50-Plus and Vaccines

Written in collaboration with Dr. Trupti Gilada, with additional inputs from Dr. Agam Vora, Dr. Raja Dhar and Dr. Shashank Joshi

A recent paper from the UK [1] headed by Dr. Rutendo Muzambi, studied 989,800 people between 2004 and 2018, above the age of 65 years without dementia, with at least one episode of documented infection. Their results showed an increasing incidence of cognitive decline and dementia even after just one infection event.

This is just one of the many ill-effects of contracting infections as we age. Long Covid has received a lot of press, but the same is also true of other infections, many of which can produce significant morbidity in the short, medium and long term and sometimes even cause death. I have a friend for example, who has long-dengue with severe myopathy, persistent 3 years after the episode.

In our quest to be atmasvasth, to live long, healthy, it is important to not get infected.

Though, unlike the situation, just 80 years ago, when there was no way to effectively treat infections, we now have antibiotics, antivirals, antifungals and anti-parasitic medicines that can take care of most infections quite effectively. Nevertheless, preventing the infection from occurring in the first place is a far better option than treating it, something we have learnt the hard way during this Covid-19 pandemic.

In adults, apart from good personal hygiene, clean water, proper sanitation, hygienic food and drink and mosquito free environments, the other element that makes a difference is vaccination against vaccine preventable infections (VPIs). Vaccines help us be atmanivaaran,  to protect ourselves from being infected and if we do get infected, then having minimal to mild disease. The common VPIs are influenza (common flu), Streptococcal (Pneumococcal) pneumonia, varicella (chicken-pox), herpes zoster and the triad of diphtheria, pertussis and tetanus.

Good data on incidence and prevalence of these diseases is hard to come by in India, especially in those above 50, but we know anecdotally that the flu and pneumococcal pneumonia are common and the older the patient, the worse the outcome.

Unfortunately, most of us believe that vaccines are for children. Our pediatricians and family physicians tell us what our kids have to take and when, and all we have to do is make sure they show up…and it all just gets taken care of. As adults, we only think of vaccines when we have to travel to say East Africa and we need a yellow fever shot, or if we have been bitten by a dog and need an anti-rabies injection or when we go for an anti-tetanus jab if scratched by a dirty nail or injured while playing outdoors.

It is only with Covid-19, that vaccination against infections in adults has entered our consciousness. Just as we focussed on the at-risk population with co-morbidities and those over 65 during the earlier months of vaccination, so also, we need to take vaccines against the common VPIs, once we turn 50.

This is the list

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If you have to prioritize, then the two most important vaccines are the yearly influenza and the one time pneumococcal…and they can be taken together, one in each arm.

Then, come the varicella, zoster and Tdap vaccines. If you ever go for a tetanus shot these days, get the Tdap, so you’re done. Varicella is required only if you have not had chicken pox as a child.

So to summarize, at age 50, 1 flu shot every year, one time varicella (2 doses), if not earlier infected with chicken pox and one time pneumococcal. At age 60, one time zoster. One Tdap anytime between 50-65 years once in 10 years. And if you are over 50, but haven’t bothered till now, just start at whatever age you are at.

In the future we may also have dengue, malaria and tuberculosis vaccines added to this list. Let’s see what happens!

Vaccines are not free. Over 15 years, the cost of taking these vaccines minus influenza would come to around Rs. 11,000. Influenza over 15 years costs around Rs. 22,500 (1500 x 15).

This may seem a bit much, but if you take the cost of days lost at work because of flu or pneumonia or chicken pox and/or the cost of hospitalization if the infection becomes severe, then this expense is virtually negligible.

So, what is your matka here? If you are over 50, you need to be vaccinated against the flu, pneumococcal pneumonia, chicken pox and zoster to ensure you are protected. No one is going to do this for you. As with so many things in our quest to be atmasvasth, this is on you…you have to be atmanirbhar and take responsibility. So have a conversation with your doctor and make sure you and your family get vaccinated against these VPIs.

Footnotes

1. Muzambi R et al. The Lancet Health Longevity 2021; June 18 online first

2. Dhar R, Ghoshal AG, Guleria R, et al. Clinical practice guidelines 2019: Indian consensus-based recommendations on influenza vaccination in adults. Lung India. 2020 Aug;37(Supplement):S4-S18. doi: 10.4103/lungindia.lungindia_270_20. PMID: 32830789; PMCID: PMC7703812.

3. S Arulrhaj, Shashank R Joshi, Siddharth N Shah et al. API Guidelines on Immunizations during COVID 19 Pandemic. http://apiindia.org/wp-content/uploads/pdf/corona-virus/guideines-on-immunizations-COVID-publication-05.pdf