Not surprisingly, the most effective preventive measures are vaccinations. We think of vaccinations as something you get as a child, and this is certainly true. I don’t treat children, but vaccines are of growing importance for adults. The older you are, the more important they become:

1. Tetanus is often fatal. It starts with an infection caused by bacteria that live in the soil, so you don’t catch it from anyone. Though you can get it from an infected cut, 15% of people who develop tetanus have no history of an injury. The bacteria secrete a toxin that makes all your muscles go into spasm, and you can’t breathe. Get a tetanus shot every ten years, regardless of age. It’s one of the most effective vaccinations available.

2. Pertussis is the medical term for whooping cough, a serious lung infection that causes spasms of coughing in adults. Pertussis is hard to treat and can kill babies and small children. For reasons that aren’t clear, pertussis is becoming more common. There’s a new pertussis vaccine for adults under 65 that’s mixed with the regular tetanus shot. You only need it once. It’s particularly important if you have lung disease or are around small children.

3. Pneumovax (pneumococcal vaccine) helps prevent a particularly serious and deadly bacterial infection. In 1990 this bacteria killed Jim Henson, founder of the Muppets. He was perfectly healthy one day, caught pneumonia, and was dead 24 hours later. You need Pneumovax at least once if you are over 65 or have diabetes or another chronic illness. I recommend getting a booster every ten years.

4. Everyone should have an annual influenza vaccine (“flu shot”) every October or November. This vaccine is also critical if you care for sick or elderly people. Many of my patients wrongly believe that “getting the flu vaccine causes the flu”: a few days after getting the shot, they’ll come down with a cold. This has been proven scientifically not to be the case. Besides, it’s ridiculous: influenza and colds are completely different. Over 200 different viruses cause colds. Only the influenza virus causes the high fever, chills, and severe body aches of influenza. The reason people are confused is we give the vaccine at the start of the cold season, and you can catch a cold whether or not you get a flu shot. It’s true that the effectiveness of the influenza vaccine varies from year to year, but even if you get the vaccine and then come down with influenza, that illness is apt to be shorter and milder.

5. Zostavax is a vaccine to prevent shingles, or herpes zoster. The virus that caused chicken pox when you were a child hides silently in your nervous system, only to erupt decades later to cause the burning rash of shingles. The rash typically occurs on one side of your face, neck, or trunk. The affected area burns like fire and is painful to light touch. The rash goes away in 2-4 weeks, but 20% of patients have persistent burning (called postherpetic neuralgia or PHN) that can last for weeks or years. Severe PHN is often hard to treat and can be disabling. Interestingly, although Zostavax is only fair at preventing shingles, it’s especially effective in preventing PHN. Zostavax is a live virus that’s been greatly weakened, but you should still avoid it if you have immune suppression.

Update: The FDA has recommended that instead of Zostavax, you get Shringrix, brand new in 2017, which is a great deal more effective than Zostavax. And it’s a killed virus preparation, so it’s safe in people with compromised immune systems.

6. Young adults and any health care worker should be sure they have been immunized against hepatitis B, a potentially serious virus that can cause fatal liver damage or cancer. You catch it from infected body fluids. Hepatitis B is also a major risk in drug addicts and men who have sex with men, so they should also get the hepatitis B vaccine.

7. A number of vaccines and other preventive measures are recommended for travelers to foreign countries, though very few precautions are needed if you’re going to Japan or Europe. The most comprehensive and up-to-date reference is always the CDC Traveler’s Health page.