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 and diphtheria are also recommended for older people.

Influenza and swine flu

Influenza, or the flu, is a viral infection that causes fever, tiredness, muscle aches, headache and cough. 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 susceptible to complications from the flu, such as pneumonia (infection of the lungs), and even death.

Influenza vaccination

Because of the increased risk of complications from flu in older people, vaccination against influenza is recommended for all Australians aged 65 and over, and Aboriginal and Torres Strait Islander people aged 15 years and over. (Indigenous Australians should be vaccinated from a younger age because their risk of pneumonia and death is much higher than that of other Australians.) Free influenza vaccine is available for these groups of Australians.

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 a fever and muscle aches, but it is impossible to get the flu from the vaccine. Allergic reactions to the vaccine are very rare, but 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.

The flu virus is changing all the time, so each year the vaccine is made up of different virus strains. Therefore it is important to be revaccinated each year with the correct seasonal vaccine. The best time of year to be vaccinated is in autumn, before the outbreak of flu in winter.

In 2009 a new and potentially more serious strain of influenza emerged - H1N1 (2009) or 'swine flu'. A separate vaccine was produced against this particular strain and was available free of charge to all Australians. Since 2010 the seasonal flu vaccine has included protection against swine flu, removing the need for 2 separate vaccines.

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.

Pneumococcal vaccination

Vaccination is recommended for older adults because they are more vulnerable to pneumococcal disease. The vaccine used in older people is known as Pneumovax, and is effective against the 23 most common strains of pneumococcal bacteria that cause disease in adults. Pneumococcal vaccination is available for free for all Australians aged 65 years and over. Aboriginal and Torres Strait Islander people are eligible for free vaccinations from the age of 50, because Indigenous Australians are more at risk than non-Indigenous Australians.

After you are vaccinated 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, but the chance of having an allergic reaction to the vaccine is extremely small. Most people will need to have a single booster shot 5 years after their initial vaccination to ensure ongoing protection.

Shingles (herpes zoster)

Herpes zoster or shingles is a painful rash caused by the chickenpox virus, also known as varicella-zoster virus. 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. Some people, particularly older people, may develop complications of shingles. For example, pain may last long after the rash heals, or the rash may spread to the eye or other parts of the body.

Zoster vaccination

Vaccination against zoster is recommended for adults aged 60 and over unless they have already received a dose of zoster vaccine, are allergic to any of its ingredients or have another disease or treatment that significantly lowers their immunity.

Only one dose of zoster vaccine is needed. After the vaccination, you may have some soreness and 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

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 and tetanus boosters

Fortunately, tetanus is easily preventable by vaccination, and tetanus vaccination is recommended for babies and children. In the past, adults were recommended to have a tetanus booster every 10 years, but this is no longer thought necessary if you have had a full course of the vaccine - 5 doses. However, all adults are now recommended to have a tetanus booster at age 50 unless you have had a booster in the previous 10 years.

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.

Like tetanus vaccination, diphtheria vaccination is recommended for babies and children. Because we lose some of our immunity as we get older, adults are recommended to have a diphtheria booster vaccination at age 50 unless you have had a booster in the previous 10 years.

The diphtheria and tetanus boosters are usually combined in one injection. Your doctor may also recommend including pertussis (whooping cough) vaccine in the same injection.

Last Reviewed: 3 February 2010
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References

1. National Health and Medical Research Council. Diphtheria, influenza, pertussis, pneumococcal disease, tetanus, zoster (herpes zoster). In: The Australian immunisation handbook (9th ed.). Australian Government Department of Health and Ageing; 2008. http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home (accessed Sep 2010).
2. Australian Government Department of Health and Ageing. National Immunisation Program Schedule (valid from 1 July 2007). http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/nips2 (accessed Sep 2010).
3. Fact sheet for immunisation providers. Influenza vaccination 2010. http://www.immunise.health.gov.au (accessed Sep 2010).
4. CSL. Pneumovax 23 prescribing information. Accessed via eMIMS. Date of TGA approved information: 13 Jan 2010.
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