While the focus in recent months has been on how vaccine hesitancy affects uptake of the COVID-19 vaccine, the reality is that adult-vaccination rates in the United States are low across the board and have been for years, according to a new report.
An article in the Morbidity & Mortality Weekly Report notes that adults are at risk for illness, hospitalization, disability, and even death from vaccine-preventable diseases, and vaccinations are recommended by public-health officials for adults, based on age, health conditions, prior vaccinations, and other considerations.
For this review, CDC researchers focused on the period of August 2017 to June 2018 for influenza vaccination and January 2018 to December 2018 for pneumococcal, herpes zoster, tetanus, and diphtheria [Td]/tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis [Tdap], hepatitis A, hepatitis B, and human papillomavirus [HPV] vaccination.
“Coverage for the adult age-appropriate composite measure was low in all age groups,” the authors explained. “Racial and ethnic differences in coverage persisted for all vaccinations, with lower coverage for most vaccinations among non-White compared with non-Hispanic White adults.”
The good news, they write, is that coverage appears to have increased from 2010 to 2018 for most vaccines in the report. Yet, according to the authors, “few adults 19 or older had received all age-appropriate vaccines, including influenza vaccination, regardless of whether inclusion of Tdap (13.5%) or inclusion of any tetanus toxoid-containing vaccine (20.2%) receipt was measured.”
The report notes that coverage among adults for influenza vaccination during the 2017-2018 season, 46.1%, was in line with the estimate for the 2016-2017 season (45.4%). Coverage for other vaccines also was similar to 2017 estimates, including:
• Pneumococcal (adults aged ≥65 years [69.0%])
• Herpes zoster (adults aged ≥50 years and aged ≥60 years [24.1% and 34.5%, respectively])
• Tetanus (adults aged ≥19 years [62.9%])
• Tdap (adults aged ≥19 years [31.2%])
• Hepatitis A (adults aged ≥19 years [11.9%])
• HPV (females aged 19-26 years [52.8%]).
Some vaccines had increased coverage between 2017 and 2018, including Hepatitis B for adults aged 19 years and older and healthcare personnel and HPV for males aged 19 to 26 years, which increased 5.2% to 26.3%.
In terms of HPV vaccination, the authors note that while HPV vaccination coverage among females aged 19 to 26 years did not increase overall, rates among Hispanic females, aged 19 to 26 years, increased 10.8% to 49.6%.
Health insurance coverage appeared to make a difference in who received vaccines, the report points out. Adults without health insurance were less likely to receive influenza, pneumococcal, Td, Tdap, hepatitis A, hepatitis B, herpes zoster, or HPV vaccines.
On the other hand, researchers advise, “Adults who reported having a usual place for health care generally reported receipt of recommended vaccinations more often than those who did not have such a place, regardless of whether they had health insurance.”
In addition, vaccination coverage was found to be higher among adults reporting one or more physician contacts during the preceding year compared with those who did not have that, whether or not they had health insurance.
But frequent medical visits were no guarantee of getting vaccinated, however. “Even among adults who had health insurance and ≥10 physician contacts during the preceding year, depending on the vaccine, 20.1%-87.5% reported not having received vaccinations that were recommended either for all persons or those with specific indications,” the authors write.
Another factor affecting immunization was whether adults were born in the U.S. or not; those who were had significantly higher rates of flu, pneumococcal, tetanus, Tdap, hepatitis B, herpes zoster, and HPV vaccination than those who were not. Citizenship status and years living in the U.S. also appeared to have an influence.
“Substantial improvement in adult vaccination uptake is needed to reduce the burden of vaccine-preventable diseases,” the researchers conclude. “Following the Standards for Adult Immunization Practice (www.cdc.gov/vaccines/hcp/adults/for-practice/standards/index.html), all providers should routinely assess adults’ vaccination status at every clinical encounter, strongly recommend appropriate vaccines, either offer needed vaccines or refer their patients to another provider who can administer the needed vaccines, and document vaccinations received by their patients in an immunization-information system.
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