WASHINGTON — States insist that children have all their immunizations before they can enroll in school.
Veterinarians even send reminder cards to pet owners when Fido or Tabby is due for a shot.
But no such safety net exists for adults, especially the elderly, who are particularly susceptible to many diseases preventable by vaccines, according to a new report about the low rate of adult immunization.
It found that a third of seniors received no immunizations against pneumonia in 36 states as of 2008. Just under a third of people over age 65 went without the seasonal flu vaccine that same year, as well.
"The country has an absolutely stunningly first-rate system for immunizing children, but too many adults fall through the cracks," said William Schaffner, an expert on infectious diseases at the Vanderbilt University School of Medicine.
The report was prepared by the Trust for America's Health, a nonpartisan health research group; the Infectious Diseases Society of America; and the Robert Wood Johnson Foundation, the largest health care philanthropy in the country.
The report, "Adult Immunization: Shots to Save Lives," said that millions of Americans forgo routine vaccinations for preventable diseases. Between 40,000 and 50,000 adults die every year as a result.
Failure to use them adds about $10 billion annually to the cost of heath care, according to the U.S. Centers for Disease Control and Prevention.
The seasonal flu can often lead to pneumonia among the elderly, which can be particularly lethal in that age group, experts said.
Nearly 32 percent of Kansas seniors age 65 and older had not had pneumonia vaccine in 2008, mirroring the national average.
Oregon had the highest immunization rate for pneumonia among seniors. Almost three out of four received the vaccine. Washington, D.C., had the lowest. Almost half the elderly population had not taken it.
One reason for low immunization rates among adults, according to the report, was that unlike schoolchildren or military personnel, many adults are not connected to an institution or network where vaccinations are required.
The report also said that adults usually see medical specialists for a particular problem and don't have primary care physicians who oversee their overall health, as children do.
Other roadblocks were the high costs of some vaccines, misinformation about vaccines' effectiveness and safety, and insurance coverage that limits or doesn't offer vaccine coverage.
Concern about the widespread availability of vaccines has figured in the debate over health care reform. Both the House and Senate bills contain language that would make them more easily obtainable.
"We need a national strategy to make vaccines a regular part of medical care and educate Americans about the effectiveness and safety of vaccines," said Jeffrey Levi, executive director of the Trust for America's Health.
The CDC has recommended that everyone over 65 be vaccinated for pneumonia. It hopes to reach 90 percent this year.
The report cited a 2007 National Immunization Survey by the CDC to highlight the problem of low adult vaccination rates:
* Just 2.1 percent of eligible adults had received vaccines for tetanus, whooping cough and diphtheria.
* Under 2 percent of patients 60 and over had taken the vaccine for shingles, an extremely painful condition.
* Just 10 percent of adult women 18 to 26 years old, the eligible age for the human papillomavirus, had received the vaccine.
* Only 36.1 percent of adults have been vaccinated annually for seasonal flu.
"It sort of plateaued at that level," said Glen Nowack, a spokesman for the CDC. "The next groups are not as easily persuadable. They have not been in the habit of getting the influenza vaccine. They have concerns about it, or don't believe it's going to be as effective. We've been working real hard to try and persuade them."