Do I need to get these vaccines before starting Ocrevus?

Here is My Question: 
I am 37 and will be starting Ocrevus soon but a bunch of vaccines were ordered before I start it. My doctor wants me to get the Hep A, HPV, HIB, Pneumococcal, shingles, tdap. I got the tdap and pneumococcal today. HIB, HPV, and shingles were denied because of age and hep A for unknown reasons. 

1. Do I need the HPV vaccine at 37 if I’ve had HPV in the past and am now completely negative since I had my daughter in 2010 and I’m also in a monogamous relationship? 

2. Should I get the shingles vaccine this early? I did have chickenpox as a child. 

3. Are the HIB and Hep A usually recommenced? 

Also, should I get the breast cancer gene test if I am unsure of family history or beast cancer? 

Answer:
The vaccines you mention are all appropriate but not all will be covered.

1.  The FDA only recommends the HPV vaccine to age 26. it will not hurt you to get it after age 26 but it’s also not likely to be required given your monogamous relationship. If you plan on more sexual partners or think your partner may be having more sexual partners then it may be a good idea. No matter the circumstances you would need to pay for it yourself.

2. Shingles is probably not required at your age if you have good immunity to varicella ( a blood test will tell).

3. Hep A is a good idea if you live in certain areas like San Diego or the southwest where we have had frequent outbreaks.

4. By HIB you are referring to the haemophilis influenza type B vaccine. This is usually given to children and probably not necessary for you, especially since your daughter is 8 or 9 and probably received this vaccine before the age of 2.

5. Ask your doctor about getting BRCA 1 or 2 gene testing. This is usually only recommended for people with family medical histories of breast cancer or several other types of invasive cancer (pancreatic and prostate) especially in people with an ashkenazi jewish background. We usually do recommend pap smears and mammograms before starting Ocrevus if not done recently.

Good luck
Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego