What vaccinations or immunizations should I get?

August 16, 2005 6:32 PM

I'm not a tinfoil hat type of guy but just in case, what vaccinations or immunizations should I, as a 30 year old american, get? Let's say I budgeted $1,000 to cover the bases; I'm not planning on taking any trips to the jungle, working with blood, doing drugs or having anal sex. What could I take care of with a budget like that?
posted by pwb503 to health & fitness (28 comments total)

If you haven't had the basics, get them? Especially chicken pox and hep b? You're going to see the doctor anyway for this so I'm a little confused, why don't you just call them up and tell them you haven't been vaccinated for anything and ask what they recommend. Your insurance should cover a lot of it and the rest should be fairly cheap.
posted by geoff. at 6:35 PM on August 16, 2005

This is a really strange question. Have you not had any shots at all, pwb503 (hard to believe)? Or are you just to looking for options on all different sorts of crazy, weird vaccines you could get? If it's the latter, you could always do trials for the HIV vaccine for free.
posted by ThePinkSuperhero at 6:57 PM on August 16, 2005 [1 favorite]

Tetanus.

CDC pdf document here.
posted by lobakgo at 7:07 PM on August 16, 2005

I was going to suggest tetanus as well. You're childhood shot doesn't last forever and so you need boosters every ten years or so.
posted by smackfu at 7:09 PM on August 16, 2005

Oh, I forgot: why tetanus? Because when you scrape your arm on some random thing, you won't have to worry about getting screwed up for the rest of your life.
posted by smackfu at 7:10 PM on August 16, 2005

Hep A and B, and certainly Tetanus.
posted by tomble at 7:11 PM on August 16, 2005

Tinfoil hat? Does that mean that medical science is a conspiracy?
posted by spilon at 7:19 PM on August 16, 2005

Meningococcus! Yearly flu! $1,000 will get you far as far as vaccines go.
posted by gramcracker at 7:19 PM on August 16, 2005

i'm with tomble--hep and tetanus.
posted by amberglow at 7:29 PM on August 16, 2005

Most insurance plans cover routine vaccinations as part of preventive health --- it's cheaper for you to get your shots than risk getting the flu or measles or something. You'll probably just pay for an office call.
posted by nathan_teske at 8:04 PM on August 16, 2005

mumps-measles-rubella, varicella, diphtheria-pertussis-tetanus, yearly influenza, and Hep B are things that most folks get these days; if you grew up in USA and your folks took the path of least resistance, you might have gotten them already. Tetanus needs periodic boosting.

Little kids get the H. flu (Haemophilus influenzae) vaccine but you don't need it; and given your healthy spleen Pneumovax is probably also off the table.

I'd advise against bacille Calmette-Guerin for tuberculosis; it's not clear that it confers full immunity, and in the USA it will make your PPD reactive, causing needless chest x-rays throughout your life.
posted by ikkyu2 at 8:24 PM on August 16, 2005

Tetanus/diphtheria (Td) -- every 10 years throughout your lifetime -- BUT if you have a deep cut or burn and it's been more than 5 years since your last tetanus booster, you need another one.

Measles/Mumps/Rubella (MMR) -- since you're 30 and therefore born after 1957, you need one dose or proof of immunity; if you're a college student, you need a second dose two months later.

Varicella (chicken pox) -- if you have never had chicken pox, you need two doses, one now and another 4 to 6 weeks later.

Hepatitis B -- three doses, one now, the second dose one month after the first dose, and the third six months after the first dose.

Hepatitis A -- two doses, one now and the second six months after the first dose.

Influenza -- annually.

Pneumococcal (pneumonia) -- you don't need this until you're 65, and then you need it every 5 years.

If you plan on travel outside the United States, there are a few more shots, depending on your destination. And none of these should cost very much. Your county health department will vaccinate you at no cost.
posted by lambchop1 at 8:24 PM on August 16, 2005

I agree that tetanus is a good vaccination to remain current on, and I do . . . but has this happened to anyone else? I've had about 5 tetanus shots in the past 10 years. This is because every time I go to the doctor for something that needs stitches, or for a burn, etc., they ask me if I've had a recent tetanus shot. I say yes, on XX date. I always know the exact month and year of my last shot. They basically shrug and say, "Eh, let's just give you another shot now to be safe." So what's the point of having an up-to-date tetanus shot?? Do they not believe that I know my medical history?
posted by peep at 8:35 PM on August 16, 2005

Slight derail, is tetanus still painful? I thought they stuck a long needle in your stomach?
posted by geoff. at 8:37 PM on August 16, 2005

geoff. I think you're confusing a tetnaus shot with rabies treatment. Tetnaus shots feel like a hard punch in the upper arm, but they're not that terrible, though they can sometimes induce flu-like symptoms.
posted by jessamyn at 8:39 PM on August 16, 2005

peep: Don't let them give you tetanus shot after tetanus shot. There are people who develop allergies to tetanus toxoid, and then you're kind of in trouble, aren't you? You'd be surprised how many people are allergic to tetanus toxoid; it's probably in the top 5 of all the allergies I've ever seen.

If it's been more than 5 years since your booster and you have a deep injury or a burn -- not just a surface scratch, because that's not how the spore can develop into the bacteria -- then get a booster. Otherwise, every 10 years. They should know better than that.

It's your body, so tell them you've had a tetanus booster within the last 5 years, and you don't need another one because you know better. And now you do. :-)

geoff.: Unfortunately, a tetanus shot is still pretty painful, although it is a deltoid injection. (One type of rabies vaccine is given in the abdomen.) I tell patients to get it in their nondominant arm (and it MUST be in the arm) and that it will be sore for about a week. Ibuprofen or acetaminophen (Tylenol) help the soreness.

And quickly about the TB vaccine ikkyu2 mentioned: In some countries people are vaccinated against TB, but that vaccine isn't approved in the United States. You can't even get it here AFAIK -- I've never seen it anyway. I have seen patients who have had the vaccine, and it makes the PPD skin test for TB positive even though they've never been exposed to TB.

Because all positive PPD tests have to be double-checked by other means, you're treated as if you are really positive for tuberculosis. Healthcare workers need annual TB skin tests, but the general public doesn't have to worry about it.
posted by lambchop1 at 8:46 PM on August 16, 2005

Just had my tetnus and pneumococcal vaccines updated. The tetnus hurt a bit more (Ok, I gasped) and lingered for a longer time. I had a noticable, sore lump in my arm for about two weeks. It wasn't what I'd consider bad though, just something to whine about. YMMV.

If you decide to get the meningococcus vaccine, don't be surprised if your doctor doesn't carry it. Also, ask for the new one. Apparently, the old one was only effective for about six months. The new one lasts longer. If your doctor doesn't carry it, your local health department should. You may need a prescription from your doctor to get it though. I'll be getting my Friday (I think).

If you had shots for all the childhood stuff, you really shouldn't need more than tetnus and flu if you can get it when it comes out.
posted by onhazier at 8:58 PM on August 16, 2005

Also, there is Meningitis for those who live in a densely-populated area such as dorms or sharing an apartment with tons of people. We had a break-out of it at college last year so I got one for <$50, though I think the shot only works for the version that doesn't necessarily kill you.
posted by jmd82 at 9:17 PM on August 16, 2005

If you keep getting bats in your house you may want a rabies shot. My brother-in-law got scratched by a wayward bat last week, so his (NY) county gave him very inexpensive rabies shots at the ER, and to my sister too, for good measure. [It was 3 rounds of shots, a few in the bum and one in the arm.]
posted by xo at 9:22 PM on August 16, 2005

I've got all the normal ones already. My parents got me all the "kid" ones and I've had chickenpox. I was more curious about what shots you would suggest just for "covering one's ass."

I'm going to get Meningococcus, Hep A and B. I've never got but guess I should get the flu shot. Maybe the rabies shot too.

Keep 'em coming... What should I get in preparation of the end of the world? What's best to protect me from bird flu?
posted by pwb503 at 10:01 PM on August 16, 2005

I'm 42, in middling health, don't have a spleen, HIV-negative as of two years ago (and no reason to suspect that might've changed), they say I'm immune or at least highly resistent to Hep B due to getting infected in 1979, and I never get enough sleep. What immunizations should I press for? (There are a lot of things my health plan doesn't cover, and many I'd have to beg them for.)
posted by davy at 10:50 PM on August 16, 2005

What should I get in preparation of the end of the world? What's best to protect me from bird flu?

If you're concerned about pandemic bird flu--and good for you if you are, because it's probably really going to happen sometime in the next two years--then I would definitely go for the Pneumovax shot. It confers immunity for about 23 different strains of pneumonia all at once. If you're a healthy adult and have a spleen, a shot should last you ten years; if you're spleenless (like me) or elderly or otherwise immuno-compromised, it should last you five years. It rarely has side-effects if it's your first time getting it, but if you've ever had it before, you'll probably end up with a sore arm for several days.

(How sore? Let's just say the one and only time in my entire life that I came close to using physical violence--against my roommate and friend, at that!--is when she playfully whacked me in the arm hard, twice in a minute, just after I'd had a booster pneumovax shot. I seriously came very close to punching her in the face (with my other arm) out of anger and pain. That reaction was totally out of character for me. So yeah, if you've had the shot before and have it again, your arm will be very sensitive for a little while.)

Pneumovax is a good choice if you're worried about bird flu, because pandemic-type influenzas tend to kill in one of three ways: the flu itself gets you hard and fast; you develop a "cytokine storm" where your body over-reacts to the invading virus and floods your body with white blood cells and basically ends up accidentally attacking itself and its own tissues*, and death by secondary bacterial infections, especially pneumonia. The pneumovax shot may give you protection against the pneumonia.

Of course, strong modern antibiotics (Erythromycin, Augmentin) can fight secondary infections, too, but in a pandemic situation, hospitals would be totally overwhelmed and at least three countries I know of (US, Canada, UK) have publically announced plans to quarantine people with symptoms, so you may not be able to get to a hospital or a doctor to get those antibiotics. If you're really willing to spend the $1,000 you mentioned in your question, I don't think the Pneumovax shot is anywhere near that expensive, and it would certainly provide a little peace of mind for mimimal risk.

* It is thought that "cytokine storms" are why a freakishly high number of healthy 20-to-40-year-olds died in the 1918 flu epidemic--they were so healthy and their immune systems were so strong that they over-reponded to the virus, destroying their own lungs with white blood cells, etc.

on preview: davy, as a fellow spleenless person, you should get the pneumovax shot once every five years and a yearly flu shot every year. Also, be careful about high fevers; anything over 100-101 F and I was always told I'd need to go to the hospital for intravenous antibiotics. Hasn't happened yet, though (knock wood).
posted by Asparagirl at 12:16 AM on August 17, 2005

And a final note about bird flu: there likely won't be a bird flu vaccine for at least four-to-six months after a person-to-person outbreak happens in a Western country. That could mean months of quarantine, not a fun thought; Scotland's public flu plan, for example, openly calls for six months of quarantine if an outbreak happens in the Highlands.

Recent news stories about an upcoming vaccine "any day now" are bunk. First of all, they don't know which strain will be the one that will make the jump to human-to-human transmission (they're working off an old sample that's not much like the current samples taken from recent cases in China and Vietnam). They don't know if the strain they do have, if turned into a vaccine, would help confer partial immunity in people against the China or Vietnam or whatever-the-future-is strains. And even if it did, all evidence so far seems to say that they'll need many more times the virus than usual per vaccine dose, maybe even two or three shots spaced out over six weeks. Not to mention the shortage of vax plants in the US to make it all. And the US recently released it's "priority list" of who gets the eventual maybe-effective vaccine, and in what order of preference, and it's slightly disturbing reading...

So rather than assuming a bird flu vaccine is magically going to appear just in the nick of time, you might want to buy some Tamiflu, the only drug known to provide protection against all currently known forms of bird flu. (The anti-viral Amantadine repotedly won't work on southern Vietnam strains.)

Somewhat ominously, the only three online pharmacies I know of that sell Tamiflu are each almost out of stock. E-mail if you want URL's.
posted by Asparagirl at 12:41 AM on August 17, 2005

Don't get the TB vaccine!

I received it when I was born in Thailand. The result: Every time I've been tested for TB, I've come up positive, because I have antibodies in my blood. Eventually, I came across a doctor who pressured me into going onto an anti-TB drug for a while just to be safe, which was potentially damaging to my liver and required monthly blood tests to make sure it wasn't causing permanent harm. Not fun.
posted by croutonsupafreak at 6:47 AM on August 17, 2005

Out of curiosity, how on earth would you even go about obtaining a Pneumovax shot? Surely you can't just walk into a doctor's office and say you want one, so fire it up and write you a bill?
posted by clever sheep at 7:54 AM on August 17, 2005

Ask your doctor about the vaccine the next time you visit. They probably have it in stock. The doctor may ask how long since you've had one and check your risk factors for getting pneumonia before agreeing to give you the vaccine or not.

For normally healthy people, I don't know what, if any, additional criteria your doctor will use. Since I'm not a normally healthy person and I do fall into a high risk category, it's very easy for me to get the vaccine from my primary care physician. I'm at high risk because of my asthma and my recently diagnosed severe chronic neutropenia. Though, to be honest, the asthma and my repeated cycle of lung infections was enough to have them give it to me.
posted by onhazier at 10:28 AM on August 17, 2005

Out of curiosity, how on earth would you even go about obtaining a Pneumovax shot? Surely you can't just walk into a doctor's office and say you want one, so fire it up and write you a bill?

Why not? Do it just like that, except call the doc's office in advance so they can order it if they don't have any in stock.

Asparagirl, Pneumovax does not protect against 23 different strains of pneumonia. It protects against 23 different strains of Streptococcus pneumoniae, a bacteria responsible for a lot of community-acquired bacterial pneumonia. It doesn't do a damn thing for Klebsiella, respiratory syncytial virus, Mycoplasma, influenza, or any of the other nasty pneumonias you can get in the community, to say nothing of hospitals.
posted by ikkyu2 at 1:25 PM on August 17, 2005

Good to know. Thanks, Doc!
posted by Asparagirl at 4:25 PM on August 17, 2005