I wasn't vaccinated. Now what?
October 31, 2014 8:11 PM Subscribe
Which vaccines are most important (and effective) for me to get as an adult, to fulfill the moral imperative of contributing to the herd immunity that I benefit from?
My parents didn't vaccinate me. Let's not argue about this, and the efficacy or dangers of vaccines. Not interested. When I've travelled to countries with active infectious diseases, I've received the necessary vaccinations. I'm also not particularly interested in getting vaccines for my own health. It'd be great to not argue about that either.
However, I've seen a number of essays in the last year noting that it's primarily wealthy people who are choosing not to immunize their children, and relying on the herd immunity provided by others for protection. That so many are choosing to rely on others that the herd is no longer protective in some places. I am currently doing that, and it's an ethically problematic position for me. Thus, I would like to get the vaccinations necessary to contribute to the herds I am actively relying on.
Which vaccines are the most pressing to contribute to active herd immunity in the United States?
I've been told that some vaccines are less effective when not given at birth, to the point that it might not be worth to get them as an adult. Which ones are most likely to have an impact now? Is there a hierarchy of importance?
My parents didn't vaccinate me. Let's not argue about this, and the efficacy or dangers of vaccines. Not interested. When I've travelled to countries with active infectious diseases, I've received the necessary vaccinations. I'm also not particularly interested in getting vaccines for my own health. It'd be great to not argue about that either.
However, I've seen a number of essays in the last year noting that it's primarily wealthy people who are choosing not to immunize their children, and relying on the herd immunity provided by others for protection. That so many are choosing to rely on others that the herd is no longer protective in some places. I am currently doing that, and it's an ethically problematic position for me. Thus, I would like to get the vaccinations necessary to contribute to the herds I am actively relying on.
Which vaccines are the most pressing to contribute to active herd immunity in the United States?
I've been told that some vaccines are less effective when not given at birth, to the point that it might not be worth to get them as an adult. Which ones are most likely to have an impact now? Is there a hierarchy of importance?
When I've travelled to countries with active infectious diseases, I've received the necessary vaccinations.
When that happened, did you act as if you'd been immunized against the standard childhood stuff like measles, polio, diptheria, etc. or have all those immunizations done at the time?
A lot of the traditional childhood illnesses are still endemic in the developing world, and it's recommended that you get immunized before traveling there, if you haven't been previously. If you made up for your lack of childhood vaccinations when you traveled, you're probably fine.
posted by Sara C. at 8:17 PM on October 31, 2014 [2 favorites]
When that happened, did you act as if you'd been immunized against the standard childhood stuff like measles, polio, diptheria, etc. or have all those immunizations done at the time?
A lot of the traditional childhood illnesses are still endemic in the developing world, and it's recommended that you get immunized before traveling there, if you haven't been previously. If you made up for your lack of childhood vaccinations when you traveled, you're probably fine.
posted by Sara C. at 8:17 PM on October 31, 2014 [2 favorites]
Getting a flu shot can help protect your "herd" right now.
posted by ThePinkSuperhero at 8:18 PM on October 31, 2014 [7 favorites]
posted by ThePinkSuperhero at 8:18 PM on October 31, 2014 [7 favorites]
The CDC has a page about that including schedules for what an un-immunized adult might need and a quiz for anyone partially immunized.
posted by Margalo Epps at 8:21 PM on October 31, 2014 [25 favorites]
posted by Margalo Epps at 8:21 PM on October 31, 2014 [25 favorites]
Re: Bartonlong's comment, there is no vaccine for hep c.
I'm pretty sure I got vaccinated for whooping cough a few years ago. This was very important to my doctor because I'm getting to the age where I'm more likely to be around babies and small children.
posted by kinddieserzeit at 8:22 PM on October 31, 2014
I'm pretty sure I got vaccinated for whooping cough a few years ago. This was very important to my doctor because I'm getting to the age where I'm more likely to be around babies and small children.
posted by kinddieserzeit at 8:22 PM on October 31, 2014
I had to get the following before I could get a green card. I had had them all done growing up but my mothers record keeping was dogdy to say the least so had no proof & had to get them all again. So these are the ones the US govt considers important to be covered for at least.
Mumps
Measles
Rubella
Polio
Tetanus and Diphtheria Toxoids
Pertussis (Whooping Cough)
They have since added.
Haemophilus influenzae type B
Hepatitis B
I'd also add yearly flu shots to the list, having had an elderly neighbour get hospitalised with it last winter.
posted by wwax at 8:25 PM on October 31, 2014 [2 favorites]
Mumps
Measles
Rubella
Polio
Tetanus and Diphtheria Toxoids
Pertussis (Whooping Cough)
They have since added.
Haemophilus influenzae type B
Hepatitis B
I'd also add yearly flu shots to the list, having had an elderly neighbour get hospitalised with it last winter.
posted by wwax at 8:25 PM on October 31, 2014 [2 favorites]
Yup, no vaccine for Hep C but there is for Heps B and A.
This is best asked of your gp with the additional information of what vaccines you've already had.
As the mother of an immune compromised person , I cannot thank you enough for this. It means the world to families like ours. It could save his life.
posted by taff at 8:27 PM on October 31, 2014 [33 favorites]
This is best asked of your gp with the additional information of what vaccines you've already had.
As the mother of an immune compromised person , I cannot thank you enough for this. It means the world to families like ours. It could save his life.
posted by taff at 8:27 PM on October 31, 2014 [33 favorites]
Get all of them. They are all important to protect younger people. That is why they were developed.
posted by Nevin at 8:36 PM on October 31, 2014 [2 favorites]
posted by Nevin at 8:36 PM on October 31, 2014 [2 favorites]
these are the ones the US govt considers important to be covered for at least.
They also checked your bits for STDs and assessed you for mental illnesses that are no longer in the DSM. The health criteria for immigration purposes were established a long time ago, and they're not necessarily what's considered medically appropriate now.
The CDC chart linked from Margalo Epps' comment is a better guide.
posted by holgate at 8:43 PM on October 31, 2014 [1 favorite]
They also checked your bits for STDs and assessed you for mental illnesses that are no longer in the DSM. The health criteria for immigration purposes were established a long time ago, and they're not necessarily what's considered medically appropriate now.
The CDC chart linked from Margalo Epps' comment is a better guide.
posted by holgate at 8:43 PM on October 31, 2014 [1 favorite]
Best answer: The only vaccine that I can think of that is given to children where it's not recommended for adults is the Hib vaccine (Hemophilus influenza b). Surprised to see it on the list of what's needed to get a green card, as healthy adults do not need it. Not because it's ineffective, because most adults have had Hib infection and have antibodies to it already.
Even for Hib, if you look at it from the herd's standpoint, it's better for you to be vaccinated - the herd includes small unvaccinated children who could die from being exposed to your Hib infection. There is no vaccine that only benefits you to receive it, because every vaccine protects you against an infectious disease that could be transmitted to others. If it's something you can catch, it's something you can pass on!
Even the HPV vaccine, which protects against cancer, could prevent you from passing on cancer-associated HPV (a virus) to others. I assume from your username that you may be female, but even if you are male, HPV vaccine can protect your future partners as well as you from cancers of the throat, anus, penis, and also genital warts. I'd like to add my thanks to you for getting vaccinated, both as a doctor and as a mother of one, soon to be two small children!
posted by treehorn+bunny at 9:41 PM on October 31, 2014 [9 favorites]
Even for Hib, if you look at it from the herd's standpoint, it's better for you to be vaccinated - the herd includes small unvaccinated children who could die from being exposed to your Hib infection. There is no vaccine that only benefits you to receive it, because every vaccine protects you against an infectious disease that could be transmitted to others. If it's something you can catch, it's something you can pass on!
Even the HPV vaccine, which protects against cancer, could prevent you from passing on cancer-associated HPV (a virus) to others. I assume from your username that you may be female, but even if you are male, HPV vaccine can protect your future partners as well as you from cancers of the throat, anus, penis, and also genital warts. I'd like to add my thanks to you for getting vaccinated, both as a doctor and as a mother of one, soon to be two small children!
posted by treehorn+bunny at 9:41 PM on October 31, 2014 [9 favorites]
Best answer: By the way, to elaborate on a few answers above, TdaP is given as a single vaccine that covers against tetanus, diphtheria, and pertussis (whooping cough). Considering that made me realize that I did make an inaccurate statement above - tetanus is a vaccine-preventable disease that isn't transmitted from person to person, tetanus is something you are exposed to in the environment. So tetanus vaccine will not help the herd, but given that pertussis/whooping cough is VERY important for the herd, and you'll get covered for all 3 together with TdaP, it doesn't really matter for the purposes of your question.
posted by treehorn+bunny at 9:45 PM on October 31, 2014 [1 favorite]
posted by treehorn+bunny at 9:45 PM on October 31, 2014 [1 favorite]
Response by poster: Thanks for all the answers so far!
I'd like to emphasize the specificity of the question -- I'm aware of the generally advised course of vaccinations for an unvaccinated adult. I'm narrowing from that list, to vaccines that are necessary for the health of others. Example: I don't have HPV, and based on the types of sex I choose to have, I'm not concerned about getting it. There's not potential for me to do harm to babies, elderly people, or immunocompromised people by not getting vaccinated.
I've been vaccinated for typhoid, tetanus, and Hep A/B for travel. It seems like there's consensus that I'll need an MMR.
A couple specific questions:
There seems to be limited research and a lack of consensus on the effectiveness of a pertussis vaccine in adults. The booster is clearly effective, but there's doubt about effectiveness with no prior vaccination. In addition, effectiveness has been estimated to last three years, which makes it seem potentially not worth it. Can someone give me more information about this?
Hib -- Please correct me if I'm wrong, it seems like if I already have an Hib infection, the vaccine will not cure me of it, and I'll still have the potential to transmit it. Is that right?
Is diphtheria actually relevant in the United States, or simply packaged in with tetanus?
As far as I can tell, CDC doesn't recommend varicella (chicken pox) if you've had the disease as a child, which I did. My own immunity aside, would getting the vaccine mean that I would be further less likely to infect another person?
posted by femmegrrr at 9:54 PM on October 31, 2014
I'd like to emphasize the specificity of the question -- I'm aware of the generally advised course of vaccinations for an unvaccinated adult. I'm narrowing from that list, to vaccines that are necessary for the health of others. Example: I don't have HPV, and based on the types of sex I choose to have, I'm not concerned about getting it. There's not potential for me to do harm to babies, elderly people, or immunocompromised people by not getting vaccinated.
I've been vaccinated for typhoid, tetanus, and Hep A/B for travel. It seems like there's consensus that I'll need an MMR.
A couple specific questions:
There seems to be limited research and a lack of consensus on the effectiveness of a pertussis vaccine in adults. The booster is clearly effective, but there's doubt about effectiveness with no prior vaccination. In addition, effectiveness has been estimated to last three years, which makes it seem potentially not worth it. Can someone give me more information about this?
Hib -- Please correct me if I'm wrong, it seems like if I already have an Hib infection, the vaccine will not cure me of it, and I'll still have the potential to transmit it. Is that right?
Is diphtheria actually relevant in the United States, or simply packaged in with tetanus?
As far as I can tell, CDC doesn't recommend varicella (chicken pox) if you've had the disease as a child, which I did. My own immunity aside, would getting the vaccine mean that I would be further less likely to infect another person?
posted by femmegrrr at 9:54 PM on October 31, 2014
Best answer: You don't need the chicken pox vaccine if you had chicken pox as a child. When you're 50 or so, you will want to start talking to your doctor about shingles boosters.
You need to get the TDaP. Pertussis sucks for you, but it kills infants and the elderly. You cough on a teenager at Starbucks, they go home and cough on an infant sibling. It's been locally epidemic in many states the past decade and people who get it can cough their ribs broken.
This is really a question for your doctor.
posted by Eyebrows McGee at 10:27 PM on October 31, 2014 [7 favorites]
You need to get the TDaP. Pertussis sucks for you, but it kills infants and the elderly. You cough on a teenager at Starbucks, they go home and cough on an infant sibling. It's been locally epidemic in many states the past decade and people who get it can cough their ribs broken.
This is really a question for your doctor.
posted by Eyebrows McGee at 10:27 PM on October 31, 2014 [7 favorites]
Is diphtheria actually relevant in the United States, or simply packaged in with tetanus?
it is in animals, I lost a cat to it. I don't know how transmittable it is between species but it is not really common in humans but it is around.
posted by bartonlong at 11:18 PM on October 31, 2014
it is in animals, I lost a cat to it. I don't know how transmittable it is between species but it is not really common in humans but it is around.
posted by bartonlong at 11:18 PM on October 31, 2014
Best answer: I'm aware of the generally advised course of vaccinations for an unvaccinated adult. I'm narrowing from that list, to vaccines that are necessary for the health of others. Example: I don't have HPV, and based on the types of sex I choose to have, I'm not concerned about getting it. There's not potential for me to do harm to babies, elderly people, or immunocompromised people by not getting vaccinated.
If you never have vaginal, anal, or oral sex (or you have them monogamously with the same partner who you expect to be with indefinitely), then you're right, you probably aren't at risk for contracting or transmitting HPV and you don't need the vaccine - but there was no way for us to know that from your question, and HPV vaccine IS important for the health of others (babies and the elderly aren't the only ones whose health is important, right?).
There seems to be limited research and a lack of consensus on the effectiveness of a pertussis vaccine in adults. The booster is clearly effective, but there's doubt about effectiveness with no prior vaccination. In addition, effectiveness has been estimated to last three years, which makes it seem potentially not worth it. Can someone give me more information about this?
I'm not sure where this information on pertussis comes from, but here is a major article from the New England Journal of Medicine that concludes "The acellular pertussis vaccine was protective among adolescents and adults, and its routine use might reduce the overall disease burden and transmission to children." This study evaluates duration of protection for the pertussis vaccine in adults and finds that at 3 years post-vaccination, 90% of adults appeared to still have protection against pertussis. I haven't been able to find any recent literature on PubMed regarding duration of protection with pertussis vaccine specifically for adults who were not previously vaccinated, so if you could point to the study you're referencing, I'm happy to critique it.
Is diphtheria actually relevant in the United States, or simply packaged in with tetanus?
I'm not sure what defines relevance for you, but it does occur in the United States, and therefore has the potential for outbreaks as vaccine coverage wanes.
From 1980 through 2004, 57 cases of diphtheria were reported in the United States, an average of 2 or 3 per year (range, 0–5 cases per year). Only 5 cases have been reported since 2000.
Of 53 reported cases with known patient age since 1980, 31 (58%) were in persons 20 years of age or older; 44% of cases were among persons 40 years of age or older. Most cases have occurred in unimmunized or inadequately immunized persons.
Hib -- Please correct me if I'm wrong, it seems like if I already have an Hib infection, the vaccine will not cure me of it, and I'll still have the potential to transmit it. Is that right?
Do you mean if you have ever had a Hib infection, or if you have a current Hib infection?
Serious Hib infections include meningitis, cellulitis or epiglottitis. If you had one of these infections, you would be treated with antibiotics. If you just have antibodies from having had a Hib infection sometime in the past, you will not transmit Hib disease.
As far as I can tell, CDC doesn't recommend varicella (chicken pox) if you've had the disease as a child, which I did. My own immunity aside, would getting the vaccine mean that I would be further less likely to infect another person?
Without an active varicella infection, you will not infect others. At some point in the future, your varicella could be reactivated and cause shingles, or herpes zoster. This is why the zoster vaccine is recommended for older adults. If you did develop herpes zoster, at that time you would be able to infect others with chickenpox, which is particularly dangerous for babies, the immunocompromised, and pregnant women who have never had chickenpox or the vaccine.
I hope that is helpful. As others have noted, your physician can likely answer these questions in a way that will take your personal history and risks into account.
posted by treehorn+bunny at 11:34 PM on October 31, 2014 [12 favorites]
If you never have vaginal, anal, or oral sex (or you have them monogamously with the same partner who you expect to be with indefinitely), then you're right, you probably aren't at risk for contracting or transmitting HPV and you don't need the vaccine - but there was no way for us to know that from your question, and HPV vaccine IS important for the health of others (babies and the elderly aren't the only ones whose health is important, right?).
There seems to be limited research and a lack of consensus on the effectiveness of a pertussis vaccine in adults. The booster is clearly effective, but there's doubt about effectiveness with no prior vaccination. In addition, effectiveness has been estimated to last three years, which makes it seem potentially not worth it. Can someone give me more information about this?
I'm not sure where this information on pertussis comes from, but here is a major article from the New England Journal of Medicine that concludes "The acellular pertussis vaccine was protective among adolescents and adults, and its routine use might reduce the overall disease burden and transmission to children." This study evaluates duration of protection for the pertussis vaccine in adults and finds that at 3 years post-vaccination, 90% of adults appeared to still have protection against pertussis. I haven't been able to find any recent literature on PubMed regarding duration of protection with pertussis vaccine specifically for adults who were not previously vaccinated, so if you could point to the study you're referencing, I'm happy to critique it.
Is diphtheria actually relevant in the United States, or simply packaged in with tetanus?
I'm not sure what defines relevance for you, but it does occur in the United States, and therefore has the potential for outbreaks as vaccine coverage wanes.
From 1980 through 2004, 57 cases of diphtheria were reported in the United States, an average of 2 or 3 per year (range, 0–5 cases per year). Only 5 cases have been reported since 2000.
Of 53 reported cases with known patient age since 1980, 31 (58%) were in persons 20 years of age or older; 44% of cases were among persons 40 years of age or older. Most cases have occurred in unimmunized or inadequately immunized persons.
Hib -- Please correct me if I'm wrong, it seems like if I already have an Hib infection, the vaccine will not cure me of it, and I'll still have the potential to transmit it. Is that right?
Do you mean if you have ever had a Hib infection, or if you have a current Hib infection?
Serious Hib infections include meningitis, cellulitis or epiglottitis. If you had one of these infections, you would be treated with antibiotics. If you just have antibodies from having had a Hib infection sometime in the past, you will not transmit Hib disease.
As far as I can tell, CDC doesn't recommend varicella (chicken pox) if you've had the disease as a child, which I did. My own immunity aside, would getting the vaccine mean that I would be further less likely to infect another person?
Without an active varicella infection, you will not infect others. At some point in the future, your varicella could be reactivated and cause shingles, or herpes zoster. This is why the zoster vaccine is recommended for older adults. If you did develop herpes zoster, at that time you would be able to infect others with chickenpox, which is particularly dangerous for babies, the immunocompromised, and pregnant women who have never had chickenpox or the vaccine.
I hope that is helpful. As others have noted, your physician can likely answer these questions in a way that will take your personal history and risks into account.
posted by treehorn+bunny at 11:34 PM on October 31, 2014 [12 favorites]
I would also like to add that even if pertussis vaccination only conferred immunity for 3 years, I'd gladly get it every 3 years to prevent the spread of pertussis. Pertussis is a terrible disease that kills babies and there have been many outbreaks lately meaning that many babies are at risk (nearly 50,000 cases in 2012, and it's been in all 50 states already this year - and that's the reported cases alone!)... I'd get it every year if I had to. But, fortunately it is only recommended for one single dose for adults.
posted by treehorn+bunny at 11:39 PM on October 31, 2014 [3 favorites]
posted by treehorn+bunny at 11:39 PM on October 31, 2014 [3 favorites]
Best answer: You can have a blood test called a titer to confirm that your childhood varicella infection conferred immunity that is still active. I work in a healthcare setting with immunocompromised patients and my vaccination requirements were that I have the varicella vaccine or a positive titer.
posted by telegraph at 4:18 AM on November 1, 2014 [3 favorites]
posted by telegraph at 4:18 AM on November 1, 2014 [3 favorites]
Best answer: I would focus on the MMR because they are communicable enough and vaccination rates are high enough that herd immunity is relevant. Herd immunity doesn't really kick in for the flu shot, for example, because vaccination rates are so low; I suspect the same is true of pertussis at this point (until recently adults were virtually never vaccinated for it, and childhood immunity usually ran out around 15). I wouldn't bother with polio because it's almost eradicated. I wouldn't bother with diseases that are harder to transmit unless your lifestyle makes it likely you would pass them on to other people.
posted by metasarah at 11:09 AM on November 1, 2014
posted by metasarah at 11:09 AM on November 1, 2014
Also your can lose immunity for vaccines you already have so titers aren't a bad idea. Had chicken pox as a kid but needed the vaccination as an adult. Also needed a booster of something many people dont need boosters for but I forgot what it was now.
posted by AlexiaSky at 12:59 PM on November 1, 2014
posted by AlexiaSky at 12:59 PM on November 1, 2014
Best answer: Please, please, please vaccinate against pertussis. In adults, you can not even realize you have it, just thinking that you have a bad cold -- which will mean that you won't take the steps necessary to protect others. I was vaccinated as an adult despite never having had the vaccine as a child and I still have antibodies 8 years later. It is a devastating illness for young children.
posted by KathrynT at 1:05 PM on November 1, 2014
posted by KathrynT at 1:05 PM on November 1, 2014
Nthing the pertussis vaccination. I had it as an adult last year, and was in bed for 6 months thanks to complications. And I WAS vaccinated as a child. I can only imagine how horriffic it would be to have pertussis as a child or an elderly person.
posted by The Almighty Mommy Goddess at 1:29 PM on November 1, 2014
posted by The Almighty Mommy Goddess at 1:29 PM on November 1, 2014
I wouldn't bother with polio because it's almost eradicated.
My perspective is different - I see disease anywhere in the world as a threat to us all, in today's interconnected world. Polio, like Ebola, is only a plane flight away. Complacency leads to outbreaks. In May 2014, the WHO declared a global health emergency as wild poliovirus spread from Pakistan to Afghanistan, from Syria to Iraq, and from Cameroon to Equatorial Guinea. An additional 4 countries (Somalia, Nigeria, Ethiopia, Israel) continued to report ongoing cases of polio but had not spread it to other nations. Anyone who thinks "that may be happening there, but it won't happen here" hasn't been watching the news lately.
My opinion might also be affected by the fact that both my grandparents had polio during an outbreak when my mother was 2 years old. My grandmother suffered post-polio syndrome for the rest of her life after losing her second child while in an iron lung. So unless polio is someday eradicated (and I hope I will see it happen someday), I would never forgive myself if I didn't get vaccinated against the disease that took my grandmother's ability to dance away, and almost took her life. /anecdote
posted by treehorn+bunny at 6:54 PM on November 1, 2014 [1 favorite]
My perspective is different - I see disease anywhere in the world as a threat to us all, in today's interconnected world. Polio, like Ebola, is only a plane flight away. Complacency leads to outbreaks. In May 2014, the WHO declared a global health emergency as wild poliovirus spread from Pakistan to Afghanistan, from Syria to Iraq, and from Cameroon to Equatorial Guinea. An additional 4 countries (Somalia, Nigeria, Ethiopia, Israel) continued to report ongoing cases of polio but had not spread it to other nations. Anyone who thinks "that may be happening there, but it won't happen here" hasn't been watching the news lately.
My opinion might also be affected by the fact that both my grandparents had polio during an outbreak when my mother was 2 years old. My grandmother suffered post-polio syndrome for the rest of her life after losing her second child while in an iron lung. So unless polio is someday eradicated (and I hope I will see it happen someday), I would never forgive myself if I didn't get vaccinated against the disease that took my grandmother's ability to dance away, and almost took her life. /anecdote
posted by treehorn+bunny at 6:54 PM on November 1, 2014 [1 favorite]
This thread is closed to new comments.
Hep A,B,C (these takes multiple vaccines). Usually are only really a problem if you are in contact with human waste/fluids.(i am a public works engineer and come into contact with sewage every so often, and run across needles doing it, so...)
Chicken Pox. Turns out lifetime immunity from a childhood episode isn't for some people...and it is life threatening as an adult.
Going by your name, HPV (although there is starting to be some evidence about benefits to males as well).
posted by bartonlong at 8:17 PM on October 31, 2014 [1 favorite]