Adult Immunization Retake: Lost Opportunities for Protection, Shared Responsibility

Sandra Adamson Fryhofer, MD


February 25, 2014

In This Article
Sandra Adamson Fryhofer, MD
Adjunct Associate Professor of Medicine, Emory University School of Medicine, Atlanta, Georgia; Past President, American College of Physicians

A "Big Reveal" for Vaccines

In February 2014, we experienced a "big reveal" in the area of adult immunization: the release of the 2014 Adult Immunization Schedule,[1] the most recent National Health Interview Survey (NHIS) data for adult vaccination coverage,[2] as well as an enlightening Centers for Disease Control and Prevention (CDC)-funded physician survey on adult vaccine delivery.[3]

Lost Opportunities to Immunize

Of the 30,000 Americans who die on average each year from vaccine-preventable diseases, most (95%) are adults.[3] The most recent NHIS report card collating data from 2012 shows failing grades and, therefore, missed opportunities for adult vaccine coverage when compared against Healthy People (HP) 2020 goals.[2]

Pneumococcal vaccination. Only 20% of high-risk patients aged 19-64 years and only 59.9% of those aged 65 and older have received the pneumococcal vaccination. The HP goals are 60% and 90%, respectively.[2]

Shingles. Shingles vaccination protection represents another lost opportunity. There are 1 million new cases of shingles each year. One in 3 adults will suffer from shingles at some point in their lives. As an internist, I have firsthand knowledge of the problems and pain that patients experience with shingles. The Advisory Committee on Immunization Practices (ACIP) recommends shingles vaccine for adults aged 60 years and older. Although coverage for the shingles vaccine increased 4.4% since 2011, we are still way below the HP 2020 goal of 30%. Only 20.1% of adults aged 60 years and older have received the shingles vaccine.[2]

Tdap (tetanus, diphtheria, acellular pertussis). A Tdap booster is now recommended for all adolescents and adults. Our nation's recent whooping cough outbreaks and the devastating (and potentially deadly) effect they have had on infants and newborns should emphasize the importance of adult vaccination. Apparently, however, we are still not connecting the dots: Only 15.6% of adults have received a Tdap booster.[2]

HPV (human papillomavirus). The HPV vaccine series (3 doses recommended for those aged 9-26 years) prevents anal, cervical, and other genital cancers. It's a prophylactic vaccine, so to be protective, it must be given before exposure to the virus. Only 34.5% of young adult women (aged 19-26 years) have received at least 1 dose. Coverage for males is even more abysmal: 2.4% of males aged 19-21 years and 2.2% of males aged 22-26 years.[2]

Hepatitis B.Hepatitis B vaccination is another example of a failure that hits home for healthcare professionals. Only 65% of healthcare professionals have been vaccinated against hepatitis B, with no increase in coverage since 2011. The HP 2020 goal is 90%.[2]


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