Vaccines for Geriatrics

• Flu

  Options

  • High dose (Fluzone)
  • Higher concentration of virus to elicit higher response
  • Adjuvanted (Fluad)
  • Additional something to help immune respond better

   

  Why

  • Associated w/ stronger immune reponse
  • Higher antibody production

   

  Caveats and Considerations

  • Specifically NOT LAIV (live vaccination)
  • NEVER turn someone away -- give what you have
• Tdap/Td

  Why

  • Pertussis particularly dangerous to very young and very old

   

  Caveats and Considerations

  • When in doubt -- Tdap
• Shingles

  Option

  • Shingrix

   

  Caveats and Considerations

  • Even if previously vaccinated w/ Zostavax (the old shingles vaccine)
• COVID-19

  Caveat and Consideration

  • Pfizer or Moderna COVID-19 vaccine
• Hepatitis B

  Why

  • For those w/ DM

   

  Caveats and Considerations

  • Based on SCDM
• Pneumococcal Vaccines (PCV15, PCV20, PPSV23)

  • If you don't know history, or they've not received anything:
  • 1 dose of PCV15 followed by PPSV23 one year later
  • Minimum 8 wks for those an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak

  OR

  • 1 dose of PCV20
  • If they've previously received PCV13 only (at any age)
  • PPSV23 one year apart
• Pneumococcal Vaccines (cont.)

  OR

  • PCV20 one year apart
  • If they've previously received PPSV23 only
  • Either PCV15 or PCV20 one year apart
  • If they've previously received both PCV13 and PPSV23
  • Check what year PPSV23 was given
  • If given when < 65 yo --> PCV20 (5 yrs apart) OR PPSV23
  • 1 yr apart from PCV13 dose, and 5 from PPSV23 dose
  • If given when ≥ 65 yo --> may give PCV20 (5 yrs apart) [SCDM]
• Shared Clinical Decision-Making

  • Individuals may benefit from vaccination, but broad vaccination of people in that group is unlikely to have populaiton-level impacts
  • Q: who is considered a HCP w/ regard to shared clinical decision-making recommendations?
  • A: in this context, CDC defines a HCP as anyone who provides or administers vaccines: primary care physician, specialists, physician assistants, nurse practitioners, registered nurses, and pharmacists
• Shared Clinical Decision-Making (cont.)

  • Q: what resources are available for providers who want to implement these recommendations?
  • A: for every ACIP recommendation, CDC publishes a policy note in Morbidity and Morality Weekly Report (MMWR), which provides background and considerations on each recommendation
  • CDC will also develop vaccine-specific guidance to help clinicians understand and apply shared clinical decision-making recommendations
  • HCP can find information on ACIP's recommendations on the ACIP Vaccine Recommendations and Guidelines page