Increased immunizations have reduced the rates of specific diseases associated with childhood. However, adults who are infected with the same viruses can experience dire consequences—and a vaccination in childhood may not guarantee immunity in middle age.  While the evidence supporting childhood vaccination and booster immunizations for adults is overwhelming, ignorance about the science of vaccination and the real-world risks of infectious disease remains unabated.

Due to unfounded fears of an autism link there has been a decline in the percentage of children who receive vaccinations. Even seemingly slight drops in immunization rates in a population can lead to severe, even deadly outbreaks.  According to CDC data, the percentage of children receiving the MMR vaccine has dropped from 92.3 percent in 2006 to 91.9 percent—and the greatest drop has been in Connecticut, Missouri, Ohio, Virginia, and West Virginia.1  

Chicken Pox and Shingles in Adults

Adults who were never vaccinated (or never had chicken pox in childhood) can contract the varicella-zoster virus. The risk of death is higher in adults, and 5-14 percent of adults who have chicken pox develop lung infections.2 Additionally, the fetuses of pregnant women who contract chicken pox prior to 20 weeks gestation can develop congenital varicella syndrome.3 Since the varicella-zoster virus can remain dormant for years in nerve roots, even persons vaccinated as children risk developing shingles (herpes zoster) in their later years.

The following are typical shingles symptoms:4

  • Sensations of pain, burning, numbness, or tingling
  • Skin sensitive to touch
  • Red rash following commencement of pain
  • Fluid-filled blisters (which break open, and then crust over)
  • Itching of blisters

Shingles Risk and the Shingles Vaccine

There are around one million cases of shingles in the U.S. each year.5 One in three adults in the U.S. develops shingles over their lifetime,6 and the majority of cases occur in adults over 50 years of age.7 People who are immunocompromised (e.g., HIV-positive or undergoing cancer chemotherapy) are also at higher risk of developing shingles. Meanwhile, an article in the Journal of General Internal Medicine reported a higher incidence of shingles in females in the U.S. than males.8

Following healing of the rash from shingles, chronic pain (termed postherpetic neuralgia) can persist for years. Therefore, the U.S. Advisory Committee on Vaccine Practices (ACIP) recommends that most adults at age 60 or older receive the shingles vaccine—and most insurers provide coverage for adults who are at least 60 years old.9 However, insurers do not generally cover shingles vaccine costs for adults between 50-59 years old, although the Food and Drug Administration (FDA) has approved the shingles vaccine for adults over 50 years of age.10 Shingles can also recur following a first occurrence, and the shingles vaccine effectiveness weakens over time.

Whooping Cough (Pertussis) in Adults

Whooping Cough is caused by an aerobic, gram-negative bacteria called Bordetella pertussis—and exposed children who have not been vaccinated for pertussis can pass this highly contagious disease to adults. According to the Journal of the American Board of Family Medicine, pertussis is estimated in adults to account for up to 17 percent of prolonged cough illnesses.11 Furthermore, research findings in Respiratory Medicine suggested that atypical pertussis (more common in adults than children) is often misdiagnosed by physicians as post-viral bronchospasm, asthma, or chronic sinusitis.12

Adults suffering from whooping cough can easily infect non-immunized children and adolescents.13 Since vaccines for pertussis are effective for only 4-12 years, “booster” shots are necesssary. In 2014, the CDC reported 32,971 cases of whooping cough (a 15 percent increase as compared to 2013).14  Notably, researchers in 2015 found a correlation between B. pertussis IgA seropositivity and the development of chronic obstructive pulmonary disease (COPD).15

Rubella in Adults

Rubella (also called German Measles) is a virus that can produce arthralgia and arthritis in up to 70 percent of adult women who contract this preventable disease.16 The MMR vaccine (against Measles, Mumps, and Rubella) is usually administered in two doses to young children. While usually mild in childhood, birth defects (e.g., deafness and cardiovascular abnormalities) occur in 85 percent of babies born to pregnant women infected with Rubella during the first trimester of pregnancy.17

Serological immunity precludes the necessity of an adult woman receiving a vaccine against Rubella. However, women who plan to bear children—and have no immunity—should receive the MMR vaccine at least one month prior to conception.

Measles in Adults

There were 159 cases of measles reported in 2013 in the U.S. between January 1, 2013 – August 24, 2013 (per the Morbidity and Mortality Weekly Report [MMWR])—and 8 outbreaks accounted for 77 percent of the U.S. cases.18 Largely eradicated by use of the MMR vaccine, measles outbreaks are increasing due to parental refusal to comply with childhood immunization recommendations. Around one out of every 1,000 people with measles develops encephalitis.19 Other common measles complications in adults include hepatitis, hypocalcemia, and pancreatitis.20

As a highly infectious viral illness, mortality worldwide due to measles remains high in children and adults—and 75-90 percent of household contacts with no immunity typically contract this disease.21

Mumps in Adults

Two-fifths of infected adults with mumps do not display symptoms.22  However, around 15 out of every 100 adults develops meningitis as a complication23—and 3-10 percent of men develop orchitis (testicular inflammation).24 In 2006, an outbreak of mumps in the Midwestern region of the U.S. (predominantly affecting college students) resulted in 6,500 infected individuals.25 Likewise, another outbreak in 2009-2010 in the northeastern region involved 3,500 people.26

Additional complications from mumps that can occur in adults include pancreatitis, oophoritis, and deafness.27 For pregnant women, contracting mumps increases the risk of miscarriage.28 Estimates of hearing loss resulting from mumps range from one in 1,000 cases (to 1 in 30,000 cases).29  Meanwhile, an article in the Journal of the Royal Society of Medicine reported male subfertility as a consequence of mumps-related orchitis—and especially linked to defects in sperm movement.30

References:

  1. Chinni, Dante. State by State: How Vaccination Rates Have Changed. The Wall Street Journal Webpage: http://blogs.wsj.com/washwire/2015/02/04/state-by-state-how-vaccination-rates-have-changed/
  2. National Health Services. Chicken Pox – Complications. Webpage: http://www.nhs.uk/Conditions/chickenpox/Pages/complications.aspx
  3. National Organization for Rare Diseases. Congenital Varicella Syndrome. http://rarediseases.org/rare-diseases/congenital-varicella-syndrome/
  4. Mayo Clinic. Diseases and Conditions: Shingles. Webpage: http://www.mayoclinic.org/diseases-conditions/shingles/basics/symptoms/con-20019574
  5. Centers for Disease Control. Shingles (Herpes Zoster). Webpage: http://www.cdc.gov/shingles/about/overview.html
  6. Centers for Disease Control. Shingles (Herpes Zoster). Webpage: http://www.cdc.gov/shingles/about/overview.html
  7. Immunize.org. Unprotected People Reports: Shingles (zoster). Webpage: http://www.immunize.org/reports/report089.asp
  8. Insinga RP, Itzler RF, Pellissier JM, et al. The Incidence of Herpes Zoster in a United States Administrative Database. Journal of General Internal Medicine 20(8):748-753. Webpage: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490195/
  9. HistoryofVaccines.org. Shingles (Herpes Zoster). Webpage: http://www.historyofvaccines.org/content/articles/shingles-herpes-zoster
  10. National Public Radio. Engineering A Shingles Vaccine That Doesn’t Wimp Out Over Time. Webpage: http://www.npr.org/sections/health-shots/2015/07/13/421570746/engineering-a-shingles-vaccine-that-doesnt-wimp-out-over-time
  11. Brooks DA, and Clover R. Pertussis Infection in the United States: Role for Vaccination of Adolescents and Adults. Journal of the American Board of Family Medicine 19(6): 603-611. Webpage: http://www.jabfm.org/content/19/6/603.full
  12. Kapaskelis AM, Vouloumanou EK, Rafailidis PI, et al. High prevalence of antibody titers against Bordetella pertussis in an adult population with prolonged cough. Respiratory Medicine 102(11): 1586-1591. Webpage: http://www.sciencedirect.com/science/article/pii/S0954611108002023
  13. Brooks DA, and Clover R. Pertussis Infection in the United States: Role for Vaccination of Adolescents and Adults. Journal of the American Board of Family Medicine 19(6): 603-611. Webpage: http://www.jabfm.org/content/19/6/603.full
  14. Centers for Disease Control. Pertussis (Whooping Cough). Pertussis Outbreak Trends. Webpage: http://www.cdc.gov/pertussis/outbreaks/trends.html
  15. Hashemi SH, Nadi E, Hajilooi M, et al. High Seroprevalence of Bordetella pertussis in Patients with Chronic Obstructive Pulmonary Disease: A Case-Control Study. Tanaffos 14(3): 172-176. Webpage: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745185/
  16. Centers for Disease Control. Vaccines and Immunization – Rubella: Epidemiology and Prevention of Vaccine-Preventable Diseases. Webpage: http://www.cdc.gov/vaccines/pubs/pinkbook/rubella.html
  17. Centers for Disease Control. Vaccines and Immunization – Rubella: Epidemiology and Prevention of Vaccine-Preventable Diseases. Webpage: http://www.cdc.gov/vaccines/pubs/pinkbook/rubella.html
  18. Centers for Disease Control. Measles — United States, January 1–August 24, 2013. Morbidity and Mortality Weekly Report (MMWR) 62(36): 741-743. Webpage: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6236a2.htm
  19. Mayo Clinic. Diseases and Conditions – Measles. Webpage: http://www.mayoclinic.org/diseases-conditions/measles/basics/complications/con-20019675
  20. Orenstein WA, Perry RT, and Halsey NA. The Clinical Significance of Measles: A Review. Journal of Infectious Diseases 189(1): S4-S16. Webpage: http://jid.oxfordjournals.org/content/189/Supplement_1/S4.long
  21. Orenstein WA, Perry RT, and Halsey NA. The Clinical Significance of Measles: A Review. Journal of Infectious Diseases 189(1): S4-S16. Webpage: http://jid.oxfordjournals.org/content/189/Supplement_1/S4.long
  22. AdultVaccination.org. Facts about Mumps for Adults. Webpage: http://www.adultvaccination.org/vpd/mumps/facts.html
  23. Centers for Disease Control. Diseases and the Vaccines that Prevent Them – Mumps. Webpage: http://www.cdc.gov/vaccines/vpd-vac/mumps/downloads/dis-mumps-color-office.pdf
  24. Centers for Disease Control. Mumps – For Healthcare Providers. Webpage: http://www.cdc.gov/mumps/hcp.html
  25. Centers for Disease Control. Diseases and the Vaccines that Prevent Them – Mumps. Webpage: http://www.cdc.gov/vaccines/vpd-vac/mumps/downloads/dis-mumps-color-office.pdf
  26. Centers for Disease Control. Diseases and the Vaccines that Prevent Them – Mumps. Webpage: http://www.cdc.gov/vaccines/vpd-vac/mumps/downloads/dis-mumps-color-office.pdf
  27. White SJ, Boldt KL, Holditch SJ, et al. Measles, Mumps, and Rubella. Clinical Obstetrics and Gynecology 55(2): 550-559. Webpage: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334858/
  28. White SJ, Boldt KL, Holditch SJ, et al. Measles, Mumps, and Rubella. Clinical Obstetrics and Gynecology 55(2): 550-559. Webpage: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334858/
  29. Cohen BE, Durstenfeld A, and Roehm PC. Viral Causes of Hearing Loss: A Review for Hearing Health Professionals. Trends in Hearing 18: 2331216514541361. (online) Webpage: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222184/
  30. Masarani M, Wazait H, and Dinneen M. Mumps orchitis. Journal of the Royal Society of Medicine 99(11): 573-575. Webpage: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1633545/