Long before vaccines existed, Benjamin Franklin said, “An ounce of prevention is worth a pound of cure.” This statement has as much validity now as it did then. Despite all of the treatments that have been developed in the modern medical era, there is no question but that preventing illness, when possible, is a considerably better strategy than treating illness.

In the text that follows I will discuss some illnesses that can be prevented by timely vaccination. I will not discuss foreign travel–related illnesses that can be prevented by vaccination, since this is an entire topic unto itself. Instead, I will focus on infectious diseases that you are at risk of acquiring right here at home. My hope is that you will learn something about these illnesses and the vaccines that prevent them, so that you can have an intelligent discussion with your doctor and ultimately decide if vaccination is the right choice for you.

Influenza Vaccine

The influenza virus causes an illness characterized by the abrupt onset of malaise, fever, headache, muscle aches, sore throat, runny nose, and cough. Although most patients with influenza will recover within a week, complications (including death) can occur in some patients, particularly in the elderly, patients with a weakened immune system, patients with heart or lung disease, and pregnant women.

Although the influenza vaccine is most beneficial for these patients at high risk, studies have demonstrated clear advantages of vaccinating young, healthy adults. For this reason, the current recommendation from the Centers for Disease Control (CDC) is that all adults (including pregnant women) receive the influenza vaccine yearly prior to the flu season (i.e. in the fall).

Possible side effects of influenza vaccination include soreness at the injection site and low-grade fever. Despite what you may have heard, it is not possible to get the flu from the flu vaccine. Influenza vaccine should be used cautiously in patients who are allergic to eggs. For patients who do not like to receive injections, a nasal vaccine exists as an alternative, but there are certain restrictions on who can receive the nasal vaccine, because it is a live vaccine.

Vaccines Protecting Against Tetanus, Diphtheria, Pertussis

Tetanus is a rare but severe infection that can be acquired following injury when a wound is contaminated, such as when someone steps on a rusty nail. It causes painful muscle spasms, including spasms of the muscles of the jaw (“lockjaw”).  Diphtheria is a very rare infection of the throat. Pertussis, or “whooping cough,” is a highly contagious disease that can cause a persistent cough in adults, but can be fatal in infants. All three of these illnesses can be prevented by vaccination.

Every woman should receive the dT (diphtheria, tetanus) vaccine every 10 years and a dTP (diphtheria, tetanus, pertussis) vaccine should be given once for adults under 65 years of age who have not received dTP previously. By vaccinating caregivers (mothers, grandmothers) of infants with the dTP vaccine, infants can be protected. Anyone who develops a wound from a cut or a scrape of the skin should get a tetanus shot if he or she has not had one in the past 10 years. Common and frequent side effects of the vaccine includes tenderness, pain, redness, and swelling at the site of injection that can last for a few days.

Varicella

Varicella is the cause of chickenpox. Most women in the United States have already had chickenpox and are therefore immune, so they cannot get chickenpox again. For the few women who have not had chickenpox, the varicella vaccine, which is administered as two doses given four to eight weeks apart, can provide immunity. Women who work with children (such as teachers) and women who are healthcare workers should receive the vaccine if they are not immune. For women who are not sure if they have had chickenpox, a simple blood test can determine whether or not they are immune.  It is important to immunize women who are at risk of this disease, because chickenpox is a much more severe illness in adults than in children, particularly in women who are pregnant. The vaccine is made from a live but weakened virus, so it should not be given to pregnant women (it should be given before they get pregnant) or women who have a weakened immune system. A common side effect is a rash, which can resemble chickenpox that can occur at the site of injection or elsewhere.

Hepatitis A

Hepatitis A is a virus that causes infection and inflammation of the liver. Patients with hepatitis A will typically have fever, aches, nausea, abdominal pain, and jaundice (which means that the skin and the whites of the eyes can turn yellow). Although there is no treatment, the illness generally resolves on its own after several weeks.

Hepatitis A is acquired by ingesting contaminated food or water. Hepatitis A exists in the United States, but is much more common in Third World countries. Any woman who travels to areas of the world where Hepatitis A is common, women who are exposed to Hepatitis A, and women who seek protection from this virus should be vaccinated. The vaccine is given as two doses, the second of which is given six to twelve months after the first. The vaccine is generally well tolerated, but soreness at the injection site and low-grade fever may develop.

Photo: USA Today

Hepatitis B

Hepatitis B is another virus that causes infection and inflammation of the liver.  Patients have similar symptoms as patients with Hepatitis A. However, whereas Hepatitis A almost always resolves spontaneously, some patients with Hepatitis B can develop a chronic or ongoing infection that can cause continued liver damage. Hepatitis B is acquired via sexual contact or exposure to blood or bodily fluids of someone with the disease.

The Hepatitis B vaccine is now generally given to all children in this country and should be given to women who are at risk of Hepatitis B due to potential sexual exposure, blood exposure (eg., health care workers), or women who are seeking protection from Hepatitis B. The vaccine is given as three doses; the second dose is given one month after the first, and the last (third) dose is given six months after the first. The vaccine is generally well tolerated, but local pain and redness, as well as low-grade fever, may occur.

Shingles

Zoster (also known as “shingles”) is caused by the same virus that causes chickenpox. It occurs when the chickenpox virus reactivates, or “wakes up,” after spending years in a dormant or quiet state. Shingles causes a rash that can occur anywhere on the body, but this rash affects only one side of the body (left or right). Because both skin and nerves are infected, patients experience some pain, which can be quite severe. Unfortunately, pain can persist even after the rash of shingles has resolved.  Shingles is more common in older individuals.  Indeed, the varicella vaccine was originally approved for patients 60 years of age or older who had had chickenpox, but the vaccine can now be given to patients who are 50 years of age or older who had had chickenpox. The vaccine cuts the risk of getting shingles by about half, but lowers the risk of the pain that can follow an infection by about two-thirds.

The vaccine is administered as a one-time dose, but, since it is a live vaccine, it cannot be given to patients with a weakened immune system (such as patients with cancer or patients who take drugs that weaken the immune system). Redness, pain, tenderness, and warmth at the site of injection are common, but more severe reactions can occur. [For Dr. Kendler’s recent, and more extensive, article on the shingles vaccine, see “Should I Get the Shingles Vaccine?” ]

Pneumococcal Vaccine

Streptococcus pneumoniae is the name of a bacterium that is the most common cause of bacterial pneumonia, a lung infection.  Patients with pneumonia may complain of fever, cough, chest pain, or shortness of breath. The same bacterium can also cause other infections, including sinus infections, ear infections, and meningitis. All women who are 65 years of age or older should receive a single dose of the pneumococcal vaccine. Women with other medical conditions, including diabetes, lung disease, and heart disease should receive the vaccine prior to age 65.

The vaccine commonly causes pain, redness, and swelling at the site, but other side effects, including fever, may occur.

My hope is that you are now better informed and can have a educated discussion with your doctor about vaccination for influenza, diphtheria/tetanus/pertussis, varicella, viral hepatitis, shingles, and pneumonia.  Although side effects are always a concern, please realize that most of these vaccines are very well tolerated and the benefit outweighs the small risk involved. Remember that prevention is better than cure! Stay healthy.

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