NHIS 2009 Adult Vaccination Coverage

The National Health Interview Survey (NHIS)

At a Glance

Vaccination is required throughout the lifespan to minimize the risk of morbidity and mortality from vaccine-preventable diseases. Vaccination for adults can protect against illness, lost days from work, or impacts on activities of living as well as hospitalization or death. This report describes vaccination coverage levels for adults age 19 years and older using the 2009 National Health Interview Survey (NHIS) data and includes comparison to vaccination coverage in 2008 for pneumococcal disease, tetanus with and without pertussis, hepatitis A, hepatitis B, herpes zoster (shingles), and human papillomavirus (HPV) by selected characteristics (age, vaccination target group status, and race/ethnicity). This report also contains influenza vaccination coverage for the 2008-09 season compared to the 2007-08 season.

For assistance or answers to questions about the analysis of the data, please contact "vaccination coverage assistance".

 

Key Findings

• In 2009, adult vaccination coverage for influenza (2008-09 season), pneumococcal disease, and hepatitis was lower than the Healthy People 2010 targets (1), (2). However, overall 2008-2009 seasonal influenza vaccination coverage did improve compared to 2007-2008. (Tables 1, 2, 3 [3 pages]*) (compliant)
• Hepatitis B vaccination coverage increased in 2009 from 2008 among adults age 19-49 years at high risk for infection, particularly among non-Hispanic blacks. There were no differences in hepatitis B vaccination coverage between non-Hispanic whites and blacks. (Table 2 [3 pages]*)
• Vaccination coverage with two new vaccines primarily recommended to minimize long term complications of infectious diseases, herpes zoster (shingles), and infection with human papillomavirus (HPV), was low but increased by 3.3 and 6.6 percentage points, respectively. (Table 2 [3 pages]*)

Select Adult Vaccination Coverage Levels

Influenza Vaccination

Estimated 2008-09 season influenza vaccination coverage was 33.4% for adults age 19-49 years at high risk for influenza-related complications, 40.1% for adults age 50-64 years, and 65.6% for adults age 65 years and older. Vaccination coverage for persons at high risk for influenza-related complications was higher than for persons in the same age group without high risk conditions (19-49 years: 33.4% vs. 19.7%; 50-64 years: 51.5% vs. 34.2%). Rates by ethnicity/race for adults age 65 years and older were highest for non-Hispanic white older adults (68.6%), lower for non-Hispanic black older adults (50.8%), and slightly lower for Hispanics older adults (50.6%).

The largest gains in influenza vaccination coverage from the 2007-08 to 2008-09 seasons were seen among health care personnel (HCP) with an increase of 7.1 percentage points. (Tables 1, 3 [3 pages]*)

Pneumococcal Vaccination

Pneumococcal vaccination coverage among high-risk adults age 19-64 years was 17.5%, a decrease of 7.4 percentage points from 2008. It is likely that the decreased vaccination coverage was due to expanding the high risk category to include persons with asthma and current smokers in accordance with the updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for prevention of invasive pneumococcal disease (3). Pneumococcal vaccination coverage among adults 65 years and older was stable at 60.6%, with non-Hispanic white older adults (64.9%) more likely to be vaccinated than non-Hispanic black older adults (44.8%) and Hispanic older adults (40.1%). (Table 2 [3 pages]*)

Tetanus Vaccination, With or Without Pertussis

The proportion of adults in 2009 receiving tetanus vaccination during the past 10 years showed a similar stable pattern compared to 2008 across all adult age groups with minimal change. For adults age 19-49 years, coverage among non-Hispanic whites was higher (68.3%) compared to non-Hispanic blacks (56.5%) and Hispanics (53.8%). In 2005, the ACIP recommended that the newly licensed Tdap vaccine replace a single decennial dose of tetanus diphtheria (Td) vaccine for persons age 10-64 years (4). Of adults age 19-64 years who received a tetanus vaccine since 2005 and knew whether they received a tetanus vaccine containing a pertussis component, only 50.8% reported receiving Tdap. There were no significant racial or ethnic differences among non-Hispanic white (50,9%), non-Hispanic black (53.7%), or Hispanic (48.7%) respondents. Tdap prevalence of total tetanus vaccinations received from 2005-2009 among adults was higher for health care personnel (HCP) (58.3%) than among adults age 19-64 years (50.8%). (Tables 2, 3 [3 pages]*)

Hepatitis A vaccination

Hepatitis A vaccination coverage among adults age 19-49 years was low overall (9.8%) but slightly higher (15.0% versus 7.1%) among travelers outside of the United States to countries other than Europe, Japan, Australia, New Zealand, or Canada since 1995. (Table 2 [3 pages]*)

Hepatitis B vaccination

Hepatitis B vaccination coverage increased from 2008 to 2009, especially among adults age 19-49 years at high risk for infection. The largest gain (13.6 percentage points) was seen for non-Hispanic black adults. With this large increase in coverage among non-Hispanic blacks, hepatitis B vaccination coverage in 2009 was similar between non-Hispanic whites (43.2%) and non-Hispanic blacks (43.6%). The estimate for Hispanics was 36.7%. Overall coverage among HCP was 64.7%, but coverage for non-Hispanic black HCP increased 10.4 percentage points to 65.5%, compared to 65.4% for non-Hispanic white HCP and 55.5% for Hispanic HCP. (Tables 2, 3 [3 pages]*)

Herpes zoster vaccination

Varicella zoster virus (VZV) causes two distinct clinical conditions. Primary infection causes varicella, also known as the chickenpox, a contagious rash illness that typically occurs among children. The virus can reactivate decades later to cause herpes zoster, also known as herpes zoster (shingles), a localized and generally painful skin eruption that occurs most frequently among older adults. A common complication of shingles is chronic, often debilitating, pain that can last months or even years. Herpes zoster vaccination is recommended for all persons age 60 years and older who have no contraindications, including persons who report a previous episode of shingles. Persons with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication (4), (5) . In 2009, only 10.0% of adults age 60 years and older reported receiving shingles vaccination, a slight increase from 6.7% reported in 2008. (Table 2 [3 pages]*)

Human Papillomavirus (HPV) vaccination

Genital HPV is a common sexually transmitted infection in the United States and two HPV types cause the majority of cervical cancers in women. HPV vaccine was licensed in the United States in 2006. Vaccination with a three dose series is universally recommended for adolescent females age 11 or 12 years. Catch-up vaccination is recommended for females age 13-26 years who have not been previously vaccinated (6). In 2009, only 17.1% of women age 19-26 years had received at least one dose of HPV vaccination, although this was an increase from 10.5% reported for 2008. Significant increases of 6 to 7 percentage points were observed among all racial/ethnic groups. (Table 2 [3 pages]*)

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Summary

In 2009, most adult vaccination coverage levels continued to improve but were lower than optimal vaccination levels seen among children (7). However, overall 2008-2009 seasonal influenza vaccination coverage did improve compared to 2007-2008. Vaccination coverage levels for influenza, pneumococcal disease, and hepaitits B were lower than the Healthy People 2010 targets (1), (2). Vaccination coverage for Tdap was low, especially among health care personnel (HCP). HCP are at increased risk for acquiring pertussis which can be transmitted to susceptible contacts (4).

There were improvements in select adult vaccination coverage levels. Hepatitis B vaccination coverage increased in 2009 from 2008 among adults age 19-49 years at high risk for infection. There were no differences in hepatitis B vaccination coverage between non-Hispanic white adults and non-Hispanic black adults. Vaccination coverage with two new vaccines primarily recommended to minimize long term complications of infectious diseases, herpes zoster (shingles) and infection with human papillomavirus, was low but increased by 3.3 and 6.6 percentage points, respectively. Although strides have been made to protect adults from vaccine-preventable diseases, with a larger number of vaccines licensed and recommended for use continued improvement in adult vaccination coverage levels is needed (8).

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Data Source and Methods

The National Health Interview Survey (NHIS) collects information about the health and health care of the noninstitutionalized, civilian population in the United States and is designed to produce nationally representative samples. Interviews are conducted in respondents' homes continuously throughout the year by interviewers of the U. S. Census Bureau for the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS). This analysis uses weights to produce national estimates. Data weighting procedures are described in more detail elsewhere (9). Point estimates and estimates of corresponding variances for this analysis were calculated using the SUDAAN software package (10) to account for the complex sample design of the NHIS. Questions about receipt of recommended adult vaccinations are asked of a randomly selected adult within the household. Inclusion and development of the vaccination questions on the NHIS was supported, in part, by CDC's National Center for Immunization and Respiratory Diseases (NCIRD) and for HPV, the National Institutes of Health's (NIH) National Cancer Institute (NCI).

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Authors

Stacie M. Greby, Peng-Jun Lu, Gary Euler, Walter W. Williams, and James A. Singleton are with CDC's National Center for Immunization and Respiratory Diseases, Immunization Services Division.

References

1. Healthy People 2010, accessed 10/03/2010.
2. Healthy People 2010 Midcourse Review, accessed 10/15/2010.
3. Centers for Disease Control and Prevention. Updated Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23). MMWR 2010;59:1102-1106, accessed 11/10/2010.
4. Centers for Disease Control and Prevention. Preventing Tetanus, Diphtheria, and Pertussis Among Adults: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine. MMWR 2006;56(No. RR-17):1-33, accessed 11/1/2010.
5. Centers for Disease Control and Prevention. Prevention of Herpes Zoster: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 2008: 57(RR-5); 1-30, accessed 11/1/2010.
6. Centers for Disease Control and Prevention. Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). 2007;56(RR-2):1-24, accessed 11/1/2010.
7. Centers for Disease Control and Prevention. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2009. MMWR 2010;59:1171-1177.
8. Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP), Recommended Adult Immunization Schedule United States – 2010, accessed 10/03/2010.
9. Centers for Disease Control and Prevention. NHIS Methods, accessed 11/03/2010.
10. Research Triangle Institute. SUDAAN (Release 9.1). Research Triangle Park, NC: Research Triangle Institute. 2004.

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* NOTE: All tables are in one Excel spreadsheet file. Use the TABS at the bottom of the Excel window to move from table to table.

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