Adult immunization rates remain low

There was little improvement in the overall immunization rates among adults from 2010 to 2011, according to data presented at the Advisory Committee on Immunization Practices meeting.

CDC researchers analyzed data from the National Health Interview Survey to assess rates of immunization with pneumococcal vaccine, hepatitis A and hepatitis B vaccines, tetanus toxoid vaccine, containing vaccines, herpes zoster (shingles) vaccine and HPV vaccine.

The most significant increase was for women aged 19 to 26 years receiving the HPV vaccine: 29.5% had received at least one dose in 2011, an 8.8-percentage point increase from the rate in 2010, Walter Williams, MD, of the CDC’s National Center for Immunization and Respiratory Diseases, said during his presentation.

Walter Williams

Williams said there were minor, if any, increases for pneumococcal vaccination among adults aged at least 65 years and high-risk adults aged 19 to 64 years. There were also minor increases in hepatitis A and hepatitis B vaccination among adults aged 19 to 49 years, HPV vaccination in men aged 19 to 26 years and herpes zoster in adults aged at least 60 years.

There has been no change in the number of adults of any age who received a tetanus vaccination within the past 10 years. Vaccination with the tetanus-diphtheria-acellular pertussis vaccine remained low at 12.5%, which is a 4.3-percentage point increase from 2010. However, there was a large increase in Tdap vaccination among adults who were living with infants aged younger than 1 year.

“This is important because we know that protection with Tdap vaccination among people who have close contact with infants younger than 1 year provides protection against the risk of transmission to unprotected infants,” Williams said.

Physician practices

Laura Hurley, MD, of the University of Colorado, presented data from a study of a national sample of general internists and family medicine practitioners about their practices in recommending and stocking vaccines. They also looked at the barriers to delivering vaccines and the physicians’ attitudes toward ACIP recommendations.

Hurley and colleagues found that almost all physicians assess immunization status at annual visits and initial visits, but only 30% assess immunization status at every visit. Almost all physicians assess the need for and stock seasonal influenza vaccine, pneumococcal vaccine and Td and Tdap vaccines. Most physicians are assessing the need for herpes zoster, but only 50% stock it. Few physicians assessed the need for or stocked hepatitis vaccines. Most assessed the need for and stocked HPV vaccine.

The top five barriers to recommending and stocking vaccines were all financial: lack of adequate reimbursement for vaccine; difficulty ensuring that a patient’s insurance will reimburse for a vaccine; patient’s insurance does not cover vaccine; lack of adequate reimbursement for vaccine administration; and upfront cost of buying vaccine.

“Primary care physicians perceive themselves as having a central role in making sure that patients receive vaccines,” Hurley said. “Physicians are referring patients to other vaccinators, like pharmacists and health departments as needed, but there is no systematic approach. In addition, although attitudes toward the ACIP immunization schedule were favorable, some physicians find aspects of it unclear.”

Patient knowledge

In the last presentation, Kris Sheedy, PhD, of the CDC’s National Center for Immunization and Respiratory Diseases, presented data from surveys mailed to 6,000 patients in October 2012 to analyze the consumer perspective on vaccination.

Kris Sheedy

Most patients reported seeing a PCP within the past year. A significant number did not know that the hepatitis vaccines, the pneumococcal vaccine or the Tdap vaccine were recommended. With the exception of seasonal influenza vaccine, few adults believed they received the vaccine or were told about the vaccines.

Most of the adults believed that vaccines were important to protecting their health, their family’s health and the health of the community. In addition, provider recommendation was the No. 1 factor influencing vaccination decisions.

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“Most respondents agree that vaccines are important to protecting health,” Sheedy said. “Adults are seeing their doctors, but they receive few vaccine recommendations and are unaware of the recommended vaccines, other than the influenza vaccine.”

Sheedy said the CDC is developing programs aimed at promoting awareness of vaccines among consumers, aiming to target resources for all different groups. They also are working with physicians to encourage them to discuss the need for vaccines with their patients.

Disclosure: Williams, Hurley and Sheedy report no relevant financial disclosures.