Andrew Siegel, M.D. Blog #94
Vaccinations are not just for kids! Vaccinations are as equally important for “grownups” as they are for children. Many assume—mistakenly so—that vaccinations are only administered by pediatricians or that the vaccinations they received as children provide indefinite protection. That stated, most adults are aware of the importance of obtaining an annual flu vaccine, particularly in light of the severe flu season we’ve experienced this year. This is one vaccine that needs to be updated and modified annually because of the dynamic nature of influenza viruses, and is typically effective for only a several-month period of time.
As much as I am not a “pill-prescribing”-oriented physician and believe in lifestyle management as a first-line therapy for many medical issues, I strongly believe in vaccines. Vaccines are exceptions because they don’t treat disease but actually prevent disease before it has an opportunity to arise. Vaccines contain the very same microorganisms that cause disease, although they are weakened to the extent that they do not actually incite the infection. This small dose of attenuated microorganisms stimulates one’s immune system to produce antibodies, resulting in immunity to the disease without having to suffer through the actual disease.
As a result of vaccinations, certain infectious diseases have become extraordinarily rare. Polio is a prime example of this. So why is it important to continue vaccinating for a disease that has become so rare? To help explain this, I borrow an analogy from the CDC (Center for Disease Control). The vaccine situation is analogous to bailing out a boat that has a slow leak. When beginning the bailing process, the boat is quite filled with water. After laborious bailing, the boat eventually becomes near dry. We could be complacent and stop the bailing process and rest on our laurels and enjoy the almost dry boat. However, the root cause–the leak–is still present. Eventually, water would seep in to the extent that it would be up to the same level as when we first began bailing. Until we can stop the leak (i.e., completely eliminate the disease), it is important to keep bailing (i.e., immunizing). Even if there are only sporadic cases of a particular disease today, if we eliminate the protection afforded by vaccination, more and more people will ultimately be infected and spread the disease to others; as a result, the progress that has been made over the years will be for naught.
With respect to smallpox, we were able to stop the “leak in the boat” completely, eradicating the disease. Smallpox vaccinations are no longer necessary because the disease no longer exists at all. If we keep aggressively vaccinating, hopefully other diseases including polio and meningitis will no longer be around to infect, maim, or kill children. Thus, the goal of vaccinations is not only to preempt the disease in an individual but also to eventually wholly eliminate the disease for the benefit of the society at large.
In 1974, Japan had a successful vaccination program for whooping cough (pertussis) with nearly 80% of children vaccinated. That year, only about 400 cases of whooping cough were reported in the entire country and there were no deaths. For some mysterious reason, rumors abounded that the vaccine was no longer needed nor was it safe, and by 1976 only one of 10 infants was getting vaccinated. Subsequently, in 1979, Japan suffered a major pertussis epidemic with more than 13,000 cases and over 40 deaths. Ultimately, the government resumed their aggressive vaccinating program and the number of cases dropped significantly, once again. The point is that if we stopped vaccinating, diseases that have seemingly been abolished would resurface. More people will get ill and some of them will die.
Thus, we vaccinate not only for the individual, but to protect the future of our community. This concept is referred to as “herd immunity,” the protection against disease that occurs when the vaccination of a significant portion of a population provides a measure of security for those who have not developed immunity. When large numbers of the population are immune to a disease, the probability that a susceptible individual will come into contact with one who is infected is diminished. Vaccination acts as a “firewall” in disease spread, slowing or preventing transmission of the infectious disease to unvaccinated individuals who are indirectly protected by vaccinated individuals. In order for herd immunity to be effective, it is advantageous that only a small fraction of the “herd” is left unvaccinated. This population should be those who cannot safely receive vaccines because of medical conditions such as immune disorders, organ transplants, or certain allergies.
Vaccines for pneumonia, influenza, hepatitis, HPV (human papillomavirus) and the combined tetanus, diphtheria, and pertussis vaccine are available for adults. The recent resurging incidence of pertussis has led to an update of the traditional booster. Pneumonia vaccine is recommended for adults 65 and older, particularly those with asthma, diabetes, cardiac disease, and in any other situation that compromises the immune system and places individuals at a higher risk for pneumonia. Additionally, the vaccine is recommended for those who are in close contact with high-risk individuals. The hepatitis A vaccine is recommended particularly for those who travel to Third World countries. The hepatitis B vaccine is recommended for those with diabetes and those who are otherwise at risk, such as healthcare workers. The HPV vaccine is recommended for adolescents and young adults up to the age of 26.
Shingles—aka herpes zoster—results from the same virus that causes chickenpox. After exposure to chickenpox, the virus never quite completely leaves one’s system, living dormant in nerve endings. For most people, the antibodies manufactured by the body keep the virus in check for many, many years. However, when our immunity becomes compromised by age or other factors, the virus can be re-activated in the form of a painful skin rash known as shingles. A one-time vaccination for shingles can prevent the occurrence of this painful condition. The FDA has approved the vaccine for adults 50 or older, although some insurance companies will not cover it until age 60.
Bottom line: Staying up-to-date with adult immunizations provides important protection for ourselves as well as our loved ones and other members of our “herd.”
For the CDC recommended vaccination schedule for adults, go to the following site:
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6201a3.htm
Andrew Siegel, M.D.
Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com
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Tags: adult, CDC, diphtheria, hepatitis A, hepatitis B, herd immunity, herpes zoster, HPV, immunization, influenza, pertussis, pneumonia, shingles, tetanus, vaccinations
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