WASHINGTON - The confusion surrounding adult vaccination help illustrates some of the big problems looming for Congress as it struggles with healthcare reform legislation, doctors and health officials said on Wednesday.

They released two surveys showing how few adults realize they can get vaccines against deadly diseases such as meningitis, whooping cough, tetanus and pneumonia or painful conditions such as shingles.

But awareness and demand are only part of the problem, the experts said. The system itself is a barrier to vaccination, said Dr. William Schaffner of Vanderbilt University in Tennessee and the National Foundation for Infectious Diseases.

Some insurance companies pay for the vaccines, others do not, doctors get paid very little to administer them and no one is responsible for ensuring the vaccines are available.

It is cumbersome almost to the point of not being able to get the vaccine, Schaffner told a news conference.

Schaffner and other vaccine experts said they hope Congress addresses the issue in any healthcare reform legislation. Better vaccination would save billions of dollars, they said.

More than $10 billion a year is spent in direct medical costs and indirect costs of vaccine-preventable diseases such as pneumonia, meningitis and influenza, Schaffner said.

Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention released a survey of 22,000 U.S. adults that showed most are not getting the vaccinations they need.

About half of adults had received a tetanus shot within the past 10 years, Schuchat told the news conference. Tetanus shots should be given every 10 years.

WARTS AND CHICKENPOX

Just 11 percent of 19- to 26-year-old women had received the human papillomavirus, or HPV vaccine, which protects against genital warts and cervical cancer, the survey found. Only 6.7 percent of all people over age 60 had been vaccinated against shingles -- an extremely painful recurrence of chickenpox.

While people are often not even aware that they can get these vaccines, the system -- or lack of a system -- means doctors often forget to recommend them.

Dr. Cora Christian of the AARP, which represents people over age 50, said doctors get just $18 to administer a flu shot under Medicare, the federal health insurance plan for the elderly. This should be 100 percent covered by insurance, Christian said.

Dr. Susan Rehm of the Cleveland Clinic in Ohio said the shingles vaccine is expensive, tricky to store and administer, and ends up costing $200 to $400 a dose.

Some private insurers cover adult vaccines and some do not. You can imagine there is an extraordinary variety of schemes out there, Schaffner said.

Speaking as an individual, I am totally confused, Rehm said.
She said alternative settings -- such as retail clinics or box stores -- offer an opportunity to vaccinate adults. Some seasonal flu and pneumococcal vaccines are offered at such clinics.

Healthcare reform experts have said such alternatives to the doctor's office may offer a less expensive and easier way for people to get a range of medical services, from cholesterol tests to simple walk-in emergency care.

Companies that make adult vaccines include Wyeth, which is testing a vaccine against Streptococcus pneumoniae for adults, Merck, which makes the Gardasil HPV vaccine and a shingles vaccine, and GlaxoSmithKline, which makes the Cervarix HPV shots, hepatitis shots, flu vaccines and others.

(Editing by Xavier Briand)

Tennessee Medicine