The Medical Minute: National Vaccine Awareness Month 2008

By John Messmer

Until only 50 years ago, the month of August would have been a time of worry for parents. Polio epidemics closed pools and public facilities to reduce the spread of the virus, which is passed like a common cold virus. In 1952, there were 58,000 cases of polio in the United States. By 1957, a mass immunization campaign with the recently developed Salk polio vaccine reduced the number of cases to 5,600. In 1964, only 121 cases were reported, and by 1979, polio was eliminated from the United States. Even greater success has been realized for smallpox, which no longer exists in the world. These major public health advances are due to vaccines.

Diphtheria and tetanus are rare in the United States, occurring mostly in unvaccinated immigrants and the occasional elderly person who was never immunized. Measles, mumps, German measles and whooping cough, once considered the "usual childhood illnesses," also are unlikely except in the unimmunized.

Medical research has made significant inroads into reducing or eliminating many other diseases through vaccination. Meningitis used to be fairly common, but immunizations against the three most common bacteria have cut the risk greatly. As an added benefit, being immune has reduced the occurrence of ear infections caused by related bacteria. There is even a vaccine against the virus that causes cancer of the cervix.

As more vaccines become available, knowing which ones to get is more complex. For newborns through age 2, vaccines are currently administered for 13 diseases. Pre-teens and adolescents get boosters for tetanus, diphtheria and whooping cough plus a vaccine for meningitis and for girls, the cervical cancer vaccine.

Adults up to age 65 should get a one-time booster for whooping cough in combination with a tetanus-diphtheria booster. (It has not yet been determined if people older than 65 will respond to the whooping cough vaccine, so it is not currently recommended.) Tetanus and diphtheria should continue to be given every 10 years. Adults older than 65 should receive up to two doses in 10 years of the vaccine for pneumonia caused by the Strep bacterium. All adults older than 50 should receive annual flu vaccinations.

Women up to age 26 should consider the cervical cancer vaccine. Adults who have never had or are uncertain about having had chickenpox should be immunized. Some adults should have their measles, mumps and German measles immunity boosted: those born after 1957 who have not had two shots of the live vaccine or are not sure. Adults older than 60 should consider the shingles vaccine, although it is not yet on the recommended list.

There are many recommendations for travelers, and those recommendations vary by country. The Centers for Disease Control and Prevention (CDC) maintains a Web site with current recommendations for vaccines and other preventive strategies for travelers at http://wwwn.cdc.gov/travel/default.aspx online. People with certain medical problems, such as reduced immunity, sickle cell disease, heart and lung conditions, diabetes, kidney failure on dialysis and so on have other specific recommendations regarding immunizations.

It’s a complex process to keep even the standard immunization straight, and as new vaccines become available and new information as to who would benefit, recommendations are updated. Fortunately, the CDC’s Web site has complete information about the current recommendations for all ages and health conditions. Go to http://www.cdc.gov/vaccines/ for details. It also reviews the very limited risks associated with vaccines at http://www.cdc.gov/od/science/iso/general_info/parents.htm online.

National Vaccine Awareness Month is a good time to check on current immunization status. Schedule a health maintenance visit so a doctor can review personal needs and make specific recommendations.

John Messmer is associate professor of family and community medicine at Penn State College of Medicine and a staff physician at Penn State Hershey Medical Center.