Adult Immunizations

Most people realize that kids should get childhood vaccines (makes my kids hate going to the doctor because they don’t like getting shots).  Immunizations are recommended for adults, too.

Adult immunization schedules can be found at the CDC website and at WebMD (cool spreadsheet, see page 3), among other places.  My general, layman’s summary (in keeping with the autoimmune theme of this blog) is:

Three vaccines are currently recommended for all adults:

Influenza - annually (IM)
If you’re taking immunosuppressants for RA, such as methotrexate, one of the TNF inhibitors, or prednisone (not sure if plaquenil or sulfasalazine count as immunosuppressants), then you should be sure to get the shot, not the nasal spray.  Also, others in your household should get the shot, not the nasal spray (sorry, kids).  The vaccine is made for three different viruses; it changes annually.  This year, the H1N1 (swine flu) vaccine is separate and also recommended.  (note – I’m a bit uncomfortable with a fast-tracked vaccine so am not sure if I’ll get the H1N1, but that’s just me)

Pneumonia - every five years (IM or SC)
For the general population, the pneumonia vaccine isn’t recommended until age 65.  Those who do get the shot at a younger age should have a one-time repeat for their 65th birthday.  However, for those on immunosuppressants, the recommendation is every five years.  I had such a bad site reaction last year that I’m not sure that I wouldn’t prefer to just die of pneumonia.  My arm swelled up and turned red from my shoulder to clear below my elbow, and it lasted for three weeks.  I was miserable and sure that it was infected.  The pharmacist who gave the shot was shocked and said it’s the worst reaction he’s ever seen (but he still thought it was not infected).  If I get another shot in four years, it will be in a doctor’s office on a Monday (not Thursday or Friday) so that a doctor is available to help if needed.  For another scary pneumonia vaccine story, check Leslie‘s blog.

It will be interesting to see if this recommendation changes, since a new study says, “Pneumococcal vaccination does not appear to be effective in preventing pneumonia, even in populations for whom the vaccine is currently recommended.”  Read Efficacy of Pneumococcal Vaccination in Adults: a Meta-Analysis at MedScape for more details.

Tetanus - every ten years (IM)
Nobody wants lockjaw.  I have friends who won’t get their kids immunized, but even they go in for an injection whenever their kids get a puncture wound.

Three vaccines are contraindicated.  I wonder if it would make sense to discuss discontinuing immunosuppressants long enough to get any needed vaccines:

Shingles - (one-time dose) - contraindicated
The zoster vaccine is a live virus.  Those taking immunosuppressants should not get the shingles vaccine.
When we had extended family with shingles, we were phoned and told to stay home for Christmas instead of attending the family gathering.  The guy’s doctor told him to stay away from little kids who hadn’t been immunized for chicken pox, and since we homeschool the doctor doubted that our kids were vaccinated!  I’d be looking for a different doctor if he can’t make better judgement calls than that!
Shingles is reported to be extremely painful.  You don’t want to get it.

Chicken Pox – (two doses over 4-8 weeks) – contraindicated
The varicella vaccine is a live virus.  Those taking immunosuppressants should not get the chicken pox vaccine.
Despite numerous exposures, I have never had the chicken pox.  When I was expecting my first child, the doctor insisted that I must have had a mild case that nobody noticed.  To prove it to me, he ordered the appropriate lab work.  At my next appointment, the nurse came into the exam room, looked at the lab report, and declared (with an astonished look on her face), “You’ve never had chicken pox!”

MMR - (one or two doses over 4+ weeks) – contraindicated
Measles/Mumps/Rubella is a live vaccine.  Those taking immunosuppressants should not get the MMR vaccine.
I remember this vaccine at age 15.  Seems a bit odd for this to be on the adult immunization schedule.  Then again, I know people who don’t immunize their kids so some people will eventually need to do all the childhood immunizations as adults (if they live that long).

Four vaccines depend on your circumstances.  There is a ton of tiny print about these vaccines, so I probably missed some criteria.  Click on the CDC link above and go look at the tables, or read about the individual vaccines.  If you have questions, talk to your doctor.

HPV - women ages 9-26, three shots over six months

Hepatitis A – some food handlers, some lab workers, some foreign travellers, people adopting a baby from some foreign countries, people with chronic liver disease (2 doses over six months)

Hepatitis B – people with liver disease, people with renal disease, people who are promiscuous, people who are HIV+ (3 doses over six months)

Meningococcal - college freshmen living in a dorm (apparently if you live off-campus your first year, you’re automatically immune if you later move into a dorm?!), people with no spleen, some foreign travelers, some microbiologists

All vaccines appear to be contraindicated if you are allergic to components of the vaccine.  Just in case you couldn’t figure that out!

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One thought on “Adult Immunizations

  1. Thanks so much for this; I learned a lot. It’s been suggested I get the pneumonia vaccine both because of the RA and my cardiac condition, but I haven’t done it yet. I suppose I should get around to it sometime soon.

    It sounds like there’s also a lot to consider if I want to get the shingles vaccine. When I had them before, it was a mild case, but it was enough to tell me I really don’t want to know what a severe case feels like.

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