Older adults lax about prevention

Three out of four Americans older than 60 don't get a shingles vaccine to protect themselves from the virus' miseries: rashes over the face and body, stinging pain that can last for weeks or months, and the threat of blindness.

Sometimes, people must feel a pound of pain - someone else's - to take a shot of prevention. Physician Robert Wergin tells of one elderly patient with shingles who came to his Milford, Neb., office over the summer. "I'm sorry, doc, I should have listened to your advice to get the shot," the man said. A few weeks later, the man's wife and brother, both in their 60s, visited Wergin, asking for the vaccine.

"It's amazing how once people see the disease up close, getting the vaccine suddenly raises up on their list of priorities," said Wergin, president of the American Academy of Family Physicians.

The shingles vaccine is not the only shot that public health officials are struggling to persuade older Americans to get.

Vaccination rates for children have steadily risen well over 90 percent in the last few years, but the rates for older adults getting flu, pneumonia, tetanus, or shingles shots - the four most-used vaccines among the elderly - have stayed stubbornly flat and trail national goals, according to the latest federal data. That leaves millions of older adults at risk of dying, being hospitalized, or, in the case of shingles, suffering debilitating effects that can last years.

With fall flu vaccination season underway, public health officials say they are disappointed by the trends.

"Progress has been barely visible," physician Bruce Gellin, the nation's top vaccine official, said at a recent briefing in Washington to highlight the problem. It was sponsored by the Alliance for Aging Research.

Here's how the challenge measures up for each vaccine:

One in three seniors each year skips the flu vaccine, recommended annually for everyone older than 6 months. For 30 years through 2007, 3,000 to 49,000 Americans, primarily older adults, died of flu or related illnesses each flu season, according to the latest estimates from the Centers for Disease Control and Prevention.

Four in 10 seniors are not vaccinated for pneumonia. It's recommended once for people 65 and older who have not have it. Pneumonia affects about 900,000 seniors a year.

Nearly half of seniors are not immunized for tetanus. A shot is recommended once every 10 years to prevent a rare but often deadly bacterial condition known as "lockjaw."

The shingles vaccine has the lowest acceptance rate among older adults of these leading preventives - 76 percent had not received it as of 2013, the latest year for which data are available. Of an estimated one million cases each year in the United States, half are among people older than 60. Shingles is caused by a reactivation in the body of the same virus that causes chicken pox. The vaccine, approved in 2006, is recommended once for everyone 60 and older, regardless of whether they had chicken pox. Nearly one in three people in the United States will develop shingles in his or her lifetime.

Vaccines' varying rates of effectiveness are one reason for lagging adult-immunization rates, said Gellin, director of the National Vaccine Program Office of the Health and Human Services Department. Childhood vaccines for measles and polio are nearly 100 percent effective, but shots for flu and pneumonia are not as successful. Last year, for instance, the flu vaccine reduced by only 19 percent a person's chances of a serious flu bout. Still, if a flu shot doesn't prevent flu every time, it often helps ensure a milder case.

Medical experts say adult immunizations' slow growth is linked to other factors, too.

The Affordable Care Act requires private insurers to pay 100 percent for all preventive services, including vaccines. Medicare patients don't get the same deal. Flu and pneumonia shots are free for them because they are covered under Medicare Part B, but vaccinations for shingles and tetanus are covered under Medicare Part D and often require co-payments of $100 or more.

Another challenge is that primary-care physicians often don't store the shingles vaccine in their offices because it has a limited shelf life and because billing private Medicare prescription-drug insurers is complex. Doctors often issue a prescription for the shot, and the patient fills it at a pharmacy or health clinic. That extra step deters some people.

"Money becomes a hurdle for patients and providers," said Reid Blackwelder, a family doctor in Kingsport, Tenn., and chairman of the American Academy of Family Physicians.

Another reason for low adult participation is lack of patient education. "Many adults don't know what vaccines they should have," said Wergin, the Nebraska doctor. One tip: The new tetanus vaccine includes a booster for whooping cough, which helps seniors and protects their grandchildren from illness.

Kaiser Health News is a nonprofit national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.