Study Finds Overall Vaccination Rates Remain Low

Overall vaccination coverage rates remain low, and with the Advisory Committee on Immunization Practices’ (ACIP) 2015 recommended immunization schedule for adults ≥19 years of age, comes a reminder to healthcare providers that their recommendations to patients are a strong predictor of whether patients receive recommended vaccines [Ann Intern Med. 2015;162:214-223].

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Pneumococcal vaccination rates for adults ≥65 years of age and adults 19 to 64 years of age, for example, were found to be 59.7% and 21.2%, respectively, in 2013, which was similar to 2012 rates and far below the Healthy People 2020 goal of 90% for adults ≥65 years of age and 60% for high-risk adults 18 to 64 years of age. Additionally, 24% of adults ≥60 years of age have received the herpes zoster vaccine, and 26% of adults 19 to 59 years of age with diabetes have received the hepatitis B vaccine.

Chief among the changes from the 2014 schedule include a recommendation for routine administration (rather than “recommended if some other risk is present”) of the 13-valent pneumococcal conjugate vaccine (PCV13) in series with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults ≥65 years of age.  Recommendations for the live attenuated influenza vaccine (LAIV) now relegate “influenza antiviral use within the past 48 hours” to a contraindication rather than a precaution; and asthma/chronic lung diseases as well as cardiovascular, renal, and hepatic diseases and diabetes are now indicated as a precaution rather than a contraindication. Immune suppression, egg allergy, and pregnancy remain contraindications to receiving LAIV.

Furthermore, the FDA granted approval to expand the age for administration of the recombinant influenza vaccine to ≥18 years of age from the previous recommendation of 18 to 49 years.

Infection by Streptococcus pneumoniae has remained a major health issue as a cause of bacteremia, meningitis, and pneumonia, despite extensive and targeted recommendations for use of PCV13 and PPSV23 vaccination by age and risk groups. There are approximately 40,000 cases of invasive pneumococcal disease each year, of which 13,500 occur in adults ≥65 years of age. Therefore, ACIP has recommended PPSV23 for adults ≥65 years of age as well as those with high-risk conditions since 1997. Smoking and asthma were added to these conditions by ACIP in 2010. Routine use of PCV13 for adults ≥19 years of age with immunocompromising conditions, anatomical or functional asplenia, cochlear implant, or cerebrospinal fluid leak, was added to the ACIP recommendations in 2012. After receiving PCV13, a dose of PPSV23 is recommended at least 8 weeks later, with a second dose of PPSV23 at least 5 years after the first dose. A third dose is recommended after an individual reaches 65 years of age if the second dose was received before 65 years of age and at least 5 years have passed.

In August 2014, ACIP recommended the use of PCV13 in series with PPSV23 for all adults ≥65 years of age. The timing of the PCV13 dose is dependent on age and health conditions. Generally, adults ≥65 years of age not previously vaccinated with PCV13 should receive PCV13 followed by PPSV23 6 to 12 months later. This series of vaccines is noted by ACIP to be challenging in terms of complexities in timing the 2 vaccines, frequency, and intervals between doses, due to a patient’s age, health conditions, vaccination history, and other factors.

Healthcare providers should be routinely assessing their patients’ immunization status, making patients aware of ACIP recommendations, ensuring they receive the necessary vaccines, and documenting receipt in vaccine registries. These steps will increase
vaccination rates among adults and reduce illness, hospitalizations, and deaths from vaccine-preventable diseases, according to the ACIP report.

Full ACIP recommendations for each vaccine can be found at www.cdc.gov/vaccines/hcp/acip-recs/index.html.—Mary Mihalovic