The disturbing resurgence of infectious diseases like measles, mumps and whooping cough has sparked much conversation about the importance of childhood vaccination.
But lost in the hand-wringing and the ever-louder calls for mandatory vaccination of children is that many of these infections are occurring in adults.
Pregnant women, babies and children get good medical care in Canada. Immunization is a routine and dominant aspect of visits to the doctor’s office, especially in the first couple of years of life when there is a seemingly endless number of shots.
Attention to preventing infections continues throughout the daycare years and the start of school, even though vaccination for school admission is mandatory only in Ontario and New Brunswick. Somewhere between 10 and 30 per cent of kids are not adequately vaccinated – an abysmal record.
After the age of 6, there is a long lull in vaccination, with no shots again until Grade 6 to 7, again, depending on the province. That’s when soon-to-be teens get vaccinated to protect against HPV (human papillomavirus), meningococcal conjugate (Men-C-ACYW) and hepatitis B – viruses that are more likely to spread when teens start sharing bodily fluids.
But once you’re out of middle school, you’re pretty well on your own when it comes to vaccination.
Unsurprisingly, adult vaccination rates are a fraction of what they are in children.
As new vaccines come along and show their worth, they get added to childhood immunization schedules. But we don’t do catch-up programs, so entire cohorts miss out on protection.
A striking example of this is that babies born between 1970 and 1996 received only one dose of the MMR (measles-mumps-rubella) vaccine. That has proven to be insufficient so this group is at higher risk of infection as adults. (Now, kids get two doses.)
Every now and then there is an outbreak of mumps among young adults like hockey players or bar patrons, but by then it’s too late – and those stories aren’t the most effective way to promote vaccination.
Similarly, with relatively new vaccines like chickenpox and HPV, large numbers of young adults simply don’t know they weren’t vaccinated.
Not everyone realizes either that boosters are required to protect against some conditions. For example, you need a new tetanus shot every decade, and probably for whooping cough, too – and it comes in the form of the TDaP vaccine (tetanus, diphtheria, pertussis).
While children get a vaccine for Men-C-ACYW, and a booster around the age of 16, a vaccine for serogroup B meningococcal disease is only covered by some provinces. It is recommended, but not actively promoted, for young adults living in group settings like college or university. But just last month, an 18-year-old Montreal college student died of Men B.
The sheer number of vaccines and changing schedules can make tracking difficult, especially since Canada has poor electronic health records.
Most Canadians still use a paper yellow vaccination booklet, though there is a great free app called CANimmunize available. Knowing your status is especially important if you travel internationally. There are a number of travel vaccines, some of them mandatory in some countries, such as typhoid, yellow fever, Japanese encephalitis, cholera and hepatitis A.
Travel vaccines almost always have to be paid out-of-pocket – a penny-wise-pound-foolish policy, because when Canadians come home with these grave illnesses, their health costs are covered.
Increasingly, there are vaccines aimed specifically at adults, especially older adults. The flu vaccine is the most heavily publicized, though kids should get that, too. But older adults, especially those living in institutional settings like nursing homes, should get a pneumococcal vaccine, too, which can protect from up to 23 strains of the bacteria.
But the illness that should most make us question and rethink our approach to adult vaccination is shingles.
Currently, Ontario is the only province to cover shingles vaccination, and only for people aged 65 to 70. Private insurers aren’t much better – they don’t always cover vaccines like other drugs, sometimes putting a cap on reimbursement or not covering them at all.
Yet, there is a highly effective vaccine named Shingrix that protects against this sometimes debilitating condition. Since it came on the market in January 2018, close to 400,000 Canadian have paid out-of-pocket for it. So the demand is there – but the publicly funded programs are not.
Imagine if only children whose parents could afford vaccines received them. Our approach should be no different with young adults or seniors.
Universal coverage of disease-prevention programs should be a lifelong project. Vaccination is a serious business – and not simply kids stuff.