How many elderly adults are immunized to help prevent influenza and pneumonia?

Among community-dwelling elderly adults, only about two-thirds (65% to 66%) has been getting a flu shot in recent years. A flu vaccine shortage reduced this rate to 60 percent in 2005. Only a little more than one-half has ever received a pneumococcal vaccination (56% in 2005). Among the states in 2005, influenza vaccination rates ranged from 53 to 78 percent and pneumococcal vaccination rates ranged from 52 to 72 percent of this group.

Percentage of Community-Dwelling Adults Ages 65 and Older Who Received Recommended Vaccinations, 1989–2004

Why is this important?

• Influenza and pneumonia are the fifth-leading cause of death among elderly adults ages 65 and older in the United States (NCHS 2005b). Complications from influenza lead to 32,000 deaths among seniors annually (Thompson et al. 2003). Severe pneumococcal infections (bacteremia and meningitis) account for 3,400 deaths each year within this age group (Robinson et al. 2001).
• Public health experts recommend annual influenza vaccination and a one-time pneumococcal vaccination for the elderly, which can prevent many hospitalizations and premature deaths (ACIP 1997; Harper et al. 2005).

Findings

Nationally, among community-dwelling elderly adults ages 65 and older:

• the proportion who received a flu shot in the past year more than doubled from 31 percent in 1989 to 65 percent in 2004, but decreased to 60 percent in 2005 during a vaccine shortage;
• the proportion who ever received the pneumococcal vaccination quadrupled from 14 percent in 1989 to 56 percent in 2005.

There has been no increase in these vaccination rates since 2002 (NCHS 2004, 2006).

Among the states in 2005:

• influenza vaccination rates ranged from 53 percent in Nevada to 78 percent in Minnesota;
• pneumococcal vaccination rates ranged from almost 52 percent in the District of Columbia to almost 72 percent in North Dakota (NCCD 2006).

From 2004 to 2005, rates of influenza vaccination decreased significantly in 16 states (from 3 to almost 10 percentage points). Rates of pneumococcal vaccination increased significantly in three states (from 4 to 6 percentage points) and decreased significantly (by 5 percentage points) in one state (CDC 2006).

Implications

The nation remains far from the Healthy People 2010 goal of 90 percent coverage for these vaccines. Common reasons that seniors give for not getting vaccinated include not knowing the vaccines are needed, fearing that the vaccine will cause infection or side effects, not believing that the vaccine will be effective, and forgetting about it (CDC 1999, 2004). A delay in flu vaccine supply during the 2000–2001 flu season and a shortage of flu vaccine during the 2004–2005 flu season highlight the need to improve vaccine production and timeliness (GAO 2004).

Improvement Ideas and Resources

A meta-analysis of research studies found that "organizational changes that make identification and delivery of [preventive] services a routine part of patient care" were the most effective interventions for increasing adult preventive care (Stone et al. 2002). For example, standing orders programs that authorize nurses and pharmacists to administer vaccines according to a physician-approved protocol have been shown to be effective (CDC 2003; Goebel et al. 2005). Education, reminders, and financial incentives also were generally effective.The federal Medicare program has paid for pneumococcal vaccination of Medicare beneficiaries since 1981 and for influenza vaccination since 1993 (GAO 2002). The Centers for Disease Control and Prevention reports that it is "working with manufacturers and distributors to improve the availability, timeliness, and completeness of a vaccine-supply tracking system first initiated during the 2004–2005 influenza season" (CDC 2006).

Measure:

The denominator includes civilian, noninstitutionalized elderly adults ages 65 years and older. The numerators include those in the denominator who reported that they had received an influenza vaccination in the past year, and the proportion who reported that they had ever received a pneumococcal vaccination. Receipt of the nasal spray flu vaccination was counted in the flu vaccination rate starting in 2005. These vaccinations are recommended by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP 1997; Harper et al. 2005). National rates were age-adjusted to the 2000 U.S. standard population.

Limitations:

Self-reported data are subject to potential recall bias; the validity of self-reported vaccination status is better for influenza than for pneumococcal vaccination (MacDonald et al. 1999). Each annual influenza vaccination rate spans two different flu seasons. Vaccination rates reported in telephonic state surveys are somewhat higher than reported in the national personal interview surveys (CDC 2006).

Source:

National rates were compiled by the National Center for Health Statistics (NCHS 2004 for years 1989 to 1995 and NCHS 2006 for years 1997 to 2005) using data from the National Health Interview Survey, a nationally representative household survey of the civilian, noninstitutionalized population of the United States. State rates were compiled by the National Center for Chronic Disease Prevention and Health Promotion (NCCD 2006) using data from the Behavioral Risk Factor Surveillance System, a telephone survey that is representative of the civilian, noninstitutionalized adult population in each state.

References:

* Indicates source of data used in the chart(s).ACIP (Advisory Committee on Immunization Practices). 1997. Prevention of Pneumococcal Disease: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recommendations and Reports 46(RR-8): 1–24. CDC (Centers for Disease Control and Prevention). 1999. Reasons Reported by Medicare Beneficiaries for Not Receiving Influenza and Pneumococcal Vaccinations—United States, 1996. Morbidity and Mortality Weekly Report 48(39): 886–90. CDC (Centers for Disease Control and Prevention). 2003. Facilitating Influenza and Pneumococcal Vaccination Through Standing Orders Programs. Morbidity and Mortality Weekly Report 52(4): 68–9. CDC (Centers for Disease Control and Prevention). 2004. Influenza Vaccination and Self-Reported Reasons for Not Receiving Influenza Vaccination Among Medicare Beneficiaries Aged > or =65 Years—United States, 1991–2002. Morbidity and Mortality Weekly Report 53(43): 1012–5. CDC (Centers for Disease Control and Prevention). 2006. Influenza and Pneumococcal Vaccination Coverage Among Persons Aged =>65 Years—United States, 2004–2005. Morbidity and Mortality Weekly Report 55(39): 1065–8. GAO (Government Accountability Office). 2002. Medicare Beneficiary Use of Clinical Preventive Services. GAO-02-422. Washington, D.C.: Government Accountability Office. GAO (Government Accountability Office). 2004. Flu Vaccine: Recent Supply Shortages Underscore Ongoing Challenges. GAO-05-177T. Washington, D.C.: Government Accountability Office. Goebel, L. J., S. M. Neitch, and M. A. Mufson. 2005. Standing Orders in an Ambulatory Setting Increases Influenza Vaccine Usage in Older People. Journal of the American Geriatrics Society 53 (6): 1008–10. Harper, S. A., K. Fukuda, T. M. Uyeki et al. 2005. Prevention and Control of Influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendations and Reports 54 (RR-8): 1–40. Mac Donald, R., L. Baken, A. Nelson et al. 1999. Validation of Self-Report of Influenza and Pneumococcal Vaccination Status in Elderly Outpatients. American Journal of Preventive Medicine 16(3): 173–7. * NCCD (National Center for Chronic Disease Prevention and Health Promotion). 2006. Behavioral Risk Factor Surveillance System. Atlanta, Ga.: Centers for Disease Control and Prevention. * NCHS (National Center for Health Statistics). 2004. Health, United States, 2004. Hyattsville, Md.: Centers for Disease Control and Prevention. * NCHS (National Center for Health Statistics). 2006. Early Release of Selected Estimates Based on Data from the 2005 National Health Interview Survey. Hyattsville, Md.: Centers for Disease Control and Prevention. NCHS (National Center for Health Statistics). 2005b. Health United States, 2005. Hyattsville, Md.: Centers for Disease Control and Prevention. Robinson, K. A., W. Baughman, G. Rothrock et al. 2001. Epidemiology of Invasive Streptococcus Pneumoniae Infections in the United States, 1995–1998: Opportunities for Prevention in the Conjugate Vaccine Era. Journal of the American Medical Association 285 (13): 1729–35. Stone, E. G., S. C. Morton, M. E. Hulscher et al. 2002. Interventions that Increase Use of Adult Immunization and Cancer Screening Services: A Meta-Analysis. Annals of Internal Medicine 136 (9): 641–51. Thompson, W. W., D. K. Shay, E. Weintraub et al. 2003. Mortality Associated with Influenza and Respiratory Syncytial Virus in the United States. Journal of the American Medical Association 289 (2): 179–86.