By:  Tehila Mörtl

Today I would like to discuss senior health care in regards to health risks to seniors; particularly, those posed by falling behind on vaccinations.  One malady that effects far too many elders is Shingles.  According to the Mayo Clinic, shingles is caused by the varicella-zoster virus which is the same virus that causes chickenpox.  Once one has recovered from the chickenpox, the virus can enter the nervous system where it can lie dormant for years.  Given that anyone with a history of chickenpox is susceptible and that the pain alone caused by a single bout of shingles can be excruciating, it is alarming that three out of four Americans 60 and older remain unprotected for lack of getting this one simple vaccine that is, from my understanding, often covered at least in part by Medicare and most health insurance plans.  Shingles can result not only in painful rashes over the face and body which can last for weeks or months but can also result in blindness should it spread into the eyes.  The exact reason why some develop shingles while others do not is unclear; however, it might be due to weakened immunity to infections as one ages.  Those most susceptible include the elderly, newborns and women who are with child.  An individual who has shingles can also pose a risk to anyone who is not immune to chickenpox.  The varicella-zoster virus can be spread through direct contact with the open sores of the shingles rash, causing those susceptible to develop chickenpox.  One continues to be contagious until their shingle blisters scab over.  Individuals who have not had Chickenpox should discuss with their physician the chickenpox vaccine.

Another important vaccine in regards to senior care include the Flu.  Seniors should receive an antiviral flu shot annually.  Further, the early use of antiviral flu medication can reduce hospital stay, risk of need for extended care and a variety of disabling effects on elders.  Given those 65 and older are at an increased risk of serious Flu complications, in the interest of senior health care, the CDC recommends individuals who do develop the flu be treated with influenza antiviral medications as early as possible.  Dr. Dan Jernigan, director of CDC’s Influenza Division stated that, “Flu can be extremely serious in older people, leading to hospitalization and in some cases long-term disability. This important study shows that people 65 and older should seek medical care early when they develop flu symptoms.”  Further, the CDC’s study revealed that elders 65 and over who sought medical care or were hospitalized within two days of onset of illness and received antiviral medications within first four days of illness had substantially shorter hospital stays.  On the other hand, those who waited longer than four days not only required longer hospitalization but some even experienced extended aftercare as well.  Need a serious motivating fact to encourage your elder to get their flu vaccine?  Those 65 and older account for 80 to 90 percent of seasonal flu related fatalities.

Health and age factors which are known to increase risk of serious complications from Flu include:

• Adults 65 years and older

• Asthma

• Heath disease

• Liver disorders

• Kidney disorders

• Neurological conditions

• Blood disorders

• Chronic lung disease (i.e. Chronic Obstructive Pulmonary Disease [COPD])

• Endocrine disorders (i.e. Diabetes)

• Metabolic disorders

• Weakened immune system as a result of disease or medication

• American Indians

• Alaskan Natives

Finally, Hib Haemophilus influenzae are given in one to three doses.  Again, this is information your primary care giver can provide as to what is recommended for the patients current age and health.

Pneumonia affects approximately 900,000 seniors yearly; however, 4 out of 10 seniors do not receive this all important vaccine.  Although these vaccination rates are up slightly over the past decade, it is vital that all elders, who are healthy enough, receive a pneumonia vaccine beginning by the time they reach age 65.  With our not being fond of the flu and in consideration of all the risks, my spouse and I began receiving the vaccine at a much earlier age.  Please note, there are two different types of pneumococcal vaccine: PCV13 (conjugate) and PPSV23 (polysaccharide).  We recommend that you speak with your primary healthcare provider to establish if one or both pneumococcal vaccines are recommended for the seniors in your life.

One immunization that falls drastically short in senior care is Tetanus.  Surprisingly, almost half of the elders in the U.S. have not been immunized for tetanus and despite the advances in medical care, this rate has changed little since 2008.  The recommendation is for one to receive a shot every 10 years to prevent a rare but sadly often deadly bacterial condition Lockjaw.  One benefit of the new tetanus vaccine that most individuals are not aware of is that it includes a booster for Whooping Cough, which is also of great benefit not only to seniors but their grandchildren as well.  When discussing the tetanus immunization with your primary care physician, ask if Td/Tdap Tetanus, Diphtheria, Pertussis is appropriate for you or your elder.

The following is a portion from the CDC website which explainsTd andTdap:

Td or Tdap - FOR ADOLESCENTS AND ADULTS

• Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every ten years, or after an exposure to tetanus under some circumstances. 

• Tdap is similar to Td but also containing protection against pertussis. Tdap should be given as a one-time booster in place of Td. Tdap is especially important for those in close contact with infants.

• Adolescents 11 through 18 years of age (preferably at age 11-12 years) and adults 19 years of age and older should receive a single dose of Tdap.

• Tdap can be given no matter when Td (tetanus-diphtheria vaccine) was last received.

   

Note: Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. Lower-case “d” and “p” denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations. The “a” in DTaP and Tdap stands for “acellular,” meaning that the pertussis component contains only a part of the pertussis organism.

Another vaccine to discuss with your health care provider is for Meningococcal.  He or she will be able to recommend the number of appropriate dosages needed.

Immunization vaccines for Hepatitis A and Hepatitis B are of serious importance in elderly care as well.  Hepatitis A immunization is given in two doses while that for Hepatitis B is given in three.

Just as important in elder care is for those planning to travel abroad, it is of tremendous importance that vaccinations appropriate for one’s destination be obtained prior to leaving the U.S.  Further, to help establish which vaccines should be discussed with your physician.

In the interest of senior care, to help protect yourself, your loved ones and others in your community, the Measles-Mumps-Rubella (MMR) vaccine is tremendously important to all those who plan to travel abroad.  According to the governmental vaccines site, “Each year, unvaccinated people get measles while in other countries and bring it to the United States. This has sometimes led to outbreaks.  Since 2000, when measles was declared eliminated from the U.S., the annual number of people reported to have measles ranged from a low of 37 people in 2004 to a high of 668 people in 2014. The majority of measles cases brought into the U.S. come from U.S. residents. When we can identify vaccine status, almost all are unvaccinated.”

• CDC recommends that all residents of the U.S. 6 months or older who travel abroad receive the MMR vaccine, if needed, prior to leaving the country.

• All adults without evidence of being immune to measles must have documentation of 2 appropriately spaced doses of the MMR vaccine.

Thank you for joining me in this discussion on senior vaccines.  For those who would like to share their own experiences with senior health care, elderly care or seniors help, advice which might be of help to others, questions or ideas for future Blog articles, please feel welcome and encouraged to contact us directly at (646) 820 - 9220