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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Notice to Readers Assessing Adult Vaccination Status at Age 50 YearsIn January 1994, the National Vaccine Advisory Committee (NVAC) reported on the status of adult vaccination in the United States (1) and concluded that vaccine-preventable infections among adults are a continuing cause of morbidity and mortality, particularly among older persons. Missed opportunities to vaccinate adults during health-care visits have markedly influenced adult vaccination levels (2). To improve vaccination levels, the NVAC recommended changes in clinical practice, including systems for regularly offering vaccines to patients at risk. Consistent with the NVAC recommendations, the American College of Physicians Task Force on Adult Immunization and the Infectious Diseases Society of America have recommended linking the assessment of vaccination status and the administration of vaccinations at age 50 years to other established prevention measures (3). At its meeting on October 19-20, 1994, the Advisory Committee on Immunization Practices (ACIP) adopted the recommendation that, for their patients aged 50 years, health-care providers 1) review adult vaccination status, 2) administer tetanus and diphtheria toxoids as indicated, and 3) determine whether a patient has one or more risk factors that indicate a need to receive one dose of pneumococcal vaccine and begin annual influenza vaccination. This recommendation is consistent with those of other groups that have recommended age 50 years as a time to assess important prevention measures, (e.g., screening for certain cancers that occur more commonly with advancing age or counseling of older women regarding estrogen replacement therapy) (4). Establishing a routine vaccination status assessment at age 50 years provides an opportunity to improve the delivery of vaccination services to adults. ACIP recommends that all primary-care physicians schedule a prevention visit for their patients at age 50 years to assess vaccination status, provide recommended vaccines, and offer other prevention services that may be indicated. In the United States, tetanus is primarily a problem among adults aged greater than 50 years (5) who never completed a primary vaccination series, never received appropriate treatment of a wound that could result in infection with Clostridium tetani, or both (5). Reviewing the need for either primary or booster tetanus toxoid administration at age 50 years would assure high levels of protection at an age when the incidence and the case-fatality rates of tetanus begin to increase. Although diphtheria has virtually disappeared from the United States, the re-emergence of diphtheria in the former Soviet Union (6) has heightened concerns regarding the low prevalence of protective antibody levels among adults in the United States. An age-based recommendation for tetanus and diphtheria toxoids (Td) vaccination should improve the use of Td among adults and decrease the risk for reoccurrence of widespread diphtheria in the United States. Many persons aged 50-64 years have either cardiovascular or pulmonary risk conditions and are, therefore, candidates to receive pneumococcal and influenza vaccines (CDC, unpublished data, 1994) Table_1. The prevalence of these conditions is probably even higher among those who regularly seek medical care. Persons aged greater than or equal to 18 years for whom influenza and pneumococcal vaccines are recommended include all those aged greater than or equal to 65 years, those with chronic disorders of the pulmonary and cardiovascular systems, and those who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunosuppression (including immunosuppression caused by medications) (7,8). In addition, pneumococcal vaccine is recommended for persons with alcoholism, cirrhosis, cerebrospinal fluid leaks, and splenic dysfunction or anatomic asplenia (8). The rapid emergence of drug-resistant pneumococcal infections underscores the need for adherence to ACIP recommendations for pneumococcal vaccination (9). Physicians should review a patient's vaccination status at every visit to identify these conditions in patients and provide the appropriate vaccines whenever indicated. In 1991, 9% and 15% of persons with cardiovascular or pulmonary high-risk conditions, respectively, in the 50-64-year age group reported having ever received pneumococcal vaccine, and 21% and 28%, respectively, reported having received influenza vaccine during the previous year (CDC, unpublished data, 1994;Table_1). In contrast, although still below the national health objective for the year 2000 (60% vaccination levels for these vaccines; objective 20.11) (10), a substantially higher percentage of persons aged greater than or equal to 65 years with these conditions reported receiving these vaccines than did persons aged 50-64 years Table_1. These data indicate that the recommendations to vaccinate persons aged less than 65 years based on the presence of certain chronic medical conditions have been inadequately implemented. A specific age-based standard should improve vaccination rates among those with high-risk conditions. Reported by: Advisory Committee on Immunization Practices. National Immunization Program, CDC. References
Table_1 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 1. Prevalence of high-risk medical conditions and influenza and pneumococcal vaccine coverage -- National Health Interview Survey, United States, 1991 ========================================================= Age group (yrs) ------------------- Conditions 50-64 >=65 --------------------------------------------------------- Cardiovascular Percentage with conditions 36.1 45.2 Percentage with conditions receiving pneumococcal vaccine 9.2 23.0 Percentage with conditions receiving influenza vaccine 21.2 48.2 Pulmonary Percentage with conditions 12.4 12.0 Percentage with conditions receiving pneumococcal vaccine 14.7 33.4 Percentage with conditions receiving influence vaccine 27.8 52.3 ======================================================== Return to top. Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.Page converted: 09/19/98 |
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