Every year millions of adults get sick from diseases they would not have gotten had they been up to date on their vaccines. And it's not just the flu.

For over a decade most of us have heard only two types of vaccine talk: anti-vaxxers making a lot of scientifically-uninformed noise about the dangers of immunization, and a general advisory to get an annual flu shot.

A message that has not been widely voiced is that adults should be—but aren't—keeping their vaccination schedule current. And right now the Centers for Disease Control (CDC) is trying to get the word out with its Adult Immunization Schedule.

It's not just right now, actually: every year the CDC's Advisory Committee on Immunization Practices (ACIP) approves immunization schedules for all U.S. residents, including "recommendations on the use of licensed vaccines routinely recommended for adults aged 19 years or older," a list approved by the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives.

In addition to the annual flu vaccine, the schedule lists seven vaccinations that all persons should receive at least one dose of during adulthood: tetanus, diphtheria, and pertussis (Tdap); measles, mumps, and rubella (MMR); human papillomavirus (HPV); chicken pox; shingles; and two different types of pneumonia.

Some of the vaccinations are age-specific. HPV vaccination, for example, is suggested only for individuals aged 19 to 26, while the pneumococcal vaccines are only for persons 65 or older. For several of the vaccines, only one dose is required during the adult's lifetime, while in most other cases three is the maximum. The exception is immunization against tetanus and diphtheria, which the CDC recommends getting once every 10 years.

Five other vaccines, such as ones against hepatitis A and B, are suggested only for adults with specific medical conditions. There are also conditions that contraindicate specific immunizations. Pregnant women, for example, are advised against receiving chicken pox and MMR vaccinations.

In February 2015, the CDC sounded an alarm about the low levels of adult vaccination coverage, noting that none of the recommended immunizations had been received by as many as two-thirds of American adults, while others had a penetration rate of less than 15%. "Improvement in adult vaccination is needed to reduce the health consequences of vaccine-preventable diseases among adults," said the report's authors. "[…] Routine assessment of adult patient vaccination needs, recommendation, and offer of needed vaccinations for adults should be incorporated into routine clinical care of adults."

The toll of vaccine-preventable diseases among the adult population is significant. A few estimates from the CDC:

• 900,000 cases of pneumonia every year, leading to as many as 400,000 hospitalizations and 19,000 deaths
• 700,000 to 1.4 million people suffer from chronic hepatitis B, with complications such as liver cancer.
• 27,000 HPV-caused cancers per year
• 1 million cases of shingles annually

In 2015, a team of researchers attempted to assess the economic cost of vaccine-preventable diseases (VPDs). Using 2013 as a model, they concluded that the annual cost to the U.S. for VPDs (not including the flu) in adults aged 50 and older is approximately $10 billion.

While a host of factors relate to why the adult population is so under-immunized, an extensive study published in 2014 in the Annals of Internal Medicine found financial barriers to be the most prominent contributors, ranging from medical providers not having all of the recommended vaccines in stock to patients not having sufficient insurance coverage.

According to Litjen Tan, the American Medical Association's director of medicine and public health, the Affordable Care Act (more commonly known as Obamacare) removed some of these barriers for both patients and healthcare providers. But with Donald Trump and his Republican Congress making the repeal of Obamacare one of their top priorities, those improvements may be lost.

Whatever the nation's medical insurance landscape looks like in the future, Tan's words should be heeded: "Until the establishment of a national adult immunization program that provides vaccines for uninsured adults, this burden of adult vaccine-preventable disease will remain one of the more important issues facing public health."

______________________________________________________________________________________________________________________________________

About the Author:

Except for a four-month sojourn in Comoros (a small island nation near the northwest of Madagascar), Greggory Moore has lived his entire life in Southern California.  Currently he resides in Long Beach, CA, where he engages in a variety of activities, including playing in the band MOVE, performing as a member of RIOTstage, and, of course, writing. 

His work has appeared in the Los Angeles Times, OC Weekly, Daily Kos, the Long Beach Post, Random Lengths News, The District Weekly, GreaterLongBeach.com, and a variety of academic and literary journals.  HIs first novel, The Use of Regret, was published in 2011, and he is currently at work on his follow-up.  For more information:  greggorymoore.com