Trucker MD
About those other adult vaccines … tetanus, pneumonia and shingles

By John McElligott, MD

While we are getting used to scheduling our annual flu shot, there are three more that need your attention.

During a recent exam, the doctor asked when I had last had a tetanus shot. I could not remember ever having one. Should everyone have a tetanus shot? Even adults? If so, how often should you get a tetanus shot and why do you need one anyway?

Tetanus is recommended every 10 years. If you cannot remember, then you have two choices: Take a booster or review your history with a close family member; then both of you can go and get the booster. Remember the tetanus shot is now the “Tdap,” which covers tetanus, diphtheria and pertussis. The latter two are on the rise again in the U.S.

The current recommendation is that one dose of the Tdap vaccine be substituted for one dose of the tetanus (Td) vaccine between the ages of 11 and 64.

Bottom line – be sure to keep a shot record.

When I got my flu shot in the fall, I was asked if I had had a pneumonia shot in the past two or so years. I had not. Should adults have pneumonia shots? How old should you be before you recommend one and how long does it last?

As you get older, it’s tougher to fight pneumonia. So if you are older than 50, get vaccinated and make sure it is the pneumococcal conjugate vaccine, called the PCV13 or Prevnar 13 vaccine. This vaccination is one you should have twice during your adult years, usually seven-10 years apart.

I say make sure it’s the PCV13 because pneumonia just isn’t plain old pneumonia any more. PCV13 covers a new strain of pneumococcal bacteria that has become the badass of pneumonias.

The Centers for Disease Control say more than 4,000 people die each year due to pneumococcal infections. These infections can be hard to treat as some strains are resistant to antibiotics. This makes it even more important to protect yourself. Get vaccinated.

Do you recommend a shingles shot? If so, what if I already have had shingles?

Some medical sources say a third of Americans will get shingles in our lifetime. Those are not odds I like. According to the Centers for Disease Control, there are an estimated 1 million cases of shingles – also known as zoster or Herpes zoster – in the U.S. each year. Herpes zoster should not be confused with the virus that causes genital herpes.

Anyone who has had chickenpox can get it, and the risk of developing it increases as you get older. That Varicella zoster virus stays in your body in a dormant state and can reactivate years later.

The CDC says about half of all cases occur among men and women 60 years old or older. People who develop shingles typically have only one episode in their lifetime. In rare cases, however, a person can have a second or even a third episode.

So, yes, I strongly recommend the shingles, or zoster, vaccination for everyone 65 and older whether you have had chickenpox or shingles or not. This recurrence of the virus in the form of shingles can cause debilitating pain that is very hard to control. 

In 2006, the Food and Drug Administration approved a VZV vaccine (Zostavax) for use in people 60 and older who have had chickenpox. In March 2011, the FDA extended the approval for the shingles vaccine to include adults age 50 to 59 as well.

Researchers found that giving older adults the vaccine reduced the expected number of later cases of shingles by half. And in people who still got the disease despite immunization, the severity and complications of shingles were dramatically reduced.

The shingles vaccine is a preventive therapy and not a treatment for those who already have shingles or postherpetic neuralgia, which is a painful condition affecting nerve fibers and skin. LL

John McElligott is an MD, Fellow of the American College of Physicians, and medical director of the St. Christopher Trucker Development and Relief Fund. Jeff Heinrich, who serves as the column's medical editor, has a Doctor of Education degree and is Physician Assistant Certified.

This column is the opinion of the writer and does not necessarily reflect the opinions of Land Line Magazine or its publisher. Please remember everyone's health situation is different. If you have questions regarding medical issues, consult your personal physician.