Adult Vaccines: Never Miss a Chance

Carolyn B. Bridges, MD


April 07, 2014

Editorial Collaboration

Medscape &

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Hello. I'm Dr. Carolyn Bridges, Associate Director of Adult Immunizations at the Centers for Disease Control and Prevention (CDC). I'm pleased to speak with you today as part of the CDC Expert Commentary Series on Medscape.

CDC has recently released reports[1,2] revealing 2 findings that raise concern. First, adults in the United States are not getting recommended vaccines, and second, there are many missed opportunities to immunize them. However, research indicates that healthcare professionals can play a critical role in improving this situation. That is why CDC supports the recently updated Standards for Adult Immunization Practice,[3] which call on all healthcare professionals to take steps to ensure that their patients get the vaccines they need.

Even though most health insurance plans cover the cost of recommended vaccines, adult vaccination rates are unacceptably low. In February 2014, CDC released immunization coverage estimates from the 2012 National Health Interview Survey (NHIS) reporting:[1]

Only 14% of adults 19 years or older were up-to-date on Tdap vaccine. More than 48,000 cases of pertussis were reported in 2012, and many more cases go unreported. Five out of 100 adults with pertussis are hospitalized and others may have complications, which could include pneumonia or cracked ribs. All adults should have 1 Tdap dose. In addition, because infants are at greatest risk for severe illness and death from pertussis, pregnant women should get Tdap vaccine during each pregnancy to protect their infants.

Although adults aged 60 years or older are recommended to get the shingles vaccine, only 20% of them have received it. Among the estimated 1 million cases of shingles in the United States each year, about half occur in adults aged 60 years or older. This age group is also the most likely to experience severe postherpetic neuralgia with prolonged pain from shingles that can last for many months.

Only 20% of adults aged19-64 years recommended for pneumococcal vaccination because of a high-risk medical condition, such as chronic heart or lung disease or an immune-compromising condition, received the vaccine. And only 60% of adults aged 65 years or older, all of whom are recommended to get pneumococcal vaccine, received it. There were approximately 32,000 cases of invasive pneumococcal disease in 2012 and about 3000 of those resulted in death.

Healthcare professionals are critical to improving vaccination rates. Why aren't adults getting the vaccines they need?

A 2012 national consumer survey indicates that adults believe that immunization is important, but most adults are not aware that they need vaccines throughout their lives to protect against diseases such as shingles, pertussis, and hepatitis. Healthcare professionals are the most valued and trusted source of health information for adults, and research shows that a recommendation from their healthcare professional is the top predictor of adults getting the vaccines they need.

Unfortunately, research also shows that there are many missed opportunities for vaccination. Although many of the consumer survey respondents had seen a healthcare professional in the preceding year, few reported receiving recommendations to be vaccinated. In addition, a recent study of primary care physicians revealed that only 28% of general internists and 30% of family physicians assess immunization status at every visit.

The Standards for Adult Immunization Practice call on all healthcare professionals to take these 4 steps and use every opportunity to improve immunization of your patients:

1. Implement procedures in your office to ensure that your patients' vaccine needs are routinely reviewed based on the latest CDC vaccine recommendations for adults.

2. Share a strong recommendation with your patients for the vaccines they need. Address any patient questions or concerns and explain the benefits of getting vaccinated and potential costs of getting the diseases that the vaccines protect against.

3. For vaccines that you stock, make vaccination services as convenient as possible for your patients. For vaccines that you don't stock, refer patients to providers in the area who offer vaccination services.

4. Make sure to document vaccines received by your patients. Participate in your states' immunization registry to help your office, your patient, and your patients' other providers know which vaccines your patients have had.

Whether you provide immunization services or not, you can play a critical role in ensuring that your patients have the best protection against serious -- and sometimes deadly -- vaccine-preventable diseases.

For more information and resources on adult immunization, visit

Web Resources

CDC. Adult Immunization Schedules.

CDC. Vaccine Resources to Share With Your Adult Patients

Carolyn B. Bridges, MD, is the Associate Director of Adult Immunizations in the Immunization Services Division, National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC). A board-certified internal medicine physician, Dr. Bridges was in clinical practice before joining the Epidemic Intelligence Service at CDC in 1996, working primarily on influenza. After 5 years as the Associate Director for Epidemiologic Science in the Influenza Division, Dr. Bridges transitioned to her current position in 2011 as the Associate Director of Adult Immunizations, where she leads CDC efforts on adult immunizations, co-chairs the National Adult Immunization Summit, and leads the ACIP Adult Immunizations Work Group. Her career in public health has included research and policy on influenza prevention and control, vaccine effectiveness, improving the understanding of transmission of influenza, and improving uptake of adult vaccinations. She has authored or co-authored more than 100 articles and book chapters on influenza and adult immunizations.