4 vaccines older adults need to protect their health




It’s been at least a half-century since older adults have been in school — why do they need to be vaccinated?

According to the U.S. Centers for Disease Control and Prevention, in 2017 there are four recommended immunizations for older adults: flu, pneumonia, shingles and Tdap. Vaccine expert Richard Zimmerman, professor in the University of Pittsburgh School of Medicine and its Graduate School of Public Health, recently explained some of the key reasons why people need the vaccines. As a director of the University of Pittsburgh’s Vaccination Research Group (known as PittVax), he’s part of the team that evaluates the flu vaccine every year. Dr. Zimmerman is also a member of the CDC’s Advisory Committee on Immunization Practices.

Influenza (flu)

One dose of the flu vaccine every year is recommended for all age groups. A higher-dose vaccination is an option for adults 65 and up. The high-dose vaccine (Fluzone High-Dose) and a flu vaccine with adjuvant (FLUAD) were made to create a higher immune response and designed specifically for people 65 years and older.

“My opinion is based on data,” Dr. Zimmerman said. “I would have my mother get either the high-dose vaccine (made by Sanofi Pasteur) or the adjuvant (FLUAD). One or the other. ... We could say both are better than regular dose for seniors.”

Even though flu vaccines are less effective in people 65 and up, the CDC says they’re needed because that age group is at high risk of getting seriously ill, being hospitalized and dying from the flu. Many people that age are healthy and active, with more responsive immune systems, but others have medical conditions that weaken their immune system and reduce their response to the vaccine. The CDC cites a study published last summer that found people 50 years and older who got a flu vaccine had a 57 percent lower risk of being hospitalized from the flu.

Dr. Zimmerman said there’s no safety concern with flu vaccine. “You may get a sore arm. Some get an elevated temperature.” He said the best time — “the sweet spot” — to get the flu vaccine runs from October through mid-November.

Pneumonia

The pneumonia vaccine is recommended for people age 65 and above, considered at highest risk of pneumonia. In the 2017 recommendation, adults 65 or older with normal immune response should receive one dose of 13-valent pneumococcal conjugate vaccine (PCV13, brand name Prevnar 13, covering 13 types of pneumococcal bacteria). That should be followed by one dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23, brand name Pneumovax) at least one year after PCV13.

“Ideally, one would, at 65, get the Prevnar 13 and a year later get the 23,” Dr. Zimmerman said. “With the 23 you get some extra types … There are immunological advantages to get the 13 before the 23.”

People over 65 are more at risk. Dr. Zimmerman said, because they’re more likely to have chronic illnesses such as diabetes and lung disease and the aging immune system makes them more likely to be weakened by a viral infection, which can lead to pneumonia.

Herpes zoster (shingles)

Most people born before 1980 got chickenpox when they were young, so older adults are at risk for shingles and its complications, particularly the pain syndrome known as postherpetic neuralgia, causing a burning pain that lasts after the rash and blisters disappear. CDC recommends one dose for people 60 years old or older, whether or not they’ve had shingles already. It’s not advised for adults with compromised immune systems and some HIV patients.

“There’s a higher rate for shingles as you age,” Dr. Zimmerman said. The pain that can follow is severe, he added. “Not everybody gets that, but among those who have it, they complain bitterly.”

He explained that because commercial insurance covers a shingles shot at the age of 60, the best time for people to get it is between 60 and 64. Under Medicare, the shingles vaccine is covered under prescription drug plans (Part D) and generally requires a co-payment.

Tdap (tetanus, diphtheria and acellular pertussis)

Adults who aren’t sure if they’ve had the Tdap vaccine, or if immunity to pertussis is not known, are advised to get one dose of Tdap followed by a tetanus and diphtheria booster every 10 years. Pertussis (whooping cough) continues to appear in outbreaks and older adults who get it can pass it along to babies and children.

Tdap is safe for adults, Dr. Zimmerman said, adding that even if you don’t remember when you had your last shot, it’s still safe to get another, without serious side effects.

“It’s the last thing grandparents want is to get their grandchildren sick. It’s critical, the immune system in infants is immature; they might not react strongly to their first vaccine. No grandparent wants to be responsible for giving their infant grandchild pertussis. Just get the vaccine.”

Jill Daly: jdaly@post-gazette.com, 412-263-1596.





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