Vaccines

Date Published:
20 Jun 2014
image - Max Walker

MEDIA RELEASE
FRIDAY, JUNE 20, 2014

Old and forgotten: health system exposing seniors to vaccine-preventable diseases

The growing immunisation gap between young and old is exposing Australian seniors to life-threatening, vaccine-preventable diseases.1

Former Australian Test Cricketer, VFL/AFL footballer, author and commentator, Max Walker, AM, will join public health experts at the Equity in disease prevention: vaccines for the elderly workshop in Melbourne today (Friday, June 20), to tackle the monumental health challenges facing our greying nation. Innovative, effective and long-term approaches to elderly immunisation will be proposed, to safeguard the health of our growing, ageing population, including the establishment of whole of life vaccination records.

 
According to workshop convenor, Professor Raina MacIntyre, Head, School of Public Health and Community Medicine, UNSW and Director, NHMRC Centre of Research Excellence in Population Health Research, Sydney, vaccination among the elderly is under-valued and under-utilised. More than 90 per cent of Australian children are fully immunised against 12 diseases under the Government’s free National Immunisation Program (NIP), tracked by the Australian Childhood Immunisation Registry (ACIR), compared to only 50 to 60 per cent of older Australians.2,3

“While we have an excellent health system that protects our children from contracting these diseases from birth, we could be doing much better for our elderly.”

By 2050, experts predict 25 per cent of the population will be older than 65.4 Rates of vaccine-preventable diseases such as pneumonia, influenza, shingles and whooping cough are continuing to rise each year among Australia’s ageing population.1 The elderly have a higher incidence of infection, more severe and serious consequences of infection, as well as the highest burden of disease, and risk of complications and death for all the major vaccine-preventable diseases.1,5

Max Walker, 65, has first-hand experience of the toll that vaccine-preventable diseases can wreak. Having contracted shingles and whooping cough; observed his daughter, Isabella fight a severe bout of influenza at 2.5 years of age; braved his father’s near death from pneumococcal pneumonia while touring in the West Indies; and his father’s brother’s death from whooping cough, Max is an advocate for controlling infectious diseases to ensure healthy ageing.
“To me, healthy ageing means being able to do all of the things that I wanted to do, or should have done when I was younger.

“Having practised as an architect, I’ve now returned to watercolour painting, photography, writing and speaking,” said Max.

“I also walk up to six kilometres, three-to-four times a week, and travel extensively.

“Vaccination and safeguarding yourself against vaccine-preventable diseases is pivotal to healthy ageing,” said Max, who had his annual flu shot earlier this month.

According to Prof MacIntyre, research has shown inequality in immunisation practices, with older people less likely to be vaccinated, especially if they are over 80 years of age, or living with dementia.4

“This not only increases their risk of disease, but also their risk of infecting others around them, including grandchildren.5

“There may be value judgements and ageism coming into play for prevention of disease in the elderly, illustrated by the common saying that “pneumonia is the old man’s friend,1” Prof MacIntyre said.
“However pneumonia is not the old man’s friend. Why would someone want to die from the pneumonia?”

“Old age should not be the only reason for withholding protection against this life-threatening disease, and older people deserve every chance to be healthy,” said Max.

Prof MacIntyre cites under-vaccination is leading to preventable suffering, hospitalisations and the death of older Australians.1

“Healthy ageing is everyone’s business.                   

“We may all grow old, we all have loved ones who are elderly, and the economic future of the country will come to rely on ongoing contributions from older people to society, making healthy ageing a high priority,” Prof MacIntyre said.

Australian Immunisation Guidelines recommend older Australians are vaccinated against four diseases – pneumococcal disease, influenza, shingles and tetanus. Yet only pneumococcal pneumonia and influenza vaccines are funded on the National Immunisation Program (NIP).6,7

Today’s NHMRC Centre of Research Excellence in Population Health Research and Public Health Association Australia workshop will feature presentations from local and international experts. Professor of Vaccinology and Immunology, Institute of Child Health, University College London, and Director, World Health Organization (WHO) Pneumococcal Reference Laboratory, Professor David Goldblatt, will discuss pneumonia and pneumococcal disease and outline how the approach towards immunisation globally has not kept abreast of the changes involving this shifting and ageing demographic.

Dr David Gronow, pain medicine specialist and Immediate President of the Australian Pain Relief Association, Sydney, says while vaccination awareness exists for more common diseases such as pneumococcal pneumonia and influenza, routine vaccination practices are not standard.6 Also, there is little awareness around the exponential rise of shingles, which increases in incidence after the age of 50, as does the risk of developing post-herpetic neuralgia (nerve pain due to damage caused by shingles), which can be a very painful and disabling condition and difficult to treat.1,8                 
                                                                                                    
“Shingles and its complications can have a profound effect on the lives of the elderly and their carers.9                      

“Reducing the risk of developing shingles and post-herpetic neuralgia is the best way of eliminating this suffering and costs to the community.                                      

“I’ve seen independent-living, older people become institutionalised after developing complications of shingles,” said Dr Gronow.                                                       
                                                    
According to Associate Professor Michael Woodward, Senior Geriatrician, Austin Health, Melbourne, the elderly may also have multiple healthcare providers, making it difficult to keep track of vaccinations.

“Whole of life vaccination records would make a difference.

“Doctor recommendation determines vaccination. Yet when doctors compare the effectiveness of vaccines in the elderly to that in children, they are not confident in administering vaccines to older people. So a mandated policy can be overridden by subjective judgements made by healthcare providers,1” A/Prof Woodward said.

“There is also poor representation of geriatric medicine experts in vaccine assessment bodies, and significant barriers and missed opportunities to control vaccine-preventable diseases in the elderly, despite the availability of free pneumococcal pneumonia and influenza vaccinations for those aged 65 and above.1

“More has to be done for the elderly to ensure fair and equitable immunisation practices.1 Adequate representation on peak vaccination bodies with experts in geriatrics would be a good place to start,” said A/Prof Woodward.

“Given our ageing society,1,4 older age of retirement and reliance on older people remaining in the workforce, immunisation is low hanging fruit for healthy ageing. However there is under-use of vaccines in this age group3,” said CEO of the Public Health Association of Australia, Mr Michael Moore.

“Prevention is always better than cure. We should utilise every opportunity for prevention, not only to reduce suffering and death, but also to reduce the transmission of infections to others, to improve the control of infectious diseases in the population and ensure healthy ageing.1

Other primary challenges facing routine vaccination among the elderly include monitoring, service delivery and confusion surrounding the need to immunise this demographic, in particular, a general lack of healthcare provider confidence in elderly vaccination, which often results in under-immunisation.4,10,11

There is a common misconception upheld by doctors and nurses that the frail and elderly cannot respond to vaccines, and due to poor immunity associated with age, vaccination is not worthwhile.4 However, studies have shown there is a clear benefit in vaccinating the frail and very old to reduce disease in elderly Australians.4

“No elderly person should be denied vaccination simply because immunity wanes with age,” Prof MacIntyre said.

“The elderly have weaker immunity than younger people1,5, which is a fact of ageing, so vaccine immunity may wane in this group1. But if someone is 75 years old, does it matter if vaccine protection only lasts 10 years?

“Even with reduced effectiveness of vaccines in the elderly, vaccines are still far more effective in prevention than other accepted preventive measures used for other non-infectious diseases4,5,” said Prof MacIntyre.

“Effectiveness of vaccines in the order of 50 or 60 per cent is comparable, or better than many other accepted preventive strategies.

“There needs to be a paradigm shift whereby the glass is viewed as half full rather than half empty,1” Prof MacIntyre said.

“Effective, up-to-date vaccination for all older Australians is a national imperative. It’s time to view elderly vaccination through a different lens, to engage all stakeholders in ageing, to have a positive message about vaccination for the elderly, and to make the best use of immunisation to contribute to healthy ageing,1” said Prof MacIntyre.

Today’s workshop will draw leading experts from a number of health-related industries including immunisation, ageing and health, primary care, insurance, government, non-government organisations, community and advocacy groups. The workshop will focus on scientific evidence, ethics and value-judgements which affect disease-prevention for the elderly.

For information about the NHMRC Centre for Research Excellence in Population Health, the Public Health Association Australia (PHAA) and the UNSW School of Public Health & Community Medicine, head to www.creimmunisation.com.au; www.phaa.net.au and www.sphcm.med.unsw.edu.au.

                                
MEDIA CONTACTS

Kirsten Bruce, Emma Boscheinen, Mark Henderson, VIVA! Communications
0401 717 566 / 0410 630 531 / 0431 465 004

 

1.    MacIntyre CR. Elderly vaccination – The glass is half full. Health. 2013;5(12A):80-85. Available at http://dx.doi.org/10.4236/health.2013.512A011
2.    Immunise Australia. 2013. Australian Childhood Immunisation Register – Current Data. 13 May 2014. [online] Available at: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/conte... [last accessed June, 2014].
3.    Australian Institute of Health and Welfare. 2011. 2009 Adult Vaccination Survey: summary results. Cat. No. PHE 135. Canberra: AIHW.
4.    MacIntyre, CR., Ridda, I., Gao, Z., Moa, AM., McIntyre, PB., et al. A Randomized Clinical Trial of the Immunogenicity of 7-Valent Pneumococcal Conjugate Vaccine Compared to 23-Valent Polysaccharide Vaccine in Frail, Hospitalized Elderly. PLoS ONE. 2014:9(4): e94578. doi:10.1371/journal.pone.0094578
5.    Woodward, M. (2012) Immunisation of Older People. Journal of Pharmacy Practice and Research.42(4):316-322.
6.    AIHW 2010. Australia's health 2010. Australia's health no. 12. Cat. No. AUS 122. Canberra: AIHW.
7.    NHMRC, The Australian Immunisation Handbook, 10th Edition, 2013. Last updated January 2014), Chapter 4.13. Available at http://www.health.gov.au/internet/immunise/publishing.nsf/Content/EE1905...$File/handbook-Jan2014v2.pdf [last accessed June, 2014].
8.    Stein A, Britt H, Harrison C, Conway L, Cunningham A, MacIntyre R. (2009) Herpes zoster burden of illness and health care resource utilization in the Australian population aged 50 years and older. Vaccine;27(4):520-529.
9.    Shingles – More than once in a lifetime. Australian Pain Management Association. Available at: http://www.painmanagement.org.au/content/shingles-%E2%80%93-more-once-li... [last accessed June, 2014].
10.    Ridda, I., Lindley, R. and MacIntyre, C.R. (2009) Differences in the attitude and knowledge of hospital healthcare workers regarding older patient vaccinations. Human Vaccines,5;761-764.
11.    Oxman, M.N., Levin, M.J., Johnson, G.R., Schmader, K.E., Straus, S.E., Gelb, L.D., et al. (2005) A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. The New England Journal of Medicine, 352, 2271-2284.
http://dx.doi.org/10.1056/NEJMoa051016

Image Galery
Pneumonia infographic (see below for download)
Shingles infographic (see below for download)