Vaccine 'adequate protection' for frail elderly against pneumonia

24 April, 2014

A new study shows the frail and elderly shouldn't be overlooked for vaccines – among other practical measures – to protect against pneumonia this winter, challenging conventional wisdom on immunisation effectiveness in older patients.

In a novel finding, the research by the University of NSW (UNSW) demonstrated even older, frail hospital patients with low baseline immunity are able to generate a significant response to pneumococcal vaccines.

Pneumonia is one of Australia's leading causes of death, ranking in the top 20 in 2012 and is more common in winter. It is especially dangerous in young children and the elderly. In high-risk groups such as the hospitalised frail elderly, mortality is greater than 50 per cent.

As the old adage goes, prevention is better than cure, and there are a number of things to consider in order to ensure the elderly are protected against the infection, according to Gerry Halpern, National Sales & Marketing Manager at specialist aged care equipment provider Jomor Healthcare.

"To protect the elderly against pneumonia it is essential that they enjoy a warm environment, good clothing and a healthy diet," he said.

"There is a tendency to neglect these requirements and the elderly may often need to be encouraged. A regular flu shot is also essential as a preventative method."

Previous work* has shown that the frail elderly are also significantly less likely to be offered vaccines than other patients – those older than 80 are 30 per cent less likely to be immunised and dementia patients are 70 per cent less likely. This may be because doctors are not confident such patients can mount a sufficient immune response to vaccines.

But a randomised controlled trial examining two different pneumococcal vaccines (23vPPV and PCV7) in frail hospitalised elderly found that both can elicit a robust reaction from those with low baseline immunity and there is a greater and more sustained response when the two vaccines are used together, in sequence.

"This study offers hope for novel combinations of the old and new vaccines for prevention of pneumococcal disease in this vulnerable group," said Professor MacIntyre, the head of UNSW's School of Public Health and Community Medicine.

The finding, published in PLoS One, is an important discovery given those with the lowest immunity are at greatest risk of developing invasive pneumococcal disease — the most common bacterial cause of pneumonia – and shows there is a case for vaccinating older patients.

As well as pneumonia, pneumococcal disease (an infection with the bacterium Streptococcus pneumoniae) can cause middle ear and sinus infections, meningitis and septicaemia. The majority of deaths occur in those aged 65 or older, and most cases are preventable by vaccination.

"Vaccination against preventable diseases is low-hanging fruit as a strategy for healthy ageing, and no elderly person should be denied vaccination simply because immunity wanes with age," said Professor MacIntyre.

*Ridda, MacIntyre et al (2007). Predictors of Pneumococcal Vaccination Uptake in Hospitalized Patients Aged 65 Years and Over Shortly Following the Commencement of a Publicly Funded National Pneumococcal Vaccination Program in Australia. Human Vaccines 3(3) 57-60.