Adult Immunization Status (AIS-E)

The percentage of persons 19 years of age and older who are up to date on recommended routine vaccines for influenza, tetanus and diphtheria (Td) or tetanus, diphtheria and acellular pertussis (Tdap), zoster, pneumococcal, hepatitis B and coronavirus disease 2019 (COVID-19).

Why it Matters

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; pneumococcal vaccination for all adults 65 and older and for those 18–64 with certain underlying conditions; hepatitis B for adults 19–59 years of age; and COVID-19 vaccination for persons 65 years of age and older ¹. These vaccines have been included in recommendations to prevent serious disease, but vaccination coverage remains low ², 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, data indicate that:

• 49.4% of adults aged 19 and older reported receiving the influenza vaccine ².
• 59% of adults 19 and older reported having received any tetanus toxoid-containing vaccination in the past 10 years, and 28.6% reported receiving the Tdap vaccine ².
• 36% of adults 50 and older reported receiving one or more doses of any type of herpes zoster vaccine ².
• 64% of adults 65 and older reported receiving one or more doses of any type of pneumococcal vaccine ².

Additionally, NHIS data from 2021 found that of adults 19 years and older, 34% reported receiving the hepatitis B vaccination ³. More recent estimates of national vaccination coverage are available through the National Center for Immunization and Respiratory Diseases and show that as of April 2025, 39.1% of adults 65 years and older reported having received an updated 2024-2025 COVID-19 vaccine ⁴.

Racial disparities in coverage exist across all six vaccines, with White adults reporting higher rates of vaccine receipt when compared to Black and Hispanic adults with the exception of COVID-19 vaccination where White adults had lower coverage compared to Asian adults ².

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 ⁵. 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 ⁶. Influenza vaccines are commonly offered at retail pharmacies; offering other types of adult vaccines at retail pharmacies could potentially increase uptake ⁷. For COVID-19 vaccination specifically, one of the major strategies to overcoming barriers was educating patients on the safety and efficacy of COVID-19 vaccination ⁸. 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 ⁹. 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 ⁹.

Historical Results – National Averages

Results

NCQA published a special report summarizing HEDIS measurement year 2020 results for eight measures that leverage electronic clinical data, including this measure. This report can be found here: www.ncqa.org/ecds.

References

1. Murthy, N., A.P Wodi., V.V. McNally, M.F. Daley, S. Cineas,. 2024. “Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older—United States, 2024.” MMWR Morb Mortal Wkly Rep 73:11–15. http://dx.doi.org/10.15585/mmwr.mm7301a3
2. Hung, M.-C. et al. 2024. “Vaccination Coverage among Adults in the United States, National Health Interview Survey, 2022.” Updated October 4. https://www.cdc.gov/adultvaxview/publications-resources/adult-vaccination-coverage-2022.html
3. Hung, M.-C. et al. 2023. “Vaccination Coverage among Adults in the United States, National Health Interview Survey, 2021.” Updated July 19. https://www.cdc.gov/adultvaxview/publications-resources/vaccination-coverage-adults-2021.html#:~:text=Hepatitis%20B%20vaccination%20coverage%20in,and%20Other%20(40.2%25)%20adults
4. CDC. 2025. “Vaccination Uptake, Intent, and Confidence.” Updated May 16. https://www.cdc.gov/respvaxview/dashboards/vaccination-behavioral-social-drivers.html
5. Lu, P., M. Hung, et al. 2021. “Surveillance of Vaccination Coverage among Adult Populations—United States, 2018.” MMWR Surveill Summ 70(No. SS-3):1–26. http://dx.doi.org/10.15585/mmwr.ss7003a1
6. Kaiser Family Foundation. 2020. Addressing Racial Equity in Vaccine Distribution. https://www.kff.org/racial-equity-and-health-policy/issue-brief/addressing-racial-equity-vaccine-distribution/ (accessed January 31, 2024).
7. Murray, E., K. Bieniek, M. Del Aguila, S. Egodage, S. Litzinger, A. Mazouz, H. Mills, & J. Liska. 2021. “Impact of Pharmacy Intervention on Influenza Vaccination Acceptance: A Systematic Literature Review and Meta-Analysis.” International Journal of Clinical Pharmacy 43(5), 1163–72.
8. Nawas GT, Zeidan RS, Edwards CA, El-Desoky RH. “Barriers to COVID-19 Vaccines and Strategies to Improve Acceptability and Uptake.” Journal of Pharmacy Practice. 2023;36(4):900-904. https://doi.org/10.1177/08971900221081621
9. Scharf, L.G., R. Coyle, K. Adeniyi, J. Fath, L. Harris, S. Myerburg, M. Kurilo, & E. Abbott. 2021. “Current Challenges and Future Possibilities for Immunization Information Systems.” Academic Pediatrics 21(4), S57–64.