Adult vaccination rate still too low

The Centers for Disease Control and Prevention says a substantial increase in immunizations is needed to avoid vaccine-preventable deaths.

By — Posted Feb. 22, 2012

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Not enough adults are receiving recommended vaccinations, and there has been little progress increasing coverage in recent years, according to the latest Centers for Disease Control and Prevention statistics.

Significant improvement is needed to stem the negative health consequences of vaccine-preventable diseases among adults, said the Feb. 3 Morbidity and Mortality Weekly Report (link).

"We can't give up," said Sandra Fryhofer, MD, American College of Physicians' liaison to the Advisory Committee on Immunization Practices. "Vaccinations are vital to our nation's health, and they save health care dollars over the long term."

At least 45,000 American adults die each year of diseases that could be prevented by vaccines. By comparison, fewer than 1,000 Americans die of childhood diseases that are vaccine-preventable, the CDC says.

The report examined 2010 data on six vaccines: pneumococcal, hepatitis A, hepatitis B, herpes zoster, human papillomavirus and tetanus antigen-containing vaccines, including the tetanus, diphtheria and acellular pertussis vaccine (Tdap). Overall, vaccination rates were similar to 2009, except for modest increases in Tdap, HPV and zoster vaccine coverage, the report said.

Pneumococcal vaccination coverage among high-risk adults 19 to 64 years old was 18.5%, while tetanus antigen-containing vaccines coverage was 64%. One in 10 adults 19 to 49 received at least two doses of hepatitis A vaccine, and 42% of high-risk adults in the same age group were vaccinated against hepatitis B.

For the relatively new HPV vaccine, 20.7% of women 19 to 26 received at least one dose. About 14% of adults 60 and older received the herpes zoster vaccine to prevent shingles.

Barriers to vaccinating adults

There are several challenges in getting adults recommended immunizations, said Carolyn B. Bridges, MD, CDC associate director for adult immunizations. Patients may lack insurance coverage or a medical home. Some have misconceptions about vaccine safety or simply don't know about adult vaccines.

There is a limited infrastructure to support adult vaccination compared with children's vaccinations. For example, there is no adult equivalent to Vaccines for Children, a federal program that provides free vaccines for children who otherwise might not be able to get them. Another problem is that some physicians may be unaware of current adult vaccine recommendations, Dr. Bridges said. Time pressures also can contribute to physicians not offering or failing to discuss vaccines with patients.

"One of the biggest impacts on patient acceptance of vaccination is a provider making a strong recommendation for vaccination," Dr. Bridges said. "So encouraging more providers to assess their patients' vaccine needs and recommend vaccination is one way to improve vaccine coverage."

Educating patients also is important, Dr. Fryhofer said. The ACP's Immunization Portal provides information to help physicians incorporate vaccinations into their daily practice (link). Electronic medical records that alert doctors when patients need vaccinations are helpful, she said.

"The more information [patients] have before they go into the exam room, the more likely they are to get vaccinated," Dr. Fryhofer said. "Health care is not just about doctors taking care of patients. It really is a partnership."

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Not enough adults get vaccinated

Coverage remains low for most vaccines recommended for adults, according to the latest Centers for Disease Control and Prevention statistics from 2010. The figures show little improvement in the percentage of adults vaccinated from 2009 to 2010.

Vaccine Age range Percent vaccinated Difference from 2009
Pneumococcal (high risk, ever vaccinated) 19-64 18.5% 1.0%
Tetanus (vaccinated within last 10 years) 19-49 64.0% 0.9%
Hepatitis A (ever received two or more doses) 19-49 10.7% 0.9%
Hepatitis B (high risk, ever received three or more doses) 19-49 42.0% 0.2%
Herpes zoster (ever vaccinated) 60 and older 14.4% 4.4%
HPV (females, ever received one or more doses) 19-26 20.7% 3.6%
HPV (males, ever received one or more doses) 19-26 0.6% n/a

Source: "Adult Vaccination Coverage," Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, Feb. 3 (link)

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