Vaccinations that are important any time of the year

The vaccine on everyone’s mind right now is the one that pharmaceutical companies are racing to develop for COVID-19 protection. But even during a pandemic, it’s important to remember that we already have a lot of very effective vaccines – for children and adults - that should be considered.

For months now, parents may have hesitated about bringing their children to see their pediatrician, which means many children have fallen behind in their vaccination schedule. Pediatricians like Kenneth Colmer, MD, of Bass River Pediatric Associates, have been assuring parents that it is safe to come in, especially since vaccinations are so important.

“We’re trying to get the young kids in to keep their vaccines on schedule and not have them fall behind,” he said. 

Children aren’t the only ones who need vaccinations. In addition to the yearly flu shot, which the CDC is saying will be more important than ever this year because of the coronavirus, adults need booster shots for some of the most common childhood vaccinations. The CDC guidelines for vaccinations are a good source to see what boosters you may need.

The pandemic has created an alarming decrease in vaccinations for people of all ages. The National Foundation for Infectious Diseases has reported that some vaccination rates are down by as much as 95 percent. With that in mind, they have begun a campaign called “Keep Up the Rates” to encourage people to keep getting routine vaccinations during the COVID 19 pandemic.

Tetanus and Diphtheria

One of the most common booster shots for adults is the one for tetanus and diphtheria. Primary care and emergency care physicians are very good about making sure anyone with a cut or laceration has an updated tetanus vaccine. In Massachusetts the tetanus vaccine is a combined vaccine for both diseases so you get revaccinated for diphtheria by default.

A new study published this spring in Clinical Infectious Diseases concluded that people who were vaccinated against tetanus and diphtheria as children do not need booster shots. In the study, researchers compared disease incidence over 15 years in 31 industrialized countries in North America and Europe with similar healthcare and socioeconomic structures. Researchers looked particularly close at France, which recommends a 10-year booster, and the United Kingdom, which never has made that recommendation.

In analyzing the data from 2001 through 2016, there was no decline in tetanus or diphtheria in countries like France that recommends the booster compared to those like the United Kingdom, which doesn’t.

That data isn’t enough to convince the CDC and it doesn’t convince primary care physician Floyd McIntyre, MD, whose office is in South Dennis.

“It is an interesting study, but I don’t think we are ready to change our actions based on that study,” he said. “One of the ways that doctors think is that we try to always figure out what the condition is in front of us, but we try to protect the person from the most serious condition that could be. There’s a corollary with tetanus because tetanus is a very difficult condition to treat, even with modern technology in the United States.”

Tetanus, which resides in the dirt and dust all around the world, has a very high mortality rate. Those who are diagnosed can linger in the hospital for weeks or even months before dying, Dr. McIntyre said. Patients die because the neurotoxin that tetanus secretes kills the nerves that inhibit muscle contraction so the nerves that allow the muscles to keep firing are not inhibited.

“It’s an irreversible toxin, so it is a very grave condition,” he said. “And the spores for tetanus are in the dirt and dust everywhere.”

About 50 people die from tetanus each year in the United States and Dr. McIntyre credits good immunization rates for that number. Since it is such a devastating illness, he feels it is better to be safe than sorry.

Dr. McIntyre pointed out that the studies in France or Germany might not be comparable to the United States. For example, what if the workers in the study in France were all laborers who are at higher risk and the workers in England were all professionals who didn’t have as much exposure? That would skew results and those details are necessary to determine whether the study is applicable across the board, he said.

Another thing to consider is that in undeveloped countries, tetanus is still a high risk because not everyone is immunized. Someone who grew up in Haiti and moved to the U.S. wouldn’t have the same protection as someone born in this country where immunization rates are high.

“We have to balance the danger and cost of the medicine versus the danger of the condition,” Dr. McIntyre said. “The DT vaccine is relatively inexpensive and extremely safe. You just get an occasional sore arm from it. I think everyone tends to err on the side of caution because of all the uncertainties and because there is at least some risk and it’s a very grave risk.”

Those who are wary of vaccines should consider what, exactly, they are made of, he said.

“They are a very natural way of fighting disease. Rather than getting sick, we tune up our own immune system and let our immune system fight the infection,” he said. “People are sometimes hesitant and say, ‘I don’t want to put something in me,’ but these are proteins that occur on the surface of the cell of all of these organisms, so they are all part of nature. It’s just that they are dead, so they don’t hurt us. But it gives us a chance to respond to them in a safe way, so I think it’s really good to use our own immune system.”

HPV

Another vaccine that Dr. McIntyre thinks is woefully underused is HPV. Parents are uncomfortable talking about it because it has sexual connotations, he said. The current vaccine protects against nine different viral strains of HPV. The recommendation is two doses for kids, who get vaccinated under the age of 15, and three doses for those who are older than 15.

The HPV vaccine age guidelines recommend the vaccine to anyone up to 26 years old. In recent years, the guidelines have expanded to encourage people age 27 to 45 to discuss with their doctor whether a vaccine would be recommended. A person in that older age group who has had a lot of sexual partners wouldn’t benefit from the vaccine, Dr. McIntyre said, because they probably have already been exposed to HPV. Someone in a committed monogamous relationship doesn’t need vaccination either. But if that person becomes single again in their 30s or early 40s, it wouldn’t be unreasonable to consider getting vaccinated, he said.

“It’s not one size fits all that everyone up to age 45 should be given the HPV vaccine,” he said.

HPV can cause cervical cancer, but it also causes oral cancer and anal cancer, which is becoming an increasing problem for people in their 50s and 60s.

Check Which Vaccines You Need

When travel restrictions lift, Dr. McIntyre suggested that anyone who is traveling abroad check with the Barnstable Department of Health and Environment (508-375-6617) to see what vaccinations are recommended for the area in mind. They also have a vaccine clinic, so they are an excellent resource for anyone who needs vaccines.