Who Says the Elderly Do Not Need to Be Vaccinated?

• Influenza vaccination is effective in preventing the virus up to 90% of the time, depending on the vaccination’s compatibility with the strain currently being spread.
• Vaccinations against Streptococcal pneumonia are available to those over the age of 65 years, as they are most at risk of contracting the virus. The vaccination is 68–78% effective in preventing the infection.

Elderly people have a weakened immune system which means that they are at greater risk of infection than those of younger ages. Thus, vaccinating the elderly against infections that can lead to major illnesses helps to reduce the severity of any conditions, decreases the need to visit hospital for treatment and consequently reduces fatalities.

The various strains of influenza virus undergo mutations every year, so vaccinations must be given on an annual basis in order to reduce the risk of the elderly contracting the flu virus. Those elderly patients who do contract the virus may suffer from more severe symptoms alongside more health complications than the general population. For the elderly, the flu has the potential to cause a failure of the respiratory system and even death.

The World Health Organization (WHO) currently recommends that influenza vaccinations consist of four major strains of the influenza virus, namely two strains from the A type of virus and two strains from the B type of virus. Such vaccinations help to stimulate the body’s immune system and are effective in preventing the flu virus up to 90% of the time, depending on the vaccination’s compatibility with the strain currently being spread.

Additionally, the vaccinations are completely safe and can help to reduce the risk of patients developing numerous other respiratory health conditions – including decreasing the risk of otitis media developing in newborns and infants. Immediately after receiving the vaccination, the patient may experience a slight fever for 1–2 days, after which they will feel better.

The effects of the DTaP vaccination that we receive during infancy will have worn off by the time we reach old age. A booster vaccination (tetanus-diphtheria toxoids : Td) should therefore be given to reduce the risk of illness and decrease any costs that may occur as a consequence of suffering a cut from a contaminated sharp object. The vaccination also prevents diphtheria and pertussis, which is particularly important for geriatric patients who may frequently come into contact with infant family members. They may risk passing on the condition or contracting the condition if their immune system is not working well enough. Those elderly patients who have never received the DTap vaccination before are advised to have an initial, single injection of DTap vaccination, with a booster vaccination (Td) then being necessary for tetanus and diphtheria every 10 years thereafter. This vaccination is also available for adults over the age of 19 who wish to boost the strength of their immune system.

Patients over the age of 65 years are categorized as being at risk of developing pneumococcal infections or streptococcal pneumonia. These conditions have the potential to enter the bloodstream or cause meningitis after entering the brain tissue. The streptococcal pneumonia vaccination is 68–78% effective in controlling the condition. In Thailand, there are two types of vaccination used:

1. Pneumococcal 13-valent conjugate vaccine (Prevnar 13)
2. Pneumococcal 23-valent polysaccharide vaccination (PPSV23)

Apart from the geriatric population, the invasive pneumococcal vaccination is advised for the following groups of patients who are at higher risk of contracting various forms of pneumonia:

• Patients between 19–64 years of age who suffer from chronic health conditions, such as cardiovascular disease (excluding high blood pressure), chronic lung diseases such as asthma or emphysema, diabetes, liver cirrhosis, as well as those who regularly consume alcohol or smoke cigarettes. Said groups are recommended to receive one PPSV23 vaccination and then, when they reach 65 years of age, receive a Prevnar 13 vaccination followed by another PPSV23 vaccination one year later.
• Patients under the age of 19 who have any of the following conditions: Those born without a spleen; those whose spleen has been removed; those whose spleen does not function normally; Thalassemia sufferers; patients with a weakened immune system or who take immunosuppressant medication; patients with AIDS; chronic kidney failure patients; patients with nephrotic syndrome; patients with specific conditions, such as cerebral fluid leakage; and patients who have undergone surgery to install a cochlear implant. These groups are all advised to receive an initial single Prevnar 13 vaccination which should be followed up with a single PPSV23 vaccination after a period of two months. The PPSV23 vaccination should then be given every five years thereafter until the age of 65, at which point one more PPSV23 vaccination should be given (after a time of at least 5 years since the last PPSV23 vaccination). Subsequently no more vaccinations are necessary.
• Patients over the age of 65 who do not suffer from any of the aforementioned conditions and who have not received any prior pneumococcal vaccination are advised to receive a single Prevnar 13 vaccination, followed by a single PPSV23 vaccination one year later. No subsequent booster vaccinations should be necessary.

Patients are at a much higher risk of contracting shingles after they reach the age of 50 years. The potential complications that can arise from such an infection are a burning sensation of the areas of skin affected by the virus, corneal wounds and conjunctivitis. However, elderly patients tend to experience much more severe symptoms, for example encephalitis or a rash that can present itself in various locations around the body. Their symptoms also last longer than they do in younger people, so the shingles vaccination is advisable as it can reduce the chances of contracting the infection and at the same time decrease the risk of any of the aforementioned complications.

For patients above the age of 60 years, there are currently shingles vaccinations that can be administered via a single injection. Studies have found that this type of vaccination can reduce the chance of contracting shingles by up to 51.3% in the three years following the vaccination.

Moreover, in cases whereby patients do contract shingles, the vaccination has been found to prevent postherpetic neuralgia up to 66.5% of the time when compared to patients who have not been vaccinated.