It's the first month of a new year, and it's only appropriate that we consider some things that will help insure our good health in the months (and years) to come. As we have talked about in the past, the issue of "preventive medicine" revolves largely around our individual lifestyles. Exercise, diet, weight control, not smoking, driving safely. These are basic yet fundamental things, and actually impact our health more significantly than any single or combination of pills, elixirs, or root medicines.

There is an important area however that does fall outside of our choice of lifestyles, and it has to do with the seemingly mundane consideration of immunizations. We're not going to consider childhood shots here but rather what the CDC has to say about current guidelines for the immunization of adults. And you may have thought yourself finished with this business once you reached twenty-one or so. Not so fast.

First, the flu shot. Most of us are familiar with the usual indications for this immunization: age older than 50, a history of a compromising disease (diabetes, heart disease, lung disease, etc), persons living in a long-term care facility, and pregnant women. (We get a lot of calls about this one, and yes, it is perfectly safe for a pregnant woman to be given the vaccine.) There are now 15 indications for this vaccination, including all healthcare workers and those of us who have difficulty handling respiratory secretions or who have an increased risk of aspiration.

Another vaccine for which we receive a lot of questions is the new herpes zoster shot (to prevent shingles). The guidelines call for all adults 60 years of age and older and with normal immune systems to be given this injection. It only has to be given once in a lifetime, and does not require a booster.

You should by now know about the "pneumonia shot". This is a vaccine that protects against most of the strains that cause the most common form of bacterial pneumonia. It should be given at age 65, earlier if certain risk factors are present (again, things like diabetes and heart disease). Now, there are some confusing points concerning the pneumonia vaccine, even in medical circles. Many people will ask us "when does the shot need to be repeated?" The answer is five years after the first dose but only if your immune system is impaired. Once again, this means that your immune system is damaged in some way, either by chronic medication (steroids) or by disease (diabetes). At any rate, the current guidelines specifically state that no one should receive more than two doses.

Then there is the issue of pertussis (the old-fashioned whooping cough). We have mentioned in this space that this disease is making somewhat of a comeback, with immunity waning in our older population, and many of our children not being properly vaccinated. The new vaccine combines pertussis with diphtheria and tetanus and should be given as a one-time, one-dose vaccination to all adults age 64 or younger. Generally, this is given when you are scheduled for your next tetanus booster, which, by the way, is only every 10 years.

For young women, the new human papilloma virus vaccine has now been recommended for those aged 11 to 26 years. This has been a relatively recent addition to our armamentarium and has some pretty impressive data supporting its use. It protects against the virus that causes most of the cases of genital warts, which causes as much as 70% of all cervical cancers. We should see a significant decrease in the incidence of this disease, assuming that young women will avail themselves of this protection. The vaccine is given in three does, over a six month period, just as with the Hepatitis B vaccine.

And speaking of Hepatitis B, there is some interesting news here. Previously this was recommended to those of us in the healthcare field or those who had the potential of coming into contact with bodily fluids, such as blood. These would be our firemen, police officers, and others. The new guidelines recommend that all sexually active adults who are not in a long-term mutually monogamous relationship should be immunized. You'll have to decide what "mutually monogamous" means, but this recommendation has the potential of affecting a lot of people. It needs to be given in the deltoid muscle (upper arm), so if your girlfriend comes home with a sore shoulder, well...

So, that's all we have time and space for this month. Next time we'll consider the important topic of osteoporosis and its prevention and treatment (how early should we start?) and the latest for the treatment of Bell's palsy.