Undervaccinated Adults (herd what?)
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|Tue, 07-22-2008 - 10:03am|
Get Your Shots: Adults Need Vaccines, Too Public-Health Experts Push For National Inoculation Plan; A Rise in Whooping Cough
July 9, 2008; Page D1
When it comes to getting vaccinated against debilitating and deadly diseases, adults are notoriously lax.
Most adults fail to take advantage of newer vaccines, such as one for shingles and another that protects against the virus linked to cervical cancer. Adults also are often unaware that their immunity may have waned from shots they had as kids, such as pertussis -- or whooping cough -- and forget whether they have had diseases such as chicken pox and measles. And they often skip recommended immunizations before traveling, even though diseases can crop up unexpectedly, such as a current outbreak of measles in Europe and Asia. Complicating matters: Adult vaccines often aren't covered or are only partially covered by insurance plans.
Now, infectious-disease experts and public health officials are calling for a national program to make immunization as routine a part of health care for adults as it has long been for children. The American Medical Association is working with physicians, who often don't check immunization status, to ensure they recommend vaccinations to their adult patients. And a growing number of walk-in clinics in drugstores are offering consumers a convenient way to get vaccinated.
"Low immunization rates represent a national public health crisis, and we need to do a better job of educating practitioners and patients about the need for vaccines and covering vaccination as a preventive service," says William Schaffner, chairman of the preventive medicine department at Vanderbilt University and president-elect of the non-profit National Foundation for Infectious Diseases.
According to the Centers for Disease Control and Prevention, only 2.1% of adults aged 18 to 64 are immunized against tetanus, diphtheria and whooping cough, even though since 2006 there has been a combination vaccine that can protect against all three. This is especially worrisome amid a current resurgence of whooping cough in the U.S. The disease can have symptoms in adults such as fractured ribs from coughing and vomiting, and can be fatal. Adults also can pass it along to young children who have smaller air passages and are far more vulnerable.
A vaccine against shingles, developed by Merck & Co., was first approved in 2006 and is recommended for all adults over 60. But only 1.9% of adults have been immunized for the disease. Shingles, caused by a reawakening of the chicken pox virus, can result in severe nerve pain that can last for years, and can involve nerves around the eye that might lead to blindness. Adults are at risk if they had chicken pox as a child, or even if they previously had shingles. Those who haven't had chicken pox should also get a separate vaccine against that disease, called varicella.
Among other immunizations, only about 10% of women aged 18 to 26 have received the new vaccine for human papillomavirus, linked to cervical cancer. And though seasonal flu vaccines are widely available each year, fewer than 30% of the adults at highest risk get the shot.
"It's far better to prevent these diseases than to have to treat them, and with the array of vaccines we have available, people ought to be taking better advantage," says Gina Mootrey, associate director for the CDC's adult immunization services division.
Though many adults keep their immunity from certain childhood vaccinations, it is difficult to know if a person is still protected without blood tests that can be expensive and aren't always reliable. What's more, many people don't remember what vaccines they were given at an early age. To avoid the risk, health experts say there's no harm in getting immunized again.
"As we age, we become more susceptible to serious disease caused by common infections," such as the flu and the bacteria pneumococcus, which causes pneumonia, says Sandra Ryan, chief nurse practitioner at Take Care Health Systems, a unit of Walgreen Co. that runs walk-in clinics at many Walgreen drugstores.
After seeing a friend suffer through a painful bout of shingles, Jane Ballard and her husband, a retired couple in Stockbridge, Ga., asked their primary care provider for the new vaccine against the virus after doing some research on the Web. "I didn't even realize that you can get shingles again or that the chicken-pox virus causes shingles," says Mrs. Ballard, age 65.
The doctor didn't have the shingles vaccine in stock, and recommended they try a walk-in clinic at a nearby drugstore, where the nurse practitioner provided a two-page handout on the vaccine and answered some of their questions. Though the price was about $219 each, all but $40 was covered by their drug benefit plan. "I'm proactive on doing anything that can help me prolong my life and be healthy," Mrs. Ballard says.
Although immunization rates for children are at an all-time high, and young people rarely die from diseases that vaccines can prevent, that's not the case for adults. As many as 70,000 adult Americans die each year from vaccine-preventable diseases like influenza, pneumonia and complications of hepatitis, federal data show. Such diseases also sicken hundreds of thousands of adults, at a cost of treatment exceeding $10 billion annually, according to the CDC.
One problem is a lack of any national system to promote and monitor adult vaccination. While the federal Vaccines for Children Program provides vaccines at no cost to children who can't afford them, and carefully monitors supply and demand, "the infrastructure to ensure the adult-vaccination pipeline is woefully inadequate," says L.J. Tan, director, Infectious Disease, Immunology, and Molecular Medicine at the AMA. He says there is currently little coordination between federal public health agencies, private medical providers, and the private companies that make adult vaccines.
Most adults over 65 have many vaccines paid for by Medicare, Medicaid or private insurers. But for adults under 65, insurance often doesn't cover all types of recommended vaccines. Several bills have been introduced in Congress that would create a national vaccine program to provide free immunizations for uninsured and under-insured adults and streamline the way vaccines are covered by Medicare to cut paperwork. The National Business Group on Health, an employer coalition, is recommending that its members cover all CDC recommended vaccines at 100% and educate employees about the benefits of vaccination.
There are a number of resources to help patients and doctors. The AMA has sent 100,000 free booklets on adult immunizations to doctors' offices to encourage practitioners to inquire about patients' immunizations and to help patients understand the vaccines they need and the diseases they prevent.
The CDC provides a list of vaccination recommendations, updated each year, on its Web site (go to www.cdc.gov and search for "adult immunization schedule"). It also has information about the immunizations Americans need when traveling abroad, which often change as new infectious threats emerge (find the Travelers' Health link at www.cdc.gov).
Among current recommendations: People traveling to European countries, including Austria, Germany and Switzerland, or to Beijing for the Olympics games this summer should consult their doctor about whether they need a measles vaccine. Measles, which is highly contagious, can cause pneumonia, brain inflammation, ear infections, severe diarrhea and death. In addition to longstanding recommendations that travelers to developing countries be vaccinated against hepatitis A and B, and typhoid fever, the CDC is also recommending this summer that travelers to certain destinations consider vaccination against rabies, meningitis, yellow fever and Japanese encephalitis, a mosquito-borne disease that is a growing threat in some Asian countries.
Travelers often don't take into account the time they need to receive all their vaccines in advance of travel, which could take several weeks. Some vaccines, such as for hepatitis A, require multiple doses to be effective.
Many doctors' offices aren't willing or able to stock a wide range of vaccines. The new shingles vaccine, for instance, is relatively costly at about $220 a dose and must be frozen until use. But the growing number of walk-in clinics in drugstores are able to purchase vaccines in bulk and store them in their facilities. Walgreen's Take Care clinics offers most recommended adult vaccinations at its 180 clinics in 14 states, and plans to have more than 400 open by the end of the year. MinuteClinic, a unit of CVS Caremark Corp., operates 516 clinics in 25 states.
Vaccination costs at Take Care and MinuteClinic range from about $30 for a flu shot to $110 for a meningitis vaccine. Minute Clinics hopes to offer the shingles vaccine later this year while Take Care began offering it nationwide last month.
http://online.wsj.com/article/the_informed_patient.html (some sidebars in the article worth looking at)
"According to the Centers for Disease Control and Prevention, only 2.1% of adults aged 18 to 64 are immunized against tetanus, diphtheria and whooping cough, even though since 2006 there has been a combination vaccine that can protect against all three."
2.1% of adults - what's the level for so-called herd immunity again? ;)