Vaccination for the over 65s

The focus on vaccination is often on children but what about our over 65 population? Older people suffer higher rates of serious illness and death from infectious diseases such an influenza, pneumococcal disease and herpes zoster. This is because as we get older, our immune systems become less effective at protecting us. Despite these vaccinations being government funded, through the National Immunisation Program, elderly vaccination rates are low. Only 74% of adults aged over 65 years receive their free vaccines compared to over 90% of children. Immunisation plays a vital role in keeping older people healthy as they age.

Influenza vaccination

Influenza is a viral infection that causes the sudden onset of fever, muscles aches and pain, headache, cough and fatigue. It is worse than the common cold, very contagious and can lead to more serious health problems especially in the elderly.

2017 was a particularly severe flu season with over 1000 flu related deaths in Australia and more than 90% of these people were aged over 65. To overcome this two new ‘enhanced’ vaccines have been produced for the over 65’s to offer better protection against the flu subtypes that can specifically affect the older population. The high dose Fluad and Fluzone High vaccines will be available from mid April and are government funded for the over 65’s.

Although the flu vaccine doesn’t offer 100% protection, if you still get infected it can make your illness milder and it also helps protects the more vulnerable around you such as babies, the frail and those with chronic health conditions. Vaccine effectiveness can decline after 3 – 4 months so with peak flu season usually from July to September, it is important not to get your yearly flu vaccination too early.

Are the new influenza vaccines safe?

Both of the new influenza vaccines are safe but can cause mild side effects. This can range from a sore arm or some mild flu-like symptoms such as fevers and muscle aches. More severe reactions are rare. It is NOT possible to get the flu from the vaccine because it doesn’t contain any live influenza virus. However the flu vaccination doesn’t protect against other respiratory viruses circulating around the time of vaccination which is often mistaken for the flu.

Pneumococcal vaccination

Pneumococcal disease is a bacterial infection that causes many illnesses such as pneumonia, meningitis and blood poisoning. It has a higher rate of complications, hospitalisation and premature death in the elderly. Vaccination against pneumococcus is recommended for the over 65’s and is government funded. This Pneumococcal Polysaccharide Vaccine (23vPPV) is affective against the 23 most common strains of pneumococcal bacteria that causes disease in Australia. People with chronic illnesses that have a higher risk of pneumococcal infection may also require a booster dose after 5 years.
Side effects include a sore arm at the injection site for a few days, low grade fevers and tiredness.

Shingles (herpes zoster) vaccine

Shingles or Herpes Zoster is a disease caused by reactivation of the chicken pox virus. It causes a painful, blistering rash and even when the rash has gone it can cause severe burning pain (post-herpetic neuralgia) that can last for months or longer. 1 in 3 people will get shingles at some point in their lives but as we get older the risk of complications and post-herpetic neuralgia is higher.

A single dose of the shingles vaccine (Zostavax) is recommended for all adults aged over 60 years who have not previously received a dose. The vaccine is free for adults aged 70 years with catch up for those aged 71 – 79 funded until October 2021. As it is a live virus it should not be given to someone with a low immune system or those on medications that lowers your immunity so your doctor or immunisation provider should check this with you.

Side effects after a shingles vaccination includes soreness, redness, itch and swelling at the injection site. Rarely you can develop a chicken pox like rash at the injection site.

Booster vaccinations

As we get older we loose immunity to some of our childhood vaccinations and a booster dose is recommended.

A booster dose of tetanus/diptheria containing vaccine is recommended for adults > 50 years of age who have not received a tetanus containing vaccine in the previous 10 years. A booster dose is also required in the event of a tetanus prone injury if it has been more than 5 years since the last booster.

A booster dose of the pertussis (whooping cough vaccine) is also recommended for adults > 65 years who have not had a previous dose in the last 10 years and also for adults in close contact with children < 6months if it has been than 10 years since the last dose. The pertussis booster dose comes in combination with tetanus and diptheria (dTpa) do if you are due for a tetanus shot ask your doctor if you should be covered for pertussis as well. This vaccine however is not funded under the National Immunisation Program.

If you are travelling overseas or are medically at risk you may require other vaccinations so please discuss with your doctor or immunisation provider.

There is been a lot in the media recently regarding MMR (measles, mumps and rubella) vaccination given the recent measles outbreaks around the world. Most people born before 1966 are immune to MMR because they were probably exposed in childhood therefore do not require a booster vaccination.

About the author

Dr Georgia Page MBBS, FRACGP, BSc (Biomedical)
Dr Georgia Page graduated from the University of Sydney in 2002 and has been working on the Central Coast since 2002. She has many interests, in particular Women's health, paediatrics, preventative health and men's health. She is a medical educator for GP Synergy, regularly lecturing and supervising the GPs of tomorrow and is also an examiner for the RACGP (Royal Australian College of General Practitioners).

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