Vaccinations for senior citizens

Vaccination programmes in different countries are mainly aimed at children and young people. Vaccines have significantly improved people’s health and life expectancy. While life expectancy has increased and the relative proportion of senior citizens in the population has increased, it has been found that there is a need for separate vaccine recommendations for the older population.

Seniors need their own vaccinaton programme

Seniors are in good shape today: they are in good nutritional status and many are active in their daily life. If they stay healthy, then active and functional aging or retirement is not an impossible dream but a realistic option.

Aging inevitably affects the functioning of the immune system. Chronic diseases and their medication also increase with age. Vaccination needs are already starting to change after the age of 50. At the latest when you are over 65, vaccination protection should be supplemented as necessary. These age recommendations are by no means absolute, but the epidemiological situation of the living area and the underlying diseases should be taken into account when considering the vaccination needs of a senior citizen.

Some of the diseases in the elderly are ones that we cannot anticipate or prevent, but vaccinations can be effective in preventing a large proportion of premature deaths or diseases that impair quality of life. Such vaccines, which are especially important for seniors, include influenza, pneumococcal disease, shingles, whooping cough, and tetanus-diphtheria. Depending on their lifestyle, the tick-borne encephalitis vaccine may also be considered necessary, especially for the elderly.

Influenza vaccines are safe and especially recommended for seniors

Influenza vaccine is one of the vaccines provided by society for everyone over the age of 65. Thus, although it is a free vaccine for this group, according to public health statistics, only about 50% of those in the group have taken the vaccine. Influenza vaccine coverage varies quite a lot.

The willingness to take the vaccine is apparently reduced by the side effects associated with the 2009 pandemic H1N1-vaccine and the perception of its poor effectiveness. Indeed, the efficacy of an influenza vaccine may vary from year to year, as circulating viruses do not always fully correspond to the viruses in the vaccine. If the viruses differ greatly, the effectiveness of the vaccine may be as high as 30% and in the elderly even worse. However, this is rare.

Older people have a worse response to vaccines than younger adults, so getting the disease after vaccination is not exceptional. In the United States, a vaccine only for people over the age of 65 has been used for more than 10 years, with 4 times the amount of the vaccine compared to a regular vaccine. The efficacy of the vaccine has been found to be better and the vaccine will certainly be available in Finland within a few years.

For the time being, however, Finland must be satisfied with traditional influenza vaccines, which have a long experience and are known to be very safe for all ages. It is also worth remembering that a poorer response to the vaccine in the elderly also indicates that the immune response to the correct pathogen is similarly impaired. Thus, in those over 65, vaccination has been shown to reduce influenza-related hospitalizations by an average of 40-70% and mortality by 50-70%.

Pneumococci cause the premature death of many seniors

Pneumococci cause pneumonia, sepsis, and meningitis in this age group. Vaccinations are particularly effective in preventing sepsis and meningitis in the elderly, with a 75% reduction in the incidence of the conjugate vaccine (13 different types of pneumocaccal bacteria). In the prevention of pneumonia, both the newer conjugate vaccine and the older polysaccharide vaccine (23 different bacteria) are clearly ineffective.

Pneumococcal vaccines are intended for vaccination of different risk groups and all people over 50 years of age. It has been calculated in several Finnish municipalities that vaccinations for the elderly are profitable and in these municipalities the residents receive pneumococcal vaccinations free of charge. You only take on vaccination and the need for boostering is not well understood.

Influenza viruses and pneumococci together are a particularly effective killer. In influenza epidemics, many, even the majority of patients die from pneumococcal pneumonia. The influenza virus, like many other viruses, impairs the immune system’s ability to fight pneumococci and these can more easily penetrate deeper into the lung tissues to cause destruction. The link between coronavirus and pneumococcus is not yet known, but many COVID patients develop bacterial pneumonia due to the disease, which must be treated with antibiotics.

Vaccination against pneumococci is strongly recommended for all people over the age of 65, and especially during the COVID epidemic, it is well justified to take it over the age of 50 years. If the patient has other risk factors, then the age of 50 is not an absolute lower limit. Vaccination can be started with a newer conjugate vaccine and boosted with an older polysaccharide vaccine, for example, after 12 months. The shortest interval between vaccines could be 2 months.

Shingles vaccine for people over 50 years of age

Shingles is a nasty blistering skin change caused by the chickenpox virus. It becomes more common with age. Most adults have had chickenpox in childhood and thus carry the chickenpox virus in the nerve cells in the spinal cord. The chickenpox virus never disappears from the body after the illness but hides in the nerve cells where the immune system keeps it inactive. With age, the immune system weakens and the chickenpox virus can become active, causing shingles. Immune-lowering medications and diseases also predispose young people to shingles.

Shingles appears as a banded blister-like skin change on the other side of the centerline of the body. The disease is not life-threatening, but long-lasting and, above all, it significantly impairs the quality of life due to its pain. Pain affects sleep, mood, and general activity. The pains start with blisters but last up to months after the blister phase. Because the pain is nerve pain, it is poorly treated with conventional anti-inflammatory medication. In the area of ​​the face, the infection can spread to the eye and damage the structures of the eye and cause permanent problems.

The incidence of shingles in Finland is 1,500 to 2,000 patients a year, and it is becoming more common after the age of 50. A vaccine is available to prevent shingles and prolonged nerve pain (postherpetic neuralgia). The basic vaccination series consists of 2 doses with the interval of 2-6 months.

Whooping cough (pertussis) also affects seniors

Whoopin cough is known to be a life-threatening disease in babies under 1 year of age, but it can also be present in the elderly. A whooping cough epidemic broke out in the Dutch monastery among 99 people, the majority of whom did not have vaccination protection against whooping cough. Of these, four died of cerebral hemorrhage and all of those who died were over 55 years of age.

The whooping cough vaccine is part of the basic national vaccine program in Finland, but the effectiveness of vaccine weakens quite rapidly and epidemics are reasonably common in school-age children. Due to the danger of the disease, booster doses have been recommended for parents, e.g. just before pregnancy, during pregnancy, or immediately after delivery. Similarly, it is conceivable that grandparent protection could be well recommended to prevent the disease from spreading to newborns. And as the epidemic in the monastery showed, the disease is not completely harmless to the elderly either. The most common complications associated with whooping cough in adults are weight loss, urinary incontinence, fainting, and fractures of the ribs due to cough. In the elderly, every fifth prolonged cough is a symptom caused by whooping cough.

The whooping cough vaccine is most often given together with tetanus and diphtheria vaccines. Almost everyone in Finland has received a boost against whooping cough for the last time as an infant or at school, and is prone to getting and spreading whooping cough to others. So when boosting tetanus and diphtheria, a single dose of a vaccine with an additional effect against whooping cough may well be administered to adults or the elderly. The whooping cough vaccine boosters are no longer given, but the tetanus and diphtheria boosters are continued every 10 years after the age of 65 in Finland.

The tetanus vaccine should be renewed

Tetanus vaccination must be valid for everyone. Vaccination provides good protection against tetanus. Some tetanus vaccines also come with protection against whooping cough. The basic vaccine series is given to children at the child welfare clinics. The series is intensified for working-age people every 20 years at a health center, occupational health or private actors. A combination vaccine against diphtheria, tetanus and pertussis is always available at the Vaccine Bus and Vaccination Clinics. For people over 65, the effect interval is 10 years.

Tick-borne encephalitis (TBE) has spread to an ever-widening area in Finland

As previously already mentioned the senior citizens are now in good condition and move around a lot in nature, thus exposing them to diseases transmitted by ticks. The TBE virus affects people of all ages, but the older the patient, the more common the disease leading to paralysis, convulsions and death. The need for TBE vaccination depends primarily on place of residence and one’s own lifestyle, but age is also important in this regard.

The basic vaccination series is the same for everyone and consists of three vaccination. Boosters are given to people over 50 every five years and to people over 60 every three years. TBE vaccines are often taken in Finland in the spring or summer, but there is no obstacle to taking or boosting vaccine schedule at other times of the year also.

Vaccine Type When
Influenza Inactivated, four viruses Yearly
Pneumococcal PCV13 (conjugated) > 50 years, single dose
Shingles Inactivated  > 50 years, 2 doses, interval of 2 months
Whooping cough (pertussis) dtap vaccine Once in adulthood
TBE Freely selectable 3 vaccinations at months 0,1,10-13, boosters after 3 years and at age 50-60 every 5 years and at age over 60 every 3 years