More adults are getting vaccinated against human papillomavirus (HPV) and whooping cough, according to a new report from the Centers for Disease Control and Prevention (CDC). However, as a whole, adults aren't doing a good job at keeping up to date with recommended shots, the CDC said.

Besides the flu shot, there are nearly a dozen vaccines recommended for adults, the CDC says. Coverage rates for most adult vaccines, including vaccination with the herpes zoster (shingles) vaccine, the pneumococcal vaccine, and the hepatitis A and B vaccines, are low, and have seen little to no change in recent years.

"Far too few adults are being vaccinated against these important diseases," said Dr. Howard Koh, assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS). "We're encouraging all adults to talk with their health care provider about which vaccines are appropriate for them."

In the new report, the biggest improvements in vaccination rates were seen among young women receiving the HPV shot.

In 2011, nearly 30 percent of women ages 19 to 26 said they had received at least one dose of the HPV vaccine, up from about 21 percent in 2010, the report said. Among men in this age group, 2.1 percent had received the shot in 2011, up from 0.6 percent in 2010. HPV vaccination is primarily recommended for girls and boys ages 11 to 12, but is also recommended for women up to age 26 and men up to age 21 who did not receive the shot when they were younger.

Between 2010 and 2011, the percentage of adults who reported receiving the "Tdap" vaccine (which protects against tetanus, diphtheria and whooping cough, also called pertussis) increased from 8.2 percent to 12.5 percent, the report said. The CDC recommends Tdap vaccines for adults in place of a tetanus booster, especially those who expect to have close contact with infants, and pregnant women.

But improvements in vaccination rates for other adult vaccines were limited.

For example, in 2011, 15.8 percent of adults ages 60 and over reported ever receiving the herpes zoster vaccine to prevent shingles. That was similar to the rate in 2010 (14.4 percent). The CDC recommends the shingles vaccine for people ages 60 and over. A goal of HHS is to increase herpes zoster vaccination in adults in this age group to 30 percent by 2020.

Also in 2011, 12.5 percent of adults ages 19 to 49 were vaccinated against hepatitis A, and 36 percent were vaccinated against hepatitis B.

Hepatitis A vaccination is recommended for adults who are at increased risk for infection with the disease, such as those traveling to countries with high rates of hepatitis A, or those who have chronic liver disease. The agency recommends hepatitis B vaccine for adults who wish to be protected against hepatitis B, and those who have risk factors, such as sexually active people not in a monogamous relationship. (The hepatitis B vaccine is primarily recommended for children and adolescents.)

Rates of pneumococcal vaccination were 62.3 percent among adults ages 65 years and older, and 20 percent for adults ages 19 to 64. The CDC recommends one type of vaccine pneumococcal, called PPSV23, for adults ages 65 and older, and another type, called PCV13, for adults with certain medical conditions such as HIV infection. By 2020, the HHS hopes 90 percent of older adults will be vaccinated against the disease.

Making vaccines more widely available, such as offering them in workplaces and at pharmacies, and sending reminders to patients, may be ways to increase vaccination rates among adults, the CDC said.

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The percentage of school children obtaining exemptions from required vaccinations for nonmedical reasons is increasing, a new report says.

In 2011, just over 2 percent of school children were exempt from getting their vaccines for nonmedical reasons, up from about 1 percent in 2006, the report found.

"Our results show that nonmedical exemptions have continued to increase, and the rate of increase has accelerated," in recent years, the researchers at Emory University wrote in a letter published today (Sept. 20) in the New England Journal of Medicine.

All U.S. states allow children to be exempt from vaccination requirements for medical reasons — some children are allergic to vaccines, others have conditions that severely compromise their immune systems, and could make vaccination dangerous to a child's health.

In addition, 48 states allow exemptions for nonmedical reasons (Mississippi and West Virginia do not). Nonmedical exemptions can be granted for religious reasons or philosophical reasons, though fewer states allow philosophical exemptions than religious ones.

For their report, researchers used data on vaccine exemptions from the Centers for Disease Control and Prevention  for school years 2005–2006 through 2010–2011.

They found that the rates of nonmedical exemptions were 2.5 times higher in states that allowed philosophical exemptions, compared with states that allowed only religious exemptions.

However, the rate of exemptions was rising faster in states that allowed only religious exemptions, the report said.

The researchers also looked at state exemption rates in terms of how difficult exemptions are for parents to get — some states use a standardized form to request exemptions and make this form available at schools, others require parents to go though the state health department, or require a specifically worded letter or notarization.

Over the study period, the exemption rates were higher in states with "easy" exemption policies, compared with states with "difficult" policies. In 2011, the average exemption rate in states with easy policies was 3.3. percent, while it was 1.3 percent in states with difficult policies.

"In an earlier analysis of data from 1991 through 2004, we found an increase in exemption rates only in states with philosophical exemptions and in states with easy exemption procedures," the researchers said.

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An older version of the whooping cough vaccine offered better protection against the disease than the current version does, a new study from Australia suggests.

Children who received the older version of the vaccine were less likely to catch the disease before age 12, compared with those who received the newer version of the vaccine, or a combination of the two vaccines, the study found.

The study followed the children during a three-year whooping cough epidemic, which is still taking place in Australia, and nine years before the epidemic.

The work agrees with previous studies showing the protection offered by the newer whooping cough vaccine, called the acellular pertussis vaccine, wanes after a few years. (Whooping cough is also known as pertussis.)

The acellular pertussis vaccine was introduced in the United States in 1997, and Australia in 1999, after concerns that the previous vaccine, called the whole cell pertussis vaccine, caused unwanted side effects in some. These side effects included fever and swelling at the injection site. The older version was less purified, but its protection was thought to last for most of a person's life.

The challenge will be to develop a whooping cough vaccine that offers long-lasting protection from the very first dose, without adverse effects, the researchers of the new study said.

In the study, Sarah Sheridan, of the University of Queensland in Brisbane, and colleagues analyzed information from about 40,500 children born in Queensland in 1998 who had received the required three doses of the whooping cough vaccine during infancy.

Because the new vaccine was introduced in 1999, children born in 1998 may have been vaccinated with the old version only, the new version only, or a combination of the two, throughout their three-shot series.

About 270 whooping cough cases were reported during the 12-year study period.

Between 1999 and 2008, the yearly rate of whooping cough infection was 5.2 cases per 100,000 kids who received only the old version of the vaccine, and 13.2 cases per 100,000 people among kids who received only the new version.

During the current whooping cough epidemic — which began in 2009 and peaked in 2011 — the yearly rate of whooping cough infection was 113 cases per 100,000 people among kids who received the old version of the vaccine, and 373 cases per 100,000 people among kids who received the new version.

Those who received mixed doses were better protected against whooping cough during the outbreak if their first vaccination dose was with the old vaccine as opposed to the new vaccine.

The study will be published tomorrow (Aug. 1) in the Journal of the American Medical Association.

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Doctors may need to reconsider the current schedule of whooping cough vaccinations in order to prevent outbreaks, researchers say.

In a recent study of the 2010 whooping cough outbreak in California, researchers found that kids between ages 8 and 12 were vulnerable to whooping cough even though they had been vaccinated against the highly contagious bacterial infection, which is also known as pertussis. These children had a higher rate of whooping cough than vaccinated children of other ages, the researchers said.

The finding suggests children may need to receive whooping cough booster shots earlier than they do currently, perhaps as young as age 8, to prevent immunity from waning to the point where children become susceptible to the disease, said study researcher Dr. David Witt, an infectious-disease physician at Kaiser Permanente Medical Center in San Rafael, Calif.

Currently, children receive their last dose of the five-shot vaccine series between ages 4 and 6, and then get a booster shot at age 11 or 12.

The vaccine's protection "doesn’t seem to last as long as the five to seven years that would be required" to keep children from getting sick in the years between the end of the series and the booster, Witt said.

Experts say more research is needed to confirm the findings, and it's unlikely the current vaccination schedule will be changed anytime soon.

The first version of the whooping cough vaccine, known as the whole cell pertussis vaccine, provided long-lasting immunity, but there were concerns about the vaccine's safety.

In 1997, a more purified version of the vaccine, with fewer side effects, was introduced. However, recent research suggests that the immunity this newer version provides is not as durable.

In 2010 California experienced its largest outbreak in 53 years, with 10,000 pertussis cases and 10 deaths.

In the new study, researchers examined medical records from 132 children who were treated for pertussis during the outbreak at the medical center where Witt works. They also looked at vaccination rates among children at the center who didn't develop the disease.

The rate of whopping cough among vaccinated children was about 245 per 10,000 for children ages 8 to 12, compared with 36 per 10,000 for children ages 2 to 7. (The rate for unvaccinated children was higher, at about 320 per 10,000 children ages 8 to 12.)

The researchers determined the vaccine was 41 percent effective in protecting children ages 2 to 7, but only 24 percent effective in protecting children ages 8 to 12. It was 79 percent effective in protecting those ages 13 to 18.

A whooping cough booster shot at age 8 would "lessen the burden of pertussis disease," said Dr. Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia, but "it would be a burdensome thing to do."

A booster scheduled for this age would require a doctor's visit at a time when kids don't typically have one, Offit said. Children usually go to the doctor for shots in their younger years, and then again at ages 11 or 12, when entering middle school. "There's not really a platform on which to build that vaccine," Offit said.

Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University School of Medicine, said the first line of action will be to make sure everyone currently recommended to receive a whooping cough vaccine gets it, including adolescents ages 11 to 12 and adults. This will lessen the amount of circulating pertussis disease and lower the chances that those with waning immunity will become infected, Schaffner said.

After the current vaccine schedule is properly implemented, researchers could take another look at whether to recommend a booster shot around age 8, Schaffner said.

The study is published in the June issue of the journal Clinical Infectious Diseases. It first appeared online March 15.

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