The Grown-Up's Guide to Vaccinations

Sorry, you don't get a pass on shots when you're an adult. Read our guide and talk to your doctor about the immunizations you didn't even know you needed.
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Last year, at age 54, I started training for a marathon. I was feeling pretty fit and healthy and I pushed myself hard in the months leading up to the race. The effort paid off: I got through those 26.2 miles despite high winds, pouring rain, and near-freezing temperatures. But afterward, instead of feeling great, I felt awful. After literally running my immunity down, I got slammed with a raging case of shingles, an infection caused when the chickenpox virus (which, in my case, was dormant since childhood) suddenly reappears in a nasty new form. I spent weeks enduring extreme fatigue and head-to-toe achiness, along with a blistering rash that started on my lower back, then snaked around and down my right thigh almost to my kneecap. Let me tell you, shingles is painful and it isn't pretty. And, as it turns out, I probably could have avoided it completely if I'd just gotten the vaccine.

A lot of people like me don't even think about adult vaccinations. Only about 14 percent of those at highest risk for shingles (60 and older) have gotten the shot, according to the CDC. A tiny 8 percent of American adults have gotten a booster for pertussis (also known as whooping cough), a bacterial infection that causes violent coughing, vomiting, and even sleep apnea in adults. Fewer than one in five adults with health problems that put them at risk for pneumococcal disease, a lung infection that can be fatal, have gotten vaccinated against it. And in 2011 only about 40 percent of adults got a flu shot, which is as easy to find as candy at many drugstores. "Most women know how important it is for children to be immunized, but they may not realize they need vaccines, too," says Carolyn B. Bridges, MD, associate director of adult immunizations at the CDC.

With the minimal time you get to spend talking with your doctor, the subject may not come up. "And many of us are just too busy: It's hard to take time out for something that doesn't feel all that urgent," says Julie K. Wood, MD, medical director of Goppert-Trinity Family Care Center, in Kansas City. But don't blow it off: You'll be sorry when you come down with an illness you could have prevented. See our guidelines, then ask your doctor if you could use a shot.

Tdap (Tetanus, Diphtheria, and Pertussis)

Who It's For: All adults.

Why You Need It: Right now pertussis is at epidemic levels in some areas of the United States. When adults get it, they usually experience cold-like symptoms and a persistent hacking cough for weeks. In children and the elderly, pertussis is much more likely to be serious or even fatal. Tetanus, a bacterial infection that can cause lockjaw, kills about one out of five people who are infected, while diphtheria is a respiratory disease that can lead to difficulty breathing, paralysis, heart failure, and even death.

When to Get It: You need one Tdap at any time after age 19, followed by boosters of tetanus/diphtheria (the Td vaccine) every 10 years.

Seasonal Flu (Influenza)

Who It's For: All adults.

Why You Need It: Flu viruses spread like wildfire, so it's hard to avoid them. Even a mild infection can leave you feeling wiped out for weeks, while a severe case of the flu can cause pneumonia and be life-threatening. Every year an estimated 200,000 people are hospitalized for flu-related complications and, on average, more than 23,000 die.

When to Get It: Every year. If you haven't gotten this year's already, it's not too late: Flu season typically cranks up in December and January and peaks in February, according to the CDC. It takes about two weeks to develop antibodies for protection.

Shingles (Herpes Zoster)

Who It's For: Some women over age 50 (and everyone over age 60).

Why You Need It: A bout of shingles is bad enough, but up to a third of people who get it go on to develop post-herpetic neuralgia (PHN), a condition in which deep aching, burning, or stabbing pains persist in shingles-rash areas, sometimes for years. Research shows the vaccine is more than 66 percent effective in preventing PHN.

When to Get It: The risk of an outbreak begins to rise at age 50, says Kenneth Schmader, MD, professor of medicine at the Duke University School of Medicine in Durham, North Carolina. He led a recent study that found the vaccine is over 70 percent effective in preventing shingles in 50- to 59-year-olds, which prompted the FDA to approve the vaccine for use in adults in this age group. The CDC still only recommends the shot for those above age 60, but if you have a strong family history of shingles, you'll want to talk to your doctor about getting the vaccine earlier.

Pneumococcal Disease

Who It's For: Anyone who smokes or has asthma, diabetes, or other chronic disease -- and everyone over 65.

Why You Need It: Pneumococcus bacteria can cause anything from a relatively mild ear infection to life-threatening pneumonia, meningitis, or sepsis, an infection of the blood. You're at higher risk for serious infections when you have other health problems.

When to Get It: You should have it now if you have a chronic health condition (with a recommended booster in five years) or when you turn 65, the age when it's recommended for everyone.

HPV (Human Papillomavirus)

Who It's For: Women of any age who are dating.

Why You Need It: Some strains of the HPV virus, the most common sexually transmitted disease in the United States, can lead to cervical, vulvar, and anal cancer. Both Gardasil and Cervarix protect against the strains likely to cause cancer, and Gardasil also protects against strains likely to cause genital warts. (HPV can also cause oral and penile cancer, but more research is needed to show if the vaccines can prevent these.) The vaccines are approved for women 26 and under. The thinking has been that older women aren't likely to benefit since they've probably already been exposed to the virus. But a multicenter study found Gardasil was more than 88 percent effective in preventing new infections in women between 24 and 45 as well as almost 67 percent effective in protecting those who have had previous infection or exposure to HPV. The main lesson, according to study coauthor Kevin A. Ault, MD, professor of ob-gyn at the Emory University School of Medicine: "One-size-fits-all advice doesn't always make sense. I've given the vaccine to women over 45 who are very concerned about exposure because they're newly divorced and have started dating again after many years of marriage." Ask your doctor to help you sort out the pros and cons (the main con being cost -- about $390, with insurance unlikely to cover it if you're older than 26).

When to Get It: After your first dose you need a second dose one to two months afterward, then a third dose six months after the first one.

Hepatitis B

Who It's For: All women under 60 with diabetes, and all healthcare workers.

Why You Need It: Blood-glucose monitoring and insulin injections double the risk of contracting this virus, which is transmitted through blood and can lead to severe liver disease or cancer.

When to Get It: For Hepatitis B protection you need three doses spaced out over at least four months.

Continued on page 2:  Boost Your Shots


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