You’re An Adult, So Get Vaccinated!

29 01 2013

adults onlyOnce we leave our family home and go off to college or the military or the workforce, how healthy we are is up to us.

For our first couple of decades, mom and dad do all the work. They get us in for our immunizations, tell us to wash our hands, nag us to eat our greens—well, the nagging about our health never ends. But the point is, we don’t worry about that stuff because we know someone else is doing that for us.

Then, in our 20s, 30s, and 40s, we’re hauling our own kids to the clinic for shots and sniffles, or nagging them to eat their greens. We haven’t the time for a long shower; forget finding time to take care of our own health.

In our 50s, we’re working hard and at the peak of our careers, or getting laid off and stressing about that. Plus, we’re watching out for our parents’ health. We have no time for check-ups or even basic immunizations. Even if we have the time, we have no idea what we’re supposed to take care of and might not have a “medical home,” a physician we see when we need to see one.

Our 60s and 70s are when we wake up to the fact that we have to take care of our bodies. Most of the time, we do that by reacting to health issues that pop up rather than working to prevent problems.

After 80, we’re bossed around by our middle-aged children who can find us a specialist in 10 minutes, but have no idea that we need a Tdap vaccine.

Adults 19 and older in the US are not taking advantage of vaccines, and that’s an easy place to start taking care of ourselves. Each of us should check in with a healthcare provider and find out what vaccines we need. Nobody has time to do it, so just do it anyway.

Here’s a list from the CDC, although it’ll be much simpler to ask a physician. But, if you love the details (full recommendations for each vaccine can be found here):

  • Pneumococcal Vaccine Information
    • Pneumococcal polysaccharide vaccine is recommended for all adults aged 65 years and older.
    • In addition, certain adults younger than 65 years should be vaccinated if they have certain high-risk conditions such as cardiovascular disease, pulmonary disease, diabetes, alcoholism, cirrhosis, cerebrospinal fluid leak, or a cochlear implant, or if they have a suppressed immune system.
    • Adults aged 19 years and older should also get a pneumococcal polysaccharide vaccine if they have asthma or smoke cigarettes.
    • Preliminary data report approximately 37,000 cases of invasive pneumococcal disease in 2011. Of those cases, there were about 4,000 deaths.
    • The majority of cases and deaths occur among adults 50 years or older, with the highest rates among those 65 years or older. Almost everyone who gets invasive pneumococcal disease needs treatment in the hospital.
    • Overall, pneumococcal polysaccharide vaccine (PPSV23) is 30% to 70% effective in preventing invasive pneumococcal disease, such as meningitis and bloodstream infections.
      • Effectiveness is highest among otherwise healthy adults.
      • Effectiveness is lowest among adults with significant underlying illness.
    • There is not consensus regarding the effectiveness of PPSV23 against non-invasive pneumococcal pneumonia.
    • Certain adults with significant underlying illness should also get the pneumococcal conjugate vaccine (PCV13), which has proven highly effective among children.
      • A large clinical trial is underway in the Netherlands that is studying the effectiveness of PCV13 against pneumococcal pneumonia among adults.
    • Adults at high risk for pneumococcal disease who haven’t gotten the vaccine yet should talk with their doctor about getting it now.
  • Tetanus and Tdap Vaccine Information
    • Tdap vaccine is recommended for adults aged 19 years and older to protect against tetanus, diphtheria, and pertussis (whooping cough).
    • Tdap vaccine is especially important for adults who will have close contact with infants less than 1 year old.
    • In addition, pregnant women are recommended Tdap vaccination during each pregnancy, preferably at 27 through 36 weeks’ gestation, to help protect their newborns from whooping cough.
      • Tdap vaccine can be safely given at any time during pregnancy, but is recommended during the third trimester to pass the most amount of protection to the baby.
    • Tetanus, diphtheria, and pertussis are all caused by bacteria.
      • Both diphtheria and pertussis are spread from person to person.
      • Tetanus enters the body through cuts, scratches, or wounds. • Provisional data report nearly 42,000 cases of pertussis during 2012, a nearly 60-year high.
    • Our current estimate is that Tdap vaccination protects 7 out of 10 people who receive it.
    • Since Tdap vaccines were only licensed in 2005, we don’t yet have results on long-term vaccine protection.  We’re still working to understand how that protection declines over time.
    • CDC is conducting an evaluation in collaboration with health departments in Washington and California to better understand how long Tdap vaccines protect from pertussis.  The data from these evaluations will help guide discussions on how best to use vaccines to control pertussis.
    • Adults who haven’t gotten a Tdap shot yet should talk to their doctor about getting it as soon as possible, no matter when they last got a tetanus (Td) booster.
    • After receiving the Tdap shot, adults should continue to get a Td booster every 10 years.
    • Adults need to get Tdap even if they were vaccinated as a child or have been sick with pertussis in the past; neither provides lifelong protection.
  • Hepatitis A Vaccine Information
    • Hepatitis A vaccine is recommended for adults who are working in or traveling to any area of the world outside of Canada, Western Europe and Scandinavia, Japan, New Zealand, and Australia.
    • Other adults that should get the vaccine include men who have sex with men, people who use illegal drugs, people who have clotting factor disorders, people with chronic liver disease, and people who might be exposed to hepatitis A on the job (such as those who work with hepatitis A virus in laboratory settings or with hepatitis A-infected primates).
    • Hepatitis A is caused by a virus and spreads primarily by oral contact with fecal matter, either through person-to-person or by contaminated food or water.
    • More than 95% of adults will develop immunity within one month of a single dose of hepatitis A vaccine, and nearly 100% will develop immunity after receiving two doses.
  • Hepatitis B Vaccine Information
    • Hepatitis B vaccination is recommended for adults at high risk of infection by sexual or blood exposure to hepatitis B virus.
    • People at high risk of sexual exposure include sex partners of people who are positive for Hepatitis B, people who’ve had more than one sex partner in the last six months, people seeking evaluation or treatment for a sexually transmitted disease, and men who have sex with men.
    • People at risk of blood exposure include current or recent injection-drug users, household contacts of people who are positive for Hepatitis B, residents and staff of facilities for the developmentally disabled, people with end stage renal disease, and some health-care and public safety workers.
    • Other groups at risk include international travelers to regions with high or intermediate levels of Hepatitis B infection and people with HIV infection.
    • Hepatitis B is caused by a virus and is spread from person to person primarily through blood or semen. • In healthy adults, the vaccine is 80% to 95% effective in preventing infection or clinical hepatitis in those who complete a hepatitis B vaccine series (usually 3 doses).
  • Herpes Zoster Vaccine Information
    • Herpes zoster (shingles) vaccine is recommended for adults aged 60 years and older.
    • Shingles occurs when latent varicella zoster (chickenpox) virus reactivates later in life.
    • Pain from shingles lesions, called post-herpetic neuralgia, can be very severe and last a year or more.
    • 50% of people who live until age 85 will develop shingles.
    • In people 60 years of age and older, the shingles vaccine:
      • Reduces the risk of shingles by about half (51%)
      • Reduces the risk of post-herpetic neuralgia (prolonged pain at the rash site) by 67%
    • The shingles vaccine is effective for at least six years but may last longer; research is being done in this area.
  • HPV Vaccine Information
    • HPV vaccine is recommended for routine vaccination of females and males at age 11 or 12 years.  Vaccination is also recommended for females 13-26 years of age and for males 13-21 years of age, if not previously vaccinated.  Males aged 22-26 years may be vaccinated.
    • HPV2 or HPV4 is recommended for females; HPV4 is recommended for males.
    • Men who have sex with men (MSM) may especially benefit from vaccination to prevent condyloma and anal cancer.  HPV4 is recommended for MSM through age 26 years who did not get any or all doses when they were younger.
    • HPV is a common virus that is primarily spread through sexual contact.
    • There are approximately 40 types of genital HPV.
      • Some types can cause cervical cancer and other kinds of cancer in both men and women.
      • Other types of HPV can cause genital warts in both males and females.
    • About 6 million people become infected with HPV each year.
    • Studies found vaccine efficacy of over 93% against disease due to HPV vaccine types if a female had not already been infected with that type.
    • HPV vaccine is not therapeutic and does not treat existing infection or disease.
    • Prior infection with one HPV type did not lessen the effectiveness of the vaccine against other vaccine HPV types.
    • There are 2 vaccines licensed by the Food and Drug Administration (FDA) and recommended by CDC to protect against HPV-related illness; these vaccines are Cervarix (made by GlaxoSmithKline) and Gardasil (made by Merck).
      • Both vaccines are very effective against HPV types 16 and 18, which cause most cervical cancers, so both vaccines prevent cervical cancer in women.
      • Only Gardasil protects against HPV types 6 and 11 – the types that cause most genital warts in females and males.
      • Only Gardasil has been tested and shown to protect against cancers of the vulva, vagina, and anus.
      • Only Gardasil has been tested and licensed for use in males.
  • Vaccine Safety
    • All vaccines used in the United States are required to go through years of extensive safety testing before they are licensed by the U.S. Food and Drug Administration (FDA).
    • FDA and CDC work with health-care providers throughout the United States to monitor the safety of vaccines, including for any adverse events, especially rare events not identified in pre-licensure study trials.
    • There are three systems used to monitor the safety of vaccines after they are licensed and being used in the U.S.
      • These systems can monitor side effects already known to be caused by vaccines as well as detect rare side effects that were not identified during a vaccine’s clinical trials.
      • One of the three systems used to monitor the safety of vaccines after they are licensed and used in the U.S. is called the Vaccine Adverse Event Reporting System (VAERS).
      • VAERS accepts reports from health professionals, vaccine manufacturers, and the general public and receives about 28,000 U.S. reports per year, compared with millions of vaccine doses given to adults.

By Trish Parnell