Most adults fail to take advantage of newer vaccines, such as one for shingles and another that protects against the virus linked to cervical cancer. Adults also are often unaware that their immunity may have waned from shots they had as children and forget whether they have had diseases such as chicken pox and measles.
And they often skip recommended immunizations before traveling, even though diseases can crop up unexpectedly, such as a current outbreak of measles in Europe and Asia.
Complicating matters: Adult vaccines often aren't covered or are only partially covered by insurance plans.
Now, infectious-disease experts and public health officials are calling for a national program to make immunization as routine a part of health care for adults as it has long been for children. And a growing number of walk-in clinics in drugstores are offering consumers a convenient way to get vaccinated.
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According to the Centers for Disease Control and Prevention, only 2.1 percent of adults aged 18 to 64 are immunized against tetanus, diphtheria and whooping cough, even though since 2006 there has been a combination vaccine that can protect against all three. At the same time, there has been a resurgence of whooping cough in the U.S. The disease can cause fractured ribs from coughing, and can be fatal. Adults also can pass it along to young children. A vaccine against shingles, developed by Merck & Co., was approved in 2006 and is recommended for adults over 60. But only 1.9 percent of adults have been immunized for it. Shingles, caused by a reawakening of the chicken pox virus, can result in severe nerve pain that can last for years, and can involve nerves around the eye that might lead to blindness. Adults are at risk if they had chicken pox as children, or if they previously had shingles.
Among other immunizations, only about 10 percent of women aged 18 to 26 have received the new vaccine for human papillomavirus, linked to cervical cancer. And though seasonal flu vaccines are widely available each year, fewer than 30 percent of the adults at highest risk get the shot.
“It's far better to prevent these diseases than to have to treat them, and with the array of vaccines we have available, people ought to be taking better advantage,” says Gina Mootrey, associate director for the CDC's adult immunization services division.
After seeing a friend suffer through a painful bout of shingles, Jane Ballard, 65, and her husband, a retired couple in Stockbridge, Ga., asked their primary care provider for the new vaccine after doing some research on the Web. “I didn't even realize that you can get shingles again or that the chicken-pox virus causes shingles,” said Ballard.
Though the price was about $219 each, all but $40 was covered by their drug benefit plan. Although immunization rates for children are at an all-time high, and young people rarely die from diseases that vaccines can prevent, that's not the case for adults. As many as 70,000 adult Americans die each year from vaccine-preventable diseases like influenza, pneumonia and complications of hepatitis. Such diseases also sicken hundreds of thousands of adults, at a cost of treatment exceeding $10 billion annually, according to the CDC.
One problem is a lack of any national system to promote and monitor adult vaccination. While the federal Vaccines for Children Program provides vaccines at no cost to children who can't afford them, “the infrastructure to ensure the adult-vaccination pipeline is woefully inadequate,” says L.J. Tan, director, Infectious Disease, Immunology, and Molecular Medicine at the American Medical Association. Most adults over 65 have many vaccines paid for by Medicare, Medicaid or private insurers. But for adults under 65, insurance often doesn't cover all recommended vaccines.
Where to look
The CDC provides a list of vaccination recommendations, updated each year, on its Web site (www.cdc.gov and search for “adult immunization schedule”). It also has information about immunizations Americans need when traveling abroad. These often change as new infectious threats emerge (see Travelers' Health link at www.cdc.gov).
Among current recommendations: People traveling to European countries, including Austria, Germany and Switzerland, or to Beijing for the Olympics games this summer should consult their doctor about whether they need a measles vaccine. Measles, which is highly contagious, can cause pneumonia, brain inflammation and death.
In addition to longstanding recommendations that travelers to developing countries be vaccinated against hepatitis A and B, and typhoid fever, the CDC is also recommending this summer that travelers to certain destinations consider vaccination against rabies, meningitis, yellow fever and Japanese encephalitis, a mosquito-borne disease that is a growing threat in Asia.
Travelers often don't take into account the time they need to receive all their vaccines in advance of travel, which could take several weeks.Many doctors' offices aren't willing or able to stock a wide range of vaccines. But the growing number of walk-in clinics in drugstores are able to purchase vaccines in bulk and store them in their facilities.