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A comprehensive assessment of the immunization status of 2,451 adults was carried out at Walter Reed Army Medical Center's Allergy-Clinical Immunology Service, Washington, DC, during an influenza immunization program from October 1985 through February 1986. More than 66 percent of those screened needed either immunization other than for influenza, or an immunologic test, a decline from 72 percent noted during a 1984-85 influenza immunization program. The mean number of interventions was 2.00 per patient in the 1985-86 program and 2.26 during the previous program. Of patients screened in the period 1985-86, 20.5 percent received diphtheria-tetanus toxoids, 15.7 percent received pneumococcal vaccine, and 23.1 percent received a tuberculin skin test. Vaccination or titers for measles were ordered for 10.4 percent, for rubella for 10.9 percent, and for hepatitis B for 20.3 percent. Assessment of those who came to the clinic for influenza vaccination in the second program demonstrated that the needs of some patients had been met in the first program. However, a general lack of immune protection existed in the majority of patients screened in the second program. In both programs, those older than 59 years needed pneumococcal vaccine and diphtheria-tetanus toxoids more frequently than the general population. The means of the numbers of interventions and the percentages of patients needing intervention other than influenza vaccine declined from the first program to the second, suggesting progress in meeting some individual immunization needs in a large and changing ambulatory population.

All patients and employees presenting for influenza A and B vaccination were studied for the need for other immunizations or tests, based on criteria of the Immunization Practices Advisory Committee. More than 72% of patients and employees needed at least one other vaccine or test. During a 4 1/2-month period, 1,353 doses of influenza virus vaccine, bivalent, types A and B, were prescribed. Health care providers ordered doses of diphtheria and tetanus toxoids (adult) for 36.8% of these recipients, pneumococcal vaccine, polyvalent 23, for 42.1%, and a tuberculin skin test for 36.3%. Determinations of hepatitis B titers or hepatitis B vaccine doses were ordered for 140 individuals. Patients older than 60 years needed additional immunizations with greater frequency. Rates of delayed adverse reactions (35.9%) and subsequent self-medication (11.7%) were recorded. The systemic adverse reaction rate was 17.3%. Annual influenza vaccination programs are valuable public health opportunities to determine immunizations needed by patients who might not otherwise receive a comprehensive, individualized review of the status of their immunization protection.