Gaps in vaccines for adult Americans need to be addressed

Immunization Update

What will it take to get adult Americans fully immunized? What roles should pharmacists play in that effort? Those are central questions for the profession as the public health community considers the less-than-optimal data released last month by CDC. In the February 6 Morbidity and Mortality Weekly Report (MMWR), the 2012 National Health Interview Survey results showed that adult vaccination coverage remains low and far below Healthy People 2020 targets. Two weeks later, CDC reported that younger and middle-aged Americans had been particularly hard hit by this season’s influenza strains, with increased levels of hospitalizations and deaths. The good news was that this influenza vaccine had worked—immunized individuals had a 61% reduced risk of any influenza infection.

Noninfluenza immunizations

As shown in Figure 1 (below), vaccine coverage for adult Americans changed little from 2011 to 2012. Even though more than one-half of the nation’s community pharmacies are offering pneumococcal, zoster, and tetanus vaccines (see article on page 65 of the Special Immunization Section), Americans in target age groups have suboptimal coverage. Even the high figure for tetanus vaccine is misleading, since fewer than 1 in 7 adults had received a formulation that combats the problematic Bordetella pertussis bacterium.

Compared with 2011 estimates, coverage for most vaccines and risk groups did not improve, and racial and ethnic disparities persisted for routinely recommended adult vaccines. Wider use of practices shown to improve adult vaccination is needed, CDC said.

Influenza immunizations in 2013–14

In two reports in the February 20 MMWR, CDC wrote that a higher prevalence of H1N1 influenza virus during the current season caused more morbidity and mortality among younger Americans than in older individuals. This is similar to what happened during the 2009–10 pandemic, which was also caused by H1N1 strains. Of the hospitalizations reported to CDC this season, 61% have been in people 18 to 64 years old. This is in contrast to the usual situation, CDC said, in which 50% to 60% of hospitalizations for influenza occur in people aged 65 years or older. Additionally, CDC said that this season, people 25 to 64 years of age have accounted for about 60% of deaths from influenza, compared with 18%, 30%, and 47% for the three previous seasons, respectively. During 2009–10, people in this age group accounted for an estimated 63% of deaths.

Younger adults—especially those who are otherwise healthy—are less likely to get vaccinated, CDC added. That is particularly unfortunate this season, since vaccine effectiveness was high, but only 34% of people aged 18 to 64 had received the influenza vaccine by early November 2013, according to available estimates.

“Despite a decrease in several key indicators, influenza activity remains elevated overall nationally and is expected to continue for several weeks in certain parts of the country,” CDC said. “Annual influenza vaccination efforts should continue for as long as influenza viruses are circulating.”

Pharmacists can lead

Ideas for overcoming barriers to adult vaccination are presented in a second article in this issue’s Special Immunization Section. See page 66 for information on making sure pharmacy is a central player in the immunization neighborhood, and review the latest recommendations for adult vaccines on pages 63–64.


MMWR website
Healthy People 2020 immunization objectives
APhA’s Immunization Center