Features November 2019 Issue

Adults Need Vaccines Too

Protect yourself, and possibly your loved ones, by following the recommended vaccine schedule for adults.

Vaccinations are not only for children. Adults can also protect themselves against certain illnesses and their complications with vaccines. You are not only protecting yourself. You may also be shielding those around you from preventable diseases.

"Everyone should make sure they are up to date with their vaccinations," says Cassandra Calabrese, DO, Cleveland Clinic staff physician in the Departments of Rheumatology and Infectious Disease. "Vaccines are especially important for people with diseases that compromise the immune system, which includes rheumatoid arthritis and other types of inflammatory arthritis, because they are at higher risk for infection," she adds.

There are four vaccines that all adults should get. Some are given one time only in a series, while others need to be repeated. For some, the timing depends on whether you have any health conditions that impact the immune system, which includes diabetes and asthma in addition to inflammatory arthritis. Medications you are taking may also affect timing.

Get a Flu Shot

vaccine

© AlexRaths | Getty Images

Adults should make sure they are up to date on at least four vacctines.

The flu is a contagious illness caused by the influenza virus. You can get the flu by breathing air contaminated with the virus from someone who has the flu. Flu symptoms can be mild to severe. They include fever, cough, sore throat, runny nose, body aches, headache and fatigue.

Anyone can get the flu. It usually lasts about a week and often requires bed rest for a few days. Some people are at high risk for developing flu-related complications, such as pneumonia. They include children, older adults and people with some chronic diseases (including rheumatoid arthritis and psoriatic arthritis). During the 2017–2018 flu season, close to 1 million people were hospitalized for the flu, and there were 79,400 deaths from the flu.

The best defense against the flu is vaccination. "Everyone needs a flu shot every year," says Dr. Calabrese. This is necessary because every year different strains of the influenza virus circulate. Therefore, a new vaccine is created each year.

Adults ages 65 and older should get the high-dose vaccine, which is four times more powerful than the standard dose. In the past, people with an egg allergy could not receive certain flu vaccine formulations. This has changed. "People with egg allergy, even if the allergy is severe, can safely receive any formulation of the seasonal flu vaccine," says Dr. Calabrese.

Prevent Pneumonia

Pneumonia is a lung infection caused by bacteria, viruses or other infectious agents. It can be mild to severe, and it causes symptoms such as cough, fever and difficulty breathing.

If the cause is bacterial, pneumonia can be treated with antibiotics and usually cured. However, it can be particularly dangerous for young children, older adults and people with a compromised immune system. Each year, about 1 million people in the United States are hospitalized with pneumonia, and about 50,000 die from the disease.

The type of bacteria that commonly causes pneumonia is Streptococcus pneumoniae (pneumococcus). There are two types of vaccine against pneumococcus. One is the pneumococcal conjugate vaccine (Prevnar®13) and the other is the pneumococcal polysaccharide vaccine (Pneumovax®23).

Vaccination is done in a series of two or three shots, with the two different vaccines spaced out over various periods of time based on several factors. The timing depends on your age and whether you have any medical conditions that compromise the immune system.

The Centers for Disease Control and Prevention (CDC) recommends both vaccines for adults ages 65 and older. Talk to your doctor about the timing.

"People who have a condition that impairs the immune system, such as rheumatoid arthritis, diabetes or asthma, should start the series at the time of diagnosis," says Dr. Calabrese.

Shield Against Shingles

Anyone who had chickenpox as a child can get shingles as an adult. That's because the herpes zoster virus, which caused the chickenpox, lies dormant in the nerve cells of your spinal cord. Years later, it can reawaken in the form of shingles, a painful blistering rash.

Shingles can develop in anyone who has the herpes zoster virus. But the risk increases as you age, and it is higher for people with medical conditions that impair the immune system. For people with inflammatory arthritis, such as rheumatoid arthritis or psoriatic arthritis, the risk is doubled.

Everyone ages 50 and older should get vaccinated against shingles with the Shingrix® vaccine, which is administered in two doses spaced two to six months apart.

"Shingrix is preferred over the Zostavax® vaccine," says Dr. Calabrese. Even if you had the Zostavax vaccine in the past, talk to your doctor about getting Shingrix. Shingrix is over 90% effective at preventing shingles, while Zostavax reduces risk only by about 51%.

Use of Shingrix in people with autoimmune diseases, such as rheumatoid arthritis, is being studied. "From our experience, it appears to be safe and the benefits outweigh any risks," says Dr. Calabrese.

Tetanus Too

If you were ever treated for a deep cut or puncture wound, your doctor probably gave you a tetanus shot (if you weren't up to date with the vaccine schedule). Tetanus is an infection caused by a bacterium called Clostridium tetani, which is all around in the environment, including soil, dust and manure.

The bacteria enter the body through breaks in the skin. Tetanus is sometimes called lockjaw because it causes tightening of the jaw muscles. Tetanus is actually uncommon. The main reason is the availability of a vaccine to prevent it.

The CDC recommends getting a tetanus vaccine in childhood and then a booster every 10 years. Several vaccines against tetanus also contain vaccines against diphtheria and pertussis (whooping cough). The combinations are recommended mostly for children and preteens. However, adults should get one combination vaccine.

"For adults, one tetanus booster should be Tdap, which also protects against diphtheria and whooping cough," says Dr. Calabrese.

Whooping cough itself is not a concern for older adults. However, it can be dangerous, even deadly, for babies. Adults who may be around babies who have not been vaccinated yet need this vaccine.

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