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Approach to immunizations in healthy adults

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


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).

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Literature review current through: Nov 2017. | This topic last updated: Apr 28, 2017.
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