CDC: Adult vaccination rates remain low

CDC. MMWR. 2012;61:66-72.

CDC officials reported that adult vaccination coverage during 2010 remained as low as it did from 2008 to 2009 for most routine vaccinations in those aged 19 years and older, according to a recent Morbidity and Mortality Weekly Report.

“Wider use of practices shown to improve adult vaccination is needed, including implementing reminder-recall systems, use of standing order programs for vaccination and assessment of practice-level vaccination rates with feedback to staff members,” officials wrote in the report.

Data were pooled from the 2010 National Health Interview Survey to examine pneumococcal, hepatitis A, hepatitis B, herpes zoster, human papillomavirus and tetanus-diphtheria-acellular pertussis vaccinations among adults aged 19 years and older.

Compared with data from 2009, data from 2010 indicated a 1.6% increase in Tdap vaccinations among those aged 19 to 64 years to 8.2%; an increase of 4.4% to 14.4% in herpes zoster vaccination among those aged 60 years and older; and a 3.6% increase to 20.7% in HPV vaccinations among women aged 19 to 26 years. However, coverage for all other vaccinations was unchanged at less than 70%, according to the report.

“These data indicate only limited recent improvements in vaccination coverage among adults in the United States,” officials wrote. “Substantial increases are needed to reduce the occurrence of vaccine-preventable diseases among adults.”

Disclosure: The researchers report no relevant financial disclosures.

William Schaffner, MD

In contrast to the generally splendid immunization rates in infants and children, once the threshold of the 19th birthday is crossed, immunization rates among adults are far from optimal. This is not new news and there are numerous longstanding reasons that contribute to this dismal state of affairs. This is not the time and place to go into them all, but there is a peek of sunshine among the clouds. The Affordable Care Act (Health Care Reform) will provide a funding base for adult immunizations, such that many more adults will qualify for first-dollar coverage of immunizations and their providers will be paid a reasonable administration fee. In the meantime, the CDC has provided this report card on our ongoing accomplishments in providing adults the immunizations for which they are recommended by the ACIP. Our grades are a mixture of ‘Cs and a few ‘Bs’. A recurring theme was disparity by racial or ethnic grouping.

Not only do we need to improve the use of these traditional vaccines, the ACIP recently has made a couple of substantial new recommendations. First, it was determined that adults with diabetes had higher risk of acquiring hepatitis B than did comparable non-diabetic adults. Thus, the ACIP recommended that adults aged younger than 60 years receive the hepatitis B vaccine as soon as possible after the diagnosis of diabetes. Those older than age 60 also should be considered for vaccination. This will come as a surprise to both providers of care as well as persons with diabetes, so considerable education will be needed. It would be helpful if this were incorporated quickly into the list of quality of care guidelines in widespread use in the care of patients with diabetes.

The other long-awaited recommendation was to extend routine HPV vaccination to males starting at age 11 and extending through age 21. For MSM and men who are immunocompromised (including those with HIV infection) the recommendation extends up to age 26. This is yet another challenge for providers who care for adults. Using the annually-published adult immunization schedule will help us provide the appropriate vaccines to the patients that need them. As the Nike ad said, “Just do it”!

- William Schaffner, MD

Infectious Disease News Editorial Board member

President, National Foundation for Infectious Diseases

Disclosure: Dr. Schaffner reports no relevant financial disclosures.

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