Tag: adults

What Percentage of Adults Are up to Date on Their Immunizations?

Are you up to date on your vaccines?

What about everyone else?

What Percentage of Adults Are up to Date on Their Immunizations?

Can you guess why this question comes up so often?

Yup.

There is no plan to force adults to get vaccinated...
There is no plan to force adults to get vaccinated…

It’s about herd immunity.

If most adults aren’t immune because they haven’t been vaccinated or don’t get boosters, then since we aren’t seeing that many outbreaks, herd immunity itself must be a myth.

The thing is though, adults were either born in the pre-vaccine era and likely earned their natural immunity or were born in the vaccine era and are vaccinated and immune.

It is also important to understand that herd immunity is disease specific, so when we talk about herd immunity for measles, it doesn’t matter if everyone has herd immunity levels of protection against hepatitis A or Hib.

And adults do get a few boosters and some vaccines that are only recommended for adults, including the shingles vaccine.

In addition, some vaccines, like Hib and Prevnar, have indirect effects, protecting adults even though they aren’t vaccinated, because vaccinated kids are less likely to become infectious.

But back to the original question, how many adults are up to date on their immunizations?

“While modest gains occurred in vaccination coverage for pneumococcal, Tdap, hepatitis A (persons with chronic liver conditions), herpes zoster, and HPV vaccination, coverage did not improve for other vaccinations and many adults remained unvaccinated with recommended vaccines. “

Vaccination Coverage Among Adults in the United States, National Health Interview Survey, 2016

While most adults are immune to what were once common childhood diseases, like measles and mumps, because they were either vaccinated or had the disease naturally, many could do better with newer vaccines that weren’t available when they were kids.

More on Adult Vaccination Statistics

The Shingles Vaccine Shortage

Shingrix became the second shingles vaccine to be licensed in the United States, becoming the preferred shingles vaccine in 2017.

“Shingrix provides strong protection against shingles and PHN. Two doses of Shingrix is more than 90% effective at preventing shingles and PHN. Protection stays above 85% for at least the first four years after you get vaccinated.”

What Everyone Should Know about Shingles Vaccine

The first, Zostavax, was licensed in 2006.

Both are for older adults.

The Shingles Vaccine Shortage

Having a new and better shingles vaccine is good!

High levels of demand for shingles vaccine has lead to shortages and Shingrix manufacturing facilities are already at maximum capacity.
High levels of demand for shingles vaccine has lead to shortages and Shingrix manufacturing facilities are already at maximum capacity.

Not being able to actually get the vaccine and get vaccinated and protected isn’t so good. There has been a shortage of the vaccine due to high levels of demand since last year.

“Recombinant zoster vaccine (RZV) is recommended for the prevention of herpes zoster and related complications for immunocompetent adults aged ≥50 years.”

Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines

Fortunately, we will likely see more doses of the vaccine available this year and everyone will eventually be able to get vaccinated. In addition to your doctor or favorite pharmacy, the Shingrix Vaccine Locator might help you find a dose until the shortage is over.

More on the Shingles Vaccine Shortage

How Do You Get Caught up If You Have Never Been Vaccinated?

Why would someone have never gotten any vaccines and need to catch up?

Getting caught up on your vaccines is easy.
Getting caught up on your vaccines is easy.

The usual story is that a child’s vaccines were delayed or skipped for some reason, typically over fears of anti-vaccine propaganda.

You can always get caught up though, right?

Well, not always…

Tragically, kids can get sick and catch these vaccine-preventable diseases before they have time to get vaccinated and protected. You can wait too long to get vaccinated!

How Do You Get Caught up If You Have Never Been Vaccinated?

That’s why it is important to get caught up as soon as possible.

How does that work?

The first step is figuring out which vaccines you need, considering that:

  • rotavirus vaccines are only given up to age 9-months
  • Hib and Prevnar are typically only given up to age 5-years, unless someone has specific conditions that put them at high risk for disease, although Prevnar becomes routine again at age 65-years
  • the polio vaccine is typically only given up to age 18-years
  • the meningococcal vaccines (MenACWY and MenB) are routinely given to teens and young adults through age 16 to 23-years, but older high-risk adults can also be vaccinated if necessary
  • the HPV vaccines are routinely given up to age 26-years, although they are FDA approved to be given through age 45 years
  • hepatitis A vaccines are routinely given to children and teens, but are recommended for high-risk adults, including those who travel out of the country or just want to be protected
  • hepatitis B vaccines are routinely given to children and teens, but are recommended for high-risk adults, including those who travel out of the country or just want to be protected
  • the Pneumovax (PPSV23) and shingles vaccines are given to seniors
  • if you already had a natural case of chicken pox, while you won’t need to be vaccinated, some folks might need a varicella titer to confirm that they are immune

So, depending on your age when you are starting your catch-up, there may be some vaccines that you don’t need anymore.

Still, unless you have a contraindication, you will likely at least need:

  • a yearly flu vaccine
  • 1 to 2 doses (high risk groups) of MMR
  • 2 doses of the chicken pox vaccine (Varivax)
  • 1 dose of Tdap, followed by 2 doses of Td

What’s next?

Once you have an idea of which vaccines you need, you should schedule an appointment with your health care provider and get vaccinated and protected.

A local pharmacy or health department are other places that might offer vaccines to older teens and adults.

More on Getting Caught up on Vaccines

Did Dr. Bob Uncover a CDC Plot to Give Adult Flu Shots to Babies?

Have you heard the news?

Uh, the ACIP can't request a license for a vaccine...
Uh, the ACIP can’t request a license for a vaccine…

Dr. Bob and his new podcasting side kick think that the “CDC wants the FDA to approve adult doses of the flu vaccine for babies, because the normal half-doses approved for babies don’t work well enough.”

Did Dr. Bob Uncover a CDC Plot to Give Adult Flu Shots to Babies?

This is likely going to surprise Dr. Bob, but many infants already get the same dose of flu vaccine as adults.

Both FluLaval and Fluarix are given at the same 0.5ml dose, containing 15 µg of HA per vaccine virus, to infants, older children, and adults.

Fluzone, on the other hand, is still given at a 0.25ml dose, containing 7.5 µg of HA per vaccine virus, to children between the ages of 6 months to three years, and a larger 0.5ml dose to older kids and adults.

Why the differences?

“In a randomized trial comparing immunogenicity and safety of 0.5 mL FluLaval Quadrivalent with 0.25 mL Fluzone Quadrivalent, safety and reactogenicity were similar between the two vaccines.”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season

Because they are just as safe at the lower doses and might actually work better.

Then why did we ever use a lower dose for infants?

That recommendation was based on the older, whole-virus version of the flu shot, which did cause more side effects for infants when given at a full dose. We now use split-virus flu shots that don’t have this problem.

And now, the manufacturer of Fluzone has done a study, and not surprisingly, they have also found that “safety profile of a 0.5 ml (full-dose) is similar to 0.25 ml (half-dose) and may be more immunogenic.”

So they are submitting a BLA to the FDA for the use of the 0.5ml dose of their flu vaccine for infants.

What about the idea of an “adult dose of mercury” for infants?

Over 80% of flu vaccines were thimerosal free this year. You almost have to go out of your way to get your kids a flu vaccine with thimerosal, so no, this won’t mean an “adult dose of mercury” for your infant.

Most importantly though, if you understand how vaccines work, you know that the dose of vaccines for kids and adults is not calibrated by weight or age, so none of this really matters. The immune reaction that helps antibodies travel all through your body starts locally, near where the vaccine was given, so a 20-pound infant and a 200-pound adult can get the same dose of flu shot and both can be protected.

More on Dr. Bob’s CDC Plot to Give Adult Flu Shots to Babies