National Immunization Awareness Month is Upon Us!

Actually, National Immunization Awareness month (August) is almost over already! But it's still a great time to talk about the importance of routine adult vaccinations.

We've all been focused on Covid-19 vaccines in the past several months. You may find the changing recommendations for Covid-19 vaccines confusing or even alarming. But did you know that recommendations for all vaccines change occasionally? Vaccine experts continually collect and analyze data on preventable infections, along with vaccine safety and effectiveness. When new information shows that a vaccine can be used more effectively or safely, recommendations change.

Vaccine efficacy and the public health that follows depends on following the most updated guidelines. That's up to your provider. But vaccine efficacy also depends on each of us remembering (and being willing) to stay up to date on immunizations. So let's talk about recommendations for some of the most common adult vaccinations so you know what to expect. We'll also discuss what you can do to make sure you're doing your part to stay healthy.

A little background on dosing

There are two different aspects of vaccine dosing. An initial vaccine series is a number of doses given at specific intervals. The number and frequency is different for nearly every vaccine. It's meant to induce a robust immune response that provides protection from infection for a period of time. On the other hand, a booster dose is an extra dose of vaccine given at a specific interval to boost immunity that has waned over time.

Most of us can't remember the initial series of many of the vaccines we've had. Those series start at a very young age, and many are complete before kids start kindergarten. Most initial series require two to five doses given over a period of two to five years. Most adult vaccinations, but not all, also require more than one dose in the initial series.

Routine adult vaccinations

If you had all your routine vaccinations as a child, there are only a few you need to be concerned about as an adult. Here are the most common ones.

Pneumonia

There  are two adult pneumonia vaccines currently in use in the US -- Prevnar-13 and Pneumovax-23. Each provides immunity for different strains of pneumonia-causing bacteria than the other. Adults 18 and older who have certain underlying medical conditions (asthma, diabetes, and others)will  receive one dose of Prevnar-13 and one (or sometimes two) doses of Pneumovax before age 65.

Many adults, though, won't need both vaccines. If you're otherwise healthy, you'll only need a single dose of Pneumovax-23 when you turn 65. If you and your doctor agree that your health would benefit from the addition of Prevnar-13, you can choose to get that vaccine too.

Tetanus

We all need a tetanus booster every 10 years for maximum protection. Tetanus vaccines are combined with diphtheria vaccine (Td) or both diphtheria and pertussis vaccines (Tdap). And though the pertussis outbreaks that happened over the past decade or so are no longer a problem, guidelines still allow either Td or Tdap to be used when a tetanus booster is needed.

Shingles

If you haven't been vaccinated against shingles yet, now's the time! The newest shingles vaccine, Shingrix, is extremely effective in preventing a shingles outbreak. When it first came out, it was so popular that supplies ran short and lots of people had trouble finding it. That's no longer the case. And many, if not most, health insurers cover the cost of the vaccine for people aged 50 and over. That's true even if you were previously vaccinated with the older shingles vaccine, Zostavax.

The initial series for Shingrix is two shots, spaced 2 to 6 months apart. No boosters are currently required.

Influenza

We've gotten used to the need for an influenza vaccine annually. The annual flu vaccine is both a single-dose initial series AND a booster. Different strains of influenza circulate every year, so each year the vaccine may create a whole new immune response. But we also know immunity wanes after several months, which is the reason vaccination drives happen around October. That way most people are vaccinated before the flu begins to circulate in earnest, but late enough that immunity lasts until the flu season is over in the spring. So during years when the circulating strains don't change, a repeat vaccination acts as a booster.

This year, 2021-2022, all available flu vaccines will be "quadrivalent", meaning they'll cover four different strains of influenza. Along with standard flu shots, a high-dose vaccine and an adjuvanted vaccine will again be available for adults 65 and older. These vaccines seem to provide a modest, but real, increase in protection against influenza. They're fine options for older adults, but the added protection isn't worth delaying your vaccination if one of them isn't immediately available.

FluMist will also be an option again this year. It's the only flu vaccine given through the nose, and can be used in people aged 2-49. Its great advantage is that it doesn't require an injection. But unlike other flu vaccines, it contains an inactivated, live virus, that can potentially be dangerous to people with underlying health problems, or who are pregnant. Be sure to talk with your doctor or pharmacist if you're interested in this unique vaccine.

Covid

Yes, we'll probably have to consider Covid vaccination part of our routine vaccinations from here on out. We don't know exactly what that will look like, but here are the current recommendations.

MRNA vaccines (Pfizer and Moderna): in healthy people aged 12 and up, the initial vaccine series is two doses, spaced 3-4 weeks apart. The initial series extends to three doses for immune-compromised people, with the third dose given at least a month after the second. Otherwise healthy people will need a booster, probably six to eight months after the second initial dose. 

Johnson & Johnson vaccine: the initial series is a single dose for all adults. Information about immunocompromised persons and boosters is still being collected and analyzed, so "stay tuned".

Do you know if you're up-to-date on your vaccines?

Here in Michigan, the Michigan Care Improvement Registry (MCIR) recently made each person's immunization record available to them online. If your providers have consistently reported your vaccinations to MCIR, your record will be complete with dates of vaccinations and due dates for upcoming ones. Your electronic health record may also show you what vaccines you might be due for. Take a look at your records and make sure you're protected!

If you have questions about other vaccines (or other medications) please contact us at BetterMyMeds or leave a comment below. The goal of BetterMyMeds is to help you stay as healthy as possible!