Top Vaccines for Older Adults to Consider and Why
By Emily Cheshire, DNP, MS, FNP-BC ~
Did you skip your flu shot last year? You are not alone.
The Centers for Disease Control and Prevention (CDC) report that about 46% of adults 65 and older chose not to get a flu shot last year. And that’s just the tip of the proverbial vaccination iceberg. Flu is not the only vaccination that older adults are neglecting. According to the CDC, 43% of those 65 and older are not current on tetanus shots, and two-thirds didn’t receive the recommended shingles vaccine.
Vaccines are important for seniors as it protects them from a variety of illnesses including pneumonia, whooping cough, shingles, flu, and COVID-19. Don’t be laid low this year because you forgot or didn’t have time to schedule an annual shot or booster.
In May of 2023, two RSV vaccines were approved for adults over age 65. RSV is a virus that can lead to hospitalization and may be life threatening for those with weak immune systems.
As we age, our immune systems weaken, leaving us more susceptible to contracting these illnesses. With a weakened immune system, we may be more susceptible to complications like pneumonia from the flu virus. So for most of us, the benefit of receiving a vaccination outweighs the disadvantages.
If you are vaccinated and still get the flu, shingles, COVID-19, etc., your illness is likely to be milder than without the vaccine.
Keep in mind, no matter what your age, vaccines don’t necessarily provide complete protection. For instance, the flu shot reduces your risk of getting influenza by about half.
Flu Vaccine – why it works some years and not others
Influenza is a variety of viruses, not just one strain. So, every year scientists predict which strains will circulate in the US in a given flu season based on the circulating flu virus in the southern hemisphere (remember- flu circulates in Australia when it’s summer in the US!) Scientists use that data to make an educated guess on the strain, but it’s not 100% accurate because of virus mutations.
Even though it can be hit or miss, the once-a-year shot is a “must” for older adults. In a recent study published by the CDC, approximately 90% of flu related deaths and 50-70% of flu related hospitalizations occur in adults over the age of 65.
A recent study showed that participants who did 90 minutes of mild exercise- like walking or riding a stationary bike- right after their flu or COVID-19 vaccine, generated a higher antibody response in the subsequent four weeks. Taking a brisk walk after your vaccines may improve your response.
Can the flu shot give you the flu?
As the CDC states, the flu shot cannot cause the flu virus. Those who experience mild illness after getting the flu shot, have oftentimes been infected with another mild virus- such as the rhinovirus- or common cold. Because he/she received the flu shot at a time when he/she was already infected with a different virus, he/she associates the flu shot with causing illness. Keep in mind the flu virus causes much more severe symptoms than the common cold. Flu vaccines given with a needle are made in two ways: the vaccine is made either with flu viruses that have been ‘inactivated’ or killed and are therefore not infectious and cannot cause one to get the flu. The second way is by using only a single gene from a flu virus (as opposed to the full virus) to produce an immune response without causing infection.
Is there a better flu shot for seniors?
To improve your chances of escaping the flu, consider a vaccine created for seniors. Three vaccines are currently available that fit that bill.
- Flublok Quadrivalent and Fluzone High-Dose vaccines both appear more effective in older adults than the standard vaccine. Fluzone contains four times the amount of antigen than regular flu shots — making it 24% less likely for those vaccinated to catch the flu than those who received a standard shot. A New England Journal of Medicine study found that people 50 and older who received Flublok were 30% less likely to get the flu than those who received the standard vaccine.
- Fluad works on the immune system, prompting a stronger response than the traditional flu shot.
Flu season usually starts in late October, so early fall is the best time to receive your shot, which will provide adequate time to build immunity. Flu usually peaks in February and can circulate into April.
Pneumonia and influenza are two of the top killers of the elderly in the United States. Pneumococcal disease kills about 18,000 adults 65 + each year. Older adults are more at risk of having life-threatening complications from a pneumonia infection, so it’s important to get vaccinated around the age of 65. If you have a chronic illness such as asthma, diabetes, or kidney, heart or liver disease, talk to your health care provider or pharmacy about earlier vaccination.
Two vaccines protect against pneumococcal disease – Prevnar 13 and Pneumovax 23. The CDC recommends that all adults 65 and older have both shots, a year apart, with Prevnar first. Less than 20% of older adults get both. Check to see if you have received both vaccines. One to three doses of vaccine will likely last the rest of your life. Talk to your health care provider to determine your dosing schedule.
Shingles, or herpes zoster, occurs when the chickenpox virus reactivates later in life. The condition often brings a blistering, painful rash, which usually scabs over in 10 days and clears up within a month. But for 20% to 25% of those infected, they continue to experience nerve pain for months or even years.
A new shingles vaccine developed at the University of Colorado Anschutz Medical Campus called Shingrix is more than 90% effective at preventing shingles. But you must get the two recommended doses (spaced two to six months apart) for protection. Because of high demand, there have been shortages. So, make sure to call ahead to ask if your pharmacy or provider has it in stock.
Making sure you’ve had the Tdap (tetanus, diphtheria, and pertussis) booster is especially important if you will be spending time with an infant. Pertussis, or whooping cough, is a highly contagious respiratory-tract infection that can be life threatening for babies. Even if you were vaccinated against whooping cough as a child, protection fades over time. If you had a Tdap 10 or more years ago, get a booster against tetanus and diphtheria, called Td.
Respiratory syncytial virus (RSV) usually causes mild cold-like symptoms, but older adults have higher risk of developing severe symptoms requiring hospitalization. Similar to flu, RSV season is in the fall and winter months, so getting both flu and RSV is important.
2020 data from the CDC shows that 81% of all deaths from COVID-19 were in adults over the age of 65.
The 2023-2024 updated COVID-19 vaccines provide a high level of protection against the virus and similar to flu, make contracting COVID-19 less severe making death 63.5% less likely. Older adults should get one dose of the updated vaccines a least two months after their last COVID-19 vaccine.
If you’re an older adult who is moderately or severely immunocompromised, you may receive an additional dose of an updated COVID-19 vaccine.
If you recently had COVID-19, you may consider waiting up to 3 months before you get another vaccine. Having COVID-19 infection results in some immunity so reinfection within weeks or months is unlikely. However, if you or someone close to you is at risk of severe illness, do not delay past 3 months. Talk to your healthcare provider to determine your optimal COVID-19 protection plan.
What to do if you cannot track your vaccinations
Sometimes it’s hard to keep track of vaccinations we’ve received and those we have not. Because pharmacists, nurse practitioners and physicians can all vaccinate, we might not always remember when or where a vaccination was given.
If you’re unsure if you have been vaccinated or when, there’s no harm in being vaccinated again. If the idea of getting a shot bothers you, you can also request that the provider obtain titers to test your blood to determine if you have the antibodies in your system- but that entails a blood draw. Titers can tell you if you ever received it or still have an immunity to the illness or not, and is not available for all types of immunity from vaccines. Be aware, though, that you will have to return to get your results and/or get the shot if the results show you are not protected and need a booster.
Emily Cheshire, DNP, FNP-BC is nurse practitioner and Assistant Professor at the University of Colorado College of Nursing. Emily holds DNP, MS and BSN degrees, has been a practicing primary care provider for 13 years and presents in the community on a variety of topics that affect the elderly.
National Institute on Aging: https://www.nia.nih.gov/health/vaccinations-older-adults
National Institute on Aging: https://www.ncoa.org/article/covid-vaccines-what-seniors-need-to-know
National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380102/
National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709178/#:~:text=Vaccination%20markedly%20reduced%20adverse%20outcomes,respectively%2C%20across%20the%20same%20period.
Research: Doing this One Thing for 90 Minutes After your Flu or COVID-19 Vaccine Maximizes your Immunity: https://www.msn.com/en-us/health/other/research-doing-this-one-thing-for-90-minutes-after-your-flu-or-covid-vaccine-maximizes-your-immunity/ar-AA1h4iec?ocid=winp1taskbar&cvid=60772665bb0544e4ab4b63284fc2e396&ei=41#image=AA1hx6Im|1