What can adults be vaccinated against?

What can adults be vaccinated against?

In order to plan vaccination, it is worthwhile to find out which protective injections have already been made, whether something needs updating and what risks it would be reasonable to mitigate with vaccination.

Vaccine-preventable diseases

• Viral hepatitis A, i.e. jaundice, is a liver inflammation that does not have a specific medication for treatment. The disease is accompanied by a fever, weakness, loss of appetite, muscle and joint pain, nausea, vomiting, abdominal pain. Symptoms on the skin, mucous membranes and the whites of the eyes turn yellow.

Recommendation – the following people should be vaccinated in priority order:

1. people with chronic liver disease or hepatitis C;
2. people with blood clotting disorders;
3. men who have sexual intercourse with other men;
4. injecting drug users;
5. laboratory staff who come into contact with hepatitis A virus;
6. persons travelling to countries with high incidence of hepatitis A (or persons who host people from these countries).

• Viral hepatitis B is extremely contagious and can cause chronic liver infection. The younger the person is at the time of contracting viral hepatitis B, the higher the likelihood that the disease will become chronic. Chronic viral hepatitis B can cause cirrhosis and liver cancer in the future.

Recommendation – the following people should seriously consider getting vaccinated:

1. sexually active people who often change their partners;
2. people with STDs;
3. injecting drug users;
4. men who have sexual intercourse with other men;
5. sex partners of a person suffering from viral hepatitis B or people living with them long-term;
6. healthcare, laboratory and law enforcement workers who come into contact with blood and other bodily fluids;
7. patients with chronic liver disease;
8. persons with chronic kidney disease and patients of hemodialysis;
1. diabetic people;
10. HIV-infected persons;
11. close ones, family members and sex partners of people with chronic viral hepatitis B;
50. patients and staff of institutions providing care for people with disabilities and people with developmental disorders;
1000. detainees and prisoners;
14. visitors to countries with a high incidence of viral hepatitis B.

• Diphtheria is a serious bacterial infection that can take the form of pharyngitis, inflammation of the throat or nose.  The disease is accompanied by fever, sore throat, enlargement of the neck lymph nodes and a swollen neck, the so-called bull neck. Diphtheria pathogens release a strong poison – diphtheria toxin, which is particularly damaging to the heart muscle. As a result of damage to the nervous system, paralysis of soft palate muscles develops, thereby causing problems with speech and swallowing. Paralysis may also affect muscles of respiration, which can lead to death.

Recommendation: adults vaccinated against diphtheria, tetanus and pertussis in childhood and adolescence should get re-vaccinated every 10 years from the age of 25 years. Adults, who are previously unvaccinated, their history of vaccinations is unknown or their vaccination scheme has been interrupted (less than three doses), should undergo the entire vaccination course.

• Influenza (flu) is a viral disease characterized by a high fever, headaches, coughing and/or rhinitis, fatigue and weakness, muscle and joint pain. Influenza is more severe than regular colds and can lead to serious health problems such as pneumonia. Children contract influenza most commonly, but more serious consequences are experienced by high risk individuals, such as the elderly and people with chronic health problems.

Recommendation: all adults (in particular, people ≥ 65 years of age) should be vaccinated against seasonal influenza.

• Haemophilus influenzae type b  (Hib infection) causes suppurative meningitis (inflammation of brain membrane) in young children. Complications of Hib infection can include hearing loss or deafness, mental retardation and persistent cramping syndrome. According to the WHO, nearly 3 million people contract Hib infection each year, and nearly 400,000 of them die as a result.

Recommendation: people with HIV infection, leukemia, sickle cell disease and asplenia should be vaccinated against Haemophilus influenzae type b infection.

• Nearly 80% of people contract the human papilloma (HPV) virus during their lifetime. The most harmful HPV strains cause the majority of cervical cancer. In Estonia, morbidity and mortality of cervical cancer are one of the highest in Europe. In addition, HPV can cause cancer of the vulva, vagina, anus, penis and oral cavity.

Recommendation: women and men up to 26 years of age should get vaccinated.

• Measles is a highly contagious viral disease that manifests as an inflammation of the throat and eyes, and is accompanied by a characteristic rash. The most common complications of measles are pneumonia and middle ear infection (otitis media). A less common complication is inflammation of the brain, i.e. encephalitis, which can result in disability or death. There is no specific treatment for the disease, only symptoms can be alleviated.

Recommendation – the following people should be vaccinated in priority order:

1. persons who have come into contact with people with measles (including people who have people sick with measles among their relatives or colleagues);
2. university students and members of the Defence Forces;
3. healthcare workers;
4. people who travel frequently.

• Pertussis is a highly contagious bacterial disease that occurs in the form of severe uncontrolled bouts of coughing. Complications of the disease may include pneumonia, seizures, brain damage due to oxygen deficit and apnoea, which can lead to death.
  You can find more information on the diseases here (link to the detailed description of the disease).

Recommendation – vaccination of pertussis is recommended to the following people due to the increased rate of adults contracting the disease:

1. people who come into contact with children aged ≤1 years (parents, grandparents, babysitters, etc.);
2. healthcare workers who come into contact with patients who are not immune;
3. healthcare workers who come into contact with patients with no immunity;
4. pregnant women after the 27th week of pregnancy or after childbirth;
5. people who are not vaccinated or whose history of vaccinations is unknown.

• Meningococcal infection causes meningitis, the symptoms of which are headaches, high fever (up to 40°C), vomiting, clouding of consciousness and stiff neck. This form of illness is treatable, but it can be fatal.

Recommendation – the following people should seriously consider getting vaccinated:

1. persons with anatomical or functional asplenia;
2. complement-deficient people;
3. persons with immunodeficiency;
4. conscripts of the Defence Forces;
5. first year university students living in shared housing;
6. people in long-term camps;
7. laboratory staff working with meningitis diagnostics;
8. travellers headed to the African meningitis belt from December to June;
1. persons planning a pilgrimage to Mecca in Saudi Arabia.
   Adults in risk groups are re-vaccinated every five years.

• Mumps manifests in a fever and painful swelling mostly in parotid salivary glands; the swelling can sometimes spread to other (submandibular and sublingual) salivary glands as well. In boys, inflammation can spread to the testicles, causing severe pain and swelling. Infertility may occur as a complication of inflammation of the testicles. The most severe form of the disease causes inflammation of brain membrane or of the brain. There is no specific treatment for mumps.

Recommendation – the following people should be vaccinated in priority order:

1. persons who have come into contact with people infected with mumps;
2. university students and members of the Defence Forces;
3. healthcare workers;
4. people who travel frequently.

• The most common manifestation of pneumococcal infection is acute otitis media. The disease is characterized by severe ear pain, feeling of pressure and decline in hearing due to the accumulation of pus in the ear canal. In most cases, otitis media is also accompanied by a high fever. Pneumococcal infection can also cause sinusitis or pneumonia, bacteraemia i.e. circulatory infection, and inflammation of the brain membrane. Children under the age of two, the elderly and immunodeficient people are most at risk.

Recommendation – the following people should be vaccinated in priority order:

1. people with chronic lung, heart, liver or kidney diseases;
2. diabetic people;
3. people with anatomical or functional asplenia (vaccinated at least two weeks before the splenectomy);
4. immunodeficient people;
5. people with cochlear implants;
6. spinal fluid leakage patients;
7. chronic alcoholics;
8. patients and inhabitants of welfare facilities and long-term care homes;
1. smokers;
10. people aged ≥ 65 years (vaccinated before the beginning of the flu season);

Re-vaccination is recommended after every five years (with one dose of vaccine for the following people):

11. Persons aged 19–65 years with chronic renal failure or nephrotic syndrome;
12. patients with anatomical or functional asplenia;
1000. persons with immunodeficiency;
14. people aged ≥ 65 years. 

• Poliomyelitis, i.e. infantile paralysis, is an acute viral infectious disease, which manifests as paralysis of the muscles. 1/200 of the cases result in paralysis, 5–10% of those cases in turn end with death. Approximately 25% of patients with paralytic course of disease become people with disabilities.

Recommendation – adult vaccination should be considered, first and foremost, when:

1. wild poliovirus emerges in Estonia and it starts spreading among the population again;
2. an outbreak of poliomyelitis occurs;
3. you are about to travel to a country where a poliomyelitis outbreak is underway.

• Rubella is an acute communicable disease. The disease is particularly dangerous for pregnant women. The earlier the pregnancy stage at the time of contact with the rubella virus, the more severe is the damage to the fetus. If the infection occurs during the first 11 weeks of pregnancy, 90% of fetuses will develop congenital rubella syndrome. Such newborn child will be underweight, may have heart problems, deafness and several other health problems.

Recommendation – the following people should be vaccinated in priority order:

1. women who have been found to lack immunity to rubella and who are not pregnant. Pregnant women can be vaccinated after childbirth;
2. women of reproductive age, who do not know their vaccination history for rubella. In this case, getting pregnant should be avoided during one month after vaccination.

• Tick-borne encephalitis is a viral infectious disease transmitted by ticks, and it has no specific treatment. Tick-borne encephalitis affects the central nervous system; the disease is often bi-phasic. In the first phase, influenza-like symptoms can occur within 1–2 weeks after contracting the disease: fever with headaches and muscle pain. These discomforts usually last up to a week and then disappear. In one third of the infected people, the virus can reach the brain and brain membrane and cause meningitis or meningoencephalitis of varying severity. In this case, the disease intensifies, bringing about a high fever, severe headaches, stiff neck, vomiting, drowsiness and general malaise.

Recommendation – the following people should be vaccinated in priority order:

1. people living and working in areas with high incidence of tick-borne encephalitis;
2. forestry and agricultural workers and hunters;
3. members of the Defence Forces currently in field training;
4. people who often go picking berries or mushrooming.

• Tetanus, also known as lockjaw, is a bacterial infectious disease characterised by the occurrence of muscle cramps. The risk of tetanus occurs in the case of abrasions, cut and puncture wounds, splinters that puncture the skin, as well as bites from insects and animals. In less severe cases, the diseases is curable, in more severe cases, it can end in death.

Recommendation: adults vaccinated against diphtheria, tetanus and pertussis in childhood and adolescence should get re-vaccinated every 10 years from the age of 25 years. Adults, who are previously unvaccinated, their history of vaccinations is unknown or their vaccination scheme has been interrupted (less than three doses), should undergo the entire vaccination course.

• Chickenpox is an extremely itchy skin rash. The disease brings about a rash with pink or red papules and a fever. The number of rash blisters is different in children and adults. For example, a toddler may have only a few spots, adults over 500. Complications may include pneumonia or encephalitis, in the case of severe forms of the disease. Adults have a more serious course of disease than children.
  Adults are not vaccinated against chickenpox on the basis of the immunisation schedule, as at least 95% of the adult population in Estonia has already had chickenpox and therefore acquired natural immunity.

The presence of immunity against chickenpox is confirmed by:

1. chickenpox diagnosis;
2. herpes zoster diagnosis;
3. laboratory confirmation of chickenpox immunity;
4. data on vaccination against chickenpox with two doses of vaccine.

Non-immune adults should be vaccinated against chickenpox if:

1. they do not wish to have (or spread) the disease;
2. they are in constant close contact with immunodeficient persons (above all, children);
3. they are constantly exposed to people who are at risk of complications of chickenpox;
4. they are about to travel to a country with a high incidence of chickenpox.

• Herpes zoster occurs in people who are infected with varicella zoster virus. The virus stays in the body in a concealed state and usually reactivates in the elderly (up to the age of 50). The disease manifests primarily as nerve pain and rash in various parts of the body. Many older people will experience the pain for months or years.

Recommendation: vaccination is recommended for people who are ≥ 50 years old (in particular, ≥ 60 years old), regardless of whether they have had herpes zoster.