Don't Ask, Don't Tell: a Telephone Survey Promoting Adult Immunizations for Travelers

Background:
In 2002 the Advisory Committee on Immunization Practices (ACIP) published the first recommended vaccine schedule for adults. Although the recommendations are reviewed annually adults are not being vaccinated. Studies indicate that adult immunization rates are substantially lower than childhood vaccine coverage levels. Nearly 99% of vaccine-preventable diseases occur in adults and are associated with high morbidity and mortality rates. Many adults are not aware that the need for immunizations continues into adulthood. Most equate immunizations with travel, school, or employment requirements. The aforementioned reasons served as a catalyst to develop a survey and educate adults inquiring about travel vaccine recommendations.

Objectives:
To promote recommended adult immunizations by educating prospective travelers on the importance of vaccination and being protected against vaccine-preventable diseases.

Methods:
Los Angeles County Immunization Program (LACIP) nurses surveyed prospective travelers aged > 19 years to assess: knowledge base of adult immunizations; adult vaccination history; if healthcare providers discussed immunizations during visit; and barriers to adult/travel immunizations. Nurses provided education on the current recommended adult immunization schedule to all callers.

Results:
Fifty-five participants were interviewed for this survey. The results indicated that although 64% (35) of adults were aware of the recommended adult immunizations, a majority 86% (47) stated their physician did not discuss their immunization status during their last healthcare visit. Seventy-eight percent (43) did not know their adult vaccination history and were unsure if they were up-to-date. The most commonly missed vaccines were MMR (86%), Hepatitis A (89%) & B (73%), Td/Tdap (76%), and Flu (56%). The only barrier identified to receiving adult immunizations was cost (45%).

Conclusions:
Lack of education from health care providers and lack of routine adult vaccination screening contribute to low adult immunization rates. Providers should be encouraged to advocate for federally funded vaccine programs to increase adult immunization rates.