Shots in the arm still good for children, adults By Amanda Isley • Staff writer
WARM SPRINGS and MONTEREY - Diet fads and exercise routines certainly get plenty of attention when it comes to a focus on health, but one of the most important ways people can protect themselves is through immunizations - a decades-old practice that has become routine in this country.
But the typical required round of childhood shots has changed slightly in recent years, generating some negative publicity for a variety of reasons. There are required childhood vaccines for children entering school, and there are a number of recommended vaccines for various age groups.
Health officials in this area, however, stress that all vaccines approved by state and federal health organizations are safe and important. Those who have been vaccinated against diseases not only boost their own immune system, but also protect individuals with whom they come in contact.
The major drawback to recommended vaccines that are not required under state and federal guidelines is often the cost, says Bath County nurse practitioner Kim Rexrode.
Rexrode works with Dr. James Deboe in a physician's office owned by Bath Community Hospital, just down the hall from Dr. James Redington's Bath County Family Practice, a private practice.
One of the newer vaccines, for shingles, is a good example of one with big dollar signs attached.
Large health insurance providers usually give partial coverage for most vaccines, but there is an initial hesitancy to cover newer immunizations. Insurance companies and Medicare do not currently cover the cost of the shingles vaccine, Zostavax, which was released last year, even though it's highly recommended for adults over the age of 60, she said. Shingles is a painful skin rash caused by the same virus as chicken pox and it affects an estimated 1 million Americans each year.
Only someone who has had chicken pox or received the chicken pox vaccine can get shingles - the virus stays dormant in the body once it is contracted. People over age 50 are much more likely to get shingles because the immune system weakens with each decade of age, according to the Department of Health and Human Services Centers for Disease Control and Prevention.
Shingles lasts about two to four weeks, but the nerve pain associated with it can last years after the rash is gone. The Society for Women's Health Research says the virus affects men and women equally, but that women make up a larger portion of the elderly population.
The vaccine is recommended even for those over age 60 who have already had shingles, added Rexrode.
The bad news is, the vaccine - a shot administered one time - costs about $150, Rexrode said.
The Central Shenandoah Health District serves Highland, Bath, Rockingham, Rockbridge and Augusta counties; its main office is located in Staunton. The satellite offices in all counties offer required childhood immunizations at no cost, as mandated by the state. But neither the Bath nor Highland health department offers the shingles vaccine. Interested individuals are instead referred to private physicians like Redington's Bath County Family Practice for the vaccine.
Rexrode said Redington's office has to special order the vaccine, so there is a waiting period. It is sold in sets of 10, and Bath physicians keep a running list of those who want it so none of the vaccines go unused.
In Monterey, Highland Medical Center medical director Dr. Kim Bird said the shingles vaccine has been ordered in single-dose form for a patient who requested it, and the issue of ordering multiple doses had not yet come up at the facility. HMC doesn't keep the shingles vaccine on-site.
"We certainly encourage all recommended vaccines, but we don't keep all of them in stock," Bird explained.
Many recommended vaccines have to be special ordered, or individuals have to be referred elsewhere, says Deborah Bundy-Carpenter, nurse epidemiologist and the health district's immunization coordinator. She explains the shingles vaccine is extremely difficult to handle and transport. "It's a live vaccine - it has to remain frozen up until the time it is to be administered and it can't be exposed to light, otherwise it will die," she said.
During transport, the vaccine must be kept on dry ice. The health district does not offer it at this time, but that could change down the road, she added.
Rexrode said neither Bath County Family Practice nor Deboe's office administers childhood immunizations and refers people to the health department for those. Deboe's office has applied for rural health clinical status, which would allow it to administer those shots to a limited portion of the population, she explained.
"There's a long list of vaccines children have to have in order to start school," said Bundy-Carpenter. The list includes a diphtheria, tetanus, and pertussis shot, flu shot, hepatitis B vaccine, measles, mumps and rubella vaccine, pneumococcal (pneumonia) vaccine, polio vaccine, and chicken pox vaccine, she said.
As for the recent debate centering on the role vaccination plays in rising numbers of autistic children, Bird of HMC said she hasn't seen medical research data to support any correlation. "There does seem to be a rise in autism, but it does not seem to be caused by vaccination," Bird said.
Vaccines that are highly recommended, but are not required and not free, are: meningitis, a second chicken pox vaccine, booster diphtheria, tetanus and pertussis (whooping cough) vaccine, hepatitis A vaccine and human papillomavirus (HPV) vaccine. Shots range in price from $25 to $300, according to Bundy-Carpenter.
The health district strongly recommends that middle school, high school, and college-bound students get the meningitis shot. "The risk for adults decreases at age 25," she said.
Also, Bundy-Carpenter said the newest recommendation is to give children who have not had chicken pox, but have received the required first shot, a second dose of the vaccine. "One was not covering kids from getting chicken pox. They were getting what is called breakthrough chicken pox, so it is recommended that everyone get a second chicken pox vaccine if they have not had the virus."
Usually, children receive their first chicken pox vaccine after their first birthday, and get the second before they head to kindergarten, but they can get it as soon as one month after the initial dose, she noted.
Instead of receiving a normal tetanus shot every 10 years, the health district encourages adults to get a one-time diphtheria, tetanus and pertussis shot (Tdap), which is required for school-aged children, in place of the regular tetanus by itself.
Pertussis, more commonly known as whooping cough, is a highly contagious respiratory disease marked by a dry, wheezing cough often followed by vomiting. "It's a nagging cough for adults that can last for months, but it can be deadly for infants," she said.
Bath public health nurse Jackie Baughn said the Bath health department does stock the Tdap vaccine. "We're now immunizing adults one time," she said.
In order to prevent the spread to young children, adults are encouraged to get a one-time booster. However, adults should continue to get a regular tetanus shot every 10 years, said Bundy-Carpenter.
Although people commonly associate tetanus with rusty metals, she pointed out that tetanus is a bacteria that lives in the dirt and it can be contracted by getting dirt into a cut, not just by a rusty nail in the foot or scratch from old barbed wire.
Hepatitis A, which is a food-borne or fecally transmitted disease, causes severe nausea. "We are recommending a hepatitis A vaccine across the board for everyone," she said.
One of the newest vaccines that has been widely publicized is Gardasil, which protects young women against many HPV viruses that can cause cervical cancer and genital warts. Gov. Tim Kaine recently mandated that upcoming sixth-grade girls, age 11-12, receive the vaccine, although parents may choose to opt out on behalf of their daughters. The mandate goes into effect October 2008.
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