Internal Medicine Blog

Shingles: What You Need To Know

By: Dr. Lauren O’Brien MD

We have all seen the commercials. A patient in obvious pain is shown with a terrible looking rash over a significant portion of his or her body. They are asking questions such as “why me?” and “what could I have done to prevent this?”. These patients have been diagnosed with shingles, and the suffering pictured can be accurate. Here’s what you needs to know about this disease and how to prevent a severe outbreak.

Shingles, also know as Herpes Zoster, is caused by the Varicella Zoster Virus (VZV). This is the same virus that causes chicken pox (varicella). After a patient has had the chicken pox or received the varicella vaccine, the VZV continues to reside in the nerve roots indefinitely. The VZV can then be reactivated, leading to a case of shingles. Any patient who has had the chicken pox or the Varicella vaccine is therefore at risk for shingles.

While most severe cases are seen in patients over the age of 60, shingles can occur at any age. Generally, individuals will only have one case of shingles in a lifetime, but recurrent cases are possible. Those who are immunocompromised are at higher risk of recurrence.  

The hallmark symptoms of shingles are pain and rash. Approximately 75% of patients have pain prior to the rash developing. This pain is usually described as burning, throbbing or stabbing and can occur days to weeks prior to skin lesions.  

The shingles rash starts as red papules (bumps) and evolves into grouped vesicles or blisters. After about 3-4 days the lesions may become pustular and will crust over at 7-10 days. Once these lesions are dry and crusted, the patient is no longer contagious. Because the virus resides in the nerve roots, the rash tends to involve a limited area on only one side of the body. The most dreaded shingles infection involves the trigeminal nerve located in the head. Infection here can lead to Herpes Zoster Opthalmicus, which can be sight-threatening. An individual with this manifestation will have lesions around one eye and the tip of the nose.

The most common complications of shingles include: post-herpetic neuralgia and bacterial superinfection of the skin lesions. Post-herpetic neuralgia is pain that persists at the sight of the rash for months to years following infection. It occurs in 5-20% of those with shingles and is more common in patients over the age of 60.

When discussing shingles with patients, the most common questions I hear relate to transmission and contagiousness of this disease.  Let me try to break it down simply for you. You cannot give someone else a case of shingles. The VZV can be passed from contact with the skin lesions and is generally not airborne in an individual with shingles. Only people who have not had chicken pox or the varicella vaccine, or are immunocompromised are at risk when in contact with a shingles patient. If one of these individuals comes in contact with the active shingles lesions, they could go on to develop chicken pox, but NOT shingles. I am often asked about pregnant women and exposure to shingles. If the pregnant woman has had chicken pox or the vaccine in the past, there is very little risk present. That being said, I would recommend that a patient with an active shingles infection avoid infants, pregnant women and the immunocompromised until lesions have crusted over. It is advised to keep the rash covered and wash hands frequently to prevent transmission.

For older patients, there is a vaccine available to help prevent shingles. Though this vaccine will not prevent 100% of cases, it has the potential to reduce the severity of an infection and prevent the dreaded post-herpetic neuralgia. This vaccine is recommended in patients 60 and over (though it is FDA approved for those over 50). It can and should be given even if a patient has had a history of shingles. Talk with your doctor to see if the shingles vaccine is right for you.

In summary, the vast majority of the population is at risk for shingles. It is most common in older patients and those with weakened immune systems. The VZV responsible for this disease can be transmitted through contact with the skin lesions, but only those who have not had chicken pox or the varicella vaccine or the immunocompromised are at risk. If you are older than 50 talk with your doctor about getting the shingles vaccine.

Treating Acne With Birth Control

By: Dana Shanis, MD

Whether you just get a pimple or two the day before your period or have a constant struggle, acne is a frustration that can cause embarrassment and anxiety for many women. Acne can be triggered by excess oil production, which can clog pores and promote bacteria growth. Many treatments exist, both topical and oral, that target different portions of the process leading to acne. One very effective treatment is birth control pills. Combined birth control pills (those containing both estrogen and progesterone) have been shown in many studies to cause decreased acne flare-ups, fewer pimples, less inflammation and less severe acne.


HOW IT WORKS

Birth control pills work to improve acne mainly by reducing the amount of androgens (male-type hormones, including testosterone) in your bloodstream. This occurs as a result of your liver increasing its production of a protein called sex hormone-binding globulin, which binds androgens making them inactive. This is beneficial, as oil-producing glands in the skin are stimulated by androgens. For some, the pill will also decrease the amount of androgens made by the ovary, additionally decreasing oil production in the skin. It can take a few months on the pill to maximize these effects.

WHICH PILL IS RIGHT FOR ME?

There has been an explosion in the number of new birth control pills in the past decade and few have been directly studied for their effect on acne. Currently, only 3 types have been FDA approved for treating acne: Ortho Tri-Cyclen, Estrostep and Yaz. However, all combined pills will likely have some effect. The degree of improvement can depend on the type of progesterone in the pill, since some types directly cause more androgen-like effects than others.  

SIDE EFFECTS

While birth control pills are a safe and effective way to decrease acne (and prevent pregnancy) for many women, there are some side effects and risks of this hormonal treatment. Some women experience headaches, nausea, breast tenderness and mood changes, which may improve or resolve with switching to a pill with a different dose or type of progesterone. All combined birth control pills can mildly increase the risk of blood clots, such as a deep vein thrombosis or stroke. This increase is small overall, but may be of concern if you have another risk factor for clots such as smoking, obesity or a significant family history of clots. Recent studies also indicate that some types of progesterone may have a higher risk of clotting than others, although these differences are likely very small.

OTHER BENEFITS OF THE PILL

Birth control pills have other benefits, such as decreasing amount of menstrual bleeding, cramping and premenstrual symptoms, and have also been shown to cut the risk of ovarian cancer in half if taken for >5 years. If you are interested in learning more or think birth control pills might be a good option for you, come in for a discussion with your doctor or nurse practitioner.



Misconceptions About Depression and Anxiety Medication

By: Jillan Rowbotham, D.O.

I’d like to address some common misconceptions about daily medications used to treat depression and anxiety. These medications are classified as antidepressants or antianxiety medications, and work by affecting the neurotransmitters in the brain, chemicals that help transmit signals. One person can have mostly depressive symptoms and benefit from the same medication as a person who has crippling anxiety but doesn't feel a bit depressed. Though lifestyle changes and seeing a therapist can help many with mild symptoms, if your depression or anxiety persists despite this (or it prevents you from being able to take these steps) it does not mean that you failed or that you just didn't try hard enough. Sometimes you need some additional help for a time and that is okay. 

Like most medications antidepressants or anti-anxieties come with a long list of potential side effects, but the doctor will review the most serious and most common ones with you before prescribing. Everyone is different - you may experience a lot, some, or none of the side effects. These medications are not “happy pills,” nor are they intended to make you feel numb or like a zombie; if you are feeling this way then it may be a sign that it is not the correct medication or dose for you. The goal is to make you feel more like yourself! 

Often I will hear people say that they don’t want to use these medications because they see them as a crutch. I like to think of them more like a cast; they help hold everything in place while you do the work of healing. Then you take them off. 

Many people worry if they start taking a pill then they will be on it their entire life. Though there are people who continue to take daily medication for decades, a vast majority will be on it for a much shorter time. Part of the process is a regular and ongoing reassessment. When a medication is first started, your doctor will have you come back in about six to eight weeks to see how it is working. Once they have found a medication and a dose that works for you we generally have you follow up every six months or so thereafter to see how you are doing. Timing, of course, varies from case to case. If things are going well then you may feel like it is a good time to stop the medication. If things are still not that great then you should continue the medication and check back in in a few months. These are not medications you want to stop abruptly; they can have some pretty unpleasant withdrawal symptoms, so your doctor will wean you off of them by incrementally decreasing the dose over a period of time. 

Medications are not for everyone but having correct information is a great first step in determining if something is right for you. If you would like to learn more about treatments or talk over how you have been feeling please come in, the doctors at Rittenhouse Women’s Wellness Center are always here to talk and to listen.

Understanding Contraceptive Coverage

CONTRACEPTIVECOVERAGE

Contraceptive care is an integral part of women’s health and family planning. The choice to plan to bear children or not is an important decision, and the outcome can have life changing effects. According to the National Conference of State Legislature, almost half of pregnancies in the U.S. are unintended. Most women nowadays graduate college and are career driven. They would prefer to plan their pregnancies – and this is possible through the use of contraceptives.  It is critical to understand your insurance coverage under changes in health care laws, which have pushed to expand women’s’ health care since January 2013 by requiring coverage of certain preventative health services and screenings, including contraception. Despite comprehensive coverage required by law, some employers have the ability to not offer contraceptives.

Required contraceptive care can be bypassed by employer’s plans that have been “grandfathered” in as well as those who opt out due to religious beliefs. Churches and other houses of worship are not required to include birth control coverage to their employees. Non-profit organizations that object to offering birth control because of religious reason may also do so, but women may still have access directly from their insurance company. You may remember the Hobby Lobby controversy, in which the for-profit “family-owned” corporation was able to refuse birth control coverage. In this case the Supreme Court decided that certain “closely-held” for-profit corporations can deny coverage on religious grounds.  Figure out what your employer’s insurance plan allows and if it is in accordance with the law.


As mentioned earlier, most insurance plans now allow women to select an option to include contraceptive benefits at no additional cost. If you are sexually active and not looking to have children at this point in your life, (and your employer does not offer this benefit) you may want to talk to you Human Resources Director to see if this benefit can be added for you. Once you are ready to have children, you may talk to your health care provider about discontinuing your contraceptive care.

The bottom line: When you visit your health care provider regarding birth control, be sure you have contraceptive coverage and you should not have to pay a co-pay for your oral contraceptive.

Finding Your Birth Control Method

By: Eterial Burrell, NP

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Did you know that approximately half of all pregnancies are unintended?  Pregnancy and parenthood have a lasting impact on a woman’s emotional, mental, physical, and financial well-being, so it is best to approach the decision to have children seriously. More and more women are postponing childbearing or opting to have a life without children. Careers, relationships, living and financial situations are frequently changing for women of this generation and are common reasons why women are seeking birth control. Being proactive and exploring your options now is key to family planning. So let’s talk birth control!

Hormonal or Non-Hormonal?

There are several non-hormonal methods to prevent pregnancy. Natural family planning or fertility awareness method is a method in which a couple opts to avoid sexual intercourse or use a barrier method during times of ovulation. This requires careful planning and discipline; a woman must have regular menstrual cycles and understand when she is likely to ovulate to be successful in pregnancy prevention. There are various apps for smart phone users that can keep track of cycles and peak ovulatory days. The efficacy of this method largely depends on consistency and vigilance of the couple; it is unclear but suspected that as many as 25% of women experience unintended pregnancy within the first year of typical use of this method.

Other non-hormonal methods work by either creating a physical barrier preventing sperm from reaching the egg  (inhibiting fertilization) or killing sperm altogether. In general, non-hormonal methods tend to be less effective than hormonal methods, with the exception of the Copper-T IUD.  Male and female condoms are the only methods that can decrease the risk of transmission of sexual transmitted infections (STI/STD).  Examples of non-hormonal methods include:

·         Male or female condom
·         Spermicide
·         Diaphragm
·         Cervical cap (FemCap)
·         Copper – T IUD (Paragard®)

Hormonal birth control alters the hormone fluctuations in a woman’s body, thereby inhibiting ovulation, thinning the uterine lining, and/or thickening the cervical mucus. Hormonal birth control not only prevents pregnancy but it is also used to control heavy menstrual cycles, improve menstrual cramps, stop PMS, and even treat acne and unwanted hair growth. Studies also prove that prolonged use can decrease the risk of endometrial and ovarian cancer. But hormonal birth control does not come without risks and side effects. Some women may experience side effects including headaches, bloating, and mood changes. Also hormonal birth control may increase blood pressure, lead to migraines with visual disturbances, and carry a slight increased risk for stroke and blood clots, especially in certain health populations. It is also important to note that hormonal birth control does not prevent the transmission of STI’s. If used correctly hormonal methods tend to be more effective than non-hormonal methods. Examples of hormonal birth control include

Oral contraceptives (“birth control pill”) – a pill taken at the same time every day to prevent pregnancy.  There are both estrogen/progestin preparations and progestin-only preparations. It is the most commonly used hormonal method. Side effects may include nausea, bloating, and breast tenderness.

Ortho Evra® (“The Patch”) – estrogen/progestin containing patch placed on the skin (usually abdomen or buttocks) that is worn for 3 weeks and removed for 1 week to induce a cycle. Side effects are similar to the birth control pill.

NuvaRing® – estrogen/progestin vaginal ring placed for 3 weeks and removed for 1 week to induce a cycle. Side effects are similar to the birth control pill.

Depo Provera® (“The Shot”) – progestin-only injection given in office every 3 months. The shot may cause irregular bleeding and weight gain.

Nexplanon® (“The Implant”)– small, progestin-only rod placed in the upper arm in a quick office procedure. It is effective for 3 years. Most common side effect is irregular bleeding

Levonorgestrel Intrauterine Device (Mirena®, Skyla®, Liletta®) – progestin-only T-shaped device placed in the uterus at a quick office procedure. Approved for use for 3 or 5 years use. Most common side effect is irregular bleeding.

Which Method is Right for Me?

When choosing a birth control method several factors should be considered. Do you plan to have children soon or many years in the future? Does cost matter? How effective is each birth control method? How will a particular method impact my health? There is no perfect form of birth control that fits the needs of every woman, so approach your birth control choice with personal reflection. Speaking with a healthcare provider about what your needs is the best way to start the conversation. We offer various options of birth control at Rittenhouse Women’s Wellness Center. Please contact the office at 215-735-7992 to schedule your appointment and start the path towards taking charge of your reproductive health; your future depends on it.

Treating Rosacea

By: Catherine McGinty, MSN, FNP-BC

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Have you noticed redness and irritation to your face that is worsened by extreme temperatures and certain hot or spicy foods? You may be one of the 16 million people in America who suffers from a skin condition called Rosacea. While Rosacea is an incurable condition, there are many ways to treat the symptoms and prevent flare ups. If you think you are suffering from this condition, or have had similar symptoms in the past, learn more here and call our office to schedule an appointment to speak with one of our medical providers.


Rosacea can be seen in both men and women, and affects people of all ages and races; however, it is mostly seen in fair-skinned women between the ages of 30 to 50 years old. The most common symptoms are redness, pimples, burning and stinging sensations, and red lines to the nose, cheeks, chin, forehead and/or neck. Less common symptoms include facial dandruff, oily skin, and swollen skin.

These symptoms are most often the result of a trigger like alcohol, spicy foods, hot drinks, hot showers, and harsh weather. Therefore, the first step in managing Rosacea is to avoid triggers by decreasing foods or drinks that aggravate the skin condition and wearing a hat and scarf in the winter to shield your face from the cold and wind. Other methods of preventing a flare up include using a daily moisturizer during the winter to keep your face moist, and wearing sunscreen on exposed skin every day, even when its cloudy outside. It is important to make sure that you use a broad-spectrum sunscreen that has a sun protection factor (SPF) of 30 or higher to ensure the most effective protection. Lastly, make sure to use soaps, lotions, and makeup made for sensitive skin that do not contain alcohol, are not abrasive, and will not clog pores, for these will ensure a lesser chance of flare-ups.

If your maintenance routine is still not controlling your symptoms, we have a number of options here at Rittenhouse Women’s Wellness Center and in our Dermacenter Medical Spa. After a full evaluation with one of our medical providers, they may start you on a prescription antibiotic cream to apply to your face daily. This is a good option if you are having a flare up or to have in case you have a flare up in the future. Also, in our Dermacenter, we have a therapy called Intense Pulse Light (IPL) which can be used for pigmentation, sun damage, broken capillaries and Rosacea. The IPL or Photofacial can safely and effectively reduce dilated blood vessels and persistent redness or flushing found in patients with a history of Rosacea. After a series of 3-6 treatments done monthly, you will be able to see amazing results. It is recommended to have this treatment done seasonally or twice a year depending on the severity of the Rosacea in order to maintain the positive results. 

If think you have been suffering from Rosacea, contact the front desk for information and to schedule an appointment with one of our providers or aestheticians. Through the month of October, IPL treatments are discounted so make sure take advantage of this special price!!

Top Misconceptions about the Flu Vaccine

By: Lauren O’Brien, MD

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With the heat of summer still upon us, I know that it is hard to believe that fall- and the dreaded flu season- will soon be here.  Flu vaccines are set to arrive soon, so this is the perfect time to review some common misconceptions about this illness and vaccine. 

Influenza is more than the “common cold”.  It is a respiratory illness caused by the Influenza viruses, which can be very severe.  Common symptoms include: fever, cough, sore throat, body aches, headaches and fatigue.  Occasionally individuals will have vomiting and diarrhea, but this is more common in children. Most people who get the flu will recover in 5-14 days, but complications (such as pneumonia) can occur that can lead to serious illness or even death. 

These complications and the control of the spread of the influenza virus are some of the main reasons why we recommend that all of our patients without contraindications get the flu vaccine.  Here are a few common misconceptions to think about as you prepare to come in to the office for your yearly vaccine.

Misconception #1:

“I am healthy and I have never had the flu, so I don’t need to get the vaccine.”

It is great that an individual has escaped contracting the flu in the past and a healthy immune system is important, but it does not mean that you are naturally immune to the virus and will not come down with the flu in the future.  The annual flu vaccine will help to protect you against getting the flu or at the very least give you a much milder case of symptoms.  This leads to less missed days of work and less disruption in your daily life.  In addition, the more healthy individuals we vaccinate the less likely the flu is to spread to those who are immunocompromised and those who cannot get the flu vaccine themselves.

Misconception #2:

“I got the flu from the vaccine in the past!”

This is a very common misconception.  The flu vaccines that we give in the office are made from ‘inactivated” flu viruses and are therefore not infectious.  The most common side effects include: local reactions at the sight of injection (redness, tenderness, or swelling).  In some patients, a low grade fever, headache and body aches are possible, but these are not as severe as the flu and are of a much shorter duration.

In studies where some patients were given an injection of the flu vaccine versus an injection of a salt water solution, the only difference in side effects was a slight increase in arm soreness with the flu vaccine.  There was no difference in fever, body aches or headaches.

Misconception #3:

“I got the flu vaccine last year, so I don’t need one this year”

The Influenza vaccine is an annual vaccine for good reason.  The circulating strains of flu viruses can change from year to year.  Because of this, scientists study the trends in circulation and make a very educated guess as to which strains will be present in the up coming flu season.  Production of this year’s flu vaccine then ensues.  Sometimes the scientists get it right on and the vaccine is highly effective.  Sometimes they miss the mark (as with last season) and the effectiveness is low.  Even in these cases, the vaccine can still provide enough protection so that an individual’s illness is much less severe.  Therefore, since the viruses and vaccines change each year, an annual flu vaccine is essential.

Misconception #4:

“It’s too early to get the flu vaccine!”

We anticipate that the supply of this year’s flu vaccine will be arriving in September.  This is a great time to get your vaccine.  The flu season generally peaks in December thru February, but illness can be seen from October thru May.  Getting your flu vaccine early allows you to mount the appropriate immune response early and gives you the best protection for the entire flu season.  On the flip side, if you do not get in to the office in September or October, it’s not too late to get the flu vaccine.  Vaccinating after December can still be effective for the remainder of the season.

Misconception #5:

“I am pregnant, so I can’t get the vaccine”

If you happen to be pregnant during the flu season it is even more important that you get the vaccine this year.  Pregnancy increases an individual’s risk of complications from the flu so vaccination is highly recommended.

If you have further concerns about Influenza or the flu vaccine, please come in to see your doctor to discuss things further.  If you are not coming in for your routine care this fall, please schedule a visit with one of our nurses to get your flu vaccine as soon as they become available.

Added Protection with Gardasil 9

By: Maria Mazzotti, D.O. 

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At the end of last year the new version of Gardasil (Gardasil 9) was approved.  This is very significant, because it has coverage for 5 additional HPV strains that account for 20% of cervical cancers diagnosed.  So previously the vaccine was up to 75%, now it is up to 90% effective!  The added news is it is just as safe.


The shot is approved for use in females ages 9 through 26. (In males ages 9 through 15.)  Obviously the sooner you get the vaccine, the more effective it will be for you.  HPV screening is not recommend before starting, therefore, even if you have tested positive for HPV, there are still strains it can protect you against.  As long as you start your first dose by age 26 and follow through with the recommended immunization schedule, it will be covered by your insurance.  It is administered on the initial dose, 2 months later and 6 months after the initial dose. 

There are also a few more added benefits, but you do not hear about as frequently such as: protection against vulvar, vaginal and anal cancers.  This is great news when I consider how frequently I see positive HPV results.  Keep a look out for the arrival of the new Gardasil 9 to our office!

Sunburn Do's and Don'ts

By: Jillan Rowbotham, D.O.

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With summer now in full swing sunburns are, unfortunately, an all too common occurrence. More than 30 percent of adults and 70 percent of children and adolescents report at least one sunburn during the course of a year.  The best approach for sunburn is prevention through sun avoidance or diligent use and reapplication of a sunscreen. Sometimes, despite our best efforts, we end up lobster red after a sunny day.

Sunburn is a self-limiting condition that usually resolves in a few days. There is nothing you can do to reverse the skin damage or speed up the healing time but there are some things you can do, and things you shouldn’t do, to reduce pain and further damage.

Do get out of the sun as soon as possible if you think you are starting to get burned.

Don’t just apply sunscreen over burned areas in an attempt to stay outside longer.

Don’t think that a “base tan” is healthy and that it will protect you from getting sunburned. Tanned skin provides an SPF of less than four. Any change in skin color is a sign of damage and increases your risk of premature skin aging and skin cancer. 

Don’t underestimate the relief you can get from an over the counter anti-inflammatory medication such as aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve). These medications are especially helpful if you take them as soon as you notice pain, don’t wait until the pain gets really bad.

Do be aware that NSAIDs such as ibuprofen or naproxen will make your skin more sensitive to the sun while you are taking them so take appropriate precautions to avoid getting burned again.

Do use cool water to soothe sunburned skin. A cool bath, shower, or compress (a towel soaked in cool water) can give you some relief. If your shower water pressure is high it is best to opt for a bath or cool compress to avoid pressure on your burn.

Do drink plenty of water. Sun exposure and heat can cause fluid loss through your skin.

Do feel free to use aloe on intact sunburned skin. Keep commercially-prepared aloe lotion or gel in the refrigerator to make it extra soothing. You can also apply aloe gel directly from the plant. I keep an aloe plant on hand for such occasions and have found that it makes a great houseplant and is surprisingly easy to keep alive.

Don’t use petroleum jelly, butter, egg whites, or other home remedies on your sunburn.

Don’t be tempted to pop a blister if one develops. Popping a blister will increase you risk of infection. If a blister does rupture on its own then apply a bit of antibacterial ointment and keep it clean and covered with a bandage. Don’t remove the top layer of skin, it helps protect the tender underlying skin and will eventually come off on its own. If left alone blisters will generally heal without scarring in 7-10 days.

Do treat peeling skin gently. Keep the peeling area moisturized and don’t try to speed up the peeling with harsh exfoliants or scrubbing with a loofah.

Do come into the office if your sunburn is severe, blistering, and covers a large part of your body; if you have developed a skin infection from scratching sunburned skin, or you have a severe sunburn that does not begin to improve within a few days.

If you have a severe sunburn and also have fever, headache, confusion, nausea, vomiting, blurry vision, or fainting you may also have heat exhaustion or heat stroke. If you have any of these problems, you should go to the emergency department immediately.

Update on Immunizations: Get Your Shots!

By: Monica Duvall, M.D.

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Many of our patients use the summer months to catch up on routine health screenings--gyn exams, dental cleanings, physicals--which is great.  Despite this motivation to get healthy, however, I have noticed that when it comes to vaccinations, many patients are unaware, or uninterested, in taking care of this very important--and effective--step in preventing disease.  The development of vaccines has been one of the most important and cost-effective public health initiatives of the past century, saving untold numbers of lives worldwide from now-preventable disease.  Ironically, this success has caused some vaccine apathy in our population, as many once-deadly diseases are simply off our radar and do not seem to pose an immediate threat.    

The American Committee on Immunization Practices (ACIP) releases new vaccine updates annually, and occasionally more frequently.  CDC researchers recently analyzed data from the 2013 National Health Interview Survey and found that for at least six vaccines recommended for adults by the ACIP, the rates of coverage were far below the goals of the Healthy People 2020 targets (this is a national collaborative effort to reduce disease and promote health in America).

So, what vaccines should you be getting?  
Here is a general list of vaccines recommended for a healthy adult:

1.  First of all, all adults should get a tetanus shot every 10 years, and a Tdap (Tetanus and Pertussis, or whooping cough) shot at least once.  In addition, pregnant women should be getting the Tdap shot in the third trimester of EVERY pregnancy, regardless of previous immunization status--this will protect you and your newborn from whooping cough, which can be deadly (it is usually recommended that any close contacts of your newborn also be up to date on this immunization).  

2.  Flu shots are now universally recommended for everyone, healthy or not (this not only protects you, but contributes to "herd immunity", reducing the likelihood of spreading disease through a community).  

3.  Shingles vaccination is recommended for all adults over age 60, even if you have had the shingles, even if you think you have never had the chicken pox. 

4.  Two pneumonia vaccines are recommended for all adults over age 65.  One or two pneumonia shots are also recommended for younger people who are smokers or have chronic lung diseases (including asthma) or certain other chronic diseases (including Diabetes, liver disease, congestive heart failure).  

5.  MMR/Varicella (Chickenpox)--vaccination is recommended is you were born after 1957 and have not been previously vaccinated.  Some OBs recommend getting screened for titers for these diseases prior to conception, so women planning to conceive can get vaccinated safely ahead of time, reducing the risk of contracting these diseases while pregnant.

6.  Gardasil (HPV) vaccination with the 2-, 4-, or new 9-valent vaccine is recommended for all girls/women from age 9-26 to prevent cervical cancer (those who were previously vaccinated with the 2- or 4-valent vaccines do not have to repeat the series with the 9-valent version, because all of the vaccines protect against the highest-risk HPV strains, 16 and 18).  Cervical cancer is still a significant cause of death worldwide; the development of this vaccine is a remarkable modern vaccine success story.

7.  Hepatitis B may be considered for those who are sexually active, and is recommended for healthcare workers, as this liver disease can be spread through exposure to contaminated blood and body fluids.

This is by no means a comprehensive list; certain other vaccines like Hepatitis A, Typhoid, and Polio are recommended for travel to certain countries, or under other circumstances.  And there are some people with health conditions or allergies that are contraindications to some/all of the above vaccines, so it is best to have a conversation with your provider about what YOU need.  The takeaway point is that vaccines have changed the face of disease in our world, and they continue to be a valuable component of your efforts to maintain good health.  Be sure to round up your immunization records ahead of your next physical, so you and your physician can make sure you are up to date.


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