In vaccinating adults, clinicians face 2 types of challenges: (1) staying current on recommendations for influenza, pneumococcal, hepatitis A and B, zoster, and other vaccines and (2) addressing systemic barriers to implementing practices that increase vaccination rates. Although adult immunization rates remain suboptimal, there has been much good news in adult vaccination recently. New high-dose and adjuvanted influenza vaccines help improve immune response and may reduce influenza complications in older adults. The new recombinant zoster vaccine offers significantly more efficacy against zoster outbreaks and postherpetic neuralgia than zoster vaccine live. Pertussis vaccine given during the third trimester of pregnancy may prevent between 50% and 90% of pertussis infections in infants. Shorter time for completion (1 vs 6 months) of new, adjuvanted hepatitis B vaccine may increase adherence. Clinicians can address systemic barriers to increasing vaccination rates in their clinics and health care systems by following the Centers for Disease Control and Prevention's Standards for Adult Immunization Practice. Clinicians can help increase vaccination rates by writing standing orders and by advocating for nurses or medical assistants to receive training and protected time for assessing and documenting vaccination histories and administration. Strong recommendations that presume acceptance of vaccination are effective with most patients. Communication techniques similar to motivational interviewing can help with vaccine-hesitant patients. Clinicians, as experts on providing preventive services, can educate community leaders about the benefits of immunization and can inform vaccine experts about challenges of implementing vaccination recommendations in clinical practice and strategies that can work to raise vaccination rates.

中文翻译：

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在一般医学实践中对成年人进行疫苗接种。

在给成年人接种疫苗时，临床医生面临两种挑战：（1）紧跟流行性感冒，肺炎球菌，甲型和乙型肝炎，带状疱疹和其他疫苗的建议，以及（2）解决实施增加疫苗接种率的做法的系统性障碍。尽管成人疫苗接种率仍然不理想，但是最近在成人疫苗接种方面有很多好消息。新的高剂量和辅助性流感疫苗有助于改善免疫反应，并可以减少老年人的流感并发症。新型带状带状疱疹疫苗比带状带状疱疹疫苗具有更大的抗带状疱疹暴发和疱疹后神经痛的功效。在妊娠晚期，百日咳疫苗可预防婴儿百日咳感染的50％至90％。完成新产品的时间更短（1比6个月），辅助乙肝疫苗可能会增加依从性。临床医生可以遵循疾病控制和预防中心的《成人免疫实践标准》，解决诊所和医疗保健系统中增加疫苗接种率的系统性障碍。临床医生可以通过制定常规命令并倡导护士或医疗助理接受培训并保护他们的时间，以评估和记录疫苗接种历史和管理工作，从而帮助提高疫苗接种率。强烈建议假定接受疫苗接种对大多数患者有效。与动机面试类似的交流技术可以帮助疫苗敏感性患者。临床医生，作为提供预防服务的专家，