Vaccinations

The older adult should have an annual fecal immunochemical test or FIT test every year and a colonoscopy every 10 years, starting at age 50. Breast cancer screening is done after 50 every two years, although high-risk women should be screened annually. At age 75, the mammography is done after discussing risks and benefits. PSA screening for prostate cancer is reserved for men between 40 and 69 years.

An eye examination is done every 2 to 4 years between the ages of 40 and 54 years and every 1 to 3 years in adults between 55 and 64 years. As mentioned, glaucoma screening is done in people of African-American descent. Hearing screening is not done if there are no symptoms.

The only change for immunizations in the middle-aged adult is that 2 doses of the recombinant Herpes zoster vaccine are given to older adults above aged 50 years. The live-attenuated zoster immunization is given at aged 60 years or older.

Adults aged 65 years or older have some changes in their screening tests. Individuals aged 75 years to 85 years should talk to the doctor about screening for colon cancer but those older than 85 years should not be evaluated as a screening measure. Mammography is not recommended after 75 years unless the benefits outweigh the risks. Skin cancer screening is done annually.

After ag 60, all adults should have glaucoma screening every 2 years. Hearing testing is not recommended in the older person unless there are symptoms. The Zoster immunization and influenza shots are recommended as has been discussed. Tetanus shots continue to be recommended in this age group.

VACCINATIONS

Immunizations involve the provision of active immunity to the person by providing them with antigens that allow for antibodies to be made against part or all of a pathogen. As long as the antibodies and antibody-producing memory cells can be made, this type of immunity is possible. Passive immunity is different because it provides the antibodies to the patient for temporary immune function. Immune globulins and antitoxins are examples of providing passive immunity.

Toxoids are immunizations that involve modified toxins that themselves are nontoxic. Vaccines are whole inactivated pathogens or fractions of organisms given to provide immunity. Live, attenuated vaccines are often preferred but carry the risk of mutating back to a pathogenic organism and infecting the patient.

Vaccinations are very effective and have been responsible for eliminating or nearly eliminating diseases that were once prevalent. The smallpox vaccine has eradicated smallpox, while diphtheria and polio are now rare. There are no vaccines yet for most STDs, all tick-borne infections, most tropical diseases, and emerging diseases like Ebola and West Nile virus.

There are some vaccines that are available for people at risk for them. These include vaccines for yellow fever, typhoid, and rabies. Vaccines, as mentioned, are given for all age groups but it is rare to have 100 percent compliance with vaccinations. Minority groups have a particularly low rate of vaccination.

Many vaccines are not given in one shot but have several shots given in a row. People should get their shots at the recommended intervals, because the vaccine will lose its effectiveness if not given at the proper intervals Shots are given into the mid-lateral thick in children under five years of age and in the deltoid muscle in those older than that. Some are subcutaneous instead of intramuscular. If the interval has been too great, you will need to restart the series.

It is almost always possible to give different vaccinations together for convenience. The main exception is the provision of the pneumococcal vaccine and the pneumococcal vaccine to children with asplenia. There should be a month separating these shots.

People with egg allergies will need to be careful about getting their vaccines. Most influenza shots and childhood shots contain some egg antigens but serious allergic reactions are not likely. If anaphylactic reactions happen, the vaccinations should not be given. There are interventions for lesser reactions that can be used to counteract the reaction.

Patients with asplenia have a high risk of getting certain bacterial infections, mainly to encapsulated organisms, such as Neisseria meningitidis, Streptococcal pneumoniae, and

Haemophilus influenzae type B. These patients should be vaccinated against these organisms.

Live vaccines shouldn’t be given with blood products or immune globulin because the simultaneous giving of these will interfere with antibody development. Minor infections shouldn’t be contraindications to vaccinations but high fevers or severe illnesses should delay the giving of these shots. Patients who have gotten Guillain-Barre syndrome after their tetanus or influenza shot should still get the shot if the benefits outweigh the risks.

Immunocompromised patients shouldn’t get live virus vaccines because of the risk of mutation and severe illness from the shot. HIV patients should get inactivated shots only unless they have normal CD4 counts. Pregnant patients shouldn’t get the MMR live vaccination or the live influenza shots. Patients who plan to have a solid organ transplant should get their shots before the transplant. There is no risk of autism with childhood vaccines. There are special vaccines given to travelers depending on where they are traveling to.