Recommended Vaccinations for Elderly Individuals
All elderly individuals (≥65 years) should receive annual influenza vaccination (preferably with high-dose, recombinant, or adjuvanted formulations), pneumococcal vaccines, Tdap/Td boosters, and recombinant zoster vaccine to reduce morbidity, mortality, and improve quality of life. 1
Core Vaccinations for Elderly (≥65 years)
Influenza Vaccination
- Annual vaccination is strongly recommended for all elderly individuals 1
- Preferred formulations for ≥65 years:
- Quadrivalent high-dose inactivated influenza vaccine
- Quadrivalent recombinant influenza vaccine
- Quadrivalent adjuvanted inactivated influenza vaccine 1
- These enhanced vaccines have demonstrated superior effectiveness in reducing hospitalizations and mortality in the elderly population 2, 3
- Timing: Ideally administered before influenza season begins (typically September-October in Northern Hemisphere)
- Clinical impact: Reduces hospitalizations by up to 51.2% for pneumonia/influenza and decreases all-cause mortality by 45% 2
Pneumococcal Vaccination
- Current recommendations:
- Special considerations for immunocompromised elderly:
- More aggressive scheduling with shorter intervals between doses may be required 4
Tetanus, Diphtheria, Pertussis (Td/Tdap)
- One-time dose of Tdap if not previously received as an adult
- Td or Tdap booster every 10 years thereafter 1
- Important for preventing pertussis transmission to vulnerable populations, including infants 1
Zoster Vaccination
- Recombinant zoster vaccine (RZV, Shingrix) - 2 doses, preferred over older live vaccine 1, 4
- Recommended for all adults ≥50 years, regardless of previous herpes zoster episode 1
- Provides >90% protection against shingles and post-herpetic neuralgia
Additional Vaccinations Based on Risk Factors
Hepatitis A and B
- Recommended for elderly with specific risk factors:
- Hepatitis B: 2-3 doses depending on vaccine formulation 1
- Hepatitis A: 2-4 doses depending on vaccine and schedule 1
Meningococcal Vaccines
- Recommended for elderly with:
- Anatomical or functional asplenia
- Persistent complement component deficiencies
- HIV infection 1
- Dosing: 1-2 doses depending on risk factors 1
MMR (Measles, Mumps, Rubella)
- Consider for elderly born after 1957 without evidence of immunity
- Generally not routinely recommended for adults ≥65 years unless specific outbreak situation 1
Implementation Considerations
Vaccine Timing and Co-administration
- Multiple vaccines can be administered during the same visit
- No need to restart vaccination series if schedule is interrupted 1
- Prioritize influenza and pneumococcal vaccines if patient is unlikely to return for multiple visits
Special Populations
- Long-term care facility residents:
- Immunocompromised elderly:
- May require modified schedules
- May have reduced vaccine response; focus on household contacts also being vaccinated 4
Common Pitfalls to Avoid
- Delaying vaccination while waiting for a specific formulation - administering any available age-appropriate vaccine is better than postponing vaccination 5
- Overlooking Tdap - many elderly have never received the pertussis component
- Missing zoster vaccination - highly effective at preventing significant morbidity
- Assuming previous vaccination - always verify vaccination history, as many elderly may have incomplete records
Conclusion
Vaccination represents one of the most effective interventions to reduce morbidity and mortality in the elderly population. The evidence strongly supports comprehensive vaccination with particular emphasis on enhanced influenza formulations, pneumococcal vaccines, Tdap, and recombinant zoster vaccine for all individuals ≥65 years.