What’s New in Adult Immunizations?
By Jillian Foglesong Stabile, MD
The world of medicine is constantly evolving. New medications and recommendations come out regularly. Vaccination is one of the most important public health advancements in history. Immunizations have significantly increased the expected lifespan. In some cases, vaccines have nearly eradicated diseases (such as polio). In other cases, vaccines may not fully prevent illnesses, but vaccinated patients who get the illness have milder symptoms and less risk of long-term complications.
History of Vaccines
While attempts to prevent illness by exposing people to illness have been present since at least the 1400s (possibly as far back as 200 BCE), the modern vaccine was first successfully introduced in the late 1700s when Dr. Edward Jenner discovered that milkmaids who had cowpox weren’t dying from smallpox. The 1800s brought vaccines for cholera, rabies, and diphtheria. Vaccine technology advanced quickly and over the next 120 years, significant progress was made in treating infectious diseases and even eradicating polio in the United States.
Now that we’ve briefly discussed the history of vaccines, let’s discuss what’s new in adult immunizations and what the current guidelines recommend. The recommendations vary based on age and health conditions.
COVID-19 is a viral illness that emerged in late 2019. It primarily attacks the respiratory system and causes cold or flu-like symptoms. COVID-19 can also attack other parts of the body. Symptoms can range from none to severe illness and death. COVID-19 is generally a short-term illness with symptoms that resolve within a couple of weeks, but in some cases, symptoms may linger for weeks or months.
The COVID-19 vaccine was first introduced in 2020 in response to the SARS COV-2 pandemic. There are three vaccines available in the United States for COVID-19. Two of the vaccines are mRNA-based (Moderna and Pfizer), and the third is a protein subunit vaccine (Novavax). The COVID-19 vaccine manufactured by Janssen is no longer available in the United States.
The COVID-19 vaccination is recommended for everyone 6 months and older in the United States. The initial series in adults 19 or older is a 2- or 3-dose primary series and a booster of the bivalent mRNA vaccine. The interval for the initial series depends on which vaccine is used. If you received the Novavax primary series, the current recommendation is for a bivalent mRNA booster. In certain cases, a Novavax monovalent booster may be recommended in addition to the bivalent mRNA booster.
Severely immunocompromised patients should not delay COVID-19 vaccines. Vaccines should be administered at least 2 weeks before initiation or resumption of immunosuppressive therapies. Patients with immunocompromising conditions or on immunocompromising therapies should work with their healthcare provider to determine the optimal timing for vaccination. The COVID-19 vaccination should not be administered if you’ve had a severe allergic reaction to a covid-19 vaccine or the components or if you have a fever.
The FDA recently approved an updated COVID-19 vaccination for the fall of 2023.
Influenza is a respiratory virus that generally causes muscle aches, fevers, headaches, and fatigue. It is commonly confused with gastroenteritis (the “stomach flu”). Influenza is a rapidly changing virus that generally appears in the fall and peaks in the winter.
The influenza vaccine is recommended annually for everyone aged 6 months and older. People age 65 and older should get a higher-dose vaccine. The influenza vaccine should not be administered when you have a fever, if you have a history of allergic reaction to the influenza vaccine or its components, or if you’ve had Guillain-Barre syndrome in response to a vaccine.
Hepatitis B is a virus that attacks the liver. It is transmitted through blood or other bodily fluids. It can cause scarring and liver failure long term. It is more common in certain ethnic populations.
The hepatitis B vaccine is recommended for all adults 19 to 59. It is also recommended for adults 60 or older who have risk factors for hepatitis B. The hepatitis B vaccine is frequently administered in childhood, so it is reasonable to test for immunity to hepatitis B before receiving the vaccine. The hepatitis vaccine is administered in a 2-, 3-, or 4-vaccine series depending on the vaccine or condition. The hepatitis B vaccine should not be given when you have a fever or if you have had a severe allergic reaction to a previous dose of vaccine or a vaccine component.
Human Papillomavirus (HPV)
HPV is a virus that is associated with cervical cancer and genital warts. It is also associated with some types of oral and anal cancers. It is transmitted by sexual contact.
The HPV vaccine is recommended for preteens and adolescents. However, one of the vaccines is available up to age 45. The HPV vaccine is administered in a 2- or 3-vaccine series depending on the age at which it’s started. HPV vaccination should not be administered when you have a fever or if you have had a severe allergic reaction.
Pneumonia is an infection of the lungs. Pneumonia can be caused by viruses or bacteria. Pneumococcal pneumonia is caused by pneumococcus bacteria. There are many subtypes of pneumococcus. Pneumococcus bacteria can also cause meningitis and bloodstream infections.
There are several pneumococcal vaccines on the market. They are recommended alone or in combination depending on which vaccine is given. The pneumococcal vaccine is part of the childhood vaccine series but is also administered in adulthood. The pneumococcal vaccine is recommended for all adults 65 and older and adults 19-64 with certain high-risk medical conditions. The pneumococcal vaccine should not be given when you have a fever or if you’ve had a severe allergic reaction to a vaccine or component.
Shingles is a reactivation of the varicella (chickenpox) virus. The virus leaves in a part of the nervous system called the dorsal root ganglia. Under certain circumstances, the virus reactivates and travels down a nerve and causes a painful rash.
The shingles vaccine is recommended for all adults aged 50 and older. It is currently administered in a 2-vaccine series. If you previously received the single-dose shingles vaccine (Zostavax), you should still get the 2-shot Shingrix vaccine series. The shingles vaccine should not be given when you have a fever or when you have a current shingles infection. It should also not be given if you’ve had a severe reaction to a vaccine or component.
Tetanus, Diphtheria, Pertussis (Tdap)/Td
Tetanus is a condition that causes severe contraction of the muscles. It is caused by a bacteria called Clostridium tetani. Diphtheria is a condition caused by a bacteria called Corynebacterium diphtheriae. Diphtheria toxin causes trouble breathing because of a thick layer of dead cells that covers the throat. Pertussis is a bacterial infection that causes upper respiratory symptoms and the disease of whooping cough.
The Tdap vaccine is recommended during the third trimester of every pregnancy as well as every 10 years in individuals who have not had an injury. If you have a cut or injury that is open to the outside environment, you may need a Tdap booster sooner. The Td vaccine contains only the tetanus and diphtheria components of the vaccine but not pertussis. The vaccine should not be given when you have a fever, if you’ve had Guillain-Barre syndrome within 6 weeks of a previous Tdap vaccine, if you have uncontrolled seizures or an unstable neurologic disorder, or if you’ve had a severe allergic reaction to a vaccine or component.
Respiratory Syncytial Virus (RSV)
RSV is a viral illness that can cause upper respiratory infections. RSV is spread from respiratory droplets. It causes illness in all ages but is especially dangerous in infants and older adults, especially those with chronic medical conditions or who live in nursing homes or long-term care facilities.
The first vaccine for RSV was approved for people 60 years and older in early May 2023. The current recommendation is for a single dose of the RSV vaccine in all adults aged 60 or older.
Travel vaccines are not vaccines that are routinely recommended. However, if you are going to be traveling out of the country, there may be vaccines that are recommended or required depending on where you are traveling. The recommendations vary based on the diseases that are endemic in certain areas of the world. Because the recommendations vary based on location, the best way to determine what vaccines you may need before you travel is to visit the CDC’s website. It is best to look up the vaccine recommendations as soon as you start to plan your trip because some of the vaccines require more than 1 dose spaced out over various time intervals.
Vaccine recommendations may vary based on your specific medical conditions and circumstances. Your healthcare provider can work with you to determine what vaccines you need and the best timing for them.
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Dr. Foglesong Stabile is a board-certified Family Physician who enjoys full scope Family Medicine, including obstetrics, women’s health, and endoscopy, as well as caring for children and adults of all ages. She also teaches the family medicine clerkship for Pacific Northwest University of Health Sciences.