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Smart Shots
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Keeping up with your vaccines can be a matter of life and death
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By Diane Umansky
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MediZine's Healthy Living Fall 2009
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Can you think of five diseases that are prevented by vaccines for grownups? A survey by the National Foundation for Infectious Diseases (NFID) found that most of us can’t name more than one or two.
Kids receive a veritable slew of vaccines throughout childhood, to prevent them from diseases such as rubella, diphtheria and tetanus. But to shield themselves and their loved ones from vaccine-preventable ills, adults need to stay up to date on vaccines as well. “The vast majority of vaccine preventable disease in the United States is now in adults,” says William Schaffner, M.D., chair of the department of preventive medicine at the Vanderbilt medical school in Nashville and president elect of NFID.
Statistics show that most adults don’t get the vaccines they should. The result: “We see maybe a couple of hundred deaths a year in children due to vaccine-preventable disease, but we see somewhere in the order of 50,000 deaths in adults,” says Gregory A. Poland, M.D., professor of medicine at the Mayo Clinic and director of the Mayo Vaccine Research Group in Rochester, MN.
A mix of factors are at work. “Many adults don’t go to the doctor on a regular basis as children do,” says Dr. Schaffner. “And some go only to a specialist—their gynecologist, or their cardiologist. Specialty doctors don’t have it in their minds that they ought to provide immunization.”
Too, while childhood immunization is generally covered by insurance, coverage for adult vaccines can be uneven or intimidatingly complex. For Medicare recipients to receive coverage for the shingles vaccine, for example, they may need to get a prescription from the doctor, and have it filled and administered by a qualified pharmacist.
And many of us may be unaware of the need for adult vaccines—an NFID survey found that some 40 percent of grownups think they’re still protected by childhood shots—or which vaccines we should be getting. To help, here’s a rundown of some of the adult vaccines recommended by the Centers for Disease Control and Prevention (CDC):
The CDC recommends that grownups get a booster shot for tetanus every ten years. And with pertussis (whooping cough) on the rise, health officials now say that one of these boosters, for adults up to 64 years old, should be a newer vaccine, Tdap that offers protection against tetanus, diphtheria and pertussis. This protects not only the adults, but also the youngsters around them who may catch whooping cough from the grownups in their lives. (Kids need a series of vaccines over a period of years to fully shield them from whooping cough). And while whooping cough can make grownups ill, it can be lethal to babies.
This bacterial condition, the leading cause of pneumonia, can also cause meningitis, sinus infections, ear infections and a bloodstream infection known as bacteremia. The vaccine is recommended for all adults age 65 and older, along with adults with chronic health conditions and those who are missing their spleen, or are immunocompromised. Recent additions to this group: smokers and those with asthma. “Good studies show elevated risk in those groups,” says Dr. Poland. “And it should be easy for doctors to remember to give the vaccine to those people; we already know they need the flu vaccine.”
The flu, a highly contagious viral illness marked by fever, chills, cough, headache and sore throat, kills 36,000 Americans each year. The novel H1N1 pandemic strain of the virus has been front and center for health officials for the past six months, and that’s helped to bring more attention to the importance of the flu vaccine.
An annual vaccine is developed against what experts project will be the leading strains each year and all adults age 50 and over, those with chronic health conditions, health care workers, and all adults that are in close contact with children under five years old are advised to get that vaccine. “This should also be given to women who are pregnant during the influenza season,” says Dr. Schaffner. “If you are pregnant and get the flu, the rate of complications is comparable to that of people age 65 and over. Most people, including most obstetricians, don’t know that.”
Many adults avoid the flu vaccine, thinking they won’t catch the virus or that the vaccine itself may be dangerous. “The majority of U.S. health-care workers don’t get influenza immunizations,” points out Dr. Poland. “The latest statistic is that only 42 percent of health-care workers get the vaccine.”
The optimal time to get the vaccine: “From the time the vaccine is released until its expiration in June,” says Dr. Poland. “You don’t have to have it by November or December. The majority of outbreaks occur in the January through March time frame, but his year we saw outbreaks in April, May and June.”
Anyone who has had chickenpox is at risk for shingles—which can trigger the rise of painful blisters on the body and debilitating nerve pain that may persist for years. The culprit is the same virus that causes chickenpox, which can lay dormant in the body for years before reemerging and wreaking havoc. Advancing age and weakened immunity can increase the risk for shingles, and one in three Americans will be affected during their lifetime. The vaccine, for those 60 and over, cuts the risk of shingles in half and reduces the risk for lingering nerve pain, by almost 70 percent. “That’s its real value,” says Dr. Poland. But less than two percent of those who are candidates for the vaccine have received it, according to the CDC’s National Immunization Survey.
Human papillomavirus (HPV), which infects more than 6 million females each year, is the cause of some 70 percent of cervical cancers. The HPV vaccine is “wonderfully effective, astoundingly so, and also very safe,” says Dr. Schaffner. “It’s a tremendous advance in women’s health.”
The vaccine is recommended primarily for young women—up to age 26—because it may be less effective in women who have already been exposed to HPV. Only 10 percent of women between 18 and 26 have received the vaccine. “This vaccine is being tested now in adolescent males, and I think we’ll see a recommendation for males coming down the line in the next few years,” says Dr. Poland.
Several other vaccines, such as those for hepatitis A and B, and the meningococcal vaccine, may be recommended for adults with certain medical or lifestyle-related risk factors. With hepatitis B, for example, which can be passed through sexual intercourse or exposure to the blood of an infected person, candidates for the vaccine include—but aren’t limited to—those who have another sexually transmitted disease or are not in a sexually monogamous relationship. Ask your doctor to discuss all the vaccines you might need; they are a vital component of health care.
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