Introduction
Vaccination is often associated with childhood, but immunity to several vaccine-preventable diseases wanes over time, and new risks emerge with age, occupation and comorbidity. Immunization prevents millions of deaths every year, yet adult vaccination rates remain well below recommended coverage in most countries. For healthcare professionals (HCPs), proactively addressing adult immunization is an important and often overlooked component of preventive care.
Why Adult Immunization Is Often Missed
Unlike childhood immunization, which follows a structured schedule reinforced at routine visits, adult vaccination depends heavily on opportunistic recommendation during unrelated consultations. Common reasons for under-vaccination include patients assuming childhood vaccines provide lifelong protection, lack of a systematic reminder process in adult care settings, clinician uncertainty about which vaccines apply to which risk groups, and missed opportunities during hospital admissions or specialist visits.
Key Vaccines to Consider in Adult Practice
Influenza: Recommended annually, particularly for older adults, pregnant women, and those with chronic conditions.
Pneumococcal vaccines: Indicated for adults 65 and older and younger adults with relevant risk factors such as chronic lung, heart, liver or kidney disease, diabetes, or immunosuppression.
Herpes zoster (shingles): Recommended for older adults to reduce the risk of shingles and post-herpetic neuralgia.
Tetanus-diphtheria-pertussis (Td/Tdap): Booster doses roughly every 10 years, with Tdap recommended during each pregnancy to protect the newborn.
COVID-19: Continued vaccination per current national guidance, particularly for high-risk groups.
Hepatitis B: For adults with occupational, medical or lifestyle risk factors who were not previously vaccinated.
HPV: Catch-up vaccination may be appropriate for eligible younger adults not vaccinated earlier.
Special Populations
Pregnant women: Influenza and Tdap vaccination are generally recommended during pregnancy to protect both mother and infant.
Immunocompromised patients: Vaccine selection requires careful review, as some live vaccines may be contraindicated.
Healthcare workers: Should maintain up-to-date vaccination given occupational exposure risk.
Travellers: May require additional vaccines depending on destination and planned activities.
Practical Steps for Clinicians
Ask about vaccination history at routine visits, not only during illness.
Use every clinical encounter, including hospital discharge, as an opportunity to review immunization status.
Document vaccination status clearly in the patient record.
Address vaccine hesitancy with clear, non-judgemental information rather than assumptions.
Follow current national immunization schedules, as recommendations vary by country and may be updated.
Conclusion
Adult immunization is a preventable gap in many health systems. Systematically reviewing vaccination status across the adult lifespan, particularly in older adults, pregnant women and those with chronic conditions, can meaningfully reduce the burden of vaccine-preventable disease.
Disclaimer: This article is intended for professional education. Vaccine recommendations vary by country; please follow applicable national immunization guidelines.