Louise Chang, MD
The free gift that the San Francisco Giants offered to fans who showed up for a game with the Cincinnati Reds last August probably didn’t attract a big crowd, since it involved a procedure that most people shun whenever possible: It was a booster shot.
Throughout the game, California Department of Public Health nurses were administering the Tdap vaccination, which protects against tetanus, diphtheria, and pertussis (whooping cough), at first aid stations in the Giants’ AT&T Park. Although the shot stung, as a giveaway it was worth a lot more than a bobblehead doll or an inflatable baseball bat.
Like other vaccines designed for adults, the Tdap vaccine protects the people who get it, but also their friends, children and aging parents. The free Tdap clinic occurred in the midst of a public health tragedy in California -- the worst epidemic of whooping cough reported since 1947. The outbreak killed 10 babies and sickened more than 8,300 children and adults in 2010, and it continues in California and other states.
Tdap is one of several vaccines that offer adults a reasonably inexpensive and valuable protection against disease. We’re all aware of the fact that infants and toddlers are required to be vaccinated against bugs such as influenza, measles, mumps rubella, chickenpox, polio, pneumococcus, and viral hepatitis. But adults need protection from some of the same diseases.
In 2010, the CDC’s vaccine policy group, the Advisory Committee on Immunization Practices, recommended that everyone 6 months of age and older get an annual shot against influenza, or flu. “Should you get the flu vaccine? The answer is yes,” said William Schaffner, MD, chair of the department of preventive medicine at Vanderbilt University. Besides young infants less than 6 months old, exceptions, he said, should include people with serious egg allergies. People who have had a life-threatening or serious allergic reaction to a previous flu vaccine or to any of its components should not be vaccinated. Talk to your provider before getting the vaccine if you have ever had Guillain-Barre Syndrome or are moderately or severely ill.
Flu kills thousands of adults every year; people over 65 are among those at greatest risk for severe complications from flu, including death. Although the immune systems of the elderly may not respond as effectively to the flu vaccine and other shots, vaccination can still protect against serious complications. Another way to protect the elderly, it turns out, is to vaccinate their close contacts such as children and grandchildren. If the younger ones remain healthy, they are less likely to spread the flu to their elders.
With whooping cough a growing problem in the United States, the CDC also now recommends that all adults get a one-time Tdap booster followed with Td (covering tetanus and diphtheria) booster every 10 years. In the past, adults were urged to get a Td booster only every 10 years. But it has become clear that pertussis bacteria continue to circulate.
By some estimates, there are up to a million cases of whooping cough in the United States each year. Most cases occur in adults and are similar enough to a humdrum cold or flu that they aren’t diagnosed by a doctor. That guy in the cubicle next to yours who hacked for three months? He may have had whooping cough without knowing it.
While the disease is rarely a critical illness in adults, they are just as capable as a sickly toddler of spreading the germ to infants, who can die or have serious illness as a result of it. Over half of babies younger than 1 year old with pertussis need to be hospitalized.
The Tdap shot can cause a sore arm or fever, but that’s a small price to pay for the children you’ll be protecting from the disease by not getting it yourself, says Poland.
“We’re having major outbreaks of pertussis in the United States today,” said Poland. “When we’ve looked at this problem and considered the best way to protect people, we’ve decided that a sore arm or a fever, or even a day in bed, was reasonable tradeoff to save the lives of a children.”
Some of the other vaccines recommended for adults include the following:
SOURCES:Ward, J. Clinical Infectious Diseases, 2006; vol 43(2): pp 151-157.Morbidity and Mortality Weekly Report, 2005; vol 54(36): pp 893-897.CDC: “Seasonal Influenza: Vaccine Effectiveness.”California Department of Public Health: "Pertussis Report, Jan. 7, 2011."Sanofi-Pasteur information on Fluzone.CDC: "Adult Immunization Schedule."William Schaffner, MD, Vanderbilt University.Gregory A. Poland, MD, Mayo Clinic Medical College.
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