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Keeping up on vaccinations as we grow older

The baby boomer generation was the first generation to be widely vaccinated in this country.  Most of us were on the cutting edge of science and public health when we received vaccines for polio, measles and influenza.  The same is true for the combined vaccine against diphtheria, tetanus, and pertussis or whooping cough. Thanks to these vaccines, most of these diseases have largely disappeared from the United States.

Most everyone who received a tetanus shot as a child knows that they should receive a booster shot every 10 years.  But there are recommendations for people over 60 years of age to take other vaccines as well. Some are newly discovered vaccines, and others are the same, or similar, to those we took as children. A vaccine for shingles, known as Zostravex, is an example of one of the more recently discovered vaccines.

Shingles is a skin rash that can blister and be very painful. It is caused by varicella zoster, the same virus that causes chicken pox. Anybody that had chicken pox when they were young is susceptible to shingles when they are older. As of May 2006, the Centers for Disease Control’s (CDC) Advisory Committee on Immunization Practices has recommended Zostravex for people 60 years old or older. The vaccine can reduce the risk of shingles and its associated pain.

“Risk of shingles and its complications, such as postherpetic neuralgia, increase with age,” Dr. Craig Hales with CDC’s Division of Viral Diseases, said. “The vaccine (Zostravex) offers protection against shingles for at least five years, but it is uncertain how long this protection lasts beyond five years. CDC recommends vaccination of adults 60 years of age or older so that adults at higher risk of shingles and its complications are protected.”

The older a person gets, the less effective the shingles vaccine seems to be, however.

“In a clinical trial involving thousands of adults 60 years old or older, Zostavax reduced the risk of shingles by about half (51 percent) and the risk of postherpetic neuralgia by 67 percent. While the vaccine was most effective in people 60 to69 years old it also provided some protection for older groups,” according to the CDC’s website.

“The Shingles Prevention Study showed that in adults 70 years of age or older, the vaccine reduced the risk of shingles by 38 percent and the risk of postherpetic neuralgia by 67 percent,” Dr. Hales said.

In March of 2012 the Food and Drug Administration (FDA) approved this shingles vaccine for people between 50 and 59 years of age.

“In trials with the 50 to 59-year-old age group, Zostravex was 70 percent effective in reducing the risk of shingles,” according to Shelly Burgess of the FDA.

However, the CDC does not currently have a recommendation on Zostravex for the 50 to 59-year-old age group, according to Dr. Hales.

The CDC does recommend that everyone over the age of six months, including seniors, should get the seasonal influenza vaccine. Even though most of us have been getting the flu shot every year since grade school, the ever-mutating nature of the influenza virus makes it seemingly impossible to eradicate.  Because the virus is constantly changing, a new vaccine has to be made each year in an effort to control the most recent mutation. Because a new vaccine is created each year there seems to be an annual controversy about influenza vaccine.

During the 2012 – 2013 and 2013 – 2014 flu seasons the extra dose vaccine developed especially for seniors was available and somewhat controversial. The Fluzone High-Dose vaccine, developed by the pharmaceutical company Sanofi Pasteur, provides four times the antigens to control the influenza virus than the regular vaccine provides. It was believed that the quadruple dosage of antigens would help seniors because their immune systems are typically less robust than the immune systems of younger people.  The problem was that between December 2009, when Fluzone High-Dose was first released, and 2013 there was no evidence that it was more effective than the regular vaccine.

Then, in August 2013, Sanofi Pasteur released the results of their own two-year flu season study comparing their regular dosage Fluzone vaccine with Fluzone High-Dose vaccine.

“In the study, Fluzone High-Dose vaccine was 24.2 percent more effective in preventing influenza in adults 65 years of age and older than Fluzone vaccine,” Sanofi Pasteur wrote in its August 26, 2013, announcement of study results.

During the 2012 – 2013 influenza season 27 percent of people 65 years or older who received any brand of flu vaccine were prevented from having to visit the doctor for flu symptoms, according to the CDC’s website.

Since the Sanofi Pasteur study only compared Fluzone High-Dose with the company’s other flu vaccine the CDC has not yet recommended taking the high-dose vaccine.

“Either the regular flu shot or the high-dose vaccine are perfectly acceptable options for people 65 and older this season,” Dr. Alicia Fry, with CDC’s Influenza Division, said at the beginning of the 2013 – 2014 flu season. “The important thing is to get vaccinated because it’s still the best protection currently available against the flu.”

The CDC also recommends that people age 65 and older receive one dose of pneumococcal vaccine. Pneumococcal pneumonia is a very serious bacterial pneumonia that spreads through respiratory secretions, like coughing and sneezing. Anybody can get it, but seniors are more susceptible to it, according to the CDC.

The CDC’s 2014 Recommended Adult Immunization Schedule recommends a tetanus and diphtheria booster shot for all age groups every 10 years, according to Jason McDonald who handles media relations for CDC’s National Center for Immunizations and Respiratory Diseases. In July 2011 the U.S. Food and Drug Administration approved the Boostrix vaccine to prevent tetanus, diphtheria and pertussis (whooping cough) in people ages 65 and older. At the time of the FDA approval there were separate vaccines approved for the prevention of tetanus and diphtheria that could be used in adults 65 and older. Boostrix, which is given as a single-dose booster shot, is the first vaccine approved to prevent all three diseases in older people.

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