Being an adult carries certain rights and responsibilities. We are expected to manage our lives with an amount of panache as healthcare providers, understanding that how we exist as individuals may be modeled by others in our community. The decisions we make are often replicated by others because we are trusted to have the most accurate and current information. This is especially true during a chaotic year when the public is frightened and nervous with an ongoing pandemic blending into the beginning stages of influenza season.
This year, more than any year preceding 2020, there will be questions regarding vaccinations. Healthcare providers will be expected to receive influenza prevention as a requirement for employment, and exemptions may be denied for all but the most stringent exceptions. When the all-important Covid-19 vaccination arrives, it has been suggested that frontline healthcare workers be the first to receive the injection (if injection is the route of choice). Yet, the anti-vaxxer movement in the United States is not only alive but growing steadily in numbers. This will make a unique challenge for providers as the season progresses.
Adults Need Vaccines Too
Each year anywhere between 8,200 to 20,000 die from influenza in the United States, but nurses know how difficult it may be to convince the public to be vaccinated. Three of every 10 Americans believe vaccinations should not be mandated in the US, and that number is growing, despite the recent coronavirus pandemic. Unfortunately, 80% of Americans who believe vaccinations should not be mandated include parents of children who require immunizations against diseases such as Measles, which is why we have seen a resurgence of a disease which had previously been eradicated in this country.5
However, as an adult in the United States, there are currently FIVE vaccinations you should discuss with your primary care provider to assure you will be protected against diseases that are preventable. This is especially important as a healthcare provider.
For the 2019-2020 season, all influenza vaccinations will be cell-grown, rather than in eggs, so if people are allergic to eggs, this will no longer be a concern. The influenza vaccination (injection) does not contain live virus, and one injection will provide modest protection against most strains. Because the flu manages to mutate as it travels around the globe, it is important to receive an annual injection so that immunity does not wear off. For people >65, a high-dose injection provides greater protection.4
A nasal spray is also available for protection against the flu, but it contains weakened live virus, and cannot be given to anyone who is pregnant or thinks they may be. The spray can be given to healthy individuals between the ages of 2-50, if they have intact immune systems, and their primary care provider believes a live vaccine is appropriate for them. Studies regarding efficacy show no difference between the two modes.4
Pneumonia as an adult can be a tough affair, but pneumococcal pneumonia can be deadly. In my career working Intensive Care Units, I have witnessed patients with pneumococcal pneumonia present in the ER, be intubated and ventilated and die within 48 hrs. of acquiring the microorganism; it is that deadly.
For patients under the age of 65, pneumococcal vaccines (one or two injections) are recommended for those who smoke or are otherwise considered high risk. For those >65, two vaccines are the recommended dose. Vaccine side effects are typically mild, including arm soreness at the injection site. Severe side effects to the vaccine are very unusual. Most health insurance plans will cover the cost of the vaccinations, including Medicare. Check with your healthcare provider about where to receive the injections, but usually it is a quick appointment at the office or a clinic.1
Tetanus Boosters (including Td)
Most people never think about the need for tetanus unless an injury occurs, but the injection needs to be repeated every decade for full effectiveness. Women need to receive tetanus, diphtheria, and pertussis (Tdap) with every pregnancy. Anyone else who might be around newborns should also be vaccinated against whooping cough by receiving a Tdap vaccine, as whooping can be deadly for infants. This includes Dads, grandparents, aunts, uncles, etc.3
As far as tetanus is concerned, we do not see the disease much clinically, but it is an abhorrent disease. When it occurs, a bacterium releases a toxin that painfully contracts all the muscles throughout the body, starting in the jaw and then progressing to the rest of the body. In 2017, ~ 38,000 people died from tetanus, which accounts for approximately 11% of reported cases.3
Shingles (Herpes Zoster)
Adults over the age of 60 have an increased chance of contracting shingles (Herpes Zoster), a very painful rash that is contagious during the “moist” stage of the outbreak, when blisters have formed. Shingles can occur as a stripe of blisters or a painful rash on the trunk of the body, but unfortunately, it can also occur on the face, involving the eye. Although the outbreak itself is very painful, shingles may also cause a syndrome called “post herpetic neuralgia” in approximately 25% of patients. In this syndrome, chronic neuropathic pain continues along the nerve route involved in the outbreak, causing profound misery.
It is estimated that almost 1 of every 3 people will get shingles in their lifetime, so it is important to evaluate your risk carefully with input from your healthcare provider. Although people initially only had an option to receive a live vaccine to prevent shingles, there are now two vaccines available. One of the options is a nonliving vaccine. Both can be given after the age of 50 for appropriately screened candidates, which includes people who may have had shingles before.
Although some people will still develop shingles despite the vaccine, the symptoms will be milder and less likely to cause long lasting sequelae. Injection site redness and swelling are the typical reactions reported at the time of vaccination.
Healthcare workers and anyone else consistently exposed to body fluids needs to be vaccinated against hepatitis B. Travelers should be vaccinated for hepatitis A. Children are routinely vaccinated for both at this time, because if left untreated, hepatitis is not only contagious, but will attack the liver, causing scarring, potential liver failure, possibly even malignancy or death. Currently, there is no vaccine available to prevent hepatitis C, but there is medication to treat the illness once it has been detected.3
Hepatitis B vaccination is given via a series of three injections, which most nurses may remember receiving. Hepatitis A vaccination is available for those who may be traveling abroad (see below), or for high risk individuals (e.g. those with chronic liver conditions).3
People always have questions about what they might need when traveling, and the basic answer is: you will always need something in the way of vaccination, so plan. Most travel specialists recommend an update of current adult vaccinations 4-6 weeks before a trip. Vaccinations that are required for a trip to Africa may be entirely different than one for Thailand, but you may need any or all:2
Hepatitis A, B
Typhoid, Paratyphoid fever
Meningococcal disease, Yellow fever, Rabies
A travel health specialist who can coordinate your individual needs with the area you plan to visit is ideal, especially with the inclusion of your primary care provider. The plan would need to be modified to fit any individualized risks such as hypertension, diabetes, etc.2
As you can see, the topic of immunizations is one that is very much an adult responsibility, one that should include discussion with a primary care provider to determine a plan and a timetable. If you are an adult with an immune disorder or health condition that warrants special attention, it is particularly important to know which vaccines may carry live agents (i.e. one of the shingles vaccines for patients over age 50). The risk/benefit analysis is one that should be discussed so it is specific to your needs.
As for the growing risk of anti-vaxxers, this is an individual choice, but one that conflicts with the premise of promoting health and wellbeing. Nurses need to be aware that a plethora of disinformation is posted on social media, and these posts should be reported and taken down when observed. Vaccines have allowed us to eradicate/minimize life-threatening diseases since the days of Jonas Salk and a horrific illness known as polio. Sixty-five years later, we can honor him by doing our best to promote the profusion of vaccines we have available for healthful adults!
- Cdc.gov “Immunization schedule for adults.” Page last reviewed February 25, 2019. U.S. Department of Health and Human services, USA.gov
- Cdc.gov “Vaccine information for adults.” Page last reviewed May 2, 2016. U.S. Department of Health and Human services, USA.gov
- Healthclevelandclinic.org “5 vaccines for adults: Why (and when) you need them.” August 3, 2017, Health Library Cleveland Clinic.
- Healthline.com “Adults need vaccines too: What you need to know.” Citroner, G. February 3, 2020, Healthline Media.
- Washingtonpost.com “Here’s how many Americans are actually anti-vaxxers.” Blake, A., February 9, 2015, The Washington Post.