Experts are now predicting an increase in pertussis, or whooping cough, a life-threatening disease that once seemed to have been virtually eliminated in this country.

Although childhood immunizations are on the rise in Texas, there is new concern that adults whose immunizations have worn off might be susceptible to the disease, and pass it on to children too young to be fully immunized and too vulnerable to fight back.

August is National Immunization Awareness Month, a good time to spread the word about the importance of immunizations across a lifespan, and to remind adults that childhood immunizations can fade over time, and some vaccinations require boosters in order to stay effective.

Grownups should review their own immunization records for their health as well as that of any children in their care.

On a positive note, The Center for Disease Control and Prevention reports the number of Texas children receiving vaccinations has risen more than 19 percent over a five-year period.

Texas now ranks 22nd in the country, the highest ranking the state has ever achieved, a testament to a sustained educational effort by both state and local agencies.

The CDC's National Immunization Survey provides vaccination coverage estimates for children 19 through 35 months of age in those early years before school-mandated immunizations. These important vaccines provide protec- tion against once all-too-common diseases such as diphtheria, tetanus and pertussis; polio; measles; Hib disease; hepatitis B; and chicken pox.

According to a recent survey by the Texas Department of State Health Services, however, many adults in Texas are not keeping up with their own immunization needs. Only 43 percent of Texans over the age of 18 have received a tetanus shot (Td) in the last 10 years.

Only 11 percent of adults report having recently received a booster for tetanus, diphtheria and pertussis (Tdap), and only 36 percent of Texans over 18 and under 65 report receiving an influenza vaccine, according to 2008 data from the Texas Department of State Health Service's Behavioral Risk Factor Surveillance System.

New vaccines, unavailable to many in childhood, can offer protection from potentially serious and debilitating diseases, while updating older vaccines can continue a lifetime of protection. Those who stand to benefit most include college students, the elderly, caregivers, overseas travelers and anyone who comes in contact with children.

At the top of the list of recommended immunizations for adults is an annual flu shot. While anyone can receive the benefits of the vaccine, the CDC recommends it for those who are at high risk of having serious flu complications, or anyone who lives with or cares for someone at risk.

For adults over 65, or those with long-term health problems, a pneumococcal vaccine is also recommended.

Even healthy adults should review the CDC's immunization guidelines. A tetanus shot is recommended every 10 years from ages 19 through 65, while a new kind of tetanus booster (Tdap) offers added protection against pertussis, also known as whooping cough.

Depending on age, occupation and medical history, the CDC also recommends adult vaccines to protect against shingles, meningitis, hepatitis, and human papillomavirus, which causes cervical cancer in women.

Adults should follow their physician's advice with regard to any necessary vaccines or boosters, and anyone planning a trip out of the country should consult with their physician about additional vaccinations that may be recommended or required prior to traveling.

Physician visits should be scheduled four to six weeks prior to departure because most vaccines take time to become effective, and some must be given in a series, over a period of days or sometimes even weeks.

To learn more about the recommended vaccination schedule, contact a physician or review the vaccination schedule set by the Advisory Committee on Immunization Practices and the Center for Disease Control and Prevention.

A complete list of recommended vaccinations can be found at www.cdc.gov/vaccines.