Providers should encourage senior patients to receive vaccinations for influenza, pneumococcal disease, and shingles, as well as boosters for tetanus, diphtheria, and pertussis (Tdap) because of their role in helping avoid infection, reducing symptom severity, and preventing hospitalizations often associated with infections among older patients.
“Compared to the era when we did not have these vaccines for older adults, they have certainly had an important protective effect,” says Kenneth E. Schmader, MD, chief of the Duke Division of Geriatrics and a leading specialist in geriatric vaccines. “Unfortunately, we appear to have reached a ceiling in terms of vaccine coverage for these vaccines among older people.”
Despite evidence supporting clinical effectiveness, in recent years about 35 to 40 percent of persons 65 years and older did not receive the influenza vaccine. Approximately 35 percent did not receive a pneumococcal vaccination. Similar percentages are evident with other important vaccinations: approximately 65 percent did not receive a shingles vaccination; 80 percent did not receive the Tdap vaccination despite that fact that these vaccinations are paid by Medicare.
The CDC issued age-specific guidance for the 2018-19 influenza season and encourages individuals over 65 to get vaccinations, particularly flu shots. Schmader, who serves as a liaison to the CDC’s Advisory Committee on Immunization Practices (ACIP), encourages seniors to be vaccinated for influenza, pneumococcal and shingles infections, and to get a booster or update for Tdap (tetanus, diptheria, and pertuissis).
Even though most U.S. residents received Tdap inoculations as children, the effectiveness wanes over time, Schmader says. The Tdap booster is particularly important because of recent outbreaks of pertussis in nursing homes.
While many forms of flu vaccine are now available, the high dose and adjuvanted influenza vaccines are licensed by the FDA specifically for seniors. The ACIP recommends that people ages 65 and older should receive both pneumococcal conjugate vaccine and pneumococcal polysaccharide vaccine.
CDC recommendations promote shingles vaccinations for people ages 50 and older, but Schmader notes “the risk of shingles at 80 is much higher than 60, and the risk just goes up exponentially with age,” he says. “The important concern is the risk for developing extreme pain. Older people are also at risk for developing postherpetic neuralgia.”
Shingles is more likely to present among people who have pronounced problems with the immune system as aging occurs, particularly among patients who have undergone bone marrow or organ transplantation. Shingles are also more common among patients who have been treated for cancer, immune-mediated diseases, or have taken immunosuppressant drugs such as prednisone.