Feature Articles Archive
- Adult Vaccination Coverage - Mar. 2012
- Childhood vaccine coverage in Botswana, Africa - Feb. 2012
- Cervical Health and the Human Papillomavirus (HPV) Vaccine - Jan. 2012
Adult vaccination coverage
Adults are 100 times more likely than children to die of vaccine-preventable diseases. Each year in the United States, vaccine-preventable diseases claim the lives of 500 children and approximately 50,000 adults. The Centers for Disease Control and Prevention (CDC) recently reported adult vaccination coverage in the United States during 2010. The data indicated minimal improvement in the numbers of adults receiving recommended vaccines and concluded that significant increases in adult vaccination coverage are needed to reduce the prevalence of vaccine-preventable diseases.
Most adults do not realize they need to get vaccines; but adults still need vaccines for several reasons:
- For some vaccines, including those for diphtheria, tetanus and pertussis, immunity fades so protection is not life-long.
- In the case of influenza, the virus changes through time; therefore, protection from previous versions of the vaccine may be limited.
- Vaccines such as those for shingles and pneumococcus are necessary because of increased susceptibility with increasing age.
While some vaccines, such as influenza and tetanus-diphtheria (Td) or Tdap, are recommended for all adults, others including vaccines for varicella (chickenpox), hepatitis B, measles, mumps and rubella, and pneumococcus are recommended depending upon prior disease or vaccination, age, medical condition, occupation and travel. Check with your healthcare provider to ensure that you are up to date on recommended vaccines.
Learn more about vaccines for adults»
Special vaccine considerations for adults
This month’s "Spotlight" features special vaccine considerations for the following groups of adults:
- Women who are pregnant or who are considering becoming pregnant should make sure they are up to date on their vaccines, particularly the MMR and chickenpox vaccines. Women who are pregnant are not typically given vaccines; however, the influenza shot and Tdap vaccines are given during pregnancy. The influenza vaccine is important because pregnant women who are infected with influenza are more likely to suffer complications from the disease than women their age who are not pregnant.
- The Tdap vaccine is given to mothers-to-be so they don’t get pertussis and pass it on to their newborns, who are particularly susceptible to the disease. Learn more about vaccines and pregnancy»
- Healthcare workers are more likely to catch certain infections than the general population, so it is important for them to be up to date on vaccines. Specifically, the vaccines recommended for hospital workers include influenza and hepatitis B vaccines.
- Child care workers have a high risk of being exposed to many viruses and bacteria; therefore, they should be up to date on their vaccines.
- International travelers should be up to date on vaccines recommended for adults and should receive the necessary vaccines to protect against diseases they might encounter during travel. Because some vaccines and medications may require multiple doses, it is important to begin this process as early as possible. Learn about a four-step plan to help you prepare for your trip»
- People with egg allergies should speak with their healthcare providers before receiving the yellow fever vaccine because it is made in eggs.
While the influenza vaccine is also made in eggs, advances in technology have made the remaining quantities of egg proteins so minimal that most people with egg allergies can now safely get the vaccine. However, people with a known egg allergy are recommended to remain in the provider’s office for about 30 minutes after getting the influenza vaccine in case any reaction occurs.
Childhood vaccine coverage in Botswana, Africa
Maura Murphy, MPH, Global Health Program Manager at The Children’s Hospital of Philadelphia
Botswana is a country of remarkable natural beauty, political stability and economic prosperity. Located in southern Africa and about the size of Texas, Botswana has a population of about 2 million people. Since its independence in 1966, Botswana has made investing in health, including childhood immunizations, a priority. Although it has one of the region’s highest rates of HIV/AIDS, it boasts one of the most comprehensive national responses to the disease, and the rates of new infections have decreased dramatically over the past few years. In Botswana, routine pediatric vaccination rates are very high; in fact, national immunization rates surpass many of the World Health Organization’s goals.
Karata
In health posts and clinics all across the delta and rolling plains of Botswana, mothers can be found holding their child’s personal health record in their hand. Called the karata, which means “Under-5 card” in Setswana, the local language of Botswana, these cards are given to children at birth and contain valuable health information, including their growth charts and vaccine history. Many mothers store the cards in plastic or decorate them with stickers, highlighting the importance of these “traveling medical records.”
These are especially important because, although health centers have records of all of their patients, sometimes they are not readily available when a child visits a clinic, and oftentimes children visit different clinics. The karata travels with children as they grow; and, in fact, many adults also carry their own karata tucked into their current health record, so their medical history is always at hand.
Herd immunity and HIV/AIDS
Pediatric immunizations are an important part of the health strategy for the Botswana Ministry of Health, the governing body of public healthcare in the country. In fact, vaccines are provided free of charge to all children through the public sector at health posts throughout the country. Typically, children get their vaccinations at a local clinic, such as a rural outpost or larger community clinics.
Ensuring that all children are vaccinated becomes more important with the prevalence of HIV/AIDS in the general and pediatric populations. According to Elizabeth Lowenthal, MD, a CHOP pediatrician and HIV specialist who spent years living and working in Botswana: “The high prevalence of HIV in countries such as Botswana makes herd immunity for vaccine-preventable diseases of particular importance since sometimes children with HIV won’t mount sufficient immunity from vaccinations, particularly if they are given before the child’s HIV is well-controlled.” Herd immunity refers to the concept that a disease cannot spread as easily throughout a community in which most people have been immunized against it, therefore, protecting individuals who have not developed immunity, especially children and those with weakened immunity, such as people suffering from HIV and AIDS.
More vaccines in Botswana
Because diarrhea and pneumonia are very common in the pediatric population, the Ministry of Health in Botswana hopes to introduce the rotavirus and pneumococcal vaccines into their immunization program. Clinicians in Botswana are excited about these additional ways to keep their patients healthy. According to Matt Kelly, MD, the CHOP David N. Pincus Global Health Fellow who currently lives and works in Botswana, "Pneumonia and diarrheal illnesses are the most common reasons for children in Botswana to be admitted to the hospital. The addition of pneumococcal and rotavirus vaccines to the national immunization schedule will undoubtedly save lives and improve the health of children throughout the country."
As health officials in Botswana continue to focus on improving the health of their citizens, progress against HIV/AIDS and vaccine-preventable diseases is likely to remain among their top priorities.
To learn more about pediatric vaccines in the developing world, visit the UNICEF immunization website.
Cervical Health and the Human Papillomavirus (HPV) Vaccine
In addition to being the start of a new year, January is Cervical Health Awareness Month. As such, it is a great opportunity to think about issues related to cervical cancer, HPV disease and the importance of prevention and early detection, especially as they relate to the HPV vaccine.
Pap testing and cervical health
At one time cervical cancer was the most common cause of cancer in the United States. One test changed that: the Papanicolaou (Pap) test. The Pap test is performed by scraping cells from the opening of the cervix and examining them under the microscope to see whether they show changes consistent with the early development of cancer (called pre-cancerous changes). Typically, the length of time from infection with HPV to development of cervical cancer is about 15-20 years. For this reason, although most HPV infections occur in teenagers and young adults, cervical cancer is more common in women in their 40s and 50s.
The Pap test is one of the most effective cancer-screening tests available and has dramatically reduced the incidence of cervical cancer in the United States. But the test isn't perfect and not all women get tested as often as they should. Thus, women cannot avoid cervical cancer by simply getting routine Pap testing.
HPV vaccine
Cervical cancer is unique in that it has only one cause: HPV. Typically, HPV infects the skin and causes warts. Although unsightly and emotionally crippling, warts are not harmful. But sometimes HPV infects the genital area, including the lining of the cervix. When HPV infects the cervix, it can cause cervical cancer.
The HPV vaccine reduces or prevents the risk of contracting HPV. The Centers for Disease Control and Prevention (CDC) recommends that all adolescents between 11 and 12 years of age receive the HPV vaccine. The vaccine can be given to girls as young as 9 years of age and is also recommended for all teenage and adult women between 13 and 26 years of age.
After HPV vaccination
Women who get the HPV vaccine still need to get Pap tests because the HPV vaccine prevents only about 7 of every 10 cases of cervical cancer.
In addition, women who have received the HPV vaccine still need to worry about other sexually transmitted diseases such as syphilis, gonorrhea, chlamydia and herpes virus. Further, the HPV vaccine doesn't prevent all types of HPV. Vaccinated women should still practice safe sexual behaviors (abstinence, monogamy or limiting the number of sexual partners, and condom use).
To learn more about cervical cancer and the vaccine:
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