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Vaccines are part of health prevention
By Paula Aucoin, M.D.
Health prevention for adults often focuses on reducing the risk of heart disease and stroke as well as watching one’s diet to minimize the likelihood of developing diabetes or cancer. Adults over 65 are often surprised to learn that decreasing their risk of infectious diseases can also be part of their preventive health care.
Infection prevention measures include immunizations, which have been traditional for adults over 50, updates for vaccine preventable childhood diseases, and new vaccines which have been developed for prevention of common conditions. The “flu” and “pneumonia” vaccines are now routinely offered to adults as part of preventive care and are considered “measures of quality” for the practice of medicine because of their recognized benefit to the health of older adults.
Influenza vaccine has to be given every year as the types of influenza virus are variable from year to year. The vaccine is composed of the three most common strains of the virus which are expected in a given fl u season. The vaccine is given usually in the fall, but people can be vaccinated with benefit even after the fl u season has begun. Influenza vaccine has been clearly demonstrated to decrease the likelihood of the disease and, particularly in the older population, impact on secondary diseases such as pneumonia which can cause significant illness and death in the elderly. The “fl u vaccine” is an inactivated vaccine. While some patients may become ill with a mild fever and muscle aches, it is not possible to “catch the flu” from the vaccine.
Pneumococcal vaccination is another safe vaccine which is recommended in particular for adults 65 and over. The vaccine is effective in producing antibody against the bacteria, Streptococcus pneumoniae, an organism which is the most common cause of bacterial pneumonia and may also cause meningitis or blood stream infections. This vaccination does not protect against all forms of pneumonia, but particularly in those patients with illnesses such as diabetes, lung disease, or cancer, it may give some protection against this particularly serious strain of bacteria. Most adults should receive the vaccine once they are age 65; however, a second injection five years later is suggested to protect seniors or younger patients with chronic diseases.
An exciting new vaccination has become available this year which offers adults some protection from shingles or “zoster," which is the reactivation of the childhood disease, chickenpox. The initial trial of the vaccine was reported last year in the New England Journal of Medicine. The study involved over 38,000 recipients aged 60 and older. The vaccine prevented over 50% of expected cases of the disease and over 60% of the expected cases of post-herpetic neuralgia.
Currently, only one dose is recommended. The vaccine is a weakened, but “live-virus vaccine” and as such cannot be given to individuals with certain chronic diseases which may result in problems with the immune system.
Adults are offered a safe and effective vaccination for “tetanus” every 10 years, provided they have had the initial immunization series either in childhood or adulthood. Tetanus or “lockjaw” is an infection that can grow in a wound caused by an injury from stepping on a nail or cutting oneself in the garden or workshop. The tetanus vaccine has additional protection in the injection for diphtheria, a severe form of throat infection rarely seen today. The newest innovation in tetanus vaccination is the inclusion of a vaccine for whooping cough. This vaccine is currently offered as a one time injection to adults under 64, who are due for their every 10 year tetanus vaccine. Although adults 65 and over are not currently recommended to receive the new tetanus vaccine, they should maintain their tetanus/diphtheria injections every 10 years, particularly if they enjoy an active lifestyle.
Most seniors have been exposed and are immune to the infectious diseases against which children are routinely immunized. The usual viral childhood diseases: measles, mumps, German measles, and chickenpox are contagious and children growing up now are immunized against all of these illnesses. Adults can be tested for prior infection of these viruses, and vaccines can be offered if they are susceptible to the disease. These are weakened, but “live-virus vaccines,” so those with immune systems problems such as those caused by certain drug treatments for malignancy or inflammatory or arthritic diseases should not have the vaccine. Polio vaccinations – which are available in an inactivated form, are frequently recommended for older adults who may be traveling to places in the world where the disease is still seen.
Dr. Paula Aucoin is a board certified consultant in Infectious Diseases at Berkshire Medical Center. She is Medical Director of Infection Control and an Assistant Professor of Internal Medicine.