Adults know needed vaccines, but skip them anyway

Most adults know what vaccinations they need and about the diseases they prevent, but they still remain non-compliant.

While cost and access were previously believed to be barriers to adult vaccine compliance, a new study suggests that improving adult vaccination rates can be as simple as a nudge from a physician.

Peng-Jun Lu, MD, PhD, of the Centers for Disease Control and Prevention (CDC) led the study and said incorporating vaccines as part of the standard patient assessment can help reduce missed opportunities for adult immunization.

“A healthcare provider recommendation is the strongest predictor of whether adults get vaccinated,” Lu told Medical Economics. “Whether or not they stock vaccines, all healthcare professionals should routinely assess patient vaccine needs and recommend the appropriate vaccines to ensure their patients are protected against serious, sometimes deadly, diseases.”

Most adults know about vaccine-preventable diseases and which vaccines are recommended, but still don’t get them, according to Lu.

In the study, “Awareness among adults of vaccine-preventable diseases and recommended vaccinations, United States, 2015,” and published in Vaccine, researchers used data from a 2015 online survey of U.S. adults conducted for CDC and found that a wide range of respondents reported awareness of vaccine-preventable diseases ranged from 63.4% to 94%, but that ranged by disease type. According to the report, participants were most aware of influenza and pneumonia, followed by herpes zoster, hepatitis B, pertussis and tetanus. Respondents were least aware of HPV.

Knowledge about the disease did not directly correspond to knowledge about a vaccine against that disease, according to the report, with just 59.3% of respondents aware of the herpes zoster vaccine compared to the 75.4% that were aware of the disease.

Females and college graduates were most knowledgeable about vaccines and vaccine-preventable diseases, according to the report. Awareness was also high among individuals with high-risk conditions, those with higher household incomes, seniors and among individuals with private health insurance.

Next: Boosting immunization rates

How physicians can boost immunization rates

Despite promising levels of awareness, however, adult vaccination among the study group and nationally remain less than optimal. Half of the respondents reported receiving the flu vaccine, with that percentage rising with age to 74.7% in those aged 65 and up.

Compliance was low for the pneumococcal vaccine among respondents under age 65 with high-risk conditions at 37.5%, but jumped to 72.1% in seniors over age 65. Another 61% of adults under age 50, 72.2% of adults 50 to 64 years of age, and 81.4% of seniors over age 65 received the tetanus vaccine, 24% received the hepatitis B vaccine, 35.2% of adults over age 60 received the herpes zoster vaccine and 27.1% of females aged 19 to 26 reported receiving the HPV vaccine.

The study identified a few reasons for this non-compliance, with 5.5% of participants reporting cost as a barrier to vaccination and 5.2% reporting non-compliance because their insurance company did not cover the cost of the vaccine.

The study authors note that this is a small portion of the population, indicating that cost may not be as great a barrier as previously thought.

The authors concluded that high awareness does not always result in high vaccination coverage, and that awareness is not enough to motivate patients to get vaccinated. Therefore, researchers hypothesized that lower compliance with adult vaccination may be a consequence of physicians not recommending immunization to adult patients, as well as the tendency of adult patients to not seek out routine and preventive medical care. According to the report, only 26% of adults under the age 50 involved in the survey had not seen a provider in the last year, and those who hadn’t seen a physician in the last year were more likely to have lower vaccination coverage.

Lu said some strategies to increase vaccination rates include: implementing patient reminder systems that will alert patients to a need for a vaccine and recall them for vaccines they are missing; implementing healthcare system-based interventions including patient education, expanded access, reminders for both physicians and patients and standing order programs; and assessing a patient’s vaccination status at every encounter.

CDC offers additional guidance to healthcare providers for increasing adult vaccination rates on its website.

“We hope this report serves as a reminder for healthcare providers to follow the standards for adult immunization practice to ensure their patients are up to date on all their recommended vaccines,” Lu said.