Adults often don't find affordable access to vaccines that could protect them from illnesses, according to the head of the National Immunization Program at the U.S. Centers for Disease Control and Prevention.

"There's very little safety net" to provide vaccines to adults who need them and can't afford them themselves, says Dr. William L. Atkinson. While many children who don't have insurance or come from low-income families receive needed immunizations through Vaccines for Children, there's no comparable program for adults, and "insurance companies commonly don't cover those."

So adults become ill with tetanus, meningitis, pertussis, shingles, human papillomavirus or hepatitis B, for example, although there are vaccines to prevent them, he said.

Even flu vaccination rates aren't that good among adults, he said. The same is true of the pneumonia shot.

And what public health officials know about at-risk populations and what they do to actually target them is limited by public health budgets, he said. For instance, they know that thousands of (mostly young) adults need hepatitis B vaccine, and a logical way to reach large numbers of those most at risk would be to make the vaccines available in clinics that specialize in sexually transmitted diseases and in jails, among other places. But those places already "operate on a shoestring" and likely can't afford to vaccinate the people coming in, Atkinson said.

"Many people are not getting them because we can't put the vaccines out there where they are," Atkinson said. Instead, the public health system relies on people to find out what vaccines they need and where to get them, then figure out how to pay for them. Too often, it doesn't happen.

He says all adults should be asking their health-care provider if they have had all the vaccines they need and, if not, where to get them.

The Utah Health Department tracks use of influenza and pneumonia shots among adults as much as it can, said Rebecca Ward, education outreach coordinator for the Utah Immunization Program. It requires long-term care facilities to make the vaccine available to residents and keep track of how many actually are immunized.

In 2005, 72.6 percent of those in nursing homes had flu vaccine and 40.3 percent were vaccinated against pneumonia, she said. They use the Behavioral Risk Factor Surveillance Survey, a random phone survey, to determine rates among non-institutionalized adults. In 2005, 69.6 percent of respondents had had flu vaccine and 66.4 percent had the pneumonia vaccine, slightly better than national averages.

Data on other adult immunizations is less complete, Ward said.