Marilyn Bulloch, PharmD, BCPS, FCCM
Marilyn Novell Bulloch, PharmD BCPS, is an Associate Clinical Professor of Pharmacy Practice at the Auburn University School of Pharmacy and an Adjunct Associate Professor at the University of Alabama-Birmingham School of Medicine and the University of Alabama College of Community Health Sciences . She completed a post-graduate pharmacy practice residency at the University of Alabama-Birmingham Hospital and a post-graduate specialty residency in critical care pharmacy at Charleston Area Medical Center in Charleston, West Virginia. Dr. Bulloch also completed a Faculty Scholars Program in geriatrics through the University of Alabama-Birmingham Geriatric Education Center in 2011. She serves on multiple committees and in leadership positions for many local, state, and national pharmacy and interdisciplinary medical organizations.
The life of a young adult is constantly changing as one settles into newfound freedom and learns to make practical decisions on their own. During this time the risk of acquiring or becoming ill from a vaccine-preventable disease does not go away.1 Some young adults are at risk for other preventable infections outside of those recommended for everyone aged 18 to 26 years.
August is National Immunization Awareness Month, and pharmacists can play a key role in ensuring that this age group remains fully vaccinated against preventable diseases that may impact their lives. Several vaccines have specific indications involving smoking, alcoholism, injection drug use, and occupations, which can increase the likelihood of acquiring a disease such as pneumonia or meningitis that should be considered when screening patients.2
Special Circumstances Necessitating Vaccination
Since 2016 , the number of hepatitis A infections in the United States (US) has increased, with 60% of cases resulting in hospitalization and 236 confirmed deaths as of August 2019.3 The incidence rate of hepatitis A in those aged 19 to 29 years was 10.9 cases per 100,000 people in Florida.4 Because hepatitis A has not historically been a widespread illness in the United States, vaccination is not routine, except in specific circumstances.3
While the hepatitis A vaccine is traditionally a 2- or 3-dose series, a single dose can be given during outbreaks.2,3 This dose is 95% effective towards preventing further spread of infection. If post-exposure prophylaxis is needed, 1 dose provides 95% seroprotection for up to 11 years.3
Immunization against hepatitis B in adults is also not routine as immunity persists for approximately 30 years after childhood immunization.5 Any young adult who volunteers in or has a career in health care whose titers do not prove sufficient immunity should receive the vaccine to prevent potential spread of disease. Sexual partners of hepatitis B surface-antigen positive individuals should also be vaccinated.2
Certain young adults should receive the pneumococcal vaccine (PPSV23) before age 65 years. Specifically, it should be recommended to all smokers and alcoholics beginning at age 19.2 Smoking was found to be the greatest risk factor for acquiring pneumococcal disease in healthy young adults.6 Those who smoke are 4 times more likely to be diagnosed than nonsmokers with an infection due to Streptococcus pneumoniae.7 Furthermore, smoking and alcohol abuse increase alterations in host immune response and the risk of bacterial colonization.8
MenB protects only against serotype B meningitis and is an optional vaccine for those aged 16 to 23 years old for additional meningitis protection.2,9 This vaccination given with MenACWY for protection against other serotypes of meningitis, can be recommended to those with potential exposure to Neisseria meningitides, such as students doing research and career microbiologists; vaccination should be repeated every 5 years as long as exposure remains.2
Those who choose a career in health care may also need proof of varicella and measles, mumps, rubella (MMR) immunity.2 A case report was published regarding a physician unvaccinated for measles who came in contact with 110 people to whom the disease could have spread. Three known, and 1 potential case of measles resulted within the hospital, which implicates the importance for health care providers being adequately immunized against vaccine-preventable disease.10
Immunity and Booster Doses
While most people receive the recommended childhood vaccinations, immunity for some vaccine-preventable diseases can decrease with time. As immunity wanes, booster doses are recommended to provide individual and community level protection.11 A study on the meningitis vaccine (MenACWY) in 2015 showed that immunity from the vaccine declined after 3-4 years, compelling a second dose at 5 years be given to maintain immunity.12 Conversely, 2 doses in childhood or 1-2 doses as an adult of the MMR vaccine provides full protection and does not require revaccination in most cases.13
Waning immunity does not occur in all vaccines or occur to a level significant enough to indicate revaccination with booster doses. Live vaccines, such as varicella and MMR, do not need boosting due to longevity of effects. Inactivated vaccines may or may not require boosting to either increase potency of initial effects or provide sustained protection. Typically, the inactivated vaccines with reduced protective effects over time needing booster doses include tetanus, diphtheria, pertussis, meningococcal, and pneumococcal.14,15
Overall, during the ages of 18 to 26 years, there are many vaccines that could be indicated depending on individual factors such as smoking, sexual orientation, and occupation. Pharmacists have the ability to serve as a reference to the community and other providers for vaccine recommendations in an at-risk population for vaccine-preventable disease as they are trying to figure out how to take charge of their own health care.
- Centers for Disease Control and Prevention. Vaccine preventable adult diseases. CDC website. https://www.cdc.gov/vaccines/adults/vpd.html. Updated May 2, 2016. Accessed Aug 1, 2019.
- Centers for Disease Control and Prevention. Recommended adult immunization schedule for ages 19 years or older. CDC website. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf. Published 2019. Accessed Jul 30, 2019.
- Centers for Disease Control and Prevention. Widespread outbreaks of hepatitis A across the United States. CDC website.https://www.cdc.gov/hepatitis/outbreaks/2017March-HepatitisA.htm. Updated Aug 26, 2019. Accessed Aug 26, 2019.
- Hepatitis A Surveillance May 2019. Florida Health. http://www.floridahealth.gov/diseases-and-conditions/vaccine-preventable-disease/hepatitis-a/surveillance-data/_documents/2019-may-hepatitis-a-summary.pdf. Published May 2019. Accessed Aug 26, 2019.
- Centers for Disease Control and Prevention. Hepatitis B questions and answers for health professionals. CDC website. https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm. Updated May 16, 2019. Accessed Aug 24, 2019.
- Nuorti JP, Bulter JC, Farley MM, et al. Cigarette smoking and invasive pneumococcal disease. N Engl J Med [Internet]. 2000 [cited 2019 Aug 25];342(10):681-89. Available from: https://www.nejm.org/doi/pdf/10.1056/NEJM200003093421002?articleTools=true.
- Wang Y, Li J, Wang Y, et al. Effectiveness and practical uses of 23-valent pneumococcal polysaccharide vaccine in healthy and special populations. Hum Vaccin Immunother [Internet]. 2018 [cited 2019 Aug 25];14(4)1003-12. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5893217/pdf/khvi-14-04-1409316.pdf.
- Grau I, Ardanuy C, Calatayud L et al. Smoking and alcohol abuse are the most preventable risk factors for invasive pneumonia and other pneumococcal infections. Int J Infect Dis [Internet]. 2014 [cited 2019 Aug 25];25:59-64. Available from: https://doi.org/10.1016/j.ijid.2013.12.013.
- Serogroup B meningococcal vaccine (MenB): What you need to know. Vaccine information statement. CDC website. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mening-serogroup.pdf. Published Aug 9, 2016. Accessed Aug 1, 2019.
- Baxi R, Mytton OT, Abid M, et al. Outbreak report: nosocomial transmission of measles through an unvaccination healthcare worker – implications for public health. Eur J Public Health [Internet]. 2013 [cited 2019 Aug 26];36(3):375-81. Available from: https://doi.org/10.1093/pubmed/fdt096.
- What vaccines do I need? Adult vaccination website. http://www.adultvaccination.org/what-vaccines. Accessed July 31, 2019.
- Ostergaard L, Van der Wielen M, Bianco V, Miller JM. Persistence of antibodies for 42 months following vaccination of adolescents with a meningococcal serogroups A, C, W-135, and Y tetanus toxoid conjugate vaccine (MenACWY-TT). Int J Infect Dis [internet]. 2013 [cited 2019 Aug 5];17:e173-6. Available from: https://doi.org/10.1016/j.ijid.2012.10.001
- Centers for Disease Control and Prevention. What everyone should know. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/mmr/public/index.html. Updated Mar 28, 2019. Accessed Aug 18, 2019.
- Centers for Disease Control and Prevention. Chapter 2: general recommendations on immunization. CDC website. https://www.cdc.gov/vaccines/pubs/pinkbook/genrec.html. Updated May 16, 2018. Accessed Aug 19, 2019.
- Vaccine types. Vaccines.gov. https://www.vaccines.gov/basics/types. Updated Dec 2017. Accessed Aug 19, 2019.