The article underscores immunisation's vital role for the elderly, covering immune changes, vaccines, safety, and strategies. It also addresses post-HSCT patient vaccination recommendations and ways to tackle vaccine hesitancy.

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Importance of immunisation in the elderly

1. Immunisation in the elderly is crucial to help prevent serious illnesses and complications that can be more severe at their age.
2. It boosts their immune response, reducing the risk of infections like flu, pneumonia, and shingles.
3. Vaccines protect their overall health and well-being, promoting a higher quality of life.

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Age-related changes in immune response

The immune response in elderly people tends to weaken with age, a phenomenon known as immunosenescence. This can lead to reduced effectiveness in fighting off infections and increased susceptibility to diseases. Certain components of the immune system, such as T cells and B cells, may function less efficiently, impacting the body's ability to produce antibodies and memory cells.

Additionally, chronic low-grade inflammation, known as inflammation, is more common in the elderly, which further affects immune function. Vaccines may also be less effective in older individuals due to these age-related changes in the immune system.

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Recommended vaccines for geriatric patients

Some of the recommended vaccines for geriatric patients (elderly individuals) include:

1. Influenza (Flu) vaccine: Given annually to protect against seasonal influenza, which can be particularly severe for older adults.
2. Pneumococcal vaccines: These include the pneumococcal conjugate vaccine (PCV13) and the pneumococcal polysaccharide vaccine (PPSV23), which help protect against bacterial pneumonia and related infections.
3. Shingles (Herpes Zoster) vaccine: The shingles vaccine helps prevent the painful rash and complications associated with the reactivation of the varicella zoster.
4. Tetanus, Diphtheria, and Pertussis (Tdap) vaccine: Older adults should receive a Tdap booster once and then a tetanus-diphtheria (Td) booster every 10 years to maintain immunity.
5. COVID-19 vaccine: The COVID-19 vaccine is recommended for all eligible individuals, including geriatric patients, to protect against the severe effects of the virus.
6. Hepatitis B vaccine: For those who haven't been previously vaccinated, this vaccine can protect against hepatitis B, a viral infection that can affect.

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Vaccine safety & side-effects

It is a top priority, and vaccines are thoroughly tested for safety and efficacy before they are approved for use. However, like any medical intervention, vaccines can have side effects. For elderly individuals, vaccine side effects are generally mild and temporary. Here are some key points to consider:

1. Common side effects: Common side effects of vaccines for the elderly can include pain or swelling at the injection site, mild fever, fatigue, headache, and muscle aches. These side effects usually resolve on their own within a few days.
2. Serious side effects: Serious side effects from vaccines are rare. Vaccines undergo rigorous testing and continuous monitoring to identify and address any safety concerns. The benefits of vaccination usually far outweigh the risks.
3. Allergic reactions: Severe allergic reactions (anaphylaxis) to vaccines are extremely rare. Healthcare providers are trained to manage such reactions if they occur.
4. Vaccine-specific side effects: Different vaccines may have specific side effects. For instance, the shingles vaccine might cause redness and pain at the injection site, as well as headaches. The flu vaccine might lead to a mild fever.
5. Immune response: Some side effects, like mild fever or fatigue, are actually signs that the immune system is responding to the vaccine. This is normal and indicates that the body is building immunity.
6. Precautions: Elderly individuals, especially those with underlying health conditions, should discuss their medical history with their healthcare provider before getting vaccinated. Certain conditions may require modified vaccine schedules or additional precautions.
7. Benefits outweigh risks: Vaccination in the elderly helps prevent serious illnesses and complications that can be particularly severe in this age group. Vaccines reduce the risk of hospitalisation and mortality from vaccine-preventable diseases.
8. Monitoring: Healthcare providers usually monitor patients for a short period after vaccination to ensure there are no immediate adverse reactions. Patients are also provided with information about what to watch for in the days following vaccination.

Remember that individual responses to vaccines can vary, but overall, vaccines have been proven to be safe and effective in protecting elderly individuals from vaccine-preventable diseases. If you or an elderly loved one have concerns about vaccines, it's best to have an open discussion with a healthcare professional.

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Public health strategies for immunisation

Here are some key components of a public health strategy for adult immunisation:

1. Education and awareness campaigns: Launch public awareness campaigns to educate adults about the importance of vaccines, the diseases they prevent, and the benefits of immunisation. These campaigns can use various media channels to reach a wide audience.
2. Healthcare provider engagement: Collaborating with healthcare providers to ensure they are well-informed about adult vaccines, can address patients' questions and concerns, and actively recommend and administer vaccines during routine visits.
3. Vaccine recommendations and guidelines: Developing clear and evidence-based vaccine recommendations for different age groups and risk factors. These guidelines should be regularly updated and communicated to healthcare providers and the public.
4. Vaccine access and availability: Ensuring that vaccines are readily available and accessible to adults through various healthcare settings, such as clinics, pharmacies, workplaces, and community centres.
5. Vaccine coverage tracking: Establishing systems to monitor and track adult vaccine coverage rates to identify gaps and target populations with low vaccination rates.
6. Tailored messaging: Designing messaging and outreach efforts that resonate with different adult populations, considering factors such as cultural diversity, language barriers, and health literacy.
7. Partnerships and collaboration: Collaborating with community organisations, advocacy groups, employers, and other stakeholders to promote and facilitate adult immunisation.
8. Vaccine financing and insurance coverage: Ensuring that vaccines are covered by insurance plans, including Medicare and Medicaid, to reduce financial barriers for adults seeking vaccination.
9. Vaccination clinics and events: Organising vaccination clinics and events in convenient locations and at times that suit working adults, encouraging them to get vaccinated without disrupting their routines.
10. Targeted outreach: Identifying and targeting populations that are at higher risk of vaccine-preventable diseases, such as older adults, pregnant women, individuals with chronic health conditions, and healthcare workers.
11. Data and research: Conduct research on barriers to adult immunisation and evaluate the effectiveness of different strategies to continuously improve the approach.
12. Vaccine registries: Implementing vaccine registries or information systems that allow healthcare providers to access patients' vaccination histories and recommend needed vaccines.
13. Emergency preparedness: Developing plans for vaccine distribution and administration during public health emergencies, such as disease outbreaks or pandemics.

A comprehensive public health strategy for adult immunisation involves a multi-faceted approach that engages various stakeholders and leverages a combination of communication, accessibility, and policy measures to increase vaccine coverage and protect adult populations from vaccine-preventable diseases.

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Consideration for the immunocompromised geriatric patient

When considering their healthcare, several important factors should be considered:

• Avoid live vaccines
• Monitoring for adverse reactions
• Avoid illness
• Regular health checks up

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Vaccine hesitancy in geriatric patients

Some reasons for vaccine hesitancy in geriatric patients include:

• Misinformation
• Historical context
• Health beliefs are based on superstition.
• Fear of side effects
• Complacency
• Complex health situations
• Lack of access
• Provider trust

Addressing vaccine hesitancy in geriatric patients involves:

• Clear communication
• Empathy and respect
• Education campaigns
• Healthcare provider recommendations
• Family involvement
• Peer testimonials
• Easy access to vaccines
• Patient engagement
• Continued follow up
• Local community

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Case scenario: A 60-year-old male with AML has undergone an allogenic bone marrow transplant patient has been referred for advice on vaccination.

Post HSCT vaccination:

• Hib conjugate
• Hepatitis B
• Hepatitis A
• Tdap/DT/Td
• Influenza(inactivated)
• Pneumococcal conjugate vaccine (PCV 13)
• Recombinant zoster vaccine
• COVID 19 mRNA vaccine

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Khemeswar Agasti is an MD in General Medicine from Cuttack.