Adult Vaccinations: Overlooked and Underappreciated

Despite the overwhelming evidence in favor of childhood vaccinations, there’s been a lot of buzz lately about their safety and scheduling. Lost in all that chatter is the fact that the rate for adult vaccinations is lower than that for children, and, according to the Centers for Disease Control and Prevention (CDC), unacceptably low.

We’re talking about more than just flu shots here.

The CDC reported last month that although more people were getting the Tdap vaccine, which protects against tetanus, diphtheria and pertussis or whooping cough, adults are not getting vaccinated against other illnesses, such as pneumonia and hepatitis.

“While everyone knows about the importance of the flu vaccine and childhood vaccination, adults are unaware” about other diseases they need to protect themselves against, including whooping cough and shingles, said Assistant Secretary of Health and Human Services Dr. Howard Koh during a media session with reporters including those from MedPage

For example, only about 12 in 100 adults between 19 and 49 have been vaccinated against hepatitis A; about 36 in 100 adults the same ages have been vaccinated against hepatitis B. Target rates are 9 in 10 for both.

Both hepatitis A and B damage the liver, and are caused by a virus. (Hepatitis C also affects the liver, but there is no vaccine.) You get the A virus from: eating or drinking contaminated food or water; coming into contact with the stool or blood of a person with the disease; participating in certain sexual practices with someone with the disease. You get the B virus from: having a blood transfusion (rare in the U.S.); coming into direct contact with blood in health-care settings; sexual contact with an infected person; tattoos or acupuncture with unclean needles or instruments; sharing needles during drug use; sharing personal items (toothbrushes, razors, nail clippers) with an infected person. You can also get the B virus at birth if your mother had hepatitis B. This is common in some Asian countries.

Vaccination rates for all illnesses rise after an outbreak, when people are more aware of the diseases and their consequences, but you don’t get the most protection unless you’re vaccinated before being exposed.

The CDC analyzed coverage rates for six shots. (I discussed shingles, the common name for herpes zoster, in my newsletter here.) They are:

  • Pneumococcal disease
  • Tdap
  • Hepatitis A
  • Hepatitis B
  • Herpes zoster
  • HPV (human papillomavirus)

HPV is effective only if you get it before you’re sexually active; it’s recommended that the first shot in the series be given to children in the early middle-school years.

One CDC official called coverage rates for the pneumococcal vaccine “way too low”; only 1 in 5 high-risk adults 19 to 65,and only 6 in 10 adults 65 and older were vaccinated. The CDC’s Healthy People 2020 initiative sets a goal of 9 in 10 older people, and 6 in 10 for the high-risk population.

Only about 16 in 100 people 60 and older are getting the herpes zoster vaccine; the goal is 30 in 100.

Cost, for once, should not be an issue for most people-the Affordable Care Act (Obama’s health-care reform) makes preventive services, which includes vaccines, free to all insured patients.

Different people need different vaccines. According to the CDC, some adults incorrectly assume that the vaccines they received as children will protect them for the rest of their lives. Generally this is true, except that:

  • Some adults were never vaccinated as children.
  • Newer vaccines were not available when some adults were children.
  • Immunity can begin to fade over time.
  • As we age, we become more susceptible to serious disease caused by common infections (such as flu and pneumococcus; shingles can strike anyone who ever had chicken pox).

If you haven’t been vaccinated lately, or can’t remember the last time you got a vaccination, contact your doctor to review your medical record. Schedule an appointment if you’re due for a vaccination, or contact a drugstore-affiliated clinic to see what vaccines they have-many can accommodate you on a walk-in basis.

To find out what vaccines are recommended for what groups of adults (by age and/or risk factor, link to the CDC’s Immunization Schedule.

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