Transcript of Get Ready Report Podcast, episode 41

This is the Get Ready Report, coming to you from Washington, D.C. In this episode entitled, “Seniors and Immunization,” we interview Dr. Steven Cohen, Assistant Professor at Virginia Commonwealth University’s Department of Family Medicine and Population Health, Epidemiology Division. Dr. Cohen is also an elected leader of APHA’s Aging and Public Health Section. He is interviewed by Get Ready team member Nathan Bhatti.

Can you tell us a little bit about your experience with the aging population, and how your research indicates that vaccination plays a role in improved senior health?
Sure thing. I’ve been working in aging populations for about 10 years; started my dissertation back in graduate school and been working on various issues mostly related to…started out looking at vaccination coverage and flu and pneumonia research in the older population for about six years then transitioned more into caregiving and the role that family caregiving has in older populations. I’m also interested in social determinants, and so I actually put those all together in research that we did a couple of years ago looking at who to vaccinate to best reduce pneumonia and influenza in older adults, particularly the Medicare population. What we found, which was confirmed by many previous studies and individual vaccine trials and things like, is that getting annual flu shots, getting pneumonia vaccines, especially for the diabetic population, the entire older adult population, in particular, should be aware that getting those types of shots are instrumental to preventing almost easily preventable diseases in the older populations.

What are some myths about vaccination and the elderly population?
There are bunch. One is that it’s not effective, I reference pneumonia and influenza because it’s one of the leading causes of disease, it’s one of the only infectious disease that’s a leading cause the top 10 in the United States so I’m referencing that, but it actually stands true for a couple other diseases as well like shingles. In terms of pneumonia-influenza, one myth is that the vaccines aren’t effective, and the fact is that’s just not true. It may not be effective at preventing colds or other things that may look like flu or seem like flu, but trial after trial our research has certainly found this as well is that vaccinating older adults is very effective at preventing diseases in older adults.
Another myth that we have is that “if I get the flu vaccine this year, I won’t need it for another couple of years because maybe the strain is the same or I’ll be good for a while,” and that’s mostly a myth. There’s a little truth in that in the sense that when the WHO and the CDC comes out with their vaccine cocktail, they usually address three of the major influenza viruses that are out there and very often you get repeats so maybe one or two of those three strains will be the same one that will be affecting the world next year.
But there is usually some change and so it’s important to make sure that in terms of flu vaccines, older adults get vaccines every year because the strains can change and there’s always the risk of something happening in the middle of the year. We saw that in 2009 with the H1N1 swine flu if you recall that came not during the flu season. It came out in April and May at the tail end of the flu season. It wasn’t as deadly as they thought it was going to be but it’s still very important in that it was kind of a novel thing that we hadn’t seen in a very long time so the idea is that the existing vaccine might not have protected against that particular strain because it didn’t emerge until after the flu season was over but it was still really important because most of the flu out there can be prevented by the vaccines out there. So those are the two major myths I would say are out there.

We often focus on vaccination early on in life — why are adult vaccinations so important?
That’s a fantastic question. Vaccines are so important at every stage of life and particularly in older adults it’s because of a process called immunosenescence, which basically means that our immune systems tend to decline over time, they put us at higher risk for certain diseases and two which are out there which are major causes of death in older adults are influenza and pneumonia, in particular, which kill between (50,000) and 100,000 adults per year. Most of them are 50 and above.
And that’s because it’s just a natural biological process that your immune system says “well, I remember that I had that disease when I was 30 but I just don’t have the cells to attack that disease,” and that’s something that it’s possible that you got a flu strain maybe 20, 30, 40 or 50 years ago. If it’s one of the active strains that’s going around you still may be at risk because you had the strain before.
It’s a similar thing with pneumonia. With pneumonia a lot of times what happens is that an older adult might get influenza and then while they’re hospitalized for it contract a co-infection that’s pneumonia, so if you prevent influenza you can also prevent pneumonia. And then another way of course to prevent pneumonia is to get vaccines, which is unique, and this is largely because pneumonia can be caused virally and by bacteria but its viral form can be prevented by vaccine as well. Which is particularly important for older adults because they often get hospital-acquired pneumonia because they’re hospitalized for influenza, pneumonia or other chronic conditions.

Great, so that leads us to our next question: According to the CDC, an estimated 1 million Americans get shingles, something that you mentioned, every year, and about half of them are 60 years old or older. Additionally, over 60 percent of seasonal flu-related hospitalizations occur in people 65 years and older. Why is the aging population at such a high risk?
That’s a great question and the reason goes back to that immunosenescence, where our immune systems weaken over time. So a lot of the diseases that may be in our systems, such as shingles that we’ve gotten because we had chickenpox when we were kids, emerges when the immune system starts to break down.
In terms of flu and pneumonia, why so many people get flu, why so many older adults get flu is that same reason, our ability to fight disease weakens over time. So having that annual vaccination gives us that boost and says okay, here are the three strains that you pretty much won’t get or you have a substantially reduced risk of getting it if you get that flu vaccine every year at the right time in the fall.

Perfect, thank you. So in closing, the Get Ready campaign focuses on preparation for disasters and hazards, including infectious disease and the flu. What advice can you give our audience to help their senior family members or friends best prepare for the upcoming flu season?

It’s an excellent question. And I would say that the best advice I can give is to think about it in this way: Getting vaccinated every year is one of the easiest things you can do to prevent a major cause of death, and it’s extremely cheap and usually available.
There have been years when we haven’t had quite the supply but usually you can go to any pharmacy, any outpatient clinic, you can get it at your annual checkup. It’s an easy thing, it takes about a minute and you might be in a little pain for a little while afterwards at the injection site but it’s easy to get. It’s cheap, and the other thing is there’s no lifestyle change.
There’s so many diseases — chronic disease, cancers — that require lifestyle changes; change your diet, increase your exercise. But getting a vaccine every year requires very little change. You may get it because you’re at the doctor’s office for your annual checkup anyway.
The other thing I would say is there’s a lot of talk about research on flu vaccines and other vaccines being detrimental to health. There’s so many myths out there that we have talked about. I can confirm that systematically all of the research or the supposed research that shows that there are harmful effects of vaccines have been largely discredited and if you ask any major medical or public health association they all would recommend the same thing which is to get vaccinated every year.
This is such an easy thing to prevent and there’s almost no negatives about it, except for that little bit of pain for those few seconds when you’re being injected.

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Posted: Sept. 10, 2014