What kind of vaccines do adults need?

Adults sometimes mistakenly think that immunizations are something they only have to worry about for their children. But immunizations can also prevent a number of serious adult diseases. And immunizations are not just for travelers to faraway places. A number of preventable infectious diseases are commonplace here in this country. Adult immunizations may not be a sexy or high-tech topic, but I think it is very important for adults to ask themselves, Are my immunizations up to date?

Adults sometimes mistakenly think that their childhood vaccines will continue to protect them throughout their lives. Often, this is true.  But, immunity from certain vaccines wanes with time, and booster shots may be necessary. In addition, new vaccines have been developed for adults, and some adults were never fully vaccinated as children.

What vaccines should you get? All adults should be immunized against a number of specific diseases. And high-risk people, such as those with immune deficiencies or those with specific risk exposures (such as veterinarians), may need additional vaccinations.  In addition, certain vaccines are recommended for adults when they reach a certain age. This is because older people are more susceptible than younger people to certain illnesses such as shingles (varicella-zoster) and they also are less able to tolerate an infection such as influenza and pneumococcal pneumonia.

Here is a list of vaccines that adults should consider getting. (I will not address immunizations for travel, as that is really another topic.)
 

• Pneumonia vaccine: Pneumonia is a serious infection, and can be fatal. The pneumonia vaccine protects against many strains of the pneumococcus bacteria. All adults over 65, and younger people who are at high risk of getting pneumonia, should get this vaccine. Those at high risk include people with diabetes, heart and lung disease, liver failure, and immune suppression.   If you get this vaccine before age 65, you should get another dose when you turn 65. 

• Influenza vaccine: The influenza (flu) vaccine is recommended yearly for everyone over age 50, and for younger people who are at higher risk of complications from the flu, such as people with heart and lung disease, diabetes and other chronic illnesses. It is also recommended for people, such as healthcare workers, who might give the flu to high-risk people.
  

• Tetanus and diphtheria vaccine: Tetanus is a wound infection; diphtheria is an acute respiratory illness. Both are preventable. Boosters every 10 years are recommended for all adults who received the primary series in childhood. 

• Pertussis vaccine: Pertussis (whooping cough) causes a severe lung infection. Almost all children are immunized against pertussis, but the protection does not appear to last into adulthood. Recently, a booster vaccine for adults has been developed to extend our immunity for a longer time. The vaccine is combined with tetanus booster and is known as Tdap 

• Herpes Zoster (shingles) vaccine: Shingles is a painful, blistering rash caused by reactivation of the chickenpox (varicella-zoster) virus. The virus can stay dormant in anyone who previously had chickenpox, and then reappear as painful shingles. It is most common among people over 50 and those with weak immune systems. This new vaccine cuts the chance of getting shingles by 50%, and those who get shingles after the vaccination usually get a milder case. This vaccine is recommended for people age 60 or older. Unfortunately, if you have a weakened immune system (for example, due to HIV/AIDS), you should not get this vaccine. A weakened live virus vaccine, such as the herpes zoster vaccine, could lead to a more widespread rash or severe chickenpox-like disease if you are immunosuppressed. 

• Varicella (chickenpox) vaccine: A blood test can be done to check for evidence of immunity to chickenpox. All adults should check with their doctors about whether they should get the blood test and the vaccine.  It’s especially important to know your immunity status if getting chickenpox would be dangerous, such as if you are planning to become pregnant. 

• Measles, mumps, rubella (MMR) vaccine: Adults born after 1956 should get at least one dose of measles vaccine and mumps vaccine (usually combined as MMR). Certain groups such as students and health workers should get at least two doses of the measles vaccine. One dose of rubella-containing vaccine should be given to women of child-bearing age who don’t have a clear history of vaccination or immunity. 

• Hepatitis A vaccine: People with certain chronic illnesses or risk factors should consider hepatitis A immunization. This includes people with chronic liver disease, hemophiliacs, homosexual men, and intravenous drug users. 

• Hepatitis B vaccine:  People with certain chronic illnesses (such as chronic liver disease and chronic kidney disease on hemodialysis), and people at a high risk of exposure (such as health care workers,  close contacts of people infected with hepatitis B, and sexually active people with multiple partners), should get immunized against hepatitis B infection. 

• HPV: This vaccine against the human papillomavirus that causes cervical cancer is recommended for all women younger than 26 years old.
  

• Meningococcal vaccine: To protect against one type of meningitis, students, military recruits, and people with an impaired immune system (especially those who have had their spleen removed) should get this vaccine.

      Who should not be vaccinated?

Women who are pregnant (or plan a pregnancy in the near future) and people with weakened immune systems should not get live virus vaccines (see below for more on live virus vaccines). People who have had a major reaction to a specific vaccine should avoid revaccination with that vaccine.  People with major allergies to components of certain vaccines (such as egg proteins or neomycin) should avoid vaccines containing these substances.

A vaccine is designed to stimulate an antibody response by the person getting it. Then, if that person is subsequently exposed to the organism against which the vaccine is directed, there is a secondary antibody response that protects the person against the disease.

Vaccines are made in several different ways. One way is to inactivate a harmful toxin made by bacteria. The vaccine uses the inactivated toxin (called a toxoid). The diphtheria and tetanus vaccines are made this way.  Toxoids are toxins that are chemically changed to be harmless but still can induce the body to make antibody against the toxin. If the person is then exposed to the toxin, the antibody will bind the toxin, preventing toxin-induced disease.

Sometimes a vaccine, such as the measles vaccine, is made with a live virus that has been weakened during the manufacturing process.  The weakened virus cannot cause disease, but can still stimulate an antibody response that provides protection against infection. Immunity from a live virus vaccine is generally lifelong. However, these “live virus” vaccines should not be given to people who are immunocompromised, such as some people with cancer or HIV/AIDS. Other vaccines are made by killing viruses or using only parts of an organism.

 

 

What’s your vaccination status?

Are you up to date with your vaccinations?  Has your doctor recommended vaccines to you lately?  Did you get them?  Let me know what you think about the ever expanding list of vaccines available to protect you from infections.

Diana Post, M.D., is an Assistant Professor of Medicine at Harvard Medical School and a practicing internist at Brigham and Women's Hospital in Boston, MA. She is also a rheumatologist.

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