Get your cootie shots

Posted on 10 Sep 2009 at 7:34pm
By David Taffet I Staff Writer taffet@dallasvoice.com

Health care professionals say adult vaccinations important to LGBTs



TAKE THE SHOT I Dr. Gary Sinclair, medical director for Parkland/UT Southwestern HIV Services, recommends that everyone over age 50 get vaccinated against both the flu and swine flu. Flu vaccinations will be available at Resource Center Dallas’ Nelson-Tebedo Health Resource Center when the clinic receives a supply of the vaccines. (DAVID TAFFET/Dallas Voice)

Each year, influenza is responsible for more than 20,000 deaths in the United States, while up to 50,000 Americans die from diseases that are preventable by vaccine.

Gay men, people over 50, those with compromised immune systems and people on steroids are among the groups the Centers for Disease Control notes should be especially aware of the need to update their vaccinations.

Flu
The American College of Preventive Medicine says that as many as 200,000 people annually are hospitalized with the flu. Those numbers don’t take into account particularly bad epidemic years when a strain like the H1N1 virus threatens.

While other vaccines provide virtually 100 percent protection, among adults vaccinated for the flu, the incidence of illness decreases by 70 to 90 percent.

Dr. Gary Sinclair, medical director at Parkland/UT Southwestern HIV Services, said this year there will be two flu vaccines. The first should be widely available over the next few weeks and the H1N1 vaccine should be available sometime in October.

"The flu vaccine is based on flu strains circulating in the southern hemisphere.

Sometimes they hit it right and we have a mild flu season. Sometimes we guess wrong and it doesn’t protect a lot of people," Sinclair said.

He recommends both flu vaccines for anyone over 50 and people who are HIV positive. Health care workers who are likely to come in contact with people with the virus should also be vaccinated, and Sinclair recommends it for all adults who work in close quarters with people who have children, the group mostly likely to contract it.

Bret Camp, associate executive director of health and medical services at Resource Center Dallas, said, "I would recommend everyone get the vaccines this year."

He said a number of retail locations will offer them.

Some Walgreens locations in Oak Lawn already have signs posted that they have the flu vaccine in stock. Camp said a shortage is not expected, but for some reason, retail locations seem to have priority over clinics and doctors that deal with high-risk populations.

Dr. Nick Bellos, whose specialty is infectious disease, agreed and encourages early vaccination.

"It takes six weeks to develop antibodies once you get it," Bellos said.

Hepatitis
The vaccine for Hepatitis B was originally created from blood drawn from infected gay men. At first there was a fear of contracting HIV from the vaccine, but Bellos said that the antigens drawn from the blood were purified before being used.

He said those who got the early vaccine created directly from those blood products probably got a better immunity than those protected by the current vaccine cloned from those antigens.

Infection occurs through sexual contact with an infected person or by sharing needles. Non-monogamous gay men are at particular risk for Hepatitis B. The CDC also recommends the vaccine for lesbians with multiple partners.

This liver disease may range in severity from a few weeks illness to a chronic condition that may lead to cirrhosis and liver cancer. There is no treatment for this virus once a person is infected, and Hepatitis B causes 5,000 deaths a year.

Sinclair said that over the past year he has seen eight patients with chronic active Hepatitis B who developed cancer.

Hepatitis A, an acute liver disease that lasts from several weeks to several months, can be prevented by vaccine as well. Twinrix is a series of three shots each given a week apart followed by a booster a year later that creates immunity to both Hepatitis A and B.

Camp suggests everyone should be immunized because "Hepatitis B can be such a dastardly disease."

Tetanus and pertussis
Once every 10 years, everyone should get a tetanus booster, but it becomes especially important for people over the age of 50. After 50, the tetanus booster should be replaced once with the TDAP vaccine that also includes protection against diphtheria and pertussis (also known as whooping cough).

According to the CDC, pertussis is a highly contagious respiratory tract infection that initially resembles a common cold.

Bellos said, "I have seen four or five cases in the last 15 years." He said that pertussis, unless treated in the first week or two of infection, leaves someone with a persistent, hacking cough for about three months.

Zoster, MMR, varicella, pneumococcal
The Zoster vaccine protects against shingles, recommended for anyone over 60.
Sinclair said, "It has not been determined if it is safe in the HIV positive and other immuno-compromised communities. We’re working on something more attenuated."

While many vaccines do not contain any live virus, Zoster contains an attenuated, or weakened, strain. A normal immune system will react to this mitigated virus to produce antibodies that protect from the disease. Those with a compromised immune system may not be able to produce those antibodies and may actually contract the illness.

Varicella and MMR are two other vaccines that people who are HIV positive should only consider if they have a T cell count over 200.

MMR (for mumps, measles and rubella, also known as German measles) is recommended for men and women over 50 and born after 1957. Most people born earlier either contracted these diseases as children or were exposed to them and developed immunity.

A measles booster is recommended after age 50 because immunity wears off.

Before the introduction of the varicella vaccine in 1995, 4 million cases of chickenpox were reported annually.

Adults accounted for most of the 9,000 hospitalizations and 100 deaths annually.

Adults develop 250 to 500 itchy blisters and are more likely to suffer other serious complications including pneumonia, bone and joint infections, toxic shock syndrome and encephalitis. 

One of those side effects, pneumonia, can be prevented with yet another vaccine. In older individuals, the pneumococcal vaccine can cut morbidity from pneumonia in half.

Sinclair said the pneumococcal vaccine is recommended for people over 60 with a booster every six years.

Bellos called the vaccine effective for "anyone HIV-impacted with over 200 T cells" and recommends a booster every five years.

Travel vaccines
Sinclair said other vaccines the gay and lesbian community should be aware of are what he calls the travel vaccines. He said the CDC Web site lists requirements for travel to any country.  The Dallas County Health Department administers these vaccines.

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Who should, who shouldn’t
Centers for Disease Control guidelines on who should get which vaccines:
• Those over 50 should get: Flu, H1N1, Tetanus (booster every 10 years), Zoster

• Those over 50 but born after 1957:
MMR

• Those over 65: Flu, H1N1, Tetanus (booster every 10 years), Zoster, Pneumonia

• HIV+ (all): Flu, Pneumonia

• Those who are HIV positive with a T cell count over 200: Varicella, Meningococcal

• Gay Men: Hepatitis A, Hepatitis B

• Lesbians who have multiple partners: Hepatitis B

• Those who are on steroids:

Flu, Pneumonia
This list may not be complete. Consult your physician.

Centers for Disease Control guidelines on who should NOT get what vaccines:
• Those who are HIV positive should not get the nasal spray flu vaccine because it contains live virus. But they should get injected seasonal flu and H1N1 vaccines

• Those who are HIV positive and have a T cell count under 200 should not get MMR, Varicella or Zoster because these contain attenuated virus, which may cause the diseases covered. Studies have not been done to prove safety. These vaccines have been shown safe and effective for those with T cell counts over 200.

• Those with allergy to eggs should not get flu vaccines because they are cultured in eggs.

This list may not be complete. Consult your physician.

Travel vaccines:
Yellow fever, Japanese encephalitis, Rabies, Typhoid

Available at:
Dallas County Health Department
2377 N. Stemmons Freeway (at Medical District Drive)
Call 214-819-2162 for availability.

This article appeared in the Dallas Voice print edition September 11, 2009.

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