Over the past week we’ve looked at the importance of staying up-to-date with immunizations, even as adults. Measles, mumps, and rubella; tetanus, diphtheria, and pertussis — these are all real dangers that have been kept, for the most part, out of sight and out of mind as a result of the success of vaccines. But the fact is that too many adults are not vigilant with staying up-to-date. Last year, FoxNews reported:
In 2012, only 64.2 percent of adults were up-to-date with their tetanus shots, and only 20 percent of adults at high risk for pneumonia had received the pneumococcal vaccine. Additionally, a mere 14.2 percent of adults had received the Tdap vaccination, which protects against tetanus, diphtheria and pertussis – also known as whooping cough.
Hepatitis A vaccination coverage was even lower, with only 12.2 percent of adults between the ages of 19 and 49 receiving immunization. Fortunately, vaccination for the human papilloma virus (HPV) increased from 29.5 percent in 2011 to 34.5 percent in 2012, and 20.1 percent of adults received the shingles-fighting herpes zoster vaccine in 2012 – up from 15.8 percent in 2011.
Given the report’s findings, CDC officials are urging American adults to get vaccinated, in order to reduce the spread of preventable diseases to the elderly and children.
Let’s look some other vaccine-preventable diseases adults should protect themselves against:
Polio is a disease that is slowly (but not surely) on the way to eradication. Until it is, polio vaccine is recommended for all international travelers who either have not completed the recommended polio series as children, or those who don’t know whether or not they have. A single, intramuscular dose of the vaccine is all that’s needed. You may not know your own polio vaccine status, so if you travel, talk with your doctor.
Varicella (Chickenpox) is caused by the very contagious varicella-zoster virus. Children 13 years old and older and adults who have never had chickenpox or received chickenpox vaccination should run, not walk, to their doctor and either request titers to prove immunity (adults often don’t remember having chickenpox) or get immunized. Approved for use in the U.S. in 1995, the vaccine is safe and effective for all ages beginning at one year of age. It has saved a generation of recipients the miserable symptoms (a widespread, blistering, itchy, and painful rash of the skin and mucus membranes, and fever) and complications (dehydration, pneumonia, brain inflammation causing dysfunction of the cerebellum (ataxia), bone and joint infections, secondary bacterial skin infections (sometimes by that terrorist bug, MRSA), and, in 100-150 people per year in the U.S. before the vaccine was available, death). For most people who get chickenpox, it’s a week-long nuisance; for some, it’s a horror show of pain and misery; and for those who are immunocompromised from disease or drugs, it’s a potential death sentence. Unvaccinated adults who never had chickenpox seem to suffer the worst of all.
Here is how prevention is done (and, yes, we do want to prevent people from getting and spreading chickenpox!):
- Varicella vaccine (Varivax) is given in two doses — one at 12 months of age and the second at kindergarten age (4-6 years old – often in a MMR-Varivax combination vaccine).
- Adolescents and adults who have not had chickenpox vaccine or chickenpox disease should receive two doses of vaccine, separated by one month, in order to be adequately protected.
That’s it. Simple. Run, don’t walk…
Hepatitis A is a food-borne and water-borne viral infection that causes inflammation of the liver. In 2003, the largest hepatitis A outbreak in U.S. history occurred in Pittsburgh, PA at the popular Chi-Chi’s Mexican Restaurant. 660 illnesses and four deaths resulted from the use of contaminated green onions grown in Mexico. Within a year, Chi-Chi’s was settling lawsuits and going out of business. Infection in healthy children usually produces no symptoms or mild symptoms. Pediatric immunizations are indicated because of the risks infected children pose to the rest of the herd — especially adults, the elderly, and immunocompromised patients in whom infections can be severe and life-threatening. Symptoms of hepatitis A include fever, fatigue, anorexia and weight loss, abdominal pain, and jaundice.
Preventing hepatitis A is easy and relatively painless:
- Two vaccines given six months apart are given at 12 months of age and again at 18 months.
- Catch-up vaccines for those who didn’t receive them as infants has traditionally been at 11 years old (with a second dose six months later).
- Adolescents and adults who have not been immunized with hepatitis A should receive two doses of hepatitis A vaccine, separated by six months.
- Hepatitis A vaccine (2 doses) is strongly recommended for children and adults who travel internationally, including Mexico and Central America.
Hepatitis B is a blood-borne infection of the liver that is still, in 2015, one of the leading causes of cirrhosis and chronic liver failure (necessitating liver transplantation surgery), and hepatocellular carcinoma (liver cancer) worldwide. Transmission occurs through exposure to infected blood and through the placenta from an infected mother. Hepatitis B is also considered a sexually-transmitted infection.
Immunization is simple and effective, and begins at birth:
- A three-dose series protects most people for life, beginning shortly after birth, then a second dose at one month of age, and a third dose at six months of age. (Note: sometimes four doses of hepatitis B vaccine are given — at birth, 2, 4, and 6 months of age — if the combination Pediarix vaccine is used in infancy.)
- Proof of vaccination or blood titers proving immunity are required in the United States in order to work as a health care professional.
Meningococcal disease is caused by the bacteria Neisseria meningitidis. The two horrible infections caused by this bacterium are meningococcemia (infection of the blood with downstream devastation) and meningitis (inflammation of the brain’s protective covering). Meningococcal disease is remarkably efficient in how easily it gains access to the body, in the speed at which it spreads, and in its predilection to maim and kill quickly.
Immunization is accomplished in all children and young adults beginning at 11 years old, with a second dose given at 16 years old. Meningococcal vaccine is a requirement for entry into 6th grade for all public and most private schools in the United States except for those with medical exemptions and (in a shrinking number of states that still tolerate) personal, religious, and philosophical exemptions. Those people most at risk are:
- Infants. (Immunizing older children and teenagers protects infants. A vaccine is available for infants with certain medical conditions; another vaccine is being developed for use in all infants.)
- Teenagers and young adults. Two doses are strongly recommended for college entry and required for military service.
- People who don’t have a functioning spleen.
- Travelers to the “meningitis belt” of sub-Saharan Africa.
Human Papillomavirus (HPV) is a sexually-transmitted cancer-causing virus. Even though many people who are infected are asymptomatic, they can be effective transmitters of the infection to their sexual partners. (By the way: any sexual activity — not just intercourse — can lead to transmission from an infected person to a non-immune partner.) Some infected people develop genital warts, which are uncomfortable, embarrassing, and difficult and often painful to treat. But like any warts, they will eventually go away and not cause any problems.
It’s the cancer HPV causes that we’re trying to prevent here. HPV infection causes cancer of the cervix in females, which is one of the most common cancers in humans and still one of the most common cancer-causes of death in women worldwide. HPV is also the leading cause of oral cancer (tongue and throat) in the U.S. — ahead of tobacco and alcohol — in both men and women.
The vaccine has been very well studied for more than a decade and is very safe. It’s effective for most strains of HPV that cause cancer as a three-dose series. The vaccine is recommended for:
- Girls and boys beginning at age 11 (though it can be given as young as 9 years old), with a second dose given 1-2 months later and a third dose given 4 months after the second.
- HPV vaccine has been approved for both men and women up to the age of 26.
There has been a lot of controversy regarding HPV ever since it came out more than a decade ago, almost all based on misinformation (from the usual suspects) and unfounded fears (no, getting the vaccine does not result in children becoming sexually active). All you have to remember are three words to ensure your tween, teen, and young adult children get immunized against HPV: Sexually. Transmitted. Cancer.
Herpes Zoster (Shingles) occurs years-to-decades after having varicella (chickenpox). The virus lives deep in nerve ganglia where it waits for a person’s immune system to, however briefly, drop. The virus then travels along nerve fibers, causing an intense burning pain, before emerging on the skin in a painful and itchy rash that lasts weeks-to-months. “It’s horrible,” says everyone.
The vaccine is given as a single dose at 60 years of age and older. The vaccine is said to cut the risk of getting shingles in half. Getting vaccinated against chickenpox as a child and not getting the disease is the best strategy to prevent shingles later in life.
Pneumococcal vaccine has long been recommended for adults of all ages with chronic medical conditions, such as cigarette smoking, chronic lung diseases, asthma, heart disease, blood disorders like sickle cell disease, asplenia (no spleen), chronic kidney disease, and compromised immune systems. Because pneumonia from the bacterium Streptococcus pneumoniae is so common and severe, recent guidelines recommend that all people 65 years and older receive immunizations to prevent it. First, pneumococcal conjugate vaccine (PCV 13) is given, followed eight weeks later by a pneumococcal polysaccaride vaccine (PPSV 23) that covers even more strains.
Influenza vaccine is administered every fall and winter to children beginning at 6 months of age and continuing annually until a person’s last breath. In a perfect world.
Unfortunately, one of the simplest ways there is to prevent a very common, always severe, often painful, sometimes life-threatening infection — a flu shot that barely pinches or a painless FluMist — has to contend with pervasive misinformation, unfounded fears, lame excuses, and just plain laziness.
So now you know how I feel about influenza vaccines. Get one every year.
After spending the past five days reviewing the recommendations for adult vaccinations, please remember these few things:
- Vaccines are important. Protect yourself and the ones you love.
- Shots hurt. Get over it.
- Keep your children up-to-date with their immunizations. Bucking the standard of care and refusing to vaccinate based on fear and nonsensical hearsay hurts everyone in the herd, most of all your own precious children.
- Make sure you are up-to-date on your vaccines. Dig up your records, ask your mother, and ask your doctor! (Or maybe you’ll need to start by identifying a doctor or clinic as your PCP and then make an appointment and go!)
- Keep records of your immunizations handy so you, or any provider who cares for you, knows what immunizations you need to stay up-to-date.