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Hot Shots: What You Should Know About Adult Immunizations
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Hot Shots: What You Should Know About Adult Immunizations

If you think immunization is kid's stuff, you might want to reconsider. Although childhood immunizations continue to be a major and controversial focus of preventive health, adults are also subject to many vaccine-preventable diseases such as hepatitis, rubella, tetanus, diphtheria, pneumonia, and influenza. Vaccines are also important in protecting against diseases which may be prevalent while traveling in other countries, such as cholera, malaria, and yellow fever.

The National Coalition for Adult Immunization (NCAI) in Bethesda, MD reports that approximately 50,000 adult deaths each year are caused by illnesses that could have been avoided through the appropriate immunizations. The three leading culprits are influenza, pneumonia, and hepatitis B .

Influenza

The influenza vaccine helps prevent flu and all its associated symptoms such as fever, muscle ache, coughs, sore throat, and headaches. The flu is very contagious and can be life-threatening to anyone with a heart condition, diabetes, lung disease, kidney problems, or immune system deficiencies.

Influenza costs $4.6 billion in medical care each year and, combined with pneumonia, is the fifth leading cause of death among older adults in the United States. Although people over 65 are at an increased risk for contracting the illness, younger people are also susceptible. (For example, normally healthy women who care for young children or aging parents can place themselves and those close to them at risk.)

The flu vaccine is recommended for people who:

  • are over 65
  • have a heart condition, diabetes, lung disease, kidney problems, or immune system deficiencies
  • live with someone for whom the flu could be dangerous
  • are pregnant

The annual flu shot should ideally be given in the fall before flu season begins. Most people who get a flu shot have a sore arm for a day or two. If you are allergic to eggs, you must notify your healthcare provider because the flu vaccine is derived from chicken eggs.

Pneumonia

The pneumococcal vaccine helps prevent pneumonia and blood infections that can be especially dangerous for people with heart, lung, kidney, or liver disease, or diabetes. The pneumonia vaccine may confer lifetime protection and can be given concurrently with the annual flu vaccine. Your arm will feel sore for a day or two after receiving the vaccine.

Diphtheria/Tetanus

This vaccine, also called DpT, is a combination vaccine for tetanus and diphtheria. The tetanus vaccine prevents lock jaw, which causes painful and potentially lethal muscle spasms. Everyone should get a tetanus shot, but it is particularly recommended for those with dirty cuts or wounds. Diphtheria is an infection of the throat that can spread to the heart and lungs. The toxoid for diphtheria is usually given in conjunction with the tetanus vaccine.

Over half of all Americans over age 50 aren't adequately protected against tetanus and diphtheria. Tetanus infects 50 or fewer people and claims abut five lives each year. Most deaths occur in adults over age 60. One in ten people who get diphtheria will die from it.

The vaccine is initially injected in three doses at recommended intervals—the second dose is given one month after the first, and the third dose is given four months after the second. A booster shot should be given every 10 years. It is common to have a low grade fever and a sore arm for a few days after receiving the injection.

Measles/Mumps/Rubella (MMR)

Today, the vaccines for the measles, mumps, and rubella are combined into one injection, although in the past they were given as three separate shots. Today, most people receive the combined MMR vaccine in two doses by the time they are six years old. However, adults who should receive the vaccine include anyone over 18 who was born after 1956, especially if they are working in healthcare, traveling internationally, attending college, or have never gotten the measles, mumps, or rubella before.

Once a person has contracted measles, lifelong immunity is established and a vaccination is not required or recommended. People whose immune systems are suppressed (other than HIV-infected people, who should be vaccinated if susceptible), people with severe egg allergies, and pregnant women should not receive the measles vaccination.

Rubella (also called German measles) is very contagious. A pregnant woman who becomes infected may expose her unborn child to serious birth defects. Women of childbearing age who have missed the vaccine or the rubella infection itself should be immunized. A sore arm and mild fever are the most common side effects. Some physicians recommend re-administering the rubella vaccine with the diphtheria and tetanus boosters (every ten years).

Hepatitis B

Each year, it is estimated that: 80,000 people—mostly young adults—get infected with the hepatitis B virus (HPV); 1,000 people are hospitalized due to HBV; and 4,000-5,000 people die from chronic HBV. The disease can have many damaging long-term effects such as jaundice and/or liver disease resulting in liver failure, cancer, or even death. Although HBV is 100 times more contagious than AIDS, only five percent of susceptible individuals are vaccinated.

Since HBV is a serious and preventable liver infection, the HBV vaccine is highly recommended , particularly for the following categories:

Individuals who have had

  • a sexually transmitted disease (including AIDS)
  • multiple sexual partners

or people who are

  • homosexual men
  • intravenous drug abusers
  • healthcare workers
  • police officers
  • dialysis patients
  • living with someone who carries HBV
  • currently diagnosed with another type of liver disease

The HBV vaccine is administered in three doses and should provide lifelong immunity. The second dose is given one month after the first, and the third dose is given five months after the second. The most common side effect is a sore arm, which subsides within a few days.

Chicken Pox

A chicken pox vaccine has recently been developed and is recommended for anyone over age 13 who has not had the illness. This recent development was in response to a recent surge of new cases. The illness normally lasts two weeks and infected individuals must remain at home to decrease the risk of infecting others who have not had the chicken pox. Many parents, especially dual-income households, are immunizing their children as a prevention measure.

Chicken pox can have deleterious fetal effects during the first 20 weeks of pregnancy. After 20 weeks, there is less cause for concern unless it is close to the time of delivery. Therefore, it is strongly recommended that women of childbearing age who have not had chicken pox should receive the vaccine before becoming pregnant.

Less than 5% of Americans are at risk for the chicken pox, but adults who become infected with the chicken pox are 10 times more likely to require hospitalization and to develop pneumonia and bacterial infections.

Doctors are debating the merits of the chicken pox vaccine since it is so new to the market. When it is recommended, normally two doses, two months apart are recommended for anyone over age 13 who has not had the chicken pox.

Vaccines Recommended for Travelers

At least 10 weeks prior to traveling anywhere internationally, check that you are up-to-date with the

  • Measles/Mumps/Rubella Vaccine
  • Diphtheria Vaccine
  • Polio Vaccine
  • Haemophillus Influenza Vaccine

Pregnant and breastfeeding women can be given most inactivated vaccines, but always check with your doctor first.

You can also call the Centers for Disease Control's (CDC) traveler's health hotline at 1-877-394-8747 for updated immunization safety information.

RESOURCES:

Immunization Action Coalition
http://www.immunize.org

National Foundation for Infectious Diseases
http://www.nfid.org

Recommended Adult Immunization Schedule for Adults by Vaccine and Age Group (Printable Schedule)
US Centers for Disease Control
http://www.cdc.gov/nip/recs/adult-schedule.pdf

Traveler's Health Hotline
National Center for Infectious Disease
Centers for Disease Control (CDC)
phone: 1-877-394-8747
http://www.cdc.gov/travel

References:

Recommended adult immunzation schedule for adults by vaccine and age group (printable schedule), 2004-2005. CDC's National Immunization Program websote. Available at: http://www.cdc.gov/nip/recs/adult-schedule.pdf. Accessed January 2005.

Vaccine information statements (VIS). CDC's National Immunization Program website. Available at: http://www.cdc.gov/nip/publications/VIS/default.htm. Accessed January 2005



Last reviewed June 2006 by Jill Landis, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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