Experts Urge Integration of Adult Vaccines into Routine Care to Save Lives, Reduce Needless Illness

WASHINGTON, D.C. -- New data released by the Centers for Disease Control and Prevention (CDC) paint a disappointing picture of adult immunization against serious infectious diseases in the United States. In addition, a new consumer survey shows the vast majority of adult Americans lack awareness of vaccines and the severity of infectious diseases.

An expert panel discussed the data at a press conference held by the National Foundation for Infectious Diseases (NFID), which called for increased use of vaccines in adults to reduce needless illness and deaths associated with infectious diseases.

CDC's National Immunization Survey shows only 2.1 percent of adults 18 to 64 years of age are immunized against tetanus-diphtheria-whooping cough. Immunization to prevent shingles among people 60 and over was only 1.9 percent. Vaccine coverage for the prevention of HPV (human papillomavirus) among women 18 to 26 is about 10 percent. In addition, influenza and pneumococcal vaccination rates for the elderly are well below the 90 percent national target rates.

"Routine immunization of children in the United States has saved hundreds of thousands of lives and prevented millions of cases of disease, but vaccines are not just for children," said Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases. "These new data show there are not yet very many adults taking full advantage of the great advancements in prevention that have been made in the past few years."

"There are now 17 diseases that can be prevented from vaccines given to children, teens and adults.  Several vaccines, including three fairly new ones licensed since 2005, are recommended specifically for the adult years. By skipping vaccination, people are leaving themselves needlessly vulnerable to significant illness, long-term suffering and even death," said Schuchat. "We are extremely fortunate in this country to have safe and effective vaccines available, but we have to use them better."

Immunization is recommended for U.S. adults to protect them against chickenpox, diphtheria, hepatitis A, hepatitis B, human papillomavirus/cervical cancer (HPV), influenza, measles, meningococcal disease, mumps, pertussis (whooping cough), pneumococcal disease, rubella, shingles and tetanus.

"Combined, these infectious diseases kill more Americans annually than either breast cancer, HIV/AIDS or traffic accidents," said William Schaffner, MD, vice president of the NFID and chairman of the Department of Preventive Medicine at Vanderbilt University School of Medicine. "A concerted effort is needed to raise adult immunization rates," said Schaffner. "The important thing to remember is that deaths and illness associated with these infections are largely avoidable through vaccination."

Also released were results of a new national survey conducted by NFID that show most adults cannot name more than one or two diseases that are vaccine preventable in adults. Each vaccine for adults was identified by only 3 percent to 18 percent of those polled; the only exception was the influenza vaccine, which was named by just under half of respondents.

Also disconcerting is that half of those surveyed say they are not concerned about whether they or another adult family member gets a vaccine-preventable disease. When asked about specific diseases, consumers expressed most concern about getting influenza, which likely reflects the more frequent messages they receive about influenza versus the other diseases.

One adult vaccine with low immunization rates (<2 percent) prevents herpes zoster or shingles, a severely painful and debilitating infectious disease. "There are more than 1 million new cases of shingles in the U.S. every year; over half in people 60 and older," said Michael N. Oxman, MD, professor at the University of California, San Diego, staff physician at the San Diego VA Medical Center; and chairman of the Shingles Prevention Study, the VA Cooperative Study that demonstrated the efficacy of the shingles vaccine. "The vaccine not only helps reduce the risk of getting shingles, but it reduces the incidence of postherpetic neuralgia (PHN), a long-lasting shingles pain syndrome that constitutes the most common serious and debilitating complication of shingles." PHN pain can last for years after the initial shingles outbreak and is often resistant to treatment.

Stanley A. Gall, MD, professor of obstetrics, gynecology and women's health and the American College of Obstetricians and Gynecologists (ACOG) liaison member to the Advisory Committee on Immunization Practices, addressed the importance of using the HPV vaccine to protect women against human papillomavirus. "The 2007 reported coverage rate of 10 percent in women 18 to 26 is a start, but we need to get these rates up. This is a safe and effective vaccine that protects against cervical cancer. I urge all young women to talk to their doctors about getting the three-dose vaccine series."

Although immunization rates are higher for influenza than for other vaccines recommended for adults, "influenza remains a significant threat to the public health," according to Kristin L. Nichol, MD, MPH, MBA, chief of medicine at Minneapolis VA Medical Center and professor of medicine and vice chair of the Department of Medicine at the University of Minnesota. "We are learning more all the time about just how severe, debilitating and widespread influenza can be. A recent report connected influenza infection with an increased risk of heart attack and stroke. It is clear that our work is far from done."

Dr. Robert Hopkins, associate professor at the University of Arkansas for Medical Science and a member of the Adult Immunization Advisory Board of the American College of Physicians and the organization's Arkansas Chapter Governor, detailed the terrible burden of pneumococcal disease in adults. "Up to 5,000 Americans die every year from a disease that can be prevented by vaccination," said Hopkins. "Many pneumococcal infections can be prevented or their severity significantly reduced by this simple immunization."

The decades-long increase in pertussis (whooping cough) rates was highlighted by Dr. Mark Dworkin from the Division of Epidemiology and Biostatistics at the University of Illinois at Chicago School of Public Health. According to Dworkin, "we need to use the newly available booster vaccines against pertussis for adults and adolescents widely because this may get pertussis back under control. Adults and adolescents can get coughing illness that may last for weeks or even months and they represent a large reservoir of infection putting others, such as vulnerable infants, at increased risk of infection."

Schaffner called on everyone to focus more on this important issue for the public health good. "Low immunization rates represent a national public health crisis whose consequences affect the entire country as well as affected individuals and their families. The challenges to increasing rates are real, but the benefits of achieving high vaccination rates are substantial."

Source: National Foundation for Infectious Diseases