Flu's Not the Only Ill That Might Merit a Preventive Shot

By Rachel Saslow
Washington Post Staff Writer
Tuesday, August 18, 2009

All the vaccine buzz is about the H1N1 virus right now, but the Centers for Disease Control and Prevention is reminding Americans to make sure all of their vaccinations are up-to-date. The CDC encourages adults to guard against vaccine-preventable diseases such as shingles, human papillomavirus (HPV), tetanus, meningitis, whooping cough and pneumococcal disease.

If getting those shots hadn't occurred to you, you're not alone. A survey released last month by the National Foundation for Infectious Diseases (NFID) found that about three-quarters of American adults were extremely or very familiar with only two vaccine-preventable diseases: influenza and chickenpox. (See chart for the recommended vaccination schedule.)

Young adults, defined as ages 18 to 26 for the survey, tend to be especially complacent about vaccination. "This is not that surprising, because they have been well-protected against these diseases and have little or no experience with the manifestations," says Susan J. Rehm, the medical director of NFID.

For example, less than half of the young adults surveyed knew that tetanus causes lockjaw and that one should be vaccinated against tetanus every 10 years; 84 percent of adults 50 and older knew this.

Shingles, which is caused by the same virus that causes chickenpox and results in a painful, sometimes debilitating rash, strikes fear into people who have seen its effects firsthand, but that hasn't translated into mass vaccination: Only 7 percent of Americans who are supposed to receive the shot -- people age 60 or older -- have done so. The shingles vaccine has only been approved by the Food and Drug Administration since 2006. The vaccination costs $200 to $500, depending on how much a doctor charges for buying and handling the delicate medicine, which must remain frozen until shortly before it is injected.

"In my adult practice, if you say the word 'shingles' in that visit, you can tell immediately if that patient has had direct contact with somebody who has had shingles," says Robert H. Hopkins, an Arkansas doctor who is involved in local and national efforts to improve immunization rates. "If they've had direct contact with somebody who's had shingles in their family, in their neighborhood, in church, most of them will say, 'I don't care what it costs, I want to prevent it.' "

At a July 22 NFID news conference, Hopkins and other doctors tried mightily to stay focused on their message of encouraging adults to get vaccinated, but they kept bumping into health-care-reform issues: Discussion of the pricey shingles vaccine brought up questions about Medicare and prescription drug costs. The role of primary care doctors in educating patients about appropriate vaccines led to discussion of the shortage of general practitioners; reasons for that shortage include a medical system that rewards specialized services over prevention.

Vaccination is a perfect example of good preventive, evidence-based medicine, said CDC physician Anne Schuchat: "There's a need for culture change in America, where we worry about things when they're really bad rather than taking care of prevention and wellness."

Comments: saslowr@washpost.com.

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