Vaccination isn’t just for kids – a guide for over-65s 165



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We live in an ageing society, with the global median age rising steadily. Australia’s economic viability will increasingly rely on retaining older people in the workforce for longer. This, of course, relies on keeping older people healthy into old age – and immunisation can play an important role.


Free vaccinations

The federal government recommends Australians 65 years old and over be vaccinated against influenza and pneumococcal disease – common illnesses that pose a higher risk of complications and premature death in older age. These vaccines are fully subsidised for over-65s and other high-risk groups.

Yet compared with children, who are also eligible for free vaccinations, elderly vaccination rates are low. More than 90% of children are vaccinated age appropriately compared with 74% of adults aged over 65 years.

This could be because doctors don’t value vaccines for over-65s as highly as vaccines for children because older people have weaker immune responses and generally cannot respond as well to vaccines.


Weakening immunity

When babies are vaccinated, the immune system matures and strengthens with each dose. But the immune system starts to decline around the age of 50.

Countering this progressive loss of immunity with vaccination requires novel approaches to boosting of immune responses. This can include giving extra doses, using adjuvants (extra substances) and using different modes of vaccine delivery such as injecting into the skin rather than the muscle, which stimulates a higher immune response.

Despite weaker immunity, most vaccines still have significant benefit in older age. Recent research shows that even those with no immunity to pneumococcal vaccines can mount a robust immune response once vaccinated.


Unequal burden of disease

Older people have a far higher risk of contracting vaccine-preventable infections and severe complications than younger people. Influenza, pneumococcal disease (a common cause of pneumonia) and herpes zoster (shingles), for instance, are much more common in older age.

Other diseases such as whooping cough (pertussis) are now also causing illness and even death in older people.

Nursing homes and long-term residential facilities also suffer a disproportionate burden of severe outbreaks of infectious diseases such as gastroenteritis and influenza. Research shows that vaccinating nursing home residents is highly effective at preventing outbreaks. Yet vaccination rates are suboptimal, among both residents and staff.

There is also growing evidence that influenza vaccination prevents heart attacks, because infection is a risk factor for acute clotting and blockage of arteries. But again, many patients at risk of heart attacks are under-vaccinated.


Disease burden vs immune response

The impact of vaccines is not only a factor of immune response to the vaccines, but also to burden of disease.

If there are 100 cases of disease X in people aged 20 to 50 years, for example, and the vaccine is 90% effective, we could prevent 90 cases of disease. In contrast, if there are 1,000 cases of disease X in people aged over 65 years, but the vaccine is less effective in older adults – say 60% instead of 90% – we would be able to prevent 600 cases of disease.

In terms of population health benefit, then, it’s better to vaccinate older people who have a higher burden of disease but reduced ability to respond to vaccines, than to vaccinate younger people who have a lower burden of disease and better ability to respond to vaccines: 600 cases prevented versus 90.

Because of this lower efficacy, health-care providers often dismiss vaccination for older people as worthless. But compared with other preventive health measures – such as statins for prevention of heart attacks, which are approximately 25% effective – most vaccines for over-65s are far more effective.


Ageism, ethics and value judgements

“Pneumonia is the old man’s friend” is a common saying, laden with value judgement. This implies that old people shouldn’t bother with treatment – or prevention. It also assumes older people have less rights to autonomy and self-determination, and that they are at the mercy of others when they are vulnerable and ill.

Research shows that people over 80, nursing homes residents and those with conditions such as dementia are less likely to get vaccinated. Yet these same people are likely to be admitted to hospital when they develop acute infections.

Prevention with vaccination is a better option than treatment after the event, from any perspective: cost-effectiveness, use of health-care resources, risk to others, and ethics. If we’re serious about healthy ageing, we need to address the pervasive ageism in health care and ensure people of all ages have the opportunity to prevent illness through vaccination.

The NHMRC Centre for Research Excellence in Population Research Health will convene the workshop Equity in disease prevention – vaccine for the elderly in Melbourne on Friday June 20. Registration is free.

The Conversation

This article was originally published on The Conversation.
Read the original article.

Raina MacIntyre

Raina MacIntyre has been on advisory boards for vaccine manufacturers GSK, Pfizer and Merck. She is also on expert advisory groups on adult vaccination for the WHO SAGE (VZV working group), the Australian Technical Advisory Group on Immunisation working groups for influenza and pneumococcal vaccines; She is a Director of the Influenza Specialist Group; she has receives funding or in-kind support for investigator-driven research from the NHMRC, ARC, GSK, BioCSL and Merck. She works for UNSW and the National Centre for Immunisation Research and is Director of a NHMRC Centre for Research Excellence in Immunisation.

  1. Are vaccinations a yearly event, my doctor tells me once every five years is enough.

    2 REPLY
    • The flu shot is every year, I work in health care & we are given it every autum, I’ve been having it for years now, I occasionally get a cold in winter but influenza is something much more serious & that’s what the flu shot is to protect us from.

  2. My husband and I have the flu vaccination every year and don’t get the flu. My husband has had pneumonia once so he has been vaccinated every 5 years. Still don’t know why only every 5 years

    1 REPLY
  3. No thanks ! All the people I know who get ‘flu vaccine are the ones who get ‘flu really badly every year. Why would I inject my healthy self with a disease that I never get anyway ?

    8 REPLY
    • I have the flu needle every year and don’t get the flu. If a person has a chronic lung condition, they would be stupid if they did not have the flu needle.

    • I don’t dispute that. I am perfectly healthy & never get ‘flu, rarely even colds, so for me it seems stupid to get shots, for myself.

    • Perhaps you are just lucky that you have not been infected by contact with someone that is carrying this virus so far.

    • What about the people you could infect. Especially children and aged friends . What a outs other booster injections. You would be mad to travel overseas without checking with a travel Dr.

    • How can I infect anyone if I’m not sick – seriously ? Influenza is not a virus that lies dormant, if you have it you’re sick !

    • FLU KILLS people dont just not get it you will and it will hit hard ..and the older you get the more fatal it can be

  4. Very important issue addressed and we need to ensure that health professionals know the risks.

  5. Personal choice, I have a flu vaccination every year with no side effects or flu. But it is my choice.

    2 REPLY
    • My daughter and myself both do, I have Asthma and she has immune problems. Advised by the doc and neither of us have had side effects.

    • Me neither ‘ I have had Bronchitis the last two years .Plus mild Asthma from time to time.. So I’m having my flu shot 🙂

  6. I get flu vaccination each year but I do always get a mild infection about 7 days later. I have heard this reaction just doesn’t happen, that it is coincidence etc, but despite the reaction I experience I would still rather get the flu injection than a bad case of the flu. We also got our mixture including whooping cough last year before flying to Canada to meet our new granddaughter. I used to travel for work for a few years and I never experienced a period where I got more cold and other bugs, so inoculations to try to reduce the risk of passing something on.

  7. One only has to look at the biased writing to know this is pHARMA propaganda. Credentials of the writer big pHARMa credentials. Do your own informed research and you will more than likely choose against vacs likei have for over 70 years. Unlike above writers have not had a cold or flu for over 50 years and no vaccinations.

    6 REPLY
    • I am guessing you are a healthy person, but for someone who has chronic lung problems, I would suggest they would be silly to not have the influenza needle.

    • Perhaps you are just lucky that you have not been subjected to influenza by an infected person yet.

    • Looking after your own Immune system is not luck. As paramedic, teacher and naturopathic therapist over the years, I have been in contact with numerous infections. However as a child was exposed to all chord ailments, polio sufferers and hep.

    • James you were very lucky is all I can say. I have to wonder how much exposure you had to polio and other diseases. Exposure and close contact is very different.

  8. The flu shot is to protect us against the influenza virus which can cause serious complications including death, it won’t stop us from very bad colds but, I also get whooping cough shot, especially because I’m around my grandchildren, I had it once & thought I was going to die, the older we get get we need to protect ourselves against these things, the flu shot has never given me bad cold in all the years I’ve been having it, influenza & bad colds are different things.

  9. Tetanus is the only vaccination I use. Actually, the last time was October 2008 when I was helping a skinny feral cat and kittens in the warehouse where I worked. She was happy to take my food poor thing but got agitated regarding her kittens. The blood ran down my leg and into my shoes. I decided to google ‘cat bite’ and saw the recommendation and got a tetanus needle. The good news is that the Tetanus injection was painless – not like the ones I remember from earlier years. Yes – I found homes for the kittens, the cat was spayed and I supply her food to this day. I don’t remember having the flu and never have those injections.

  10. Interesting. I have the influenza needle each year but knew nothing about the other one, so will have to speak to my doctor about it.

    1 REPLY
    • Helen Joan Harmon Ask your Doctor re the Boostrix vaccination at the same time.It is known that over45 yrs our childhood immunisation against Diptheria & whooping Cough has a diminished effect, Boostrix gives you the immunity back 99 percent of the time ,thus making it safer for preventing you passing on these diseases to your grandchildren especially the new born ,before they can have vaccinations.Also protects you better if travelling overseas.

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