Most of us are guilty of it – keeping up to date with our children’s jabs but not our own. But, the truth is, adults really do need protection, too – yes, even when we aren’t visiting malaria-laden locations and exotic, third-world wonders with not-so-sanitary conditions. So, in honour of World Immunisation Week – the last week of April – we spoke to Dr Maria Tang of Complete Healthcare International (CHI) about the importance of keeping our own boosters up to date.
For many of us adults, a visit to the doctor for our own vaccinations, rather than our kids’, is usually only an afterthought, if even a thought at all. (“I already got vaccinated as a child”, you might say.) And this lax attitude toward routine adult immunisations is sort of understandable, really, as kids living in Singapore are required by law to immunise against illnesses such as diphtheria and measles, whereas adults aren’t required to follow any such schedule, leaving us “in charge” of actively pursuing protection against the illnesses around us.s
“A common myth among Singaporeans is that vaccination is mainly for travellers. This is true for those who travel a lot around Southeast Asia, but there are also certain vaccinations that are deemed important to have while living in Singapore,” says Dr Tang. “Unlike places such as the United States, Europe and Australia, Singapore doesn’t currently offer an official adult immunisation schedule.”
Additionally, many people assume that the vaccines they received during childhood will protect them for the rest of their lives. “This is partly true, but it’s important to remember that some adults were only partly vaccinated as children, or not at all, and that there are newer vaccines that weren’t available when these adults were children.” In addition, she says, “Immunity can wane over time and, as we age, we become more susceptible to serious diseases caused by common infections – influenza and pneumococcus, for example”.
So, what are the routine jabs that we adults need to be conscious of?
“The ‘routine’ adult vaccinations include influenza, pneumococcal infection, diphtheria, tetanus, pertussis, varicella zoster, human papillomavirus, measles, mumps and rubella, and shingles,” says Dr Tang. “If you travel a lot in Southeast Asia, you may also wish to consider vaccinating for Hepatitis A and Hepatitis B, and typhoid, which is endemic to areas of poor sanitation. Remember to complete your vaccination at least one week before you travel so the vaccine has time to take effect. Typhoid vaccination loses effectiveness after three years, so re-vaccination with a booster dose is recommended every three years.”
“Vaccination provides significant protection against infectious diseases and their complications that can cause long-term illness, hospitalisation and even death,” notes Dr Tang. “The specific immunisations you need as an adult are determined by factors such as your age, lifestyle, occupation, high-risk conditions, types and locations of travel and previous immunisation history.”
Here’s a closer look at the infectious illnesses that are on the must-have list for routine inoculation.
Recommended for all adults and children annually, the flu vaccine is especially important for those 65 years and older, pregnant women, people with weakened immune systems, and those who work in a healthcare setting or care for someone at high risk of flu-related complications including people with certain chronic medical conditions such as diabetes and chronic lung disease, for instance.
“There is often a misconception of influenza being a mild disease,” says Dr Tang. “Influenza is caused by the highly contagious influenza virus: type A, B or C. Influenza A viruses are the most pathogenic and account for more severe illnesses and complications. These complications can include inflammation of the heart, brain or muscle and even multi-organ failure.”
Dr Tang also notes that the influenza vaccination has been shown to be clinically effective in reducing the rate of hospital admissions as well as reducing the incidence of influenza-related mortality in the older population. The traditional “influenza seasons” are from April to July and November to January when there is a peak in reported cases.
“This is caused by the bacterium Streptococcus pneumonia and accounts for approximately 50 percent of pneumonia cases in the hospital,” says Dr Tang. “The bacteria can attack different body systems and can result in pneumonia, meningitis, bacteraemia and other life-threatening conditions. Pneumococcus bacteria can also cause middle ear and sinus infections.” Which is why the vaccine is recommended for those 65 and above, those with an underlying chronic illness or a weakened immune system, or patients who have had a splenectomy or live in long-term care facilities.
There are currently two types of pneumococcal vaccines available in Singapore for use in adults.
Tetanus, diphtheria and pertussis
Diphtheria is a serious bacterial infection that affects the mucous membrane of the nose and throat. The bacteria can release a dangerous toxin into the bloodstream that can damage organs including the heart, brain and kidneys. Tetanus infection causes serious, painful spasms and stiffness in all muscles of the body. It can cause a locking of the jaw, which can result in difficulties with opening the mouth, swallowing and breathing. Pertussis (whooping cough) is a highly contagious respiratory tract infection that causes violent, uncontrollable coughing, making it hard to breath, eat and drink.
After the primary series of doses in childhood, booster vaccines for tetanus, diphtheria and pertussis should be administered once every ten years. (Pertussis has become a re-emerging infection recently because of waning immunity in adults.)
“Vaccination is especially important if you have a wound that is likely to become infected or you have close contact with infants. Preteens and teens should get a dose to boost their immunity between the ages of 11 and 12 years. Pregnant ladies should also get a booster dose of the vaccines during the third trimester of every pregnancy to help protect the baby from pertussis in the first few months of life,” advises Dr Tang.
Varicella zoster (chickenpox)
According to Dr Tang, the varicella zoster vaccine is given if you didn’t have chickenpox as a child or adolescent, if you’re not sure if you’ve had chickenpox, or if you’re considering pregnancy and don’t know if you’re immune to chickenpox. Vaccination reduces the risk of chickenpox by 90 percent and the risk of severe or fatal complications (pneumonia and encephalitis, an inflammation of the brain) by more than 98 percent. Even those who have been vaccinated can still catch chickenpox (the vaccine is 90 percent protective); however, Dr Tang says that the disease is a much milder form with a lower incidence of fever and fewer blisters and scarring. The recommendation is two doses for all adults (if this was not done during childhood) with at least a four-week interval after the first dose.
Measles, mumps and rubella (MMR)
Measles virus can lead to ear infection, pneumonia, seizures and encephalitis; mumps virus can lead to deafness, meningitis, encephalitis and painful swelling of the testicles or ovaries; rubella virus, if caught during pregnancy, can have serious implications on the baby, resulting in deafness, heart abnormalities and brain damage.
The MMR vaccine can protect children and adults from all three of these potentially serious diseases. You can get the first dose of MMR at any time and repeat with a second dose at least four weeks after.
Human papillomavirus (HPV)
HPV is a virus that causes precancerous and cancerous lesions on the cervix. It can also cause cancers of the vagina and vulva in women. In men, it can cause penile cancer, cancer of the anus and oral cavity as well as genital warts.
“Consider the HPV vaccine if you’re a woman aged 26 and under and you didn’t receive the vaccination during adolescence,” says Dr Tang. “Men aged 26 and under should also consider vaccinating against HPV. For men, the HPV vaccine can help prevent genital warts and reduces the transmission of the virus that causes cervical cancer in women.” Three doses of the vaccine over a six-month period is recommended.
Herpes zoster (Shingles)
“Shingles is a painful rash that can develop on one side of the body, face or torso. The rash forms blisters that scab over in seven to 10 days; it clears up in two to four weeks. For some people, the pain can last for months after the rash has disappeared. This is called post-herpetic neuralgia (PHN) and is the most common complication of shingles,” says Dr Tang. “The shingles vaccine is recommended for people aged 60 and older. It’s given as a single shot, and it reduces the risk of developing shingles by 51 percent and PHN by 67 percent.”
For more on World Immunisation Week, visit who.int/en
By: Amy Greenburg
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This article first appeared in the April 2017 edition of Expat Living Singapore. Subscribe now!