It’s Time for Grown-Ups to Get Their Shots

Nonflu vaccination rates for adults ‘are dismally low,’ a CDC official says. Photo: AFP/Getty Images

A new push is on to get more adults vaccinated against devastating diseases like pneumonia, shingles and whooping cough.

Public-health officials and infectious-disease experts are working with physicians, health plans and drugstore chains to better educate adults about what shots they need—and make sure they follow up. State health departments are expanding the use of registries to better document patient vaccine records, and using strategies such as “standing orders” that authorize nurses and pharmacists to administer recommended vaccines without a doctor’s exam or prescription.

Behind the effort is rising concern about the immunization status of the aging baby-boom population. While there has been more progress with geriatric patients, just over 45% of adults 50-64 were vaccinated against influenza in the 2012-13 seasons. And for six important nonflu vaccines, adult rates “are dismally low,” says David Kim, deputy associate director for adult immunization at the Centers for Disease Control and Prevention.
With the recent focus on the dangers of failing to vaccinate children, experts say, unvaccinated adults may not realize that not only are they at risk themselves, but they also pose a risk of passing diseases on to the young, the frail and the elderly. For example, adults are the most common source of whooping-cough infection in infants, who are at high risk of serious complications and death.

Yet fewer than 18% of adults ages 19 to 64 have received a Tdap vaccine in the past eight years to provide protection from tetanus, diphtheria and pertussis, the formal name for whooping cough. And less than 22% of adults in the same age bracket who are considered at high risk have received one of two pneumococcal vaccines to protect against the bacteria that causes pneumonia, ear and sinus infections, and can invade the bloodstream.

The picture isn’t much better for the shingles vaccination; only one in four adults over 60, the age at which the shot is recommended, have received the vaccine. The same virus that causes chickenpox can remain dormant in the body for years and reactivate to cause the painful, blistering condition. About one in three Americans will develop shingles, also known as zoster, in their lifetime, and it can recur. Moreover it can cause serious complications in the eye and lead to an excruciatingly painful aftereffect known as post-herpetic neuralgia, which may last for years and interfere with quality of life.

Of course, vaccines aren’t 100% effective. But even if they don’t ward off an illness entirely, they can reduce both its intensity and the risk of long-term complications.

ENLARGE

“The message isn’t just about preventing the disease but preventing the severity of the symptoms,” says Litjen Tan, chief strategy officer of the nonprofit Immunization Action Coalition, and co-chairman of a national adult-immunization summit that includes public-health officials and vaccine makers.

One reason for the scant progress in recent years is that doctors were reluctant to stock vaccines for which they might not be fully reimbursed and patients resisted paying anything out of pocket, Dr. Tan says. But the Affordable Care Act requires health plans to cover all vaccines recommended by the Advisory Committee on Immunization Practices, known as ACIP, with no copays.

In addition, the National Vaccine Advisory Committee, which sets standards for implementing the recommendations, in 2013 called on all health-care professionals—whether they provide vaccinations or not—to take steps to ensure their adult patients are fully immunized. The CDC’s Dr. Kim says doctors should ask about vaccines at appointments just as they collect information about current medications and allergies and take blood-pressure and weight readings.

Revised recommendations

The most recent adult vaccine schedule, released in February, had one major change, for the first time recommending that adults over 65 get two different vaccines—PCV13 and PPSV23—to protect against pneumonia and related infections, because each protects against different types of bacteria and works in different ways, offering broader protection.

The schedule also provides guidance on issues adults should discuss with their health-care provider, such as the MMR vaccine for measles, mumps and rubella. Adults born in 1957 or later who don’t have a record of being vaccinated or having had the diseases should talk to their doctor about how many doses they may need, especially with measles on the rise.

Dr. Tan, for example, says he wasn’t vaccinated as a child growing up in Singapore and got the MMR vaccine when he came to the U.S. for college. When his family was preparing to vacation in France during an outbreak there, he had everyone get a booster. Even if patients aren’t sure about their history, repeat vaccines are safe, he says.

Patients can also ask their doctor to do blood tests to see if they are immune to certain vaccine-preventable diseases, and ask if there are any potential risks to vaccines, such as an allergic reaction to any components.

The CDC website has an easy-to-read consumer version of the vaccination schedule (adapted in the accompanying chart), which also includes immunizations for two types of hepatitis and meningitis. Still, with so many immunizations and footnotes, “it can be complicated territory to figure out,” says Ann Marie Pettis, a nurse who is a member of the APIC board and director of infection prevention at the University of Rochester Medical Center in New York.

Pharmacists’ role

Pharmacists can be very helpful in explaining the schedule to customers, Ms. Pettis says, and are already administering annual flu shots to many of them.

Walgreens provides adult vaccines in its drugstores, and last year the chain introduced an immunization feature for its mobile app that allows patients to store their immunization history and email it to their doctors. The app also provides personalized immunization recommendations based on age and medical history and can send reminders when a vaccine is due, along with information about the disease it is meant to prevent.

Walgreens encourages its pharmacists to talk to patients about their vaccinations when they are in for other matters, like filling a prescription. “For many patients we may be the only health-care professional they come in contact with,” says Nimesh Jhaveri, divisional vice president.

Ms. Landro is an assistant managing editor for The Wall Street Journal in New York and writes the Informed Patient column. She can be reached at encore@wsj.com.