically found among the suite of services at retail health clinics. Thabault noted that there’s been an increase in recommendations for diabetics to receive the hepatitis B vaccine. Hepatitis B is spread through contact with the blood or other body fluids of an infected person.

“As we see diabetics in our clinics for other services, we might be able to offer them that additional protection,” Thabault said.

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