The Power to Protect: Vaccination Guidelines for Adults With Chronic Diseases

Raymond A. Strikas, MD, MPH


October 02, 2017

Editorial Collaboration

Medscape &

Hello. I am Dr Raymond Strikas, medical officer in the National Center for Immunization & Respiratory Diseases. I am pleased to speak with you as part of the CDC Expert Commentary Series on Medscape. I want to thank you for the work you do every day to protect your adult patients across the United States from vaccine-preventable diseases. Research shows that most adults believe vaccines are important and that a recommendation from a healthcare professional is the strongest predictor of patients getting needed vaccines. Assessing your patients' vaccination status at every clinical encounter may help decrease missed opportunities to vaccinate.

As you know, all adults need certain vaccines to help protect themselves and those around them from common and serious diseases. However, factors such as age and specific health conditions put some of your adult patients at higher risk for diseases and complications than younger, healthier adults. Patients with chronic conditions like diabetes, heart disease, and lung disease are at increased risk of developing serious complications from vaccine-preventable diseases, including long-term illness, hospitalization, and even death.

But assessing and recommending vaccines for adult patients living with chronic conditions is more complicated because there are additional vaccine guidelines and contraindications associated with different chronic conditions. Your best resource for adult vaccinations is the "Recommended Immunization Schedule for Adults Aged 19 Years or Older," which is approved annually by the Advisory Committee on Immunization Practices (ACIP), the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives. This schedule is for persons living in the United States. To help you with navigating that schedule and the fine print associated with it, I would like to share a few key vaccine insights about your adult patients, including those with chronic conditions like heart disease and diabetes.

Pneumococcal vaccines offer very important protection to your patients with chronic conditions and for all adults 65 years of age or older. Pneumococcal vaccines are recommended for patients with immunocompromising conditions, such as HIV infection, or those with common chronic conditions, including heart disease, diabetes, and chronic lung conditions such as chronic obstructive pulmonary disease, emphysema, and asthma. On average, presence of these conditions increases the odds for mortality from pneumococcal disease among unimmunized individuals with just one risk factor by 50% more than for individuals without any risk factors.[1] You likely have a number of adult patients in your practice who have multiple risk factors for pneumococcal disease which, combined, have an additive effect on the odds of mortality.[1]

The two vaccines available for pneumococcal disease prevention among adults—the pneumococcal conjugate vaccine (Prevnar) and the pneumococcal polysaccharide vaccine (Pneumovax)—are often recommended sequentially in a series. If you would like to walk through the recommendations or want a reminder to hang on the clinic wall, a helpful resource, Pneumococcal Vaccine Timing for Adults, is available for download.

I'm certain that you are aware of how important it is that your diabetes patients receive the hepatitis B vaccine. People with diabetes have higher rates of hepatitis B than the rest of the population. Outbreaks of hepatitis B have been associated with blood glucose monitoring procedures. Therefore, CDC and ACIP recommend that all adults aged 19 through 59 years with diabetes be vaccinated against hepatitis B as soon as possible after a diagnosis of diabetes is made. For patients with diabetes who are aged 60 years or older, hepatitis B vaccination is left to the discretion of the treating clinician after assessing the risk and the likelihood of an adequate immune response to vaccination.[2] The hepatitis B, influenza, and pneumococcal vaccines are all important to recommend as part of a diabetes management plan.

Adult patients with heart disease, or those who have had a stroke, have almost three times the risk of being hospitalized with influenza than those without heart disease.[3] Influenza can also make it harder for these patients to control their blood sugar, and sometimes influenza causes serious complications, including pneumonia, bronchitis, sinus infections, and ear infections.[4] Influenza can cause airway edema in patients with chronic lung disease, making it harder for the patient to breathe and leading to serious respiratory complications and illnesses.

CDC and ACIP recommend that everyone aged 6 months or older receive an annual influenza vaccine for protection against the influenza virus. Recommending the influenza vaccine annually, particularly to patients with chronic conditions, is as an effective way to help protect them from serious complications from flu.

Finally, for all adult patients, it is also important to keep in mind that CDC also recommends tetanus, diphtheria, and acellular pertussis (Tdap) and zoster vaccines. Adults who did not receive a Tdap vaccine as an adolescent should receive one dose to increase pertussis immunity, regardless of when they received their last tetanus and diphtheria (Td) vaccine. Then they should receive a Td booster every 10 years. I remind you that pregnant women should get a dose of Tdap vaccine during every pregnancy to help protect the infant from pertussis.

The risk for shingles increases as patients get older, with almost half of all cases occurring in men and women 60 years old or older. CDC recommends a single dose of herpes zoster vaccine to prevent shingles for people 60 years old or older.[4]

As your adult patients' most valued and trusted source of health information, you have the power to protect them from vaccine-preventable diseases. You should take every opportunity to discuss and help all patients get vaccinated to maximize their protection from common, preventable infectious diseases. The full 2017 adult vaccine schedule is available on the CDC website, which also offers a variety of other healthcare professional resources and materials to help you make strong vaccine recommendations.

I trust that these insights are helpful in explaining important condition-specific vaccine recommendations to your staff and patients. Thank you again for the work you do to keep adults across the nation healthy and safe.

Web Resources

Recommended Immunization Schedules for Adults

Pneumococcal Vaccine Timing for Adults

Pregnancy and Whooping Cough