Physicians asked to persuade adults to get immunized

New surveys show that rates of adult vaccination are low and that young adults are unaware of the dangers of vaccine-preventable diseases.

By — Posted Aug. 3, 2009

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Physicians wield a great deal of influence over their adult patients' decisions to receive vaccinations against a range of diseases, from pertussis to shingles, according to a National Foundation for Infectious Diseases survey.

Sixty-nine percent of adults said their physicians would influence them the most to get vaccinated. The next most influential group, at 19%, was family members.

The NFID survey results were released during a July 22 briefing in Washington, D.C., as were results from the most recent Centers for Disease Control and Prevention's National Health Interview Survey, which showed that vaccination rates among adults remain low.

Physicians who spoke at the briefing urged colleagues to recommend appropriate immunizations during patient encounters.

Stanley Gall, MD, emeritus professor of obstetrics and gynecology and women's health at the University of Louisville School of Medicine in Kentucky, said ob-gyns could play an important role by making sure patients are up to date with vaccinations, particularly for human papillomavirus, pertussis and meningococcal disease.

According to the CDC's health interview survey, only 11% of women ages 19 to 26 have been vaccinated against HPV. Fewer than 40% of young adults have received the tetanus, diphtheria, pertussis -- Tdap -- vaccine licensed in 2005.

Another benefit of alerting women to the need for vaccines is that they often are the gatekeepers for their families' health care and can convey the immunization message, Dr. Gall said.

Robert Hopkins, MD, associate professor of internal medicine and pediatrics at the University of Arkansas for Medical Sciences in Little Rock, urged physicians to step up efforts to advise patients on what immunizations they need throughout life. Older adults, ages 50 to 64, need to be made aware that new health hazards, such as obesity and diabetes, place them at greater risk for infectious diseases that vaccines can prevent. A Tdap shot is appropriate for older adults, too, Dr. Hopkins said, since they may care for infant grandchildren for whom pertussis can be deadly.

Since Medicare pays for both the influenza and pneumococcal polysaccharide vaccines, the number of people vaccinated should be higher, said Cora Christian, MD, MPH, a member of AARP's board of directors. But the health interview survey found that 60% of adults 65 and older received the pneumococcal vaccine, despite a national goal to immunize 90% of that population.

Disparities in vaccines

The health survey also revealed ethnic and racial disparities among those who receive vaccines. For example, 60% of adults older than 65 received a pneumococcal vaccination last year, but only 36% of Hispanic people older than 65 did. For influenza, 67% of all people older than 65 were vaccinated, but the percentage fell to 50% among blacks and Hispanics.

The survey results were disappointing, said Anne Schuchat, MD, assistant surgeon general and director of the CDC's National Center for Immunization and Respiratory Diseases.

"We have a need for a culture change in America," she said. "We worry about things when they are really bad, when they need treatment, rather than taking advantage of preventive steps like vaccines."

Considering the epidemic of chronic diseases in the country, vaccines should be used more widely to protect those younger than 65 who have diabetes, heart disease and asthma, she said. They should receive flu and pneumococcal vaccines routinely, but many don't. Only 15% of Hispanics younger than 65 who should receive the pneumococcal vaccine get it, as opposed to blacks (23%) and whites (27%) who should receive it.

One reason for the low rates is that adults often are unaware of the seriousness of vaccine-preventable diseases such as pneumococcal disease, hepatitis B, meningitis and seasonal influenza, said William Schaffner, MD, NFID president-elect and chair of the Dept. of Preventive Medicine at Vanderbilt University School of Medicine in Nashville, Tenn. About 50,000 adults die each year from these diseases -- more than those who die from HIV/AIDS, traffic crashes or breast cancer, Dr. Schaffner said.

Young adults up to age 26 are particularly unaware of the role vaccines play in preventing diseases, said Susan Rehm, MD, medical director for the NFID and vice chair of the Dept. of Infectious Disease at the Cleveland Clinic. For example, just 30% of young adults know that flu kills more Americans than any other vaccine-preventable disease.

The success of the nation's childhood vaccination program, which covers children and teens up to age 19, likely has ensured that young adults have no contact with diseases such as polio or measles, Dr. Rehm said.

The NFID survey results suggest that young adults are open to getting vaccinated, she said. "Our hope is that physicians across the specialties will become more familiar with the vaccines and recommend them to their patients."

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Who influences adults to get vaccinated?

A telephone survey by the National Foundation for Infectious Diseases shows the importance of physician recommendations for adult immunizations. When asked who would most influence the choice to get vaccinated, the older the adults were, the greater likelihood they named a personal physician. Here are figures from either end of the adult age spectrum:

All adults Age
Age 65
and older
Personal physicians 69% 47% 82%
Family member 19% 33% 6%
Celebrity physician,
public figures, other
7% 11% 4%
None of these 4% 7% 6%
Don't know,
refused to answer
1% 2% 1%

Note: Figures do not add up to 100% due to rounding.

Source: National Foundation for Infectious Diseases, 2009 National Adult Immunization Consumer Survey, conducted Feb. 19-22

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