I have recently started thinking more seriously about vaccines – not because I suddenly became a person who wants to get every vaccine available, but because two things are coming together in my life.
First, we are planning to travel to the Philippines next February for three weeks. Second, our daughter will eventually start nursery, which means that our household is going to enter a completely new era of exposure to childhood infections.
That made me look at my own vaccination history and ask a fairly simple question: Am I actually properly protected?
The first group that caught my attention was MMR, Adacel, typhoid, flu and Twinrix.
MMR seems particularly important because measles is incredibly contagious and international travel can increase the chances of encountering infections that are less common in everyday life. I started looking at the two MMR vaccines that are commonly encountered in Europe: Priorix and M-M-RVAXPRO.
Interestingly, they don’t contain exactly the same vaccine strains.
Priorix uses the Schwarz measles strain and RIT 4385 mumps strain, while M-M-RVAXPRO uses the Enders’ Edmonston measles strain and Jeryl Lynn mumps strain. Both use the same Wistar RA 27/3 rubella strain.
At first, the different names made me wonder whether one might be substantially better than the other. But the differences are mainly historical and laboratory-related. Both are established live attenuated MMR vaccines, and there isn’t a good reason for a healthy adult to consider one dramatically superior to the other.
So my conclusion was surprisingly simple: if I need an MMR vaccination, I would be happy with either one.
Twinrix is particularly attractive because it combines protection against hepatitis A and hepatitis B.
Hepatitis A is a relevant travel consideration in the Philippines, while hepatitis B is also worth considering for international travelers. The nice thing about Twinrix is that it isn’t merely a short-term travel vaccine. Protection following a completed vaccination course is expected to last for many years, potentially decades.
Typhoid is different. I see that primarily as a Philippines-trip vaccine rather than something I need because my daughter will start nursery.
It provides much shorter-term protection than MMR or hepatitis vaccination, so I don’t see it as part of my permanent adult vaccination “maintenance” in the same way.
Adacel – or a Tdap-containing vaccine – is interesting for a different reason.
Once you have a small child, pertussis becomes something worth thinking about. Whooping cough can be particularly serious in babies, and children in nurseries have plenty of opportunities to encounter respiratory infections.
Tetanus and diphtheria protection also need periodic maintenance, so if my booster is due, this seems like a sensible vaccination to get anyway.
There are also combination vaccines such as Adacel Polio, which add polio protection. When comparing MMR with an Adacel-Polio booster, I wouldn’t say that one is universally “more important.” It depends on what I have already received.
If my MMR history were incomplete or uncertain, I would give MMR a high priority, particularly because of international travel. If I already had adequate MMR vaccination but my tetanus/pertussis/polio booster was overdue, then Adacel Polio would make more sense.
What about flu and COVID?
These are different from MMR.
I don’t expect one flu vaccination to protect me for the next ten years. Influenza vaccines are updated and administered seasonally, so flu vaccination is something I would think about every year.
COVID vaccination is also more of a seasonal/updated-vaccine issue than a one-time lifetime vaccination.
For my particular situation, I think both make sense to consider, especially around winter, travel and eventually having a child in nursery bringing home all sorts of microscopic souvenirs.
And, unfortunately, vaccination isn’t going to stop my daughter from bringing home every ordinary cold known to humanity.
Nursery children seem to possess a remarkable ability to manufacture and distribute respiratory viruses.
I also wondered about meningococcal vaccines.
Bexsero protects against meningococcal group B, while Nimenrix protects against groups A, C, W and Y. Together they cover the major meningococcal groups represented by those vaccines.
These are different from MMR or Tdap in terms of how I would prioritize them for myself.
For a healthy adult, having a child start nursery doesn’t automatically mean that Bexsero and Nimenrix become essential. They are more of an additional layer of protection rather than something I would put ahead of routine vaccinations that are due or travel vaccines that are specifically relevant to my destination.
If I decide to get them anyway, that isn’t unreasonable. Meningococcal disease is rare but potentially extremely serious, so I can understand why someone might prefer to have additional protection.
But I don’t feel that I need to collect vaccines simply because they exist.
How long will all this protection last?
This was another thing I wanted to understand.
MMR is the long-term one. After appropriate vaccination, protection against measles, mumps and rubella is generally very durable, often lifelong.
Hepatitis A and B vaccination is also a long-term investment. After completing the recommended series, healthy people generally don’t need routine boosters.
Tdap is different: tetanus and diphtheria boosters are generally given periodically, commonly every ten years, while pertussis protection also decreases over time.
Typhoid is much shorter-lived, which is why I see it mainly as a travel measure.
Flu and COVID are the obvious seasonal ones.
So if I get the appropriate vaccines before February 2027, I’m not simply preparing myself for three weeks in the Philippines. Some of those vaccinations could continue protecting me throughout the years when my daughter is in nursery and kindergarten.
One concern I had: neurological complications. This is probably the part I thought about the most.
The infections themselves can cause neurological complications. Measles, mumps, influenza, COVID, tetanus and several other infections can, in rare circumstances, affect the nervous system.
That made me think about the risk-benefit balance differently.
It’s easy to look at a vaccine leaflet and become frightened by the long list of possible adverse effects. But the relevant comparison isn’t simply “vaccine versus nothing.”
It’s vaccine versus the disease I’m trying to prevent.
A disease such as measles can cause encephalitis. Mumps can cause meningitis or encephalitis. Tetanus produces its characteristic neurological effects through a bacterial toxin. Influenza and COVID can occasionally produce neurological complications as well.
That doesn’t mean I’m likely to develop any of these complications. They are uncommon.
But it does mean that preventing the infection has value beyond simply avoiding a few days of fever and coughing.
Another question I had was whether taking Lexapro – escitalopram – would interfere with these vaccines.
It doesn’t.
Being on escitalopram isn’t a reason to avoid MMR, Adacel, Twinrix, typhoid, influenza or COVID vaccination.
So I don’t need to stop Lexapro or change the dose just because I’m getting vaccinated.
Rather than trying to get absolutely everything, I think the sensible approach is to check what I’ve already received and then fill the gaps.
For the Philippines, the things I’m particularly interested in are:
- MMR, if my vaccination history isn’t adequate
- Twinrix for hepatitis A and B
- Typhoid
- Flu
- Adacel/Tdap, if I’m due
- COVID, according to the current seasonal recommendation
For the longer term, with a child entering nursery, I’d make sure my routine vaccinations are up to date, particularly MMR, pertussis/tetanus and influenza.
Bexsero and Nimenrix are things I can consider as additional protection, but they don’t seem to belong in quite the same priority category for a healthy adult.
And I don’t need another chickenpox vaccine simply because my daughter is going to nursery. I had chickenpox as a child and was also vaccinated, so I already have evidence of immunity.
Ultimately, what started as a fairly vague worry about “Should I get some vaccines?” has turned into something much more straightforward:
I want to make sure my basic adult vaccinations are up to date, add the vaccines that make sense for a three-week trip to the Philippines, and then maintain the seasonal ones as necessary.
That seems much more reasonable than either ignoring vaccination altogether or trying to vaccinate myself against every conceivable microorganism before my daughter discovers nursery.
Because, realistically, nursery will probably introduce me to plenty of microorganisms that haven’t even made it onto my vaccination list.