Vaccines: They're Not Just for Kids

More than 2,000 New Yorkers die every year of the influenza virus and its complications. In the U.S., the flu combined with pneumonia is a top ten cause of death for those aged 65 and older. However, approximately 30 percent of older adults skipped their flu shot last year, even though it generally cuts the risk of infection by about half. Further, many adults are not up to date with their vaccines for diseases like shingles and pneumonia, which increase with age.

With that in mind, here is what you need to know about the vaccinations that adults should be up to date on,

The Flu Vaccine: The flu is a contagious respiratory illness that can be severe and life threatening, especially for children, older adults, and people who have diabetes or heart disease. Every year, different strains (or types) of the flu virus are common, and the flu vaccine helps reduce the health risks of these strains. The Center for Disease Control and Prevention (CDC) studies the effectiveness rates of flu vaccine, which change from season to season, depending on which strains of the virus are most common. Typically, the flu vaccine reduces the risk of infection by 40-60 percent. And even in years when it is less effective, it can help reduce the severity of the flu if you do catch it. For older adults, physicians typically recommend a higher dose of the vaccine (called “Fluzone High-Dose”). This is because their immune systems do not mount as strong of a response. Based on studies, the high-dose flu vaccine may be approximately 25 percent more effective in preventing the flu in people aged 65 and older, and it has been shown to lower the risk of hospital admissions.

Every adult should consider receiving the flu shot early in the season (it is currently widely available), as it takes approximately two weeks to become effective. You can get the flu shot from your local pharmacy or your primary care office. While there are many different options for the flu vaccine, the most important thing is for everyone to be vaccinated, so talk to your doctor about which flu vaccine is best for you.

Does the Flu Vaccine Give You the Flu? There are many myths about the flu vaccine, specifically that the vaccine itself makes you sick with the flu. This is probably based on a number of factors. One is that we all receive the flu vaccine in peak virus season, meaning you are more likely to catch another virus around the time of vaccine administration. Additionally, it is true that any vaccine activates your immune system, the part of your body that fights infections. When the immune system is kicked into high gear, you may feel a little achy and sore, but this is NOT because the flu vaccine has given you the flu. Instead, just as your muscles may get sore after hitting the gym, your immune system may make you sore after being “worked out” by the flu vaccine. Over time, just like exercise makes you stronger, receiving the flu vaccine will make your immune system stronger.

Pneumococcal Vaccine: Pneumonia is a lung infection that can lead to symptoms such as cough, fevers and chills, or chest pain. The pneumococcal vaccine helps protect against strep pneumoniae, which is a type of bacteria that is a leading cause of pneumonia. Possible complications of pneumococcal infection include bacteremia (infection of your blood) and meningitis (infection of your nervous system). There are two types of pneumococcal vaccine: PCV13 (“Prevnar”) and PPSV23 (“Pneumovax”). Since risk for infection with pneumonia goes up with age, it is recommended that all adults 65 and older receive both pneumonia vaccines: first the PCV13, then the PPSV23 a year later. For people with medical conditions that can weaken their immune system, such as diabetes or chronic kidney disease, your doctor may recommend these vaccines at a younger age.

PCV13 protects about 75 percent of older adults, and PPSV23 shields up to 85 percent of healthy adults from invasive pneumococcal disease (meaning the type of disease that can lead to serious health effects such as sepsis or respiratory failure). Unfortunately, according to a study published in July 2017 in the CDC’s Morbidity and Mortality Weekly Report, only about 20 percent of older adults receive both vaccines.

Shingles Vaccine: Shingles is a painful skin rash that is caused by the same virus responsible for chickenpox, the varicella zoster virus. After patients recover from chickenpox, the varicella virus remains dormant in their nerve cells, where it is typically kept in check by the immune system. As we get older, and our immune systems weaken, the virus may become active again, particularly in the setting of stress or another infection. When the virus reactivates, it leads to a painful inflammatory rash with blisters that forms in a band across the skin. Almost 1 out of 3 Americans will develop shingles.

People who have been vaccinated against chickenpox may also get shingles, but it is believed to be less common than in those who had the natural disease. Shingles is less contagious than chickenpox, but can be passed on to another person while the rash is active. Even after shingles passes, long-term pain at the site of the rash, called postherpetic neuralgia (PHN), can linger. Even though the shingles vaccine reduces the risk of getting an active shingles rash or PHN, it is one of the most neglected vaccines. Unfortunately, about two-thirds of adults who get shingles did not receive the recommended shingles vaccine. The newer shingles vaccine, called “Shingrix,” is more effective than the old vaccine, called “Zostavax.” The CDC recommends adults 50 and older get the Shingrix vaccine. This vaccine is given in two doses, 2 to 6 months apart.

TDap Vaccine: In adults, TDap, commonly referred to as the tetanus vaccine; actually helps protect again three different types of infections: tetanus, diphtheria and pertussis. Every adult should receive a TDap booster every 10 years. Even though this vaccine has been shown to be safe and effective, surprisingly, according to a 2017 report from the CDC, 43 percent of adults are not up to date on their tetanus shots.

Tetanus is a rare but serious infection that is caused by bacteria in the environment, and can lead to severe muscle rigidity; we are at increased risk for this infection if we get cuts or animal bites. Diphtheria is a type of respiratory infection. Pertussis, also known as the whooping cough, is a highly contagious bacterial respiratory-tract infection that can be life threatening for children younger than 12 months. This means that the TDap booster is especially important if you are spending time around infants (and who isn’t, in our city!).

Final Thoughts: Everyone should talk to their doctor about which vaccines make the most sense for their health. Particularly in adults 65 and older, who may have a weakened immune system, getting vaccinated against the flu can help protect them from this virus, and may reduce the severity if they do catch the flu. Getting vaccinated against the flu protects not only you, but also the people around you who are more likely to suffer from serious illness, such as children, pregnant women, and elderly adults.

Talk with your doctor, nurse, or pharmacist to find out which vaccines are recommended for you. Check out the HealthMap Vaccine Finder, https://vaccinefinder.org, to find all locations near you that offer the vaccine. If you would like to learn more, you can also visit the CDC website, https://www.cdc.gov, for further details about all vaccines.

Mayce Mansour, MD, is an assistant professor of medicine (Division of General Internal Medicine) and Medical Director, Mount Sinai Community Relations Department at The Mount Sinai Hospital.