Essential Vaccines for Older Adults

Vaccines are designed to prevent disease by preparing the recipient’s immune system ahead of time. The vaccine schedule begins in infancy to begin training a child’s immune system against infections such as Pertussis and Hepatitis B. There are other vaccine’s given in this timeframe as well. Once-common and dangerous diseases such as Polio, Hemophilus influenza, and Diphtheria are now rarely encountered in the United States due to increased population immunity. Even Chicken Pox is scarcely seen in clinics now that we have the Varicella vaccine. However, adults have a vaccine schedule as well. Vaccines are especially important for aging adults as their immune systems tend to be less robust. Older adults also tend to have more co-morbidities, the presence of two or more diseases or medical conditions, putting them at higher risk for worse outcomes should they contract these infections. Below, I will discuss five diseases and when vaccination is recommended.

Tetanus

Tetanus is caused by bacteria (Clostridium tetani) that most commonly infects the body through open wounds, especially dirty wounds or wounds caused by a rusty object. It causes painful muscle spasms, and advanced disease can cause the entire body to painfully lock up as large muscle groups contract uncontrollably. Unfortunately, tetanus may never be eradicated because it lives in the soil and creates durable spores. However, routine vaccination has massively decreased the incidence of tetanus. The vaccine schedule for tetanus begins in childhood with the DTaP vaccine (also covering for diphtheria and pertussis). After age 19, the Tdap vaccine is recommended with a booster every 10 years. Patients who sustain injuries causing open wounds are often vaccinated (sometimes before the 10-year interval) following certain risk guidelines.

Shingles

Shingles is a re-activation of the virus that causes Chicken Pox. Nowadays, the best way to prevent Shingles, is childhood vaccination against Varicella. However, this vaccine did not exist for previous generations, and anyone who had Chicken Pox is at risk for developing Shingles later in life. After recovering from the initial infection, some of the virus can remain latent in nerve cells for many years. Immunodeficiency and/or stress can trigger its re-activation causing local moderate to severe pain and a rash. This syndrome is known as Shingles. If the virus affects the nerves of the face, there is a high risk for causing blindness requiring urgent treatment. Fortunately, there are vaccines for shingles, usually given in 2 doses, and vaccination should be considered for anyone over the age of 50.

Influenza

The flu needs no introduction. Common symptoms include fever, body aches, and upper respiratory symptoms. Influenza virus has genetic material that is prone to changing in small ways over time. The modified genes slightly change the proteins that are created during viral replication. Therefore, every year a new strain is formed that is unrecognized by our immune systems. Again, older adults are at higher risk for worse outcomes if they catch the disease, due to diminished immune systems and generally higher burden of comorbidities. It is highly recommended that older adults receive the flu shot every year.

Pneumonia

Bacterial pneumonia is most commonly caused by the species Streptococcus pneumoniae. Pneumonia is a common cause of hospitalization among the elderly, and in severe cases can lead to respiratory distress and even death. Vaccination is important to build as much protection as possible. The Pneumococcal Conjugate Vaccines (PCV) target Streptococcus pneumoniae. The series starts in childhood (PCV13) with multiple doses given before the age of 2 and completed in adulthood (PCV15 or PCV20) given after age 65.

Covid-19

Since the initial impact of the SARS-Cov-2 virus, older adults have been one of the most affected populations. Therefore, it is highly recommended that older adults and other high-risk individuals get vaccinated. Here are some facts. With the Covid vaccines being available for over a year now, we have good evidence regarding their safety. The vaccines available in the United States are not live-attenuated vaccines. This means they do not contain any viable virus particles and they cannot give you Covid. Regarding the mRNA vaccines, these introduce viral genetic material (specifically mRNA) that causes replication of viral proteins by your cells. This occurs outside of the cells’ nuclei and the mRNA is unable to integrate with your own DNA, as it lacks the machinery. The resulting proteins are used for “target practice” by the immune system as antibodies are being developed. Common side effects during the immune-building process include fever, fatigue, or body aches. Side effects can begin within 24 hours and usually go away after a day or two. Full vaccination (one or two doses depending on which kind) and boosting is recommended at this time, especially in the elderly. Talk with your doctor to stay updated on current vaccine recommendations.

For more information, you can find detailed vaccine schedules on the CDC website.

Dr. Simpson is a resident physician who sees patients of all ages and provides obstetrical services at Lone Star Family Health Center, a non-profit 501©3 Federally Qualified Health Center operating facilities in Conroe, Spring, Willis, Grangerland, and Huntsville, and serving as home to a fully integrated Family Medicine Residency Program to increase the number of Family Medicine physicians for Texas and our community.