Physician Focus: Why should adults be vaccinated?
Vaccines are some of medicine’s best preventive measures with extraordinary records of effectiveness and safety. Because of vaccines, diseases that once killed millions, such as smallpox, diphtheria and polio, are no longer a threat to health or life.
While Americans do well in immunizing children (though many are still unprotected, as evidenced by recent outbreaks of measles and whooping cough), adults are another story.
Consider the following, from the National Foundation for Infectious Diseases:
- More than 50,000 adults die each year from vaccine-preventable diseases and their complications.
- More than 36,000 people die from seasonal flu complications every year; 90 percent are people 65 and older.
- Some 1.25 million people are chronically infected with the hepatitis B virus, which can lead to liver cancer.
- Nearly one-third of the reported cases of pertussis, or whooping cough, are in adults.
Several factors contribute to this disappointing picture. When it comes to their own health, most adults appear indifferent to vaccination. They are conscientious about getting their children shots, but they don’t think of vaccinations for themselves when they visit their doctor.
Many have forgotten or are unaware of what vaccines adults should have, whether they be "booster" shots for certain diseases or recommended shots for seniors.
Myths and misconceptions
Some misconceptions about vaccines also continue to linger. Physicians often hear patients say that a flu shot will give them the flu -- it won’t -- or that they had a flu shot last year so they don’t need one this year -- you need one every year because the vaccine only lasts a year and changes annually due to different strains of flu. Or they say they were vaccinated for a disease when they were a child -- some vaccines don’t provide lifelong immunity. A minority of people also believe that vaccines are unsafe and are a contributing factor in some diseases -- they’re not.
Getting the vaccines is also a concern. Many physician offices, particularly smaller ones, find it impractical or too expensive to store vaccines for the needs of all their patients. Some vaccines have special storage requirements, and all vaccines have expiration dates. If they are stored too long or improperly -- subjected to excessive heat or cold, for example -- they lose their effectiveness.
Finally, cost may be a factor for some, particularly for those on limited incomes. Insurance policies have different deductibles and different provisions on what is covered, and some shots can be expensive if one has to pay out of pocket.
Getting it done
These obstacles to adult vaccination, however, can be overcome. Physicians must help patients learn what vaccines are recommended for their age, condition or lifestyle, and patients can be more attentive by checking immunization schedules and asking their doctors what shots may be needed.
Technology, such as electronic health records in the doctor’s office and personal online tools for patients, has made it easier to record, track and keep both physician and patient up to date on vaccinations. Local boards of health, hospitals and pharmacies can expand access to and, in some cases, reduce the cost of vaccines for such conditions as influenza, pneumonia and shingles.
It’s important to recognize that new vaccines are constantly being developed, and recommendations for shots can change over time. A hepatitis B vaccination, for example, is now recommended for all adults 19-59 who have diabetes -- a large and growing population.
We must also remind ourselves that immunity from some conditions can fade over the years, requiring booster shots. Vulnerability to diseases from common infections like the flu increases as we age, too, and that those working in certain professions -- health care, elder and child care, as examples -- should be immunized to protect those they care for as well as themselves.
Vaccines are medical miracles than prevent illness and death, benefiting the patient, family members and our overall public health. Adults should consider them an integral part of health care.
Elisa Choi, M.D. and Margaret Sandin, M.D., are board-certified primary care physicians at Harvard Vanguard Medical Associates, Boston, and Mount Auburn Hospital, Cambridge, Mass., respectively.
Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org.