By Dr. K C Wong
Positive Healthy Ageing Programme Malaysia
When we discuss about vaccination, we often assume that it is only for children. Vaccination is one of the important tenets in health maintenance and disease prevention in the elderly population. This is well demonstrated in the recent Covid-19 pandemic that ravaged this globe and emphasized the importance of vaccinations especially in the elderly. We will discuss the reasons for elderly vaccinations, the schedule and the recommendations especially in the adults above 65 years old.
Why the elderly need vaccination?
As we grow graciously old, we are more susceptible to diseases and infections. Some diseases like diabetes mellitus, chronic kidney disease, heart diseases, chronic lung disease and cancers makes us prone to infections. This is due to in part also to downgrading of our immune systems qualitatively and quantitatively in terms of the cells or antibody response.
Thus, older adults are more likely to get sick and may suffer from more serious symptoms and complications when they are infected with serious germs. This can result to a more prolonged illness, hospitalisation and even death. More-over recovery from the illness can be prolonged.
In addition, immunity acquired during childhood vaccination may wane over time. Hence, even though we have been vaccinated before, the protection may not last and we may need to get booster shots to keep ourselves protected against vaccine-preventable diseases. These are the few reasons why it is important for you to consult your doctor about vaccinations in the elderly to stay healthy.
Which vaccines are recommended?
For the elderly the following are the recommended vaccines:
- COVID-19 vaccine: Coronavirus disease (COVID-19) is a respiratory infection caused by the SARS-CoV-2 virus. Older adults are at a higher risk of suffering from serious complications, especially those with underlying medical conditions like diabetes or heart disease. COVID-19 vaccine reduces the risk of getting this disease and protects us from getting seriously ill if we do get infected. Most Malaysian citizens have completed their primary doses during the nationwide COVID-19 vaccination drive. But consider getting the booster dose as well if you haven’t received it!
- Influenza vaccine: Influenza or flu is easily transmitted from person to person. While it is usually a mild infection, it can be severe in vulnerable populations such as the elderly. They may develop serious complications such as pneumonia and have a higher risk of hospitalisation and mortality. Influenza vaccine should be taken annually – this is because the flu virus mutates over time and the vaccine is updated every year to ensure it remains effective against the current virus strain.
- Pneumococcal vaccine: The bacteriapneumococcus causes one of the most common lung infections called pneumonia. This disease can spread by direct contact with respiratory secretions from patients and healthy carriers. Other than pneumonia, this disease can also lead to bacteraemia (blood infection) and meningitis (an infection of the brain), which can be fatal. All adults above 60 years old, especially those with underlying medical conditions like chronic lung and heart diseases, are recommended to be vaccinated with Pneumococcal vaccine.
- Tdap vaccine: Tdap vaccine protects against tetanus, diphtheria and pertussis, three bacterial infections that can cause serious illness. Tetanus (lockjaw) causes muscles to contract involuntarily, diphtheria results in breathing difficulty and pertussis (whooping cough) causes severe coughing. As a child, most of us have been vaccinated against these diseases with DTaP vaccination, but the immunity wanes over time. Thus, a booster shot is recommended every 10 years to stay protected against these diseases.
- Shingles vaccine: The same virus, varicella-zoster virus, causes shingles and chickenpox. After a person has recovered from chickenpox, the virus still lingers in the body. As you get older, the virus may reactivate and cause shingles (Zoster), which can cause painful nerve pain at the site of infection called Post-Herpetic Neuralgia. Even after the rashes disappear, 1 in 5 people may experience long-term pain. Shingles vaccine is recommended for people who are 50 years and above with a history of chickenpox to prevent this severe and debilitating neuralgic pain.
Table of recommended immunisation for the elderly (≥ 65 years old)
| Vaccines | Dosages |
| COVID-19 vaccine | 2-3 primary doses, booster doses as advised |
| Influenza vaccine | 1 dose annually |
| Pneumococcal conjugate vaccine (PCV) or pneumococcal polysaccharide vaccine (PPV) | 1 dose |
| Tetanus, diphtheria, pertussis vaccine (Tdap) | Boost with Tdap/Td every 10 years (after completion of 3 doses of primary vaccination) |
| Shingles (Zoster) vaccine | 1 dose |
| Meningococcal vaccine | 1 or more doses |
| Hepatitis A vaccine | 2-3 doses depending on the type of vaccines |
| Hepatitis B vaccine | 3 doses |
| Haemophilus influenzae type b vaccine (Hib) | 1 or 3 doses depending on indications |
Keeping ourselves fit and healthy as we age is important so that we can continue doing things that we like and spending time with our loved ones. Vaccination is one way to achieve that. Certain vaccines such as influenza and pneumococcal vaccines may be available at public hospitals for the elderly with chronic medical conditions. You may also get vaccinations for adults at private health facilities. This is a general guideline – talk with your doctor to see the suitable vaccines for you and to learn more about vaccinations for the elderly.
References:
- http://www.myhealth.gov.my/en/vaccinations-for-the-elderly/
- https://www.nia.nih.gov/health/vaccinations-older-adults
- https://adultimmunisation.msidc.my/wp-content/uploads/2020/12/AIG-3rd-edition-Final-version-09122020-c.pdf