Medically Speaking - Article 20

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Articles and Publications: Medically Speaking

Medically Speaking: Archives

"Are Your Family’s Vaccines Up-to-Date?"
Part 2: Adult Immunizations
By Margaret Trexler Hessen, M.D., specialist in infectious diseases & member of the Delaware County Medical Society

Periodically the Advisory Committee on Immunization Practices (ACIP), a body of internationally recognized experts on vaccine use, evaluates new vaccines and new information on older vaccines. Their recommendations form the basis for guidelines published by the Centers for Disease Control and Prevention (CDC). Recently this column focused on new immunizations and updated recommendations for older vaccines in children and adolescents. Some of the new vaccines apply to adults as well, and this column will outline those applications and other new recommendations based primarily on the ACIP/CDC revisions of October 2006.

The new vaccines of note are those for human papilloma virus (HPV) and for shingles. The HPV vaccine, recently licensed and recommended in girls and women ages 11-26, is designed to prevent infection with the sexually transmitted virus that causes one form of venereal warts and, after long-term infection, cervical cancer. The goals are to prevent both infection and cervical cancer. The vaccine is administered as a series of 3 shots over 6 months.

The other new vaccine for adults is designed to prevent shingles and its complications. Shingles is a painful blistering rash caused by reactivation of chickenpox (varicella) virus, which lives in a dormant condition in the nerve roots of all who have had chickenpox. It occurs most often in the elderly, long after the original chickenpox infection, as immunity declines. One of the main hazards of shingles, apart from the pain and annoyance of the rash itself, is the fact that it can cause continued severe pain even after the rash itself has healed. It can also cause blindness if the eye is involved. The vaccine has been approved by the Food and Drug Administration for use in people over the age of 60. Official CDC recommendations are pending.

Some modifications have been made in the use of older vaccines as well. It has been found that some vaccines do not generate life-long immunity. This was discovered in the 1980s when measles outbreaks arose and involved many people previously vaccinated. As a result, it was recommended that a second dose of measles vaccine be given. This is now a part of the standard childhood schedule and is required for school attendance in many states. Recently, for similar reasons, a third dose of varicella (chickenpox) vaccine was recommended for children and adolescents (but not yet for adults). Recent outbreaks of mumps in the Midwest have now prompted the CDC to recommend a second dose of that vaccine for adults who have not had mumps or who have received only a single dose of vaccine. There is also a new recommendations for a booster against whooping cough (pertussis) with a new formula of vaccine.. This disease has begun appearing in adults as their immunity from childhood vaccine wears off. The new “acellular” formula is much safer in adults than the older vaccine given in childhood, which, when given to adults, could cause severe reactions and therefore was not recommended past childhood. It is usually given combined with a tetanus or tetanus/diphtheria booster. Those adults who have not had these vaccines (or the diseases) should consider the full vaccine series.

Lastly, of course, it should be mentioned that the formula and recommendations for influenza vaccine are updated yearly. New recommendations this year include the addition of adults who have close contact with children under the age of 5 years. Because these children have a high rate of complications from influenza, every effort should be made to prevent transmission of the flu to them by family and other close associates.

It should be noted that these are general recommendations for healthy people. Pregnancy, a compromised immune system, or the presence of certain other medical conditions may make it inadvisable to receive some of these vaccines. Likewise, unusual circumstances may dictate the need for “non-routine” immunizations depending for example, on exposures related to the workplace, to foreign travel, etc. . Your doctor can review your immunization and health records and advise you of the risks and benefits in your individual circumstances, as well as the potential side effects of any vaccines.

Note: this article is presented through the efforts of the Delaware County Medical Society and is intended for informational purposes only, the contents should not be intended as medical advice.

Readers are invited to view the society’s entire “Medically Speaking” series on the DCMS web site: www.delcomedsoc.org

“You and Your Doctor – Preserve the Relationship”.

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