Adult vaccinations: What do you need?

The flu shot may get a lot of attention this time of year, but it isn’t the only immunization adults should be considering. Health issues such as shingles, and pneumonia can also cause serious and even life-threatening complications — but their incidence and severity can also be reduced.

You may be thinking: aren’t vaccines just for children? Not so, warn health experts. According to the U.S. Centers for Disease Control, some adults didn’t receive vaccinations as children, or they haven’t had the latest versions. Furthermore, adults should keep up with their vaccinations to protect themselves as well as more vulnerable members of their community — like children and seniors — to whom they might transmit infections.

But there’s one more factor to consider: age. “As we get older, our immune system ages too,” warned Dr. Jay Keystone, in a presentation at the 2nd annual CARP Conference “A New Vision of Aging” in Toronto. It’s a process known as immunosenescence — that is, an age-related decline in our immune function . That’s why older adults are at higher risk for infections and complications.

It’s also why adult vaccinations aren’t a magical shot-in-the-arm. They won’t always prevent infection, but they can ward off serious complications that can kill.

“We immunize children to prevent illness,” Dr. Keystone said. “We immunize adults to reduce the severity of illnesses and prevent death.”

Here are four vaccines adults should consider:

Shingles (herpes zoster)

Shingles can’t be passed from person to person, but halting transmission isn’t the issue since anyone who has had chicken pox already carries the virus. After decades of lying dormant in a person’s system, the Varicella Zoster virus can come back in full force — causing a severe rash and accompanying nerve pain (known as postherpetic neuralgia or PHN) that can last for months or even years.

Most people have a 28 per cent chance of getting shingles during their lifetime — but as age increases so does the risk, warned Dr. Keystone. People over the age of 50 have a 40 per cent chance of getting shingles, and that risk jumps to 80 per cent by age 80.

The vaccine, known as Zostavax™, became available in Canada this fall. Clinical trials showed that it reduces risk by 50 per cent for people over the age of 50. The most benefit is seen for people ages 60 – 69, who saw a reduced risk of 64 per cent. However, for those who do get shingles, the vaccine reduced the duration of the illness and severity of pain.

Who should get it? Most adults over the age of 60, even if they’ve had a previous bout of shingles. (Dr. Keystone advised that people between the ages of 50 and 60 can consider it too.) Because the vaccine contains live (but weakened) virus, people who have weakened immune systems due to illness or medication should take a pass. Same goes for people with certain allergies, untreated tuberculosis or a history of bone or lymphatic cancer.

If you’re one of the slim percentage of adults who hasn’t had chicken pox or the chicken pox vaccine, experts recommend getting a Varicella vaccine – this is especially important for new immigrants and people who are at risk for exposure. However, ask to be tested first: the Public Health Agency of Canada notes that most adults don’t require a vaccine thanks to prior immunity.

How often? For the shingles vaccine, one dose in adulthood is needed — for now. Experts aren’t sure how long it will be effective, so there currently aren’t any recommendations for booster shots.

For more information, see WebMD or the CDC information sheet (PDF).

Whooping cough (pertussis)

Pertussis is making a comeback, Dr. Keystone warned. It can strike anyone at any age, but poses the most risk to infants. However, adults can easily transmit this disease to children so everyone should play a part in prevention.

According to the Public Health Agency of Canada, all adults should get tetanus and diphtheria shots (known as Td) every ten years. Experts recommend that while we’re keeping up with this routine, we should get a dose of the acellular pertussis vaccine shot in with it (known as Tdap).

Who should get it? All adults who haven’t had a dose of Tdap, especially ones that work with or are in contact with infants.

How often? Only one dose of Tdap is needed, then the regular Td will do. As with the shingles vaccine, boosters aren’t currently required.

What about other routine vaccinations for measles, mumps and rubella (MMR)? Adults born before 1970 need not apply. Adults born later who haven’t had a vaccine and who have no evidence of immunity to these illnesses should talk to their doctor about getting an MMR shot.

For more information, see the Public Health Agency of Canada website.


Respiratory illnesses, including the flu, are a top cause of death in developed countries. Millions of Canadians will get influenza each year, and the infection will kill between 4000 – 8000 people.

The influenza vaccine, or flu shot, can reduce your chances of getting the flu or reduce the severity of the illness if you do catch it.

Who should get it? The seasonal flu shot is recommended for most adults, especially people over 65, pregnant women, people who have underlying health conditions and people with weakened immune systems. People who live in a long-term care facility and people who work with children or older adults are also a high priority for flu shots.

How often? One dose every fall. Different strains circulate each year, so the vaccine is “updated” annually.

For more information, see Health Canada’s Influenza webpage.

Pneumococcal vaccine

Along with influenza vaccines, the pneumococcal vaccine can reduce the risk of serious complications and death among people who are at the most risk. Pneumonia can move in when the lungs and the body are already weak — sometimes with devastating consequences.

While the vaccine doesn’t cover all types (some are viral and some are bacterial), it can offer up to 97 per cent protection against some of the most common strains, according to Health Canada. In Canada, there are two types available: the newer conjugate pneumococcal vaccine (mostly used for young children) and the polysaccharide pneumococcal vaccine (which has been around longer).

Who should get it? Adults who are at higher risk include people age 65 and over, people who have compromised immune systems, people with chronic diseases like heart disease, lung disease, diabetes or kidney disease and people who don’t have a properly functioning spleen.

How often? Adults over the age of 65 only need one dose. Adults under the age of 65 need a dose plus a booster every five years.

For more information, visit Health Canada’s Pneumococcal Vaccine webpage.

Additional risks

Of course, this list isn’t exhaustive. Other than routine vaccinations, many people should consider additional preventatives based on their age, medical history, occupation, lifestyle risks and travel.

For example, health care workers and those who care for children and older adults have a greater risk of exposure and transmitting certain illnesses. Travellers to certain regions may require vaccines for illnesses like yellow fever, Japanese encephalitis and typhoid. In addition, the meningococcal vaccine is recommended for people living in close quarters, like students or the military, as well as people with certain medical conditions.

And what about safety? Vaccinations, like other medications, can cause side effects, but most doctors agree that the benefits usually outweigh the risks. It’s important to talk to your doctor to weigh the pros and cons.

And the costs? Unfortunately, provincial or employer health care plans don’t always cover the costs of vaccinations. For example, the Zostavax vaccine carries a price tag of $150 that most people will have to pay out of pocket. Shingles, unlike the flu, isn’t considered to be a public health issue and doesn’t warrant the same coverage.

The best advice: talk to your doctor and do a little research through reputable health websites to make an informed decision about preventative health care measures.


For more information on adult vaccines, see:

The Public Health Agency of Canada: Immunizations Recommended for Adults

The Centers for Disease Control and Prevention: Adult Immunization Schedule

Canadian Coalition for Immunization Awareness and Promotion brochure (PDF)

Dr. Keystone is currently Director of Medisys Travel Health Clinic, Professor of Medicine at the University of Toronto and staff physician at the Centre for Travel and Tropical Medicine at the Toronto General Hospital. For more information, visit the Medisys Travel Health Clinic website.

Photo © Amy Walters


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