There’s a lot of buzz these days about the importance of childhood vaccines, but less attention is paid to those vaccines routinely recommended for older adults and seniors. With only a few exceptions, the basic guidelines from the U.S. Centers for Disease Control and Prevention include an annual flu shot for all adults, a vaccine against shingles at age 60 or older and a two-part vaccine against pneumococcal disease at age 65 or older.
But many seniors aren’t receiving these vaccines, leaving them more vulnerable to serious illness — and raising the possibility of sickening loved ones and others in their lives.
Neglecting or rejecting recommended vaccines undermines the critical public health principle of “herd immunity,” according to Dr. Jabbar Fazeli, a board-certified geriatrician who has practiced in Portland since 2001.
In herd immunity, the health of the most vulnerable is protected by a high rate of immunity within the general population.
“Even if you, personally, are healthy, these vaccines help protect the health of people you interact with, including your parents, grandparents and grandchildren,” Fazeli said.
Influenza and pneumococcal disease hospitalize hundreds of thousands of Americans each year with life-threatening respiratory illness, blood infections, meningitis and other dangerous conditions. A bout of shingles, caused by the re-emergence in the body of the same virus that causes chickenpox, is less likely to be fatal, but it can cause weeks or months of extreme discomfort, limited mobility and even the risk of blindness and permanent nerve damage.
Any of these serious infectious diseases also can be spread to others, including unimmunized infants and children, children and adults with suppressed immune systems because of chronic diseases such as AIDS, heart disease and diabetes, and seniors whose immune systems are weakened by the normal processes of aging.
Even a mild case is miserable
For 52-year-old Andre Blanchard of Liberty, shingles started with a weird kind of headache. He was just getting settled in at the annual spring convention of the Barbershop Harmony Society in Nashua, New Hampshire, at the end of April, when he noticed it.
“It was this pulsing headache, kind of on the right side of my scalp and forehead, almost down into my eye,” he said.
Blanchard, an avid, sociable and generally healthy barbershopper, did his best to ignore the persistent discomfort over the busy days of the conference, but the following Tuesday, he visited his doctor’s office. By then, he had noticed a spray of tiny, tender, itchy bumps on the right side of his face, along with the dull, lingering headache.
“It looked like tiny little individual bites,” he said.
The nurse practitioner thought they might be blackfly bites and suggested Benadryl to relieve the itching. Two days later, the bumps had merged into a rough, red, seeping rash that was very sensitive to the touch. He went back to his doctor, who immediately diagnosed shingles.
Blanchard was started on an antiviral medication that cleared the worst of the rash within an uncomfortable week.
“But I still have a lot of skin sensitivity in those areas,” he said.
Unlike other viral diseases, shingles can recur. The vaccine significantly lessens the likelihood of a repeat attack and the severity of the symptoms, should they emerge. Blanchard’s case wasn’t especially serious. Still, it was unpleasant enough that once he reaches 60, the recommended age for the vaccine, he’ll be sure to ask for it.
Compliance is low
Flu, pneumonia and shingles can be acquired at any age. But they are both more common and more serious as we grow older, as our immune systems falter and leave us more vulnerable to microbial attack.
However, rates of vaccine compliance are low. While they aren’t tracked as rigorously as childhood vaccination rates, the CDC estimates that only about 65 percent of seniors get the annual flu shot. Slightly more than half get vaccinated against pneumococcal disease, which is among the most common and most deadly causes of pneumonia in the elderly.
The shingles vaccine has the lowest uptake of all. Though shingles affects about a million Americans each year, half of them age 60 or older, only about 25 percent of Americans over age 60 got the shot in 2013, the last year for which data are available. Rates of all vaccines are higher in nursing homes, hospitals and other facilities where compliance is tracked more closely and is tied to Medicare and Medicaid reimbursements.
Geriatrician Fazeli said many factors play into low immunization rates among older adults. The most common objection he hears is from patients convinced they will be sickened by the vaccine itself. While it is essentially impossible for a vaccine to cause a full-blown case of flu, for example, uncomfortable side effects may last a few days, including a low fever and achiness.
Other patients have the same anti-vaccination suspicions that lead some young parents to forgo routine immunizations for their children. In some cases, Fazeli said, adult children with anti-vaccine leanings counsel their elderly parents to reject vaccines or simply make the decision themselves.
Another factor is cost. While basic Medicare covers the pneumococcal vaccine and the flu shot as primary preventive care, it does not pay for the shingles vaccine. If a patient is age 65 or older, the shingles vaccine may or may not be covered by the specific Medicare Part D prescription plan the patient is enrolled in. Younger patients covered by private insurance may find the shingles vaccine is covered in their plans. But for those paying out of pocket, the vaccine typically costs about $200, more than many seniors are willing or able to pay. But even the trouble of paying the out-of-pocket cost may well be offset by the health benefits of side-stepping a bout of shingles.
Fazeli said health care providers must be more assertive in recommending vaccines for their older patients. The current trend toward doctors simply providing “options” to patients without strong guidance works against individual and public health in this case, he said. Even busy providers should take the time to understand their patient’s concerns and allay them through education.
And, he said patients and their caregivers should inform themselves about vaccine recommendations, benefits and costs — and then make the right decision, not just for their own health but also for the well-being of those around them.
