Had a tetanus shot lately? Most adults missing key vaccinations

Millions of American adults are not getting routinely recommended vaccinations each year, resulting in 40,000 to 50,000 preventable deaths, according to public-health experts.

The experts point to major gaps in insurance coverage and a lack of health-care providers prepared to administer vaccines as key reasons behind the problem.

Even when a recommended vaccination is covered by insurance, as is the case for senior citizens covered by Medicare, the researchers noted in a report that nearly a third of adults 65 and older had not been immunized against pneumonia as of 2008.

More than 30 percent of older adults had not gotten the shot in 36 states and the District of Columbia, where 45.6 percent of seniors were unvaccinated. Even in the state with the highest pneumonia-vaccination rate, Oregon, 26.8 percent were not immunized.

The vaccine is particularly important to seniors because it protects against a variety of bacterial infections that can attack the lungs should they come down with the flu. Immunity provided by the shot is thought to be strong enough that most seniors only need one dose.

Ideally, experts encourage health workers to check whether seniors have gotten the pneumonia shot each year as they get a flu shot. But that often doesn't happen because seniors get the shots at community clinics or pharmacies that don't ask about the other vaccine and don't offer it.

Dr. William Schaffner, an immunization specialist at Vanderbilt University who helped write the report, said the United States is much better at vaccinating children because shots are a routine part of pediatric care required by schools and well-covered through government programs and private insurance.

"We need a national strategy to make adult vaccines a regular part of medical care and to educate Americans about the effectiveness and safety of vaccines,'' added Jeffrey Levi, executive director of the Trust for America's Health, a nonprofit group that advocates for disease prevention. It sponsored the report along with the Infectious Diseases Society of America and the Robert Wood Johnson Foundation.

The report also noted that besides low rates for the pneumonia shot, only about 2 percent of eligible adults are up to date on tetanus, diphtheria and whooping-cough shots, and only 36 percent get a seasonal-flu shot.

Schaffner said immunization of adults faces many barriers, including lack of insurance or insurance coverage for shots and a piecemeal system of care for many adults - no regular doctor, infrequent visits, medical records that fail to track vaccination - and a failure of many doctors to make it a priority.

"It's a mental, conceptual thing - many adult providers simply are not used to giving shots - and many of them don't want to make the investment in buying, storing and administering vaccines,'' Schaffner said.