Have you had all your shots? Adult immunizations are important too.

Has everyone in your family had all their shots? If your family is like most American families, the answer to this question is "Yes" for the children, but "Maybe not" for the adults.

Many people think that adults don't need immunizations unless they're planning to travel to exotic places. But this is a misconception. All adults need immunizations to prevent serious infectious diseases. In fact, some shots are more important for adults than for children. Adults in the United States are at least 100 times as likely as children to die as a result of diseases that could have been prevented by immunization. Vaccine-preventable diseases kill as many as 70,000 American adults each year.

"In the United States we do a good job of immunizing children but a very poor job of immunizing young and older adults," says Angela Staab, R.N., C.N.P., a nurse practitioner in Reidsville, North Carolina. "While most people associate vaccination with children, adults also need to be immunized throughout their lifetime."

For middle-aged and elderly people two of the most important immunizations are an annual flu shot and a once-in-a-lifetime shot to protect against pneumococcal pneumonia.

Everyone age 50 or older should get an annual flu shot, and so should people of all ages who have chronic health problems. "Flu shots should be given between October and December because they take a few weeks to kick in, and peak flu season is from January to March," says Gilbert L. Ross, M.D., medical director of the American Council on Science and Health in New York City. Last year's flu vaccine won't work well against this year's flu, Dr. Ross explains, because the influenza virus changes from one year to the next. That's why people need to get a flu shot every year.

Everyone age 65 or older should receive the pneumococcal vaccine, as should younger people with certain chronic illnesses. In most instances, people need to get this immunization only once; yet many people never get it, probably because they don't realize how important it is. Less than 45 percent of senior citizens have had this immunization, according to the New York State Department of Health. That's one of the reasons 40,000 people a year die from pneumococcal disease.

"Pneumococcus is a bacterium that often causes pneumonia, especially in the elderly and those with chronic disease," says Dr. Ross. "Like the flu vaccine, this shot is very safe and effective. Every older person should get it unless there is a specific reason to avoid it."

One shot that's important for all adults--not just older people--is the combination shot that protects against tetanus and diphtheria. All adults should have a booster shot against these two deadly diseases every 10 years. Unfortunately, though, more than one third of people age 18 to 49 and more than half of those in older age groups haven't had a tetanus/diphtheria booster within the past decade, according to the Centers for Disease Control. Because adults are less likely than children to be immune, tetanus has become almost entirely an adult disease. U.S. government statistics show that about 95 percent of all cases of tetanus occur in adults.

Some adults also need to get shots to protect themselves against the classic childhood diseases--measles, mumps, rubella (German measles), and chicken pox. If you've never had these diseases and you've never been immunized against them, you can catch them--and they can have several complications in adults (especially in pregnant women).

Immunization against hepatitis B was once recommended only for people with special risk factors for this disease, but that isn't true anymore. This vaccine is now part of the routine childhood immunization schedule, and the federal government's Centers for Disease Control is recommending that all teenagers who missed out on it in childhood should be immunized now. Adults who are likely to be exposed to this disease should also be immunized.

To find out whether you need hepatitis B shots, talk to your doctor. You'll need to answer some questions about your job, your health, and your lifestyle. If your doctor says that you should be immunized, make sure to do it, even though it's a bit inconvenient (it involves three shots over a six-month period). Hepatitis B can cause severe liver damage, and some people who get this virus carry it for the rest of their lives--and they can infect other people without even knowing it.

Misconceptions prevent many adults from getting the shots that they need. Sometimes an individual will make a doctor's appointment to get a flu shot or other immunization but then cancel it because of not feeling well that day. "People don't realize that you don't have to be 100 percent healthy to get a shot," Staab says. "If you have a cold or if a chronic health problem is acting up, it's usually still OK to get immunizations." Just make sure to tell the health care provider about your problem before you receive the shot.

Another reason some adults don't get their shots is that they have lost the records of their past immunizations and therefore don't know which vaccines they need. But this should not be a major problem. When it comes to flu shots, your records don't matter--you need a new shot every year anyway. For other types of shots, you and your doctor may be able to reconstruct your history, or you can have blood tests to determine whether you're already immune. Of course, keeping an immunization record is a good idea (Staab recommends carrying it in your wallet or purse), but if you don't have one, don't let that prevent you from getting the vaccines that you need.

Make sure that immunization is on your health care schedule--not just your child's. Make an appointment with your doctor to find out what shots you need, or ask about immunizations when you go to the doctor for another reason. "Don't just talk about immunizations, go get them," Staab says. "Just do it."

Shots: Who Needs Them?

Immunization             Who Needs It

Influenza (the flu)      People age 50 and older, people of all ages
                         who have chronic diseases, pregnant
                         women, or anyone else who wants to be
                         protected against the flu. This vaccine is
                         needed every year.

Pneumococcus             Everyone age 65 and older and people with
                         certain chronic illnesses. Usually needed only
                         once, but those who received a shot before
                         age 56 may need a second one later.

Tetanus/diphtheria       All adults, once every 10 years.

Hepatitis B              All adolescents who were not previously
                         immunized and all high-risk adults, including
                         health-care workers, people with multiple sex
                         partners, and family members of people with
                         chronic hepatitis B

Hepatitis A              International travelers and members of
                         certain high-risk groups.

Chicken pox (varicella)  Anyone who has never had the disease or
                         the vaccine, especially health-care workers,
                         women of childbearing age who are not
                         currently pregnant, and those who live or
                         work with children.

Measles, mumps, rubella  Anyone who has never had the diseases or
                         the vaccines, especially health-care workers
                         and women of childbearing age who are not
                         currently pregnant.

Lyme disease             People age 15-70 who live, work, or play
                         often in wooded or overgrown areas infested
                         by ticks that carry the disease.

Kathleen Meister writes on health issues from North Potomac, Maryland.