Many Adults Not Getting Recommended Vaccines

HPV and shingles vaccination rates among adults slightly increased but overall rates remain low

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Adults may be concerned about their children's vaccinations, but are they concerned with their own? New data from a US survey suggests that adult vaccination levels may need a boost.

This recent study used a national phone survey to determine the rates of a variety of vaccinations in 2012, not including the flu vaccine.

The study found that overall levels of adult vaccinations were low in 2012, but that small increases were seen, including in rates for the shingles and human papillomavirus (HPV) vaccinations.

"Ask your doctor if you should consider any vaccinations."

According to the authors of this study, who were led by Walter W. Williams, MD, of the Immunization Services Division at the Centers for Disease Control and Prevention (CDC), vaccinations are recommended throughout life, but vaccination coverage for adults is typically low.

To explore recent rates of vaccinations among adults in the US, Dr. Williams and colleagues looked at data from the 2012 National Health Interview Survey, a national phone survey of adults aged 19 or older.

Dr. Williams and team focused on vaccines for pneumococcal disease, tetanus, hepatitis A, hepatitis B, herpes zoster (shingles) and HPV.

These vaccines are all recommended for different groups depending on factors like age, risk factors and health conditions. The researchers looked at rates for specific vaccines among groups who are recommended to receive them.

Dr. Williams and team found that pneumococcal vaccination rates, which protect against a group of highly contagious illnesses including meningitis, didn't change much from 2011 to 2012. In the latest data, an estimated 20 percent of high-risk adults between the ages of 19 and 64, and 59.9 percent of adults aged 65 and older, were vaccinated.

National goals for the year 2020 are to have 60 percent of high-risk people between ages 18 and 64 and 90 percent of people aged 65 or older vaccinated for pneumococcal disease — well above the rates seen in 2012.

Tetanus (lockjaw) is a serious condition caused when bacteria enters the body through a deep wound. The vaccines to protect against it generally last for about 10 years.

Dr. Williams and team found that in 2012, 64.2 percent of adults between the ages of 19 and 49 had received a tetanus vaccine over the previous 10 years. The same was true for 63.5 percent of adults aged 50 to 64 and 55.1 percent of adults aged 65 or older. These rates were all similar to rates seen during 2011.

Hepatitis A and B are viral infections that can cause major liver problems. The researchers found that a fairly low amount (12.2 percent) of adults aged 19 to 49 received at least two hepatitis A vaccinations — a rate similar to that in 2011. Adults in this age group who had traveled to a country with high hepatitis A rates had a higher level of vaccination (18.9 percent).

A larger percentage (35.3 percent) of adults aged 19 to 49 had received at least three doses of hepatitis B vaccines — also similar to the rate seen in 2011.

Shingles, a painful condition involving the skin, is commonly seen in older adults and is prevented by the herpes zoster vaccine. Of adults aged 60 or older, 20.1 percent reported being vaccinated against shingles in 2012, an increase from the 15.8 percent seen in that same age group during 2011.

The HPV vaccine is recommended for women under the age of 26, and protects against several forms of HPV, some of which can cause cervical cancer. Of women aged 19 to 26, 34.5 prevent reported receiving more than one HPV vaccine dose in 2012, an increase from 29.5 percent in 2011.

Dr. Williams and team concluded that overall, these rates represented low vaccination coverage for US adults in 2012. The researchers did note that the small increases seen in some cases, like the herpes zoster vaccine for older adults and the HPV vaccine for women aged 19 to 26, were important.

According to E. Lee Carter, RPh, Clinical Pharmacy Specialist at the Department of Veterans Affairs in Prestonsburg, Kentucky, "Of all the potential barriers to adult vaccination, financial constraints continue to provide the biggest obstacle."

Carter told dailyRx News, "Many providers simply do not stock the eleven recommended adult vaccinations either due to cost, lack of third-party reimbursement, or lack of ability to proper store these vaccines. For instance, the shingles vaccine must be stored in a specialized (laboratory-type) sub-zero freezer which is not commonly found in most primary-care offices. Many patients find that the cost of receiving these vaccines is prohibitively expensive due to limited insurance coverage or higher copays. The new Affordable Care Act should help to ensure that insurers cover adult vaccination."

Carter continued, "Although it can prove cumbersome, providers should be encouraged to inquire about the vaccine status of every patient at each office visit. And, public education is crucial. There is simply no reason why up to 30,000 patients die each year due to preventable diseases.  Patients should discuss questions or concerns about vaccination with their healthcare provider or pharmacist. Many pharmacies now provide comprehensive vaccination services at convenient locations near home. The benefits of vaccination are evident not only to the adult patient, but also to younger children in the household that can be affected by unnecessary exposure to these diseases."

According to these researchers, further improvement in adult vaccination rates are needed to both protect adults themselves and to protect infants they might be in contact with. The researchers suggested programs that incorporate public education, increased access to vaccines in medical settings, a removal of barriers to vaccination and recommendations for vaccines from health care providers.

"Routine assessment of adult patient vaccination needs, recommendation, and offer of needed vaccinations for adults should be incorporated into routine clinical care of adults," the researchers wrote.

It is important to note that vaccination status was self-reported by the study participants.

This study was published online February 6 in the CDC's Morbidity and Mortality Weekly Report. No conflicts of interest were reported.

Review Date: 
February 6, 2014
Last Updated:
February 10, 2014