Protected or Neglected? A Preventable Disease "Report Card" on Older Adults Shows Few Passing Grades

Children get much better grades than adults over 65 for immunization against vaccine-preventable diseases.

BETHESDA, Md., /PRNewswire/ -- Parents, pediatricians, clinics, state health departments and schools are getting As and Bs when it comes to immunizing the nation's children against vaccine-preventable diseases. Some of these same healthcare providers are earning Cs and sometimes Ds, however, when it comes to caring for the grandparent generation. This is bad news for those over 65, who are by definition more vulnerable to flu and pneumococcal diseases, particularly during the winter months when epidemics are more likely. The two diseases account for 60,000 deaths each year, most of them among the elderly.

According to Centers for Disease Control and Prevention (CDC) reports, the nationwide average for DTP/DT (diphtheria, tetanus and pertussis vaccine/diphtheria and tetanus), polio and measles vaccination exceeded 90 percent among children aged 19-35 months. However, the nationwide averages for adults over 65 were significantly lower, with flu vaccination rates at 65.5 percent and pneumococcal vaccination rates at 45.4 percent.

Gregory A. Poland, M.D., Chairman of the National Coalition for Adult Immunization (NCAI) and head of vaccine research at the Mayo Clinic, gives the U.S. healthcare system "about a C" for adult immunizations. Flu shots have become more common, yet many doctors still neglect to offer pneumococcal vaccines. Hospitals and long-term care facilities, where outbreaks are potentially deadly, have been slow to institute standing orders that mandate routine administration of flu and pneumococcal vaccines.

"Adult immunization could be far more effective if it were an integral part of the nation's public health system, similar to state mandates for childhood immunization," according to Poland. He noted that despite the fact that flu and pneumococcal disease together are the nation's fifth leading cause of death among those 65 and older, the elderly usually don't need proof of vaccinations to get into Senior Center programs, long term care facilities or local Y classes.

"Although most public schools require proof of immunizations before children start kindergarten, there is no comparable requirement for seniors. Maybe it's time we looked at that."

Examples of the disparity between adult and childhood immunization can be found around the country. Childhood immunization rates in New York reached 98 percent for DTP/DT and 85 percent for measles, compared to 38.9 percent of adults aged 65 and older who reported receiving pneumococcal vaccination and 64.5 percent who were given flu shots.(1) Illinois immunizes 95 percent of children against DTP/DT and 80 percent against measles, but only 44.7 percent (pneumococcal) and 67.8 percent (flu) of its adults. Seniors fare about the same in California -- 49.8 percent were immunized against pneumococcal disease and 65.5 percent against the flu -- but fall short compared to childhood rates of 94 percent for DTP/DT and 89 percent for measles. Rates for minority adults are even lower.

The importance of vaccination is further underscored by the declining effectiveness of antibiotics to treat pneumococcal disease. The CDC recommends that pneumococcal vaccine be given to everyone over age 65 and to those two years of age and older with certain underlying medical conditions, including weakened immune systems. Pneumococcal vaccination is usually given only once in a lifetime for those 65 and older. Those who were vaccinated before they were 65 and those who are immunocompromised by underlying medical conditions should be re-vaccinated after five years, according to the CDC. Pneumococcal vaccine is 100 percent reimbursable through Medicare Part B.

The CDC recommends the influenza vaccination annually for all persons 65 and older and all persons in high-risk groups, including those who are immunocompromised; have chronic heart or lung conditions, including asthma; are residents of elder care facilities; and women who will be in the second or third trimester of pregnancy during flu season. The vaccination, which is also 100 percent reimbursable through Medicare Part B, is recommended for healthcare workers and employees of eldercare facilities who have any contact with patients or residents.

The National Coalition for Adult Immunization, headquartered in Bethesda, Maryland, is an umbrella organization of more than 100 medical, voluntary, government and corporate healthcare organizations committed to improving the immunization status of adults.

(1) Sources:

Adults aged 65 and over who reported receiving pneumococcal or influenza vaccine by reporting area: Behavioral Risk Factor Surveillance System (BRFSS), 1997,

CDC Morbidity and Mortality Weekly Report, Oct. 2, 1998, Vol. 47;38,797-802.

Estimated vaccination coverage with individual vaccines among children aged 19-35 months, by state and selected urban area: United States, National Immunization Survey, 1997, CDC MMWR, July 10, 1998, Vol.47;26, 547-554.

National Coalition for Adult Immunization

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