Role of Immunization in Frail and Elderly Individuals - Dr Rajalakshmi A

The increase in life expectancy challenges our society to protect the elderly from morbidity and mortality related to infections, apart from other diseases. Vaccination against certain infections is an important intervention to safeguard this population.

Infections such as influenza and pneumonia are among the top killers of the elderly. Elderly individuals are more prone to severe infections due to immune senescence (ageing and weakening of the immune system).

Severe infections result in hospitalization and even death. Hence, adults aged 65 and older are advised specific vaccines. With the COVID-19 pandemic, this became evident as the elderly and frail population were considered at high risk for severe COVID-19.

During this pandemic, the majority of the world's population, especially the elderly, were vaccinated. There is evidence that vaccination prevented severe disease and death due to COVID-19. Here are some of the vaccines that the elderly and frail are eligible for and should be considered at every opportunity.

Influenza Vaccine

Influenza (flu), caused by a virus, has been a recurring problem, leading to seasonal outbreaks that range from simple respiratory illness to severe diseases requiring hospitalization.

Severe disease is commonly observed among the elderly, particularly those with underlying heart, lung, and other diseases. The influenza vaccine is an important method for preventing severe illness. Flu vaccines need to be administered annually as the strain causing infection changes periodically.

Pneumococcal Vaccine

Similar to flu, pneumonia caused by pneumococci, significant bacteria, can be severe, requiring hospital admission, especially among the elderly. Individuals aged more than 65 years, even without any other medical illness, are advised to receive pneumococcal vaccines.

There are two types of pneumonia vaccines, taken sequentially within a few months. If the individual has any other medical condition, the timing of the vaccine can be earlier and as per recommendations.

Shingles Vaccine

A vaccine to prevent shingles (herpes zoster) has been recently approved and is available in India. Shingles is a debilitating disease commonly seen in people aged above 50 years and those with low immunity.

All these individuals will have been previously affected by chickenpox, and shingles is a reactivation of a quiescent virus that can occur at any time during their lifetime, commonly in the elderly.

The problem with shingles is the pain following it, which can persist for many months in some cases. It can also rarely result in visual and neurological complications.

The shingles vaccine is advised for those above 50 years and in immune-compromised individuals, and requires 2 doses. It is also recommended for those who have had shingles to prevent recurrences.

Tdap Vaccine

Tdap (tetanus, diphtheria, and whooping cough) is advised for the elderly who are caring for infants yet to be vaccinated against these diseases and thus lack immunity. Through vaccination of the close contact caring for the baby, the baby is protected, a strategy known as cocooning. Elderly individuals may require additional vaccines based on their medical conditions.

Some vaccines are contraindicated for those who are immunocompromised or experiencing acute illness, while others are essential, depending on medical circumstances. Consulting with your doctor can help determine which vaccines are recommended for you. It's also important to maintain a vaccination record for adults, similar to those for children.

This serves as a valuable health record and serves as a reminder of upcoming vaccinations. Each clinic visit presents an opportunity to discuss disease prevention, with vaccination being a crucial aspect of maintaining health as we age.

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