Since the last vaccine update, NEW vaccines and updated recommendations for previous vaccines are available. Therefore, the medical team has decided to keep recommendations in one place with an updated global document. Vaccinations for children and for transplant recipients are not included in this update. Further information on specific recommendations is found on the Center for Disease Control (CDC) website at https://www.cdc.gov/vaccines/hcp/vis/index.html.
Vaccines raise your immunity against specific infections. This does not guarantee that you cannot get the targeted infection because there are variants to the genetic makeup of every infection. However, vaccine recipients may have a milder case of an infection if acquired.
Most Alphas are recommended to receive immunizations as adults because of the increased risk of lung and liver disease. Annual Influenza (flu) shots are one such recommendation, as is immunization against common germs that cause pneumonia.
The pandemic has been declared over, but COVID-19 is still common, and hospitalizations are slowly increasing since summer 2023. Like many experts had predicted, the virus that causes COVID-19 changes frequently into variants that remain very infectious, even to previous vaccine recipients. With regular input from the CDC, vaccine manufacturers have been making and testing a new vaccine targeting an omicron descendant named XBB.1.5. Regardless of past COVID-19 vaccination history, the recommendation is to get this vaccine at the same time as the regular influenza vaccination. In the months since the target was set by the CDC, XBB.1.15 has faded away. However, newer variants share a relationship and the hope is that some crossover protection will occur. Specific recommendations on the age groups to get the vaccine, differences between manufacturers, and timing of distribution will be emerging in the weeks ahead with a target for an early October 2023 release.
The CDC will likely recommend all individuals to get this vaccine, however people over 50 years with underlying medical conditions should definitely receive a booster.
One key to protecting family and friends is to diagnose COVID-19 early. This has proven difficult since there are many presentations that include fatigue, sore throat, diarrhea, fever, headaches, and cough. Home test kits remain available and allow for social distancing if a positive test is seen.
Influenza A and B
For the past few years, the CDC has directed manufacturers to include two influenza A strains and two influenza B strains in a quadrivalent (four strain) booster. Everyone 6 months of age and older should be vaccinated. Yearly vaccination adds meaningfully to decrease the risk of influenza infection compared to taking the vaccine on some years but not others.
Adults ages 65 years and older are eligible to receive a higher dose or adjuvanted influenza vaccine. There are 3 options for high dose vaccines that include an inactivated, a recombinant, or an adjuvanted inactivated booster. Usually, insurance coverage is not present for individuals less than age 65 who wish to receive a higher dose vaccine.
Testing has shown that influenza vaccination can occur at the same time as other vaccines such as COVID-19 without losing effectiveness.
Respiratory Syncytial Virus (RSV)
New this year is a vaccine for one of the other common respiratory viruses, RSV. RSV is a lower respiratory viral illness that results in severe pneumonia for infants and older adults. Most people will have respiratory symptoms of cough, runny nose, wheezing, and fever. However, this can be a 2-week illness resulting in lower oxygen levels and hospitalizations for supportive care.
The CDC recommends that adults aged 60 years and older may receive a single dose of RSV vaccine based on discussions between the patient and health care provider. This was a recommendation that was weaker than recommendations for other vaccines because the primary studies documented that vaccination of 740 individuals was required to prevent one case of RSV. This number would likely be different if more cases of RSV were to occur in an outbreak. Therefore, the decision is a personal one and can be individually discussed.
Pneumonia vaccines for Strep pneumoniae (pneumococcus)
Strep pneumoniae remains the most common cause of pneumonia. Since the last vaccine update, there are many changes to the recommendations. In 2020, there were two pneumonia vaccines available – the pneumococcal conjugate vaccines (PCV13) or Prevnar 13 and pneumococcal polysaccharide vaccine (PPSV23) or Pneumovax 23. In 2021, a PCV15 and PCV20 vaccine became available that cover additional variants of this bacteria. It also complicated recommendations for which adults get which vaccine.
- Currently, all children less than 5 years are vaccinated with PCV13 or PCV15.
If you are an adult, you should get a once in a lifetime dose of the PCV15 or the PCV20 vaccination if:
- You are age 65
- You are 19-64 and have certain medical conditions or risk factors, like Alpha-1.
If you take the PCV15, you should follow this with the PPSV23 one year later. If you take the PCV20, then there is no need to take a PPSV23. In practice, this means that everyone who has not received a PCV15 should get a PCV20 and this will be good enough for the rest of life.
The shingles vaccine is an injection that builds up your immunity to the Herpes Zoster virus and prevents shingles or, if shingles occurs, minimizes the effects of this infection. This virus causes chickenpox in people who have never been infected with this virus before and can cause shingles (a very painful, blistering skin rash) in people who have had chickenpox in the past (often the distant past). The Herpes Zoster virus lives in the nerves of people who have had chickenpox in the past and, as you get older or develop certain chronic illnesses, can reactivate as shingles.
In 2006, the shingles vaccine Zostavax became available in the United States. Although no longer in use in the US as of November 2020, Zostavax was a live virus vaccine that immunized people against the Herpes Zoster virus. There is now a new shingles vaccine available called Shingrix, which offers strong protection from shingles and long-term nerve pain. In people who have already had an episode of shingles, the vaccine can prevent or minimize recurrence.
Unlike Zostavax, Shingrix is not a live virus vaccine. Two doses of Shingrix (taken 2 to 6 months apart) are recommended for all adults aged 50 years and older, regardless of whether or not they have already received the Zostavax vaccine.
Whooping cough (pertussis) vaccine
Most of us were immunized against whooping cough or pertussis when we were children. We now know that the immunity to the bacteria that causes whooping cough rarely extends to adults. It is recommended that all adults 65 years old and above be revaccinated against pertussis. This is usually done with a Tdap vaccine which covers tetanus, diphtheria, and pertussis. You only need to receive this vaccination once as an adult. If you have Alpha-1, especially if you have lung disease, your doctor may recommend immunization even if you are younger than age 65. Immunization for adults younger than age 65 is also recommended if you are regularly exposed to infants or young children.
Hepatitis B vaccine
Hepatitis B can be transmitted through infected blood and bodily fluids. It can become a chronic condition and lead to serious, permanent liver damage and even death. In 2017, the first-ever two-dose hepatitis B vaccine called HEPLISAV-B™ was approved for use by the FDA. And in 2018, the Advisory Committee on Immunization Practices (ACIP) voted to recommend HEPLISAV-B for those aged 18 and older to prevent hepatitis B infection.
Because having Alpha-1 may exacerbate the liver disease caused by these infections, it is recommended that all Alphas get the hepatitis B vaccine series.
There are a number of other vaccinations recommended for patients with Alpha-1. It is recommended that you consult your doctor to find out if your vaccinations are up to date.