The United States spends billions on healthcare services of questionable value while basic, evidence-based preventive services are not getting done as often as they should be, according to the Partnership for Prevention, which has ranked 25 clinical preventive services recommended by the Advisory Committee on Immunization Practices and the U.S. Preventive Services Task Force.

Bright spots in a generally poor record are three procedures that rate a "10" on the Partnership’s rating scale. Judged to be widely used, effective, and cost-saving are childhood immunizations, recommendations for daily aspirin to prevent heart attacks, and screening and brief interventions for adult tobacco use.

Concentrating on the preventive services that practitioners could make available to their patients, the Partnership for Prevention calculated the disease, injury, and premature death that could be prevented if some 25 clinical services were delivered to 100 percent of the target populations. They include:

• Services that have small target populations but are very cost-effective. Examples are screening young women for Chlamydia and screening young children for visual impairments;
• Adult vaccines (influenza and pneumococcal); and screenings for cervical, colorectal and breast cancer, hypertension, cholesterol, and problem drinking;
• Screenings for obesity, diabetes, and depression; diet counseling; and a tetanus-diphtheria booster for adults every 10 years.

The Partnership for Prevention based its ratings on the report of a 24-member National Commission on Prevention Priorities convened in 2005 under the leadership of former U.S. Surgeon General David Thatcher.

In other reports released in July, another professional organization, the National Foundation for Infectious Diseases, stressed the need for immunization against two vaccine-preventable illnesses--influenza and meningococcal disease.

Reasons for the foundation’s concern: only 36 percent of healthcare workers avail themselves of annual influenza vaccinations and only a third of children with asthma get flu shots. That’s despite evidence that unvaccinated healthcare workers tend to come to work with active cases of the flu, posing a serious threat to patients, and that influenza and other respiratory viruses can be deadly for children with asthma. The foundation also said many clinicians do not realize that vaccination can prevent the most common form of serious and even deadly meningocccal disease in adolescents and young adults.

In a "Call to Action," the foundation stressed the need for increasing influenza immunization rates among healthcare workers and said the term "healthcare workers" includes not just doctors and nurses but anybody in a clinic, hospital, residence, or any other place where person-to-person contact that could spread infection. Unvaccinated personnel are no small problem, the foundation pointed out; there have been deaths attributable to influenza brought into a care facility by a worker, and an influenza epidemic sparked by a sick-but-working health employee could cost millions in public health dollars.

To achieve better immunization coverage, the foundation suggests educating healthcare workers that vaccination cannot cause influenza, which is one of the most common reasons given for skipping flu shots, and by removing cost barriers and making vaccination convenient in time and place. With the first full week in November the optimal time to administer vaccinations, the foundation suggests using August, September, and October to take the necessary preliminary steps, including education, setting up planning committees, and ordering vaccine.

The foundation also called for action on "identifying and overcoming barriers to improved influenza immunization rates" for children with asthma. Viral respiratory infections commonly precipitate wheezing in children with asthma, the report points out, and though many viruses can cause increased airway obstruction, only one—influenza—is vaccine-preventable. Inactivated flu vaccine has been shown to be safe in children with asthma, though the live attenuated vaccine is not recommended for this population.

In an extensive clinical monograph, the foundation describes meningococcal disease among children, adolescents, and young adults in the United States as a life-threatening infection caused by the bacterium Neisseria meningitides that infects 1,400 to 2,800 persons annually, with an overall case fatality rate of 10 percent to 14 percent and impairments such as hearing loss, brain damage, renal failure, or limb amputation in up to 19 percent of those who survive.

A quadrivalent conjugate menngococcal vaccine has recently become available for use in persons 11 to 55 years of age, the monograph points out. Like an earlier polysaccharide vaccine that has been around since 1978, the new vaccine protects against four serogroups of N. meningitides and should reduce the risk of meningococcal disease in adolescents and adults, who are the most likely to be infected. It’s recommended for routine vaccination at 11-12 years of age, with catch-up vaccination at 15. The conjugate vaccine is expected to have a protection duration of eight years.

Documents having to do with influenza and meningococcal infections and vaccination are available online from the National Foundation for Infectious Diseases, at http://www.nfid.org/publications/

The full report by the Partnership for Prevention, "Priorities for America’s Health: Capitalizing on Life-Saving, Cost-Effective Preventive Services," is published in the July 2006 issue of the American Journal of Preventive Medicine at www.prevent.org/ncpp.

See also: Recommended Childhood and Adolescent Immunization Schedule, 2006, at http://www.healthinschools.org/ejournal/2006/jan1.htm and CDC Says More Healthcare Workers Need to Get Flu Shots, at http://www.healthinschools.org/2006/feb10c_alert.asp.