Most of us will receive the majority of our vaccinations in childhood. But Australian adults still die and become disabled from vaccine-preventable diseases. Immunisations are therefore an important preventive health measure at all stages of life.
So, when might adults need to be immunised?
Some adults are not up-to-date with today’s vaccine recommendations. This can be for a number of reasons, such as having missed vaccine doses that were recommended during childhood or booster doses during adolescence.
In some cases, the immunisation schedule has changed which means adults didn’t have the opportunity to get vaccines as part of a childhood program. Measles, mumps and rubella (MMR) vaccination is a good example of this.
Two doses of MMR vaccine are now recommended to get maximum protection. However, many adults born after 1966 (when these viruses have no longer been circulating at high levels) grew up when only one dose of MMR vaccine was recommended.
Even though catch-up vaccination campaigns for the second dose of MMR vaccine were rolled out in the late 1990s and early 2000s, many adolescents and young adults still missed out. It’s among this young adult age group where we now see high number of measles cases, often acquired during overseas travel.
Other vaccinations which are routinely recommended during childhood today, for diseases against which adults may not be adequately protected, include diphtheria, tetanus, pertussis (whooping cough), varicella (chicken pox) and hepatitis B.
Adults may not always have documentation of what vaccines they have previously received. For some vaccines, such as measles and hepatitis B, a blood test can be done to check for immunity if this information is not available. But in most instances, the best approach is the give the required vaccines.
With the exception of Q-fever vaccine, there are no safety concerns with giving vaccines to an adult who is already immune.
Based on the best available scientific evidence, government health bodies recommend and fund a number of routine vaccinations for adults via the National Immunisation Program (NIP).
Influenza and pneumococcal disease pose a high risk to the elderly; vaccines against these two diseases are recommended and funded for Australians 65 years or older under the NIP. Even so, the number of older Australians who are vaccinated against them is less than optimal.
Importantly, some adults younger than 65 years are also at greater risk of severe influenza and pneumococcal disease than the general population and are eligible for these free vaccines under the NIP. This includes Aboriginal and Torres Strait Islander adults, who are three- to six-times more likely to be hospitalised with influenza than non-indigenous peers.
Invasive pneumococcal disease is also more common in Indigenous than non-indigenous adults.
Adults with certain medical conditions, such as chronic heart and lung disease and immune-compromising conditions, among others, are also eligible for NIP-funded influenza and pneumococcal vaccine.
Discussing any current or anticipated medical conditions or treatments with your doctor is the best way to make sure you get these important, free vaccines. It may also help identify a need for other vaccines which are recommended for adults with certain medical conditions that are not fully funded on the NIP.
Some additional vaccines that aren’t funded on the NIP are also recommended for elderly Australians and can be accessed with a prescription. The herpes zoster vaccine, for instance, protects against shingles, which is more common in older age.
Planning pregnancy is an important time for women and those around her to review their vaccination needs.
A pre-pregnancy check for immunity to rubella (german measles) and varicella (chicken pox) is essential to allow time for vaccination, if required. Both of these viruses can cause severe disease in the unborn child if infection occurs when a woman is pregnant.
All family members should have their immunity to pertussis reviewed before a new baby arrives to reduce the chance of passing the infection on. The highest rates of hospitalisation and death from pertussis are in infants less than six months of age, who are not yet completely vaccinated.
Expectant or new mothers can receive pertussis vaccine either when planning pregnancy, in the third trimester of pregnancy, or as soon as possible after giving birth.
Influenza vaccine is strongly recommended for women who are pregnant and freely available under the NIP. Influenza infection during pregnancy poses a risk to the pregnant women and their unborn child.
Many clinical studies have shown that influenza vaccine during pregnancy protects the pregnant women and also her infant up to six months of age through the transfer of the mother’s antibodies across the placenta.
There are a number of health and lifestyle factors that can increase a person’s risk from vaccine-preventable diseases. Some examples include smoking (pneumococcal disease), drug use (hepatitis A and B) , sexual preferences (hepatitis A and B, and human papillomavirus), certain occupations (hepatitis B and influenza, among others) and, of course, travel.
Summaries of the recommended vaccines for these different risk factors are available on National Centre for Immunisation Research and Surveillance website.
Unlike children, adults don’t often have regular “health-checks” so it’s important for adults to be aware of any changes in their circumstances which may change their risk of illness and in turn their immunisation needs.
Many immunisation providers, including GPs, hospitals and other specialist health services, Aboriginal Medical Services and travel vaccination clinics can provide specific advice on and administer vaccinations for adults.
A great acronym to keep in mind for adults when thinking of immunisation needs is H-A-L-O (health, age, lifestyle and occupation). Reviewing these factors can be a good trigger for discussions on any vaccine needs that might otherwise be forgotten. After all, an ounce of prevention is better than a pound of cure.
Melina Georgousakis, Senior Research Officer, National Centre for Immunisation Research and Surveillance, University of Sydney and Kristine Macartney, Associate Professor, Discipline of Paediatrics and Child Health, University of Sydney