Vaccine Uptake Among Adults Better, but Still Low

Ricki Lewis, PhD

February 06, 2015

Adult uptake of recommended vaccines remains generally low, with increased coverage for herpes zoster, Tdap, and HPV, according to a report published in the February 6 issue of the Morbidity and Mortality Weekly Report.

Vaccines protect people of all ages from infectious diseases and their sequelae, but uptake among adults remains low, despite clear and timely recommendations from the Centers for Disease Control and Prevention (CDC) and advice to healthcare providers to incorporate vaccines into standard practice. Recommendations advise influenza vaccine for all adults and other vaccines tailored to patients' characteristics, such as health, age, travel, and behavioral risk factors.

Walter W. Williams, MD, from the Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, and colleagues compared National Health Interview Survey data from 2013 for selected vaccines with data from 2008 to 2012, which had indicated vaccine uptake below Healthy People 2020 targets among US adults aged 19 years or older. The data come from in-person interviews with adults from families randomly selected by the US Census Bureau for the CDC's National Center for Health Statistics.

Vaccine use among adults remains low overall, but the 2013 data indicate slight increases for vaccination against herpes zoster among adults aged 60 years or older (4.1 percentage point increase to 24.2%), tetanus and diphtheria toxoid with acellular pertussis vaccine (Tdap) vaccination among adults aged 19 years or older (2.9 percentage point increase to 17.2%), and human papillomavirus among males aged 19 to 26 years (a 3.6 percentage point increase to 5.9%). Human papillomavirus coverage for women was similar to 2012, at 36.9%. Coverage did not increase for vaccines against pneumococcal pneumonia, hepatitis A, or hepatitis B.

Racial/ethnic disparities in receiving recommended vaccines persisted for all six vaccines considered and widened for Tdap and herpes zoster. Whites are more likely to be vaccinated.

Many adults are not aware of their need for vaccines, and education has fallen to healthcare providers. To address lack of information and population disparities, the CDC has advised that healthcare providers assess each adult patient's vaccine requirements and offer the vaccinations at "every clinical encounter."

The three vaccinations that are part of Healthy People 2020 — pneumococcal, herpes zoster, and hepatitis B — did not reach target levels.

The researchers conclude, "These data indicate little progress was made in improving adult vaccination coverage in the past year and highlight the need for continuing efforts to increase adult vaccination."

"With all of the online physician review and evaluation sites, as well as the [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," Sandra Adamson Fryhofer, MD, from Emory University School of Medicine and Piedmont Hospital in Atlanta, explained in a commentary on the newly published report for Medscape Medical News. "This evaluation of adult immunization coverage rates reveals much opportunity for improvement."

The report offers suggestions for increasing vaccine uptake. These include increased efforts at education, publicity, access to vaccination services in healthcare settings, and use of reminder-recall systems. The researchers repeat the need for adult vaccination to be a consistent part of routine clinical care of adults.

Limitations of the analysis include omission of institutionalized individuals and military in the sample; a low response rate (61.2%), possibly introducing bias; a lack of validation of information from medical records; recall bias; and confusion in reporting tetanus alone vs combinations with diphtheria and pertussis toxoids.

The researchers have disclosed no relevant financial relationships.

Morb Mortal Wky Rep. 2015;4:95-102. Full text

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