Shots are not just for kids. A number of infectious diseases can really foul up an adult's life, can be spread by adults to children, and sometimes can be fatal. Do I need TDP, Td, Tdap, MMR, HPV, or maybe HepA or HepB? The alphabet soup of the vaccination jargon can be confusing and off-putting. This background will help you when discussing your own vaccination needs with your health care provider.
Major Vaccine-preventable Diseases
With little discomfort and little cost, you can cut your risk of getting these serious diseases.
Influenza. A highly contagious disease caused by a virus. It usually attacks the respiratory system. Most people survive after a week or so of misery. Some virus strains are especially dangerous. Get this immunization yearly. Vaccines come in three varieties: the standard attenuated virus vaccine given by needle; a high dose variety developed for seniors, also a shot; and a live attenuated nasal mist, which is not for pregnant women or anyone with certain high-risk medical conditions.
Tetanus is the result of a poison made by bacteria. The poison attacks nerves and causes extremely painful cramps, often in the jaw muscles, hence the name "lockjaw." Many professions have mandatory immunization, but boosters are needed every 10 years. The vaccine is referred to as "T," and is usually combined with diphtheria vaccine (Td) or diphtheria and acellular pertussis vaccine (Tdap).
Diphtheria comes from a bacterial infection, usually in the throat where it forms a membrane that can choke a child or adult. Skin infections also occur, and can transmit the disease. Recently there has been a resurgence of diphtheria. The vaccine is represented by the letter "d," a capital D for high strength and a lower case d for a lower dose. Children get the D level. Adults get d, combined with tetanus (Td or Tdap), so every ten years is the routine.
Pertussis is whooping cough, a disease that in the past wiped out thousands of children. There are still epidemics of whooping cough in the US. In 2009, over 16,000 cases were reported. Adults can transmit this disease to babies and children, which is an additional reason to get vaccinated. The vaccine is usually packaged with Td, and is labelled Tdap. The "ap" stands for acellular pertussis, a relatively new form that is unlikely to cause the side effects seen in early pertussis vaccines.
Combination for adults. Adults under age 65 should receive one Tdap in place of one of their 10 year Td boosters. People over 65 who are in contact with infants (grandchildren, neighbors, or who work around small children) should also receive one Tdap shot.
Human papillomavirus (HPV). This virus causes cervical cancer. Women aged 19–26 years should have three doses. They should have started their series at age 11 or 12. Males may be vaccinated with one of the vaccines, Gardisil™, to prevent genital warts.
Zoster. This vaccine will greatly reduce the risk of shingles, a painful virus infection of nerves by the same virus that causes chickenpox. For people over 60, it reduces the relative risk of shingles by 50%. Previous infection with chickenpox does not give immunity to shingles; in fact, it sets one up to get shingles, since the chickenpox virus can stay dormant in nerves only to erupt and cause shingles many years later. Previous shingles does not prevent getting it again. Zoster vaccination is recommended one time for people over 65. The US Food and Drug Administration (FDA) recently approved the vaccine Zostavax™ for people age 50 and up.
Varicella or chickenpox in adults can cause sever neurologic damage. It is caused by one of the herpes viruses, HSV-3. Adults without evidence of immunity should receive two doses, unless there are medical reasons not to. Pregnant women who don't have evidence of immunity should not be immunized until after delivery. "Evidence of immunity" is a special term defined by the CDC (see Source).
Measles, Mumps, Rubella. This is the familiar MMR vaccine of childhood. If you were born in 1957 or later, you should be able to document that you have had the MMR series (unless you have a medical contraindication to MMR vaccine, or you have laboratory proof you are immune to these diseases).
Pneumonia. The pneumococcal polysaccharide vaccine (PPSV) is recommend for everyone over 60, and for all adults with asthma, smokers, or with a number of medical conditions. A one time revaccination after five years is recommended for those age 19 to 64, and for older people if they were first vaccinated below age 65 and at least five years have since elapsed.
Special Cases for Hepatitis and Meningitis
One or both of these immunizations may be recommended for college students, medical personnel, military recruits, international travelers, men who have sex with men, heterosexuals who have more than one partner, and others. Inquire of your health care provider if this means you.
Summary of Vaccinations for All Adults
These should be on the checklist of all adults:
- flu shot, annual
- Td or Tdap
- varicella
- MMR
- HPV (age to 26)
- zoster (age over 50)
- pneumonia polysaccharide.
Some people should also have hepatitis and meningitis immunization on their list.
Action to Take
The purpose of this article is to provide information about the opportunities available to adults to prevent serious diseases. It is meant to encourage discussion of vaccinations with your health care provider. Gather your vaccination records (type, date) and have this discussion.
Source: MMWR, Morbidity and Mortality Weekly Report, Feb. 4, 2011. Centers for Disease Control and Prevention, Atlanta.
James Cooper - I'm on the faculty of a health science department at a large university. Most of my articles derive from conferences or presentations ...
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