Adult Immunization: Shots to Save Lives

More than 30 Percent of Seniors Are Not Immunized Against Pneumonia in 36 States; New Report Finds Low Adult Vaccination Rates in U.S.

A February 2010 report, Adult Immunization: Shots to Save Lives, released by the Trust for America’s Health (TFAH), the Infectious Diseases Society of America (IDSA), and the Robert Wood Johnson Foundation (RWJF) found that more than 30 percent of adults ages 65 and older had not been immunized against pneumonia in 36 states as of 2008.  The U.S. Centers for Disease Control and Prevention (CDC) and other experts recommend that all seniors should be vaccinated against pneumonia, which is a one-time shot for most individuals, since seniors who get the seasonal flu are at risk for developing pneumonia as a complication.

Nationally, 33.1 percent of seniors had not been immunized against pneumonia, and even in the state with the highest immunization rate – Oregon – more than one quarter (26.8 percent) of seniors were not immunized.  Washington, D.C. had the lowest number of seniors immunized, with nearly half (45.6 percent) of seniors not immunized.

Overall, the Adult Immunization report found millions of American adults go without routine and recommended vaccinations each year, which leads to an estimated 40,000 to 50,000 preventable deaths, thousands of preventable illnesses, and $10 billion in preventable health care costs each year.  In addition to low rates of pneumonia immunizations, only 2.1 percent of eligible adults have had the tetanus, diphtheria, and whooping cough vaccine in the previous two years; only 10 percent of eligible adult women have had the human papillomavirus (HPV) vaccine; and only 36.1 percent of all adults were vaccinated against the seasonal flu in 2008.

The report outlines a number of policy recommendations to increase rates of adult vaccinations.  Some top recommendations include:

• Close coverage gaps: Providers should be required to offer full coverage for all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP); Medicare should fully cover all recommended vaccinations under Part B; and a Vaccines for Uninsured Adults (VFUA) Program should be created to cover all adults who are uninsured.
• Consider post-health reform scenarios: As any vaccine-related provisions are being phased in, steps should also be taken to expand support of existing adult vaccine programs during the interim time before these proposals are in full effect, and a Vaccines for Uninsured Adults (VFUA) Program would still need to be created to cover adults who will remain uninsured after reform.
• Increase public education: CDC and local and state health departments should receive increased resources to create and manage broad public education campaigns targeted at improving adult immunization rates, including communicating about the effectiveness and safety of vaccines.
• Increase provider and patient information: Standard practices should be developed to review patients’ immunization histories and vaccinations should be offered at appropriate medical encounters, such as during physicals, cancer screenings, and pre-natal visits. Health providers should also play an increased role in reducing transmission of disease and set an example by complying with the recommended vaccines to protect themselves, their staffs, and their patients.
• Increase research, development, and production: The National Institutes of Health (NIH), CDC, and the U.S. Food and Drug Administration (FDA) should receive increased resources for vaccine research and development, including safety surveillance and research, and incentives should be provided for development and research in the United States to assure supplies of vaccines, especially during times of crisis.

Percent of Seniors NOT Vaccinated Against Pneumonia by State

Rates listed are the number of adults aged 65 and older who have not been vaccinated against pneumonia.  1= Lowest vaccination rate; 51 = Highest vaccination rate.  Rankings are based on combining three years of data (2006-2008) from the U.S. Centers for Disease Control and Prevention‘s Behavioral Risk Factor Surveillance System to “stabilize” data for comparison purposes.  The pneumococcal vaccine is a one-time shot.

1. District of Columbia (45.6%); 2. Illinois (40.4%); California (39.0%); 4. Florida (37.6%); 5. New York (36.7%); 6. New Jersey (36.5%); 7. Texas (36.3%); 8. (tie) Alabama (36.0%), Alaska (36.0%), Georgia (36.0%), and South Carolina (36.0%); 12. Arkansas (35.8%); 13. New Mexico (35.4%); 14. (tie) Idaho (35.3%) and South Dakota (35.3%); 16. Kentucky (34.8%); 17. Tennessee (34.6%); 18. Michigan (34.2%); 19. (tie) Maryland (33.9%) and Nevada (33.9%); 21. Louisiana (33.7%); 22. Connecticut (33.4%); 23. Mississippi (33.2%); 24. (tie) Indiana (33.1%) and West Virginia (33.1%); 26. Missouri (32.7%); 27. Hawaii (32.1%); 28. Utah (32.0%); 29. Virginia (31.9%); 30. Arizona (31.8%); 31. Ohio (31.6%); 32. Kansas (31.5%); 33. North Carolina (31.2%); 34. Vermont (31.0%); 35. North Dakota (30.6%); 36. Massachusetts (30.4%); 37. Pennsylvania (30.3%); 38. (tie) Delaware (30.0%) and Washington (30.0%); 40. Iowa (29.9%); 41. Nebraska (29.8%); 42. Wyoming (29.7%); 43. (tie) Maine (29.5%) and Wisconsin (29.5%); 45. Minnesota (29.2%); 46. Oklahoma (28.9%); 47. (tie) Montana (28.8%) and New Hampshire (28.8%); 49. Rhode Island (28.2%); 50. Colorado (27.4%) and 51. Oregon (26.8%).