Adequate vaccination is just as important for adults as it is for children. It's not just travel vaccines that are relevant for adults. Some vaccines given in childhood need boosters to ensure they still offer protection. Sometimes people miss having essential vaccines in childhood and so are not protected against specific diseases.
Fortunately, boosters and catch-up vaccines are available for many vaccines normally given in childhood. Your doctor is best placed to advise you on whether you need any vaccines. The National Health and Medical Research Council makes recommendations for both child and adult immunisations, which are detailed in the National Immunisation Program Schedule.
Some of the diseases Australian adults should consider being vaccinated against are listed here.
Tetanus vaccination is included in the National Immunisation Program Schedule. The primary course for children is followed with a booster at 4 years of age. A second booster at 10 to 15 years is intended to help maintain immunity into adulthood.
Adults aged 50 years should have a booster unless they have had one in the previous 10 years. Travellers to developing countries should have a booster if it is more than 10 years since their last tetanus vaccination.
Adults receiving a wound that may become infected with tetanus, such as a gardening wound or nail puncture, should have a tetanus booster if they haven't had one within 5 years.
Although diphtheria has been almost eradicated in Australia, there are still isolated cases in people who haven't been immunised, almost entirely due to imported infections, particularly from developing countries. If people don't keep up their immunity through vaccination, then we are at risk of more infections.
In Australia, diphtheria vaccination is part of the standard schedule of vaccinations given in childhood, in conjunction with tetanus and whooping cough vaccines. Booster doses are also recommended at 4 years and 10 to 15 years.
Adults aged 50 years should have a booster unless they have had one in the previous 10 years. Diphtheria vaccination is generally combined with tetanus, or tetanus and pertussis (whooping cough).
Although it is more often associated with children than adults, whooping cough does infect adults. And infected adults pose a serious risk to very young babies who are too young to be vaccinated or who haven't finished their vaccination course.
Whooping cough (pertussis) vaccine is usually given in a combination vaccine along with diphtheria and tetanus vaccines. Following the primary vaccination course, the National Immunisation Program Schedule recommends booster doses at 4 years and 10 to 17 years.
Vaccination is recommended for any adult who wishes to reduce the chance of getting whooping cough, and is especially important for adults in special risk groups. Special risk groups include:
- women who are planning to become pregnant, are pregnant, or have recently delivered a baby;
- other household contacts and carers of infants younger than 6 months (e.g. fathers, grandparents);
- healthcare workers and staff working in early childhood care centres.
Adults aged 65 years and older should be offered a booster if they have not had one in the last 10 years.
Rubella (German measles) infection in early pregnancy (up to 10 weeks) is well-known to result in damage to the unborn baby in a high proportion of affected pregnancies. This damage can cause multiple defects including deafness, intellectual disabilities, cataracts, and heart abnormalities. This is why it is important for women to be immunised against rubella before becoming pregnant.
Rubella vaccine is usually given as part of a combination vaccine called MMR, which stands for measles, mumps, and rubella. MMR-containing vaccines are part of the Australian Standard Vaccination Schedule and are given as 2 doses in childhood. Women of child-bearing age who have missed being vaccinated or who are not immune after vaccination should be vaccinated (unless they're pregnant) and must not become pregnant for 28 days after vaccination.
Men born during or after 1966 who have no record of being immunised against rubella should also be vaccinated. Immunity to rubella can be checked with a simple blood test.
An ongoing hepatitis B vaccination programme for infants and adolescents is aimed at controlling hepatitis B infection in Australia. Other groups who are at increased risk of hepatitis B (for example, injecting drug users, residents and staff of facilities for people with developmental disabilities, and sexual contacts of people with hepatitis B) are also recommended to have hepatitis B vaccination.
For adults and children who have not been vaccinated, a simple course of 2 or 3 injections will give protection. Hepatitis A immunisation is covered as part of the National Immunisation Program Schedule for Aboriginal and Torres Strait Islander children in high-risk areas. Among other groups, it is mainly a risk for travellers. It is contracted from shellfish, water, ice or food that has become contaminated with human sewerage, or directly from an infected person. You should see your doctor at least 4 weeks before you travel to ensure your vaccination offers full protection.
Combination vaccines that offer protection against hepatitis A and hepatitis B are available.
Chickenpox is a highly infectious disease caused by the varicella-zoster virus, and is often more serious in adults than in children. Chickenpox virus can also reactivate years after the initial infection and cause shingles (herpes zoster). Chickenpox infection during pregnancy can result in abnormalities in the baby including eye problems, limb defects, and problems with the nervous system.
Chickenpox vaccination is part of the standard schedule of vaccinations given in childhood. It is also recommended for adults and adolescents aged 14 years or older who have not had chickenpox. Adolescents and adults require 2 doses of vaccine for adequate protection.
Pneumococcal disease is a risk for the older person whose immune system may not be able to protect them. The recommendation of the National Immunisation Program Schedule is that people aged over 65 should be vaccinated against pneumococcal disease. Adults aged 65 years or older without any additional risk factors require only one dose of pneumococcal vaccine.
Aboriginal and Torres Strait Islander people are at greater risk of pneumococcus, and vaccination is recommended at 50 years or older. A second dose is recommended 5 years after the first dose.
Annual vaccination against influenza (the flu) is recommended for all adults who want to reduce the chance of becoming ill with influenza.
Influenza vaccination is strongly recommended for certain groups of people who are at increased risk of complications and becoming very unwell with influenza, including:
- adults aged 65 years and older;
- pregnant women and women planning a pregnancy; and
- people with certain medical conditions (e.g. heart disease, chronic lung disease, diabetes).
Yearly influenza vaccination is recommended for Aboriginal and Torres Strait Islander people from the age of 15 years.
Human papillomavirus (HPV) infection
The human papillomaviruses are a group of viruses that can cause skin warts, genital warts and some cancers, including cervical cancer. The HPV types that can cause genital warts and cervical cancer are spread by direct, skin-to-skin contact during all types of sexual activity with someone who has the virus.
There is a vaccine available against several types of HPV that cause cervical cancer and genital warts (Gardasil), and another vaccine that can protect against 2 types of HPV that cause cervical cancer (Cervarix).
HPV vaccination is recommended for females aged 9 to 18 years. Vaccination with Gardasil is also recommended for males aged 9 to 18 years. HPV vaccination is available as part of the National Immunisation Program Schedule. Free vaccination is provided as part of a school-based programme for girls and boys aged 12 to 13 years. The vaccine is given as a course of 3 injections over 6 months.
Some people older than 19 years may benefit from HPV vaccination – check with your doctor whether vaccination is appropriate for you. Generally speaking, the more likely you are to have already been exposed to HPV through sexual activity, the less likely the vaccine is to be beneficial.
It's important to note that even women who have had a full course of HPV vaccination still need to have regular HPV tests (which have replaced Pap smears as cervical cancer screening tests), because HPV vaccines do not prevent all cervical cancers.
2. Australian Government Department of Health and Ageing. The Australian Immunisation Handbook, 10th Edition 2013. http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home (accessed Jul 2013).