Vaccines for Grown Ups

I was just sewing up a patient’s lip when I asked about his last tetanus shot. He shrugged and mumbled something about childhood, which it turns out, is a pretty common response.

We worry about vaccinating our kids, but what about us? Vaccines prevent disease in big people too. With that in mind, here are the major ones you need to be sure are up to date:

photo © 2009 El Alvi | more info (via: Wylio)

Tdap
Until recently, we knew adults needed protection from tetanus and diphtheria, but pertussis is mainly a childhood disease, so we didn’t vaccinate for it. Trouble is, it can be fatal to kids, and usually kids catch it from an infected adult. So this vaccine is a 3-in-1. You get great immunity from tetanus, diphtheria and pertussis with a single Tdap vaccination. This vaccine should be received every 10 years.

Flu
Flu vaccine is next in importance. There are more than 40,000 influenza deaths per winter in this country alone. This is a yearly vaccine and is another 3-in-1. The Center for Disease Control and Prevention and World Heath Organization closely monitor the various strains of influenza circulating around the world. They pick the three stains of flu most likely to hit the U.S. this winter and make a new vaccine against all three. Because there are different influenza strains every winter, you need a new flu shot every fall or early winter. The flu vaccine is recommended for almost everyone.

Pneumonia
Pneumococcal pneumonia is still a very serious disease. This bacterial pneumonia was called “the old man’s friend” as it commonly caused death in the elderly. That’s no kind of friend I like. Pneumonia is most dangerous to those who have less robust heath due to age, disease or smoking. For that reason, this one-time vaccine is recommended for those over 65, people with heart or lung disease, or smokers.

Chicken Pox/Shingles
Varicella vaccine – this is marketed as either the chicken pox or the shingles vaccine. It protects against both because both diseases are caused by the same virus. Because it is a herpes-type virus, the virus lies dormant in the nerves for decades after active infection. If your immunity against this virus goes down, the virus can travel down the nerves and cause painful blisters in one area of your body (shingles). This is another one-time vaccine, and most adults should consider receiving this.

Prevention is always easier than facing the disease. In many ways, children are stronger and healthier than the grown ups who take care of them because they get vaccinated. Give yourself the same chance, and take a minute to talk to your doctor about these vaccines.

Take care,

Dr. B

Protecting Your Business’ Most Valuable Assets

Every businessperson does what they can to protect their company. Strategic planning is a part of every move to ensure the likelihood of success. Insurance provides all sorts of protection. But even so, we sometimes forget to protect our most valuable resources – our people. People are the backbone of any organization. In today’s economy each person can be mission critical in carrying out the effective operations of any business, large or small.

Earlier this year, the California Department of Public Health (CDPH) declared an epidemic of whooping cough (Pertussis), a highly contagious bacterial illness spread by coughs and sneezes. Transmission can also occur indirectly through touching contaminated shared surfaces in common areas. The work environment is a potential place for Pertussis to spread quickly.

Although Pertussis most significantly impacts the health of infants and children; adults who get infected with the bacteria can potentially be off work for months due to severe coughing attacks. Employees may also spread infection to their children, who can become severely ill. The employee may require time to care for their family and need to take time away from work.

In response to the high levels of Pertussis in the community, the CDPH is recommending that all Californians make sure that they are immunized against this disease, especially if they are in contact with infants and children. Many adults may require “booster” vaccinations to achieve immunity.

The Tdap vaccine which became available in 2005 offers the best protection against whooping cough. The threat of Pertussis affecting employees and the potential effect on businesses is clear. Vaccination is the best defense against whooping cough.

- Dr. Minh Q. Nguyen, Area Medical Director

Whooping Cough Outbreak May Be Worst Such Epidemic in 50 Years

An epidemic of pertussis, or “whooping cough,” has descended on California. As of last week, seven deaths have been blamed on the disease and 2,174 cases have been reported.

Graphic courtesy of the Los Angeles Times

On Monday, the California Department of Public Health said that compared to last year at this time, there are six times the number of reported cases, and we could be on the edge of the worst epidemic in 50 years.

What’s more, there’s legitimate concern that this will soon spread to other states around the country.

For many years, the last pertussis vaccine was given when children started school (approximately age 6). In more recent years, the Center for Disease Control and Prevention has recommended a booster vaccine (called Tdap) to prevent the illness for all adolescents and adults.

So what are the symptoms of whooping cough?

Stage 1

The first stage, also known as the catarrhal stage, lasts 1-2 weeks. It resembles a simple upper respiratory infection. Cough, runny nose, sneezing, body aches, and low grade fever are the most common. Many believe they simply have a cold.

Stage 2

After 2 weeks, the cough becomes more severe. This is the beginning of stage 2; it can last as long as 6-10 weeks. Coughs will come in paroxysms, or bursts of rapid, harsh coughs, as the infected person is trying to expel thick mucus. The coughing will increase in severity over two weeks and then very slowly diminish. At the end of the cough, as the person inhales, you will hear the characteristic whooping sound. The cough can be so severe that one can lose their “breath” and even turn a little blue (cyanosis), from a lack of oxygen. Frequently, the cough is so harsh that the person will vomit at the end of the coughing spell. These coughing attacks occur more frequently at night; some will have as many as 24 attacks of coughing in 24 hours.

Stage 3

When the coughing begins to diminish in severity and frequency, it is considered the third stage. But remember, this stage can last many weeks.

How is pertussis transmitted?

Whooping cough is highly contagious and is spread among people by direct contact with fluids from the nose or mouth of infected people. People contaminate their hands with respiratory secretions from an infected person and then touch their own mouth or nose. In addition, small bacteria-containing droplets of mucous from the nose or lungs enter the air during coughing or sneezing. People can become infected by breathing in these drops. Adults can get the disease, and generally, they get a milder case than children. 

How can you tell you have pertussis?

Your doctor can make the diagnosis. Your history and physical examination will provide information that will lead your physician to make the diagnosis. A special test for the bacterium, Bordatella Pertussis, can be sent to your local lab to get confirmation.

How do you treat pertussis?

Since whooping cough is caused by a bacterium, it is treated with antibiotics. There is no clear evidence that treating with antibiotics after the first couple weeks will be of any benefit to the patient. There is no proven treatment for the severe coughs, though many will try various cough preparations.

So, if you are experiencing these symptoms and you have not been vaccinated, see your physician.

What is best way to avoid getting pertussis?

• Get vaccinated! Ask your doctor about the Tdap vaccine for adults and children.
• Wash your hands frequently.
• Avoid contact with people who are coughing.
• Disinfect common areas such as work stations and door knobs.

The physicians at U.S. HealthWorks Medical Group are available to help with vaccination, evaluation and treatment.

 – Dr. Alesia Wagner, Regional Medical Director, U.S. HealthWorks Medical Group of California

Hit Me with Your Best (Tdap) Shot

We’re all aware of the importance of tetanus shots, and now there’s a vaccine to prevent tetanus while also fighting other serious ailments at the same time.

Multiple health organizations are now recommending that adults have a one-time dose of something called Tdap. This is a combination vaccine that contains tetanus, diphtheria and pertussis vaccines. The Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) all recommend this vaccine.

As usual, something prompts me to think about certain topics. Why this one? Ok, I admit it…I was not paying attention and I grabbed some papers with a partially closed staple in them. As it ripped through the tip of my finger, I knew I would need to recall when my last tetanus vaccine was. And, as a healthcare worker, I did know that I had not yet had a Tdap. So, my weekend included a sore arm….

There is no vaccine for just pertussis alone, and this ailment, like tetanus, is one I’m sure we’d all like to avoid. Pertussis is known as the “whooping cough,” and this bacterial infection is passed from person to person. It’s generally not serious in adolescents and adults, but can be very dangerous to young children.

The symptoms of whooping cough come in 3 stages:

• The first begins much like your common cold – runny nose, sneezing and coughing. The cough will last 1-2 weeks, getting worse instead of better.
• In the second stage, you will have uncontrollable coughing spells, frequently vomiting after coughing, and you will emit a “whopping” noise when you breathe in. Patients can even stop breathing or turn blue in the face from lack of air during these cough episodes. This can last 2-6 weeks.
• During the last stage, the symptoms actually start to lessen. The coughing spells decrease in frequency and severity.

The course of this illness can be 6-10 weeks. Adults, teens and vaccinated children will generally have milder symptoms, like those of bronchitis.

Pertussis is spread by the “spray” of our secretions in the air, when we sneeze, cough or talk. We can also get it from sharing our cups and silverware. Initial symptoms will appear in 7-10 days after the exposure, and we will be contagious from 2 weeks prior to the start of the cough until 3 weeks after the cough starts, or until we have completed a 5-day course of appropriate antibiotic therapy.

Here is an information sheet on Tdap from the CDC. It discusses who should and shouldn’t have the vaccine, as well as the side effects.

If you are due for a tetanus vaccine and have not had your Tdap, consider receiving one at your nearest U.S. HealthWorks center. Then the only whooping you will hear is out of glee because you know you’ll be pertussis and tetanus-free.

- Alesia J. Wagner, Regional Medical Director, Southern California