While driving home one day, I heard the radio announcer ask a trivia question: What is the total number of vaccines recommended for adults?* As I recited them to myself, I wondered who else would know—the general public? Health-care providers? Community immunizers? Health-care policy makers?
But there is a much more important question: Are we providing those vaccines to our patients? Unfortunately, the answer is no. Case in point: As reiterated at the CDC/AMA National Influenza Vaccine Summit in Atlanta in May, manufacturers made available 140 million doses of influenza vaccine during the 2007-2008 influenza season, yet 27 million doses went unused.
The recently expanded recommendation from the CDC’s Advisory Committee on Immunization Practices (ACIP) raises the number of individuals eligible for annual influenza vaccine to 250 million, with approximately 73% of the U. S. population included in one or more of these target groups. However, fewer than half of these individuals seek annual flu shots, and influenza and its complications claim the lives of about 36,000 Americans per year on average—most of them older than 65 (MMWR. 2007; 56[RR-6]:1-54).
A recent measles resurgence illustrates the need for making sure adults are properly immunized. Ongoing measles transmission was declared eliminated in the United States in 2000, yet in the first four months of this year, 64 cases had been reported across several states (MMWR. 2008;57:494-498). All but one of the patients were unvaccinated or had unknown or undocumented vaccination status. About a third of the group ranged in age from 20 to 71 years, and 14 were younger than 12 months old.
Most of the cases (54) were tied to measles infections that came in from other countries. This highlights the ongoing risk of measles in the unvaccinated; the risk of the unvaccinated transmitting measles to other unvaccinated persons, including infants too young to be immunized; and the importance of maintaining high vaccination rates overall.
Every clinical encounter represents an opportunity to ensure that patients are up to date with their immunizations. And improving our patients’ knowledge on this front is a critical mission: In January 2008, the National Foundation for Infectious Diseases released the results of a survey on adult vaccination that revealed a low awareness of vaccine-preventable diseases. More alarming, 49% of those surveyed were not concerned with contracting such a disease, even though these illnesses cause the death of approximately 50,000 U.S. adults each year.
On the other hand, 87% of those surveyed said that they would probably get a vaccine if it were recommended by their health-care provider.
Vaccines are among the greatest public-health achievements of the 20th century. They empower us to prevent disability and reduce morbidity and mortality from infectious diseases. Standing orders, immunization registries, and reminder systems are available to support health-care providers in their efforts to improve adult immunization rates. It is the duty of primary-care clinicians to use these systems to raise each patient’s awareness of vaccines old and new. This, in turn, will enhance the health of all individuals.
*Answer: There are 10 recommended vaccines for adults: influenza, pneumococcal, hepatitis A, hepatitis B, MMR, varicella, Tdap, HPV, meningococcal, zoster. The full adult immunization schedule is available at the CDC Web site.