Types of Vaccinations Needed Changes with Age



Dr. David Nace, M.D., M.P.H.

Aging brings about a host of changes, especially when it comes to our health. The good news is that these changes aren’t all bad, and many concerns can be addressed with vaccinations. To assist seniors with the information they need to make informed decisions about their healthcare and vaccines, North Hills Monthly talked with Dr. David Nace, M.D., M.P.H., chief of medical affairs for UPMC Senior Communities and clinical chief of geriatric medicine, University of Pittsburgh.


North Hills Monthly (NHM): What are some ways that our health needs change as we age?


Dr. David Nace (Nace): As we grow older, the types of conditions that we face will change. For example, some types of infections become less common, while others become more common. From a vaccination standpoint, that means that we need to consider different vaccines at different points in our lives.


NHM: What types of health conditions affect older people more seriously than they did when they were younger?


Nace: As we get older, our immune system becomes less reliable in protecting us from getting infections. Protection against serious complications of infections, such as hospitalizations and death, also goes down with age. For example, flu is more common with advanced age. And nine out of every 10 deaths from flu occur in adults over the age of 65. Pneumonia is also very common in older adults and can be quite serious.


Vaccines work to prepare the immune system against infection. Vaccines boost the ability of a person’s body to respond better and more quickly. While some vaccines are less effective in older adults, they still improve the body’s capacity to respond. In other words, without these vaccines, an older adult would be starting out already behind the eight ball.


NHM: What are some of the various vaccinations that older individuals should consider, and at what age do they make sense?


Nace: There are a number of vaccines that are recommended for older adults. A lot of attention right now is focused on COVID-19 vaccines because of the high risks posed by COVID, particularly for those over age 50. Currently, the Centers for Disease Control and Prevention (CDC) recommend that all persons over the age of 6 months receive a primary series of COVID-19 shots and a booster shot. For adults over age 50, a second booster is recommended. For the mRNA vaccines (Moderna and Pfizer), that means two shots for the primary series followed by a first booster shot at least five months later. A second booster shot is recommended at least four months after the first booster.


Protection against flu is also important. All persons aged 6 months and older should get the flu shot. The flu shot not only helps protect the person, but also helps protect others. This is because people can have a mild flu case with minimal or even no symptoms but can pass the virus on to those around them.


The pneumococcal pneumonia vaccine is recommended for all adults ages 65 and older. Pneumococcal pneumonia is thought to be the most common cause of bacterial pneumonia in adults. This vaccine is also recommended for some younger adults with certain chronic health conditions. Protection against pneumococcal pneumonia may require one or two shots depending on the type of vaccine used.


NHM: There are a lot of commercials on TV right now about shingles. Is that also a concern?


Nace: Shingles is a disease that occurs commonly as we age. It causes skin blisters and often a burning or stabbing pain at the site of the rash. It can be quite painful and debilitating. Shingles vaccination is recommended for those persons ages 50 and older. Two doses of vaccine are given two to six months apart.


Another vaccine, often overlooked in adults, is the hepatitis B vaccine. Hepatitis B causes liver damage and can result in cirrhosis, liver cancer, and liver failure. Hepatitis B vaccination of children, adolescents, patients with diabetes, persons with certain risk factors, and healthcare workers has long been recommended. Because of continued cases of hepatitis B and the difficulty in knowing whether a person has risk factors, the CDC recently expanded vaccination recommendations. Hepatitis B vaccination is now recommended for all adults ages 18-59 years. Adults 60 years and older who have known risk factors for hepatitis B, and adults 60 and over who simply request vaccination should also be offered the vaccine. The good news about hepatitis B vaccination is that the vaccine is very effective and protection is long-lasting, even if antibody levels are low or absent.


All persons should receive a tetanus, diphtheria, pertussis vaccine known as Tdap at least once as an adult. Additionally, adults should be revaccinated with a tetanus vaccine at least once every 10 years. The tetanus vaccine may be either the Tdap vaccine, or a tetanus diphtheria vaccine referred to as Td. If a person receives a significant cut or burn and it has been more than five years since their last tetanus shot, they should be given either a Tdap or Td vaccine.


NHM: Are there vaccinations that we no longer have to worry about?


Nace: A common misconception exists around the pneumococcal vaccines. In the past, some clinicians recommended giving a pneumococcal pneumonia vaccine booster every five years. That is not recommended.


Some vaccines may be important to selected individuals such as the meningococcal vaccine which protects against meningococcal meningitis. This infection is uncommon in older adults, except those who have had their spleen removed or have sickle cell anemia. The chicken pox vaccine is also not typically needed as nearly all persons born in the United States before 1980 have likely had chicken pox.


NHM: This is some very helpful information. Anything else to add?


Nace: Keeping your vaccination status up to date remains an important part of medical care, even for older adults. Today’s vaccines are safe and they work.


More information about recommended adult vaccines can be found on the CDC website at https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html.


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