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Staying Healthy

Although no one can prevent every illness or accident, there are many things you can do to improve your health. The choices you make about the way you live are important to your health. Here are some choices you can make to help yourself stay healthy:

  • Don't use any form of tobacco.
  • Eat a healthy diet.
  • Exercise regularly.
  • Drink alcohol in moderation, if at all.
  • Don't use illegal drugs.
  • Practice safe sex.
  • Use seat belts (and car seats for children) when riding in a car or truck.
  • See your doctor regularly for preventive care and wellness exams.

Wellness Care

What is an annual exam?

An annual exam is a once-a-year visit to your primary care provider for a general health check, including a breast exam and pap smear for women.  An annual exam visit does not include discussion of new problems or detailed review of chronic conditions. Annual exams are also called routine check-up, yearly exam, comprehensive exam, annual pap, and preventive visit.

To schedule: Please call 785-843-5160 and ask to schedule your Well Care Visit. Please schedule a separate appointment if you have health concerns other than your routine physical exam. Examples are:

  • A list of concerns or questions
  • New health care concerns or problems found at the time of your annual exam
  • Ongoing health problems that need more attention

What should I expect during my annual exam?

  • General physical exam (not included in the Medicare Annual Wellness Visit)
  • Pelvic exam and breast exam for women (every 24 months for Medicare)
  • Update of life and work situation
  • Update of family health history (any new serious illnesses in your family?)
  • Review of your health history
  • Update of current medications, herbs, and supplements (bring a list)
  • Need for medication refills
  • Evaluation of need for health screening test based on age and personal family history (such as mammogram, test for sexually transmitted disease, colon cancer screening, prostate cancer screening)
  • Update on immunizations (Medicare will cover Influenza, Pneumonia, and Hepatitis B immunizations in the physician office setting when indicated.)
  • Laboratory tests may be ordered during your annual exam. Your insurance policy may not cover routine laboratory testing. (Lab tests for existing conditions will be billed as diagnostic lab and you may responsible for co-payments and deductibles.)

What happens if you have a new health problem when you come for your annual exam?

You and your provider will need to decide whether to use the time that day to address your problem, in which case your annual exam visit can be rescheduled. Or you may choose to go ahead with your annual exam, and to defer the health concern to another visit. Scheduled appointment times do not allow for both.

Insurance Coverage Issues

  • Please check your insurance policy to make sure you are covered for yearly preventive medicine visits.  Different insurance policies have different rules for preventive care coverage
  • Most insurance companies allow for only one annual exam per 12 month period (and some will not pay for a visit even a few days early).

Disease Prevention and Disease Screening

Disease prevention could include having certain tests done, following advise for disease prevention or being immunized. Taking these actions actually prevent a disease from occurring. Eating healthy, exercising and maintaining a normal weight can prevent diabetes. Getting a flu shot can prevent you from getting the flu. Having a colonoscopy will both screen for colon cancer and lower your chances of developing colon cancer.

Screenings are tests that look for diseases before you have symptoms. Screening tests can find diseases early, when they're easier to treat. Which tests you need depends on your age, your sex, your family history, and whether you have risk factors for certain diseases. After a screening test, ask when you will get the results and whom to talk to about them.  Examples of disease screening could include getting your blood pressure measured or BMI determined to detect high blood pressure or obesity, getting laboratory tests to check for diabetes or high cholesterol or having a mammogram to screen for early breast cancer.

Prevention:  Immunizations and Vaccinations

Why should I get immunizations? 

Adults are 100 times more likely to die from vaccine-preventable diseases than children.  Immunization is a safe and effective way to reduce your chance of getting several life threatening illnesses.  By getting immunized you further help protect your children and grandchildren and even help lower the chances of other people in your community becoming ill with the diseases for which you have been immunized.  Which immunization you should have depends on your age, your general health and any chronic illnesses you might have.  That's why you should talk to your physician.  Once you have visited with your physician, you should read the VIS (Vaccine Information Statement) for the immunization you are going to receive and then proceed with the immunization. The information below outlines the most common and important immunizations for adults and provides helpful links for additional information.

Take the Adult Vaccination Quiz to find out which immunizations are appropriate for you.

You're never too old to get immunized! Click on the link most appropriate for a table of recommended immunizations:

Vaccinations for Adults:  English   Spanish

Vaccinations for Adults with Diabetes:  English   Spanish

Vaccinations for Adults with HIV:  English   Spanish

Vaccinations for Adults with Hepatitis C:  English   Spanish

Vaccinations for Adult HealthCare Workers

Summary of Adult Immunization Recommendations

Influenza Vaccine

Influenza:       VIS Inactivated       VIS Live  
 
Do I need it?   YES
 
Who?  Everyone
 
How Often?  Every year in the fall
 
Which Vaccine?  Currently there are multiple different vaccines available.  The most commonly used vaccine is called "trivalent" and is best for most people. There is a intranasal spray, which is effective but contains live virus which should not be used by anyone with immune suppression. There is a more concentrated formulation which does produce higher antibody titer's and potentially might be more protective in older adults, but this is not yet proven. This year a new "quadrivalent" vaccine which will protect against four strains of influenza instead of three will have limited availability. In the past people with allergy to eggs could not have the standard vaccine, but this year a vaccine is available which was not produced using eggs, which then allows these people to be safely vaccinated.  Your physician can explain these differences more completely.
 
Why?  Influenza or the "flu" is a contagious disease caused by the influenza virus.  In the United States flu season is generally between September and last until February or March. "Flu" is spread by coughing, sneezing and   nasal secretions. The virus is highly changeable, so the vaccine is changed every year to cover the anticipated most prevalent viral strains. The young, the old, and people with chronic illness are at highest risk of severe "flu" with more complications. Other viruses can cause illness with similar symptoms and are not prevented by the vaccine.  Also, the "stomach flu" is caused by other viruses and is not prevented by the vaccine.
  • Symptoms of the "flu" include fever/chills, runny nose, and muscle aches.  Also common are headache, fatigue, and sore throat.

Pneumococcal Vaccine

Pneumococcal Vaccine VIS PPSV23        VIS PCV13    
 
Do I need it?   MAYBE
 
Who?  See description of the two types of vaccines below describing PPSV23 and PCV 13
  • All adults over age 65 should receive the PPSV23 vaccine
  • Patients age 2 – 64 should receive the PPSV23 vaccine if they have one of the following conditions:
    • cigarette smokers age 19 yrs and older
    • chronic cardiovascular disease (e.g., congestive heart failure, cardiomyopathies; excluding hypertension)
    • chronic pulmonary disease (including COPD and emphysema, and for adults ages 19 years and older, asthma)
    • diabetes mellitus
    • alcoholism
    • chronic liver disease, cirrhosis
    • candidate for or recipient of cochlear implant
    • cerebrospinal fluid (CSF) leak
    • functional or anatomic asplenia (e.g., sickle cell disease, splenectomy)
    • immunocompromising conditions (e.g., HIV infection, leukemia, congenital immunodeficiency, Hodgkin's disease, lymphoma, multiple myeloma, generalized malignancy) or on immunosuppressive therapy
    • solid organ transplantation; for bone marrow transplantation, see www.cdc.gov/vaccines/pubs/hemato-cell-transplts.htm.
    • chronic renal failure or nephrotic syndrome
  • Adults over 19 with the following conditions should receive the PCV13 vaccine
    1. Immunocompromising conditions (e.g., congenital or acquired immunodeficiency, HIV, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, iatrogenic immunosuppression, solid organ transplant, and multiple myeloma)
    2. Functional or anatomic asplenia (e.g., sickle cell disease and other hemoglobinopathies and congenital and acquired asplenia)
    3. Cerebrospinal fluid (CSF) leak
    4. Cochlear implants

How Often? For most people one immunization at age 65. People with certain chronic illnesses or impaired immunity may need to have more than one immunization.

Which vaccine? In 1983 the current PPSV23 (pneumococcal polysaccharide vaccine) replaced the older PPSV14 vaccine which had been used since 1977. This vaccine has protection against 23 of the pneumococcal serotypes. It is the primary vaccine used for all adults.  A new PCV13 (pneumococcal conjugate vaccine) provides protection against an additional 13 serotypes of pneumococci, including those strains which cause most disease in children. It will replace the the PCV7 vaccine which has been the primary pneumococcal vaccine for children. Adults with the conditions above should have the PCV13 vaccine in addition to the PPSV23 vaccine.

Why? Pneumococcal disease is caused by Streptococcus pneumonia, a bacteria that has more than 90 serotypes (strains). Most serotypes cause disease, but only a few produce the majority of invasive pneumococcal disease. The 10 most common types cause 62% of invasive disease worldwide. other viruses and is not prevented by the vaccine. The disease is spread from person to person by droplets in the air. The pneumococci bacteria are common inhabitants of the human respiratory tract. They may be isolated from the nasopharnyx of 5%-70% of normal, healthy adults.  There are two major clinical syndromes of invasive pneumococcal disease: bacteremia, and meningitis. They are both caused by infection with the same bacteria, but have different manifestations. Pneumococcal disease is a serious disease that causes much sickness and death. In fact, pneumococcal disease kills more people in the United States each year than all other vaccine-preventable diseases combined.

More than 40,000 cases and more than 4,000 deaths from invasive pneumococcal diseases (bacteremia and meningitis) are estimated to have occurred in the United States in 2007. More than half of these cases occurred in adults who had an indication for pneumococcal polysaccharide vaccine. Young children and the elderly (younger than age five years and older than 65) have the highest incidence of serious disease.

  • Symptoms of pneumococcal pneumonia  abrupt onset of fever, shaking chills or rigors, chest pain, cough, shortness of breath, rapid breathing and heart rate, and weakness. The fatality rate is 5%-7% and may be much higher in the elderly.

Tetanus Vaccine

Tetanus   VIS Td or Tdap                

 

Do I need it?   YES

Who?  Everyone

How Often?  Every 10 years

Which Vaccine?  Td (Tetanus-diptheria) should be given every 10 years. Tdap(Tetanus-diptheria-acellular pertussis) should be given one time to adults and can replace one Td booster. 

Why? Tetanus (lockjaw) is caused by a toxin (poison) produced by the bacterium Clostridium tetani. The C. tetani bac­teria cannot grow in the presence of oxygen. They produce spores that are very difficult to kill as they are resistant to heat and many chemical agents. C. tetani spores can be found in the soil and in the intestines and feces of many household and farm animals and humans. The bacteria usually enter the human body through a puncture (in the presence of anaerobic [low oxygen] conditions, the spores will germinate). Tetanus is not spread from person to person. There is no "cure" for tetanus once a person develops symptoms, just supportive treatment and management of complications. Tetanus kills about 1 out of 5 people who contract the disease. The best "treatment" is prevention through immunization.

  • The symptoms of tetanus are caused by the teta­nus toxin acting on the central nervous system. In the most common form of tetanus, the first sign is spasm of the jaw muscles, followed by stiffness of the neck, difficulty in swallowing, and stiffness of the abdominal muscles.
  • Other signs include fever, sweating, elevated blood pressure, and rapid heart rate. Spasms often occur, which may last for several minutes and continue for 3–4 weeks. Complete recovery, if it occurs, may take months.

Diphtheria is caused by a bacterium, Corynebacterium diphtheriae. The actual disease is caused when the bac­teria release a toxin, or poison, into a person's body. Diphtheria bacteria live in the mouth, throat, and nose of an infected person and can be passed to oth­ers by coughing or sneezing. Occasionally, transmis­sion occurs from skin sores or through articles soiled with oozing from sores of infected people.  Diphtheria is a serious disease: 5%–10% of all people with diphtheria die. Up to 20% of cases lead to death in certain age groups of individuals (e.g., children younger than age 5 years and adults older than age 40 years).

  • Early symptoms of diphtheria may mimic a cold with a sore throat, mild fever, and chills. Usually, the dis­ease causes a thick coating at the back of the throat, which can make it difficult to breathe or swallow. Other body sites besides the throat can also be affect­ed, including the nose, larynx, eye, vagina, and skin.

Pertussis (whooping cough) is caused by a bacterium, Bordetella pertussis.  Pertussis is spread through the air by infectious drop­lets and is highly contagious.  Adults with pertussis can have complications such as pneumonia (up to 5% of cases) and rib fracture from coughing (up to 4% of cases). Other reported side effects include (among others), loss of conscious­ness, female urinary incontinence, hernias, angina, and weight loss.

 Pertussis disease can be divided into three stages:

  • Catarrhal stage: can last 1–2 weeks and includes a runny nose, sneezing, low-grade fever, and a mild cough (all similar symptoms to the common cold).
  • Paroxysmal stage: usually lasts 1–6 weeks, but can persist for up to 10 weeks. The characteristic symp­tom is a burst, or paroxysm, of numerous, rapid coughs. At the end of the cough paroxysm, the pa­tient can suffer from a long inhaling effort that is characterized by a high-pitched whoop (hence the name, "whooping cough"). Infants and young chil­dren often appear very ill and distressed, and may turn blue and vomit. “Whooping” does not necessar­ily have to accompany the cough.
  • Convalescent stage: usually lasts 2–6 weeks, but may last for months. Although the cough usually disap­pears after 2–3 weeks, paroxysms may recur when­ever the patient suffers any subsequent respiratory infection. The disease is usually milder in adolescents and adults, consisting of a persistent cough similar to that found in other upper respiratory infections. However, these individuals are still able to transmit the disease to others, including unimmunized or in­completely immunized infants.

Chickenpox and Shingles

Varicella (chickenpox) and Herpes Zoster (shingles)   VIS Varicella  VIS Shingles 

Do I need it?   MAYBE

Who?    Adult Varicella: Everyone age 13 and over who has never had chicken pox or evidence of immunity.

Zostavax (shingles shot): Adults over age 60.

What is evidence of immunity? 

  • Documentation of age-appropriate varicella vaccination;
    • Preschool-age children (i.e., age 12 months through 3 years): 1 dose
    • School-age children, adolescents, adults: 2 doses
  • Laboratory evidence of immunity or laboratory confirmation of disease
  • Birth in the United States before 1980 (Should not be considered evidence of immunity for health care personnel, pregnant women, and immunocompromised persons)
  • Diagnosis or verification of a history of varicella or herpes zoster by a health care provider

How Often?  Adult Varicella: 2 doses given 4-8 weeks apart — one time. Zostavax (shingles shot): Adults over age 60.

Which Vaccine?  Varivax —adults without evidence of immunity HZV  (Zostavax) — adults age 60

Why? Chickenpox is caused by a virus, the varicella-zoster virus. Chickenpox spreads from person to person by direct contact or through the air by coughing or sneezing. It is highly contagious. It can also be spread through direct contact with the fluid from a blister of a person infected with chickenpox, or from direct contact with a sore from a person with shingles. Many cases of chickenpox are mild, but deaths from this disease can occur. Before vaccine became avail­able, about 100 people died every year in the United States from chickenpox. Most of these people were previously healthy. Chickenpox also accounted for about 11,000 hospitalizations each year. Because it is so easy to catch chickenpox, almost every adult in the United States has been infected. Until a vaccine became available, there were an esti­mated four million cases/year. Since the vaccine was licensed in 1995, the number of cases of chickenpox had fallen more than 90%.

  • The most common symptoms of chickenpox are rash, fever, coughing, fussiness, headache, and loss of appetite. The rash usually develops on the scalp and body, and then spreads to the face, arms, and legs. The rash usually forms 200–500 itchy blisters in several successive crops. The illness lasts about 5–10 days.  of tetanus are caused by the teta­nus toxin acting on the central nervous system. In the most common form of tetanus, the first sign is spasm of the jaw muscles, followed by stiffness of the neck, difficulty in swallowing, and stiffness of the abdominal muscles.

Shingles   Both chickenpox and shingles are caused by the same virus, the varicella zoster virus (VZV). After a person has had chickenpox, the virus rests in the body’s nerves permanently. Approximately 30% of all people who have been infected with chickenpox will later develop herpes zoster, commonly known as zoster or shingles.  Herpes zoster, or shingles, occurs when latent VZV reactivates and causes recurrent disease. It is not well understood why this happens in some people and not others. The risk of getting shingles increases as a person gets older. People who have medical con­ditions that keep the immune system from working properly, or people who receive immunosuppressive drugs are also at greater risk to get shingles. 

  • Shingles usually starts as a rash with blisters that scab after 3 to 5 days. The most frequently men­tioned symptom is pain. The rash and pain usually occur in a band on one side of the body, or clustered on one side of the face. The rash usually clears within 2 to 4 weeks.
    • Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of shingles can include fever, head­ache, chills, and upset stomach. For about one person in five, severe pain can con­tinue even after the rash clears up, a situation called post-herpetic neuralgia (PHN). As people get older, they are more likely to develop PHN, and it is more likely to be severe and long lasting. The pain may be sharp or throbbing, and it may extend beyond the area of the original rash. The skin may be unusually sensitive to touch and to changes in temperature. PHN can last for months, or even years.

Human papillomavirus (HPV)

Human papillomavirus (HPV)   VIS HPV Gardasil    VIS HPV Cervarix

Do I need it?   MAYBE

Who?  Routine vaccination: HPV vaccine is recommended for girls and boys 11 or 12 years of age. It may be given starting at age 9.

  • Catch-up vaccination  is recommended for the following people who have not completed the 3-dose series:
    • Females 13 through 26 years of age.
    • Males 13 through 21 years of age.
    • This vaccine may be given to men 22 through 26 years of age who have not completed the 3-dose series.
    • It is recommended for men through age 26 who have sex with men or whose immune system is weakened because of HIV infection, other illness, or medications.

How Often?  A three-dose series one time. The second dose should be with 1-2 months of the first dose. The third dose should be within 6 months of the first dose.

Which Vaccine? Gardasil (by Merck), protects against four HPV types: 6, 11, 16, 18. Garasil is licensed for males and females.  Cervarix (by GlaxoSmithKline) protects against HPV types 16 and 18. About 70% of cervical cancers are caused by HPV types 16 and 18; more than 90% of anogenital warts are associated with HPV types 6 and 11.

Why? Human papillomavirus (HPV) is the name of a group of viruses that includes more than 100 different types. More than 40 of these viruses infect the geni­tal area, including the skin of the penis, vulva, or anus, and the lining of the vagina, cervix, or rectum. Some of these viruses are called "high-risk" types; they may cause abnormal Pap tests and can also lead to cancer of the cervix, vulva, vagina, anus, or penis. Others are called "low-risk" types; they may cause mild Pap test abnormalities or genital warts. HPV is the most common sexually-transmitted infec­tion in the United States. Approximately 20 million people are currently infected with HPV. At least 50% of sexually active men and women acquire genital HPV infection at some point in their lives.

  • Most people who become infected with HPV have no symptoms. Some people get visible genital warts, or have pre-cancerous changes in the cervix, vulva, anus, or penis.
  • Genital warts usually appear as soft, moist, pink, or flesh-colored swellings, usually in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. After sexual contact with an infected person, warts may appear within weeks or months, or not at all.

Hepatitis A (HAV)

Hepatitis A (HAV)  VIS Hepatitis A

Do I need it?  MAYBE

Who?   Some people should be routinely vaccinated with hepatitis A vaccine:

  • All children between their first and second birthdays (12 through 23 months of age).
  • Anyone 1 year of age and older traveling to or working in countries with high or intermediate prevalence of hepatitis A, such as those located in Central or South America, Mexico, Asia (except Japan), Africa, and eastern Europe. For more information see www.cdc. gov/travel.
  • Children and adolescents 2 through 18 years of age who live in states or communities where routine vaccination has been implemented because of high disease incidence.
  • Men who have sex with men.
  • People who use street drugs.
  • People with chronic liver disease.
  • People who are treated with clotting factor concentrates.
  • People who work with HAV-infected primates or who work with HAV in research laboratories.
  • Members of households planning to adopt a child, or care for a newly arriving adopted child, from a country where hepatitis A is common.

Other people might get hepatitis A vaccine in certain situations (ask your doctor for more details):

  • Unvaccinated children or adolescents in communities where outbreaks of hepatitis A are occurring.
  • Unvaccinated people who have been exposed to hepatitis A virus.
  • Anyone 1 year of age or older who wants protection from hepatitis A

How Often?  A two-dose series. The second dose at least 6 months after the first dose. No current recommendation for booster doses.

Which Vaccine?  Havrix adult (by GlaxoSmithKline) Vaccine for Hepatitis A. Twinrix  combines the vaccine for Hepatitis A with the vaccine for Hepatitis B so that you are immunized against both viruses with one series, but requires a series of three shots.

Why? Hepatitis A is a liver disease caused by hepatitis A virus (HAV). There are multiple other viruses which cause liver disease. Two other common hepatitis viruses are Hepatitis B virus and Hepatitis C virus. Hepatitis A virus is spread from person to person by putting something in the mouth that has been con­taminated with the stool of a person infected with hepatitis A virus. This type of spread is called “fecal-oral.” This can happen in a variety of ways, such as when an infected person who prepares or handles food doesn’t wash his or her hands adequately af­ter using the toilet and then touches other people’s food. A person can also be infected by drinking water contaminated with hepatitis A or drinking beverages chilled with contaminated ice.

Most hepatitis A viral infections in the United States result from international travel, contact with a household member or sex partner who has hepatitis A, or illegal drug use. Casual contact, as in the office, factory, or school setting, does not spread the virus. Hepatitis A can be transmitted by sexual contact.  Hepatitis A only causes acute (recently acquired) infection, not chronic infection. Relapsing hepati­tis A, as described above, goes away and is NOT a chronic infection. (Both hepatitis B and hepatitis C viruses can cause chronic infection.) 

  • People with hepatitis A can feel quite sick. If symp­toms are present, they usually occur suddenly and can include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice (yel­lowing of the skin and eyes).

Hepatitis B (HBV)

Hepatitis B (HBV)  VIS Hepatitis B  

Do I need it?  MAYBE

Who? You should get the hepatitis B vaccine if:

  • You have sex with or live in the same house as a person with hepatitis B virus infection.
  • You have sex with more than one partner.
  • You seek care in a clinic for sexually transmitted diseases, HIV testing or treatment, or drug treatment.
  • You are a man who has sex with other men.
  • You inject drugs.
  • You have a job that involves contact with human blood*.
  • You are on the staff of, or a client in, an institution for the developmentally disabled*.
  • You are a hemodialysis patient or have end-stage renal disease.
  • You have HIV infection.
  • You are a dialysis patient.
  • You have chronic liver disease.
  • You have diabetes and are under age 60.
  • You live or travel for more than 6 months a year in countries where hepatitis B is common.
  • You seek care in a clinic for sexually transmitted diseases, HIV testing, or drug treatment.
  • You are a prisoner in a correctional facility.

How Often?  A three-dose series.  The second dose at one month after the first dose. The third dose and 6 months after the first dose. No current recommendation for booster doses.

Which Vaccine?  Recombivax HB adult (by Merck) Vaccine for Hepatitis B. Twinrix combines the vaccine for Hepatitis A with the vaccine for Hepatitis B so that you are immunized against both viruses with one series, but requires a series of three shots.

Why? Hepatitis B is a liver disease caused by the hepatitis B virus. There are multiple other viruses which cause liver disease. Two other common hepatitis viruses are Hepatitis A virus and Hepatitis C virus.  The virus is found in the blood or certain body flu­ids and is spread when blood or body fluid from an infected person enters the body of a person who is not infected. This can occur in a variety of ways including:

• Unprotected sexual contact

• Sharing drugs, needles, or “works” when using drugs

• Poor infection control practices in medical set­tings, particularly with equipment to test blood sugar

• Needle sticks or sharps exposures on the job

• From mother to baby during birth

• Contact with wounds or skin sores

• When an infected person bites another person

• Pre-chewing food for babies

• Sharing personal-care items, such as razors or toothbrushes

Hepatitis B virus particles can be found on objects, even in the absence of visible blood. The virus can remain infectious and capable of spreading infection for at least seven days outside the human body. Hepatitis B is not spread through food or water, shar­ing eating utensils, hugging, kissing, coughing, and sneezing or by casual contact, such as in an office or factory setting.

  • About 7 out of 10 adults who become infected with hepatitis B develop symptoms. Children under age 5 years rarely have symptoms. When people have symptoms, they usually appear between 60 and 150 days after onset of infection. People who have symp­toms generally feel quite ill and might need to be hospitalized.

Symptoms of hepatitis B might include the following:

• Yellowing of skin and whites of eyes

• Dark-colored urine

• Loss of appetite or nausea

• Bloated and tender belly

• Extreme tiredness

• Fever

• Pain in joints 

  • Hepatitis B can be very serious. Infection with this virus can cause chronic infection that can lead to cirrhosis and liver cancer. Many people in the United States die every year from hepatitis B-related liver disease. Fortunately, there is a vaccine to prevent acute (recently acquired) hepatitis B.

Measles, mumps, rubella

Measles, mumps, rubella   VIS MMR  

Do I need it?   YES

Who?  Some adults should also get MMR vaccine: Generally, anyone 18 years of age or older who was born after 1956 should get at least one dose of MMR vaccine, unless they can show that they have either been vaccinated or had all three diseases.

How Often?  Once

Which Vaccine?  MMR (Measles Mumps Rubella)

Why? Measles, mumps, and rubella are serious diseases. Before vaccines they were very common, especially among children.

Measles (rubeola) is caused by a virus. Measles is spread from person to person through the air by infectious droplets; it is highly contagious. Measles can be a serious disease, with 30% of re­ported cases experiencing one or more complica­tions. Death from measles occurred in approximately 2 per 1,000 reported cases in the United States from 1985 through 1992. Complications from measles are more common among very young children (younger than five years) and adults (older than 20 years). Before the vaccine was licensed in 1963, there were an estimated 3–4 million cases each year. Due to extensive vaccination efforts, the number of reported measles cases began a rapid decline during the 1990s. By 2004, only 37 cases were reported—a record low. However, new cases continue to be re­ported, primarily in populations that have refused vaccination for religious or personal belief reasons. In addition, measles is still common in many other countries and can be easily imported or contracted when traveling.

  • Symptoms include fever, runny nose, cough, loss of appetite, “pink eye,” and a rash. The rash usually lasts 5–6 days and begins at the hairline, moves to the face and upper neck, and proceeds down the body.

Mumps  is caused by a virus. Mumps spreads from person to person via droplets of saliva or mucus from the mouth, nose, or throat of an infected person, usually when the person coughs, sneezes, or talks. The virus may also be spread in­directly when someone with mumps touches items or surfaces without washing their hands and then someone else touches the same surface and rubs their mouth or nose. Mumps is less contagious than measles or chickenpox. Due to good immunization coverage, mumps is now rare in the United States. An estimated 212,000 cas­es occurred in 1964, while only 454 cases were re­ported in 2008. Large outbreaks of mumps occurred in the United States in 2006 and 2009–10 with more than 6,000 and 3,000 cases, respectively, reported in those years.

  • Individuals with mumps usually first feel sick with nonspecific symptoms like headache, loss of appetite, and low-grade fever.
  • The most well-known sign of mumps is "parotitis," the swelling of the salivary glands, or parotid glands, below the ear. Parotitis occurs only in 30%–40% of individuals infected with mumps. Some people with mumps have no signs or symptoms of illness; others may have respiratory symptoms or only nonspecific symptoms such as headache, loss of appetite, and low-grade fever.

Rubella (German Measles) is caused by a virus. Rubella spreads from person to person via airborne transmission or droplets shed from the respiratory secretions of infected people. Rubella is contagious but less so than measles and chickenpox. Rubella is usually a mild disease in children; adults tend to have more complications. The main concern with rubella disease, however, is the effect it has on an infected pregnant woman. Rubella infection in the first trimester of pregnancy can lead to fetal death, premature delivery, and serious birth defects.                      

  • Children with rubella usually first break out in a rash, which starts on the face and progresses down the body. Older children and adults usually first suf­fer from low-grade fever, swollen glands in the neck or behind the ears, and upper respiratory infection before they develop a rash. Adult women often de­velop pain and stiffness in their finger, wrist, and knee joints, which may last up to a month. Up to half of people infected with rubella virus have no symptoms at all.

Meningoccocal

Meningoccocal  VIS Meningoccocal

Do I need it?   Maybe

Who?  Routine vaccination:  Two doses of MCV4 are recommended for adolescents 11 through 18 years of age: the first dose at 11 or 12 years of age, with a booster dose at age 16. Adolescents in this age group with HIV infection should get three doses: two doses two months apart at 11 or 12 years, plus a booster at age 16. If the first dose (or series) is given between 13 and 15 years of age, the booster should be given between 16 and 18. If the first dose (or series) is given after the 16th birthday, a booster is not needed.

Other people at increased risk:

  • College freshmen living in dormitories.
  • Laboratory personnel who are routinely exposed to meningococcal bacteria.
  • U.S. military recruits.
  • Anyone traveling to, or living in, a part of the world where meningococcal disease is common, such as parts of Africa.
  • Anyone who has a damaged spleen, or whose spleen has been removed.
  • Anyone who has persistent complement component deficiency (an immune system disorder).
  • People who might have been exposed to meningitis during an outbreak.
  • Children between 9 and 23 months of age, and anyone else with certain medical conditions need 2 doses for adequate protection. Ask your doctor about the number and timing of doses, and the need for booster doses.

 How Often?  2 doses

Which Vaccine?  MCV4 (meningococcal conjugate vaccine) is the preferred vaccine for people 55 years of age and younger. MPSV4 (meningococcal polysaccharide vaccine) has been available since the 1970s. It is the only meningococcal vaccine licensed for people older than 55

Why? Meningococcal disease is caused by the bacterium Neisseria meningitidis. This bacterium has at least 13 different serogroups. Five of these serogroups, A, B, C, Y, and W-135, cause almost all invasive disease. The relative importance of these five serogroups depends on geographic location and other factors. The disease is spread person-to-person through the exchange of respiratory and throat secretions (e.g., by coughing, kissing, or sharing eating utensils). Me­ningococcal bacteria can't live for more than a few minutes outside the body, so the disease is not spread as easily as the common cold or influenza. Meningococcal bacteria can make a person extremely ill by infecting the blood (septicemia) or by infecting the fluid of the spinal cord and around the brain (meningitis). Because this disease progresses quickly, it is important to be diagnosed and start treatment as soon as possible.

Meningococcal disease is very serious. About 9–12% of people with meningococcal disease die even with appropriate antibiotic treatment. Of those who re­cover, up to 20% suffer from some serious after-ef­fect, such as permanent hearing loss, limb loss, or brain damage.

  • The most common symptoms are high fever, chills, lethargy, and a rash. If meningitis is present, the symptoms will also include headache and neck stiff­ness (which may not be present in infants); seizures may also occur. In overwhelming meningococcal in­fections, shock, coma, and death can follow within several hours, even with appropriate medical treat­ment.
           

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