National Health Interview Survey: Adult Vaccination Rates Need Boost

The Centers for Disease Control and Prevention (CDC) recently released immunization coverage estimates from the 2012 National Health Interview Survey (NHIS) for six vaccines routinely recommended for adults including pneumococcal, tetanus and Tdap, Hepatitis A, Hepatitis B, herpes zoster (shingles), and Human papillomavirus (HPV). These data indicate little overall improvement in vaccination coverage among adults from 2011 to 2012.

Compared with 2011, modest increases occurred in three vaccines: Tdap, herpes zoster and HPV. However, vaccination coverage estimates for pneumococcal, herpes zoster, and hepatitis B for healthcare professionals are below the Healthy People 2020 target levels.

There is an increased emphasis on giving the Tdap vaccine to close contacts of infants, including their parents and grandparents, to help prevent spread of whooping cough and its severe complications to infants too young to be vaccinated. Vaccination of pregnant women with Tdap vaccine can help protect their infants from whooping cough. Additionally, people with certain medical conditions (like pregnant women or people undergoing cancer treatment) may not be able to get certain vaccines, but are very vulnerable to illness.

Healthcare professionals play a critical role in ensuring that patients are fully immunized. Patients trust health care providers to give them the best advice on how to protect their health, and their recommendations are one of the most important factors in whether a person chooses to get recommended vaccines. All healthcare professionals, whether they provide immunization services or not, should routinely assess patient vaccination needs at every visit, provide a strong recommendation for needed vaccines, and administer needed vaccines or refer to a provide who can immunize.

The survey on adult vaccination coverage provides a “report card” on protecting adults against six vaccine-preventable diseases. The NHIS is a random survey of civilian, non-institutionalized adults aged 19 years and older conducted annually in respondents’ homes. The estimates are provided based on the different age and high-risk groups recommended for each of the vaccines and by race/ethnicity. High-risk groups can be based on certain medical conditions, occupation, and/or travel.

Below are topline results from the survey, and full recommendations for each vaccine can be found at: http://www.cdc.gov/vaccines/hcp/acip-recs/index.html.

2012 NHIS Data By Recommended Vaccine

Pneumococcal Vaccine

  • Coverage among high-risk adults aged 19-64 years was 20%, similar to coverage in 2011.
  • Coverage among high-risk non-Hispanic whites age 19-64 (21.4%) was higher than among Hispanics (13.8%) and non-Hispanic Asians (13.2%).
  • Coverage among high-risk Hispanics age 19-64 was 13.8%, a 4.6 percentage point decrease from 2011.
    • No other significant differences between 2011 and 2012 coverage by race/ethnicity among adults age 19-64.
  • Coverage among adults aged 65 years and older was 59.9%, similar to coverage in 2011.
  • Coverage among non-Hispanic whites (64%) aged 65 years and older was higher than among all other racial and ethnic groups, including non-Hispanic blacks aged 65 years and older (46.1%), Hispanics aged 65 years and older (43.4%), non-Hispanic Asians aged 65 years and older (41.3%), and non-Hispanics who reported other race (44.7%).

Tetanus and Tdap Vaccines

  • The proportion of adults who received a tetanus vaccination during the past 10 years was 64.2% for those aged 19-49 years, 63.5% for those aged 50-64 years, and 55.1% for those aged 65 years and older.
  • Coverage for all age groups in 2012 was similar to 2011 for tetanus vaccination.
  • Non-Hispanic whites in all age groups had higher coverage than non-Hispanic Asians, Hispanics, and non-Hispanic blacks.
  • Overall Tdap vaccination of adults aged 19-64 was 15.6%, a 3.3 percentage point increase from 2011 (denominator for estimate includes adults who reported they were not vaccinated with any type of tetanus vaccine)
  • 36.3% of respondents reported they knew what type of tetanus vaccine they received during 2005-2012:
    • Of the 36.3% of respondents who reported they knew what type of tetanus vaccination they received, 65.4% reported that they received Tdap.
  • Tdap coverage among non-Hispanic whites aged 19-64 years (18.2%) was higher than among non-Hispanic blacks (10.5%) and Hispanics (9.2%).
  • Tdap coverage for people aged 19-64 years who have household contact with an infant less than one year old was 25.9%, similar to the estimate for 2011.
  • Among all healthcare professionals aged 19-64 years Tdap coverage was 32.6%, a 5.8 percentage point increase from 2011.

Hepatitis A Vaccine

  • Coverage (>2 doses) among adults aged 19-49 years remained low at 12.2%, similar to 2011 coverage.
  • Coverage was higher for non-Hispanic Asians (18.7%) than for non-Hispanic whites (12.2%), but coverage for Hispanics (10.5%) was lower compared with whites.
  • Coverage was higher (18.9%) among people who traveled since 1995 to countries where hepatitis A has been prevalent (outside the United States, Europe, Japan, Australia, New Zealand, and Canada).

Hepatitis B Vaccine

  • Coverage (>3 doses) among adults aged 19-49 years remained similar to 2011 at 35.3%.
  • Coverage was lower for non-Hispanic blacks (34.2%) and Hispanics (27.1%) compared with non-Hispanic whites (37.5%).
  • For people with diabetes, coverage was 28.6% for adults aged 19-59 years and 15.1% for adults aged 60 years and older.
  • Overall hepatitis B vaccination coverage among healthcare professionals was 65%, similar to coverage in 2011.
    • There were no racial/ethnic differences in hepatitis B coverage among healthcare professionals.

Herpes Zoster (Shingles) Vaccine

  • Among adults aged 60 years and older, 20.1% reported receiving herpes zoster vaccination, an increase of 4.4 percentage points from 2011.
  • Coverage was higher for non-Hispanic whites (22.8%) than for non-Hispanic blacks (8.8%), Hispanics (8.7%), and non-Hispanic Asians (16.9%).
    • Coverage for non-Hispanic whites aged 60 years and older rose more than 5 percentage points from 2011.
    • Data indicate a widening gap in coverage among non-Hispanic blacks and Hispanics when compared with non-Hispanic whites.

Human Papillomavirus (HPV) Vaccine

  • Among all women aged 19-26 years, 34.5% reported receiving at least one dose of HPV vaccine, an increase from 29.5% in 2011, 20.7% in 2010, and 17.1% in 2009.
  • Coverage was 44.3% among women aged 19-21 years and 28.2% among those aged 22-26 years.
  • Among women aged 19-26 years, non-Hispanic blacks (29.1%), Hispanics (18.7%), and non-Hispanic Asians (15.6%) each had lower coverage compared with non-Hispanic whites (42.2%).
    • Data indicate a widening gap in coverage among non-Hispanic blacks, Hispanics, and non-Hispanic Asians when compared with non-Hispanic whites.
  • HPV vaccination coverage was 2.4% for males aged 19-21 years and 2.2% for those aged 22-26 years.

Improving Adult Immunization Coverage: Opportunities for action

Clinicians, public health partners and other stakeholders are all critical in increasing adult vaccination. Ways to support these efforts include:

  • Increase awareness about adult vaccines other than influenza.
  • Increase awareness of the need for adult vaccine assessments as a part of routine medical care.
    • Increase partnership opportunities within healthcare and public health to improve awareness and vaccination coverage among partner constituents.
  • Promote the new Standards for Adult Immunization Practice.
  • These standards will be published in Public Health Reports in March 2014.
  • These standards were approved by the National Vaccine Advisory Committee (NVAC) and supported by the CDC and a number of national medical associations including American Academy of Family Physicians (AAFP), American Congress of Obstetricians and Gynecologists (ACOG), American Pharmacists Association (APhA), Association of Immunization Managers (AIM), Infectious Diseases Society of America (IDSA), American Academy of Physician Assistants (AAPA), National Foundation for Infectious Diseases (NFID), Association of State and Territorial Health Officials (ASTHO), American Academy of Pediatrics (AAP), and others.
  • The new standards acknowledge:
    • The current low levels of vaccine coverage among adults
    • The critical role that all healthcare providers, including those who do not offer all recommended adult vaccines in their practices, have in ensuring that their patients are up-to-date on recommended vaccines.
    • And the fact that adults patients often see more than one provider and may receive vaccinations in a variety of settings (e.g. doctor’s office, pharmacy, and work)
  • Healthcare professionals play a critical role in ensuring that their patients are fully immunized:
    • Your patients trust you to give them the best advice on how to protect their health.
    • Your recommendation is one of the most important factors in whether a person chooses to get recommended vaccines.
    • All healthcare professionals, whether they provide immunization services or not, should routinely assess patient vaccination needs at every visit, provide a strong recommendation for needed vaccines, and administer needed vaccines or refer to a provide who can immunize.
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