Older Adults Need Immunizations, Too

Immunizations, other than the annual flu vaccine, are just for kids, right? Wrong.

“A substantial proportion of vaccine-preventable diseases in this country occur in adults,” says Dr. Harman Chawla, a physician specializing in infectious diseases and geriatrics at Washington Township Medical Foundation. “Older adults are particularly vulnerable to complications from infectious diseases because their immune systems are often weaker. Vaccines offer safe and effective protection from a variety of infectious diseases, so it’s important for adults – especially older adults – to make sure their immunizations are up to date.”

After finishing a residency in internal medicine at Jamaica Hospital Medical Centre in Jamaica, New York, Dr. Chawla completed a fellowship in geriatrics (the medical field that specializes in older adults) in June 2012 at New Jersey Medical School. He then spent a year as an assistant professor in the Department of Medicine there before completing an additional two-year fellowship in infectious diseases in June 2015 before joining Washington Township Medical Foundation in September.

“My decision to work in geriatrics stemmed from an interest in providing preventive care to older adults,” he says. “Infectious disease medicine goes hand-in-hand with geriatrics because older people, especially those who live in close quarters in skilled nursing facilities or assisted-living centers, generally get sicker from infections than younger adults.”

Dr. Chawla notes that annual flu vaccines are very important for older adults. Flu vaccines must be administered on a yearly basis because flu viruses change from year to year.

This season’s flu vaccine protects against the influenza viruses that research indicated will be the most common viruses this year. The “trivalent” vaccine with a combination of three viruses includes an A (H1N1) virus, an A (H3N2) virus and an influenza B virus. A “quadrivalent” vaccine includes those same three viruses, plus an additional influenza B virus.

“There is a higher-dose flu shot for people over age 65 because their immune systems often aren’t as strong,” Dr. Chawla says. “The higher-dose flu vaccine and the quadrivalent vaccine are both better for older adults. Both of these vaccines use killed viruses, and they do not cause the flu. Generally, the only side effects are mild soreness and perhaps a slight rash at the site of the injection. There also is a vaccine for people who are allergic to raw eggs. The egg-free vaccine should be used by anyone who has ever had an allergic reaction to the regular flu vaccine such as hives or anaphylaxis.”

According to Dr. Chawla, there has been a dramatic improvement in flu vaccination rates among adults over the past three decades.

“In 1985, only about 35 to 40 percent of adults were vaccinated against the flu,” he explains. “Thanks, in part, to increased awareness of the importance of vaccines, today we are seeing 65 to 70 percent of adults receiving flu vaccines. That is still not as good as we’d like it to be, however.”

While flu shots are one important means of protecting your health, there are other vaccine-preventable diseases that can cause serious illness or even death, including pneumococcal disease.

“An infection caused by the pneumococcus bacteria can lead to serious health problems such as pneumonia,” Dr. Chawla says. “Besides pneumonia, pneumococcus can cause other types of infections, such as ear and sinus infections or a blood stream infection called bacteremia. The bacteria also can cause meningitis, a potentially life-threatening infection of the tissues and fluids surrounding the brain and spinal cord.”

The Centers for Disease Control and Prevention (CDC) estimates that about 900,000 Americans get pneumococcal pneumonia each year and about 5 to 7 percent die from it. In the United States, about 90 percent of invasive pneumococcal disease cases are in adults.

“The best way to prevent pneumococcal disease is to be vaccinated,” Dr. Chawla emphasizes.

There are currently two types of pneumococcal vaccines:

• Prevnar 13 – recommended for all children younger than 5, all adults 65 years or older, and persons age 6 through 64 with certain medical conditions such as sickle cell disease, chronic heart or lung disease, a compromised immune system, a damaged spleen or no spleen.
• Pneumovax 23 – currently recommended for all adults 65 years or older and for persons who are 2 years and older and at high risk for pneumococcal disease, including those with sickle cell disease, HIV infection or other conditions that weaken the immune system. This vaccine also is recommended for adults age 19 through 64 who smoke cigarettes or who have asthma or chronic obstructive pulmonary disease (COPD).

“Both of these vaccines are intended to prevent bacterial pneumococcal infections,” Dr. Chawla explains. “The CDC’s general recommendation is for adults age 65 or older to get one dose of the Prevnar 13 vaccine, and then wait at least eight weeks before getting one dose of the Pneumovax 23 vaccine. The CDC does not recommend Prevnar 13 vaccination for people between ages 6 and 64 who are not considered high-risk for complications of pneumococcal infection. People younger than 65 who have high risk factors such as COPD can get the Pneumovax 23 vaccine every five years and again at age 65.

“People over 65 who have received the Pneumovax 23 vaccine, but not the Prevnar 13 vaccine, should wait at least one year after getting the Pneumovax 23 vaccine before getting the Prevnar 13 vaccine,” he adds. “You should consult your doctor about the proper pneumococcal vaccines for you.”

In addition to annual flu vaccines and the pneumococcal vaccines, the CDC recommends several other immunizations for adults:

• Meningococcal – Meningococcal disease is a leading cause of bacterial meningitis. Meningococcal infections can be treated with antibiotics, but about 10 percent of people who get the disease die from it, which is why prevention through vaccination is so important. The vaccine is now recommended beginning in preadolescence, as well as for other people who have never received the vaccine. It is especially encouraged for people living in close quarters, such as students in dormitories, people in military barracks or seniors in communal housing.
• Measles, Mumps, Rubella (MMR) – Most Americans are vaccinated against these diseases as children, but the vaccine is recommended for adults born in 1957 or later – especially those born outside the U.S. – if there is no documentation of immunization or proof of immunity via a blood test.
• Polio – The polio vaccine is not usually recommended for adults over age 18, but those who never received the vaccine in childhood may wish to be vaccinated if they intend to travel to countries where exposure to the virus is possible, such as Russia, South Africa, Nigeria, Pakistan and Afghanistan.
• Hepatitis A – This vaccine protects against a viral disease that often results in chronic liver failure. Immunization is especially important for people who travel or work outside the U.S., particularly in developing countries, and those with liver disease.
• Hepatitis B – This vaccine protects against a virus spread through contact with blood or other bodily fluids. The vaccine is recommended for all adolescents and adults, but especially for people who have intimate contact with hepatitis B-positive persons.

The common childhood disease of chickenpox also can be a very serious disease in adults. Adults who did not have chickenpox as a child should receive the varicella vaccine, which is very effective in preventing the disease.

“There also is a herpes zoster vaccine to prevent shingles, which is caused by the same virus that causes chickenpox,” says Dr. Chawla. “Anyone who has had chickenpox can develop shingles. The herpes zoster vaccine is recommended to reduce the risk of shingles and its associated pain in people 60 years old or older. Even if you have received the varicella vaccine, you still need the vaccine for shingles. However, the shingles vaccine is not suitable for people who have compromised immune systems or who have had severe allergic reactions to gelatin or neomycin because the vaccine contains those ingredients.”

Dr. Chawla notes some vaccines, such as the chickenpox vaccine, can provide lifetime immunity. Other vaccines require “booster” shots to remain effective.

“There are still cases of tetanus in the United States, and it is easy to prevent,” he says. “Adults should receive a tetanus booster shot every 10 years, and perhaps as early as five years after receiving a previous dose if they incur a puncture wound. Most often, the vaccine used is a tetanus-diphtheria (Td) booster, but because pertussis – also called whooping cough – has become more prevalent in recent years, adults who have not received a tetanus-diphtheria-pertussis (Tdap) booster vaccine should get one. Tdap also is recommended for parents-to-be and the grandparents or other infant caregivers to prevent infection in newborns.”

All of the above vaccines provide “active” immunity to various infections by prompting the body’s immune system to produce antibodies that identify and neutralize specific viruses and bacteria.

“Active immunity is a more potent and durable way to prevent infectious diseases,” Dr. Chawla notes. “For people with compromised immune systems – due to factors such as HIV, chemotherapy or other medications that suppress the immune system – ‘live’ vaccinations to stimulate active immunity may not be an option. In those cases, it might be necessary to stimulate ‘passive’ immunity with injections of antibodies called immunoglobulins to fight specific diseases. Once the patient’s immune system is healthy, it may be possible to vaccinate again.”

Learn More

If you need help finding a physician who can discuss what vaccinations may be right for you, visit www.whhs.com and click on the link for “Find Your Physician.” For more information about vaccination recommendations from the CDC, visit www.cdc.gov.