Why Boomers Should Get These Three Vaccinations

admin | September 21, 2017 | 0 Comments |

Nurse prepares hepatitis a vaccine for injection.

We usually think of babies and little kids when we think about vaccinations, but did you know that there are three vaccines specifically recommended for older adults? They are pneumococcal vaccination, the shingles vaccine, and flu shots. Even if you hate needles, the benefits of these vaccines far outweigh any discomfort, such as a needle stick or a sore arm, and could save your life.

Pneumococcal vaccination

Diseases due to infection with pneumococcal bacteria can be quite serious, even deadly, in older people. In fact, they have one of the highest mortality rates of all age groups, particularly if they have significant co-existing diseases. Because pneumococcal disease can be serious or even fatal in older adults, the United States Advisory Committee on Immunization Practices (ACIP) recommends that all adults 65 and older receive vaccination against pneumococcal disease.

There are two vaccines that are currently recommended for older adults:

Pneumococcal polysaccharide vaccine PPSV23 or Pneumovax, and
Pneumococcal conjugate vaccine (PCV13 or Prevnar).

PPSV23 provides protection against the 23 most common pneumococcal strains that cause 60% of all pneumococcal infections in adults. It provides good but not perfect protection against serious pneumococcal illnesses in older adults, such as meningitis (an infection of the covering of the brain and spinal cord) and bacteremia (bacteria in the blood stream). PCV13 covers an additional 13 pneumococcal serotypes.

The APIC recommends sequential administration of both vaccines to all adults 65 and older. PVC13 is given first with PPSV23 given a year later. Some experts believe that older adults who are healthy only need to receive PPSV23 with the two-vaccine regimen being reserved for people at high risk for serious pneumococcal complications, such as those with no functioning spleen, immuno compromised from HIV, cancer and other diseases, advanced kidney disease,a cerebro spinal fluid leak, and cochlear implants.Most seniors will only need one vaccination of each type starting around the time of their 65^th birthday although some experts favor revaccinating with PPSV23 at 10 year intervals because our immune responses wane as we age.

Shingles vaccine

Shingles is a painful rash that some older people get if they had chicken pox as a child. The virus that causes chicken pox, called the varicella-zoster virus or herpes zoster, remains dormant in the body for life. But it can become reactivated if the immune system is weakened by age or disease.

Although it is now common for children to get vaccinated against chicken pox, there are still millions of people in the U.S. who are at risk for shingles. It is estimated that 95% of U.S. adults are at risk for the disease and half of all Americans will have had it by the time they reach the age of 80. According to the CDC, there are approximately 1 million new cases of shingles diagnosed every year. It is most common in 60-80 year olds.

The initial symptom of shingles is a painful, red, often blistered rash that is localized to one side of the body in the distribution of the nerve that is involved with the infection. The rash lasts about 2-4 weeks. In rare cases, such as people with immune compromise, the rash can become more widespread, resembling chicken pox.

About a third of adults who get shingles will develop serious complications, and 1-4% of shingles sufferers require hospitalization for treatment of complications. The most common complication is continued pain after the rash has cleared, a syndrome known as post-herpetic neuralgia (PHN). In most people, this resolves within weeks or a few months.But in some unfortunate individuals, the pain can last for years. This places the person at risk for depression, loss of sleep, and social isolation. Long term and more severe pain become increasingly common as people age.

A recent study from the Mayo Clinic suggests that shingles may also increase the short-term risk of a heart attack or stroke in older adults. Other serious complications include bacterial infection of open sores in the rash, blindness if the infection affects the cornea, and hearing loss if the vestibular nerves are involved. Rarely, shingles can cause pneumonia, brain inflammation, or even death.

ACIP recommends the shingles vaccine,Zostavax,for anyone over the age of 60 who is not immunocompromised whether or not they recall having chicken pox as a child. Overall, the vaccine reduces the risk of developing shingles by 51% and PHN by 67%. The effectiveness of the vaccine lessens with age, providing only a 38% reduction in the disease by age 70. The protection lasts about five years.

A new 2-dose inactivated adjuvant vaccine has recently become available that has an efficacy in people over 70 that is similar to that in the 50-59 age range. It may be useful for older adults and those who cannot take a live vaccine because of immunocompromised.

Flu shots

People 65 and older are at greater risk of serious complications from the flu compared to younger, healthy adults. Between 71-85% of seasonal flu-related deaths and 54-70% of flu-related hospitalizations occur in that age range. This is because our immune defenses weaken with age.

Although it is recommended that every one who doesn’t have a contraindication (reason why they shouldn’t take the shot) should be vaccinated against flu every year. The shots are required every year because the flu vaccine is updated annually to reflect the flu strains likely to be present in that flu season. Most healthy seniors can get by with any injectable influenza vaccine, but it is important to know that there are two vaccines that are designed specifically for people 65 and older:

High dose

The high dose vaccine has 4 times the amount of antigen and is associated with a stronger antibody production than the regular flu shot. One large study showed that seniors 65 and older had 24% fewer influenza infections after high dose compared to regular flu shots.

Fluad

This is a relatively new flu vaccine first becoming available in the U.S. during the 2016-2017 flu season. It is made with an MF59 adjuvant that is designed to elicit a stronger immune response to the vaccination.

Both of these shots may result in more of the mild side effects that can occur with standard seasonal shots, including pain, redness, or swelling at the injection site, headache, muscle ache, and malaise.

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Patricia Salber, MD, MBA is the Founder and Editor-in-Chief of The Doctor Weighs In. She is also the CEO of Health Tech Hatch, the sister site of TDWI that helps innovators tell their stories to the world. She is also a physician executive who has worked in all aspects of healthcare including practicing emergency physician, health plan executive, consultant to employers, CMS, and other organizations. She is a Board Certified Internist and Emergency Physician who loves to write about just about anything that has to do with healthcare.