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Pre vention Vaccines Just as Important for Adults as for Children A one-time vaccination for shingles, recommended for all adults, can prevent the occurrence of a painful condition that is most common in the elderly, according to UCLA experts. Shingles (herpes zoster) is caused by varicella zoster, the same virus that causes chickenpox. “After exposure to chickenpox, the virus never completely leaves a person’s system, living in the nerve endings,” explains Zachary Rubin, M.D., UCLA infectious disease specialist. For most people, the antibodies developed against chickenpox keep the virus dormant for decades. But when the immune response is reduced — particularly in older patients — the virus can be activated in the form of a painful skin rash. In addition, notes Dr. Rubin, a small percentage of shingles patients suffer a highly painful complication known as postherpetic neuralgia, which can last months. The older a person is, the more severe the effects of shingles tend to be. The FDA has approved the shingles vaccine for adults beginning at age 50, though some insurance companies will not cover the cost until age 60 or older. The shingles vaccine is one of several important adult immunizations. Others that nearly all adults need at some point — and in some cases on an annual or periodic basis — include vaccines for influenza, pneumonia and hepatitis B, as well as the combined tetanus, diphtheria and pertussis (Tdap) shot. Giselle Namazie, M.D., an internist at UCLA Health System Westlake Village, says she often encounters patients who mistakenly assume vaccinations are only for children, or that the shots they received as children protect them for life. Most know about the importance of obtaining an annual flu shot, Dr. Namazie notes. “This is recommended even for healthy young adults, not only because they may come in contact with children or elderly parents who are immunocompromised, but also because it keeps them from missing important time from work or studies,” she says. The influenza vaccine changes every year and is effective for only a period of months; thus, it is ideally administered just before the onset of the flu season each year. In addition to the injection, a nasal-spray vaccine is available as an alternative for healthy individuals ages 2-49 who are not pregnant. of pertussis, also known as whooping cough, has led to an update of the traditional tetanus- diphtheria booster. “Because of the recent change, we recommend that anyone who hasn’t gotten a tetanus booster in the last few years receive an updated shot that includes pertussis,” Dr. Namazie says. Other adult immunizations include the pneumonia vaccine (recommended for anyone 65 and older; adults with asthma, diabetes, heart disease and any other immunocompromising condition that places them at higher risk for pneumonia; and those who are in close contact with high-risk individuals); the vaccine for hepatitis B infection (for those with diabetes or who are otherwise at risk); the hepatitis A vaccine (particularly for those who travel to underdeveloped countries); and the HPV vaccine, recommended for adolescents and young adults up to the age of 26. Dr. Namazie notes, “Staying up to date with adult immunizations provides important protection not only for ourselves, but for our loved ones as well.” Some adults are less familiar with the need to obtain a Tdap (tetanus, diphtheria and pertussis) vaccine every 10 years. The increased incidence Vital Signs Winter 2013 Vol. 57 11