Variation In Adult Immunization Recommendations and Vaccine Coverage In Countries with Advanced Economies

Background: In developed countries, childhood vaccination schedules and coverage rates are well characterized but relatively less so for adults.

Objectives: To examine variation in adult vaccine recommendations, vaccine coverage, and funding mechanism and availability in countries with advanced economies.

Methods: We executed a cross-sectional survey of 31 selected countries with advanced economies defined by the International Monetary Fund from March-September 2010.  Countries asked to describe adult vaccination recommendations, vaccine coverage estimates, and how recommended adult vaccines are financed for 16 vaccines or antigens.

Results: Of 31 countries contacted, 29 (93.5%) completed the survey.  Twenty-one (67.7%) countries reported having a comprehensive adult immunization schedule.  The most commonly recommended for adults were seasonal influenza (n=31 countries), tetanus and diphtheria (n=27 each), and hepatitis B (n=26).  The least commonly recommended vaccines or antigens for adults were Bacille-Calmette-Guerin (BCG; n=5), human papillomavirus (HPV;n=4), and herpes zoster (n=4).  Most vaccines for adults were recommended for specific risk groups rather than for all adults.  Full or partial public or private funding availability ranged from 26 countries for seasonal influenza, 22 for hepatitis B, and 19 for tetanus and diphtheria, respectively, to 5 for BCG and polio, respectively, 2 for HPV, and 1 for herpes zoster.  The most recently available vaccine coverage estimates for seasonal influenza ranged from 25% in the Czech Republic to 82% in the Netherlands for adults 65 years+; for tetanus ranged from 47% in Canada to 71% in France among all adults; and for hepatitis B ranged from 69% in the U.S. to 100% in the Czech Republic for healthcare workers.

Conclusions:  About one third of countries surveyed do not have a comprehensive adult recommended immunization schedule.   The majority of recommended vaccines for adults are paid through public funding.  The availability of coverage data varies by vaccine, and is generally poorly available except for seasonal influenza.