Saar Kuzi
Alessandra Coutinho Fernandes
William Cope
Richard Tapping
Kashif Ahmad
Reda Sadki
Shubhra Kanti Karmaker Santu
Adam P Rusch
Elle Meisner
Nereyda Ochoa
Landon J. Kunzelman
James DotimasFA16 Immunization Module’s Updates
Immunizations in the geriatric community: Why older adults need vaccines too
When we talk about vaccination, we frequently refer to the need for vaccinating children. However, noting the increased susceptibility of infections in older adults, vaccinations can be critical in preventing serious health implications in the elderly. With several classes of vaccines requiring boosters at various schedules, it becomes difficult for both patients and providers to keep up with the recommended immunizations. For instance, USPSTF recommends that adults receive a tetanus-diphtheria toxoid (DTaP) booster every ten years, with older adults over 60 years old accounting for around 60 percent of tetanus cases in the United States [1]. Although clinical tetanus is relatively rare in the U.S., rates are on the rise due to a number of reasons, with a decline in childhood vaccinations being one particular factor [2].
One of the most severe infections that older adults can contract is seasonal influenza, with more than 90 percent of deaths occurring in individuals over 60 years old. A serious complication arising from influenza-related infection is acute-respiratory failure, which affects older adults 10-30 times more than younger adults. The inactivated influenza vaccine (IIV) is the only vaccine class approved for administration in adults over 65 [1]. Although the effectiveness of these vaccines is not thoroughly understood, it has been previously shown to produce a 43 percent effectiveness rate against influenza-like illness. Nevertheless, an effectiveness of merely 40 percent has been estimated to avert nearly 60,000 hospitalizations of older adults for complications due to pneumonia and influenza. Factors such as impaired herd immunity in older, immunosuppressed adults in addition to suboptimal immunization results has led to outbreaks in nursing homes even though 80-98 percent of the residents were vaccinated. Additional factors such as statin administration (which are implicated in influencing the immune system) by hyperlipidemic patients could potentially subvert the immunization effects of the vaccine [3].
As a whole, the main issue with understanding the necessary protocols for vaccinating adults is the lack of information/research available on the subject. Considering the vulnerability of the immune system at both extremes in age deserves special attention. When it comes to setting up a discrete schedule/timing of vaccines in older adults, the specifics are ambiguous. Better measures and more concrete guidelines should be made to direct providers in a more efficient manner when taking care of the geriatric population.
1. J Am Geriatr Soc. 2015;63(3):584-588. http://www.medscape.com/viewarticle/842397_1.
2. https://www.uptodate.com/contents/geriatric-health-maintenance?source=search_result&search=vaccines%20geriatric&selectedTitle=1~150#H9
3. https://www.uptodate.com/contents/seasonal-influenza-vaccination-in-adults?source=see_link§ionName=Older%20adults&anchor=H14#H14
I agree that considering the vulnerability on both ends of the spectrum it is equally as important to consider the vaccination of the geriatric community. In regards to the pneumococcal vaccine, the CDC recommends all people 65 years or older to receive the vaccination considering the 30-40 percent mortality rate in this population when infected and the more increasingly common occurrence of antibiotic resistance strains of the pneumococcal bacterium. It is thus very important to provide a strong drive to increase vaccination to the geriatric community to avoid preventable deaths due to these infections.
A well recognized problem is the high incidence of secondary bacterial infections that often accompany the flu in elderly patients. This is why the flu vaccine is so important in this population. Would love to see a comment about the pneumococcal or the Zoster vaccines.
This is a significant problem to consider. As our geriatric population continues to grow, it is increasingly important to think about how to better keep older adults protected through vaccinations. In addition, influenza and pneumonia have been the 7th leading cause of death in adults over the age of 65 for many years. I am sure that it is very difficult to carry out studies on this topic due to a multitude of co-morbidities, as well as the environmental factors @Elizabeth Edwards and @Gabriel Swords mentioned. However, I agree that there needs to be more research and better standardized protocols in place.
In my mind, it would seem that both the pediatric and geriatric populations maintain higher levels of morbidity and mortality than the general public. That being said, when primed with the question of who needs a vaccine, the idea of an elderly patient never jumped to my mind. The statistic that showed 90% of deaths due to seasonal influenza are found in the geriatric population astounded me. Because of this, I would argue that vaccines should be required to be given regularly in places such as retirement communities where there are large groups of elderly people living together.