Vaccinations – Not Just for Kids!

Karissa Loper, MPHHealth Program Manager

Nevada State Immunization ProgramDivision of Public and Behavioral Health

Objectives:O After this lecture you will

O Know what vaccines are recommended for adults

O Know the diseases vaccines protect against

O Have a working knowledge of the CDC’s Adult Immunization Schedule

O Understand the importance of adults being up-to-date on their vaccinations

Vaccine-Preventable Disease

O There are 14 vaccine-preventable diseases which affect children AND adults:O Varicella (chickenpox)O DiphtheriaO Hepatitis AO Hepatitis BO Human Papillomavirus (HPV)O Influenza (annually)O MeaslesO MeningitisO MumpsO Pertussis (whooping cough)O PneumoniaO RubellaO Zoster (shingles)O Tetanus (lockjaw)

O What you usually get as a child (since the early 2000’s):O Hepatitis B – a birth dose and then a 3 or 4-dose series

depending on the brand of vaccine usedO Rotavirus – 2 or 3-dose series depending on the brand of

vaccine usedO Diptheria, Tetanus, and Pertussis (DTaP) – 5-dose childhood

series and periodic boosters needed in adolescence and adulthood

O Haemophilus influenzae type b (Hib) – 4-dose seriesO Pneumococcal disease (PCV) – 4-dose series that protects

against 13 serotypesO Poliovirus (IPV) – 4-dose seriesO Measles, Mumps, Rubella (MMR) – 2 doses needed for full

protection; one at 12-15mos and a booster before Kindergarten

O Varicella (chickenpox) – 2-dose seriesO Hepatitis A – 2-dose series begun after one year of ageO Influenza – one annual dose beginning at age 6mos

KNOWLEDGE CHECKO Name three vaccine preventable

diseases.

O How many shots in a Hepatitis B series; how many in a MMR series?

O What is the earliest age you can get a flu shot?

O What is now recommended for adolescents beginning at age 11-12 years:O Tetanus, Diphtheria, and Pertussis (Tdap) – booster shot at age

11-12; many states now have middle school entry requirementsO Nevada law requires this vaccine for all students entering the

7th grade (NRS 392.435/NAC 392.105)

O Human Papillomavirus (HPV) – 3-dose series for girls and boys that can be started as early as age 11-12 years, but must be started before age 26 years

O Meningococcal disease (MCV4) – 1 or 2 doses depending on when the first dose is given; can be given as early as age 11-12 years; recommended for adults at high riskO Nevada law requires this vaccine for university students living

in a student housing environment (NRS 441A.120/NAC 441A.755)

O Influenza – the dreaded annual FLU SHOT!

I’m not a kid or a teen, why do I need vaccines?

O Your immune response to certain antigens wanes over time, which is why many vaccinations have “booster” recommendations – to “boost” our immunity memory back to protective levels.

O Vaccines are the number one way we protect the public’s health. But for “herd immunity” to work, a majority of the population must be vaccinated.

O By getting vaccinated, you are protecting yourself and those around you (especially babies, the elderly, and the immunocompromised) from contracting preventable diseases.

O Recent outbreaks across the United States have brought our attention back to how damaging vaccine-preventable diseases can be to families and communities.

Here’s one reason:

Whooping Cough Outbreaks!

O Since 2010, confirmed cases of pertussis have been on the rise in all 50 states and across the world.O As of 12/21/12 Nevada had 110 reported and confirmed cases of

Pertussis; this is a 223% increase in cases or 3x the amount we had in 2011.

O SO WHAT?O In 2012, pertussis reportedly killed 18 people with the majority of

those being children under 3mos of ageO Protection against pertussis from early childhood vaccination

decreases over time and teens and adults can become infected repeatedly if they continue to forgo the Tdap booster

O Children, teens, and adults with undiagnosed pertussis spread the disease to others, especially infants <1 year who have no protection

Emily & Zack’s Story

Tdap is the ONLY adolescent and adult vaccine available to

protect against pertussis

KNOWLEDGE CHECKO At what age can you get your first

HPV vaccine?

O Why do teens and adults need to stay up to date on their vaccinations?

O How many Pertussis cases were reported in Nevada in 2012?

Human Papillomavirus (HPV)O HPV is a virus that infects the skin and mucous

membranes. There are over 100 types of HPV. About 30-40 types affect the genital area.

O About ¾ of cases of cervical cancer are caused by HPV types 16 and 18.

O 9 out of 10 cases of genital warts are caused by HPV types 6 and 11.

O JANUARY IS CERVICAL CANCER AWARENESS MONTH!

Human Papillomavirus (HPV)

O Cervarix protects girls and women against types 16 and 18.O Gardasil protects girls/women and boys/men against types 6,

11, 16, and 18.O Both HPV vaccines are recommended beginning at age 11-12 years – this is

so the patient has enough time to finish the 3-dose series before they ever have their first sexual encounter.

O The immune response for HPV is most effective in early adolescence.

O The recommendation for vaccination ends at age 26 – this is because by age 26, most Americans have or have had one or more types of HPV already.

O And finally, there is no mechanism to test men for HPV, so even if the patient doesn’t have sex until they are married or in a monogamous, committed relationship – HE may be an HPV carrier and not even know!

MeningitisO Adolescents have the highest case mortality

rateO College students in general, but especially

those living in dorm or multiple roommate situations are at increased risk of contraction

O MCV4 (Menactra or Menveo) recommended beginning at age 11-12 years with one booster dose at age 16

Amy’s Story

KNOWLEDGE CHECKO Gardasil protects against what

disease? How many types does it protect against?

O Is the HPV vaccine for girls only?

O How quickly does Meningitis present?

O At what age can you get your first Meningitis vaccine?

Adult Vaccination Schedule

What about the rest?

O Although Tdap, HPV, and MCV4 are the most highly recommended vaccines for teens and adults to be caught up on, the others are just as important for preventing widespread disease.O Tetanus and diphtheria (Tdap also boosts your protection against these diseases) – more

than 50% of U.S. adults >20 years don’t have protective antibody levels against TD.

O Influenza – THE FLU! Kills an average 30,000 adults each year in the U.S., mostly the elderly. Annual influenza vaccination is recommended by the CDC and the ACIP.

O Pneumococcal (Pneumonia) – most severe in infants/young children and older adults. PCV13 is recommended for children beginning at 2mos of age; PPSV23 is recommended for adults >65 years and for any smokers ages 19-64 with immunity lasting up to 6 years. One booster can be given 5 years after the first dose.

O Herpes Zoster (Shingles) – can be very painful for older adults. The vaccine is recommended for adults >60 years as they are the population affected most by shingles.

O Hepatitis A and B – both diseases of the liver; B can become a chronic condition. The Twinrix vaccine given as a 3-dose series can protect adults from both diseases (if they haven’t received the series separately).

O Measles, Mumps, & Rubella (MMR) – duration of immunity after 2 doses is estimated to be lifelong. Recent outbreaks of measles and mumps in young children have brought to light the decrease in vaccination rates for this vaccine. If you plan to travel outside of the U.S., you may want to make sure that you received the vaccine as a child.

A brief cost-benefit analysis

O The Hepatitis B series can cost an uninsured cash paying adult $52.50/dose x 3 doses = $157.50 + any office visit fees from your physician.

O Average one-year cost of treating chronic Hepatitis B (from the Australian Centre of Economic Research for Health) = $1800O Say you contract HepB at age 25; it’s completely

‘manageable’ so you end up living to age 85. That’s a total of $1800x60 = $108,000.

O Would you rather pay $157.50 (lets say $300 to cover those docs) over a three month period or $1800 a year until you die? I can do this with any of the vaccines I’ve discussed today.

ConclusionO Vaccinations are a “cradle to grave” service, and

frankly cheaper than contracting any of the diseases they protect against.

O There are three vaccines (Tdap, HPV, MCV4) now expressly recommended for adolescents and adults (MCV4 only recommended for high-risk adults) that haven’t received them.

O There are two vaccines (zoster and pneumococcal) now expressly recommended for older adults.

O Vaccines are the best way to protect yourself and those you love against PREVENTABLE disease.

REFERENCES

O http://www.cdc.gov/vaccines/

O http://www.immunize.org/

O http://www.ecbt.org/

O http://shotbyshot.org/

O http://www.immunizenevada.org/