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Open Access
Feature Article

Other vaccine recommendations for older people

Michael Woodward, JOHN C.B. LITT

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© BOWDEN IMAGES/ ISTOCKPHOTO.COM MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY

Abstract

In addition to influenza, pneumococcal and herpes zoster vaccines, older people are recommended to have tetanus and pertussis booster vaccines and vaccines for special risk scenarios. A range of vaccines against other diseases with a high burden in older people are in the pipeline.

Key Points

  • Most tetanus cases and deaths are in older people.
  • A tetanus booster vaccine is recommended for all adults at ages 50 years and 65 years if their last dose was more than 10 years previously; unvaccinated adults should receive a primary course plus boosters.
  • Most older people are susceptible to pertussis, which can have severe consequences in this age group, as well as potentially infecting infants they contact.
  • An opportune time for pertussis vaccination is at the time of tetanus vaccination, using the combined vaccine.
  • Older travellers and healthcare workers should follow the same vaccine recommendations as younger people.

Several vaccines are recommended for older people in addition to  the influenza, pneumococcal and herpes zoster vaccines already discussed in this Supplement.1-3 For example, boosters of tetanus and pertussis vaccines are important in this age group. Further, older people in specific scenarios are at increased risk of vaccine-preventable diseases, and extra vaccines should be considered. These include older people with reduced immune function and travellers. Recommendations for these extra vaccines and specific risk groups are outlined here. Vaccines for older people in the development pipeline are also described. 

Tetanus

In Australia, 80% of tetanus notifications and 90% of tetanus deaths since 1980 have been in adults aged over 50 years.4,5 In the US, 60% of tetanus cases occur in ­people aged over 60 years.6 Despite ­tetanus being mainly seen in the older population, the number of deaths from this disease is very low. 

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Almost all adult cases of tetanus occur in people who never completed a primary childhood immunisation series. A history of immunisation from patients, families or medical charts may be an unreliable indicator of tetanus immunity. Thus, the main thrust of any adult tetanus vaccination policy should be to ensure that everyone receives a primary immunisation series and booster vaccinations. 

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Seroprevalence studies in the US have shown that more than half of adults lack antibody levels that are considered ­pro­tective against tetanus and support the need to give primary courses and boosters, ­especially to those with tetanus-prone wounds.7 Older people have a good response to a single dose of tetanus vaccine.8 

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The 2018 edition of the Australian Immunisation Handbook recommends a booster dose of tetanus-containing vaccine for all adults at 50 years and 65 years of age if their last dose was more than 10 years ago.9 Unvaccinated adults should receive a primary course of three doses, followed by boosters 10 and 20 years later. Tetanus vaccine is available in combination with diphtheria vaccine (dT) or with diphtheria and pertussis vaccines (dTpa).9  The latter differs from the childhood formulation (DTPa) as it contains smaller amounts of diphtheria and pertussis antigens. 

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© BOWDEN IMAGES/ ISTOCKPHOTO.COM MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY
© BOWDEN IMAGES/ ISTOCKPHOTO.COM MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY
Associate Professor Woodward is Director of Aged Care Research and a Senior Geriatrician at Austin Health’s Heidelberg Repatriation Hospital, Melbourne, Vic. Associate Professor Litt is a Public Health Physician and Associate Professor in the Discipline of General Practice, Flinders University, Adelaide, SA.