Adult Vaccination Rates Are Rising but Fall Short

Healthy People 2020 Goals Prove Elusive, but Pharmacists Can Advocate, Educate, Identify, and Immunize.

The CDC has declared that vaccinations are one of the top 10 public health achievements of the 20th century.^1-3

The incidence, morbidity, mortality, and prevalence of vaccine-preventable diseases have considerably diminished since vaccinations became available. Yet despite the effectiveness and safety of vaccines, an estimated 40,000 to 50,000 US adults die from vaccine-preventable diseases every year.^4,5 Vaccines are considered a cost-effective, efficient, and safe means of preventing death, disability, and illness from certain infectious diseases.^6,7

In the adult patient population, modest gains in vaccination rates were observed in 2015 for the hepatitis B; herpes zoster; influenza; pneumococcal; and tetanus, diphtheria, and pertussis (Tdap) vaccines compared with rates in 2014, according to most recent data from the National Health Interview Survey (NHIS).^8,9

However, vaccination rates among adults are still suboptimal, with many well below the federal government’s Healthy People 2020 goals.^8,9 Based on a published comparison of vaccination rates with those goals, only the herpes zoster vaccination rate of 30.6% in individuals 60 years or older has exceeded the target goal of 30.0%.^8,9 All other vaccination rates fell far below the goals. For example, less than 45% of adults received the annual influenza vaccine, yet the Healthy People 2020 goal was 70%.^8,9 Influenza vaccination rates for health care providers were also less than the recommended goal of 90.0%, at 68.6% overall.^8,9

The Advisory Committee on Immunization Practices (ACIP) recommends a single dose of zoster vaccine for all adults 60 years and older, regardless of whether they report a prior episode of herpes zoster.^8,9 Herpes zoster vaccination coverage in 2015 met the Healthy People 2020 target of 30%.^8-10 The recent NHIS data also showed that there are ethnic and racial variances in vaccinations rates, with Caucasian individuals typically having higher ones.^8,9 Moreover, results from the NHIS report showed that overall rates of vaccination are typically lower in adults without health insurance and greater in those with private versus public insurance.^8,9 The data showed that adults who obtain routine health care are more likely to receive the recommended vaccinations.^8,9

Pharmacists are well positioned to improve vaccination rates and can act as advocates, educators, identifiers, and immunizers. The CDC encourages all health care providers to educate patients about vaccine-preventable diseases and strongly recommend vaccines, as data have shown that provider recommendation is one of the strongest drivers of vaccination.^9,10

Vaccine-Preventable Diseases

However, efforts to promote effective vaccination are under way. Vaccine-preventable diseases kill more Americans each year than breast cancer, HIV/AIDS, and traffic accidents, according to the National Foundation of Infectious Diseases.¹¹ The ACIP annually reviews and continually updates recommended immunizations, vaccination standards, and vaccine schedules in the United States. The 2019 National Adult and Influenza Immunization Summit is scheduled for May 14 to 16, 2019. In February 2018, the CDC released its Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2018, became effective, as recommended by the ACIP. The new vaccination recommendations are primarily based on factors such as age, health status, immunization history, lifestyle, occupation, and whether an individual is immunocompromised or planning to travel.^1,12 When no contraindications are present, the ACIP recommends that all adults obtain the influenza vaccine annually and get the Tdap vaccine booster every 10 years.^12,13 The ACIP also recommends that in addition to those vaccines, individuals 65 years and older get the pneumococcal and zoster vaccines.^12,13 The most current ACIP recommendations and the schedule for adult immunizations are available at cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf. Some vaccines may be recommended for adults because of particular job- or school-related requirements, health conditions, lifestyle, and other factors.^13,14 A complete list of all vaccine-preventable diseases is available at cdc.gov/vaccines/vpd-vac/vpd-list.htm. In addition, those traveling to certain countries may need specific vaccinations prior to their visit. For information regarding travel vaccinations, go to the CDC’s website., see

Vaccines in the News

In October 2018, the FDA expanded the approval of Gardasil 9, the human papillomavirus vaccine, to include adults aged 27 to 45 years.¹⁵ Meanwhile, results from a new study confirm that the flu vaccine reduces the risk of influenza-related hospitalization among pregnant women.¹⁶

The Pharmacist’s Role

Although vaccination is still a patient’s choice, as one of the most accessible health care professionals, pharmacists can be instrumental in providing patients with pertinent information to help them make informed choices regarding immunizations, discussing their benefits as well as their risks. Pharmacists are also in a unique position to identify those patients who are in target groups for certain vaccinations. They may also be able to ease the fears of many patients by providing them with facts such as clinical data and by dispelling common misconceptions and myths about vaccinations; they can also stress the significant risks associated with not being vaccinated. In addition, pharmacists can share resources to educate patients (see Table).

Yvette C. Terrie, BSPharm, RPh, is a consulting pharmacist and a medical writer in Haymarket, Virginia.

References

• Oldfield BJ, Stewart RW. Common misconceptions, advancements, and updates in pediatric vaccine administration. South Med J. 2016;109(1):38-41. doi: 10.14423/SMJ.0000000000000399.
• Ventola CL. Immunization in the United States: recommendations, barriers, and measures to improve compliance: part 2: adult vaccinations. P T. 2016;41(8):492-506.
• Temoka E. Becoming a vaccine champion: evidence-based interventions to address the challenges of vaccination. S D Med. 2013;(theme issue): 68-72.
• Bach AT, Goad JA. The role of community pharmacy-based vaccination in the USA: current practice and future directions. Integr Pharm Res Pract. 2015;4:67-77. doi: 10.2147/IPRP.S63822.
• Poland GA, Schaffner W, Hopkins RH Jr, US Department of Health & Human Services. Immunization guidelines in the United States: new vaccines and new recommendations for children, adolescents, and adults. Vaccine. 2013;31(42):4689-4693. doi: 10.1016/j.vaccine.2013.03.031.
• Esposito S, Durando P, Bosis S, Ansaldi F, Tagliabue C, Icardi G; ESCMID Vaccine Study Group (EVASG). Vaccine-preventable diseases: from paediatric to adult targets. Eur J Intern Med. 2014;25(3):203-212. doi: 10.1016/j.ejim.2013.12.004.
• Rémy V, Zöllner Y, Heckmann U. Vaccination: the cornerstone of an efficient healthcare system. J Mark Access Health Policy. 2015;3(1). doi: 10.3402/jmahp.v3.27041.
• Williams WW, Lu PJ, O’Halloran A, et al. Surveillance of vaccination coverage among adult populations — United States, 2015. MMWR Surveill Summ. 2017;66(11):1-28. doi: 10.15585/mmwr.ss6611a1.
• Tanzi MG. Adult vaccination rates show modest, but far from optimal gains. Pharm Today. 2017;23(8):43. pharmacytoday.org/article/S1042-0991(17)31108-8/fulltext?rss=yes. Accessed October 17, 2018.
• Surveillance of vaccination coverage among adult populations. American Pharmacists Association website. pharmacist.com/article/surveillance-vaccination-coverage-among-adult-populations. Published May 8, 2017. Accessed October 18, 2018.
• Top reasons to get vaccinated. National Foundation for Infectious Diseases website. nfid.org/about-vaccines/reasons. Accessed October 17, 2018.
• Adult vaccination resources. CDC website. cdc.gov/vaccines/hcp/adults/index.html. Updated June 7, 2018. Accessed October 18, 2018.
• Immunization schedules. CDC website. cdc.gov/vaccines/schedules/hcp/imz/adult.html. Updated March 5, 2018. Accessed October 18, 2018.
• Vaccines and preventable diseases. CDC website. cdc.gov/vaccines/vpd/vaccines-age.html. Updated May 1, 2018. Accessed October 17, 2018.
• Ingram I. FDA OKs HPV vaccine for adults up to age 45. MedPage Today. October 7, 2018. medpagetoday.com/obgyn/cervicalcancer/75551. Accessed October 17, 2018.
• Flu vaccine reduces risk of flu hospitalization among pregnant women [news release]. Atlanta, GA: CDC; October 11, 2018. cdc.gov/media/releases/2018/p1011-flu-vaccine-reduces-risk-pregnant-women.html. Accessed October 17, 2018.