Lewin and Williams say they don't hear as many concerns about the safety of vaccines and their additives from their adult patients, a common and controversial concern with childhood vaccines. "But it's important for providers to educate," said Williams "There have been huge, well-done studies that have discounted most of the speculation of vaccine safety. We need to talk about data and facts rather than conjecture."

I can't afford these vaccines. Williams works in a veterans' hospital, where, he says, "We think of vaccinations as sort of another vital sign, along with taking your temperature and blood pressure when you come in."

But this isn't always the case: "We'd like to get the shingles immunization, but our doctor does not give it," said Linda Carlson, who works in marketing for a parenting magazine. "The only source for this expensive vaccine is drugstores. And our insurance provider will not cover shots given in the drugstore."

For people who aren't covered by a Medicare D prescription plan or private insurance, the one-time vaccine can cost between $200 and $300.

Not all insurance plans routinely cover adult vaccinations as part of preventive care, and some physicians may not carry certain vaccines if they don't feel there will be a demand for them. In some cases, as was illustrated by the H1N1 vaccination push in 2009, the vaccines themselves might be in short supply (although now, in 2010, there is an over-supply of H1N1 vaccine).

I can't find these vaccines. Patient assistant programs sponsored by some pharmaceutical companies provide free vaccines to low-income and uninsured patients, if the patients apply for the program through their physicians. Other options include county health departments and vaccination drives sponsored by a pharmaceutical or drugstore chain. The national Immunization Action Coalition Web site (www.immunize) mostly aimed at health professionals, also contains "shot finder" searches.

It's not that big of a deal. Williams hears this one a lot, and he's ready with his story. He missed his seasonal flu shot one year and "Boy, did I pay for it," he says. "I had a severe case of influenza in February and ruptured a disc in my neck from coughing so hard."

"People don't realize how deadly this problem is," he said. "We have 35,000 to 40,000 deaths each year from influenza and the bacterial pneumonia that can follow, and we believe this may be a gross underestimate."

"I think that people who have seen people with these serious diseases like lockjaw, older people who knew someone who had shingles, know what they are getting vaccinated against," said Lewin. "Most of us haven't seen someone go deaf from measles, or infertile from mumps, or lose a pregnancy with German measles. We take for granted the protections we have."

If you're wondering whether your own vaccinations are up to date, the best place to start is with your primary care doctor. Gather your medical records related to any vaccination you've had as a child or adult, and use those as a guide when you have the conversation with your physician. Remember that any vaccinations you've received outside of your doctor's office ”a flu shot at the library, or a measles shot at school ”won't be part of your primary care record unless you carry or arrange to have this information sent to your physician.

Don't forget to tell your doctor about any special circumstances that could affect your vaccination needs, including your work, your recreation, and your travel plans. --Center for Advancing Health

SOURCE The Advisory Committee on Immunization Practices

cdc/vaccines/default.htm.