Vaccination rates for adults continue to drop below optimal levels

Health experts are urging physicians to discuss recommended vaccines with adult patients during every office visit in light of new data that show this age group remains largely unimmunized against many preventable infectious diseases.

Vaccination rates for adults 19 and older continued to fall below optimal levels in 2009 despite some improvement since 2008, according to a Centers for Disease Control and Prevention report issued Nov. 17. The data come from the CDC's 2009 National Health Interview Survey.

To bolster the rates, health professionals encourage physicians to regularly inform staff of new vaccine recommendations, educate adult patients about why the immunizations are needed, and provide opportunities for adults to get vaccinated at each office visit.

"Physicians have to do a better job conveying the importance of immunizations to patients, particularly to our adult patients," said Susan J. Rehm, MD, medical director of the National Foundation for Infectious Diseases. "I know very well how busy primary care physicians are. There are tons of things to be covered in every visit."

But, she added, "The immunization discussion doesn't need to be long. It needs to be concise and clear."

About 50,000 U.S. adults die from vaccine-preventable diseases each year, according to the NFID. Among the biggest killers is influenza. Between 1976 and 2006, estimates of annual flu-associated deaths were as low as 3,000 and as high as 49,000, the CDC said. The majority of deaths typically occur among adults 65 and older.

Sixty-five percent of seniors were immunized against the flu during the 2008-09 season, according to the new CDC data. That figure fell short of the Healthy People 2010 target of 90%.

Health care personnel made the most significant gain in flu vaccination coverage. Rates for this group climbed from 45.8% during the 2007-08 season to 52.9% for 2008-09.

Vaccinations among health professionals also improved slightly for the hepatitis B vaccine (64.7% received at least three doses as of 2009) and the Tdap immunization (58.3% got the vaccine between 2005 and 2009).

Meanwhile, the herpes zoster vaccine, recommended for all Americans 60 and older, had the lowest adult immunization rate at 10%.

"For most [vaccines], coverage isn't as high as we'd like it to be. But there are trends going up, and that's good," said Melinda Wharton, MD, MPH, deputy director of the National Center for Immunization and Respiratory Diseases at the CDC.

She highlighted the pertussis outbreak in California as an example of what can happen when immunity against preventable diseases begins to wane. More than 6,500 cases and 10 pertussis-related deaths in infants have been reported in the state, said Patrick Joseph, MD, vice president of the NFID.

Unvaccinated and undervaccinated adults have been identified as a source of transmission to children who are too young to be immunized against the disease. To slow the spread of pertussis across the country, the CDC's Advisory Committee on Immunization Practices has broadened recommendations for the Tdap immunization.

"The only way we can protect children ... is to vaccinate adults" who spend time with them, Dr. Wharton said.

Communication gaps

Poor communication between physicians and patients is a possible reason adult vaccination levels remain low, according to two NFID surveys released Nov. 17.

The organization in October polled 300 primary care physicians who spend at least two-thirds of their time seeing adult patients and whose practices administer vaccines to this group. The same month, the NFID surveyed 1,013 adults 18 and older on immunization issues.

Researchers found that 87% of doctors reported discussing vaccines with all their patients. But almost half of surveyed patients said their physician talked about only the influenza immunization. An additional 21% of patients could not recall discussing vaccines with their physician at all.

The NFID found that nearly nine in 10 patients said a strong vaccine recommendation from their doctor would influence their decision to be immunized.

"I'm hopeful we will continue to see an increase in [vaccine] coverage" among adults, Dr. Wharton said. "But we clearly have lots of room for improvement."