CDC: Adult Vaccination Rates Too Low

Only 2% of Eligible Adults Have Had Shingles Vaccine

From the WebMD Archives

Jan. 23, 2008 -- Far too few adults in the United States are being vaccinated against serious and even deadly diseases, such as the flu, pneumonia, shingles, and cervical cancer, new data from the CDC confirms.

Findings from a nationwide survey of adults revealed that few Americans can name more than one or two of the 10 vaccines now recommended for adults.

Vaccination rates for the most widely known vaccinations fell far short of target goals, and only a small percentage of the eligible adult population received some of the less-established immunizations.

"These (vaccine) coverage estimates suggest that we are at the infancy of developing the strong adult immunization system that we would like to have," U.S. Assistant Surgeon General Anne Schuchat, MD, said at a Wednesday news conference. "We obviously have a lot more work to do, and it involves literally rolling up our sleeves."

The news conference was held by the National Foundation for Infectious Diseases (NFID).

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Vaccination Goals Not Being Met

The government's goal is to vaccinate at least 90% of people 65 and over against the flu and pneumococcal disease, but coverage estimates in this age group as of last summer were just 69% and 66%, respectively.

Kristin L. Nichol, MD, MPH, of the Minneapolis VA Medical Center, made it clear that it is not too late for people to get vaccinated against the flu this year because flu season generally peaks in February.

Flu shots are recommended for all adults aged 50 and over, for children between the ages of six months and 5 years, pregnant women, people with chronic diseases such as diabetes or heart disease, and those who come in contact with those who are at high risk for flu complications.

"This year we have more influenza vaccine than ever before," she said. "And we still have months of influenza activity in front of us."

Other highlights from the survey included:

  • A shingles vaccine licensed in the spring of 2006 is recommended for adults aged 60 and over. But after being available for one year, only about 2% of eligible adults appear to have been vaccinated.
  • Only about 2% of people surveyed also reported immunization with a new combination vaccine against tetanus, diphtheria, and whooping cough, recommended for adults aged 18 to 64.
  • The newly licensed human papilloma virus (HPV) vaccine, which protects against cervical cancer, is also not being widely used. The three-dose vaccine series is recommended for females aged 26 and under, but only about 10% of 18- to 26-year-olds surveyed reported having had at least one dose of the vaccine.
  • Only 44% of adults over 65 reported receiving a tetanus shot during the previous decade.

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Elderly, Babies Most Vulnerable

Michael N. Oxman, MD, of the San Diego VA Medical Center, said the newly available herpes zoster vaccine has the potential to prevent 280,000 shingles cases annually and 47,000 cases of an excruciatingly painful nerve complication known as postherpetic neuralgia.

One million new cases of shingles are diagnosed in the U.S. each year, and more than half occur in people aged 60 and older.

Shingles is caused by reactivation of the same virus that causes chickenpox, so anyone who has had chickenpox is at risk. Estimates suggest that more than half of people who reach age 85 develop shingles.

"Nearly everyone who gets shingles has pain (caused by nerve damage), and that pain can be severe," Oxman says. "Many people describe shingles pain as the worst pain they've ever endured."

Immunization against whooping cough, or pertussis, is routine in childhood, but adults need to be vaccinated too because immunity disappears over time.

While whooping cough can be serious and even deadly in adults, it is babies too young to be vaccinated who are most at risk, says Mark S. Dworkin, MD, of the University of Illinois at Chicago School of Public Health.

"This disease is a baby killer," he said. "If we can immunize adolescents and adults, we can markedly impact the risk to infants. ... In the United States, we do see deaths in infants, even in this immunization era."

'Deaths Are Preventable'

In addition to shingles, whooping cough, influenza, and pneumococcal disease, vaccination is recommended in the U.S. for adults at various ages to protect against diphtheria, hepatitis A, hepatitis B, HPV (cervical cancer), measles, meningococcal disease, mumps, rubella, and tetanus. Immunization for measles, mumps, and rubella is given as a combination vaccine, as is tetanus, diphtheria, and pertussis (whooping cough).

"Combined, these infectious diseases kill more Americans annually than either breast cancer, HIV/AIDS, or traffic accidents," NFID Vice President and Vanderbilt University infectious disease specialist William Schaffner, MD, said in a news release.

"A concerted effort is needed to raise adult immunization rates," he said. "The important thing to remember is that deaths and illness associated with these infections are largely avoidable through vaccination."

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Ob-gyn professor Stanley Gall, MD, said as many as 72% of the nearly 10,000 cervical cancer cases diagnosed each year in the United States could be prevented if all eligible females got the vaccine before being infected with HPV.

The survey suggested that only about one in 10 eligible adult women get vaccinated.

"That is a start, but we really do need to do better," Gall said.

WebMD Health News Reviewed by Louise Chang, MD on January 23, 2008

Sources

SOURCES:

CDC and National Foundation for Infectious Diseases news conference, Jan. 23, 2008.

Anne Schuchat, MD, assistant surgeon general, United States Public Health Service, director, National Center for Immunization and Respiratory Diseases, CDC.

Michael N. Oxman, MD, professor, University of California, San Francisco; staff physician, Infectious Disease Section, VA Medical Center, San Diego.

Kristin Nichol, MD, MPH, chief of medicine, Minneapolis VA Medical Center; professor of medicine and vice chair, department of medicine, University of Minnesota.

MMWR Recommended Adult Immunization Schedule: U.S. October 2007-September 2008.

Stanley A. Gall, MD, professor of ob-gyn, University of Louisville, Louisville, Ky.

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