You May Need More Than the COVID-19 and Flu Vaccines

By now, most of us are well aware of the benefits of getting the COVID-19 vaccine. The COVID-19 vaccine is safe and effective, and you should strongly consider getting vaccinated. Hopefully, you are used to getting your seasonal flu shot to protect you from influenza.

While we are focusing on COVID-19 and flu vaccines, there are many other vaccines most of us have received. The majority of American children receive all recommended immunizations, such as DTaP (tetanus, diphtheria, and pertussis, better known as whooping cough) and MMR (measles, mumps, and rubella). Nationally, close to 90% of kindergarten students have received the recommended vaccines (Tan, 2015). Pennsylvanians can pride themselves for ranking third (only after Nebraska and Maine) nationally for the highest percentage of children (84.3%) who received all recommended doses of the combined 7-vaccine series by the age of 3 (Hill et al., 2018). Unfortunately, among adults 19 years and older, the vaccine coverage rate is much lower (Tan, 2015). Parents, guardians, and caregivers routinely take babies, toddlers, and school-aged children for wellbeing check-ups to ensure they receive the age-recommended vaccines. Those same adults neglect to check their own immunization status and keep up to date with their boosters. This not only places them at risk, but it also puts other at-risk adults (those with chronic health conditions) as well as infants and children too young to get vaccinated at risk. Adults at higher risk for infectious diseases and their complications, such as those with heart disease and diabetes, remain the least vaccinated group overall in the United States (Tan, 2015). Each year, between 40,000 and 80,000 Americans die from vaccine-preventable diseases, such as pneumococcal disease and hepatitis B (Tan, 2015). Another at-risk population, unvaccinated pregnant women and their unborn children are at greater risk of severe adverse effects from infectious diseases. Complications can include miscarriage, preterm birth, low birth weight, intrauterine growth retardation, severe congenital disabilities, and stillbirth.

Rubella infection can be serious at any age, especially for pregnant women. In addition to the risk of miscarriage and stillbirths, congenital (present at birth) rubella syndrome can cause deafness, blindness, brain damage, and severe disabilities in babies (Centers for Diseases Control and Prevention [CDC], 2017). Similarly, varicella (chickenpox) infection during pregnancy is dangerous for the mother but even more so for the unborn child leading to skin scarring, low birth weight, and limb abnormalities (CDC, 2021a). Unfortunately, not all vaccines are safe during pregnancy. Such is the case for the MMR and the chickenpox (varicella) vaccine. Because some vaccines cannot be given during pregnancy, it is essential for all women of childbearing age to check with their doctor to determine if they are up-to-date with their immunizations. Some vaccines require multiple doses, so it is important to allow enough time before planning to get pregnant.

On the other hand, many vaccines are safe during pregnancy and are recommended to protect mother and child, such as COVID-19, flu, and DTap (or its booster Tdap) vaccines. Pregnant women are at increased risk of severe illness, complications, and hospitalization for both COVID-19 and influenza.  A recent study concluded that maternal flu carries a higher risk of late miscarriage, stillbirth, low birth weight, and preterm birth (CDC, n.d.-b, n.d.-a). There is increasing evidence that COVID-19 infection during pregnancy may increase the risk of preterm birth and pregnancy loss (CDC, 2021b). Whooping cough can be serious at any age but is dangerous for healthy infants under three months who are too young to get vaccinated (CDC, 2019a). It is essential all children and adults in contact with those too young to be vaccinated are fully immunized. A Tdap dose is recommended during each pregnancy (National Center for Immunization and Respiratory Diseases [NCIRD], 2020). Receiving vaccines during pregnancy may also protect the newborn through maternal antibodies. Tetanus is a rare but severe disease caused by bacteria found in soil, dust, and manure. It is more common in rural and agricultural areas. Infections happen almost exclusively in individuals who did not receive the recommended doses or 10-year booster vaccine (CDC, 2019b).

Over 85% of Americans will contract human papillomavirus (HPV) infection in their lifetime. The HPV vaccine is recommended for teens aged 9 to 14 years old. However, it can be given up to 26 years of age. The health benefits of the vaccine decrease with age as people get exposed to the virus. Therefore, adults between 26 and 45 years old should consult with their doctor to discuss if the HPV vaccine is appropriate for them (NCIRD, 2020).

The same virus causing chickenpox can reactivate later in life and cause shingles. Anyone who has had chickenpox in the past can develop shingles later in life. While the illness is not life-threatening, it can be painful and lead to complications such as neurological problems and vision loss. Therefore, the vaccine is routinely recommended for healthy adults 50 years and older to protect against shingles, even if they have had shingles in the past (NCIRD, 2018). 

It's impossible to mention and discuss every single recommended adult vaccine. The examples provided illustrate the importance of adult immunizations. Hopefully, it will spark your curiosity and start a conversation with your doctor. The CDC recommended adult immunization schedule includes 12 vaccinations depending on age, health history, and risk factors (NCIRD, 2020). Ask your doctor which vaccines are recommended for you and verify you have received all doses and boosters to ensure you and those around you are fully protected. If you are pregnant or planning to be, review your vaccine status with your doctor as soon as possible. Encourage everyone around you to get vaccinated to protect you and your child. Getting a vaccine can be intimidating. There is a lot of misinformation around vaccines. It's OK to ask your doctor questions about adult vaccinations you should receive. Get the facts and make the best decision for you based on science.

References

Centers for Disease Control and Prevention (n.d.-a). Flu & pregnancy.

Centers for Disease Control and Prevention. (n.d.-b). New study finds influenza during pregnancy is associated with increased risk of pregnancy loss and reduced birthweight.

Centers for Diseases Control and Prevention. (2017). Pregnancy and rubella.

Centers for Disease Control and Prevention. (2019a). Vaccines during and after pregnancy.

Centers for Disease Control and Prevention. (2019b). Tetanus causes and transmission.

Centers for Disease Control and Prevention. (2021a). Chickenpox (varicella) for healthcare professionals. 

Centers for Disease Control and Prevention. (2021b). Pregnant and recently pregnant people. 

Hill, H. A., Elam-Evans, L. D., Yankey, D., Singleton, J. A., & Kang, Y. (2018). Vaccination coverage among children aged 19–35 months. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention. doi.org/10.15585/MMWR.MM6740A4

National Center for Immunization and Respiratory Diseases. (2018). Shingrix shingles vaccination: what everyone should know. Centers for Disease Control and Prevention.

National Center for Immunization and Respiratory Diseases. (2020). Adult immunization schedule by vaccine and age group. Centers for Disease Control and Prevention.

Tan, L. (2015). Adult vaccination: now is the time to realize an unfulfilled potential. Human Vaccines & Immunotherapeutics, 11(9), 2158. doi.org/10.4161/21645515.2014.982998