copyright Jessica Snyder Sachs, as first appeared in HEALTH magazine
Three months before she gave birth last year, Diana Simpson, a dental hygienist in Davison, Michigan, started coughing uncontrollably. The pain in her throat and chest was unbearable. "It brought me to tears," she remembers. Simpson's family doctor tested her for asthma, but she didn't have asthma. She had pertussis, a bacterial infection that usually goes by the name whooping cough because of its distinctive seal-like cough.
Most people are vaccinated against pertussis as kids. But here's a surprise: It's come roaring back since an all-time low in the 1970s, largely due to waning immunity in adults who received shots in early childhood. The Centers for Disease Control and Prevention (CDC) now recommends that all adults get a pertussis booster shot to strengthen their immunity, yet only 2 percent of adults have had their shots updated. Experts say that's just one of several vaccines you may need now. Here's the scoop.
The good news: If you get your regular tetanus-diptheria (Td) booster every 10 years, you won't need an extra jab for pertussis. Vaccine makers have added a pertussis component to that booster, so next time you're due for your Td booster request the Tdap. If you've lost track of your vaccines, ask your doc to contact your previous physicians. And there's no harm in getting the Tdap as long as two years have passed since your last Td booster. Better too soon than too late when a pertussis outbreak has hit your community.
Simpson was too late: She had passed the infection to her mother and her baby, too, landing the newborn in the hospital three weeks after he was born. That's when they all were diagnosed and received the antibiotic erythromycin to keep the infection from spreading further, though they all continued coughing for months. If pertussis isn't caught in the first few weeks, the infection may take three months to run its course. The greatest danger is to babies, who almost always catch it from unvaccinated adults. (The number of U.S. pertussis cases now ranks in the thousands each year, with deaths in the double digits, mostly due to related pneumonia.)
Simpson and her baby, along with her mother (and husband, too), eventually got the shot for future protection.
More than 90 percent of women in their childbearing years are immune to chicken pox because they had it as kids. The rest should be vaccinated before they try to get pregnant because catching the illness during pregnancy can lead to devastating birth defects. Once you get the vaccine (which was introduced in 1995), the CDC says you should delay trying to conceive for at least one month, due to the small risk that the fetus can get the virus from the vaccine. Chicken pox complications are much more frequent and severe in adults than children and can include life-threatening pneumonia and encephalitis (brain inflammation). And people who've had it are also at risk for shingles. Most insurers cover the chicken pox vaccine for adults.
If you've had chicken pox, you have a significant risk of developing shingles, a painful reawakening of the chicken pox virus. Worse, in nearly 50 percent of cases in adults in their 50s, shingles progresses to postherpetic neuralgia, an often agonizing form of nerve damage that can linger for years. (The risk increases with age.) But with the recent Food and Drug Administration (FDA) approval of the Zostavax vaccine, you can lower your risks dramatically. In a study of more than 38,000 adults over age 60, the vaccine cut the rate of shingles by over half and reduced the incidence of postherpetic neuralgia by two-thirds.
The vaccine was studied in and approved for people over the age of 60 because they have the highest rates of shingles, says William Schaffner, MD, head of preventive medicine at Vanderbilt University Medical Center. "The rates take off at age 50 and become more steep with each decade," he says. But around half of all shingles cases occur in younger adults.
Insurers won't currently pay for vaccination in people under 60, but that may change because studies in 50-and-overs are ongoing. Younger adults can pay out of pocket for this $150 to $200 shot. (Ask your doctor.) Researchers don't yet know whether the vaccine's protection will prove lifelong, though, so you may need a booster when you get older.
Vaccine: MMR booster
The measles-mumps-rubella (MMR) vaccine, a must for kids, is back in the adult-vaccine lineup, too. "Mumps is the problem," reports CDC epidemiologist Andrew Kroger, MD. The number of Americans who caught this viral disease jumped to 6,584 in 2006 from 300 or less in most years. A large mumps outbreak in the Midwest was responsible for most of these cases, and outbreaks continue in Canada and neighboring states such as Maine. The problem may be a spillover from countries like the United Kingdom and Japan, where lagging childhood immunization rates spurred a comeback.
Mumps can be painful and sometimes dangerous. There's the textbook swelling of salivary glands around the neck, but some women also suffer from inflammation of the ovaries. In rare instances, mumps can trigger life-threatening encephalitis.
The CDC encourages all adults to check their status: Do you know whether you were immunized or had the disease as a child? Those born before 1957 are presumed to have been infected or exposed, which provides lifelong immunity. The spottiest protection is among those born between 1957 and 1967, who are less likely to have had mumps or who may have received a less-effective vaccine. A single dose of the current MMR should bring your protection up to date, Kroger says, and it may be covered by your insurance.
Going on a cruise or an organized tour? Consider getting a flu shot, says Schaffner, who reports that influenza outbreaks frequently occur on cruise ships, even during summer voyages to northern destinations like Alaska. "Whenever people are jammed together, influenza is a risk," he explains.
In addition, visitors to Asia should talk to their doctors about vaccine protection against typhoid and Japanese encephalitis. Visitors to the "meningitis belt" of central Africa should get a meningococcal vaccine. And yellow fever vaccines are important for travelers to much of South America and parts of Africa.
Vaccine: Recombivax HB or Engerix-B
Both vaccines protect against the hepatitis B virus, which is spread through sexual contact or contaminated needles and blood. An infection can lead to dangerous liver disease. Each year, more than 78,000 Americans become infected and about 5,000 die of associated liver diseases, including cancer, yet few know that the CDC recommends the vaccine for all sexually active people who are not in long-term relationships.
Vaccine: Influenza shot or FluMist nasal vaccine
A dangerous bug known as methicillin-resistant Staph. aureus (MRSA) may aggressively attack flu-weakened lungs, according to William Schaffner, MD, head of preventive medicine at Vanderbilt University Medical Center. MRSA was previously confined to hospitals but is spreading into communities nationwide. The link is unclear, but there may be a connection in the way that flu weakens the immune system and MRSA attacks it. MRSA is often marked by nasty skin infections. The strains contracted outside the hospital are now associated with some 13,500 deaths in the United States each year, many involving flu sufferers. "If you need further motivation to get a flu shot," Schaffner says, "there it is."
Jessica Snyder Sachs is the author, most recently, of Good Germs, Bad Germs.