Immunization for Adults: Have you had your shots?

Spring 2009 CSANews Issue 70  |  Posted date : Apr 30, 2009.Back to list

A great deal of attention is paid to children's immunization, but adults also need to protect themselves from certain infectious diseases. Over the past few decades, remarkable progress has been made in the development of vaccines, not only for childhood diseases, but also for many life-threatening and debilitating infections that pose a risk to adults, especially seniors. This article will help remind you of what protection you need, as well as describing some of the recently developed vaccines, such as the shingles vaccine.

The first major breakthrough in vaccination was the discovery in 1796 by Edward Jenner in England that children purposefully infected with a mild infection, cowpox, demonstrated very effective immunity to smallpox, a devastating world infection that claimed millions of lives, predominantly children. In the decade before I graduated, the polio vaccine had been discovered, manufactured and used extensively throughout North America to eradicate polio. Children were already receiving immunization against tetanus, pertussis (whooping cough) and diphtheria. I never saw a case of diphtheria or active polio. Our son, practising family medicine, tells me that he has never seen a case of measles, rubella (German measles) or mumps, because of the widespread use of these vaccines developed in the early 1970s.

These programs to protect the public from infectious diseases have been very successful, especially for childhood infections. Public health agencies and experts continually modify recommendations as new vaccines and protocols are developed. Getting regular immunization throughout our lifetime protects our own health and that of others through the reduction in the spread of these diseases.

Vaccines work by helping the body's immune system fight off illness and infections usually caused by bacteria or viruses. When a person's immune system experiences a foreign organism, it stimulates the production of proteins called "antibodies." These not only fight the invading bacterium or virus, they also prevent a future infection from a particular organism by quickly responding to another exposure. Vaccines are preparations that stimulate the body to develop specific antibodies to fight off such infecting agents, once exposed. Sometimes the protection is lifelong, but in other cases re-vaccination or "booster" shots are needed. The majority of vaccinations are by injection.

In addition to the development of vaccines to prevent the infections which once afflicted most children and sometimes caused permanent impairment or death, there is now routine immunization for children against varicella (chicken pox), influenza and hepatitis B. In addition, vaccinations for haemophilus influenzae, rotavirus, pneumococcus and meningococcus are recommended for certain children at risk. The recent development of a vaccine (HPV) to combat the virus that causes most cases of cervical cancer has resulted in its widespread use by young women in Canada.

Prevention of infection by immunization, however, is a lifelong process. Too often we, as adults, especially seniors and individuals with certain medical conditions such as those with heart, lung, immune-related diseases and diabetes, do not pay attention to the recommended immunizations for adults. Because of an increased risk of severe illness, complications and even death, paying close attention to these recommendations in our age group is important. Busy family physicians often overlook these immunization protocols, making it important for you to know the Canadian standards for adult immunization and to ask your doctor.

Recommendations in Canada are contained in the Canadian Immunization Guide supported by The Public Health Agency of Canada.

Tetanus, Diphtheria and Pertussis

Assuming most seniors have received immunization for whooping cough, tetanus, polio and diphtheria and have likely had exposure to or suffered from chicken pox, measles and German measles during childhood, the regime recommended for ongoing protection for most adults is a booster shot for tetanus combined with diphtheria every 10 years. If there is no record of pertussis immunity, this vaccination can be combined with the above vaccination booster, once, as an adult.

Influenza Vaccine

All individuals over the age of 65, as well as those adults with medical conditions which increase their chances of complications, should receive a yearly vaccination against influenza. Fewer than half of these individuals actually get the vaccine. Influenza, or so-called "flu" is a highly contagious viral infection which usually presents itself in the early to mid-winter months. Characterized by fever, aches and respiratory symptoms, its most common complications, such as pneumonia, occur in those over 65 and those with certain predisposing illnesses. In some provinces, the vaccine is supplied and recommended for persons of all ages. Those who are health-care workers, providers of home care, household members in homes where there are high-risk individuals and workers in long-term institutions should always be immunized each year.

There is always controversy among some as to the rationale of getting "the flu shot," but there is overwhelming evidence of its value not only in protecting an individual from the infection, but also in reducing the spread of the disease. As with all immunization "shots," there can be side-effects but these are rare, mild and insignificant when compared to the potential benefits.

Pneumococcal Vaccine

All individuals over the age of 65, as well as those adults with medical conditions which increase their chances of complications, should receive a vaccination to prevent pneumococcal infection. Unlike the type of vaccine used in children, this adult vaccine, sometimes called "the pneumonia vaccine" by patients, can be given just once to be effective. At the present time, the Canadian Public Health Agency does not recommend the need for a booster, except for those with conditions that put them at increased risk. Pneumococcus is a common bacterial infection that causes meningitis, pneumonia and blood infections which can be especially serious in the elderly. This infection remains a common cause of hospitalization and its use is highly recommended to reduce the risk of these infections.

Shingles Vaccine

In August 2008, Health Canada announced the approval of a new vaccine, Zostavax, for the prevention of shingles (herpes zoster) in individuals over the age of 60. Shingles is a reactivation of the same virus that causes chicken pox. It is characterized by the development of pain, itching or burning on one side of the body, most often the chest or trunk, and is followed within days by blister formation in that area. If it affects the face, it can have serious consequences including involvement of the eye. Although an antiviral drug taken immediately upon the outbreak of the rash may lessen the suffering, there had been no way of preventing the disease. For individuals over the age of 60, the illness can be very painful and debilitating with many being afflicted with post-herpetic neuralgia, nerve pain that is prolonged, sometimes for years.

The vaccine production has been delayed and its distribution in Canada has been delayed. When it will be available and whether all provinces will pay for the vaccine is not known. The long-term effectiveness of the vaccine is unclear, however in the studies done so far, there appears to be approximately a 50% reduction in the incidence, a slight decrease in the duration of pain and discomfort in those acquiring the infection, and the incidence of post-herpetic neuralgia is reduced by about 67%. Authorities in the U.S. have recommended that adults over the age of 60 should receive the vaccine. Although approved for sale in Canada, our public health experts have not yet made this recommendation. As with all vaccines, persons with certain allergies and diseases should not receive it. Ask your doctor, when it is available, if you should receive this vaccine.

Vaccines and Travelling

Healthy travellers to all parts of Canada and continental U.S. do not need other specific immunizations, however, persons travelling to parts of Mexico, Central America, the Caribbean islands and other world destinations should seek specific advice from their physician or travel medical clinic. According to one's individual health status, the site(s) visited and the duration of the trip, there may well be recommendations for protection against hepatitis A, hepatitis B, meningococcus, malaria and infectious diarrhea. In certain countries, there may be added advice for protection against yellow fever, typhoid and certain tropical diseases.

Many individuals suffer from common infectious diseases needlessly, due to their failure to receive adequate or complete immunization. Many of us have forgotten when we had our last tetanus shot or whether we have ever had the pneumococcus vaccine. It's important to keep a personal record of your illnesses, past conditions, prescribed drugs and immunization record, especially when travelling. Getting up to date with these basic health promotion initiatives may protect your health and even your life. Your doctor is the best source of information and answers to the questions about your individual needs. Be sure to find out if your immunizations are up to date!