Vaccination Recommendations: An Update

Sudden fever.  Terrible headache and body aches.  Dry, hacking, painful cough.  Stomach upset and loss of appetite.  Overwhelming fatigue.  Yep, it’s the flu.  You can expect 7-10 days of this misery, and the only medicine available doesn’t do much and may give you diarrhea to boot.  What’s the best way to deal with the flu?  Don’t get it in the first place.

Last year I wrote about ways to avoid colds and flu.  While this is all still good information, this week I want to focus on vaccination as a method of preventing illness.

There have been a number of recent changes to the vaccination recommendations for children, adolescents and adults.  This week, since we’re heading into the flu season and everybody seems to be talking about shots, I thought I’d review them.  It’s a good reminder for me, too!

Since we’re talking about the flu, let’s start with the flu vaccine.  Not much has changed, except that there are both 3-strain and 4-strain versions available (my office gives the 4-strain version without preservatives).  Children receiving their first dose ever should get 2 half-doses a month apart.  All healthy adults and children 6 months of age and older can be vaccinated;  the vaccine changes every year because new and different vaccine strains keep popping up (darn bugs!!).

Speaking of the little ones, the major change to the primary vaccination series (birth to 18 months of age) is the addition of the rotavirus vaccine. This is an oral vaccine given at 2 and 4 months of age.  It prevents a horrible diarrheal illness that just about every baby got before they turn 2.  Both my boys had it.  As a resident doing my inpatient pediatric training, rotavirus season would see an endless parade of exhausted parents and listless, dehydrated babies admitted to the hospital for IV fluids.  The vaccine has dramatically decreased hospitalizations and deaths from diarrhea and dehydration not just in the USA but around the world.

For the adolescents, most of them know they have to get a shot before they start 7th grade.  What they DON’T know is that they actually need FIVE shots (insert evil laugh…)  At age 12 kids get a TDaP (which is required in the state of Ohio), their first meningitis shot, and the 2-shot Gardasil series.  If teens wait until age 15 to get Gardasil they have to get 3 shots.

Debating about the merits of vaccinating against a sexually transmitted disease is outside the scope of this post.  I strongly encourage all parents to discuss with their children the dangers of sexually transmitted diseases (I have the “cootie talk” with my teens and preteens in the office too) and advocate chastity until marriage.  This is the healthiest choice both physically and emotionally.

However, I also expect my teens to drive safely but to wear their seatbelts every time they’re in the car as an extra safety measure, and I consider Gardasil the “safety belt” for HPV.  The science suggests the HPV vaccine is one of the safest and definitely one of the most effective vaccines ever developed.  It protects against the strains of HPV that cause 90% of cervical cancer, 90% of genital warts, and the majority of oropharyngeal cancer.  Studies have shown the immunity from the vaccine does not decrease for over 10 years at least.

Meningitis gets an booster at age 16 to hold them through college.  High school and college-age people (particularly if they live in a dorm) are at risk for meningococcal meningitis, a thankfully rare but extremely contagious and devastating disease.

In adults, the recommendations haven’t changed much.  We still need a TDaP shot every 10 years or sooner if we hurt ourselves.  Unfortunately it still causes pain, redness and swelling at the injection site (I know because I just got my booster in August, ow!).  We need annual flu shots, of course.  Adults with chronic illnesses like asthma, diabetes, and COPD should have a shot for pneumococcal pneumonia.  At age 60 anyone who has had chickenpox should get the shingles vaccine.  If you know anyone who has had shingles, you know how miserable it is.

This is just an overview of the general recommendations and some changes that have been made in the last few years.  You should discuss with your own doctor what your specific vaccination recommendations are.

Vaccinations are one of the reasons we enjoy the health and long life we have in the United States.  In other parts of the world illnesses like measles, polio, hepatitis and pertussis are major causes of illness and death.

QUESTION:  Are you and your family up to date on shots?  Have you ever refused a vaccine?  Why?

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