Shots just aren't just for kids, but grown-ups don't seem to know that. Just 2 percent of adults have been immunized against Tetanus, Diphtheria, and Whooping Cough, according to data that the U.S. Centers for Disease Control and Prevention (CDC) released in January. And just 2 percent of people over age 60 have received the new vaccine against Shingles. Young women are doing a bit better; 10 percent of women ages 18 to 26 have availed themselves of the new HPV vaccine designed to prevent cervical cancer. Still, it's hardly a stellar showing.
"More and more people are talking about wellness," says Assistant Surgeon General Dr. Anne Schuchat. Most adults know they should be getting mammograms, colon cancer screening, and other preventive tests, she says. "We really need to think about vaccines in that same context."
The three newest adult vaccines, the Tdap, Shingles vaccine, and HPV vaccine, are the latest in almost a dozen vaccines routinely recommended for healthy adults by the federal government:
- Tdap (for pertussis and other infections). Cases of Whooping Cough -- also called Pertussis -- are on the rise among adults and teenagers, with about 25,000 cases annually. In adults, the bacterium causes a nasty cough that can linger for weeks, but the real concern is that adults can pass the bug on to unvaccinated infants, for whom the disease can be fatal.
Adults have been told for decades to get a Tetanus booster shot once every 10 years. The CDC now says one of those should be the shot known as the Tdap, licensed in 2005. It protects against Tetanus, Diphtheria (a bacterial disease that causes life-threatening throat infections), and Whooping Cough. Healthcare workers and people who have contact with infants should get the Tdap every two years to reduce the risk of spreading infection.
Caveats: Side effects in adults include pain or swelling at injection site, fever, headache, tiredness, and nausea. Tdap hasn't been tested for safety in people over age 65.
- Shingles vaccine. The CDC says people over age 60 should get this new vaccine to help avoid getting Shingles, which causes a painful, lingering rash. About 1 million people in the United States get Shingles each year, and the risk goes up with advancing age. The vaccine, licensed in 2006, also protects against a painful condition known as Post-herpetic Neuralgia, which can persist long after a Shingles attack. In a clinical trial, the vaccine prevented Shingles in 51 percent of participants, and Post-herpetic Neuralgia in 67 percent.
Caveats: The Shingles vaccine contains a live virus and thus is too risky for pregnant women or people infected with HIV. Reported side effects include soreness and swelling at the shot site, as well as headache. It was more effective in people ages 60 to 69 than in older age groups. The vaccine costs about $160 and is covered under Medicare Part D, which means that private insurers decide whether or not to pay for it.
- Human Papilloma Virus vaccine. Women up to age 26 should now get vaccinated against strains of HPV that most commonly cause cervical cancer. (It's believed to confer the most protection to women who haven't been previously exposed to those strains.) The vaccine was licensed in June 2006. It contains no live virus, which makes it generally safer.
Caveats: Side effects include injection-site discomfort and mild to moderate fever. The vaccine has not been tested for safety during pregnancy and thus isn't recommended for pregnant women. It takes three shots over six months to confer protection. The three shots cost a total of $360, and while large insurers are increasingly paying for it, not all health plans do.
- Influenza. Adults over 50 should get a shot to protect against seasonal flu. The vaccine is also recommended for women who are pregnant, immune-compromised people, healthcare workers, people traveling in the tropics or on cruise ships, and people who have household members in those categories.
Caveats: Side effects are generally mild. The vaccine is made using chicken eggs, so people who are allergic to eggs shouldn't get a flu shot. Each year, manufacturers change the formula for the flu vaccine in an attempt to match it to widespread strains of the virus; some matches are better than others, so the shot's effectiveness varies from year to year. FluMist, a nasal spray that contains a live attenuated vaccine, was approved in 2003. It can cause mild flulike symptoms and is not recommended for women who are pregnant or people who are immune-compromised.
- Pneumonia. The Pneumococcal vaccine is aimed largely at people with risk factors--those over age 65 or with chronic illnesses such as diabetes, heart disease, cancer, or HIV. It's effective in reducing the risk of hospitalization and death in the elderly. People who get their first Pneumococcal shot before age 65 should get a booster five years later.
Caveats: Reported side effects are mild, including tenderness at the shot site and mild fever.
- Measles-Mumps-Rubella. Adults born before 1957 are considered immune to this trio of diseases, and most younger adults were vaccinated as children. But people born outside the United States should probably get a shot. That's particularly true for women, because Rubella can cause birth defects. The CDC also recommends that college students, healthcare workers, and international travelers get a booster. Measles remains much more common in other countries, particularly in Africa.
Caveats: This vaccine contains live virus and thus should not be used by pregnant women or immune-compromised people, including those with HIV and a low count of CD4 immune cells. Side effects include fever, rash, seizure, and temporary joint pain or stiffness.
- Meningitis. First-year college students living in dormitories, international travelers, and healthcare workers are the main customers for the Meningococcal vaccine, which combats bacterial Meningitis. The vaccine has a piece of the bacterium instead of live bacteria and is considered safe.
Caveats: The vaccine doesn't protect against all strains of the Nesseria meningitidis bacterium. About half of recipients get mild side effects, such as a sore arm.
- Hepatitis A. Hepatitis A is common in the developing world; the virus is spread in feces and causes flulike illness that can last for weeks or months. The vaccine is recommended for people traveling to less-developed areas overseas, as well as people with risk factors such as intravenous drug use and men who have sex with men.
Caveats: This is a killed-virus vaccine and is considered safe. Side effects include soreness at the injection site, headache, and tiredness.
- Hepatitis B. Hepatitis B is a blood-borne virus that causes liver damage. The need for a vaccine is based on a person's risk factors: People who are on dialysis or have HIV or another sexually transmitted disease should be vaccinated. So should healthcare workers, people who use street drugs, men who have sex with men, and people in drug-abuse treatment or correctional institutions. It is more common overseas, particularly in Africa and Asia, so travelers should check with the CDC to see if they need the vaccine.
Caveats: This is a recombinant-DNA vaccine and is considered safe. Side effects include soreness at the injection site and fever. Three shots are recommended, but Gina Mootrey, associate director for adult immunizations at the CDC, says taking "two doses is better than no doses."
- Chickenpox. Adults who haven't had Chickenpox (a.k.a. varicella) or the vaccine for it should get two doses of this shot. It has been offered to children since 1995.
Caveats:The vaccine loses effectiveness over time, which is why children are now given a second shot. It's unclear whether adults will need boosters, too. Side effects include soreness at the shot site, fever, and a rash that can persist for up to a month. Because this is a live attenuated vaccine, it's not recommended for pregnant women, people with HIV, or those with suppressed immune systems.