Adult Vaccines: Fact vs. Fiction

Vaccines are critical components of routine healthcare for adults, providing protection against vaccine-preventable severe illness, disability and death from 15 infectious diseases. But, the Centers for Disease Control and Prevention (CDC) says at least three out of four adults are missing one or more recommended vaccines.¹ According to CDC, approximately 63 percent of adults ages 19 years or older have received a tetanus-containing vaccine in the past 10 years; about 14 percent of adults ages 50 years or older have received at least one dose of recombinant zoster vaccine; and almost 24 percent of at-risk adults ages 19 through 64 years have received a pneumococcal vaccine.² Any lapse in routine vaccination can result in waning community immunity and pose a real risk that previously eradicated viruses could return to the general population.

But many people do not know they need vaccines in adulthood, nor do they know which vaccines are recommended throughout adulthood. Others do not get vaccinated due to conflicting information, misinformation, hesitancy or lack of access. As trusted health experts, healthcare providers can play a critical role in helping adults understand their need to get vaccinated. Research shows most adults believe vaccines are important and that a recommendation from their healthcare provider is a key predictor of whether they get their recommended vaccines.³

To assist healthcare professionals, several medical associations provide information and resources to assist in dispelling any misconceptions adult patients might believe about vaccines. These resources can help to educate their patients about choosing the appropriate vaccines for their circumstances at the correct time in adulthood.

Adults Need Vaccines Too

According to the American Academy of Family Physicians (AAFP), the only medical society devoted solely to primary care, most vaccines recommended by CDC are given to children during routine pediatric visits. However, adults need them too because protection from childhood vaccinations may wane as people age, and adults may need additional vaccines every year.

As the president of AAFP, Tochi Iroku-Malize, MD, MPH, MBA, FAAFP, explains, “Vaccines are safe, effective and save lives. The best way to prevent getting seriously ill, being hospitalized or even dying is to get vaccinated. Immunizations are among the most cost-effective and successful ways to create communities of immunity. Family physicians play an important role in administering vaccines to adults, as well as to help adults overcome vaccine hesitancy and determine a vaccination schedule.”

Annual check-ups are an opportunity to discuss which vaccines adult patients might need; remind patients that family doctors are the best source of health information for patients; and recommend the right vaccines that can protect from illness based on patients’ age, job, travel plans and health risks.⁴

Recommended Adult Immunization Schedule

Every year, CDC publishes the Recommended Adult Immunization Schedule, which outlines recommended adult vaccines, along with when and why adults should get them. As well as yearly influenza vaccines and staying up-to-date on COVID-19 vaccines, CDC’s current recommendations for adults ages 19 years and older includes:⁵

• Tdap (tetanus, diphtheria and pertussis) vaccine once if not received as an adolescent, and then a Td (tetanus, diphtheria) booster every 10 years. Women should also get one Tdap dose each time they are pregnant.
• Hepatitis B vaccine for all adults ages 19 through 59 years, as well as adults ages 60 years or older who have risk factors for hepatitis B infection.
• Herpes zoster (shingles) vaccine for healthy adults ages 50 years and older, as well as adults ages 19 years and older who have weakened immune systems.
• Pneumococcal vaccine for all adults ages 65 years and older, or ages 19 through 64 with certain medical conditions or risk factors.

CDC encourages healthcare providers to talk to their adult patients about which vaccines are recommended for them since these patients might need other vaccines based on age, health conditions, job, lifestyle or travel habits.

Addressing Misconceptions

According to AAFP, there are many misconceptions regarding vaccines, which can lead to some adults not getting their recommended vaccinations. Working hard to rectify the problem, the following are five common misconceptions about vaccines identified by AAFP, followed by the facts:⁶

1) Vaccines don’t work. The fact is, vaccines prevent many diseases that used to make people very sick. Now that people are being vaccinated for those diseases, the diseases are not common anymore. However, for vaccines to work properly, they need to be given at certain times.

2) Vaccines aren’t safe. The fact is, when a vaccine is developed, it goes through a strict and detailed process overseen by the U.S. Food and Drug Administration (FDA). FDA must prove the vaccine is safe before it can be administered to people. CDC and FDA also monitor the vaccine production facilities to make sure vaccines are being produced safely. Each batch of vaccines is checked before it is distributed to the public to make sure it is safe.

3) Vaccines aren’t necessary because natural immunity is better. The fact is, many preventable diseases are dangerous and can cause lasting side effects. It is much safer and easier to get the vaccine instead of contracting the disease. Getting vaccinated also helps people from spreading the disease to people who can’t get vaccinated.

4) Vaccines include a live version of the virus. Although some vaccines contain live versions of the bacteria or virus that cause the disease, the fact is they have been so weakened during the vaccine creation process that they cannot make a person sick. Most vaccines contain a pretend version of the infection that causes the body to produce antibodies to defend itself as if the infection were real. It is this reaction, along with the creation of antibodies in a person’s system, that makes the body immune to the disease.

5) Vaccines have negative side effects. The fact is, severe side effects of vaccines are rare. Minor side effects of vaccines commonly include pain, redness and swelling near the injection site. The benefits of getting vaccines outweigh the possibility of side effects.

Efforts to Boost Vaccine Confidence

To help combat vaccine hesitancy, AAFP is calling upon its members who are passionate about vaccines to emphasize the critical role they play in keeping the community healthy. “Vaccines are one of the best preventive health tools we have,” AAFP maintains. “But vaccine misinformation is a real threat to public health, and with increased patient hesitancy, potentially deadly disease outbreaks will happen.” Therefore, emphasizes AAFP, “More education is needed to improve vaccination rates.”⁷

In November 2021, AAFP collaborated with its vaccine partners to develop materials for family physicians to use at the point of care. These materials are intended to build vaccine confidence, disseminate accurate vaccination information and provide recommendations and guidance on routine vaccination. Recommendations include:

• Vaccinating all age groups, as per CDC’s recommendations, regardless of economic and insurance status;
• Vaccinating patients during routine, annual well-check appointments;
• Educating physicians and healthcare teams about CDC-recommended vaccinations;
• Addressing misinformation and myths about vaccinations; and
• Implementing evidence-based interventions to improve vaccination rates.

Standards for Adult Immunization Practice

To assist family physicians in educating their adult patients on recommended adult vaccines, CDC has prepared standards, fact sheets and initiatives, including “Standards for Adult Immunization Practice,” which emphasizes the role of all healthcare professionals to ensure adult patients are fully immunized. To make immunization a standard of patient care, CDC recommends providers do the following:⁸

1. Assess the immunization status of all patients at every clinical encounter.
2. Strongly recommend vaccines patients need.
3. Administer needed vaccines or refer patients to a vaccination provider.
4. Document vaccines received by patients.

In addition, CDC created a series of six fact sheets for healthcare professionals with information and tips on how to improve vaccination practice, including assessment, recommendation, administration, referral and documentation.

The Let’s RISE Initiative

Further, to help specifically address pandemic-related declines in routine immunizations, CDC launched the Routine Immunization on-Schedule for Everyone campaign, known as the “Let’s RISE” initiative, in January 2023. (RISE is an acronym for routine immunizations on schedule for everyone.) Let’s RISE equips partners and healthcare providers with strategies, resources and data to support getting adults back on schedule with their routine immunizations. “During the COVID-19 pandemic, we saw a concerning drop in routine immunizations for adults,” reports CDC. “Routine vaccination is rebounding, but unevenly, and has not yet recovered among all groups.” CDC recommends healthcare professionals help get adults get back on schedule with their routine immunizations by:⁹

• Prioritizing ensuring everyone catches up on routine vaccination.
• Identifying individuals who are behind on their vaccinations.
• Encouraging vaccination catch-up through reminders, recall and outreach.
• Making strong vaccine recommendations.
• Making vaccines easy for everyone to find and afford.

Changes to the Recommended Adult Immunization Schedule

The American Medical Association (AMA) provides information about immunizations to physicians through a variety of media (e.g., website, webinars, blog and social media). AMA supports the immunization recommendations of the Advisory Council on Immunization Practices (ACIP).

According to Sandra Adamson Fryhofer, MD, AMA board chair, “The AMA encourages all eligible adults to receive their routine vaccinations according to [ACIP’s] latest adult immunization schedule. Making sure you’re up-to-date on your vaccines is vitally important to help protect yourself and your loved ones from vaccine-preventable diseases. As a result of the COVID-19 pandemic, reports show adults are behind on routine vaccinations.”¹⁰

To achieve this, providers must be aware that there are important changes to the 2023 Recommended Adult Immunization Schedule. According to Dr. Fryhofer, the three most important changes are as follows:10

1. The recent case of paralytic polio in New York emphasized the importance of the polio vaccination in childhood and raises questions about the need for polio vaccine boosters.
2. For the first time, the Recommended Adult Immunization Schedule has been approved by the American Pharmacists Association, which validates pharmacists as established partners in vaccine administration.
3. There is a new, shared clinical decision-making option for pneumococcal vaccines.

“We encourage everyone to talk with their physician to ensure they’re up-to-date on their vaccinations,” encourages Dr. Fryhofer.¹⁰

I Raise the Rates Program

The American College of Physicians (ACP), an organization of internal medicine physicians, specializes in the diagnosis, treatment and care of adults. With support from CDC and Sanofi Pasteur, and previous support from GSK, Merck and Pfizer, ACP created the I Raise the Rates program, which is an initiative that provides adult immunization resources and vaccination information to help clinicians increase adult immunization rates in their practices.

As part of the initiative, ACP developed an adult immunization resource hub to assist physicians and their teams to assess, understand and improve adult immunization rates and patient outcomes in their clinical settings. Featured resources available via the hub include:¹¹

• 2023 ACIP Adult Immunization Recommendation Videos
• Practical Immunization Tips: Microlearning Resources
• High Value Care Immunization Referral Toolkit
• Increasing Adult Vaccinations: A Subspecialist’s Perspective

Underscoring the Need for Updated Adult Vaccines

The National Foundation of Infectious Diseases (NFID), a nonprofit organization that educates the public and healthcare professionals about the prevention and treatment of infectious diseases, works to raise awareness about the importance of vaccination across the lifespan, from infancy to adulthood.

NFID says that every year in the United States prior to the COVID-19 pandemic, approximately 50,000 adults died from vaccine-preventable diseases, yet overall vaccination rates remain low. NFID Medical Director William Schaffner, MD, professor of medicine in the division of infectious diseases at Vanderbilt University Medical Center, says vaccines are not just for babies and kids anymore: “Adults are eligible for several vaccines that can prevent a series of serious infections. Doctors and pharmacists can advise their patients and customers about which vaccines are appropriate for them — some vaccines are recommended for all adults and other vaccines are recommended for adults with various occupations or chronic medical conditions.”¹²

Dr. Schaffner says two vaccine examples underscore the importance of recommended adult vaccinations: the pneumococcal vaccine and the shingles vaccine.

Pneumococcal vaccine: “All adults should receive the pneumococcal vaccine when they reach age 65, but those with certain chronic medical conditions are eligible when they are younger.” Pneumonia can be very serious and even deadly. Older adults are more likely to suffer from complications if they have certain chronic health conditions or a weakened immune system.¹³

Shingles vaccine: “The risk of shingles increases as a person ages. To prevent shingles, a vaccine is recommended for all adults starting at age 50.” Shingles causes a painful rash that can be severe. The shingles rash usually develops on one side of the face or body. Before the rash appears, adults can experience pain, itching or tingling in the areas where the rash will develop. The virus can cause nerve pain that can last for weeks or months.¹⁴

Vaccines Remain Important in Adulthood

Dispelling misconceptions about adult vaccines remains important. With help from these medical associations and the resources they offer, healthcare professionals can continue the important work of addressing misconceptions about recommended vaccines and easing fears patients may have about getting them. These efforts will help adult patients get their immunizations back on schedule, which in turn will help return community immunity to the levels that existed before the COVID-19 pandemic erupted.