Vaccines are highly recommended for seniors.
For example, studies have shown that the ‘flu vaccine is 50-60% effective in preventing influenza-related hospitalisation, and 80% effective in preventing influenza-related deaths in the elderly.
Vaccines were used as far back as the 1918 influenza epidemic in an attempt to stop the spread of infection. The cause of influenza was not known at the time, and all the vaccines that were used during the pandemic were against bacterial infections associated with influenza. Influenza is a viral infection, and the virus causing influenza was only identified in the 1930s. The first vaccine developed against influenza, was only developed in the mid-1940s.
It is true for most vaccines, that as one gets older, one’s immune response is not as good as it was in one’s youth. The same is true for immune responses against natural infection, which is why the elderly are at a much greater risk of death and severe outcomes from infections, than younger adults. However, this does not mean that vaccines for the elderly are useless. In fact, they are life-saving, since the elderly are at a very high risk of dying from vaccine-preventable diseases such as pneumonia and influenza. Also, the older one gets, the higher the risks of severe outcomes from shingles.
In addition, the elderly often suffer from chronic diseases that put them at an even greater risk of dying from vaccine-preventable diseases. Therefore, vaccines are highly recommended for the elderly. In addition, we should be advocating for more resources to be allocated to research in developing more effective vaccines for the elderly. Also, we should not only look at effectiveness at preventing disease, but also at effectiveness at preventing complications and death. For example, while the influenza vaccine is only moderately effective at preventing influenza in the elderly, studies have shown that it is 50-60% effective in preventing influenza-related hospitalisation, and 80% effective in preventing influenza-related deaths in the elderly. In other words, vaccinated elderly people who subsequently develop influenza, have a much milder course of illness and better outcomes than those who are not vaccinated.
In general, vaccination against influenza, invasive pneumococcal disease and herpes zoster (shingles) are recommended for healthy adults aged 65 years or older. In addition, because grandparents can be a source of pertussis infection (whooping cough) for infants, they should be recently vaccinated with the adult combination vaccine that protects against pertussis, diphtheria and tetanus, in order to protect the baby from pertussis. This is known as “cocooning”, which is a vaccination strategy used to protect infants who are too young to be vaccinated. Finally, elderly people with various health conditions may need other vaccines as well. These health conditions include asplenia, diabetes, cardiovascular disease, liver disease, lung disease, renal disease and diseases of the immune system, including HIV infection. The best advice I can give is that they should consult their medical practitioner to ensure that they are protected to the greatest extent possible.
There are risks associated with vaccination. However, these risks are minimal when compared with the benefits, and in healthy children and adults, including the elderly, these risks are generally confined to local reactions such as redness, soreness and swelling. One exception is that anyone suffering from an underlying disease that causes immunosuppression, or is on an immunosuppressive treatment such as chemotherapy, is at an increased risk for adverse outcomes from live vaccines, regardless of age. At the same time, these are the very people who are at high risk of severe outcomes, including death, from natural infections, and thus need to be protected. While inactivated vaccines are recommended for this group, very often they are unable to mount a good enough immune response to produce long-lasting protection. Again, the best advice I can give is that they should consult their medical practitioner to ensure that they receive all the vaccines they need.
It is regrettable that public trust in influenza vaccination is not very high. However, distrust in the influenza vaccine was around long before 2009, with many people believing that it causes influenza. This misconception arises from the difficulty that most people have with distinguishing between the common cold and influenza. So if they are incubating a cold which develops after receiving their vaccination, they mistakenly blame the cold on the vaccine. In fact the influenza vaccine is an inactivated vaccine, thus it cannot cause any disease. In addition, because of this confusion with the common cold, many people mistakenly believe that influenza is a mild disease. Also, because the influenza virus constantly mutates, new influenza vaccines must be developed and administered annually. This makes many people mistakenly believe that the motive behind these vaccinations is purely profit-driven. All of these misconceptions have led to a low uptake of the influenza vaccine, not only in the elderly, but across all age groups.
Many thanks to Professor Rose Burnett for her contribution of this article.
Professor Burnett is a Professor in the South African Vaccination and Immunisation Centre, Department of Virology, Sefako Makgatho Health Sciences University
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