Immunization Issues

Adult Immunizations

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Updated: January 08, 2008

Each year in the United States, up to 60,000 adults die from vaccine-preventable diseases or their complications. These diseases include influenza, pneumococcal disease, and tetanus among others.

For example, pneumonia and influenza together are the seventh leading cause of death in the US, and the fifth leading cause of death among older adults. Also, most deaths due to tetanus that occur each year in the US (usually less than 50 deaths annually) are in those 60 years of age or older— who have either never been vaccinated, or who completed their primary series but have not had a booster vaccination in the past 10 years. (1)

Vaccine-preventable diseases that are sometimes mild in children can be serious diseases in adults. For instance, serious complications of mumps are more common among adults than among children. Similarly, adolescents and adults are more likely than children to develop severe complications or die when infected with the chickenpox virus. (1)

Another vaccine-preventable disease with potentially serious complications in adulthood is rubella. If rubella occurs during pregnancy, it can result in severe birth defects, miscarriages and stillbirths.

Although vaccines received as children may provide some protection in adulthood, there are several reasons for immunizing the adult population:

• Some adults were never immunized as children 
• Newer vaccines were not available when some adults were children 
• Immunity from some vaccines can begin to fade over time 
• As people age, they become more susceptible to serious disease caused by common infections such as influenza and pneumococcus. (2)

The CDC recommends various vaccines for adults, depending on their age, medical condition, and potential risk for a particular disease. (3) There are different recommendations for vaccines given during pregnancy. Vaccines recommended for adults include: (2)

• Tetanus-Diphtheria (Td) vaccine—is recommended for all adults, every 10 years. 
  
  Two new Td vaccines-containing acellular pertussis vaccine (Tdap)-were licensed by the Food and Drug Administration for use in adolescents and adults. Recommendations for the use of these newly licensed vaccines have recently been published: A single dose of Tdap is recommended once instead of a dose of Td.
  • 11-18 year olds should receive a single dose of Tdap instead of a Td booster if they have completed the recommended childhood DTP/DTaP immunization series and have not received a Td or Tdap booster. The preferred age for Tdap vaccination is 11-12 years. If they have already received a Td booster, it is recommended that there be an interval of at least 5 years before Tdap is administered to reduce the likelihood of local and systemic reactions. Detailed recommendations for the use of Tdap are available for the CDC. (4) 
  • Adults 19-64 years of age should receive a single dose of Tdap (ADACEL) to replace a single dose of Td for booster immunization if their most recent tetanus toxoid-containing vaccine was 10 or more years earlier. Detailed recommendations for the use of Tdap are available for the CDC. (4)
    
• Measles-Mumps-Rubella (MMR) vaccine—for susceptible adults (that means people who never got the disease nor the vaccine). 
• Meningococcal Conjugate Vaccine (MCV4)—is recommended for children 11 - 12 years of age and (for the next 3 years, in order to more rapidly reduce disease among older teenagers) MCV4 is also recommended at high school entry (15 years old). Others at increased risk for meningococcal disease should also receive a dose of meningococcal vaccine.
• Influenza vaccine— Trivalent inactivated influenza vaccine is needed annually by those with underlying medical conditions, those who are 50 years of age and older, pregnant women, and all health-care personnel. Persons without underlying medical conditions aged 6-49 years could receive the live attenuated influenza vaccine as a nasal spray as an alternative. 
• Pneumococcal vaccine—for people 65 years of age and older. 
• Varicella (chickenpox) vaccine—all persons 13 years of age and older without evidence of immunity should be immunized with 2 doses of varicella vaccine 4-8 weeks apart.  
• Hepatitis A vaccine—States, counties, and communities with existing hepatitis A immunizations programs for persons 2-18 years of age should maintain those programs. Adults at risk of exposure should receive the vaccine. (4)
• Hepatitis B vaccines—for unvaccinated adolescents and all adults at risk of exposure. 
• Vaccines for travelers such as yellow fever, meningococcal and typhoid vaccines.

While childhood immunization coverage rates are above 90% in the US, adolescent and adult immunization rates are under 70%. This is because in the US a financing system and an infrastructure exists for childhood immunizations—such as the Vaccines for Children Act, which provides vaccines for underinsured children. Furthermore, most states enforce vaccination requirements for school entry. Such infrastructure is not in place for adult immunizations. (5)

Many health officials in the US have suggested several strategies to raise immunization rates for adolescents and adults. These strategies include:

• Institute state immunization requirements for middle school entry. 
• Use reminder and recall interventions, in which providers send reminders to patients when vaccinations are due and recall notices when they are overdue. 
• Increase patient education about vaccines. 
• Reduce out-of-pocket costs for adult immunization. 
• Expand access to vaccinations in healthcare settings, such as healthcare facilities having special flu shot clinics and drop-in times. 
• Provide federal support for state vaccine purchase and delivery infrastructure for uninsured and high-risk adults under age 65. (5)

So far various organizations such as the National Coalition for Adult Immunization and CDC’s National Immunization Program have implemented some of these strategies to improve immunization coverage among adolescents and adults. (5)

References

1. National Coalition for Adult Immunization (2004). Facts about Adult Immunization. 

2. CDC, National Immunization Program (2004). Adult Immunization Schedule. 

3. ACIP (2003). Recommended Adult Immunization Schedule by Age Group and Medical Conditions, United States, 2003–2004. 

4. CDC (2005). ACIP Provisional recommendations.

5. National Foundation for Infectious Diseases and the National Coalition for Adult Immunization (2002). A Report on Reaching Underserved Ethnic and Minority Populations to Improve Adolescent and Adult Immunization Rates.