Turning the Tide on Adult Vaccination Rates

In 2010, the U.S. Department of Health and Human Services set their sights on improved vaccination rates by 2020 as part of a far-reaching campaign “Healthy People 2020.” Yet, early metrics confirmed immunizations among adults are lagging behind schedule. As a result, the National Vaccine Program Office (NVPO) proposed a five-year plan to turn the tide.

 In February, the NVPO drafted a five-year plan with the goal of improving infrastructure, access, and demand for adult immunizations. Beyond supporting the use of all recommended adult vaccines, this plan is particularly designed to help the U.S. play catch-up on vaccination goals that were set in 2010 for use of pneumococcal disease or pneumococcal pneumonia, shingles, hepatitis B, and the flu. According to data from 2013, significant progress is needed, particularly in vaccinations against pneumococcal disease and hepatitis B, as illustrated in the chart below:

2013 Adult Vaccine Rates

The need for improvement among adult immunizations was further supported by instances of infection that could be prevented by vaccines. For instance, the Centers for Disease Control and Prevention (CDC) estimates that there are approximately 40,000 cases and 4,000 deaths as a result of invasive pneumococcal disease, 3,000 cases of hepatitis B, and roughly one million cases of shingles each year. In addition, influenza is responsible for more than 225,000 hospitalizations and thousands of deaths annually—the majority of which occurring among adults above the age of 65.

While a wide range of stakeholders is being called on by the NVPO to reach its goals outlined in the plan, those providing care to adults will likely have the largest impact. Today’s low immunization rates among adults are a result of a number of factors including an overall lack of knowledge and a reduced emphasis as a preventative care measure. Preventative care has neglected vaccines for too long. As one of the best ways to keep your patients safe from preventable diseases, consider sharing this vaccine checklist to ensure they are compliant with therecommended immunizations:

  • Influenza (Flu) – The flu shot should be given annually to everyone age six months or older to protect patients from influenza, which can cause serious complications. For adults over 65, a high-dose flu vaccine is available to provide greater protection.

  • Haemophilus Influenzae Type B (Hib) – If an adult has previously not received the vaccine, one dose of the Hib vaccine should be administered to individuals who have asplenia, sickle cell disease, or are undergoing an elective splenectomy.

  • Hepatitis A Virus (HAV) – Two doses of the HAV vaccine are recommended for adults with certain occupational, medical, and lifestyle indications. Health care workers, patients with chronic liver disease, and individuals who participate in illegal drug use should receive the HAV vaccine.

  • Hepatitis B Virus (HBV) – A three-dose series vaccine should be given to adults based on certain indications. Those who work medical settings, adults who are sexually active and not in monogamous relationships, patients who have chronic liver disease or diabetes, and individual who participate in illegal drug use are recommended to receive the HBV vaccine.
  • Human Papillomavirus (HPV) – If the vaccine was not received as an adolescent, men and women up until 26 should receive three doses of the HPV vaccine to protect against four strains of HPV that can lead to cancer.

  • Measles, Mumps and Rubella (MMR) – If a patient did not receive the vaccine as a child, one or more doses of the MMR vaccine are recommended for individuals born after 1957.

  • Meningococcal Meningitis – Two vaccines are now available to help protect against the most common serogroups of the meningococcal disease. The standard meningitis vaccine protects against four strains, A, C, W and Y, and is recommended in two doses at age 11 and then again at 16. Another meningitis vaccine protecting against the B strain of the virus was also recently introduced. Adolescents are recommended to receive this vaccine primarily between the ages of 16 and 18. For adults, one or more doses of the vaccines are advised for those who are identified as having increased risk depending on medical indications and lifestyle. All first-year college students living in a residence hall and military recruits are also advised to receive the vaccines. 
  • Pneumococcal Disease – One dose of the pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) are recommended for all adults 65 years or older. Individuals with certain medical indications, smokers, and adults living in a nursing home or long-term care facility should receive the vaccinations. After five years, a booster shot is required.

  • Tetanus, Diphtheria, Pertussis (Td/ Tdap) – Individuals who received the vaccine series as a child should receive a tetanus and diphtheria toxoids (Td) booster shot every 10 years. For individuals whose vaccine status is unknown, it is suggested they receive one dose of the Tdap followed by the Td booster dose, which then should be administered every 10 years. Pregnant women should also receive one dose of the Tdap vaccine between 27 and 36 weeks of pregnancy.

  • Varicella (Chicken pox) – All adults without evidence of immunity to varicella, particularly those in contact with young children, should receive two doses of the vaccine.

  • Zoster (Shingles) – One dose of the zoster vaccine should be given to adults 60 years and older to reduce the risk of developing shingles.

By building awareness and making vaccines a priority in preventative care, we will be in a better position to not only meet our collective health goals, but also keep patients protected and healthy.