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A SHOT IN THE ARM


Your best defense against disease may be at the point of a needle. Here's what vaccination can do for you
By Melissa Meyers Gotthardt

All your hard work and sacrifice have paid off. Your body is a lean, hard, efficient machine that can lift more, run farther, and last longer when it really counts. In fact, you're just about invincible. Until flu season, that is.

Sometimes, your body can't go it alone, especially when it comes to fending off diseases. It needs a little boost--an immunity boost, to be exact. That's why vaccines were invented: To keep your efficient machine from crashing every time it runs into a rogue microbe.

A vaccination puts a weakened or inactivated virus or bacteria directly into your bloodstream, spurring your body to produce antibodies--its main disease-fighters--without giving you the disease. When an active bug strikes, the antibodies will crush it. "Vaccines are the most direct defense you can give your body against some diseases," explains Raymond Strikas, M.D., medical epidemiologist with the National Immunization Program of the Centers for Disease Control and Prevention.Ask the Expert

When you were a kid, your mother probably made sure you were up on all your shots. But now that you're in charge of your own health, here are the vaccines to consider.


INFLUENZA

Should you be vaccinated? Probably.

Each year, the flu strikes up to one-fifth of the American population, which means that as many as 40 million of us will suffer chills, fever, nausea and congestion. Twenty thousand people--mostly the very old and the very young--will die from it. Granted, most of us will just suffer in bed for a while, but the time we miss from work will cost American businesses billions of dollars. And there are the untold costs of watching daytime TV. So why catch it if you don't have to?

The Centers for Disease Control and Prevention recommends flu shots for the 65-and-over crowd, the chronically ill and their families, and health-care professionals who are in close contact with those at risk. But even if you aren't in one of these categories, you can probably benefit from the vaccine. A recent study of healthy, working adults found that those who got flu shots missed nearly half as many work days due to upper-respiratory illness as people who weren't vaccinated (and they had nearly half the doctor's visits).

Because influenza is caused by several related, rapidly mutating strains of the same virus--this year's models are A/Johannesburg, A/Texas and B/Harbin--you need to be vaccinated each year.

However, if you're allergic to eggs, you shouldn't receive a flu shot, since the vaccine itself is grown in egg-based cultures.

The vaccine sometimes causes minor swelling at the vaccination site and fever even in people who don't have an egg allergy. (See page 90 for news of a side effect- free vaccine.) The pain and discomfort, if any, are worth it. Flu shots protect against illness from the virus in about 80 percent of those who get them.


CHICKEN POX/SHINGLES

Should you be vaccinated?
Yes, unless you like to itch.

If you never had chicken pox as a kid, be aware that what usually amounts to a week or so of discomfort for infants and toddlers can become a serious illness if you contract it as an adult. And if you had chicken pox as a kid, you're still not off the hook. That's because chicken pox has a nasty habit of revisiting during the adult years as shingles, a painful skin disease marked by red, tender blisters that usually form on the arms, shoulders and torso.

After you recover from your childhood case of chicken pox, the virus can hide out in nerve endings, waiting for the immunity you built up to dip because of time or illness. Then it erupts as shingles blisters.

It takes days for the blisters to go away; even then, they can leave behind highly sensitive scars.

A relatively new complication of chicken pox and shingles is the risk of secondary infection with streptococcus bacteria. Some newly discovered streptococcus strains can kill in a matter of days. They can also be highly resistant to antibiotics, and they often enter the body through chicken pox or shingles lesions. Dr. Strikas recommends checking with your family doctor to see if there's any concern about these streptococcal infections in your area. If there is, immunization against chicken pox may be of an even higher priority.

The chicken pox/shingles vaccine is relatively new. It was approved by the FDA last year after studies demonstrated that as many as 85 percent of those who got the shot showed significant increase in immunity against the virus. Protection for adults lasts for at least four years.

If the kids in your household have never had chicken pox or been vaccinated, or you work around a lot of children, line up for your shots now, because if your child comes down with chicken pox, you're the next prime target. Adults need two shots given about a month apart. And if you have any illness that compromises your immunity, ask your doctor if you're a candidate for vaccination.

As for shingles, the medical community is still debating whether re- exposure to chicken pox plays a role in shingles outbreaks, but we say you're better safe than spotty.


PNEUMONIA

Should you be vaccinated? Probably not, unless you're 65 or older or have chronic health problems.

Pneumonia takes an estimated 40,000 lives each year, yet few people know there's a vaccine that may prevent 60 to 70 percent of these deaths. And studies show that only one in five of the people at highest risk for pneumococcal (bacterial) pneumonia have ever been vaccinated against it. The pneumonia vaccine protects against 23 different strains of bacteria that cause pneumonia, including several of those antibiotic- resistant varieties you've read so much about lately.

"Since some strains of bacterial pneumonia are proving to be more and more difficult to treat with conventional medications, immunization is gaining a lot more attention," notes Dr. Strikas. "Obviously, if you can prevent the disease, you don't have to worry about what to use to treat it." He also points out that the several seconds you devote to getting your shot will pay off with years of protection.

You should definitely have the vaccine if you're age 65 or older; younger men should consider it if they have a history of respiratory illness, heart, lung or kidney disease, or diabetes. Also, it's recommended if you have immune-system problems stemming from disease or medication. And bear in mind that although shots are up to 60 percent effective in preventing bacterial pneumonia, they won't protect you against the less common (and less serious) pneumonia caused by viruses. But as Joseph F. Plouffe, M.D., professor of internal medicine at Ohio State University, points out, "Pneumococcal pneumonia is the most common pneumonia we see. If we can prevent just 60 percent of these cases, we will have prevented a huge number of deaths."


HEPATITIS A

Should you be vaccinated?
You should only if you're traveling.

If you've ever vacationed in a strange country, taken a sip of the local water and come down with Montezuma's revenge, consider yourself lucky. You could have come down with hepatitis A. Hep A targets the liver, producing debilitating symptoms, jaundice and, in rare cases, liver failure. It's most common in Mexico, the Caribbean, South and Central America, Africa, Eastern Europe, the Mediterranean basin, the Middle East and Asia (except Japan).

If you're headed to a hepatitis-prone destination, you can protect yourself by avoiding the drinking water. That includes ice cubes, any cold drink that may be made with water, and any food rinsed in the water. Brushing your teeth with the local brew is a bad idea, too, as is eating native shellfish. "They filter a huge amount of water and they concentrate the virus," explains Raymond S. Koff, M.D., chairman of the department of medicine and chief of the hepatology section at Metro West Medical Center in Framingham, Massachusetts.

But now there's a better way of protecting yourself than avoiding all things aqueous and shunning seafood on that Caribbean vacation. The hepatitis A vaccine, just approved by the FDA last year, offers an estimated 96 percent protection against the virus. The CDC recommends Hep A vaccines for sexually active gay men and anyone traveling to a Hep A hot spot.


HEPATITIS B

Should you be vaccinated?
It's not a bad idea.

Each day, as many as 14 Americans die from illnesses related to the hepatitis B virus, which infects 200,000 to 300,000 people each year. In up to 40 percent of these new cases, the patient won't even know how he or she contracted the disease. But doctors have learned a lot about this particularly nasty member of the hepatitis family.

Like hepatitis A, Hep B also targets the liver. But Hep B is far more aggressive. It's the leading cause of liver cancer worldwide, and it's 100 times more contagious than HIV. Many people with Hep B will develop a full menu of symptoms--fever, nausea, vomiting, jaundice, skin rash and arthritis--that can lead to death. Others will have no symptoms at all.

These "carriers" can spread the disease and not even know it. Currently, there are an estimated 1.2 million carriers in this country alone.

The Hep B vaccine involves a series of three shots given during a six-month period, but it provides lifetime protection, so you won' t need any boosters. And the vaccine is the only real way to protect yourself against the virus. Need we say more?


TETANUS

Should you be vaccinated?
If you can't remember the last time you were, yes.

Widespread regular vaccinations have helped nearly eradicate smallpox, polio and measles. But tetanus will always be with us, since the bacteria can flourish just about anywhere. It likes dirt, which explains why Mom rushed you to the doctor for a tetanus shot that time you stepped, barefoot, on a rusty nail. Despite its reputation, the tetanus bacteria doesn't need dirt--in fact, it's quite happy hanging out on an apparently clean surface. If you get a cut, scratch or scrape, you're primed for tetanus to take hold. The result: a gradual, painful stiffening of all the muscles in the body. Left untreated, this stiffening progresses to those muscles that control breathing. And you die.

Since the tetanus bacteria is so virulent and can enter the body through breaks in the skin so tiny you can't even see them, you should be faithful about getting regular booster shots. You probably had a series of three tetanus shots during your childhood years, but to sustain peak immunity, you should have a booster every 10 years. If you've lapsed and find yourself in one of those rusty-nail situations, go to the doctor as soon as possible. The tetanus vaccine works quickly, so once it enters your body, it should bolster your immune system faster than the bacteria can take hold.

When you receive your tetanus shot, you'll get a free bonus. Tetanus vaccine is usually combined with the diphtheria vaccine, so you'll automatically be protected against that, too. If you haven't heard much about diphtheria lately, our point is proven. It's one of those diseases made rare by the advent of vaccination.

Here's a roundup of experimental vaccines that may be coming soon to a doctor's office near you

* Cholesterol.

Scientists at the Walter Reed Army Medical Center in Washington, D.C., have discovered that most people have antibodies that help wipe out cholesterol before it clogs their arteries. The researchers injected rabbits with these "anticholesterol antibodies" and found that their cholesterol stayed low even when placed on a diet that produced high cholesterol in other, unvaccinated rabbits. EntreMed Corporation, a biopharmaceutical company in Rockville, Maryland, is currently at work on a human vaccine, which could be used on individuals whose high or borderline cholesterol levels didn't respond to low-fat diets.


*Herpes.

This sexually transmitted disease affects as many as one in five people in North America. Early clinical trials on a genital herpes vaccine show that the shot appears to be well-tolerated by patients and promotes the development of antibodies to the virus. Final-stage clinical trials are in progress that will test whether the vaccine can protect individuals against getting herpes from a partner. If these trials are successful, the vaccine may be on the market in five years.


* Lyme disease.

For years, staying out of the woods was your best protection against this fatigue-producing disease, spread mainly by deer ticks that carry the Lyme bacterium. Then researchers discovered a process to reproduce a protein from the bacterium that, when injected into volunteers, increased their immunity to the disease, while producing no major side effects. The vaccine is in its final phase of testing, and results are expected soon. Researchers believe the vaccine itself will be available within the next several years.


* Melanoma.

The most prevalent deadly form of skin cancer, melanoma strikes nearly 19,000 American men each year (4,500 will die). Overexposure to sunlight is the biggest risk factor. Researchers at the New York University School of Medicine are working on a vaccine that could be used to prevent melanoma or its recurrence in high-risk individuals such as fair-skinned people or those who work outdoors a lot. The vaccine works by stimulating immune cells to recognize and destroy abnormal cancer cells, says Jean-Claude Bystryn, M.D., who's doing the research at New York University's Kaplan Comprehensive Cancer Center.


*AIDS.

Testing a vaccine for the AIDS virus seems only a remote possibility for the near future, at least in the U.S. The National Institutes of Health recently vetoed funding to test the vaccine hopeful gp120, citing insufficient evidence that it had potential to ward off the virus. Proponents of gp120 are still seeking funding, and there is no other candidate as close to testing.

Copyright 1998, Rodale Press, Inc. Reprinted with permission from Men's Health Magazine.


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