The New York City Department of Health wants to increase the odds of people getting their flu and pneumonia shots by permitting pharmacists, not just doctors, to administer the inoculations. And the public could use the help: results from the Centers for Disease Control's new National Immunization Survey show that adult Americans arise woefully ignorant of the benefits -- and even of the availability -- of many of the vaccines recommended for them.
The consequences of this lack of information are profound, if not widely known: one million cases of shingles (herpes zoster), a painful viral infection which can become chronic and debilitating; 6 million new cases of human papillomavirus infection (HPV), which is the precursor to cervical cancer in women (almost 10,000 cases occur here each year) as well as less lethal but still significant cases of genital warts in both sexes; a whooping cough (pertussis) increase; and of course the old standbys, influenza and pneumococcal pneumonia. DTP booster shots are not being utilized, either -- though this vaccine combination protects against diphtheria, tetanus, and pertussis.
The results of the new survey (reported in today's Journal of the American Medical Association, although first published in the CDC's newsletter a few weeks ago) are cause for concern. The fourteen infectious diseases that the current vaccine schedule protects against are the source of much illness, suffering, and even death among adult Americans.
Over 35,000 of us succumb to influenza each year, yet only about 60% get the vaccine, which is widely available in drugstores and workplaces, not just in doctors' offices. Shingles is caused by a reactivation of long-dormant chickenpox virus -- the varicella-zoster virus -- and can be reduced by about half with the vaccine, recommended for all over the age of sixty. But only 2% of those eligible get it.
The story is much the same for HPV. Only 10% of women aged eighteen to twenty-six -- those most likely to encounter the silent infection, which is almost always sexually transmitted -- have gotten the new HPV vaccine, Gardasil. The current controversy about this vaccine is whether or not also to recommend it to boys, as they are the "vectors" who carry the virus to their partners. However, males are equally susceptible to genital warts induced by HPV -- and new reports indicate they may be more susceptible to oral and throat diseases, including cancer, caused by oral sex and its attendant transmission of HPV.
Even the childhood scourge, measles, occasionally rears its ugly head among adults. Epidemics here are almost always "imported" -- carried in by travelers from abroad. Europe has persistent nests of measles in endemic form -- a recent epidemic in San Diego was introduced by a visitor from Switzerland.
The CDC recommends adult vaccinations against the following: chickenpox/shingles, DPT, hepatitis A and B, HPV, influenza (the "flu"), meningitis, MMR (measles, mumps, rubella), and pneumonia.
The most disconcerting facet of the report is that half of those surveyed could neither name nor recognize any of the vaccines (except for influenza) and that less than half are even concerned about themselves or an adult family member contracting one of these illnesses.
These infections kill more Americans annually, combined, than the toll of HIV/AIDS, breast cancer, or traffic accidents. Almost all such deaths are preventable with these safe vaccines. Public health authorities must make a more concerted effort to educate adults about the benefits of immunizations and the consequences of ignoring them.
Doctors too need to emphasize the importance of getting the recommended vaccines -- often, primary care doctors either don't know about or don't take the time to explain these benefits, and the patients suffer for it.
Gilbert Ross, M.D., is Executive and Medical Director of the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com).
