For many of us, the word “immunization” conjures a vision of a sobbing child in a doctor’s office, having just received their shots. But what a lot of people fail to realize is that adults need vaccinations, too.
According to figures from the Centers for Disease Control and Prevention (CDC), adult vaccination coverage in the US remains low.
In 2012, only 20% of adults ages 19-64 at high risk of pneumonia received the pneumococcal vaccine, while only 64.2% of adults ages 19-49 were vaccinated against tetanus. Furthermore, the Tdap vaccine – which protects against tetanus, diphtheria and pertussis (whooping cough) – was only administered in 14.2% of adults aged 19 or over.
Such low immunization coverage is a huge concern for public health. Earlier this year, Medical News Today reported on a study led by Dr. Laura Hurley of the University of Colorado in Denver, revealing that 30,000 people in the US die from vaccine-preventable diseases every year, and more than 95% of these deaths are among adults.
In this spotlight, we look at which vaccinations are recommended for adults, what is deterring individuals from receiving them, and what can be done to increase future vaccination coverage.
Influenza and Tdap vaccines
The CDC recommend that all adults are vaccinated against influenza (seasonal flu) every year. This vaccine is particularly important for those more susceptible to serious flu-related complications, such as pregnant women, individuals with chronic health conditions and older adults.
If not administered as an adolescent, all adults should receive the one-off Tdap vaccine. In addition, a booster – called Td – should be administered every 10 years. The Tdap vaccine should also be given to women every time they are pregnant, with the optimal time being between 27-36 weeks’ gestation.
Other vaccinations are recommended based on age, sex, health conditions and lifestyle factors, among other circumstances.
The HPV vaccine protects against the human papillomaviruses 6, 11, 16 and 18. HPV causes almost all cervical cancers, with types 16 and 18 being responsible for around 70% of all cases. The virus is also a main cause of anal cancer and genital warts.
It is recommended that all women aged up to 26 years receive the vaccine if they did not have it during adolescence. Men up to age 21 years should also have the vaccine, as well as men aged 22-26 who have sex with other men.
The pneumococcal vaccine is recommended for all adults aged 65 years and over. It protects against illnesses caused by Streptococcus pneumoniae bacteria, including pneumonia, meningitis and ear and sinus infections – all of which older adults are more prone to.
The zoster vaccine protects against shingles – a painful skin rash caused by the varicella zoster virus (VZV). It is recommended for adults aged 60 and over, as they are highly susceptible to complications associated with the virus.
According to the CDC, approximately 1 million Americans develop shingles every year, and 50% of these are over the age of 60.
Additional vaccinations – including hepatitis B, MMR, varicella (chickenpox) and meningococcal – may be recommended for health care workers, who are more likely to be exposed to a wider array of infectious and potentially deadly diseases.
Adults who are traveling abroad may also require additional vaccinations, depending on their destination. The Vaccination and Travel Checklist from the CDC can advise on which vaccinations are needed.
The 10-year objectives set by Healthy People 2020 include significantly increasing adult vaccination coverage in the US.
But it seems there is a long way to go before their targets are met. For example, a 70% vaccination coverage target has been set for seasonal influenza vaccination coverage in adults aged 18 and over. But 2012-13 figures reveal that such coverage is only at 41.5%.
It is a similar picture for pneumococcal vaccination coverage among adults aged 65 or over. The Healthy People 2020 target is 90%, but rates currently stand at 59.9%.
As earlier figures revealed, such low vaccination coverage is having a significant impact on public health. But what is discouraging individuals from being vaccinated?
Dr. Carolyn Bridges, associate director for adult immunizations at the Immunization Services Division of the CDC, told Medical News Today:
“Many adults are not aware that there are vaccines recommended for them. One misperception we found in focus group testing was that some thought vaccines for adults were mostly for travel.”
Misperceptions regarding adult immunization are echoed in a
In this study – which surveyed over 2,000 adults over the age of 19 – 60% of participants said they thought healthy individuals do not need to be vaccinated.
In addition, many participants were found to have negative attitudes toward vaccinations. For example, 43% of participants said they were deterred from receiving the influenza vaccine because they were worried about potential side effects. However, the CDC note that almost all people who receive the influenza vaccine have no serious problems as a result.
Another vaccination deterrent appears to be the costs involved. Bridges told MNT that private insurance tends to cover the cost of all routine immunizations. For those over the age of 65, Medicare covers the cost of certain vaccines, such as influenza and pneumococcal vaccines.
But some vaccines – such as Tdap and Zoster – are covered by Medicare Part D. When providing the patient with such a vaccine, the doctor must charge the patient and file a claim form to receive reimbursement. This process, as revealed in the aforementioned study led by Dr. Hurley, can discourage the patient from opting for these vaccines.
In addition, Dr. Hurley and colleagues note that not all physicians are stocking the recommended vaccines because they have problems getting reimbursement from insurance companies. As a result, many patients are referred elsewhere to receive their vaccinations.
But it seems one of the main causes of low adult vaccination coverage could be physicians themselves.
Dr. Bridges told us:
“Most adults are willing to obtain recommendations when they have a recommendation from their provider, but adults often report that they are not being asked about immunizations by their provider.”
This statement is supported in the 2008 study led by Dr. Johnson, which revealed that 51% of adults said they did not receive their tetanus vaccination because their doctor did not tell them they needed it. This same reason was cited by 38% of adults who had not received the influenza vaccine, and by 57% who had not had the pneumococcal vaccine.
However, Dr. Johnson and colleagues also found that 79-85% of adults (depending on the vaccine in question) said they would be more likely to have their vaccinations if their health care providers recommended them.
What is more, 50% of health care providers questioned in this study said they do not always inform their patients of the consequences of missed vaccinations.
The more recent study by Dr. Hurley and colleagues also found that the vaccination status of patients is not being assessed at every visit, although they admit that this is an “ambitious goal.”
“For the most part, adults and providers believe vaccines are an important part of staying healthy. The difficulty is making time to address prevention during busy medical visits,” said Dr. Bridges.
The CDC – in collaboration with the National Vaccine Program Office and the Immunization Action Coalition – have launched the National Adult and Influenza Immunization Summit (NAIIS).
According to Dr. Bridges, the NAIIS aims to “raise awareness about adult vaccinations and the need for routine vaccine assessments of patients, and increase the number of adults protected against vaccine-preventable diseases.”
Although adult vaccination coverage in the US remains low, there are signs that it is heading in the right direction. For example, the 41.5% adult influenza vaccination coverage for 2012-13 was 2.7% higher than the coverage for 2011-12.
But there is no doubt that more needs to be done. Dr. Bridges told us that medical, pharmacist, nursing and other professional organizations need to educate their members about the importance of recommending vaccinations to their patients.
She adds that as part of routine adult clinical care, regular assessment of a patient’s vaccination needs should be incorporated, and any required vaccinations should be offered.
In their study, Dr. Hurley and colleagues also make some recommendations they believe could increase adult vaccination coverage:
“Implementation of system changes, including adopting practices that improve communication between primary care physicians and alternate vaccinators, more widespread use of effective tools, and removing policy-related barriers, could improve adult vaccination in the United States.”
You can find out which vaccinations you need by taking the Adolescent and Adult Vaccine Quiz, compiled by the CDC.