Far too few U.S. adults are getting recommended vaccines

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Although small improvements were seen for Tdap and HPV vaccine coverage from 2010 to 2011, the number of U.S. adults getting recommended vaccines remains well below optimal levels.

Although modest improvements were seen for tetanus–diphtheria–acellular pertussis (Tdap) and human papillomavirus (HPV) vaccine coverage from 2010 to 2011, the number of U.S. adults getting recommended vaccines remains far too low, reported Carolyn Bridges, MD, Associate Director for Adult Immunizations, CDC, during a telebriefing yesterday.

In addition, the 2013 immunization recommendations of the Advisory Committee on Immunization Practices (ACIP) were published in Morbidity and Mortality Weekly Report on January 28.

During yesterday's telebriefing, Bridges described some of the key findings from the 2011 National Health Interview Survey (NHIS).

Pneumococcal vaccines

Bridges noted that the 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccine has been recommended for many years for adults, while the 13-valent pneumococcal conjugate vaccine (PCV13) was recommended last year for adults with weakened immune systems and specific patient groups. The data she reported were for PPSV23 vaccine uptake.

  • PPSV23 vaccine is recommended for all individuals 65 years or older and adults 19 to 64 years of age with certain conditions (e.g., heart disease, asthma, diabetes) to prevent severe illness caused by bacteria called Streptococcus pneumoniae or pneumococcus.
  • For adults 65 years or older, PPSV23 vaccine coverage was slightly more than 62% in 2011—about a 3–percentage point increase compared with 2010.
  • Regarding PPSV23 coverage by race/ethnicity for those 65 years or older, 67% of whites, 48% of blacks, 43% of Hispanics, and 40% of Asians received the vaccine.
  • Among high-risk adults aged 19 to 64 years, PPSV23 coverage was only 20% overall, which was about a 2–percentage point increase versus 2010. In this high-risk group, vaccine coverage was 23% among blacks, 20% among whites, 18% among Hispanics, and 12% among Asians.

Tdap vaccine

Pertussis (i.e., whooping cough) outbreaks occurred frequently during the previous year. Bridges noted the importance of all adults getting the Tdap vaccine, not only to protect themselves but also to help prevent the spread of pertussis to infants.

She also pointed out that expectant mothers should get the Tdap vaccination during every pregnancy. Pregnant women, Bridges said, "can safely get the vaccine at any time during pregnancy, but the vaccination is particularly recommended in the third trimester and this will allow the mother to pass the most amount of protection on to the baby."

  • Slightly less than 13% of 19- to 64-year-old adults reported getting the Tdap vaccine, which was about 4 percentage points greater than in 2010.
  • Among those aged 19 to 64 years who were living with an infant younger than 1 year of age, about 22% received the Tdap vaccine—an increase of about 11 percentage points.
  • The percentage of health care workers getting the Tdap vaccine jumped 6.5 percentage points to nearly 27%. "These coverage levels, even with the observed gains, remain well below where we would like to see them," stated Bridges.

HPV vaccine

The HPV vaccine protects against strains of HPV that are responsible for approximately 70% of cervical cancers. The CDC recommendation for adult women who are not already vaccinated is three doses of HPV vaccine by 26 years of age.

Bridges said that the best time for women to get the HPV vaccine is during adolescence.

"We continue to see gains in the number of women 19–26 who have received one or more doses of HPV vaccine either as an adult or as an adolescent," said Bridges. "During 2011, the percentage was nearly 30% and increased from almost 21% in 2010, and a further increase from 17% HPV coverage in 2009. That's very good news."

  • Bridges also noted the low (20%) HPV vaccine coverage in Hispanic women.
  • In late 2011, the Advisory Committee on Immunization Practices (ACIP) recommended that males up to 21 years of age receive the HPV vaccine. The 2011 NHIS, therefore, does not reflect any changes in vaccine uptake as a result of the recommendation, but data showed HPV vaccination coverage of slightly less than 3% among men 19 to 21 years of age.

Hepatitis A and hepatitis B vaccines

  • From 2010 to 2011, coverage for the hepatitis A and hepatitis B vaccines remained relatively unchanged.
  • In 2011, 13% of adults received the hepatitis A vaccine and 36% received the hepatitis B vaccine.
  • Of adults aged 19 to 59 years with diabetes, 27% reported getting at least three doses of hepatitis B vaccine in 2011.
  • According to race/ethnic group, 38% of whites, 33% of blacks, and 29% of Hispanics reported receiving the hepatitis B vaccine.

Zoster vaccine

  • In 2011, a little less than 16% of adults 60 years or older reported getting the zoster (i.e., shingles) vaccine. Bridges noted that 50% of people who live to age 85 will develop shingles.
  • By race/ethnic group, whites had about 18% zoster vaccine coverage while Asians were at 14%, Hispanics at 8%, and blacks at nearly 8%.

Summary

Bridges summarized the findings as follows: "While we are pleased to see any increase in adults getting their recommended vaccines, these numbers remain low overall. We have made little progress, and improving adult coverage from 2010 to 2011 and racial and ethnic disparities in coverage remains. These data highlight the need for continuing effort to increase the number of adults to get their recommended vaccines. People sometimes like to wait to get vaccines until they hear about outbreaks like pertussis or flu in their state or community. I want to stress it is important to be vaccinated before disease arrives to get the most benefit out of these vaccines. Vaccines like pertussis and flu cannot only protect the person vaccinated from disease, but can also help protect family members and friends around the person vaccinated. As adult vaccines are becoming increasingly easier to access with vaccines offered at doctor offices, health departments, pharmacies, and other venues such as workplaces. I urge all adults to talk to their health provider about which vaccinations they need."

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