Childhood vaccination is one of America's genuine success stories -- only 200 to 300 American children now die every year from diseases that could have been prevented by vaccination. But the figures for adults tell a much sadder story.
Every year, 50,000 to 70,000 adults die of influenza, pneumonia, hepatitis B and other diseases that could be prevented, says the National Coalition for Adult Immunization, a group of 85 health organizations.
In fact, despite safe and effective vaccines, influenza (the "flu") and pneumonia together remain the fifth leading cause of death among older people, according to the U.S. Department of Health and Human Services. In a typical season, 200,000 people wind up in the hospital and 20,000 die of flu; in a bad year, 40,000 die.
Part of the problem is that the immune system weakens with age. But many adults just don't think about vaccines for themselves. And while all states require that kids get shots before they're allowed into school, there are few such carrots -- or is it sticks? -- for adults.
Some specialists now argue that immunization should be made mandatory for adults, too, says Dr. Thomas Yoshikawa, chairman of internal medicine at the Charles Drew University of Medicine and Science in Los Angeles. At the very least, vaccine specialists say, you should use the big birthdays -- like 50 and 65 -- as reminders to get your shots.
So what vaccinations, specifically, should you ask about? The following eight immunizations are recommended for many or all adults by the federal Centers for Disease Control and Prevention in Atlanta:
Influenza. This disease, not to be confused with the merely miserable common cold, brings fever, muscle aches, cough, sore throat and severe malaise.
If you're a young adult in good health, you probably don't need a flu shot, though it can't hurt. But the CDC strongly recommends an annual flu shot for everybody 65 or older; people in nursing homes or other chronic care facilities; adults and kids who have chronic conditions, including heart trouble, asthma and other lung problems, diabetes, kidney dysfunction or blood cell abnormalities; and people who have weakened immune systems.
Children from 6 months to 18 years should also get flu shots if they are taking aspirin long-term because this raises the risk of a disease called Reye's syndrome that can follow the flu. And you should probably also get it if you live with a high-risk person.
This year's flu shots use a mixture of three flu virus strains: an "A" strain discovered in Texas in 1991; an "A" strain similar to one found in Wuhan, China, in 1995; and a "B" strain similar to one found in Beijing in 1993.
"There's nothing unusual expected" for this flu season, which should be at its worst in December, January and February, says Dr. Carolyn Bridges of the epidemic intelligence service at the CDC. For best protection, though, you should get your flu shot by the end of this month, she says.
Because the flu vaccine is made from viruses grown in eggs, however, you should not get the vaccine if you are allergic to eggs.
Pneumococcal pneumonia. While you've got one sleeve rolled up for a flu shot, roll up the other for a vaccine against pneumonia, suggests the American Lung Association. People 65 and older and anyone with a chronic illness should get this vaccine, which protects against 23 strains of bacteria, can be given on the same day as the flu shot.
Most people need only one vaccination, but if you're at higher risk, you may need a booster every three to six years.
Tetanus. This vaccine is given to prevent lockjaw, a disease caused when bacteria invade the body through cuts. If you've never had a tetanus shot, you'll need a series of three shots. After that, you need a booster every 10 years, or after five years if you suffer a deep puncture wound. The tetanus shot is usually combined with another one for
Diphtheria. This disease is rare in the United States but common elsewhere, and is fatal 10 percent of the time. You need a shot every 10 years. When the diphtheria shot is combined with the tetanus vaccine, it's called Td.
Hepatitis B. This virus attacks the liver and can be fatal. It is spread much like AIDS -- through sex and contact with bodily fluids -- but 100 times more easily. You should get this vaccine if you are a health worker, have several sexual partners, use IV drugs or have sex with or live with people who carry the virus. You need three shots over four to six months for maximum protection.
Measles, mumps and rubella (German measles). If you were born after 1956, chances are you need at least one combined MMR vaccine against all three diseases. And if you are a health care worker or a college student, you need two shots. (You should not get this vaccine while you are pregnant or less than three months before becoming pregnant.)
In addition to these eight vaccines, the National Coalition for Adult Immunization recommends two others: Chicken pox (varicella zoster) for health care workers and people who have not had chicken pox or are immunosuppressed; and hepatitis A for men who have sex with men. The varicella vaccine may also protect against shingles, a painful nerve condition.
Whatever vaccines you need, don't let fear of the cost stop you. Flu and pneumococcus vaccines are available free for anyone covered by Medicare Part B.
The bottom line is simple. While many medical decisions are wrenchingly complicated, this one is a no-brainer.
Pub Date: 11/26/96