Immunizations for adults older than age 65

Immunizations are recommended from birth on to help your body develop immunity against infectious diseases. If you're older than age 65, a variety of specific immunizations may be recommended.


General information
When you're immunized, you receive a vaccine or toxoid by injection or mouth. The vaccine contains a weakened or dead disease germ. The toxoid contains a harmless version of the poison the germ produces. When you've received the vaccine or toxoid, your body produces antibodies (compounds that help neutralize or destroy foreign substances in the blood) to fight the weakened or dead germ or poison. These antibodies remain in your system, ready to protect you from illness if you're later exposed to the real disease germ or poison.
You may experience minor reactions after an immunization, such as soreness at the site of the injection. Most mild reactions can be treated with ice to the injection site and acetaminophen for discomfort or fever.

Rarely, immunization can lead to serious side effects. Any adverse reactions typically develop within 72 hours after the immunization. There are some exceptions, however. A reaction to the measles, mumps and rubella vaccine (MMR) may be delayed for one to two weeks. A reaction to the chickenpox vaccine may be delayed up to one month. Discuss any concerns about adverse reactions with your doctor.

You can receive immunizations from your doctor, the local health department or a hospital immunization clinic. Before you're immunized, it's important to mention if you:

are ill, either from a minor illness such as the common cold or a chronic condition such as a seizure disorder or human immunodeficiency virus (HIV, the virus that causes AIDS)
have any allergies
are taking any medications
have experienced any adverse reactions to previous immunizations
Vaccine shortages
Recently, there have been shortages of some vaccines in the United States. Most shortages are related to a manufacturer stopping production of a particular vaccine, manufacturing problems and insufficient stockpiles. In some cases, vaccine shortages affect the recommended immunization schedule. The most current information about shortages is available from the Centers for Disease Control and Prevention (CDC).


Recommended immunizations for older adults
Certain immunizations are recommended for all adults. We'll address the three additional vaccinations that are recommended specifically for adults older than age 65 -- influenza, pneumococcal disease and tetanus-diphtheria.
Influenza
Influenza (flu) is a viral infection of the throat, bronchial tubes and lungs that occurs most often from November to April. It can cause chills, a moderate to high fever, cough, sore throat, runny nose, headache, muscle aches and tiredness. (This isn't the same as the stomach flu.)

Symptoms can be mild or severe, and may lead to complications such as ear infections, sinus infections, bronchitis or pneumonia. Sometimes hospitalization may be needed. Influenza also causes thousands of deaths each year, especially among those who are weak due to other diseases or advancing age. More than 90 percent of deaths from influenza occur in people age 65 or older.

There are various influenza viruses, but only a few are responsible for most of the flu cases in a given year. Each year researchers determine which three viruses are most likely to cause flu, and then create a vaccine to help the body develop immunity. Within one to two weeks after the immunization, you may develop immunity to the flu. For some older adults and those with certain chronic diseases, the flu vaccine may be less effective. However, if you've been vaccinated and still get the flu, you may have less severe symptoms and a smaller risk of complications.

Generally, a yearly flu shot is recommended for all adults older than age 50. This year, however, the recommendations have changed due to a shortage of the inactivated influenza vaccine. For the 2004-2005 flu season, the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) initially recommended flu shots for the following adults:

anyone age 65 or older
anyone younger than age 64 who has a chronic medical condition
residents of nursing homes and long-term care facilities
health care workers who provide direct patient care
caregivers and household contacts of children younger than age 6 months
As of January 2005, flu shots were still available in some parts of the United States. Given the supply, the recommendations for flu shots have been expanded to include:

caregivers and household contacts of people in a high-risk group (such as children younger than age 2, people age 65 or older or anyone with a chronic illness)
adults ages 50 to 64
Check with your doctor or county or state health department to see if the vaccine is available in your area.

One injection of the vaccine should be given in the upper arm shortly before the flu season begins. The vaccine is typically given between September and December, with October and November as the optimal time. If the vaccine is given too early, the immunity may decline before the flu season ends. If it's given too late, there's a risk of getting the flu before the protection has begun. Other immunizations may be given at the same time in other locations.

Potential reactions to influenza immunization
Any adverse reactions to the vaccine are usually mild and occur during the six to 48 hours after vaccination. The most common reactions are tenderness, redness or a lump at the injection site that lasts up to two days. Less common reactions may include:

fever or chills
general feeling of discomfort
muscle aches
A serious allergic reaction is possible, but rare.

In 1976, the Guillain-Barre syndrome (GBS, a serious central nervous system condition that can lead to breathing difficulty, shock and paralysis) was associated with the flu vaccine. The swine flu part of the vaccine was thought to be responsible. Since then, this component has been eliminated from the vaccine and Guillain-Barre syndrome hasn't been clearly associated with the vaccine. If there's a risk today, it's extremely rare.

The immunization may be postponed if you have a moderate to severe acute illness. It's not recommended if you've had a serious allergic reaction to a prior dose of the vaccine or any vaccine component (such as eggs). Since the vaccine composition varies from year to year, discuss any allergies with your doctor each year. If you have a history of Guillain-Barre, be sure to consult your doctor before receiving the vaccine. Immunization may not be recommended, especially if you developed GBS within six weeks of having a flu shot.

Pneumococcal disease
The Streptococcus pneumoniae bacteria is responsible for pneumonia (a lung infection), bacteremia (bacteria in the blood) and meningitis (inflammation of the membranes surrounding the brain or spinal cord). As you age, you're more susceptible to this bacteria and its complications. Older adults also face a higher risk of fatal illness related to pneumococcal disease. The vaccine is about 60 to 70 percent effective in preventing pneumococcal infections. The immunity may last five to 10 years.

The pneumococcal vaccine is recommended for everyone older than age 65. A second immunization is recommended if it's been more than five years since your first vaccination and that vaccination was received before age 65. Revaccination is also recommended after five years if youuch as cancer, cancer treatment, HIV, long-term steroid therapy, organ transplantation, kidney disease or a dysfunctional spleen (including sickle cell disease).

The injection is given in the upper arm. Other immunizations may be given at the same time in other locations.

Potential reactions to pneumoccocal immunization
Adverse reactions to the pneumococcal vaccine are usually mild. The most common are pain and redness at the injection site.

Rarely, adverse reactions may include:

fever
muscle aches
severe reaction at the injection site
serious allergic reaction
Immunization must be postponed if you have a moderate to severe acute illness. The pneumococcal vaccine isn't appropriate if you've had a severe allergic reaction to a prior dose of the vaccine or any vaccine component.

Tetanus-diphtheria
Tetanus (lockjaw) and diphtheria are serious bacterial infections that can be fatal in some cases. Tetanus and diphtheria infections mainly develop in people who've never been immunized or didn't receive the necessary booster shots. Adults age 50 and older account for most of these infections.

Tetanus bacteria are found in the soil, air and on human skin. They enter the body through breaks in the skin, injuries to the eye or burns. The bacteria produce a toxin that causes muscles to tighten painfully. This produces the "locked" jaw, which keeps the mouth from opening and may also interfere with or prevent swallowing.

Diphtheria bacteria spread through contact with infected respiratory droplets, which may be coughed or sneezed into the air. Diphtheria produces a thick covering in the back of the throat that can lead to difficulty breathing. It may even cause paralysis and heart failure.

The immunization against tetanus and diphtheria contains tetanus and diphtheria (Td) toxoids. Children are routinely given this immunization. As an adult, you must receive booster shots every 10 years to maintain your immunity. If you weren't immunized against diphtheria and tetanus as a child, you'll need three doses of the Td toxoid to develop immunity. (The first and second doses should be four to eight weeks apart, followed by a third dose six to 12 months later.) The shot is given in the upper arm, and other immunizations may be given at the same time in different areas.

For a clean or minor wound, you need a booster if:

you have completed the initial three-part series, but your last dose was more than 10 years ago
your initial three-part series isn't complete or you're unsure of your immunization status
For a major or unclean wound, you need a tetanus booster if:

your last booster shot was more than five years before the injury
your immunization history is unknown
you haven't completed the initial three-part series (Tetanus immune globulin, or TIG, may also be needed and is given along with the tetanus vaccine.)
Potential reactions to tetanus-diphtheria immunization
The most common adverse reactions to tetanus-diphtheria immunization last for 24 to 48 hours. You may notice soreness, redness and swelling at the injection site or a fever up to 102°F. After immunization, you may notice a lump at the injection site that may last one to two weeks. In reaction to frequent booster shots of Td, some people have swelling that extends from the elbow to the shoulder. This usually begins two to eight hours after the injection. Rarely, a serious allergic reaction or brain disorder may develop after the vaccination. Very rarely a severe allergic reaction, brain disorder or prolonged pain and weakness in the upper arms may develop after the vaccination.

The immunization may be postponed if you have a moderate to severe acute illness. The Td toxoids aren't appropriate if you had a severe allergic reaction or developed a brain disorder after a previous dose of the toxoids.