Adult Immunization Status

Measure Specification

The Advisory Committee on Immunization Practices (ACIP) recommends influenza and Td/Tdap vaccination for all adults 19 years of age and older; herpes zoster vaccination for all adults 50 years and older; and pneumococcal vaccination for all adults 65 and older and for those 18–64 with certain underlying conditions; and hepatitis B for adults 19–59 years of age.

These vaccines have been included in long-standing recommendations to prevent serious disease, but vaccination coverage remains low, leaving many adults unprotected against vaccine-preventable diseases. Estimates of national vaccination coverage are available through the National Health Interview Survey (NHIS), in which a sample of adults self-report receipt of vaccines.

In 2022, the survey found that only 22.8% of adults 19 and older were up to date on all recommended age-appropriate vaccines. Only 49.4% of adults aged 19 and older received the influenza vaccine during the 2021–2022 flu season. Herpes zoster vaccine receipt for any type of herpes zoster vaccination was reported among only 36% of adults aged 50 and older.

When looking specifically at receipt of the recombinant zoster vaccine, only 25.6% of adults 50 and older reported receiving 1 or more doses of the vaccine. Receipt of the pneumococcal vaccine among adults aged 65 and older was 64% in 2022. NHIS data from 2021 found that of adults 19 years and older, 34% reported receiving the hepatitis B vaccination NHIS data from 2019 found that of adult 19 years and older, 62.

9% reported having received any tetanus toxoid- containing vaccination in the past 10 years, and 30.1% reported receiving the Tdap vaccine in the past 10 years. Racial disparities in coverage exist across all five vaccines, with White adults reporting higher rates of vaccine receipt when compared to Black, Hispanic and Asian adults. There are evidence-based practices for improving adult vaccination coverage.

Health care providers should routinely assess patients’ vaccination history; strongly recommend appropriate vaccines; offer needed vaccines to adults or refer patients to a provider who can administer the vaccine; and document vaccinations received by their patients in an immunization information system. In addition, providing easy access and convenience for adult vaccination in and outside the health care setting is important for increasing equitable adult vaccine uptake.

Sharing immunization related information between providers, health systems, public health agencies and patients is required to increase vaccination coverage and ensure high-quality data to inform clinical and public health interventions. Leveraging health information technology, such as immunization information systems, is important for targeting and monitoring immunization program activities and providing clinical decision support at the point of care.

The Advisory Committee on Immunization Practices recommends annual influenza vaccination; and tetanus, diphtheria and acellular pertussis (Tdap) and/or tetanus and diphtheria (Td) vaccine; herpes zoster vaccine; pneumococcal vaccine; and hepatitis B vaccine for adults at various ages.

This measure contains five strata defined by five submission criteria. This measure produces five performance rates which contribute to the final weighted average. There are 5 Submission Criteria for this measure: 1) Patients (19 years of age and older on the date of the encounter) who received an influenza vaccine on or between July 1 of the year prior to the measurement period and June 30 of the measurement period.

AND 2) Patients (19 years of age and older on the date of the encounter) who received at least 1 tetanus and diphtheria (Td) vaccine or 1 tetanus, diphtheria, and pertussis (Tdap) vaccine between 9 years prior to the encounter and the end of the measurement period. AND 3) Patients (50 years of age and older on the date of the encounter) who received 2 doses of the herpes zoster recombinant vaccine anytime on October 20, 2017, through the end of the measurement period.

AND 4) Patients (66 years of age or older on the date of the encounter) who were administered any pneumococcal conjugate vaccine or polysaccharide vaccine, on or after their 19th birthday and before the end of the measurement period. AND 5) Patients (19 years of age and older on the date of the encounter) who were administered a hepatitis B vaccine series.

This measure will be calculated with 5 performance rates: 1) Percentage of patients (19 years of age and older on the date of the encounter) who received an influenza vaccine on or between July 1 of the year prior to the measurement period and June 30 of the measurement period. 2) Percentage of patients (19 years of age and older on the date of the encounter) who received at least 1.

tetanus and diphtheria (Td) vaccine or 1 tetanus, diphtheria, and pertussis (Tdap) vaccine between 9 years prior to the encounter and the end of the measurement period. 3) Percentage of patients (50 years of age and older on the date of the encounter) who received 2 doses of the herpes zoster recombinant vaccine anytime on October 20, 2017, through the end of the measurement period.

4) Percentage of patients (66 years of age or older on the date of the encounter) who were administered any pneumococcal conjugate vaccine or polysaccharide vaccine, on or after their 19th birthday and before the end of the measurement period. 5) Percentage of patients (19 years of age and older on the date of the encounter) who were administered a hepatitis B vaccine series.

Submission of the five performance rates is required for this measure. A weighted average, which is the sum of the performance numerator values divided by the sum of performance denominator values, will be used to calculate performance. For the purposes of MIPS implementation, this patient-periodic measure is submitted a minimum of once per patient per timeframe specified by the measure for the performance period.

The most advantageous quality data code will be used if the measure is submitted more than once. If more than one quality data code is submitted during the episode time period, performance rates shall be calculated by the most advantageous quality data code.