Because of the number of available vaccines, and because of declining immunity and the need for booster doses of many vaccines, immunization schedules for children and adults have become very complicated. Adult schedules are far less complex than those of children, but when there are more than twenty vaccines available for administration, it takes a roadmap to keep it straight.
For purposes of this blogpost I will limit the discussion to the following disease-specific vaccines:
SHINGLES — Shingrix, Zostavax
INFLUENZA — Fluzone, Fluad
TETANUS, DIPHTHERIA, WHOOPING COUGH — Tdap
HUMAN PAPILLOMA VIRUS — Gardasil
PNEUMOCOCCAL INFECTIONS — Pneumovax, Prevnar
MENINGOCOCCAL INFECTIONS — Menactra, Menveo, Bexsero, Trumemba
HEPATITIS A — Hepatitis A vacc.
HEPATITIS B — Heplisav-B
Each of the above have specific administration age and interval dosing recommendations. None of the recommendations are the same so complex diagrams are used for clarification. Below, I will share the current schedules for the fourteen vaccines listed.
Shingles Vaccines: There are two; the original, ZOSTAVAX, no longer recommended
because it is a “live-attenuated virus” vaccine and is only 51% effective.
SHINGRIX is the new recombinant vaccine that shows 90% efficacy. Recommended for
persons over 50, those previously receiving Zostavax, and those on immunosuppressive
drugs.
Influenza Vaccines: FLUZONE High Dose is for patients over 65 and contains 4 times
the standard dose of antigen.
FLUAD is for those over 65 and contains 3 times the antigen. Regular Flu vaccine is
recommended for anyone over age 6 months.
TETANUS, DIPHTHERIA, PERTUSSIS VACCINE: Combined tetanus toxoid,
diphtheria, and acellular pertussis vaccine is given to adults once in their lifetime.
Booster dose may be given 8-10 or more years after. Adults over 64 not recommended.
Human Papilloma Virus (HPV): GARDASIL is given to both girls and boys at age 11-
12. Recommended for adults (M & F) up to age 45, not previously vaccinated .
Pneumococcal Infections: There are 2 vaccines—the older Pneumovax-23 and newer
Prevnar-13. Most people have had Pneumovax-23, but not Prevnar-13. Prevnar-13 is
preferred. Age 65+ with normal immunity—single dose of Pneumovax-23. If never
previously vaccinated give Prevnar-13 first, followed 12 months later with Pneumovax-23.
Age 65+ with compromised immunity—single dose of Prevnar-13, followed 8+ weeks
later with single dose Pneumovax-23. Highest risk patients need a booster(23) at 5 yrs.
Meningococcal Infections: There are 4 vaccines—Menactra is preferred. Routine
vaccination at age 11-12 with booster age 16. Adult vaccination recommended for high-
risk patients (people without a spleen, microbiologists, HIV patients) only.
Hepatitis A: Recommended prior to travel to areas where it is common and to homeless
patients.
Hepatitis B: New vaccine Heplisav-B seems to be stronger and requires only 2 doses,
not the usual three. Doses are one month apart. Other Hep-B vaccines are still given but
immunity requires 3 shots (0 month, 1 month, and 6+ month).
Dr. G’s Opinion: Annual flu vaccination is a must. Do not avoid this benefit.
Shingles vaccine is also a must. Shingles is a horrible disease and Shingrix provides a 90+%
chance of immunity.
Tetanus, Diphtheria, Pertussis vaccine is a must. Though rare these disease can be very
serious. The vaccine is safe and effective.
Gardasil HPV vaccine is optional. HPV is a sexually-transmitted disease so those at increased
risk should receive the vaccine.
Pneumococcal vaccine is a must. Pneumococcal infections, especially pneumonia, are a
significant concern in adults. Vaccination is safe and effective.
Meningococcal vaccine is recommended for only those at high risk. This type of infection is
fortunately rare.
Hepatitis A vaccine is a must for missionaries, homeless people, shelter workers, and those
folks traveling to high risk countries.
Hepatitis B is a must for health care workers and anyone in close contact with the public on
a regular basis.These vaccines are safe and efficacy is improving with each new generation introduced.
A lot of us are blessed to be immune to serious illness as a result of our parents having us vaccinated as children and from “herd immunity”—if no one else gets the disease, we won’t, either. Vaccines are one of the major wonders of the 20th century. Their effect has been incredible on the quality of life and longevity of several generations. This will only improve if parents continue to vaccinate their children.
“Anti-vaxers” have their reasons and feel strongly about their positions, but they are risking their children’s lives. A child deaf or blind from measles, sterile from mumps testicular infection, paralyzed from chicken pox meningitis or polio, or mentally handicapped from any nervous system infection is a tragedy that could have easily been prevented. Their parents think they are protecting them from supposed harmful vaccine effects when they are really neglecting their child’s welfare.
Preventive medicine has become an important subspecialty. Every physician practices prevention every day. It’s what saves lives, money, and improves quality of life. We do it subtly in many ways, but overtly in others with vaccines being one of those preventive measures that starts at birth and continues life long. Fear and misinformation have influenced too many people. That’s a shame because it exposes all of us to unnecessary risk. Hopefully, attitudes will change, but ever the skeptic, I have my doubts.
Reference: Sha E., Adult Immunization Update JAMA 2019 Sep 17;322(11):1096-1097.
