NFID Urges Docs to Help Boost Adult Immunization Rates

Physician Recommendation Plays Huge Role in Uptake

November 18, 2010 04:50 pm David Mitchell

Although nearly 90 percent of U.S. adults would agree to immunizations if their physician recommended a vaccine, only 41 percent would agree to receive a vaccine if their doctor did not prompt them. That is according to recent surveys by the National Foundation for Infectious Diseases, or NFID.

"Patients need to hear these recommendations from their providers, and it needs to be clear," said NFID medical director Susan Rehm, M.D., during a Nov. 17 news conference( to announce a campaign that calls for adult vaccinations to be integrated into routine health care.

The initiative is supported by more than a dozen national health organizations, including the AAFP.

"Practices need to institute formal procedures to make sure vaccines are discussed and the value of vaccines is reinforced at every visit," said Rehm, who also is vice chair of the department of infectious diseases at the Cleveland Clinic. "Each visit needs to be an immunization visit because we don't get adults in for routine care as often as we'd like."

Fifty thousand Americans die each year from vaccine-preventable illnesses, and 95 percent of those are adults, according to HHS. Hundreds of thousands of individuals are hospitalized with preventable illnesses, while millions of others get sick and suffer lost productivity.

"Communication Breakdown"

Rehm said separate NFID surveys( of consumers and primary care physicians showed a "communication breakdown" between doctors and their patients.

For example, 87 percent of physicians surveyed said they discuss vaccines with all their patients, and 12 percent said they discuss vaccines with all patients who have risk factors or indications for particular immunizations.

Patients With Egg Allergies Can Get Influenza Vaccine

People with egg allergy no longer have to take their chances with seasonal influenza.

Such patients have been told to avoid immunization in the past because trivalent inactivated influenza vaccine is grown in eggs and contains egg protein. However, new recommendations( from the American Academy of Allergy, Asthma and Immunology, or AAAAI, say that the level of egg protein in the vaccine is so minute that people with allergies are unlikely to have adverse reactions to immunization.

The AAAAI recommendations call for people with suspected egg allergy to be evaluated by an allergist or immunologist for testing and diagnosis. Patients with a confirmed egg allergy can then receive trivalent inactivated influenza vaccine using one of two protocols:

  • In a two-step graded challenge, the patient receives 10 percent of the age-appropriate dose with a 30-minute observation period for symptom development. If no symptoms occur, the remainder of the vaccine can be administered followed by another 30-minute observation period.
  • Patients also can receive a single, age-appropriate dose followed by a 30-minute observation period.

With either protocol, the same product brand should be used for booster vaccinations. Children who need a booster can receive this as a single dose, regardless of whether a different lot is used.

Although skin testing for egg allergy is part of diagnosis, skin testing for reaction to the vaccine itself is no longer recommended. Recent evidence indicates that skin testing using the vaccine is not predictive of a patient's ability to tolerate the vaccine.

However, nearly half of the consumers surveyed said they didn't recall discussing immunizations, other than the seasonal flu vaccine, with their physician, and 21 percent said they had not discussed any vaccines with their physician. Furthermore, 99 percent of physicians indicated that they initiate vaccine conversations with their patients, but 45 percent of patients said they had to ask their physicians about vaccines.

Melinda Wharton, M.D., M.P.H., deputy director of the CDC's National Center for Immunization and Respiratory Diseases, said the role of health care professionals in improving adult immunization rates could not be overstated. "That's who people want to get advice from," Wharton said during the news conference. "They want to hear from their doctor about what's in their best interest for their health."

Wharton added that provisions in the health care reform law should help increase adult vaccination rates because, in the future, more people will have coverage for preventive services. In addition, physicians will feel more confident about recommending vaccinations because they will be assured of payment for providing immunizations.

It also is important that health care professionals are up-to-date on the adult immunization schedule(4 page PDF) developed by the CDC's Advisory Committee on Immunization Practices, the AAFP, the American College of Obstetricians and Gynecologists, and the American College of Physicians, said Wharton. She noted that the NFID initiative has a Web page dedicated to physician resources on vaccinations(, including a toolkit designed to help practices improve adult vaccination rates.

Vaccination Rates

The influenza vaccine has the highest uptake among immunizations recommended for adults. According to the CDC's 2009 National Health Interview Survey(, 65.6 percent of seniors, 40.1 percent of people ages 50-64 years and 33.6 percent of those 19-49 receive the vaccine. However, influenza still takes the harshest toll in terms of vaccine-preventable illnesses. It kills about 36,000 Americans each year -- most of them elderly -- and causes more than 200,000 hospitalizations.

In addition, influenza costs Medicare up to $1 billion a year in hospital reimbursements, and HHS estimates the cost of a moderately severe flu season at $10 billion.

Pneumococcal vaccine has the next highest uptake with 60.6 percent of seniors and 17.5 percent of all other adults in high-risk groups receiving the vaccine. However, the disease still is responsible for 41,000 illnesses and 5,000 deaths each year.

Immunization rates are much lower for the herpes zoster vaccine and human papillomavirus, or HPV, vaccine. Ten percent of adults ages 60 or older have received the herpes zoster vaccine. The disease affects 20 percent of U.S. adults. And fewer than 20 percent of women ages 19-26 have received the HPV vaccine.

In addition, more than 60 percent of adults in the immunization survey indicated they had received tetanus vaccinations during the past 10 years, but only half of those ages 19-64 had been immunized with the tetanus, diphtheria and acellular pertussis vaccine, which means half of these adults did not receive a pertussis booster.