Vaccinations—Staying Current

As a child growing up many years ago, I remember the constant emphasis on vaccinations. How I dreaded those advertisements and school efforts that reminded my mother to take me for boosters to keep me protected.

I recall seeing the results of polio and the relief that came when a vaccine was developed to prevent it. There was the dread of smallpox and the requirement to receive boosters, until, as medical missionaries in Africa, we learned the World Health Organization (WHO) declared the world literally "free of smallpox." What a triumph!

Years later, there remain diseases that have not been eradicated but for which there are excellent, safe vaccinations. For these, it is vital to keep up to date with boosters.

Vaccinations against tetanus should be updated at least every 10 years or with any laceration or puncture wound that occurs after five years of your last booster. While not common in the developed world because of the high immunization rates, tetanus is still a deadly disease. A few years ago there was a noted rise in the number of cases of tetanus among the elderly who had not kept up with their boosters. They would sustain a seemingly insignificant puncture or scratch while working in the yard or garden, and then would later come down with the disease of tetanus, also known as lockjaw. Recent awareness campaigns by various medical organizations have led to much better rates of immunization and a decrease in the number of cases reported.

Most infants and children receive an immunization called DTP (for diphtheria, tetanus and pertussis or "whooping cough"). The pertussis portion of the vaccine was dropped for those beyond the age of seven because of fairly severe adverse reactions in the teen and adult population, but about ten years ago a new vaccine was successfully tested. Known as Tdap, this booster is encouraged for older children and adults. If you are 64 or under, I encourage you to have this vaccination.

Another immunization you should receive is for the bacteria that causes the most common type of pneumonia. Everyone should receive the pneumococcal vaccine one time at age 65. There are some medical conditions, particularly chronic lung problems and having had a spleen removed, where this vaccine is recommended earlier than age 65. Also, a booster may be needed six years after the first dose.

There are also vaccines available to prevent Hepatitis A and B. I strongly urge everyone to at least be vaccinated against Hepatitis A. It requires two injections six months apart for full protection, but requires no further boosters after that. Hepatitis A is the type of liver infection acquired in situations of poor sanitation, such as after natural disasters that disrupt the infrastructure. Hepatitis B is an infection acquired through contaminated blood products, sexual contact or IV drug use. For many of you this is not a concern, but if you do any travel to the underdeveloped nations of the world, you would be wise to have this vaccine. It requires an initial series of three injections for full protection.

Finally, there is a vaccine for shingles that medical authorities recommend for all those over 60 years of age. Shingles can be a prolonged painful problem and cause a fair amount of disability. Therefore, if you have insurance that covers this or if you can afford this rather expensive vaccination, it is well worth it. During my last visit with my physician, he recommended I consider having the shingles inoculation, but I haven't done it yet. I did receive my pneumonia vaccine that day, and my tetanus immunization is up to date, so I am trying to practice what I preach.

Review your immunization history with your physician. If you are computer savvy, there is an interactive website at www.cdc.gov where you can track your own immunization history and make certain you keep up to date. Get your immunizations updated as needed, and plan now to get your influenza vaccine this fall!

Dr. Paul Wardlaw is a board-certified family physician who has enjoyed the practice of medicine in various settings for more than 35 years.

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