Vaccines

Many adults are unaware that they may be in need of one or more vaccines. This is either because their old vaccinations have expired, or because new  vaccinations have been developed in recent years, or perhaps because they are traveling to parts of the world where certain illnesses are more common. Vaccinations are an important way to prevent many illnesses. Some of these illnesses are untreatable once contracted. Some like Hepatitis B can cause chronic and even fatal diseases. This article will review how vaccines work and why they are important. It also goes over some of the vaccines that adults should consider. Contact your physician if you think you need one of these or have any questions about vaccines in general.

Topics

How do Vaccines Work?

When our body is invaded by a bacteria or virus the immune system must respond to fight it off. To do this some of the body's white blood cells known as Dendritic Cells or Antigen Presenting Cells (APC's) engulf the invader. Every virus and bacteria has proteins on their surface which we call antigens. These are as unique to the particular virus or bacteria as a fingerprint.  APC's  break down the invader and then put these key antigens from the invader on their outer surface. Other white blood cells known as B-cells then use those antigens to produce specific antibodies that can bind to the anitgens like a lock and key. Antibodies circulate through the blood stream. When they find an invader with the same antigen on its surface they latch on and help other white cells locate and destroy them.

The one weakness in this system is the time it takes for our immune system to recognize the invaders and create these special antibodies. Its as though our cells have to take a class to learn how to make antibodies against this new virus or bacteria and until they graduate they don't have the knowledge they need to attack the invader.  That class takes one to two weeks to complete on average and during that time the invader is free to roam our body and wreak havock.
By vaccinating ourselves against an illness we are speeding the process up by holding the immune system class before the invasion ever occurs.  An army that develops its defenses before the enemy invades will stand a much better chance of winning the battle than one which waits until the enemy is at the gates. This is why vaccines are so important. They train our immune system to recognize an invader before it can do any damage.

Why do we need to vaccinate?

 Obviously we vaccinate so we don't contract contagious illnesses, but we also vaccinate so we don't pass those diseases on to anyone else. Before vaccines were developed many children died in childhood or developed disabilities that followed them through life do to illnesses which are now preventable. With the exception of rare outbreaks, today's vaccines have mostly made these tragedies a distant memory in the history of medicine. Unfortunately in recent years outbreaks of vaccine preventable diseases have become more common again largely due to complacency on the part of the public and misinformation  which has spawned unfounded fears and reduced our vaccination rates.

I have heard many different reasons why people think they don't need to vaccinate themselves against many illnesses. These are some common ones that need to be addressed.
  • Most of these illnesses are very uncommon these days and if everyone else vaccinates themselves then I don't have to.
While some of the things we vaccinate for are uncommon today they are only uncommon because we have been vaccinating against them. As a result there are fewer people carrying these diseases and therefor less chance of contracting them.  If enough of the population (or herd) is vaccinated  then the rest of the population will derive some protection even if they are not vaccinated.  This is called herd immunity. But herd immunity is only effective if most of the population keeps up with their vaccines.  As we have seen in recent years, people have not been keeping up with them as much as they should and with certain illnesses like whooping cough and measles we are starting to see a dangerous resurgence.  In the case of influenza, every year about 30,000 people die because they weren't vaccinated and because the people around them weren't vaccinated. We don't have nearly enough of the population vaccinated to develop influenza herd immunity. These gaps in our herd immunity make vaccination more important than ever.
 
 
It's important to remember that when we get vaccinated we protect not only ourselves but also others who are unable to get fully vaccinated ( newborns and immune suppressed people) and those who don't develop enough immunity from the vaccination to protect them adequately (the elderly and cancer patients).
  • I never get sick.
There is no such thing as a super immune system or someone who doesn't get sick. Some people only appear to be immune to contagious illnesses. We all get lucky now and then. Some people have just managed to avoid contact with anyone who was ill enough to transmit a preventable disease but sooner or later everyones luck runs out.
  • These illnesses were common when sanitation was poor. Now that our environment is much cleaner we don't need to worry about them anymore.
Sanitation has no doubt helped us reduce the rates of certain illnesses like cholera for example but it has played only a minor role in reducing illnesses from things like measles, polio, mumps, rubella and most other vaccine preventable illnesses that previously killed millions of people every year. Small pox has been eliminated from the surface of the earth and yet there are large sections of the world with horrible sanitation. Clearly good sanitation did not eradicate small pox from the many third world countries that remain impoverished to this day. Only vaccines can do that.

Many vaccine preventable illnesses like measles and rubella are airborne and become contagious before signs of illness develop. For these viruses sanitation has a very a limited role if any in preventing epidemics. Good sanitation is important but it will never eradicate illnesses or even control them the way vaccines can.
  • Its better to get the actual illness since it provides better immunity.
The whole purpose of vaccines is to prevent the illness in the first place. The illnesses we vaccinate against are not harmless diseases. Most cause significant discomfort at a minimum and depending on the particular illness, permanent disability and death will occur in some of those who fall victim to these diseases.  In some cases getting an illness may provide longer lasting immunity than the vaccine but only at the risk of harm from the very illness we are trying to prevent. The idea of intentionally getting an illness so one can develop immunity to that illness is as senseless as crashing your new car into a tree so it won't get into another accident. If you total the car that may work but it leaves you with a totaled car and perhaps a dead driver. Getting vaccinated is like putting good breaks and tires on your car so it doesn't get into an accident in the first place. Doesn't that make a lot more sense?

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The Vaccine Non-Controversy

Vaccines have been around in some form for nearly 1,000 years since folk doctors in India used dry small pox scabs to "variolate" or vaccinate people so they would be immune to small pox. Those first attempts at vaccination were crude but they dramatically reduced deaths from small pox. Today modern science allows us to understand how vaccination works giving us tools the ancient healers did not have. This knowledge has allowed physicians and scientists to develop newer and better vaccines that protect us from dozens of illnesses that previously killed and injured millions.

Despite the dramatic success of modern vaccines there are individuals and groups who believe that vaccines are unsafe. The internet has given a voice to these concerns and unfortunately caused fear that has lead to lower vaccine rates. We are seeing the fallout from this now as diseases which were once nearly eliminated are starting to make a comeback.  Pertussis (Whooping Cough) cases have increased significantly in recent years and Measles outbreaks which had been almost unheard of after decades of successful vaccination programs have now started to spring up again. Most cases are occurring among children who have not been vaccinated.  Measles had been all but eradicated from the United States until very recently when several widely publicized outbreaks occurred. In Jan 2015 an outbreak of measles was traced to Disneyland California and to date more than 50 cases have been identified as a result of this one outbreak. The majority of these cases were in children who had not been vaccinated.

While no treatment can ever be 100% safe or effective, vaccines are one of the safest and most successful medical innovations ever created. Minor side effects such as injection site soreness can occur commonly and some individuals may occasionally experience a day or two of low grade fever or fatigue after a vaccine as the immune system goes into action, but serious side effects are extremely rare. While even one serious complication is one too many its important to remember that failure to vaccinate exposes that individual and their close contacts to the actual illness which is thousands of times more likely to result in serious side effects than any vaccine.

Even though the media and the internet have presented vaccine concerns as a real controversy, within the medical community there is no significant controversy at all. Instead of controversy there is great concern that misinformation and irrational fear will lead to reduced vaccination rates that put everyone at risk. The vast majority of physicians including myself vaccinate themselves, their children, and other family members. That, more than anything should send a message that the people who know the most about vaccines trust them and depend on them to protect the people they love.

The videos on this page (see side panel above) review this topic in much greater detail. If you are concerned about vaccines or not sure about them, it is well worth your time to watch these shows courtesy of PBS and Khan Academy.

Specific Vaccine Information.

Adult Vaccine Schedule

Childhood Vaccine Schedule

The CDC provides Vaccine Information Statements (VIS) for most vaccines and you can access them below. The VIS will give you the basic information describing the vaccine as well is the risks and benefits so you can make an informed decision about your vaccine choices.
CDC Vaccine Information Sheets.

MMR - measles,mumps, and rubella

Additional Vaccine Information Resources

Vaccines and Adults: A Lifetime of Health Booklet

Nova Vaccine Video

Very informative video from PBS examining the benefits of vaccines and addresses the public concerns

Vaccine/Autism Myth

This video by Dr. Rishi Desai a pediatric infectious disease specialist gives the history of the vaccine autism controversy and debunks the myth that there is any link between vaccines and autism.
The MMR vaccine is a "3-in-1" vaccine that protects against Measles, Mumps, and Rubella.
Adults, born after 1956, should have two doses of the MMR vaccine. If they are uncertain of their immunization status or if they have only had one MMR prior to school entry they should be revaccinated. Adults born during or prior to 1956 are presumed to be immune. Many people within that age group had the actual diseases during childhood.

Click here to view the Vaccine Information Sheet (VIS) for the MMR Vaccine

Influenza

Influenza, commonly called "the flu," is caused by viruses that infect the respiratory tract. Compared with most other viral respiratory infections, such as the common cold, influenza infection often causes a more severe illness.

Most people who get the flu recover completely in 1 to 2 weeks, but some people develop serious and potentially life-threatening medical complications, such as pneumonia. In an average year, influenza is associated with about 30,000 deaths in the United States.

Much of the illness and death caused by influenza can be prevented by annual influenza vaccinations. People of all ages can benefit from the flu vaccine and should consider getting it when its offered in the fall. While certain groups like the elderly, very young and those with chronic illnesses are at greatest risk of flu complications there are deaths and significant disability every year even in patients who had no known risk factors. 

The influenza vaccine causes no side effects in most people. Less than one-third of those who receive vaccine have some soreness at the vaccination site, and about 5% to 10% experience mild side effects, such as headache or low-grade fever for about a day after vaccination just like nearly all vaccines. One common misconception regarding the flu vaccine is that it can cause the flu. This is not true . The flu vaccine contains no active virus and has never been capable of causing influenza.

The optimal time for vaccination is usually the period from September to through November. It takes about 1 to 2 weeks after vaccination for antibody against influenza to develop and provide protection.

Click here for more information including the different type of influenza vaccines available.

Click here to view the Vaccine Information Sheet (VIS) for the Influenza Vaccine

TDaP - Diphtheria, Tetanus, and Pertussis

Diphtheria is found only in humans and is transmitted by respiratory droplets from infected persons or carriers. The incubation period is 1 to 4 days. The bacteria primarily infect the nose and throat. It can spread via the bloodstream to other organs where it can cause significant damage. Although the toxin can damage any tissue, that of the heart, kidneys and nervous system are most frequently and most severely affected.

Tetanus (also called lockjaw) is a disease caused by the toxin of a bacteria that lives in the soil. The toxin affects the brain and nerves, sometimes resulting in death. Infection begins when the bacteria enters a dirty wound or cut. The bacteria that multiply produce a neurotoxin. The toxin causes muscles to go into spasms which may be so powerful that they tear the muscles or cause fractures of the vertebrae. Without treatment, 1 out of 3 affected people die.

Pertussis - Pertussis causes a respiratory infection often referred to as Whooping Cough. In adults this illness is relatively mild but children are more likely to get seriously ill.  Pertussis rates in young children have increased significantly in the past decade. 92% of these cases were in children under 6 mos of age. Many of these cases may have been caused by exposure to adults who have let their immunization expire. It is therefor important for all adults who have contact with small children to update there DTaP vaccination if they have not had one recently.

It is recommended that adults receive a combined immunization for Diphtheria, Tetanus, and Pertussis once every ten years. All pregnant women should get a new TDaP vaccine during the third trimester of each pregnancy and preferably between weeks 27 and 36 of the pregnancy in order to provide the baby with immunity to pertussis from the first day they enter the world.

Click here to see the Vaccine Information Sheet (VIS) for TDaP

Penumococcal (Pneumonia) Vaccine

Pneumococcal pneumonia is one of the most common and serious types of bacterial pneumonias. It still results each year 500,000 cases of pneumonia in the US alone. Pneumococcal infection causes an estimated 40,000 deaths annually in the United States.

Adults 65 or older are at increased risk for Pneumococcal infection. Also persons with cardiovascular diseases (e.g., congestive heart failure or cardiomyopathy), chronic pulmonary diseases (e.g., Asthma or Emphysema), chronic liver diseases or diabetes are at increased risk for developing Pneumococcal infection and experiencing severe complications.

Persons under 65 with any of the above risk factors should be vaccinated. All persons over 65 regardless of risk factors should also be vaccinated

UPDATE:  The recommendations above apply to the Pneumovax Vaccine (PPSV 23). There is a new vaccine called Prevnar 13 or PVC 13  that covers some additional pneumococcal strains. It is now recommended that all individuals over 65 get this vaccine in addition t the PPSV 23 and that they be given at least a year apart.

Click here for more information about the Pneumonia Vaccines from the Centers for Disease Control.

Click here to see the Vaccine Information Sheet (VIS) for Pneumovax (PPSV 23)
Click here to see the Vaccine Information Sheet (VIS) for Prevnar 13 ( PCV 13)

Hepatitis B

Hepatitis B can affect anyone. Each year in the United States, more than 200,000 people of all ages get hepatitis B and close to 5,000 die of sickness caused by HBV  ( Hepatitis B Virus). One out of 20 people in the United States will get hepatitis B sometime during their lives.

Hepatitis B is contracted through direct contact with the blood or body fluids of an infected person, Infection can occur through sexual contact or sharing needles with an infected person. You may have hepatitis B and not know it. Sometimes a person with HBV infection has no symptoms at all. There are treatments for hepatitis B but it can not always be cured. Chronic Hep B infections can lead to hepatitis, liver failure, and liver cancer. This is why prevention is so important. Hepatitis B vaccine is the best protection against HBV

Most people born after 1990 were likely vaccinated for Hep B when they entered middle school. Persons of any age whose behavior puts them at high risk for HBV infection or whose jobs expose them to human blood should get vaccinated.

Hepatitis B vaccine is a three part vaccine given at  0 ,1, and 6 months and usually imparts lifelong immunity

Click here to view the Vaccine Information Sheet (VIS) for the Hepatitis B Vaccine

Hepatitis A

Hepatitis A is a liver disease caused by hepatitis A virus. Symptoms usually last less than 2 months; a few persons are ill for as long as 6 months. Hepatitis A virus is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis A. Food is a frequent source when restaurant workers don’t wash their hands after using the bathroom. For this reason, the virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed.

Hepatitis A vaccine is recommended for people who work in day care centers, or anywhere that may bring them in contact with human waste. It is also recommended for people traveling to areas of the world outside the US, Canada, Western Europe, Japan, and Australia. The Caribbean and Mexico are high risk areas.

Hepatitis A vaccine is a two part vaccine given at 0 and 6 months and usually imparts lifelong immunity.

Click here to view the Vaccine Information Sheet (VIS) for the Hepatitis A Vaccine

Shingles Vaccine - Zostavax

This vaccine is approved for patients 50 and older who have previously had chicken pox. It is recommended especially for those more than 60 years old since most cases occur in individuals 60 and up......Click here for information.

Click here for more information about the shingles vaccine from the Centers for Disease Control

Click here to view the Vaccine Information Sheet (VIS) for the Shingles Vaccine

Meningococcal (Meningitis) Vaccine

The "Meningitis Vaccine" protects against several strains  of bacterial meningitis caused by the Meningococcal bacteria. College students living in dorms and military recruits living in close quarters are at the greatest risk for developing meningitis.  Even with antibiotic treatment 10-15% of people who contract this form of meningitis will die from it so vaccination is the best defense in high risk individuals.

There are two meningococcal vaccines:
Menactra (MVC4) - Approved  for individuals 9 months to 55 yrs old
Menomune (MPSV4) - Approved for individuals 2 years and older

Click here to view the Vaccine Information Sheet (VIS) for the Meningococcal Vaccine

HPV ( Human Papilloma Virus) Vaccine

Human Papilloma Virus (HPV) is the most common sexually transmitted disease. Some studies have shown that as many as 80% of sexually active women will contract at least one strain of HPV sometime during their life time. Although there is no test for this virus in men it is believed that a similar percentage of men will contract this virus as well.

HPV has been proven to be the cause of nearly all cervical cancer as well as many anal and some oral cancers. It also causes genital warts. For this reason it is now recommended that all individuals be vaccinated for HPV between the ages of 11 and 12 so that they are protected well before they have sexual contact with another individual since even one contact is enough to contract the virus. Anyone who missed the vaccine at an earlier age can still get it later. It is approved for females up to age 26 and males up to age 21.

Although there was initially some misinformation in the media concerning possible problems with the HPV vaccine this was mostly triggered by comments made by uninformed politicians and internet bloggers. There have never been any safety concerns about the HPV vaccine in the medical community. In fact millions of doses of HPV vaccine have been administered as of this date and no serious adverse reactions have been linked to it.

Click here to view the Vaccine Information Sheet (VIS) for the HPV Vaccine

Chicken Pox ( Varicella) Vaccine

The chicken pox vaccine is usually given in childhood but adults who have not previously had chicken pox should be vaccinated. The vaccine is given in two doses 4 weeks apart.

Click here to view the Vaccine Information Sheet (VIS) for the Varicella Vaccine

Travel Vaccines

Travel to countries outside of the U.S. often exposes people to illnesses that don't exist in the U.S.. For this reason additional vaccines may be required or advised when traveling abroad even when going to many common destination like the Bahamas and Caribbean. Check with your physician to see which vaccines may are recommended for the area you are traveling to. More information on recommended travel vaccines can be found at the CDC's Travelers' Health Web Site

Common Vaccines Recommended for Travel Abroad
  1. Hepatitis A
  2. Hepatits B
  3. Typhoid
  4. Yellow Fever
  5. Japanese Encephalitis
  6. Polio