Vaccinations for older people

As we get older, our immune systems become slightly less effective at protecting us from disease. This means that we become more prone to catching infections, and once we catch an infection we can take longer to recover. Also, we may lose some of our immunity to diseases we were vaccinated against in childhood. And some infectious diseases, such as the flu, can make us much sicker than they used to when we were younger, and can even lead to life-threatening complications.

The best way of protecting yourself from serious infections is to be vaccinated against them. Three common but potentially dangerous diseases that older people should be vaccinated against are influenza, pneumococcal disease and shingles (herpes zoster). Booster vaccinations against tetanus, diphtheria and whooping cough are also recommended for older people.

Influenza vaccination

Influenza (the flu), is a viral infection that causes sudden onset of fever, tiredness, muscle aches, headache and cough. It is highly infectious and easily spread from person to person or caught from touching objects such as doorknobs, usually during winter. The flu generally makes you feel much worse than the common cold does, and can also lead to more serious health problems. Older people are particularly prone to complications from the flu, such as pneumonia (infection of the lungs), and even death.

Influenza vaccination has been shown to reduce the risk of being hospitalised due to influenza and pneumonia in those aged 65 years and older. So getting a flu vaccine each year is recommended for all Australians aged 65 and over, and is available for free at this age on the National Immunisation Program.

The flu vaccine is changed each year so that it protects against the 3 or 4 predominant virus strains that are circulating that year. In Australia, influenza season usually peaks around August. Immunity develops within 2 to 3 weeks of being vaccinated. Your doctor can advise you about the best time of year to be vaccinated.

Side effects of influenza vaccination

Some people feel a little sore at the site of the injection for a couple of days after being vaccinated against flu. It is also possible to get some flu-like symptoms, such as a fever and muscle aches, after flu vaccination - these symptoms may start a few hours after being vaccinated and last a couple of days. However, it is NOT possible to get the flu from the flu vaccine because it does not contain any live influenza virus.

Allergic reactions to the influenza vaccine are very rare, but if you have had an anaphylactic (severe, life-threatening) reaction to influenza vaccination in the past you should not have it again. If you are severely allergic to eggs you may also have a reaction to the flu vaccine as it contains traces of egg protein. Milder reactions to egg may not cause a problem, but you should discuss with your doctor whether it is safe to have the vaccine.

Vaccination against pneumococcal disease

Pneumococcal disease refers to any illness that is caused by an infection with the bacterium Streptococcus pneumoniae (also known as 'Strep. pneumoniae' or pneumococcus). As well as ear infections and sinusitis, the pneumococcal bacteria can cause more serious illnesses, such as pneumonia, meningitis (inflammation of the membrane surrounding your brain and spinal cord) and septicaemia (blood poisoning). Pneumonia is the most common form of serious pneumococcal disease in adults. It usually needs to be treated in hospital and can be life-threatening.

Vaccination against pneumococcus is recommended for older adults because they are more vulnerable to pneumococcal disease. The vaccine used in older people is called pneumococcal polysaccharide vaccine (23vPPV), brand name Pneumovax 23. It is effective against the 23 most common strains of pneumococcal bacteria that cause disease in adults in Australia.

Vaccination with a single injection of Pneumovax is recommended for most adults at age 65 years. Pneumococcal vaccination is available for free for all Australians aged 65 years and over.

People with illnesses that increase their risk of pneumococcal infection may need more than one dose, and immunisation may need to start at a younger age. Indigenous Australians are also more at risk than non-Indigenous Australians. For Indigenous Australians, pneumococcal vaccination is recommended at age 50 years, plus a single booster shot after 5 years to ensure ongoing protection.

Aboriginal and Torres Strait Islander people are eligible for free vaccination from the age of 50.

Side effects of pneumococcal vaccination

After you are vaccinated with Pneumovax you may experience some soreness at the site of the injection for a few days. Some people also experience a low-grade fever (less than 39 degrees Celsius) following the injection, as well as side effects such as muscle pain and tiredness. The chance of having an allergic reaction to the vaccine is extremely small.

Shingles (herpes zoster) vaccine

Herpes zoster, or shingles, is a painful rash caused by the chickenpox virus, also known as varicella-zoster virus (VZV). When we are infected with this virus for the first time, it causes chickenpox (varicella). Although most people recover quickly from chickenpox, the virus stays in the nerve cells, where it is kept in check by the immune system. As we get older and our immune systems become less effective, the virus may be reactivated and cause shingles. One in 3 people will get shingles at some point in their lives.

Some people, particularly older people, may develop serious ongoing complications from shingles. For example, pain may last long after the rash heals (post-herpetic neuralgia), or the rash may involve the eye (affecting sight) or other parts of the body. The nerve pain can be severe and involve burning or stabbing sensations.

Vaccination against herpes zoster (Zostavax) is recommended for older adults. A single dose is recommended at age 70 years for Australians who have not previously been vaccinated, and is available free of charge. For those who missed out on this, catch-up vaccination is also available for free (for people aged 71-79 years) until October 2021.

Vaccination may not be recommended if you have already received a dose of zoster or varicella vaccine (e.g. Varilrix, Varivax) or are allergic to any of its ingredients. Zostavax may also not be suitable if you have a condition or take medicines that significantly lower your immunity. You can, however, be vaccinated if you’ve had an episode of shingles in the past - but you should wait 12 months after an episode of shingles to be vaccinated.

After a Zostavax injection, many people have some soreness, redness, itch and/or swelling at the site of the injection. In very rare cases, you might develop a chickenpox-like rash at the injection site.

Tetanus, diphtheria and pertussis vaccination

Tetanus is a disease caused by the bacterium Clostridium tetani. These bacteria secrete a neurotoxin that causes painful and intense muscular spasms which are often life-threatening. Most people know that you can develop tetanus if you have a wound that is deep or contaminated with soil (where tetanus bacteria may be found), but tetanus infection can also follow an injury that seems trivial or is not even noticed.

Diphtheria is another serious disease, which at one time caused more deaths in Australia than any other infectious disease. However, since vaccination became widespread in the mid 20th century it is rarely seen. Diphtheria is caused by the bacterium Corynebacterium diphtheriae, which infects the upper respiratory tract. A grey membrane may form in the throat and obstruct breathing. The bacteria also produce a toxin that may affect nerves and the heart.

Whooping cough is caused by infection with the bacterium Bordetella pertussis. It causes a persistent, choking cough that can be life-threatening for young children and cause severe symptoms in adults. Whooping cough is very contagious and is still commonly seen in Australia, with outbreaks occurring every 3 to 4 years. Being immunised helps prevent infection and reduce the severity of disease. Immunity tends to wane after childhood immunisation, and even if you’ve had whooping cough you can catch it again.

Tetanus, diphtheria and whooping cough boosters

Tetanus, diphtheria and whooping cough vaccination is recommended for babies and children as part of their routine childhood vaccinations. Because we lose some of our immunity as we get older, adults are recommended to have booster vaccinations.

A tetanus/diphtheria booster at age 50 is recommended for all adults unless a booster has been given in the previous 10 years. The booster dose should be given as the combination vaccine dTpa, which protects against whooping cough as well. A booster dose of dTpa is also recommended for people aged 65 and over (as long as a booster hasn’t been given in the last 10 years) for ongoing protection against whooping cough. These booster vaccinations for older people are not funded under the National Immunisation Program.

Boosters for whooping cough are also recommended for any adults who are likely to be visiting or caring for babies (such as grandparents).

For older adults who also need protection from polio (for example, if travelling to high-risk overseas countries), a combination vaccine that also contains polio vaccine can be used. Combination vaccines against tetanus, diphtheria and pertussis (whooping cough) include Adacel and Boostrix; those that also protect against polio include Adacel Polio and Boostrix IPV.

If you have never been vaccinated against tetanus, diphtheria and pertussis, your doctor can advise you on how many vaccinations you’ll need and when to have them.

Tetanus, diphtheria and pertussis vaccine can cause mild pain or discomfort where you had the injection. This can last several days. Headache, fever, muscle pains and tiredness are uncommon side effects and allergic reactions are rare.

References

1. Australian Technical Advisory Group on Immunisation (ATAGI). The Australian immunisation handbook 10th ed (2017 update). Canberra: Australian Government Department of Health, 2017. http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home (accessed Dec 2017).
2. Australian Government Department of Health. Immunise Australia Program. National Immunisation Program Schedule (From November 2016). http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/national-immunisation-program-schedule (accessed Dec 2017).
3. Immunise Australia Program. Older Australians (updated 5 Oct 2016). http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/older-australians (accessed Dec 2017).
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