Adult Immunization 2015: Our Performance Review

Sandra Adamson Fryhofer, MD


February 05, 2015

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

Adult Immunizations: Are We Making the Grade?

This first edition of "Staying Well for 2015" targets adult immunization. When appropriately implemented, adult immunization helps all of our patients to do just that: stay well. This edition also addresses an issue that we all are becoming way too familiar with: reflection and self-evaluation. With all of the online physician review and evaluation sites, as well as the MOC (Maintenance of Certification) jungle through which many internists and subspecialists are plodding, physicians are getting quite used to report cards and trying to improve their grades. This evaluation of adult immunization coverage rates reveals much opportunity for improvement.

The adult immunization overall scorecard grade is "needs improvement." It is almost a tradition that the most recent National Health Interview Survey (NHIS) adult vaccination report card[1] is published in the same month as the new adult immunization schedule.[2] The NHIS is typically published either simultaneously or immediately after the publication of the new adult immunization schedule in the Annals of Internal Medicine.[3] The NHIS 2013 used face-to-face interviews from a nationally representative sample to collect information about the healthcare (including vaccination status) of noninstitutionalized Americans. Vaccination status for six types of vaccines (pneumococcal, tetanus, hepatitis A, hepatitis B, shingles, and human papillomavirus [HPV]) was assessed. Comparisons of these results to Healthy People (HP) 2020 targets also will be made.[4] The most recent data on influenza coverage rates for 2013-2014 season were released in September 2014[5] with separate Morbidity and Mortality Weekly Reports on coverage rates for pregnant women[6] and healthcare personnel[7] based on data from Internet panel surveys.

Although NHIS found no overall decline in adult immunization coverage, there was only modest improvement (compared with 2012) for just three of the six vaccines included in the survey: tetanus toxoid, diphtheria, acellular pertussis (Tdap), shingles, and HPV vaccination for men. Another concerning observation was persistent racial/ethnic gaps for all six vaccines, with actual widening of the coverage gap for both Tdap and shingles vaccination.[1]


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