Immunization Awareness: How common is it for adults to "get their shots"?

Patient Expert

National Immunization Awareness Month (NIAM) is a "good time to promote back to school immunizations, remind college students to catch up on immunizations before they move into dormitories, and remind everyone that the influenza season is a few months away. It's a great reminder to our nation that people of all ages require timely immunization to protect their health," says the Center for Disease Control and Prevention (CDC).

Although this is a good time to start thinking about getting the flu vaccine in September or October, that is not the focus of this post.   Instead it is about learning from the experiences of others.

Vaccines are not something which I thought much about until after I was diagnosed with chronic disease.   There are a number of diseases which can be prevented through adult diseases, including diphtheria, shingles (herpes zoster), influenza, pneumonia (pneumococcus), tetanus (lockjaw), pertussis, hepatitis A and B, human papillomavirus (HPV), and more.   But before we all run out and ask the doc to shoot us up with all these vaccines, we should evaluate how these shots might impact our lives, positively or negatively.

One reason I have chosen to receive annual flu vaccines and the pneumonia vaccine is because of the serious trouble these diseases would cause in my life as an MS patient.   Getting sick puts me out of commission for weeks     But the vaccine experience is not always easy.   If you haven't already, I recommend you read Leslie's story of how an improperly given vaccine caused her serious illness (cellulitis) on top of living with RA and lupus.

Is a specific vaccine contraindicated with my disease or current treatment?Am I at increased risk of developing a disease if I don't get vaccinated at some point?How do I time the vaccines so that I receive the greatest benefit?Should I avoid "live" vaccines?

These questions are ones which should be discussed with our physicians while we conduct our own research.   If we are lucky, we will have a doctor who is proactive and thinks of these questions and answers them before we've even asked.

When I was a child, I received all of the recommended vaccines which were available.   I even received the smallpox vaccine although it was not available to my brother who is four years younger than I.   Recommendations change, availability fluctuates, and getting vaccines is not something set in stone, I have learned.

When I was diagnosed with rheumatoid arthritis, my rheumatologist ran extra bloodwork to test my resistance or immunity to several diseases.   She recommended that I receive the DTaP vaccine (diphtheria, tetanus, pertussis) before starting methotrexate.   I was almost due for a tetanus shot anyway so the timing was good.   Tetanus vaccines are recommended every ten years, and at least once, adults should received the DTaP combo vaccine instead of the single tetanus shot.

Just before I started Rituxan, my rheumatologist wanted me to get both the annual flu vaccine and the separate H1N1 vaccine (which was only available to high priority persons at the time).   This was easily done; maybe I developed a few sniffles afterwards, but nothing serious.   I have never had a severe reaction to any vaccine, and certainly never one as serious as the one Leslie shared with us.

But since I know that my experience is just that of one person and Leslie's experience is   another, I wanted to know what other people's experiences have been.   So I posted a brief survey to learn a little bit more about adults living with or without chronic disease and their experience with vaccines.   Thirty-seven people responded.

Here are the questions and a summary of responses:

1. Did you receive the standard CDC-recommended childhood vaccines?

  • Thirty-five respondents (94.6%) indicated "Yes" or that they had received what was available at the time.   One respondent said "No" and one respondent said "I don't know."

2. Have your children received the standard vaccines?

  • Nineteen respondents (51.3%) indicated "Yes." Two respondents (5.4%) indicated "No." Fifteen respondents (40.5%) have no children and one person skipped this question.   So of the persons with children, nineteen (90.5%) had their children fully vaccinated.

3. Do you have a chronic or autoimmune disease?

  • Four respondents (10.8%) either skipped this question or indicated that they did not have a chronic disease.   The remaining 33 respondents report having 45 diseases collectively: multiple sclerosis (27), rheumatoid arthritis (8), lupus (4), mixed connective tissue disease and/or scleroderma (2), psoriatic arthritis (1), heart disease (1), lung disease (1), chronic thrush (1).   The co-morbidities included MS and RA (4), lupus and MCTD (2), MS and lupus (2), RA and lupus (1), MS and heart disease (1), MS and chronic thrush (1), and scleroderma and lung disease (1).

4. Have you received any vaccines as an adult?

  • Thirty-three respondents (89.2%) report having had ANY vaccine as an adult.   Two respondents (5.4%) have had NO adult vaccines and two respondents skipped this question.

5. Are you immunosuppressed or do you take immune-suppressing medications?

  • Seventeen respondents (45.9%) answered "Yes" while seventeen respondents (45.9%) answered "No."   One person skipped this question.   However, the medications cited by two respondents are not immune-suppressing, thus there may be confusion as to which disease-modifying drugs are immune-suppressing (ie. methotrexate, rituxan, humira, cytoxan) and which are immune-modulating (ie copaxone, rebif).

6. Have you ever had a severe reaction to any vaccine as an adult?

  • Thirty respondents (81%) answered "No."   Six respondents (16.2%) answered "Yes" and one answered "I don't know."   Two of the severe reactions involved triggering optic neuritis or an MS relapse and one reaction involved a serious case of cellulitis.

7. Do you get an annual flu vaccine?

Twenty-one respondents (56.8%) answered "Yes."   Sixteen respondents (43.2%) answered "No."

8. Have you had any of the following vaccines as an adult? (choose all that apply)

  • Influenza with or without H1N1 = 28
  • Diphtheria, tetanus, pertussis (DTaP) = 18
  • Pneumonia vaccine = 12
  • Hepatitis A or B = 10
  • Tetanus alone = 5
  • Chickenpox = 2
  • Shingles = 1
  • Four respondents skipped this question or answered "No."

9. If you take disease-modifying drugs, did your doctor recommend adult vaccines? If so, when? (I was most interested in the responses to this question.)

  • Five people chose the response - "I have not received any adult vaccines besides an annual influenza shot."
  • Three people chose the response - "I received updated vaccines (eg. DTaP, pneumonia, hepatitis) before starting disease-modifying therapy."
  • One respondent replied, "I'll consult with the docs when it's time for the next DTaP, but will skip other vaccines."
  • One respondent replied, "Doctor said nothing about adult vaccines at all, and this was before starting Avonex and later Copaxone."
  • One respondent replied, "I chose to get the pneumo shot on my own and the flu shot on my own. My doctor did not advise one way or the other on vaccinations."
  • Nine people chose the response - "I received vaccines (other than influenza) after starting disease-modifying therapy"
  • Five people chose the response - "I do not plan to receive any more vaccines as an adult. If not, please explain below."
  • Five people chose the response - "I have not received any adult vaccines besides an annual influenza shot."

Deciding whether to get vaccinated is a complicated matter when you live with chronic disease (see contraindications for specific vaccines).   Always discuss options with your doctor.   And if you have a negative experience with any vaccination, you should contact the Vaccine Adverse Event Reporting System.