Earlier this week, I told you about the California Medical Association Foundation's new campaign focused on adult vaccinations. The campaign – called Community Immunity – is intended to raise low vaccination rates among adults.
How low are we talking about?
Everyone over 19 years old should get a tetanus booster shot every 10 years. But in 2013, fewer than two in three adults ages 19 to 64 had done so, according to a February report from the Centers for Disease Control and Prevention. The numbers are even worse for the herpes zoster shot, which prevents shingles and is recommended for all adults over age 60. Less than one in four adults in that age group had received the shot in 2013, according to the CDC.
I reached out to several Los Angeles-area doctors to find out why adult vaccination rates are so low. I also asked them for more information about which vaccinations adults should definitely get.
Get these shots
As part of its campaign, the CMA Foundation is distributing this adult vaccination schedule to thousands of doctors and patient advocates.
Now, let's break that down a little more.
Dr. Sharon Orrange, an assistant professor of medicine at the Keck School of Medicine of USC, says beyond the flu shot – which she recommends for virtually every adult, every year – there are four types of vaccines that adults should have:
- The two vaccines, known as PCV13 and PPSV23, which prevent different strains of pneumococcal disease. All adults need these at age 65. Keep in mind: They can't be given at the same time.
- The herpes zoster vaccine, which prevents shingles. One dose of this vaccine is recommended for all adults over age 60.
- One tetanus booster every 10 years. One of those boosters should be the Tdap shot, which protects against tetanus, diphtheria and pertussis, also known as whooping cough. This is recommended for all adults, even those who've had pertussis.
- The hepatitis A shot, for those who are traveling abroad.
There are a couple of vaccines that are targeted toward specific groups of people, Orrange says:
- The human papilloma virus – or HPV – vaccine is recommended for young men up to age 21 and young women up to age 26. It protects against genital warts and several types of cancer, including cervical cancer. The vaccines are given as a series of three shots over six months.
- The meningococcal vaccine, which prevents meningitis, is recommended for teenagers, first-year college students living in dormitories and military recruits. After age 21, it's mainly recommended for sexually active gay men.
Barriers to boosters
A February report from the Centers for Disease Control and Prevention finds that adult vaccination coverage remains low for most routinely recommended vaccines.
Doctors are partially to blame for those low rates, says Dr. Oliver Brooks, the associate medical director of the Watts Healthcare Corporation and chairman of the Immunize LA Families coalition.
Brooks says doctors and families are focused on vaccinating children, but "the physician community, to a degree, is not quite as focused on vaccinating adults."
When it comes to treating adults, he says, doctors are more focused on preventing chronic conditions and caring for illness. But, he says, vaccination must be part of that mix, too.
Getting vaccinated as an adult can be a bit of a headache - albeit a necessary one, admits Dr. Daniel Vigil, a physician with UCLA's Department of Family Medicine.
"It takes time, money, effort, parking, co-pays – the things that interfere with real life," Vigil says.
All of that, he says, just to prevent a disease that you haven't yet contracted: "You may never get shingles, you may never get pneumonia, so it's not in the forefront of people's minds to prioritize this," he says.
On top of that, Vigil says, some vaccinations require multiple doses, and that requires scheduling multiple trips to the doctor. And then there's the whole issue of cost.
The price of prevention
Some of the recommended vaccinations – like the shingles shot – are not covered by all insurance companies, and can therefore carry a hefty price tag, the doctors told me.
A spokeswoman for the California Association of Health Plans says the five health plans with the largest enrollment in the state all confirmed that they covered the shingles vaccine, per the CDC guidelines. She expects other health plans follow the guidelines as well.
Dr. Vigil describes a common scene in his office: "I've given this big advocacy speech for why they should get the shot, only to find out later that it’s $60 or $80, or a couple of hundred dollars sometimes and not covered by insurance," he says. "That sort of puts a damper on the whole conversation."
Dr. Orrange faces this roadblock, too. She even sees it with Medicare recipients: Most, but not all, Medicare Part D plans cover the shingles vaccine itself, but not the charge to administer it, she says.
Her advice? "People should find out first if it's covered by their plan," Orrange writes via e-mail. If not, she says, "remember that receiving [the shingles shot] at a pharmacy instead of your doctor's office may be the way to go."
Still worth it
So, given all of those barriers, why should adults ensure they're fully vaccinated?
Dr. Vigil says he often convinces adults to get their shots by framing it as a contribution to overall public health. He tells patients: "We adults are walking around, not fully immunized, and we pose a risk to those who are at risk for these infections, and those folks who are at risk are typically the very young, the very old, and those who are not very healthy."
Dr. Orrange says this message really resonates with a certain group of people.
"I call those people the new grandparents," she says. "They're the ones who come into my office and ask, 'what do I need before I see my grandkids?'"
In case you're in that group, the answer, she says, is the Tdap booster and the flu shot.
What questions do you have about adult vaccinations? Let me know in the comments section below or e-mail me at Impatient@scpr.org.
This post has been updated.