The pandemic has brought the importance of vaccines to the front of the public consciousness in ways not seen since the eradication of smallpox. While its creations has allowed the pandemic to move toward an endemic, the COVID-19 vaccine is far from the only life-saving advancement in vaccination technology.
Beneficial as they are, however, vaccine adoption is far from universal. A flood of misinformation and disinformation has contributed to rising anti-vax movements in the United States and beyond. Three of every 10 Americans believe vaccinations—including vaccines for highly communicable diseases like measles—should not be mandated in the U.S.
For healthcare professionals, this hesitance has often proved to be a barrier to quality care and communication.
The basics of adult immunizations
While most children in the U.S. receive foundational vaccines (hepatitis B, diphtheria, pertussis, tetanus, measles, mumps, rubella, polio, chickenpox, etc.) in their first 18 months of life, adults also need to pay attention to their own immunizations.
Vector-borne diseases like malaria, Zika, and yellow fever are often endemic to other parts of the world, and unvaccinated travelers may contract these diseases during their travels. There are, however, five regular vaccinations all adults should discuss with their healthcare provider, regardless of their travel plans.
Recommended for nurses: Emerging Infectious Diseases
Influenza
In the U.S., the CDC estimates the latest flu season has hospitalized between 280,000 and 630,000 Americans, as well as claiming the lives of between 18,000 and 55,000 Americans. The ubiquity of the flu, as well as its contagiousness, is one reason yearly influenza vaccines are critical.
The influenza vaccination (injection) does not contain live virus, and one injection will provide modest protection against most strains. Because the flu manages to mutate as it travels around the globe, it is important to receive an annual injection so that immunity does not wear off. For people >65, a high-dose injection provides greater protection.
A nasal spray version of the vaccine also provides protection against the flu, but it contains weakened live virus. Those who are pregnant or think they may be pregnant should not take the nasal spray. Healthcare professionals can give healthy individuals between the ages of 2-50 the spray if they have intact immune systems, and their primary care provider believes a live vaccine is appropriate for them. Studies regarding efficacy show no difference between the two modes.
Pneumococcal vaccine
Pneumonia as an adult can be a tough affair, but pneumococcal pneumonia can be deadly. Adults with pneumococcal pneumonia can arrive in the emergency room, get intubated and put on a ventilator, and still die within 48 hours of acquiring the bacteria. It is that deadly.
For patients under the age of 65, experts recommend pneumococcal vaccines (one or two injections) for those who smoke or are otherwise considered high risk. For those >65, experts recommend a two-vaccine dose.
Vaccine side effects are typically mild, including arm soreness at the injection site. Severe side effects to the vaccine are very unusual. Most health insurance plans will cover the cost of the vaccinations, including Medicare.
Tetanus boosters (including Td)
Though tetanus isn’t often seen in clinical context, it can be a particularly abhorrent disease. The Clostridium tetani bacterium releases a toxin that painfully contracts all the muscles throughout the body, starting in the jaw before progressing to the rest of the body.
Most people never think about the tetanus vaccine until they’re injured, but adults need a tetanus booster every decade for full effectiveness. Additionally, women need the tetanus, diphtheria, and pertussis (Tdap) vaccine with every pregnancy. Anyone else frequently around newborns should also get vaccinated against whooping cough, as whooping can be deadly for infants.
Shingles (herpes zoster)
Adults over the age of 60 have an increased chance of contracting shingles (herpes zoster), a very painful rash that is contagious during the “moist” stage of the outbreak, when blisters have formed. Shingles can occur as a stripe of blisters or a painful rash on the trunk of the body, but unfortunately, it can also occur on the face, involving the eye.
Although the outbreak itself is very painful, shingles may also cause a syndrome called “post herpetic neuralgia” in approximately 25% of patients. In this syndrome, chronic neuropathic pain continues along the nerve route involved in the outbreak, causing profound misery.
1 of every 3 people will get shingles in their lifetime, so it is important to evaluate each person’s individual risk. There are two adult vaccinations available: live and nonliving. Appropriately screened candidates over the age of 50 can get either vaccine. This includes people who may have had shingles before.
Although some people will still develop shingles despite the vaccine, the symptoms will be milder and less likely to cause long lasting sequelae. Injection site redness and swelling are the typical vaccination reactions.
Hepatitis
Healthcare workers and anyone else consistently exposed to body fluids need to be vaccinated against hepatitis B. Travelers should get vaccinated for hepatitis A. If left untreated, hepatitis is not only contagious, but will attack the liver. This can cause scarring, potential liver failure, possibly even malignancy or death. Currently, there is no vaccine available to prevent hepatitis C, but there is medication to treat the illness once detected.
Adult vaccinations for Hepatitis B come in a series of three injections. Hepatitis A vaccination is available for those who may be traveling abroad. It is also available for high risk individuals (e.g. those with chronic liver conditions).
Traveling abroad
Most travel specialists recommend an update of current adult vaccinations 4-6 weeks before an international trip. The destination will dictate any additional vaccines needed, which many include:
- Hepatitis A, B
- Typhoid, paratyphoid fever
- Meningococcal disease
- Yellow fever
- Rabies
- Encephalitis
Adult vaccinations for immunocompromised adults
Adults with an immune disorder or health condition should pay attention to which vaccines carry live agents. The risk/benefit analysis for adult vaccinations will differ for each individual.
