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Other vaccine recommendations for older people

Michael Woodward, JOHN C.B. LITT
OPEN ACCESS

Older travellers

Older people should be offered the same travel vaccinations as those recommended for younger people for the countries they are to visit. This is particularly important as travel becomes easier and safer, and thus more often undertaken by older people. Individualised advice according to older people’s medical conditions and degree of immunosuppression is recommended; more details are available in the Aus­tralian Immunisation Handbook.21

Older healthcare workers

Increasingly, older people continue to work into their 60s and 70s, including in health care. Older healthcare workers should ­follow the same vaccination recommendations as their younger counterparts. This includes annual influenza vaccination. Influenza vaccine coverage of GPs is more than 70%, whereas coverage in ­hospital staff is less than 50%.22,23 

Regional issues

Healthcare practitioners should remain aware of regional outbreaks, and adjust vaccination recommendations accordingly. Similarly, in some tropical regions the usual seasonal variations in influenza are less apparent, and vaccination at other times may need to be considered, subject to vaccine availability.

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Vaccines in the development pipeline

Over the next few years, new vaccines for older people are likely to become available. These include more effective vaccines than those currently available (e.g. both a 15-serotype and a 20-serotype conjugate pneumococcal vaccine) and vaccines for infections not currently ­covered by vaccines (e.g. Clostridium ­difficile, Pseudo­monas aeruginosa and Staphylococcus aureus infections and­ possibly even malaria). 

In addition, a range of vaccines are in the development pipeline against viruses responsible for considerable morbidity and mortality among older people. These include cytomegalovirus and ­respiratory pathogens such as respiratory syncytial virus and human metapneumovirus (Box 2).24-35 

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Vaccines against noninfectious diseases may also become available in the future. For example, research is underway on  antiamyloid vaccines to prevent or modify Alzheimer’s disease.36 

Conclusion

Immunosenescence is a significant ­problem in older people that mandates offering them vaccines against a range of vaccine-preventable diseases. As well as influenza, pneumococcal and herpes zoster vaccines, booster vaccines against tetanus and pertussis are important in this age group. 

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A booster dose of tetanus-containing vaccine should be offered to all adults at age 65 years if their last dose was more than 10 years ago. Reviewing pertussis vaccination status is also recommended for all people when they turn 65 years of age, as pertussis causes considerable morbidity and even ­mortality in older people. Those about to become grandparents should also be vaccinated. Older travellers and older people who are employed should follow the same vaccine recommendations as their younger counterparts.      MT

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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.