Vaccinations

It’s that time of year—vaccination time. Vaccines trigger the body’s immune system to create antibodies before a person has the real illness. When the infection strikes, these antibodies are present to help fight off the infection. No vaccine is 100% effective, but they can decrease the risk of contracting the disease and the severity of the illness.

As people age, their immune systems change and are not as effective, which is partly why the elderly are more susceptible to cancer, infection, and late-life allergies. Adult vaccines can stimulate and support a waning immune system.

Major illnesses for which we should be vaccinated are influenza (flu), COVID, and pneumonia. According to the Centers for Disease Control, in 2022, flu and pneumonia were an underlying or contributing cause for 50,000 to 60,000 deaths—COVID for about 210,000 to 225,000. Today, let’s look at vaccinations for these and other sicknesses and why you may need them this winter.

Influenza (Flu)

A flu shot is recommended for everyone. It is most beneficial for older people or anyone with chronic illness, such as asthma, lung disease, diabetes, or heart disease. During infections, especially strenuous ones, the heart is taxed and has to work harder. People with heart or coronary artery disease who receive a flu shot are less likely to die during flu season than those who do not. Also, flu can result in pneumonia, which is usually the cause of flu-related deaths.

Current inactivated flu vaccines cannot cause the flu. The flu is not a bad cold; colds are different illnesses caused by different viruses. Cold viruses can result in nagging, uncomfortable symptoms like cough, congestion, runny nose, and low-grade fever. Flu can cause high temperatures, muscle and joint aches, and may lead to pneumonia in some. The confusion between cold and flu is amplified because the time of year the vaccine is given coincides with when people are prone to get colds. Some people get a cold within a few days of receiving the vaccine, mistake it for flu, and think the flu shot caused it.

It is true that after receiving the vaccine, some people get side effects of pain at the injection site, achiness, malaise, or even have a low-grade fever, but this is their immune system at work. These symptoms usually resolve within 24 hours.

Pneumonia

The vaccine PCV20 decreases the risk of hospitalization from pneumonia and is recommended for all adults over 65 and those between 19 and 64 years with high-risk medical conditions. The most common side effect is pain at the site of inoculation.

COVID

Time for a booster! The new vaccine is bivalent and protects against more and different COVID types than the original. There was hope that the first version would be a one-and-done vaccine; however, as the virus mutates, the vaccine is being adjusted to expand protection. The good news is that mutations seem to have led to a less virulent virus than the original; however, COVID still increases the risk of hospitalization and death for at-risk people who catch it, so getting a booster is a good precaution.

COVID still increases the risk of hospitalization and death for at-risk people who catch it, so getting a booster is a good precaution.

Tetanus, Diphtheria, and Pertussis (Tdap)

Tdap vaccine, which protects people from tetanus, diphtheria, and pertussis (whooping cough), is recommended every 10 years. The “a” in Tdap is for acellular pertussis, which means it is not a tiny amount of real pertussis being injected.

Tetanus causes lockjaw. With proper treatment, most people recover, but it’s a risk that can be avoided with a vaccination.

While diphtheria and pertussis can make adults sick, pertussis can result in what has been called a post-viral “100-day cough.” A big value in Tdap is that it protects newborns from these viruses which can kill them with their less mature respiratory and immune systems.

Shingles

Shingrix, for herpes zoster virus, is recommended for people over 50 years of age and covered under Medicare Part D drug benefits. It involves two injections separated by two to six months. There are about 1 million cases of shingles in the USA annually, with each person having a 30% lifetime risk of contracting the painful disease. It can occur at any time, but is more likely during times of stress or with advancing age. Shingles is the reactivation of the herpes virus that causes chickenpox. This vaccination’s value is that it decreases the chance of developing postherpetic neuralgia (PHN), a remarkably painful syndrome that occurs in 20% of people after the rash resolves. This pain can be debilitating, affect function, and sometime defies treatment.

Respiratory Syncytial Virus (RSV)

The newcomer to the adult vaccine list was previously given to premature babies to decrease the risk of them developing RSV pneumonia, thus decreasing their chances of dying. RSV causes about 60,000 to160,000 hospitalizations and 6,000 to 10,000 deaths annually in adults 65 years and older. Recent studies found that RSV vaccine in people 60 years and older decreases their risk of pneumonia, hospitalizations, and death, preventing one case of RSV for every 375 people vaccinated.

Managing Risk and Benefits

Whether it’s seatbelts, adherence with medications, exercising regularly, getting cancer screenings, wearing a helmet while motorcycling, or looking both ways before crossing the street, maintaining good health involves managing risk and benefits. Health is a part of life. Vaccines can tilt the odds in favor of those who receive them, for some a little, for others a lot more. I recommend all these vaccines to most of my adult patients, with special attention to those at higher risk for developing the diseases and either dying or becoming debilitated by them. For an average person, priorities might include influenza and COVID, then pneumonia and Tdap, then shingles and RSV. An individual’s health and medication history could result in a different prioritization. Also, there are rare individuals with special allergies or who are taking certain medications for whom risk may outweigh benefits for some vaccines, so each person should consult their family physician. For most people, however, the benefits of being vaccinated outweigh the risk.

Dr. Stephen A. Wilson, MD, MPH, FAAFP, is Chair of Family Medicine at Boston University Chobanian and Avedisian School of Medicine and Chief of Family Medicine for Boston Medical Center.