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    Adult Vaccines

    Dr. Jung Smith MD 08/12/2020

    Most people are aware pediatric vaccinations are very important to prevent serious diseases and related complications. However, people often forget there are adult vaccinations and boosters that are recommended to keep us healthy and prevent complications associated with certain infections. Here we will look briefly at some of the recommended adult vaccinations and schedules. Please speak with your primary care provider about what vaccines are recommended for you.
    Influenza is a very contagious viral infection. Scientists research which strains are likely to be most prevalent during the flu season and immunizations are created based on this research. It takes about 2 weeks for your body to build up the antibodies against the virus, so you want to make sure and get the vaccine before you are likely to be exposed. The flu vaccine is typically offered throughout the duration of the “flu season” which starts around September and runs through the winter, but varies from year to year. For more information about the influenza vaccine and different types of vaccines, visit the CDC's Flu Facts website.  
    There are two types of pneumonia vaccines: Pneumococcal conjugate vaccine (PCV13 or Prevnar) and pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax). There are several biologic differences in the vaccines and how your body develops immunity, which is beyond the scope of this article, but essentially they cover you against 13 and 23 strains of pneumonia, respectively. It can be confusing, so let’s talk about recommendation for each vaccine separately.

    All adults age 65 and older should get the PPSV23 vaccine. Once you receive this vaccine at 65 or older, you will not need another one regardless of any chronic medical condition. Certain health problems require you to have this vaccine earlier than 65. These include cigarette smokers age 19 and older, chronic cardiovascular disease, chronic lung disease including COPD, emphysema and asthma, diabetes, alcoholism, chronic liver disease, a candidate or recipient of a cochlear implant, a CFS leak, sickle cell disease, previous splenectomy, an immunocompromising disease such as HIV, leukemia or other cancers, recipient of organ transplant, or chronic renal failure. If you have one of these conditions you are considered higher risk for developing pneumonia and should have a PPSV23 regardless of age. For some of these conditions, an additional booster is given 5 years after the first vaccination. For these individuals who received one or two doses of PPSV23, a 3rd and final dose should be given at age 65. Again, once you are vaccinated at or after age 65, no further doses of PPSV23 are necessary.            

    Now onto PCV13. This vaccine is given in a series to pediatric patients. Adults age 19-64 who have one of the aforementioned health problems and are not sure or did not receive the pediatric vaccine should get PCV13. This is good for life, a booster is not necessary. Otherwise, all adults 65 and older who are not sure or have not received PCV13 should do so.
    Zoster (Shingrix)
    A new shingles vaccine is available, called Shingrix, which replaces the previous vaccine called Zostavax. It is recommended for healthy adults ages 50 years and older and requires two doses given 2 to 6 months apart. It protects well against shingles and post-herpetic neuralgia, a painful sequela of the shingles virus. If you were previously vaccinated with Zostavax, it is recommended that you still receive the Shingrix vaccine.
    I.E. the chicken pox vaccine. Immunity to chicken pox is defined by having had two doses of varicella vaccine (typically given during the recommended children’s vaccination schedule), U.S. born before 1980 (unless you are a healthcare worker or pregnant), history of chicken pox, or history of shingles.  All adults who do not meet these criteria should receive two doses of varicella vaccine.

    Tetanus, Diphtheria, Pertussis (Td/Tdap)
    Tetanus is a serious illness which leads to death in about 1 in 10 cases. Symptoms include painful tightening and spasms of the muscles and “locking” of the jaw. It is caused by a bacterium which can enter the body through a break in the skin or puncture wound by a contaminated object and is commonly found in soil. It is not contagious. Diphtheria is an upper respiratory illness that causes a thick membrane in the back of the throat, which can cause airway blockage that can be fatal. Diphtheria is now very rare in developed countries due to the success of vaccinations. Pertussis, also known as “whooping cough”, is a highly contagious upper respiratory virus manifested by violent coughing spells. There have been pertussis outbreaks in the U.S. in recent years. It is most common in infants and children and can be fatal in babies. Once thought to be exclusive to children, now roughly half of cases occur in teens and adults. It is very important for adults to get vaccinated not only for their own health, but to provide herd immunity to protect vulnerable infants and children. This is especially true for caregivers and family members of new infants.

    This vaccination gets confusing because of the multiple vaccines and boosters available. There is the DTaP (diphtheria, tetanus and acellular pertussis given to children under 7 in a series), the Tdap (tetanus, diphtheria and acellular pertussis given to children and adults over the age of 7) and the Td (tetanus and diphtheria booster, given to adults every 10 years). Historically, it was recommended children be vaccinated in a series, then for adults to get a Td booster every 10 years. However, due to the waning immunity of the pertussis vaccine over time, it is now recommended to get a booster for pertussis as well. For adults that have not had a pertussis booster since they were a child, your physician may recommend getting a Tdap instead of a Td when your next tetanus is due. You should also ask for a Tdap if you plan on being around a newborn, for example a new grandchild, because they are at high risk for complications if exposed. One more caveat to protection against tetanus: if you have an injury or wound other than a clean, minor wound, you should get a tetanus booster if you have not had one in the last 5 years.

    Measels, Mumps, Rubella (MMR)
    There have been questions raised about adults receiving the MMR vaccine due to the recent outbreak of measles in the United States. I have personally seen several cases of Mumps in young adults over the past few years. Adults born before 1957 are generally considered immune against measles and mumps. Adults born after 1957 should have documentation of an MMR vaccine.  Certain high-risk individuals should receive two doses of MMR vaccine unless they have evidence of immunity. This includes students or educators in postsecondary education, healthcare personnel, those living in an area experiencing an outbreak or recently exposed, and those planning to travel internationally. Two more caveats to the MMR recommendation are those who were vaccinated for measles between 1963-1967 with the inactivated “killed” measles vaccine or unknown vaccine type should be revaccinated with two doses of MMR, and those vaccinated before 1979 with either killed mumps vaccine or unknown vaccine type AND are in a high-risk group mentioned above should be revaccinated with two doses of MMR for mumps.
    Bacterial meningitis is a serious infection of membranes that cover the brain and spinal cord, and if not treated quickly, can lead to death or permanent damage.  There are 2 types of meningococcal vaccines, one protects against serogroup B (MenB) and another one protects against serogroups A, C, W and Y (MenACWY). 

    The MenACWY vaccine is now recommended in the pediatric vaccine series from age 11, and generally up to age 18 for a total of 2 shots. The MenB vaccine is recommended for adolescents and young adults ages 16 through 23. Conditions and individuals that require the vaccine, and possibly subsequent boosters, include first-year college students living in a residence hall, military recruits, previous splenectomy or damaged spleen, complement deficiency, scientist working with Neisseria meningitides (the causal pathogen) and those traveling in countries where the disease is common.
    Human Papillomavirus (HPV)
    HPV is the most common sexually transmitted disease among adults. Nearly all sexually active men and women will get some form of HPV at some point in their life. There are many different strains, and not all strains cause problems - in fact most infections will resolve on their own. However, some high-risk strains cause serious health problems such as cervical cancer, penile cancer, anal cancer, oropharyngeal cancer, vulvar and vaginal cancer, and genital warts. It is now recommended in the children’s immunization schedule to get this series between 11-12 years of age, before they are at risk of exposure to the virus. Because this is a relatively new vaccine, females and males up to age 45 who have not received these should consider it but it is a shared decision with your doctor after age 27. It is not recommended until after pregnancy, but no intervention is needed if it was given during pregnancy.  No pregnancy testing is needed before the vaccination. These recommendations are constantly evolving, so the CDC is a reliable source for staying current on HPV vaccine guidelines.  

    Hepatitis A
    Hepatitis A is a viral liver infection. It is spread by the stool of infected persons and is associated with unsanitary conditions as well as contaminated food or water that is ingested. Occasionally, hepatitis outbreaks are traced back to food served in restaurants or a batch of produce from a specific location. Anyone wanting vaccination against hepatitis A can receive the vaccine. It should be considered when traveling out of the country. Some individuals with high risk of contracting hepatitis A are those planning to adopt a child from a country where hepatitis A is prevalent, men who have sex with men, people who use street drugs, those treated with clotting factor concentrates, people with chronic liver disease, or those in a community where there is an active outbreak. Currently, there is a regional outbreak of hepatitis A with the majority of cases arising in high risk populations including homelessness or illicit drug use, so individuals with these risk factors should urgently be vaccinated.

    Hepatitis B
    Hepatitis B is a viral liver infection spread through infected body secretions and fluids. Individuals can have an acute infection, which they recover from and develop immunity to the virus, or they can become carriers of the disease (i.e. dormant and asymptomatic, but able to spread it) and can also go on to develop chronic disease and liver problems including cirrhosis, liver cancer, and death. Hepatitis B can be spread to an infant from an infected mother during birth. Infants are vaccinated against hepatitis B due to the high risk of developing chronic infection if they are exposed. This risk decreases with age. Most children now receive the hepatitis B vaccine series. Any adult who has not been vaccinated can get the vaccine series which is given in a series of 3-4 shots over a six month period. Those at higher risk of developing hepatitis B are any healthcare or public safety workers at risk for exposure to blood or body fluids, anyone at risk of contracting a sexually transmitted disease (previous STD, multiple partners), people with HIV, IV drug users or anyone who has previously used IV drugs, people with close household contact with someone infected, those with end stage renal disease, those with chronic liver disease, and residents and staff of facilities for the developmentally disabled. Anyone who has not been previously vaccinated against hepatitis B can be. 
    For any international travel, you should visit for the latest country-specific information on outbreaks and diseases in that area. Do this as soon as possible as some preventative treatments and vaccination series must be started well in advance of the travel date.
    If you have certain medical conditions such as pregnancy, HIV, kidney failure, previous splenectomy, chronic liver disease, or any chronic illness, discuss this with your healthcare provider as certain restrictions or additional recommendations may be applicable. If you have an incomplete or unknown vaccination series as a child, speak with your healthcare provider about how to become current and protected against preventable diseased. 

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