Vaccines for Older Adults

Objective: To update senior care pharmacists with current recommendations on influenza, pneumococcal, zoster, and tetanus vaccines for older adults 65 years of age or older.

Data Sources: A search of immunization guidelines on influenza, pneumococcal, zoster, and tetanus infection was performed at various Web sites, including Immunization Action Coalition (www.immunize.org) and the Centers for Disease Control and Prevention (www.cdc.gov). MEDLINE (January 1966 to September 2008) and Pub-Med (January 1955-September 2008) databases and manual bibliographic searches were used to identify additional information. Search terms included influenza, herpes zoster, shingles, pneumococcal pneumonia, pneumovax, tetanus, and vaccine, used alone or in combination.

Study Selection and Data Extraction: Relevant Englishlanguage articles identified from the data sources were evaluated.

Data Synthesis: Trivalent influenza vaccine is recommended to high-risk groups and persons who are likely to transmit the infection, including selected health care staff and caretakers, adults 50 years of age or older, and those with comorbidities that increase the risk of influenza complications. Pneumococcal vaccine is recommended for all persons 65 years of age or older and those with certain medical conditions. One-time revaccination can be offered to the elderly who initially received the vaccine before they turned age 65 and at least five years passed since the initial vaccination. Zoster vaccine should be offered to all persons 60 years of age or older unless contraindications or precautions exist. Tetanus booster every 10 years should be considered in adults who have completed the primary series. Influenza and pneumococcal vaccines, as well as tetanus booster for postexposure management, are covered under Medicare Part B. Zoster vaccine is covered under Medicare Part D.

Conclusion: The Advisory Committee on Immunization Practices offers detailed recommendations for the prevention of influenza, invasive pneumococcal disease, zoster, and tetanus infection for target groups.

Abbreviations: ACIP = Advisory Committee on Immunization Practices, GBS = Guillain-Barre syndrome, H = Hemagglutinin, HZ = Herpes zoster, LAIV = Liveattenuated influenza vaccine, N = Neuraminidase, NCPDP = National Council for Prescription Drug Program, NHANES = National Health and Nutrition Examination Survey, PHN = Postherpetic neuralgia, PPV = Pneumococcal polysaccharide vaccine, PPV23 = 23-valent polysaccharide vaccine, TIV = Trivalent inactivated influenza vaccine, VZV = Varicella zoster virus.

Consult Pharm 2009;24:380-91.