INSIDE

By Virginia Lester,
RN, MSN, ARNP

This article will cover immunization recommendations for healthy adults over age 20, not selected groups such as those with serious chronic illnesses, healthy pregnant women, health care workers or international travelers. Each of these groups has specific indications or contraindications for recommended immunizations.

Immunization programs in the U.S. have been quite successful in the pediatric population. Almost 80 percent of preschool children have received immunizations that target specific diseases.

This increase in immunization coverage is due in part to improved education programs, proof of immunization status for admission to school and federal support for programs that subsidize immunization costs for children whose parents cannot afford the cost. As a result, fewer than 500 children die annually of vaccine preventable diseases. 
Immunization rates for adults 65 years of age and older have also improved over the past 15 years. Unfortunately, immunization rates in younger adults are still unacceptable. This is especially true for two diseases, pneumococcal disease and influenza; between 50,000 and 70,000 adults die annually in the U.S. of these two vaccine preventable diseases alone. Receiving appropriate immunizations plays a crucial role in protecting health throughout the lifetime.

There are two main types of immunizations: active and passive. Active immunization uses a harmless form of a disease-causing organism to stimulate the immune system to produce appropriate antibodies against the invading organism. Should a person be exposed to this same infectious organism, the immune system recognizes it as a foreign agent and rapidly produces the specific antibody to destroy it. Passive immunity is temporary and is accomplished by receiving a concentrated preparation of antibodies made from a large pool of donors who have immunity. Passive immunity provides short-term protection to patients who have been exposed to an infectious disease and there is not enough time to produce their own antibodies.

Side effects do occur and in most part are mild: localized warm reddish tenderness at the site of injection and occasionally fever, skin rash, swollen lymph nodes and joint pain. Severe reactions are rare and may be caused because the patient is allergic to egg or egg protein, gelatin or antibiotics (neomycin or streptomycin) used in vaccine preparation or allergy to a specific vaccine.

Conditions that do not preclude immunizations are: Current or recent mild illnesses with low grade fever; current or recent antibiotic therapy; mild reaction at the site of injection or fever less than 104.9 degrees F following a previous vaccination; personal history of allergies, except as listed above and a family history of adverse reactions to immunization. 
Each immunization has specific recommendations for age, number of doses to be given and when boosters should be given. Space is too limited to discuss each vaccine other than to list the ones that are common for healthy adults. They are as follows: Tetanus, diphtheria and pertussis (Td or Tdap); Human papillomavirus (HPV); Measles, mumps and rubella (MMR); Varicella; Influenza; Pneumococcal; Hepatitis A & B; Herpes zoster (shingles); and Meningococcal.

Prevention of the spread of these infectious disease starts with each individual. The more people who receive immunization the less likely we are to have epidemics. Immunization decreases the number of cases and severity of illness. The number of deaths is reduced. Absenteeism at school and work decreases. The burden to society in general is reduced. Ask your health care provider if you are due for any immunizations and keep an updated record in your wallet. 

The following are reliable web sites for more complete information on each specific immunization. Patient information is also available at the clinic on request. National Library of Medicine (www.nlm.gov/medlineplus/healthtopics.html); National Institute of Allergy and Infectious Diseases (www.niaid.nih.gov/); Centers for Disease Control and Prevention (CDC) (www.cdc.gov/) toll-free: 800/311-3435; National Foundation for Infectious Diseases (www.nfid.org) Telephone: 301/656-0003.