InteliHealth:

2009 Immunizations for Adults

The Advisory Committee on Immunization Practices (ACIP) has released new advice on which vaccines adults should get to prevent disease. ACIP consists of experts chosen to make recommendations for the U.S. Centers for Disease Control and Prevention (CDC). The American College of Physicians (ACP), the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists have also endorsed the advice.

What's New?

Vaccination against pneumococcal pneumonia (the "Pneumovax") is now recommended for all adults who smoke. This is a wise change. Half of the young and middle-aged adults who get bacterial pneumonia are smokers. Clearly, smoking puts you at extra risk for this serious infection.

Because there is now an abundant supply of flu vaccine in the United States, the CDC encourages all adults to consider getting flu shots. Flu shots have long been recommended for adults 65 and over and people with chronic illnesses. Now the CDC recommends the shot for adults starting at age 50 and for people living with or taking care of anyone at high risk of flu complications.

Until now, there was no clear recommendation for people who previously had shingles. Now, the ACIP recommends the shingles vaccine for people who have had shingles. It should be given 12 months or more after the rash has faded.

Vaccine advice for adults has changed several times in recent years. The list below summarizes what's recommended now. Discuss these vaccinations with your doctor if you are not up to date with recommendations:

Flu shot (influenza): Any adult who desires vaccination can request a flu shot every year in the fall or winter. Healthy adults under age 50 may be able to receive a nose spray (FluMist) instead of a shot. The CDC strongly recommends a flu shot if:
- You are age 50 or older
- You have a long-term (chronic) medical condition affecting the heart, lungs, brain or immune system
- You have diabetes or major kidney or liver problems
- You are pregnant
- You live with or take care of anyone at high risk of flu complications, especially a child younger than 6 months of age (children under 6 months old cannot get flu shots)
- You live in a nursing home or other long-term care facility
- You are a health care worker
Pneumococcal pneumonia vaccination ("Pneumovax"): You should have the pneumococcal vaccine at least once in your life if:
- You smoke
- You have asthma
- You live in a nursing home or other long-term-care center
- You are older than 65
- You have any of the medical problems mentioned in the flu shot section
You need a booster shot five years or more years after the first vaccination if:
- You have kidney disease
- You have sickle cell disease
- Your spleen has been surgically removed or doesn't function normally
- You have trouble with your immune system
- You are older than 65 and received your first vaccination at age younger than 65
Tetanus and diphtheria, with or without pertussis ("Td" and "TDaP"): Most people these shots in childhood. But everyone needs a booster for tetanus and diphtheria every 10 years. One time in your adult years, your shot should include a pertussis (whooping cough) booster. Adolescents and adults don't usually get severely ill from whooping cough, which can cause uncomfortable symptoms for several months.

Human papilloma virus (HPV) vaccine ("Gardasil"): Three doses are recommended for all girls and women 9 through 26 years old. This protects against the virus that causes cervical cancer. The shots should precede the start of sexual activity for the best protection. The follow-up doses should occur at two months and six months from the first vaccine date.

Varicella "part 1" (chickenpox vaccine): If you had chickenpox in the past, you won't get it again. If not, you need two doses of the vaccine to be protected. Most people born before 1980 are probably protected because most of them had chickenpox as children. Protection against the virus means that, if exposed to infection, you would not get the rash, fever, and possibly serious pneumonia that can come with an adult chicken pox.

Varicella "part 2" (shingles vaccine, "Zostavax"): Chickenpox and shingles are caused by the same virus, varicella. To prevent shingles, you need a one-time vaccination after age 60, even if you have previously had shingles. People who are immune to chickenpox can still get the shingles, a painful skin rash. It's also called herpes zoster. This occurs because the varicella virus can hide from your immune system in small knots of nerve tissue next to your spine, called dorsal roots. The virus then can attack later in life. The shingles rash appears just on the area of skin that has nerve connections to the dorsal root. Anyone who has had chickenpox can get shingles.

Measles, Mumps, and Rubella (MMR): Most younger adults had shots in their childhood to prevent measles, mumps, and rubella, but many people need a booster. About 9 out of 10 adults born before 1957 were infected as children and have strong immunity. But younger adults and health care workers of any age may need a booster. You need a booster if:
- You live near a measles or mumps outbreak or you have been exposed to measles
- You are about to attend college (or another institution where people gather in very large, close-knit groups)
- You plan to travel to another country
- You might have received a less potent version of the MMR as a child. People who received this "killed" vaccine are mostly ages 43 to 47 now. If you are unsure about your immunity, a blood test can check for antibodies, or you can simply get a booster shot.

Hepatitis B vaccination: Hepatitis B is spread through sexual contact, contact with blood, and sometimes contact with an infected person. Ask your doctor if you need the three shots in the hepatitis B series. It is recommended for people who:
- Have sex with more than one partner
- Have liver disease, or kidney disease and need dialysis
- Are infected with HIV or practice high risk behavior
- Work in health care

Hepatitis A vaccination: Two doses are given. You need this vaccine if:
- You plan to travel to a country with high rates of hepatitis A
- You have liver disease
- You are a man who has sex with men
- In some cases, if you use illegal drugs

Meningococcal vaccine: A one-time vaccine is now routinely recommended for children ages 11 to 18. Adults don't need this vaccine unless they:
- Plan to attend college or enter the military
- Don't have a spleen

Some of the vaccines above are live virus vaccines. Live vaccines might be not given to people with weakened immune systems, or people who have close contact with such a person. Ask your doctor whether this concern applies to you.

Last updated January 26, 2009

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