UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Approach to immunizations in healthy adults

Author
Patricia L Hibberd, MD, PhD
Section Editor
Peter F Weller, MD, FACP
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

There have been marked improvements in immunization rates in adults 65 years and older, although the rates are lower than in children. This was illustrated in a review from the Centers for Disease Control (CDC) comparing vaccinations in elderly adults in 1989 and 2003: pneumococcal vaccine coverage increased from 15 to 64 percent and annual influenza immunization increased from 33 to 70 percent [1].

Immunization rates for younger adults at risk for pneumococcus and influenza remain unacceptably low. Based upon 2010 National Health Interview Survey (NHIS) data, only 18.5 percent of adults aged 18 to 64 years at risk of pneumococcal disease have received the vaccine and only 40 percent of those at risk for influenza were immunized against influenza in the 2012 to 2013 influenza season [2,3]. Approximately 50,000 to 70,000 adults die annually of these two vaccine-preventable diseases alone. (See "Pneumococcal vaccination in adults" and "Seasonal influenza vaccination in adults".)

Immunity to tetanus and diphtheria also continues to wane among adults in the United States. In one large serologic survey, only 47 percent of adults over the age of 20 years in the United States had protective antibody to both diseases and only 63 percent of adults with immunity to tetanus also had protective antibody to diphtheria [4]. By contrast, 91 percent of children from 6 to 11 years of age had protective antibody to both diseases. (See "Tetanus-diphtheria toxoid vaccination in adults".)

The national goals of Healthy People 2020 continue to focus on increasing immunization rates and reducing preventable infectious diseases in adults as well as children. Specific goals directed at adults include increasing coverage of 17 vaccines administered across the life span [5].

The principles behind adult immunization, the recommended schedule for healthy adults, and strategies to incorporate these recommendations into practice will be reviewed here. The rationale and risk-benefit considerations for the administration of each vaccine as well as immunizations for selected groups such as immunocompromised individuals, healthy women who are pregnant or breast feeding, the healthcare worker, and international travelers are discussed separately. (See appropriate topic reviews).

             

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Nov 02 00:00:00 GMT 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Centers for Disease Control and Prevention (CDC). Influenza and pneumococcal vaccination coverage among persons aged > or =65 years and persons aged 18-64 years with diabetes or asthma--United States, 2003. MMWR Morb Mortal Wkly Rep 2004; 53:1007.
  2. Santibanez TA, Zhai Y, O'Halloran A, et al. Flu vaccination coverage - United States, 2012-13 influenza season. Centers for Disease Control and Prevention; Atlanta, GA 2013.
  3. Williams WW, Lu PJ, O'Halloran A, et al. Surveillance of Vaccination Coverage Among Adult Populations - United States, 2014. MMWR Surveill Summ 2016; 65:1.
  4. McQuillan GM, Kruszon-Moran D, Deforest A, et al. Serologic immunity to diphtheria and tetanus in the United States. Ann Intern Med 2002; 136:660.
  5. HealthyPeople.gov http://www.healthypeople.gov/2020/default.aspx (Accessed on March 03, 2014).
  6. National Center for Immunization and Respiratory Diseases. General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011; 60:1.
  7. Poland GA, Borrud A, Jacobson RM, et al. Determination of deltoid fat pad thickness. Implications for needle length in adult immunization. JAMA 1997; 277:1709.
  8. Honkanen PO, Keistinen T, Kivelä SL. Reactions following administration of influenza vaccine alone or with pneumococcal vaccine to the elderly. Arch Intern Med 1996; 156:205.
  9. Pickering LK, Baker CJ, Freed GL, et al. Immunization programs for infants, children, adolescents, and adults: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49:817.
  10. Centers for Disease Control and Prevention (CDC). Carbon monoxide poisonings associated with snow-obstructed vehicle exhaust systems--Philadelphia and New York City, January 1996. MMWR Morb Mortal Wkly Rep 1996; 45:1.
  11. Centers for Disease Control and Prevention (CDC). Update: influenza activity--United States, 1993-94 season. MMWR Morb Mortal Wkly Rep 1994; 43:1.
  12. Kim DK, Bridges CB, Harriman KH, Advisory Committee on Immunization Practices. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older: United States, 2016. Ann Intern Med 2016; 164:184.
  13. Centers for Disease Control and Prevention (CDC). Missed opportunities for pneumococcal and influenza vaccination of Medicare pneumonia inpatients--12 western states, 1995. MMWR Morb Mortal Wkly Rep 1997; 46:919.
  14. Buffington J, Bell KM, LaForce FM. A target-based model for increasing influenza immunizations in private practice. Genesee Hospital Medical Staff. J Gen Intern Med 1991; 6:204.
  15. Clancy CM, Gelfman D, Poses RM. A strategy to improve the utilization of pneumococcal vaccine. J Gen Intern Med 1992; 7:14.
  16. Crouse BJ, Nichol K, Peterson DC, Grimm MB. Hospital-based strategies for improving influenza vaccination rates. J Fam Pract 1994; 38:258.
  17. Metersky ML, Fine JM, Tu GS, et al. Lack of effect of a pneumonia clinical pathway on hospital-based pneumococcal vaccination rates. Am J Med 2001; 110:141.
  18. Centers for Disease Control (CDC). Pneumococcal immunization program--California, 1986-1988. MMWR Morb Mortal Wkly Rep 1989; 38:517.
  19. Immunization Work Group of the National and Global Public Health Committee of the Infectious Diseases Society of America. Executive summary--Actions to strengthen adult and adolescent immunization coverage in the United States: policy principles of the Infectious Diseases Society of America. Clin Infect Dis 2007; 44:1529.
  20. Szilagyi PG, Bordley C, Vann JC, et al. Effect of patient reminder/recall interventions on immunization rates: A review. JAMA 2000; 284:1820.
  21. Willis BC, Ndiaye SM, Hopkins DP, et al. Improving influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among adults aged <65 years at high risk: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep 2005; 54:1.