About Adult Immunizations

Let’s get the linguistic nonsense out of the way first. Purists distinguish vaccination, being given a vaccine, from immunization – actually developing immunity after vaccination. The CDC refers to its vaccination schedule as an immunization schedule. If it’s good enough for the CDC, it’s good enough for me. Linguistic Puritanism be damned!

The subject of vaccinations came up several times last week. Once in relation to the next anticipated COVID wave; again, in relation to the upcoming Influenza season; still again in the context of paper cuts (more on this later); and finally in relation to recommended vaccines for those of us 65+.

Here is the 2002 CDC Adult Immunization Schedule. Below, I’ll try to decode it for you.

Vaccines you should receive unless you have experienced a serious (potentially life-threatening) adverse effect after receiving the same vaccine:

• Annual Influenza (Flu shot) formulations specifically for older adults
• Tetanus-Diphtheria (Td) or Tetanus-Diphtheria-acellular Pertussis (Tdap) every 10 years
• Zoster (Shingrix) – 2 doses at age 50 or as soon as you can
• Pneumococcal pneumonia (either PCV15 and PPSV23 or just PCV20) preferably, around age 65

Vaccines that you may need depending on individual risk factors (consult your PCP):

• Hepatitis A in two or three doses depending on the vaccine
• Hepatitis B in two, three, or four doses depending on the vaccine and health circumstances
• Meningococcal vaccines (MenACWY and MenB  depending on health conditions
• Hemophilus influenza type b in one or three doses depending on health conditions

Some comments on the four vaccines all of us older adults should get.

Influenza – often, the greatest risk of death from the Flu is among older adults and infants. Like the Spanish Flu pandemic of 1918, the H1N1 pandemic killed many young adults; it was not a typical Flu season.

Tetanus-Diphtheria-(acellular Pertussis) booster – this is a vaccine that is easily overlooked for a variety of reasons including the fact that in the USA, Tetanus is an uncommon disease and because the booster interval is so long. That said, a fellow FB friend observed that in his years of medical practice, he had seen two cases – both were women, and both died. The first of these was a lady who got a paper cut (who hasn’t had one?) The other was a lady who experienced an accidental staple puncture.

People often associate Tetanus with “stepping on a rusty nail” or experiencing an injury in a barnyard. These kinds of injuries can indeed seed a wound with Clostridium tetani (the bacteria that causes Tetanus), but the most common injuries that lead to Tetanus in our country are probably kitchen injuries, gardening injuries, and other innocuous cuts and punctures. Clostridium tetani is ubiquitous in soil; one needn’t be exposed to the barnyard to come in contact with its spores which are very hardy. Puncture wounds contaminated with these spores are especially dangerous because irrigation with soap and water is unlikely to cleanse a puncture wound adequately. Moreover, punctures often create an anaerobic (low oxygen) environment in which the spores can germinate and the bacteria flourish.

In the USA, the people who most often develop Tetanus are folks >60 years old and more often women than men. Why? Probably because younger folks are typically more active, more likely to experience injuries, and hence more likely to get a Td shot before their ten-year booster interval. Why more women than men? Men tend to tinker and putter around more, like the young, they see doctors more often for injuries for which a tetanus shot is recommended.

I had a Tdap in 2009; so, I’m three years overdue for my Td booster; I’ll get it in a week or two when I see my PCP for this year’s Flu shot.

Zoster – the Lifetime Risk of developing Shingles is about 1 in 3. Shingles is more likely to occur in folks over the age of 50, and the risk increases the older we get. Folks aged >60 are more likely to develop severe illness with complications such a painful neuropathy that may persist forever, pneumonia, severe eye disease if the Shingles affects the nerves in that region, and even the brain. So, the recommendation is to get two doses of the vaccine at age 50. If like some of my own family, you didn’t get yours, schedule it now.

Pneumococcal pneumonia – the point of vaccination against pneumococcal disease is to prevent not only lung infection (pneumonia) but also blood infection (bacteremia). Both types of infections can be severe at any age, but the older we get, the worse the toll from either one.

I hope that you find this information helpful.