A Tale of Two Vaccines

By Caroline Spana, PhD, RN

Vaccines work in different ways for different reasons. Two vaccines developed in recent years are examples of this — Tdap and Shingrix. Each has a slightly different public health strategy behind it. There are people who cannot be vaccinated for medical reasons, and there are people who would like protection from a specific disease. Sometimes those are the people who are most vulnerable to the disease. Vaccines are one of the best ways to protect everyone’s health.

Tdap Helps the Youngest

The vaccine Tdap is Tetanus, diphtheria and acellular pertussis — pertussis referring to whooping cough and acellular designating the type of vaccine used. The disease, primarily affecting children, is characterized by convulsive coughs followed by a whoop. Tdap is a good example of a vaccine designed to protect those most vulnerable, because the people who are the most likely to suffer from or die of whooping cough are under a year old. Newborn infants have little or no immunity to diseases and are too young to be vaccinated. The idea behind the pertussis vaccine is that we have everyone else carry immunity to protect the most vulnerable population.

The protection offered by the vaccine was demonstrated when the incidence of whooping cough began to increase in the late 1990s, which was unusual. Furthermore, 60% of deaths from whooping cough were in infants under one year of age. Further investigation of deaths found these infants were cared for by adults who had very mild cases and did not know they had whooping cough. Some of those infants were cared for by parents and grandparents and, sadly, even nurses in neonatal units. One dose of Tdap is all that it takes to prevent infants from contracting the virus.

You may have wondered why or when the Tdap vaccine became a requirement for everyone.

Most nurses in practice had whooping cough as a child and vaccine providers thought they would continue to be immune against the bacterial disease — this turned out not to be true.

Shingrex Protects Older Adults

Let us look now at another vaccine. Most adults experienced chicken pox, a highly contagious disease, as a child. The disease, caused by a virus, leaves the virus on nerves in the body — for some reason, the virus can become “activated” in adults as a painful nerve disease known as shingles. About one in three adults can expect shingles as adults.

In 2006, a shingles vaccination known as Zostavax became available. This vaccine was thought to be about 50-67% effective and could not be used by people with weak immune systems or who were immunocompromised. In 2017, a second vaccine known as Shingrix became available. This vaccine, although it requires two doses, had a more than 90% effectiveness, and can be used by people with immune system concerns.

Shingrix is recommended for adults over 50 years of age by multiple vaccination agencies and the Centers for Disease Control and Prevention. The strongest recommendation for the vaccine is for an adult who has encountered someone else with shingles.

That’s it for the news of the past 10 years in the immunization world for you. This tale can easily be expanded on if you are interested. There are new vaccines being created each year and by getting vaccinated, you protect not only yourself but others as well. Learn more about vaccines and practice implications at https://www.immunize.org.