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Did you know that adults, not children, incur a greater risk of death due to vaccine-preventable diseases? The tremendous success of childhood immunization has rendered diseases such as polio and measles "invisible" and fostered the perception that vaccination beyond childhood is no longer necessary. While most responsible moms reading this column have addressed their children's vaccination needs, they personally may be susceptible to illness, because over the past 20 years, the United States has not had a comprehensive adult vaccination program. Do you know what your needs are? Read on to learn more about if you have achieved all of the benefits of vaccination. Why bother? The reasons are many. For women who are pregnant or planning to conceive, benefits will extend to your newborn child through the first 4 to 6 months of life. For all women, especially those with coexisting chronic diseases, immunization stands to reduce death rates and serious complications. What are some of the sobering facts? Only 54 percent of elderly patients get immunized against pneumonia, and unfortunately the mortality rate of pneumonia in persons ages 70 or older is 55 percent. The one-time pneumococcal vaccine should be given to all adults over 65 years of age and all persons with chronic illnesses who are under 65 years of age. Smokers are especially at high risk of contracting pneumonia and so are persons receiving chemotherapy or those who are immunosuppressed, such as people on steroid medications. Influenza, on the other hand, is more likely to cause death in middle-aged persons; it causes approximately 20,000 deaths each year. This inactivated vaccine should be dosed each year during flu season to anyone who wishes to reduce the chance of becoming ill with the flu. Despite the availability of the vaccine, during flu season, almost half of the hospitalizations and deaths for cardiopulmonary conditions in healthy pregnant women are due to influenza. Influenza vaccine is recommended for women who will be in the second or third trimester of pregnancy during influenza season (December through March). This raises some important issues about a very important population of women - those who are pregnant or planning a pregnancy. See your doctor first. A key moment in life Women who intend to become pregnant should have documentation of immunity to tetanus, diphtheria, measles, mumps, rubella and varicella. A history of chicken pox is considered adequate evidence of varicella immunity. A tetanus/diphtheria booster is needed every 10 years. Hepatitis B immunity is also recommended for women with occupational or behavioral risk factors for hepatitis B virus infection. This includes household contacts and sexual partners of hepatitis B virus carriers, women with more than one sexual partner in the last six months, patients with other sexually transmitted diseases, international travelers and patients who work in the health-care field. Live virus vaccines (MMR and varicella) should not be given to a woman known to be pregnant or planning to become pregnant in the next month. Adult tetanus-diphtheria toxoids and other inactivated vaccines such as hepatitis B, hepatitis A, influenza, and polio may be administered to pregnant women if indicated. The benefits of immunization to the pregnant woman and her newborn usually outweigh the theoretic risks of adverse effects. This is especially true when the likelihood of exposure to disease is high, infection would pose a risk to the mother or fetus, and the vaccine is unlikely to cause illness or injury. A main reason behind underimmunization is disproportionate media attention to adverse reactions, which discourages people from getting vaccinated. Your physician will identify contraindications to vaccination. Anaphylaxis with a previous vaccination is a main reason not to undergo immunization. Egg allergy is a contraindication for influenza, measles, mumps and yellow-fever vaccines. Neomycin or streptomycin allergy is a contraindication for MMR vaccine. Also, immunosuppression is a problem for live virus vaccines. Why are so many women not up to date with their vaccines? Ask questions at your next office visit. Dr. Lisa M. Karamardian is a board-certified OB/GYN and fellow of the American College of Obstetricians and Gynecologists. A frequent speaker in the community, she also serves as medical adviser for Contemporary Nutrition. She lives in Newport Beach with her husband and two sons. She can be reached at 949.644.2722. |
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