While the nation’s childhood immunization rates remain high, adult immunization rates can hardly be called a public health success story. Millions of adult Americans go without routine and recommended vaccines each year, resulting in tens of thousands of preventable deaths and illnesses and billions of dollars in health care costs, according to a new report.
Improving the nation’s ability to immunize adults would prevent disease, ease suffering and reduce costs, according to the report, “Adult Immunization: Shots to Save Lives.” Released jointly in February by the Infectious Diseases Society of America, Trust for America’s Health and the Robert Wood Johnson Foundation, the report points to the 2009 novel H1N1 flu outbreak as a “serious reminder” that no strong mechanism is in place for vaccinating adults in the United States, and calls for the development of a strong adult immunization program to help prevent between 40,000 and 50,000 vaccine-preventable deaths each year and hundreds of thousands of preventable illnesses.
“Thousands of lives could be saved each year if we could increase the number of adults who receive routine and recommended vaccinations,” said Jeffrey Levi, PhD, executive director of Trust for America’s Health. “We need a national strategy to make vaccines a regular part of medical care and to educate Americans about the effectiveness and safety of vaccines.”
To illustrate the breadth of the problem, the report’s authors looked at pneumonia immunizations and found that more than 33 percent of seniors ages 65 and older had not been immunized against pneumonia in 36 states as of 2008. Even in Oregon — the state with the highest adult immunization rates — more than 25 percent of seniors had not received the pneumonia shot. Washington, D.C., had the fewest number of seniors immunized against pneumonia, with nearly half falling through the cracks. The U.S. Centers for Disease Control and Prevention recommends that all seniors be vaccinated against pneumonia, especially because seniors who get seasonal flu are at risk for developing pneumonia.
Similarly, only a fraction of adults receive a seasonal flu shot. Only about 36 percent of all adults were vaccinated against the seasonal flu in 2008, even though vaccine for seasonal flu is the largest existing program for adult vaccinations in the United States. According to the report, the rates of adult vaccinations for the flu is as low as 25.5 percent in Nevada, and even in the state with the highest flu vaccination rate, South Dakota at 49.2 percent, less than half of the state’s adult population has been vaccinated. And even with targeted efforts to vaccinate people older than 65, the rates of annual flu vaccinations for seniors is as low as 61.3 percent in the District of Columbia, and no state exceeds 80 percent.
In addition to low rates of pneumonia and flu immunizations, only about 2 percent of eligible adults have had the tetanus, diphtheria and whooping cough vaccine in the previous two years; and only 10 percent of eligible adult women have had the human papillomavirus vaccine.
The report recommends that adults be vaccinated against a range of diseases, including chickenpox, diphtheria, hepatitis A and B, human papillomavirus, influenza, measles, meningitis, mumps, pertussis, pneumonia, rubella, shingles and tetanus.
“Today, the vast majority of vaccine-preventable disease, hospitalization and deaths occur among adults,” said William Schaffner, MD, FIDSA, chair of the Infectious Diseases Society of America’s Immunization Work Group and co-author of the report.
Key reasons adult vaccination rates remain low in the United States include limited access to vaccinations, lack of health insurance coverage, misinformation, and limited vaccine research and development. Private medical insurance does not always pay for adult vaccinations, the report said, and many adult patients cannot afford vaccines.
To improve vaccination rates, providers should be required to offer full coverage for all vaccines recommended by the Advisory Committee on Immunization Practices, the report said. Also, Medicare should fully cover all recommended vaccinations under Part B and a special program should be created to cover all uninsured adults. In addition, the report calls for standards that would require reviewing patients’ immunization histories during appropriate medical encounters, such as during physicals and cancer screenings.
The full report, “Adult Immunization: Shots to Save Lives,” is available at www.idsociety.org.
- Copyright The Nation’s Health, American Public Health Association
