Prevention - Immunization Trends: Adults

Immunizations are not just for kids. According to the Centers for Disease Control (CDC), they can save adult lives. This graphic shows trends relative to two of the most common vaccine-preventable diseases afflicting adults: influenza (flu) and pneumonia. Flu shots are also recommended for all adults 50 and up and pneumococcal polysaccharide vaccine (PPV) shots are recommended to protect against pneumonia for all adults 65 and up. The CDC also recommends that all adults receive the Tetanus-diphtheria toxoid immunization every 10 years. The CDC publishes a list of recommended immunizations for adolescents and adults, including those who have not been immunized against childhood diseases, travelers, homosexuals, and illegal drug users. For more information, please see http://www.cdc.gov/nip/recs/adult-schedule.pdf.

The graphic shows epidemic-related pneumonia and influenza deaths among people 65 years and over (per 100,000) and percentages of that population who were immunized in the 1990s. The years are not precisely comparable, but the trend is clear: epidemic-related pneumonia and influenza deaths went down while the percentage of older adults who were immunized went up. Is this just a coincidence?

Kristine Severyn has this to say: "Considering that more than 90 percent of pneumonia and influenza deaths occur in persons 65 years of age or older, but that about 65 percent of all deaths (from any cause) occur in this age group anyway, it is nearly impossible to prove if flu shots significantly increase life expectancy in the elderly…. Congress and the American taxpayer have been defrauded about the alleged advantages of flu shots."

The CDC Web site tells us that flu and pneumonia are the fifth leading cause of death among the elderly. The CDC has been strongly urging immunizations for senior citizens since the early 1990s. Medicare has paid for pneumonia vaccinations since 1981 and flu vaccinations since 1993. By 1998, only 63% of the population over age 65 received the flu vaccine and only 46% received the pneumococcal vaccine. Even fewer African- Americans and Hispanics were immunized, as the table below shows.

Pneumococcal and Influenza Immunizations: 1991-1998

	1991	1993	1994	1995	1997	1998
Pneumococcal immunizations
Noninstitutionalized	21%	28%	30%	34%	43%	46%
people 65 years+
a. Black 65 years+	14%	14%	15%	23%	22%	26%
b. Hispanic 65 years+	12%	12%	14%	23%	23%	23%
Influenza immunizations (in last 12 months)
Noninstitutionalized	42%	52%	55%	58%	63%	63%
people 65 years+
a. Black 65 years+	27%	33%	39%	40%	45%	46%
b. Hispanic 65 years+	NA	47%	38%	50%	53%	50%

According to CDC data published in JAMA, flu vacci- nation levels are higher among people with more than a high school education.

Some immunizations are now available at the corner pharmacy for a nominal fee. Why, then, are immunization rates so low? NursingWorld offers these explanations: "Misconceptions about vaccine safety, efficacy and inadequate knowledge of indications"; "'Well adults' often lack awareness of the need for immunization"; "Financial barriers"; "Current low mortality rates of tetanus and diphtheria as compared with other vaccine-preventable diseases may not appear to justify cost and practice of periodic TD [tetanus-diphtheria] vaccination"; "High costs of hepatitis B vaccine and the failure of most insurance companies to pay for its use… populations at greatest risk for hepatitis B are often hard-to-reach populations who lack regular health care"; and "Access to health care."

The great weight of expert opinion is on the side of immunizations as recommended by the CDC. We live in a world where, contrary to what many of us may believe, infectious diseases have not been eradicated and are easily spread through global travel. Advances in modern medicine are keeping us alive longer but leaving us vulnerable to infection. Chemotherapy, for example, or drugs taken after organ transplants, can weaken the immune system and leave a patient unprepared to fight a powerful virus.

Next we look at community health programs. They are the major sources for knowledge about disease prevention for much of the population.

Sources: National Center for Health Statistics, Healthy People 2000 Final Review, Table 20: http://www.cdc.gov/nchs/. Severyn,
R.Ph.,Ph.D.,Kristine."AreFluVaccinesBeneficial?" Spotlight: http://www.spotlight.org/01_07_00/Vacc/vacc.html. "Position Statements: Adult Immunization.": http://www.nursingworld.org/readroom/position/social/scaltimm.htm. "Influenza and Pneumococcal Vaccination Levels Among Persons [greater than or equal to] Aged 65 Years — United States, 1999." JAMA, the Journal of the American Medical Association, 25 July 2001. p.413.