Immunizations: Not Just for Kids Anymore
Immunizations: Not Just for Kids Anymore
By Matthew Zahn, M.D.
Getting your vaccinations is a childhood rite of passage in the United States . Millions of lives have been saved by the universal pediatric use of vaccines such as polio, measles, and smallpox vaccines in the United States .
New vaccines have recently been introduced, however, that are aimed at preventing adult diseases. Adult illnesses from meningitis to cancer can now be prevented by vaccine. Vaccinations, however, are not often thought of as a standard part of adult health, and it will be up to medical providers and the public health community to get the word out about their benefits.
A list of adult vaccines, new and old, includes:
Human papillomavirus (HPV) causes genital HPV infection. Genital HPV infection is probably the most common sexually transmitted viral infection. Over 50 percent of sexually active men and women will be infected with HPV at some point in their lives. An American woman has a 75 percent chance of acquiring this infection by age 50. Most people who are infected with HPV clear the infection without any symptoms. However, some can develop illness associated with HPV, most commonly genital warts.
A less common but much more severe illness associated with HPV infection is cervical cancer. Cervical cancer kills approximately 3,700 women each year in the United States , and is the second most common cause of death from cancer in women worldwide. While there are over 100 HPV strains, a select few account for most cases of cancer and cervical warts.
The HPV vaccine Gardasil is an inactivated (not live) vaccine. It protects against two types of HPV virus that cause 70 percent of cervical cancers and two types of HPV virus that cause 90 percent of genital warts. The vaccine is given in 3 intramuscular injections over a 6-month period. The ACIP recommends the HPV vaccine for girls 11-12 years of age. However, the vaccine can be given to girls as young as 9 up to age 26 for women who have not yet completed the vaccine series.
Meningococcal Conjugated Vaccine
This vaccine is particularly aimed at those entering college. Meningococcus is a bacteria that causes bacterial meningitis or sepsis in previously healthy adults. Meningococcal meningitis outbreaks can occur in closed communities such as colleges and military bases. The effects of meningococcal disease can be very severe, including permanent neurological damage, limb amputation, or even death. College-age adolescents in particular have been found to be at risk of contracting meningococcal disease.
A meningococcal polysaccharide vaccine has been available for years, but the inactivated meningococcal conjugated vaccine called Menactra promises to provide much longer-lasting coverage against potential illness. It is licensed for persons 11-55. It is given intramuscularly as an individual dose. This vaccine is recommended for specific groups at high risk of contracting meningococcal disease, including college freshmen who plan to live in dormitories.
Tdap vaccine is a variant of the DTaP (diphtheria, tetanus, attenuated pertussis) vaccine that has been given to infants for years. Tdap is an inactivated vaccine and will take the place of the Td (or tetanus booster) vaccine and add a pertussis component to these booster shots.
Bordetella pertussis causes pertussis, or whooping cough. Whooping cough disease is aptly named — the most prominent feature of this illness is a severe cough. Persons with whooping cough will have coughing spells that can last for several minutes, punctuated by a “whoop” as the person gasps for air. These spells can continue to occur for weeks. While antibiotic therapy can prevent a person from being infectious, it will usually not improve the cough or shorten the length of illness. Infants under one year of age can have coughing spells that are severe enough to deprive them of oxygen, leading to brain damage.
While we have known for many years that whooping cough causes the most severe disease in infants, pertussis can also afflict adolescents and adults. This is important for two reasons. First, whooping cough in adults, while less likely to lead to severe illness or death, can be extremely unpleasant and long lasting. Second, adults who are not recognized as having this illness can pass pertussis to infants around them, providing the source of the pertussis that makes infants seriously ill. We have known that while childhood pertussis immunization in the form of the DTaP is effective at preventing infants and toddlers from getting pertussis, immunity provided by the vaccine can wane in 5-7 years. This means that if children get their last dose of DTaP at 4 years old, they will have no immunity against pertussis by age 11.
In 2005 the Advisory Committee on Immunization Practices (ACIP), the body that provides guidance to the U.S. Centers for Disease Control and Prevention regarding immunization practices, voted to recommend the routine use of Tdap vaccines in adolescents ages 11–18 years in place of Td vaccines and recommended routine use of a single dose of Tdap for adults 19-64 years of age to replace the next booster dose Td. The ACIP also recommended Tdap for adults who have close contact with infants less than12 months of age.
Influenza vaccine is strongly recommended for everyone age 50 and older, because they are most at risk for severe influenza infections that lead to over 200,000 hospitalizations and over 30,000 deaths that occur in the United States each year. But adults of any age should get the flu vaccine, as this vaccine can also prevent or ameliorate the three to five days of illness that people suffer with flu infection. For those who don''t want a shot, the live vaccine Flumist is given intranasally and is appropriate for most healthy people ages 5-49.
The medical community has historically not had much success convincing adults to get their vaccines. The elderly and those with high-risk medical conditions tend to get their annual flu shot, but the flu vaccine is recommended for all adults as a part of standard preventive care, and overall few comply. Adults often let their Td booster status lapse.
There are many reasons for our adult vaccine failures. Adults have busy work schedules, and many adults don''t enjoy the pain of a vaccine shot any more than their children. Moreover, many adults do not seek routine medical checkups, which are generally the visits during which children are vaccinated. Many lack insurance, or have insurances that do not cover some of the above vaccines. One of the challenges for American medicine and public health in the years ahead will be to change this paradigm so that we all recognize adult immunizations to be a fundamental part of healthy living.
If you would like more information about whether these vaccines are right for you, you can consult your doctor, or visit the CDC website at www.cdc.gov/nip .
Matt Zahn, M.D., is an assistant professor of infectious disease at Kosair Children''s Hospital in Louisville and Medical Director of the Louisville Metro Health Department.
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