August is National Immunization Awareness Month (NIAM) and is a great time to check to make sure we all are up to date with our immunizations. Most people think of immunizations as something for young children or adolescents, but the fact is adults need immunizations as well. Immunizations are the best way to protect yourself against very debilitating and deadly diseases that still exist in our environment today. They are very easy to access and there are many options to receive immunizations at low, or even no cost from several providers in the community. Immunizations are rigorously tested and monitored, making them extremely safe with only minor side effects that last only a few hours to a few days. There are many reputable, scientifically reviewed sources of information to learn more about immunizations and the vital role they play in keeping you, your family, your neighbors, and your community safe and healthy. As I speak about specific diseases below, I will link each one to the Centers for Disease Control and Prevention’s Vaccine Information Statements.
Getting your immunizations may not be the first thing you think of when preparing to return to school. But making sure you are protected against common diseases that are spread in large crowds should be just as important as getting that new backpack, notebook, tablet, or hand sanitizer. Oftentimes I hear people talk about not needing an immunization for a disease that is no longer prevalent or common where they live or attend school. However, these diseases do still exist in many parts of the world and can easily be transported by an unvaccinated person who traveled over the summer to one of the areas.
There was a large measles outbreak that I helped investigate as a nurse and disease investigator at Tri-County Health Department in 2015. The outbreak started with a family trip to California’s Disneyland. Because Disneyland is a vacation destination for many people in the United States (U.S.), several families with unvaccinated children and adults returned with the disease, contributing to one of the largest measles outbreaks in recent U.S. history. Measles is a highly infectious airborne virus that survives in the air for several hours and can be prevented by two measles, mumps, and rubella (MMR) vaccinations that last a lifetime. There are several other immunizations that young people need to receive to protect themselves and others from contracting these illnesses. The CDC has an easy-to-follow table on which immunizations are recommended and at what ages.
Immunizations are not just for children. Yes, children often receive immunizations at their yearly check-up with their health care provider and as you get older, you receive less immunizations, but you never reach an age where you are completely done being vaccinated. Adults still need to receive a tetanus and diphtheria (Td or Tdap, which has pertussis protection, all-in-one immunization) every 10 years at a minimum, receive a shingles immunization after the age of 50, and a pneumococcal (think pneumonia, sinus and ear infections, and meningitis) immunizations at the age of 65, or younger if they have a chronic condition like heart disease, cancer, diabetes, or human immunodeficiency virus (HIV). Adults, just like children, should get an annual influenza vaccination to prevent contracting the flu and missing over a week of school or work, and possibly having more life-threatening complications from the disease.
A choice to not vaccinate is a choice to get the disease and is removing the choice to get the disease from someone who may not have a choice. There is a lot to unpack in this statement. What I mean by this is that we all recognize that there are some people who CAN’T be vaccinated with specific immunizations because they are either too young to receive the immunization, they are allergic to the immunization, or they have a current health condition that prevents them from getting the immunization. These individuals DO NOT have a choice. They simply can’t be vaccinated.
This is very different than someone who CAN be vaccinated but chooses not to for personal or philosophical reasons. These are healthy people who do not have an allergy or health condition preventing them from being vaccinated. We know that both sets of people are susceptible to catching a disease they are not vaccinated against, and that the higher number of people that are unvaccinated in a community or population, the better the chance a disease has of establishing, and spreading among the people that are not vaccinated.
This takes us back to the healthy people who CAN be vaccinated, but choose not to, making the decision not only to put themselves at risk for a disease, but also making the decision to put other people who do not have a choice be vaccinated at risk for the disease. For example, someone who does not want to be immunized against the flu each year physically and medical speaking can be vaccinated, but they choose not to because they “don’t want to get a shot every year” or they “don’t think getting the flu is that bad.” Now let’s say later in the year when flu is spreading, this person who chose not to be vaccinated catches the flu but doesn’t recognize it’s the flu and has been spreading it to other people in the community. What happens if this person with the flu is a daycare provider for infants and young children? They now made the choice to catch the flu virus for themselves, and they made the choice to catch it and spread it to young children who can’t be vaccinated with the flu immunization because they are too young. This leads us to a concept called herd immunity.
Herd immunity (or more accurately, community immunity) means that a significant amount of people (or herd, if you will) are vaccinated against a specific disease, so that the disease does not have a very good chance of taking hold of an unvaccinated person and spreading within that population. Because each disease is different and has varying abilities to transmit and survive in the environment, there are different herd immunity rates for each immunization preventable disease. For example, measles is highly infectious, and because it can survive for up to two hours in the air, and only a small amount of the virus is needed to cause infection, the herd immunity for measles needs to be around 95%. This means 95% of the population needs to be vaccinated against measles to protect the other 5% who can’t be vaccinated. With a disease like polio, which is a bit harder to spread, the herd immunity level is around 80%, or the population needing to be vaccinated so the other 20% who can’t medically get the polio immunization are protected.
If we have a large number of people who CAN be vaccinated but choose not to be, this creates a larger number of unvaccinated people in the population, lowering the herd immunity, allowing diseases like measles, flu or polio to take hold and spread to people who medically could not be vaccinated, or were too young to be vaccinated. These groups are also at higher risk from complications or death because they have other health conditions or are simply too young to fight off the virus on their own, requiring hospitalization. Some of these hospitalized individuals never survive the infection. This can all be prevented. These young people, or people with a medical complication to an immunization could have avoided hospitalization, or in some cases death, if those in their same community who had a choice to be vaccinated made the choice to get the immunization. We are currently seeing the same trends with COVID-19 and people choosing to not be vaccinated against it. Nearly 99% of current COVID-19 deaths are in people who are unvaccinated.
I want to end by talking about access to immunizations and the safety of vaccines. It is pretty easy to access vaccines in the US. We are lucky: if we want them, most of us can get them. If you have health insurance, your provider likely carries them and can administer them, or will send you to practically any pharmacy to receive them. If you have children under the age of 18 years, and they do not have health insurance, you can make an appointment at your local health department or community clinic to be vaccinated, often for any donation amount you can afford. That’s right, if you have three kids without health insurance and they each need five vaccines, and you only have $2.00 that you can donate, these health departments and providers will accept the $2.00 and waive the rest of the cost. This is because of national program called Vaccines for Children.
Why do we have such easy access to vaccines? Because vaccines work! They prevent illness, sick days, disease complications, hospitalizations, and death. Vaccines are one of the most tested and monitored medications on the market today. Think about it, what company wants to make a product that will hurt or kill a significant number of people who take the medication? It’s not a good marketing strategy. We give vaccines to infants, children, adolescents, and adults of all ages, and there are very few serious side effects that people experience. Most people may have a sore arm, a small red area, or even a fever for a few hours.
Vaccines are no different than an antibiotic your provider may prescribe to you for an infection. Both vaccines and antibiotics could cause an allergic reaction, and because you have never had it before, you won’t know until you take the medication. But how many of us question, debate, or even deny an antibiotic that our provider prescribes, much like what happens with vaccines? The other great thing about vaccines are that most are only a dose or two and they can last a lifetime. Or in the case of tetanus and diphtheria, you need one every 10 years. Can you say that you have only needed an antibiotic once every 10 years for an infection? Likely you can’t. Most of us have had a round of antibiotics within the last 12 months, yet we don’t question the safety of those antibiotics, even though some antibiotics can cause side effects and death such as antibiotic resistance, sudden cardiac arrest, tendon rupture, or permanent hearing loss. You didn’t know that? Read the package insert of any medication you are taking now, and you might be surprised at the side effects they could cause. So let’s start the school year off right, stay smart, stay healthy, get vaccinated.