Public health and aging: influenza vaccination coverage among adults aged > or =50 years and pneumococcal vaccination coverage among adults aged > or =65 years--United States, 2002

Vaccination of persons at risk for complications from influenza and pneumococcal disease is a key public health strategy in preventing morbidity and mortality in the United States. During the 1990-1999 influenza seasons, approximately 36,000 deaths were attributed annually to influenza infection, with approximately 90% of deaths occurring among adults aged > or =65 years. In 1998, an estimated 3,400 adults aged > or =65 years died as a result of invasive pneumococcal disease. One of the national health objectives for 2010 is to achieve 90% coverage of noninstitutionalized adults aged > or =65 years for both influenza and pneumococcal vaccinations (objective no. 14.29). In 2000, the Advisory Committee on Immunization Practices (ACIP) broadened the universal recommendations for influenza vaccination to include adults aged 50-64 years in addition to adults aged > or =65 years. To assess progress toward achieving the 2010 national health objective and implementing the ACIP recommendations, CDC analyzed data from the 2002 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate that influenza and pneumococcal vaccination levels among adults aged > or =65 years and influenza vaccination levels among adults aged 50-64 years varied widely among states/areas and racial/ethnic populations. Innovative approaches are needed to increase vaccination coverage, particularly among certain populations.     

Influenza and pneumococcal vaccination coverage among persons aged > or = 65 years--United States, 2004-2005

Vaccination of persons at increased risk for complications from influenza and pneumococcal disease is a key public health strategy in the United States. During the 1990-1999 influenza seasons, approximately 36,000 deaths were attributed annually to influenza infection, with approximately 90% of deaths occurring among adults aged > or = 65 years. In 1998, an estimated 3,400 adults aged > or = 65 years died as a result of invasive pneumococcal disease. One of the Healthy People 2010 objectives is to achieve 90% coverage of noninstitutionalized adults aged > or = 65 years for both influenza and pneumococcal vaccinations (objective 14-29). To assess progress toward this goal, this report examines vaccination coverage for persons interviewed in the 2004 and 2005 Behavioral Risk Factor Surveillance System (BRFSS) surveys. The 2004-05 influenza season was characterized by an influenza vaccine shortage. As a result, the Advisory Committee on Immunization Practices (ACIP) issued recommendations that influenza vaccine be reserved for persons in priority groups, including persons aged > or = 65 years, and that others should defer vaccination until supply was sufficient. The results of this assessment indicated that, overall, influenza vaccination coverage was lower in the 2005 survey year than in 2004, whereas pneumococcal vaccination coverage was nearly unchanged from 2004 to 2005. In both years, influenza and pneumococcal vaccination coverage varied from state to state. Continued measures are needed to increase the proportion of older adults who receive influenza and pneumococcal vaccines; health-care providers should offer pneumococcal vaccine all year and should continue to offer influenza vaccine during December and throughout the influenza season, even after influenza activity has been documented in the community.     

Nonfatal self-inflicted injuries among adults aged > or = 65 years--United States, 2005

In 2005, an estimated 372,722 persons in the United States were treated in hospital emergency departments (EDs) for intentional, nonfatal self-inflicted injuries. Nonfatal self-inflicted injuries are most common among adolescents and young adults; few studies have investigated these types of injuries among adults aged > or =65 years. However, older adults are one of the fastest-growing population groups in the United States and can require more extensive and more costly medical treatment than younger adults. To characterize ED visits for nonfatal self-inflicted injuries among U.S. adults aged > or =65 years, CDC analyzed ED visits for 2005 using data from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP). This report summarizes the results of that analysis, which indicated that, in 2005, adults aged > or =65 years made an estimated 7,105 visits to EDs (i.e., 19.3 visits per 100,000 population) for nonfatal self-inflicted injuries, and ED health-care providers attributed 80.4% of these visits to suicidal behavior. In addition, a significantly higher percentage of adults aged > or =65 years compared with younger adults were hospitalized after ED visits for suicidal behavior. Comprehensive prevention strategies that combine community outreach, crisis intervention, and clinical management are needed to decrease morbidity and mortality from suicidal behavior among older adults.     

Update: influenza-associated deaths reported among children aged <18 years--United States, 2003-04 influenza season

Since October, 42 influenza-associated deaths among children aged <18 years have been reported to CDC. All patients had influenza virus infection detected by rapid antigen testing or other laboratory testing methods. This report describes preliminary findings based on data provided from multiple states, as of December 17, 2003. To improve surveillance, CDC has requested that all influenza-associated deaths of children aged <18 years be reported to CDC through state health departments.     

Update: influenza-associated deaths reported among children aged <18 years--United States, 2003-04 influenza season

During the 2003-04 influenza season, CDC has received reports from state health departments regarding deaths among children with evidence of influenza virus infection. To help investigate these deaths, CDC has requested that all influenza-associated deaths among children aged <18 years be reported to CDC through state and local health departments during the 2003-04 season. This summary is based on preliminary data reported from 31 states as of January 6, 2004, and updates a previous report published in MMWR.     

Use of mammograms among women aged > or = 40 years--United States, 2000-2005

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer-related death (after lung and bronchial cancer) among women in the United States. In 2002, at least 182,125 women in the United States had a diagnosis of invasive breast cancer, and 41,514 died from the disease. Screening mammography can reduce mortality from breast cancer by approximately 20%-35% in women aged 50-69 years and approximately 20% in women aged 40-49 years. Organizations including the American Medical Association, American College of Obstetricians and Gynecologists, and American Cancer Society support mammography screening beginning at age 40 years, although these groups vary in their recommendations regarding intervals for rescreening. The U.S. Preventive Services Task Force, an independent panel of private-sector experts in prevention and primary care convened by the Department of Health and Human Services, recommends that women aged < or = 40 years be screened for breast cancer with a mammogram every 1-2 years. Although mammogram use increased substantially during the 1990s, results from a recent cohort study of health maintenance organization members revealed declining screening rates during 1999-2002. This report describes Behavioral Risk Factor Surveillance System (BRFSS) findings that indicate a similar decreasing trend in self-reported use of mammograms among women aged < or = 40 years during 2000-2005. Continued declines in mammography use might result in increased breast cancer mortality.     

Influenza vaccination coverage among children aged 6-23 months--United States, 2005-06 influenza season

Children aged <2 years are at increased risk for influenza-related hospitalizations, and those aged <5 years have more influenza-related health-care visits than older children. In 2004, the Advisory Committee on Immunization Practices (ACIP) recommended annual influenza vaccination of children aged 6-23 months. Two doses, at least 4 weeks apart, were recommended to fully vaccinate children aged <9 years who were receiving influenza vaccination for the first time. To assess influenza vaccination coverage among children aged 6-23 months during the 2005-06 influenza season, data from the 2006 National Immunization Survey (NIS) were analyzed. This report describes the results of that analysis, which indicated that 31.9% of children in this age group received at least 1 dose of influenza vaccine and 20.6% were fully vaccinated according to ACIP recommendations; however, results varied substantially among states. The results underscore the need to continue to monitor influenza vaccination coverage among young children, develop systems to provide childhood influenza vaccination services more efficiently, and increase awareness among health-care providers and caregivers about the effectiveness of influenza vaccination among young children.     

State-specific influenza vaccination coverage among adults--United States, 2006-07 influenza season

Adult groups included in the 2008 Advisory Committee on Immunization Practices (ACIP) recommendation for annual influenza vaccination include all persons aged >/=50 years, women who will be pregnant during the influenza season, persons aged 18-49 years with high-risk conditions, and other persons at increased risk for complications from influenza. Health-care personnel and household contacts and caregivers of persons at high risk also should receive annual influenza vaccination, as should adults who want to reduce their risk for becoming ill with influenza or for transmitting it to others. Healthy People 2010 influenza vaccination coverage targets are 90% among all persons aged >/=65 years and 60% among persons aged 18-64 years who have one or more high-risk conditions. Data from the 2006 and 2007 Behavioral Risk Factor Surveillance System (BRFSS) surveys indicate that influenza vaccination coverage among adults for the 2006-07 season increased significantly compared with the 2005-06 season, reaching 35.1% among persons aged 18-49 years with high-risk conditions, 42.0% among all persons aged 50-64 years, and 72.1% among all persons aged >/=65 years. However, vaccination coverage remained well below Healthy People 2010 targets. Increasing influenza vaccination coverage among adults in the United States will require more cooperation among health-care providers, professional organizations, vaccine manufacturers, and public health departments to raise public awareness about influenza vaccination and to ensure continued distribution and administration of available vaccine throughout the vaccination season.     

State-specific prevalence of cigarette smoking among adults and quitting among persons aged 18-35 years--United States, 2006

Each year, cigarette smoking in the United States causes approximately 438,000 deaths and results in an estimated $167 billion in health-care costs plus lost productivity attributed to premature deaths. Although smoking cessation has major and immediate health benefits for persons of all ages, the benefit is greater the earlier in life a person quits. Persons who quit before the age of 35 years have a life expectancy similar to that of those who never smoked. To assess the prevalence of current smoking among all adults and among those aged 18-35 years, and to assess the proportion of smokers aged 18-35 years who have quit or attempted to quit, CDC analyzed state and area data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated substantial variation in current cigarette smoking prevalence among the 50 states, the District of Columbia (DC), Puerto Rico (PR), and the U.S. Virgin Islands (USVI) (range: 9.1%-28.6%). The majority of current smokers aged 18-35 years reported that they had attempted to quit smoking during the past year (median: 58.6%; range: 48.0% [Nevada] to 69.2% [New Mexico]), and the median proportion of ever smokers aged 18-35 years who had quit smoking was 34.0% (range: 27.0% [Louisiana] to 47.9% [Utah]). Effective, comprehensive tobacco-use prevention and control programs should be continued and expanded to further reduce smoking initiation by young persons and to encourage cessation as early in life as possible.     

Influenza vaccination and self-reported reasons for not receiving influenza vaccination among Medicare beneficiaries aged > or =65 years--United States, 1991-2002

Annual influenza vaccination of the U.S. elderly population has been demonstrated as safe and effective in reducing the risks of illness, hospitalization, and death. The Medicare Current Beneficiary Survey (MCBS) has measured annual influenza vaccination rates since 1991; the latest data available are for the 2001-02 influenza season. Since 1996, self-reported reasons for not receiving influenza vaccine also have been measured. During 1991-2002, MCBS indicated a steady upward trend in vaccination coverage among Medicare beneficiaries, with the exception of the 2000-01 influenza season, when vaccine distribution was delayed. The most frequently cited reasons for not receiving influenza vaccine were 1) not knowing that influenza vaccination was needed and 2) concerns that vaccination might cause influenza or side effects. During the 2000-01 influenza season, vaccine shortage or unavailability was noted for the first time as an important reason for nonvaccination. Further efforts are needed to educate the elderly regarding the benefits of influenza vaccination and to address any concerns regarding the safety of the vaccine.     

Influenza and pneumococcal vaccination levels among persons aged > or = 65 years--United States, 2001

Two vaccine-preventable diseases, influenza and pneumococcal disease, contribute to the mortality of older persons in the United States. Influenza caused an average of 20,000 deaths per year during influenza epidemics in the United States from 1969 to 1996; persons aged > or = 65 years accounted for approximately 90% of these deaths. Pneumococcal disease caused approximately 3,400 deaths among persons aged > or = 65 years in the United States in 1998. National health objectives for 2010 include increasing influenza and pneumococcal vaccination levels to > or = 90% among persons aged > or = 65 years (objective nos. 14.29a and 14.29b, respectively). To assess progress toward achieving these objectives, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results, which indicate that the estimated point prevalences of influenza and pneumococcal vaccination were <80% among persons aged > or = 65 years in all reporting areas. Influenza vaccination levels during 2000-2001 decreased from 1998-1999 levels in 27 of 52 reporting areas; pneumococcal vaccination prevalence increased a median of 7 percentage points from 1999 to 2001. Continued efforts are needed to increase the proportion of older adults who receive influenza and pneumococcal vaccines; health-care providers should offer pneumococcal vaccine all year and should continue to offer influenza vaccine during December and throughout the influenza season, even after influenza activity has been documented in the community.     

Influenza and pneumococcal vaccination coverage among persons aged > or =65 years and persons aged 18-64 years with diabetes or asthma--United States, 2003

Vaccination of persons at risk for complications from influenza and pneumococcal disease is a key public health strategy for preventing associated morbidity and mortality in the United States. Risk factors include older age and medical conditions that increase the risk for complications from infections. During the 1990-1999 influenza seasons, more than 32,000 deaths each year among persons aged > or =65 years were attributed to complications from influenza infection. National health objectives for 2010 call for 90% influenza and pneumococcal vaccination coverage among noninstitutionalized persons aged > or =65 years and 60% coverage among noninstitutionalized persons aged 18-64 years who have risk factors (e.g., diabetes or asthma) for complications from infections. To estimate influenza and pneumococcal vaccination coverage among these populations, CDC analyzed data from the 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that 1) influenza vaccination levels among adults aged 18-64 with diabetes or asthma, 2) pneumococcal vaccination levels among adults aged 18-64 years with diabetes, and 3) influenza and pneumococcal vaccination levels among adults aged > or =65 years all were below levels targeted in the national health objectives for 2010. Moreover, vaccination coverage levels varied among states for both vaccines and both age groups. Innovative approaches and adequate, reliable supplies of vaccine are needed to increase vaccination coverage, particularly among adults with high-risk conditions.     

Racial/ethnic disparities in influenza and pneumococcal vaccination levels among persons aged > or =65 years--United States, 1989-2001

Influenza and pneumococcal diseases are key causes of mortality among persons aged > or =65 years, accounting for approximately 36,000 and 3,400 deaths per year, respectively, during 1990-1999. Substantial racial/ethnic disparities in adult vaccination have been documented in national surveys. Although the national health objective for 2000 of 60% receipt of influenza vaccination during the preceding 12 months by persons aged > or =65 years (objective no. 20.11) was met in 1997, and the objective of 60% for pneumococcal vaccination was nearly met in 2000, vaccine coverage levels among non-Hispanic blacks and Hispanics were 31% and 30%, respectively, compared with 57% for non-Hispanic whites. To characterize these disparities, CDC analyzed data from the 2000 and 2001 National Health Interview Surveys (NHIS) and examined trends in NHIS results for 1989-2001. This report summarizes the results of these analyses, which indicate that marked differences in vaccination coverage by race/ethnicity are observed even among persons most likely to be vaccinated (e.g., persons with the highest education level and persons with frequent visits to health-care providers). Racial/ethnic disparities in influenza and pneumococcal vaccination coverage have persisted over time. Several approaches to reduce these disparities are needed, including increasing demand for vaccination among racial/ethnic minority populations and the use of standing orders and other systems changes that promote vaccination.     

Influenza vaccination coverage among persons with asthma--United States, 2005-06 influenza season

During 2006, approximately 6.8 million (9.3%) U.S. children and 16.1 million (7.3%) U.S. adults were reported to have asthma. Since 1964, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination of all persons with asthma because of the higher risk for medical complications from influenza for those persons. Influenza vaccination coverage of persons with asthma varies by age group and remains below Healthy People 2010 targets of 60% coverage of persons aged 18--64 years with high-risk conditions (14-29 c) and 90% of all persons aged > or =65 years (14-29 a). Influenza vaccination rates of children and older adults with asthma have not been well studied. Using 2006 National Health Interview Survey (NHIS) data, this report provides the first examination of influenza vaccination rates and related factors across a national sample of persons with asthma aged > or =2 years. The results indicated that 36.2% received influenza vaccination during the 2005--06 influenza season. Vaccination rates remained below target levels among all subgroups examined, including those reporting the greatest number of health-care visits in the past 12 months. The results of this study indicate that influenza vaccination coverage of all persons with asthma can be improved by increasing access to health care and using opportunities for vaccination during health-care visits.     

National vaccination coverage among adolescents aged 13-17 years--United States, 2006

Before 2005, vaccines were administered during adolescence to "catch up" children with vaccinations not received at a younger age, with the exception of the tetanus and diphtheria (Td) booster. However, since 2005, three new vaccines specifically for older children have been licensed and recommended in the United States: meningococcal conjugate vaccine (MCV4) for those aged 11-12 years and 15 years; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine for those aged 11-12 years (or at ages 13-18 years if not received at ages 11-12 years); and human papillomavirus (HPV) vaccine for girls aged 11-12 years (or at ages 13-18 years if not received at 11-12 years). Since 1996, the Advisory Committee on Immunization Practices (ACIP) and professional organizations, including the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Medical Association (AMA), have recommended a health-care visit at ages 11-12 years for receipt of recommended vaccinations. In addition, a Healthy People 2010 objective (14-27) is to achieve > or =90% vaccination coverage among adolescents aged 13-15 years for certain vaccines. In 2006, for the first time, the National Immunization Survey (NIS) collected provider-reported vaccination information for adolescents aged 13-17 years (NIS-Teen). This report describes the results of that survey, which indicated that the Healthy People 2010 target has not been met for any of the vaccines analyzed. HPV vaccination coverage is not included in this report because NIS-Teen was conducted before HPV vaccination recommendations were published in March 2007. Routine health-care visits for adolescents should be encouraged, with emphasis on a visit at ages 11-12 years, and providers should continue to assess the need for vaccinations at every opportunity. NIS-Teen will be conducted annually to monitor coverage with recommended vaccines during ages 11-17 years and to identify groups with lower coverage.     

Influenza vaccination coverage among persons aged 50-64 years enrolled in commercial managed health-care plans--United States, 2003-04 and 2004-05 influenza seasons

To combat an unexpected shortage of influenza vaccine in the fall of 2004, CDC issued guidance to direct available vaccine supplies to persons in designated priority groups (e.g., persons aged >/=65 years, persons with certain health conditions, health-care workers, and close contacts of persons at high risk for complications from influenza). Analyses of influenza vaccination coverage for the 2004-05 influenza season indicated that coverage levels for adults in priority groups nearly reached the levels of previous years, whereas coverage levels among adults not in priority groups were approximately half the levels of the 2003-04 season. These findings suggested that national public health actions to direct available vaccine supply to persons at high risk for complications from influenza during the supply disruption were successful. To assess influenza vaccination coverage among persons aged 50-64 years for the 2004-05 influenza season relative to the 2003-04 season and to estimate the effect of shortages on selected subgroups, the National Committee for Quality Assurance (NCQA) analyzed data from a survey of persons enrolled in commercial managed care health plans. This report summarizes the findings of that analysis, which indicated that, although vaccination coverage declined substantially from 2003-04 to 2004-05 among all subgroups in this age range, respondents who were older or who reported poorer health status exhibited smaller relative declines in vaccination coverage between the two seasons.     

Influenza vaccination levels among persons aged > or =65 years and among persons aged 18-64 years with high-risk conditions--United States, 2003

Influenza vaccination is an effective tool for preventing hospitalization and death among persons aged > or =65 years and among persons aged 18-64 years with medical conditions that increase the risk for influenza-related complications. Two national health objectives for 2010 are to increase influenza vaccination coverage to 90% among persons aged > or =65 years and to 60% among persons aged 18-64 years who have one or more high-risk conditions (objectives 14-29a and 14-29c, respectively). To determine influenza vaccination coverage among persons in both targeted groups, CDC analyzed data from the 2003 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which determined that influenza vaccination coverage among persons aged > or =65 years and persons aged 18-64 years with high-risk conditions remains substantially below 2010 target levels. In addition, racial/ethnic disparities in coverage levels persist in both targeted populations. To improve overall influenza vaccination coverage and reduce racial/ethnic disparities, combinations of evidence-based effective interventions should be implemented, and the influenza vaccine supply should be stabilized.     

Colorectal cancer test use among persons aged > or = 50 years--United States, 2001

Colorectal cancer is the second leading cause of cancer-related death in the United States. The lifetime risk for having colorectal cancer diagnosed is 6%. Screening measures decrease the incidence and mortality of colorectal cancer by detecting early disease and removing precancerous lesions. The U.S. Preventive Services Task Force recommends routine cancer screening for U.S. adults aged > or = 50 years with one or a combination of the following screening options: annual home fecal occult blood testing (FOBT), sigmoidoscopy every 5 years, colonoscopy every 10 years, or double contrast barium enema every 5 years. To estimate rates and evaluate trends for colorectal cancer test use among U.S. adults aged > or = 50 years, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) on the use of FOBT and sigmoidoscopy/colonoscopy and compared the data for 2001 with those for 1997 and 1999. This report summarizes the results of that analysis, which indicate that despite small increases in the self-reported use of colorectal cancer tests, screening rates remain low. Efforts to increase awareness and encourage regular colorectal cancer screening should continue.     

Strength training among adults aged >/=65 years--United States, 2001

Strength training (also referred to as resistance training) enables adults to improve their overall health and fitness by increasing muscular strength, endurance, and bone density and by improving their insulin sensitivity and glucose metabolism. For older adults (i.e., persons aged >/=65 years), strength-training exercises are recommended to decrease the risk for falls and fractures and to promote independent living. The American College of Sports Medicine recommends that adults include strength training as part of a comprehensive physical activity program. A national health objective for 2010 is to increase to 30% the proportion of adults who perform, >/=2 days per week, physical activities that enhance and maintain muscular strength and endurance. To determine the percentage and characteristics of older adults who perform strength training consistent with this objective, CDC analyzed data from the 2001 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which indicated that approximately 12% of persons aged 65-74 years and 10% of persons aged >/=75 years met the strength-training objective. These findings underscore the need for programs that encourage older adults to incorporate strength training into their lives along with regular physical activity.     

Childhood influenza vaccination coverage--United States, 2003-04 influenza season

Children aged <2 years are at increased risk for influenza-related hospitalizations. Beginning in 2002, the Advisory Committee on Immunization Practices (ACIP) encouraged that, when feasible, children aged 6-23 months and household contacts and out-of-home caregivers for children aged <2 years receive influenza vaccinations each year. Beginning with the 2004-05 influenza season, ACIP strengthened the encouragement to a recommendation. Other children recommended to receive influenza vaccination include children aged 6 months-18 years who have certain high-risk medical conditions, are on chronic aspirin therapy, or who are household contacts of persons at high risk for influenza complications. This report provides an assessment of childhood influenza vaccination coverage for the 2003-04 influenza season, the second year of the ACIP encouragement for influenza vaccination of children aged 6-23 months. The findings demonstrate that vaccination coverage increased from the previous influenza season but remained low, with substantial variability among states and urban areas.