Adults Need Vaccines, Too

By William Schaffner, MD

As I like to tell my patients, the best approach to everyday health is a proactive one, and that means staying up-to-date on recommended vaccinations in addition to annual checkups.

Many adults don’t visit a doctor unless they feel ill, nor do they think about vaccination as part of their routine, preventive healthcare. This leaves them needlessly vulnerable to diseases that can cause severe health complications or even death. 

Vaccines are a safe, effective way to help prevent a number of diseases at any age-from 6 months to 60 years, and beyond. In fact, there are several vaccines recommended specifically for adults because of their risk for certain infections.

It’s important for all adults to check with a healthcare professional about which vaccines are recommended for them, as we all need some vaccinations as we age. For example, the chance of having complications from the flu, or getting shingles or pneumococcal disease (see below for more information) increases with age. In other cases, a weakened immune system or the presence of underlying illnesses like cancer, heart disease, or diabetes can make us more susceptible to diseases.

Many adult vaccines are readily available at primary care medical offices and in pharmacies, and the cost of vaccination is usually covered by Medicare and most private insurers. So, there are no excuses for not staying up-to-date!

Vaccines and the immune system

If you have a weakened immune system due to cancer or related treatment, there are vaccines you should receive – and some that you should not receive.

Vaccines come in two forms: inactivated or live. Inactivated vaccines only contain killed viruses or bacteria and can be used for those with compromised immune systems. Live vaccines, such as the flu nasal spray (but not the shot, which has inactivated virus) or shingles, contain weakened but live components. While this does not pose a risk for people with a healthy immune system, live vaccines are not recommended for people whose immune system is weakened by certain cancers, cancer treatment, or other factors. 

Cancers like leukemia, lymphoma, and Hodgkin disease interfere directly with the immune system. In most cases, however, it’s not the cancer itself, but the cancer treatment, that changes the immune system. Some cancer treatments, such as radiation, certain chemotherapies, and transplantations, prevent your immune system from responding the way it should to infections. If you aren’t sure whether your immune system is being affected, talk to your doctor or other healthcare professional before you or anyone you spend a lot of time with gets any vaccines. [more]

Vaccines especially important for those with cancer

 

The following vaccinations are generally recommended by the Centers for Disease Control and Prevention (CDC) for healthy adults, and specifically advised for cancer patients.          

Pneumococcal: Most people hear “pneumo” and think about “pneumonia,” but that’s just part of the story. Pneumococcal disease can cause several serious and potentially life-threatening illnesses, including pneumonia, meningitis, and blood poisoning (sepsis).

All forms of pneumococcal disease can be serious, but sepsis and meningitis are the most severe and can lead to hospitalization, long recovery time, and complications such as hearing loss, seizures, and even blindness or stroke-like paralysis. Pneumococcal pneumonia is also dangerous, causing death in 5 to 7 percent of people who get it.

CDC recommends pneumococcal vaccination for everyone at age 65. It’s also recommended for adults of any age with a weakened immune system or certain other health conditions like diabetes, heart disease, and asthma.

There are two types of pneumococcal vaccines available for adults. Adults age 65 or older and those of any age with a weakened immune system, including most people with cancer, need to receive both. Your doctor or other healthcare professional will be able to advise you about your specific circumstances.

Pneumococcal infection also is a common complication of influenza, making prevention of both important for healthy adults and those with an illness.  Cancer treatment weakens the immune system, making cancer patients more likely to get flu and pneumococcal disease, and more likely to suffer complications from these infections.

Flu (influenza): In the United States, as many as 1 in 5 adults get influenza each year. The illness can last up to 15 days, with up to 5 missed work days. While the virus may be mild in some years, it can be severe in others, causing illness and death, even in previously healthy people. The flu vaccine is recommended yearly for everyone age 6 months and older, including healthy adults, pregnant women, and those with health conditions like cancer.

Patients with cancer should receive the inactivated influenza vaccine (shot) yearly. Cancer patients should not receive the flu nasal spray, which contains live virus. Ideally, patients should receive the influenza vaccine at least two weeks before starting chemotherapy treatments, if possible, to increase the immune response to the vaccination. Family members and caregivers of cancer patients also should get a yearly flu shot, to help protect the patient from exposure. If you have cancer or care for someone who does, talk to your doctor or other healthcare professional about getting the flu shot.

Other important vaccines for adults

 

There are several other vaccines that are important for preventing infection among adults, including Tdap, shingles, and hepatitis B vaccines. However, if you have cancer or a weakened immune system, you may not be able to receive them or you may have to wait until after treatment.   

Tdap (tetanus, diphtheria, and pertussis-also known as whooping cough): While all these diseases can be serious, whooping cough is a big concern. When adults get whooping cough, some may not even know they have it, while others may suffer greatly. Either way, they can pass the infection on to infants, for whom whooping cough is most deadly. Every adult should get a Tdap vaccine in place of one tetanus shot (Td) booster, and pregnant women should get a Tdap vaccine during each pregnancy.

Tdap vaccination may need to be postponed or not given at all to people with a weakened immune system caused by cancer and receiving cancer treatments. People with cancer should talk with their doctor or healthcare professional for specific guidance.

Shingles (herpes zoster): The shingles vaccine reduces the risk of shingles by half, but more importantly, it is about 67 percent effective at reducing the long-lasting shingles-related pain syndrome, which can last for months and be severe. The vaccine is recommended for everyone age 60 and older except those with a weakened immune system. People with cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma, or receiving cancer treatment such as radiation or chemotherapy should not get the shingles vaccine because it includes live virus, which could trigger infection.

Hepatitis B: The hepatitis B virus is the leading cause of liver cancer and liver cirrhosis. The vaccine is recommended for all adults with diabetes through age 59; adults of any age who are sexually active but not in a long-term, single-partner relationship; and others with certain risk factors. People receiving cancer treatment such as radiation or chemotherapy within the previous three months, should not receive this vaccine.

These are just a few commonly recommended adult vaccines; adults may need others depending on their age, immunization history, and health conditions. Visit adultvaccination.org for more information and to download a questionnaire that you can complete and bring to your healthcare professional or pharmacist. 

You can read more about infections in people with cancer, including who’s at risk as well as signs of infection. For information about vaccine safety, see what the CDC has to say.

 

Guest blogger Dr. Schaffner is past president of the National Foundation for Infectious Diseases and professor of preventive medicine and infectious diseases at the Vanderbilt University School of Medicine in Nashville, TN.

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