Immunization Update for Older Adults

Vaccines aren't just for children. Every year, thousands of American adults become ill, are disabled or die of diseases that could have been prevented by vaccines.

Although infectious diseases are no longer the most common causes of death for older Americans, pneumonia and influenza remain among the top 10 causes of death for seniors, according to the Centers for Disease Control and Prevention (CDC).

The following guide can help you determine if you need to be immunized. If you have a chronic health condition or a disease that affects your immune system, you may need to follow a different schedule from the one listed below. Check with your health care provider about which immunizations you might need.

Influenza

An annual flu shot is recommended for all adults 50 and older; for adults of any age who have diabetes or chronic heart, lung or kidney disease; and for adults living in nursing homes or other long-term care facilities. The flu shot is especially important for older adults because flu can cause major complications and death, especially among those in poor health. (People not in this age group who are in close contact with someone at high risk for the flu also should get vaccinated.)

Although a nasal spray flu vaccine is now available as an alternative to a vaccine given by injection, the nasal spray vaccine is not approved for people older than 49.

The best time to get vaccinated is in October or November, as flu season begins. If you miss getting a vaccination at that time, getting the vaccine in December or later may still be beneficial, according to the CDC. Talk to your health care provider if you have questions about the flu shot.

Bacterial pneumonia

The pneumococcal vaccine is recommended for all adults 65 and older, and for younger adults who have HIV or diabetes, are alcoholic or have chronic liver, heart, lung or renal disease, the CDC says. If you are 65 or older, you should get a booster if you received your first vaccination before age 65 and more than five years has elapsed. Adults with certain medical conditions should also receive a one-time booster five years after the first vaccination. Talk to your health care provider before getting this vaccination if you have a chronic health problem.

Tetanus/diphtheria/pertussis

A booster of tetanus-diphtheria is recommended every 10 years for adults 65 and older. This is especially important for older adults because they have thinner skin and may be more vulnerable to tetanus-infected cuts and puncture wounds. Call your health care provider if you have a puncture wound or injury that breaks the skin and you haven't had a tetanus immunization or booster in five years.

Because of waning immunity against pertussis (whooping cough), two boosters have been developed that combine protection against pertussis, as well as tetanus and diphtheria. The U.S. Food and Drug Administration approved the two new vaccines in 2005. The vaccines are designated as Tdap (tetanus/diphtheria/pertussis) and are recommended for people from age 10 to 64. The booster should be given every 10 years to maintain adequate immunity against these three diseases. Recommendations for the Tdap booster in people ages 65 and older have not been formulated.

Polio

Most older adults don't need a polio vaccine because they were vaccinated as children. If you are in a high-risk group, however, the CDC recommends that you talk to your health care provider about the polio vaccine:

• If you travel to areas of the world where polio is common

• If you are a laboratory worker who might handle the polio virus

• If you are a health care worker who deals with patients who could have polio

If you are in one of these groups, your health care provider may recommend that you get a polio booster even if you have had three of more doses of the vaccine in the past. If you did not receive at least three doses of the vaccine, your provider may recommend that you get the doses you are lacking.

Hepatitis A

You should have the hepatitis A vaccine if you are in one of these high-risk groups:

• You travel to areas of the world where hepatitis A is common

• You have chronic liver disease

• You work as a food handler

The CDC recommends at least two doses of the vaccine for lasting protection; these doses should be given at least six months apart.

Hepatitis B

Hepatitis B vaccine is recommended if you are at increased risk for exposure to hepatitis B. These are circumstances that increase your risk:

• You have had sex with more than one person in the last six months, you've had a sexually transmitted disease, or you're a man who has sex with other men

• You are treated with clotting factor products

• You have chronic liver disease

• You are a dialysis patient

• You are in a nursing home or other institution

• You are a health care worker or work in a health care setting

• You travel abroad

• You used injected drugs

• You are exposed to hepatitis B through a family member or live-in friend

Measles, mumps and rubella (MMR)

Adults born before 1957 are considered immune to measles and mumps. Adults born during or after 1957 should receive at least one dose of the MMR vaccine unless they have a medical condition that makes it unadvisable, or have had measles or mumps, or have had a blood test that shows they have immunity. A second dose of the MMR vaccine is recommended for adults who were recently exposed to measles. Women of childbearing age who are not pregnant, don't plan to become pregnant within four weeks, and who did not have routine immunization as a child should have one dose of the MMR vaccine.

Varicella

The varicella, or chicken pox, immunization is recommended if you haven't had chicken pox, and if you're a health care or child care worker, or a resident or staff member in an institutional setting. It is also recommended if you are in the military or travel internationally.

The CDC's Advisory Committee for Immunization Practices now recommends a second dose of varicella vaccine for any adult previously immunized against chicken pox.

If you are older than 60, a vaccine to prevent shingles is available. The Zostavax vaccine was licenses by the FDA in 2006. Shingles is a disease caused by the varicella-zoster virus, the same virus that causes chicken pox. After an attack of chicken pox, the virus lies dormant in certain nerve tissue. As people age, it is possible for the virus to reappear in the form of shingles, which is estimated to affect two in every 10 people in their lifetime. Shingles is characterized by clusters of blisters, which develop on one side of the body. The blisters can cause severe pain that may last for weeks, months or years after the virus reappears. Studies show that the vaccine reduces the occurrence of shingles by 50 to 64 percent.