Immunization coverage of teenagers and adults in 2004 fell short of the coverage achieved in children, the Centers for Disease Control and Prevention reported at a press briefing.
Data from the 2004 National Immunization Survey show that 80.9% of children aged 19–35 months received the recommended vaccinations (diphtheria and tetanus toxoids with acellular pertussis, polio, measles, Haemophilus influenzae type b, and hepatitis B), said Stephen Cochi, M.D., acting director of CDC's National Immunization Program. The 80.9% rate in 2004 surpassed the Healthy People 2010 goal of 80% for that age group.
David A. Neumann, Ph.D., executive director of the National Partnership for Immunization, said efforts to immunize adolescents are bearing fruit, but there's a lot of work to be done.
About 25% of U.S. adolescents have not received at least one of the vaccines recommended for them (hepatitis B, MMR, varicella, meningococcal, or the combination DTP vaccine). “Also, in recent years, we've seen an upsurge of pertussis among adolescents. We find that pertussis immunity wanes during adolescence, and [so] this year we have two new licensed vaccines that will add a pertussis booster for use by adolescents and adults,” Dr. Neumann said.
The status of adult immunization in the United States is less encouraging, he said. “Despite the availability, value, and effectiveness of vaccines we have for adults, the statistics that we have are very disappointing. We are not meeting the nation's public health targets for protecting adults against vaccine-preventable diseases. For example, at best, we immunize barely 70% of adults 65 years and older against influenza each year.”
Only about 48% of African-American seniors and 58% of Hispanic seniors get flu shots, while the Healthy People 2010 target is to have 90% of seniors immunized each year against influenza. Of high-risk adults, only about 37% of those aged 50–64 years and 24% of those aged 18–49 get immunized. The 2010 target for this group is 60% coverage. Finally, on an annualized basis, about 40% of health care workers are immunized against influenza.
“The bottom line seems to be that we lack an appropriate infrastructure to support adult immunization,” Dr. Neumann said at the briefing.
“So how can we create an infrastructure?” he asked. “We and others in the public health community can look for increased support for the public purchase and distribution of influenza vaccine for underinsured and uninsured adults. We can look for leadership from the federal government to [ensure] that influenza and pneumococcal vaccines are part of the first dollar benefits under the federal employee health benefit program. We can work for the inclusion of beneficiary and health care worker immunization as measurable quality indicators for the Centers for Medicare and Medicaid Services. We also can encourage the CMS to pursue the inclusion of health care worker immunization as a criterion for accreditation of health care facilities throughout the nation.”
Otherwise, he envisions a beefed-up adult immunization infrastructure as being a copy of that used for children. “We would see health care providers being proactive and providing immunization services to their patients just as pediatricians now do for children. Currently in the United States, public money purchases vaccines for about half of children. … There's little that can come close in terms of adult immunization.”
Adult education also is neglected, according to Dr. Neumann. “One of my favorite ways of expressing that is that many of us in the baby boom generation think that we're immortal, and we do well for 20 or 30 years and, boom! We end up with chest pains, and we go see a cardiologist. Well, the cardiologist will take care of your cardiac issues, but the cardiologist isn't even thinking about influenza or pneumococcal immunization, even if you're in a high-risk group. So there's a lot of provider education that we need to do as well, through CME and other programs.”