Greetings, Dr. Roach In late January, my son and daughter-in-law will welcome their first child. I am a fit, healthy 65-year-old woman. I do yoga and go on daily walks. I don’t have any health risks, except from my age. She is asking for the respiratory syncytial virus (RSV) vaccine to be administered to me. I fail to see any justification for its necessity. She believes that compared to where I reside, RSV is more common in her area.
Six years ago, when my second granddaughter was born, I also had the Tdap vaccine. My daughter-in-law is requesting that I get this vaccination again, even though I informed her that it is normally given every ten years. Although I believe I know a little about the matter, would you kindly share your medical knowledge? — R.N., C.P.
ANSWER: I hope I can phrase things in a way that will benefit you, acknowledging your knowledge as an infection control nurse.
There are two infections your son and daughter-in-law are concerned about: pertussis (whooping cough) and RSV, both of which can be transmitted from adults to newborns. Newborns are particularly vulnerable to both of these diseases since their immune systems are still developing and they have very little defense. Some clinical judgment is necessary because grandparents’ decisions to receive the vaccine aren’t entirely clear-cut.
For pertussis, you are completely right that adults are recommended to have the Tdap vaccine every 10 years. Although you received the vaccination six years ago, its effectiveness does diminish with time. My personal opinion is that the harm of vaccinating you before you are due is outweighed by the benefit of getting more-robust protection against pertussis. This is particularly important now, as whooping cough cases are five times higher this year than they were last year at this time. The harm from getting the vaccine before you are due is very small.
The RSV vaccine is recommended for all adults over 75, but adults between 60-74 with high-risk conditions (such as any chronic heart or lung disease or any deficiency in the immune system) should consider the vaccine as well. At this time, the vaccine is intended to be a one-time-only vaccine, but it is possible that the Advisory Committee on Immunization Practices will decide whether boosters would be beneficial.
Again, you do not fit the strongest recommendation for getting the vaccine now, but it would be entirely reasonable to do so. The added benefit of protecting your new grandchild would prompt me to recommend the vaccine to patients in your situation.
I looked up the current RSV levels in wastewater (available through the Centers for Disease Control), and at the time of this writing, the levels are low in your state and minimal in hers. However, RSV typically begins in the fall and ends in the spring. Mask-wearing during the pandemic made the RSV season later than usual during these past few years, so it s not clear whether this year will be part of the usual pattern.
Overall, the benefit to you, your grandchild, and your daughter-in-law s peace of mind is worth the small cost of getting these vaccines earlier than strictly necessary.
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