Grown-Ups Need Shots Too
An internist at Saint Barnabas Medical Center explains the vaccinations adults require.
Physicians are quick to point out that in medicine nothing is 100 percent guaranteed. Every intervention, from major surgery to a daily aspirin, carries both risks and benefits. The doctor’s job is to weigh those two opposites and decide which carries the day. But one intervention is perhaps the closest thing there is to a “sure thing”—immunization.
“Most people in the health field agree that vaccines are one of the greatest tools we have to save lives—if not the greatest,” says Carl Postighone, D.O., an internal medicine specialist with Saint Barnabas Medical Center. “It is unquestioned that since the advent of vaccines in the early 20th century millions of lives have been saved.”
While most people think of vaccination as something we do for our children, there are important vaccines that adults need as well. “In the adult community in the United States alone, more than 100,000 lives are saved and millions of illnesses are prevented annually from vaccines,” he says. Yet statistics reveal that the compliance rate for adult immunizations is only about 40 percent. “It is bewildering to me, as a primary care physician, why everyone would not get a vaccine,” he says. “There is no greater return for your money than getting immunized.”
There are four vaccines with which every adult should stay current: influenza, pneumonia, shingles and tetanus-diphtheriapertussis (Tdap). Dr. Postighone explains how each offers a high return on a very modest investment of time.
The flu is a far more serious disease than most people realize. According to estimates by the U.S. Centers for Disease Control and Prevention (CDC ), annual flu-associated deaths in the United States have ranged as high as 49,000 in recent decades. The flu sends upwards of 100,000 people to the hospital every year. The best way to lower those numbers is through immunization.
As Dr. Postighone explains, the flu vaccine is reformulated annually and comes in many forms, including
- trivalent vaccine, which protects against three different flu viruses, two of type A and one of type B
- quadrivalent vaccine, which targets a fourth strain—a second type B strain—in addition to the other three
- a high-dose variant known by the brand name Fluzone, which contains four times the amount of antigens (the substance that prompts the body to make an antibody) as in regular flu shots and is recommended for people over age 65
- a nasal spray called FluMist that combats two strains of A and two of B. (Learn more about these flu vaccines at cdc.gov.)
An annual flu shot is recommended for every adult. “Some people are getting it in August, which is too early,” says Dr. Postighone. “The flu can linger into May and even June, and protection may wear off by then. October is the best time to be vaccinated.”
About 18,000 older adults die each year from pneumococcal disease in the United States, the CDC reports. As some strains of the disease have become resistant to antibiotics, prevention through vaccination has become more important.
Vaccination protects against the most commonly acquired strains of the bacteria. There are actually two vaccines: the PCV 13 vaccine, known by the brand name Prevnar, which inoculates against 13 strains, and the pneumococcal polysaccharide vaccine (PPSV 23), which protects against 23 types.
Vaccination is recommended for all adults age 65 and older, and for younger adults who smoke, have asthma or have certain long-term health conditions or a weakened immune system.
“Initially, you should get the Prevnar vaccine, and then get the PPSV 23 vaccine 12 months later,” says Dr. Postighone. Most people need only one dose of PPSV 23, though a second dose is recommended for certain high-risk groups. If you have already received the PPSV23, the PCV 13 is still recommended a year later.
“Shingles is far more common than most people perceive,” Dr. Postighone says. “We see about one case a week across all age groups.”
Shingles is caused by the varicella zoster, the same virus that causes chickenpox, which lies dormant in the body of those who have been infected by it as children. It can reactivate and cause mild to severe pain and a blistering rash. “Anyone who had chickenpox can get shingles at any age, but is more likely as you get older,” Dr. Postighone says. “People over age 60 are also more likely to suffer from postherpetic neuralgia,” which is pain that lasts long after the rash has abated—usually up to a year, but sometimes longer than that.
For that reason, the shingles vaccine is recommended for all adults age 60 and older who have a history of chickenpox. “This vaccine is a live version of the varicella vaccine that kids get, but is 10 to 14 times the potency,” he says. “Because it is live, we traditionally would not give it to somebody with a weakened immune system. A very small percentage of people can get a chickenpox-like reaction from the vaccine.”
Pertussis, better known as whooping cough, “is a horrendous disease,” Dr. Postighone says. “You cough for three months, and you cough so hard you vomit. You do not want whopping cough as an adult.”
That’s why you do want the tetanus-diphtheria-pertussis (Tdap) vaccine. “Tetanus, which can cause lockjaw, is extremely rare in this country,” says the doctor. “So is diphtheria. Pertussis, though, has come back with a vengeance. In 2012, 48,000 people contracted whooping cough and 16 infants died from it. And there were probably countless others who were undiagnosed.” One of the theories as to why this is happening, he says, is that childhood vaccines are not lasting a lifetime. “So we’re asking all adults to be revaccinated.”
Most people tolerate this one-time booster shot well. “Some will get a low-grade fever,” he says. “Most will get a sore arm.” Which, as with all vaccines, is a lot better than the “horrendous disease” it prevents.
To contact Carl Postighone, D.O., or to find another Saint Barnabas Medical Center affiliated physician, please call 1.888.724.7123 or visit barnabashealth.org/sbmc.