POSTED: Wednesday, Feb. 24, 2010

Adults need to get vaccinations too

Why should adults get immunized? For the same reasons we give vaccines to children. They are a safe and effective way to prevent certain infections, some of which can be fatal or cause long-lasting complications. Some vaccines not only help the person receiving the vaccination, but also protect their families, friends, and others in the community.

This month the Trust for America's Health, The Infectious Disease Society of American and the Robert Wood Johnson Foundation issued a report "Adult Immunization: Shots to Save Lives." It shows that the use of vaccines by adults in America is far behind what is recommended by public health agencies. Washington state does about as well as the U.S. as a whole. Annual influenza shots and a pneumococcal vaccine are recommended for everyone more than 65 years of age, but 3 out of 10 seniors have not received these vaccines.

Pneumococcus bacteria cause pneumonia, meningitis and blood infections, resulting in about 5,000 deaths per year in the U.S. Widespread vaccination of children has reduced serious pneumococcal disease for them and has also resulted in decreased infections in elderly contacts to these children. The vaccine is recommended for all adults who smoke or who have asthma, heart, lung or other chronic diseases, and everyone more than 64 years of age.

In 2005, a new pertussis vaccine, combined with the tetanus-diphtheria shot, was introduced for teens and adults up to age 64. Although rarely fatal in adults, pertussis (whooping cough), can be fatal in infants and small children, and can cause illness that last for weeks and a cough that can last more than two months. Infants vaccinated against pertussis may still become infected, usually from contagious adolescents or adults who may have mild illness. Vaccination of teens and adults with the Tdap (tetanus-diphtheria-acellular pertussis) vaccine protects vulnerable infants and toddlers. In 2007, only 2.1 percent of adults 18-64 had received the vaccine.

Human Papilloma Virus (HPV) is responsible for almost all cancer of the cervix. In 2008, there were about 11,000 new cases and 3,800 deaths from cervical cancer. A vaccine against four of the 40 types of HPV was introduced in 2006. Two of these types are responsible for 70 percent of cervical and anogenital cancer and the other two for 90 percent of genital warts.

Currently, about 80 percent of sexually-active women become infected with HPV by age 50. The vaccine is more than 95 percent effective in preventing disease from these four types of HPV in women who had not been infected before receiving the vaccine. The vaccine is recommended for all females from age 11 through 26, ideally before potential exposure to HPV. Women who have not been infected by any of the types in the vaccine will have full benefit, but those who already infected with one or more of the types in the vaccine may still benefit.

Chickenpox virus stays in the body for life after someone is infected. The virus can activate years later and travel down sensory nerves to the skin, causing shingles in about a third of people who ever had chickenpox. The risk of shingles increases with age, and about 50 percent of those living to age 85 have had shingles. The risk of prolonged pain after shingles increases with age.

In 2006, a vaccine was introduced to prevent shingles. It is recommended for everyone more than age 60, including those who have already had shingles. Its effectiveness in preventing shingles decreases with age: 64 percent for those 60-69 but 18 percent for those 80 or older. However, those who were vaccinated had 66 percent less postherpetic neuralgia, the pain that can last after shingles goes away. In 2007, only 2 percent of people over 60 had obtained the vaccine.

Other vaccines are recommended for adults, some for those with specific risk factors. See cdc.gov/vaccines for details on vaccines, the diseases they prevent, their effectiveness and safety and recommendations on which you should receive.

Check with your clinician or with the Whatcom County Health Department (676-4593) for information on vaccine availability. And check healthyamericans.org for the report on adult immunizations and recommendations for a national strategy to improve their use.

Greg Stern, MD, is Whatcom County Health Officer, president of the Whatcom County Medical Society and is board-certified in family medicine. He has served on the Washington State Vaccine Advisory Committee. This column is one of an occasional series on health care issues written by members of the Whatcom County Medical Society. If you have a column suggestion for the doctors, send it to wcms@hinet.org