When You Need Adult Vaccinations

Remember the painful shots and sugar-cube polio vaccines you endured as a kid? Turns out some don’t last a lifetime and you may need adult vaccinations. As researchers discover new ways to safeguard us from disease, vaccines have changed. Read on to learn which inoculations you need and how to track down your immunization records...

Going back to school at age 52 to learn a second career was an exciting decision for me. But the rehabilitation services career I chose meant I’d be working in hospitals, where I might be exposed to anything from measles and mumps to hepatitis B.

Like all health-care students, I had to show proof I was fully immunized before beginning my training.

The Centers for Disease Control and Prevention (CDC) recommends that toddlers be inoculated against 13 diseases, and young adults against 15. That’s why most people think of vaccines as “baby shots.”

But as I delved deep into my vaccination history, I discovered that most grown-ups also need adult vaccinations to be fully protected – but may not realize it.

Available Adult Vaccinations
When a germ gets into your body, your immune system goes into action, making the right antibody to knock it down. If you’ve encountered that germ before, you can make that specific antibody much faster.

Vaccines make your body think it’s been invaded by the germ before. They’re tiny bits of deactivated germ material, giving your immune system the ability to fight off the disease at a moment’s notice.

But if you’re over 29 years old and were last immunized as a child, you may not be protected against diseases for which vaccines weren’t available until the 1990s or later.

“Because of medical advances, there are now some vaccines aimed at adults that we ought to think about,” says William Schaffner, M.D, president of the National Foundation for Infectious Diseases and chair of the department of preventive medicine at Vanderbilt University Medical Center in Nashville, Tenn.
Depending on your immunization history, age, health status and lifestyle, you and your doctor may decide that vaccines for these diseases and infections make sense for you:

Chicken pox: Highly contagious viral infection that causes rash and fever. Most people born before 1980 caught the disease as kids and are already immune.

Hepatitis A: Contagious liver disease spread by poor hygiene can become chronic.

Hepatitis B: Sexually transmitted, can become chronic and lead to liver disease and cancer.

Hib (Haemophilus Influenzae Type b): Contagious bacterial infection that can cause blindness, retardation and death in preschoolers. If you catch Hib as an adult, you’re unlikely to become seriously ill, but you can easily pass the infection to a child. People over age 2 who have survived a Hib infection are considered immune.

Pneumococcal pneumonia: Potentially fatal bacterial disease of the lungs that can also attack the brain. Other bacteria and viruses can cause pneumonia, but pneumococcal infections are especially dangerous.

Meningitis: Potentially fatal bacterial infection of the brain and spine that can lead to amputations and brain damage.

Rotavirus: Intestinal virus that can cause severe diarrhea in infants.

Herpes zoster: “Shingles,” a reactivation of the chicken pox virus. Causes painful skin blisters.

HPV: Human papilloma virus; different strains cause genital warts or cervical cancer. The Food and Drug Administration licensed the HPV vaccine for females age 11-26 – the age group studied by the manufacturer. “If a woman is 32, newly divorced and back on the dating scene, she might want to get that vaccine, so she won’t pick up that virus,” Schaffner says. But some insurance companies may not pay for vaccinating a woman over age 26 because it would be considered an “off-label” use, he says.

Influenza: Viral illness that can lead to complications and even death. The formula for the flu vaccine changes annually to reflect new strains, so you need a booster every fall.

Measles, mumps and rubella: Measles and rubella cause fever and rashes, sometimes with serious complications; mumps causes swelling of the neck and can damage the pancreas and sex organs in adults. Two MMR shots provide lifetime immunity; if you only got one MMR shot as a child, you might need a booster. Most people born before 1957 have natural immunity, according to the CDC.

Tetanus, diphtheria and pertussis: Three potentially deadly diseases. Immunity to each of the three diseases lasts about 10 years, so a “Tdap” booster is recommended every 10 years.

Tetanus: Caused by contaminated puncture wounds. Rare in the United States, but 10% of victims die, according to the Immunization Action Coalition, a nonprofit immunization advocacy group based in St. Paul, Minn. Vaccine is effective if you get it within 24 hours after injury.

Diphtheria: Bacterial disease of the throat, heart, kidneys and nervous system. At one time, 150,000 annual cases were reported in the U.S. Now the disease is almost eradicated, according to The Children’s Hospital of Philadelphia.

Pertussis: “Whooping cough” attacks the lungs. About a third of cases are adults, according to the National Network for Immunization Information.
Who Needs Adult Vaccinations?
Most people don’t need to rush out and be vaccinated against every single disease on the above list. The need for adult vaccinations depends on your age, job, medical condition and lifestyle.

But in some cases, you definitely should be immunized. For example, you may need the following vaccinations if you’re:

Pregnant or in contact with a newborn:
Influenza. “A flu shot will protect the mother and some of that protection crosses the placenta and helps protect the baby after [birth],” Schaffner says.

Pertussis. The CDC recommends that everyone in contact with a newborn – including the pregnant mother (in the second or third trimester), siblings, grandparents and caregivers – be immunized with Tdap.

“We want to create a cocoon of protection around the infant,” Schaffner says.

Headed for college:
Meningitis. Most common in babies but also a problem for young adults age 15-24, according to the CDC. Thirty-nine states require either vaccination or education about meningitis for college freshmen, according to the National Conference of State Legislatures.

Employed in health care:
Hepatitis B. “Anyone who deals with sharps (hypodermic needles) should be vaccinated,” Schaffner says.

Exposed to unvaccinated children:
Full immunization. “A kindergarten teacher gets exposed to a lot of different illnesses, so I’d want her to have full vaccination protection,” says Daniel Rubin, M.D., clinical assistant professor at the University of Florida Department of Community Health and Family Medicine in Gainesville, Fla.

Physical laborer:
Tetanus. “A carpenter might need tetanus protection [due to high risk for physical injuries in that profession],” Rubin says. The same applies for construction workers.

Female under age 26:
HPV. “If you’re between 11 and 26 and have a cervix, you should be vaccinated against HPV,” Schaffner says.

Sexually active:
Hepatitis B. One out of 20 people in the U.S. are infected with hepatitis B, according to the Immunization Action Coalition.

“Be honest with yourself,” Schaffner says. “If you’re not in a mutually monogamous, long-term relationship, get vaccinated.”
Over 50 years old, a smoker and/or chronically ill:
Herpes zoster. “The CDC and American Academy of Family Physicians recommend it for everybody over 50,” Rubin says.

The vaccine is expensive, however, and not always covered by insurance, so check your policy. Most recent estimates by the National Center for Immunization and Respiratory Diseases say fewer than 7% of senior citizens have received this vaccine.

Pneumonia. The pneumococcal vaccine is routinely given for people over 65 and smokers age 19 and over, according to the CDC.

A second dose of pneumococcal vaccine given five years after the first boosted immunity levels in seniors, a 2010 study by Merck Research Laboratories found.

Asthma, heart or lung disease, diabetes or a compromised immune system can also make pneumonia deadly, Schaffner says.

Hib (Haemophilus Influenzae type B). If you’re an adult with sickle cell anemia, HIV infection, leukemia or a weakened immune system, this childhood disease could be serious – but most other adults do not need this vaccination, according to the CDC.

Adopting a child from a foreign country:
Hepatitis A. “You need to get the vaccine before you bring the child home,” says Deborah L. Wexler, M.D., board-certified family physician and executive director of the Immunization Action Coalition.

Planning to travel outside the country:
Measles, hepatitis A and any other diseases – such as typhoid, yellow fever, or diphtheria – that are a problem at your destination. The CDC recommends everyone older than 12 months old who travels get MMR vaccinations up-to-date.

“Hepatitis A is a problem in Asia, India, Africa and the Caribbean. Diphtheria is still common in Asia, and it’s only a plane ride away,” Wexler says.

The CDC also has information about which diseases are currently a danger in each country.

Any age or condition and don’t want to catch the flu:
Influenza. “I make sure my youngest and oldest patients get the vaccine,” Rubin says. “I like everyone in between to get it too.”
Tracking Down Your Vaccination Records
The clerk at my former high school actually laughed when I told her I was trying to reconstruct my immunization records from more than three decades earlier. The county health department staff was more polite, but no more helpful.

If you’d like to try to track them down, the CDC offers this advice:

Start with your family: Did your parents keep immunization records in your baby scrapbook or family Bible?

Schools: If you graduated recently, your school might still have your immunization records.

Public: Check whether the state where you were vaccinated has the Immunization Information Systems (IIS) database. The CDC has links to states that participate.

Doctor: Your childhood doctor might still have your vaccination records on file. It’s a long shot.

Military: The U.S. Department of Veterans Affairs might have records of immunizations you got while in the service.

Can’t Find the Information?
“A blood test will tell us [what you are immune to],” Rubin says. Called an antibody titer, the test measures the level of antibodies you have against specific germs. Each antibody level is tested separately for a separate fee.

But it’s often easier and less expensive to just get the shots again, Schaffner says.

“When in doubt, immunize. You can’t hurt someone by giving them the vaccine.”

I took that advice and got re-immunized when I wasn’t sure of my vaccination status.

Where to Get Immunized
Your doctor’s office: The best place to catch up on your immunizations might be your doctor’s office. Your family doctor is aware of all your health conditions and can take into account your job, travel plans and other special circumstances.

A public health clinic: The least expensive place to be immunized might be your local public health clinic. Call ahead to check on prices and to see if you’ll need a doctor’s orders. Also, call your insurance company to see if it’ll pay.

Your local drugstore: Many pharmacists offer adult vaccinations without prescription.

“It can be easier, quicker and more private to go to a drugstore,” Schaffner says.

At CVS Pharmacy Minute Clinics, 2011 prices range from $29.95 for a flu shot to $206 for one dose of HPV vaccine. Walgreens Take Care Clinics have comparable prices and also offer the herpes zoster vaccine for $219.99 per dose.
Are Shots Safe?
Some adult vaccinations carry side effects or risks.

Adults are more susceptible to autoimmune reactions from vaccinations, says Robert Sears, M.D., pediatrician and author of The Vaccine Book: Making the Right Decision for Your Child (Little, Brown and Co).

Adult vaccinations stimulate the immune system. If you have an autoimmune disease such as diabetes, fibromyalgia, or psoriasis, your immune system is already working too hard and the additional stimulation might make it worse, Sears says.

Spreading multiple vaccines may minimize reaction risk, he says.

Your doctor can help you assess the risk of each immunization against the odds of contracting the disease or illness.

For example, if you made it to age 40 without catching the mumps, should you get vaccinated now?

Merck Laboratories, which makes the MMR vaccine, says the vaccine causes joint pain and/or arthritis in as many as 26% of adult women. The inflammation usually goes away but can become chronic.

However, mumps are more serious for adults than for children, according to the National Foundation for Infectious Diseases.

But the annual flu shot is “incredibly safe,” Schaffner says. No deaths occurred among last year’s 120 million U.S. doses, while 32,000 unvaccinated people die annually from the flu and its complications.

In my case, I decided I was past the age of danger for diseases of young adults and not old enough for the senior citizen shots.

Because I’ll be working with children, I also want protection against germs that might harm them. With that in mind, my doctor and I drew up a vaccination schedule that included protection against Hepatitis B, influenza and Hib.

Since it had been more than 10 years since my last tetanus shot, I also got the Tdap booster. Three boosters in one shot seemed like a good deal, and it hardly hurt at all.

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