Massachusetts Medical Society's Physician Focus

August 2012

Adult Vaccinations


  • More than 50,000 U.S. adults die each year from vaccine-preventable diseases and their complications.

  • More than 36,000 people die from seasonal flu complications every year; 90 percent of those are people 65 and older.

  • An estimated 1.25 million people in the U.S. are chronically infected with the hepatitis B virus, which can lead to liver cancer.

  • Nearly one-third of the reported cases of pertussis, or whooping cough, are in adults.

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Vaccines are some of medicine’s best preventive measures and have an extraordinary record of effectiveness and safety in preventing disease. While most children get their recommended immunizations, adult vaccination rates remain low. As a result, more than 50,000 adults in the U.S. die each year from vaccine-preventable diseases.

Why does this happen? As with most health issues, there’s no one, simple answer. Several barriers to higher adult vaccination rates exist, and physicians say lifting those rates will take a concerted effort by both physicians and patients.

“A lot of adult patients don’t associate getting vaccinations with going to the doctor’s office,” said Elisa Choi, M.D., a physician with Harvard Vanguard Medical Associates in Boston who is board certified in both internal medical and infectious diseases. “Vaccinations are not at the top their list when they go to see their physician.”

Dr. Choi and Margaret Sandin, M.D., a board-certified primary care physician with Reservoir Medical Associates and Mount Auburn Hospital in Cambridge, Massachusetts, appeared as guests on the August edition of Physician Focus with the Massachusetts Medical Society with program host Lynda Young, M.D. to discuss the subject of adult vaccinations.

The two physicians, both members of a Massachusetts Medical Society group whose aim is to make vaccinations a priority among adult patients, offered details about why vaccinations are important for adults, why immunization rates are low, what patients and physicians can do to improve them, and specific vaccines that adults should consider getting.

“It’s not just a doctor issue,” said Dr. Sandin. “It’s a systems issue as well. Does the doctor’s office have vaccines available? If not, where can a patient get vaccines? An important part of the system is the patient. We need to make sure that the patient understands what vaccines they may be eligible for as adults.”

The doctors agree that some barriers to adult vaccination do exist - difficulty in getting access to vaccines, little awareness of what immunizations are required or recommended, and, in some cases, cost – but they also believe those obstacles can be overcome.

Many physician offices, particularly smaller ones, for example, may not have the necessary equipment to store the wide variety and large supply of vaccines needed for all patients. Dr. Sandin suggests that local boards of health, pharmacies, and hospitals, where supplies of vaccines may be more readily available, can improve access to such vaccines as those taken to protect against the flu, pneumonia, and shingles.

Awareness must also increase. Adults must be reminded that some childhood vaccinations do not provide lifelong immunity and that some immunizations require a series of shots. They also should seek out the latest information, as physicians note that some patients have misconceptions about vaccines.

Doctors must remind patients, for example, that the seasonal flu vaccine will not give a person the flu, that the annual flu shot provides immunity for only about one year, and that a shot is required each year to maintain immunity because the vaccine is formulated differently each year for different strains of flu. They also need to know that booster shots for such diseases as tetanus or whooping cough are recommended for adults, especially for those who care for children.

Both Dr. Choi and Dr. Sandin are strong advocates for vaccination.

Immunization is one of our most powerful methods of prevention,” says Dr. Sandin. “We need to take a team approach to increase vaccinations, and patients are part of that team. The benefits are not only for the individual, but also for family members, and the general public.”

Dr. Choi echoes that sentiment. “The vaccines we have available to us are really a modern scientific miracle that can prevent illness. We are really fortunate to be living in this era when we can actually prevent life-threatening diseases.”

Watch the accompanying video for more discussion, including conversation on the cancer-preventing HPV (human pappilomavirus) vaccine, hepatitis B immunization and why it is now recommended for patients with diabetes, the importance of pertussis booster shots for adults, the concept of “cocooning” to protect infants and newborns, and ways to keep track of and up-to-date on immunizations.

MMS/Richard Gulla

National Foundation for Infectious Diseases

Centers for Disease Prevention and Control

Immunization Action Coalition

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Adult Vaccinations PSA - 60 seconds

From left:
Lynda Young, M.D., Margaret Sandin, M.D., Elisa Choi, M.D.
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