Roll Up Your Sleeve: Adult Vaccinations

Written By Becky Ham, Science Writer

Yearly vaccinations aren't just for kids any more. You probably heard a lot about a seasonal or H1N1 flu shot last fall, but you should know that a battery of other adult vaccinations might also become part of your health care routine. Pneumonia and shingles vaccines are preventive-care essentials for older adults, and meningitis and tetanus shots are now college rites of passage. Even the vaccines of childhood—measles, mumps and rubella, and whooping cough—are recommended for adults who missed out in their younger years.

Adult vaccinations should be part of all preventive care, but they are especially critical for people with chronic diseases such as diabetes, since flu and other illnesses can make routine medications less effective, throw off health goals such as stable blood sugar, and reduce a person's ability to care for herself. For America's growing population of older adults, vaccinations may head off potentially deadly disease complications—a bout of influenza leading to a trip to the hospital for pneumonia, for example.

Vaccinations can also be a good way to establish your medical home with a primary care provider, as a non-critical visit where you can discuss other preventive health goals and maybe ask questions about minor symptoms in a less urgent setting. But for adults without a regular doctor, immunizations are one of the few preventive care tools widely available through public clinics, drugstores and community vaccination drives.

Who Gets What?

Let's start with the flu. Seasonal influenza vaccinations are a must for all adults, since the major strain of flu changes from year to year. New flu strains such as the H1N1 virus may also require additional vaccinations each year, although researchers aren't sure yet how often that virus will change.

No one likes to get the flu, but for some, catching it means more than a bad week in bed. Nancy Nally has lupus with complications that include seizures. "The only seizure that I have had since starting medication was because I was running a fever from having the flu," says the 38-year old mother. "The fever, although not extremely high, was enough to cause a seizure despite the anti-seizure medications that I take." Nally also gets the annual shot to reduce the chance that her elementary school daughter, who has autism, will get sick.

It's enough of a reason for television producer John Z. Wetmore as well: "I have elderly relatives who could be in serious trouble if I caught the flu and passed it on to them," he said.

Another vaccination recommended for all adults is the tetanus shot, which should be given every ten years. Margaret Lewin, M.D., medical director of Cinergy Health and a vaccination expert, recommends more frequent tetanus shots for her patients who rock-climb or enjoy other sports where skin-penetrating injuries are common. "If they get the shot every five years, we might be able to save them a trip to the emergency room," she explains.

Annual pneumonia vaccinations are important for those 65 and older, along with people who have underlying heart, lung or immune disorders. For adults over 60, Dr. Lewin also recommends a shingles vaccine. Shingles is caused by a reactivated chicken pox virus, and can be "devastatingly painful," she says. "It's never very hard to talk someone into getting a shot for shingles, if they know someone who has had the disease."

Some vaccines are recommended mostly to special groups of adults. College students and soldiers bunking in dorms and barracks should receive meningitis vaccinations, since the close- quarters living makes them prone to potentially deadly outbreaks. Hepatitis B vaccines are recommended for all sexually active adults, emergency personnel, health care workers and those who work with small children. The new vaccine against cervical cancer is now widely offered to young girls and women. And international travelers may need to get shots for yellow fever, typhoid, hepatitis A and polio, depending on their destination.

"This isn't just kid stuff," says Bernard Kaminetsky, M.D., medical director of MDVIP, a concierge medical group. "Some of these diseases are deadly to adults who are not properly inoculated and can spread quickly from continent to continent."

One of the newest frontiers in adult immunizations is also the oldest—the alphabet soup of childhood vaccinations such as Tdap and MMR that protect against diphtheria, whooping cough, measles, mumps and rubella. If you never received these vaccinations as a child, or even if you did, it might be worth another…ahem…shot.

"Most people are not aware that childhood vaccines and boosters may lose effectiveness by the time adults reach 30 years of age," Dr. Kaminetsky says. A simple blood test can determine whether your body still has antibodies against these diseases.

In some places where childhood vaccinations are spotty, diseases like whooping cough are "back with a vengeance," Lewin said. "I've seen adults with horrendous coughs that last six to eight weeks."

The vaccine for another formerly widespread childhood disease—chicken pox, or varicella—has been available only since 1995, so many adults may have missed out. The disease has worse symptoms in adults than in children, and can be very dangerous for pregnant women.

Why Won't You Get Vaccinated?

I don't like needles. Amy Baxter is a pain researcher and CEO of MMJ Labs, a company that markets a device to reduce the pain of injections. The product was developed with mostly children in mind, but she says "needlephobia" is also "a big deal" among adults. She works in an emergency department, "so I'd be crazy not to get my shots," she says. "In a geriatric population, who you think would be over it by then, 3 to 6 percent cite needlephobia as their reason for not getting their flu shots."

The shot will make me sick. Pulmonologist and lung disease expert Dr. Mark Williams says this is the most common objection he hears when he brings up flu immunizations with his patients. "They say, 'Every time I get the flu shot I get sick.' Some people might get a mild, flu-like reaction, but you don't really get flu from a flu shot."

Lewin agrees, saying the shots are safe for the majority of people with normal immune systems. "Most vaccines are dead, dead, dead, and you can't catch the disease from them."

Lewin and Williams say they don't hear as many concerns about the safety of vaccines and their additives from their adult patients, a common and controversial concern with childhood vaccines. "But it's important for providers to educate," said Williams "There have been huge, well-done studies that have discounted most of the speculation of vaccine safety. We need to talk about data and facts rather than conjecture."

I can't afford these vaccines. Williams works in a veterans' hospital, where, he says, "We think of vaccinations as sort of another vital sign, along with taking your temperature and blood pressure when you come in."

But this isn't always the case: "We'd like to get the shingles immunization, but our doctor does not give it," said Linda Carlson, who works in marketing for a parenting magazine. "The only source for this expensive vaccine is drugstores. And our insurance provider will not cover shots given in the drugstore."

For people who aren't covered by a Medicare D prescription plan or private insurance, the one-time vaccine can cost between $200 and $300.

Not all insurance plans routinely cover adult vaccinations as part of preventive care, and some physicians may not carry certain vaccines if they don't feel there will be a demand for them. In some cases, as was illustrated by the H1N1 vaccination push in 2009, the vaccines themselves might be in short supply (although now, in 2010, there is an over-supply of H1N1 vaccine).

I can't find these vaccines. Patient assistant programs sponsored by some pharmaceutical companies provide free vaccines to low-income and uninsured patients, if the patients apply for the program through their physicians. Other options include county health departments and vaccination drives sponsored by a pharmaceutical or drugstore chain. The national Immunization Action Coalition Web site ( mostly aimed at health professionals, also contains "shot finder" searches.

It's not that big of a deal. Williams hears this one a lot, and he's ready with his story. He missed his seasonal flu shot one year and "Boy, did I pay for it," he says. "I had a severe case of influenza in February and ruptured a disc in my neck from coughing so hard."

"People don't realize how deadly this problem is," he said. "We have 35,000 to 40,000 deaths each year from influenza and the bacterial pneumonia that can follow, and we believe this may be a gross underestimate."

"I think that people who have seen people with these serious diseases like lockjaw, older people who knew someone who had shingles, know what they are getting vaccinated against," said Lewin. "Most of us haven't seen someone go deaf from measles, or infertile from mumps, or lose a pregnancy with German measles. We take for granted the protections we have."

If you're wondering whether your own vaccinations are up to date, the best place to start is with your primary care doctor. Gather your medical records related to any vaccination you've had as a child or adult, and use those as a guide when you have the conversation with your physician. Remember that any vaccinations you've received outside of your doctor's office—a flu shot at the library, or a measles shot at school—won't be part of your primary care record unless you carry or arrange to have this information sent to your physician.

Don't forget to tell your doctor about any special circumstances that could affect your vaccination needs, including your work, your recreation, and your travel plans.



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