1. Vaccinations –
Not Just for Kids!
Karissa Loper, MPH
Health Program Manager
Nevada State Immunization Program
Division of Public and Behavioral Health
2. 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
3. Vaccine-Preventable Disease
O There are 14 vaccine-preventable diseases which affect children
AND adults:
O Varicella (chickenpox)
O Diphtheria
O Hepatitis A
O Hepatitis B
O Human Papillomavirus (HPV)
O Influenza (annually)
O Measles
O Meningitis
O Mumps
O Pertussis (whooping cough)
O Pneumonia
O Rubella
O Zoster (shingles)
O Tetanus (lockjaw)
4. 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 used
O Rotavirus – 2 or 3-dose series depending on the brand of
vaccine used
O 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 series
O Pneumococcal disease (PCV) – 4-dose series that protects
against 13 serotypes
O Poliovirus (IPV) – 4-dose series
O Measles, Mumps, Rubella (MMR) – 2 doses needed for full
protection; one at 12-15mos and a booster before
Kindergarten
O Varicella (chickenpox) – 2-dose series
O Hepatitis A – 2-dose series begun after one year of age
O Influenza – one annual dose beginning at age 6mos
5.
6. KNOWLEDGE CHECK
O 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?
7. 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
requirements
O 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 risk
O 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!
8.
9. 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.
11. 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 age
O 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
13. Tdap is the ONLY adolescent
and adult vaccine available to
protect against pertussis
14. KNOWLEDGE CHECK
O 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?
15. 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!
16. 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!
17. Meningitis
O Adolescents have the highest case mortality rate
O 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
19. KNOWLEDGE CHECK
O 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?
23. 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.
24. 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) = $1800
O 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.
25. Conclusion
O 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.
