Immunizations, other than the annual flu vaccine, are just for kids, right? Wrong.
“A substantial proportion of vaccine-preventable diseases in this
country occur in adults,” says Dr. Harman Chawla, a physician specializing
in infectious diseases and geriatrics at Washington Township Medical Foundation.
“Older adults are particularly vulnerable to complications from
infectious diseases because their immune systems are often weaker. Vaccines
offer safe and effective protection from a variety of infectious diseases,
so it’s important for adults – especially older adults –
to make sure their immunizations are up to date.”
After finishing a residency in internal medicine at Jamaica Hospital Medical
Centre in Jamaica, New York, Dr. Chawla completed a fellowship in geriatrics
(the medical field that specializes in older adults) in June 2012 at New
Jersey Medical School. He then spent a year as an assistant professor
in the Department of Medicine there before completing an additional two-year
fellowship in infectious diseases in June 2015 before joining Washington
Township Medical Foundation in September.
“My decision to work in geriatrics stemmed from an interest in providing
preventive care to older adults,” he says. “Infectious disease
medicine goes hand-in-hand with geriatrics because older people, especially
those who live in close quarters in skilled nursing facilities or assisted-living
centers, generally get sicker from infections than younger adults.”
Dr. Chawla notes that annual flu vaccines are very important for older
adults. Flu vaccines must be administered on a yearly basis because flu
viruses change from year to year.
This season’s flu vaccine protects against the influenza viruses
that research indicated will be the most common viruses this year. The
“trivalent” vaccine with a combination of three viruses includes
an A (H1N1) virus, an A (H3N2) virus and an influenza B virus. A “quadrivalent”
vaccine includes those same three viruses, plus an additional influenza B virus.
“There is a higher-dose flu shot for people over age 65 because their
immune systems often aren’t as strong,” Dr. Chawla says. “The
higher-dose flu vaccine and the quadrivalent vaccine are both better for
older adults. Both of these vaccines use killed viruses, and they do not
cause the flu. Generally, the only side effects are mild soreness and
perhaps a slight rash at the site of the injection. There also is a vaccine
for people who are allergic to raw eggs. The egg-free vaccine should be
used by anyone who has ever had an allergic reaction to the regular flu
vaccine such as hives or anaphylaxis.”
According to Dr. Chawla, there has been a dramatic improvement in flu vaccination
rates among adults over the past three decades.
“In 1985, only about 35 to 40 percent of adults were vaccinated against
the flu,” he explains. “Thanks, in part, to increased awareness
of the importance of vaccines, today we are seeing 65 to 70 percent of
adults receiving flu vaccines. That is still not as good as we’d
like it to be, however.”
While flu shots are one important means of protecting your health, there
are other vaccine-preventable diseases that can cause serious illness
or even death, including pneumococcal disease.
“An infection caused by the pneumococcus bacteria can lead to serious
health problems such as pneumonia,” Dr. Chawla says. “Besides
pneumonia, pneumococcus can cause other types of infections, such as ear
and sinus infections or a blood stream infection called bacteremia. The
bacteria also can cause meningitis, a potentially life-threatening infection
of the tissues and fluids surrounding the brain and spinal cord.”
The Centers for Disease Control and Prevention (CDC) estimates that about
900,000 Americans get pneumococcal pneumonia each year and about 5 to
7 percent die from it. In the United States, about 90 percent of invasive
pneumococcal disease cases are in adults.
“The best way to prevent pneumococcal disease is to be vaccinated,”
Dr. Chawla emphasizes.
There are currently two types of pneumococcal vaccines:
- Prevnar 13 – recommended for all children younger than 5, all adults
65 years or older, and persons age 6 through 64 with certain medical conditions
such as sickle cell disease, chronic heart or lung disease, a compromised
immune system, a damaged spleen or no spleen.
- Pneumovax 23 – currently recommended for all adults 65 years or older
and for persons who are 2 years and older and at high risk for pneumococcal
disease, including those with sickle cell disease, HIV infection or other
conditions that weaken the immune system. This vaccine also is recommended
for adults age 19 through 64 who smoke cigarettes or who have asthma or
chronic obstructive pulmonary disease (COPD).
“Both of these vaccines are intended to prevent bacterial pneumococcal
infections,” Dr. Chawla explains. “The CDC’s general
recommendation is for adults age 65 or older to get one dose of the Prevnar
13 vaccine, and then wait at least eight weeks before getting one dose
of the Pneumovax 23 vaccine. The CDC does not recommend Prevnar 13 vaccination
for people between ages 6 and 64 who are not considered high-risk for
complications of pneumococcal infection. People younger than 65 who have
high risk factors such as COPD can get the Pneumovax 23 vaccine every
five years and again at age 65.
“People over 65 who have received the Pneumovax 23 vaccine, but not
the Prevnar 13 vaccine, should wait at least one year after getting the
Pneumovax 23 vaccine before getting the Prevnar 13 vaccine,” he
adds. “You should consult your doctor about the proper pneumococcal
vaccines for you.”
In addition to annual flu vaccines and the pneumococcal vaccines, the CDC
recommends several other immunizations for adults:
Meningococcal – Meningococcal disease is a leading cause of bacterial meningitis.
Meningococcal infections can be treated with antibiotics, but about 10
percent of people who get the disease die from it, which is why prevention
through vaccination is so important. The vaccine is now recommended beginning
in preadolescence, as well as for other people who have never received
the vaccine. It is especially encouraged for people living in close quarters,
such as students in dormitories, people in military barracks or seniors
in communal housing.
Measles, Mumps, Rubella (MMR) – Most Americans are vaccinated against these diseases as children,
but the vaccine is recommended for adults born in 1957 or later –
especially those born outside the U.S. – if there is no documentation
of immunization or proof of immunity via a blood test.
Polio – The polio vaccine is not usually recommended for adults over age
18, but those who never received the vaccine in childhood may wish to
be vaccinated if they intend to travel to countries where exposure to
the virus is possible, such as Russia, South Africa, Nigeria, Pakistan
Hepatitis A – This vaccine protects against a viral disease that often results
in chronic liver failure. Immunization is especially important for people
who travel or work outside the U.S., particularly in developing countries,
and those with liver disease.
Hepatitis B – This vaccine protects against a virus spread through contact with
blood or other bodily fluids. The vaccine is recommended for all adolescents
and adults, but especially for people who have intimate contact with hepatitis
The common childhood disease of chickenpox also can be a very serious disease
in adults. Adults who did not have chickenpox as a child should receive
the varicella vaccine, which is very effective in preventing the disease.
“There also is a herpes zoster vaccine to prevent shingles, which
is caused by the same virus that causes chickenpox,” says Dr. Chawla.
“Anyone who has had chickenpox can develop shingles. The herpes
zoster vaccine is recommended to reduce the risk of shingles and its associated
pain in people 60 years old or older. Even if you have received the varicella
vaccine, you still need the vaccine for shingles. However, the shingles
vaccine is not suitable for people who have compromised immune systems
or who have had severe allergic reactions to gelatin or neomycin because
the vaccine contains those ingredients.”
Dr. Chawla notes some vaccines, such as the chickenpox vaccine, can provide
lifetime immunity. Other vaccines require “booster” shots
to remain effective.
“There are still cases of tetanus in the United States, and it is
easy to prevent,” he says. “Adults should receive a tetanus
booster shot every 10 years, and perhaps as early as five years after
receiving a previous dose if they incur a puncture wound. Most often,
the vaccine used is a tetanus-diphtheria (Td) booster, but because pertussis
– also called whooping cough – has become more prevalent in
recent years, adults who have not received a tetanus-diphtheria-pertussis
(Tdap) booster vaccine should get one. Tdap also is recommended for parents-to-be
and the grandparents or other infant caregivers to prevent infection in
All of the above vaccines provide “active” immunity to various
infections by prompting the body’s immune system to produce antibodies
that identify and neutralize specific viruses and bacteria.
“Active immunity is a more potent and durable way to prevent infectious
diseases,” Dr. Chawla notes. “For people with compromised
immune systems – due to factors such as HIV, chemotherapy or other
medications that suppress the immune system – ‘live’
vaccinations to stimulate active immunity may not be an option. In those
cases, it might be necessary to stimulate ‘passive’ immunity
with injections of antibodies called immunoglobulins to fight specific
diseases. Once the patient’s immune system is healthy, it may be
possible to vaccinate again.”
If you need help finding a physician who can discuss what vaccinations
may be right for you, visit www.whhs.com and click on the link for “Find
Your Physician.” For more information about vaccination recommendations
from the CDC, visit www.cdc.gov.