and Adults A Lifetime of Health

Fifth Edition, 2017 You’ve got a job, a family and a mortgage. Isn’t it time to update your shots?

Adults are 100 times more likely than children to die of diseases that vaccines can prevent. Each year in the United States, -preventable diseases claim the lives of hundreds of children and tens of thousands of adults. While childhood rates are high, most adults don’t even realize they need to get vaccines. Adults often don’t get vaccines because they don’t think they need them, they are worried about how they are going to pay for them or they typically haven’t been encouraged to get them. But they need to — influenza, pneumococcus, hepatitis B, tetanus, shingles, (pertussis), and head, neck and genital cancers are all adult diseases that can be prevented by vaccines. In this booklet, we describe adult vaccines, the diseases they prevent and who should get them. We will remind you why vaccines are an important part of your health and why your doctor feels strongly about their value. Table of Contents

How do vaccines work?...... 2 Vaccines for all adults...... 4 • Td (Tetanus-) or Tdap Vaccine...... 5 • ...... 8

Vaccines for all adults 60 years and older...... 10 • Shingles Vaccine...... 10

Vaccines for all adults 65 years and older...... 12 • ...... 12

Vaccines for some adults...... 16 • Human Papillomavirus Vaccine (HPV)...... 16 • ...... 18 • ...... 19 • Varicella (Chickenpox) Vaccine...... 21 • Measles-Mumps-Rubella (MMR) Vaccine...... 23 • ...... 25 Vaccines for special populations...... 28 • Pregnant Women...... 29 • Healthcare Workers...... 29 • Child Care Workers...... 29 • Travelers...... 30

Paying for vaccines...... 32 Adults are 100 times more likely Common questions and concerns about vaccines...... 34 than children to die of diseases Vaccine schedule...... 38 that vaccines can prevent. Resources...... 40 Immunization record...... 44 HOW DO VACCINES WORK? Why do adults need vaccines? Types of vaccines By the time we are adults, our immune There are several different methods systems have seen many for making vaccines: and developed many memory cells. • Use the live, weakened virus ­– However, there are several reasons Examples of this type are the why vaccines are still necessary: shingles, chickenpox, measles, • Sometimes the vaccine does not mumps and rubella vaccines. provide lifelong protection because • Use the whole, killed virus or bacteria – immunity fades (examples: diphtheria, Examples are hepatitis A vaccines and Vaccines and the immune system tetanus and pertussis vaccines). most of the influenza shots. When we get sick from with • Sometimes the virus or bacteria • Use a piece of the virus or a virus or bacteria, we usually will not changes through time, so the bacteria – The hepatitis B, get that illness again. That is because memory cells will not recognize human papillomavirus (HPV), our immune systems have memory. it as well, or even at all (example: meningococcal and pneumococcal Immune cells, called T cells and B influenza). cells, monitor our bodies after an vaccines are made by this method. infection, and if the same offender • Sometimes the aging immune Sometimes, these pieces of the virus comes back, the immune system system becomes susceptible to or bacteria are linked to another recognizes and kills the virus or diseases that were less of a threat at protein that helps make the immune bacteria before it can hurt us. an earlier age (examples: shingles response stronger. and pneumococcus). Vaccines are made with a form of the • Use inactivated toxins (poisons) virus or bacteria that cannot make produced by the bacteria — In us sick, but they allow our immune Did you know? some cases, poisons produced by systems to develop memory cells and the bacteria are the cause of disease. Any HIV vaccine would need To protect people from illness, subsequently protect our bodies. to adapt to changes that the virus makes naturally. they must be protected against the These continual changes, poisons more than from the bacteria. Did you know? like those of influenza, are These vaccines contain the poisons one of the reasons that that have been inactivated (called Our immune system has two the development of an HIV ), so that they cannot cause parts to fight infections: one vaccine has been so difficult. part that quickly attacks illness. The vaccines for tetanus, anything foreign to our bodies, diphtheria and pertussis are examples called our innate immune of this type. system, and one part that provides specific immune responses to different viruses and bacteria, called our adaptive Vaccines are made with a form of the virus or bacteria immune system. The adaptive immune system is the one that that cannot make us sick. vaccines strengthen.

2 3 Td/Tdap (Tetanus-diphtheria-acellular pertussis) Vaccine VACCINE FOR ALL ADULTS WHO SHOULD GET THE Td/Tdap VACCINE? • Adults who have not previously gotten the Tdap vaccine should receive one dose of Tdap Td (Tetanus-diphtheria) or Tdap Vaccine • Influenza Vaccine • Pregnant women should get a single dose of Tdap between 27 and 36 weeks’ gestation during each pregnancy, preferably earlier during this window • Adults who will be around young infants and who have not had a dose of Tdap vaccine previously should get a dose of Tdap • Adults who have had Tdap vaccine should get Td boosters every 10 years

What diseases do the Td and Tdap vaccines protect against? Did you know?

Td vaccine protects against tetanus The is the only and diphtheria. Tdap vaccine protects vaccine that protects against a against tetanus and diphtheria as well disease not transmitted from one person to another. as pertussis (whooping cough). The “T” stands for tetanus. Tetanus is a bacterium that typically infects The “d” stands for diphtheria. older adults. The tetanus bacterium Diphtheria is caused by a bacterium makes a poison (called a toxin) that that typically infects children and causes severe and painful spasms of adolescents. However, recent outbreaks the muscles, including the muscles in other countries have been primarily of the jaw. (Tetanus is often referred among adults, due to fading immunity to as “lockjaw.”) as people age. Sometimes, tetanus can be fatal. The diphtheria bacterium causes Muscle spasms of the throat can a thick coating on the back of the block the windpipe and cause instant throat that makes it difficult to death from suffocation. The tetanus swallow and breathe. Also, the toxin can also cause severe and bacterium makes a harmful protein permanent damage to the heart. (toxin) that can invade the heart, About three of every 10 people who kidneys and nervous system. In get tetanus die from the disease. children younger than 5 and adults The tetanus bacterium is present in older than 40 years, one of every the soil and can enter the skin after a five people infected with diphtheria cut or puncture wound. Because dies from suffocation, heart failure or tetanus bacteria will always be present paralysis. in soil, the risk of getting infected Diphtheria is very contagious and is with tetanus will never go away. spread by coughing and sneezing.

4 5 Young infants are particularly at risk How is the Tdap vaccine Occasionally, and particularly in Did you know? because of their small windpipes. different from the Td vaccine? adults, there is an exaggerated local Since adults are known to pass the Tdap differs from the Td vaccine reaction at the injection site resulting The bacteria that cause disease to children, it is important in swelling from the shoulder to the diphtheria are only found in because it also contains the pertussis people, whereas most other for adults to be immunized as a . Both adolescents and adults elbow. bacteria are found in some means of protecting infants who are should get the Tdap vaccine instead of animals as well as people. too young to have completed their the Td vaccine for their next booster if Do the benefits of the vaccine immunizations. they have not had it previously. outweigh the risks? The “p” stands for pertussis. Pertussis Subsequent doses (every 10 years) Every year in the United States, is a bacterium that infects infants, are currently recommended for the people contract these diseases and children, adolescents and adults. Did you know? Td vaccine. some die from them. Although severe reactions are a very rare consequence Pertussis bacteria make several toxins While most diseases are passed Does either vaccine cause any of these vaccines, these reactions causing people to have thick, sticky from children to adults, pertussis is reaction? do not result in permanent harm or mucus that clogs the windpipe and often transmitted in the opposite direction, from adults to children. death. Therefore, the benefitsof the causes painful spasms of coughing. Both the Tdap and the Td vaccines vaccine clearly outweigh its risks. When people breathe in against sometimes cause mild reactions like pain, redness or tenderness at the site their narrowed windpipe, it causes What is my chance of getting of the injection. Headache, fatigue or a whooping sound, which is why one of these diseases? pertussis is also known as whooping low-grade fever might also occur. cough. Coughing spasms make it Each year in the United States, there difficult to breathe, eat or drink. are approximately 40 cases of tetanus People with a cough lasting for several with several deaths, one or two cases weeks may well be infected with of diphtheria, and tens of thousands pertussis, a common infection. of cases of pertussis with 15 to 20 deaths. Did you know? What is the Tdap vaccine? Pertussis is also known as the For each of these bacteria, the toxins 100-day cough because of the length of time people cough they produce are inactivated with after getting pertussis. The a chemical. The chemical is then cough often persists for months washed away, leaving the purified, after the infection. inactivated toxin (called toxoid). Pertussis bacteria can also cause pneumonia, seizures and permanent brain damage.

People with a cough lasting for several weeks may well be infected with pertussis, a common infection.

6 7 Influenza Vaccine What is the influenza vaccine? Because the quantity of egg proteins There are a few different influenza in the influenza vaccine is about a vaccines. hundredfold less than that necessary WHO SHOULD GET THE INFLUENZA VACCINE? to induce an allergic response, even • Everyone 6 months of age and older • Most influenza vaccines given people with severe egg allergies as a shot are inactivated whole can receive an influenza vaccine. influenza viruses made by However, as is true for all vaccines, What is influenza? bronchiolitis (infection of the small growing them either in eggs or the person who receives an influenza Influenza is a virus that infects the breathing tubes) caused by influenza mammalian cells, purifying them vaccine should remain at the respiratory system, attacking the virus. and chemically inactivating them provider’s office for 15 minutes after lining of the nose, windpipe, large so they cannot cause disease. receiving the vaccine in case of a breathing tubes, small breathing • A small number of influenza reaction. tubes and lungs. shots contain only one influenza Do the benefits of the Every year in the United States, virus surface protein (known as influenza vaccine outweigh approximately 200,000 people hemagglutinin) that was made in the risks? are hospitalized and thousands to insect cells, purified and used as tens of thousands die from severe the vaccine. This version is only Influenza virus kills thousands pneumonia caused by influenza. available for adults between 18 to tens of thousands of people and 49 years old and is the first every year. In addition, about Most of the deaths caused by influenza vaccine that contains no 200,000 people are hospitalized influenza occur in people 65 or egg proteins. when influenzavirus causes fever, older. However, young children , bronchitis, bronchiolitis or are more likely than adults to be Influenza vaccines are typically reformulated annually so that they pneumonia. Because the vaccine hospitalized with infections caused does not cause serious reactions, by influenza, and young children contain the three or four different strains of influenza viruses expected the benefits of the vaccine clearly commonly transmit influenza virus outweigh its risks. to their parents and grandparents. to cause disease that year. In addition, people with diseases such as asthma are, like the elderly, Does the influenza vaccine at high risk of severe pneumonia cause any reactions? and death from influenza. The influenza vaccine causes fever, Did you know? muscle aches and fatigue in less than What is my risk of getting 1 of 100 people. These reactions influenza infection? Because other viruses cause usually begin six to 12 hours after respiratory illnesses and colds, Influenza is extremely common. immunization and can persist for it is important to remember the one to two days. Reactions are most Hundreds of thousands of people influenza vaccine will only protect are hospitalized each year with fever, against influenza viruses. likely to occur in children who croup (infection of the voice box), were not immunized with influenza pneumonia, bronchitis (infection vaccine or were not infected with of the large breathing tubes) or influenza virus before (typically very young children).

8 9 VACCINES FOR ALL ADULTS 60 YEARS AND OLDER How do you catch shingles? Does the shingles vaccine People don’t catch shingles from cause any reactions? Td (Tetanus-diphtheria)/Tdap Vaccine • others. People who had chickenpox The shingles vaccine is safe. Common Influenza Vaccine • Shingles Vaccine can get shingles because the virus that side effects include redness, pain, causes chickenpox lives silently in their swelling and itching at the injection nervous system for many years. The site. A few people might also get a virus reawakens as the immune system rash at the site of injection. is weakened from advancing age, infections with other viruses or use of Does someone who got the Shingles Vaccine immune-suppressive drugs, such as shingles vaccine need to stay those used to treat cancers. away from infants who did WHO SHOULD GET THE SHINGLES VACCINE? not yet receive the chicken- Did you know? pox vaccine? • All adults 60 years and older who have not had the vaccine before (even if they have had shingles) A person with shingles can give No. However, if a rash develops, be chickenpox to a person who sure to keep the unvaccinated baby has not previously had either from coming into contact with the chickenpox or a chickenpox blisters. What is shingles? Approximately 15 of every 100 cases of vaccine. Transmission occurs by exposure to open blisters. Shingles is a disease caused by a shingles involve the nerves around the If blisters haven’t yet developed Do the benefits of the vaccine reawakening of the chickenpox eye and might lead to reduced vision or or if they are crusted over or outweigh the risks? virus. Therefore, shingles only blindness. covered, transmission is less likely. occurs in people who have already Each year, 500,000 to 1 million had chickenpox. Shingles most What is my chance of getting people in the United States have often occurs in elderly people and shingles? What is the shingles vaccine? shingles. Because the vaccine does not cause serious reactions, people with weakened immune Every year in the United States, shingles The shingles vaccine is a more systems. concentrated version of the the benefits of the vaccine clearly affects between 500,000 and 1 million outweigh its risks. Common symptoms of shingles people. Twenty to 30 of every 100 chickenpox vaccine that is currently include a rash — usually along people can expect to get shingles during given to children. Both are made a nerve path — and severe pain. their lifetime. For people who live to be from the same live, weakened form Are new shingles vaccines likely Sometimes the pain can last for 85 years old, at least half of them will of the chickenpox virus. to become available soon? months or years. The pain can beso have a bout with shingles. How is this vaccine different Two new shingles vaccines, both severe that it leads to sleeplessness, from the chickenpox vaccine? made using a single protein depression and weight loss. Some obtained from the chickenpox people are so debilitated from the Did you know? The shingles vaccine contains about virus, are likely to be available soon. pain that they cannot complete 14 times the amount of weakened Because these vaccines are not made everyday activities such as bathing Up to five of every 100 people chickenpox virus as the vaccine for who get shingles will get it again. using the live, weakened form of and dressing. The severity of the children. This amount of virus is the virus, they are likely to be safer, pain also can impair sufferers’ normal needed to induce a protective response particularly for adults who are social activities. in people who have already been immune-compromised. infected with chickenpox virus but 10 need to boost their immunity. 11 VACCINES FOR ALL ADULTS 65 YEARS AND OLDER Td (Tetanus-diphtheria)/Tdap Vaccine • Influenza Vaccine • Shingles Vaccine • Pneumococcal Vaccine

Pneumococcal Vaccine

WHO SHOULD GET THE PNEUMOCOCCAL VACCINE? • Adults 65 years of age and older • People with chronic illnesses such as heart disease, lung disease (including asthma), diabetes, alcoholism or chronic liver disease (cirrhosis) • People without a spleen • People with Hodgkin’s disease, lymphoma, multiple myeloma, kidney disease, cochlear implants or cerebrospinal fluid leaks • People undergoing chemotherapy • People infected with the AIDS virus • People living in high-risk environments or social settings, such as nursing homes or long-term care facilities by pneumococcus. If the bacteria How do you catch • People who smoke reach the bloodstream, up to six of pneumococcus? What is pneumococcus? What is my chance of getting 10 elderly people with this disease Pneumococcal infections are pneumococcus? could die from it. In addition, passed from one person to another Pneumococcus is a bacterium that there are 3,000 to 6,000 cases of Each year in the United States, by coughing and sneezing. The causes several different types of pneumococcal meningitis in the pneumococcal bacteria commonly serious infections, the most common approximately 400,000 people nation each year. Eight of every are hospitalized with pneumonia live in the noses and throats of of which is pneumonia. People with 10 children and two or three of many people. Transmission occurs pneumonia have high fever, cough caused by pneumococcus, which is 10 adults who get pneumococcal how the bacteria got its name. The more often in crowded settings, and and rapid, difficult breathing. meningitis die from their infections. during the winter and early spring. Sometimes, an accumulation of elderly are particularly vulnerable pus can cause a lung to collapse. to this infection, especially those Pneumococcus can also infect the in nursing homes. Among the blood (sepsis), or the brain and spinal elderly, five to seven of every 100 cord (meningitis). people die from pneumonia caused 12 13 What is the pneumococcal vaccine? Did you know?

There are two vaccines to protect Interest in developing a against pneumococcus. One pneumococcal vaccine waned contains the sugar coating (called after the discovery of penicillin. polysaccharides) from 23 different However, with the emergence types of pneumococcal bacteria. It of antibiotic resistance, interest in vaccine development was has been commonly used in adults reignited about 20 years later. since the early 1980s. The 23 types of pneumococcus in the vaccine are responsible for most pneumococcal disease in adults. The vaccine is called Does either of the two the pneumococcal polysaccharide pneumococcal vaccines cause vaccine. any reactions? The second pneumococcal vaccine In both cases, the vaccine might cause was originally developed for very mild pain, redness and tenderness at the young children because they are also site of the injection. In a small subset of at increased risk for this infection, patients, a mild fever might also occur. but the polysaccharide vaccine did not protect them. In this version, Do the benefits of the vaccine polysaccharides from 13 types of outweigh the risks? pneumococcus are attached (or Every year in the United States, people conjugated) to a harmless protein that die from infections caused by allows children to be better protected. pneumococcus. Because pneumococcal This vaccine is referred to as the vaccines do not cause severe reactions, pneumococcal . the benefits of getting the vaccine Because this version also works outweigh the risks. in adults, it is now recommended for a subset with certain immune- compromising conditions and all adults 65 years of age and older.

Each year in the United States, approximately 400,000 people are hospitalized with pneumonia caused by pneumococcus.

14 15 VACCINES FOR SOME ADULTS

Pneumococcal Vaccine • Human Papillomavirus (HPV) Vaccine • Hepatitis A Vaccine • Hepatitis B Vaccine • Varicella (Chickenpox) Vaccine • Measles-Mumps-Rubella (MMR) Vaccine • Meningococcal Vaccine Why do males need this vaccine? What is my chance of getting HPV? Males are infected with HPV; Before the HPV vaccine, every year in therefore, they can suffer negative the United States, 6 million people were health effects, including cancers Pneumococcal Vaccine – Some groups of adults are recommended to get newly infected with HPV. At any time of the penis, anus or throat. They the pneumococcal vaccine regardless of their age, including: about 20 million people in the United can also get genital warts that are States are infected with this virus, and unsightly and may need to be • People with chronic illnesses such as heart disease, lung disease (including about 25,000 people are diagnosed asthma), diabetes, alcoholism or chronic liver disease (cirrhosis) removed or treated by a healthcare annually with cancers caused by HPV. provider. • People without a spleen How do you catch HPV? • People with Hodgkin’s disease, lymphoma, multiple myeloma, kidney disease, Do people who get this cochlear implants or cerebrospinal fluid leaks HPV is transmitted by genital contact, vaccine still need to worry most often, but not always, during sex. about sexually transmitted • People undergoing chemotherapy Although condoms are helpful, they are diseases? • People infected with the AIDS virus not completely protective. Yes. The HPV vaccine does not • People living in high-risk environments or social settings, such as nursing protect against all types of HPV, homes or long-term care facilities What is the HPV vaccine? nor does it prevent other types of The HPV vaccine is made using a protein sexually transmitted infections such • People who smoke from the surface of nine different types of as syphilis, gonorrhea, chlamydia Refer to pages 12 – 14 for more information. HPV — the seven that most commonly and herpes. cause cancer and the two that most often cause genital warts. Does the HPV vaccine cause Human Papillomavirus Vaccine (HPV) any reactions? Do women who get this The vaccine might cause pain or vaccine still need to get WHO SHOULD GET THE HPV VACCINE? redness at the site of injection. A Pap tests? small number of people also get a • All adolescents and young adults up to 26 years of age who have not previously Yes. The HPV vaccine does not protect slight fever. received the vaccine against all papillomavirus strains that can cause cervical cancer nor is it effective Do the benefits of the vaccine What is human papillomavirus? Did you know? after exposure to one or more of the outweigh the risks? Human papillomavirus (HPV) is a virus types, so women should still be screened Every year, millions of people are that infects the genital area, the lining of The HPV vaccine is the second regularly. infected with HPV and some die vaccine to prevent a form the cervix and, sometimes, the lining of of cancer. The first cancer- from their infections. Since the the throat. There are many different types prevention vaccine was the vaccine does not cause any serious of HPV. Some types cause genital warts hepatitis B vaccine, developed reactions, the benefits of getting the in men and women and other types cause in the early 1980s. vaccine clearly outweigh the risks. cancers of the cervix, anus, penis or throat.

16 17 Hepatitis A Vaccine Hepatitis B Vaccine

WHO SHOULD GET THE HEPATITIS A VACCINE? WHO SHOULD GET THE HEPATITIS B VACCINE? • People traveling to countries with moderate or high rates of hepatitis A • Healthcare workers who may have contact with blood • Men who have sex with men • Sexually active people who are not in long-term, mutually monogamous relationships • People who share needles using injection drugs • Men who have sex with men • People who have chronic liver disease or who receive clotting factor concentrates • People with any sexually transmitted diseases • Laboratory workers who work with hepatitis A virus • People who live with or are physically intimate with a chronically infected person • People who want to be protected against hepatitis A virus • People with chronic liver disease • People traveling to countries with moderate or high rates of hepatitis B • People receiving hemodialysis What is hepatitis A? What is my risk of getting • Prison inmates hepatitis A infection? • People using injection drugs who share needles Hepatitis A is a virus that infects the • Clients and staff of institutions for persons with developmental disabilities liver. Some adults who catch hepatitis A Hepatitis A virus is usually spread from don’t have any symptoms. Some have one person to another or in contaminated loss of appetite, vomiting, nausea, fatigue food or water. Every year, thousands of What is hepatitis B? and jaundice (yellowing of the eyes and people in the United States get hepatitis Did you know? skin). Hepatitis A virus infections are A virus infections and about 30 die from Hepatitis B is a virus that infects often much less severe than hepatitis B the disease. the liver. Every year in the United Since hepatitis B vaccine is now virus infections. (See next page.) States, about 3,000 new cases of recommended for all children, What is the hepatitis A vaccine? hepatitis B are diagnosed. Most scientists predict a dramatic However, hepatitis A virus can cause people who catch hepatitis B virus decrease in the number of a rapid, overwhelming infection of the The hepatitis A vaccine is made by cases of liver cancer as these taking hepatitis A virus, purifying it don’t have any symptoms. Some children become adults. liver and death; this usually occurs in have loss of appetite, vomiting, people with chronic liver disease. and completely inactivating it with a chemical (formaldehyde). nausea, fatigue and jaundice (yellowing of the eyes and skin). Did you know? Does the hepatitis A vaccine Hepatitis B virus can also cause cause any reactions? a rapid, overwhelming infection Hepatitis A used to be known as infectious hepatitis because The vaccine might cause pain, warmth of the liver, a long-term liver it is transmitted through or swelling where the shot was given, or disease called cirrhosis, and liver contaminated food and water, a headache. cancer. Young infants infected whereas hepatitis B was known with hepatitis B virus are more as serum hepatitis because likely to develop cirrhosis it is transmitted in blood. Do the benefits of the hepatitis A than older children or adults; vaccine outweigh the risks? however, every year in the United Every year, thousands of people in the States, hundreds of people die United States are infected with hepatitis from complications of hepatitis B People who catch A virus and some die. The hepatitis A virus infections. hepatitis A often don’t vaccine does not cause any severe reactions. Therefore, the benefits of have any symptoms. the hepatitis A vaccine clearly outweigh 18 19 its risks. What is my risk of getting Many of these people do not know Varicella (Chickenpox) Vaccine hepatitis B? they have hepatitis B until they are A common misconception is that diagnosed with liver disease or liver WHO SHOULD GET THE ? hepatitis B virus is spread only by cancer years after being infected. sexual contact among adults. The • Adults who have not been diagnosed with chickenpox by a healthcare provider reality is that hepatitis B virus can What is the hepatitis B vaccine? or who have not received the chickenpox vaccine also be spread in other ways: The hepatitis B vaccine is made by • Adults who previously received only a single dose of the chickenpox vaccine • Mothers who are infected with isolating the protein coat that hepatitis B virus can pass the surrounds the virus (called the infection on to their babies at hepatitis B surface protein). birth. Immunity to this protein protects What is varicella? people from infection with the virus. Did you know? • Hepatitis B is found in high Varicella (chickenpox) is a highly contagious virus that is spread by concentrations in the blood Does the hepatitis B vaccine People infected with chickenpox coughing and sneezing. People are at a greater risk of having of infected people. Further, it cause any reactions? can be present at low levels in infected with varicella usually an infection with something The hepatitis B vaccine can cause pain, develop fever as well as about 300 commonly known as “flesh- saliva; therefore, the virus can be eating bacteria.” This happens transmitted by sharing personal redness and tenderness at the site of to 500 blisters over their entire when open blisters become items such as razors, toothbrushes the shot and sometimes, fever. In about body. Varicella can also infect the infected with bacteria. These or washcloths. one of every 600,000 people given the lungs (pneumonia) and the brain infections are one of the most hepatitis B vaccine, a severe allergic (encephalitis) and can set the stage common causes of hospitalization Because most people infected with reaction occurs. Symptoms include for severe skin infections (caused for people with chickenpox. hepatitis B virus don’t have any hives, rash or low blood pressure and by “flesh-eating” bacteria). Varicella symptoms, they often don’t know usually occur within 15 minutes of commonly infects young children; they are infected. Up to 2 million receiving the vaccine. however, teens and adults tend to What is my risk of getting people in the United States are suffer more severe complications varicella? infected with hepatitis B virus and when infected. For example, only Do the benefits of the hepatitis B Before the varicella vaccine, almost can spread the infection to others. about five of every 100 cases of vaccine outweigh the risks? everyone got varicella during chickenpox are in adults; however, Every year, thousands of people are childhood. Since the varicella approximately 35 of every 100 permanently harmed or killed by vaccine first became available in deaths from chickenpox are in adults. hepatitis B virus. Many of these people 1995, the incidence of varicella Varicella can also infect unborn catch the infection from friends, family infections has decreased tenfold. babies during pregnancy, causing members or relatives who didn’t know However, varicella infections are still birth defects or fetal death. they were infected. On the other hand, fairly common in the United States. severe reactions to the hepatitis B vaccine are extraordinarily rare and do not cause permanent harm. Therefore, the benefits of the hepatitis B vaccine People infected with varicella usually develop fever as clearly outweigh its risks. well as about 300 to 500 blisters over their entire body.

20 21 What is the varicella vaccine? Does the varicella vaccine Measles-Mumps-Rubella (MMR) Vaccine The varicella vaccine is a live, cause any reactions? weakened form of the chickenpox Some people develop reactions like WHO SHOULD GET THE MMR VACCINE? virus. The vaccine is made by pain, redness or tenderness at the growing the virus in specialized site of injection. About five of 100 • People born during or after 1957 who have not had measles, mumps or cells in the laboratory. As the recipients will develop a few blisters rubella or the MMR vaccine (Adolescent girls and women who are not virus gets better at growing in the after receiving the vaccine. pregnant and have not had rubella are of particular concern because of the laboratory cells, it gets worse at risk to their future babies.) growing in people. So, when used Do the benefits of the varicella • People entering college who have not had two doses as a vaccine, the immune system vaccine outweigh the risks? • Healthcare workers who have not had two doses and those born before 1957 remembers the chickenpox virus, Before the varicella vaccine became who do not have laboratory confirmation of disease but the person does not get ill available, every year thousands from it. • International travelers who have not had two doses of people were hospitalized and some were killed by varicella. The What diseases does the MMR vaccine protect against? varicella vaccine has decreased, but MMR vaccine protects against three 3. The “R” stands for rubella. not eliminated, chickenpox diseases: Rubella is a virus that typically infections in the United States. causes swelling of the glands 1. The first “M” stands for measles. behind the ear, mild rash and Because varicella infections are still Measles is a virus that infects the fever. Rubella infections are fairly common, and because the lining of the back of the throat usually mild in young children. disease is highly contagious, a choice and nose. People with measles However, when a woman is not to get the varicella vaccine have cough, runny nose, fever, infected with rubella virus during is a choice to risk getting varicella. pink eye and a rash that starts on pregnancy, the virus can cause Because the vaccine does not the face and spreads to the rest permanent and severe birth cause any serious reactions, the of the body. Measles virus can defects or miscarriage. benefits of the varicella vaccine also infect the lungs (causing clearly outweigh its risks. pneumonia) and the brain (causing permanent brain What is my chance of getting damage or death). Measles is one of these diseases? very contagious and is spread by In 2005, the Centers for Disease About five of coughing and sneezing. Control and Prevention (CDC) declared that rubella had been 2. The second “M” stands for 100 recipients will eliminated from the United mumps. Mumps is a virus that States. Several hundred cases of develop a few blisters typically causes a painful swelling mumps and fewer than 100 cases of the glands located just below after receiving the of measles are typically reported the ear (parotid glands). Mumps varicella vaccine. each year in this country. However, also infects the lining of the brain as immunization coverage has and spinal cord (meningitis) and improved, the relative number can cause permanent hearing loss. of adults getting disease during Mumps can also infect the unborn outbreaks has increased. For child in the first trimester of pregnancy and cause fetal death. 22 23 example, since 1990, people 15 Meningococcal Vaccine years and older have accounted for Did you know? 30 to 40 percent of the cases of mumps. In addition, adults who Some people feared that the WHO SHOULD GET THE MENINGOCOCCAL VACCINE? MMR vaccine was a cause of get these diseases tend to experience autism. This led to decreased • People without a spleen more complications. rates of vaccine coverage and • People with an uncommon immune problem called complement deficiency subsequent disease outbreaks. • Travelers to areas where meningococcal disease is present What is the MMR vaccine? Fifteen large, carefully performed • Military recruits The vaccine contains live, weakened scientific studies have now • Lab workers who might be exposed to the bacteria clearly shown that the MMR • Teenagers forms of the measles, mumps and vaccine does not cause autism. rubella viruses. The vaccine is made in the same manner as the chickenpox vaccine. (See Page 22.) What is meningococcus? Do the benefits of the MMR Meningococcus is a bacterium Does the MMR vaccine cause vaccine outweigh the risks? that lives on the lining of the nose any reactions? Although infections with these three and throat of some people. Some people given the MMR viruses are relatively uncommon in Approximately one of every 10 vaccine develop pain, redness or the United States, they are common adolescents and adults have these tenderness at the site of injection. in other parts of the world. So a bacteria in the lining of their throat The vaccine might also cause fever drop in immunization rates would and don’t have any symptoms of or a rash that occurs eight to 10 increase the likelihood of outbreaks infection. days after the vaccine is given. This in this country. For example, as happens in approximately five to 15 recently as 2014, more than 650 What is my chance of getting people out of every 100 who get people got measles. Similarly, meningococcus? the vaccine. more than 1,000 people developed Every year, about 2,500 people in the mumps in 2015 in the United The MMR vaccine can also cause a United States get meningococcus and States. decrease in the number of cells in some 120 die from their infections. the bloodstream that help the Because severe reactions to the Approximately 400 people who blood clot (platelets). This reaction is MMR vaccine are extraordinarily survive are left with permanent extremely rare (occurring in about rare, the benefits of the vaccine disabilities, such as seizures, loss of one in 24,000 people) and is not clearly outweigh its risks. limbs, kidney disease, deafness and a cause of death or prolonged mental retardation. hospitalization. The rubella component can also Did you know? cause a short-lived swelling of the small joints (arthritis). The arthritis There is an area across sub- is temporary and occurs primarily Saharan Africa where outbreaks in adolescent girls and women given of meningitis occur so commonly the vaccine. that it is known as the “meningitis belt.”

24 25 How do you catch Does the meningococcal meningococcus? vaccine cause any reactions? Meningococcal bacteria are passed Some people receiving a from person to person by coughing meningococcal vaccine may develop or sneezing. pain or redness at the site of the injection. What is the meningococcal vaccine? Do the benefits of the vaccine There are two types of meningococcal outweigh the risks? vaccines. One protects against Every year, people in the United four of the five different types of States are severely debilitated or die meningococcus (A, C, W and Y) and from infections with meningococcal is made using sugars from the protein bacteria. Since the vaccine does not coating of those types. This vaccine cause severe reactions, the benefits also includes a harmless protein clearly outweigh the risks. that isn’t part of meningococcus, but helps improve immunity to the meningococcal sugars in the vaccine. Because the meningococcal sugars are attached to a protein, this vaccine is called the meningococcal conjugate vaccine. The other type of meningococcal vaccine protects against the fifth type of meningococcus — type B. Two versions of this vaccine exist; both are typically given in two doses. One contains two purified proteins, and the other contains four proteins.

Does the meningococcal vaccine prevent all cases of meningitis? No. Meningitis refers to an infection of the lining of the brain and spinal cord. Meningococcal bacteria are not the only cause of meningitis, so while preventing meningococcal infections will reduce the number of cases of meningitis, it will not prevent all cases of meningitis. 26 27 VACCINES FOR SPECIAL POPULATIONS Pregnant women can provide protection. While it can be administered any time during this Pregnant women • Healthcare workers • Child care workers • Travelers Women who are considering becoming pregnant should check window, earlier is better to allow for with their healthcare providers maximal protection for the baby. to be sure they are up to date on their vaccines. This is particularly Healthcare workers important for the MMR vaccine Healthcare workers should have since the main purpose of the immunity to measles, mumps, rubella is to prevent birth and varicella. They should receive a defects resulting from infection hepatitis B vaccine if they could be with rubella during pregnancy. exposed to blood or body fluids. If Anyone receiving either the MMR they are working in a lab where they or varicella (chickenpox) vaccine might be exposed to the bacteria should wait for four weeks before that cause meningococcal infections, becoming pregnant. If a woman is they should receive the meningococcal already pregnant, she should wait vaccine. All healthcare workers, to get either of these vaccines until especially those with direct patient after delivery. contact, should receive an influenza Women who are pregnant should vaccine every year. get the influenza vaccine if they will be pregnant during influenza Did you know? season. This is important because expectant mothers are at a higher Healthcare workers who are risk of complications from influenza infected with influenza have transmitted it to their patients. compared with the general Check if your healthcare population. Additionally, studies providers have been immunized have shown that babies whose if you are visiting them during mothers were immunized against influenza season. influenza during pregnancy are less likely to have influenza in the first few months of life before they can Child care workers be immunized against influenza. Because of their environment, Women should also receive one dose child care workers come in contact of the Tdap vaccine between 27 and with many viruses and bacteria, so 36 weeks’ gestation during every they should be up to date on the pregnancy. This is timed vaccines recommended for adults. In to protect the baby from pertussis addition, they should get an influenza during the first few months of life vaccine each year. before his or her own 28 29 Travelers or rural area of a country are also People traveling to other countries important in determining which should check with their primary vaccines are necessary. care physician, local health Recommended vaccines that are department or a travel clinic to important to check include be sure they receive the necessary diphtheria, polio, hepatitis B, immunizations. It is important measles, pertussis, influenza, mumps, to begin this process as early as rubella, tetanus and hepatitis A. possible because: • Some vaccines require more Did you know? than one dose to be effective and minimum intervals are required Influenza season occurs at between doses. different times in the northern and southern hemispheres • Many healthcare professionals do and is present year-round in not store travel vaccines because of the tropics, so an influenza a lack of demand for them. They vaccine might be necessary for travel even if it is not might need to order the vaccine or influenza season in the United refer you to another location. States. • Travel vaccines are not always covered by insurance and tend Vaccines that might be necessary to be more expensive, so you will depending upon the trip include have time to find out what is Japanese encephalitis, meningococcus, covered and what your out- rabies, tick-borne encephalitis (TBE), of-pocket expenses will be for typhoid and yellow fever. everyone in your family who is traveling. Did you know? People should consider two issues before traveling. First, travelers Some countries require proof should be up to date with the of receipt of the yellow fever vaccines recommended for them in vaccine before crossing the border. this country. Second, they should This vaccine can be given only be given vaccines necessary for their by certified centers. travel destination. To determine which vaccines they need, providers should know the location, duration, activities, dates and purpose of the Influenza season occurs at different times in the trip. Details like the time of year or whether one is staying in a city northern and southern hemispheres and is present year-round in the tropics.

30 31 PAYING FOR VACCINES

• Ask both your healthcare provider If you get any vaccines outside of and your local health department if your healthcare provider’s office, ask they are aware of any place where the person giving them to provide you can get the vaccines that you you with the necessary information need at a reduced cost. An example to be added to your permanent is the annual influenza vaccine medical record the next time you see for which clinics are often set up your provider. A convenient vaccine throughout the community. These record is provided in the back of this might be less expensive than getting booklet. the vaccine from your doctor. If you need immunizations and you • Contact your employee health • Check with your pharmacist to see have private insurance, call your department to see if you qualify which, if any, vaccines they offer insurance company to see if it covers for any vaccines due to a work- and the relative cost. the costs of the vaccines that you related risk. For example, require. healthcare workers might be able to get the hepatitis B vaccine If you are a recipient of Medicaid because they are at increased risk or are 65 years or older and if they are exposed to blood or Medicare-enrolled, you should be blood products. eligible for most immunizations. Discuss vaccines with your • If you have insurance that does not healthcare provider. cover vaccines, contact the benefits office at your place of employment If you do not have insurance or to voice your concern that vaccines are not covered by your immunizations are not covered by insurance provider, you should do your current insurance plan. the following: • Contact your local health department to see if you qualify for free or reduced cost vaccines through any existing programs.

32 33 COMMON QUESTIONS AND Are vaccines safe? Do we still need vaccines? CONCERNS ABOUT VACCINES To best answer this question, we Vaccines are still given for three reasons: must first define what we mean • For common diseases (like chickenpox, when we say “safe.” If by “safe” we pertussis or pneumococcus), a choice mean completely risk-free, then not to get a vaccine is a choice to risk vaccines aren’t 100 percent safe. Like natural infection. For example, every all medicines, vaccines have mild year hundreds of thousands of people side effects, such as pain, tenderness are infected with pertussis and some or redness at the site of injection. die from the disease. Therefore, it’s And some vaccines have very rare, important to get the vaccine. but more serious, side effects. • Some diseases (like measles or But nothing is harmless. Anything mumps) still occur in the United that we put into our bodies (like States at low levels. If immunization vitamins or antibiotics) can have rates drop, even by as little as 10 to side effects. Even the most routine 15 percent, these diseases will come activities can be associated with back. hidden dangers. For example, consider seat belts. It’s possible that • While some diseases (like polio, in an accident a seat belt could rubella or diphtheria) have been cause a minor injury, like a bruise. either completely or virtually But if you measure the risk of wearing eliminated from the United States, a seat belt against the risk of not they still occur in other parts of the wearing one, the decision to wear a world. Because international travel seat belt is an easy one. Likewise, for is common, these diseases are only a each of the recommended vaccines, plane ride away from coming back the benefits far outweigh the risks. into the United States.

If by “safe” we mean completely risk-free, then vaccines aren’t 100 percent safe.

34 35 Why do adults need vaccines? primarily infects those younger than was compared with that in people Adults need vaccines for the following 2 years old, immune-compromised who didn’t. Again, these groups reasons: people, and those 65 and older. Since were matched to make sure the there was not a vaccine available when only difference between them was • To boost immunity – Some most adults were children, and the cell-phone use. The result was also vaccines do not provide enough susceptibility increases beyond age clear: Cell phones didn’t cause brain immunity to last throughout life, 65, the vaccine is recommended for cancer. so additional doses are necessary as this age group. Some adults younger Because vaccines are given to nearly adults. Examples of this type include than 65, but with particular immune- everyone, many people with chronic tetanus, diphtheria and pertussis. related conditions that increase their diseases will have received vaccines. susceptibility are also recommended • To protect against diseases that And some of these people will have to receive this vaccine. have not been encountered – For received vaccines close in time example, since the introduction of Similarly, since the chickenpox virus to the appearance of the chronic the chickenpox vaccine, there is less lives silently in the nervous system, condition. The question is: “Did the opportunity for the immune system it can reactivate to cause shingles at vaccine cause the disease?” The best to “see” varicella virus, and since any time; however, most frequently Can vaccines cause long-term way to answer this question is to do adults who get chickenpox tend to this occurs when a person’s immune diseases like multiple sclerosis, studies similar to those described for be more ill, it is important for adults system is weakened by other diseases, diabetes or asthma? smoking and cell phones. Although who have not had chickenpox to get some treatments or through aging. When one event precedes another, not all potential associations have the vaccine. This is why the shingles vaccine is we often wonder whether they are been studied, many have. What we • To protect against viruses that change – recommended for everyone 60 years related. For example, some people do know is that vaccines don’t cause Some viruses adapt to their of age and older. who smoke a lot of cigarettes get autism, diabetes, multiple sclerosis, environment in a “survival of the lung cancer. But when scientists allergies, asthma or permanent brain fittest” manner, so that older versions Do vaccines weaken the wanted to know whether cigarette damage. of the vaccine are no longer effective immune system? smoking caused lung cancer, a number of studies performed in the in protecting against the disease. An No. But sometimes, infections with If I have an egg allergy, can 1950s compared the incidence of example of this type is the yearly natural viruses can weaken the I get vaccines? lung cancer in people who smoked influenza vaccine. immune system. For example, people Yes. Because the quantity of egg cigarettes with that in people who infected with influenza virus are at proteins in the influenza vaccine is • To protect against diseases that didn’t smoke. The best studies risk of developing severe bacterial about a hundredfold less than that tend to infect particular groups of matched these two groups of people pneumonia. Also, people infected required to induce a severe allergic people – The pneumococcal vaccine with regard to age, general health, with chickenpox virus are at risk of reaction, the influenza vaccine can is an example of this type because it medications and so on. By matching developing severe infections of the be given safely even to those who these groups, they made sure the skin caused by “flesh-eating” bacteria. have severe egg allergies. However, only difference between them was people should stay in the doctor’s Some vaccines do not However, because the bacteria and cigarette smoking. The result was office for at least 15 minutes after viruses contained in vaccines are highly clear: Cigarette smoking caused provide enough immunity receiving the vaccine. (Refer to Pages weakened versions of natural bacteria lung cancer. Similarly, some people 8 and 9 for more information.) to last throughout life, and viruses, they do not weaken who use cell phones get brain so additional doses are the immune system. On the contrary, cancer. To answer the question of Yellow fever vaccine is also grown vaccines prevent infections that in eggs, so people with egg allergies necessary as adults. whether cell phones caused brain weaken the immune system. cancer, the incidence of brain cancer should discuss the risks and benefits 36 in people who used cell phones with their doctor. 37 VACCINE SCHEDULE Vaccines that MIGHT be necessary Below is a schedule for all routinely recommended vaccines for adults.

HPV Hep A

Mening (Mening ACWY and Hep B Mening B)

See previous pages to determine your individual needs.

Recommended Schedule for ALL Adults Abbreviations: Tdap – tetanus-diphtheria-acellular Age Vaccine(s) Td – tetanus-diphtheria vaccine Influenza – influenza vaccine • Immunity to MMR and varicella Younger than 60 years • Tdap once and Td every 10 years Shingles – shingles vaccine • Influenza annually Pneum – pneumococcal vaccine • Shingles – 1 dose HPV – human papillomavirus vaccine 60 years or older • Influenza annually • Tdap once and Td every 10 years Hep A – hepatitis A vaccine Hep B – hepatitis B vaccine • Pneum – 1 or 2 doses 65 years or older • Shingles if not had previously Varicella – varicella (chickenpox) vaccine • Influenza annually • Tdap once and Td every 10 years MMR – measles-mumps-rubella vaccine Mening ACWY – meningococcal ACWY vaccine Mening B – meningococcal B vaccine

38 39 RESOURCES We hope the information in this booklet has answered your questions about vaccines. If you would like to know more about vaccines, vaccine safety, the science behind vaccines, or the process by which they are tested and approved for use, here are some other useful sources of information.

Books Complete Idiot’s Guide to Vaccinations (Penguin Group USA, 2009) was co- written by Michael J. Smith, M.D., and Laurie Bouck. Do Vaccines Cause That?! A Guide for Evaluating Vaccine Safety Concerns (i4ph, 2008) was co-written by Martin G. Meyers, M.D., and Diego Pineda. Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases (Smithsonian Books, 2007) was written by Paul A. Offit, M.D. Deadly Choices: How the Anti-Vaccine Movement Threatens Us All (Basic Books, 2010) was written by Paul A. Offit, M.D. Vaccines and Your Child: Separating Fact from Fiction (Columbia University Press, 2011) was co-written by Paul A. Offit, M.D. and Charlotte A. Moser.

Pamphlets and Informational Sheets Vaccine Information Statements (VIS) on all childhood and adult vaccines are offered by the Centers for Disease Control and Prevention (CDC) and can be found at www.cdc.gov/vaccines/hcp/vis. Various informational tear sheets are available for download from the Vaccine Education Center at The Children’s Hospital of Philadelphia at vaccine.chop.edu/resources.

Videos Videos are available from the Vaccine Education Center at The Children’s Hospital of Philadelphia at vaccine.chop.edu/resources. Videos of families affected by vaccine-preventable diseases are available from Parents of Kids with Infectious Diseases (PKIDS) at www.pkids.org/immunizations/videos.html. The Pennsylvania Department of Health, Pennsylvania Immunization Coalition (PAIC) and several immunization coalitions from Southeastern Pennsylvania collaborated to produce a 17-minute video regarding the importance of adult immunizations during different life moments. It is 40 available at www.immunizepa.org/resources/video-materials/. 41 Hotlines was founded by former First Lady Rosalynn Carter and The Centers for Disease Control and Prevention Contact Center answers Betty Bumpers and works to increase awareness of the need for immunizations questions about vaccines in English or Spanish; the Center can be reached by by 2 years of age. The website is www.ecbt.org. calling 1-800-CDC-INFO [800-232-4636] or completing the form at Vaccinate Your Family is an immunization awareness campaign administered by www.cdc.gov/dcs/ContactUs/Form ECBT and can be found at www.vaccinateyourfamily.org. Institute for Vaccine Safety is based at Johns Hopkins Bloomberg School of Social Media Public Health and provides excellent, thorough and up-to-date information Vaccinate Your Family is on Facebook and Twitter; on vaccine safety. The website is www.vaccinesafety.edu. go to www.vaccinateyourfamily.org. Albert B. Sabin Vaccine Institute aims to reduce needless human suffering from Shot of Prevention is a blog hosted by Every Child by Two (ECBT); infectious and neglected tropical diseases through innovative vaccine research go to www.shotofprevention.com. and development; and to advocate for improved access to vaccines and essential PKIDS is on Facebook, Twitter, Flickr, YouTube, Delicious and other social medicines for citizens around the globe. The website is www.sabin.org. media sites. It also has a blog; learn more at www.pkids.org. National Adult and Influenza Immunization Summit is dedicated to addressing and resolving adult and influenza immunization issues. The website is Professional and Parent Groups www.izsummitpartners.org. The Vaccine Education Center at The Children’s Hospital of Philadelphia(VEC) National Foundation of Infectious Diseases has a website dedicated to adult is composed of physicians, scientists and parents interested in explaining the immunizations at www.adultvaccination.com. science of vaccines in a clear and straightforward manner. The website is vaccine.chop.edu. Families Fighting Flu is a nonprofit public organization composed of families and pediatricians who have experienced first-hand what it islike to lose a child Parents PACK is a program administered by the VEC that people can join to to the flu or to have a child experience severe medicalcomplications from the flu. receive monthly email newsletters and updates about vaccines. The website is Thewebsite is www.familiesfightingflu.org. vaccine.chop.edu/parents. Vaccine information is provided for all age groups. PKIDS is a nonprofit public organization devoted to supporting children The American Academy of Pediatrics(AAP) is an organization of pediatricians who have been affected by viral hepatitis, HIV/AIDS and other chronic, interested in promoting the health and well-being of children. The AAP has viral infectious diseases and to educating the public about effective disease information about vaccines on its website. See www.aap.org/immunization. prevention practices. The website is www.pkids.org. Immunization Action Coalition (IAC) is a nonprofit organization that works to Autism Science Foundation (ASF) is a nonprofit organization that funds autism boost immunization rates and prevent disease. The IAC provides excellent and research and supports individuals and families affected by autism. The website timely information, including practical tips about vaccine use. In addition, is www.autismsciencefoundation.org. the IAC translates vaccine information into many languages. The website is www.immunize.org. Voices for Vaccines (VFV) is a parent-driven organization that provides science- based information about vaccines and vaccine-preventable diseases. The website Vaccine Information for the Public is a site administered by the IAC and is is www.voicesforvaccines.org. designed for the public and healthcare professionals. The website is www.vaccineinformation.org. PATH Vaccine Resource Library gathers the world’s best immunization resources into a single, easy-to-use website at www.path.org/vaccineresources.

42 43 IMMUNIZATION RECORD

Below is a list of the recommended adult immunizations. Please keep this Immunization Record for: ______with your permanent medical information and have your physician or other healthcare professional fill in the dates you receive vaccines and any notes. Date of Birth: ______

Immunization Record for: ______Mening ACWY Immunization on ______Immunization on ______Date of Birth: ______Mening B Immunization on ______Immunization on ______MMR Born before 1957 History of Measles Tdap/Td History of Mumps Immunization dates: History of Rubella ______Immunization on ______Immunization on ______Varicella History of Varicella Immunization on ______Immunization on ______

Hepatitis A Immunization on ______Influenza Immunization on ______Immunization dates: Hepatitis B Immunization on ______Immunization on ______Immunization on ______HPV Immunization on ______Immunization on ______Immunization on ______Shingles Immunization on ______Pneumococcal Immunization on ______44 45 Notes

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46 Vaccines and Adults was written and produced by the Vaccine Education Center at Children’s Hospital of Philadelphia. The Center was formed in October 2000 to provide accurate, comprehensive and up-to-date information about vaccines and the diseases they prevent. The Vaccine Education Center is funded by endowed chairs from Children’s Hospital of Philadelphia. The Center does not receive support from vaccine companies. For more information about vaccines, visit the Vaccine Education Center websites at vaccine.chop.edu and vaccine.chop.edu/parents.

©2016 Children’s Hospital of Philadelphia, All Rights Reserved. • 17VEC0123/NP/12 -16