Adult Immunization 2015: Our Performance Review

Sandra Adamson Fryhofer, MD


February 05, 2015

In This Article

Individual Vaccine Coverage Reports

Pneumococcal: Stagnant

The survey inquired about receipt of "a pneumonia shot," so it could not be determined which specific vaccine was received. That said, results were similar to last year's. Only 21.2% of high-risk adults aged 19-64 (HP target 60%) and only 59.7% of adults aged 65 and older (HP target 90%) received pneumococcal vaccination.[1] These are respectively 40% and 30% below HP targets.

Pneumococcal vaccination recommendations for adults are complicated, with dual vaccinations (the pneumococcal polysaccharide vaccine PPSV23 and pneumococcal conjugate vaccine PCV13) for seniors and certain high-risk groups. The Advisory Committee on Immunization Practices (ACIP) recommends routine use of PCV13 in series with PPSV23 for adults aged > 65 years.[8] Vaccination with PCV13 in series with PPSV23 has been recommended since October 2012 for adults aged ≥ 19 years with immunocompromising conditions and certain other medical problems (functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants).[9] PPSV23 is recommended as well for those who smoke or have asthma.[10] At the time of this survey,[1] dual pneumococcal vaccinations for seniors had not yet been recommended.

Tdap: Modest Improvement Yet Widened Racial/Ethnic Coverage Gap

Adults of all ages need a Tdap shot if they have not received one previously.[11] This particular NHIS survey[1] is only the second time that Tdap status was collected for those aged 65 and older. The recommendation that pregnant women receive a Tdap booster in each and every pregnancy, preferably in the late third trimester, became Centers for Disease Control and Prevention (CDC) policy in February 2013.[12] The difference between the tetanus-containing vaccines can be confusing for patients. Overall, 61.8% of those surveyed were not sure what kind of tetanus-containing vaccine they received. For 51.2% of respondents, the reason was "doctor did not inform." However, 10.6% of respondents simply "could not recall the vaccine type."[1]

Overall coverage specifically for Tdap for all adults aged 19 or older showed a very modest improvement of nearly 3%, rising to 17.2%. Despite overall improvement for Tdap, the racial/ethnic divide was magnified. Tdap coverage was 19.7% for white adults aged 19 or older as compared with 15.5% for Asians, 12.6% for blacks, and 10.2% for Hispanics.[1] These results are especially disappointing considering the devastating and potentially deadly effect that pertussis infection has on infants and young children. Fortunately, Tdap vaccination of healthcare professionals (at 37.3%) did increase nearly 6% from 2012 estimates.[1]

Hepatitis A: Stagnant

Hepatitis A (two vaccine doses) coverage for adults was 9% and stagnant. Although vaccination rates for international travelers to hepatitis A highly endemic countries were higher (15.9%) than the overall rates, they were not much different from 2012 estimates. Although hepatitis A vaccination is recommended for adults with chronic liver disease, the NHIS estimate of 13.3% for this specific group also showed no significant improvement.[1] Footnotes to the adult schedules include a reminder for hepatitis A vaccination for anyone with close contact to an international adoptee.[2]

Hepatitis B: More Disappointment

Adult hepatitis B vaccination (at least three doses) coverage was 25% with a concerning trend. Coverage actually declined more than 2%. No gains in adult hepatitis B vaccination coverage were seen for those with chronic liver conditions (34%) or for all individuals with diabetes aged 59 and younger (26.3%).[1] Hepatitis B vaccination is also recommended for anyone who has had more than one sex partner during the past 6 months.[2]

Healthcare personnel are not practicing what ACIP recommendations are preaching! The hepatitis B vaccination HP target for healthcare personnel is 90%, but the NHIS coverage estimate of 61.7% shows no real improvement from 2012. Sadly, hepatitis B vaccination coverage for Hispanic healthcare personnel was even lower at 54% compared with 62.9% for their white counterparts.[1]

Shingles: Making Headway but Racial/Ethnic Gaps a Concern

The more than 4% improvement in shingles (herpes zoster) vaccination coverage to 24.2% is somewhat encouraging, but coverage for blacks (10.7%) and Hispanics (9.5%) is still lagging behind that for whites (27.4%).[1]

The risk for shingles increases with age. Although the shingles vaccine is US Food and Drug Administration (FDA)-approved for adults starting at age 50, ACIP recommends waiting until at least age 60 to vaccinate.[13] The shingles vaccine is a live virus vaccine and should not be given to anyone who is pregnant or severely immunocompromised.[14]


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