Immunizations Primarily Recommended for the Elderly

By: Jenny Punnoose Pharm. D.

Immunizations are a major means of preventing diseases and one of the best ways to put an end to the serious effects of certain diseases. Currently, the Advisory Committee on Immunization Practices (ACIP) and the centers for disease control and prevention (CDC) recommend that all individuals 65 years and older receive four vaccines. These vaccines include an influenza vaccine, annually, 23-Valent pneumococcal polysaccharide vaccine (PPSV23), tetanus, diphtheria, and pertussis (Tdap) or tetanus diphtheria (Td) booster every 10 years and a onetime dose of the varicella-zoster vaccine. There are several types of influenza vaccines available; however, only two are approved in the elderly.

The first is the inactivated trivalent or quadravalent influenza vaccine, approved for all individual 6 months or older. In December of 2009, a high-dose influenza vaccine was developed for older adults. It contains four times more antigen than the standard vaccine which increases the productions of antibodies providing higher efficacy. Currently this vaccine is only approved for those 65 years of age and older. Flubok is an influenza vaccine that is not produced in eggs and can be given to individuals with a significant egg allergy. Fluzone intradermal is an alternate parenteral vaccine available. Risk factors that increase the incidence of pneumonia are particularly higher in the older individuals due to the following chronic conditions such as pulmonary diseases, cardiopathy, diabetes mellitus, smoking, alcoholism, liver disease, and nephropathy. The current PPSV23 vaccine covers the 23 most prevalent bacterial strains from streptococcus pneumoniae species, which are responsible for majority of pneumonia cases.

CDC recommends that all adults older than 65 should receive one time dose of PPSV23 unless the person was previously vaccinated. If a person was vaccinated prior to age 65, a second vaccination should be administered 5 years from the first vaccination. CDC also recommends that all adults 65 years of age and older unvaccinated previously, receive the PCV13 followed by PPSV23 six to twelve months later. The incidence of tetanus diphtheria and pertussis has become more prevalent in recent years. After the initial DTap vaccine received during childhood, it was recommended that the adults receive Td booster every ten years, which contained only tetanus and diphtheria antigens. Since 2005, CDC recommends one time substitution of Tdap, which contains pertussis antigens in addition to tetanus and diphtheria because of the increased incidence of pertussis in the last decade. The varicella Zoster virus, which causes shingles, is the same virus that causes chicken pox in children. When this virus is reactivated years later, it causes shingles, manifested by significant pain and itching along nerve branches. Shingles typically affects people as they age and therefore, older adults are at an increased risk of developing shingles. CDC recommends all adults older than age 60 to receive a one-time dose of varicella-zoster vaccine. However, the Food and Drug Administration recommends and has approved the vaccine for adults 50 years and older.