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Patient education: Vaccines for adults (Beyond the Basics)

Patient education: Vaccines for adults (Beyond the Basics)
Author:
Patricia L Hibberd, MD, PhD
Section Editor:
Peter F Weller, MD, MACP
Deputy Editor:
Keri K Hall, MD, MS
Literature review current through: Nov 2022. | This topic last updated: Apr 06, 2022.

INTRODUCTION — Vaccines are a way of teaching your body how to fight the germs (eg, viruses or bacteria) that cause infections. Thanks to vaccines, many fewer people get seriously ill or die from infections than in the past. When a person gets a vaccine, this is called "vaccination" or "immunization."

Pediatric vaccine programs in the United States have been extremely successful against a range of contagious diseases, including measles, rubella, tetanus, diphtheria, and poliomyelitis ("polio"); fewer than 500 children die in the United States each year of vaccine-preventable diseases.

However, healthy adults also require regular vaccines to prevent certain infections. Getting the recommended immunizations plays a crucial role in protecting health throughout a person’s lifetime.

The following is a general discussion of vaccines currently recommended for healthy adults. Recommendations for pregnant people and children are discussed separately. (See "Patient education: Why does my child need vaccines? (Beyond the Basics)" and "Patient education: Vaccines for infants and children age 0 to 6 years (Beyond the Basics)" and "Patient education: Vaccines for children age 7 to 18 years (Beyond the Basics)" and "Patient education: Vaccination during pregnancy (Beyond the Basics)".)

HOW DO VACCINES WORK?

Infection and your immune system — Your immune system protects you against illness and infection. When a germ (such as a bacterium or virus) gets into your body, it multiplies and attacks your cells; this is what makes you sick. Your immune system responds by creating proteins called antibodies to fight the infection and help you recover.

Antibodies also work to prevent you from becoming ill in the future. Once you have antibodies, the next time you are exposed to the germ, your immune system recognizes it and rapidly produces the antibodies required to destroy the germ. This response protects you from developing the disease. In some cases, this protection lasts for life; for example, if you had measles as a child, you are unlikely to get it again, even if you are in close contact with a person who is infected. In other cases, you need to get regular "booster" vaccines to maintain your immunity over time.

Vaccines work by stimulating your immune system to produce antibodies, like it would if you had an infection. However, unlike bacteria and viruses, vaccines do not actually make you sick.

Active versus passive immunity — There are two main types of immunity, active and passive:

"Active" immunity means you have antibodies against a particular germ. This can happen if you have had the infection in the past (this is called "natural immunity") or because you have received a vaccine that stimulated your immune system to produce the antibodies. Most vaccines induce active immunity.

"Passive" immunity comes from serum immune globulin, which provides temporary immunity with antibodies obtained from a large pool of donors. This approach offers short-term protection to people who have been exposed to a specific germ; it is not routinely recommended for individuals.  

Herd immunity — For diseases that can spread from person to person, the goal of vaccines is to get to "herd immunity." This is when enough people are immune to a disease that it can no longer spread easily. To get to herd immunity, lots of people need to get vaccinated. This helps protect people who cannot get vaccinated for some reason.

Diseases such as diphtheria are uncommon in resource-rich countries such as the United States. However, these illnesses are still common in other parts of the world, and can spread when people travel or relocate. Vaccines help reduce the number of people who can spread the infection.

An example of a successful vaccine program is smallpox. Before a vaccine was available, smallpox killed millions of people every year. As a result of an intensive vaccination program, smallpox has been completely eliminated throughout the world.

Types of vaccines — Some vaccines are called "live" vaccines because they are made with a weakened form of the organism (germ); such vaccines should be avoided in certain groups with suppressed immunity, as discussed below (see 'Contraindications to live vaccines' below). Other vaccines are made with dead organisms or parts of organisms.

VACCINE SAFETY — Many people are concerned about the risks of vaccines. However, vaccines have a long record of being a safe and effective way of preventing disease. Before a vaccine is approved for use, it has to go through a specific process to test it for safety. This involves running "clinical trials" with lots of people who volunteer to try the vaccine. During these trials, researchers study how well the vaccine works and how many people had side effects. The results are reviewed by doctors and other experts who do not work for the drug companies that made the vaccine. These experts must agree that the vaccine is safe and effective enough to be given to the public.

In most cases, the benefits of vaccinating are much greater than the potential risks.

While some people experience side effects after getting vaccinated, these are usually mild and do not mean the vaccine has caused illness. (See 'Vaccine side effects' below.)

HOW ARE VACCINES GIVEN? — Most immunizations are given to adults in the form of an injection (shot) into the upper arm. Some vaccines are also given in other ways, such as by mouth or as a nasal spray.

VACCINE SIDE EFFECTS — Most vaccines cause few if any serious side effects. Very rarely, serious side effects do occur. People who are vaccinated and then develop symptoms that could be related to the vaccine should contact their health care provider. There is a national Vaccine Adverse Events Reporting System (VAERS, http://vaers.hhs.gov/index, telephone number 1-800-822-7967), which can be consulted if necessary. Occasionally, recommendations for a vaccine are changed in response to this type of report.

Mild side effects — With many vaccines, side effects can include:

A mild fever

A reddish, tender area at the site of injection

Occasionally, an immune system reaction similar to something called "serum sickness" that is characterized by fever, skin rash, swollen lymph nodes, joint pain, and/or other symptoms

These side effects do not mean that you are sick or that the vaccine has given you an infection; rather, they indicate that your immune system is responding to the vaccine.

Severe side effects — Severe side effects of vaccines are rare but may include a severe neurologic reaction (eg, seizures) or severe allergic reactions (anaphylaxis). Allergic reactions usually occur within minutes to hours of receiving the vaccine. If this occurs in the health care provider's office, emergency care can be given immediately. If a severe reaction occurs later, the person or a family member should call emergency medical services (in the United States and Canada, call 9-1-1).

If you have a history of allergic reactions to particular foods, medications, or ingredients, you may need to avoid certain vaccines; your health care provider can talk to you about this. (See 'Allergies' below.)

CONTRAINDICATIONS TO VACCINATION — There are some cases in which a person should not receive a specific vaccine or formulation of vaccine.

Allergies — In some cases, a particular vaccine may not be recommended for people with a serious allergy to the following:

Eggs or egg protein – People with a known egg allergy should not get the yellow fever vaccine.

Certain antibiotics – The antibiotic medications neomycin or streptomycin (some vaccines contains trace amounts of neomycin)

Gelatin

Other vaccine ingredients or components

Contraindications to live vaccines — Live virus vaccines, including the measles, mumps, and rubella vaccine and the varicella vaccine, are generally not recommended for the following groups:

Those with a weakened immune system, since there is an increased risk of infection as a result of the vaccination

Patients who have recently received a blood transfusion or immune globulin, which can delay the normal response to active vaccination. In this case, the vaccination should be delayed for one month.

People who are pregnant or considering getting pregnant within the next 28 days, due to the potential risk of the vaccine to the developing fetus

Conditions that do not affect vaccination — The following conditions do not require that a person delay or avoid vaccination:

Current or recent mild illness, with or without low-grade fever

Previous mild to moderate tenderness, redness, or swelling at the site of injection or fever less than 104.9ºF (40.5ºC) after any previous vaccination

A personal history of allergies, except those listed above

A family history of adverse reactions to vaccines

RECOMMENDED IMMUNIZATIONS FOR ADULTS — In the United States, immunizations are recommended for healthy adults based upon policies developed by expert groups. Additional information concerning vaccines is available at the CDC Hotline (at 1-800-232-2522) or from the CDC website.

There are also specific recommendations for people with an increased risk of developing certain infections (and/or transmitting them to at-risk individuals), including:

Residents of long-term care facilities (including nursing homes), young adults residing in college dormitories, household members living with at-risk individuals, or inmates of correctional facilities

Health care or public safety workers, laboratory staff, daycare center workers, and food handlers

People who are planning travel to particular countries

Men who have sex with men

People who inject drugs

Your health care provider can talk to you about when to get certain vaccines based on your situation. The recommendation will depend on what vaccines you have received in the past as well as your personal risk factors (for example, your age, occupation, medical conditions, and travel plans). The different available vaccines for adults are discussed below.

COVID-19 — Coronavirus 2019 (COVID-19) is an infection caused by a virus called SARS-CoV-2. It can cause a fever, cough, and trouble breathing, along with other symptoms. Some people get severely ill from COVID-19.

Vaccines for COVID-19 became available in the United States in late 2020. They are recommended for most adults, as the risk of severe illness or death from COVID-19 increases with age. Experts also recommend getting a booster shot for extra protection. The timing of the booster shot depends on which vaccine you got initially.

Pneumonia — Pneumonia is a serious lung infection that can be fatal, especially in older adults, individuals with underlying medical conditions, and those with a weakened immune system. Pneumonia is usually caused by bacteria; the most common is Streptococcus pneumoniae, or "pneumococcus." Pneumococcal pneumonia can develop as a complication of a respiratory tract viral infection such as influenza. (See "Patient education: Pneumonia in adults (Beyond the Basics)".)

The pneumococcal vaccines protect against many of the types of pneumococci. They are recommended for adults who are age 65 years or older and/or have certain health conditions. More detailed information about the pneumococcal vaccines is available separately. (See "Patient education: Pneumonia prevention in adults (Beyond the Basics)".)

Influenza — Commonly known as flu, influenza is a highly contagious viral infection that occurs in outbreaks worldwide, usually in the winter season in the United States and other non-tropical regions. Serious complications can develop in people with influenza, including bacterial pneumonia. (See "Patient education: Influenza symptoms and treatment (Beyond the Basics)".)

A yearly vaccine to prevent influenza is recommended for adults. While some forms of the influenza (flu) vaccine contain small amounts of egg, the amount is so small that it does not cause an allergic reaction, and people with an egg allergy should still get the flu vaccine each year.

The flu vaccine is discussed more separately. (See "Patient education: Influenza prevention (Beyond the Basics)".)

Tetanus, diphtheria, pertussis

Tetanus is a wound infection caused by a bacterial toxin. The bacterium resides in soil and the intestinal tracts of certain mammals and enters the body through a wound; it then multiplies and produces toxins that act on nerves controlling muscle activity.

Diphtheria is a sudden illness caused by a bacterium that is usually transmitted via droplets coughed or sneezed into the air. The bacteria typically multiply in the throat and may release a toxin into the bloodstream, which can lead to damage of the brain and heart.

Pertussis, or whooping cough, is an upper respiratory illness caused by a bacterium called Bordetella pertussis. The bacterium is spread easily and can cause serious illness, especially in infants and people with a weakened immune system.

Tetanus and diphtheria are rare in the United States because most infants are given a series of five vaccinations, starting at two months of age. Some people have an increased risk of developing tetanus or diphtheria, including people who were not vaccinated during childhood, older adults (due to a decline in protection from the vaccine over time), people who live in rural areas, injection drug users, and immigrants.

Pertussis has become increasingly common in adults, despite the fact that most people were immunized during childhood. This is due to fading immunity to pertussis over time.

A "booster" with either the tetanus-diphtheria vaccine (Td) or the tetanus-diphtheria-pertussis vaccine (Tdap) is recommended for all adults every 10 years for life. At least one of these should be Tdap in adults older than 19 years of age who have not previously had Tdap. Health care workers or those who have close contact with infants under one year of age (eg, grandparents, childcare providers) should get a single dose of Tdap (if they have not already) as soon as they can, regardless of how long ago they had a tetanus booster. If the booster dose is overdue and there is concern that the person was exposed to tetanus, tetanus immune globulin is given along with the Td or Tdap. The immune globulin provides temporary protection from the toxin. A series of three tetanus-diphtheria vaccines, one of which includes acellular pertussis (Tdap), is recommended for adults who did not receive any of the childhood diphtheria-tetanus vaccines.

Measles-mumps-rubella (MMR) — Measles, mumps, and rubella are transmitted when an infected person releases airborne droplets while coughing or sneezing. The incidence of these diseases fell dramatically in the United States since the live virus vaccine was developed.

A series of MMR vaccines is given to most infants and children in the United States. People who were born before 1957 in the United States are usually considered to be immune to measles and mumps. If you are not sure that you had measles, mumps, or rubella or whether you were vaccinated against these diseases, your health care provider can order a blood test to check for antibodies. If you are not immune to measles or mumps or rubella (ie, to one or more of the three diseases), the MMR vaccine is recommended.

There are no negative consequences of receiving MMR if you are already immune to one or more of the three diseases. The number of doses to get depends on whether you are considered "high risk." High-risk groups include anyone who could become pregnant, college students, health care workers, and international travelers:

If you are in one of these high-risk groups and are not immune to measles, mumps, or rubella, you should receive two doses of the MMR vaccine.

If you are not in one of these high-risk groups and are not immune to measles, mumps, or rubella, you should receive one dose of MMR. However, you should not get the MMR vaccines if you are pregnant or considering pregnancy in the next 28 days.

If there is an outbreak of mumps in the community, experts recommend that people who were not previously vaccinated get the mumps vaccine. Also, if you received the two-dose vaccine in the past, your doctor may suggest that you get a third dose in the setting of an outbreak. This can help protect you against mumps, particularly if it has been a long time since you initially received the vaccine.

Varicella (chickenpox) — Chickenpox is a highly contagious viral illness caused by infection with the varicella-zoster virus (VZV). The disease causes fever, sore throat, and a distinctive, itchy, blistering rash that later forms scabs. The virus is transmitted by airborne droplets or direct contact with the skin rash.

People who have had chickenpox in the past are immune to reinfection and do not need the varicella vaccine. However, adults who have never had chickenpox or the vaccine can benefit from being vaccinated. Experts recommend the vaccine in this situation, particularly for people who are at risk of exposure. The varicella vaccine requires two doses given at least four weeks apart. If you are pregnant or plan to become pregnant within the next month, you should not get the varicella vaccine. (See "Patient education: Chickenpox prevention and treatment (Beyond the Basics)".)

Herpes zoster (shingles) — Herpes zoster (also known as shingles) is caused by varicella-zoster virus, the same virus that causes chickenpox. After an episode of chickenpox, the virus lingers in cells of the nervous system, where it can reside quietly for decades. However, later in life, the varicella-zoster virus can become active again. When it reactivates, it causes shingles. Shingles can occur in individuals of all ages, but it is uncommon in children, adolescents, and young adults. It is much more common in adults aged 50 years and older and in those whose immune system has been weakened. (See "Patient education: Shingles (Beyond the Basics)".)

The shingles vaccine is recommended for adults 50 years of age or older to reduce the chance of developing shingles. It might also be recommended for some younger adults who are immunocompromised (meaning their immune system is weaker than normal, for example, because they have certain medical conditions or take certain medications).

If you do develop shingles after receiving the vaccine, your infection may be less severe and you are less likely to develop postherpetic neuralgia. Postherpetic neuralgia is the most common complication of shingles. It causes mild to severe pain or unpleasant sensations and is often described as "burning."

The shingles vaccine is given as a shot. The one available in the United States is given as two doses, usually two to six months apart.

Hepatitis B — Inflammation of the liver (hepatitis) is caused by infection with certain viruses, including hepatitis B virus (HBV). Although the infection often resolves or is asymptomatic (does not cause symptoms), HBV can result in chronic infection that can lead to progressive liver scarring (cirrhosis) or liver cancer. HBV is transmitted by contact with an infected person’s body fluids, such as during unprotected sexual intercourse, the sharing of contaminated needles during injection drug use, or contact with contaminated blood or blood products. HBV can also be transmitted from a pregnant person to their baby. (See "Patient education: Hepatitis B (Beyond the Basics)".)

A vaccine is available that protects against HBV. HBV vaccination is recommended for all children at birth or as a "catch-up" immunization during early childhood or adolescence. In the United States, experts recommend HBV vaccination for all people <60 years of age.

People age 60 or older should receive the HBV vaccine if they want protection from HBV or are at high risk for infection. People considered at high risk include:

Health care and public safety workers who could be exposed to blood or bodily fluids

People who live or work in facilities that care for people with developmental disabilities

Incarcerated persons

Household contacts and sex partners of people with chronic HBV

People with multiple sex partners, people with sexually transmitted diseases, and men who have sex with men

People who use injection drugs

People with certain health conditions, including end-stage kidney disease, chronic liver disease, HIV infection, hepatitis C, or diabetes

People traveling to areas where HBV is common

The HBV vaccine is usually given in three doses, with the second and third doses given one month and six months after the first dose. A newer vaccine formulation that requires two doses given one month apart is also available.

Hepatitis A — Hepatitis due to infection with the hepatitis A virus (HAV) is one of the most common viral infections in children and adolescents in the United States. HAV infection often causes few or no symptoms in children. By contrast, infection in adults can vary in severity from a mild flu-like illness to rapidly progressive, severe hepatitis. Vaccinating children can help to protect adult caregivers from a potentially serious illness. (See "Patient education: Hepatitis A (Beyond the Basics)".)

HAV is found in the stool (bowel movements) of infected individuals. A person can become infected with HAV by consuming contaminated food or water or by touching the mouth, nose, or eyes after touching a contaminated surface (eg, in the bathroom or during a diaper change). Washing the hands can help to prevent infection.

Vaccines are available to prevent infection with HAV. Both are equally effective in preventing infection:

VAQTA is given in two doses, with the second dose given 6 to 18 months after the first dose. This vaccine was temporarily recalled in the fall of 2001 because some prefilled syringes did not contain the proper amount of antigen to produce a reliable amount of antibody; this problem was subsequently corrected. People who were previously vaccinated against hepatitis A should contact their health care provider to determine which vaccine was given and if revaccination is needed.

HAVRIX is given in two doses, with the second dose given 6 to 12 months after the first.

The hepatitis A vaccine is recommended for susceptible at-risk adults, including:

Travelers to countries where HAV is common

Injection and non-injection illegal drug users

Men who have sex with men

People with chronic liver disease

Adults with blood clotting factor disorders

Adults who are at risk for infection at work, including daycare center staff, personnel in health care facilities (eg, nursing homes), and food handlers

People who are pregnant should discuss the risks and benefits of the hepatitis A vaccine with their obstetrical health care provider.

Meningococcus — Neisseria meningitidis is a bacterium that causes serious illnesses, including bacterial meningitis. The bacteria live on surfaces of the nose and pharynx (wind pipe) and is transmitted from person to person by direct contact with respiratory secretions. Although meningococcal disease is treatable in some people, 10 to 14 percent of people die from the infection.

Meningococcal vaccines are available to reduce the risk of infection. Expert groups recommend a meningococcal vaccine for all adolescents, college freshmen living in dormitories, military recruits, travelers going to areas where meningococcal disease frequently occurs, microbiologists who are exposed to Neisseria meningitidis, people who have had their spleen removed or whose spleen does not work properly, and people with terminal complement deficiency. Meningococcal vaccines can be used in adults infected with human immunodeficiency virus (HIV).

Human papillomavirus (HPV) — Human papillomavirus (HPV) causes more than 99 percent of cases of cervical cancer and genital warts. Persistent infection with certain types of HPV can lead to cancer of the cervix, anus, vagina, vulva, penis, mouth, or throat.

In the United States, routine HPV vaccination is recommended for all children ages 11 to 12 years and can be given as early as 9 years of age. "Catch-up" vaccination is recommended for all people up to 26 years of age who have not yet received it. The HPV vaccine is also approved by the US Food and Drug Administration (FDA) for individuals aged 27 to 45 years; the decision to vaccinate adults in this age group should be individualized, typically in conversation with a health care provider, as some people in this age group may still benefit from it. (See "Patient education: Human papillomavirus (HPV) vaccine (Beyond the Basics)".)

WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Vaccines for adults (The Basics)
Patient education: What you should know about vaccines (The Basics)
Patient education: Human papillomavirus (HPV) vaccine (The Basics)
Patient education: Vaccines and pregnancy (The Basics)
Patient education: Whooping cough (The Basics)
Patient education: Sickle cell disease (The Basics)
Patient education: Rubella (The Basics)
Patient education: Tetanus (The Basics)
Patient education: Poliomyelitis (The Basics)
Patient education: Diabetes and infections (The Basics)
Patient education: Measles (The Basics)
Patient education: Tdap vaccine (The Basics)
Patient education: Flu vaccine (The Basics)
Patient education: COVID-19 vaccines (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Why does my child need vaccines? (Beyond the Basics)
Patient education: Vaccines for infants and children age 0 to 6 years (Beyond the Basics)
Patient education: Pneumonia in adults (Beyond the Basics)
Patient education: Pneumonia prevention in adults (Beyond the Basics)
Patient education: Influenza symptoms and treatment (Beyond the Basics)
Patient education: Influenza prevention (Beyond the Basics)
Patient education: Chickenpox prevention and treatment (Beyond the Basics)
Patient education: Shingles (Beyond the Basics)
Patient education: Hepatitis B (Beyond the Basics)
Patient education: Hepatitis A (Beyond the Basics)
Patient education: Human papillomavirus (HPV) vaccine (Beyond the Basics)
Patient education: Vaccines for travel (The Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Standard immunizations for nonpregnant adults
Assessing antibody function as part of an immunologic evaluation
Hepatitis A virus infection: Treatment and prevention
Hepatitis B virus immunization in adults
Immunizations during pregnancy
Immunizations in hematopoietic cell transplant candidates and recipients
Immunizations for health care providers
Immunizations for patients with chronic liver disease
Immunizations for travel
Immunizations in persons with HIV
Immunizations in adults with cancer
Immunizations in patients with end-stage kidney disease
Immunizations in solid organ transplant candidates and recipients
Measles, mumps, and rubella immunization in adults
Meningococcal vaccination in children and adults
Pneumococcal vaccination in adults
Poliovirus vaccination
Human papillomavirus vaccination
Seasonal influenza vaccination in adults

The following organizations also provide reliable health information.

National Library of Medicine

     (www.nlm.nih.gov/medlineplus/healthtopics.html)

National Institute of Allergy and Infectious Diseases

     (www.niaid.nih.gov/)

Centers for Disease Control and Prevention (CDC)

     Toll-free: (800) 311-3435
     (www.cdc.gov/)

National Foundation for Infectious Diseases

     Tel: (301) 656-0003
     (www.nfid.org)

This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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