Influenza (Flu) Vaccine

• The single best way to prevent the flu is to get a flu vaccine each season. Flu vaccine is recommended for everyone age 6 months and older.

• While everyone should get vaccinated, certain people are at greater risk for serious complications if they get the flu: older people, young children, pregnant women, people with certain health conditions such as asthma, diabetes or heart disease, and people living in facilities like nursing homes.

• It’s also important for anyone who lives with or cares for people at high risk for developing flu-related complications to get vaccinated each year.

• Flu seasons are unpredictable and can be severe. Annual flu vaccination should begin by September or as soon as vaccine is available, and continue throughout the flu season. Flu season can begin as early as October and can last as late as May. Seasonal flu activity usually peaks in January, February or later.

• It takes about two weeks after vaccination for antibodies to develop for protection against influenza virus infection. Flu vaccines will not protect against flu-like illnesses caused by non-influenza viruses.

• Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration and worsening of chronic medical conditions, such as congestive heart failure, asthma or diabetes.

• A 2013 study by CDC flu experts estimated that cumulatively over six flu seasons, from 2005 to 2011, flu vaccination averted approximately 13.6 million illnesses, 5.8 million medical visits, and approximately 112,900 flu-related hospitalizations in the U. S.

Tetanus and Tdap Vaccine

• One dose of Tdap vaccine is recommended for adults age 19 and older who never received the shot as an adolescent to protect against tetanus, diphtheria, and pertussis (whooping cough).

• Tdap vaccine is especially important for adults who will have close contact with newborn babies or infants younger than 1 year.

• Pregnant women are also recommended to get the Tdap vaccination during each pregnancy, preferably at 27 through 36 weeks, to help protect their newborns from whooping cough.
  • Tdap vaccine can be safely given at any time during pregnancy, but is recommended during the third trimester to pass the most amount of protection to the baby.

• Tetanus, diphtheria, and pertussis are all caused by bacteria.
  • Both diphtheria and pertussis are spread from person to person.
  • Tetanus enters the body through cuts, scratches, or wounds.

• More than 48,000 cases of whooping cough were reported during 2012, a nearly 60-year high. While overall reporting of whooping cough declined during 2013, 13 states and Washington, D.C. reported an increase in cases compared with the same time during 2012.

• CDC’s current estimate is that Tdap vaccination protects about 65 out of 100 adolescents who receive it.

• Tdap is an effective vaccine, but it does not protect as well as we would like and may only protect against whooping cough for a few years.

• Adults who haven’t had a Tdap shot yet should talk to their doctor about getting it as soon as possible, no matter when they last got a tetanus (Td) booster.

• After receiving the Tdap shot, adults should continue to get a Td booster every 10 years.

• Adults need to get Tdap even if they were vaccinated as a child or have been sick with whooping cough in the past; neither provides lifelong protection.

Human Papilloma Virus (HPV) Vaccine

• HPV vaccine is recommended for routine vaccination of females and males at age 11to 12 years. Vaccination is also recommended for females 13 to 26 years of age and for males 13 to 21 years of age, if not previously vaccinated. Males aged 22 to 26 years may be vaccinated.

• HPV2 (Cervarix) or HPV4 (Gardasil) is recommended for females; HPV4 (Gardasil) is recommended for males.

• The series of quadrivalent HPV vaccine is routinely recommended for boys at 11 or 12 years for prevention of anal cancer and genital warts.

• The quadrivalent HPV vaccine is also recommended for gay and bisexual men (or any man who has sex with men) and men with compromised immune systems (including HIV) through age 26, if they did not get fully vaccinated when they were younger.

• HPV is a common virus that is primarily spread through sexual contact.

• Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection. There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not know they have it.

• About 14 million people become infected with HPV each year.

• Recent studies found a significant 56% reduction in prevalence of HPV vaccine types seen among females aged 14-19 years

• HPV vaccine does not treat existing infection or disease.

• Prior infection with one HPV type did not lessen the effectiveness of the vaccine against other vaccine HPV types.

• There are two vaccines licensed by the Food and Drug Administration (FDA) and recommended by CDC to protect against HPV-related illness; these vaccines are Cervarix® (made by GlaxoSmithKline) and Gardasil® (made by Merck).
  • Both vaccines are very effective against HPV types 16 and 18, which cause most cervical cancers, so both vaccines prevent cervical cancer in women.
  • Only Gardasil protects against HPV types 6 and 11–the types that cause most genital warts in females and males.
  • Only Gardasil has been tested and shown to protect against cancers of the vulva, vagina, and anus.
  • Only Gardasil has been tested and licensed for use in males.

Meningococcal Vaccine

• College students, especially first-year students who will be living in residence halls, are at a slightly increased risk for meningococcal disease compared with others of the same age.

• Many states have adopted legislation requiring colleges to provide information on risks of meningococcal disease to incoming students and students residing on campus, and some have mandated vaccination for certain students, unless a vaccination waiver is provided.

• The Advisory Committee on Immunization Practices (ACIP) has issued the following recommendations regarding the use of vaccines for college students:

• College freshmen living in dorms are recommended to be vaccinated with meningococcal conjugate vaccine. If they receive this vaccine before their 16th birthday, they should get a booster dose before going to college for maximum protection.

• Colleges who have requirements for vaccination of new students entering the college should consider a vaccine received within five years before entering the college as valid.

• Among college students who are not freshman, the risk of getting meningococcal disease, which can lead to meningitis, is similar to the risk for the general population. However, the vaccine is safe and effective and therefore can be provided to non-freshmen.

Vaccine Safety

• All vaccines used in the U. S. are required to go through years of extensive safety testing before they are licensed by the U.S. Food and Drug Administration (FDA).

• FDA and CDC work with health-care providers throughout the U. S. to monitor the safety of vaccines, including for any adverse events, especially rare events not identified in pre-licensure study trials.

• Three systems are used to monitor the safety of vaccines after they are licensed and being used in the U.S.

• These systems can monitor side effects already known to be caused by vaccines, as well as detect rare side effects that were not identified during a vaccine’s clinical trials.

• One of the three systems used to monitor the safety of vaccines after they are licensed and used in the U.S. is called the Vaccine Adverse Event Reporting System (VAERS).

• VAERS accepts reports from health professionals, vaccine manufacturers, and the general public and receives about 30,000 U.S. reports per year, compared with millions of vaccine doses given to adults.

• Many types of adverse events can occur after vaccination. About 85 to 90 percent of the reports describe mild adverse events such as fever, local reactions and mild irritability. The remaining reports reflect serious adverse events involving life-threatening conditions, hospitalization, permanent disability, or death, which may or may not have been caused by a vaccine.

Frequently Asked Questions

Why do young adults need vaccines?

Immunizations are not just for children. Even if you were vaccinated at a younger age, the immunity from those vaccines can wear off, or the virus or bacteria that the vaccine protects against changes, so your immunity is not as strong. And as young adults get older, they may also be at risk for vaccine-preventable diseases due to their job, hobbies, travel, or chronic health conditions.

All young adults need immunizations to help them prevent getting and spreading serious diseases that could result in poor health, missed school or work, medical bills, and not being able to care for family.

Are vaccine-preventable diseases really a threat for young adults?

Yes. Any of the diseases that adult vaccines protect against can be serious. Every year, thousands of adults in the U.S. still suffer serious health problems, are hospitalized, and even die from diseases that could be prevented by vaccines. For example, it is estimated that 32,000 Americans got invasive pneumococcal disease in 2012, resulting in 3,300 deaths.

People with chronic health conditions such as lung disease (asthma or COPD), heart disease, and diabetes are at higher risk of complications from pneumococcal bacteria, influenza and other vaccine-preventable diseases.

What vaccines do young adults need? How often and when do they need them?

All young adults need a flu vaccine every year. The flu vaccine is also recommended for pregnant women to decrease the risk of flu and flu-related severe illnesses in children less than 6 months old.

The HPV vaccine is recommended for boys and girls ages 11-12. Young women and men who have not started or finished the HPV vaccine series may be vaccinated through age 26.

Meningococcal vaccine is recommended for young adults, especially first-year college students who will be living in residence halls.

All adults need a tetanus vaccine every 10 years to protect against harmful bacteria in the environment that can enter through broken skin.

All young adults should get a one-time dose of Tdap vaccine if they did not receive it as an adolescent to protect against tetanus and diphtheria plus whooping cough. Whooping cough epidemics have increased in the US in the past few years. Women are recommended to get a Tdap vaccine during every pregnancy to protect themselves and their newborn babies.

Other vaccines you need as a young adult are determined by factors such as age, lifestyle, job, health condition, and vaccines you’ve had in the past. They may include those that protect against pneumococcal disease, hepatitis A and B, chickenpox (varicella), and measles, mumps and rubella. Adults traveling outside the U. S. may need additional vaccines.

Ask your doctor or health care professional which vaccines are recommended for you.

Are these boosters or whole new vaccines you’re recommending?

Some vaccines recommended for adults can be boosters, like the Tdap vaccine, which provide a boost in immunity because the protection from the vaccines we get as children don’t last into adulthood. Other vaccines, like the zoster vaccine, protect against diseases that affect adults and aren’t recommended for children.

The pneumococcal polysaccharide vaccine is given to adults younger than 65 if they have certain conditions and then again at age 65 years. Some people 19-64 years might also need a booster dose 5 years after their first dose.  Other people may need a second kind of pneumococcal vaccine, called pneumococcal conjugate vaccine, if they have certain medical conditions such as a weakened immune system.

Like the pneumococcal vaccine, recommendations for other vaccines also may need to be tailored to each individual person and their situation. So, make sure to discuss vaccines with your doctor.

Why are we hearing about these vaccines now?

Many of the vaccines recommended for adults have been around for years, while other vaccines and vaccine recommendations are newer.

One reason we’re hearing more about Tdap vaccine is the increase in whooping cough in the last few years. More than 48,000 cases were reported in the U. S. in 2012.  While overall reporting of whooping cough declined during 2013, 13 states and Washington, D.C. reported an increase in cases compared with the same time during 2012. We have learned that protection from the DTaP whooping cough vaccine given to children doesn’t last into adulthood. Therefore, now all adults are recommended to get one dose of Tdap whooping cough vaccine if they did not receive it as an adolescent. Women are also now recommended to get a Tdap vaccine during each pregnancy to protect their newborns, who are at high risk for developing serious complications or even dying from whooping cough.

How can I find out which vaccines I need?

Ask your health care professional which vaccines are right for you based on your age, lifestyle, medical conditions, and previous vaccinations. You can also visit www.cdc.gov/vaccines/adults for more information and find a link to an adult vaccine quiz to see which vaccines are recommended for you.

What are potential risks from adult vaccines?

Side effects from vaccines are usually minor and temporary, such as soreness at the injection site or a slight fever which goes away in a few days. Serious and long-term effects are rare.

As with any medical procedure, vaccination has some risks as well as important, proven benefits. Individuals react differently to vaccines, and there is no way to absolutely predict the reaction of a specific individual to a particular vaccine.

Anyone who takes a vaccine should be fully informed about both the benefits and the risks of vaccination. Any questions or concerns should be discussed with a physician or other health care professional.

Are adult vaccines safe?

Yes! The long-standing vaccine safety system in the U.S. ensures that vaccines are as safe as possible. In fact, the U. S. currently has the safest, most effective vaccine supply in its history.

Safety monitoring begins with the U.S. Food and Drug Administration (FDA), who ensures the safety, and effectiveness of vaccines for the U. S. Before a vaccine is approved by the FDA for use by the public, results of studies on safety and effectiveness of the vaccine are evaluated by highly trained FDA scientists and doctors. FDA also inspects the sites where vaccines are made to make sure they follow strict manufacturing guidelines.

FDA and CDC continue to monitor vaccines after licensing to ensure continued safety of the vaccines in the U.S.

What are the ingredients in vaccines?

Vaccines contain ingredients, called antigens, which cause the body to develop immunity. Vaccines also contain very small amounts of other ingredients – all of which play necessary roles either in making the vaccine, or in ensuring that the vaccine is safe and effective, such as preventing vaccine contamination.

For more information, see www.cdc.gov/vaccines/vac-gen/additives.

Is it safe to get vaccines if I have certain health conditions or am taking certain prescription medications?

For people with chronic health conditions like diabetes, asthma, or heart disease, it is actually more important to be up-to-date on vaccines because they are at higher risk from complications from vaccine-preventable diseases like flu and pneumonia.

People with HIV and other immune-compromising conditions are also at higher risk for complications from disease. They are recommended to get some vaccines, but cannot safely get all vaccines, so it’s very important to check with your medical provider about which vaccines are right for you. People with very weakened immune systems also might not get as much protection from the vaccine as people without a weakened immune system. Making sure people around those with weakened immune systems get vaccinated is also important to help protect them.

It is safe for people who are taking prescription medications to get vaccines. There are, however, other factors that may make it unsafe for individuals to get certain vaccines, such as allergy to a vaccine or certain vaccine ingredients.  And, some vaccines should not be given to people with weakened immune systems, such as people taking medication for cancer treatment or taking other medication that weakens the immune system. Talk to your doctor to determine which vaccines are right for you.

How well do adult vaccines work?

Vaccines work with the body’s natural defenses to reduce the chances of getting certain diseases and suffering from their complications. The amount of protection varies by vaccine and each person’s age and health (vaccines generally work better when given to younger, healthier persons), but immunization is the best defense against many of these serious, and sometimes deadly, diseases. The greatest risk of vaccine preventable diseases occurs among the unvaccinated.

Will insurance help pay for vaccines?

All Health Insurance Marketplace plans and most other private insurance plans must cover the following list of vaccines without charging a copayment or coinsurance when provided by an in-network provider:

• Hepatitis A
• Hepatitis B
• Herpes Zoster
• Human Papillomavirus
• Influenza
• Measles, Mumps, Rubella
• Meningococcal
• Pneumococcal
• Tetanus, Diphtheria, Pertussis
• Varicella

Check with your insurance provider for details of coverage. Under the Affordable Care Act, insurance plans that cover children now allow parents to add or keep adult children on their health insurance policy until they turn 26 years old.

Medicare Part B will pay for the following vaccines:

• Influenza (flu) vaccine
• Pneumococcal vaccines
• Hepatitis B vaccines for persons at increased risk of hepatitis
• Vaccines directly related to the treatment of an injury or direct exposure to a disease or condition, such as rabies and tetanus

Medicare Part D or Medicare Advantage Plan Part C that offers Medicare prescription drug coverage may also have coverage for:

• Zoster
• MMR
• Tdap

Additionally, the Vaccines for Children (VFC) program provides vaccines to children under 19 years of age from low-income families. Most State Medicaid agencies cover at least some adult immunizations but may not all offer vaccines. Check with your state Medicaid agency for more information.

Where can I get vaccines?

Vaccines may be available at private doctor offices, pharmacies, workplaces, community health clinics, health departments or other community locations such as schools and religious centers. There is an online tool to help you find immunization providers near you: http://vaccine.healthmap.org. You can also contact your state or local health department to learn more about where to get vaccines in your community.

If your primary health care provider does not stock all the vaccines recommended for you, ask for a referral.

Why aren’t young adults getting their recommended vaccines?

Many adults do not always go for “well visits” like children do.  When it has been a while since an adult has seen a doctor or other health care professional, there are often competing issues to discuss. However, make sure you take the time during your visit to talk with your doctor or other health care professional about vaccines you may need – it could help you prevent a serious disease!

Cost has also been an issue for some young adults. However, most insurance now covers routinely recommended vaccines. Those eligible for Medicare and Medicaid also have coverage for certain vaccines. Although adults do believe immunization is important, a recent national survey showed that most adults are not aware that they need vaccines throughout their lives to protect against diseases like shingles, pertussis, and hepatitis.  Cost has been an issue in the past however most private insurance plans now cover the cost of recommended vaccines.

I hear that some people get the flu from the flu vaccine because the virus is injected in us. Can I get the disease that a given vaccine is supposed to prevent?

You cannot get the flu from the flu vaccine.  Vaccines are very safe and healthy people receiving vaccines cannot get sick because the antigens in vaccines are either killed or greatly weakened. Vaccine antigens are not strong enough to cause disease but they are strong enough to make the immune system produce antibodies (immunity) against them so they can fight the disease in the future. Vaccination provides us with immunity without suffering from the diseases the vaccines prevent.  There are some weakened vaccines that women who are pregnant or those with weakened immune systems shouldn’t get.  If you are concerned, talk with your health care professional.

What about people who say they don’t get a flu vaccine or any other vaccines and they don’t ever get sick. Does it depend on who you are?

The lifestyle you lead?

There are certain things that can increase your risk of getting some vaccine preventable diseases, like being in crowded places or around sick people. We can’t always avoid these things. When it comes to your family’s health, take the best precautions available to protect yourselves from these diseases and to avoid spreading them to others.

What’s the bottom line? What should people know about adult vaccinations?

There are many things adults do to stay healthy. We know we need to eat the right foods and exercise. We need to get our recommended cancer screenings.

Another important thing we need to do is get our recommended vaccines.

If we aren’t up-to-date on our vaccinations, we are at greater risk of getting and spreading vaccine-preventable diseases. It is especially important for older adults and those with health conditions such as heart disease, lung disease, and diabetes to get vaccinated because they are at higher risk for complications from diseases. CDC encourages adults to talk to their doctor or health care professional about which vaccines they need – and get vaccinated.

Pertussis (Whooping Cough)

I thought whooping cough was a disease of the past?

Why do we need to get vaccinated against it now?

Whooping cough is not a disease of the past. While we no longer see the number of cases we did before whooping cough vaccines were available, it is a growing health concern.

The U. S. experienced a nearly 60-year record high number of cases in 2012, with data showing more than 48,000 reported cases and 20 deaths. Whooping cough is most severe for babies; about half of infants younger than 1 year of age who get the disease need treatment in the hospital and 1-2 percent of infants who are hospitalized with whooping cough will die.

Why are cases of whooping cough increasing?

There are several reasons that help explain why we’re seeing more reported cases of whooping cough lately. We are more aware of whooping cough, have better tests to diagnose it, and have better systems for reporting. There is also more circulation of the bacteria, and waning immunity.

When it comes to waning immunity, it seems that the acellular pertussis vaccine (DTaP) we use now may not protect for as long as the whole cell vaccine (DTP) we used before. Throughout the 1990s, the U.S. switched from using DTP to using DTaP for infants and children to reduce potential side effects. Therefore, we now need to have additional doses of whooping cough vaccine to increase immunity.

Why do women need to get Tdap vaccine with every pregnancy?

Whooping cough can be serious for anyone, but it is life-threatening in newborns and young babies. Most of the deaths reported in 2012 were in babies younger than 3 months of age and about half of babies who get whooping cough need treatment in the hospital.

CDC recommends that pregnant women receive the Tdap vaccine during each pregnancy. This is because the mother’s body creates protective antibodies and passes some of them to her baby before birth. These antibodies give babies some short-term protection against whooping cough until they can begin building their own immunity through childhood vaccinations.

The amount of whooping cough antibodies a person has decreases over time. This is why women need a whooping cough vaccine during each pregnancy so high levels of protective antibodies are transferred to each baby.

What is CDC doing?

CDC has also developed a variety of resources and materials to help get the word out about the whooping cough vaccine. There are tools for both health care professionals and their patients, ranging from fact sheets and infographics to podcasts and videos.

Where can I get more information?

• Talk with your health care provider about which vaccines are right for you.

• Visit CDC’s website on adult vaccination:

www.cdc.gov/vaccines/adults/index.html

• Take the CDC quiz to find out which vaccines are recommended for you: www.cdc.gov/vaccines/AdultQuiz

• Use the Healthmap Vaccine Finder to find vaccines: http://vaccine.healthmap.org/

• For more information on adult vaccines and the Affordable Care Act, visit: www.health care.gov/what-are-my-preventive-care-benefits/

Web Links & Resources

CDC: Vaccination of College Students and Young Adults Age 19-26

http://www.cdc.gov/vaccines/adults/rec-vac/college.html

This is CDC’s young adult vaccination home page, where you can find links to the vaccine schedule and quiz, recordkeeping tools, vaccine finder, international travel recommendations, and information about vaccines specifically recommended for young adults (Tdap, HPV, seasonal flu, meningococcal vaccine).

CDC: Easy-to-Read Adult Immunization Schedule (PDF) – English & Spanish

www.cdc.gov/vaccines/schedules/easy-to-read/adult.html

CDC: What Vaccines Do You Need? Quiz

Take the quiz to find out what vaccines you may need.

www.cdc.gov/vaccines/AdultQuiz

CDC: Vaccines for Travelers Information

www.cdc.gov/vaccines/adults/rec-vac/travel.html

Important for anyone traveling or studying abroad!

CDC: HPV Resources

www.cdc.gov/vaccines/vpd-vac/hpv/default/htm

CDC: Tdap Resources

www.cdc.gov/vaccines/vpd-vac/pertussis/default.htm#vac

Recommended for college age young adults and especially important for young adults in contact with infants (as a nanny, babysitter, etc.)

CDC: Seasonal Flu Resources

www.cdc.gov/vaccines/vpd-vac/hpv/default.htm

CDC: Finding and Paying for Vaccines – www.vaccines.gov

Healthmap Vaccine Finder

Locate vaccines near you – http://vaccine.healthmap.org

PKIDs Online: GetVaxed.org

Website for teens and 20-somethings: “Funny vids, good info.”

Resources for Health Care Professionals and Advocates

CDC: Resources for Educating Adult Patients about Vaccines

www.cdc.gov/vaccines/hcp/patient-ed/adults/index.html

Immunization Action Coalition

www.vaccineinformation.org  (public) &  www.immunize.org (providers/coalitions)

Here you will find lots of information, and a collection of videos, testimonials and resources for people of all ages, health care providers and coalitions, plus easy-to-read informational flyers in plain English and many languages.

12 handouts about childhood diseases/vaccines for patients and parents:

www.immunize.org/handouts/vaccine-summaries.asp

Vaccinate Adults is a new publication for health care providers: www.immunize.org/va/

National Foundation for Infectious Diseases

www.adultvaccination.org

Here you will find lots of information,’10 Reasons To Be Vaccinated’, radio PSAs, testimonials and video PSAs, including ‘Are You That Guy?’ (about the flu).

ACOG: Immunization Toolkit

http://immunizationforwomen.org