Articles written by me on Self-care and Palliative Medicine
On Self-Care & Palliative Medicine

Calling your Own Shots

Hopefully, we all got our “baby shots.” Those were the good ole days when our parents took care of all the practical stuff. But recommendations for immunizations do not end in childhood. In fact, some of the shots we received as children lose their protective effect for as we age and must be boosted periodically throughout our lifetimes. Each year, our public health organizations devote one week to National Adult Immunization awareness. The vaccines stressed during that week are: influenza, pneumococcal disease, hepatitis B, diphtheria, tetanus, measles, mumps, rubella, and varicella. I’ll provide you with an overview here, but there are numerous articles that can provide you with detailed risk/benefit information if you’re interested.

The influenza vaccine (or flu shot) should be given to everyone 65 years of age or older on an annual basis. Because the virus may change every year, protection from one shot is limited and also lasts for only a short time. . .about six months. The shot is also recommended for younger adults with heart, lung, or kidney problems, people with diabetes, and people with poorly functioning immune systems. Health care workers should routinely get the vaccine, and I recommend it routinely to my school teacher patients as well. There are more than 20,000 influenza-deaths reported each year in the United States, and more than 90% of these deaths occur in adults over age 65 and in high risk adults.

People at high risk for developing influenza are also at high risk for pneumococcal pneumonia. U.S. death from all pneumococcal diseases is estimated at 40,000 people annually, and up to 500,000 Americans develop pneumonia from this bacterial infection each year. The current pneumococcal vaccine protects against over 80% of the pneumococcal diseases. One vaccination is recommended for adults older than age 65. Re vaccination is not recommended in healthy adults but may be indicated at age 65 if the person was vaccinated 6 or more years previously. Re vaccination on a 5 year basis is indicated in some high risk adults (regardless of age). Your doctor can advise you on your risk status.

Measles, mumps, rubella, and varicella(Chicken pox) are considered to be childhood diseases by many adults; however, statistics paint a different picture. 33% of U.S. measles cases in 1996 occurred in adults older than 20; in 1993 20% of reported mumps cases for which age was known were in adults older than 20, and 85% of rubella cases with known age reported between 1994–1996 were age 15 and older. Most of the 4 million chicken pox infections reported annually do occur in children, but severity of infections and mortality rates increase in adults. Adults born after 1956 need one or two doses of MMR (Measles/Mumps/Rubella) vaccine–depending on their occupations, travel agendas, and living situations. Two doses of chicken pox vaccine generally provide immunity for adults who did not have the infection in childhood.

Adults older than 20 years of age represented 95% of tetanus cases and 100% of the deaths due to tetanus during 1991–1995; one of every three people who get the disease will die. Additionally, adults over 20 years of age accounted for more than 60% of the diphtheria cases between 1985–1989. For adults, tetanus vaccine is generally combined with diphtheria vaccine in one shot called Td. When used properly, the vaccine is nearly 100% effective in preventing tetanus and at least 85% effective in preventing diphtheria. After primary immunizations in childhood, this vaccine should be given every 10 years to adults–at least up until age 65.

Hepatitis B vaccine is now given routinely as a part of the childhood immunization series. But many adults have never been immunized. For people working in health care or other occupations which expose them to body fluids (such as fire fighters, police, workers in homes for the developmentally disabled), people with multiple sex partners, and dialysis patients, the three series vaccination for Hepatitis B is indicated. Also, frequent world travelers may benefit from vaccination with both Hepatitis B and Hepatitis A vaccines. Nearly 200,000 new Hepatitis B infections occur annually in the United States, and yet the vaccine series produces protective immunity in the majority of the recipients. Why risk infection when such a safe and effective vaccine is available?

So, check your immunization records, consider your personal risks of various infections, and then make sure your vaccinations are up to date. Remember, flu vaccination needs to be updated yearly, and boosters for tetanus-diphtheria, and Hepatitis B are needed. Adverse reactions to vaccines are rare and usually local–such a sore arm, redness, or briefly swollen glands. There are patient information statements provided by the CDC for all vaccines–which include disease descriptions, potential adverse reactions to vaccine, and contraindications to administration. Your doctor or health department can provide this information, or you may obtain it directly from the CDC. Most adults have not been immunized in accordance with the recommendations. Lack of documentation is often a stumbling block because patients can be reluctant to receive a shot when they “think” they may have already had the vaccine or the disease. Since relocation, travel and change in healthcare providers is so common in our society, please take the responsibility to keep personal vaccination records. And let your understanding of the disease consequences outweigh your momentary “fear of needles”. Remember, calling your own shots can protect you from serious, even life-threatening disease.

Stephen L. Hines, M.D.
May 2000

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