Older population’s immunisation recommendations

पृष्ठभूमि

Providing older people with adequate protection against vaccine-preventable diseases is incredibly important but can be complex. As people age, there is a gradual decline in the functioning of the immune system (immunosenescence). Immunosenescence impacts how well the immune system can fight infections and respond to vaccines. Long-term immune memory, gained from past infections or through previous immunisation, can also wane (decline).

The increasing prevalence of chronic disease in older people (e.g. renal conditions, cardiac conditions and cancers) adds to the complexity. Required treatments for medical conditions (e.g. chemotherapy and immunosuppressive medications) can result in an increasing vulnerability to infections and their complications.

Recommendations

There are multiple vaccines recommended and funded on the राष्ट्रीय टीकाकरण कार्यक्रम (एनआईपी) for older people. Extra vaccines and/or doses are also important for those with additional risk factors (e.g. प्रथम राष्ट्र के लोग, those with .) to optimise protection. There are also other vaccines (unfunded) that should be considered for older people.

It is always important to check an individual’s immunisation record, on the Australian Immunisation Register (AIR), as recall may be unreliable.

Note that adults may present to healthcare services at an age older than the minimum recommended timepoint; they should be opportunistically offered any overdue vaccines.

Funded vaccines

इन्फ्लुएंजा

Annual influenza vaccination is strongly recommended for everyone aged 6 months and older, and is funded on the NIP for those at highest risk of severe disease, including:

• 6 महीने से लेकर 5 वर्ष से कम आयु के बच्चे
• 65 वर्ष या इससे अधिक आयु के सभी वयस्क
• 5 वर्ष से 64 वर्ष की आयु की विशिष्ट आबादी जिनमें इन्फ्लुएंजा से होने वाली जटिलताओं के विकसित होने का खतरा अधिक होता है (जिनमें गर्भवती महिलायें, प्रथम राष्ट्र के लोगऔर कुछ चिकत्सीय जोखिम कारकों वाले लोग शामिल हैं)।).

Influenza is highly infectious, and aged-care facilities are recognised as high-risk areas for outbreaks. Older adults carry the highest rates of influenza infection and its associated complications (including pneumonia and death). 

Adjuvanted (given from > 65 years) and high-dose (> 60 years) influenza vaccines are the preferred type of influenza vaccine for the older population. These vaccines contain additional ingredients to invoke a stronger immune response to overcome the challenges posed by immunosenescence. 

For more information, refer to एमवीईसी: इन्फ्लुएंजा.

COVID-19

Vaccination against COVID-19 aims to reduce the severity of symptoms and the need for hospitalisation.  Individuals with advancing age (particularly > 70 years), immunocompromise, obesity, respiratory conditions, heart disease, diabetes, renal disease, liver disease, neurological conditions and disability are more likely to experience severe symptoms if infected.

Completion of a primary course, followed by receipt of further doses is important to protect older adults.

For more information, refer to एमवीईसी: कोविड-19.

Herpes zoster (shingles)

Herpes zoster is caused by the reactivation of the varicella zoster virus (VZV) in the form of a painful, blistering rash. It affects half of all people who live to 80 years and can present more than once.

Post-herpetic neuralgia (PHN) is the most common complication of zoster and is more likely to occur in older people (> 70 years) than younger people. PHN is a chronic neuropathic (nerve) pain which can affect 1 in 4 cases of zoster diagnosed in those aged > 80 years. It can persist for months or up to several years. Given that pain control for PHN can be difficult to manage, it can have a significant impact on quality of life.

 Vaccination is funded for the following groups:

• First Nations Australians aged ≥ 50 years
• all adults from ≥ 65 years
• adults from ≥ 18 years who have an increased risk of herpes zoster.

Vaccination is also recommended (but not funded) for immunocompetent, non-Indigenous adults aged 50 to 64 years who are household contacts of a person who is immunocompromised. 

For more information, refer to एमवीईसी: ज़ोस्टर. 

न्यूमोकोकल

मैंnvasive pneumococcal disease (IPD) is a leading cause of serious illness and death among older people (and children under 2 years of age). First Nations Australian adults of any age have a high prevalence of IPD, whereas for non-Indigenous Australians the incidence increases with increasing age (2-fold higher risk in those > 70 years, compared with those aged 65–69 years). Other factors such as immunosuppression and chronic conditions (e.g cardiac disease) also increase an individual’s risk for pneumococcal disease. 

Vaccination against pneumococcal is scheduled at various ages throughout the lifespan. Specific timepoints for adults are dependent on risk factors (e.g. age, underlying medical conditions, First Nations background).  

For more information, refer to एमवीईसी: न्यूमोकोकल. 

Other recommended vaccines (unfunded)

रेस्पिरेटरी सिंकाइटियल वायरस (आरएसवी)

Older adults (and young children) carry the highest burden of RSV disease with the bulk of infections occurring during the autumn and winter months in temperate regions of Australia. It is estimated that bacterial co-infections occur in around 30% of hospitalised patients. In older adults, RSV can exacerbate chronic obstructive pulmonary disease or lead to heart failure. Aboriginal and Torres Strait Islander adults are at greater risk of RSV-associated hospitalisation than non-Indigenous adults.

Vaccination is recommended for adults from 75 years of age but can be considered from 60 years. It can be administered at any time of year; however, it may be more beneficial if it is administered prior to the start of RSV season.

For more information, refer to एमवीईसी: Respiratory syncytial virus.

Tetanus and pertussis

The incidence of tetanus is rare in Australia. However, infections are more commonly seen in older adults who have never been vaccinated or were vaccinated more than 10 years ago. Without treatment symptoms can be severe, leading to hospitalisation and the need for intensive care. If untreated it can be fatal.

Adults aged 50 years and older who have not received a dose of tetanus-containing vaccine in the last 10 years should consider a booster dose (unfunded).

Pertussis infection in adults can usually be attributed to waning immunity from previous vaccination. Natural disease does not result in life-long immunity. Vaccination of adults not only protects their own health, but also helps optimise protection for infants too young to be fully vaccinated (cocooning principle).

Adults of any age, particularly those aged 65 years and older, who have not received a pertussis-containing vaccine in the last 10 years are recommended to be vaccinated against pertussis.

Utilising dTpa (diphtheria-tetanus-pertussis) combination vaccines allows the recipient to boost their protection against diphtheria, tetanus and pertussis.

For more information, refer to MVEC: Tetanus और एमवीईसी: काली खांसी. 

Considerations

Residents of residential aged care facilities (RACF)

Every effort should be made to protect RACF residents from vaccine-preventable diseases and their complications.

It is also important to monitor for adverse events following immunisation (AEFIs). Due to a high incidence of cognitive impairment, RACF residents may not have capacity to self-report any side effects. Any AEFIs observed within 5 days of vaccination should be reported to the adverse event reporting service in your jurisdiction. It is important to monitor for non-specific symptoms seen in the RACF population when unwell, such as falls, delirium, functional decline, decrease or loss of appetite, or changes in mood and behaviour.

संसाधन

• ऑस्ट्रेलियाई सरकार का स्वास्थ्य विभाग: वरिष्ठ नागरिकों के लिए टीकाकरण
• Better Health Channel: Immunisations for Older People
• एमवीईसी: ऑस्ट्रेलियाई टीकाकरण रजिस्टर
• Aw D, Silva एबी, Palmer Dबी. Immunosenescence: emerging challenges for an ageing population. Immunology. 2007;120(4):435-446. doi:10.1111/j.1365-2567.2007.02555.x
• Gustafson CE, Kim C, Weyand CM, Goronzy JJ. Influence of immune aging on vaccine responses. J Allergy Clin Immunol. 2020;145(5):1309–1321. doi:10.1016/j.jaci.2020.03.071