Vaccinating through a lifetime: adult priorities.

Vaccination strategies for adults have recently been updated to include newer vaccine products and to reflect the changing epidemiology of vaccine-preventable diseases in adults. New products include vaccines against shingles and the human papillomavirus, and a combination vaccine which contains an acellular pertussis component (Tdap). In some cases, existing vaccines have been re-formulated to provide alternate routes of delivery, as is the case with the influenza vaccine, or more effective formulations, as is the case with the meningococcal vaccine. Vaccine strategies for adults are designed to respond to existing, emerging, or re-emerging infectious diseases in populations at risk. This includes the resurgence of pertussis and recent evidence showing that diabetics are at increased risk for hepatitis B. Unfortunately, large portions of the adult population do not receive recommended vaccinations. As a result, more adults die from vaccine-preventable diseases than die from motor vehicle accidents. Strategies to improve vaccine coverage include public education campaigns and making some vaccines available in nontraditional settings such as retail stores or workplaces. Within health care settings, successful strategies have included the use of standing orders, automatic reminders for physicians using the electronic health record and recall/reminder letters for patients. Appropriate use of adult vaccines plays a key role in prevention of disease and the provision of high-quality care.