Immunization update: Recommendations for adults with chronic disease

Adults with diabetes, heart disease, and chronic lung diseases are susceptible to increased morbidity and mortality from infectious diseases. Utilization of vaccinations for disease prevention in this population is low. The Centers for Disease Control and Prevention provide vaccine guidance for patients with these conditions and the schedules are published annually. Patients with chronic conditions are advised to receive annual inactivated influenza vaccinations and the pneumococcal polysaccharide vaccine. An additional dose of pneumococcal polysaccharide vaccine is recommended if the first dose was administered before the age of 65 and 5 years have elapsed since the first dose. The hepatitis B vaccine series was recently added to the vaccine schedule for patients with diabetes because of the increased incidence of infection and poor disease outcomes. All adults are recommended to receive the tetanus, diphtheria, and acellular pertussis vaccine in place of a routine tetanus diphtheria booster. In addition, all adults older than 60 years should be vaccinated against herpes zoster. Strategies to increase immunization rates utilize multiple approaches; however, direct recommendations from healthcare providers are more successful at increasing patient engagement and compliance. Immunization counseling should be a priority and standard of care in the office.