February 4, 2010 — The United States needs a national strategy to immunize adults against infectious diseases that would achieve the same success found in childhood immunization efforts, according to a report released today that characterized adult immunization rates as dangerously low.
Between 40,000 and 50,000 adults die each year from vaccine-preventable illnesses, according to the report, published by the Infectious Diseases Society of America, the Robert Wood Johnson Foundation, and the Trust for America's Health.
The report, titled "Adult Immunization: Shots to Save Lives," states that one third of adults aged 65 years and older have not been vaccinated against pneumonia, and 30.5% have not been vaccinated against the seasonal influenza.
The report asserted that too many adults go without recommended vaccinations because "our medical system is not set up to ensure adults receive regular preventive care."
At a press conference today, William Schaffner, MD, chair of the Infectious Diseases Society of America's Immunization Work Group and report coauthor, compared the state of adult immunizations to that of pediatric immunizations 30 years ago.
"We had a very disjointed system, with many gaps in children not being immunized," said Dr. Schaffner. "Now what we have crafted in this country is something wonderful. We have extraordinarily high immunization rates in children. We'd like to extend this beyond the nineteenth birthday to adults."
Trust for America's Health Executive Director Jeffrey Levi, PhD, said that the 3 report sponsors wanted to capitalize on the visibility and momentum of recent efforts to immunize people against the H1N1 influenza virus.
"The [H1N1] outbreak illustrated that we don't have a strategy for immunizing adults against infectious diseases," said Dr. Levi, adding, "I can't emphasize enough that the H1N1 immunization campaigns were quite amazing when you realize how little infrastructure is in place to support adult vaccinations."
Almost Half of Seniors in Nation's Capital Lack Immunization Against Pneumonia
The pneumococcal vaccination rate of 66.9% nationwide for seniors falls considerably short of the 90% goal set by the Centers for Disease Control and Prevention. Even the highest-ranking state — Oregon, at 73.2% — is an underperformer. More than 30% of seniors are not immunized against pneumonia in 36 states and the District of Columbia, where 45.6% of seniors overall lacked this vaccination — the worst rate in the country. Most people need only 1 pneumococcal immunization dose for their lifetime, the report noted.
The figures are slightly better for protecting seniors against seasonal influenza — the nationwide immunization rate is 69.5%. Among all adults, however, the rate is only 36.1%.
For other diseases, immunization is even spottier:
Human papillomavirus vaccine for eligible adult women (ages 18 - 64 years): 10%
Shingles vaccine for patients aged 60 years and older: less than 2%
Tetanus, diphtheria, and whooping cough vaccine for eligible adults (ages 18 - 64 years): 2.1%
Report Recommends More Generous Insurance Coverage of Vaccinations
In contrast to the adult world, efforts to vaccinate children against various diseases have been far more successful, in large measure because state laws require immunization as a condition of attending school or day care, the report stated. No such institutional mandate exists for adults, apart from those in the military or certain colleges.
The report pointed to other reasons for low adult vaccination rates:
The nation's healthcare system is not geared toward primary care or prevention. Dr. Schaffner noted Thursday that many Americans receive all their medical care from subspecialists, "who by and large aren't immunizers." In addition, an estimated 44 million uninsured Americans lack access to primary care entirely.
Private health insurance coverage often does not pay for vaccines and their administration, shifting the costs to individuals and possibly deterring them from getting vaccinated.
Many adults mistakenly believe vaccines are unsafe or ineffective.
Not enough money has been spent to bring out new and improved vaccines.
To cure the problem, the report recommends that all private insurers as well as Medicare pay for any adult vaccination recommended by the Advisory Committee on Immunization Practices. Pending healthcare reform legislation, said Dr. Levi, would bring about these changes.
The report also recommends the creation of a Vaccines for Uninsured Adults Program, stepped-up public education, the development of standard practices for physicians to track and meet their patient's immunization needs, and increased funding for vaccine research, development, and production.
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Cite this: Make Adult Vaccinations as Widespread as Those for Children, Say Immunization Advocates - Medscape - Feb 04, 2010.