Editor’s note: This story has been updated to clarify which adults may need an MMR vaccination.
With my first grandchild due in a matter of weeks, I knew I had to be current on my own vaccinations because the baby couldn’t receive immunizations for some time to come. The very last thing any grandparent wants is to introduce so much as a sniffle to the nursery.
I had recently had my flu shot and Tdap (tetanus, diphtheria, and pertussis) booster. I had read reports about the rise in pertussis (or whooping cough) cases linked with waning effectiveness of the vaccine. I also know that pertussis may be a bad cough for some sufferers, but it can be deadly for infants.
With so much news about mumps and measles outbreaks across the nation, I had new concerns. Approaching my 60th birthday, I suspected I had the MMR (measles, mumps, and rubella) vaccine as a kid, but wasn’t positive. I also wondered whether the measles portion of the vaccine could have worn off over the years, as research has shown.
I emailed my doctor’s office and the nurse responded that they didn’t have a record of me having the MMR vaccine, so I could get an antibody blood test that would show whether I was immune to measles. But, she warned, the test would likely not be covered by insurance. A call to Quest, the lab where I get my blood work, revealed that the antibody test would cost me $136.10. Ouch!
After some digging, I found my childhood immunization records that my mother had actually saved. Remember, way back when, before electronic records, that folded white card on which our parents handwrote the date of each vaccine? Sure enough, next to measles: 1963.
But that didn’t mean I was immune. Between 1963 and 1967, roughly one million people were immunized with the so-called killed measles vaccine, which was later found to be ineffective, according to the Centers for Disease Control and Prevention. (Those who got the weakened “live” measles vaccine during that time are likely protected.) My record doesn’t show which vaccine I received.
“The recommendation was that if you were born during that time, you should get a second immunization to ensure that folks have the protective immunity against measles, mumps and rubella,” said Ian Frank, professor of medicine in the infectious diseases division at the University of Pennsylvania.
And, I learned, I didn’t have to bother with the antibody test.
“There's no harm in just getting the immunization as long as someone doesn't have a compromised immune system,” said Frank.
To be safe, I’m going to get a booster shot.
Vaccine insurance coverage
I am not alone in my concern. My doctor, Nancy Beggs, professor of medicine at Cooper Medical School of Rowan University, said she’s getting more calls than usual with questions about vaccines. And insurance companies are reporting more questions on whether vaccines are covered.
“We have seen a considerable increase in the number of calls we’ve received where members are asking about vaccines or immunizations,” said Ginny Calega, vice president of medical affairs at Independence Blue Cross.
According to the CDC, all Health Insurance Marketplace plans (those governed by the rules of the Affordable Care Act) and most other private insurance plans must cover certain vaccines without charging a copayment or coinsurance when provided by an in-network provider. This is true even for patients who have not met a yearly deductible. Doses, recommended ages, and recommended populations for vaccinations vary. If in doubt, call your insurer.
The danger of adults’ not getting vaccinated
A lot of people associate vaccinations with childhood, when guidelines call for shots starting at age 2 months and continuing through adolescence. So adults may not realize how important it is for them to keep up with their own immunizations.
“Often, healthy folks who don’t have any medical condition may not be seeing a primary-care provider,” Frank said. “It’s worth having a primary-care provider, if for no other reason than to make sure that you have gotten all of the vaccines that would potentially benefit you.”
The guidelines continually change, Beggs said. “The purpose of a prevention visit with your health-care provider is to review health-care recommendations according to age, risk factors, and preference,” she said. “A discussion should include an overview of vaccinations, screening tests, and counseling designed to maintain good health and to prevent potential problems.”
Failing to protect yourself also puts others at risk, Frank said. “For the most part, these are infections that can be spread by a respiratory route or through sexual contact, so the more people that are protected, the less likely we are to see cases spread in the community,” he said.
He’s seen his share of heartbreak that could have been prevented.
“I have done infectious disease consults on young, healthy pregnant women – one who died of the flu and two cases where individuals had to be hooked up to an ECMO machine, that bypasses the lungs to deliver sufficient oxygen.”
And while pregnancy is a time when alcohol and many drugs are off limits to women, flu shots are definitely recommended.
Your vaccine shopping list
The CDC recommends that all healthy adults (age 19 and older) have the following vaccines:
MMR if you were born after 1957 (people born before then are presumed to have acquired immunity) and do not have evidence of immunity to measles, mumps and/or rubella. The mumps portion of the vaccine is not as durable as the others – that’s probably why we saw the recent outbreak at Temple University among people who had been immunized in the past. But there’s no harm in getting an MMR booster, according to the CDC. (By the way, a booster shot is no different from the regular shot.)
Flu shot to protect against influenza viruses. Get one annually.
Tdap if you did not receive it as an adolescent to protect against pertussis, and then a Td (tetanus, diphtheria) booster shot every 10 years. The CDC advises that for those of us caring for infants, it might be easier just to get another Tdap shot, but ask your doctor.
HPV to protect against the human papillomavirus that causes most cervical cancers, anal cancer, many head/neck cancers, and genital warts. The CDC guidelines recommend it up to age 26 for girls and women as well as males who are gay or bisexual, or have a compromised immune system. For other males, the series of two shots is recommended to age 21. But last October, the Food and Drug Administration expanded its recommendation to men and women up to age 45. Frank agrees with the new recommendation. “I recommend it because it does decrease the likelihood that women will have evidence of cervical changes that are precancerous,” he said. “Also, we’re seeing an increase in the number of men, in particular, who get head and neck cancer caused by HPV.”
Older adults should have two additional vaccines according to the CDC:
The shingles vaccine to protect against complications from the disease that can arise in anyone who has ever had chickenpox. Both a single-dose and a two-dose vaccine are available, but the CDC says GSK’s two-dose Shingrix vaccine is preferred for adults over 50 because it is more than 90 percent effective. It is sometimes in short supply, so call before you go.
The single-dose pneumococcal vaccine to protect against the disease, including infections in the lungs and bloodstream (recommended for all adults over 65 years old, and for adults younger than 65 years who have certain chronic health conditions). Some doctors suggest periodic boosters of the pneumococcal vaccine for certain patients.
There are additional vaccines, including Hepatitis A and Hepatitis B that may be warranted for certain individuals, for example, if you are pregnant or travel internationally. Talk to your doctor about your specific needs.