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Barriers for immunizations include lack of knowledge about risks

Individuals may be unaware of their immunization schedule, health officials say.

Barriers for adult immunizations for vaccine-preventable diseases include a lack of knowledge about the immunization schedule, according to Central Valley Health District officials.
Masaki Ova / The Jamestown Sun
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JAMESTOWN, N.D. — Many barriers exist for adult immunizations for vaccine-preventable diseases even though children receive many vaccines when they are newborns to 6 years old.

Barriers for adult immunizations for vaccine-preventable diseases include lack of knowledge about the immunization schedule and risks and consequences of the diseases, lack of awareness to get vaccines other than influenza, skepticism regarding vaccine safety and effectiveness and conflicting and inaccurate information about immunizations in the media, according to Central Valley Health District officials in Jamestown, North Dakota.

Adults don’t think about getting vaccines once they are 18 because parents often took their children to get their routine vaccinations, said Kim Lee, director of nursing at Central Valley Health. She said people around 20 to 50 years old fall off on their immunizations.

“When they get older and their immune system is waning, then they start remembering, ‘Oh, I probably need my pneumonia (vaccine). I don’t want to get shingles,’” Lee said. “Then they start thinking about it again.”

The North Dakota Immunization Information System collects immunization data for all state citizens. An individual’s primary health care provider can access the North Dakota Immunization Information System and provide an immunization record.


Sometimes people need a reminder.

“If they can’t remember, most likely they are due for one,” said Robin Iszler, unit administrator at Central Valley Health.

Iszler said unvaccinated adults can unknowingly spread vaccine-preventable diseases. And despite the widespread availability of safe and effective vaccines, adult vaccination rates remain low in the U.S., she said.

Iszler said the immunity of adults diminishes over time to a disease such as pertussis, which is whooping cough and is most dangerous to newborns who cannot be vaccinated for it until they are 3 months old. She said pediatricians recommend that grandparents and other relatives who might be around a newborn be vaccinated.

Tetanus is another common vaccine-preventable disease. Lee said adults don’t keep up with their tetanus vaccination and go to the hospital after they suffer an injury, such as from stepping on a rusty nail or getting snagged with a fishing hook.

“That is common,” she said. “They just forget about it.”

Iszler said another reason for vaccine hesitancy is adults thinking the vaccine will give them the disease.

“Most vaccines are not live. We are not giving you the disease,” Iszler said. “We are giving you an inactivated virus, and then we are teaching your body’s immune system to respond to that specific disease.”


Lee said people don’t think the coronavirus vaccine is safe because of how quickly it arrived, and how hard it was touted by the federal government.

“I think there were so many things going around about the COVID vaccine, a lot of misinformation,” she said. “I think that is why we struggled with that.”

Recommended immunizations for adults include:

  • getting vaccinated for COVID;
  • influenza (yearly);
  • DTaP to protect against tetanus, diphtheria and pertussis;
  • and additional vaccines such as hepatitis A and B, human papillomavirus, meningococcal, pneumococcal and shingles that may be recommended based on age, lifestyle, health status, occupation, prior vaccination history and travel plans.

When individuals get an annual checkup, their health care provider will check what vaccines are needed or can be asked questions about vaccinations, Iszler said. She said individuals with underlying medical conditions will need to talk with their primary care provider about which vaccinations will be beneficial to them.
Iszler said most vaccines have a series. Once the series is complete, individuals don’t need another vaccine from the series unless a study determines that they are no longer immune to a specific disease.

Vaccinations for children

Individuals get vaccinations for up to 14 vaccine-preventable diseases during the first six years of their lives but the amount needed tapers off after that.

People have a good immune response when they are young but not as infants, Lee said. She said when children are 10 to 12 years old, they won’t be as susceptible to get a vaccine-preventable disease because the vaccine is still in the system.

“I think the other thing is when you vaccinate your child, some of those times they are getting four or five shots at a time,” she said. “They probably aren’t going to remember you are giving them six shots at one time.”

Iszler said vaccinations for children are required.


“There is no ‘recommended’ except for when you get to be more of a teen,” she said.

Lee said some vaccines are required if a child will be in child care or in school but vaccinations for diseases such as hepatitis A or human papillomavirus are not required but highly recommended.

Combined Recommended Immunization Schedule for Persons Aged 0 th
This graphic shows the schedule for recommended immunizations for children from birth through 6 years old.
Contributed / U.S. Centers for Disease Control and Prevention and the National Center for Immunization and Respiratory Diseases<br/>

Minimum requirements for children attending early childhood facilities, Head Start programs and preschool educational facilities should be age-appropriate immunizations against diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella, haemophilus influenzae type B disease, varicella (chickenpox), pneumococcal disease, rotavirus and hepatitis A and B, according to North Dakota Administrative Code Title 33-06-05-01.

Minimum requirements for children attending kindergarten through grade 12 are getting age-appropriate immunizations against diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella, varicella, meningococcal disease and hepatitis B.

Children must get a second dose of the varicella vaccine before being admitted into kindergarten or first grade if the student's school does not have kindergarten. A student must receive meningococcal conjugate and tetanus, diphtheria and pertussis vaccine before being admitted into any seventh grade.

Iszler said most families are open and responsive to vaccines whether they are recommended or required.

“Most of the time, we explain the differences but people, once it is explained what it’s for, they will have their child get vaccinated,” she said.


Iszler said more people across North Dakota have opted for a medical, religious or philosophical exemption from vaccines.

“But we also see when providers like medical doctors and nurses suggest vaccines that people will consider them,” she said.

A child with a medical, religious or philosophical exemption is exempt from any or all of the immunization requirements, according to the North Dakota Administrative Code. A physician must sign the exemption form and indicate which vaccines are included in the medical exemption. A parent or guardian must sign an exemption form stating the child has a beliefs exemption and which vaccines are exempt because of beliefs.

A child with a reliable history of chickenpox, hepatitis A and B, measles, mumps or rubella is exempt from applicable immunization requirements, according to the North Dakota Administrative Code. A physician will need to sign an exemption form stating the child has had the disease.

Exemption forms are kept on file with the immunization records at the child’s school, early childhood facility, Head Start program or preschool educational facility.

Lee said parents can reverse any exemptions that they have chosen for their children not to be vaccinated.

“They can get rid of the exemption at any time and resume their vaccinations,” she said.

She said individuals don’t get exemptions unless it is a medical one at many colleges.

Lee also said individuals in certain professions are mandated to take vaccines. She said nurses have to get vaccines and the military is “very strict” on making sure their service members’ vaccinations are updated.

Masaki Ova joined The Jamestown Sun in August 2021 as a reporter. He grew up on a farm near Pingree, N.D. He majored in communications at the University of Jamestown, N.D.
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